Free thyroxine but not TSH levels are associated with decline in functional status in a cohort of geriatric outpatients

2021 ◽  
Author(s):  
Aline S. da S. Correia ◽  
Michele L. F. Nascimento ◽  
Letícia B. B. de M. Teixeira ◽  
Silvana O. e Silva ◽  
Mário Vaisman ◽  
...  
Keyword(s):  
Functional Status ◽  
Free Thyroxine ◽  
Tsh Levels

Patients with Central Hypothyroidism are Less Sufficiently Treated with Levothyroxine than Patients with Primary Hypothyroidism

2021 ◽  
Author(s):  
Barbara Samec ◽  
Gaja Setnikar ◽  
Simona Gaberscek ◽  
Tomaz Kocjan
Keyword(s):  
Primary Hypothyroidism ◽  
Free Thyroxine ◽  
Free Triiodothyronine ◽  
Central Hypothyroidism ◽  
Tsh Levels

Abstract Background Contrary to patients with hypothyroidism after radioiodine (HRI) or after thyroidectomy (HTh), patients with central hypothyroidism (CH) cannot rely on thyrotropin (TSH) level to guide their treatment with L-thyroxine (L-T4). Consequently, they are at constant risk of under- or overtreatment. We aimed to establish the adequacy of L-T4 treatment in patients with CH in our cohort. Methods Consecutive patients with CH on L-T4 treatment were compared with patients adequately treated for HRI or HTh. Levels of free thyroxine (fT4) and free triiodothyronine (fT3) were evaluated and the fT4/fT3 ratio was calculated. Results Forty patients with CH, 136 patients with HRI and 43 patients with HTh were included in this study. Patients with HRI were significantly younger than patients with HTh and CH (p<0.001 for both). Levels of fT4 were significantly lower in CH than in adequately treated patients with HRI and HTh (median (range), 15.6 (12.7–21.3), 18.4 (12.2–28.8), and 18.7 (13.8–25.5) pmol/L, respectively, p<0.001 for both comparisons). Levels of fT3 did not differ significantly (p=0.521) between CH, HRI and HTh (median (range), 4.5 (2.7–5.9), 4.3 (3.2–6.2), and 4.4 (2.9–5.5) pmol/L, respectively). Accordingly, the fT4/fT3 ratio was significantly lower in the CH group than in HRI and HTh groups (median (range), 3.7 (2.5–5.2), 4.2 (1.2–7.7), and 4.4 (2.5–6.1), respectively, p<0.001 for both comparisons). Conclusions Patients with CH have lower fT4 levels and lower fT4/fT3 ratios than patients adequately treated for HRI or HTh. The cause for this difference may be the unreliable TSH levels in patients with CH.

THE EFFECTS OF PHENYLBUTAZONE ON THYROID FUNCTION

1973 ◽  
Vol 72 (2) ◽  
pp. 257-264 ◽  
Author(s):  
M. O. Abiodun ◽  
R. Bird ◽  
C. W. H. Havard ◽  
N. K. Sood
Keyword(s):  
Thyroid Function ◽  
Significant Rise ◽  
Free Thyroxine ◽  
Continuous Treatment ◽  
Total Serum ◽  
Thyroid Function Tests ◽  
Tsh Secretion ◽  
Total Thyroxine ◽  
Pre Treatment ◽  
Tsh Levels

ABSTRACT It is known that phenylbutazone suppresses the thyroidal uptake of radioactive iodine and the serum level of protein-bound iodine (PBI) during the first week of treatment, with a return to normal values after 2 weeks of continuous treatment. Up till now the initial suppression of thyroid function has been presumed due to inhibition of TSH secretion. In the present study, total serum thyroxine and percentage dialysable thyroxine have been measured and the serum absolute free thyroxine concentration calculated in 12 patients before starting treatment with phenylbutazone orally, after 4 days of treatment and again after 14 days. Serum TSH was assayed in 10 of these patients before, and on the 4th day of treatment. Sera were assayed for TSH after 14 days on the drug in 6 patients. On the 4th day of treatment, the levels of total thyroxine had fallen but the levels of free thyroxine remained unchanged. TSH levels were also unaltered. By the 14th day of treatment, free thyroxine levels had fallen significantly below pre-treatment values but no significant rise in TSH could be demonstrated in the 6 patients studied. At no time was there a fall in TSH levels and we conclude that suppression of some thyroid function tests during the first week of treatment with phenylbutazone is due to direct inhibition of the gland by the drug.

scholarly journals Maternal TSH levels at first trimester and subsequent spontaneous miscarriage: a nested case–control study

2019 ◽  
Vol 8 (9) ◽  
pp. 1288-1293 ◽  
Author(s):  
Jiashu Li ◽  
Aihua Liu ◽  
Haixia Liu ◽  
Chenyan Li ◽  
Weiwei Wang ◽  
...  
Keyword(s):  
Case Control Study ◽  
First Trimester ◽  
Case Control ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Thyroid Peroxidase ◽  
Spontaneous Miscarriage ◽  
Control Study ◽  
Tsh Levels ◽  
Stimulating Hormone

Thyroid dysfunction is a frequently found endocrine disorder among reproductively aged women. Subclinical hypothyroidism is the most common condition of thyroid disorders during pregnancy and is defined as manifesting a thyroid-stimulating hormone concentration exceeding the trimester-specific reference value, with a normal free thyroxine concentration. Here, we evaluated the prospective association between spontaneous miscarriage and first-trimester thyroid function. We conducted a case–control study (421 cases and 1684 controls) that was nested. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroid-peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) status were measured. We found that higher TSH was related to spontaneous miscarriage (OR 1.21; 95% CI, 1.13–1.30, P < 0.001). Compared with women with TSH levels of 0.4–<2.5 mIU/L, the risk of miscarriage was increased in women with TSH levels of 2.5–<4.87 mIU/L (OR 1.47; 95% CI, 1.16–1.87) and TSH greater than 4.87 mIU/L (OR 1.97; 95% CI, 1.22–3.18). After controlling for the confounding factor, TPOAb positivity status and FT4, the results were similar. The present study showed that higher TSH was associated with miscarriage in early pregnancy. In fact, TSH levels between 2.5 and 4.87 mIU/L increased the risk for miscarriage, with TSH greater than 4.87 mIU/L increasing the risk even further.

scholarly journals Free thyroxine is an independent predictor of subcutaneous fat in euthyroid individuals

2009 ◽  
Vol 161 (3) ◽  
pp. 459-465 ◽  
Author(s):  
Maria Alevizaki ◽  
Katerina Saltiki ◽  
Paraskevi Voidonikola ◽  
Emily Mantzou ◽  
Christos Papamichael ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subcutaneous Fat ◽  
Cross Sectional Study ◽  
Free Thyroxine ◽  
Hip Circumference ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Regional Adiposity ◽  
Tsh Levels ◽  
Apparently Healthy

ObjectiveThyroid function parameters have been associated with obesity, but associations with the type of adiposity have not been examined. We used ultrasound (US) to assess regional adiposity and investigated associations of thyroid function with parameters of central obesity.DesignCross-sectional study.MethodsA total of 303 apparently healthy individuals (age 42.9±8.8, body mass index (BMI) 19.0–43.3, median 26.2 kg/m2, 181 women) were examined for indices of the metabolic syndrome. BMI, waist and hip circumference, abdominal subcutaneous fat (SF), and preperitoneal fat (PF) layer was estimated. TSH, free thyroxine (fT4), triiodothyronine (T3), thyroid autoantibodies, insulin, glucose, and lipid levels were measured. Subjects receiving T4(9.2%) were excluded.ResultsSF and SF/PF ratio were inversely correlated with fT4levels (r=−0.169,P=0.023,r=−0.193,P=0.009 respectively). In multivariate analysis, fT4was a predictor of SF and SF/PF, independently of age, sex, and smoking. SF correlated with TSH levels (r=0.149,P=0.037). PF and SF were positively associated with T3levels (r=0.245,P=0.004 andr=0.189,P=0.019 respectively). T3levels were positively associated with BMI (r=0.257,P=0.0004), waist perimeter (r=0.324,P<0.0001), and waist-to-hip ratio (WHR;r=0.363,P<0.0001). The T3/fT4ratio was positively correlated with SF (r=0.182,P=0.028), WHR (r=0.267,P=0.0003), and BMI (r=0.146,P=0.043).ConclusionsIncreasing SF accumulation as assessed by US is associated with lower fT4and higher TSH levels among euthyroid slightly overweight individuals. These associations indicate that subtle variation in thyroid function may participate in regional adiposity.

scholarly journals Euthyroid athyroxinemia – a novel endocrine syndrome

2017 ◽  
Vol 2017 ◽  
Author(s):  
Nicholas Woodhouse ◽  
Fatima Bahowairath ◽  
Omayma Elshafie
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Function ◽  
Urinary Iodine ◽  
Free Thyroxine ◽  
List Type ◽  
Thyroid Function Tests ◽  
Thyroxine Level ◽  
Learning Points ◽  
Free Thyroxine Level ◽  
Tsh Levels

Summary A 55-year-old female was referred with abnormal thyroid function tests (TFTs); the free thyroxine level (FT4) was undetectable <3.3 pmol/L (normal: 7.9–14.4), while her FT3, TSH and urinary iodine levels were normal. She was clinically euthyroid with a large soft lobulated goitre that had been present for more than thirty years. She received an injection of recombinant human TSH (rhTSH) following which there was a progressive rise of the FT3 and TSH levels to 23 pmol/L and >100 mIU/L respectively at 24 h, The FT4 however remained undetectable throughout. Being on thyroxine 100 µg/day for one month, her FT4 level increased to 15 pmol/L and TSH fell to 0.08 mIU/L. Four years earlier at another hospital, her FT4 level had been low (6.8 pmol/L) with a normal TSH and a raised Tc-99 uptake of 20% (normal<4%). We checked the TFTs and Tc-99 scans in 3 of her children; one was completely normal and 2 had euthyroid with soft lobulated goitres. Their Tc-99 scan uptakes were raised at 17% and 15%, with normal TFTs apart from a low FT4 7.2 pmol/L in the son with the largest thyroid nodule. This is a previously unreported form of dyshormonogenesis in which, with time, patients gradually lose their ability to synthesize thyroxine (T4) but not triiodothyroxine (T3). Learning points: This is a previously unreported form of dyshormonogenetic goitre. This goitre progressively loses its ability to synthesize T4 but not T3. The inability to synthesize T4 was demonstrated by giving rhTSH.

scholarly journals Effect of satiety on TSH and free thyroxin levels in healthy individuals and patients with subclinical and overt hypothyroidism

2021 ◽  
Vol 16 (4) ◽  
pp. 28-32
Author(s):  
Mehmet G. Kılınçarslan ◽  
Cihan Çelik ◽  
Erkan M. Şahin
Keyword(s):  
Tertiary Hospital ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Overt Hypothyroidism ◽  
Fasting State ◽  
Healthy Individuals ◽  
Control Groups ◽  
And Control ◽  
Tsh Levels ◽  
Paired T Test

Background: Thyroid stimulating hormone (TSH) and thyroxine levels may change according to fasting — satiety status. AIM: The aim of this study was to determine the effect of satiety on TSH and free thyroxine levels.Methods: This study was conducted in a tertiary hospital. According to previous TSH and thyroxine levels, groups of 30, 30 and 60 participants were designated as subclinical hypothyroidism, hypothyroidism, and control groups respectively. To obtain TSH and thyroxine results first phlebotomy was performed at 8 am while participants were in fasting state. Then participants were allowed to have non-standardized breakfast. Second phlebotomy was performed at 10 am while participants were in non-fasting state. Paired t-test and ANOVA were used to analyze the data.Results: The fasting TSH levels of the participants (2.57 ± 1.84 mlU/L) were significantly higher than the satiety TSH levels (2.04 ± 1.48 mlU/L) (t = 8.566, p < 0.001, d = 0.80). The fasting free thyroxine values (1.31 ± 0.38 mg/dl) of the participants were significantly lower than the satiety free thyroxine values (1.39 ± 0.35 mg/dl) (t = -1.988, p = 0.049, d = 0.20).Conclusion: Knowing how TSH and free thyroxine tests are affected by satiety has the power to affect treatment of many patients. Our study has shown that both TSH and free thyroxine levels changed significantly according to satiety status.

scholarly journals Higher free thyroxine levels are associated with all-cause mortality in euthyroid older men: the Health In Men Study

2013 ◽  
Vol 169 (4) ◽  
pp. 401-408 ◽  
Author(s):  
Bu B Yeap ◽  
Helman Alfonso ◽  
Graeme J Hankey ◽  
Leon Flicker ◽  
Jonathan Golledge ◽  
...  
Keyword(s):  
Thyroid Disease ◽  
Older Men ◽  
Community Dwelling ◽  
Free Thyroxine ◽  
Physical Factors ◽  
Medical Comorbidities ◽  
All Cause Mortality ◽  
Thyroid Function Testing ◽  
Using Data ◽  
Tsh Levels

ObjectiveThyroid dysfunction predicts poorer health outcomes, but the relationship between thyroid hormone levels within the reference range and mortality in older adults remains unclear. In this study, we examined the associations between the concentrations of free thyroxine (FT4) and TSH and all-cause mortality in older men without thyroid disease.Subjects and methodsWe performed a longitudinal study in community-dwelling men aged 70–89 years. Men with thyroid disease or taking thyroid-related medications were excluded. Baseline FT4and TSH levels were assayed. Incident deaths were ascertained using data linkage.ResultsThere were 3885 men without thyroid disease followed for (mean±s.d.) 6.4±1.5 years, during which time 837 had died (21.5%). Men who had died had higher baseline FT4levels (16.2±2.3 vs 15.8±2.1 pmol/l,P<0.001), but comparable TSH levels (2.4±1.5 vs 2.3±1.5 mIU/l,P=0.250). After accounting for age, smoking, physical factors and medical comorbidities, higher circulating FT4levels predicted all-cause mortality (quartile Q4 vs quartiles Q1–Q3: FT4levels ≥17.32 vs <17.32 pmol/l: adjusted hazard ratio (HR)=1.19, 95% CI=1.02–1.39,P=0.025). TSH levels did not predict mortality. After excluding men with subclinical hyperthyroidism or hypothyroidism, there were 3442 men and 737 who had died (21.4%). In these men, higher FT4levels remained independently associated with all-cause mortality (quartile Q4 vs quartiles Q1–Q3: adjusted HR=1.19, 95% CI=1.02–1.41,P=0.032).ConclusionsHigher FT4levels are associated with all-cause mortality in euthyroid older men, independently of conventional risk factors and medical comorbidities. Additional research is needed to determine whether or not this relationship is causal and to clarify the utility of thyroid function testing to stratify mortality risk in ageing men.

scholarly journals Thyrotropin N-glycosylation and Glycan Composition in Severe Primary Hypothyroidism

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Leif Wide ◽  
Karin Eriksson
Keyword(s):  
Sialic Acid ◽  
Half Life ◽  
Primary Hypothyroidism ◽  
Free Thyroxine ◽  
Target Cells ◽  
Serum Samples ◽  
Glycan Pattern ◽  
Levothyroxine Treatment ◽  
Tsh Levels

Abstract Context In severe primary hypothyroidism (sPH), the serum thyrotropin (TSH) levels are elevated with an increased degree of sialylation. The circulating TSH comprises 2 different TSH glycoforms: TSHdi with 2 and TSHtri with 3 N-glycans and methods have developed to determine their contents of anionic monosaccharides (AMS), that is, sialic acid (SA) and sulfonated N-acetylglactosamine (SU) residues. Objective Characterize N-glycosylation and glycan composition of circulating TSH molecules and determine the effects during levothyroxine treatment in patients with sPH. Methods Serum samples were obtained from 25 patients with sPH, from 159 euthyroid individuals, and from 12 women during treatment with levothyroxine for sPH. Degrees of N-glycosylation and concentrations of TSHdi and TSHtri as well as their contents of AMS, SA, and SU residues were determined. Results The circulating TSH molecules in sPH patients had lower degrees of N-glycosylation, higher degrees of sialylation, and lower degrees of sulfonation than in euthyroid individuals. Levothyroxin restored sialylation and sulfonation of the glycans already at low free thyroxine (FT4) levels, while degree of N-glycosylation was not restored until the FT4 levels were normal. Conclusions The majority of TSH molecules in severe primary hypothyroidism were less N- glycosylated, more sialylated, and less sulfonated compared with euthyroid individuals. This glycan pattern favors a prolonged half-life in the circulation combined with lower in vitro biopotency at the target cells. During levothyroxine treatment of sPH patients, the sialylation and sulfonation of glycans were restored already at low FT4 levels, while N-glycosylation of TSH was not restored until the FT4 levels were normal.

Spine Impairment Evaluation: Sixth Edition Approaches

2009 ◽  
Vol 14 (1) ◽  
pp. 1-5
Author(s):  
Craig Uejo ◽  
Marjorie Eskay-Auerbach ◽  
Christopher R. Brigham
Keyword(s):  
Functional Status ◽  
Spinal Injury ◽  
Current Medical ◽  
Clinical Testing ◽  
Medical Evidence ◽  
Sixth Edition ◽  
Whole Person ◽  
Rating Process ◽  
Impairment Ratings ◽  
Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

Tools and Resources: Web Sites of Interest

2001 ◽  
Vol 6 (2) ◽  
pp. 6-8
Author(s):  
Christopher R. Brigham
Keyword(s):  
Informed Consent ◽  
Physical Examination ◽  
Functional Status ◽  
Web Sites ◽  
Satisfaction Survey ◽  
High Quality ◽  
Diagnostic Studies ◽  
Physician Relationship ◽  
Complete History

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, explains that independent medical evaluations (IMEs) are not the same as impairment evaluations, and the evaluation must be designed to provide the data to answer the questions asked by the requesting client. This article continues discussions from the September/October issue of The Guides Newsletter and examines what occurs after the examinee arrives in the physician's office. First are orientation and obtaining informed consent, and the examinee must understand that there is no patient–physician relationship and the physician will not provide treatment bur rather will send a report to the client who requested the IME. Many physicians ask the examinee to complete a questionnaire and a series of pain inventories before the interview. Typical elements of a complete history are shown in a table. An equally detailed physical examination follows a meticulous history, and standardized forms for reporting these findings are useful. Pain and functional status inventories may supplement the evaluation, and the examining physician examines radiographic and diagnostic studies. The physician informs the interviewee when the evaluation is complete and, without discussing the findings, asks the examinee to complete a satisfaction survey and reviews the latter to identify and rectify any issues before the examinee leaves. A future article will discuss high-quality IME reports.

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