Diagnosis and investigation in endocrine disorders

2018 ◽  
Author(s):  
John Newell-Price ◽  
Alia Munir ◽  
Miguel Debono
Keyword(s):  
Adrenal Glands ◽  
Clinical Problem ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Disorders ◽  
Dynamic Tests ◽  
Thyroid Status ◽  
Gadolinium Enhancement ◽  
Free Triiodothyronine ◽  
The Common

This chapter introduces the reader to some of the common investigations used in the diagnosis of endocrine disorders. Tests used to diagnose disorders of the thyroid, pituitary, and adrenal glands are discussed. Measurement of plasma levels of thyroid-stimulating hormone, free thyroxine, and free triiodothyronine define the thyroid status. Imaging of the thyroid is usually done in the first instance by ultrasonography. The investigation of pituitary disorders involves measurement of the levels of the multiple pituitary hormones, with basal and dynamic tests as appropriate to the clinical problem. Imaging of the pituitary is typically done using magnetic resonance with gadolinium enhancement. Adrenal disorders (which include hyperaldosteronism, Cushing’s syndrome, and adrenal insufficiency) can be investigated with a range of basal and dynamic tests.

scholarly journals Prevalence of Thyroid Dysfunction in Community of Duwakot, Bhaktapur

2017 ◽  
Vol 7 (2) ◽  
pp. 1184-1187
Author(s):  
Binita Pradhan ◽  
Sailesh Bahadur Pradhan
Keyword(s):  
Thyroid Dysfunction ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Endocrine Disorders ◽  
Free Triiodothyronine ◽  
Function Test ◽  
History Of ◽  
The Common ◽  
Primary Hyperthyroidism

Background: Thyroid dysfunction is one of the major public health problems in the Nepalese community and of the common endocrine disorders diagnosed in community primary health care centres.  The aim of this study is to analyze the prevalence of Thyroid dysfunction in Duwakot, NepalMaterials and Methods:  All the patients from Duwakot community who presented with the history of weight gain with tiredness and weight loss with palpitation were subjected to thyroid function test free triiodothyronine, free thyroxine and thyroid stimulating hormone. Results: Thyroid dysfunction was  found in 26% with M:F ratio of 1:5.  Subclinical hypothyroidism 62 (11.44%) was the most prevalent one followed by Primary hypothyroidism  48 (8.85%), primary hyperthyroidism 16 (2.95%) and subclinical hyperthyroidism 15 (2.76%).Conclusion: Thyroid dysfuntion has been observed despite of nationwide program regarding supplementation of micronutrient iodised salt.  Key words: Euthyroid, Hyperthroidism, Hypothyroidism, Iodine, Prevalence, Thyroid dysfunction

Cognitive Function, APOE Gene Polymorphisms, and Thyroid Status Associations in Postmenopausal Women in Poland

2016 ◽  
Vol 42 (3-4) ◽  
pp. 169-185 ◽  
Author(s):  
Iwona Bojar ◽  
Magdalena Stasiak ◽  
Anna Cyniak-Magierska ◽  
Dorota Raczkiewicz ◽  
Andrzej Lewiński
Keyword(s):  
Postmenopausal Women ◽  
Cognitive Functions ◽  
Vital Signs ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Chain Reactions ◽  
Polymerase Chain Reactions ◽  
Potential Association ◽  
Total Triiodothyronine

Background: The objective of the study was to analyze a potential association between cognitive functions and thyroid status in postmenopausal women with different polymorphisms of the apolipoprotein E gene (APOE). Methods: The examined population included 402 postmenopausal women from south-eastern Poland. The evaluation of cognitive functions was made with the use of the diagnostic Central Nervous System-Vital Signs equipment (Polish version). Multiplex polymerase chain reactions were performed to assess APOE polymorphisms. The thyroid hormone tests were assessed by an accredited laboratory. Results and Conclusion: Lower results of cognitive functions were associated with the presence of the ε4 APOE allele in postmenopausal women. The ε4 APOE polymorphism was associated with a higher concentration of thyroid-stimulating hormone and lower concentrations of free triiodothyronine and total triiodothyronine.

scholarly journals THYROID STATUS OF ATHLETES IN VARIOUS DISCIPLINES

2020 ◽  
Vol 20 (S1) ◽  
pp. 5-12
Author(s):  
R Radzhabkadiev ◽  
K Vybornaya ◽  
C Lavrinenko ◽  
A Vasilev
Keyword(s):  
Female Athletes ◽  
Elite Athletes ◽  
Reference Intervals ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Thyroid Peroxidase ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Male Athletes ◽  
Normal Limits

Aim. The article deals with the assessment of the thyroid status of athletes engaged in physical activity of varying intensity. Materials ant methods. 146 elite athletes involved in bobsleigh, biathlon, shooting and snowboarding participated in the study. We determined the serum concentration of thyroid stimulating hormone (TSH), free triiodothyronine (f.T3), free thyroxin (f.T4) and thyroid peroxidase antibodies (TPO-ab) with the COBAS e411 immunochemistry analyzer (Roche, Germany). The integral thyroid index ((f.T3 + f.T4)/TSH) was used for the assessment of the level of function of the thyroid proper. The conversion index of thyroxin to triiodothyronine (f.T4/ f.T3) was also studied. Results. 40 % of the bobsleigh athletes examined and 29 % of the snowboarders had high serum f.T3. The concentration of f.T4 in all examined athletes both male and female was within normal limits. Approximately 25 % of the male athletes examined had low II values. Among female athletes, 25 % of shooters and 33 % of bobsleigh athletes had low II values. In male biathletes and bobsleigh athletes, TPO-ab was 56 % higher than in shooters and snowboarders. In 43 % of bobsleigh athletes, 19 % of shooters, 10 % of biathletes and snowboarders, the content of TSH in males exceeded the reference intervals. Among females, TSH was high in 25 % of shooters and bobsleigh athletes. Conclusion. There were no statistically significant differences in the content of thyroid hormones in the compared sports groups, which can probably be explained by the activity of deiodinases at the local, intracellular level. At the same time, in a large number of respondents surveyed, the indicators of II and TPO-ab were outside the physiological norm.

scholarly journals Pattern of Thyroid Dysfunction in Women with Menstrual Disorders

2016 ◽  
Vol 2 (1) ◽  
pp. 3-6
Author(s):  
Saroj Khatiwada ◽  
Sharad Gautam ◽  
Rajendra KC ◽  
Shruti Singh ◽  
Shrijana Shrestha ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Endocrine Disorders ◽  
Thyroid Disorder ◽  
Menstrual Disorders ◽  
Free Triiodothyronine ◽  
Menstrual Disorder

BACKGROUNDThyroid disorders are among the commonest endocrine disorders worldwide. Thyroid dysfunction can interfere in multiple metabolic and physiological processes including menstrual cycle. This study was conducted to find pattern of thyroid dysfunction among women with menstrual disorders.METHODSTwo hundred thirty three females with menstrual disorders were screened for thyroid dysfunction. Thyroid function was assessed by measuring serum free triiodothyronine (T3), free thyroxine (T4) and thyroid stimulating hormone (TSH) levels.RESULTSThe mean age of study patients was 25.7±6.8 years. The most common menstrual disorder observed was irregular cycle (72.5%, n=169) followed by amenorrhea (21.9%, n=51) and menorrhagia (5.6%, n=13). Most of the patients were in the age group 15-24 years (51.1%, n=119), followed by 25-34 years (36.1%, n=84) and 35-45 years (12.9%, n=30). Mean level of free T3 and T4 was 2.91±1.05 pg/ml, 1.42±0.57 ng/dl respectively. Median TSH was 2.0 mIU/L (IQR, 1.0-4.0). Thyroid dysfunction was seen in 25.8% (n=60) women. Most common thyroid dysfunction was subclinical hypothyroidism (14.2%, n=33) followed by subclinical hyperthyroidism (6.9%, n=16), overt hyperthyroidism (3%, n=7) and overt hypothyroidism (1.7%, n=4).CONCLUSIONSThe study finds thyroid dysfunction especially subclinical hypothyroidism to be common among women with menstrual disorders. Thus, it may be beneficial to screen menstrual disorder patients for thyroid function especially to rule out thyroid disorder as potential etiological agent for menstrual disturbance.

High-dose biotin therapy leading to false biochemical endocrine profiles: validation of a simple method to overcome biotin interference

2017 ◽  
Vol 55 (6) ◽  
pp. 817-825 ◽  
Author(s):  
Marie-Liesse Piketty ◽  
Dominique Prie ◽  
Frederic Sedel ◽  
Delphine Bernard ◽  
Claude Hercend ◽  
...  
Keyword(s):  
Simple Procedure ◽  
Thyroid Stimulating Hormone ◽  
Alternative Methods ◽  
High Dose ◽  
Endocrine Disorders ◽  
Free Triiodothyronine ◽  
Simple Method ◽  
Number Of Patients ◽  
Two Samples ◽  
Stimulating Hormone

Abstract Background: High-dose biotin therapy is beneficial in progressive multiple sclerosis (MS) and is expected to be adopted by a large number of patients. Biotin therapy leads to analytical interference in many immunoassays that utilize streptavidin-biotin capture techniques, yielding skewed results that can mimic various endocrine disorders. We aimed at exploring this interference, to be able to remove biotin and avoid misleading results. Methods: We measured free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), parathyroid homrone (PTH), 25-hydroxyvitamin D (25OHD), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, C-peptide, cortisol (Roche Diagnostics assays), biotin and its main metabolites (liquid chromatography tandem mass spectrometry) in 23 plasmas from MS patients and healthy volunteers receiving high-dose biotin, and in 39 biotin-unsupplemented patients, before and after a simple procedure (designated N5) designed to remove biotin by means of streptavidin-coated microparticles. We also assayed fT4, TSH and PTH in the 23 high-biotin plasmas using assays not employing streptavidin-biotin binding. Results: The biotin concentration ranged from 31.7 to 1160 µg/L in the 23 high-biotin plasmas samples. After the N5 protocol, the biotin concentration was below the detection limit in all but two samples (8.3 and 27.6 μg/L). Most hormones results were abnormal, but normalized after N5. All results with the alternative methods were normal except two slight PTH elevations. In the 39 biotin-unsupplemented patients, the N5 protocol did not affect the results for any of the hormones, apart from an 8.4% decrease in PTH. Conclusions: We confirm that most streptavidin-biotin hormone immunoassays are affected by high biotin concentrations, leading to a risk of misdiagnosis. Our simple neutralization method efficiently suppresses biotin interference.

P5513Relation of thyroid hormones level to the extent of myocardial injury in patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Badran ◽  
G Soltan ◽  
A Belal
Keyword(s):  
Acute Coronary Syndrome ◽  
Thyroid Hormones ◽  
Myocardial Injury ◽  
Troponin I ◽  
Thyroid Stimulating Hormone ◽  
Gensini Score ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Coronary Syndrome ◽  
Significant Difference

Abstract Objective Previous studies have identified that abnormal thyroid hormonal status is associated with worse prognosis especially in coronary artery disease (CAD). The present study further explores whether thyroid hormones associated with size of myocardial injury and extent of CAD in patients with acute coronary syndrome (ACS). Methods In this study, we enrolled 120 consecutive patients (52% male, mean age 54.2±6.4 years) who were admitted to ICU with ACS and having coronary angiography. All patients underwent testing for thyroid function status [thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4)], cardiac troponin I (cTnI), cardiac enzymes, C-reactive protein (CRP). Risk profile, clinical characteristics and angiographic results (Gensini score) were also analyzed. Results 43.3% of patients presented with STEMI, 33.3% with NSTEMI and 23.3% unstable angina. CK-MB, troponin and CRP were significantly higher in STEMI compared with NSTEMI group (P<0.0001). Abnormal thyroid status was prevalent in 13.4% of total population; Low FT3 syndrome in 6.7%, subclinical hypothyroidism in 5% and clinical hypothyroidism in 1.7%. Lower thyroid hormone levels showed significantly lower HDL (P<0.02), higher triglyceride level& CRP and cTnI (P<0.007), higher rate of in hospital complications including recurrent angina, CHF and cardiogenic shock (P<0.001) and more severe CAD using Gensini score (P<0.0001). However, there was no significant difference in abnormal thyroid status between STEMI and NSTEMI. After adjusting for conventional risk factors, FT3 showed direct correlation to LV EF% (r=0.62, P<0.000) and inverse correlation to LV internal dimension (r=−0.57, P<0.0001), troponin (r=−0.27, P<0.03), CRP (r=−0.39, P<0.003), Gensini score (r=−0.48, P<0.0001) and number of in hospital complications (r=−0.62, P<0.0001). From a linear stepwise regression analysis low EF% (β: 0.032, 95% CI: 0.009–0.055, P<0.007) and presence of complications (β: 0.625, 95% CI: 1.194–0.056, P<0.03) are independent predictors of low FT3. Conclusions In ACS, the lower thyroid hormones levels are associated with larger myocardial injury, more severe CAD and higher rate of complications especially during their hospital course.

scholarly journals Folate cycle genetics, level of homocysteine, thyroid and pituitary hormones in the blood among the children from the districts bordering the Chornobyl exclusion zone

2021 ◽  
Vol 100 (3) ◽  
pp. 30-37
Author(s):  
Yu.I. Bandazhevskyi ◽  
◽  
N.F. Dubova ◽  
Keyword(s):  
Thyroid Hormones ◽  
Genetic System ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
The State ◽  
Blood Levels ◽  
Exclusion Zone ◽  
Free Triiodothyronine ◽  
Total Group ◽  
Folate Cycle

Objective: The aim of the study was to identify interrelations between the state of folate cycle genetic apparatus and blood levels of homocysteine, thyroid and adenohypophysis hormones in the blood among the children from Ivankivskyi and Poliskyi districts, Kyiv region, bordering the Chornobyl exclusion zone (СhEZ). Methods: Immunochemical, genetic, statistical ones. Results: We measured blood levels of homocysteine (Hcy), pituitary thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4) in 158 children from Poliskyi district and 178 children from Ivankivskyi district and assessed the state of a genetic system of the folate cycle (FC). The average age of the examined was (15.2 ± 0.9) years old (95% CI 15.0-15.4 years old). Taking into account the FC genotypes, genetic subgroups were formed, they were based on 100% representation of one specific genotype. The laboratory examination was carried out twice: in April and December 2015 (before and after the fires in the ChEZ). It was found out that in the total group of the children, as well as in most of analyzed genetic subgroups, the level of Hcy and thyroid hormones (TG) in the children from Ivankivskyi district was statistically significantly higher than in those from Poliskyi district. At the same time, a direct association between Hcy and TSH was observed in the total group, as well as in most of the genetic subgroups of children from Ivankivskyi district, and this ssociation was absent in the children from Poliskyi district. The blood level of Hcy both in the children from Poliskyi district and in the children from Ivankivskyi district was statistically significantly higher in the subgroup containing only homozygous variants of the T allele of the MTHFR:677 genetic polymorphism in comparison with the subgroups containing neutral C alleles of the same polymorphism. At the same time, there were no differences for TSH, T3 and T4. Сonclusions: The analysis enabled to establish a synchronous reaction of metabolic cycles ensuring the metabolism of Hcy and thyroid hormones in the adolescents, regardless of the FC genotypes. Correlation analysis, as well as the results of statistical analysis, indicate that an increase in the level of Hcy in the blood of children induced the synthesis of TSH and T3. The results show a close relationship between thyroid hormone genesis and the metabolism of methionine sulfur-containing amino acids and Hcy. A forest fire, containing long-lived radioactive elements, is the most likely reason for the increase of Hcy level and, as a result, the hormones of the pituitary-thyroid axis in the blood of the children living in the districts, bordering the ChEZ.

scholarly journals Thyroid Hormones—An Underestimated Player in Dilated Cardiomyopathy?

2021 ◽  
Vol 10 (16) ◽  
pp. 3618
Author(s):  
Karolina Zawadzka ◽  
Radosław Dziedzic ◽  
Andrzej Surdacki ◽  
Bernadeta Chyrchel
Keyword(s):  
Thyroid Hormones ◽  
Dilated Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Thyroid Stimulating Hormone ◽  
Left Ventricular ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Beneficial Effects ◽  
Low T3 ◽  
Altered Thyroid

Dilated cardiomyopathy (DCM) is the most prevalent cardiomyopathy, typified by left ventricular dilation and systolic dysfunction. Many patients with DCM have altered thyroid status, especially lower levels of free triiodothyronine (T3) and elevated levels of thyroid-stimulating hormone. Moreover, growing evidence indicates that even subtle changes in thyroid status (especially low T3) are linked with a worse long-term prognosis and a higher risk of mortality. Notably, recent discoveries have shown that not only local myocardial thyroid hormones (THs) bioavailability could be diminished due to impaired expression of the activating deiodinase, but virtually all genes involved in TH biosynthesis are also expressed in the myocardium of DCM patients. Importantly, some studies have suggested beneficial effects of TH therapy in patients suffering from DCM. Our aim was to discuss new insights into the association between TH status and prognosis in DCM, abnormal expression of genes involved in the myocardial synthesis of TH in DCM, and the potential for TH use in the future treatment of DCM.

Primary Amenorrhoea with Pituitary Dwarfism: A rare case report

2016 ◽  
Vol 2 (2) ◽  
pp. 145-147
Author(s):  
Siva S ◽  
Divya Gopineni ◽  
Shafi P ◽  
Chandra Sekhar
Keyword(s):  
Pituitary Gland ◽  
General Medicine ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Primary Amenorrhea ◽  
Pituitary Dwarfism ◽  
Primary Amenorrhoea ◽  
Sexual Characteristics ◽  
Loss Of Appetite ◽  
Secondary Sexual

Females with pituitary dwarfism and a multiple deficiency of pituitary hormones show ovarian dysfunction due to hypogonadotropism. Primary amenorrhea can be diagnosed if a patient has normal secondary sexual characteristics but no menarche by 16 years of age. A 16 year-old female patient admitted in general medicine department with chief complaints of shortness of breath on exertion since 15 days, swelling of both legs since 10 days, loss of weight since 5 months, loss of appetite since 3 months, history of pain during swallowing. Pelvis scan examination reveals that uterus measures 3.2×0.5×0.5cm; uterus is hypo plastic, ovaries not visualized. Patient parents reveled that from patient birth to 11years of age her growth and other developments were normal, after that her growth is stopped and no changes were observed in development since 5 years. Patient has hypothyroidism so pituitary gland make an important role to maintain hormone levels, pituitary gland produces thyroid stimulating hormone (TSH) which stimulates thyroid gland to produce thyroid hormones. Primary Amenorrhea, short stature and poorly developed secondary sexual characters which could have been contributed and should be subjected for karyotyping. This type of Pituitary Dwarfism is very difficult to manage.

The Invisible Evil Twin of an Adrenal Adenoma

2019 ◽  
Vol 4 (1) ◽  
pp. 58
Author(s):  
Aimi Fadilah Mohamad ◽  
Fatimah Zaherah Mohamed Shah ◽  
Nur Aisyah Zainordin ◽  
Ur 'Aini Eddy Warman ◽  
Nazimah Ab Mumin ◽  
...  
Keyword(s):  
Adrenal Glands ◽  
Adrenal Adenoma ◽  
Definitive Diagnosis ◽  
Dynamic Tests ◽  
Venous Sampling ◽  
Aldosterone Secretion ◽  
Aldosterone Level ◽  
Suppression Test ◽  
The Right ◽  
Secondary Causes

Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the presence of unilateral adrenal adenoma. It can be cured with surgical resection of the aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man with previous ischemic heart disease (IHD) who presented with resistant hypertension. Investigations for secondary causes of hypertension revealed an elevated aldosterone level and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling showed lateralization of aldosterone secretion towards the right. He subsequently underwent a laparoscopic right adrenalectomy which improved his BP control promptly. This case highlights the importance of recognizing the need to investigate for secondary causes of hypertension. It also underscores the importance of dynamic tests, which may not be easily accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective treatment.

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