scholarly journals An Adolescent with Transient Hyperthyroxinemia after Blunt Trauma to Head and Neck

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Michelle Romijn ◽  
Leo M. G. Geeraedts ◽  
Jonathan I. M. L. Verbeke ◽  
Martijn J. J. Finken
Keyword(s):  
Blunt Trauma ◽  
Reference Range ◽  
Thyroid Storm ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Neck Trauma ◽  
Free T4 ◽  
Blunt Neck Trauma ◽  
Patient Reported ◽  
Lower Neck

Background. Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions. This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

scholarly journals SAT-481 Pembrolizumab-Induced Thyroiditis with Negative Thyroid Peroxidase Antibody

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Branavan Ragunanthan ◽  
Omar Suheil Zmeili
Keyword(s):  
Locally Advanced ◽  
Smoking History ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Close Monitoring ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Thyroid Peroxidase Antibody ◽  
Negative Case ◽  
Patient Reported

Abstract Introduction: Immune checkpoint inhibitors (ICI) have reformed oncology treatment through its immunomodulatory effect on T-lymphocytes to target metastatic and locally advanced cancers but have been known to produce immune-related adverse events (irAEs). Thyroiditis is a well-documented endocrinopathy occurring in patients receiving ICI; however, a Thyroid Peroxidase Antibody (TPO Ab) negative case of ICI induced thyroiditis suggests that its pathogenesis is independent of antibody mediated thyroid destruction and more associated with an alternative immunoregulatory mechanism. Case Description: A 60-year-old Caucasian, male with a 37-year smoking history and lung adenocarcinoma with metastasis to the brain was referred to Endocrinology clinic for evaluation of suppressed thyroid stimulating hormone (TSH) level. Patient was treated with a four-month course of IV Pembrolizumab every three weeks. TSH was <0.015 (NL 0.465-4.680 IU/mL) four weeks before being seen at the office. TSH level was normal 2.359 before starting immunotherapy. Patient reported occasional anxiety and heat intolerance, but did not experience other hyperthyroid symptoms. Physical examination in office demonstrated no significant thyromegaly, nodules, or tenderness. Vital signs were normal. Thyroid function tests obtained during the office visit were consistent with subclinical hypothyroidism. TSH was mildly elevated 7.545 with normal Free T4 of 0.94 (NL 0.78 - 2.19 ng/dL) and normal Free T3 level of 3.61 (NL 2.77 - 5.27 pg/mL). TPO antibodies were negative. Four weeks later, patient developed overt hypothyroidism; TSH level was higher 12.437 with low Free T4 of 0.71. Patient was then complaining of fatigue and cold intolerance. A diagnosis of drug-induced thyroiditis from Pembrolizumab was made. The patient was prescribed levothyroxine 75 mcg daily and followed closely. Discussion: While literature exists documenting the rare side effect profile of ICI endocrinopathies, few studies illustrate the implications and correlations of TPO Ab negative findings in ICI induced thyroiditis. The role of thyroid autoantibodies in the presumed antibody mediated pathogenesis of thyroid abnormalities is unclear and warrants further longitudinal studies to determine its function in these patients. This case report hopes to both identify the deficit of pathophysiological knowledge contextualizing irAEs while encouraging current healthcare practitioners to continue close monitoring of patients receiving ICI.

Could Thyroid Disorders Be Better Understood and Dealt as a Thyroid Syndrome

2020 ◽  
Vol 5 (08) ◽  
pp. 326-328
Author(s):  
Dr. Sushma Patil ◽  
Dr. Vikrant Patil
Keyword(s):  
Reference Range ◽  
Well Being ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Serum Concentrations ◽  
Comorbid Conditions ◽  
Free T4 ◽  
Research Perspective ◽  
Wide Range

Thyroid disorders are common worldwide. Thyroid dysfunction, both hypo- and hyperthyroidism may increase the risk of cardiovascular disorders. Current thyroid function tests may have limitations since they only measure the total or free T4 and/or T3 and TSH serum concentrations in peripheral blood and not the effect of T4 or T3 serum on different specific target tissues. Several comorbid conditions can interfere with the absorption or increase the clearance of levothyroxine. Among patients treated with thyroid replacement, under or overmedicated may-be at risk for adverse health consequences. A wide range of drugs may interfere with levothyroxine absorption, metabolism, and action. Patients report a lack of well-being, despite reaching euthyroid reference range of TSH, with psychological distress. If we will consider Thyroid related conditions as a syndrome then research perspective at the pathophysiology, interrelation between symptoms and comorbidities will be much broader that can lead researchers to get insights of different pathways in which thyroid gland functioning can be perceived and dealt therapeutically. The deliberation of thyroid disorder as a syndrome can affluence our knowledge of correlating cofounders, action of thyroid hormones on target tissues, underlying cause and thyroid health.

Resolution of hyperthyroidism and thyroid antibodies following struma ovarii resection: an uncommon entity

2021 ◽  
Vol 14 (4) ◽  
pp. e240924
Author(s):  
Preethi Padmanaban ◽  
Eric Nylen ◽  
Kenneth Burman ◽  
Sabyasachi Sen
Keyword(s):  
Ovarian Cyst ◽  
Thyroid Tissue ◽  
Lower Abdominal Pain ◽  
Ovarian Tumour ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Surgical Removal ◽  
Thyroid Function Tests ◽  
Struma Ovarii ◽  
Free T4

We report a case of 34-year-old clinically asymptomatic woman who had been followed for 6 years for hyperthyroidism with thyroid stimulating hormone <0.006 uIU/mL, free T4 1.98 ng/mL, free T3 5.3 pg/mL, elevated thyroid stimulating immunoglobulin 1.70 IU/L, thyroid peroxidase antibody 38 IU/mL and thyroglobulin antibody 9.3 IU/mL. Radioiodine thyroid scan showed minimal uptake in both thyroid lobes (24-hour uptake was 0.3%). She subsequently underwent evaluation for lower abdominal pain and menstrual irregularities, which revealed a large left ovarian cyst measuring 15.9 cm × 10.8 cm × 13.2 cm and right-sided ovarian cyst measuring 2.7 cm × 3.3 cm × 3.5 cm. Laparoscopic bilateral ovarian cystectomy was performed and the final pathology revealed struma ovarii of the left ovarian cyst with the entire ovarian tumour made up of benign thyroid tissue. Thyroid function tests performed 3 months after surgical removal of struma ovarii showed euthyroidism. We present a rare case with detailed laboratory and immunological data before and after ovarian extirpation with resolution of hyperthyroidism associated with functional struma ovarii.

scholarly journals SAT-576 Possible Involvement of Thyroid Function in PCSK9 Inhibitor Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Masayasu Iwabuchi
Keyword(s):  
Thyroid Function ◽  
Ldl Cholesterol ◽  
Inhibitor Therapy ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Pcsk9 Inhibitors ◽  
Free T4 ◽  
Hyperthyroid Patient ◽  
Pcsk9 Inhibitor ◽  
The Impact

Abstract INTRODUCTION Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition is an effective strategy for lowering plasma LDL-cholesterol and enhancing the LDL-cholesterol lowering ability of statins. PCSK9, a serine protease that binds to the LDL receptor promoting its degradation, is an important regulator of LDL metabolism. In addition, LDL-cholesterol is also controlled by TSH and thyroid hormones via PCSK9. TSH has received increasing attention as being closely associated with increased LDL-cholesterol level and higher atherosclerotic risks. In vitro study, the effects of TSH on hepatic PCSK9 expression in HepG2 cells were reported (1). I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. This case highlights the involvement of thyroid function in PCSK9 Inhibitor therapy. CLINICAL CASE A 65-year-old man had a weight loss of 6 kg (13 lbs.) in 4 months, accompanied with fatigue. He had a past history of myocardial infarction and his LDL was 83 mg/dL by 2.5mg of rosuvastatin and heart rate was controlled by 10mg of carvedilol. Six months ago, he started a PCSK9 Inhibitor therapy with 140mg of evolocumab every 2 weeks for 6 weeks. He had no preceding viral illness and denied anterior neck pain or tenderness. His height was 1.53 m, weight 52.6 kg (115 lbs.), and body mass index (BMI) 22.46 kg/m2. His thyroid was not enlarged and non-tender without clear palpable thyroid nodules or neck lymph nodes. Hyperthyroidism was suspected and confirmed by thyroid function tests: TSH was less than 0.0005 μIU/mL (normal 0.35–4.94), and free T4 1.830 ng/dL (0.70–1.48). Graves’ disease was considered, and thyroid antibody tests performed. Thyroid peroxidase (TPO) antibody titer was less than 9 IU/mL (&lt;9), and TSI 141% (&lt;120%). To confirm the diagnosis of this hyperthyroid patient, Technetium-99m uptake and scan was done which showed uptake of 0.8% (0.5–7%). After careful observation for 2 months with 5mg of carvedilol, he turned asymptomatic and free T4 lowered to 1.480 ng/dL and TSH remained less than 0.0005 μIU/mL. CLINICAL LESSONS I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. There has been no report of hyperthyroidism induced by PCSK9 inhibitors. Immunological influence of anti-PCSK9 therapy on thyroid is unknown. In this case, the decrease of TSH due to hyperthyroidism was considered to reduce hepatic PCSK9 expression, leading to additive effect to PCSK9 inhibitor. PCSK9 inhibitors may modify the effects of hyperlipidemia treatment by causing changes in thyroid function. When using PCSK9 inhibitors, follow-up of thyroid function should be considered. This case highlights the involvement of thyroid function in PCSK9 inhibitor therapy. Reference (1) Gong, Y., Ma, Y., et al. Thyroid stimulating hormone exhibits the impact on LDLR/LDL-c via up-regulating hepatic PCSK9 expression. Metabolism. 2017;76;32–41

scholarly journals Does foetal gender influence maternal thyroid parameters in pregnancy?

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Georgiana Sitoris ◽  
Flora Veltri ◽  
Pierre Kleynen ◽  
Malika Ichiche ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Reference Range ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Free T4 ◽  
Cross Sectional ◽  
Maternal Thyroid ◽  
Serum Tsh ◽  
Tsh Levels

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.

scholarly journals Lyme Disease: An Autoimmunity-Based “Destructive Thyroiditis” or Just Another “Non-Thyroidal Illness”?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A940-A941
Author(s):  
Nyembezi Dhliwayo ◽  
Rana Wajahat ◽  
Andriy Havrylyan ◽  
Alvia Moid ◽  
Walid Khayr ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Thyroid Function ◽  
Paranoid Schizophrenia ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Radioiodine Uptake ◽  
Function Tests ◽  
Antigenic Properties

Abstract There is considerable evidence that some Borrelial (Lyme spirochetal) proteins share significant antigenic properties with several thyroid-related proteins (e.g. TSH receptor, thyroglobulin, thyroid peroxidase) and can induce thyroid autoimmunity, sometimes associated with Hashimoto’s thyroiditis and perhaps also a “destructive thyroiditis” such as “silent” thyroiditis or “Hashitoxicosis.” As an acute illness, Lyme disease may also constitute a “non-thyroidal illness” capable of perturbing thyroid function tests without causing thyroid dysfunction. We report a 22-year old woman admitted with an acute paranoid schizophrenia, thyroid function tests consistent with autoimmunity, transient thyrotoxicosis (tachycardia, lid-lag, brisk DTR’s) and a greatly reduced radioiodine uptake. The thyroid was not palpably enlarged, nodular or tender. On screening assay, reactivity was demonstrated to 4 of 13 Borrelial proteins. Anti-Lyme IgM but not IgG, antibodies, were positive. This was consistent with recent Lyme disease infection. Serum TSH (NL: 0.358-3.74 mcU/ml), Free T4 (NL: 0.76-1.46 ng/dl), and Free T3 (NL: 2.18-3.98 pg/ml) were, respectively: Day1: 0.087 mcU/ml (suppressed), 1.52 ng/dl (slightly elevated), 2.07 pg/ml (slightly reduced); Day2: 0.148 (suppressed), 1.18 (normal), no FT3; Day4: 0.827 (normal), no FT4 or FT3; Day5: 1.66 (normal), 0.89 (normal), 1.77 (low). Anti-Tg and Anti-Peroxidase antibodies were both moderately elevated. Thyroid Stimulating Immunoglobulins were not elevated. The radioactive iodine uptake on Day4 was 2.8% (NL: 15-30% at 24 hr). Thyroid ultrasonogram was normal. An attractive explanation is that Lyme disease triggered a “destructive thyroiditis,” perhaps but not necessarily mediated by thyroid autoimmunity. This would account for the brief interval of thyrotoxicosis accompanied by a very low radioiodine uptake. Alternatively, Lyme disease, as an acute process, would expectedly be capable of eliciting the thyroid function abnormalities of “non-thyroidal illnesses” in general, as would acute psychosis, well-known to often resemble Graves’ disease at admission.

scholarly journals SAT-501 Thyrotoxicosis with Pre-Ventricular Complexes Resulting in Thyroid Storm and Cardiac Arrest

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nam D Pham ◽  
Asra Kermani ◽  
Iram Hussain
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachyarrhythmia ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Primary Therapy ◽  
Free T4 ◽  
Cardiovascular Morbidity And Mortality

Abstract Background: Ventricular arrythmias are a rare, often lethal complication of thyrotoxicosis. We describe a patient with uncontrolled hyperthyroidism and pre-ventricular complexes (PVCs) who presented with ventricular tachyarrhythmia cardiac arrest and was successfully resuscitated. Clinical Case: A 64 year old woman was diagnosed with thyrotoxicosis secondary to Graves’ disease [TSH &lt; 0.01 (0.40 – 4.5 mcIU/mL) and free T4 of 2.8 (0.8 – 1.8 ng/dL)] 1 year ago in the setting of a 6 month history of weight loss, palpitations, tremors, and a large goiter. She was started on methimazole and metoprolol XL and was intermittently compliant. During follow-up evaluation she complained of light headedness, developed agonal breathing, and became pulseless. Chest compressions were initiated. She regained spontaneous rhythm after receiving 1 shock with an Automated Electronic Defibrillator (AED). She was transferred to the Emergency Room (ER) and intubated for altered mental status. Emergent CT Angiography and bedside echocardiogram showed no pulmonary embolism and normal biventricular function. Troponin T high sensitivity assay was negative and electrolytes were normal. Repeat thyroid function tests showed TSH &lt;0.01, Free T4 of 5.6 and free T3 of 14.5 (2.0 – 4.4 pg/mL). She was started on propylthiouracil, glucocorticoids, potassium iodide and treated for thyroid storm. EKG in the ER showed sinus tachycardia with no ischemic ST changes but PVCs and fusion complexes were noted. These were also present on EKG at the time of her initial diagnosis of hyperthyroidism. EKGs prior to the diagnosis of hyperthyroidism showed normal sinus rhythm. Cardiac arrest was attributed to thyrotoxicosis as there was no infectious nidus and no evidence of structural cardiac disease. The AED rhythm strips could not be obtained but she was presumed to have an appropriately shockable ventricular tachyarrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Her thyroid hormone levels declined appropriately over the course of the hospitalization and PVCs were no longer noted on telemetry and daily EKGs. She was discharged on methimazole which she took consistently. She underwent RAI ablation several months after discharge. Conclusion: Failure to achieve rapid euthyroidism in thyrotoxicosis is associated with increased cardiovascular morbidity and mortality (1). Most arrythmias associated with thyrotoxicosis are supraventricular and ventricular arrythmias are a rare sequela (2). This is one of the few cases reported of antecedent PVCs being noted on EKG. The PVCs resolved with anti-thyroid medications. References: (1) Okosieme, O. E., et al. (2019) Primary therapy of Graves’ disease and cardiovascular morbidity and mortality: a linked-record cohort study. Lancet Diabetes Endocrinol 7, 278-287. (2) Marrakchi, S., et al. (2015) Arrhythmia and thyroid dysfunction. Herz 40 Suppl 2, 101-109.

scholarly journals Preeclampsia and Thyrotoxicosis: A Case of Impending Storm

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A949-A949
Author(s):  
Marianne K Wilson ◽  
Kathie L Hermayer
Keyword(s):  
Reference Range ◽  
Complete Blood Count ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free T4 ◽  
Antihypertensive Medications ◽  
Free T3 ◽  
Emergency Cesarean ◽  
Pulmonary Angiogram ◽  
New Onset

Abstract Introduction: Preeclampsia is a complication of pregnancy defined by new onset hypertension after 20 weeks with proteinuria or new onset thrombocytopenia, renal or liver dysfunction, pulmonary edema or cerebral/visual symptoms. Hyperthyroidism in pregnancy is usually due to Graves’ disease, and if poorly controlled can increase the risk of preeclampsia and thyroid storm. In this case report we present a case of preeclampsia with impending thyroid storm treated successfully with medical therapy, delivery, and plasmapheresis. Case Description: A 40-year-old female who is 31 6/7 weeks pregnant presents with cough and dyspnea. She has no known thyroid disease. Her systolic blood pressure at presentation is &gt;160 mmHg. She is diagnosed with preeclampsia based on elevated spot protein/creatinine ratio (1.4 g/g) and persistent hypertension. A brain natriuretic peptide is elevated to 847 (reference range &lt;= 100 pg/ml). Complete blood count and comprehensive metabolic panel are normal, with exception of mild alkaline phosphatase elevation. A CT pulmonary angiogram is negative for pulmonary embolism but shows bilateral pleural effusions. She is started on intravenous antihypertensive medications and furosemide. Due to persistent tachycardia, thyroid function is checked and is notable for a thyroid stimulating hormone level of 0.05 (non-pregnant reference range 0.35 – 4.94 mIU/L), an elevated free T3 of 13.7 (non-pregnancy reference range 1.7 – 3.7 pg/ml), and an elevated free T4 &gt; 4 (non-pregnancy reference range 0.70-1.48 ng/dL). She is started on therapy for impending thyroid storm, including maximum doses of propranolol, propylthiouracil, hydrocortisone and saturated solution of potassium iodide. Her thyroid stimulating immunoglobulin is &gt; 500 (reference range &lt;= 122%) and TSH receptor antibody is &gt; 40 (reference range &lt;= 1.75 iU/L) leading to a new diagnosis of Graves’ disease. On hospital day three, she develops altered mental status and fetal bradycardia, warranting emergency cesarean section. On hospital day five she develops worsening confusion, abnormal liver function tests and increasing levels of free T4 and free T3. At this time, she is started on plasmapheresis therapy. Free T4 and free T3 values normalize after two rounds. Her medications are slowly weaned, and she is discharged from the hospital on methimazole 20 mg daily. Her baby is discharged after a brief hospital stay for sequela of prematurity. Discussion: While far less common than preeclampsia, thyrotoxicosis may present with similar symptomatology and can pose significant morbidity and mortality risk for pregnant patients. However, with prompt diagnosis and appropriate therapies, the disorder can be treated successfully and without lasting harm to the mother or fetus. For these reasons, it should remain on the differential for patients with symptoms of preeclampsia, and thyroid studies should be considered.

scholarly journals Tiroiditis por trauma en cuello luego de intento de suicidio. Reporte de caso y revisión de la literatura

2017 ◽  
Vol 2 (3) ◽  
pp. 72-75
Author(s):  
Carlos Alfonso Builes Barrera ◽  
Juan David Gómez ◽  
Alejandro Román González
Keyword(s):  
Hormone Level ◽  
Clinical Manifestations ◽  
Orotracheal Intubation ◽  
Psychotic Symptoms ◽  
Thyroid Storm ◽  
Inflammatory Disorder ◽  
Neck Trauma ◽  
Free T4 ◽  
Normal Value ◽  
Commit Suicide

La tiroiditis es un fenómeno inflamatorio de la tiroides, de causas diversas, incluyendo raramente traumas de la región anterior del cuello. Se presenta el caso de un paciente con depresión mayor de curso crónico, con síntomas sicóticos y farmacodependencia, quien intenta suicidarse mediante ahorcamiento. Ingresa con un Glasgow de 3/15, por lo cual requiere intubación orotraqueal inmediata, posterior traslado a unidad de cuidados intensivos y ventilación mecánica durante diez días. Durante este periodo desarrolla taquicardia persistente, diaforesis y alteraciones del sensorio, se encontró TSH en 0,00 (0,4- 4 mUI/ml); una T3 total en 2,42, (0,8-2,0 ng/ml) y T4 libre >6 (0,93-1,70 ng/dL), la gammagrafía de tiroides con tecnecio 99 mostró bloqueo de la captación. Se sospechó tormenta tiroidea y recibió propranolol 80 mg vía oral cada 8 horas en forma continua e hidrocortisona 50 mg intravenosa cada 8 horas durante5 días. Los controles, dos semanas después, muestran TSH en 0,00 (0,4-4 uUI/ml) y una T4 libre de 1,78 (0,93-1,70 ng/dl) y cuatro días después normalización de la T4 libre (1,45 ng/dl), acompañado de mejoría clínica de los síntomas adrenérgicos.Se presenta el caso de un paciente con tiroiditis postrauma, entidad que debe ser sospechada en pacientes con trauma en el cuello que presenten síntomas de tirotoxicosis.AbstractThyroiditis is an inflammatory disorder of the thyroid, which stems from a variety of causes including in some rare cases trauma to the neck. We present the case of a male patient with chronic depression associated with psychotic symptoms and drug abuse that tried to commit suicide through hanging. The patient had a Glasgow Coma Scale 3/15 requiring orotracheal intubation, a stay in the intensive care unit and mechanical ventilation for 10 days. While in the ICU the patient developed persistent tachycardia, diaphoresis and changes in mental status. A suppressed TSH was found with a level of 0,00 (0,4-4 uUI/ml) and high thyroid hormone level (total T 2,42, (normal value 0,8-2,0 ng/ml) and free T >6 (normal value 0,93-1,70 ng/dL). A technetium-99 thyroid scintygraphy showed blocked uptake. With those findings, a thyroid storm was suspected and management was begun with propranolol 80 mg per mouth every 8 hours and IV hydrocortisone 50 mg every 8 hours for 5 days. Two weeks later, the TSH was 0,00 (0,4-4 uUI/ ml) and the free T4 was 1,78 (normal value 0,93-1,70 ng/dl). Four days later, the free T4 concentration was normal (1,45 ng/dl) with a clinical improvement of the adrenergic symptoms. Inconclusion, thyroiditis should be suspected in patients with neck trauma with compatible clinical manifestations.

scholarly journals Normal Reference Range for Serum TSH, Free T4, Total T4, and Total T3 on Roche® Platforms in Basrah, Iraq

2021 ◽  
pp. 147-155
Author(s):  
Nassar Taha Alibrahim ◽  
Samih Abed Odhaib ◽  
Ali Hussain Alhamza ◽  
Ammar Mohammed Saeed Almomin ◽  
Ibrahim Abbood Zaboon ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Reference Range ◽  
Cross Sectional Study ◽  
Reference Intervals ◽  
Specific Reference ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Cross Sectional ◽  
Normal Reference Range ◽  
Tertiary Center

Background: Thyroid function tests are mandatory in clinical practice because symptoms and signs are not reliable to discriminate between various types of thyroid disease. Aim: The aim of this study was to determine assay-specific reference range for serum free T4, total T4, total T3 and TSH among healthy non-pregnant adult cohort for Roche® platforms in Basrah (Southern Iraq) from single laboratory in a tertiary center using indirect approach of the available data. Methods: A Cross sectional study for non-pregnant adults 19 years and above. Sera were analyzed by using cobs e411 for thyroid functions tests. Results: Total enrolled persons were 10,078. The 95% reference intervals for TSH were 0.20-6.50 μIU/mL, which increased with age though not linear, for free T4 were 0.8-1.70 ng/dL, for total T4 were 3.78-15.33 μg/dL, and for total T3 were 0.80-2.50 ng/mL. Colcusion: Cobs e411(Roche® analytical platform) analyzer reference range for thyroid function  cannot be applied for Iraqi population .

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