Paediatric Constipation;Think Beyond Thyroid Causes

Introduction: This study was designed to evaluate the importance of proper detailed history and examination of the patient as well as to determine the prevalence of unrecognized hypothyroidism among the paediatric patients with constipation attending the outpatient paediatric units in our hospital.Material and Methods: A retrospective review of medical records of paediatric patients ordered for thyroid function tests between July 2014 and June 2015 was performed. Total of 2210 paediatric patients were included in the study. A complete review of the medical records of these patients were performed which included indications for ordering thyroid tests, medical history, drug history, radiologic evaluation, other laboratory tests and subspeciality consultation.The samples were analyzed in the hormone unit of the Clinical Biochemistry Laboratory by a fully automated analyzer (Cobas e411, Roche). Data analysis was done using SPSS statistical software. Clinical diagnosis was made according to the paediatric reference ranges used in our clinical laboratory. Results: Out of all patients, 149 had history of constipation and 11 patients out of 149 had abnormal thyroid function. Repeat measurements after three months showed normal results for nine, while only two patients had results suggestive of hypothyroidism.Conclusion: Functional constipation is a condition which is to be diagnosed only by history or clinical examination. Thyroid profile where necessary is to be done after proper examination, to reduce the burden of cost to laboratory and society as well as exposing the pediatric patient to trauma.J Nepal Paediatr Soc 2016;36(2):143-146

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The T4:TBG Ratio: A Re-Evaluation with Particular Reference to Low and High Serum TBG Levels

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456328201900207 ◽

1982 ◽

Vol 19 (2) ◽

pp. 101-103 ◽

Cited By ~ 9

Author(s):

E C Attwood ◽

G E Atkin

Keyword(s):

Retrospective Study ◽

Thyroid Function ◽

Reference Range ◽

High Serum ◽

Reference Ranges ◽

Thyroid Function Tests ◽

Thyroxine Binding Globulin ◽

Biochemical Investigation ◽

Small Increments ◽

Routine Assay

The thyroxine: thyroxine-binding globulin (T4: TBG) ratio is now an established part of the biochemical investigation of thyroid function. Reference ranges have been reported for euthyroid subjects with TBG levels within the range 6–16 mg/l. Routine assay of TBG on all thyroid function tests in this laboratory has suggested that, in patients with low or high TBG levels, the established reference ranges for T4:TBG may not be strictly applicable. A retrospective study has been made of a large number of thyroid function requests, including serum total T4, free T4, TBG, and TSH assays. Evidence is presented to show that in subjects with a TBG level of less than 8 mg/l the reference range for T4: TBG is elevated. Similarly, in subjects with a TBG greater than 16 mg/l, the reference range for T4: TBG is lowered. The data suggest that it is necessary to quote a T4: TBG reference range based on small increments of TBG levels or to relate total T4 reference ranges to those increments.

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Young adult reference ranges for thyroid function tests on the Centaur immunoassay analyser

British Journal of Biomedical Science ◽

10.1080/09674845.2006.11732744 ◽

2006 ◽

Vol 63 (4) ◽

pp. 163-165 ◽

Cited By ~ 1

Author(s):

M. Alqahatani ◽

W. Tamimi ◽

M Aldaker ◽

F. Alenzi ◽

H. Tamim ◽

...

Keyword(s):

Young Adult ◽

Thyroid Function ◽

Reference Ranges ◽

Thyroid Function Tests ◽

Function Tests

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Application of Sigma Metrics for Evaluating the Analytical Performance of Thyroid Profile and Cortisol in Clinical Biochemistry Laboratory

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/47345.14391 ◽

2020 ◽

Author(s):

Smita Natvarbhai Vasava ◽

Roshni Gokaldas Sadaria

Keyword(s):

Quality Control ◽

Six Sigma ◽

Clinical Laboratory ◽

Clinical Biochemistry ◽

Poor Performance ◽

Analytical Performance ◽

Internal Quality ◽

Six Sigma Methodology ◽

Clinical Biochemistry Laboratory ◽

Thyroid Profile

Introduction: Now-a-days quality is the key aspect of clinical laboratory services. The six sigma metrics is an important quality measurement method for evaluating the performance of the clinical laboratory. Aim: To assess the analytical performance of clinical biochemistry laboratory by utilising thyroid profile and cortisol parameters from Internal Quality Control (IQC) data and to calculate sigma values. Materials and Methods: Study was conducted at Clinical Biochemistry Laboratory, Dhiraj General Hospital, Piparia, Gujarat, India. Retrospectively, IQC data of thyroid profile and cortisol were utilised for six subsequent months (July to December 2019). Coefficient of Variation (CV%) and bias were calculated from IQC data, from that the sigma values were calculated. The sigma values <3, >3 and >6 were indicated by poor performance procedure, good performance and world class performance, respectively. Results: The sigma values were estimated by calculating mean of six months. The mean sigma value of Thyroid Stimulating Hormone (TSH) and Cortisol were >3 for six months which indicated the good performance. However, sigma value of Triiodothyronine (T3), Tetraiodothyronine (T4) were found to be <3 which indicated poor performance. Conclusion: Six sigma methodology applications for thyroid profile and cortisol was evaluated, it was generally found as good. While T3 and T4 parameters showed low sigma values which requires detailed root cause analysis of analytical process. With the help of six sigma methodology, in clinical biochemistry laboratories, an appropriate Quality Control (QC) programming should be done for each parameter. To maintain six sigma levels is challenging to quality management personnel of laboratory, but it will be helpful to improve quality level in the clinical laboratories.

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Reference intervals for neonatal thyroid function tests in the first 7 days of life

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0007 ◽

2018 ◽

Vol 31 (10) ◽

pp. 1113-1116 ◽

Cited By ~ 4

Author(s):

Michelle S. Jayasuriya ◽

Kay W. Choy ◽

Lit K. Chin ◽

James Doery ◽

Alice Stewart ◽

...

Keyword(s):

Thyroid Function ◽

Medical Records ◽

Reference Intervals ◽

Thyroid Stimulating Hormone ◽

Primary Hypothyroidism ◽

Specific Reference ◽

Rapid Decline ◽

Thyroid Function Tests ◽

Accurate Identification ◽

Neonatal Hypothyroidism

Abstract Background: Prompt intervention can prevent permanent adverse neurological effects caused by neonatal hypothyroidism. Thyroid function changes rapidly in the first few days of life but well-defined age-specific reference intervals (RIs) for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free tri-iodothyronine (FT3) are not available to aid interpretation. We developed hour-based RIs using data mining. Methods: All TSH, FT4 and FT3 results with date and time of collection from neonates aged <7 days during 2005–2015 were extracted from the Monash Pathology database. Neonates with more than one episode of testing or with known primary hypothyroidism, identified by treating physicians or from medical records, were excluded from the analysis. The date and time of birth were obtained from the medical records. Results: Of the 728 neonates qualifying for the study, 569 had time of birth available. All 569 had TSH, 415 had FT4 and 146 had FT3 results. For age ≤24 h, 25–48 h, 49–72 h, 73–96 h, 97–120 h, 121–144 h and 145–168 h of life, the TSH RIs (2.5th–97.5th) (mIU/L) were 4.1–40.2, 3.2–29.6, 2.6–17.3, 2.2–14.7, 1.8–14.2, 1.4–12.7 and 1.0–8.3, respectively; the FT4 RIs (mean ± 2 standard deviation [SD]) (pmol/L) were 15.3–43.6, 14.7–53.2, 16.5–45.5, 17.8–39.4, 15.3–32.1, 14.5–32.6 and 13.9–30.9, respectively; the FT3 RIs (mean±2 SD) (pmol/L) were 5.0–9.4, 4.1–9.1, 2.8–7.8, 2.9–7.8, 3.5–7.2, 3.4–8.0 and 3.8–7.9, respectively. Conclusions: TSH and FT4 were substantially high in the first 24 h after birth followed by a rapid decline over the subsequent 168 h. Use of hour-based RIs in newborns allows for more accurate identification of neonates who are at risk of hypothyroidism.

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Trimester-specific reference ranges for thyroid function tests in South Indian women

Thyroid Research and Practice ◽

10.4103/trp.trp_52_18 ◽

2019 ◽

Vol 16 (1) ◽

pp. 51

Author(s):

MahmoodDhahir Al-Mendalawi

Keyword(s):

Thyroid Function ◽

Specific Reference ◽

Reference Ranges ◽

Thyroid Function Tests ◽

Indian Women ◽

Function Tests ◽

South Indian

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Relationship between thyroid function and ICU mortality (sick euthyroid syndrome)

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20173662 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1266

Author(s):

Priyadarsini Bose ◽

Ramesh Dasarathan ◽

Arun Shivaraman Mulaur Murugesan ◽

K. S. Chenthil

Keyword(s):

Critical Illness ◽

Thyroid Hormone ◽

Thyroid Function ◽

Apache Ii ◽

Apache Ii Score ◽

Thyroid Function Tests ◽

Icu Patients ◽

Thyroid Profile ◽

A Prospective Study ◽

Sick Euthyroid

Background: Sick euthyroid syndrome refers to alterations that occur in thyroid hormone levels in response to any critical illness like sepsis, ARDS, patients on mechanical ventilation and also any ICU patients. This study aimed at the relationship between thyroid hormone level changes and critical illness in ICU patients and predict the mortality based on thyroid hormone levels.Methods: A prospective study was designed to carry out in intensive care unit (ICU), Institute of internal medicine, Rajiv Gandhi government general hospital, Chennai for six months from May to August 2015. A total of 40 patients were selected who fulfilled the selection criteria.Results: APACHE II scores were calculated for all the 40 patients to assess whether thyroid function tests could independently predict the outcome of the patients. Again, the thyroid profile was compared with APACHE II scores in predicting the outcome. Values showed statistically significance.Conclusions: Thyroid profile can be used as an independent factor in predicting the outcome of the patients. Thyroid profile can also increase the sensitivity of APACHE II score in predicting the outcome.

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Changes in Thyroid Function Across Adolescence: A Longitudinal Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz331 ◽

2020 ◽

Vol 105 (4) ◽

pp. e1162-e1170 ◽

Cited By ~ 1

Author(s):

Purdey J Campbell ◽

Suzanne J Brown ◽

Phillip Kendrew ◽

Michelle Lewer ◽

Ee Mun Lim ◽

...

Keyword(s):

Thyroid Function ◽

Twin Study ◽

Specific Reference ◽

Sexually Dimorphic ◽

Reference Ranges ◽

Thyroid Function Tests ◽

Longitudinal Analyses ◽

Free Triiodothyronine ◽

Longitudinal Twin Study ◽

Abbott Architect

Abstract Objective There are no large, longitudinal studies of thyroid function across adolescence. The aims of this study were to examine longitudinal trends in thyrotropin (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) and determine age-specific reference ranges. Methods Thyroid function was assessed in 3415 participants in the Brisbane Longitudinal Twin Study at ages 12, 14, and 16, using the Abbott ARCHITECT immunoassay. Longitudinal analyses were adjusted for body mass index and puberty. Results In girls, mean fT4 (± SE) increased between age 12 and 14 (by 0.30 ± 0.08 pmol/L; P < 0.001), while remaining unchanged in boys; from age 14 to 16, fT4 increased in both girls (by 0.42 ± 0.07 pmol/L; P < 0.001) and boys (0.64 ± 0.07 pmol/L, P < 0.001). There was a slight increase in fT3 from age 12 to 14 years in girls (by 0.07 ± 0.03 pmol/L; P = 0.042), with a more marked increase in boys (0.29 ± 0.03 pmol/L; P < 0.001), followed by a decrease from age 14 to 16 in both sexes (girls, by 0.53 ± 0.02 pmol/L; P < 0.001; boys, by 0.62 ± 0.03 pmol/L; P < 0.001). From age 12 to 14, TSH showed no significant change in girls or boys, then levels increased from age 14 to 16 in both sexes (in girls, by 4.9%, 95% CI: 2.4%-10.3%, P = 0.020; in boys, by 7.2%, 95% CI: 3.0%-11.6%, P = 0.001). Reference ranges differed substantially from adults, particularly for fT4 and fT3. Conclusions Thyroid function tests in adolescents display complex, sexually dimorphic patterns. Implementation of adolescence-specific reference ranges may be appropriate.

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Trimester-specific reference ranges for thyroid function tests in South Indian women

Thyroid Research and Practice ◽

10.4103/trp.trp_24_18 ◽

2018 ◽

Vol 15 (3) ◽

pp. 117

Author(s):

Vijaya Sarathi ◽

KSandhya Rani ◽

Sunanda Tirupati ◽

KDileep Kumar

Keyword(s):

Thyroid Function ◽

Specific Reference ◽

Reference Ranges ◽

Thyroid Function Tests ◽

Indian Women ◽

Function Tests ◽

South Indian

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

Nuklearmedizin ◽

10.1055/s-0038-1625197 ◽

2004 ◽

Vol 43 (05) ◽

pp. 158-160 ◽

Cited By ~ 8

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.

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