Euthyroid sick syndrome. Association with urosepsis in an elderly man

A 91-year-old man with chronic incontinence managed by indwelling catheter was hospitalized for investigation of fever, hypotension, and cloudy urine. Dopamine was administered to maintain adequate blood pressure, and cefazolin and tobramycin were given for presumed urosepsis. Persistent bradycardia suggested hypothyroidism, but laboratory data were consistent with euthyroid sick syndrome. Thyroid values returned to normal with correction of the sepsis and improvement in nutrition. Exogenous thyroid was not necessary. The case reported here demonstrates that proper assessment of thyroid function in an acutely or chronically ill elderly patient requires attention to the factors that can influence thyroid values--such as non-thyroidal illness like sepsis, poor nutritional status, and use of medication like dopamine--as well as careful correlation of results of thyroid function studies with clinical findings. Euthyroid sick syndrome resolves with correction of the underlying disease and improvement in nutrition. In addition, the total thyroxine (T4) value in this condition is a good predictor of risk of death.