scholarly journals TSH reference range in older adults: a Brazilian study

2014 ◽  
Vol 58 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Maria Regina Calsolari
Keyword(s):  
Older Adults ◽  
Thyroid Dysfunction ◽  
Elderly Population ◽  
Thyroid Nodules ◽  
Reference Range ◽  
Adult Population ◽  
Free T4 ◽  
Upper Limit ◽  
Thyroperoxidase Antibodies ◽  
Serum Tsh

Objective: To establish serum TSH reference values for a population of Brazilian elderly, and to compare them to those found in the adult population. Subjects and methods: Healthy volunteers aged 70 to 85 years, without known thyroid disease or risk factors for thyroid dysfunction, who did not use any medication that could potentially interfere with TSH, were selected. Subjects with goiter, palpable thyroid nodules, anti-thyroperoxidase antibodies, or altered free T4 were excluded. The sample consisted of 360 older adults (180 per sex). Results: TSH values corresponding to the 2.5th and 97.5th percentile of the sample were 0.2 and 4.62 mIU/L, respectively. TSH > 2.5 mIU/L was seen in 25.26% of the volunteers, > 3 mIU/L in 15.26%, and > 4 mIU/L in 6.1% of them. TSH values were slightly higher than those previously reported for adults (18-60 years). Conclusion: This study suggests an upper limit for normal TSH of approximately 4.6 mIU/L for the Brazilian elderly population.

scholarly journals Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

2018 ◽  
Vol 2 (9) ◽  
pp. 1024-1039 ◽  
Author(s):  
Maria Cristina Vigone ◽  
Donatella Capalbo ◽  
Giovanna Weber ◽  
Mariacarolina Salerno
Keyword(s):  
Reference Range ◽  
Neonatal Period ◽  
Normal Serum ◽  
Serum Concentrations ◽  
Free T4 ◽  
Patient Factors ◽  
Neurocognitive Development ◽  
Upper Limit ◽  
Mild Hypothyroidism ◽  
Serum Tsh

Abstract Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.

Graves'-Basedow disease in pregnancy

2015 ◽  
Vol 54 (03) ◽  
pp. 106-111 ◽  
Author(s):  
S. L. Andersen ◽  
P. Laurberg
Keyword(s):  
Side Effects ◽  
Birth Defects ◽  
Thyroid Dysfunction ◽  
National Study ◽  
Antithyroid Drugs ◽  
Upper Limit ◽  
Special Concern ◽  
Maternal Thyroid ◽  
Toxic Reactions ◽  
Serum Tsh

SummaryThyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth.A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.

Abstract WMP57: Declining Blood Pressure is Associated with Subcortical Microinfarcts in Older Adults

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mekala R Raman ◽  
Jonathan Graff-Radford ◽  
Scott A Przybelski ◽  
Timothy G Lesnick ◽  
Michelle M Mielke ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Elderly Population ◽  
Adult Population ◽  
Blood Pressure Measurement ◽  
The Elderly ◽  
Pressure Measurements ◽  
Autopsy Study ◽  
Cross Sectional ◽  
Blood Pressures

Hypertension is highly prevalent in the elderly population and microinfarcts are the most common vascular brain pathology identified in older adults at autopsy. We investigated the associations between systolic and diastolic blood pressures measured antemortem and the presence of microinfarcts at autopsy. Study subjects (n=302; age range=71-95) were participants in the population-based Mayo Clinic Study of Aging autopsy study, who had blood pressure measurements recorded during life. We investigated both cross-sectional systolic and diastolic blood pressure measurements at the baseline visit and the change in blood pressure (slope). Presence and location (subcortical or cortical) of chronic microinfarcts was abstracted from the autopsy reports. Of the 302 study subjects, 47 (16%) had cerebral microinfarcts, and, of those, 18 (38%) had subcortical microinfarcts and 29 (62%) had only cortical microinfarcts. The baseline blood pressures were not different between subjects with no microinfarcts, subcortical microinfarcts, and only cortical microinfarcts. In a logistic regression model including time between last blood pressure measurement and death, a greater decline in systolic [OR= 1.06 (1.01, 1.11); p=0.02]) and greater decline in diastolic [OR= 1.11 (1.02, 1.20); p=0.01] blood pressures were predictors of the presence of subcortical microinfarcts at autopsy. However, these variables were not associated with the presence of cortical microinfarcts. In conclusion, microinfarcts are common in the older adult population, and most of them are located in the cortex. A greater decline in both systolic and diastolic blood pressures and their association with subcortical microinfarcts, but not with cortical microinfarcts, may have implications for aggressive lowering of blood pressure in the elderly population.

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 Evaluation of thyroid function and autoimmunity in HIV-infected women

2013 ◽  
Vol 57 (6) ◽  
pp. 450-456 ◽  
Author(s):  
Leiliane Gonçalves de Carvalho ◽  
Patrícia de Fátima dos Santos Teixeira ◽  
Ana Luiza Brandão Galotti Panico ◽  
Marcela Vaisberg Cohen ◽  
Maria Fernanda Miguens Castelar Pinheiro ◽  
...  
Keyword(s):  
Thyroid Dysfunction ◽  
University Hospital ◽  
Autoimmune Thyroid Diseases ◽  
Autoimmune Thyroid ◽  
Viral Loads ◽  
Highly Active ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Thyroperoxidase Antibodies ◽  
Serum Tsh

Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.

Associations Between Thyroid and Blood Pressure in Euthyroid Adults: A 9-Year Longitudinal Study

2018 ◽  
Vol 50 (03) ◽  
pp. 236-241 ◽  
Author(s):  
Hengameh Abdi ◽  
Safoora Gharibzadeh ◽  
Erfan Tasdighi ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Reference Range ◽  
Estimating Equation ◽  
Population Based ◽  
Free T4 ◽  
Men And Women ◽  
Increased Risk ◽  
Dichotomous Outcomes ◽  
Serum Tsh

AbstractLongitudinal studies considering associations between thyroid function in the reference range (RR) with blood pressure (BP) are scarce and contradictory. We aimed to investigate the associations of serum thyrotropin (TSH) and free T4 (FT4) with different components of BP also incident prehyperetension (preHTN) and HTN during a 9-year follow-up. A sum of 2282 euthyroid individuals from an ongoing population-based cohort study were selected. A sex-stratified multivariate generalized estimating equation (GEE) method was employed. Moreover, a multivariate transitional model was used considering preceding BP status as a predictor of dichotomous outcomes of preHTN and HTN. Multivariate-adjusted GEE analysis revealed a decreasing trend for systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP) throughout the study period in both men and women, either adjusted for serum TSH or FT4 levels. Serum FT4 within the RR was positively associated with all BP parameters in total population and in men, but serum TSH had a statistically significant mild increasing effect only on SBP, DBP and MAP of men. Multivariate transitional model found no association between serum TSH levels within the reference range (RR) and BP status; regarding serum FT4, a 1 ng/dl higher FT4 was associated with 40% increased risk of preHTN [OR (95% CI), 1.40 (1.02–1.90)], but not with HTN [OR (95% CI), 0.93 (0.80–1.09)]. It is concluded that serum FT4 within the RR is more strongly associated with BP parameters compared to TSH. This association is not consistent between men and women. Moreover, higher FT4 is associated with increased risk of preHTN.

scholarly journals TSH reference values for adult Brazilian population

2010 ◽  
Vol 54 (7) ◽  
pp. 603-606 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Arthur Cezar Malard Xavier ◽  
Maria Regina Calsolari
Keyword(s):  
Thyroid Disease ◽  
Clinical Biochemistry ◽  
Normal Serum ◽  
Brazilian Population ◽  
Free T4 ◽  
Clinical Criteria ◽  
History Of ◽  
Thyroperoxidase Antibodies ◽  
Serum Tsh

OBJECTIVE: To establish limits of normal serum TSH for the adult (18 to 60 years) Brazilian population according to recommendations of the National Academy of Clinical Biochemistry. SUBJECTS AND METHODS: Healthy volunteers were evaluated and those fulfilling the following clinical criteria were selected: absence of known thyroid disease; no use of any interfering medications; no history of head and neck external radiotherapy, type 1 diabetes or autoimmune disease; no family history of thyroid disease, and absence of goiter or palpable nodules. Subjects with anti-thyroperoxidase antibodies and/or altered free T4 were excluded. The sample consisted of 960 subjects (480 males and 480 females). RESULTS: TSH values corresponding to the 2.5th and 97.5th percentiles of the sample were 0.43 and 3.24 mIU/L, respectively. TSH values > 2.5 mIU/L were observed in 9.15% of the volunteers and levels > 3 mIU/L in 3.11%. CONCLUSION: The present study suggests an upper limit of normal TSH of approximately 3.5 mIU/L.

scholarly journals High Serum Thyrotropin Concentrations within the Reference Range: A Predictor of Malignancy in Nodular Thyroid Disease

2018 ◽  
Vol 27 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Karla Duccini ◽  
Marcus Vinicius Leitão de Souza ◽  
Ricardo Delfim ◽  
Ana Paula Aguiar ◽  
Patricia Teixeira ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Reference Range ◽  
Biochemical Parameter ◽  
Needle Aspiration ◽  
Differentiated Thyroid Carcinoma ◽  
Cross Sectional Study ◽  
High Serum ◽  
University Hospital ◽  
Cross Sectional ◽  
Serum Tsh

Objective: This study assessed whether or not a simple biochemical parameter, serum thyrotropin (TSH), within the reference range can predict the likelihood of thyroid malignancy in subjects undergoing fine-needle aspiration biopsy (FNAB) for thyroid nodules. Subjects and Methods: This cross-sectional study evaluated 236 patients without overt thyroid dysfunction who were not on levothyroxine therapy. They underwent FNAB of the thyroid nodules at the Clementino Fraga Filho University Hospital between 2011 and 2012. The reference range and serum TSH quartiles were determined according to age-specific values for serum TSH and then compared between the cases with benign thyroid nodular disease and differentiated thyroid carcinoma (DTC) based on surgical pathology reports. Results: Of the 236 patients, 201 (85.1%) underwent a surgical procedure (thyroidectomy) and 89/236 (44.3%) had DTC. The mean TSH concentrations were 2.09 ± 1.15 mU/L in benign patients versus 2.73 ± 1.33 mU/L in cases of DTC (p < 0.01). As TSH increased from quartiles 1 to 4, the frequency of a malignant diagnosis also increased progressively from 22% in quartile 1 to 65% in the last quartile (p ≤ 0.001). Conclusion: Thyrotropin levels were positively associated with the diagnosis of DTC in thyroid nodules.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE Subclinical hypothyroidism in children

2020 ◽  
Vol 183 (2) ◽  
pp. R13-R28
Author(s):  
Mariacarolina Salerno ◽  
Nicola Improda ◽  
Donatella Capalbo
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Current Data ◽  
Free T4 ◽  
Endocrine Disease ◽  
Cognitive Domains ◽  
Risk Of Progression ◽  
Intellectual Outcome ◽  
Serum Tsh ◽  
Tsh Levels

Subclinical hypothyroidism (SH) is biochemically defined as serum TSH levels above the upper limit of the reference range in the presence of normal free T4 (FT4) concentrations. While there is a general agreement to treat subjects with serum TSH levels above 10 mU/L, the management of mild form (TSH concentrations between 4.5 and 10 mU/L) is still a matter of debate. In children, mild SH is often a benign and remitting condition and the risk of progression to overt thyroid dysfunction depends on the underlying condition, being higher in the autoimmune forms. The major concern is to establish whether SH in children should always be considered an expression of mild thyroid dysfunction and may deserve treatment. Current data indicate that children with mild SH have normal linear growth, bone health and intellectual outcome. However, slight metabolic abnormalities and subtle deficits in specific cognitive domains have been reported in children with modest elevation of TSH concentration. Although these findings are not sufficient to recommend levothyroxine treatment for all children with mild SH, they indicate the need for regular monitoring to ensure early identification of children who may benefit from treatment. In the meanwhile, the decision to initiate therapy in children with mild SH should be based on individual factors.

scholarly journals Study of thyroid dysfunction in patients with type 1 diabetes mellitus

2017 ◽  
Vol 4 (5) ◽  
pp. 1241
Author(s):  
Rajesh V. Gosavi ◽  
Bhushan R. Mishal
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Thyroid Dysfunction ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Autoimmune Thyroid ◽  
Free T3 ◽  
Serum Tsh

Background: The association of autoimmune thyroid disease with type 1 diabetes mellitus has been well documented across populations, with it being most prevalent immunological disease in patients with type 1 diabetes. The aim of this study was to ascertain the association between type 1 diabetes and thyroid dysfunction clinically, biochemically and immunologically.Methods: Serum TSH, free T3 and free T4 values were compared between cases of type 1 diabetes mellitus and non-diabetic age and sex matched controls. Cases of type 1 diabetes mellitus were further divided in two groups, depending upon the presence or absence of antibodies against thyroid peroxidase (Anti-TPO antibodies). Mean serum TSH, free T3, free T4 levels were compared between these two groups to find or refute any association.Results: Abnormal thyroid function was reported in total 6 (14.63%) cases. Comparison of TSH, T3 and T4 levels showed statistically insignificant differences (p<0.05) in TSH levels (µIU/ml) (Cases- 3.44±2.41, controls- 3.34±0.78); T3 levels (pg/ml) (cases- 3.31±1.06, controls- 3.36±0.52) and T4 levels (ng/dl) (cases- 0.92±0.31, controls- 0.95±0.23). Total of 6 cases (14.63%) cases of type 1 diabetes mellitus were positive for anti-TPO antibodies (4- females, 2- males).Conclusions: Thyroid dysfunction is more common amongst type 1 diabetics, especially females. Estimation of anti-TPO antibodies is valuable in detecting thyroid dysfunction in type 1 diabetics.

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