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Jin Y, Zhai T, Wang Y, Li J, Wang T, Huang J. Recent advances in liquid chromatography-tandem mass spectrometry for the detection of thyroid hormones and thyroglobulin in clinical samples: A review. J Sep Sci 2024; 47:e2400466. [PMID: 39294846 DOI: 10.1002/jssc.202400466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/21/2024]
Abstract
Thyroid hormones (THs), including triiodothyronine (T3), thyroxine (T4), and their metabolites, are essential for regulating development, growth, and energy metabolism. Thyroglobulin (Tg) produced by thyroid follicular cells acts as an essential substrate for TH synthesis. The combination of THs with Tg is a widely used serological laboratory test for thyroid function assessment. Early detection and timely intervention are significant for preventing and managing thyroid disease. In recent years, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has emerged as a powerful tool for the precise detection of small molecular analytes and steroid hormones in clinical practice as a result of its high sensitivity and specificity. While LC-MS/MS has been increasingly used for detecting THs and Tg recently, its application in clinical practice is still in its early stages. Recent advances in the assessment of thyroid metabolism using LC-MS/MS in clinical samples published during 2004-2023 were reviewed, with a special focus on the use of this technique for quantifying molecules involved in thyroid diseases.
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Affiliation(s)
- Yuting Jin
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Taiyu Zhai
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Ying Wang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Jiuyan Li
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Tingting Wang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Jing Huang
- Department of Laboratory Medicine, The First Hospital of Jilin University, Changchun, China
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2
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Salvatore D, Porcelli T, Ettleson MD, Bianco AC. The relevance of T 3 in the management of hypothyroidism. Lancet Diabetes Endocrinol 2022; 10:366-372. [PMID: 35240052 PMCID: PMC9987447 DOI: 10.1016/s2213-8587(22)00004-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022]
Abstract
Levothyroxine monotherapy has been the standard of care for treatment of hypothyroidism for more than 40 years. However, patients treated with levothyroxine have relatively lower serum tri-iodothyronine (T3) concentrations than the general population, and symptoms of hypothyroidism persist for some patients despite normalisation of thyroid-stimulating hormone (TSH) concentrations. The understanding that maintenance of normal T3 concentrations is the priority for the thyroid axis has redirected the clinical focus to serum T3 concentrations in patients with hypothyroidism. This Personal View explores whether it is currently feasible to identify patients who could be considered for liothyronine supplementation in combination with levothyroxine. Genetic profiling stands out as a potential future tool to identify patients who do not respond well to levothyroxine due to suboptimal peripheral thyroxine (T4) activation. Moreover, new slow-release liothyronine preparations are being developed to be trialled in these symptomatic patients, in an attempt to restore T3 concentrations and provide conclusive results for the use of T4 plus T3 combination therapy.
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Affiliation(s)
- Domenico Salvatore
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Tommaso Porcelli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Matthew D Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, IL, USA
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, IL, USA
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3
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OUP accepted manuscript. J Appl Lab Med 2022; 7:945-970. [DOI: 10.1093/jalm/jfac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022]
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4
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Arora H, Collazo I, Palmerola KL, Parmar M, Narasimman M, Hendon N, Eisermann J, Bustillo M. Positive effects of thyroid replacement therapy on assisted reproductive technology outcomes in women with subclinical hypothyroidism with positive thyroid peroxidase autoantibodies. F S Rep 2021; 3:32-38. [PMID: 35386496 PMCID: PMC8978068 DOI: 10.1016/j.xfre.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Himanshu Arora
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
- Reprint requests: Himanshu Arora, Ph.D., Department of Urology, Miller School of Medicine, University of Miami, 1501 NW 10th Ave, Suite 809, Miami, Florida 33136.
| | - Ineabelle Collazo
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | | | - Madhumita Parmar
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Manish Narasimman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nicholas Hendon
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | - Juergen Eisermann
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | - Maria Bustillo
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
- Maria Bustillo, M.D., IVFMD, South Florida Institute for Reproductive Medicine, 7300 SW 62nd Place, 4th Floor, Miami, Florida 33143.
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Asav E. Development of a functional impedimetric immunosensor for accurate detection of thyroid-stimulating hormone. Turk J Chem 2021; 45:819-834. [PMID: 34385869 PMCID: PMC8329345 DOI: 10.3906/kim-2012-69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/26/2021] [Indexed: 12/03/2022] Open
Abstract
Thyroid-stimulating hormone (TSH), which regulates the synthesis of thyroid gland hormones affecting the whole metabolism, is a pituitary hormone. Determination of TSH is crucial for monitoring thyroid gland-related disorders and some metabolic diseases.In this study, a nonlabeled immunosensor based on covalent immobilization of anti-TSH antibody by using the formation of self-assembled monolayers (SAM) of 4-mercaptophenylacetic acid (4-MPA) and functionalization of carboxyl ends with 1-ethyl-3-(3-dimetilaminopropil) carbodiimide (EDC)/N-Hydroxysuccinimide (NHS) was fabricated for detection of TSH. Immobilization steps including the concentration of 4-MPA, the concentration of anti-TSH antibody, and duration of anti-TSH antibody incubation were optimized by utilizing electrochemical impedance spectroscopy. Under optimal conditions, a sensitive, rapid, and accurate determination of TSH at a concentration range between 0.7 and 3.5 mIU/L was accomplished with a notable linearity and LOD value of 0.034 mIU/L, as well as reproducibility and repeatability. Moreover, for comparison, linear range experiments were also carried out by using other electrochemical methods, including linear sweep voltammetry, cyclic voltammetry, and capacitance spectroscopy. Finally, the constructed immunosensor was used for analyzing TSH levels spiked in the artificial serum samples.
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Affiliation(s)
- Engin Asav
- Department of Nutrition and Dietetics, School of Health, Kırklareli University Turkey
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Hernández JM, Soldevila B, Velasco I, Moreno-Flores F, Ferrer L, Pérez-Montes de Oca A, Santillán C, Muñoz C, Ballesta S, Canal C, Puig-Domingo M, Granada ML. Reference Intervals of Thyroid Function Tests Assessed by Immunoassay and Mass Spectrometry in Healthy Pregnant Women Living in Catalonia. J Clin Med 2021; 10:jcm10112444. [PMID: 34072898 PMCID: PMC8198941 DOI: 10.3390/jcm10112444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent guidelines recommend establishing a local reference interval (RI) for thyroid function. We aimed to establish trimester-specific RIs for thyrotropin (TSH) and free thyroxine (FT4) in a cohort of healthy pregnant women in Catalonia (Spain). METHODS A prospective observational study was conducted with 332 healthy pregnant women, from the first trimester (1T) to delivery. TSH was measured using an Architect® immunoassay (Abbott) and FT4 by two immunoassays, Architect® (Abbott) and Cobas® (Roche), in the three trimesters. FT4 was also measured by liquid chromatography mass spectrometry (LC/MS/MS) in the 1T. RESULTS TSH (µUI/mL) increased throughout pregnancy (1T: 0.03-3.78; 2T: 0.51-3.53; 3T: 0.50-4.32; p < 0.0001) and FT4 (pmol/L) progressively decreased (Architect® 1T: 10.42-15.96; 2T: 8.37-12.74; 3T: 8.24-12.49; p < 0.0001; and Cobas®: 1T: 11.46-19.05; 2T: 9.65-14.67; 3T: 8.88-14.54; p < 0.0067). The FT4 RI during 1T determined LC/MS/MS was 8.75-18.27. Despite the 1T FT4 results measured by LC/MS/MS and with the two immunoassays being significantly correlated, the results obtained by the three methods were found to be non-interchangeable. CONCLUSIONS We established trimester-specific RIs for TSH and for FT4 with immunoassays in our population. We also validated the 1T FT4 using LC/MS/MS to confirm the results of FT4 lower than the 2.5th percentile or higher than the 97.5th percentile.
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Affiliation(s)
- José María Hernández
- Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain;
| | - Berta Soldevila
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Inés Velasco
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Gynecology & Obstetrics Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain
- Pediatrics, Gynecology & Obstetrics Department, Autonomous University of Barcelona, Campus UAB, Plaça Cívica, 08193 Bellaterra, Spain
| | - Fernando Moreno-Flores
- Clinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain;
| | - Laura Ferrer
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Alejandra Pérez-Montes de Oca
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Cecilia Santillán
- Endocrinology Department, Doctor Arturo Oñativia Hospital, 30 E.Paz Chain, Salta A4400AWQ, Argentina;
| | - Carla Muñoz
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Sílvia Ballesta
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
| | - Cristina Canal
- Gynecology & Obstetrics Department, ASSIR La Riera, Hospital Universitari Germans Trias i Pujol, 1 Riera Matamoros, 08911 Badalona, Spain;
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain; (B.S.); (L.F.); (A.P.-M.d.O.); (S.B.)
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Correspondence: ; Tel.: +34-934-978-860
| | - María Luisa Granada
- Endocrine, Thyroid & Obesity Research Group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, s/n Camí de les Escoles, 08916 Badalona, Spain; (I.V.); (C.M.); (M.L.G.)
- Clinical Biochemistry Department, Hospital Universitari Germans Trias i Pujol, s/n Carretera del Canyet, 08916 Badalona, Spain;
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Gant Kanegusuku A, Araque KA, Nguyen H, Wei B, Hosseini S, Soldin SJ. The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol. Ther Adv Endocrinol Metab 2021; 12:2042018821989240. [PMID: 33552466 PMCID: PMC7844449 DOI: 10.1177/2042018821989240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immunoassay (IA) measurements of thyroid hormones have previously given inaccurate results of triiodothyronine (T3), free triiodothyronine (FT3), and free thyroxine (FT4) when concentrations of TBG are low. We evaluate the hypothesis that abnormal concentrations of specific binding proteins (BPs) affect IA measurements and provide results which might misguide the diagnosis and treatment of patients. This study assesses IAs for the measurement of T3, FT3, and cortisol when levels of TBG and CBG are high or low. Comparisons are made between IA and LC-MS/MS. METHODS Serum or plasma samples with high (>95th percentile, n = 25) or low (<5th percentile, n = 27) concentrations of BP were collected. The concentrations of T3, FT3, and cortisol were measured by validated IA and liquid chromatography tandem mass spectrometry (LC-MS/MS) methods. Spearman correlation and Wilcoxon matched-pairs signed rank analyses were used to compare the two methods. RESULTS When TBG levels are <5th percentile, the differences between the IA and LC-MS/MS results for T3 and FT3 are statistically significant (T3, p = 0.0011; FT3, p = 0.0003). When CBG levels are >95th percentile, the difference between the IA and LC-MS/MS measurements of cortisol is statistically significant (p = <0.0001). CONCLUSION Abnormal BP concentrations appear to affect the accuracy of IA measurements of T3, FT3, and cortisol. The population of patients with either high or low levels of BPs is significant. Our samples reflect that 65% of women aged between 15 and 49 years are taking oral contraceptives in the US, and thus have elevated levels of BPs. In this group, IA results for cortisol are falsely low. Our samples reflect that patients with protein losing diseases have low BP concentrations. Among a group with renal complications, IA measurements of T3 are overestimated, while those of FT3 are underestimated. Are the Food and Drug Administration and diagnostic companies adequately assessing the accuracy of IA tests?
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Affiliation(s)
- Anastasia Gant Kanegusuku
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Katherine A. Araque
- Endocrinology Pituitary Institute, Pacific Neuroscience Institute, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Hung Nguyen
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bin Wei
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Saman Hosseini
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven J. Soldin
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Bethesda, MD 20892–0001, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University, Washington, DC, USA
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Kratzsch J, Baumann NA, Ceriotti F, Lu ZX, Schott M, van Herwaarden AE, Henriques Vieira JG, Kasapic D, Giovanella L. Global FT4 immunoassay standardization: an expert opinion review. Clin Chem Lab Med 2020; 59:1013-1023. [PMID: 33554525 DOI: 10.1515/cclm-2020-1696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Results can vary between different free thyroxine (FT4) assays; global standardization would improve comparability of results between laboratories, allowing development of common clinical decision limits in evidence-based guidelines. CONTENT We summarize the path to standardization of FT4 assays, and challenges associated with FT4 testing in special populations, including the need for collaborative efforts toward establishing population-specific reference intervals. The International Federation of Clinical Chemistry and Laboratory Medicine Committee for Standardization of Thyroid Function Tests has undertaken FT4 immunoassay method comparison and recalibration studies and developed a reference measurement procedure that is currently being validated. Further studies are needed to establish common reference intervals/clinical decision limits. Standardization of FT4 assays will change test results substantially; therefore, a major education program will be required to ensure stakeholders are aware of the benefits of FT4 standardization, planned transition procedure, and potential clinical impact of the changes. Assay recalibration by manufacturers and approval process simplification by regulatory authorities will help minimize the clinical impact of standardization. SUMMARY Significant progress has been made toward standardization of FT4 testing, but technical and logistical challenges remain. OUTLOOK Collaborative efforts by manufacturers, laboratories, and clinicians are required to achieve successful global standardization of the FT4 assays.
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Affiliation(s)
- Juergen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, University of Leipzig, Leipzig, Germany
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zhong X Lu
- Department of Medicine, Monash University, Victoria, Australia
| | - Matthias Schott
- Division for Specific Endocrinology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- University Hospital and University of Zurich, Zurich, Switzerland
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Segatto MS, Soler FS, Oliveira CAP, Brito-Madurro AG, Madurro JM. Novel electrochemical platform based on copolymer poly(aniline-4-aminophenol) for application in immunosensor for thyroid hormones. J Solid State Electrochem 2020. [DOI: 10.1007/s10008-020-04672-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Chun RF, Shieh A, Gottlieb C, Yacoubian V, Wang J, Hewison M, Adams JS. Vitamin D Binding Protein and the Biological Activity of Vitamin D. Front Endocrinol (Lausanne) 2019; 10:718. [PMID: 31708871 PMCID: PMC6821678 DOI: 10.3389/fendo.2019.00718] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
Vitamin D has a long-established role in bone health. In the last two decades, there has been a dramatic resurgence in research interest in vitamin D due to studies that have shown its possible benefits for non-skeletal health. Underpinning the renewed interest in vitamin D was the identification of the vital role of intracrine or localized, tissue-specific, conversion of inactive pro-hormone 25-hydroxyvitamin D [25(OH)D] to active 1,25-dihydroxyvitamin D [1,25(OH)2D]. This intracrine mechanism is the likely driving force behind vitamin D action resulting in positive effects on human health. To fully capture the effect of this localized, tissue-specific conversion to 1,25(OH)2D, adequate 25(OH)D would be required. As such, low serum concentrations of 25(OH)D would compromise intracrine generation of 1,25(OH)2D within target tissues. Consistent with this is the observation that all adverse human health consequences of vitamin D deficiency are associated with a low serum 25(OH)D level and not with low 1,25(OH)2D concentrations. Thus, clinical investigators have sought to define what concentration of serum 25(OH)D constitutes adequate vitamin D status. However, since 25(OH)D is transported in serum bound primarily to vitamin D binding protein (DBP) and secondarily to albumin, is the total 25(OH)D (bound plus free) or the unbound free 25(OH)D the crucial determinant of the non-classical actions of vitamin D? While DBP-bound-25(OH)D is important for renal handling of 25(OH)D and endocrine synthesis of 1,25(OH)2D, how does DBP impact extra-renal synthesis of 1,25(OH)2D and subsequent 1,25(OH)2D actions? Are their pathophysiological contexts where total 25(OH)D and free 25(OH)D would diverge in value as a marker of vitamin D status? This review aims to introduce and discuss the concept of free 25(OH)D, the molecular biology and biochemistry of vitamin D and DBP that provides the context for free 25(OH)D, and surveys in vitro, animal, and human studies taking free 25(OH)D into consideration.
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Affiliation(s)
- Rene F. Chun
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- *Correspondence: Rene F. Chun
| | - Albert Shieh
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Carter Gottlieb
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Vahe Yacoubian
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - John S. Adams
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Araque KA, Klubo-Gwiezdzinska J, Nieman LK, Welsh K, Soldin SJ. Assessment of thyroid function tests and harmonization: opinion on thyroid hormone harmonization. Ther Adv Endocrinol Metab 2019; 10:2042018819897049. [PMID: 31903181 PMCID: PMC6931143 DOI: 10.1177/2042018819897049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katherine A. Araque
- Adult Endocrinology department, National
Institutes of Health. National Institutes of Diabetes and Digestive and
Kidney Diseases, NIDDK, Bethesda, MD, USA
- Endocrinology Department Pacific Neuroscience
Institute, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Joanna Klubo-Gwiezdzinska
- Adult Endocrinology department, National
Institutes of Health, National Institutes of Diabetes and Digestive and
Kidney Diseases, NIDDK, Bethesda, MD, USA
| | - Lynnette K. Nieman
- Adult Endocrinology department, National
Institutes of Health, National Institutes of Diabetes and Digestive and
Kidney Diseases, NIDDK, Bethesda, MD, USA
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12
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Richards K, Rijntjes E, Rathmann D, Köhrle J. Avoiding the pitfalls when quantifying thyroid hormones and their metabolites using mass spectrometric methods: The role of quality assurance. Mol Cell Endocrinol 2017; 458:44-56. [PMID: 28153800 DOI: 10.1016/j.mce.2017.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 01/05/2023]
Abstract
This short review aims to assess the application of basic quality assurance (QA) principles in published thyroid hormone bioanalytical methods using mass spectrometry (MS). The use of tandem MS, in particular linked to liquid chromatography has become an essential bioanalytical tool for the thyroid hormone research community. Although basic research laboratories do not usually work within the constraints of a quality management system and regulated environment, all of the reviewed publications, to a lesser or greater extent, document the application of QA principles to the MS methods described. After a brief description of the history of MS in thyroid hormone analysis, the article reviews the application of QA to published bioanalytical methods from the perspective of selectivity, accuracy, precision, recovery, instrument calibration, matrix effects, sensitivity and sample stability. During the last decade the emphasis has shifted from developing methods for the determination of L-thyroxine (T4) and 3,3',5-triiodo-L-thyronine (T3), present in blood serum/plasma in the 1-100 nM concentration range, to metabolites such as 3-iodo-L-thyronamine (3-T1AM), 3,5-diiodo-L-thyronine (3,5-T2) and 3,3'-diiodo-L-thyronine (3,3'-T2). These metabolites seem likely to be present in the low pM concentrations; consequently, QA parameters such as selectivity and sensitivity become more critical. The authors conclude that improvements, particularly in the areas of analyte selectivity, matrix effect measurement/documentation and analyte recovery would be beneficial.
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Affiliation(s)
- Keith Richards
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eddy Rijntjes
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Rathmann
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Josef Köhrle
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Welsh KJ, Stolze BR, Yu X, Podsiadlo TR, Kim LS, Soldin SJ. Assessment of thyroid function in intensive care unit patients by liquid chromatography tandem mass spectrometry methods. Clin Biochem 2017. [DOI: 10.1016/j.clinbiochem.2016.11.022 pmid: 27890823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Welsh KJ, Soldin SJ. DIAGNOSIS OF ENDOCRINE DISEASE: How reliable are free thyroid and total T3 hormone assays? Eur J Endocrinol 2016; 175:R255-R263. [PMID: 27737898 PMCID: PMC5113291 DOI: 10.1530/eje-16-0193] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/08/2016] [Indexed: 11/08/2022]
Abstract
Hypothyroidism is a very common disorder worldwide, for which the usual treatment is monotherapy with levothyroxine (L-T4). However, a number of patients treated with L-T4 continue to report symptoms of hypothyroidism despite seemingly normal levels of thyroid-stimulating hormone (TSH), free-T3 (FT3) and free-T4 (FT4) measured by immunoassay. This review summarizes the limitations of the immunoassays commonly used to measure thyroid hormone levels and emphasizes the advantages of the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS). Immunoassays for free thyroid hormone are affected by alterations in serum binding proteins that occur in many physiological and disease states. Multiple studies show falsely normal values for T3, FT3 and FT4 by immunoassay that are below the reference interval when measured by (ultrafiltration) LC-MS/MS, a reference method. We suggest evaluation of thyroid hormone levels by ultrafiltration LC-MS/MS for patients who continue to experience hypothyroid symptoms on LT-4. This may help identify the approximately 20% subset of patients who would benefit from addition of T3 to their treatment regimen (combination therapy).
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Affiliation(s)
- Kerry J Welsh
- Clinical Chemistry DivisionDepartment of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven J Soldin
- Clinical Chemistry DivisionDepartment of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland, USA
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15
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Welsh KJ, Stolze BR, Yu X, Podsiadlo TR, Kim LS, Soldin SJ. Assessment of thyroid function in intensive care unit patients by liquid chromatography tandem mass spectrometry methods. Clin Biochem 2016; 50:318-322. [PMID: 27890823 DOI: 10.1016/j.clinbiochem.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/17/2016] [Accepted: 11/19/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients with non-thyroidal illness syndrome have many abnormalities in thyroid hormone tests. Such patients have medical comorbidities associated with low serum proteins and are on multiple medications that interfere with thyroid hormone measurement by immunoassay platforms. It is unknown if these thyroid hormone measurements reflect physiologic conditions or if they are artifacts of testing methodology. METHODS Fifty patients were selected from the intensive care unit (ICU) from our institution. Total and free thyroid hormones in plasma were measured by gold standard liquid chromatography-tandem mass spectrometry (LC-MSMS). The results were compared to the Roche Cobas 6000. Patient medical comorbidities and binding protein levels were assessed. RESULTS Concentrations of total 3,5,5'-triidothyronine (TT3) and total thyroxine (TT4) were significantly more likely to be low by LC-MSMS compared to immunoassay. Free 3,5,5'-triidothyronine (FT3) levels were similar by immunoassay and LC-MSMS. However, FT4 concentrations were mildly elevated for many patients when measured by ultrafiltration LC-MSMS (19/50, 38%) compared to 1/50 (2%) when measured by immunoassay (p=0.0001). Decreased albumin and thyroxine binding globulin were common and patients were on an average of 11.7±5.0 medications, all factors known to interfere with results found on immunoassays. CONCLUSIONS Marked discrepancies in thyroid hormone measurement were noted between reference LC-MSMS and a common immunoassay platform. It is hypothesized that T4 binding to low affinity albumin is displaced by several drugs, raising concentrations of FT4 by LC-MSMS compared to immunoassay, and that the immunoassay values are falsely decreased due to low binding proteins in our patient population.
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Affiliation(s)
- Kerry J Welsh
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States
| | - Brian R Stolze
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States
| | - Xiaolin Yu
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States
| | - Trisha R Podsiadlo
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States
| | - Lisa S Kim
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States
| | - Steven J Soldin
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States; (SJS) Departments of Endocrinology and Metabolism, Georgetown University, Washington, DC, United States.
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Abstract
Although mass spectrometry has been used clinically for decades, the advent of immunoassay technology moved the clinical laboratory to more labor saving automated platforms requiring little if any sample preparation. It became clear, however, that immunoassays lacked sufficient sensitivity and specificity necessary for measurement of certain analytes or for measurement of analytes in specific patient populations. This limitation prompted clinical laboratories to revisit mass spectrometry which could additionally be used to develop assays for which there was no commercial source. In this chapter, the clinical applications of mass spectrometry in therapeutic drug monitoring, toxicology, and steroid hormone analysis will be reviewed. Technologic advances and new clinical applications will also be discussed.
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Affiliation(s)
- D French
- University of California San Francisco, San Francisco, CA, United States.
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17
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Masika LS, Zhao Z, Soldin SJ. Is measurement of TT3 by immunoassay reliable at low concentrations? A comparison of the Roche Cobas 6000 vs. LC–MSMS. Clin Biochem 2016. [DOI: 10.1016/j.clinbiochem.2016.02.004 pmid: 26879528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
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Cai J, Fang Y, Jing D, Xu S, Ming J, Gao B, Shen H, Zhang R, Ji Q. Reference intervals of thyroid hormones in a previously iodine-deficient but presently more than adequate area of Western China: a population-based survey. Endocr J 2016; 63:381-8. [PMID: 26842591 DOI: 10.1507/endocrj.ej15-0574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of our study is to establish the reference intervals (RIs) of thyroid hormones in a previously iodine-deficient area but presently more than iodine-adequate area of Western China, and also to investigate the factors which affect thyroid function. The cross-sectional study conducted in Xi'an, was based on 2007-2008 China National Diabetes and Metabolic Disorders Survey. Among 1286 participating adults, 717 were finally included as reference population. Thyrotropin (TSH), total triiodothyronine (T3), free triiodothyronine (FT3), total thyroxine (T4), free thyroxine (FT4), thyroperoxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) were measured. Thyroid ultrasound examination was also performed. The present study established the new RIs of serum TSH (0.43-5.51 mIU/L), FT4 (11.0-20.4 pmol/L), FT3 (3.63-5.73 pmol/L), T4 (67.8-157 mmol/L) and T3 (1.08-2.20 mmol/L), which were different from the data provided by the manufacturers. Significant differences among all the age groups were observed in FT3, but neither in TSH nor in FT4. The TSH levels in adults with pathologic ultrasonography results or positive thyroid autoantibody were significantly higher than those in reference adults. Our present results provide valuable references for the diagnosis of thyroid diseases in population of Western China. Considering that most inland areas of China have faced the challenge of the transition from iodine deficiency to adequacy or more than adequacy, we recommend physicians utilize our RIs to determine thyroid diseases in the similar areas with Xi'an in China.
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Affiliation(s)
- Jing Cai
- Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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19
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Is measurement of TT3 by immunoassay reliable at low concentrations? A comparison of the Roche Cobas 6000 vs. LC-MSMS. Clin Biochem 2016; 49:846-9. [PMID: 26879528 DOI: 10.1016/j.clinbiochem.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Thyroid dysfunction is a common medical condition affecting an estimated 30 million people in the US alone. Employing gold standard Liquid chromatography-tandem mass spectrometry (LC-MSMS) methods we have examined the extent of inaccuracy of immunoassay (IA) measurement for total T3 (TT3) at low, normal and high concentrations. DESIGN AND METHODS 268 TT3 Roche Cobas 6000 immunoassay TT3 values (covering the low, normal, and high ranges) were compared with LC-MSMS results. RESULTS At TT3 concentrations between 50 and 113ng/dL (conversion factor for TT3 to SI Units is ng/dL×0.0154=nmol/L), n=122, LC-MSMS values were lower than immunoassay with 72% found to be below the 2.5th percentile by LC-MSMS compared to 27% for immunoassay. Strikingly 45% of the patients classified as normal TT3 by immunoassay were defined as lower than the 2.5th percentile by LC-MSMS. Only 38 of the 122 patients with low T3's were not receiving T4. In this latter group all of whom had TSH's>3.7mIU/L, 74% of results by LC-MSMS were below the 2.5th percentile while only 21% were below the 2.5th percentile by IA. The clinical consequences of these inaccuracies may affect whether dosing with T4 or combination of T4 with T3 is selected for treatment. Finally the correlation of TT3 with TSH was far superior when TT3 was measured by LC-MSMS. A typical case which demonstrates our message is included. CONCLUSION T3 being the active hormone needs to be reliably measured and if the patient has low TT3 and hypothyroid symptoms persist; treatment with T3 should be considered. A typical case report is included to illustrate the problems of inaccurate immunoassay results for TT3. Measurement of TT3 by immunoassay at low concentrations is less than optimal and often provides the clinician with a normal result when the LC-MSMS method and the patient's clinical condition suggests that supplementation with T3 (as in combination therapy) may be required to optimize patient care.
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Jonklaas J. TSH-Free Thyroxine Discordance in an Athyreotic Patient During Ipiluminab and Nivoluminab Therapy. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15975.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Loh TP, Sethi SK, Metz MP. Paediatric reference interval and biological variation trends of thyrotropin (TSH) and free thyroxine (T4) in an Asian population. J Clin Pathol 2015; 68:642-7. [PMID: 25903271 DOI: 10.1136/jclinpath-2015-202916] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/01/2015] [Indexed: 11/03/2022]
Abstract
AIMS To describe the reference intervals and biological variation data for thyrotropin (TSH) and free thyroxine (FT4) in a mixed Asian population using an indirect sampling approach and to compare them with published reports. METHODS TSH and FT4 of children measured once or twice over a 7-year period (2008-2014) at primary-care and tertiary-care settings were extracted from the laboratory information system. After excluding outliers, age-related reference intervals were derived using the Lambda-Mu-Sigma (LMS) approach, while age-partitioned biological variation data were obtained according to recommendations by Fraser and Harris. RESULTS Both TSH and FT4 were very high at birth and declined with age. Similarly within-individual and between-individual biological variations were higher for both TSH and FT4 at birth and also declined with age. Our data were broadly similar to previous studies. Significant heterogeneity in study population and methods prohibited direct numerical comparison between this and previously published studies. CONCLUSIONS This study fills two important gaps in our knowledge of paediatric thyroid function by reporting the centile trends (and reference values) in a mixed Asian population, as well as providing age-partitioned biological variation data. The variation in published reference intervals highlights the difficulty in harmonising paediatric thyroid reference intervals or recommending universal clinical cut-offs.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Sunil Kumar Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Michael Patrick Metz
- Division of Chemical Pathology, SA Pathology, Women's and Children's Hospital, Adelaide, South Australia, Australia School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
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Abstract
IMPORTANCE Subclinical hypothyroidism (SCH) is a common clinical entity with a putative role in a wide range of disorders. The impact of SCH on mortality and markers of morbidity has been demonstrated, but studies have shown inconsistent results. Evidence regarding the effect of levothyroxine treatment on reversing morbidity markers is emerging, but the value of treatment is still unclear. OBJECTIVE The objectives of this review were to assess recent, high-quality studies evaluating the role of SCH in cardiovascular health, cognition, mood, pregnancy, anemia, and renal disease; to examine the effects of levothyroxine on reducing mortality or reversing markers of morbidity in these conditions; and to consider how new research insights may help guide clinical practice. EVIDENCE REVIEW A PubMed search was conducted (using 'subclinical hypothyroidism' [Title/Abstract] AND morbidity [MeSH Subheading] as search criteria) and was restricted to human studies published in the English language between 1990 and 2013. Subsequent searches of retrieved articles yielded further studies, which were included based on quality. Emphasis was given to large observational studies, well-conducted meta-analyses, and randomized controlled trials. FINDINGS The difficulty of diagnosing SCH, particularly in the elderly, may underlie many of the conflicting results seen in the literature. Increased understanding of the at-risk patient population will result in better selection of study subjects and, likely, unequivocal results. Regardless of the current confusion, emerging evidence suggests that certain markers of morbidity are reversed by levothyroxine therapy across the disorders examined here. CONCLUSION AND RELEVANCE Future large, well-controlled studies will not only clarify the role of SCH but also help identify patients for whom levothyroxine treatment will provide the most benefit.
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Affiliation(s)
- James V Hennessey
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center , Boston, MA , USA
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23
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Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 2014; 24:1670-751. [PMID: 25266247 PMCID: PMC4267409 DOI: 10.1089/thy.2014.0028] [Citation(s) in RCA: 977] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment. METHODS Task force members identified 24 questions relevant to the treatment of hypothyroidism. The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists. Ethics reviews were provided, when relevant, by a bioethicist. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement. When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. Consensus was achieved for all recommendations by the task force. RESULTS We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non-levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones. CONCLUSIONS We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine-liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects). Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.
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Affiliation(s)
| | - Antonio C. Bianco
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Andrew J. Bauer
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kenneth D. Burman
- Endocrine Section, Medstar Washington Hospital Center, Washington, DC
| | - Anne R. Cappola
- Division of Endocrinology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Francesco S. Celi
- Division of Endocrinology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - David S. Cooper
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian W. Kim
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M. Sara Rosenthal
- Program for Bioethics, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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24
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Adaway JE, Keevil BG, Owen LJ. Liquid chromatography tandem mass spectrometry in the clinical laboratory. Ann Clin Biochem 2014; 52:18-38. [DOI: 10.1177/0004563214557678] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Clinical laboratory medicine has seen the introduction and evolution of liquid chromatography tandem mass spectrometry in routine clinical laboratories over the last 10–15 years. There still exists a wide diversity of assays from very esoteric and highly specialist manual assays to more simplified kit-based assays. The technology is not static as manufacturers are continually making improvements. Mass spectrometry is now commonly used in several areas of diagnostics including therapeutic drug monitoring, toxicology, endocrinology, paediatrics and microbiology. Some of the most high throughput analyses or common analytes include vitamin D, immunosuppressant monitoring, androgen measurement and newborn screening. It also offers flexibility for the measurement of analytes in a variety of different matrices which would prove difficult with immunoassays. Unlike immunoassays or high-pressure liquid chromatography assays using ultraviolet or fluorescence detection, mass spectrometry offers better specificity and reduced interferences if attention is paid to potential isobaric compounds. Furthermore, multiplexing, which enables multiple analytes to be measured with the same volume of serum is advantageous, and the requirement for large sample volumes is decreasing as instrument sensitivity increases. There are many emerging applications in the literature. Using mass spectrometry to identify novel isoforms or modified peptides is possible as is quantification of proteins and peptides, with or without protein digests. Future developments by the manufacturers may also include mechanisms to improve the throughput of samples and strategies to decrease the level of skill required by the operators.
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Affiliation(s)
- Joanne E Adaway
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Brian G Keevil
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Laura J Owen
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Jonklaas J, Sathasivam A, Wang H, Gu J, Burman KD, Soldin SJ. Total and free thyroxine and triiodothyronine: measurement discrepancies, particularly in inpatients. Clin Biochem 2014; 47:1272-8. [PMID: 24936679 DOI: 10.1016/j.clinbiochem.2014.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We compared the performance of tandem mass spectrometry versus immunoassay for measuring thyroid hormones in a diverse group of inpatients and outpatients. METHODS Thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3) were measured by liquid chromatography tandem mass spectrometry and immunoassay in 100 patients and the two assays were compared. RESULTS T4 and T3 values measured by the two different assays correlated well with each other (r=0.91-0.95). However, the correlation was less good at the extremes (r=0.51-0.75). FT4 and FT3 concentrations measured by the two assays correlated less well with each other (r=0.75 and 0.50 respectively). The studied analytes had poor inverse correlation with the log-transformed TSH values (r=-0.22-0.51) in the population as a whole. The strongest correlations were seen in the groups of outpatients (r=-0.25-0.61). The weakest degree of correlation was noted in the inpatient group, with many correlations actually being positive. CONCLUSION The worst between-assay correlation was demonstrated at low and high hormone concentrations, in the very concentration ranges where accurate assay performance is typically most clinically important. Based on the lesser susceptibility of mass spectrometry to interferences from conditions such as binding protein abnormalities, we speculate that mass spectrometry better reflects the clinical situation. In this mixed population of inpatients and outpatients, we also note failure of assays to conform to the anticipated inverse linear relationship between thyroid hormones and log-transformed TSH.
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Affiliation(s)
| | - Anpalakan Sathasivam
- Division of Endocrinology, Georgetown University, Washington, DC, USA; Section of Endocrinology Medstar Washington Hospital Center, Washington, DC, USA
| | - Hong Wang
- Medstar Health Research Institute, Hyattsville, MD, USA
| | - Jianghong Gu
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth D Burman
- Section of Endocrinology Medstar Washington Hospital Center, Washington, DC, USA
| | - Steven J Soldin
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, USA
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26
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Gounden V, Jonklaas J, Soldin SJ. A pilot study: subclinical hypothyroidism and free thyroid hormone measurement by immunoassay and mass spectrometry. Clin Chim Acta 2013; 430:121-4. [PMID: 24389098 DOI: 10.1016/j.cca.2013.12.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/23/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of subclinical hypothyroidism is defined as the presence of an elevated thyroid stimulating hormone (TSH) with a normal free thyroxine (FT4) level. The commonly used direct analogue immunoassays for the measurement of FT4 have been shown to have poor performance at the upper and lower limits of the FT4 reference interval. PURPOSE The purpose of this pilot study was to investigate the percentage of individuals classified as having subclinical hypothyroidism with a standard immunoassay, that actually have low free thyroid hormone levels by mass spectrometry measurements. DESIGN Outpatient samples with elevated TSH values and normal FT4 concentrations as per standard immunoassay methods were collected. FT4 and free triiodothyronine (FT3) analyses were performed on these samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS Sixty five percent (n=26) of patients (n=40) had (LC-MS/MS) FT4 or FT3 or both FT4 and FT3 values below mass spectrometry reference limits. CONCLUSIONS Our findings indicate that the direct analogue immunoassay method for FT4 measurement results in a significant proportion of patients being misclassified as having subclinical hypothyroidism.
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Affiliation(s)
- Verena Gounden
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD, USA
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, DC, USA
| | - Steven J Soldin
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD, USA; Division of Endocrinology, Georgetown University Medical Center, Washington, DC, USA.
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