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Subclinical HypothyroidismAka: Sick Euthyroid Syndrome, Euthyroid Sick Syndrome

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  1. See Also
    1. Hypothyroidism
  2. Definition
    1. Elevated TSH with normal Free T4
  3. Epidemiology
    1. Incidence Older Men: 2-8%
    2. Incidence Older Women: 5-10%
  4. Indications for treatment
    1. Thyroid Stimulating Hormone (TSH) > 10 mU/ml
    2. Clinical Features present
      1. Depression
      2. Fatigue
      3. Hyperlipidemia
      4. Goiter
      5. Hyperhomocysteinemia
      6. Coronary Artery Disease or Cardiac Risk Factors
      7. Pregnancy or expected pregnancy
  5. Contraindications for treatment
    1. Osteoporosis or Fracture risk
  6. Complications
    1. Coronary Artery Disease (increased risk in elderly)
      1. Biondi (2002) :
  7. Management
    1. See Hypothyroidism
    2. Levothyroxine
      1. Dosing
        1. Young: start at 50 ug qd
        2. Elderly: start at 12.5 to 25 ug qd
      2. Goals for treating subclinical Hypothyroidism
        1. LDL Cholesterol falls
        2. Hypothyroidism symptoms improve
        3. TSH normalizes <4.0
  8. Monitoring
    1. Aim to lower Serum TSH to mid-normal: 1-3
  9. Course: Risk of longterm progression to overt Hypothyroidism
    1. TSH 4-6 mU/ml: No increased risk of future Hypothyroidism
    2. TSH >6 mU/ml: 27-42% risk of future Hypothyroidism
    3. TSH >6 mU/ml and Thyroid Peroxidase Antibody positive: >55% risk of future Hypothyroidism
  10. References
    1. Svec (2001) CMEA Medicine Lecture, San Diego
    2. Hueston (2001) Am Fam Physician 64(10):1717
    3. Adlin (1998) Am Fam Physician 57(4):776
    4. Vanderpump (1995) Clin Endocrinol 43:55

Euthyroid Sick Syndromes (C0015190)

Definition (MSH)Conditions of abnormal THYROID HORMONES release in patients with apparently normal THYROID GLAND during severe systemic illness, physical TRAUMA, and psychiatric disturbances. It can be caused by the loss of endogenous hypothalamic input or by exogenous drug effects. The most common abnormality results in low T3 THYROID HORMONE with progressive decrease in THYROXINE; (T4) and TSH. Elevated T4 with normal T3 may be seen in diseases in which THYROXINE-BINDING GLOBULIN synthesis and release are increased.
ConceptsDisease or Syndrome (T047)
ICD9790.94
MSHD005067
EnglishEuthyroid sick syndrome, EUTHYROID SICK SYNDROME <LOW T3/ LOW T4 SYNDROME>, EUTHYROID SICK SYNDROME LOW T3 LOW T4 SYNDROME, Euthyroid Sick Syndromes, Non Thyroidal Illness Syndrome, Non-Thyroidal Illness Syndrome, Sick Euthyroid Syndrome, Sick-euthyroid syndrome
Spanishsindrome del enfermo eutiroideo
Parent ConceptsOther nonspecific findings on examination of blood (C0159073), Thyroid Diseases (C0040128)
SourcesICD9CM, MSH, NDFRT, QMR, RAM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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