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Non-thyroidal illness syndrome

Synonyms: Euthyroid-Sick Syndrome (ESS), Non–Thyroidal Illness Syndrome (NTIS), Thyroid Allostasis in Critical Illness, Tumours, Uraemia and Starvation (TACITUS)
German: Non-Thyroidal-Illness-Syndrom

1 Definition

The non-thyroidal illness syndrome is a characteristic allostatic constellation of pituitary-thyroid feedback control, which is a common bystander of acute or chronic illness and which heralds poor prognosis. In addition, it may confer problems in differential diagnosis.

2 Allostatic control patterns

NTIS is typically marked by three components, which may occur separately or in combination:

3 Therapy

Since NTIS is associated with poor prognosis, it has been suggested to treat the condition by substitution with levothyroxine, liothyronine or TRH[3]. With respect to hard end points, e.g. survival, several studies delivered, however, insufficient evidence that therapy is beneficial.

TACITUS syndrome may even be beneficial as a saving mechanism for energy, oxygen and glutathione.

4 References

  1. Pinna G, Meinhold H, Hiedra L, Thoma R, Hoell T, Gräf KJ, Stoltenburg-Didinger G, Eravci M, Prengel H, Brödel O, Finke R, Baumgartner A. Elevated 3,5-diiodothyronine concentrations in the sera of patients with nonthyroidal illnesses and brain tumors. J Clin Endocrinol Metab. 1997 May;82(5):1535-42. PMID 9141546
  2. Dietrich JW, Müller P, Schiedat F, Schlömicher M, Strauch J, Chatzitomaris A, Klein HH, Mügge A, Köhrle J, Rijntjes E, Lehmphul I. Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling. Eur Thyroid J. 2015 Jun;4(2):129-37. doi: 10.1159/000381543. PMID 26279999
  3. De Groot LJ: Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies. Crit Care Clin 2006 , 22:57-86. PMID 16399020

5 Further reading

  1. van den Berghe G: Dynamic neuroendocrine responses to critical illness. Front Neuroendocrinol 2002 , 23:370-391. PMID 12381331
  2. Dietrich, J. W., A. Stachon, B. Antic, H. H. Klein, and S. Hering (2008). "The AQUA-FONTIS Study: Protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome." BMC Endocrine Disorders 8 (13). PMID 18851740
  3. Dietrich JW, Landgrafe G, Fotiadou EH. TSH and Thyrotropic Agonists: Key Actors in Thyroid Homeostasis. J Thyroid Res. 2012;2012:351864. PMID 23365787
  4. Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015 Oct;3(10):816-25. doi: 10.1016/S2213-8587(15)00225-9. PMID 26071885
  5. Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH and Dietrich JW (2017) Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front. Endocrinol. 8:163. doi: 10.3389/fendo.2017.00163

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