A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone

Diagnosis ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 75-77
Author(s):  
Cem Onur Kirac ◽  
Sedat Abusoglu ◽  
Esra Paydas Hataysal ◽  
Aysegul Kebapcilar ◽  
Suleyman Hilmi Ipekci ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Normal Range ◽  
Free Triiodothyronine ◽  
Case Presentation ◽  
Chronic Autoimmune Thyroiditis ◽  
Levothyroxine Replacement ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractBackgroundSubclinical hypothyroidism is a situation in which the thyroid-stimulating hormone (TSH) value exceeds the upper limit of normal, but the free triiodothyronine (T3) and thyroxine (T4) values are within the normal range. The etiology is similar to overt hypothyroidism.Case presentationAn 18-year-old female patient was referred to our endocrinology clinic due to elevated TSH levels detected during a routine examination. She was clinically euthyroid and had a normal thyroid ultrasound pattern. The TSH concentration was measured twice independently, giving values of 5.65 μIU/mL and 5.47 μIU/mL. The polyethylene glycol (PEG) method for TSH measurement was used to determine the concentration of macro-TSH (m-TSH), a macromolecule formed between TSH and immunoglobulin (Ig). Using the same blood samples for which the TSH levels were found to be high, the PEG method found TSH levels to be within a normal range, with values of 1.50 μIU/mL (5.65–1.50 μIU/mL measured; a decrease of 75%) and 1.26 μIU/mL (5.47–1.26 μIU/mL measured; a decrease of 77%), respectively. The TSH values determined by the PEG precipitation test were markedly low, with PEG-precipitable TSH ratios greater than 75%.ConclusionsThe cause of 55% of subclinical hypothyroidism is chronic autoimmune thyroiditis. However, it is necessary to exclude other TSH-elevated conditions for diagnosis. One of these conditions is m-TSH, which should be kept in mind even though it is rarely seen. m-TSH should be considered especially in patients who have a TSH value above 10 μIU/mL without hypothyroidism symptoms or who require a higher levothyroxine replacement dose than expected to make them euthyroid.

scholarly journals Transient high thyroid stimulating hormone and hypothyroidism incidence during follow up of subclinical hypothyroidism

2021 ◽  
Vol 55 (4) ◽  
pp. 204-214
Author(s):  
Munir Abu-Helalah ◽  
Hussam Ahmad Alshraideh ◽  
Sameeh Abdulkareem Al-Sarayreh ◽  
AbdelFattah Al-Hader
Keyword(s):  
Subclinical Hypothyroidism ◽  
Screening Program ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
High Prevalence ◽  
Levothyroxine Replacement ◽  
Stimulating Hormone

Abstract Objectives. Given the high prevalence of subclinical hypothyroidism (SCH), defined as high thyroid stimulating hormone (TSH) and normal free thyroxine (FT4), and uncertainty on treatment, one of the major challenges in clinical practice is whether to initiate the treatment for SCH or to keep the patients under surveillance. There is no published study that has identified predictors of short-term changes in thyroid status amongst patients with mild elevation of TSH (4.5–10 mIU/L). Subjects and Results. A cohort study was conducted on patients with SCH detected through a general population screening program, who were followed for six months. This project identified factors predicting progression to hypothyroid status, persistent SCH and transient cases. A total of 656 participants joined the study (431 controls and 225 were patients with SCH). A part of participants (12.2%) developed biochemical hypothyroidism during the follow-up, while 73.8% of the subjects became euthyroid and the remained ones (13.4%) stayed in the SCH status. The incidence of overt hypothyroidism for participants with TSH above 6.9 mIU/L was 36.7%, with incidence of 42.3% for females. Anti-thyroid peroxidase antibodies (TPO) positivity is an important predictor of development of hypothyroidism; however, it could be also positive due to transient thyroiditis. Conclusions. It can be concluded that females with TSH above 6.9 mIU/L, particularly those with free triiodothyronine (FT3) and FT4 in the lower half of the reference range, are more likely to develop biochemical hypothyroidism. Therefore, it is recommended to give them a trial of levothyroxine replacement. It is also recommended to repeat TSH after six months for male subjects and participants with baseline TSH equal or less than 6.9 mIU/L.

Symptomatic Subclinical Hypothyroidism Treated with Homoeopathy: Case Reports

2020 ◽  
Vol 33 (02) ◽  
pp. 120-125
Author(s):  
Pulakendu Bhattacharya ◽  
Shashi Giri ◽  
Baishakhi Ghosh ◽  
Abhiram Banerjee
Keyword(s):  
Cardiovascular Diseases ◽  
Normal Level ◽  
Subclinical Hypothyroidism ◽  
Case Reports ◽  
Age Groups ◽  
Thyroid Stimulating Hormone ◽  
Older Age ◽  
Overt Hypothyroidism ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractSubclinical hypothyroidism (SCH) is a condition where serum thyroid-stimulating hormone (TSH) level is high, but the T3 and T4 are within normal level. SCH carries a risk of cardiovascular diseases or progression to overt hypothyroidism. Treatment becomes more necessary in case of older age groups and in females. Two cases of SCH treated with individualised homoeopathic medicine are presented and the improvement was significant showing reduction in the TSH levels with overall improvement in health.

scholarly journals Subclinical Hypothyroidism and Lipid Metabolism: To Treat or Not to Treat?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Federica Decandia ◽  
Pierluigi Merella ◽  
Gavino Casu
Keyword(s):  
Lipid Metabolism ◽  
Subclinical Hypothyroidism ◽  
Subclinical Atherosclerosis ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Free Triiodothyronine ◽  
Thyroxine Therapy ◽  
Increased Risk ◽  
Stimulating Hormone

Abstract Thyroid hormones have multiple complex effects on lipid synthesis and metabolism. These physiological actions are well documented in overt hypothyroidism where the elevated levels of total cholesterol, low density lipoporotein cholesterol and possibly triglycerides are reverted by levo-thyroxine therapy. Subclinical hypothyroidism, defined as elevated serum thyroid stimulating hormone in the presence of reference range of free thyroxine and free triiodothyronine concentrations, is a relatively frequent clinical conditions. Many clinical and epidemiological studies have evaluated lipid metabolism, markers of subclinical atherosclerosis and other cardiovascular risk factors in subclinical hypothyroidism as well as the need of replacement therapy in these patients. The available results are rather conflicting, with variable and inconclusive results. Moreover, no consensus still exists on the clinical significance and treatment of this mild form of thyroid failure. On the contrary, available evidences suggest that patients with plasma thyroid stimulating hormone levels above 10 mU/L should be treated with levo-thyroxine, since may have an increased risk of cardiovascular disease. However, the epidemiological evidences suggest being rather conservative in older people, since higher thyroid stimulating hormone is associated with lower risk of multiple adverse events in this population. In this review, we summarized the current evidences on the association between subclinical hypothyroidism and lipid metabolism and the effect of levo-thyroxine therapy on lipid parameters.

scholarly journals Importance of thyroid-stimulating hormone levels in liver disease

2020 ◽  
Vol 33 (9) ◽  
pp. 1133-1137
Author(s):  
Hyun Jin Kim
Keyword(s):  
Liver Disease ◽  
Subclinical Hypothyroidism ◽  
Liver Steatosis ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Alcoholic Fatty Liver ◽  
Younger Age ◽  
Alcoholic Fatty Liver Disease ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractObjectivesRecently, several studies have reported the association between elevation of thyroid-stimulating hormone (TSH) levels and liver disease, especially, non‐alcoholic fatty liver disease (NAFLD). We aimed to evaluate the incidence and risk factors of TSH elevation in patients with liver disease.MethodsWe retrospectively reviewed the data of patients aged <18 years who were diagnosed with liver disease between January 2015 and March 2019.ResultsAmong the 77 patients, 17 (22.1%) had subclinical hypothyroidism and 3 (17.6%) progressed to overt hypothyroidism. A total of 26 (33.8%) patients had NAFLD, and 6 (23.1%) had subclinical hypothyroidism. The ultrasound grade of liver steatosis was not related to the elevation of TSH levels. The median age was significantly younger in patients with TSH elevation (5 vs. 9 years, p = 0.017). Albumin levels were significantly decreased (3.9 vs. 4.3 g/dL, p = 0.007), and total bilirubin levels were elevated (2.2 vs. 0.6 mg/dL, p = 0.001) in patients with subclinical hypothyroidism.ConclusionsTSH elevation commonly occurs in patients with liver disease, especially those with younger age. The cause of liver disease was not a risk factor for TSH elevation.

scholarly journals Evaluation of renal function in subclinical hypothyroidism

2018 ◽  
Vol 10 (01) ◽  
pp. 050-055 ◽  
Author(s):  
Vijayetha P. Patil ◽  
Alagilwada S. Shilpasree ◽  
Vidya S. Patil ◽  
Kangokar R. Pravinchandra ◽  
Deepti G. Ingleshwar ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Subclinical Hypothyroidism ◽  
Linear Regression Analysis ◽  
Laboratory Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Function Parameter ◽  
Overt Hypothyroidism ◽  
Free Triiodothyronine ◽  
Cross Sectional

Abstract INTRODUCTION: Patients with subclinical hypothyroidism (SCH) have a few or no symptoms or signs of thyroid dysfunction and thus by its very nature, SCH is a laboratory diagnosis. Serum creatinine is elevated and glomerular filtration rate (GFR) values are reversibly reduced in overt hypothyroid patients. We hypothesize that SCH also may be associated with low GFR. AIMS AND OBJECTIVES: The objective of this study was (1) to know the effect of SCH on kidney function, (2) to find the correlation between the renal function parameter creatinine, estimated GFR (eGFR), and thyroid-stimulating hormone (TSH), and (3) to know if creatinine values can be predicted by TSH values in SCH cases. MATERIALS AND METHODS: This is a hospital-based cross-sectional study for 1 year. A total of 608 subjects of either sex were included in the study and were divided into 3 groups: (1) SCH, (2) overt hypothyroidism (OHT), and (3) euthyroidism (ET). TSH, free triiodothyronine, free thyroxine, and serum creatinine were estimated and eGFR was calculated using modification of diet in renal disease study equation and the chronic kidney disease epidemiology collaboration equations. RESULTS: Serum creatinine levels were higher and eGFR was lower significantly in the subclinical hypothyroid group when compared to the control ET group (P < 0.001). The overtly hypothyroid group had significantly higher levels of serum creatinine and lower eGFR when compared to both the groups (P < 0.001). Significant correlation between TSH, creatinine, and eGFR was found in OHT group only. Linear regression analysis showed the regression in creatinine upon TSH is attributable to 44.5% among OHT group, 48.2% in SCH group. CONCLUSION: It can be concluded that the SCH group behaves biochemically similar to OHT group and changes in serum creatinine reflect tissue hypothyroidism in SCH cases.

scholarly journals Management of Subclinical Hypothyroidism

2014 ◽  
Vol 13 (3) ◽  
pp. 93-96
Author(s):  
Shaheda Ahmed ◽  
A S M Towhidul Alam
Keyword(s):  
Clinical Features ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Serum Thyroxine ◽  
Specific Symptoms ◽  
Review Current ◽  
Serum Tsh ◽  
Low Serum ◽  
Stimulating Hormone

Objective: To review current concepts in the management of subclinical hypothyroidism (SCH) in patients with non-specific symptoms.Data sources: A review of articles reported on overt hypothyroidism and subclinical hypothyroidism. Summary of review: In a patient with primary overt hypothyroidism, management is usually straightforward: treatment with thyroxine should be offered to anyone with characteristic clinical features, a raised serum thyroid stimulating hormone (TSH) concentration and a low serum thyroxine (T4) concentration. More difficult is the management of a patient with subclinical hypothyroidism (SCH), in whom serum TSH is slightly raised (5-20 mIU/L) but T3, T4 levels are normal, and who is either asymptomatic or has only non-specific symptoms. Left untreated, some of these patients will eventually develop overt hypothyroidism. This review will address the use of thyroxine in patients with subclinical hypothyroidism.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21045 

scholarly journals Association of Sub-Clinical Hypothyroidism with Abnormal Levels of Lipid in the Population of Nawabshah, Pakistan

2021 ◽  
pp. 452-458
Author(s):  
Nasrullah Aamer ◽  
Beenish Ghafar Memon ◽  
Abdul Rashid ◽  
Dayaram Makwana ◽  
Shahzad Memon ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Free Triiodothyronine ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group 2 ◽  
Group B ◽  
Stimulating Hormone

Aims: Aim of this investigation was to access the association of dyslipidemia with subclinical hypothyroidism. Methodology: In this cross-sectional investigation, 1948 participants were recruited. Two groups were made; participants up to 18 years were in group A and Subjects over 18 years were incorporated in group 2. They were subdivided into control, subclinical hypothyroid 1, and subclinical hypothyroid 2. SPSS 21 was used for data analysis. Results:  Data of 1619 individuals were analyzed. The mean age of Group A participants was 12.79 ± 2.779, and the mean age of Group B participants was 42.58 ± 18.012. The prevalence of subclinical hypothyroid was found at 13.5 %. Significant differences have been observed while comparing Group A and Group B (P <0.001). Free tetraiodothyronine and Free triiodothyronine also showed a significant difference in both groups. (P<0.05). No significant difference between mean Thyroid-stimulating hormone levels was observed (P>0.05). No significant association between Controls and High-density Lipid values was found between Controls and subclinical hypothyroid. Conclusion: We conclude that subclinical hypothyroidism leads to increased dyslipidemia. Lower Serum total cholesterol and low-density lipid levels were detected among children and participants under the age of 18 with Thyroid-stimulating hormone greater than 10 mIU/L. Thyroid-stimulating hormone less than 10.0 mIU/L had no lipid abnormalities in subclinical hypothyroid participants.

scholarly journals Association Between Thyroid Hormones, Lipids and Oxidative Stress Markers in Subclinical Hypothyroidism / Povezanost Izme\U Tireoidnih Hormona, Lipida I Markera Oksidativnog Stresa U SubkliniĉKoj Hipotireozi

2015 ◽  
Vol 34 (3) ◽  
pp. 323-331 ◽  
Author(s):  
Maureen Jepkorir Cheserek ◽  
Gui-Rong Wu ◽  
Arsene Ntazinda ◽  
Yong-Hui Shi ◽  
Li-Ye Shen ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Lipid Peroxidation ◽  
Thyroid Hormones ◽  
Subclinical Hypothyroidism ◽  
Plasma Lipids ◽  
Plasma Concentrations ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Lipid Peroxidation Product ◽  
Free Triiodothyronine

SummaryOxidative stress plays a role in the pathogenesis of many chronic diseases. It is recognized in overt hypothyroidism while its existence in subclinical hypothyroidism (SCH) is not well established. The aim of this study was to determine whether there was increased oxidation of lipids and proteins in SCH, and examine their association with lipids and thyroid hormones.Methods: Male adults (35-59 years) with SCH (n=467) and euthyroid controls (n=190) were studied. Anthropometric measurements, plasma lipids, thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total antioxidant capacity (T-AOC), lipid peroxidation products, malondialdehyde (MDA), advanced oxidation protein products (AOPP) and dityrosine concentrations were measured.Results: Plasma concentrations of MDA were significantly higher (p<0.05) in SCH (8.11±1.39 nmol/mL) compared with euthyroid controls (7.34±1.31 nmol/mL) while AOPP, dityrosine and T-AOC levels were not different. MDA was not associated with TSH (β=-0.019, P=0.759), FT4 (β=-0.062, P=0.323) and FT3 (β=-0.018, P=0.780) in SCH while levels increased with elevated total cholesterol (β=0.229, P=0.001), LDL (β=0.203, P=0.009) and triglycerides (β=0.159, P=0.036) after adjustment for ageand body mass index. T-AOC reduced (β=-0.327, P=0.030) with increased MDA in euthyroid controls and not in SCH (β=-0.068, P=0.349), while levels increased with elevated triglycerides in both groups.Conclusion: Oxidative stress was increased in subclinical hypothyroidism as evidenced by the elevated lipid peroxidation product, malondialdehyde, while protein oxidation was absent. Thus, reduction of oxidative stress may be beneficial in patients with subclinical hypothyroidism

Thyroid evaluation of children and adolescents with Williams syndrome in Zhejiang Province

2017 ◽  
Vol 30 (12) ◽  
Author(s):  
Wei-Jun Chen ◽  
Chai Ji ◽  
Dan Yao ◽  
Zheng-Yan Zhao
Keyword(s):  
Children And Adolescents ◽  
Thyroid Function ◽  
Williams Syndrome ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Zhejiang Province ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Thyroid Antibodies ◽  
Free Triiodothyronine

AbstractBackground:The objective of the study was to describe the prevalence of abnormal thyroid function and volume in children and adolescents with Williams syndrome (WS) in Zhejiang Province, China.Methods:Thyroid function, including thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid antibodies (thyroid peroxidase and thyroglobulin) were measured in 83 patients with WS, aged 0.2–16.5 years. Twenty-three patients were followed for an average of 1.7 years (0.4–4.1), and multiple TSH determinations were considered. Thyroid ultrasonography was performed on 49 patients.Results:One patient was diagnosed with overt hypothyroidism, and 23 patients (27%) had subclinical hypothyroidism (SH). Thyroid antibodies were absent in all patients. In five age groups (0–1 years, 1–3 years, 3–6 years, 6–9 years, 9–18 years), the prevalence of patients with subclinical hypothyroidism was 25%, 28.5%, 44.4%, 16.7% and 4.7%, respectively. Through ultrasound examination, 21 patients (42%) were observed to have thyroid hypoplasia (TH), and there were no cases of thyroid haemiagenesis. The incidence rate of TH increased with age, rising from 20% in the youngest group to 66% in the oldest.Conclusions:SH and TH is common in children and adolescents with WS. Yearly evaluation of thyroid must be performed in all patients in this population, regardless of the result of the neonatal screening. Age under 6 years and existing thyroid abnormalities are risk factors for developing SH, and a shorter follow-up interval is needed for screening in these individuals, SH is often self-limiting, and clinicians should be alert to overt hypothyroidism.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

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