ICD-10: E07.81

Sick-euthyroid syndrome, classified under ICD-10 code E07.81, is a condition characterized by abnormal thyroid function tests in patients who are clinically euthyroid, meaning they exhibit no symptoms of thyroid dysfunction. This syndrome often arises in the context of acute or chronic illness, leading to alterations in thyroid hormone levels without the presence of intrinsic thyroid disease.

Clinical Description

Definition

Sick-euthyroid syndrome is defined as a state where patients present with altered thyroid function tests—typically low levels of thyroxine (T4) and normal or low levels of thyroid-stimulating hormone (TSH)—despite having no underlying thyroid pathology. This phenomenon is often observed in critically ill patients or those with systemic diseases, such as infections, trauma, or malignancies[1][2].

Pathophysiology

The pathophysiology of sick-euthyroid syndrome is complex and involves several mechanisms:
- Altered Hormone Metabolism: In the context of illness, there is often a decrease in the conversion of T4 to the more active T3 (triiodothyronine), leading to low T3 levels while T4 may remain normal or low[3].
- Increased Deiodinase Activity: The activity of deiodinases, enzymes that convert T4 to T3, can be altered during illness, affecting thyroid hormone levels[4].
- Inflammatory Cytokines: The release of inflammatory cytokines during illness can inhibit the hypothalamic-pituitary-thyroid axis, further contributing to the altered thyroid function tests[5].

Clinical Presentation

Patients with sick-euthyroid syndrome typically do not exhibit the classic symptoms of thyroid dysfunction, such as weight changes, temperature sensitivity, or energy level fluctuations. Instead, they may present with symptoms related to their underlying illness. Common clinical scenarios include:
- Acute Illness: Patients in intensive care units often show signs of sick-euthyroid syndrome due to the stress response and metabolic changes associated with critical conditions[6].
- Chronic Illness: Conditions such as chronic kidney disease, liver disease, or cancer can also lead to this syndrome, reflecting the body's adaptive response to prolonged stress or metabolic derangement[7].

Diagnosis

The diagnosis of sick-euthyroid syndrome is primarily based on laboratory findings:
- Thyroid Function Tests: These typically show low T3 levels, normal or low T4 levels, and low TSH levels, indicating a non-thyroidal illness effect rather than primary thyroid disease[8].
- Exclusion of Thyroid Disease: It is crucial to rule out primary thyroid disorders through additional testing, including thyroid antibodies and imaging studies if necessary[9].

Management

Management of sick-euthyroid syndrome focuses on treating the underlying condition rather than the thyroid dysfunction itself. Thyroid hormone replacement is generally not indicated unless there is clear evidence of primary thyroid disease. Monitoring thyroid function tests can be useful to assess recovery as the underlying illness resolves[10].

Conclusion

Sick-euthyroid syndrome, represented by ICD-10 code E07.81, is an important clinical entity that reflects the body's response to systemic illness. Understanding its pathophysiology and clinical implications is essential for healthcare providers, particularly in critical care and endocrinology settings. Proper diagnosis and management hinge on recognizing the syndrome's characteristics and differentiating it from primary thyroid disorders.

References

1. ICD-10-CM Code for Sick-euthyroid syndrome E07.81.
2. Coders' Desk Reference for ICD-10-CM Diagnoses.
3. Endocrinology ICD-10 Codes & Classifications - MPR.
4. Other disorders of thyroid E07 - ICD-10-CM Codes.
5. ICD-10 International statistical classification of diseases.
6. ICD-10-CM TABULAR LIST of DISEASES and INJURIES.
7. ICD-10-CM INDEX TO DISEASES and INJURIES.
8. 2025 ICD-10-CM Diagnosis Code E07.81: Sick-euthyroid.
9. ICD-10 Code for Other specified disorders of thyroid- E07.8.
10. ICD 10 Codes for Endocrinology Specialists.

Sick-euthyroid syndrome, classified under ICD-10 code E07.81, is a condition characterized by abnormal thyroid function tests in patients who are clinically euthyroid, meaning they exhibit no overt signs of thyroid dysfunction. This syndrome often arises in the context of acute or chronic illness, leading to alterations in thyroid hormone levels without intrinsic thyroid disease. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with sick-euthyroid syndrome.

Clinical Presentation

Definition and Context

Sick-euthyroid syndrome is primarily observed in patients with systemic illnesses, such as infections, trauma, or chronic diseases. It is characterized by changes in thyroid hormone levels, particularly low levels of thyroxine (T4) and normal or low levels of thyroid-stimulating hormone (TSH) despite the absence of primary thyroid disease[1][2].

Common Conditions Associated

This syndrome is frequently seen in patients with:
- Acute and chronic infections: Such as sepsis or pneumonia.
- Severe trauma or surgery: Particularly in the postoperative period.
- Chronic diseases: Including heart failure, liver disease, and malignancies[3][4].

Signs and Symptoms

Laboratory Findings

Patients with sick-euthyroid syndrome typically present with:
- Low serum T4 levels: Free T4 may be decreased, while total T4 can also be low.
- Normal or low TSH levels: TSH levels may not rise as expected, which distinguishes this syndrome from primary hypothyroidism.
- Normal T3 levels: In many cases, triiodothyronine (T3) levels may remain normal, although some patients may exhibit low T3 syndrome[5].

Clinical Symptoms

While patients are clinically euthyroid, they may exhibit symptoms related to their underlying illness, which can include:
- Fatigue: Generalized tiredness due to the systemic condition.
- Weight changes: Weight loss or gain depending on the underlying disease.
- Depression or mood changes: Often linked to chronic illness.
- Changes in appetite: Either increased or decreased, depending on the patient's condition[6].

Patient Characteristics

Demographics

Sick-euthyroid syndrome can affect individuals across various demographics, but certain characteristics may be more prevalent:
- Age: More commonly observed in older adults, particularly those with multiple comorbidities.
- Gender: There is no strong gender predisposition, but some studies suggest a slight female predominance in certain chronic conditions[7].

Comorbid Conditions

Patients often have one or more of the following comorbidities:
- Cardiovascular diseases: Such as heart failure or ischemic heart disease.
- Pulmonary diseases: Including chronic obstructive pulmonary disease (COPD).
- Metabolic disorders: Such as diabetes mellitus or chronic kidney disease[8].

Clinical Management

Management of sick-euthyroid syndrome focuses on treating the underlying condition rather than the thyroid abnormalities themselves. Thyroid hormone replacement is generally not indicated unless there is evidence of primary thyroid disease or if the patient develops overt hypothyroidism[9].

Conclusion

Sick-euthyroid syndrome is a complex condition that reflects the body's adaptive response to systemic illness. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers to differentiate it from primary thyroid disorders and to manage the underlying health issues effectively. Monitoring thyroid function tests in patients with significant systemic illness can aid in recognizing this syndrome and guiding appropriate treatment strategies.

For further information or specific case studies, consulting endocrinology resources or clinical guidelines may provide additional insights into the management of patients with sick-euthyroid syndrome.

Sick-euthyroid syndrome, classified under ICD-10 code E07.81, is a condition characterized by abnormal thyroid function tests in patients who are critically ill but do not have intrinsic thyroid disease. This syndrome is often seen in the context of various acute and chronic illnesses, leading to changes in thyroid hormone levels without actual thyroid dysfunction.

Alternative Names for Sick-Euthyroid Syndrome

1. Euthyroid Sick Syndrome (ESS): This term is commonly used interchangeably with sick-euthyroid syndrome and emphasizes the euthyroid state despite abnormal thyroid function tests.

2. Non-Thyroidal Illness Syndrome (NTIS): This name highlights the association of the syndrome with non-thyroidal illnesses, indicating that the thyroid dysfunction is secondary to other medical conditions.

3. Low T3 Syndrome: This term refers specifically to the low levels of triiodothyronine (T3) that are often observed in patients with sick-euthyroid syndrome, although it may not encompass all aspects of the syndrome.

4. Sick Euthyroid State: Similar to sick-euthyroid syndrome, this term describes the physiological state where thyroid hormone levels are altered due to illness, yet the thyroid gland itself remains functional.

Related Terms

• Thyroid Function Tests (TFTs): These tests measure the levels of thyroid hormones in the blood and are crucial for diagnosing sick-euthyroid syndrome.

• Hypothyroxinemia: This term refers to low levels of thyroxine (T4) in the blood, which can be a feature of sick-euthyroid syndrome.

• Thyroid Hormone Resistance: Although not directly synonymous, this term can relate to the body's response to thyroid hormones during illness, which may mimic aspects of sick-euthyroid syndrome.

• Acute Illness-Related Thyroid Dysfunction: This broader term encompasses various thyroid function abnormalities that occur in the context of acute illness, including sick-euthyroid syndrome.

Conclusion

Sick-euthyroid syndrome is recognized by various names and related terms that reflect its clinical presentation and underlying mechanisms. Understanding these alternative names can aid healthcare professionals in diagnosing and managing patients who exhibit thyroid function abnormalities in the context of critical illness. If you have further questions or need more specific information, feel free to ask!

Sick-euthyroid syndrome, also known as non-thyroidal illness syndrome, is a condition characterized by abnormal thyroid function tests in patients who are not suffering from intrinsic thyroid disease. The ICD-10 code E07.81 specifically refers to this syndrome. Diagnosing sick-euthyroid syndrome involves a combination of clinical evaluation and laboratory testing. Below are the key criteria and considerations used in the diagnosis of this condition.

Clinical Evaluation

1. Patient History:
   - A thorough medical history is essential, focusing on any underlying acute or chronic illnesses that could affect thyroid function. Common conditions include infections, trauma, surgery, and chronic diseases such as heart failure or cancer.

2. Symptoms Assessment:
   - Patients may present with symptoms related to their underlying illness rather than thyroid dysfunction. Symptoms can include fatigue, weight changes, and alterations in appetite, which are nonspecific and can overlap with many other conditions.

3. Physical Examination:
   - A physical examination may reveal signs of the underlying illness but typically does not show signs of thyroid disease, such as goiter or thyroid nodules.

Laboratory Testing

1. Thyroid Function Tests:
   - The hallmark of sick-euthyroid syndrome is the presence of abnormal thyroid function tests, particularly:

   • Low Free T3 (triiodothyronine): Often the most affected hormone.
   • Normal or Low T4 (thyroxine): Levels may be normal or slightly decreased.
   • Normal TSH (thyroid-stimulating hormone): TSH levels are usually within the normal range, indicating that the pituitary gland is functioning properly.

2. Exclusion of Primary Thyroid Disease:
   - It is crucial to rule out primary thyroid disorders such as hypothyroidism or hyperthyroidism. This is typically done through additional tests, including:

   • Thyroid antibodies (to check for autoimmune thyroid disease).
   • Imaging studies (like ultrasound) if nodular disease is suspected.

3. Assessment of Underlying Conditions:
   - Identifying and evaluating any underlying acute or chronic illnesses is critical, as these conditions can significantly influence thyroid hormone levels.

Diagnostic Criteria Summary

• Presence of abnormal thyroid function tests (low T3, normal T4, normal TSH) in the context of an acute or chronic illness.
• Absence of intrinsic thyroid disease as evidenced by normal thyroid antibodies and imaging.
• Clinical correlation with the patient's overall health status and any underlying conditions.

Conclusion

Sick-euthyroid syndrome is diagnosed primarily through a combination of clinical assessment and laboratory tests that indicate altered thyroid hormone levels without intrinsic thyroid disease. Understanding the context of the patient's overall health is essential for accurate diagnosis and management. If you suspect sick-euthyroid syndrome, it is advisable to consult with an endocrinologist for a comprehensive evaluation and appropriate management strategies.

Sick-euthyroid syndrome, classified under ICD-10 code E07.81, refers to a condition where thyroid function tests appear abnormal in patients who are not suffering from intrinsic thyroid disease. This syndrome is often observed in patients with acute or chronic illnesses, where the body’s response to stress affects thyroid hormone levels, leading to misleading laboratory results. Understanding the treatment approaches for this syndrome requires a comprehensive look at its underlying causes, management strategies, and the importance of monitoring thyroid function.

Understanding Sick-Euthyroid Syndrome

Definition and Mechanism

Sick-euthyroid syndrome is characterized by altered levels of thyroid hormones—typically low levels of thyroxine (T4) and normal or low levels of thyroid-stimulating hormone (TSH)—in the context of systemic illness. This phenomenon is thought to be a physiological response to illness, where the body downregulates thyroid hormone production to conserve energy and resources during times of stress or illness[1][2].

Causes

The syndrome can arise from various conditions, including:
- Acute and chronic infections
- Severe trauma or surgery
- Chronic diseases such as heart failure, liver disease, or cancer
- Metabolic disorders and malnutrition[3].

Treatment Approaches

1. Addressing Underlying Conditions

The primary approach to managing sick-euthyroid syndrome involves treating the underlying illness. Since the thyroid dysfunction is secondary to another condition, addressing that condition often leads to the normalization of thyroid hormone levels. For instance:
- Infections may require antibiotics or antiviral medications.
- Chronic diseases may necessitate specific treatments tailored to the disease, such as managing diabetes or heart failure[4].

2. Monitoring Thyroid Function

Regular monitoring of thyroid function tests is crucial. In many cases, thyroid hormone levels will return to normal as the underlying condition improves. It is essential to differentiate between true thyroid disease and sick-euthyroid syndrome, as inappropriate treatment of thyroid dysfunction can lead to complications[5].

3. Avoiding Unnecessary Thyroid Hormone Replacement

In patients diagnosed with sick-euthyroid syndrome, initiating thyroid hormone replacement therapy is generally not recommended unless there is clear evidence of primary thyroid disease. Unnecessary treatment can lead to adverse effects and may complicate the management of the underlying illness[6].

4. Nutritional Support

In cases where malnutrition is a contributing factor, providing adequate nutritional support can help restore normal thyroid function. This may include:
- Nutritional counseling
- Supplementation of vitamins and minerals that support thyroid health, such as iodine and selenium, if deficiencies are identified[7].

5. Patient Education

Educating patients about the nature of sick-euthyroid syndrome is vital. Patients should understand that abnormal thyroid function tests do not always indicate thyroid disease and that their thyroid function may improve with the resolution of their illness[8].

Conclusion

Sick-euthyroid syndrome, represented by ICD-10 code E07.81, is a complex condition that reflects the body’s adaptive response to illness rather than a primary thyroid disorder. The standard treatment approach focuses on managing the underlying health issues, monitoring thyroid function, and avoiding unnecessary interventions. By addressing the root causes and providing supportive care, healthcare providers can help restore normal thyroid function and improve patient outcomes. Regular follow-up and patient education are essential components of effective management in these cases.