Euthyroid sick syndrome is a condition where your thyroid functions normally, but your thyroid levels show up as abnormal. What causes this? It can be linked to various factors, including severe liver and kidney conditions or anorexia.
For individuals experiencing this condition, addressing the underlying cause is important for improvement. In this article, we will discuss what euthyroid sick syndrome is, what may contribute to it, its clinical features, and how to approach it holistically based on the underlying health state.
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What is Euthyroid Sick Syndrome?
Euthyroid sick syndrome (ESS), also known as non-thyroidal illness syndrome, is a state wherein the levels of thyroid hormones in the blood are unusually low, yet the thyroid gland is functioning normally. This occurs in individuals experiencing systemic illnesses that are not related to the thyroid. The unique feature of this syndrome is that, while thyroid hormone levels are decreased, the affected individual remains euthyroid, meaning their thyroid is operating in a normal capacity.
Diagnosing ESS is primarily based on ruling out hypothyroidism. The focus is predominantly on managing the root illness. Notably, despite the low levels of thyroid hormones, replacement with thyroid hormones is generally not recommended in these cases (1).
Euthyroid Sick Syndrome Signs & Symptoms
ESS is observed in individuals with a range of acute or chronic non-thyroid disorders (1).
The thyroid function test results of these individuals might show abnormalities despite them having a functioning thyroid gland.
Thyroid Function Abnormalities:
- Decreased T3 Levels: This is the most common anomaly. Decreased T4 Levels: Observed in individuals with more severe or prolonged illness.
- Increased rT3 Levels: A prominent feature in ESS.
- TSH Levels: These might be within the normal range or even on the lower side. However, during the recovery phase, they might be slightly higher than normal.
Clinical Features:
- Hypothermia: A low body temperature that can be serious.
- Hypoventilation: Decreased breathing rate.
- Hypotension: Low blood pressure.
- Lethargy: A state of fatigue or sluggishness.
- Coma: A profound state of unconsciousness.
Euthyroid Sick Syndrome Underlying Causes
Euthyroid sick syndrome is associated with a variety of critical illnesses. Conditions like pneumonia, anorexia nervosa, sepsis, significant trauma including hip fractures, cardiopulmonary bypass, myocardial infarction, malignancies, burns, organ transplantations, congestive cardiac failure, hypothermia, and cirrhosis have been linked to its onset. Additionally, medical interventions such as major surgeries can act as triggers (1,2).
Recently, there's been an observed connection between this syndrome and Covid-19, especially with the discovery that low T3 levels in affected individuals may serve as an early indicator of poor prognosis. Other disorders that might lead to abnormal thyroid function test results pointing towards this condition encompass chronic kidney disease, diabetic ketoacidosis, drug overdose, and severe fasting (1,2).
Functional Medicine Labs to Test For The Root Cause Of Euthyroid Sick Syndrome
Functional medicine labs offer a variety of tests that can help tailor approaches to individuals, allowing providers to optimize management strategies.
Thyroid Function Panel
A Comprehensive Thyroid Function Panel will measure markers such as T3, T4, reverse T3 (rT3), TSH, and thyroid antibodies. Given that ESS is characterized by abnormal thyroid function in the context of a non-thyroidal illness, it's important to assess the overall function of the thyroid. This test provides insight into how the thyroid is producing and converting its hormones.
In ESS, you would expect to see TSH <10 mlU/L (usually low to slightly elevated) but not high as is usual in primary hypothyroidism. In addition, serum rT3 will be elevated, and T3 will be low (1,2).
Comprehensive Metabolic Panel (CMP)
Many of the conditions linked to ESS, such as starvation, anorexia nervosa, sepsis, diabetic ketoacidosis, and cirrhosis, are metabolic in nature. A CMP is a blood test that gives doctors a big-picture look at the body's chemical balance and metabolism. It measures glucose, calcium, and electrolytes, hence giving indications about kidney and liver function, as well as electrolyte and fluid balance. If desired and depending on the underlying cause of the condition, practitioners can explore further testing, such as a renal panel or a liver function panel (1,2).
Cardiac Health Panel
Given the association between ESS and cardiovascular conditions like myocardial infarction and congestive cardiac failure, assessing heart health may be indicated based on the individual’s history and clinical picture. This panel additionally includes hs-CRP, which is a useful marker of inflammation in the body (1,2).
Serum Cortisol
Serum cortisol is often elevated in ESS, which can make it a distinguishing factor against hypothyroidism (which is usually low or low-normal in those individuals) (1).
Conventional Treatment for Euthyroid Sick Syndrome
Conventional approaches for ESS focus on addressing the underlying disease or disorder (1,2).
Functional Medicine Approach for Euthyroid Sick Syndrome
Functional medicine approaches for ESS focus on addressing the root cause of the condition. Recognizing that every condition is influenced by holistic factors, this approach emphasizes improving nutrition, incorporating relevant supplements and herbs, and including therapies to manage stress to create a comprehensive healing environment for the individual. This personalized method ensures that strategies align with individual needs for optimal health outcomes.
Nutrition for Euthyroid Sick Syndrome
As many different conditions can trigger ESS, nutrition guidelines are based on the cause. However, generally speaking, the diet should focus on a variety of nutrient-dense whole foods to promote overall health.
Some of the healthiest diets include the Mediterranean diet and the anti-inflammatory diet. Both of these could be beneficial general choices for individuals with ESS. For those with cardiac abnormalities contributing to their symptoms, the DASH diet may also be considered.
Supplements & Herbs for Euthyroid Sick Syndrome
Like nutrition, recommended supplements and herbs depend on the underlying cause. For individuals with cardiac conditions, supplements like omega-3s or green tea may support heart health. For those with kidney conditions, supplements such as vitamin D or probiotics may be helpful. For individuals with liver concerns, supplements like milk thistle or vitamin E may support liver health. For conditions related to increased inflammation, supplements such as ginger or turmeric may help manage inflammation (10).
Complementary and Integrative Medicine for Euthyroid Sick Syndrome
Complementary and integrative medicine therapies may help to manage symptoms. Generally speaking, active conditions, especially when chronic, can cause increased stress on the body. Therefore, therapies aimed at reducing stress may help individuals with ESS, as underlying health states influence the development of this condition.
Mind-body therapies, such as yoga, meditation, and slow breathing exercises, offer effective, natural stress-reduction techniques supported by functional medicine. These practices promote physical and mental well-being, with studies highlighting their ability to improve sleep, reduce cortisol levels, and stimulate the body's "rest-and-digest" response.
Incorporating regular physical activity into one's routine can also play a pivotal role in managing cortisol levels and enhancing sleep quality as well. Exercise regimens should be tailored based on the individual and underlying health states contributing to ESS.
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Summary
In summary, euthyroid sick syndrome is a multifaceted condition with a variety of potential triggers. While traditional approaches emphasize addressing the primary condition, a functional medicine perspective provides a holistic view, targeting nutrition, stress management, and complementary therapies to support overall wellness. Understanding and identifying ESS is important to guide effective strategies. Individualized care, rooted in both conventional and functional medicine, offers individuals the best chance at achieving optimal health outcomes.
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