Euthyroid Sick Syndrome: An Overview
- 1 February 1997
- journal article
- review article
- Published by Mary Ann Liebert Inc in Thyroid®
- Vol. 7 (1), 125-132
- https://doi.org/10.1089/thy.1997.7.125
Abstract
Abnormalities of thyroid hormone concentrations are seen commonly in a wide variety of nonthyroidal illnesses, resulting in low triiodothyronine, total thyroxine, and thyroid stimulating hormone concentrations. These thyroid hormone changes may be mediated in part by cytokines or other inflammatory mediators, acting at the level of the hypothalamus and pituitary, the thyroid gland, and the hepatic deiodinase system, as well as on binding of thyroxine to thyroid binding globulin. The degree of thyroid function disturbance correlates with disease severity and low levels of thyroid hormones predict a poor prognosis in several illnesses. It remains unresolved whether the hormone responses in the euthyroid sick syndrome represent part of an adaptive response, which lowers tissue energy requirements in the face of systemic illness, or a maladaptive response, which induces damaging tissue hypothyroidism. Consequently, the use of thyroid hormone therapy in the euthyroid sick syndrome is controversial. The small number of controlled trials performed to date have shown conflicting results on the cardiovascular effects of triiodothyronine, and none has had the statistical power to address the question of altered mortality. Future trials of therapy should concentrate on patients with severe nonthyroidal illness and a high mortality rate. Meanwhile, better understanding is needed of the impact of the altered thyroid hormone status on tissue function.Keywords
This publication has 90 references indexed in Scilit:
- Suppression of the thyrotropin response to thyrotropin-releasing hormone and its association with severity of critical illnessCritical Care Medicine, 1994
- Comparison of second and third generation methods for measurement of serum thyrotropin in patients with overt hyperthyroidism, patients receiving thyroxine therapy, and those with nonthyroidal illnessJournal of Clinical Endocrinology & Metabolism, 1994
- Inhibition of thyroxine transport into cultured rat hepatocytes by serum of nonuremic critically ill patients: effects of bilirubin and nonesterified fatty acidsJournal of Clinical Endocrinology & Metabolism, 1993
- c-erb-A mRNA Correlates with T3-Receptor Levels in Liver and Pituitary of Tumor RatsThyroid®, 1993
- Fatty acid-induced increase in serum dialyzable free thyroxine after physical exercise: implication for nonthyroidal illnessJournal of Clinical Endocrinology & Metabolism, 1992
- Delivery dependent oxygen consumption in patients with septic shock: Daily variations, relationship with outcome and the sick-euthyroid syndromeIntensive Care Medicine, 1991
- Primary hypothyroidism in severe chronic heart failure.Japanese Journal of Medicine, 1988
- Hypothalamo-hypophysäre Schilddrüsen-Achse, Plasmaproteinkonzentrationen und die hypophysäre Gonaden-Achse im Low-T3-Syndrom nach akutem Myokardinfarkt (AMI)Journal of Molecular Medicine, 1987
- Thyroid Function Tests in Patients Undergoing Maintenance Dialysis: Characterization of the ‘Low-T4 Syndrome’ in Subjects on Regular Hemodialysis and Continuous Ambulatory Peritoneal DialysisNephron, 1987
- Suppression of Thyrotropin in the Low-Thyroxine State of Severe Nonthyroidal IllnessThe New England Journal of Medicine, 1985