WordNet

deeply affected by a strong feeling; "sat completely still, sick with envy"; "she was sick with longing"
people who are sick; "they devote their lives to caring for the sick"
intentionally so written (used after a printed word or phrase)
urge to attack someone; "The owner sicked his dogs on the intruders"; "the shaman sics sorcerers on the evil spirits" (同)set
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"

PrepTutorEJDIC

(人が)『病気の』;(部屋などが)病人の[ための];(顔色などが)病気を示す(思わせる) / 《名詞的に》《the ~;複数扱い》病人 / 《補語にのみ用いて》《おもに英》(…で)むかついて,吐き気を催して,気分が悪い《+『at(『with』,『from』+『名』(do『ing』)》 / 《補語にのみ用いて》(…に)『うんざりして』,あきあきして,いや気がさして;(…に)しゃくにさわって,腹が立って《+『of』+『名』(do『ing』)》 / 《補語にのみ用いて》(…に)『がっかりして』,落胆して《+『at』(『about』)+『名』(do『ing』)》 / 《補語にのみ用いて》(…を)熱望して,こがれて《+『for』+『名』》 / 病的な,異常心理の;気味の悪い
原文のまま(疑わしいまたは誤った原文をそのまま引用するときにつける)
…‘を'攻撃する / (…に対して)〈人・犬〉‘を'けしかける《+『名』〈人・犬〉+『on』+『名』》
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
=ti

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/04/21 14:21:53」(JST)

wiki en

Euthyroid sick syndrome (ESS), sick euthyroid syndrome (SES), thyroid allostasis in critical illness, tumours, uremia and starvation (TACITUS), non-thyroidal illness syndrome (NTIS) or low T₃ low T₄ syndrome is a state of adaptation or dysregulation of thyrotropic feedback control^[1] where the levels of T3 and/or T4 are at unusual levels, but the thyroid gland does not appear to be dysfunctional.

This condition is often seen in starvation, critical illness or patients in intensive care unit. The most common hormone pattern in sick euthyroid syndrome is a low total and unbound T3 levels with normal T4 and TSH levels.

Causes

Causes of euthyroid sick syndrome include a number of acute and chronic conditions, including pneumonia, fasting, starvation, anorexia nervosa, sepsis, trauma, cardiopulmonary bypass, malignancy, stress, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis.^[1]

Euthyroid sick syndrome (non-thyroidal illness syndrome) has been assumed closely related with a series of diseases, (such as inflammatory bowel disease).^[2]

Mechanisms

In critical illness the activity of peripheral type I deiodinase is downregulated, while both the central Type 2 deiodinase and type 3 deiodinase activities are upregulated. Humoral and neuronal inputs at the level of the hypothalamus may adjust the set point of thyroid homeostasis. This may play an important role in the pathogenesis of the central component of TACITUS.^[3] In addition, both illness and medication (e.g. salicylates and heparin) may impair plasma protein binding of thyroid hormones, resulting in reduced levels of total hormones, while free hormone concentrations may be temporarily elevated.

Diagnosis

Affected patients may have normal, low, or slightly elevated TSH depending on the spectrum of illness. Total T4 and T3 levels may be altered by binding protein abnormalities, and medications. Reverse T3 levels are generally increased signifying inhibition of normal type 1 deiodinase or reduced clearance of reverse T3. Correspondingly, in the majority of cases calculated sum activity of peripheral deiodinases (SPINA-GD) is reduced.^[2]^[4]^[5]^[6] Generally the levels of free T3 will be lowered, followed by the lowering of free T4 in more severe disease. Several studies described elevated concentrations of 3,5-T2, an active thyroid hormone, in NTIS.^[6]^[7] 3,5-T2 levels were also observed to correlate with concentrations of rT3 (reverse T3)^[6] in patients with euthyroid sick syndrome.

TACITUS syndrome is a component of a complex endocrine adaptation process. Therefore, affected patients might also have hyperprolactinemia and elevated levels of corticosteroids (especially cortisol) and growth hormone.

Treatment

Several trials investigated a possible therapy for ESS. However, they yielded inconsistent and partly contradictory results. This may be caused by the fact that the investigated populations were too heterogeneous in the lack of a consistent definition of non-thyroid illness syndrome.^[8]

References

^ ^a ^b "Euthyroid Sick Syndrome: Thyroid Disorders: Merck Manual Professional". Retrieved 2009-03-29.
^ ^a ^b Liu, S; Ren, J; Zhao, Y; Han, G; Hong, Z; Yan, D; Chen, J; Gu, G; Wang, G; Wang, X; Fan, C; Li, J (February 2013). "Nonthyroidal illness syndrome: is it far away from Crohn's disease?". Journal of Clinical Gastroenterology 47 (2): 153–9. doi:10.1097/MCG.0b013e318254ea8a. PMID 22874844.
^ Hoermann, R; Midgley, JE; Larisch, R; Dietrich, JW (2015). "Homeostatic Control of the Thyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment.". Frontiers in Endocrinology 6: 177. doi:10.3389/fendo.2015.00177. PMID 26635726.
^ Rosolowska-Huszcz D, Kozlowska L, Rydzewski A (August 2005). "Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure". Endocrine 27 (3): 283–8. doi:10.1385/ENDO:27:3:283. PMID 16230785.
^ Han G, Ren J, Liu S, Gu G, Ren H, Yan D, Chen J, Wang G, Zhou B, Wu X, Yuan Y, Li J. Nonthyroidal illness syndrome in enterocutaneous fistulas. Am J Surg. 2013 Sep;206(3):386-92 doi:10.1016/j.amjsurg.2012.12.011. PMID 23809674.
^ ^a ^b ^c Dietrich, JW; Müller, P; Schiedat, F; Schlömicher, M; Strauch, J; Chatzitomaris, A; Klein, HH; Mügge, A; Köhrle, J; Rijntjes, E; Lehmphul, I (2015). "Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling". European Thyroid Journal 4: 129–37. doi:10.1159/000381543. PMC: 4521060. PMID 26279999.
^ 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.
^ Dietrich, JW; Stachon, A; Antic, B; Klein, HH; Hering, S (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. doi:10.1186/1472-6823-8-13. PMC: 2576461. PMID 18851740.

External links

McIver B, Gorman C (1997). "Euthyroid sick syndrome: an overview". Thyroid 7 (1): 125–32. doi:10.1089/thy.1997.7.125. PMID 9086580.
Overview at vghtc.gov.tw
Overview at merck.com

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 非甲状腺疾患における甲状腺機能 thyroid function in nonthyroidal illness
2. 甲状腺機能正常型高サイロキシン血症および低サイロキシン血症 euthyroid hyperthyroxinemia and hypothyroxinemia
3. 成人の非ホジキンリンパ腫生存者に対するケアの概要 overview of care for adult survivors of non hodgkin lymphoma
4. 成人の古典的ホジキンリンパ腫生存者に対するアプローチの概要 overview of the approach to the adult survivor of classical hodgkin lymphoma
5. 甲状腺疾患患者の非甲状腺手術 nonthyroid surgery in the patient with thyroid disease

English Journal

Endocrine and bone metabolic complications in chronic liver disease and after liver transplantation in children.

Högler W, Baumann U, Kelly D.Source*Department of Endocrinology and Diabetes †Liver Unit, Birmingham Children's Hospital, Birmingham, UK ‡Division of Paediatric Gastroenterology and Hepatology, Children's Hospital Hannover, Hannover, Germany.
Journal of pediatric gastroenterology and nutrition.J Pediatr Gastroenterol Nutr.2012 Mar;54(3):313-21.
ABSTRACT: With improved survival of orthotopic liver transplantation (OLT) in children, prevention and treatment of pre- and posttransplant complications have become a major focus of care. End-stage liver failure can cause endocrine complications such as growth failure and hepatic osteodystrophy, an
PMID 22064631

Effects of hypothyroidism on the respiratory system and control of breathing: Human studies and animal models.

Schlenker EH.SourceDivision of Basic Biomedical Sciences, Sanford School of Medicine of the University of South Dakota, 414 East Clark St., Vermillion, SD 57069, United States.
Respiratory physiology & neurobiology.Respir Physiol Neurobiol.2012 Feb 28. [Epub ahead of print]
Hypothyroidism, subclinical hypothyroidism and euthyroid sick syndrome, are prevalent disorders that affect all body systems including the respiratory system and control of breathing. The purpose of this review article is to discuss the regulation of thyroid hormone production and their function at
PMID 22394514

Abnormal thyroid function tests in psychiatric patients: a red herring?

Dickerman AL, Barnhill JW.AbstractThyroid abnormalities can induce mood, anxiety, psychotic, and cognitive disorders. Thus, thyroid function tests are routinely checked in psychiatric patients. However, up to one-third of psychiatric patients may demonstrate thyroid function test abnormalities that do not reflect true thyroid disease, but rather are a manifestation of secondary effects on one or more levels of the hypothalamic-pituitary-thyroid (HPT) axis. Originally termed the euthyroid sick syndrome, this phenomenon is now more commonly referred to as "non-thyroidal illness." In psychiatric patients with non-thyroidal illness, patterns of thyroid function test abnormalities may vary considerably based upon factors such as the underlying psychiatric disorder, the presence of substance abuse, or even the use of certain psychiatric medications. Thus, any abnormal thyroid function tests in psychiatric patients should be viewed with skepticism. Given the fact that thyroid function test abnormalities seen in non-thyroidal illness usually resolve spontaneously, treatment is generally unnecessary, and may even be potentially harmful.
The American journal of psychiatry.Am J Psychiatry.2012 Feb 1;169(2):127-33.
Thyroid abnormalities can induce mood, anxiety, psychotic, and cognitive disorders. Thus, thyroid function tests are routinely checked in psychiatric patients. However, up to one-third of psychiatric patients may demonstrate thyroid function test abnormalities that do not reflect true thyroid diseas
PMID 22318794

Presumptive nonthyroidal illness syndrome in critically ill foals.

Himler M, Hurcombe SD, Griffin A, Barsnick RJ, Rathgeber RA, Macgillivray KC, Toribio RE.SourceDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA Hagyard Equine Medical Institute, Kentucky, USA.
Equine veterinary journal.Equine Vet J.2012 Feb;44 Suppl 41:43-7. doi: 10.1111/j.2042-3306.2011.00480.x.
Reasons for performing the study: Hypothalamic-pituitary-thyroid (HPT) axis dysfunction is associated with morbidity and mortality in critically ill people. To date, investigations of HPT axis in critically ill foals are limited. Objectives: To document the occurrence of low thyroid hormone concentr
PMID 22313472

Japanese Journal

術前・術後管理開心術後のショックに対して有効であったステロイド補充療法

伊藤俊一郎,服部隆司,重田治 [他]
胸部外科 63(3), 204-207, 2010-03
NAID 40017005197

Coexistence of Corticotroph Adenoma and Thyrotroph Hyperplasia in a Dog(Surgery)

TESHIMA Takahiro,HARA Yasushi,SHIGIHARA Kae,TAKEKOSHI Susumu,NEZU Yoshinori,HARADA Yasuji,YOGO Takuya,TERAMOTO Akira,OSAMURA Robert Y.,TAGAWA Masahiro
The journal of veterinary medical science 71(1), 93-98, 2009-01-25
… In dogs with Cushing's disease, many cases have low serum thyroid hormones concentrations due to euthyroid sick syndrome. …
NAID 110007055403

Related Pictures

★リンクテーブル★

リンク元	「甲状腺ホルモン」「低トリヨードサイロニン症候群」
関連記事	「sick」「euthyroid」「syndrome」

「甲状腺ホルモン」

Euthyroid sick syndrome
Classification and external resources
Specialty	endocrinology
ICD-10	E07.8
ICD-9-CM	790.94
eMedicine	med/753
MeSH	D005067
	[edit on Wikidata]

　　[★]

英: thyroid hormone, thyroid hormones
関: 甲状腺、サイログロブリン、カルシトニン、甲状腺ホルモン製剤; 胎児の発育・新生児の生理と適応

SP.915-

種類

サイロキシン thyroxine tetraiodothyronine T₄ 3,5,3',5'-tetraiodothyronine
トリヨードサイロニン triodothyronine T₃ 3,5,3'-triiodothyronine
リバーストリヨードサイロニンリバースT3 reverse triodothyronine rT₃ 3,3',5'-triiodothyronine

分類

ステロイドホルモン

性状

疎水性アミノ酸

産生組織

甲状腺(甲状腺濾胞)

標的組織

受容体

核内甲状腺受容体(甲状腺ホルモン受容体ファミリー)

ステロイドレセプタースーパーファミリーに属する　→ 核内受容体スーパーファミリー

作用

代謝系別

1. 熱産生

脳、脾臓、睾丸をのぞくすべての組織で酸素消費を高める　←　甲状腺クリーゼによる発熱の原因

2. 自律神経系

カテコラミンの作用を増強する
~~心筋細胞のカテコールアミン受容体を増加~~　←証明されていない？

3. 内分泌

成長ホルモンの産生亢進
コルチゾールの異化亢進

甲状腺機能低下症と副腎機能不全が共存する場合、コルチゾールの補充を先行させる

→甲状腺ホルモンの投与によりコルチゾールが減少し副腎クリーゼを誘発

4. 呼吸器系

呼吸中枢を刺激
重症甲状腺機能低下症では中枢性低換気　→　高炭酸ガス血症、低酸素血症

5. 造血器系

エリスロポエチン産生促進　→　赤血球増加
ヘモグロビンからの酸素解離を促進　→　末梢組織での酸素利用↑

6. 骨格筋系作用

骨代謝回転を高め、骨形成・骨吸収を促進　(閉経後女性で甲状腺ホルモン多　→　骨塩量減少　→　骨粗鬆症
グレーブス病では筋肉蛋白の代謝亢進、筋肉量の減少、筋力低下、筋脱力、四肢麻痺

7. 糖代謝

糖代謝の亢進

グレーブス病では耐糖能異常を引き起こしうる

8. 脂質代謝

肝臓におけるコレステロール産生を促進
肝臓のトリグリセリドリパーゼ活性を亢進し、コレステロールの代謝を促進

コレステロールが減少　←　総じて分解系の法が作用が強い

9. その他

1. ビタミンB12の腸管からの吸収↑
2. カロチンからビタミンAへの変換

薬理学的作用 (SPC.321)

成長と発育

全ての生体の活動に関わる－(不足)→成長停止、身体的・精神的発育停止

乳児期における乳児の成長に必須(インスリンと甲状腺ホルモン)

熱産生と体温調整

組織の酸素消費を高め、基礎代謝を亢進させる。Na⁺,K⁺-ATApaseの活性刺激や、核内クロマチンに作用してDNA転写を促進する作用による

代謝亢進作用

上記の通り

TSH分泌抑制

ネガティブフィードバック

分泌の調節

分泌の制御系

視床下部--(甲状腺刺激ホルモン放出ホルモン)－→下垂体前葉－－(甲状腺刺激ホルモン)－→甲状腺濾胞細胞－→T₃, T₄－→T₃, T₄は下垂体前葉・視床下部に作用し甲状腺刺激ホルモンの分泌を抑制

＋：甲状腺刺激ホルモン TSH、(TSH様作用)ヒト絨毛性ゴナドトロピン hCG
－：トリヨードサイロニン、サイロキシン

分子機構

臨床関連

過多

甲状腺機能亢進症

グレーブス病

欠乏

甲状腺機能低下症

クレチン症(=小人症)

nonthyroidal illness, euthyroid sick syndrome (異常値の出るメカニズム第5版 p.296)

甲状腺機能検査値の異常を来す病態。ほとんどの場合TSHは正常
free T₃↓、rT₃↑(重症ではT₄↓、TSH↓

低栄養、外傷、感染症、手術、腎不全、肝不全、心不全、悪性腫瘍
エネルギー消費を減らすための適応かもしれない

以上2007後期生理学授業プリント内分泌(3)

生合成 (SP.916)

「低トリヨードサイロニン症候群」

　　[★]

英: low T₃ syndrome, low triiodothyronine syndrome
同: 低T₃症候群、甲状腺機能正常症候群ユーサイロイドシック症候群 euthyroid sick syndrome sick euthyroid syndrome、非甲状腺疾患 nonthyroidal illness
関: 甲状腺、甲状腺ホルモン、ユーサイロイドシック症候群

[show details]

甲状腺機能正常症候群 : 19 件
低トリヨードサイロニン症候群 : 12 件

概念

甲状腺が異常がないにもかかわらず、サイロキシン(T3)の濃度が低下する病態。

本症候群が見られやすい病態

OLM.296

本疾患が見られる病態：低栄養状態、重症疾患罹患時(外傷、感染症、手術)、腎不全、肝不全、心不全、悪性腫瘍
意義：T4からrT3に変換させて、エネルギーを低減させる適応減少。重症化によりT4,TSHも低下。

YN.D-167

摂取カロリー低下状態(飢餓、神経性食思不振症)、手術後、熱性疾患、肝硬変、腎不全、薬剤投与(グルココルチコイド、β受容体遮断薬)
末梢でのエネルギーを節約しようとしている病態？と考えられているらしい (YN.D-167)

検査

T4：正常
T3：低値
reverse T3：高値
FSH：正常 or やや上昇

「sick」

　　[★]

病気の

関: ail、ailment、disease、ill、illness、sickness

「euthyroid」

　　[★]

adj.

甲状腺機能正常性の

関: 甲状腺、hypothyroid、hyperthyroid

「syndrome」

　　[★]

n.

症候群

[urlEuthyroid_Sick_Syndrome:_Thyroid_Disorders:_Merck_Manual_Professional-1] "Euthyroid Sick Syndrome: Thyroid Disorders: Merck Manual Professional". Retrieved 2009-03-29.

[Liu_2013-2] Liu, S; Ren, J; Zhao, Y; Han, G; Hong, Z; Yan, D; Chen, J; Gu, G; Wang, G; Wang, X; Fan, C; Li, J (February 2013). "Nonthyroidal illness syndrome: is it far away from Crohn's disease?". Journal of Clinical Gastroenterology 47 (2): 153–9. doi:10.1097/MCG.0b013e318254ea8a. PMID 22874844.

[3] Hoermann, R; Midgley, JE; Larisch, R; Dietrich, JW (2015). "Homeostatic Control of the Thyroid-Pituitary Axis: Perspectives for Diagnosis and Treatment.". Frontiers in Endocrinology 6: 177. doi:10.3389/fendo.2015.00177. PMID 26635726.

[Rosolowska-Huszcz2005-4] Rosolowska-Huszcz D, Kozlowska L, Rydzewski A (August 2005). "Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure". Endocrine 27 (3): 283–8. doi:10.1385/ENDO:27:3:283. PMID 16230785.

[5] Han G, Ren J, Liu S, Gu G, Ren H, Yan D, Chen J, Wang G, Zhou B, Wu X, Yuan Y, Li J. Nonthyroidal illness syndrome in enterocutaneous fistulas. Am J Surg. 2013 Sep;206(3):386-92 doi:10.1016/j.amjsurg.2012.12.011. PMID 23809674.

[dietrich2015-6] Dietrich, JW; Müller, P; Schiedat, F; Schlömicher, M; Strauch, J; Chatzitomaris, A; Klein, HH; Mügge, A; Köhrle, J; Rijntjes, E; Lehmphul, I (2015). "Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling". European Thyroid Journal 4: 129–37. doi:10.1159/000381543. PMC: 4521060. PMID 26279999.

[7] 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.

[8] Dietrich, JW; Stachon, A; Antic, B; Klein, HH; Hering, S (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. doi:10.1186/1472-6823-8-13. PMC: 2576461. PMID 18851740.

匿名

検索

案内

euthyroid sick syndrome