Abstract #1003758: Confounding Elevated TSH in Clinically Euthyroid Patient Due to Macro-TSH

ObjectiveTaking levothyroxine (l-T4) with coffee or with water followed by coffee intake within a few minutes results in poor TSH response in many patients. T4is available in tablet form worldwide, but novel formulations in soft gel capsule or liquid form are now available.DesignWe fortuitously identified a euthyroid patient who wrongly consumed liquidl-T4with coffee at breakfast; after changing the time of consumption to 30 min before breakfast, no change in TSH, free T4(fT4), and free tri-iodothyronine (fT3) concentrations was observed. Once the first patient was identified, additional stable euthyroid patients who consumed liquidl-T4with coffee were identified.MethodsPatients were recruited by searching our ‘thyroid patients’ database. All the patients on liquidl-T4treatment were contacted by phone to ask them whether they tookl-T4at breakfast. We identified 54 patients who were submitted to TSH, fT4, and fT3evaluation, with the indication that the same dosage ofl-T4be consumed 30 min before breakfast. We determined their TSH, fT4, and fT3concentrations after 3 and 6 months again.ResultsNo significant difference in thyroid hormone concentrations was observed in patients when they consumedl-T4at breakfast or when they consumed it 30 min before breakfast for 3 and 6 months (TSH: 2.5±1.1 vs 2.5±1.1 and 2.4±1.1 mIU/l respectively, fT4: 12.4±2.4 vs 12.5±2.4 and 12.3±2.1 pg/ml respectively, and fT3: 3.4±0.6 vs 3.4±0.6 and 3.3±0.5 pg/ml respectively).ConclusionOral liquidl-T4formulations could diminish the problem ofl-T4malabsorption caused by coffee when using traditional tablet formulations.

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Management of the single thyroid nodule

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.3317 ◽

2011 ◽

pp. 595-600

Author(s):

Laszlo Hegedüs ◽

Finn N. Bennedbæk

Keyword(s):

Thyroid Nodule ◽

Thyroid Surgery ◽

Main Concern ◽

Thyroid Malignancy ◽

Normal Gland ◽

Solitary Thyroid Nodule ◽

Euthyroid Patient ◽

Surgery Management

The main concern of patients and physicians alike, when dealing with the solitary thyroid nodule, is to diagnose the few cancers (approximately 5%) as rapidly and cost-effectively as possible, and to reduce superfluous thyroid surgery. Management has changed in recent years, but differences prevail as shown by an investigation among European thyroidologists (1). This chapter focuses on the palpably discrete swelling within an otherwise normal gland in the clinically and biochemically euthyroid patient (2, 3). The toxic nodule is dealt with in Chapter 3.3.11, and thyroid malignancy in Chapters 3.5.4–3.5.7.

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Diagnostic Efficacy of Thyrotropin to Thyroglobulin Ratio in Correlation with Histopathology of Euthyroid Patient Having Solitary Thyroid Nodule

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-020-02120-4 ◽

2020 ◽

Author(s):

Vijay Kumar Sharma ◽

Nishi Sonkhya ◽

Shubhangi Gupta ◽

Kailash Singh Jat ◽

Ritu Sehra ◽

...

Keyword(s):

Thyroid Nodule ◽

Diagnostic Efficacy ◽

Solitary Thyroid Nodule ◽

Euthyroid Patient

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Evidence of both decreased nuclear receptor-binding of T3and inhibited thyroid hormone-stimulated glucose-uptake in cells from a euthyroid patient with hyperthyroxinaemia

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.3109/00365519009091607 ◽

1990 ◽

Vol 50 (4) ◽

pp. 461-462 ◽

Cited By ~ 2

Author(s):

J. Kvetny ◽

L. E. Matzen ◽

M. Brøns

Keyword(s):

Thyroid Hormone ◽

Glucose Uptake ◽

Nuclear Receptor ◽

Receptor Binding ◽

Euthyroid Patient ◽

In Cells

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Intrathoracic Goiter in a Euthyroid Patient: Localization with125I and Study of Thyroidal Iodoproteins

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-29-2-183 ◽

1969 ◽

Vol 29 (2) ◽

pp. 183-190 ◽

Cited By ~ 1

Author(s):

GERALDO A. MEDEIROS-NETO ◽

EDUARDO MANZANO ◽

A. B. ULHOA CINTRA

Keyword(s):

Intrathoracic Goiter ◽

Euthyroid Patient ◽

Patient Localization

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Diagnostic relevance of suppressed basal concentrations of TSH compared with the negative TRH test in detection and exclusion of hyperthyroidism

Acta Endocrinologica ◽

10.1530/acta.0.1240136 ◽

1991 ◽

Vol 124 (2) ◽

pp. 136-142 ◽

Cited By ~ 4

Author(s):

Michael Roden ◽

Peter Nowotny ◽

Heinrich Vierhapper ◽

Werner Waldhäusl

Keyword(s):

Outpatient Clinic ◽

Correct Diagnosis ◽

Threshold Concentration ◽

The Other ◽

Trh Test ◽

Other Hand ◽

Concomitant Decrease ◽

Euthyroid Patient ◽

Definition Of ◽

Hyperthyroid Patients

Abstract. To evaluate the sensitivity of basal TSH concentrations as determined by an "ultrasensitive" IRMA-assay (RIA-gnost h-TSH-monoclonal, Behring) versus a "negative" TRH test (defined as an increment of TSH ≥0.2 mU/l 20 min after administration of 400 μg TRH iv) in the diagnosis of hyperthyroidism we examined 193 consecutive patients from our thyroid outpatient clinic: 34 patients displayed hyperthyroidism (total T4: 184.4±26.0 μmol/l, effective thyroxine index: 1.25±0.08), whereas 12 had isolated T3-hyperthyroidism (total T3: 3.47±0.48 nmol/l). Employing the producer's definition of subnormal ("suppressed") bTSH concentrations (≤0.1 mU/l), only 19 (41.3%) hyperthyroid patients would have been detected; on the other hand, one euthyroid patient would have been recognized false positively as hyperthyroid. Using the TRH test as criterion led to the correct diagnosis in 42 (sensitivity: 91.3%) hyperthyroid patients, whereas two had low bTSH concentrations (≤0.5 mU/l), but a normal TSH response to TRH (>2.0 mU/l). Raising the threshold concentration to 0.2 and, subsequently, to 0.4 mU TSH/l increased the number of correct results to 38 (sensitivity: 82.6%) and 43 (93.5%), respectively. This was associated with a concomitant decrease in specificity in the diagnosis of hyperthyroidism from 93.7 (0.1 mU/l) to 27.9% (0.4 mU/l). In conclusion, despite ultrasensitive methods for estimation of low TSH concentrations, the TRH test remains an irreplaceable tool for the correct diagnosis of hyperthyroidism.

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