scholarly journals SAT-336 An Unusual Case of Symptomatic Hypercalcemia from Graves’ Disease in a Young Filipino Female

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Diana Colleen Mandocdoc Dimayuga ◽  
Michael Lim Villa
Keyword(s):  
Primary Hyperparathyroidism ◽  
Thyroid Function ◽  
Complete Blood Count ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Medication History ◽  
Free T4 ◽  
Healthy Family

Abstract Hypercalcemia in hyperthyroidism is usually asymptomatic, and related to a concurrent primary hyperparathyroidism. In this report, we describe a case of symptomatic hypercalcemia secondary to Graves’ disease alone. Case Report. A 24-year-old Filipino female presented to the emergency department with generalized weakness, vomiting and abdominal pain. No other symptoms were noted. She was otherwise previously healthy. Family history was unremarkable. During physical exam, she was noted to have a non tender palpable thyroid gland without bruit. Her ECG showed sinus tachycardia. The complete blood count and electrolytes were normal however, ionized calcium was high at 1.6mmol/L (NV 1–1.3). Renal function was normal. Hydration with saline and Furosemide 20mg once daily was started though calcium levels remained elevated. Other causes of hypercalcemia were excluded as PTH was appropriate suppressed (8.8ng/L; NV 14–72), vitamin D was also suppressed (15.29nmol/L; NV >30). CT scan of chest and abdomen and bone scan did not point to any underlying malignancy nor metabolic bone disease. Medication history was also unremarkable. She was hyperthyroid with a suppressed thyroid stimulating hormone level of 0.004pmol/L (NV 0.55–4.78), free T3 of >20pmol/L (NV 2.3–4.2), free T4 of 8.4pmol/L (NV 0.89–1.76). Thyroid receptor antibody levels were raised at 41.07kU/L (NV <1) supporting the diagnosis of Graves’disease. She was started on propylthiouracil 50mg four times daily, along with propranolol 40mg three times daily. She was subsequently seen after two weeks with normal repeat calcium level and thyroid function test. Conclusion. This report aims to highlight that thyroid disease should always be considered as a cause of hypercalcemia. A concomitant primary hyperparathyroidism should also be evaluated. The definitive treatment for the hypercalcemia is correction of thyroid function.

scholarly journals MON-470 Biotin Masquerading as Subclinical Hyperthyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Anita Eapen ◽  
Hooman Oktaei
Keyword(s):  
Thyroid Function ◽  
Clinical Endocrinology ◽  
Thyroid Function Test ◽  
Graves Disease ◽  
Endocrine Disorders ◽  
Thyroid Function Tests ◽  
Medication History ◽  
Free T4 ◽  
Function Tests ◽  
History Of

Abstract Introduction: Thyroid conditions are among the most common endocrine disorders. Diagnosis is dependent on interpretation of laboratory tests. The challenge comes when the clinical picture is discordant with laboratory results. Case Report: Patient is a 53-year-old male with history of cardiac transplantation, type 2 diabetes mellitus, history of amiodarone-induced hyperthyroidism. He was noted to have labs indicative of hyperthyroidism, while taking amiodarone, in 2016-2017, which was treated with methimazole. He was then noted to have abnormal thyroid function tests with low TSH to 0.3 IU/L, normal T3 and normal T4 levels. Thyroid stimulating immunoglobulin had been checked multiple times, and was normal, which is inconsistent with Graves’ disease. Prior radioactive iodine uptake scan, while off amiodarone, was noted to be normal. He was also scheduled for thyroidectomy at another hospital, which was cancelled due to normalization of thyroid function tests. Consultation was received for suppressed TSH to 0.323 IU/L, without symptoms of hyperthyroidism. He had been taking biotin during this time, which he subsequently stopped taking. Repeat TSH following discontinuation of biotin, was within normal range, most recent TSH 2.48 IU/L, free T4 1.03 ng/dL, free T3 2.7 pg/mL. Discussion: Thyroid function tests are commonly ordered. Interpretation of these tests relies on the provider’s understanding of thyroid physiology in addition to interferences with medications and other conditions. High doses of biotin, which people take as supplements for multiple sclerosis, or metabolic disorders, or for healthy nails and hair, can cause thyroid function test abnormalities. Streptavidin and biotin are used in some immunoassay platforms to capture antigens (TSH, free T4) or antibodies. High levels of serum biotin can inhibit the formation of T4 antibody complex, which results in a falsely high free T4 result. Conclusion: Thyroid Function tests should be interpreted very cautiously, especially in the setting of discordant clinical findings. Prior to ordering these tests, should attempt to obtain a detailed history of medications including over-the-counter supplements, which are commonly not reported during medication history. References:Elston, Marianne S., et al. “Factitious Graves’ Disease Due to Biotin Immunoassay Interference—A Case and Review of the Literature.” The Journal of Clinical Endocrinology & Metabolism, vol. 101, no. 9, 30 June 2016, pp. 3251-3255., doi:10.1210/jc.2016-1971. Koehler, Viktoria F., et al. “Fake News? Biotin Interference in Thyroid Immunoassays.” Clinica Chimica Acta, vol. 484, 30 May 2018, pp. 320-322., doi:10.1016/j.cca.2018.05.053. Soh, Shui-Boon, and Tar-Choon Aw. “Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility.” Annals of Laboratory Medicine, vol. 39, no. 1, 13 Jan. 2019, pp. 3-14., doi:10.3343/alm.2019.39.1.3.

scholarly journals A comparative study on outcomes of preprandial versus postprandial thyroid function test

2019 ◽  
Vol 5 (6) ◽  
pp. 1662
Author(s):  
Vasim Ismail Patel ◽  
Akshay B. K.
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Clinical Symptoms ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Gland ◽  
Thyroid Function Tests ◽  
Sample Collection ◽  
Free T4 ◽  
Group 2

<p class="abstract"><strong>Background:</strong> The thyroid is an<strong> </strong>endocrine gland. It secretes two hormones thyroxine (T<sub>4</sub>), triiodothyronine (T<sub>3</sub>). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.</p><p class="abstract"><strong>Methods:</strong> The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially.  </p><p class="abstract"><strong>Results:</strong> TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.</p><p class="abstract"><strong>Conclusions:</strong> There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.</p>

Thyroid function test changes with adjuvant tamoxifen therapy in postmenopausal women with breast cancer.

1995 ◽  
Vol 13 (4) ◽  
pp. 854-857 ◽  
Author(s):  
C C Mamby ◽  
R R Love ◽  
K E Lee
Keyword(s):  
Postmenopausal Women ◽  
Thyroid Function ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Tamoxifen Therapy ◽  
Controlled Clinical Trial ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Double Blind ◽  
Before And After

PURPOSE While tamoxifen has been shown to alter concentration of many hormones and their binding globulins, there have been conflicting results regarding its effects on thyroid function tests. We sought to clarify these effects by studying subjects in a controlled clinical trial. PATIENTS AND METHODS We evaluated a subset of postmenopausal women who had participated in a longitudinal, double-blind, randomized, placebo-controlled toxicity study of tamoxifen 10 mg orally, twice daily. There were 14 subjects in both the tamoxifen and placebo groups. Measurement of thyroid-binding globulin (TBG), thyroxine uptake (T-Uptake), thyroxine (T4), and thyroid-stimulating hormone (TSH), and an indirect estimate of the free T4 index (FTI), were made for each subject before and after 3 months of treatment. RESULTS For T-Uptake, T4, and TBG, there were significant increases in the mean change from baseline to 3 months in the tamoxifen group compared with the placebo group (P = .02, .0001, and .003, respectively), while there were no significant changes in the measured TSH and in the calculated FTI. CONCLUSION We conclude that tamoxifen therapy in postmenopausal women results in increased TBG, with secondary increases in measured T-Uptake and T4 following. However, TSH and FTI levels are unchanged, and treated women remain eumetabolic.

Neonatal thyroid storm: the importance of an accurate antenatal history

2021 ◽  
Vol 14 (1) ◽  
pp. e239278
Author(s):  
Sean Tamgumus ◽  
Elisabeth Lauesen ◽  
Michael A Boyle
Keyword(s):  
Thyroid Function ◽  
Neonatal Intensive Care ◽  
Thyroid Function Test ◽  
Term Infant ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free T4 ◽  
Post Surgery ◽  
History Of ◽  
Near Term

A near-term infant became unwell immediately after birth with cardiorespiratory compromise—persistent tachycardia, pulmonary hypertension and reduced cardiac function. There had been no concerns during the pregnancy and the obstetrical and maternal medical history was unremarkable apart from hypothyroidism. A thyroid function test on admission revealed a significantly elevated free T4 and a diagnosis of a thyroid storm was made. On questioning it became apparent that she had Graves’ disease after her last pregnancy and was rendered hypothyroid post surgery, she was not aware of the relevance of this at her booking visit. This case highlights the importance of monitoring of women who have a history of a diagnosis of Graves’ disease, regardless of thyroid function status, to allow for appropriate antenatal monitoring, preparedness of the NICU (neonatal intensive care unit) team and correct follow-up of the neonate. It also demonstrates the importance of ensuring a patient is properly educated about their condition.

scholarly journals A study on thyroid dysfunction in acne vulgaris

2019 ◽  
Vol 5 (4) ◽  
pp. 736
Author(s):  
Shreya Srinivasan ◽  
Jayakar Thomas
Keyword(s):  
Thyroid Function ◽  
Acne Vulgaris ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Antibodies ◽  
Male Population ◽  
Free T4 ◽  
Free T3 ◽  
Function Test

<p class="abstract"><strong>Background:</strong> This study was done to evaluate the role of thyroid function i.e., free T3, free T4 and thyroid stimulating hormone (TSH) in relation to the occurrence of acne vulgaris.</p><p class="abstract"><strong>Methods:</strong> A total of 50 patients clinically diagnosed with acne vulgaris were subjected to a thyroid function test and results were evaluated.<strong></strong></p><p class="abstract"><strong>Results:</strong> While all the 50 patients had normal free T3 and free T4 levels, 9 (18%) of the 50 patients displayed an elevated TSH level. Gender distribution among the patients with elevated TSH learned more towards the male population with 6 patients while there were only 3 female patients with elevated TSH.</p><p><strong>Conclusions:</strong> There have been few studies regarding the role of thyroid function in acne vulgaris in relation to free T3, free T4 and TSH, though the presence of thyroid antibodies have been highlighted in quite a few studies. This study has shown the insignificance of thyroid function in acne vulgaris thus accentuating the negative.</p>

scholarly journals Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

2017 ◽  
Vol 6 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Jan Calissendorff ◽  
Henrik Falhammar
Keyword(s):  
Heart Rate ◽  
Thyroid Hormone ◽  
Side Effects ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Adherence To Medication ◽  
Thyroid Hormone Levels

Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

scholarly journals The Characteristics of Children with Abnormalities Detected in Thyroid Function Tests, and Distribution of Diagnoses

2020 ◽  
Author(s):  
Elif Çelik ◽  
Ayşe Anık
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Correct Diagnosis ◽  
Thyroid Function Test ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Test Results ◽  
Function Tests ◽  
Function Test

INTRODUCTION: Thyroid function tests are among the most frequently implemented laboratory tests in primary, and secondary healthcare institutions. The aim of the present study was to investigate the demographic and clinical characteristics and final diagnosis of children referred by primary and secondary healthcare institutions with the suspicion of an abnormality in thyroid function test and/or with the initial diagnosis of specific thyroid disease. METHODS: A total of two hundred eighty-nine pediatric patients, aged between 4 and 18 years admitted to the outpatient clinics of Behçet Uz Children’s Health and Diseases Hospital between January 2018 and January 2020, were included in the study. The patient data were obtained retrospectively from the hospital records. RESULTS: A total of 66% of the patients who were included in the study were female with a median age of 12 years (8.7-14.4), while 64% of them were pubertal; and 78% of the cases were referred by secondary healthcare institutions. The most common reason for referral was isolated elevation of thyroid stimulating hormone (TSH). A total of 56% of the patients were asymptomatic at the time of admission, and thyroid function test results of 75% of them were within normal limits. When evaluated according to their final diagnoses, the children were normal/healthy (64%), diagnosed with Hashimoto thyroiditis (30%), nodular thyroid disease (3%), Graves disease (2%) and isolated increase of TSH was related to obesity in 5 patients (1%). DISCUSSION AND CONCLUSION: It is essential to evaluate children with abnormal thyroid function test results with detailed history and physical examination. Besides, the thyroid function tests should be performed with reliable and sensitive methods in standardized laboratories to reach the correct diagnosis in these children.

scholarly journals INTRAVENOUS LEVOTHYROXINE DURING HEMODIALYSIS IN A PATIENT WITH HYPOTHYROIDISM AND NON-ADHERENCE TO ORAL MEDICATIONS

2020 ◽  
Vol 6 (5) ◽  
pp. e230-e233
Author(s):  
Dipa Avichal ◽  
Igor Kravets
Keyword(s):  
Renal Disease ◽  
Thyroid Function ◽  
End Stage Renal Disease ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Psychiatric Medication ◽  
Medication Regimen ◽  
Free T4 ◽  
Stage Renal Disease ◽  
End Stage

Objective: We describe an unusual and challenging clinical scenario: a patient with end-stage renal disease on hemodialysis with severely uncontrolled hypothyroidism and worsening psychosis, who refused both oral and intramuscular levothyroxine, but was successfully treated with intravenous (IV) levothyroxine given on hemodialysis days. Methods: The patient was interviewed and examined on admission and during hospitalization. Thyroid function was assessed through thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, and triiodothyronine (T3) by electrochemiluminescence immunoassay. Thyroid function was measured on admission, before and after each hemodialysis session for 1 week, and monthly thereafter. Results: The patient was a 71-year-old female with schizoaffective disorder, end-stage renal disease on hemodialysis, and uncontrolled Hashimoto thyroiditis due to non-adherence to oral levothyroxine therapy. On admission her TSH was 172.6 mIU/mL, free T4 was 0.59 ng/dL, and total T3 was 52 ng/dL. She presented to the hospital from her nursing home after repeated refusal to go to hemodialysis sessions secondary to worsening psychosis. At the hospital, she agreed to undergo hemodialysis and receive IV medications, but refused oral and intramuscular levothyroxine. After initiation of IV levothyroxine therapy 3 times weekly during hemodialysis, the patient’s thyroid function normalized within 19 weeks (TSH was 2.2 mIU/L, free T4 was 1.3 ng/dL, total T3 was 60 ng/dL). The achievement of the euthyroid status and adjustment of the patient’s psychiatric medication regimen were followed by a resolution of the patient’s psychosis. Conclusion: This case report demonstrates an unusual approach to the successful control of hypothyroidism, namely administration of IV levothyroxine 3 times weekly during hemodialysis sessions when conventional routes of levothyroxine administration could not be used due to the patient’s refusal.

Severe hypothyroidism following a single topical exposure to iodine in a premature neonate

2021 ◽  
Vol 14 (2) ◽  
pp. e240006
Author(s):  
Catherine Mary Breen ◽  
Monica Fahim Salama ◽  
Michael A Boyle
Keyword(s):  
Thyroid Function ◽  
Ductus Arteriosus ◽  
Urinary Iodine ◽  
Premature Neonate ◽  
Thyroid Stimulating Hormone ◽  
Urinary Iodine Excretion ◽  
Free T4 ◽  
Delayed Treatment ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

A neonate, born at 24 weeks, underwent a patent ductus arteriosus ligation, with previous normal thyroid stimulating hormone (TSH) levels, developed severe hypothyroidism from topical exposure to iodine following a single surgical procedure at 28 days of life. A low free T4 level of 0.05 ng/dL and a high TSH level of 228 mIU/L was detected with an increased urinary iodine excretion level of 178 mg/L (reference range 0.30–1.97 mg/L). The thyroid ultrasound was normal. Levothyroxine was started immediately but thyroid function did not recover fully during admission and levothyroxine was required beyond term corrected. This case highlighted how susceptible extremely preterm infants are to iodine induced hypothyroidism, even short-term topical exposure. Delayed treatment of hypothyroidism can lead to profound neurodevelopmental delay. As surgical advances allow for interventions at earlier gestations, the importance of early thyroid function testing postexposure to iodine is highlighted and ultimately topical iodine should be avoided in these susceptible infants.

Sign in / Sign up

Export Citation Format

Share Document