scholarly journals Guidelines for diagnosis and monitoring of thyroid disease: nonthyroidal illness

1996 ◽  
Vol 42 (1) ◽  
pp. 188-192 ◽  
Author(s):  
J R Stockigt
Keyword(s):  
Positive Predictive Value ◽  
Clinical Features ◽  
Thyroid Function ◽  
Predictive Value ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Reference Intervals ◽  
Free T4 ◽  
Prognostic Information ◽  
Increased Risk

Abstract On the basis of low specificity, poor positive predictive value, and cost, there is at present no basis for routine assessment of thyroid function in acutely hospitalized patients, unless clinical features suggest the possibility of thyroid dysfunction, or a patient's background increases the likelihood of thyroid dysfunction. When used in severely ill patients, estimates of both thyroxine (T4) and thyrotropin (TSH) show a high prevalence of abnormal results, but lack specificity and have poor positive predictive value for true thyroid disease. When thyroid function is tested in the critically ill, the positive predictive value for true thyroid disease of both free T4 and TSH measurements could be improved by using wider reference intervals than for unselected populations. The knowledge of nonspecific disease-related abnormalities of triiodothyronine, T4, and TSH is not currently likely to yield useful prognostic information or to alter management for individual patients. Thyroid testing should be readily available for any acutely ill patient with any clinical features that suggest thyroid dysfunction, and for groups at increased risk of thyroid dysfunction. An initial abnormal result for either TSH or free T4 estimate should be followed by combined analysis of free T4 and TSH with the best available methodology. Diagnosis of thyroid dysfunction should be based on the T4-TSH relation rather than either value alone. Persistence of an apparent diagnostic abnormality should be confirmed before therapy is commenced.

scholarly journals Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace

2010 ◽  
Vol 128 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Rodrigo Diaz-Olmos ◽  
Antônio-Carlos Nogueira ◽  
Daniele Queirós Fucciolo Penalva ◽  
Paulo Andrade Lotufo ◽  
Isabela Martins Benseñor
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Free T4 ◽  
Cross Sectional

CONTEXT AND OBJECTIVE: Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. DESIGN AND SETTING: Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP). METHODS: All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH), free thyroxine (free-T4) and anti-thyroperoxidase antibodies (anti-TPO). RESULTS: The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01). There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l) did not change the results. CONCLUSION: In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

scholarly journals Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals

2007 ◽  
Vol 157 (4) ◽  
pp. 509-514 ◽  
Author(s):  
Rt Stricker ◽  
M Echenard ◽  
R Eberhart ◽  
M-C Chevailler ◽  
V Perez ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Gestational Age ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Reference Intervals ◽  
Specific Reference ◽  
Thyroid Function Tests ◽  
Laboratory Evidence ◽  
Maternal Thyroid

Background: Maternal thyroid dysfunction has been associated with a variety of adverse pregnancy outcomes. Laboratory measurement of thyroid function plays an important role in the assessment of maternal thyroid health. However, occult thyroid disease and physiologic changes associated with pregnancy can complicate interpretation of maternal thyroid function tests (TFTs). Objective and methods: To 1) establish the prevalence of laboratory evidence for autoimmune thyroid disease (AITD) in pregnant women; 2) establish gestational age-specific reference intervals for TFTs in women without AITD; and 3) examine the influence of reference intervals on the interpretation of TFT in pregnant women. Serum samples were collected from 2272 pregnant women, and TFT performed. Gestational age-specific reference intervals were determined in women without AITD, and then compared with the non-pregnant assay-specific reference intervals for interpretation of testing results. Results: Thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) were positive in 10.4 and 15.7% of women respectively. TPO-Ab level was related to maternal age, but TPO-Ab status, Tg-Ab status, and Tg-Ab level were not. Women with TSH > 3.0 mIU/l were significantly more likely to be TPO-Ab positive. Gestational age-specific reference intervals for TFT were significantly different from non-pregnant normal reference intervals. Interpretation of TFT in pregnant women using non-pregnant reference intervals could potentially result in misclassification of a significant percentage of results (range: 5.6–18.3%). Conclusion: Laboratory evidence for thyroid dysfunction was common in this population of pregnant women. Accurate classification of TFT in pregnant women requires the use of gestational age-specific reference intervals.

scholarly journals Morphological and Functional Assessment of Thyroid in Individuals with Down Syndrome

2021 ◽  
Author(s):  
Celia Neder Kalil Mangabeira ◽  
Rafael Kalil Mangabeira ◽  
Luis Jesuino de Oliveira Andrade
Keyword(s):  
Down Syndrome ◽  
Thyroid Function ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Cross Sectional Study ◽  
Free T4 ◽  
Cross Sectional ◽  
Key Words Down Syndrome ◽  
Normal Thyroid Function ◽  
Increased Risk

Individuals with Down syndrome (DS) present increased risk for thyroid dysfunction, especially hypothyroidism, due in increased expression of the DYRK1A gene. Objective: The aim of this study was to make a morphological functional thyroid assessment in individuals with DS. Materials and Methods: This is a descriptive cross-sectional study, consisting of 29 individuals with DS, with a mean age of 12,3 (0.66 / 36.00) years, 16 women (55.2%) and 13 men (44.8%), with a morphological/functional thyroid assessment being made comprising hormonal dose (Free T4, TSH), antithyroid antibody (TPOAb and TgAb) and ultrasonography of the thyroid. Results: Twenty-three (79.3%) individuals presented normal thyroid function while 6 (20.7%) presented with thyroid dysfunction, 4 with hypothyroidism and 2 with hyperthyroidism. Autoimmune thyroiditis and goiter were present in 27.6% of the individuals. Conclusion: Thyroid function should be assessed periodically in individuals with DS, in view of the high prevalence of thyroid dysfunction, especially autoimmune thyroiditis with consequent hypothyroidism. Key Words: Down Syndrome, thyroid, ultrasonography, thyroid dysfunction.

scholarly journals Association between Sleep Duration and Subclinical Thyroid Dysfunction Based on Nationally Representative Data

2019 ◽  
Vol 8 (11) ◽  
pp. 2010 ◽  
Author(s):  
Woojun Kim ◽  
Jeongmin Lee ◽  
Jeonghoon Ha ◽  
Kwanghoon Jo ◽  
Dong-Jun Lim ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Multiple Logistic Regression Analysis ◽  
Subclinical Hyperthyroidism ◽  
Free T4 ◽  
Representative Data ◽  
Increased Risk ◽  
The Impact

Background: Sleep duration is an identified risk factor for adverse health outcomes. As the endocrine system is closely intertwined with sleep duration and quality, the association between endocrine dysfunction and sleep has been evaluated. Thyroid function, particularly that related to thyrotropin (TSH), is also known to be influenced by the sleep/awake status and circadian rhythm. Additionally, a link between sleep duration and autoimmunity, which is a common cause of thyroid dysfunction, has been suggested; however, depending on the sleep deprivation method used in studies, the effects of sleep on thyroid function vary. The relationship between subclinical thyroid dysfunction and sleep duration is poorly documented. Thus, to elucidate the impact of sleep on thyroid function, we investigated the association of subclinical thyroid dysfunction with sleep duration using representative data from the sixth Korea National Health and Nutrition Examination Survey, conducted from 2013 to 2015. Methods: In all, 4945 participants (2543 male and 2402 female) were included after excluding subjects using the following criteria: <19 years of age, free T4 level outside the normal range, history of thyroid disease, or incomplete data. The population was classified into three groups: short sleeper (<7 h/day), normal sleeper (7–8 h/day), and long sleeper (>8 h/day). The odds ratio (OR) for subclinical hypothyroidism or hyperthyroidism according to sleep duration was evaluated. Results: The short, normal, and long sleeper groups consisted of 2097, 2514, and 334 subjects, respectively. On multiple logistic regression analysis, compared to normal sleepers, short sleepers showed a significantly increased risk of subclinical hyperthyroidism (OR 1.37, 95% confidential interval (CI) 1.02–1.84, p = 0.036), while the risk of subclinical hypothyroidism in short sleepers was not elevated. Comparing long sleepers to normal sleepers, the OR for subclinical hyperthyroidism and hypothyroidism was 1.79 (95% CI 1.12–2.86, p = 0.015) and 1.91 (95% CI 1.03–3.53, p = 0.039), respectively. Conclusions: Both shorter and longer sleep durations were associated with an increase in the risk of subclinical thyroid dysfunction compared to the optimal sleep duration. This analysis of representative population data shows that sleep duration could intertwine with thyroid function resulting in increased risk of subclinical thyroid dysfunction.

scholarly journals To Evaluate the Relationship of Risk Factor Between Diabetes Mellitus and Thyroid Dysfunction (Thyrobetes)

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A421-A422
Author(s):  
Madhumati Varma
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Blood Glucose ◽  
Statistical Analysis ◽  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Thyroid Diseases ◽  
Free T4 ◽  
Increased Risk

Abstract Introduction: Type 2 diabetes and thyroid dysfunction are common endocrine disorder and shown mutually influence each other. As per the GOQii is a smart-tech enabled, integrated preventive healthcare platform headquartered in California, diabetes has increased from 7.1 to 12% this year. “The incidence of diabetes is highest among older adults at 23.81 per cent and seniors at 36.82 per cent.” As per the report, 13.5% of Indians have cholesterol issues. This past year, thyroid issues have increased from 6.8% to 10.7%. The thyrobetes illustrates relationship the between thyroid diseases and diabetes mellitus. Objective of the Study: This study’s objectives are as follows:To define the interrelation of factors responsible for the link between diabetes and thyroid disease development;To estimate thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, HbA1c, S. Insulin, ant-TPO antibodies, and USG neck for some thyroid patients;To describe each factor correlation between developing diabetes and thyroid diseases; andTo explain preventive measures for diabetes and thyroid diseases. Research problem of the studyThere are an increasing number of patients who experience diabetes mellitus, hypothyroidism and other types of thyroid dysfunction, but it is difficult to say which disease occurs first. This study seeks to identify the overlapping risk factor for diabetes and thyroid dysfunction. Review of literatureType 2 diabetes mellitus and thyroid dysfunction (TD) are two major public health endocrine problems. The status of iodine and thyroid with diabetic patients less studied. Materials and Methods: The study included 300 patients of diabetes and thyroid dysfunction. The questionnaires were used to record the findings on thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, and USG neck for some thyroid patients. Inclusion criteria:Sample size -300 patientsNo limit to the age groupNew or follow up cases of diabetic mellitus and thyroid diseaseExclusion criteria:Patients who had an acute illness that affects thyroid gland activityPatients who consumed drugs that could influence the thyroid hormone statusPatients who had feverData collection and tools for statistical analysisInstruments used for analyzing the samples that are availability at JNU hospital. Statistical Analysis: Statistical analysis will be performed by using SPSS software, student ‘t’ tests, and Pearson’s correlation; if the P* value &lt; 0.005, then it will considered to be statistically significant. Conclusion: Thyroid disease and diabetes are two intertwined conditions. If you have a thyroid condition, you’re at an increased risk for developing diabetes, and if you have diabetes, you’re at an increased risk for thyroid disease.

scholarly journals Thyroid and Pregnancy

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Violeta Mladenovic
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Gestational Hypertension ◽  
Current Data ◽  
Psychomotor Development ◽  
Hormonal Changes ◽  
Increased Risk ◽  
In Pregnancy

Abstract Hormonal changes and metabolic needs during pregnancy result in profound changes in biochemical parameters of thyroid function, especially if there is preexsisting autoimmune thyroid disease (AITD). Normal thyroid function is important in order to ensure the best outcome. Many changes in the functioning of the thyroid gland occur during pregnancy, and some diseases of thyroid gland can affect both mother and fetus. Hypothyroidism is the most serious disorder that occurs during pregnancy and can go unnoticed as a „non-specifi c” problem. Hypothyroidism arises from the reduced ability of the gland to adapt to the increased needs during pregnancy. Mild thyroid dysfunction of mothers in the fi rst trimester, which does not threaten during the pregnancy, can damage the psychomotor development of the child. Measurement of TSH is the most practical, simple and cost- eff ective screening test for thyroid dysfunction. It is necessary to apply the trimester-specifi c TSH reference values to correctly interpreted thyroid function during pregnancy. Th e presence of TPOAb is confi rmation of existence of AITD, and predicts increased risk of developing subclinical hypothyroidism (SH). Preconceptional education and adequate diagnosis and treatment of thyroid dysfunction in early pregnancy are of great importance, in order to prevent complications during pregnancy and off spring. Current data indicate an increase in pregnancy loss, gestational diabetes, gestational hypertension, pre-eclampsia and preterm delivery in women with SH in pregnancy. Th e control of thyroid disease reduce complications of pregnancy.

scholarly journals P82 NUn score validation at a district general hospital

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Positive Predictive Value ◽  
Anastomotic Leak ◽  
Confidence Intervals ◽  
Predictive Value ◽  
External Validation ◽  
District General Hospital ◽  
Anastomotic Leaks ◽  
Upper Gi ◽  
Increased Risk ◽  
Operative Complications

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of &gt; 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of &gt; 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

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.

scholarly journals Aspects of hormonal testing of thyroid function in patients with type 1 diabetes mellitus and chronic kidney disease

2021 ◽  
Vol 17 (1) ◽  
pp. 32-37
Author(s):  
A.G. Sazonova ◽  
T.V. Mokhort ◽  
N.V. Karalovich
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Thyroid Disorders ◽  
Free T4 ◽  
Free T3 ◽  
Peripheral Conversion

Background. Chronic kidney disease (CKD) is known to affect the thyroid axis, including thyroid hormone metabolism. It has been established that a decrease in renal function can be combined with changes in thyroid function. Thyroid dysfunction also has implications for renal blood flow, glomerular filtration rate (GFR), tubular transport, electrolyte homeostasis, and glomerular structure. The purpose of the study was to determine the features of thyroid function in patients with type 1 diabetes mellitus (T1DM) and CKD and develop recommendations for hormonal testing of thyroid pathology. Materials and methods. One hundred and twenty-one patients with T1DM with CKD were divided into 3 groups: group 1 — 78 individuals with GFR ≤ 60 ml/min/1.73 m2, group 2 — 20 people receiving renal replacement therapy (RRT), group 3 — 23 patients after renal transplantation (RT) with adequate graft function (the duration of the renal transplant is 3.62 (1.47; 4.28) years). Results. In T1DM and CKD group, the diagnostic value of thyroid-stimulating hormone is reduced due to the absence of differences in its values with a decrease in T4 and T3. Free T3 is the most sensitive marker of thyroid dysfunction in CKD. Thyroid disorders in T1D and CKD patients have a non-immune genesis. T1DM patients on RRT after hemodialysis (HD) procedure have an increase in total and free T4 and free T3, consequently, monitoring of thyroid disorders should be done immediately after the HD session. The restoration of normal values of peripheral conversion index and free T3 occurs within 1–2 years after TR, depending on the duration of RRT receiving. After more than 3 post-transplantation years, there is an increase in peripheral conversion index, which characterizes the imbalance of peripheral thyroid hormones towards a decrease in free T3 with relatively stable free T4. Conclusions. Thyroid dysfunctions are typical for all stages of the pathological process in CKD in patients with type 1 diabetes mellitus, including patients at the terminal stage and after successful kidney transplantation. The changes in thyroid hormones are associated with the RRT experience and can potentially affect the survival of patients.

scholarly journals Thyroxine, thyrotropin, and age in a euthyroid hospital patient population

1997 ◽  
Vol 43 (11) ◽  
pp. 2143-2148 ◽  
Author(s):  
Richard Davey
Keyword(s):  
Thyroid Disease ◽  
Clinical Condition ◽  
Patient Population ◽  
Reference Intervals ◽  
Hospital Patient ◽  
Free T4 ◽  
Diagnostic Algorithms ◽  
Age Related ◽  
Range Of Variation

Abstract The diagnosis of thyroid disease now often can be achieved reliably by measuring thyrotropin (TSH) alone. Thyroxine (T4), triiodothyronine, and other analytes are only needed if TSH and the accompanying clinical condition are discordant. We describe here work that confirms the age independence of TSH in both inpatient and outpatient euthyroid hospital populations between ages 20 and at least 80 years, and demonstrates that although free T4 does vary with age, the range of variation remains within the T4reference interval. On this basis, TSH-based thyroid diagnostic algorithms can be used reliably in adults without reference to age-related reference intervals.

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