Thyroid Diseases in the Critically III

  • Paul Ellis Marik


Since the 1960s, it has been known that serum thyroid hormone levels drop during starvation and illness. In mild illness, this involves only a decrease in serum T3 levels. However, as the severity of the illness increases, there is a drop in both T3 and T4. This decrease in thyroid hormone level is seen in starvation, sepsis, surgery, myocardial infarction, transplantation, and in fact, probably any severe illness. Based on the premise that patients with these abnormalities are not hypothyroid despite the low hormone levels in blood, the condition has been called the sick euthyroid syndrome (SES). However, some experts in the field believe that some of these patients may in fact have tissue hypothyroidism and prefer the designation of nonthyroidal illness syndrome.


Thyroid Hormone Thyroid Hormone Level Multinodular Goiter Relative Adrenal Insufficiency Thyroid Storm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Selected References

  1. 1.
    De Groot LJ. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab. 1999;84:151–164.PubMedCrossRefGoogle Scholar
  2. 2.
    Smallridge RC. Metabolic and anatomic thyroid emergencies: a review. Crit Care Med. 2000;20:276–291.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Paul Ellis Marik
    • 1
  1. 1.Critical Care MedicineMercy Hospital of PittsburghPittsburghUSA

Personalised recommendations