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Abdien AE, Mohamed Bulla HA, Awadelkareim lmam ML, Yousif A, Karar T.A, Eltayeb MH, Eltayeb R. ASSOCIATION OF SERUM AUTO-ANTIBODIES AND THYROID FUNCTION TEST IN PATIENTS WITH NON-NEOPLASTIC THYROID DISEASES IN SHENDI LOCALITY, SUDAN. INTERNATIONAL JOURNAL OF RESEARCH -GRANTHAALAYAH 2022; 10:179-187. [DOI: 10.29121/granthaalayah.v10.i2.2022.4473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Thyroid disorders are the most second endocrine problem after diabetes mellitus in society. Environmental, immunological, and genetic factors lead to the development of thyroid disorders.
Objectives: The study intended to evaluate the role of thyroid antibodies and hormones in the diagnosis of thyroid diseases, as well as the prevalence of thyroid antibodies in patients having thyroid disorders living in Shendi locality.
Study design: The current research was prospective, case - control, hospital-based study carried out from 2013-2017, in El-Mek Nimir Uiversity Hospital in Shendi town- Northern Sudan.-. River Nile State. Two hundred and eighty-three (283) participants selected randomly as study population, of whom Hundred and eleven (111) patients with hypothyroidism; Seventy-two (72) patients with hyperthyroidism; Hundred (100) healthy normal subjects as control group. Participants were recruited from outpatient clinics in El-Mek Nimir Uiversity Hospital in Shendi Thyroid hormones profile (TSH, T4, T3, fT3, and fT4) and Thyroid antibodies (Anti-thyroid peroxidase and antithyroglobulin) were measured.
Results: The study revealed that (60.7%) had hypothyroidism, (39.3%) had
hyperthyroidism, (91.9%) of hypothyroidism were female, and only (8.1%) were male, while (84.7%) of hyperthyroidism were female while male represented only (15.3%) of them.
The current study revealed that 107 of the case group (58.5%) were positive when evaluated for thyroid peroxidase antibodies (TPO Ab), with level more than (40.0 IU/ml). 72 (64.9%) of them were hypothyroidism, whereas a 35 (48.6%) of them were hyperthyroidism. As regard Thyroglobulin antibodies (Tg Ab), 73 (39.9%) of the case studied were positive, 51 (69.9%) of them were hypothyroidism, and 22 (30.1%) of them were hyperthyroidism.
The study also revealed statistically significant positive correlation between the presence of TPO Ab and the values of fT3
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Bennaim M, Shiel RE, Evans H, Mooney CT. Free thyroxine measurement by analogue immunoassay and equilibrium dialysis in dogs with non-thyroidal illness. Res Vet Sci 2022; 147:37-43. [DOI: 10.1016/j.rvsc.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
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Crampton N, Kalia S, Del Giudice ME, Wintemute K, Sullivan F, Aliarzadeh B, Meaney C, Moineddin R, Singer A, Hinton W, Sherlock J, Williams J, de Lusignan S, Greiver M. Over-use of thyroid testing in Canadian and UK primary care in frequent attenders: A cross-sectional study. Int J Clin Pract 2021; 75:e14144. [PMID: 33733562 DOI: 10.1111/ijcp.14144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 03/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) is a common test used to detect and monitor clinically significant hypo- and hyperthyroidism. Population-based screening of asymptomatic adults for thyroid disorders is not recommended. OBJECTIVE The research objectives were to determine patterns of TSH testing in Canadian and English primary care practices, as well as patient and physician practice characteristics associated with testing TSH for primary care patients with no identifiable indication. METHODS In this 2-year cross-sectional observational study, Canadian and English electronic medical record databases were used to identify patients and physician practices. Cohorts of patients aged 18 years or older, without identifiable indications for TSH testing, were generated from these databases. Analyses were performed using a random-effects logistic regression to determine patient and physician practice characteristics associated with increased testing. We determined the proportion of TSH tests performed concurrently with at least one common screening blood test (lipid profile or hemoglobin A1c). Standardised proportions of TSH test per family practice were used to examine the heterogeneity in the populations. RESULTS At least one TSH test was performed in 35.97% (N = 489 663) of Canadian patients and 29.36% (N = 1 030 489) of English patients. Almost all TSH tests in Canada and England (95.69% and 99.23% respectively) were within the normal range (0.40-5.00 mU/L). A greater number of patient-physician encounters was the strongest predictor of TSH testing. It was determined that 51.40% of TSH tests in Canada and 76.55% in England were performed on the same day as at least one other screening blood test. There was no association between the practice size and proportion of asymptomatic patients tested. CONCLUSIONS This comparative binational study found TSH patterns suggestive of over-testing and potentially thyroid disorder screening in both countries. There may be significant opportunities to improve the appropriateness of TSH ordering in Canada and England and therefore improve the allocation of limited system resources.
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Affiliation(s)
- Noah Crampton
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sumeet Kalia
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria Elisabeth Del Giudice
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kimberly Wintemute
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sullivan
- North York Family Health Team, Toronto, ON, Canada
- University of St Andrews Bute Medical School, St Andrews, UK
| | - Babak Aliarzadeh
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Michelle Greiver
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
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D'Aurizio F. The role of laboratory medicine in the diagnosis of the hyperthyroidism. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:91-101. [PMID: 33565846 DOI: 10.23736/s1824-4785.21.03344-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hyperthyroidism is a clinical condition characterized by inappropriately high synthesis and secretion of thyroid hormones by the thyroid gland. It has multiple aetiologies, manifestations and potential therapies. Graves' disease is the most common form of hyperthyroidism, due to the production of autoantibodies against thyrotropin receptor, capable of over-stimulating thyroid function. A reliable diagnosis of hyperthyroidism can be established on clinical grounds, followed by the evaluation of serum thyroid function tests (thyrotropin first and then free thyroxine, adding the measurement of free triiodothyronine in selected specific situations). The recent guidelines of both the American and European Thyroid Associations have strongly recommended the measurement of thyrotropin receptor autoantibodies for the accurate diagnosis and management of Graves' disease. If autoantibody test is negative, a radioiodine uptake should be performed. Considering the most recent laboratory improvements, binding assays can be considered the best first solution for the measurement of thyrotropin receptor autoantibodies in diagnosis and management of overt cases of Graves' disease. In fact, they have a satisfactory clinical sensitivity and specificity (97.4% and 99.2%, respectively) being performed in clinical laboratories on automated platforms together with the other thyroid function tests. In this setting, the bioassays should be reserved for fine and complex diagnoses and for particular clinical conditions where it is essential to document the transition from stimulating to blocking activity or vice versa (e.g. pregnancy and post-partum, related thyroid eye disease, Hashimoto's thyroiditis with extrathyroidal manifestations, unusual cases after LT4 therapy for hypothyroidism or after antithyroid drug treatment for Graves' disease). Undoubtedly, technological advances will help improve laboratory diagnostics of hyperthyroidism. Nevertheless, despite future progress, the dialogue between clinicians and laboratory will continue to be crucial for an adequate knowledge and interpretation of the laboratory tests and, therefore, for an accurate diagnosis and correct management of the patient.
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Affiliation(s)
- Federica D'Aurizio
- Department of Laboratory Medicine, Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy -
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Almudayni HK, Alhowaish RK, Alotaibi BM, Alshehri AM, Alqahtani AM, Tmraz SF, Alotaibi SM. An Overview on Hyperthyroidism, Evaluation and Management Approach in Primary Health Care Centre. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/iwjyn8yxo2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Wong JSL, Selveindran NM, Mohamed RZ, Zain FM, Anas SS, Hong JYH. Reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in infants' day 14-30 of life and a comparison with other studies. J Pediatr Endocrinol Metab 2020; 33:1125-1132. [PMID: 32841163 DOI: 10.1515/jpem-2020-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022]
Abstract
Objectives Established reference intervals of thyroid function in neonates are important; however, studies often consist of a small sample size or lack of clinical information. We aim to define reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) for infants aged 14-30 days. We also reviewed follow-up TSH for infants with initial values 10-20 mIU/L. Methods Venous TSH and FT4 of term babies aged 14-30 days with breast milk jaundice that had thyroid function test performed as part of a prolonged jaundice workout from September 2016 to March 2017 were analyzed. Electronic medical records were reviewed to ensure only well babies with no pathological causes of jaundice or conditions that may affect thyroid function were included. TSH and FT4 were analyzed using immunoassay analyzer Dxl 800, Beckman Coulter. Results There were no correlations between FT4 and TSH with gender, birth weight and ethnicity. Correlation coefficient between FT4 and total bilirubin was weak at 0.138 (p=0.001). No association was found between TSH and bilirubin levels. Mean FT4 was higher in the younger age group day 14-21 (p<0.01). There was no significant difference in TSH values between the age groups. Infants with mildly elevated TSH 10-20 mIU/L had normalized values on follow-up (mean, 11.41 vs. 4.42 mIU/L; p<0.01; 95%CI, 5.88-8.09). The following reference intervals (2.5-97.5th percentile) were derived: FT4 day 14-21 (n=513): 11.59-21.00 pmoL/L; FT4 day 22-30 (n=66): 10.14-19.60 pmoL/L; TSH day 14-30 (n=579): 1.90-10.34 mIU/L. Comparison between studies showed variations of reference intervals with different manufacturer assays, age and methodology. Conclusions Our reference intervals would be useful in the clinical setting. Infants with mildly elevated TSH could be monitored first instead of immediate treatment.
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Affiliation(s)
- Jeanne Sze Lyn Wong
- Department of Paediatrics, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
| | - Nalini M Selveindran
- Department of Paediatrics, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
| | - Rashdan Zaki Mohamed
- Department of Paediatrics, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
| | - Fuziah M Zain
- Department of Paediatrics, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
| | - Siti S Anas
- Department of Pathology, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
| | - Janet Y H Hong
- Department of Paediatrics, Putrajaya Hospital, Ministry of Health, Putrajaya, Malaysia
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Goel D, Luig M, Maheshwari R, D'Cruz D, Goyen TA. General Movement assessment and neurodevelopmental trajectory in extremely preterm infants with hypothyroxinaemia of prematurity (THOP). Early Hum Dev 2020; 144:104886. [PMID: 31668678 DOI: 10.1016/j.earlhumdev.2019.104886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transient hypothyroxinaemia of prematurity (THOP) has been associated with neurodevelopmental deficits with a paucity of literature leading to variable practice. AIM Evaluation of the relationship between free T4 (fT4) levels at 2 weeks after birth and early markers of neurodevelopmental outcome. STUDY DESIGN A retrospective study of prospectively collected data from infants born <29 weeks' gestation, admitted to NICU between January 2012 and December 2014. The primary outcomes were the relationship between fT4 levels at 2 weeks, Prechtl General Movement Assessment (GMA) at 36 weeks and 3 months postterm age, and Bayley Scales of Infant Development (BSID-III) at 2 years postterm age. Secondary outcomes were survival free of disability and other neonatal morbidities. RESULTS Of 122 infants, 101 infants had normal fT4 levels (No-THOP) and 21 had fT4 levels >1SD below the mean (THOP group). There was increased frequency of abnormal GMA in the No-THOP group compared with the THOP group at 36 weeks (abnormal writhing GMs: 43% vs 21%, p = 0.15) and 3 months corrected age (absent fidgety GMs: 7.6% vs 0%, p = 0.36), though not statistically significant. The neurodevelopmental outcome was worse in the No-THOP group compared with the THOP group with significantly lower mean cognitive and motor scores at 2 year of corrected age (90 ± 13.8 vs 100 ± 8.3, p = 0.01 and 91 ± 15.2 vs 100 ± 13.2, p = 0.04 respectively). CONCLUSIONS This is the first report describing General Movements (GMs) in preterm infants with THOP. We found worse neurodevelopmental outcome in No-THOP infants reflected by significantly worse cognitive and motor outcomes at 2 years corrected age.
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Affiliation(s)
- Dimple Goel
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | | | - Rajesh Maheshwari
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Daphne D'Cruz
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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SANTIAGO-PEÑA LF. Fisiología de la glándula tiroides. Disfunción y parámetros funcionales de laboratorio en patología de tiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Soh SB, Aw TC. Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility. Ann Lab Med 2019; 39:3-14. [PMID: 30215224 PMCID: PMC6143469 DOI: 10.3343/alm.2019.39.1.3] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/29/2018] [Accepted: 09/02/2018] [Indexed: 12/18/2022] Open
Abstract
Thyroid disorders are common, affecting more than 10% of people in the US, and laboratory tests are integral in the management of these conditions. The repertoire of thyroid tests includes blood tests for thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, thyroglobulin (Tg), thyroglobulin antibodies (Tg-Ab), thyroid peroxidase antibodies (TPO-Ab), TSH receptor antibodies (TRAb), and calcitonin. TSH and free thyroid hormone tests are frequently used to assess the functional status of the thyroid. TPO-Ab and TRAb tests are used to diagnose Hashimoto's thyroiditis and Graves' disease, respectively. Tg and calcitonin are important tumor markers used in the management of differentiated thyroid carcinoma and medullary thyroid carcinoma (MTC), respectively. Procalcitonin may replace calcitonin as a biomarker for MTC. Apart from understanding normal thyroid physiology, it is important to be familiar with the possible pitfalls and caveats in the use of these tests so that they can be interpreted properly and accurately. When results are discordant, clinicians and laboratorians should be mindful of possible assay interferences and/or the effects of concurrent medications. In addition, thyroid function may appear abnormal in the absence of actual thyroid dysfunction during pregnancy and in critical illness. Hence, it is important to consider the clinical context when interpreting results. This review aims to describe the above-mentioned blood tests used in the diagnosis and management of thyroid disorders, as well as the pitfalls in their interpretation. With due knowledge and care, clinicians and laboratorians will be able to fully appreciate the clinical utility of these important laboratory tests.
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Affiliation(s)
- Shui Boon Soh
- Department of Endocrinology, Changi General Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tar Choon Aw
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Laboratory Medicine, Changi General Hospital, Singapore.
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From feedback loop transitions to biomarkers in the psycho-immune-neuroendocrine network: Detecting the critical transition from health to major depression. Neurosci Biobehav Rev 2018. [DOI: 10.1016/j.neubiorev.2018.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Gozet T, Serdar M, Akın-Levi C, Ucal Y, Ozpinar A. Assessment of thyroid function during postpartum period with total thyroxine and total triiodothyronine levels measured by LC-MS/MS. J LIQ CHROMATOGR R T 2018. [DOI: 10.1080/10826076.2018.1511994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tuba Gozet
- Faculty of Pharmacy, Department of Analytical Chemistry, Altinbas University, Istanbul, Turkey
| | - Muhittin Serdar
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cansu Akın-Levi
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Yasemin Ucal
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Aysel Ozpinar
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Pratt R, Stapelberg NJC. Early warning biomarkers in major depressive disorder: a strategic approach to a testing question. Biomarkers 2018; 23:563-572. [DOI: 10.1080/1354750x.2018.1463563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R. Pratt
- Consultation Liaison Psychiatry, Nepean Hospital, Penrith, Australia
| | - N. J. C. Stapelberg
- Faculty of Health Sciences and Medicine, Bond University and Gold Coast Hospital and Health Service, Southport, Australia
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Sasson M, Kay-Rivest E, Shoukrun R, Florea A, Hier M, Forest VI, Tamilia M, Payne RJ. The T4/T3 quotient as a risk factor for differentiated thyroid cancer: a case control study. J Otolaryngol Head Neck Surg 2017; 46:28. [PMID: 28376913 PMCID: PMC5379683 DOI: 10.1186/s40463-017-0208-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 03/29/2017] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of thyroid nodules is increasing among patients in North America. Few of these nodules harbour malignancy, thus further research is required to identify predictive markers of malignant thyroid disease. This study set out to understand the relationship between the levels of fT4 and fT3 and differentiated thyroid cancer. Methods A case-control study was conducted with 142 cases and 86 controls from the McGill University Teaching Hospitals. All patients underwent thyroid surgery. Cases were defined as patients with malignant nodules confirmed on final pathology and controls were defined as patients with benign nodules. The serological levels of TSH, fT4 and fT3 were measured preoperatively. Odds ratios were determined for each parameter and logistic regressions were calculated between markers and probability of malignancy. Additionally, fT4 values were divided by fT3 values (fT4/fT3 quotient) for each patient and an odds ratio was calculated. Results Amongst cases, the mean TSH was 2.25 ± 0.360U/mL, fT4 was 14.8 ± 0.689pmol/L, and fT3 was 4.65 ± 0.463pmol/L. Amongst controls, the mean TSH was 2.36 ± 1.68U/mL, fT4 was 14.3 ± 1.71pmol/L, and fT3 was 5.27 ± 0.957pmol/L. Patients in the control group were more likely to have low TSH, while patients in the case group would have high fT4 and patients in the control group were more likely to have a low fT4. The OR for patients with TSH >4.4U/mL was 2.13 (0.97, 4.65), and for patients with TSH <0.4U/mL was 0.46 (0.22, 0.95). The OR for patients with fT4 > 16pmol/L was 2.10 (1.09, 4.06), and for patients with fT4 < 10pmol/L was 0.45 (0.20, 0.98). The OR for patients with fT3 > 5.5pmol/L was 0.39 (0.14, 1.28). The OR for patients with fT3 < 3pmol/L was 1.83 (0.25, 13.69). The average fT4/fT3 was 3.39 ± 0.206 for cases and 2.93 ± 0.467 for controls. The fT4/fT3 quotient was considered high if it was >3.3 (OR =6.00 (2.94, 12.25)). Conclusion In this study, a direct relationship between high levels of fT4 and malignancy was uncovered. Furthermore, low levels of TSH and fT4 increased the likelihood that a nodule was benign. In this study a fT4/fT3 ratio >3.3 increased the risk of malignancy by 3.6 times (p-value =0.0013).
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Affiliation(s)
- Mark Sasson
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Emily Kay-Rivest
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Rami Shoukrun
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Anca Florea
- Department of Pathology, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada.
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Congenital Hypothyroidism: An Audit and Study of Different Cord Blood Screening TSH Values in a Tertiary Medical Centre in Malaysia. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/387684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mothers are often discharged within 24 hours in most Asian countries. Therefore, our screening programs for congenital hypothyroidism (CH) must consider the value of cord blood TSH. Our objectives were to compare the incidence of CH, positive predictive values, and recall rates using different cord blood TSH values. We also reviewed the results of the second-screening program for premature babies. 99.7% (n=25,757) of all newborns were screened from 1st January 2009 to 31st December 2013. Babies with cord blood TSH > 25 mIU/L or 20–25 mIU/L and FT4<20 pmol/L were recalled for a repeat venous TSH and FT4 on days 3–5 of life to confirm CH. Twenty-two babies were confirmed to have CH, an incidence of 1:1170. Five were premature. Eleven term babies had cord blood TSH>30 mIU/L and six had values 25.1–30 mIU/L. Lowering the recall cut-off value to 20 mIU/L would double the recall rate from 0.63% (n=163) to 1.3% (n=340) with no additional cases detected, whereas using 30 mIU/L would have missed 35% of cases. The incidence of CH was similar, 1:1515, when using either cut-off 20 mIU/L or cut-off 25 mIU/L but lower, 1:2380, when using 30 mIU/L. We recommend the screening cord blood TSH cut-off should be 25 mIU/L and screening for premature babies should be continued.
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Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves' disease. Autoimmun Rev 2014; 13:398-402. [PMID: 24424182 DOI: 10.1016/j.autrev.2014.01.013] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/03/2023]
Abstract
Graves' disease (GD) is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor (TSHR), resulting in hyperthyroidism and goiter. Organs other than the thyroid can also be affected, leading to the extrathyroidal manifestations of GD, namely Graves' ophthalmopathy, which is observed in ~50% of patients, and Graves' dermopathy and acropachy, which are quite rare. Presumably, the extrathyroidal manifestations of GD are due to autoimmunity against antigens common to the thyroid and other affected organs. Although its exact etiology remains to be completely understood, GD is believed to result from a complex interaction between genetic susceptibility and environmental factors. Clinically, GD is characterized by the manifestations of thyrotoxicosis as well as by its extrathyroidal features when present, the latter making the diagnosis almost unmistakable. In the absence of ophthalmopathy, the diagnosis is generally based on the association of hyperthyroidism and usually diffuse goiter confirmed with serum anti-TSHR autoantibodies (TRAbs). Hyperthyroidism is generally treated with anti-thyroid drugs, but a common long term treatment strategy in patients relapsing after a course of anti-thyroid drugs (60-70%), implies the use of radioactive iodine or surgery.
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Aitken J, Williams FLR. A systematic review of thyroid dysfunction in preterm neonates exposed to topical iodine. Arch Dis Child Fetal Neonatal Ed 2014; 99:F21-8. [PMID: 24105624 DOI: 10.1136/archdischild-2013-303799] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine whether maternal exposure to iodine or neonatal exposure to topical iodine-containing solutions increases the risk of transient thyroid dysfunction in neonates born <32 weeks' gestation or <1.5 kg. DESIGN Systematic review. SEARCH STRATEGY Electronic searches were conducted using Medline and the Cochrane Library. ELIGIBILITY CRITERIA A study was eligible for review if it reported neonatal exposure to topical iodine or maternal iodine exposure. The key outcome measure was neonatal thyroid function. The search had no restrictions on date of publication, type of study or language. RESULTS 794 papers were identified during the initial search; 15 studies were fully reviewed. The incidence of (transient) hypothyroidism/hyperthyrotropinaemia following exposure to topical iodine ranged from 12 to 33 per 100 infants; the incidence in non-exposed infants was 0. CONCLUSIONS There is evidence that neonatal exposure to iodine-containing disinfectants causes thyroid dysfunction in infants born <32 weeks. None of the studies evaluated neurodevelopment. Larger scale studies are needed to determine definitively the nature of the relationship and the impact of exposure on neurodevelopment. In the meantime, it would seem prudent to restrict exposure of iodine-containing skin disinfectants in preterm infants; chlorhexidine might be a credible alternative.
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Affiliation(s)
- Julie Aitken
- Population Health Sciences, Medical Research Institute, Mackenzie Building, University of Dundee, , Dundee, Scotland
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Shahangian S, Alspach TD, Astles JR, Yesupriya A, Dettwyler WK. Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010. Arch Pathol Lab Med 2013; 138:189-203. [PMID: 23738761 DOI: 10.5858/arpa.2013-0149-oa] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Changes in reimbursements for clinical laboratory testing may help us assess the effect of various variables, such as testing recommendations, market forces, changes in testing technology, and changes in clinical or laboratory practices, and provide information that can influence health care and public health policy decisions. To date, however, there has been no report, to our knowledge, of longitudinal trends in national laboratory test use. OBJECTIVE To evaluate Medicare Part B-reimbursed volumes of selected laboratory tests per 10,000 enrollees from 2000 through 2010. DESIGN Laboratory test reimbursement volumes per 10,000 enrollees in Medicare Part B were obtained from the Centers for Medicare & Medicaid Services (Baltimore, Maryland). The ratio of the most recent (2010) reimbursed test volume per 10,000 Medicare enrollees, divided by the oldest data (usually 2000) during this decade, called the volume ratio, was used to measure trends in test reimbursement. Laboratory tests with a reimbursement claim frequency of at least 10 per 10,000 Medicare enrollees in 2010 were selected, provided there was more than a 50% change in test reimbursement volume during the 2000-2010 decade. We combined the reimbursed test volumes for the few tests that were listed under more than one code in the Current Procedural Terminology (American Medical Association, Chicago, Illinois). A 2-sided Poisson regression, adjusted for potential overdispersion, was used to determine P values for the trend; trends were considered significant at P < .05. RESULTS Tests with the greatest decrease in reimbursement volumes were electrolytes, digoxin, carbamazepine, phenytoin, and lithium, with volume ratios ranging from 0.27 to 0.64 (P < .001). Tests with the greatest increase in reimbursement volumes were meprobamate, opiates, methadone, phencyclidine, amphetamines, cocaine, and vitamin D, with volume ratios ranging from 83 to 1510 (P < .001). CONCLUSIONS Although reimbursement volumes increased for most of the selected tests, other tests exhibited statistically significant downward trends in annual reimbursement volumes. The observed changes in reimbursement volumes may be explained by disease prevalence and severity, patterns of drug use, clinical or laboratory practices, and testing recommendations and guidelines, among others. These data may be useful to policy makers, health systems researchers, laboratory directors, and industry scientists to understand, address, and anticipate trends in laboratory testing in the Medicare population.
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Affiliation(s)
- Shahram Shahangian
- From the Division of Laboratory Programs, Standards, and Services, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Shahangian and Astles and Messrs Yesupriya and Alspach)
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Bílek R, Stárka L, Zamrazil V. Dysthyronemia in normal concentrations of thyrotropin--analytical and clinical consequences. Horm Mol Biol Clin Investig 2013; 13:13-7. [PMID: 25436710 DOI: 10.1515/hmbci-2013-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/23/2013] [Indexed: 11/15/2022]
Abstract
This article discusses the conditions that may lead to a phenomenon called dysthyronemia. Here, the thyroid gland has concentration of thyrotropin in circulation within the reference range, but the concentrations of free or total fractions of thyroid hormones are outside the reference range. Normal values of thyrotropin (TSH) and increased values of THs are referred to as hyperthyroxinemia, while normal values of thyrotropin and decreased values of thyroid hormone are hypothyroxinemia. As shown by our observations, it is a relatively frequent situation in the parallel determinations of TSH and free thyroxine, when results verging on hyperthyroxinemia were found in 7% of cases (6.74%, n=259,590), and also in the parallel sets of TSH and total triiodothyronine when hypotriiodothyroninemia reached 8.5% (8.48%, n=73,143). We are assuming that the main cause of hyperthyroxinemia in the free thyroxine and TSH system is the presence of autoantibodies against thyroxine in patients with autoimmune thyroid disease. The reason of hypotriiodothyroninemia in the system of triiodothyronine and TSH is a decreased concentration of thyroid binding globulin in postmenopausal women. Manufacturers of immunoanalytical kits should take into account the potential adverse effects of autoantibodies against thyroid hormones when measuring the results of immunoassay determination of the free fraction of these hormones.
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Affiliation(s)
- Radovan Bílek
- Institute of Endocrinology, Národní 8, 116 94 Prague 1, Czech Republic.
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Affiliation(s)
- Janet E Squires
- Child Advocacy Center, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, PA 15224, USA.
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Thyroid Function Tests. PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A thyroid panel consisting of thyroid stimulating hormone (TSH) and free thyroxine (fT4) should form the first line of diagnostic tests; tri-iodothyronine (T3) — total or free may be needed occasionally. A TSH assay capable of detecting levels below 0.02mIU/L is required to differentiate the suppressed TSH levels typical in Graves' disease from subnormal levels seen in some geriatric patients, non-thyroidal illness, and patients on medications. Additional tests including thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), and TSH receptor antibody (TRAb) may be ordered to enable differential diagnosis when indicated. Serum thyroglobulin (Tg) may serve as a tumour marker for monitoring patients with differentiated thyroid cancer.
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Bílek R, Stárka L, Zamrazil V. Evaluation of dysthyronemia in endocrinological patients. Horm Mol Biol Clin Investig 2011; 8:499-504. [DOI: 10.1515/hmbci.2011.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/15/2011] [Indexed: 11/15/2022]
Abstract
AbstractDysthyronemia is the state of the thyroid gland in which the concentration of thyrotropin (TSH) in circulation is within the reference range, but the concentrations of free or total fractions of thyroid hormones (TH) are outside the reference range. Normal values of TSH and increased values of TH are referred to as hyperthyroxinemia or hypertriiodothyroninemia, while normal values of TSH and decreased values of TH are called hypothyroxinemia or hypotriiodothyroninemia.Thyroid diagnostic tests were carried out at the Institute of Endocrinology, Prague, Czech Republic, in 1999–2009 using the immunoanalytical systems of Roche Diagnostics GmbH, Germany (Elecsys 2010, Modular E170).Hyperthyroxinemia was found in 6.74% of all parallel sets of TSH and free thyroxine (FT4, n=259,590) values. Hypotriiodothyroninemia was observed in 8.48% of all parallel sets of TSH and total triiodothyronine (TT3, n=73,143). The occurrence of hyperthyroxinemia (TSH-FT4) and hypotriiodothyroninemia (TSH-TT3) was >3 times higher than the occurrence of dysthyronemia for the combinations TSH-FT4 (hypothyroxinemia), TSH-TT4 (total thyroxine, n=1996), TSH-FT3 (free triiodothyronine, n=94,090), and TSH-TT3 (hypertrijodthyroninemia), and >5 times higher in comparison with the combinations TSH-FT4-FT3 (n=93,683), TSH-FT4-TT3 (n=72,373), TSH-FT3-TT3 (n=2466), TSH-TT4-TT3 (n=1779), TSH-FT4-TT4 (n=1571), and TSH-FT3-TT4 (n=1466).In light of our patient types, we are assuming that the observed hypotriiodothyroninemia (TSH-TT3, 8.48%) is due to a decreased concentration of thyroid binding globulin in postmenopausal women and that hyperthyroxinemia (TSH-FT4, 6.74%) is caused mainly by endogenous autoantibodies against thyroxine in patients with thyroid autoimmune diseases.
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Williams F, Hume R. The measurement, definition, aetiology and clinical consequences of neonatal transient hypothyroxinaemia. Ann Clin Biochem 2010; 48:7-22. [PMID: 20930033 DOI: 10.1258/acb.2010.010174] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review focuses on neonatal transient hypothyroxinaemia, a condition characterized by temporary postnatal reductions in concentrations of Total T4 or Free T4, with normal or low concentrations of thyroid stimulating hormone (TSH). There is neither an agreed quantitative definition, nor an agreed mode of measurement for the condition. Transient hypothyroxinaemia is not routinely monitored yet it is thought to affect about 50% of preterm infants; it was thought to be without long-term sequelae but observational studies indicate that neurodevelopment may be compromised. The aetiology of transient hypothyroxinaemia is complex. There are significant contributions from the withdrawal of maternal-placental thyroxine transfer, hypothalamic-pituitary-thyroid immaturity, developmental constraints on the synthesis and peripheral metabolism of iodothyronines and iodine deficiency. It is not possible to distinguish clinically, or from laboratory measurements, whether transient hypothyroxinaemia is an independent condition or simply a consequence of non-thyroidal illness and/or drug usage. An answer to this question is important because studies of thyroid hormone replacement have been instigated, with mixed results. Until the aetiology of transient hypothyroxinaemia is better understood it would seem prudent not to routinely supplement preterm infants with thyroid hormones. Iodine deficiency, non-thyroidal illness and drug usage are the most modifiable risk factors for transient hypothyroxinaemia and are the clear choices for attempts at reducing its incidence. We suggest that transient hypothyroxinaemia in preterm infants is defined as a normal or low TSH concentration in conjunction with a concentration of Total T4, that is ≤10th percentile of cord Total T4 of the equivalent gestational age had the infant remained in utero.
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Affiliation(s)
- Fiona Williams
- Clinical and Population Sciences and Education, Human Brain Development Group, Mackenzie Building, Ninewells Hospital and Medical School Campus, Kirsty Semple Way, Dundee DD2 4BF, UK.
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Abstract
In 1977, Roy Meadow, a pediatric nephrologist, first described a condition he subsequently coined Munchausen syndrome by proxy. The classic form involves a parent or other caregiver who inflicts injury or induces illness in a child, deceive the treating physician with fictitious or exaggerated information, and perpetrate the trick for months or years. A related form of pathology is more insidious and more common but also damaging. It involves parents who fabricate or exaggerate symptoms of illness in children, causing overly aggressive medical evaluations and interventions. The common thread is that the treating physician plays a role in inflicting the abuse upon the child. Failure to recognize the problem is common because the condition is often not included in the differential diagnosis of challenging or confusing clinical problems. We believe that a heightened "self-awareness" of the physician's role in Munchausen syndrome by proxy will prevent or reduce the morbidity and mortality associated with this diagnosis. In addition, we believe contemporary developments within the modern health care system likely facilitate this condition.
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