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Euthyroid sick syndrome
Classification and external resources
ICD-10 E07.8
ICD-9 790.94
eMedicine med/753
MeSH D005067

Euthyroid sick syndrome, sick euthyroid syndrome, non-thyroidal illness syndrome or low T3 low T4 syndrome is a state of adaptation or dysregulation of thyrotropic feedback control [1] where the levels of T3 and/or T4 are at unusual levels, but the thyroid gland does not appear to be dysfunctional. This condition is often seen in starvation or critical illness.



Fasting, starvation, sepsis, trauma, cardiopulmonary bypass, malignancy, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis.


Ill patients may have normal to low TSH depending on the spectrum of illness. Total T4 and T3 levels may be altered by binding protein abnormalities, and medications. Reverse T3 are generally increased signifying inhibition of normal Type 1 enzyme or reduced clearance of reverse T3. Generally the levels of Free T3 will be lowered, followed by the lowering of Free T4 in relation to severity of the disease.Patients might have high corticosteroid level.


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