Hey #MedTwitter,
❗️It is common to be told not to assess thyroid function in severely ill patients unless clearly indicated.
Why?🤔
Today's 🧵 is about the famous euthyroid-sick syndrome.🔎
#EndoTwitter #ICU #thyroid
❗️It is common to be told not to assess thyroid function in severely ill patients unless clearly indicated.
Why?🤔
Today's 🧵 is about the famous euthyroid-sick syndrome.🔎
#EndoTwitter #ICU #thyroid
Let's start with a poll.
Do you feel comfortable discussing euthyroid-sick syndrome?
Do you feel comfortable discussing euthyroid-sick syndrome?
How are thyroid function tests in euthyroid-sick syndrome?
Let's start!
Severely ill patients often have ⬇️ TSH and ⬇️ free T4.
It was believed that the thyroid was working normally, and this condition was described as "euthyroid-sick syndrome".
It is now believed that these pts may also have acquired central hypothyroidism.
Severely ill patients often have ⬇️ TSH and ⬇️ free T4.
It was believed that the thyroid was working normally, and this condition was described as "euthyroid-sick syndrome".
It is now believed that these pts may also have acquired central hypothyroidism.
Regardless of it being central hypothyroidism or not, this condition is considered protective as it prevents tissue catabolism.
The body "tries" to avoid further stress by reducing the thyroid hormone.
Let's use a parallel: it is like an induced state of "hibernation".
The body "tries" to avoid further stress by reducing the thyroid hormone.
Let's use a parallel: it is like an induced state of "hibernation".
Euthyroid-sick syndrome presents not only with ⬇️ TSH and ⬇️ free T4, but also ⬆️ reverse T3 (rT3).
rT3 is a metabolically inactive byproduct of T4.
Again, regardless of central hypothyroidism, there are other mechanisms to avoid thyroid hormones burden in severely ill pts.
rT3 is a metabolically inactive byproduct of T4.
Again, regardless of central hypothyroidism, there are other mechanisms to avoid thyroid hormones burden in severely ill pts.
How to treat? Do not give LT4/T3. Treat the baseline condition.
Clinical meaning: do not assess thyroid function tests in severely ill pts unless there is ⬆️ suspicion for thyroid dysfunction. Be careful in interpreting it!
Clinical meaning: do not assess thyroid function tests in severely ill pts unless there is ⬆️ suspicion for thyroid dysfunction. Be careful in interpreting it!
Do you now feel comfortable discussing euthyroid-sick syndrome?
That is all folks!
👊👊
👊👊
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