scholarly journals Thyroid detectives: on the trail of Munchausen’s syndrome

2019 ◽  
Vol 12 (4) ◽  
pp. e226087 ◽  
Author(s):  
Partha Pratim Chakraborty ◽  
Soumik Goswami ◽  
Rana Bhattacharjee ◽  
Subhankar Chowdhury
Keyword(s):  
Thyroid Hormones ◽  
Clinical Features ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Psychological Disorders ◽  
Confounding Factors ◽  
Middle Aged ◽  
Considerable Effort ◽  
Munchausen's Syndrome ◽  
Munchausen’S Syndrome

Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective’s cap to get to the root of the problem. We discuss a patient whose diagnosis was reached with ingenuity after considerable effort from four endocrinologists having a total experience of 37 years in their field.

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 The kidney, subclinical thyroid disease and cardiovascular outcomes in older patients

2020 ◽  
Vol 9 (1) ◽  
pp. 55-62
Author(s):  
L E Zijlstra ◽  
D M van Velzen ◽  
S Simsek ◽  
S P Mooijaart ◽  
M van Buren ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Thyroid Hormones ◽  
Kidney Function ◽  
Thyroid Function ◽  
Primary Endpoint ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Older Patients ◽  
Thyroid Dysfunction ◽  
Subclinical Hyperthyroidism

Objective Thyroid hormones have been implicated to play a role in cardiovascular disease, along with studies linking thyroid hormone to kidney function. The aim of this study is to investigate whether kidney function modifies the association of subclinical thyroid dysfunction and the risk of cardiovascular outcomes. Methods In total, 5804 patients were included in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). For the current analysis, 426 were excluded because of overt thyroid disease at baseline or 6 months, 266 because of inconsistent thyroid function at baseline and 6 months, 294 because of medication use that could influence thyroid function, and 16 because of missing kidney or thyroid values. Participants with normal fT4 were classified, based on TSH both at inclusion and 6 months, into three groups: subclinical hypothyroidism (TSH >4.5 mIU/L); euthyroidism (TSH = 0.45–4.5 mIU/L); and subclinical hyperthyroidism (TSH <0.45 mIU/L). Strata of kidney function were made based on estimated glomerular filtration rate into three clinically relevant groups: <45, 45–60, and >60 mL/min/1.73 m2. The primary endpoint consists of death from coronary heart disease, non-fatal myocardial infarction and (non)fatal stroke. Results Mean age was 75.3 years, and 49.0% patients were male. Mean follow-up was 3.2 years. Of all participants, 109 subjects (2.2%) had subclinical hypothyroidism, 4573 (94.0%) had euthyroidism, and 182 (3.7%) subclinical hyperthyroidism. For patients with subclinical hypothyroidism, euthyroidism, and subclinical hyperthyroidism, primary outcome occurred in 9 (8.3%), 712 (15.6%), and 23 (12.6%) patients, respectively. No statistically significant relationship was found between subclinical thyroid dysfunction and primary endpoint with adjusted hazard ratios of 0.51 (0.24–1.07) comparing subclinical hyperthyroidism and 0.90 (0.58–1.39) comparing subclinical hypothyroidism with euthyroidism. Neither was this relationship present in any of the strata of kidney function, nor did kidney function interact with subclinical thyroid dysfunction in the association with primary endpoint (P interaction = 0.602 for subclinical hyperthyroidism and 0.388 for subclinical hypothyroidism). Conclusions In this secondary analysis from PROSPER, we found no evidence that the potential association between thyroid hormones and cardiovascular disease is modified by kidney function in older patients with subclinical thyroid dysfunction.

Abstract P409: Thyroid Function and Cognitive Decline in Middle-aged and Older Adults: The Elsa-Brasil Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Claudia Szlejf ◽  
Claudia K Suemoto ◽  
Carolina Janovsky ◽  
Paulo A LOTUFO ◽  
Isabela M Bensenor
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Word Recall ◽  
Adult Health ◽  
Middle Aged ◽  
Second Wave

Introduction: The role of subtle thyroid alterations on cognitive decline is controversial. We aimed to investigate the association of thyrotropin (TSH) and free thyroxine (FT4) with baseline performance on cognitive tests and with cognitive decline in middle-aged and older adults without overt thyroid disease. Methods: This is a longitudinal analysis of the Brazilian Longitudinal Study of Adult Health baseline and second wave, after 4 years of follow-up. We included participants aged ≥ 55 years without over thyroid disease, prevalent stroke and use of drugs that could affect thyroid function and cognition. TSH and FT4 were assessed at baseline. Cognition was evaluated at baseline and at the second wave using delayed word recall test (DWR), semantic verbal fluency test (SVF), and trail making test version B (TMT). Baseline and longitudinal associations of TSH tertiles and FT4 tertiles with cognitive performance were investigated with generalized estimating equations, adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors, and depression. Results: The baseline mean age of the 4675 participants was 62.4 ± 5.8 years, 52.3% women (2445 out of 4675). At baseline, TSH levels were not associated with cognitive performance in any test, although the highest FT4 tertile was associated with poorer performance on DWR (β = -0.087, 95% CI = -0.155; -0.019) and SVF (β = -0.076, 95%CI = -0.143; -0.010) after adjustment. Additionally, the lowest FT4 tertile was associated with poorer performance on SVF (β = -0.090, 95%CI = -0.152; -0.028). Cognitive performance did not change after 4 years of follow-up and there was no effect of time on the association of thyroid hormone levels with cognitive performance. Conclusion: At baseline, FT4 levels were associated with worse cognitive performance in a relatively young sample. Neither baseline FT4 nor TSH were associated with cognitive decline after 4 years.

THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

2018 ◽  
Vol 22 (4) ◽  
pp. 40-49 ◽  
Author(s):  
A. R. Volkova ◽  
O. D. Dygun ◽  
B. G. Lukichev ◽  
S. V. Dora ◽  
O. V. Galkina
Keyword(s):  
Chronic Kidney Disease ◽  
Thyroid Gland ◽  
Kidney Disease ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
The Body ◽  
Type I ◽  
Low T3 ◽  
Iodine Excretion

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney  disease is the higher incidence of various thyroid function  disturbances, especially hypothyroidism. It is known that in patients  with chronic kidney disease (CKD) iodine excretion from the body is  violated, since normally 90% of iodine is excreted in urine.  Accumulation of high concentrations of inorganic iodine leads to the  formation of the Wolf-Chaikoff effect: suppression of iodine  organization in the thyroid gland and disruption of the thyroid  hormones synthesis. Peripheral metabolism of thyroid hormones is  also disturbed, namely, deiodinase type I activity is suppressed and  peripheral conversion of T4 into T3 is inhibited (so-called low T3  syndrome). Therefore, patients with CKD are often diagnosed with  hypothyroidism, and the origin of hypothyroidism is not always  associated with the outcome of autoimmune thyroiditis. The article  presents an overview of a large number of population studies of  thyroid gland dysfunction in patients with CKD, as well as  experimental data specifying the pathogenetic mechanisms of  thyroid dysfunction in patients with CKD. Therapeutic tactics are still  not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

Munchausen's syndrome: Manifestation as renal colic

Urology ◽  
1993 ◽  
Vol 42 (3) ◽  
pp. 347-350 ◽  
Author(s):  
Gordon R. Gluckman ◽  
Marshall Stoller
Keyword(s):  
Renal Colic ◽  
Munchausen's Syndrome ◽  
Munchausen’S Syndrome

Spitting in the ear: a falsified disease using video evidence

2005 ◽  
Vol 119 (11) ◽  
pp. 926-927 ◽  
Author(s):  
A M D Bennett ◽  
S M V Bennett ◽  
P R Prinsley ◽  
M Wickstead
Keyword(s):  
Case Report ◽  
Medical Profession ◽  
Digital Photography ◽  
First Case ◽  
Munchausen's Syndrome ◽  
Munchausen’S Syndrome

We present the case of Munchausen’s syndrome by proxy (MSBP) in which the mother spat and placed blood in her child’s ear, and videoed the result, in order to gain the attentions of the medical profession. This is the first case report of this kind and may represent a disturbing trend in the use of digital photography and video to support factitious illnesses.

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