![]() Thyroid function generally returns to normal as the acute illness resolves. Data on the beneficial effect of thyroid hormone treatment on outcome in critically ill patients are so far controversial. ![]() Hormonal changes can be seen within the first hours of critical illness and, interestingly, these changes correlate with final outcome. Medications also have a very important role in these alterations. There are no symptoms of thyroid dysfunction. It occurs in several variants: a decrease in T3, a decrease in T3 and T4, an increase in T3 and T4, a decrease or increase in TSH. The changes in serum thyroid hormone levels in the critically ill patient seem to result from alterations in the peripheral metabolism of the thyroid hormones, in TSH regulation, in the binding of thyroid hormone to transport-protein and in receptor binding and intracellular uptake. Euthyroid sick syndrome is a change in the level of thyroid hormones that is not associated with thyroid disease. This condition may affect 60 to 70% of critically ill patients. The laboratory parameters of this syndrome include low serum levels of triiodothyronine (T3) and high levels of reverse T3, with normal or low levels of thyroxine (T4) and normal or low levels of thyroid-stimulating hormone (TSH). The raised levels of rT3 result in a disproportionate degree of thyroid dysfunction, as rT3 is an inactive form, and therefore a competitive antagonist of 'real' T3. The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome, describes a condition characterized by abnormal thyroid function tests encountered in patients with acute or chronic systemic illnesses. In short, the sick euthyroid syndrome is a biochemical pattern of decreased circulating T3 levels, without a strong compensatory TSH response. The metabolic support of the critically ill patient is a relatively new target of active research and little is as yet known about the effects of critical illness on metabolism. The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome, is characterized by abnormal thyroid function tests encountered in patients with acute or chronic systemic illnesses.
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