Background: Thyroid hormones play a key role in the maintenance of body growth by modulating metabolism and the immune system. These alterations in thyroid hormone levels are referred to as “euthyroid sick syndrome” or “non thyroidal illness syndrome” (NTIS), which is characterized by low serum levels of free and total triiodothyronine (T3) and high levels of reverse T3 (rT3) accompanied by normal or low levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). During critical illness, changes in circulating hormone levels are a common phenomenon. These alterations are correlated with the severity of morbidity and the outcomes of patients in ICU.Methods: This study was carried out at a tertiary care hospital. 100 patients of age above 18yrs, both sexes, admitted to intensive care units with following diseases Septicemia, ARF, Respiratory failure, CCF, DKA, Stroke were taken into the cross-sectional study. Relevant hematological and radiological examination are done. Fasting venous blood samples were collected immediately on admission to ICU from all patients and were subjected for hormone analyses. Samples were tested for total T3, total T4, and TSH. The hormone estimation was done by chemiluminescence assay.Results: Patients (59%) had low T3 level, 41(41%) patients had normal T3, 31 patients (31%) had low T4, 69 patients (69%) had normal T4 level and TSH was low in 11 patients (11%), 76 patients (76%) had normal TSH and 14 patients (14%) slightly high. Our study showed low T3 (59%) is the commonest abnormality in ICU admitted patients. There is a significant relation present between T3 and mortality (p value-0.0001) and need for ventilation (p value 0.004).Conclusions: Our study suggests that low T3 is an important marker of mortality in ICU admitted patients. We suggest that in ICU patients T3 levels should be done and used as a prognostic marker for mortality and need for ventilation.

Sweet syndrome is an acute febrile neutrophilic dermatosis first described by Robert Douglas Sweet in 1964. Sweet syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. It has been associated with hematopoietic malignancies and myelodysplastic disorders. A-28-years married woman presented to us with chief complaints of Fever and Multiple swellings over the body since 2 months. At presentation she has Pallor; venous hum present. Multiple, tender, erythematous subcutaneous swellings, firm in consistency noted in both forearms. Skin over the swellings is pinchable; superficial skin is normal. Sweet syndrome can occasionally cause an intense systemic response involving the lungs, liver and musculoskeletal system. The skin lesions in Sweet syndrome typically start as erythematous papules, plaques, and nodules. The lesions can take on pseudovesicular or pseudopustular appearance, and sometimes fully formed vesicles or pustules develop. The lesions can be subcutaneous mimicking erythema nodosum which can’t be differentiated unless a biopsy is taken. Because the diagnosis of Sweet syndrome can be challenging, particularly when associated with other connective tissue disorders such as SLE, a set of diagnostic criteria were proposed initially by Su and Liu and then revised by Von den Driesch. The diagnosis is based upon the presence of two major and two of the four minor criteria. Concurrent Sweet syndrome and SLE are exceedingly rare. Twelve patients with both Sweet syndrome and systemic lupus erythematosus (SLE) have been previously reported. We report a case of sweet syndrome associated with SLE diagnosed in our hospital. In our patient, diagnostic criteria are satisfied for Sweet syndrome as well as for SLE (ACR criteria-patient had polyarthralgia, anemia, thrombocytopenia, ANA and Ds DNA positive. Four out of 11 are fulfilled for SLE). Patient responded to corticosteroids.