Euthyroid sick syndrome causes

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 can be caused by any serious illness which leads to increased level of cytokines, decreased level of leptin, hyper-metabolism, decreased protein synthesis and decreased level of thyroid-binding globulin. The conditions include sepsis, malignancy, trauma, surgery, burns, bone marrow transplantation, metabolic disorders, and other inflammatory conditions.

Euthyroid sick syndrome can be caused by any serious illness which leads to increased level of cytokines, decreased level of leptin, hyper-metabolism, iodine containing contrast medium, decreased protein synthesis and decreased level of thyroxin-binding globulin. The conditions include:^[1]^[2]^[3]

The following table summarize the effect of various drugs on thyroid hormones level:

↓ Hormone secretion	↓ T4	↓ TSH	↓ 5′ monodeiodinase	↑ Breakdown of thyroid hormones	Thyroid binding globulin
↓ Hormone secretion	↓ T4	↓ TSH	↓ 5′ monodeiodinase	↑ Breakdown of thyroid hormones	Increased	Decreased
Lithium Amiodarone	Aluminum hydroxide Ferrous sulphate Sucralfate	Dopamine Octreotide Glucocorticoids	Propylthiouracil Amiodarone Propranolol (high dose)	Phenobarbital Rifampin Phenytoin Carbamazepine	Estrogens Tamoxifen Fluorouracil Methadone Heroin	Androgens Anabolic steroids Glucocorticoids Furosemide Mefenamic acid Salicylates

↑ Silva MH, Araujo MC, Diniz EM, Ceccon ME, Carvalho WB (2015). “Nonthyroidal illnesses syndrome in full-term newborns with sepsis”. Arch Endocrinol Metab. 59 (6): 528–34. doi:10.1590/2359-3997000000111. PMID 26677087.
↑ Frączek MM, Gackowski A, Przybylik-Mazurek E, Nessler J (2016). “[The relation between the low T3 syndrome in the clinical course of myocardial infarction and heart failure]”. Pol. Merkur. Lekarski (in Polish). 40 (240): 380–3. PMID 27403906.
↑ Girvent M, Maestro S, Hernández R, Carajol I, Monné J, Sancho JJ, Gubern JM, Sitges-Serra A (1998). “Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation”. Surgery. 123 (5): 560–7. doi:10.1067/msy.1998.87238. PMID 9591009.