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.

scholarly journals Study on thyroid function test in pregnancy in a tertiary care hospital

2021 ◽  
pp. 20-25
Author(s):  
Ajit Kumar Nayak ◽  
Manorama Swain ◽  
Sujata Misra ◽  
Manju Kumari Jain
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Tertiary Care ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Thyroid Disorder ◽  
Singleton Pregnancy ◽  
Free T4

Thyroid disorder is a very common endocrine problem encountered by pregnant women. Maternal thyroid dysfunction is associated with adverse outcome both in mother and fetus. The aim of the study: to find out the prevalence of various thyroid disorders in pregnant women attending antenatal clinic. Materials and methods. This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynecology, F.M. Medical College & Hospital, Balasore, Odisha from June 2020 to May 2021. 220 women with uncomplicated singleton pregnancy were included. Serum Thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) were estimated by using electro-chemiluminescence immunoassay technique. Results. Out of 220 pregnant women screened for thyroid dysfunction, 68 were found to have thyroid disorders. 27.3 % of pregnant women had subclinical hypothyroidism, 1.4 % had overt hypothyroidism, 1.8 % had subclinical hyperthyroidism and 0.5 % had overt hyperthyroidism. Prevalence of subclinical hypothyroidism was 6.36 % when the upper reference limit of TSH level taken as 4 mIU/L. Prevalence of thyroid disorder among pregnant women in the age groups 18–25 years, 26–30 years and 31–40 years were 28.9 %, 32.1 % and 38.9 % respectively. There were 35.5 %, 28 % and 26 % pregnant women with thyroid disorders in the first, second and third trimester respectively. Prevalence of both subclinical and overt hypothyroidism were more in multigravida compared to primigravida. Conclusion. Our study revealed high prevalence of thyroid disorders in pregnant women and maternal subclinical hypothyroidism was the most common pattern.

Long term changes in serum T4, T3, and TSH in benign thyroid disease

2004 ◽  
Vol 43 (05) ◽  
pp. 158-160 ◽  
Author(s):  
F. Hartmann ◽  
R. Rödel ◽  
M. Reinhardt ◽  
H.-J. Biersack
Keyword(s):  
Thyroid Function ◽  
Small Variation ◽  
Reference Ranges ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Wide Range ◽  
Serum T4 ◽  
The Individual ◽  
Benign Thyroid

Summary:Aim: The diagnosis of abnormalities of thyroid function is generally based on the measurement of thyroid hormones and TSH in blood. The recommended reference ranges for serum T4 and T3 as well as TSH are quite wide as the result of large differences in thyroid function tests in healthy persons. It has been proven that the individual variation within an individual is small, compared with the variation between individuals. We investigated long term variations of these parameters in patients with and without benign thyroid diseases. Methods: We performed long term follow-up serum determinations of T3, T4, and TSH in a total of 150 patients for a time period of 3 to 13 years. The majority of patients had been put on L-thyroxine. Values of total T3, total T4, free T4 were measured with an almost unmodified test (RIA) over the years. Results: The lowest relative coefficient of variation (<10%) was observed in the group of patients who had been treated with L-thyroxine only. Even for TSH, relatively low cofficients of variation were observed in this group. In the group of patients who had not received any medication, T3 and T4 showed also a variation of 10%. FT4 and TSH revealed a wider range of variation. Even after radioiodine therapy, T3 and T4 showed only a quite small variation, while TSH demonstrated a wide range with a variation of >30%. Conclusion: Our data demonstrate that there are only narrow variations of serum T4 and T3 within individuals with and without thyroid disorders.

scholarly journals PATTERN OF THYROID DISORDERS AMONG PATIENTS IN HAZARA DIVISION, PAKISTAN

2018 ◽  
Vol 16 (2) ◽  
pp. 46-50
Author(s):  
Nasir Hussain Shah Kazmi ◽  
Saima Gillani ◽  
Abdul Rauf ◽  
Haider Zaman ◽  
Shahzad Najeeb ◽  
...  
Keyword(s):  
Sampling Technique ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Thyroid Status ◽  
Cross Sectional ◽  
Medical College ◽  
Minimum Age

Background: Thyroid disorders are a commonly encountered problem in hilly areas of Pakistan. The objectives of the study were to determine the frequency and distribution of thyroid disorders among patients presenting with suggestive signs & symptoms of thyroid disorders in Hazara Division, Pakistan. Material and Methods: This cross-sectional study was conducted in Departments of Medicine and Pediatrics & Neonatology, Ayub Medical College, Abbottabad, KP, Pakistan from January, 2017 to January, 2018. Exclusion criteria was patients taking medicines such as Lithium and Cordarone. Sample size was 55 selected using consecutive sampling technique. Reference values were taken as follows; serum TSH=0.4-4.0 µIU/L, serum T3=100-200 ng/dL), serum T4=5-13.5 µgm/dL. Demographic variables were sex and age. Research variables were thyroid status (euthyroid/ hyperthyroid/ hypothyroid) and levels of thyroid function tests (TFT). Categorical variables such as sex and thyroid status were calculated by frequency and percentages whereas numeric variables such as age and TFT by Mean and SD. Descriptive statistics were calculated using SPSS Version 20. Results: Out of the total 55 patients, 11 patients were males and 44 patients were females. The minimum age was 20 years, maximum age was 90 years. Mean age was 43.24 years±15.118. Out of the total 55 patients, 14 (25.5%) were euthyroid, 30 patients (54.5%) were hyperthyroid and 11 (20%) patients were hypothyroid. Out of the 14 patients that were euthyroid, seven were males and seven were females. Out of the 30 hyperthyroid patients 26 were females and only 4 were males. All 11 hypothyroid were females. Conclusions: Hyperthyroidism is more common thyroid disorder in Hazara Division specially in adult females.

scholarly journals The spectrum of thyroid disorders at the Endocrine Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west, Nigeria

2019 ◽  
Vol 5 (1) ◽  
pp. 85-92
Author(s):  
Ayo Ale ◽  
Opeyemi Bamise Aloro ◽  
Ayanbola Adepoju ◽  
Olatunde Odusan
Keyword(s):  
Low Cost ◽  
Nodular Goiter ◽  
University Teaching ◽  
Endocrine Disorders ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
South West ◽  
The Mean ◽  
Endocrinology Clinic

Background: Thyroid disorders constitute the second most common endocrine disorders worldwide, but they are less commonly researched in this environment due to low cost-effectiveness. Objective: To study the spectrum of thyroid disorders at the Endocrinology Clinic of a tertiary health facility in Sagamu, South-west, Nigeria, over two years. Method: This retrospective study was conducted on all new clinic attendees with thyroid disorders between January 2016 and December 2017. The data retrieved included clinical data, results of thyroid function tests and thyroid ultrasonographic scan. The patients were grouped clinically into euthyroid, hypothyroid and thyrotoxic states. Results: A total of 93 thyroid cases were seen, and this constituted 13.64% of all new endocrine consultations (682 patients). The mean age (±SD; range) of the patients was 37.6 (13.6; 15-78) years. Majority of the patients were females with a female-to-male ratio of 4.5:1. Out of these, 77.4% had Goitrous enlargement. Thyrotoxicosis was the most common form of thyroid dysfunction, (72; 77.40%), mainly due to hyperthyroidism from Graves’ disease (50; 69.44%), followed by toxic multinodular goitre (12; 16.67%), toxic solitary nodular goiter (5; 6.94%) and others (5; 6.95 %). Hypothyroidism constituted 10.75% while euthyroid goitre constituted 11.85% of all thyroid cases. Conclusion: Auto-immune thyroid disease remains the most common thyroid disorder among endocrine clinic attendees. There is a need for further studies to elucidate the likely aetiologies.

Clinical assessment of the thyroid patient

2011 ◽  
pp. 321-325
Author(s):  
Peter Laurberg ◽  
Inge Bülow Pedersen
Keyword(s):  
Physical Examination ◽  
Older People ◽  
Thyroid Function ◽  
Clinical Assessment ◽  
Reference Range ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Structural Abnormalities ◽  
Complete History ◽  
Size And Structure

Thyroid disorders are common, especially in older people where 10–20% may have structural abnormalities of the thyroid glan and/or thyroid function tests outside the reference range (1). Evaluation of thyroid function, size, and structure is therefore an important part of any complete history and physical examination of a patient.

scholarly journals Association between thyroid disorders and abnormal uterine bleeding in reproductive ages

2020 ◽  
Vol 9 (9) ◽  
pp. 3580
Author(s):  
Aiyleen S. Shawl ◽  
Massarat Naz
Keyword(s):  
Subclinical Hypothyroidism ◽  
Strong Association ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Structural Defects ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Age Group

Background: Abnormal uterine bleeding (AUB) means any bleeding that is not normal in amount, duration, frequency, and cyclicity. It is a common disorder occurring in reproductive age group females. It can be understood as bleeding that occurs from the uterus outside the normal parameters and there are no structural defects in the genital tract. One of the most common associations with AUB is thyroid dysfunctions. Hence, this study aimed to see the incidence of thyroid-related disorders in AUB and also to assess the menstrual pattern.Methods: A total 100 women suffering from AUB who presented to OPD of the gynecology department of L D Hospital Srinagar, Jammu and Kashmir were recruited in the study. All females in 19 to 45 years of age group with abnormal uterine bleeding were included excluding those with a previously known thyroid disorder, abortion history within 3 months, etc. Thyroid function tests were done in all along with ultrasonography of the pelvis region. Data were analyzed using SPSS software v.23.0. and Microsoft office 2007.Results: The bleeding abnormality that was found in most of the women was heavy menstrual bleeding. Out of the 100 patients taken into study 11 had thyroid disorders, out of which subclinical hypothyroidism was most prevalent accounting for 8 cases, 2 cases were found to have hypothyroidism and 1 case of hyperthyroidism was detected.Conclusions: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction.

scholarly journals MON-475 Discrepant Thyroid Function Tests in Adenocarcinoma-Is This a True Thyroid Disorder?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mohammed Al Tameemi ◽  
Janice L Gilden
Keyword(s):  
Thyroid Function ◽  
Thyroid Function Test ◽  
Amiodarone Therapy ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Check Point ◽  
Free T4 ◽  
Function Tests ◽  
Function Test ◽  
Check Point Inhibitors

Abstract Background: Many causes of abnormal thyroid function tests (TFTs) occur that may or may not reflect a true thyroid disorder. The most common include: immune check point inhibitors therapies (ICI) used to treat various types of cancers; biotin supplements, which may interfere with thyroid function test assays; euthyroid sick syndrome; as well as amiodarone therapy for cardiac disorders. Clinical Case: A 67-year old female patient with type 2 diabetes mellitus, taking insulin and oral antihyperglycemic agents, with hyperlipidemia, hypertension and coronary artery disease, who had abnormal TFTs (TSH was 3.7 to 4.9 uIIu/ml; ref range 0.27-4.2 uIU/mL), and Free T4 was 0.92 to 1.06 ng/dL; ref range 0.55-1.6 ng/dl) prior to the diagnosis of metastatic adenocarcinoma of the lungs. She was initially treated with radiation. TFTs were unchanged. Her CEA was noted to be 129.5 (0-3.0 ng/mL). However, following chemotherapy with Tarceva (Erlotinib) 50 mg po daily, the TSH increased to 7.6 uIU/ml with Free T4 of 3.19 ng/dL. She remained clinically euthyroid. A thyroid ultrasound showed 1 -small sub centimeter nodule in each thyroid lobe. The patient later admitted to also taking biotin for an unknown period of time. TSH antibodies and TSI were both negative. Free T4 by dialysis was normal. While still taking Tarceva her TSH was noted to be 2.5 to 3.8 uIU/ml and both Free T4 and Free T3 were elevated and was 6.57 pg/ml;ref range=2.52-4.34 pg/mL). Six months later, the Free T4 decreased to 1.08 ng/dL. Thyroid antibodies and thyroglobulin remain normal. The patient remained clinically euthyroid. Conclusion: It is important to note that several factors can cause abnormal thyroid function tests, such as Immune check point inhibitors therapy, with the exact mechanism for abnormal TFTs unknown, and can also be associated with either Grave’s hyperthyroidism or Hashimoto’s hypothyroidism,as well as other autoimmune endocrine disorders. Biotin, a common supplement, has also been reported to interfere with the thyroid function test assays for free thyroxine (T4), total T4, free triiodothyronine (T3), total T3, TSH, and various cancer markers. However, It is important to clinically evaluate the patient for thyroid disorders, and recognize that therapy may not always be required, when discrepant and fluctuating thyroid function tests are obtained, such as in this patient. References: (1) Holmes EW, Samarasinghe S, Emanuele MA, Meah. Biotin interference in clinical immunoassays: a cause for concern. . Arch Pathol Lab Med. 2017;141:1459-1460. (2) Rossi E, Sgambato, De Chaira G, et al. Thyroid-induced toxicity of check-point inhibitors immunotherapy in the treatment of advance non-small cell lung cancer. J. Endocrinol Diabetes 2016;3:1-10.

scholarly journals SAT-518 Progression of Graves Disease to Hashimoto’s Thyroiditis Following Alemtuzumab Therapy for Multiple Sclerosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Brandon Rapier ◽  
Frank Gargasz ◽  
Omar Suheil Zmeili
Keyword(s):  
Multiple Sclerosis ◽  
Thyroid Function ◽  
Hashimoto’S Thyroiditis ◽  
Thyroid Nodules ◽  
Hashimoto's Thyroiditis ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Free T4 ◽  
Free T3

Abstract Introduction: Alemtuzumab, an anti-CD52 monoclonal antibody used in the treatment of relapsing-remitting multiple sclerosis is most commonly associated with Graves disease, but autoimmune hypothyroidism may also be seen. We present an unusual case where both were present in the same patient and progression from hyperthyroidism to hypothyroidism was seen within only a few months. Clinical Case: A 33-year-old female referred to Endocrinology clinic for evaluation of hyperthyroidism. She was complaining of palpitations, tremors, increased sweating, heat intolerance, and unintentional weight loss for 3 months. She received 2 cycles of alemtuzumab treatments over the last 21 months for her multiple sclerosis. Last treatment was 8 months before she developed hyperthyroid symptoms. Patient had no prior history of thyroid disorder. Thyroid stimulating hormone (TSH) level was within normal range before alemtuzumab was administered. TSH was monitored periodically and was normal till 8 months after receiving alemtuzumab therapy. Physical exam was remarkable for diffuse enlarged thyroid, not tender, without palpated thyroid nodules but with thyroid bruit. No proptosis was present. Thyroid function tests obtained by her primary care physician were consistent with hyperthyroidism. Patient found to have suppressed TSH &lt;0.015 IU/mL [0.465 - 4.680IU/mL], elevated total T3 372ng/dL [97-169ng/dL], and elevated total T4 &gt;24.9 ug/dL [5.5 - 11.0 ug/dL]. Further workup revealed elevated Free T3, 10.90 [2.77 - 5.27 pg/mL] and elevated free T4 &gt; 6.99 ng/dL [0.78 - 2.19 ng/dL]. Thyrotropin receptor antibody (TR Ab) was elevated as well at 3.43 IU/L [&lt;1.75 IU/L]. Pregnancy test was negative. Thyroid ultrasound demonstrated goiter with no focal thyroid nodules seen. She was started on methimazole 10 mg daily. One month later, TSH was elevated at 31.58 though she only took methimazole for one week and then discontinued due to rash and pruritus. At that time, she reported severe fatigue and 25 lbs weight gain. Repeated labs one month later showed elevated TSH, 60.978 IU/ML, low free T4 0.08 pg/mL and low free T3 0.72 ng/dL. Thyroid peroxidase Antibody (TPO Ab) was obtained and was 5308.8 IU/mL [0.0 - 5.5 IU/mL]. She was started on levothyroxine 100 mcg daily. Two months later, levothyroxine dose was increased to 112 mcg daily due persistent TSH elevated. At subsequent visit, patient was euthyroid with normal TSH 3.191IU/mL and normal free T4 1.48 ug/dL. Conclusion: This case was unique in that the patient developed both TR Ab and TPO Ab after alemtuzumab therapy which resulted in Grave’s disease followed by Hashimoto’s thyroiditis. The case highlights the importance of continuous monitoring of thyroid function in patients treated with alemtuzumab given the unpredictable autoimmune phenomena which may occur.

scholarly journals Hyponatremia and Isolated Free T4 Elevation in a Patient With Acute Intermittent Porphyria

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A585-A586
Author(s):  
Anand Gandhi ◽  
Michael Mortensen ◽  
Mahmoud Alsayed ◽  
Aditi Kumar ◽  
Jerome H Targovnik
Keyword(s):  
Abdominal Pain ◽  
Thyroid Function ◽  
Aminolevulinic Acid ◽  
Acute Intermittent Porphyria ◽  
Laboratory Evaluation ◽  
Porphobilinogen Deaminase ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Deiodinase Activity ◽  
Wide Range

Abstract Background: Porphyrias represent a spectrum of diseases that stem from dysfunction within the heme biosynthetic pathway. Acute intermittent porphyria (AIP) is the most common type of porphyria due to a genetic deficiency of porphobilinogen deaminase which results in a wide range of neurovisceral symptoms. Hyponatremia and abnormalities with thyroid function have been found in AIP but the mechanisms behind these processes are unclear. Clinical Case: A 26-year-old male with a history of chronic, recurrent abdominal pain presented with 10 days of progressively worsening periumbilical abdominal pain and constipation. He describes that preceding the onset of symptoms he had been binging 5-10 standard alcoholic drinks each day for a few days. Initial laboratory workup demonstrated hyponatremia with Na 114 mmol/L (n: 134 – 137 mmol/L), hypochloremia with Cl 76 mmol/L (n: 95 – 108 mmol/L), and hyperbilirubinemia with total bilirubin 2.5 mg/dL (n: 0.2 – 1.3 mg/dL). CT abdomen/pelvis was negative for any concerning pathology. Further studies showed low serum osmolality at 243 mOsm/kg (n: 275 – 295 mOsm/kg), urine Na 62 mmol/L (n &gt; 20mmol/L), and urine osmolality at 394 mOsm/kg (n: 300 – 900 mOsm/kg) consistent with SIADH. The patient was treated with 3% NaCl and free water restriction to 1.2L/day with improvement in Na levels. Further laboratory workup demonstrated normal TSH, but persistently elevated free T4 with maximum free T4 of 2.77 ng/dL (n: 0.80 – 1.70 ng/dL) which downtrended to 1.99 ng/dL by discharge. Thyroid ultrasound was unremarkable. Pituitary evaluation via hormonal workup and MRI brain was negative for any abnormalities. Given the symptomatology and laboratory findings, the patient was evaluated for porphyria. Laboratory evaluation demonstrated severe elevations in urine porphyrins, urine delta aminolevulinic acid (56.8 mg/24h, n &lt; 4.5 mg/24h), and urine porphobilinogen (82.5 mg/g, n &lt; 2.3 mg/g) consistent with AIP. The patient was treated with four days of hematin infusions which resolved his abdominal pain and was discharged in an improved state. Conclusion: AIP is a rare entity brought out by a deficiency in porphobilinogen deaminase, a key enzyme in the heme biosynthesis pathway. Various metabolic disturbances have been described in AIP including hyponatremia and alterations in thyroid function tests suggestive of thyrotoxicosis. Hyponatremia in our patient was likely due to SIADH from neurovisceral pain. Our patient displayed isolated free T4 elevation as well. We hypothesize this developed due to his acute illness causing a greater decrease in D2 deiodinase activity compared to any concomitant increase in D3 deiodinase activity. This was supported by his free T4 level downtrending following treatment of his AIP attack. More research is needed to further elucidate the mechanism behind these derangements in biochemical markers and their impact on patient prognosis.

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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