Differentiating Euthyroid sick syndrome from other diseases: Difference between revisions

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__NOTOC__
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{{Euthyroid sick syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Euthyroid_sick_syndrome]]
{{CMG}}{{AE}} {{Akshun}}
{{CMG}}{{AE}} {{Akshun}}


==Overview==
==Overview==
Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of clinical features and laboratory findings. In euthyroid sick syndrome, serum T3 is decreased more than T4, the T3RU (T3 resin uptake) is high, and TSH is normal or mildly decreased. In primary hypothyroidism, serum T4 is decreased more than T3, the T3RU (T3 resin uptake) is low, and TSH is increased.
[[Euthyroid]] sick syndrome must be differentiated from other causes of [[hypothyroidism]] on the basis of clinical features and laboratory findings. In [[euthyroid]] sick syndrome, serum [[T3]] is decreased more than [[T4]], the T3RU (T3 resin uptake) is high, and [[Thyroid-stimulating hormone|TSH]] is normal or mildly decreased. In [[primary hypothyroidism]], serum [[T4]] is decreased more than [[T3]], the T3RU (T3 resin uptake) is low, and [[TSH]] is increased. Other causes of [[hypothyroidism]] include transient hypothyroidism, sub-clinical hypothyroidism, central hypothyroidism ([[pituitary]] or [[Hypothalamic|hypothalamic]]) and peripheral [[resistance]] to [[Thyroid-stimulating hormone|TSH]]/[[Thyrotropin-releasing hormone|TRH]].


==Differentiating Euthyroid sick syndrome from other Diseases==
==Differentiating Euthyroid sick syndrome from other Diseases==
Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:<ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="pmid11836274">{{cite journal |vauthors=Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE |title=Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=489–99 |year=2002 |pmid=11836274 |doi=10.1210/jcem.87.2.8182 |url=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref>
[[Euthyroid]] sick syndrome must be differentiated from other causes of [[hypothyroidism]] on the basis of [[History and symptoms template|history and symptoms]] and [[laboratory]] findings:<ref name="pmid19949140">{{cite journal |vauthors=McDermott MT |title=In the clinic. Hypothyroidism |journal=Ann. Intern. Med. |volume=151 |issue=11 |pages=ITC61 |year=2009 |pmid=19949140 |doi=10.7326/0003-4819-151-11-200912010-01006 |url=}}</ref><ref name="pmid11836274">{{cite journal |vauthors=Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE |title=Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=2 |pages=489–99 |year=2002 |pmid=11836274 |doi=10.1210/jcem.87.2.8182 |url=}}</ref><ref name="pmid18177256">{{cite journal |vauthors=Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR |title=Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002) |journal=Thyroid |volume=17 |issue=12 |pages=1211–23 |year=2007 |pmid=18177256 |doi=10.1089/thy.2006.0235 |url=}}</ref>
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
{| class="wikitable" align="center" style="border: 0px; margin: 3px;"
! colspan="2" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="3" rowspan="2" align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! colspan="3" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="3" align="center" style="background: #4479BA; color: #FFFFFF; " |History and symptoms
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
! colspan="7" align="center" style="background: #4479BA; color: #FFFFFF; " |Laboratory findings
Line 25: Line 25:
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb  
! align="center" style="background: #4479BA; color: #FFFFFF; " |<small> TPOAb  
|-
|-
| colspan="2" style="background:#DCDCDC;" |Euthyroid sick syndrome
| colspan="2" rowspan="3" style="background:#DCDCDC;" |Euthyroid sick syndrome
|align="center" style="background:#DCDCDC;" |Mild
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | '''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| rowspan="3" align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
* Additional findings of underlying condition
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
|-
*Additional findings of underlying condition
|align="center" style="background:#DCDCDC;" |Moderate
| +
| -
| -
|Normal
/↓
|Normal
/↓
|'''''↓'''''
|'''↑'''
| -
|Normal/↓
| -
|-
|align="center" style="background:#DCDCDC;" |Severe
| +
| -
| -
|↓
|N/'''''↓'''''
|'''''↓'''''
|'''↑'''
| -
|'''''↓'''''
| -
|-
|-
| rowspan="3" style="background:#DCDCDC;" |Primary hypothyroidism
| rowspan="3" style="background:#DCDCDC;" |[[Primary hypothyroidism]]
| align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]]
| colspan="2" align="center" style="background:#DCDCDC;" |[[Hashimoto's thyroiditis|Autoimmune]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
Line 47: Line 74:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
Line 55: Line 82:
* May be accompanied by other [[autoimmune diseases]]  
* May be accompanied by other [[autoimmune diseases]]  
|-
|-
| align="center" style="background:#DCDCDC;" |[[Thyroiditis]]
| colspan="2" align="center" style="background:#DCDCDC;" |[[Thyroiditis]]
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
Line 63: Line 90:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
Line 69: Line 96:
*[[Thyroiditis|Infectious thyroiditis]] associated with neck pain
*[[Thyroiditis|Infectious thyroiditis]] associated with neck pain
|-
|-
| align="center" style="background:#DCDCDC;" |Others
| colspan="2" align="center" style="background:#DCDCDC;" |Others
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
Line 77: Line 104:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
Line 84: Line 111:
* Drug history
* Drug history
|-
|-
| colspan="2" style="background:#DCDCDC;" |Transient hypothyroidism
| colspan="3" style="background:#DCDCDC;" |Transient hypothyroidism
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +/-
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
Line 98: Line 125:
* May present primarily with [[hyperthyroidism]]
* May present primarily with [[hyperthyroidism]]
|-
|-
| colspan="2" style="background:#DCDCDC;" |Subclinical hypothyroidism
| colspan="3" style="background:#DCDCDC;" |Subclinical hypothyroidism
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
Line 108: Line 135:
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''↑'''  
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''↑'''  
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
| align="left" style="padding: 5px 5px; background: #F5F5F5;" |
* Asymptomatic
* Asymptomatic
|-
|-
| rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism
| rowspan="2" align="center" style="background:#DCDCDC;" |Central Hypothyroidism
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary
| colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Pituitary
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| rowspan="2" align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↓'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↓'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
Line 127: Line 154:
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
|-
| align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus
| colspan="2" align="center" style="padding: 5px 5px; background: #DCDCDC;" |Hypothalamus
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | +
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
Line 138: Line 165:
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
* Other [[Pituitary hormone|pituitary hormone deficiencies]] signs
|-
|-
| colspan="2" style="background:#DCDCDC;" |Resistance to TSH/TRH
| colspan="3" style="background:#DCDCDC;" |Resistance to TSH/TRH
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" | -
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |'''↑'''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |N/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal/'''''↓'''''
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal
| align="center" style="padding: 5px 5px; background: #F5F5F5;" |Normal

Latest revision as of 19:22, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of clinical features and laboratory findings. In euthyroid sick syndrome, serum T3 is decreased more than T4, the T3RU (T3 resin uptake) is high, and TSH is normal or mildly decreased. In primary hypothyroidism, serum T4 is decreased more than T3, the T3RU (T3 resin uptake) is low, and TSH is increased. Other causes of hypothyroidism include transient hypothyroidism, sub-clinical hypothyroidism, central hypothyroidism (pituitary or hypothalamic) and peripheral resistance to TSH/TRH.

Differentiating Euthyroid sick syndrome from other Diseases

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:[1][2][3]

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb
Euthyroid sick syndrome Mild + - - Normal Normal ↓ ↑ - Normal -
  • Additional findings of underlying condition
Moderate + - - Normal

/↓

Normal

/↓

↓ ↑ - Normal/↓ -
Severe + - - ↓ N/↓ ↓ ↑ - ↓ -
Primary hypothyroidism Autoimmune + +/-

Diffuse

- ↑ ↓ Normal/↓ Normal Normal/↑ Normal ↑
Thyroiditis + +/- + ↑ ↓ Normal Normal Normal/↑ Normal Normal
Others - +/- - ↑ ↓ Normal Normal Normal/↑ Normal Normal
Transient hypothyroidism +/- - +/- ↑ ↑ Normal Normal ↑ Normal Normal
Subclinical hypothyroidism - - - ↑ Normal Normal Normal ↑ Normal Normal/↑
  • Asymptomatic
Central Hypothyroidism Pituitary + - - Normal/↓ Normal/↓ Normal/↓ ↓ Normal Normal Normal
Hypothalamus + - - ↑ Normal ↓ Normal
Resistance to TSH/TRH - - - ↑ Normal/↓ Normal/↓ Normal Normal ↑/↓ Normal
  • Rare

References

  1. ↑ McDermott MT (2009). "In the clinic. Hypothyroidism". Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  2. ↑ Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE (2002). "Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)". J. Clin. Endocrinol. Metab. 87 (2): 489–99. doi:10.1210/jcem.87.2.8182. PMID 11836274.
  3. ↑ Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)". Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.

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