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Euthyroid sick syndrome treatment9/22/2023 But how can thyroid hormone treatment be justified by DeGroot for all patients with altered thyroid function tests of the ESS, which simply reflect acute homeostatic mechanisms when he acknowledges that hypothyroidism may take 2–3 weeks to actually develop? While the review cites studies showing reduced TRH biogenesis, this does not refute a concept of ESS as homeostatic in nature, nor does it imply that the patients are, by definition, hypothyroid. ( 10) carefully make the distinction between effects of acute vs. In patients such as those with prolonged coma, thyroid hormone therapy might be warranted, and in this context Van den Berghe et al. This could be true in some states of prolonged systemic illness that may lead to relative thyroid hormone deficiency as a result of chronically low degrees of TSH-driven thyroid hormone biosynthesis. DeGroot cites the increases in TSH that may be seen with recovery ( 9) as “strongly suggesting” that the patients are recovering from a hypothyroid state. ( 8) indicated that pituitary function was normal in critical illness in the absence of dopamine therapy. He postulates that ESS patients are hypothyroid on the basis of low TRH with secondarily low TSH, while ignoring the fact that observed changes in iodothyronines occur too rapidly in acute illness to be on a hypothalamic/pituitary basis. DeGroot calls the normal to low TSH levels in these situations “inappropriately low,” rather than considering them appropriate because the patients are euthyroid. Our concept of metabolic status in the ESS is that patients are indeed euthyroid during caloric deprivation, acute illness, surgery, and dozens of other models, and that the changes in thyroid function tests reflect effects by the various cytokines, circulating inhibitors, etc., as have been reviewed (1, 5–7). DeGroot would have us conclude that there is also low FT 4 in ESS, but his own literature review concludes that FT 4 may be low, normal, or elevated. Recently, Chopra ( 4) observed normal free T 3 in 83% of ESS patients and concluded it might be responsible for maintaining their euthyroid state. By definition, the ESS or “low T 3 syndrome” is characterized by low TT 3. ( 3), he overlooks their finding that only low T 3 significantly and independently predicted survival beyond what was clinically apparent to intensivist physicians. While he cites the study of Maldonado et al. Surely, a causal relationship cannot be inferred from the association of low serum T4 and risk of death, as severity of illness correlates directly with either low T 4 or risk of death. ( 2) by stating that “there is no factual basis for this dogma,” while failing to fully acknowledge that there is no factual basis for treatment either. DeGroot argues with the dogma against such treatment espoused by Chopra et al. DeGroot ( 1) cites a litany of circumstantial evidence ostensibly supporting a state of underlying hypothyroidism in patients with systemic illness, which in his view justifies treatment with thyroid hormone. Medication will give only symtomatic relief.įor more information, you can visit eMedicine.In his review of the euthyroid sick syndrome (ESS), Dr. No specicific treatment is there for euthyroid sick syndrome. What is the treatment for euthyroid sick syndrome? In severe NTI, the findings are low T4, low T3, reduced TSH, elevated rT3, and free T4 that is within the reference range or is diminished. Typical non thyroid illness (NTI) findings are T4 level within the reference range low T3 level, slightly reduced or reference range level of TSH, elevated rT3 level, and sometimes free T4 level is also raised. Investigations for Euthyroid sick syndrome? Hypothermia (decreased body temperature) What are the signs and symptoms of euthyroid sick syndrome? Include a number of chronic and acute conditions: What are the causes of euthyroid sick syndrome? Euthyroid sick syndrome is a state of adaptation or dysregulation of thyrotropic feedback control where the level of T3 and T4 are at unusual levels but the thyroid gland does not appear to be dysfunctional.
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