DOCSLIB.ORG

Deranged Thyroid Hormone Status in Non-Thyroid Illnesses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Deranged Thyroid Hormone Status in Non-Thyroid Illnesses J Ayub Med Coll Abbottabad 2006; 18(4) EDITORIAL DERANGED THYROID HORMONE STATUS IN NON-THYROID ILLNESSES; SICK EUTHYROID SYNDROME Tariq Saeed Mufti, Asif Jielani* Head of Surgical Division, Ayub Teaching Hospital, Abbottabad, *Consultant Nuclear Physician, Nuclear Medicine Department, Institu te of Nuclear Medicine, Oncology & Radiotherapy, Abbottabad Critical illness is characterized by multiple and (rT3), leading to the general term low T3 syndrome. complex metabolic, immunological and endocrine Thyroid-stimulating hormone (TSH), thyroxine (T4), alterations1. Abnormalities in thyroid homeostasis also free T4, and free T4 index (FTI) are also affected in occur in variety of non-thyroid illnesses. Changes in variable degrees based on the severity and duration of thyroid hormone metabolism in critical illnesses the NTI. As the severity of the NTI increases, both appear to reflect a continuum which relates primarily serum T3 and T4 levels may drop and gradually to the severity of the underlying disorders2,3. The normalize as the patient recovers. prevalence of one or more abnormalities of thyroid Serum TSH alterations in euthyroid patients function tests in patients with non thyroidal medical with non thyroidal illnesses include transiently illnesses has been reported from 40% to 70%4,5. The reduced or elevated basal TSH values, blunted TSH condition is reported in starvation6, sepsis 7, surgery8, response to TRH, diminished or absent diurnal myocardial infarction9, CABG surgery10, bone marrow rhythms of TSH, and altered TSH glycosylation and transplantation11, and, in fact, probably any severe bioactivity19,20. Slightly decreased serum TSH has illness. been documented in elderly patients20, in healthy Girvent et al12 noted that such changes are centenarians22. Food may also affect TSH secretion23. highly prevalent in elderly patients with acute surgical TSH levels might be considered as a sensitive marker problems, and is associated with poor nutrition and of a lack of thyroid hormone since the concentrations higher sympathetic response. The general hormonal of TSH sharply increase in primary hypothyroidism response to critical illness involves activation of the even before serum T4 and T3 fall below the normal pituitary-adrenal axis, inhibition of the pituitary- reference range (so called sub-clinical thyroid & pituitary- gonadal axes13. These normal hypothyroidism)24. In NTIS, however, despite the responses distort standard reference intervals. In case decrease in serum T3 (and T4 in severe cases), the of the pituitary-thyroid axis, evaluation is further concentrations of TSH typically remain within low to complicated by changes in nutrition and major effects normal range25.Conversely, there is a blunted response of medication. Evidence suggests that these patients of TSH to thyrotropin-releasing hormone (TRH), and may not really be euthyroid, especially at the tissue low TSH levels are associated with poor prognosis26. level14. Taken together, these findings suggest that a major Based upon the fact that patients with systemic change in thyroid hormone set point regulation occurs illness are clinically euthyroid, Wartofsky and in NTI. Accordingly, prolonged critically ill patients Bunnan15 in 1982 used the term sick euthyroid show diminished TSH pulsatility, characterized by an syndrome to describe spectrum of thyroid absent nocturnal TSH surge and decreased TSH pulse abnormalities associated with non thyroidal illness. amplitude27. On occasion, transient TSH elevation Euthyroid Sick Syndrome (ESS) and Non thyroidal occurs while the patient is still ill. The illness syndrome (NITS) are terms used alternatively pathophysiology of this apparent thyroid gland in the literature16,17. resistance to TSH is not clear28. The interpretational difficulty due to NTIS Levels of T3 rapidly decrease during leading to mismanagement of co-existing goiter, a starvation e.g. post operative period or early in the course pathology of sizable incidence in certain geographical of a critical illness. Low serum total-T3 level has been distribution including Pakistan, is a significant recognized in more than 70% of hospitalized patients possibility. with non-thyroidal illness29. Starvation, and more Initial data of thyroid function tests from precisely carbohydrate deprivation, appears to rapidly Institute of Nuclear Medicine, Oncology and inhibit deiodination of T4 to T3 by Type 1 Radiotherapy (INOR), Pakistan is indicative of this iodothyronine-deiodinase in the liver, thus inhibiting incidence where 51 out of 648 tests on patients with generation of T3, and preventing metabolism of goiter showed abnormalities of T3, T4, & TSH which reverse T3, resulting in low T3 and high reverse T3 were un-interpretable18. concentration30. The serum concentration of reverse T3 The most prominent alterations are low is increased in non-thyroidal illness, except in patients with serum triiodothyronine (T3) and elevated reverse T3 renal failure and HIV infection32. Alteration in reverse T3 1 J Ayub Med Coll Abbottabad 2006; 18(4) metabolism appear to be disease specific. Both free and non-thyroid illness is challenging. As a practical total reverse T3 levels increase as a result of reduced matter, the changes in patients with non thyroidal clearance of reverse T3, however, production rate of rT3 illness must be distinguished from those resulting remains normal. Reduced metabolic clearance is from thyroid disease, which is often rightly suspected predominantly due to decreased activity of the type I in patients with other illnesses. Clinical evaluation of iodothyronine 59-monodeiodinase (5`-MDI) in the signs and symptoms of hypothyroidism may be tissues); 5`-MDI de-iodinates T4 to T3 and rT3 to 3, extremely difficult, to discern in a patient in the ICU 39-diiodothyronine (T2)31. Thus, serum reverse T3 who typically has multiple medical problems and may levels do not reliably differentiate patients with be receiving medication for sedation. Inter current euthyroid sick patients, and are not clinically useful32. complications such as infections, may further Increased turnover of T3 and T4 in the hyper complicate the difficult interpretation of thyroid metabolic phase of illness may also contribute to low function tests. serum and tissue T3 concentrations2. Total T3, free Changes in TSH should be assessed in T3 levels and T3 daily production rate are decreased patients with NTI subjects using a sensitive third- in non-thyroid illness33 while Total T4, free T4 and generation assay 47. A normal serum TSH most likely daily production rate of T4 is normal in low T3 excludes primary thyrotoxicosis or hypothyroidism syndrome45. and suggests that the patient is euthyroid Suppressed Although the isolated low T3 state usually TSH levels may be seen in small percentage of represents the mildest form of non-thyroidal illness, the critically ill patients (eg, those receiving dopamine or magnitude of the drop in T3 level reflects the severity glucocorticoids). Elevated TSH levels may also occur 25 of illness. A very low serum T3 level has been in NTI upon recovery ; however, these values rarely associated with an increased mortality rate in patients exceed 10 mU/L28. with hepatic cirrhosis, congestive heart failure, and It is prudent not to rely solely on thyroid 35 other systemic dis eases . function tests in the setting of NTI, and a combination Serum total T4 levels can be decreased (ie, low T4 of tests should be considered in separating primary syndrome) typically inpatients with more chronic and hypothyroid from euthyroid patients due to NTI 36-38 severe systemic illness . Majority of patients have In conclusion while interpreting thyroid serum freeT4 either being normal or slightly function tests the existence of NITS/ ESS may be kept 39 decreased, but occasionally elevated . This variability in mind in order to have more appropriate in free-T4 level reflects both the assay method used management of patient. and the underlying illness. As the severity of illness, progresses, there is gradual development of a more REFERENCES complex syndrome associated with low T3 and low T4 1. Van den Berghe GHA. The neuroendocrine stress levels that may correlates with the bad prognosis40. A response and modem intensive care: the concept revisited, A comprehensive and conceptual overview of new insights. marked decrease in serum T4 is associated with a high Bums 1999; 25:7-16. 41 probability of death . Mortality rate in patients with 2. Kaptein EM. The effects of systemic illness on thyroid total T4 level <3mg/dL was 84%; the mortality rate in hormone metabolism. In: Wu SY, ed. Thyroid hormone patients with T4 levels between 3 and 5 mg/dL was metabolism. Oxford: Blackwell 1991; 211-237. 3. Chopra IJ. Euthyroid sick syndrome: abnormalities in 50%; and for those patients with T4 >5.0 mg/ dL, the circulating thyroid hormones and thyroid hormone physiology mortality rate was 15%42,43. Among patients with low in non-thyroid illness (NTI). Med Grand Rounds1982;1:201– levels of T4, those with very low T3 levels had the 12. 44 4. Kaplan MM, Larsen PR, Crantz FR. Prevalence of abnormal worst survival rate . thyroid function test results in patients with acute medical High serum total T4 is seen in situations illnesses. Am J Med 1982; 72: 9-16. where thyroid binding globulin is elevated (acute 5. Chopra IJ, Sakane S, Teco GN. A study of the serum concentration intermittent porphyria, chronic hepatitis, and primary of tumor necrosis factor in thyroidal and non-thyroidal illnesses. J 45 Clin Endocrinol Metab 1991;72(5):1113-6 biliary cirrhosis) . T4 level is elevated, TSH level is 6. Hennemann G, Docter R, Krenning EP. Causes and effects of norma l or elevated, and T3 level is normal or high. the lowT3 syndrome during caloric deprivation and non- Heparin, amiodarone and iodinated contrast agents thyroidal illness: an overview. Acta Med Kaust 1988. 15:42– increase T4 levels by inhibiting peripheral conversion 45. 7. Phillips RH, Valente WA, Caplan ES, Connor TB, Wiswell JG. of T4 to T3. In HIV multiple abnormalities have been Circulating thyroid hormone changes in acute trauma: described: increased T4 and TBG, decreased prognostic implications for clinical outcome. J Trauma 1984.
Load more

Recommended publications
  • Hyperthyroidism
    135 Review Article Hyperthyroidism Amanda R. Doubleday, Rebecca S. Sippel Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rebecca S. Sippel, MD. Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center-H4/722, Box 7375, 600 Highland Ave, Madison, WI 53792-3284, USA. Email: [email protected]; Amanda R. Doubleday, DO, MBA. Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, K4/739 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3284, USA. Email: [email protected]. Abstract: Hyperthyroidism is a condition where the thyroid gland produces and secretes inappropriately high amounts of thyroid hormone which can lead to thyrotoxicosis. The prevalence of hyperthyroidism in the United States is approximately 1.2%. There are many different causes of hyperthyroidism, and the most common causes include Graves’ disease (GD), toxic multinodular goiter and toxic adenoma. The diagnosis can be made based on clinical findings and confirmed with biochemical tests and imaging techniques including ultrasound and radioactive iodine uptake scans. This condition impacts many different systems of the body including the integument, musculoskeletal, immune, ophthalmic, reproductive, gastrointestinal and cardiovascular systems. It is important to recognize common cardiovascular manifestations such as hypertension and tachycardia and to treat these patients with beta blockers.
    [Show full text]
  • Management of Graves Disease:€€A Review
    Clinical Review & Education Review Management of Graves Disease A Review Henry B. Burch, MD; David S. Cooper, MD Author Audio Interview at IMPORTANCE Graves disease is the most common cause of persistent hyperthyroidism in adults. jama.com Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime. Supplemental content at jama.com OBSERVATIONS We searched PubMed and the Cochrane database for English-language studies CME Quiz at published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 sys- jamanetworkcme.com and tematic reviews and meta-analyses, and 52 observational studies were included in this review. CME Questions page 2559 Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geog- raphy, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reac- tions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associ- ated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid Author Affiliations: Endocrinology eye disease who cannot be treated using antithyroid drugs.
    [Show full text]
  • Newborn Screening for Congenital Hypothyroidism: Recommended Guidelines
    American Academy of Pediatrics American Thyroid Association Newborn Screening for Congenital Hypothyroidism: Recommended Guidelines During the past decade newborn screening for of identifying newborns with hyperthyroxinemia congenital hypothyroidism has become an impor- (1:20,000 to 40,000 newborns). tant health activity in most developed countries. On the other hand, this approach will miss in- These screening programs have not only benefited fants who have normal T4 values but elevated TSH patients and their families but also have produced values. Such infants are relatively commonplace in new information about the epidemiology, patho- European programs where initial screening is done physiology, diagnosis, and treatment of thyroid dis- by measurement of TSH. To identify such infants, ease in infancy and childhood. During this period the T4 concentration cutoff (for TSH testing) must of implementation and growth of the screening be increased well into the normal range. programs, a variety of issues and questions arose. Some of these have been resolved, and some have TSH not. The point has now been reached where colla- A majority of European and Japanese programs tion of the combined experiences of the North favor screening by means of primary TSH mea- American programs can address these issues. The surements, supplemented by T4 determinations on reader should understand that what follows reflects those infants with elevated TSH values. With this 0 current opinion and may require changes when the approach, infants with thyroxine-binding globulin results of the next decade of screening are reviewed. deficiency, hypo- or hyperthyroxinemia, or hypo- thalamic-pituitary hypothyroidism will be missed. SCREENING METHOD Until further advances are made in the state of the art of screening, the choice ofthe method should Thyroxine (T4) and Thyroid-Stimulating Hormone be based on the experience of the program, needs (TSH) of the population, and availability of resources.
    [Show full text]
  • Familial Dysalbuminemic Hyperthyroxinemia: an Underdiagnosed Entity
    Journal of Clinical Medicine Article Familial Dysalbuminemic Hyperthyroxinemia: An Underdiagnosed Entity Xavier Dieu 1,2,* , Nathalie Bouzamondo 1,3, Claire Briet 2,3,4 , Frédéric Illouz 3,4, Valérie Moal 1,3, Florence Boux de Casson 1,3, Natacha Bouhours-Nouet 3,5, Pascal Reynier 1 , Régis Coutant 3,5, Patrice Rodien 2,3,4 and Delphine Mirebeau-Prunier 1,2,3 1 Laboratoire de Biochimie et Biologie Moléculaire, CHU Angers, 4 rue Larrey, CEDEX 9, 49933 Angers, France; [email protected] (N.B.); [email protected] (V.M.); [email protected] (F.B.d.C.); [email protected] (P.R.); [email protected] (D.M.-P.) 2 UMR CNRS 6015-INSERM U1083, 3 rue Roger Amsler, 49100 Angers, France; [email protected] (C.B.); [email protected] (P.R.) 3 Centre de référence des maladies rares de la thyroïde et des récepteurs hormonaux, CHU Angers, 4 rue Larrey, CEDEX 9,49933 Angers, France; [email protected] (F.I.); [email protected] (N.B.-N.); [email protected] (R.C.) 4 Service d’Endocrinologie-Diabétologie-Nutrition, CHU Angers, 4 rue Larrey, CEDEX 9, 49933 Angers, France 5 Service d’Endocrinologie et Diabétologie Pédiatrique, CHU Angers, 4 rue Larrey, CEDEX 9, 49933 Angers, France * Correspondence: [email protected] Received: 5 May 2020; Accepted: 29 June 2020; Published: 3 July 2020 Abstract: Resistance to thyroid hormone (RTH) is a syndrome characterized by impaired sensitivity of tissues to thyroid hormone (TH). The alteration of TH-binding proteins, such as in Familial Dysalbuminemic Hyperthyroxinemia (FDH), can mimic the abnormal serum thyroid tests typical of RTH.
    [Show full text]
  • Hypothyroidism: Mimicker of Common Complaints Matthew C
    Emerg Med Clin N Am 23 (2005) 649–667 Hypothyroidism: Mimicker of Common Complaints Matthew C. Tews, DOa, Sid M. Shah, MD, FACEPb,*, Ved V. Gossain, MD, FACP, FACEPc aCollege of Osteopathic Medicine, Emergency Medicine Residency Program, Michigan State University–Lansing, P.O. Box 30480, Lansing, MI 48909, USA bMichigan State University, Attending Physician Emergency Medicine, Ingham Regional Medical, Center 401 W. Greenlawn Avenue, Lansing, MI 48910, USA cDivision of Endocrinology, Department of Medicine, Michigan State University, Lansing, MI 48909, USA Patients with hypothyroidism may present with vague symptoms such as fatigue, arthralgias, myalgias, muscle cramps, headaches, and ‘‘not feeling well.’’ These are also among the more common complaints encountered by the emergency physicians. The disease spectrum of hypothyroidism ranges from an asymptomatic, subclinical condition to the rare, life-threatening myxedema coma, and thus can be a challenging diagnosis to make. A progressive and chronic disease, hypothyroidism results from diminished thyroid hormone production. It slows metabolic functions in every organ system in the body. Commonly, clinical presentation of hypothyroidism can be confused with effects of aging in the elderly, musculoskeletal or a psychiatric illness such as depression in the younger patients. Spontaneously occurring hypothyroidism is relatively common, with prevalence between 1% to 2%, and is 10 times more common in women than in men [1]. The probability of developing spontaneous hypothyroidism increases with age, with women having a mean age at diagnosis of around 60 years [2]. A recent survey showed that 9.5% out of nearly 26,000 visitors to a statewide health fair in Colorado had elevated circulating thyroid stimulating hormone (TSH) levels, indicating underlying hypothyroidism [3].
    [Show full text]
  • Thyroid Emergencies
    REVIEW ARTICLE Thyroid emergencies Dorina Ylli1, Joanna Klubo ‑Gwiezdzinska2, Leonard Wartofsky3,4 1 Endocrinology Division, University of Medicine, Tirana, Albania 2 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States 3 Endocrinology Division, Department of Medicine, Georgetown University School of Medicine, Washington DC, United States 4 MedStar Health Research Institute, MedStar Washington Hospital Center, Washington DC, United states KEY WORDS ABSTRACT coma, critical care, Myxedema coma and thyroid storm are among the most common endocrine emergencies presenting to hypothermia, general hospitals. Myxedema coma represents the most extreme, life ‑threatening expression of severe hypothyroidism, hypothyroidism, with patients showing deteriorating mental status, hypothermia, and multiple organ thyrotoxicosis system abnormalities. It typically appears in patients with preexisting hypothyroidism via a common pathway of respiratory decompensation with carbon dioxide narcosis leading to coma. Without early and appropriate therapy, the outcome is often fatal. The diagnosis is based on history and physical find‑ ings at presentation and not on any objective thyroid laboratory test. Clinically based scoring systems have been proposed to aid in the diagnosis. While it is a relatively rare syndrome, the typical patient is an elderly woman (thyroid hypofunction being much more common in women) who may or may not have a history of previously diagnosed or treated thyroid dysfunction. Thyrotoxic storm or thyroid crisis is also a rare condition, established on the basis of a clinical diagnosis. The diagnosis is based on the pres‑ ence of severe hyperthyroidism accompanied by elements of systemic decompensation. Considering that mortality is high without aggressive treatment, therapy must be initiated as early as possible in a critical care setting.
    [Show full text]
  • Endocrine Test Selection and Interpretation
    The Quest Diagnostics Manual Endocrinology Test Selection and Interpretation Fourth Edition The Quest Diagnostics Manual Endocrinology Test Selection and Interpretation Fourth Edition Edited by: Delbert A. Fisher, MD Senior Science Officer Quest Diagnostics Nichols Institute Professor Emeritus, Pediatrics and Medicine UCLA School of Medicine Consulting Editors: Wael Salameh, MD, FACP Medical Director, Endocrinology/Metabolism Quest Diagnostics Nichols Institute San Juan Capistrano, CA Associate Clinical Professor of Medicine, David Geffen School of Medicine at UCLA Richard W. Furlanetto, MD, PhD Medical Director, Endocrinology/Metabolism Quest Diagnostics Nichols Institute Chantilly, VA ©2007 Quest Diagnostics Incorporated. All rights reserved. Fourth Edition Printed in the United States of America Quest, Quest Diagnostics, the associated logo, Nichols Institute, and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. All third party marks − ®' and ™' − are the property of their respective owners. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, and information storage and retrieval system, without permission in writing from the publisher. Address inquiries to the Medical Information Department, Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA 92690-6130. Previous editions copyrighted in 1996, 1998, and 2004. Re-order # IG1984 Forward Quest Diagnostics Nichols Institute has been
    [Show full text]
  • ATA/AACE Guidelines
    ATA/AACE Guidelines CLINICAL PRACTICE GUIDELINES FOR HYPOTHYROIDISM IN ADULTS: COSPONSORED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND THE AMERICAN THYROID ASSOCIATION Jeffrey R. Garber, MD, FACP, FACE1,2*; Rhoda H. Cobin, MD, FACP, MACE3; Hossein Gharib, MD, MACP, MACE4; James V. Hennessey, MD, FACP2; Irwin Klein, MD, FACP5; Jeffrey I. Mechanick, MD, FACP, FACE, FACN6; Rachel Pessah-Pollack, MD6,7; Peter A. Singer, MD, FACE8; Kenneth A. Woeber, MD, FRCPE9 for the American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. 988 989 CLINICAL PRACTICE GUIDELINES FOR HYPOTHYROIDISM IN ADULTS: COSPONSORED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND THE AMERICAN THYROID ASSOCIATION Jeffrey R. Garber, MD, FACP, FACE1,2*; Rhoda H. Cobin, MD, FACP, MACE3; Hossein Gharib, MD, MACP, MACE4; James V. Hennessey, MD, FACP2; Irwin Klein, MD, FACP5; Jeffrey I. Mechanick, MD, FACP, FACE, FACN6; Rachel Pessah-Pollack, MD6,7; Peter A.
    [Show full text]
  • Impaired Sensitivity to Thyroid Hormones Is Associated With
    Diabetes Care 1 Impaired Sensitivity to Thyroid Martin Laclaustra,1,2,3 Belen Moreno-Franco,1,2 Hormones Is Associated With Jose Manuel Lou-Bonafonte,1,4,5 Rocio Mateo-Gallego,1,2 Diabetes and Metabolic Syndrome Jose Antonio Casasnovas,1,2 Pilar Guallar-Castillon,6,7,8 Ana Cenarro,1,2 1,2 https://doi.org/10.2337/dc18-1410 and Fernando Civeira OBJECTIVE Diabetes prevalence and incidence increase among individuals with hypothyroidism but also among those with hyperthyroxinemia, which seems contradictory. Both high free thyroxine (fT4) and high thyroid-stimulating hormone (TSH) are present in the resistance to thyroid hormone syndrome. A mild acquired resistance to thyroid hormone might occur in the general population and be associated with diabetes. We aimed to analyze the association of resistance to thyroid hormone indices (the Thyroid Feedback Quantile-based Index [TFQI], proposed in this work, and the previously used Thyrotroph T4 Resistance Index and TSH Index) with diabetes. RESEARCH DESIGN AND METHODS 1Instituto de Investigacion´ Sanitaria de Aragon´ We calculated the aforementioned resistance to thyroid hormone indices based on (IIS Aragon),´ Universidad de Zaragoza, Zaragoza, ‡ Spain a U.S. representative sample of 5,129 individuals 20 years of age participating in 2Translational Research Unit, Hospital Univer- the 2007–2008 National Health and Nutrition Examination Survey (NHANES). Also, sitario Miguel Servet, Zaragoza, Spain and to approximate TFQI, a U.S.-referenced Parametric TFQI (PTFQI) can be calculated CIBERCV, Madrid, Spain 3 CARDIOVASCULAR AND METABOLIC RISK with the spreadsheet formula 5NORM.DIST(fT4_cell_in_pmol_per_L,10.075, Fundacion´ Agencia Aragonesa para la Inves- 1 2 tigacion´ y el Desarrollo (ARAID), Zaragoza, Spain 2.155,TRUE) NORM.DIST(LN(TSH_cell_in_mIU_per_L),0.4654,0.7744,TRUE) 1.
    [Show full text]
  • Some Aspects of Thyroid System Status in Persons Exposed to the Chernobyl Accident
    IAEA-CN-67/18 XA9745557 SOME ASPECTS OF THYROID SYSTEM STATUS IN PERSONS EXPOSED TO THE CHERNOBYL ACCIDENT Anatoly K.Cheban, Dmitry E.Afanasyev, Olga Y.Boyarskaya Paediatric Endocrinology Department, Endocrinology Departmant Radiation Medicine Scientific Centre of Ukrainian Medical Sciences Academy Melnikova str. No53, Kiev 254050, Ukraine ABSTRACT The thyroid system status estimation held in post-accidental period dynamics among 7868 children evacuated from the 30-km Chernobyl zone and resident now in Slavutich city (Cs-137 contaminated area), among contaminated regions permanent residents, among native kievites and evacuated from 30-km zone. The thyroid pathology incidence dependence on residence place during Chernobyl Accident and after that was revealed. The immune-inflammatory thyroid disorders are characteristic for 30-km zone migrants, goitre different forms - for the radionuclides contaminated territories residents. No thyroid function abnormalities frequency confidential increase was registered during the research activities run. The total serum cholesterol level application unavailability is revealed in Chernobyl accident survivors thyroid hormones metabolic effects estimation. Data concerning Chernobyl accident consequences cleaning up participants (CACCP) presented additionally. INTRODUCTION The thyroid gland and thyroid system in general posses the important place among nuclear facilities accidents. That is particular in case of Chernobyl nuclear power plant accident (CNPPA) [1]. Because of radioiodine high content in CNPPA fallout and iodine metabolism features the thyroid irradiation doses can exceed 10 - 20 Gy [2]. That unavoidably leads to thyroid pathology risk amplification [3]. Children are characteristic with higher thyroid irradiation doses compared to that in adults [4]. The radioecologic situation after the CNPPA in Ukraine is peculiar with extreme irregularity of present soil contamination level and radioiodine-produced thyroid irradiation doses in 1986.
    [Show full text]
  • NOTE a Case of Graves' Disease with Anti-Triiodothyronine Antibodies The
    Endocrinol. Japon. 1985, 32 (1), 181-188 NOTE A Case of Graves' Disease with Anti-triiodothyronine Antibodies SHIGEKI SAKATA, TAKASHI KOMAKI, SHIGENORI NAKAMURA, KEITA KAMIKUBO, KAORU TAKAKUWA*, MASAAKI KAMETANI*, NAOKI TOKIMITSU*, AND KIYOSHI MIURA The Third Department of Internal Medicine, Gifu University School of Medicine, Gifu 500 *Department of Internal Medicine, Takayama Red Cross Hospital, Takayama 504 Abstract A case of Graves' disease with high serum thyroxine (T4) and low triiodo- thyronine (T3) levels which was therefore initially diagnosed as a T4-thyrotoxi- cosis is reported. Examination of the serum from the patient showed the presence of unusual protein which bound T3. It was later confirmed as IgG class anti-T3 anti- bodies. In addition to treatment with methylmercaptoimidazole (MMI), the patient was treated with prednisolone for 30 days (total amount 500mg). Titers of and-T3 antibodies in the sera were unchanged before and after prednisolone treatment. Our present case indicates that it is clinically important to bear the presence of autoantibodies in mind to account for a possible error in measuring T3 and T4 by radioimmunoassay (RIA). In the case that RIA determination gives an unexpectedly high or low T3 and/or T4 value, the presence of autoantibodies to them should be considered and a test for them is recommended. Circulating autoantibodies to thyroid mone in Hashimoto's thyroiditis. The ac- hormone have been reported in various cumulation of reports up to the present sug- thyroidal (Robbins et al., 1956; Ikekubo et gest that the spontaneous occurrence of al., 1978; Ginsberg et al., 1878; Jcbrgensen antibodies to T4 and/or T3 in man may not et al., 1979; Inada et al., 1980; Pearce et be a rare phenomenon, especially in patients al., 19 81) and nonthyroidal illnesses (Tri- with Hashimoto's thyroiditis.
    [Show full text]
  • Test Selection and Interpretation the Quest Diagnostics
    The Quest Diagnostics Manual Endocrinology Test Selection and Interpretation Fourth Edition The Quest Diagnostics Manual Endocrinology Test Selection and Interpretation Fourth Edition Edited by: Delbert A. Fisher, MD Senior Science Officer Quest Diagnostics Nichols Institute Professor Emeritus, Pediatrics and Medicine UCLA School of Medicine Consulting Editors: Wael Salameh, MD, FACP Medical Director, Endocrinology/Metabolism Quest Diagnostics Nichols Institute San Juan Capistrano, CA Associate Clinical Professor of Medicine, David Geffen School of Medicine at UCLA Richard W. Furlanetto, MD, PhD Medical Director, Endocrinology/Metabolism Quest Diagnostics Nichols Institute Chantilly, VA ©2007 Quest Diagnostics Incorporated. All rights reserved. Fourth Edition Printed in the United States of America Quest, Quest Diagnostics, the associated logo, Nichols Institute, and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. All third party marks − ®' and ™' − are the property of their respective owners. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, and information storage and retrieval system, without permission in writing from the publisher. Address inquiries to the Medical Information Department, Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA 92690-6130. Previous editions copyrighted in 1996, 1998, and 2004. Re-order # IG1984 Forward Quest Diagnostics Nichols Institute has been
    [Show full text]