scholarly journals L-T4 Therapy in the Presence of Pharmacological Interferents

2020 ◽  
Vol 11 ◽  
Author(s):  
Salvatore Benvenga
Keyword(s):  
Thyroid Function ◽  
Cardiovascular Complications ◽  
Primary Hypothyroidism ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Central Hypothyroidism ◽  
Serum Free ◽  
Function Tests ◽  
Frequent Monitoring ◽  
Serum Free Thyroxine

Pharmacological interference on L-thyroxine (L-T4) therapy can be exerted at several levels, namely from the hypothalamus/pituitary through the intestine, where the absorption of exogenous L-T4 takes place. A number of medications interfere with L-T4 therapy, some of them also being the cause of hypothyroidism. The clinician should be aware that some medications simply affect thyroid function tests with no need of modifying the dose of L-T4 that the patient was taking prior to their prescription. Usually, the topic of pharmacological interference on L-T4 therapy addresses the patient with primary hypothyroidism, in whom periodic measurement of serum thyrotropin (TSH) is the biochemical target. However, this minireview also addresses the patient with central hypothyroidism, in whom the biochemical target is serum free thyroxine (FT4). This minireview also addresses two additional topics. One is the costs associated with frequent monitoring of the biochemical target when L-T4 is taken simultaneously with the interfering drug. The second topic is the issue of metabolic/cardiovascular complications associated with undertreated hypothyroidism.

A Case Series of Patients With Central Hypothyroidism From Oxcarbazepine Therapy

2020 ◽  
pp. 088307382096292 ◽  
Author(s):  
Bahareh Michelle Schweiger ◽  
Aaron-James Lao ◽  
Jane Tavyev
Keyword(s):  
Thyroid Function ◽  
Pediatric Population ◽  
Case Series ◽  
Metabolic Enzymes ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Central Hypothyroidism ◽  
Serum Free ◽  
Serum Free Thyroxine ◽  
Stimulating Hormone

Many medications can impact thyroid function. Antiseizure medications have been shown to disrupt thyroid function in adults, but information is limited about how antiseizure medications may affect thyroid function in children. Oxcarbazepine is an analog of carbamazepine designed to minimize effects from the hepatic P450 metabolic enzymes. We have found that in the pediatric population, serum free thyroxine is reduced and thyroid-stimulating hormone concentrations are unchanged in patients taking oxcarbazepine with the mechanism thus being central hypothyroidism.

Subclinical hypothyroidism

2011 ◽  
pp. 543-547
Author(s):  
Jayne A. Franklyn
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Expert Panel ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Free Triiodothyronine ◽  
Function Tests ◽  
Serum Tsh

Subclinical hypothyroidism is defined biochemically as the association of a raised serum thyroid-stimulating hormone (TSH) concentration with normal circulating concentrations of free thyroxine (T4) and free triiodothyronine (T3). The term subclinical hypothyroidism implies that patients should be asymptomatic, although symptoms are difficult to assess, especially in patients in whom thyroid function tests have been checked because of nonspecific complaints such as tiredness. An expert panel has recently classified individuals with subclinical hypothyroidism into two groups (1): (1) those with mildly elevated serum TSH (typically TSH in the range 4.5–10.0 mU/l) and (2) those with more marked TSH elevation (serum TSH >10.0 mU/l).

Pictorial reporting of multiple thyroid function results.

1976 ◽  
Vol 22 (10) ◽  
pp. 1562-1566
Author(s):  
R W Pain ◽  
B M Duncan
Keyword(s):  
Thyroid Function ◽  
Reporting System ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Testing Procedures ◽  
Function Tests ◽  
Free Thyroxine Index ◽  
Total Thyroxine ◽  
Experience Difficulty

Abstract Clinicians experience difficulty in correctly interpreting the results of in vitro thyroid function tests in the presence of abnormalities of thyrobinding proteins or when results are borderline. This difficulty has been largely resolved in our laboratory by three innovations. First, the borderline areas for each of three routine tests of thyroid function (total thyroxine, thyrobinding index, and free thyroxine index) were accurately determined. Second, the results from this routine profile of three tests were displayed pictorially so as to produce patterns characteristic of various diagnostic situations, including euthyroidism in the presence of abnormalities of thyrobinding proteins. Third, interpretive comments and, in the case of borderline patterns, suggested further testing procedures were added to the report. Clinicians find the reporting system helpful and respond when additional tests are suggested. The system, operated manually at first, was later computerized.

scholarly journals Report of the IFCC Working Group for Standardization of Thyroid Function Tests; Part 2: Free Thyroxine and Free Triiodothyronine

2010 ◽  
Vol 56 (6) ◽  
pp. 912-920 ◽  
Author(s):  
L. M. Thienpont ◽  
K. Van Uytfanghe ◽  
G. Beastall ◽  
J. D. Faix ◽  
T. Ieiri ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Working Group ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Free Triiodothyronine ◽  
Function Tests

scholarly journals HYPOTHYROIDISM AND GOITER IN A YOUNG MALE WITH SUSPECTED DIETARY IODINE DEFICIENCY FOLLOWED BY THYROTOXICOSIS AFTER IODINE SUPPLEMENTATION

2020 ◽  
Vol 6 (1) ◽  
pp. e19-e22
Author(s):  
Itivrita Goyal ◽  
Manu Raj Pandey ◽  
Rajeev Sharma
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Young Male ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Normal Range ◽  
Iodine Supplementation ◽  
Function Tests

Objective: Iodine deficiency disorders (IDDs) remain a major public health concern in most parts of the world but are extremely rare in North America. We describe a case of goiter in a young male with dietary history and findings suggestive of IDD. Methods: Laboratory and imaging procedures including thyroid function tests, autoantibodies, urine iodine, thyroid ultrasound, and radioactive iodine (RAI) uptake scan were performed. Results: On initial presentation, thyroid-stimulating hormone (TSH) was 24.4 mIU/L (normal range is 0.4 to 5.0 mIU/L), free thyroxine was <0.4 ng/dL (normal range is 0.8 to 1.8 ng/dL), and thyroid peroxidase antibody was positive at 43 IU/mL (normal range is <35 IU/mL). He reported consuming strawberries and peanut butter sandwiches with no intake of dairy or seafood due to gastrointestinal issues (abdominal pain, bloating, and nausea). Physical exam revealed a diffusely enlarged, palpable thyroid gland (grade II goiter). Ultrasound of the neck showed an enlarged thyroid gland with no nodules. RAI uptake scan showed diffuse increased uptake (91%). Given his poor diet, a 24-hour urinary iodine excretion test was ordered which was suggestive of very low iodine intake. He was started on multivitamins with 150 μg of iodine daily. On follow up, clinical exam showed grade I goiter and TSH had normalized to 0.7 mIU/L and free thyroxine was 1.2 ng/dL. He continued on iodine supplementation and tolerated iodine-rich foods. Six months later, thyroid function tests showed hyperthyroidism with TSH of <0.002 ng/dL and free thyroxine was elevated to 2.8 ng/dL. Iodine supplements were stopped. Conclusion: Hypothyroidism and goiter due to IDD should be suspected in the setting of poor dietary intake. IDDs can be rapidly diagnosed in a patient on a restricted diet with multiple urinary iodine determinations and RAI study. Regular thyroid labs should be done to monitor for hyperthyroidism that can develop after iodine supplementation.

scholarly journals Routine free thyroxine reference intervals are suboptimal for monitoring children on thyroxine replacement therapy and target intervals need to be assay-specific

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Elizabeth Wheeler ◽  
Kay Weng Choy ◽  
Lit Kim Chin ◽  
Nilika Wijeratne ◽  
Alan McNeil ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Reference Intervals ◽  
Clinical Diagnostics ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Free Triiodothyronine ◽  
Central Hypothyroidism ◽  
Thyroxine Replacement ◽  
Ortho Clinical Diagnostics ◽  
Serum Tsh

AbstractCentral hypothyroidism is a condition where there is (qualitatively or quantitatively) TSH deficiency, leading to reduced thyroid hormone production. In such patients, serum TSH does not accurately reflect the adequacy of thyroxine replacement, as the log-linear relationship between thyrotropin (TSH) and free thyroxine (FT4) is lost. We aimed to prospectively determine the optimal physiological FT4 treatment range for children treated for primary hypothyroidism, based on their serum TSH concentrations. This information could be used to guide optimal therapy for all children on thyroxine replacement, including those with central hypothyroidism. In total, sixty children (median age: 11 years, range: 11 months to 18 years) were recruited over 21 months. They were prescribed a stable dose of thyroxine for at least 6–8 weeks prior to a thyroid function test that consisted of serum TSH, FT4 and free triiodothyronine (FT3) measurements. The serum sample for the thyroid function tests was collected before ingestion of the daily dose, i.e. the trough concentration, and measured using Beckman Coulter UniCel DxI 800 instrument, Siemens Advia Centaur, Roche Cobas, Abbott Architect, Ortho Clinical Diagnostics Vitros 5600 (Ortho-Clinical Diagnostics, Raritan, NJ) platforms. The FT4 and FT3 reference intervals showed significant inter-method difference. The lower limit of the FT4 reference intervals were generally shifted mildly higher when the TSH concentration of the children were restricted from 0.5–5.0 mIU/L to 0.5–2.5 mIU/L. By contrast, the upper limit of the FT3 and FT4 reference intervals were relatively stable for the different TSH concentrations. Assay-specific target ranges for optimal thyroxine therapy are required until FT4 assay standardisation is realised.

Serum free thyroxine concentrations measured by chemiluminescence in hyperthyroid and euthyroid cats

1996 ◽  
Vol 32 (6) ◽  
pp. 489-494 ◽  
Author(s):  
M Paradis ◽  
N Page
Keyword(s):  
Thyroid Function ◽  
Reference Values ◽  
Free Thyroxine ◽  
Radioactive Materials ◽  
Serum Free ◽  
Clinically Normal ◽  
Serum Free Thyroxine

Serum free thyroxine (FT4) concentrations using chemiluminescence were measured in hyperthyroid cats (n = 72) and clinically normal cats (n = 129) to establish reference values and to determine if this method could be a useful alternative to total T4 (TT4) measurement by radioimmunoassay (RIA). Mean serum FT4 concentration (68.3 +/- 26.8 pmol/L) of hyperthyroid cats was significantly higher than that of euthyroid cats (22.9 +/- 4.8 pmol/L). Reference values for basal FT4 of hyperthyroid and healthy cats were 33 to 114 pmol/L and 16 to 30 pmol/L, respectively. The results of the present study suggest that FT4 measured by chemiluminescence could be a useful alternative to TT4 measured by RIA when evaluating thyroid function in cats, since the hazardous effects of radioactive materials on the manipulators and the environment could be avoided. Further studies are required to corroborate these preliminary findings.

Sign in / Sign up

Export Citation Format

Share Document