DOCSLIB.ORG

Thyroid Function Tests: a Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Thyroid Function Tests: a Review European Review for Medical and Pharmacological Sciences 2009; 13: 341-349 Thyroid function tests: a review G. SHIVARAJ, B. DESAI PRAKASH, V. SONAL, K. SHRUTHI, H. VINAYAK, M. AVINASH Department of Biochemistry, J. N. Medical College, Belgaum 590010, Karnataka (India) Abstract. – In this paper, we review the combination can give comprehensive data that tests that are executed to aid the diagnosis of would enhance the diagnostic accuracy1. thyroid dysfunction. Thyroid function tests pro- vide information at physiological, pathological and anatomical levels. Along with history and Serum Total Thyroxine (T4/TT4) physical examination they owe to many specific The concentration of total T4 in adults ranges findings that are associated with thyroid func- from 5 to 12 µg/dL (64 to 154 nmol/L)1. The con- tioning. So an attempt has been made to put for- centrations of T4 below or above this range in ab- ward a gist of thyroid function tests. Serum tests sence of thyroid dysfunction, is as a result of an ab- of thyroid function are serum total thyroxine normal level of serum Thyroid Binding Globulin (T4), serum total triiodothyronin (T3), free thyrox- ine (FT4), free triiodothyronin (FT3), reverse tri- (TBG). Such abnormally high values are observed iodothyronin (rT3), thyroid stimulating hormone in many physiological conditions in women with (TSH), serum calcitonin and protein thyroglobu- hyperestrogenic state of pregnancy1. Hyperthy- lin (Tg). The serological tests are antithyroglobu- roidism and hypothyroidism can be associated with lin antibodies (ATA) and antimicrosomal antibod- abnormal menstrual cycles2. Reference ranges for ies (AMA). An invasive test for histologic exami- thyroid function tests for TT in cord-blood is 7.4- nation is done by fine needle aspiration cytology 4 (FNAC) and noninvasive test includes ultra- 13.1 µg/dL, 1-2 weeks is 9.9-16.6 µg/dL, 1-4 sonography, magnetic resonance imaging, and months is 7.8-16.5 µg/dL, 1-5 years is 7.3-15 positron emission tomography. Further molecu- µg/dL, and 5-10 years is 6.4-13.3 µg/dL3. Small lar study provides molecular markers for thyroid seasonal variations and changes related to high alti- cancer. These tests can provide greater sensitiv- tude, cold and heat are also seen. The variation is ity and specificity that enhance the likelihood of also related to postural changes in serum proteins early detection of ambiguous thyroid disease concentration and true circadian variation. There is with only minimal clinical findings. Lastly, in vivo tests are thyroidal radioiodine and iodide uptake increased binding to serum proteins in cases of Fa- is also done. milial Dysalbuminemic Hyperthyroxinemia (FDH) which shows increased TBG1. Subclinical primary Key Words: hypothyroidism is more common in persons with 4 Serum total thyroxine, Free thyroxine, Thyroid stim- chronic kidney disease (CKD) . ulating hormone, Serum thyroglobulin, Serum calci- In thyrotoxic state serum TT4 concentration is tonin. elevated and said to be hyperthyroidism that can be caused by Graves’ disease, Plummer’s disease (toxic thyroid adenoma), early phase of acute thyroiditis, thyrotoxic factitia, struma ovarii and normal in some cases of Luft’s syndrome (Hy- permetabolic Mitochondrial Miopathy). Introduction In hypothyroidism serum TT4 concentration is low in case of thyroid gland failure. It can be fur- Thyroid functions have subtle clinical features ther classified into primary, secondary and tertiary. associated with some forms of thyroid dysfunc- The cause for primary hypothyroidism can be tion. The clinicians must decide which test is best gland destruction and severe inborn error of hor- suiting to diagnose or exclude disorder. It is em- monogenesis, secondary hypothyroidism is caused phasized that single thyroid function test (TFT) is by pituitary failure and tertiary by hypothalamic not absolute in diagnostic accuracy and it must be failure. Sometimes it can be subclinical if there is thus a careful selection of such tests so that their thyroid transporter defect or deiodinase defect1. Corresponding Author: Shivaraj Gowda, MD; e-mail: [email protected] 341 G. Shivaraj, B. Desai Prakash, V. Sonal, K. Shruthi, H. Vinayak, M. Avinash Serum Total Triiodothyronine (T3/TT3) are rarely used as stand-alone tests, but are em- A normal serum TT3 concentration in adult ployed in conjunction with a binding protein esti- range from 80-190 ng/dL1. It reflects the func- mate test i.e. Thyroid Hormone Binding Ratio tional state of peripheral tissue rather than secre- (THBR) to form a Free Hormone Index i.e. FT4I 12 tory performance of the thyroid gland. Sex dif- or FT3I . ference is small, but age difference is more dra- matic. The decline of mean TT4 is also observed Free Thyroxine (FT4) in old age all though not in healthy subjects, The normal values for FT4 in adults range 1 which suggest that fall in TT3, might reflect from 1.0 to 3.0 ng/dL (13 to 39 pmol/L) .A prevalence of non-thyroidal illness rather than minute amount of thyroid hormone circulates in an effect of age alone2. Positive co-relation be- the blood in a free form, not bound to serum pro- tween serum TT3 level and body weight has teins. It is in reversible equilibrium with the been observed5. Hormones are iodothyronines bound hormone and represents the diffusible that control growth and development, as well as fraction of the hormone capable of traversing cel- brain function and metabolism. The T3 and T4 lular membranes to exert its effects on body tis- level were found to be significantly raised in the sues. Although changes in serum hormone-bind- moderate depression as compared to the healthy ing proteins affect both the total hormone con- controls6. centration and the corresponding fraction circu- Thyroid study on mutations in the monocar- lating free in the euthyroid person, the absolute boxylate cell membrane transporter 8 (MCT8) concentration of free hormone remains constant genes, located on the X chromosome (Xq13-q21 and correlates with the tissue hormone level and 13 and Xq12-q13) has established the physiological its biologic effect . Serum FT4 may be sup- importance of MCT8 as a thyroid hormone trans- pressed in the patients with thyroidal illness and porter. This syndrome combines thyroid and neu- transiently rise in acute thyroidal illness, when rological abnormalities. MCT8 gene (also known thyroid-binding protein frequently falls11. as SLC16A2 and XPCT) defect should be sus- pected in front of psychomotor impairment (se- Free Triiodothyronine (FT3) vere developmental delay, truncal hypotomia and The normal adult reference value is 0.25-0.65 1 limb spasticity) and high serum T3,low T4 and ng/dL (3.8-10 nmol/L) . Free triiodothyronine rT3 concentrations. However, the neurological (FT3) measures the very tiny amount of T3 that manifestations of this syndrome cannot be ex- circulates unbound. It is useful in looking for hy- plained by the thyroid function tests. The pheno- perthyroidism or thyroxine overplacement in type is different from that of global hormone de- women who are pregnant or taking any effective 11 ficiency or excess. Treatment with L-T4 (physio- drugs that varies the TBG like estrogen . More logical doses) has not corrected in several pa- consistently, patients with a variety of non-thy- 1 tients the phenotype. It has been recommended roidal illnesses have low FT3 levels . This de- the use of higher doses of L-T4 during pregnancy. crease is characteristic of all conditions associat- MCT8 knockout mices have demonstrated tissue- ed with depressed serum TT3 concentrations due specific TH excess and deprivation due to differ- to a diminished conversion of T4 to T3 in periph- ent tissue dependency on MCT8 for cellular thy- eral tissues14. 7-8 roid hormone uptake . Marked elevations in both FT4 and FT3 con- The principle uses for obtaining the serum T3 centrations in the absence of hypermetabolism are to determine the severity of hyperthyroidism, are typical of patients with resistance to thyroid 15 and to confirm the diagnosis of suspected thyro- hormone . The FT3 concentration is usually nor- toxicosis in which serum T4 levels are normal or mal or even high in hypothyroid persons living in equivocal9. In addition it may be required to carry areas of severe endemic iodine deficiency and 16 out the test in cases of functioning thyroid adeno- their FT4 levels are, however, normal or low . In- mas, where T3 toxicosis may be present and such formation concerning this value can be the most patients may have normal or borderline elevated important parameter in evaluation of thyroid serum T4 levels along with suppressed serum function because it relates to patients status al- 10 TSH levels .Serum T3 is misleadingly elevated though other mechanisms exists for cell to con- in women who are pregnant or who take oral es- trol the active amount of the thyroid hormone by trogen, due to the high serum levels of TBG in autoregulation of receptor17 and regulation of 11 18 these conditions . TT4 and TT3 measurements deiodinase activity . Rarely, a defect in thyroid 342 Thyroid function tests: a review hormone transport in the cells would abolish the rT3 concentration in serum reflects both tissue 7 free hormone and metabolic effect co-relation . supply and metabolism of T4 and identify condi- The free hormone concentration is high in thyro- tions that favor this particular pathway of T4 toxicosis, low in hypothyroidism,and normal in degradation. The normal range in adult serum for 19 1 euthyroidism . rT3 is 14-30 ng/dl (0.22-0.46 nmol/L) although varying values have been reported. It is elevated Triiodothyronine Resin Uptake Test (T3RU) in subjects with high TBG and in some individu- Values correlate inversely with the concentra- als with Familial Dysalbuminemic Hyperthyrox- 1 2 tion of unsaturated TBG . A high resin uptake is inemia (FDH) .Serum rT3 levels are normal in seen with hyperthyroidism and with chronic liver hypothyroid patients treated with T4, indicating disease, nephrotic syndrome, anabolic steroid ad- that peripheral T4 metabolism is an important 20 ministration, and high dose corticosteroid admin- source of circulating rT3 .
Load more

Recommended publications
  • Thyroid Function Tests (Tfts) | Memorial Sloan Kettering Cancer Center
    PATIENT & CAREGIVER EDUCATION Thyroid Function Tests (TFTs) This information explains thyroid function tests (TFTs). Thyroid function tests are blood tests that let your doctor see if you have the right amount of thyroid hormone in your blood. Thyroid Stimulating Hormone (TSH) Thyroid stimulating hormone (TSH) is made and released by a gland in your brain. This hormone stimulates your thyroid to work. TSH levels The level of TSH in your blood shows if your thyroid is too active or not active enough. If you don’t have a thyroid, your TSH level tells your doctor if you’re getting the right dose of thyroid hormone replacement medication. The normal TSH range differs slightly from one lab to another. At Memorial Sloan Kettering (MSK), the normal range is 0.55 milli-international units per liter (mIU/L) to 4.78 mIU/L. Depending on the type of thyroid cancer you have, your doctor may want your TSH to be below the normal range. Talk to your doctor about your TSH levels. You can write down your TSH goal below. Your TSH goal is: _______________________ If your TSH level is low, you’re in a state of hyperthyroidism. This means your thyroid function is too active. If your TSH level is high, you’re in a state of hypothyroidism. This means your thyroid function isn’t active enough. Thyroid Function Tests (TFTs) 1/3 In people without thyroid cancer, the goal is to keep their TSH level within the normal range. In some people with thyroid cancer, the goal is to keep their TSH level below the normal range for the first couple of years after being diagnosed.
    [Show full text]
  • Sp — 001 Sd9900033
    -SP — 001 SD9900033 to ei Mansour El Tahir Farah Supervisor: Prof. El Daw Mukhtar Co-supervisor: Assoc, Prof. El Tom Sirag El Bin Khartoum -1997 r 30-36 ,• v -\ :.-- DISCLAIMER Portions of this document may be illegible in electronic image products, Images are produced from the best available original document. Contents Declaration I Acknowledgement , II Abstract English Ill Abstract Arabic V List of Abbreviations VII List of Tables VIII List of Figures X Chapter I Introduction and Literature Review 1 Objectives of the Study 40 Chapter II Patients and Methods 41 Chapter III Results 45 Chapter IV Discussion ; 75 Conclusion 82 Recommendations 84 References 85 Appendices The Questionnaire 101 I would like to declare that all the research work was done by myself. I consulted all the literature included in this study . This work has not been submitted to any other university . The information in this thesis has not been published elsewhere. ifp I would like to express my deep gratitude to my supervisor Professor El Daw Mukhtar whose continued enthusiasm and support had guided and encouraged me throughout the study period . This work would not been possible without the benefit of his generous help and leading advices . I am greatly indebted to Dr. El Tom Sirag El Din for his valuable comments and leading advices , helping me alot during preparation of this thesis . My great thanks to the staff in the diagnostic and research laboratory centre , who gave every possible help during my work . I am greatly appreciating the help that had been provided by all doctors technicians and patients .
    [Show full text]
  • Effect of Metformin on Thyroid Function Tests in Type 2 Diabetic Patients
    Iraq J Pharm Vol. 14, No.1, 2014 Effect of metformin on thyroid function tests in type 2 diabetic patients Mohammed N. Abed Department of Pharmacology and Toxicology, College of Pharmacy, University of Mosul, Mosul, Iraq correspondence: [email protected] Received Accepted 14.1.2014 4.3.2014 ABSTRACT Background: Diabetes mellitus (DM) and thyroid disorder appears to be closely related.It has long been recognised that thyroid hormones have marked effects on glucose homeostasis, and although autoimmune thyroid disease is more prevalent in type 1 diabetes as a result of their common origin, in patients with type 2 diabetes the prevalence of hypothyroidism and hyperthyroidism is similar to that of the general population. The present study was conducted to assess the interplay between metformin treatment and thyroid function in type 2 diabetic patients. Methods: A total of 73 diabetic patients were enrolled in this study, they were divided into two groups, the first group included 37 type 2 diabetic patients on metformin therapy, whereas the second group involved 36 type 1 diabetic patients on insulin therapy. Another group involved 35 apparently healthy volunteers were also included in the study as a control group. Blood samples were taken from the patients and controls, then the serum was analyzed for measurement of fasting serum glucose (FSG), total T3, free T3 (FT3), total T4, freeT4 FT4) and TSH using ELFA (Enzyme Linked Fluorescent Assay) technique (minividas). Results: the results showed that there were no significant differences between T3, FT3, FT4 and TSH of the metformin group when compared to the same parameters in the control group.
    [Show full text]
  • Thyroid Hormones in Fetal Growth and Prepartum Maturation
    A J FORHEAD and A L FOWDEN Thyroid hormones and fetal 221:3 R87–R103 Review development Thyroid hormones in fetal growth and prepartum maturation A J Forhead1,2 and A L Fowden1 Correspondence should be addressed 1Department of Physiology, Development and Neuroscience, University of Cambridge, Physiology Building, to A L Fowden Downing Street, Cambridge CB2 3EG, UK Email 2Department of Biological and Medical Sciences, Oxford Brookes University, Oxford OX3 0BP, UK [email protected] Abstract The thyroid hormones, thyroxine (T4) and triiodothyronine (T3), are essential for normal Key Words growth and development of the fetus. Their bioavailability in utero depends on " thyroid hormones development of the fetal hypothalamic–pituitary–thyroid gland axis and the abundance " intrauterine growth of thyroid hormone transporters and deiodinases that influence tissue levels of bioactive " maturation hormone. Fetal T4 and T3 concentrations are also affected by gestational age, nutritional and " neonatal adaptation endocrine conditions in utero, and placental permeability to maternal thyroid hormones, which varies among species with placental morphology. Thyroid hormones are required for the general accretion of fetal mass and to trigger discrete developmental events in the fetal brain and somatic tissues from early in gestation. They also promote terminal differentiation of fetal tissues closer to term and are important in mediating the prepartum maturational effects of the glucocorticoids that ensure neonatal viability. Thyroid hormones act directly through anabolic effects on fetal metabolism and the stimulation of fetal oxygen Journal of Endocrinology consumption. They also act indirectly by controlling the bioavailability and effectiveness of other hormones and growth factors that influence fetal development such as the catecholamines and insulin-like growth factors (IGFs).
    [Show full text]
  • Endocrinology Review – Adrenal and Thyroid Disorders
    FOCUS: ENDOCRINOLOGY Endocrinology Review – Adrenal and Thyroid Disorders LINDA S. GORMAN, JANELLE M. CHIASERA LEARNING OBJECTIVES This article represents the first of three articles focusing 1. Define endocrinology and list the major endocrine on the endocrine system. The first article will provide glands of the body. you with fundamental theory regarding the endocrine system that will serve as a basis for understanding the 2. Explain how feedback (positive and negative) Downloaded from promotes maintenance of normal levels of next two articles focusing on two specific endocrine hormones. glands, the thyroid and adrenal glands. 3. Differentiate between steroid and peptide hormones with regard to their mechanism of Endocrinology is the branch of medical science that action. deals with the endocrine system, a system that consists 4. Provide examples of peptide and steroid hormones. of several glands located in different parts of the body http://hwmaint.clsjournal.ascls.org/ 5. Explain how endocrine disorders are categorized. that secrete hormones directly into the bloodstream. Although every organ system in the body may respond ABBREVIATIONS: ACTH - adrenocorticotropic hor- to hormones, endocrinology focuses specifically on mone; ADH - antidiuretic hormone; CRH – cortico- endocrine glands whose primary function is hormone tropin releasing hormone; DHEA – dehydroepian- secretion. Major endocrine glands include the pituitary drosterone; FSH - follicle stimulating hormone; GHRH (anterior and posterior), hypothalamus, thyroid, - growth hormone
    [Show full text]
  • Vitamin D Status and Its Relationship with Thyroid Function Parameters in Patients with Hypothyroidism
    Medical Laboratory Journal, Sep-Oct, 2019; Vol 13: No 5 Original Article Vitamin D Status and its Relationship with Thyroid Function Parameters in Patients with Hypothyroidism Mojtaba Zare Ebrahimabad (MSc) ABSTRACT Department of Biochemistry and Background and Objectives: Vitamin D is an essential secosteroid that plays a Biophysics, Metabolic Disorders Research Center, Faculty of Medicine, crucial role in the homeostasis of a few mineral elements, particularly calcium. Since vitamin Golestan University of Medical D deficiency and thyroid diseases are two important global health problems, we aimed to Sciences, Gorgan, Iran investigate a possible relationship of vitamin D and calcium levels with hypothyroidism in an Hanieh Teymoori (MSc) Department of Biochemistry and Iranian population. Biophysics, Metabolic Disorders Methods: This case-control study was conducted on 175 subjects with Research Center, Faculty of Medicine, hypothyroidism (75 males and 100 females) and 175 euthyroid controls (85 males and 90 Golestan University of Medical Sciences, Gorgan, Iran females) who were referred to a laboratory in Gorgan, Iran. Serum levels of 25- Hamid Reza Joshaghani (PhD) hydroxyvitamin D, calcium, thyroid-stimulating hormone (TSH), free triiodothyronine (free Professor of Clinical Biochemistry, T3) and thyroxine (total T4) were measured in all participants. Laboratory Sciences Research Center (LSRC), Golestan University of Results: Vitamin D and calcium were significantly lower in patients with Medical Sciences, Gorgan, Iran hypothyroidism (P<0.0001). Free T3 and calcium levels differed significantly among Corresponding author: Hamid Reza hypothyroid patients based on their vitamin D status (P<0.0001), but vitamin D levels were Joshaghani Tel: +98-1732436108 within sufficient range in all groups.
    [Show full text]
  • Should Human Chorionic Gonadotropine Treatment Increase
    original article Should human chorionic gonadotropine treatment increase thyroid volume? Ayten Oguz1, Dilek Tuzun1, Murat Sahin1, Nese Bulbul1, Ahmet Celik2, Numan Guvenc3, Elif Inanc4, Kamile Gul1 ABSTRACT 1 Kahramanmaras Sutcu Objective: Our aim was to investigate the thyroid function tests and thyroid volume differences Imam University, Faculty of among males with isolated hypogonadotropic hypogonadism (IHH) who take androgen replacement Medicine, Department of treatment (ART). Materials and methods: Forty-four male with IHH with a mean age 33.2 (18-54), Endocrinology and Metabolism, Kahramanmaras, Turkey diagnosed in Endocrinology and Metabolism Department between September 2013 and September 2 Kahramanmaras Sutcu Imam 2014 and 40 healthy male control with a mean age 27.77 (18-55) were involved to study. Patient group University, Faculty of Medicine, was divided to testosterone-treated patients (n = 19) and human chorionic gonadotropine (hCG)- Department of Biochemistry, treated patients (n = 25). Patient group was compared in terms of total testosterone, thyroid func- Kahramanmaras, Turkey tion tests [thyroid stimulating hormone (TSH), free thyroxine (fT )] and thyroid volume, before and 3 4 Kahramanmaras Sutcu Imam 6 months after treatment. Patient group was compared with control group as well. Results: When University, Faculty of Medicine, Department of Family Medicine, we compared the patient group with the control group, there was no significant difference for age, Kahramanmaras, Turkey Body mass index, TSH, fT4 and thyroid volume between two groups before treatment. There was no 4 Kahramanmaras Sutcu Imam difference in terms of TSH, but fT4, testosterone levels and thyroid volume were significantly higher University, Faculty of Medicine, after treatment, when the patient group was compared before and after treatment (p < 0.05).
    [Show full text]
  • The Relationship Between Vitamin D Deficiency and Thyroid Function in the First Trimester of Pregnancy
    Original Article The relationship between Vitamin D deficiency and thyroid function in the first trimester of pregnancy Farahnaz Rostami 1, Lida Moghaddam-Benaem2, Navid Ghasemi 3, Sedighe Hantoushzadeh 4* 1Department of Midwifery & Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Al-e-Ahmad Highway, Tehran, Iran. 2 Department of Reproductive Health & Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. 3 Department of medicine, faculty of Medical Sciences Tehran, Islamic Azad University, Tehran, Iran.4 Maternal, fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Abstract Aims and Objective: There are few studies about the relationship between vitamin D deficiency and thyroid hormone levels in pregnancy. This study aimed to assess the relation serum vitamin D levels with thyroid hormones in the first trimester of pregnancy in Iran. Methods: In this case-control research 430 pregnant women (215 mothers with vitamin D deficiency, and 215 without this deficiency) attending prenatal clinics in Tehran, Iran were studied. 25 hydroxy vitamin D levels and thyroid function tests [free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), and free triiodothyronine (FT3)] were measured in all mothers. Data were analyzed using SPSS version 22 software. Kolmogorov-Smirnov test was used for normality testing of continuous variables; Student T-Test, and Mann-Whitney U test were used to compare the continuous parametric and nonparametric variables respectively in the 2 study groups; Linear regression model was used to assess the effect of potentially effective variables besides vitamin D on thyroid function tests. Results: In Mann-Whitney U test performed, T4 levels (mean± SD) were significantly higher in vitamin D deficiency group compared with the control group (20.8 ±32.5 vs.14.4 ± 24.1 ng/dl, P-value: 0.04), but there were no significant differences between the 2 study groups regarding TSH, and free T3 levels.
    [Show full text]
  • Assessment the Levels of 25(OH) Vitamin D and Ferritin in Patients with Hypothyroid
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 08, 2020 Assessment The Levels Of 25(OH) Vitamin D And Ferritin In Patients With Hypothyroid Amera Kamal Mohammed1, Thanaa Abdulmahdi2, Zainab Nasser Nabat3 1Department of Clinical Laboratory Sciences., College of Pharmacy, University of Kirkuk, 52001, Kirkuk, Iraq .ORCID ID: 0000-0002-8984-6824 , 2Babylon Technical Institute, Al-Furat Al-Awsat Technical University, 51015, Babylon, Iraq. ORCID ID: 0000-0002-9661-8280, 3Babylon Technical Institute, Al-Furat Al-Awsat Technical University, 51015, Babylon, Iraq. [email protected]. [email protected]. Abstract :Background: Thyroid hormones are essential and have various effects. For instance, they maintain normal growth and regulate metabolism. Hypothyroidism is a condition where the body doesn’t make enough thyroid hormones and people with hypothyroidism usually have a slower metabolism. The serum ferritin levels and vitamin D levels have been changed in patients with Hypothyroidism. Objective: a study has been carried out to investigate the association among thyroid disorder and the levels of both vitamin D and ferritin. Materials and Method: The BMI was calculated using the formula BMI= weight (kg)/ height2 (m)2. Vitamin D (25-hydroxyvitamin D), ferritin, T3, T4 and TSH levels were measured using the ELFA (Enzyme Linked Fluorescent Assay, Model: bioMérieux). the results were analysed using SPSS package (version 18). Results: The results indicated that the age of participants played an ignorable role in this investigation, while significant increases (P<0.05) differences were noticed between the patients and controls in terms of BMI, 25(OH) vit D, ferritin, TSH, T3 and T4.
    [Show full text]
  • Isolated Central Hypothyroidism in Short Stature
    003 1-399819513806-0967$03.00/0 PEDIATRIC RESEARCH Vol. 38, No. 6, 1995 Copyright O 1995 International Pediatric Research Foundation, Inc. Printed in U.S.A. Isolated Central Hypothyroidism in Short Stature SUSAN R. ROSE Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103-4901 Mild hypothyroidism can be difficult to diagnose, particularly tent with values seen in documented central hypothyroidism. when it is caused by deficiency of TSH or TSH-releasing hor- They were 13% of the total group, 16% of the ISS children, and mone (TRH). Such central hypothyroidism occurs most often in 32% of the ISS children with FT, in the lowest third of normal. association with growth hormone deficiency (GHD). Isolated (In comparison, diagnosis of GHD was made in 16% of the total central hypothyroidism has been considered rare. The TSH surge group.) In conclusion, use of a direct FT, assay to screen short test is the most sensitive test currently available for confirming children for possible subtle hypothyroidism (along with other the diagnosis. Results are abnormal in many cases where re- appropriate testing) identifies a subgroup with a one in three sponse to TRH is normal. Short children referred between 1986 possibility of an easily treated cause-isolated central hypothy- and 1994 for evaluation (n = 235, 74 girls; height 2 or more SD roidism. (Pediatr Res 38: 967-973, 1995) below mean for age; no history of radiation therapy) were selected for study. TSH samples were obtained hourly for study of TSH surge (1400-1800 h and 2200-0400 h). Growth hor- Abbreviations mone (GH) samples were obtained every 20 min (2000-0800 h).
    [Show full text]
  • For Oral Administration
    CONTRAINDICATIONS Adults Levothyroxine is contraindicated in patients with untreated subclinical (suppressed serum In adult patients with primary (thyroidal) hypothyroidism, serum TSH levels (using a sensitive TSH level with normal T3 and T4 levels) or overt thyrotoxicosis of any etiology and in patients assay) alone may be used to monitor therapy. The frequency of TSH monitoring during with acute myocardial infarction. Levothyroxine is contraindicated in patients with levothyroxine dose titration depends on the clinical situation but it is generally recommended uncorrected adrenal insufficiency since thyroid hormones may precipitate an acute adrenal at 6–8 week intervals until normalization. For patients who have recently initiated crisis by increasing the metabolic clearance of glucocorticoids (see PRECAUTIONS). levothyroxine therapy and whose serum TSH has normalized or in patients who have had their FOR ORAL ADMINISTRATION LEVOXYL® is contraindicated in patients with hypersensitivity to any of the inactive dosage or brand of levothyroxine changed, the serum TSH concentration should be measured ingredients in LEVOXYL® tablets (see DESCRIPTION, Inactive Ingredients). after 8–12 weeks. When the optimum replacement dose has been attained, clinical (physical Inactive Ingredients examination) and biochemical monitoring may be performed every 6–12 months, depending Microcrystalline cellulose, croscarmellose sodium and magnesium stearate. The following WARNINGS on the clinical situation, and whenever there is a change in the patient’s status. It is are the coloring additives per tablet strength: WARNING: Thyroid hormones, including LEVOXYL®, either alone or with other recommended that a physical examination and a serum TSH measurement be performed at least annually in patients receiving LEVOXYL® (see WARNINGS, PRECAUTIONS, and DOSAGE I I therapeutic agents, should not be used for the treatment of obesity or for weight loss.
    [Show full text]
  • The Relationship Between Cortisol and Thyroid Function Tests in Geriatric Patients with Psychiatric Disorder
    Current Neurobiology 2010; 1 (2): 133-135 The relationship between cortisol and thyroid function tests in geriatric Patients with psychiatric disorder. Vinayak W. Patil, Shahid A. Mujawar Department of Biochemistry, Grant Medical College and Sir J.J. Group of Govt. Hospitals, Byculla, Mumbai, Maharash- tra, India. Abstract The aim of this study was to investigate the relationship between serum cortisol and thyroid function tests in geriatric patients with psychiatric disorder. We assessed serum cortisol and thyroid function tests in newly admitted 35 geriatric age group patients in psychiatric ward and in 35 sex- and age matched controls. Study group included geriatric patients with psy- chiatric disorder diagnosed by a psychiatrist. Thyroid function tests contained serum con- centrations of total cortisol (TC) triiodothyronine (T3), thyroxine (T4) and thyrotropin (TSH). The serum concentration of TC was increased significantly in study group as com- pared with controls (P<0.001). T3 and T4 levels were slightly decreased in geriatric group as compared with controls (P<0.05). A positive and significant correlation was observed be- tween TC and TSH. We concluded that the hypothalamic–pituitary–thyroid (HPT) axis and the hypothalamic–pituitary–adrenal (HPA) axis are impaired in geriatric patients with psy- chiatric disorder. Key words: Total cortisol, thyroid function tests, geriatric patients. Accepted March 01 2010 Introduction group patients in psychiatric ward in the age group of more than 60 years were studied for estimation of serum Alteration in the hypothalamic–pituitary–thyroid (HPT) total cortisol (TC) triiodothyronine (T3), thyroxine (T4), axis and the hypothalamic–pituitary–adrenal (HPA) axis and thyrotropin (TSH) and in 35 sex- and age matched is a main cause of depressive disorder.
    [Show full text]