Review Article Euthyroid Sick Syndrome
نویسندگان
چکیده
Abnormalities in the circulating thyroid hormone concentration, without associated pituitary or thyroid disease, are seen in a variety of nonthyroidal illnesses (NIH). These abnormalities may be low plasma triiodothyronine (T3), low thyroxine (T4) or a combination of both, with an inappropriately normal plasma thyrotropin (TSH). These could be because of various factors acting on monodeiodinase, a key enzyme for the conversion of T4 to T3, or on transport system for thyroid hormones. Role of cytokines and other inflammatory mediators through their actions on hypothalamus, pituitary or thyroid gland has been extensively investigated, but their real action in vivo remains unclear. Knowledge of these hormone abnormalities is necessary to avoid errors in the diagnosis of thyroid disease. Whether the hormone responses in euthyroid sick syndrome represent part of an adaptive response, which lowers tissue energy requirement in systemic illness, or is a maladaptive response inducing damage to tissues in hypothyroidism, remains unclear. The thyroid function disturbances correlate with the disease severity, and low levels of thyroid hormones predict a poor prognosis in severe illness. The use of thyroid hormone therapy is still controversial in such illnesses, as few controlled trials have shown conflicting results for treatment with T3.
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Sick euthyroid syndrome in patients with moderate-to-severe chronic heart failure.
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