Euthyroid sick syndrome classification

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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 may be classified according to the level of thyroid hormones and the severity of the underlying disease into mild, moderate, severe, and recovery phase.

Classification

Euthyroid sick syndrome may be classified according to the level of thyroid hormones and the severity of the underlying disease. Depending upon the severity and duration of the stress inducing condition, the thyroid-stimulating hormone(TSH), thyroxine (T4), and free T4 (FT4) are affected in variable proportions. The drop in levels of T3 and T4 are more with more severe illnesses. On the basis of thyroid hormone levels euthyroid sick syndrome can be categorized into:

• Mild
• Moderate
• Severe
• Recovery

Euthyroid sick syndrome	T3 (80-180 ng/dl)	T4 (4.6-12 ug/dl)	FT4 (0.7-1.9 ng/dl)	TSH (0.4 to 4.0mIU/L)	Reverse T3 (90 to 350pg/mL)
Mild euthyroid sick syndrome	↓	N	N	N	↑
Moderate euthyroid sick syndrome	↓	N	N/↓	N/↑	↑
Severe euthyroid sick syndrome	↓	↓	N/↓	↓	↑
Recovery	N/↓	N	N	N	N/↑