Euthyroid sick syndrome
Euthyroid sick syndrome is defined as a condition of low T3 low T4 syndrome. According ot the study by the Mayo Clinic, in other word this is the abnormalities of thyroid hormone
concentrations seen commonly in a wide variety of nonthyroidal
illnesses, resulting in low triiodothyronine, total thyroxine, and thyroid stimulating hormone concentrations(a). Decreased triiodothyronine (T3) levels are most common. Patients with more severe or prolonged illness also have decreased thyroxine (T4) levels. Serum reverse T3 (rT3)
is increased. Patients are clinically euthyroid and do not have
elevated thyroid-stimulating hormone (TSH) levels(b). Causes of
euthyroid sick syndrome include a number of acute and chronic
conditions, including pneumonia, fasting, starvation, sepsis, trauma,
cardiopulmonary bypass, malignancy, stress, heart failure, hypothermia,
myocardial infarction, chronic renal failure, cirrhosis, and diabetic
ketoacidosis and inflammatory bowel disease(c). Others, in the study of
classified SES into 3 subgroups according
to the different alterations seen in the values of T3, T4, FT3, FT4,
TSH, rT3 and TBG suggested that in SES type I
the diseases seen, in order of frequency, were: obstructive chronic
bronchopneumopathy with acute respiratory failure, diabetic
ketoacidosis, neoplasms,
ischemic heart disease, cardiac failure, chronic renal failure, liver
diseases, acute cerebral vasculopathies, sepsis and collagenopathies.
The disease seen in the 2 cases of SES type II was obstructive chronic bronchopneumopathy with acute respiratory failure. In SES
type III the diseases seen were, in order of frequency: diabetic
ketoacidosis, lung diseases, ischemic heart disease, cardiac failure,
peripheral arteriopathies, acute cerebral vasculopathies, neoplasms, liver diseases, acute renal failure(d).
Treatments
Treatments
E.1. Treatments in conventional medicine perspective
1. Antibiotics
Most case of sepsis are treated with combination of two or three antibiotics given at the same time.
High doses of vancomycin
were administered in order to rescue patients from septic shock. Plasma
drug concentration dropped while clinical condition of patients
worsened. Conversely, drug levels increased spontaneously once the
infection was reverted. The theoretical model provided greater insight
into pharmacokinetic features related with the use of vancomycin in septic patients(58). Other study indicated that patients with sepsis
do not seem to have the same level of impairment of tissue distribution
as described for patients with septic shock. A 25% lower dose of
piperacillin administered by continuous infusion seems to maintain
higher trough concentrations compared with standard bolus dosing. It is
likely that the clinical advantages of continuous infusion are most
likely to be evident when treating pathogens with high minimum
inhibitory concentration, although without therapeutic drug monitoring
and subsequent dose adjustment, infusions may never achieve target
concentrations of organisms with very high minimum inhibitory
concentrations in a small number of patients(59).
2. IV Fluids
In the study to determine the clinical and pharmacokinetic differences
between continuous and intermittent dosing in patients with severe sepsis, found that continuous administration of beta-lactam antibiotics
achieved higher plasma antibiotic concentrations than intermittent
administration with improvement in clinical cure. This study provides a
strong rationale for further multicenter trials with sufficient power to
identify differences in patient-centered endpoints(60). Other study
suggested that routine use of prolonged infusion of time-dependent antibiotics
for the empiric treatment of gram-negative bacterial infections offers
no advantage over intermittent infusion antibiotic therapy with regard
to treatment success, mortality, or hospital length of stay. These
results were confirmed after controlling for potential confounders in a
multivariate analysis(61).
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(a) http://www.ncbi.nlm.nih.gov/pubmed/9086580
(b) http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/thyroid_disorders/euthyroid_sick_syndrome.html
(c) http://en.wikipedia.org/wiki/Euthyroid_sick_syndrome
(d) http://www.ncbi.nlm.nih.gov/pubmed/8028742
(1) http://clinicalcases.org/2004/05/sick-euthyroid-syndrome-in-patient-with.html
(58) http://www.ncbi.nlm.nih.gov/pubmed/18397685.
(59) http://www.ncbi.nlm.nih.gov/pubmed/19237898
(60) http://www.ncbi.nlm.nih.gov/pubmed/23074313
(61) http://www.ncbi.nlm.nih.gov/pubmed/23341160
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