sick euthyroid syndrome

Question 1

sick euthyroid syndrome

Answer 1

-Abnormalities in thyroid function that occur in patients
with serious illness not caused by primary thyroid or
pituitary dysfunction
-Features:
-Decreased thyroxine (T4), tri-iodothyronine (T3), or
both, secondary to illness (not hypothyroidism)
-TSH is usually low or normal
-Resolution of thyroid test abnormalities occurs
within 4-6 weeks of recovery from the illness

Question 2

hormone pattern

Answer 2

-!!!!!!!!!MC - Decrease in total and unbound T3 levels (low T3 syndrome) with normal levels of T4 and TSH

-Magnitude of the fall in T3 correlates with the severity of the illness
-T4 → T3 conversion impaired
-Very sick patients may exhibit a dramatic fall in total T4 and T3 levels (low T4 syndrome)
-Poor prognosis
-TSH fluctuations

Question 3

diagnosis of SES

Answer 3

-Challenging
-History - may be limited
-Pts often have multiple metabolic
derangements
-Previous history of thyroid disease and thyroid function tests
-Evaluation of severity and time course of the acute illness
-Look for medications that may affect thyroid function or thyroid hormone levels

Question 4

management

Answer 4

-Diagnosis of SES – presumptive
-Resolution of the test results with clinical recovery can
clearly establish the disorder
-Treatment of SES with thyroid hormone (T4 and/or T3)
is controversial
-Most recommend monitoring TFT’s during recovery, without administering thyroid hormone, unless there is historic or clinical evidence suggestive of hypothyroidism