Euthyroid sick syndrome

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Euthyroid sick syndrome

Endocrine System

Endocrine System

Pituitary gland histology
Thyroid and parathyroid gland histology
Pancreas histology
Adrenal gland histology
Synthesis of adrenocortical hormones
Adrenocorticotropic hormone
Growth hormone and somatostatin
Hunger and satiety
Antidiuretic hormone
Thyroid hormones
Insulin
Insulins
Glucagon
Somatostatin
Cortisol
Testosterone
Estrogen and progesterone
Oxytocin and prolactin
Parathyroid hormone
Calcitonin
Vitamin D
Phosphate, calcium and magnesium homeostasis
Congenital adrenal hyperplasia
Adrenal insufficiency: Pathology review
Primary adrenal insufficiency
Waterhouse-Friderichsen syndrome
Hyperaldosteronism
Cushing syndrome and Cushing disease: Pathology review
Cushing syndrome
Conn syndrome
Pheochromocytoma
Adrenal masses: Pathology review
Adrenal masses and tumors: Clinical
Adrenal cortical carcinoma
Thyroglossal duct cyst
Hyperthyroidism
Hyperthyroidism: Pathology review
Graves disease
Thyroid eye disease (NORD)
Toxic multinodular goiter
Euthyroid sick syndrome
Hypothyroidism
Hypothyroidism: Pathology review
Hashimoto thyroiditis
Hypothyroidism and thyroiditis: Clinical
Subacute granulomatous thyroiditis
Riedel thyroiditis
Thyroid storm
Thyroid nodules and thyroid cancer: Pathology review
Thyroid cancer
Thyroid nodules and thyroid cancer: Clinical
Parathyroid disorders and calcium imbalance: Pathology review
Parathyroid conditions and calcium imbalance: Clinical
Hyperparathyroidism
Hypoparathyroidism
Hypercalcemia
Hypocalcemia
Diabetes mellitus
Diabetes mellitus: Pathology review
Diabetes mellitus: Clinical
Diabetic nephropathy
Diabetic retinopathy
Pancreatic neuroendocrine neoplasms
Gigantism
Acromegaly
Hyperprolactinemia
Diabetes insipidus and SIADH: Pathology review
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Pituitary adenoma
Hypopituitarism: Pathology review
Hypopituitarism
Hyperpituitarism
Pituitary tumors: Pathology review
Pituitary apoplexy
Sheehan syndrome
Prolactinoma
Hypoprolactinemia
Constitutional growth delay
Puberty and Tanner staging
Precocious puberty
Delayed puberty
Kallmann syndrome
Disorders of sex chromosomes: Pathology review
5-alpha-reductase deficiency
Menstrual cycle
Polycystic ovary syndrome
Premature ovarian failure
Menopause
Androgen insensitivity syndrome
Autoimmune polyglandular syndrome type 1 (NORD)
Multiple endocrine neoplasia: Pathology review
Multiple endocrine neoplasia
Carcinoid syndrome
Neuroblastoma
Opsoclonus myoclonus syndrome (NORD)
Hyperthyroidism medications
Hypothyroidism medications
Hypoglycemics: Insulin secretagogues
Miscellaneous hypoglycemics
Mineralocorticoids and mineralocorticoid antagonists
Adrenal hormone synthesis inhibitors

Transcript

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The term euthyroid sick syndrome, also known as nonthyroidal illness syndrome, can be broken down. Eu- refers to good and -thyroid refers to the thyroid gland which produces thyroid hormones.

So, euthyroid sick syndrome is a state where the thyroid gland is functioning normally, but the thyroid hormones are at abnormal levels.

Normally, the hypothalamus, which is located at the base of the brain, secretes thyrotropin-releasing hormone, known as ΤRH, into the hypophyseal portal system - which is a network of capillaries linking the hypothalamus to the anterior pituitary.

The anterior pituitary then releases a hormone of its own, called thyroid-stimulating hormone, thyrotropin or simply TSH.

TSH stimulates the thyroid gland which is a gland located in the neck that looks like two thumbs hooked together in the shape of a “V”.

If we zoom into the thyroid gland, we’ll find thousands of follicles, which are small hollow spheres whose walls are lined with follicular cells, and are separated by a small amount of connective tissue.

Follicular cells convert thyroglobulin, a protein found in follicles, into two iodine-containing hormones, triiodothyronine or T3, and thyroxine or T4.

Once released from the thyroid gland, these hormones enter the blood and bind to circulating plasma proteins.

Only a small amount of T3 and T4 will travel unbound in the blood, and these two hormones get picked up by nearly every cell in the body.

Once inside the cell T4 is mostly converted into T3, and it can exert its effect. T3 speeds up the basal metabolic rate.

So as an example, they might produce more proteins and burn up more energy in the form of sugars and fats. It’s as if the cells are in a bit of frenzy.

T3 increases cardiac output, stimulates bone resorption - thinning out the bones, and activates the sympathetic nervous system, the part of the nervous system responsible for our ‘fight-or-flight’ response.

Thyroid hormone is important - and the occasional increase can be really useful when you need a boost to get through the final rounds of a sporting competition or to stay warm during a snowstorm!

Meanwhile, thyroid hormones are involved in a number of other things, such as normal function of sebaceous and sweat glands, growth of hair follicles and regulation of the synthesis of proteins and mucopolysaccharides by skin fibroblasts.

Key Takeaways

Euthyroid sick syndrome (ESS) is a condition in which the thyroid gland is functioning properly, but the thyroid hormone levels are abnormally low. This can lead to a variety of symptoms, including fatigue, weight gain, and hair loss. Common causes of ESS include starvation or a serious illness, and is often seen in critically ill intensive care patients

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Robbins Basic Pathology" Elsevier (2017)
  3. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  4. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  5. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  6. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  7. "Mechanisms behind the non-thyroidal illness syndrome: an update" Journal of Endocrinology (2009)
  8. "Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment" Frontiers in Endocrinology (2015)