scholarly journals A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

2019 ◽  
Vol 7 (1) ◽  
pp. 176
Author(s):  
Dharmendra Jhavar ◽  
Umesh Kumar Chandra ◽  
Shivshankar Badole ◽  
Anurag Rahekar ◽  
Sumit Vishwakarma
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Central India ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Delay In Diagnosis ◽  
High Level ◽  
High Index Of Suspicion

Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.

scholarly journals Severe primary hypothyroidism in an apparently asymptomatic 19-year-old woman: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Rania Dannan ◽  
Sulaiman Hajji ◽  
Khaled Aljenaee
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Conflicting Evidence ◽  
Thyroid Function Testing ◽  
History Of ◽  
Asymptomatic Individuals ◽  
High Index Of Suspicion

Abstract Background Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. Case presentation We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient’s insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. Conclusion There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.

Risk factors for the delayed diagnosis of extrapulmonary TB

2021 ◽  
Vol 25 (3) ◽  
pp. 191-198
Author(s):  
M. K. Lee ◽  
C. Moon ◽  
M. J. Lee ◽  
Y. G. Kwak ◽  
E. Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outpatient Clinic ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Delay In Diagnosis ◽  
Microbiological Characteristics ◽  
Significant Difference ◽  
Basic Characteristics

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

scholarly journals Thyroid dysfunction in patients of metabolic syndrome: A study from a tertiary care center in India

2021 ◽  
Vol 12 (10) ◽  
pp. 47-50
Author(s):  
Ritu Gupta ◽  
Akhil K Vijayan ◽  
Sushma Choudhary
Keyword(s):  
Metabolic Syndrome ◽  
Thyroid Dysfunction ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Free T4 ◽  
Cross Sectional

Background: Metabolic syndrome is characterized by hypertension, dyslipidemia, central obesity, glucose intolerance, insulin resistance. Thyroid hormone acts as general pacemaker, accelerating metabolic process and may be associated with metabolic syndrome. There is no information available in literature regarding the prevalence and association of thyroid dysfunction in metabolic syndrome in this central region of the country. Aims and Objective: To estimate the prevalence of thyroid dysfunction in patients of metabolic syndrome. Materials and Methods: It is a duration based prospective cross sectional study including 200 patients of metabolic syndrome. A detailed history, clinical examination and relevant investigations including serum Free T4 (FT4), Free T3 (FT3), Thyroid Stimulating Hormone (TSH) were done. Range, frequencies, percentage, mean, standard deviation and P value were calculated. P value of < 0.05 was taken as significant. Results: Prevalence of thyroid dysfunction in metabolic syndrome patients was 28.5%. Prevalence of subclinical and overt hypothyroidism was 18.5% and 8.5% respectively. In patients with both metabolic syndrome and thyroid dysfunction, most common components associated are diabetes mellitus and hypertriglyceridemia. Conclusion: Thyroid dysfunction is significantly common in metabolic syndrome patients. It should be aggressively detected and treated in these patients for better outcome.

The nocturnal thyroid-stimulating hormone surge is absent in overt, present in mild primary and equivocal in central hypothyroidism

1992 ◽  
Vol 126 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Ria Adriaanse ◽  
Johannes A Romijn ◽  
Erik Endert ◽  
Wilmar M Wiersinga
Keyword(s):  
Positive Relationship ◽  
Thyroid Stimulating Hormone ◽  
Relative Increase ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Central Hypothyroidism ◽  
Pituitary Disease ◽  
Hypothyroid Patients ◽  
Nocturnal Rise ◽  
Central Lesions

The nocturnal TSH surge was studied in controls, in 34 patients with hypothalamic/pituitary disease and in 21 patients with primary hypothyroidism. It was absent in 5/12 hypothyroid patients and in 5/22 euthyroid patients with hypothalamic/pituitary disease (42% vs 23%. NS). Central hypothyroidism relative to euthyroidism was associated with a lower absolute (0.3±0.4 vs 0.9±1.0 mU/l, p<0.05) and relative (24±31 vs 63±51%, p<0.05) nocturnal rise in TSH. In primary hypothyroidism, the nocturnal TSH surge was absent in eight often patients with overt, in one of five patients with mild and in none of six patients with subclinical hypothyroidism. The relative nocturnal rise in TSH was normal in mild (54±33%) and subclinical (92±69%), but decreased in overt hypothyroidism (2±10%). Plasma T4 was positively and 09.00 plasma TSH negatively related to the relative nocturnal TSH surge in primary hypothyroidism, but not in central lesions. In both conditions, however, a positive relationship was observed between the relative nocturnal TSH surge and the relative increase of TSH to TRH. In conclusion: (a) The nocturnal TSH surge is usually absent in overt hypothyroidism but present in mild primary hypothyroidism and equivocal in central hypothyroidism. This limits its usefulness as an adjunct in the diagnosis of central hypothyroidism. (b) The magnitude of the nocturnal TSH surge in patients with hypothalamic/pituitary disease or primary hypothyroidism is directly related to the TSH response to TRH, and thus appears to be determined by the directly releasable TSH pool of the pituitary.

Hypothyroidism following Treatment for Head and Neck Cancer

1981 ◽  
Vol 90 (5) ◽  
pp. 449-453 ◽  
Author(s):  
Donald P. Vrabec ◽  
Timothy J. Heffron
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Thyroid Function ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Patient Will ◽  
Effects Of Radiation ◽  
Tsh Levels

One hundred ninety-six head and neck patients were studied to determine the effects of radiation therapy and surgery on thyroid function. Serum thyroid-stimulating hormone (TSH) levels were obtained as a screening test for primary hypothyroidism. Elevated TSH levels were found in 57 of the 196 patients (29.1%). The highest incidence of abnormal TSH values (66%) occurred in the group treated with combination radiation therapy and surgery, including partial thyroidectomy. TSH levels rose early in the posttreatment period with 60% of the abnormal values occurring within the first three posttreatment years. Posttreatment thyroid dysfunction was twice as common in women (48.6%) as in men (25.4%). When serum thyroxine levels by radioimmunoassay (T4RIA) were correlated with the elevated serum TSH levels, a similar pattern was seen with 65% of the patients in Group 3 having a decreased T4RIA level indicating overt hypothyroidism. Pretreatment levels of thyroid function including thyroid antibody studies should be established for all patients. Serial TSH levels should be done every three months during the first three posttreatment years and semiannually thereafter as long as the patient will return for follow-up care. All patients treated with combination radiation therapy and surgery who develop elevated TSH levels should be treated with thyroid replacement therapy. Patients receiving radiation therapy alone should receive replacement thyroid therapy if they develop a depressed T4RIA value or a pattern of gradually increasing TSH levels.

scholarly journals Effect of thyroxine on initial catch-up growth in children with hypothyroidism

2019 ◽  
Vol 7 (1) ◽  
pp. 159
Author(s):  
Ami H. Patel ◽  
Pinakin P. Trivedi
Keyword(s):  
Growth Parameters ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Height Velocity ◽  
Total Serum ◽  
P Value ◽  
Adequate Treatment ◽  
The Mean ◽  
Catch Up

Background: Hypothyroidism is a common endocrinal cause of growth retardation in children. Following adequate treatment with thyroxine, growth resumes at an accelerated rate which is known as catch-up growth. There are few observational studies from India on the growth parameters following treatment with thyroxine in children with hypothyroidism.Methods: A retrospective study was done in children aged 2-10 years who were newly diagnosed cases of primary hypothyroidism [Total serum Thyroxine (T4) levels <5 µg/dl and serum Thyroid Stimulating Hormone (TSH) levels ˃15 µU/ml] and treated with oral thyroxine to attain euthyroid state. Height measured before starting treatment and at the time of follow up visits was noted, the Height Standard Deviation Scores (HSDS) were calculated. The effect of thyroxine on linear growth was studied.Results: There were 23 children who were diagnosed as having primary hypothyroidism of whom 16(69.6%) were females and 7(30.4%) were males. The mean age of the children studied was 7.3±2.3 years. The mean dose of thyroxine required to maintain euthyroid status was 4.6±2.2 µg/kg/day. Mean duration of follow up was 13.7±2.4 months. The initial HSDS was - 2.31±0.9 which improved to a final value of - 1.7±0.76 (ΔHSDS0.61, p value <0.0001). Mean height velocity was 8.1 cms/year.Conclusions: Following adequate thyroxine replacement therapy catch-up growth occurs and increased growth velocity leads to partial regain of height deficit in the first couple of years of treatment.

scholarly journals Hypothyroidism: current state of the problem

2020 ◽  
pp. 96-107
Author(s):  
E. V. Biryukova ◽  
D. V. Kileynikov ◽  
I. V. Solovyeva
Keyword(s):  
Kinase Inhibitors ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Pathological Process ◽  
Primary Hypothyroidism ◽  
The Body ◽  
Hormone Deficiency ◽  
Side Reactions ◽  
Secondary Hypothyroidism

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

scholarly journals Macro-TSH in patients with primary hypothyroidism due to autoimmune thyroiditis

2021 ◽  
Vol 17 (4) ◽  
pp. 17-20
Author(s):  
A. G. Saribekian ◽  
D. A. Petrenko ◽  
D. A. Trukhina ◽  
A. G. Kuzmin ◽  
L. K. Dzeranova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Thyroid Gland ◽  
Autoimmune Thyroiditis ◽  
Thyroid Dysfunction ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Common Phenomenon ◽  
Functional Disorders ◽  
Key Indicators

Thyroid stimulating hormone (TSH) is one of the key indicators in the diagnosis of the thyroid gland functional disorders. Minor changes in TSH concentration make it possible to suspect thyroid dysfunction even before clinical manifestations, which increases the value of correct and timely measurement of it. In the clinical practice, an endocrinologist often encounter the well-known phenomenon of macroprolactinemia; a much less common phenomenon is macrotyrotropinemia (macro-TSH). The presence of macro-TSH complexes can be suspected when the serum detects atypically high TSH values with reference values of FT4 without any signs of hypothyroidism. Since the phenomenon is based on an autoimmune mechanism, macro-TSH can often be detected in patients with autoimmune thyroiditis (AIT). This article presents clinical cases of patients with a combination of the macro-TSH phenomenon and primary hypothyroidism due to AIT.

scholarly journals Hypothyroidism: find and neutralize

2021 ◽  
pp. 266-274
Author(s):  
A. F. Verbovoy ◽  
Yu. A. Dolgikh ◽  
T. Yu. Katorzhanskaya ◽  
V. K. Katorzhanskiy
Keyword(s):  
Clinical Manifestations ◽  
Endocrine System ◽  
Gastrointestinal Diseases ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Hematological Disorders ◽  
Lipid Metabolism Disorders ◽  
Definition Of

Hypothyroidism is one of the most common diseases of the endocrine system. It is more often recorded in older women. This disease is characterized by nonspecific symptoms and a blurred clinical picture. Patients often have many symptoms from various organs and systems. Because of this, hypothyroidism often remains unrecognized, and patients are not prescribed the necessary therapy on time. Doctors of various specialties should pay attention to the symptoms that may manifest as hypothyroidism. This is especially true for elderly patients. As a screening, the definition of thyroid-stimulating hormone (TSH) is used. First of all, attention should be paid to the pathology of the cardiovascular system, the presence of arterial hypertension, often diastolic and poorly controlled, a decrease in stroke volume and heart rate. Also, in hypothyroidism, lipid metabolism disorders, an earlier onset of atherosclerosis, a connection with metabolic syndrome and type 2 diabetes mellitus were noted. Therefore, it is recommended to diagnose hypothyroidism in patients with these diseases. Screening should also be done in the presence of neurological disorders, depressive and anxiety disorders, gastrointestinal diseases, and hematological disorders (anemias). The determination of TSH is included in the examination plan for infertility, and may also be necessary for other disorders of the reproductive system: menstrual irregularities in women and androgen deficiency in men. Treatment of overt hypothyroidism consists in the appointment of replacement therapy with levothyroxine. If subclinical hypothyroidism is detected, the question of treatment is decided individually and depends on the level of TSH, the patient’s age, and the clinical manifestations of the disease.

scholarly journals MANAGEMENT OF CASE OF PRIMARY HYPOTHYROIDISM ON THE PRINCIPLES OF DHATWAGNIMANDYA - A CASE REPORT

2021 ◽  
Vol p6 (1) ◽  
pp. 3258-3261
Author(s):  
Neetu Sharma ◽  
Shalini Rai ◽  
Sisir Kumar Mandal ◽  
Anand More
Keyword(s):  
Case Report ◽  
Symptomatic Relief ◽  
Clinical Manifestations ◽  
Biochemical Parameter ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Management Approach ◽  
Endocrine Disorders ◽  
Dietary Regimen

Hypothyroidism is a condition caused by thyroid hormone deficiency. It occurs due to hormonal imbalance & decreased metabolism. Clinical manifestations range from no signs or symptoms to life-threatening conditions. In Ayurveda, it corresponds to Dhatvagni Mandya. In this case report the patient presented with puffiness of the face, swelling in both the limbs, muscle (back) pain, loss of appetite, constipation and abnormal weight gain. According to symptomatic presentations, the case was diagnosed as Dhatvagni mandya. Clinical presentation and biochemical parameter i.e., Thyroid Stimulating Hormone (TSH) was 12.07uIU/ml which confirmed the case as Hypothyroidism in modern medicine. The multimodal Ayurvedic management approach incorporating ahara, vihara and aushadha was adopted. The case was treated on the line of principles of Agnimandya. Shaman Chikitsa (pacifying therapy) including internal administration of herbo-mineral formulations such as Arogyavardhini vati, Kanchnaar guggul, Punarnava mandur, Avipattikar churna, Swarna vanga along with a dietary regimen was prescribed to the patient. After 3 months’ treatment, significant symptomatic relief along with reduction of serum TSH level (3.05uIU/ml) without any adverse effects was observed in the patients. It can be inferred from the case that Ayurvedic intervention has enough potential to be employed and utilized in such endocrine disorders. Keywords- Ayurveda, Dhatawagni, Agni, Hypothyroidism, Kanchnar Guggul, Arogyavardhini vati.

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