scholarly journals Age and Assay Related Changes of Laboratory Thyroid Function Tests in the Reference Female Population

2019 ◽  
Vol 38 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Najdana Gligorovic Barhanovic ◽  
Tanja Antunovic ◽  
Sreten Kavaric ◽  
Aleksandar Djogo ◽  
Vesna Kalimanovska Spasojevic
Keyword(s):  
Thyroid Function ◽  
Correlation Coefficients ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Cross Sectional ◽  
Female Population ◽  
Reference Limit ◽  
Function Tests ◽  
Age Related ◽  
The Impact

Summary Background: Laboratory thyroid function tests play a central role in the diagnosis of thyroid disorders. The aim of our cross-sectional study was to determine reference values for thyroid tests in a rigorously selected group of Montenegrin females, investigate the impact of possible age-related changes and the influence of the interassay bias between three frequently used immunoassays. Methods: Female subjects were randomly selected, aged between 20 and 69 and 946 of them met the selection criteria. TSH, fT3, fT4, thyroid peroxidase and thyroglobulin antibodies were measured. Eighty samples were further analyzed on two other immunochemistry platforms. Results: Median TSH progressively increased with age, there was no difference in fT3, while fT4 was significantly higher in the two oldest groups compared to the others. When using the age-related 97.5 percentile of TSH the percentage of reclassification was highest in the 20–29 years of age group (5.2%, p<0.05). In the oldest band, 7.7% had TSH values above cohort-specific and below the age-related upper reference limit. Bland-Altman bias plots revealed the highest interassay absolute mean difference between compared TSH assays of 24.5% and for fT4 assays of 13.8%. Conclusions: The correlation coefficients between fT3 assays from different manufacturers were low. Serum TSH and fT4 concentrations increased with age and the implementation of age-specific TSH reference intervals would be of interest. The bias between the three commercial immunoassays indicated that the standardization of thyroid function tests is a task of great importance.

scholarly journals SAT-576 Possible Involvement of Thyroid Function in PCSK9 Inhibitor Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Masayasu Iwabuchi
Keyword(s):  
Thyroid Function ◽  
Ldl Cholesterol ◽  
Inhibitor Therapy ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Pcsk9 Inhibitors ◽  
Free T4 ◽  
Hyperthyroid Patient ◽  
Pcsk9 Inhibitor ◽  
The Impact

Abstract INTRODUCTION Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibition is an effective strategy for lowering plasma LDL-cholesterol and enhancing the LDL-cholesterol lowering ability of statins. PCSK9, a serine protease that binds to the LDL receptor promoting its degradation, is an important regulator of LDL metabolism. In addition, LDL-cholesterol is also controlled by TSH and thyroid hormones via PCSK9. TSH has received increasing attention as being closely associated with increased LDL-cholesterol level and higher atherosclerotic risks. In vitro study, the effects of TSH on hepatic PCSK9 expression in HepG2 cells were reported (1). I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. This case highlights the involvement of thyroid function in PCSK9 Inhibitor therapy. CLINICAL CASE A 65-year-old man had a weight loss of 6 kg (13 lbs.) in 4 months, accompanied with fatigue. He had a past history of myocardial infarction and his LDL was 83 mg/dL by 2.5mg of rosuvastatin and heart rate was controlled by 10mg of carvedilol. Six months ago, he started a PCSK9 Inhibitor therapy with 140mg of evolocumab every 2 weeks for 6 weeks. He had no preceding viral illness and denied anterior neck pain or tenderness. His height was 1.53 m, weight 52.6 kg (115 lbs.), and body mass index (BMI) 22.46 kg/m2. His thyroid was not enlarged and non-tender without clear palpable thyroid nodules or neck lymph nodes. Hyperthyroidism was suspected and confirmed by thyroid function tests: TSH was less than 0.0005 μIU/mL (normal 0.35–4.94), and free T4 1.830 ng/dL (0.70–1.48). Graves’ disease was considered, and thyroid antibody tests performed. Thyroid peroxidase (TPO) antibody titer was less than 9 IU/mL (&lt;9), and TSI 141% (&lt;120%). To confirm the diagnosis of this hyperthyroid patient, Technetium-99m uptake and scan was done which showed uptake of 0.8% (0.5–7%). After careful observation for 2 months with 5mg of carvedilol, he turned asymptomatic and free T4 lowered to 1.480 ng/dL and TSH remained less than 0.0005 μIU/mL. CLINICAL LESSONS I here report a case of transient hyperthyroidism secondary to PCSK9 inhibitor therapy. There has been no report of hyperthyroidism induced by PCSK9 inhibitors. Immunological influence of anti-PCSK9 therapy on thyroid is unknown. In this case, the decrease of TSH due to hyperthyroidism was considered to reduce hepatic PCSK9 expression, leading to additive effect to PCSK9 inhibitor. PCSK9 inhibitors may modify the effects of hyperlipidemia treatment by causing changes in thyroid function. When using PCSK9 inhibitors, follow-up of thyroid function should be considered. This case highlights the involvement of thyroid function in PCSK9 inhibitor therapy. Reference (1) Gong, Y., Ma, Y., et al. Thyroid stimulating hormone exhibits the impact on LDLR/LDL-c via up-regulating hepatic PCSK9 expression. Metabolism. 2017;76;32–41

scholarly journals Lyme Disease: An Autoimmunity-Based “Destructive Thyroiditis” or Just Another “Non-Thyroidal Illness”?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A940-A941
Author(s):  
Nyembezi Dhliwayo ◽  
Rana Wajahat ◽  
Andriy Havrylyan ◽  
Alvia Moid ◽  
Walid Khayr ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Thyroid Function ◽  
Paranoid Schizophrenia ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Radioiodine Uptake ◽  
Function Tests ◽  
Antigenic Properties

Abstract There is considerable evidence that some Borrelial (Lyme spirochetal) proteins share significant antigenic properties with several thyroid-related proteins (e.g. TSH receptor, thyroglobulin, thyroid peroxidase) and can induce thyroid autoimmunity, sometimes associated with Hashimoto’s thyroiditis and perhaps also a “destructive thyroiditis” such as “silent” thyroiditis or “Hashitoxicosis.” As an acute illness, Lyme disease may also constitute a “non-thyroidal illness” capable of perturbing thyroid function tests without causing thyroid dysfunction. We report a 22-year old woman admitted with an acute paranoid schizophrenia, thyroid function tests consistent with autoimmunity, transient thyrotoxicosis (tachycardia, lid-lag, brisk DTR’s) and a greatly reduced radioiodine uptake. The thyroid was not palpably enlarged, nodular or tender. On screening assay, reactivity was demonstrated to 4 of 13 Borrelial proteins. Anti-Lyme IgM but not IgG, antibodies, were positive. This was consistent with recent Lyme disease infection. Serum TSH (NL: 0.358-3.74 mcU/ml), Free T4 (NL: 0.76-1.46 ng/dl), and Free T3 (NL: 2.18-3.98 pg/ml) were, respectively: Day1: 0.087 mcU/ml (suppressed), 1.52 ng/dl (slightly elevated), 2.07 pg/ml (slightly reduced); Day2: 0.148 (suppressed), 1.18 (normal), no FT3; Day4: 0.827 (normal), no FT4 or FT3; Day5: 1.66 (normal), 0.89 (normal), 1.77 (low). Anti-Tg and Anti-Peroxidase antibodies were both moderately elevated. Thyroid Stimulating Immunoglobulins were not elevated. The radioactive iodine uptake on Day4 was 2.8% (NL: 15-30% at 24 hr). Thyroid ultrasonogram was normal. An attractive explanation is that Lyme disease triggered a “destructive thyroiditis,” perhaps but not necessarily mediated by thyroid autoimmunity. This would account for the brief interval of thyrotoxicosis accompanied by a very low radioiodine uptake. Alternatively, Lyme disease, as an acute process, would expectedly be capable of eliciting the thyroid function abnormalities of “non-thyroidal illnesses” in general, as would acute psychosis, well-known to often resemble Graves’ disease at admission.

scholarly journals A Hospital Based Cross Sectional Study Evaluating Haemoglobin, Iron Profile and Thyroid Function Tests in Women with Telogen Effluvium, Female Pattern Hair Loss, and Alopecia Areata

2021 ◽  
Vol 19 (1) ◽  
pp. 9-13
Author(s):  
Bibush Amatya ◽  
Smita Joshi
Keyword(s):  
Thyroid Function ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Cross Sectional Study ◽  
Thyroid Function Tests ◽  
Sectional Study ◽  
Cross Sectional ◽  
Function Tests ◽  
Female Pattern Hair Loss ◽  
Iron Profile

Introduction: Hair loss is one of the most frequent complaints for which patients see a dermatologist. The three most common causes of hair loss in women are telogen effluvium, alopecia areata and female pattern hair loss.   Objectives The aim of this study was to investigate haemoglobin, iron profile and thyroid function tests in women with telogen effluvium, alopecia areata and female pattern hair loss.   Materials and Methods: This was a hospital based cross sectional study conducted at the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital (NMCTH). We recruited female patients with telogen effluvium, alopecia areata or female pattern hair loss who presented to our outpatient department between June 2019 and July 2020. Clinical and demographic data were collected and haemoglobin, serum iron profile and thyroid function investigated.   Results: A total of 80 patients were recruited in the study period.  The most common diagnosis was telogen effluvium (49, 61.25%) followed by alopecia areata (18, 22.5%) and female pattern hair loss (13, 16.25%). Although mean haemoglobin levels were within normal limits, inadequate ferritin levels for normal hair cycle were found in 77.55% of patients with telogen effluvium, 88.89% with alopecia areata and 84.61% with female pattern hair loss. Thyroid abnormalities were less commonly observed with more than 75% of the patients being euthyroid.   Conclusion: Haemoglobin levels are not representative of true iron status in females with acquired alopecia. We therefore recommend investigating iron profile in all females with telogen effluvium, alopecia areata or female pattern hair loss.

scholarly journals Relationship of thyroid peroxidase antibody test with abnormal thyroid function tests

2017 ◽  
Vol 7 (2) ◽  
pp. 1172-1175 ◽  
Author(s):  
Srijana Khadka Shrestha ◽  
Kavita Karmacharya ◽  
Mimi Giri ◽  
Manil Raj Bajracharya ◽  
Sandeep Jha
Keyword(s):  
Thyroid Function ◽  
Diagnostic Marker ◽  
Antibody Test ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Hospital Services ◽  
Autoimmune Thyroid ◽  
Function Tests ◽  
Thyroid Peroxidase Antibody ◽  
Relationship Of

Background: Autoimmune thyroid disease results from a complex interaction between genetic and enviromental factors. The aim of this study was to find association of anti-thyroid peroxidase antibody with abnormal thyroid function tests. Materials and Methods: This is a retrospective  study, conducted in 160 patients who showed abnormal thyroid function tests  in grande city clinic and hospital services and Kantipur dental college  for  duration  of 18 months since Baisakh 2072.Results: Among 160 individuals , 126(78.8%) were female and 34(21.2%) were male. Subclinical hypothyroidism (56.3%) were most common than overthyperthyroidism (18.0%), overthypothyroidism (16.9%) and subclinical hyperthyroidism (8.8%). Anti thyroid peroxidase antibodies test  was shown positive in  102/160 (63.8% ) cases.Conclusion: According to the present study, anti- thyroid peroxidase antibody has been significantly associated with thyroid dysfunction, it can be used as diagnostic marker for thyroid autoimmune diathesis.

First- and Second-Trimester Reference Intervals for Thyroid Function Testing in a US Population

2020 ◽  
Author(s):  
Dustin R Bunch ◽  
Kyle Firmender ◽  
Roa Harb ◽  
Joe M El-Khoury
Keyword(s):  
Thyroid Function ◽  
The United States ◽  
Reference Intervals ◽  
Adverse Outcomes ◽  
Specific Reference ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Second Trimester ◽  
Function Tests ◽  
Increased Risk

Abstract Objectives Thyroid dysfunction in pregnancy is associated with increased risk of adverse outcomes to mother and child. Trimester-specific reference intervals for thyroid function tests are not routinely provided by clinical laboratories. In this study, we present first- and second-trimester-specific reference intervals in a US population for thyroid-stimulating hormone (TSH), free thyroxine (FT4), total thyroxine (T4), and total triiodothyronine (T3) measured on Roche analyzers. Methods We used patient samples from first- and second-trimester prenatal screening. Samples were limited to singleton pregnancies and negative screening results for thyroid peroxidase and thyroglobulin antibodies. Analytes (TSH, FT4, T4, and T3) were measured on a Roche Modular e170 then verified on a Roche cobas e801. Results The reference intervals established on the e170 and verified on the e801 for the first trimester were 0.11 to 3.48 mIU/L for TSH, 11.2 to 19.0 pmol/L for FT4, 51.1 to 185.6 nmol/L for T4, and 1.4 to 3.5 nmol/L for T3. The reference intervals for the second trimester were 0.31 to 3.85 mIU/L for TSH, 9.4 to 16.5 pmol/L for FT4, 55.1 to 174.0 nmol/L for T4, and 1.5 to 3.7 nmol/L for T3. Conclusions This is the first report of trimester-specific reference intervals for thyroid function tests on Roche analyzers in the United States, and it is consistent with worldwide reports.

scholarly journals SAT-491 Transient Thyrotoxicosis with Immune Checkpoint Inhibitors Therapy: The Importance of Endocrine Evaluation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Diana Cruz Martins ◽  
Daniela Guelho ◽  
Nuno Vicente ◽  
Mara Ventura ◽  
Alexandra Vieira
Keyword(s):  
Medical History ◽  
Thyroid Function ◽  
Survival Data ◽  
Immune Checkpoint ◽  
Crucial Role ◽  
Checkpoint Inhibitors ◽  
Whole Body ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
The Impact

Abstract Introduction The immune checkpoint-blocking antibody nivolumab is recognized as having a crucial role in different malignancies by blocking programmed death-1 (PD-1) receptor immune cells. Besides its benefits, nivolumab may cause endocrine immuno-related adverse events (irAEs), including thyroid dysfunction (TD). Clinical case A 71-year-old man, with an uneventful past medical history, was diagnosed with stage IIIB (T4N2M0), epithelial-growth-factor-receptor (EGFR) wild type, lung adenocarcinoma. The patient underwent 4 cycles of first line chemotherapy with cisplatin/vinorelbine and then radiotherapy, obtaining a partial response. After 4 months, tumor progression was identified, as assessed by whole-body 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) scan, showing pleural and nodal metastasis. Nivolumab, 3 mg/kg every 2 weeks, was started at this point. While pre-nivolumab thyroid function was normal, 3 months after starting the therapy, a low serum TSH level of 0.04 mUI/mL (0.38-5.33) was found, associated with a normal level of FT4, of 10.8 pmol/L (7.9-14.4). Thyroid antibody (Ab) tests, including TSH-receptor Ab, were negative. At ultrasound examination, thyroid gland parenchyma was normo-echoic, demonstrating an isoechoic thyroid nodule in the right lobe, with regular margins, measuring 14mm diameter. Previous medical history was negative for thyroid disease. One week after the referred thyroid function tests, nivolumab was discontinued due to progressive disease as assessed by abdominal magnetic resonance, demonstrating right adrenal metastasis and patient started cisplatin/permetrexed chemotherapy. One month after nivolumab suspension, patient had already normalized thyroid tests, with TSH 2.27 mUI/mL and FT4 9.1 pmol/L. More recently (6 months after nivolumab discontinuation), thyroid function tests continued stable, with TSH 1.05 mUI/ml and T4L 9.4 mmol/l. At this point, patient was receiving permetrexed maintenance therapy. Conclusions Immune checkpoint molecules as nivolumab, play a crucial role in anti-tumor immunity evasion. Besides its benefits, it may cause irAEs, including TD. We believe it’s essential to perform thyroid function tests at baseline and before the administration of each nivolumab dose, if possible. Additionally, large prospective studies are required in order to assess, the impact of autoimmunity on the development of TD induced by nivolumab, and its potential effect on overall survival and specific cancer survival data.

scholarly journals The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

2021 ◽  
Vol 12 ◽  
Author(s):  
David Tak Wai Lui ◽  
Ivan Fan Ngai Hung ◽  
Chi Ho Lee ◽  
Alan Chun Hong Lee ◽  
Anthony Raymond Tam ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Treated Group ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Thyroid Antibodies ◽  
Antibody Titres ◽  
Ifn Treatment ◽  
The Impact

BackgroundSome studies have indicated that interferon (IFN) may be valuable in COVID-19. We aimed to evaluate the impact of short-term IFN on incident thyroid dysfunction and autoimmunity among COVID-19 survivors.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to January 2021 who had thyroid function tests (TFTs) and anti-thyroid antibodies measured both on admission and at three months.Results226 patients were included (median age 55.0 years; 49.6% men): 135 were IFN-treated. There tended to be more abnormal TFTs upon reassessment in IFN-treated patients (8.1% vs 2.2%, p=0.080). 179 patients (65.4% IFN-treated) had a complete reassessment of anti-thyroid antibodies. There were significant increases in titres of both anti-thyroid peroxidase antibodies (anti-TPO: baseline 29.21 units [IQR: 14.97 – 67.14] vs reassessment 34.30 units [IQR: 18.82 – 94.65], p&lt;0.001) and anti-thyroglobulin antibodies (anti-Tg: baseline 8.23 units [IQR: 5.40 – 18.44] vs reassessment 9.14 units [IQR: 6.83 – 17.17], p=0.001) in the IFN-treated group but not IFN-naïve group. IFN treatment (standardised beta 0.245, p=0.001) was independently associated with changes in anti-TPO titre. Of the 143 patients negative for anti-TPO at baseline, 8 became anti-TPO positive upon reassessment (seven IFN-treated; one IFN-naïve). Incident anti-TPO positivity was more likely to be associated with abnormal TFTs upon reassessment (phi 0.188, p=0.025).ConclusionIFN for COVID-19 was associated with modest increases in anti-thyroid antibody titres, and a trend of more incident anti-TPO positivity and abnormal TFTs during convalescence. Our findings suggest that clinicians monitor the thyroid function and anti-thyroid antibodies among IFN-treated COVID-19 survivors, and call for further follow-up studies regarding the clinical significance of these changes.

scholarly journals HYPERTHYROIDISM

2016 ◽  
Vol 23 (04) ◽  
pp. 401-405
Author(s):  
Muhammad Usman Anjum ◽  
Adil Umar Durrani ◽  
Talib Hussain ◽  
Syed Humayun Shah
Keyword(s):  
Thyroid Function ◽  
Field Studies ◽  
Mean Value ◽  
Endocrine Disorders ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Cross Sectional ◽  
Female Ratio ◽  
Function Tests ◽  
Male To Female

Thyroid disorders are one of the common endocrine disorders. Their prevalenceis affected by many factors, especially environmental and nutritional ones. Objectives: Toascertain the seroprevalence of hyperthyroidism in clinically suspected hyperthyroid patients.Design: Descriptive cross-sectional study. Setting: Frontier Medical & Dental College,Abbottabad. Period: January to August, 2015. Methods: One hundred and twenty patientswere included in the study based on inclusion and exclusion criteria. Thyroid function tests(TSH, fT3 & fT4) were performed using enzyme linked immunoassay (ELISA) method. Results:There was preponderance of males in our study with male to female ratio of 1.4:1. Maximumpatients (56.67 %) were between the ages of 21-40 years of age, with mean age of studypopulation to be 32.09±13.01 years. The prevalence of hyperthyroidism was 15% based on theresults of thyroid function tests. There were 11 males and 7 females with male to female ratio of1.57:1 and mean age of hyperthyroid patients was 25.72± 8.27 years. The mean value of TSH,fT3 and fT4 was 0.038±0.025 mIU/L, 7.08±2.19 ng/mL and 25.25±6.30 μg/dL respectively inhyperthyroid patients as compared to 3.15±2.23 mIU/L, 2.05±0.88 ng/mL and 10.69±2.69μg/dL in euthyroid subjects. Conclusion: Thyroid disorders are not very rare among generalpopulation. TFTs provide a reliable way of ascertaining the thyroid function. As this is a hospitalbased study, field studies should be conducted to ascertain the true prevalence of thyroiddisorders in the community.

Association between thyroid function tests and anti-thyroid peroxidase (TPO) antibodies in pregnancy

Endocrine ◽  
2016 ◽  
Vol 53 (3) ◽  
pp. 865-867 ◽  
Author(s):  
Tze Ping Loh ◽  
John Chee Seng Tee ◽  
Nancy Wen Sim Tee ◽  
Wan Ling Cheng ◽  
Malathi Thevarajah ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
In Pregnancy

scholarly journals Familial Dysalbuminaemic Hyperthyroxinaemia As A Cause For Discordant Thyroid Function Tests

2021 ◽  
Author(s):  
Matthew J M Ting ◽  
Rui Zhang ◽  
Ee Mun Lim ◽  
Bryan K Ward ◽  
Scott G Wilson ◽  
...  
Keyword(s):  
Protein Binding ◽  
Exome Sequencing ◽  
Thyroid Function ◽  
Equilibrium Dialysis ◽  
Cost Effective ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Liquid Chromatography Tandem Mass ◽  
Total Thyroxine ◽  
The Impact

Abstract Introduction Discordant thyroid function tests are routinely encountered in clinical practice. Differential diagnoses include acute thyroxine ingestion, laboratory interference from heterophilic antibodies, thyroid hormone resistance, TSH-secreting pituitary adenomas and thyroxine protein binding abnormalities. The impact of abnormal binding proteins may be less recognized since widespread use of free thyroxine assays compared to older total thyroxine assays. Case report A 69-year-old female was referred for assessment of discordant thyroid function tests. Biochemistry since July 2015 showed persistently elevated FT4 levels by immunoassay ranging between 25 to 34 pmol/L with normal or slightly decreased TSH ranging between 0.05 to 2.74 mU/L. The patient was clinically euthyroid on 100 mcg daily of thyroxine for Hashimoto’s thyroiditis. FT4 measured using Liquid Chromatography – Tandem Mass Spectrometry (LC-MS/MS) was 19.5 pmol/L. Exome sequencing (confirmed by Sanger sequencing) detected a guanine to adenine substitution at residue 725 of the ALB gene previously associated with dysalbuminaemic hyperthyroxinaemia. The patient’s daughter had similar thyroid function tests and the same genetic variant. FT4 results from three different automated immunoassays showed the Roche Cobas and Siemens Centaur platforms to be most affected by the variant, and Abbott Architect had the best agreement with LC-MS/MS. Conclusion Familial Dysalbuminaemic Hyperthyroxinaemia is a potential cause of discordant thyroid function tests. Clinicians suspecting protein binding abnormalities may further investigate using reference methods such as LC-MS/MS and equilibrium dialysis if available. The increasing accessibility of exome sequencing offers a cost-effective method of diagnosing genetic variants that cause discordant thyroid function tests.

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