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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Differentiating Euthyroid sick syndrome from other diseases

Introduction

Overview

Overview

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of clinical features and laboratory findings. In euthyroid sick syndrome, serum T3 is decreased more than T4, the T3RU (T3 resin uptake) is high, and TSH is normal or mildly decreased. In primary hypothyroidism, serum T4 is decreased more than T3, the T3RU (T3 resin uptake) is low, and TSH is increased. Other causes of hypothyroidism include transient hypothyroidism, sub-clinical hypothyroidism, central hypothyroidism (pituitary or hypothalamic) and peripheral resistance to TSH/TRH.

Differentiating Euthyroid sick syndrome from other Diseases

Differentiating Euthyroid sick syndrome from other Diseases

Euthyroid sick syndrome must be differentiated from other causes of hypothyroidism on the basis of history and symptoms and laboratory findings:[1][2][3]

Disease History and symptoms Laboratory findings Additional findings
Fever Goiter Pain TSH Free T4 T3 T3RU Thyroglobin TRH TPOAb
Euthyroid sick syndrome Mild + – – Normal Normal ↓ ↑ – Normal –
  • Additional findings of underlying condition
Moderate + – – Normal

/↓

Normal

/↓

↓ ↑ – Normal/↓ –
Severe + – – ↓ N/↓ ↓ ↑ – ↓ –
Primary hypothyroidism Autoimmune + +/-

Diffuse

– ↑ ↓ Normal/↓ Normal Normal/↑ Normal ↑
Thyroiditis + +/- + ↑ ↓ Normal Normal Normal/↑ Normal Normal
Others – +/- – ↑ ↓ Normal Normal Normal/↑ Normal Normal
Transient hypothyroidism +/- – +/- ↑ ↑ Normal Normal ↑ Normal Normal
Subclinical hypothyroidism – – – ↑ Normal Normal Normal ↑ Normal Normal/↑
  • Asymptomatic
Central Hypothyroidism Pituitary + – – Normal/↓ Normal/↓ Normal/↓ ↓ Normal Normal Normal
Hypothalamus + – – ↑ Normal ↓ Normal
Resistance to TSH/TRH – – – ↑ Normal/↓ Normal/↓ Normal Normal ↑/↓ Normal
  • Rare
References

References

  1. ↑ McDermott MT (2009). “In the clinic. Hypothyroidism”. Ann. Intern. Med. 151 (11): ITC61. doi:10.7326/0003-4819-151-11-200912010-01006. PMID 19949140.
  2. ↑ Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE (2002). “Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)”. J. Clin. Endocrinol. Metab. 87 (2): 489–99. doi:10.1210/jcem.87.2.8182. PMID 11836274.
  3. ↑ Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR (2007). “Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002)”. Thyroid. 17 (12): 1211–23. doi:10.1089/thy.2006.0235. PMID 18177256.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]