scholarly journals Are Changes in Thyroid Hormones Associated with Mortality in Non-Thyroidal Illness Syndrome?

2021 ◽  
Vol 2 (6) ◽  
pp. 56-59
Author(s):  
Emre Hoca ◽  
Hayriye Esra Ataoğlu ◽  
Süleyman Ahbab
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Acute Phase ◽  
Mortality Data ◽  
Thyroid Function Tests ◽  
Hormone Levels ◽  
Function Tests ◽  
Thyroid Hormone Levels ◽  
Tsh Levels

Introduction: Non-thyroidal illness syndrome (NTIS) can be defined as afunctional impairment of the hypothalamic-pituitary-thyroid axis accompanied by signs of non-thyroidal disease with changes in thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) levels. NTIS and thyroid hormone levels in this syndrome are thought to be related with mortality. This study was performed to evaluate the relationship between hormone levels and mortality in this syndrome. Methods: The 5-year mortality data of patients who were hospitalized in the first 6 months of 2014 and whose thyroid hormone levels could be checked twice within 5 years were evaluated. In our study conducted with 405 patients whose thyroid function tests was repeated, the follow-up period was 5 years. Biochemical parameters including thyroid function tests were sent from all patients. NTIS was defined as a condition in patients with low fT3 levels (<2.5 pg/mL) and TSH levels within the normal range (0.38-5.33 mIU / L). Results: 128 patients died, and the number of surviving patients was 277 during the follow-up period. Positive acute phase reactants such as CRP, sedimentation, ferritin was high and albumin (negative acute phase reactant) and fT3 levels were low in patients who died. In addition, these changes in biochemical values were statistically significant. The mortality rate was increased in patients with low fT3 and high fT4 levels. In the follow-up period, changes in TSH levels were not significantly associated with mortality. Conclusion: Both the decrease in fT3 levels and the increase in fT4 levels can be used as predictors and independent risk factors for long-term mortality risk in chronically ill and hospitalized patients with NTIS.

scholarly journals The spectrum of thyroid function tests during hospitalization for SARS COV-2 infection

2021 ◽  
Vol 184 (5) ◽  
pp. 699-709
Author(s):  
Irene Campi ◽  
Ilaria Bulgarelli ◽  
Antonella Dubini ◽  
Giovanni Battista Perego ◽  
Elena Tortorici ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Cytokine Storm ◽  
Single Center ◽  
Predictors Of Mortality ◽  
Function Tests ◽  
Tsh Secretion ◽  
Thyroid Dysfunctions ◽  
Tsh Levels

Objective Alterations in thyroid function tests (TFTs) have been recorded during SARS-CoV-2 infection as associated to either a destructive thyroiditis or a non-thyroidal illness. Methods We studied 144 consecutive COVID-19 patients admitted to a single center in intensive or subintensive care units. Those with previous thyroid dysfunctions or taking interfering drugs were excluded. Differently from previous reports, TSH, FT3, FT4, thyroglobulin (Tg), anti-Tg autoantibodies (TgAb) were measured at baseline and every 3–7 days. C-reacting protein (CRP), cortisol and IL-6 were also assayed. Results The majority of patients had a normal TSH at admission, usually with normal FT4 and FT3. Low TSH levels were found either at admission or during hospitalization in 39% of patients, associated with low FT3 in half of the cases. FT4 and Tg levels were normal, and TgAb-negative. TSH and FT3 were invariably restored at the time of discharge in survivors, whereas were permanently low in most deceased cases, but only FT3 levels were predictors of mortality. Cortisol, CRP and IL-6 levels were higher in patients with low TSH and FT3 levels. Conclusions Almost half of our COVID-19 patients without interfering drugs had normal TFTs both at admission and during follow-up. In this series, the transient finding of low TSH with normal FT4 and low FT3 levels, inversely correlated with CRP, cortisol and IL-6 and associated with normal Tg levels, is likely due to the cytokine storm induced by SARS-Cov-2 with a direct or mediated impact on TSH secretion and deiodinase activity, and likely not to a destructive thyroiditis.

The association between prenatal exposure to organochlorine compounds and neonatal thyroid hormone levels: a systematic review

2020 ◽  
Vol 33 (1) ◽  
pp. 21-33 ◽  
Author(s):  
Mahshid Gheidarloo ◽  
Roya Kelishadi ◽  
Silva Hovsepian ◽  
Mojtaba Keikha ◽  
Mahin Hashemipour
Keyword(s):  
Systematic Review ◽  
Thyroid Hormone ◽  
Organochlorine Pesticides ◽  
Thyroid Function ◽  
Prenatal Exposure ◽  
Thyroid Function Tests ◽  
Hormone Levels ◽  
Fetal Thyroid ◽  
Thyroid Hormone Levels ◽  
Organochlorine Pollutant

AbstractIn this systematic review, the association between prenatal exposure to organochlorine pesticides (OCPs) and neonatal thyroid hormone levels was studied. A systematic search of scientific literature was performed from the PubMed, SCOPUS and ISI web of science electronic bibliographic databases. The search strategy for the review was [(organochlorine OR “organochlorine pesticides” OR “organochlorine pollutants” OR “organochlorine pollutant”) AND (“thyroid hormone” OR triiodothyronine OR Thyroxine OR “fetal thyroid function” OR “thyroid function” OR “Thyroid Stimulating Hormone” AND “prenatal” AND “maternal exposure”)] in English sources. In this review, 305 papers (PubMed: 30; Scopus: 29; ISI: 246) were identified through an electronic database search. Twenty-seven articles were assessed for eligibility, from which 16 qualified articles were selected for the final evaluation. The most common OCP metabolites which were evaluated in order were hexachlorobenzene (HCB) (13 studies), pp-dichlorodiphenyldichloroethylene (pp-DDE) (13 studies), hexachlorocyclohexane (HCH) (10 studies) and dichlorodiphenyltrichlorethane (DDT) (eight studies). A review of the documents related to the association of prenatal exposure of OCPs with fetal or neonatal thyroid function tests provides us with heterogeneous data in this field. Factors such as differences in the studied populations and their area, ethnic and genetic background, time and rate of exposure, possible interaction of other thyroid-disrupting environmental factors and dietary intake of micronutrients such as iodine and/or selenium are considered the main limitations for making an accurate conclusion. For some OCPs including DDT, DDE, HCH and HCB, there are supporting evidences, and it is suggested that their exposure could potentially alter the fetal thyroid function and consequently impair the neurodevelopment process of the infants.

scholarly journals Hemogram parameters in the patients with subacute thyroiditis

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Hasret Cengiz ◽  
Ceyhun Varım ◽  
Taner Demirci ◽  
Sedat Cetin
Keyword(s):  
Thyroid Function ◽  
Acute Phase ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Operating Characteristics ◽  
Acute Phase Reactants ◽  
Lymphocyte Ratio ◽  
Function Tests ◽  
Subacute Granulomatous Thyroiditis

Background & Objective: Subacute Granulomatous Thyroiditis (De Quervain’s Thyroiditis) is an acute painful inflammatory disease of the thyroid. We aimed to investigate easily accessible and cheap hemogram based parameters of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) in the follow up of inflammatory thyroid disease. Methods: Patients admitted to Sakarya University Education and Research Hospital Endocrinology and Metabolism Outpatient Clinic and diagnosed as Subacute Granulomatous Thyroiditis between May 2017 and November 2018 were included in the study. Hemogram, thyroid function tests and acute phase values ​​of these patients were recorded and compared with the values ​​after treatment and disease recovery. On the sixth month, thyroid function tests were repeated and the rate of permanent hypothyroidism was screened. The relationships between initial hemogram parameters and acute phase reactants were evaluated. Results: Total 71 patients were included in our study. 60 (84.5%) were female and 11 (15.5%) were male. The F/M ratio was found to be 6/1. Mean age was 43 ± 9.95 years. Receiver Operating Characteristics (ROC) Curve Analysis was performed and values for Area Under the Curve (AUC) for NLR and PLR, respectively, were 0.739 (95% CI 0.657-0.820 p<0.0001) and 0.772 (95% CI 0.694-0.850 p<0.0001), which are significant and associated with disease activity. However, the AUC for MPV parameter was: 0.578 (95% CI 0.484-0.672 P: 0.10) and was not significant. The cut off values defined as 2.4 (80% sensitivity and 51% specificity) for NLR and 146.84 (83% sensitivity and 54% specificity) for PLR for the acute phase of the disease. In the Correlation Analysis, NLR and PLR values ​​were significantly correlated with ESR and CRP parameters, which are the most commonly used acute phase reactants. Conclusion: According to the present study, we believe that the NLR and PLR parameters will be of benefit in the follow-up the disease, accurately demonstrate the inflammatory load in the acute phase of the disease, and correlate with the common acute phase reactants. doi: https://doi.org/10.12669/pjms.36.2.1063 How to cite this:Cengiz H, Varim C, Demirci T, Cetin S. Hemogram parameters in the patients with subacute thyroiditis. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1063 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Thyroid function tests: often justified in the acutely ill

2000 ◽  
Vol 37 (2) ◽  
pp. 158-164 ◽  
Author(s):  
E J Lamb ◽  
J Martin
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Clinical History ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Lost To Follow Up ◽  
Symptoms And Signs ◽  
Tsh Levels

It is claimed that inappropriate requesting of thyroid function tests (TFTs) is common in acutely ill patients. Consecutive inpatient TFTs ( n=129) were assessed in relation to clinical history and common symptoms and signs of thyroid disease. Requests were justified in 69% of cases, most commonly on the basis of atrial fibrillation and/or tachycardia. There were no clear reasons for requesting TFTs in the remaining cases, although the yield of abnormal results in these patients was similar to that in those with justified requests. Thyroid stimulating hormone (TSH) concentration was increased (median 7·5 mU/L, range 4·8-38·6 mU/L) in 22 patients, six of whom had biochemical and/or clinical evidence of hypothyroidism (previously undiagnosed) and five of whom had pre-existing hypothyroidism. Of the remaining 11 patients with increased TSH levels, three were confirmed to have compensated hypothyroidism; non-thyroidal illness (NTI) (including the effect of drugs) accounted for four cases. In four patients (one of whom died during the admission) follow-up was not possible. Of six patients with reduced TSH concentration (range < 0·05-0·35 mU/L), one was thyrotoxic on carbimazole, one was receiving thyroxine for hypothyroidism, one had NTI and three were lost to follow-up (two of whom died during their admission). Manifestations of thyroid disease are protean and often subtle, and TFTs are thus clinically justified in many unwell inpatients. Although NTI contributes to some cases of abnormal TSH levels, a significant number of TFT abnormalities are consistent with underlying thyroid abnormality requiring investigation/treatment.

scholarly journals Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels

2021 ◽  
Vol 22 (12) ◽  
pp. 6521
Author(s):  
Mirjana Babić Babić Leko ◽  
Ivana Gunjača ◽  
Nikolina Pleić ◽  
Tatijana Zemunik
Keyword(s):  
Thyroid Hormone ◽  
Environmental Factors ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Lifestyle Factors ◽  
Thyroid Stimulating Hormone ◽  
Hormone Levels ◽  
Thyroid Hormone Levels ◽  
The Impact ◽  
Tsh Levels

Thyroid hormones are necessary for the normal functioning of physiological systems. Therefore, knowledge of any factor (whether genetic, environmental or intrinsic) that alters the levels of thyroid-stimulating hormone (TSH) and thyroid hormones is crucial. Genetic factors contribute up to 65% of interindividual variations in TSH and thyroid hormone levels, but many environmental factors can also affect thyroid function. This review discusses studies that have analyzed the impact of environmental factors on TSH and thyroid hormone levels in healthy adults. We included lifestyle factors (smoking, alcohol consumption, diet and exercise) and pollutants (chemicals and heavy metals). Many inconsistencies in the results have been observed between studies, making it difficult to draw a general conclusion about how a particular environmental factor influences TSH and thyroid hormone levels. However, lifestyle factors that showed the clearest association with TSH and thyroid hormones were smoking, body mass index (BMI) and iodine (micronutrient taken from the diet). Smoking mainly led to a decrease in TSH levels and an increase in triiodothyronine (T3) and thyroxine (T4) levels, while BMI levels were positively correlated with TSH and free T3 levels. Excess iodine led to an increase in TSH levels and a decrease in thyroid hormone levels. Among the pollutants analyzed, most studies observed a decrease in thyroid hormone levels after exposure to perchlorate. Future studies should continue to analyze the impact of environmental factors on thyroid function as they could contribute to understanding the complex background of gene–environment interactions underlying the pathology of thyroid diseases.

scholarly journals DIAGNOSTIC DILEMMA IN DISCORDANT THYROID FUNCTION TESTS DUE TO THYROID HORMONE AUTOANTIBODIES

2017 ◽  
Vol 3 (1) ◽  
pp. e22-e25 ◽  
Author(s):  
Panudda Srichomkwun ◽  
Neal H. Scherberg ◽  
Jasminka Jakšić ◽  
Samuel Refetoff
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Diagnostic Dilemma ◽  
Thyroid Hormone Autoantibodies ◽  
Function Tests

THYROID FUNCTION TESTS: A REVIEW

2021 ◽  
pp. 73-76
Author(s):  
Vasudev Sankhla ◽  
Aman Deep
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Radioactive Iodine ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Tsh Secretion ◽  
Line Test ◽  
Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

scholarly journals SUN-425 Indiscriminate Thyroid Function Testing on Acute Hospital Admissions Reveals a High Abnormality Rate Requiring Follow Up

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Robert P McEvoy ◽  
Anthony O’Riordan ◽  
Mark J Hannon
Keyword(s):  
Thyroid Function ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Patient Age ◽  
Function Tests ◽  
Patient Âgé ◽  
Thyroid Function Testing ◽  
Function Testing

Abstract The population attending the Medical Assessment Unit at our hospital comprises patients attending electively for investigation and acutely unwell patients presenting for unscheduled care. The standard panel of blood tests taken on arrival includes thyroid function tests (TFTs, i.e. TSH and free-T4), despite a recent review questioning the clinical utility of this practice [1]. We performed a retrospective audit to determine what proportion of our patients had abnormal thyroid function on presentation, and whether these abnormal test results were being followed up. Using the iSoft Clinical Manager software, a list was generated of all patients who attended the hospital between January 2018 and June 2018 inclusive. For each attendance, we recorded the date, medical record number, patient age, gender, and TFT result. Abnormal TFT results were classified as overt or subclinical hyper- or hypothyroid, or non-thyroid illness syndrome (NTIS), based on their admission TSH and free-T4. We then examined the hospital and primary care records of patients with abnormal TFTs to determine if they had ongoing thyroid follow up post discharge. In total, 2,298 patients attended over the 6-month study period. The mean patient age was 67.2 years, and 49% were female. Thyroid function tests were ordered on the day of attendance for 1,688 patients (73%). Of these, 181 results (11%) were abnormal: 20 overt hyperthyroid (11%), 72 subclinical hyperthyroid (40%), 12 overt hypothyroid (7%), 35 subclinical hypothyroid (19%), and 42 NTIS (23%). Twenty of these patients died within 3 months of the abnormal TFT result (4 overt hyperthyroid, 3 subclinical hyperthyroid, 3 overt hypothyroid, 6 subclinical hypothyroid, and 4 NTIS). Of the remaining 161 patients, 74 (46%) had not been followed up within 3 months (4 overt hyperthyroid, 34 subclinical hyperthyroid, 3 overt hypothyroid, 15 subclinical hypothyroid, and 18 NTIS). The low percentage of abnormal TFTs (11%) in this audit is in keeping with similar studies where thyroid function testing was performed on unselected hospital populations [1]. Subclinical hyperthyroidism was by far the most common abnormality found. A high percentage of abnormal tests (46%) were not followed up, with poor compliance with thyroid management guidelines [2]. Future work will investigate adoption of an ‘opt-in’ order system [3] and electronic alerts to flag abnormal results for follow-up. [1] Premawardhana LD. Thyroid testing in acutely ill patients may be an expensive distraction. Biochemia medica. 2017; 27(2): 300-307. [2] Ross DS et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct; 26(10):1343-1421. [3] Leis B et al. Altering standard admission order sets to promote clinical laboratory stewardship: a cohort quality improvement study. BMJ Qual Saf. 2019; 28(10): 846-52.

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