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Alterations in thyroid function in patients with systemic illness: the euthyroid sick syndrome
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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“In general terms, this syndrome is characterized by normal or even decreased serum TSH levels in the presence of low serum T3 levels and serum levels of free T4 that may be normal, increased, or decreased.”
From Can Reverse T3 Assay Be Employed to Guide T4 vs. T4/T3 Therapy in Hypothyroidism? (2019) · cites this paper as [6]
In the citing paper
“This is the basis of the alterations in thyroid hormone levels in the euthyroid sick syndrome or non-thyroidal illness syndrome (NTIS) (6).”
From Can Reverse T3 Assay Be Employed to Guide T4 vs. T4/T3 Therapy in Hypothyroidism? (2019) · cites this paper as [6]
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Metadata
- Authors
- WARTOFSKY, L., & BURMAN, K. D.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Corresponding author
- WARTOFSKY, LEONARD
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 1982-04
- Volume
- 3
- Issue
- 2
- Pages
- 164-217
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- 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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