Until recently, tracer equilibrium dialysis was believed to be the most accurate procedure for measurement of free T 3 or T 4. Most workers in the field view the measurement of free thyroid hormones by equilibrium dialysis as the gold standard, and the ultrafiltration method is comparable or a close second. NTISĪbnormalities of thyroid function in NTIS have been classified as 1) low T 3 syndrome, 2) low T 3-low T 4 syndrome, 3) high T 4 syndrome, and 4) other abnormalities ( 7).Īlthough serum concentrations of total T 3 and T 4 are now measured routinely by similar RIAs, several methods have been employed for measurement of the small, biologically active, free fraction of T 3 and T 4 ( 8– 14). I shall focus mainly on the clinical diagnosis, significance, and treatment of ESS. ![]() Several recent reviews have addressed these issues ( 3– 6). These abnormalities result from variable, usually reversible, disturbances in the hypothalamo-pituitary-thyroid axis, thyroid hormone binding to serum proteins, tissue uptake of thyroid hormones, and/or thyroid hormone metabolism. The term nonthyroidal illness syndrome (NTIS) has also been employed to describe these abnormalities ( 3). THE TERM euthyroid sick syndrome (ESS) identifies abnormalities in thyroid function tests observed in patients with systemic nonthyroidal illnesses (NTIs) and those undergoing surgery or fasting ( 1, 2).
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