endocrine and metabolic disorders
Euthyroid Sick Syndrome
Diagnosis of Euthyroid Sick Syndrome
TSH Serumcortisol The diagnostic dilemma is whether the patient has Hypothyroidism or euthyroid sick syndrome. The best test is measurement of TSH, which in euthyroid sick syndrome is low, normal, or slightly elevated but not as high (usually < 10 mIU/L) as it would be in primary hypothyroidism (see table Serum rT3 is elevated, although this measurement is rarely done, and the results do not usually return in a time frame to be useful in decision making. Serumcortisolis often elevated in euthyroid sick syndrome and low or low-normal in hypothyroidism due to pituitary-hypothalamic disease. Because tests are nonspecific, clinical judgment is required to interpret abnormal thyroid function test results in acutely or chronically ill patients. Unless thyroid dysfunction is highly suspected, thyroid function tests should not be ordered in these patients. 