Cited by 919Thyroid Disorders and TreatmentsGrowth Hormone and Insulin-like Growth FactorsAdrenal Hormones and Disorders

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Alterations in thyroid function in patients with systemic illness: the euthyroid sick syndrome

WARTOFSKY, LEONARD, BURMAN, KENNETH D.·1982·Endocrine Reviews

DOI 10.1210/edrv-3-2-164

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Abstract

GENERALLY, the purpose of assessing thyroid function in a given patient is to determine his metabolic status. In patients with systemic nonthyroidal illness, as well as in those undergoing a variety of other stresses, this determination is complicated by effects at all levels of the hypothalamic-pituitary-thyroid axis. With the availability of thyrptropin releasing hormone (TRH) and the recent development of sensitive methods for the direct measurement of serum 3,5,3′-triiodothyronine (T3) and 3,3′,5′-triiodothyronine (reverse T3 (rT3)), considerable progress has been made in gaining an understanding of the significance of the alterations in thyroid hormone economy that accompany nonthyroidal illness, stress, and the administration of certain pharmacological agents. According to basic tenets of negative feedback control of thyrotropin (TSH) secretion by circulating free thyroid hormones, alterations in hormone binding in nonthyroidal illness that produce increases in free hormone should result in predictably decreased TSH responses to TRH stimulation. Indeed, the magnitude of TSH response to TRH is often taken to be the most specific clue to the true metabolic state of the organism, and the recent publication of studies that examined the status of TRH responsiveness in nonthyroidal illness has provided critical information in this regard.

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BackgroundInfluential
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Authors: WARTOFSKY, L., & BURMAN, K. D.
Affiliations: Uniformed Services University of the Health Sciences (US)
Corresponding author: WARTOFSKY, LEONARD
ORCID: WARTOFSKY, LEONARD
BURMAN, KENNETH D.
Venue: Endocrine Reviews
Publisher: The Endocrine Society
Published: 1982-04
Volume: 3
Issue: 2
Pages: 164-217
ISSN: 0163-769X (ISSN-L)
1945-7189
DOI: 10.1210/edrv-3-2-164
OpenAlex: W1993358990
Cited by: 916
References: 0
Citations by year: 2026: 4 · 2025: 9 · 2024: 8 · 2023: 11 · 2022: 12 · 2021: 13 · 2020: 12 · 2019: 14 · 2018: 14 · 2017: 19 · 2016: 9 · 2015: 14 · 2014: 17 · 2013: 16 · 2012: 11
FWCI: 29.14
Type: journal article
Language: en
Open access: closed
Locations: Endocrine Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords: low T3 syndrome, thyroid function, hypothalamic-pituitary-thyroid axis, thyroid-stimulating hormone, triiodothyronine, reverse T3, thyroid hormone binding, TRH stimulation test, metabolic stress, free thyroid hormones
MeSH terms: Adult, Age Factors, Aged, Amiodarone, Animals, Anorexia Nervosa, Mental Disorders, Contrast Media, Diabetes Mellitus, Dopamine, Fasting, Glucocorticoids, Humans, Infant, Newborn, Iodine Radioisotopes, Kidney Diseases, Liver Diseases, Middle Aged, Myocardial Infarction, Neoplasms, Obesity, Protein-Energy Malnutrition, Starvation, Stress, Physiological, Thyroid Gland, Thyroid Hormones, Thyrotropin, Thyrotropin-Releasing Hormone

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Alterations in thyroid function in patients with systemic illness: the euthyroid sick syndrome

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