scholarly journals A raised thyroid stimulating hormone result - a 12-month follow-up study in general practice

2010 ◽  
Vol 2 (1) ◽  
pp. 29 ◽  
Author(s):  
Veronique Gibbons ◽  
John Conaglen ◽  
Ross Lawrenson
Keyword(s):  
General Practice ◽  
Quantitative Research ◽  
Best Practice ◽  
Adult Population ◽  
Laboratory Data ◽  
Reference Interval ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Stimulating Hormone

INTRODUCTION: Subclinical hypothyroidism (SCH) is common in older patients. AIM: To review the management of patients identified with a raised thyroid stimulating hormone (TSH) result in a 12-month period and compare this to current guidelines from the New Zealand Best Practice Advocacy Centre (BPAC). METHODS: We collected laboratory data on thyroid function tests (TFTs) that were reported between December 2005 and November 2006 from two general practices with an adult population of approximately 21 000. Data were collected on symptoms, investigations, thyroid medication, family history and comorbidities. We used chi-squared tests to compare findings by age, gender and ethnicity. RESULTS: Older women of European descent were more likely to be to have initial results suggesting SCH. The number of follow-up tests ranged from 0 to 5 tests in a 12-month period. Forty-eight percent of individuals did not have any follow-up investigations. Seventy-three percent of FT4 tests taken are requested concurrently with TSH. Of those who had a repeat TSH test, just over 40% had a result within the reference interval. Twenty-eight percent had two TSH results consistent with SCH. Thirty-five percent of patients with antibody results were positive. The most commonly-recorded symptoms were tiredness and weight gain. DISCUSSION: We found inconsistencies in the management of SCH which were not related to patient characteristics such as age, gender or ethnicity. Further research is needed to determine if SCH is associated with increased morbidity and to provide a clear rationale for management of patients with SCH. KEYWORDS: Hypothyroidism; family practice; quantitative research; general practice

scholarly journals Harmonization of Serum Thyroid-Stimulating Hormone Measurements Paves the Way for the Adoption of a More Uniform Reference Interval

2017 ◽  
Vol 63 (7) ◽  
pp. 1248-1260 ◽  
Author(s):  
Linda M Thienpont ◽  
Katleen Van Uytfanghe ◽  
Linde A C De Grande ◽  
Dries Reynders ◽  
Barnali Das ◽  
...  
Keyword(s):  
Total Error ◽  
Method Comparison ◽  
Reference Interval ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Nonparametric Bootstrap ◽  
Serum Samples ◽  
Global Harmonization ◽  
Method Comparison Study ◽  
Stimulating Hormone

Abstract BACKGROUND The IFCC Committee for Standardization of Thyroid Function Tests developed a global harmonization approach for thyroid-stimulating hormone measurements. It is based on a multiassay method comparison study with clinical serum samples and target setting with a robust factor analysis method. Here we describe the Phase IV method comparison and reference interval (RI) studies conducted with the objective to recalibrate the participating assays and demonstrate the proof-of-concept. METHODS Fourteen manufacturers measured the harmonization and RI panel; 4 of them quantified the harmonization and first follow-up panel in parallel. All recalibrated their assays to the statistically inferred targets. For validation, we used desirable specifications from the biological variation for the bias and total error (TE). The RI measurements were done with the assays' current calibrators, but data were also reported after transformation to the new calibration status. We estimated the pre- and postrecalibration RIs with a nonparametric bootstrap procedure. RESULTS After recalibration, 14 of 15 assays met the bias specification with 95% confidence; 8 assays complied with the TE specification. The CV of the assay means for the harmonization panel was reduced from 9.5% to 4.2%. The RI study showed improved uniformity after recalibration: the ranges (i.e., maximum differences) exhibited by the assay-specific 2.5th, 50th, and 97.5th percentile estimates were reduced from 0.27, 0.89, and 2.13 mIU/L to 0.12, 0.29, and 0.77 mIU/L. CONCLUSIONS We showed that harmonization increased the agreement of results from the participating immunoassays, and may allow them to adopt a more uniform RI in the future.

scholarly journals Management of thyroid disease in pregnancy – Room for improvement in the first trimester

2016 ◽  
Vol 9 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Helen Robinson ◽  
Philip Robinson ◽  
Michael D’Emden ◽  
Kassam Mahomed
Keyword(s):  
General Practitioner ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
In Pregnancy ◽  
Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

THYROID FUNCTION TESTS: A REVIEW

2021 ◽  
pp. 73-76
Author(s):  
Vasudev Sankhla ◽  
Aman Deep
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Radioactive Iodine ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Tsh Secretion ◽  
Line Test ◽  
Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

scholarly journals POST-CORONAVIRUS DISEASE 2019 DE QUERVAIN’S THYROIDITIS – A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 4-6
Author(s):  
MOHAMAD SAFWAN ◽  
VIJAYAN KN ◽  
NAJEEB ◽  
JITHU TG
Keyword(s):  
Neck Pain ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
C Reactive Protein ◽  
Free T4 ◽  
Persistent Fever ◽  
Reactive Protein ◽  
Technetium Uptake

De Quervain’s thyroiditis, also known as subacute thyroiditis (SAT), is a self-limiting inflammatory thyroid disease typically occurring a few weeks after a respiratory viral infection. A 29-year-old female with no comorbidities presented with persistent fever, neck pain, and swelling of 10 days duration. She also had tremors, fatigue, and palpitation. A careful enquiry revealed that she had been diagnosed with coronavirus disease 2019 (COVID-19) infection 6 weeks ago and had recovered uneventfully with conservative management. Her laboratories showed leukocytosis, elevated erythrocyte sedimentation rate, and C-reactive protein. Thyroid function tests (TFTs) yielded low thyroid-stimulating hormone, and high T3 and free T4. Ultrasonography neck was suggestive of thyroiditis. Thyroid scintigraphy demonstrated very low technetium uptake which confirmed SAT. Her symptoms ameliorated with nonsteroidal anti-inflammatory drug and beta-blockers and her TFTs improved during follow-up. We report this as emerging sequelae of COVID-19 infection. A persistent fever and neck pain following recent COVID-19 infection should alert clinician toward the possibility of de Quervain’s thyroiditis following severe acute respiratory syndrome coronavirus 2.

scholarly journals In primary care, is measuring free-thyroxine plus thyroid-stimulating hormone to detect hypopituitarism cost-effective? A cost utility analysis using Markov chain models

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029369 ◽  
Author(s):  
Brian Shine ◽  
Tim James ◽  
Amanda Adler
Keyword(s):  
Primary Care ◽  
Model Simulation ◽  
Cost Effective ◽  
Cost Utility ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Life Years ◽  
Secondary Hypothyroidism ◽  
Stimulating Hormone

ObjectiveWe examined whether it is cost-effective to measure free thyroxine (FT4) in addition to thyrotropin (thyroid-stimulating hormone (TSH)) on all requests for thyroid function tests from primary care on adult patients.BackgroundHypopituitarism occurs in about 4 people per 100 000 per year. Loss of thyrotropin (TSH) secretion may lead to secondary hypothyroidism with a low TSH and low FT4, and this pattern may help to diagnose hypopituitarism that might otherwise be missed.DesignMarkov model simulation.Primary outcome measureIncremental cost-effectiveness ratio (ICER), the ratio of cost in pounds to benefit in quality-adjusted life years of this strategy.ResultsThe ICER for this strategy was £71 437. Factors with a large influence on the ICER were the utilities of the treated hypopituitary state, the likelihood of going to the general practitioner (GP) and of the GP recognising a hypopituitary patient. The ICER would be below £20 000 at a cost to the user of an FT4 measurement of £0.61.ConclusionWith FT4 measurements at their present cost to the user, routine inclusion of FT4 in a thyroid hormone profile is not cost-effective.

scholarly journals How well does the capillary thyroid-stimulating hormone test for newborn thyroid screening predict the venous free thyroxine level?

2016 ◽  
Vol 101 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Tzveta Pokrovska ◽  
Jeremy Jones ◽  
M Guftar Shaikh ◽  
Sarah Smith ◽  
Malcolm D C Donaldson
Keyword(s):  
Newborn Infants ◽  
Rank Correlation ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Spearman’S Rank Correlation ◽  
Thyroid Screening ◽  
Spearman’S Rank Correlation Coefficient ◽  
Venous Sample ◽  
Stimulating Hormone

ObjectivesTo determine, in newborn infants referred with elevated capillary thyroid-stimulating hormone (TSH), a threshold below which a frankly subnormal venous free thyroxine (fT4) level of <10 pmol/L is unlikely, so that treatment with levo-thyroxine (L-T4) might be deferred until venous thyroid function tests (TFTs) become available.Subjects and methodsAll infants referred in Scotland since 1979 with capillary TSH elevation were studied, with particular focus on infants screened using the AutoDELFIA assay between 2002 and 2013.ResultsOf the 321 infants referred with capillary TSH elevation using AutoDELFIA, 35 were excluded (fT4/TSH unavailable (12), venous sample either preceding or >10 days after capillary sampling (13, 10)), leaving 286 eligible for analysis (208 definite/probable hypothyroidism, 61 transient TSH elevation, 17 of uncertain thyroid status). Capillary TSH and venous T4 were strongly correlated (Spearman's rank correlation coefficient −0.707355). The optimal capillary TSH threshold for predicting a venous fT4 of <10 pmol/L was found to be >40 mU/L (90.3% sensitivity and 65.9% specificity compared with 90.25% and 59.1% for >35 mU/L and 88.3% and 68.2% for >45 mU/L). 93 infants (32.5%) had capillary TSH ≤40 mU/L at referral of whom 15 (9.7%) had venous fT4 <10 pmol/L, comprising seven with true congenital hypothyroidism, five with transient TSH elevation and three with uncertain status, two of whom died.ConclusionFor infants in whom capillary TSH is ≤40 mU/L, it is reasonable to defer L-T4 treatment until venous TFT results are known provided that the latter become available quickly.

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