The Independent Association of TSH and Free Triiodothyronine Levels With Lymphocyte Counts Among COVID-19 Patients

BackgroundBoth lymphopenia and thyroid dysfunction are commonly observed among COVID-19 patients. Whether thyroid function independently correlates with lymphocyte counts (LYM) remains to be elucidated.MethodsWe included consecutive adults without known thyroid disorder admitted to Queen Mary Hospital for COVID-19 from July 2020 to April 2021 who had thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3) and LYM measured on admission.ResultsA total of 541 patients were included. Median LYM was 1.22 x 109/L, with 36.0% of the cohort lymphopenic. 83 patients (15.4%) had abnormal thyroid function tests (TFTs), mostly non-thyroidal illness syndrome (NTIS). Patients with lymphopenia had lower TSH, fT4 and fT3 levels than those without. Multivariable stepwise linear regression analysis revealed that both TSH (standardized beta 0.160, p<0.001) and fT3 (standardized beta 0.094, p=0.023), but not fT4, remained independently correlated with LYM, in addition to age, SARS-CoV-2 viral load, C-reactive protein levels, coagulation profile, sodium levels and more severe clinical presentations. Among the 40 patients who had reassessment of TFTs and LYM after discharge, at a median of 9 days from admission, there were significant increases in TSH (p=0.031), fT3 (p<0.001) and LYM (p<0.001). Furthermore, patients who had both lymphopenia and NTIS were more likely to deteriorate compared to those who only had either one alone, and those without lymphopenia or NTIS (p for trend <0.001).ConclusionTSH and fT3 levels showed independent positive correlations with LYM among COVID-19 patients, supporting the interaction between the hypothalamic-pituitary-thyroid axis and immune system in COVID-19.

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Thyroid autoimmunity in patients with hyperprolactinemia: an observational study

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/0004-2730000002846 ◽

2014 ◽

Vol 58 (1) ◽

pp. 48-52 ◽

Cited By ~ 9

Author(s):

Eda Demir Onal ◽

Fatma Saglam ◽

Muhammed Sacikara ◽

Reyhan Ersoy ◽

Bekir Cakir

Keyword(s):

Thyroid Function ◽

Thyroid Autoimmunity ◽

Serum Levels ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Thyroid Disorder ◽

Free Triiodothyronine ◽

Thyroid Autoantibody ◽

Median Serum ◽

And Gender

Objective : To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. Materials and methods : The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. Results : The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). Conclusion : HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.

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Subclinical hypothyroidism

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.3252 ◽

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).

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Thyroid function in neonates with severe respiratory failure on extracorporeal membrane oxygenation

Perfusion ◽

10.1177/026765910101600606 ◽

2001 ◽

Vol 16 (6) ◽

pp. 469-475 ◽

Cited By ~ 8

Author(s):

Dan L Stewart ◽

Noah Ssemakula ◽

Duncan R MacMillan ◽

L Jane Goldsmith ◽

Larry N Cook

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Thyroid Function ◽

Newborn Infants ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Severe Respiratory Failure ◽

Serum Concentrations ◽

Free Triiodothyronine ◽

Membrane Oxygenation

The object was to study thyroid function in neonates with severe respiratory failure on extracorporeal membrane oxygenation (ECMO) and determine whether abnormal thyroid function correlates with prognosis. Total and free thyroxine (T4, FT4), total and free triiodothyronine (T3, FT3), reverse triiodothyronine (rT3), thyroid-stimulating hormone, and thyroxine binding globulin were measured in 14 newborn infants with severe respiratory failure (age 1-30 days) from samples collected before anesthesia for cannula placement, at 30, 60, and 360 min after initiation of ECMO, and on days 2, 4, 6, and 8. The patients were divided into survivors and non-survivors for statistical analyses. No differences were noted between survivors and non-survivors in the pre-ECMO mean serum concentrations of the thyroid function tests analyzed. In nine survivors, mean serum T4, FT4, T3, FT3, and rT3 all declined significantly within 30-60 min after initiation of ECMO, compared to baseline values. The values for all mean serum concentrations recovered completely and exceeded baseline between days 2 and 8. In five non-survivors, the decline of all mean serum values was not statistically significant and recovery to baseline was not achieved. The ratios of mean serum concentration of rT3/FT3were significantly different between survivors and non-survivors across all times during the ECMO course ( p λ 0.0005). These findings indicate that abnormalities in thyroid function occur in neonates with severe respiratory failure on ECMO and that the rT3/FT3 ratio correlates with prognosis over the ECMO course. Survival was associated with a significant reduction of serum thyroid hormone concentrations followed by recovery. We speculate that, in neonates with respiratory failure on ECMO, adaptive mechanisms which enhance survival include the capacity to down-regulate the pituitary-thyroid axis.

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Relationship between Different Psoriasis Types and Thyroid Dysfunction: A Retrospective Analysis

Scanning ◽

10.1155/2021/1834556 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Juan Du ◽

Chunyue Ma ◽

Runnan Wang ◽

Lanmei Lin ◽

Luhui Gao ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Hormone Levels ◽

Significant Difference ◽

Total Thyroxine

Objective. The aim of this study was to investigate the relationship between different psoriasis types and thyroid dysfunction. Methods. The data of patients diagnosed with psoriasis between January 2013 and October 2018 who underwent thyroid function tests were collected. Free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroid-stimulating hormone (TSH), thyroglobulin antibody (TGAb), and thyroid peroxidase antibody (TPOAb) were measured. The thyroid function of patients with psoriasis vulgaris, pustular psoriasis, erythrodermic psoriasis, and psoriatic arthritis was evaluated, and the differences in hormone levels and antibodies in the pituitary-thyroid axis with psoriasis type were analyzed. Results. The data of a total of 468 patients were analyzed in this study. The proportion of normal hormone levels was higher among vulgaris patients ( P < 0.001 ), while the erythrodermic patients were more likely to have decreased FT3 or FT4 but normal TSH ( P < 0.001 ). FT3 levels were lower in pustular patients ( P < 0.05 ), FT4 levels were lower in erythrodermic patients ( P < 0.05 ), and TSH levels were higher in patients with psoriatic arthritis ( P < 0.05 ). TPOAb levels were higher than normal in all patients, but there was no significant difference in the levels of TPOAb and TGAb among 4 types of the patients. Conclusion. Psoriasis is related to thyroid dysfunction, especially in patients with atypical psoriasis types. The possibility of complications should be considered in erythrodermic patients.

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Pattern of Thyroid Dysfunction in Women with Menstrual Disorders

Annals of Clinical Chemistry and Laboratory Medicine ◽

10.3126/acclm.v2i1.14195 ◽

2016 ◽

Vol 2 (1) ◽

pp. 3-6

Author(s):

Saroj Khatiwada ◽

Sharad Gautam ◽

Rajendra KC ◽

Shruti Singh ◽

Shrijana Shrestha ◽

...

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Endocrine Disorders ◽

Thyroid Disorder ◽

Menstrual Disorders ◽

Free Triiodothyronine ◽

Menstrual Disorder

BACKGROUNDThyroid disorders are among the commonest endocrine disorders worldwide. Thyroid dysfunction can interfere in multiple metabolic and physiological processes including menstrual cycle. This study was conducted to find pattern of thyroid dysfunction among women with menstrual disorders.METHODSTwo hundred thirty three females with menstrual disorders were screened for thyroid dysfunction. Thyroid function was assessed by measuring serum free triiodothyronine (T3), free thyroxine (T4) and thyroid stimulating hormone (TSH) levels.RESULTSThe mean age of study patients was 25.7±6.8 years. The most common menstrual disorder observed was irregular cycle (72.5%, n=169) followed by amenorrhea (21.9%, n=51) and menorrhagia (5.6%, n=13). Most of the patients were in the age group 15-24 years (51.1%, n=119), followed by 25-34 years (36.1%, n=84) and 35-45 years (12.9%, n=30). Mean level of free T3 and T4 was 2.91±1.05 pg/ml, 1.42±0.57 ng/dl respectively. Median TSH was 2.0 mIU/L (IQR, 1.0-4.0). Thyroid dysfunction was seen in 25.8% (n=60) women. Most common thyroid dysfunction was subclinical hypothyroidism (14.2%, n=33) followed by subclinical hyperthyroidism (6.9%, n=16), overt hyperthyroidism (3%, n=7) and overt hypothyroidism (1.7%, n=4).CONCLUSIONSThe study finds thyroid dysfunction especially subclinical hypothyroidism to be common among women with menstrual disorders. Thus, it may be beneficial to screen menstrual disorder patients for thyroid function especially to rule out thyroid disorder as potential etiological agent for menstrual disturbance.

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Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0425 ◽

2018 ◽

Vol 31 (5) ◽

pp. 577-580 ◽

Cited By ~ 2

Author(s):

Kriti Joshi ◽

Margaret Zacharin

Keyword(s):

Thyroid Function ◽

Thyroid Stimulating Hormone ◽

Thyroid Disorder ◽

Free Triiodothyronine ◽

Autoimmune Hypothyroidism ◽

Normal Thyroid Function ◽

Neonatal Hyperthyroidism ◽

History Of ◽

Blocking Antibodies ◽

Receptor Antibodies

Abstract Background: Neonatal hyperthyroidism is rare, seen in infants of mothers with Graves’ disease (GD), with transplacental transfer of thyroid-stimulating hormone receptor (TSHR) antibodies (TRAbs). We describe a neonate with severe hyperthyroidism due to TRAbs, born to a mother with autoimmune hypothyroidism. Case presentation: A baby boy born preterm at 35 weeks had irritability, tachycardia and proptosis after birth. The mother had autoimmune hypothyroidism, from age 10, with thyroxine replacement and normal thyroid function throughout her pregnancy. She had never been thyrotoxic. There was a family history of Hashimoto’s thyroiditis (HT) and GD. The baby’s thyroid function on day 3 demonstrated gross thyrotoxicosis, TSH<0.01 mIU/L (normal range [NR]<10 mIU/L), free thyroxine (FT4)>77 pmol/L (20–35), free triiodothyronine (FT3) 15.4 pmol/L (4.2–8.3) and TRAb 18.4 IU/L (<1.8). The mother’s TRAb was 24.7 IU/L. Thyrotoxicosis required propranolol and carbimazole (CBZ). Thyroid function normalized within 10 days. The baby was weaned off medication by 7 weeks. He remains euthyroid. Conclusions: We postulate that this mother had co-existing destructive thyroiditis and thyroid-stimulating antibodies (TSAbs) and TSHR blocking antibodies (TBAb), rendering her unable to raise a thyrotoxic response to the TSAbs but with predominant TSAb transmission to her infant. Maternal history of any thyroid disorder may increase the risk of transmission to an infant, requiring a careful clinical assessment of the neonate, with important implications for future pregnancies.

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The Association of Thyroid Hormone Changes with Inflammatory Status and Prognosis in COVID-19

International Journal of Endocrinology ◽

10.1155/2021/2395212 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Ceyda Dincer Yazan ◽

Can Ilgin ◽

Onur Elbasan ◽

Tugce Apaydin ◽

Saida Dashdamirova ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Autoimmunity ◽

Oxygen Demand ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Icu Admission ◽

Inflammatory Status ◽

Length Of Hospitalization

Background. COVID-19 infection may have multiorgan effects in addition to effects on the lungs and immune system. Recently, studies have found thyroid function abnormalities in COVID-19 cases which were interpreted as euthyroid sick syndrome (ESS) or destructive thyroiditis. Therefore, in this study, we aimed to evaluate the thyroid function status and thyroid autoimmunity in COVID-19 patients. Material and Method. 205 patients were included. The medical history and laboratory parameters at admission were collected from medical records. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and thyroglobulin antibody were measured, and patients were classified according to thyroid function status. Results. 34.1% of the patients were euthyroid. Length of hospitalization ( p < 0.001 ), rate of oxygen demand ( p < 0.001 ), and intensive care unit (ICU) admission ( p = 0.022 ) were lower, and none of the euthyroid patients died. 108 (52.6%) patients were classified to have ESS, 57 were classified as mild, and 51 were moderate. The inflammatory parameters were higher in patients with moderate ESS. In cluster analysis, a high-risk group with a lower median FT3 value (median = 2.34 ng/L; IQR = 0.86), a higher median FT4 value (median = 1.04 ng/dL; IQR = 0.33), and a lower median TSH value (median = 0.62 mIU/L; IQR = 0.59) included 8 of 9 died patients and 25 of the 31 patients that were admitted to ICU. Discussion. Length of hospitalization, oxygen demand, ICU admission, and mortality were lower in euthyroid patients. Moreover, none of the euthyroid patients died. In conclusion, evaluation of thyroid function tests during COVID-19 infection may give information about the prognosis of disease.

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Euthyroid Sick Syndrome in Pulmonary Tuberculosis before and after Treatment

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456329503200406 ◽

1995 ◽

Vol 32 (4) ◽

pp. 385-391 ◽

Cited By ~ 23

Author(s):

C C Chow ◽

T W L Mak ◽

C H S Chan ◽

C S Cockram

Keyword(s):

Pulmonary Tuberculosis ◽

Thyroid Hormones ◽

Thyroid Function ◽

Thyroid Stimulating Hormone ◽

Significant Rise ◽

Chinese Patients ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Euthyroid Sick Syndrome ◽

Function Tests

Alterations of circulating thyroid hormones are frequently present in chronic nonthyroidal illnesses and may predict prognosis. Pulmonary tuberculosis, a common treatable debilitating disease, may provide a useful model for detailed evaluation of changes of thyroid hormones in relation to subsequent recovery or mortality. Over a period of 12 months, we performed a prospective study of 40 consecutive Chinese patients aged over 50 years and admitted with newly diagnosed pulmonary tuberculosis. Blood samples were drawn for serial thyroid function tests [free thyroxine (T4), free triiodothyronine (T3) and thyroid-stimulating hormone] before treatment and at 1, 2 and 4 months afterwards. Mortality was determined up to 12 months of follow-up. The euthyroid sick syndrome occurred in 63% of patients at presentation. Twelve of 25 euthyroid sick patients died as compared to one of 15 patients with normal baseline thyroid function tests ( P < 0·02). Among euthyroid sick patients, those who died had significantly lower free T3 concentration at presentation than those who survived ( P < 0·05). An undetectable free T3 concentration at presentation was associated with a subsequent mortality of 75% (9 of 12). Of the survivors, all patients demonstrated a significant rise in serum free T4 concentrations following treatment, which was apparent by 1 month. These data suggest that an undetectable free T3 concentration at presentation reflects severity of illness and predicts a subsequent high mortality.

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Altered Thyroid Function Tests Observed in Hypophosphatasia Patients Treated with Asfotase Alfa

International Journal of Endocrinology ◽

10.1155/2021/5492267 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Hajime Kato ◽

Naoko Hidaka ◽

Minae Koga ◽

Yuka Kinoshita ◽

Masaomi Nangaku ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Function ◽

Magnetic Beads ◽

Underlying Mechanism ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Asfotase Alfa ◽

Function Tests ◽

One Step

Background. Asfotase alfa is the only approved treatment that can normalize mineralization in patients with hypophosphatasia (HPP). Its interference in alkaline phosphatase (ALP) dependent immunoassays has been reported. Objective. To describe thyroid function tests interfered with by asfotase alfa and elucidate the underlying mechanism. Patients and Methods. Three patients with HPP treated with asfotase alfa were included. Thyroid hormone levels measured using five different immunoassays with or without ALP as a labeling enzyme during asfotase alfa treatment were evaluated. Results. After the initiation of asfotase alfa, three HPP patients showed low free triiodothyronine (FT3) and free thyroxine (FT4) measured with AIA-2000 (Tosoh, Tokyo, Japan), an enzyme immunoassay system that uses ALP as a labeling enzyme, but their thyroid-stimulating hormone (TSH) levels were within the normal range. The other CLEIA system using ALP as a label, AIA-CL2400 (Tosoh, Tokyo, Japan), and ALP-independent immunoassay systems demonstrated normal FT3 and FT4 levels. These data suggested that although the thyroid function of these three patients was normal, asfotase alfa interfered with the thyroid hormone measurements made with AIA-2000. AIA-2000 and AIA-CL2400 adopted one-step and delayed one-step measurements, respectively, and the same antibody was used for both immunoassays. However, asfotase alfa may be absorbed on the magnetic beads used in the AIA reagent with the AIA-2000 system but not absorbed on the microparticles used in AIA-CL2400. Conclusion. Clinicians should be aware of the possible interference in thyroid function measurements by adopting specific types of immunoassays in asfotase alfa-treated HPP patients.

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Retrospective analysis of thyroid function in drug-free patients with bipolar disorder in China

10.21203/rs.2.19666/v1 ◽

2019 ◽

Author(s):

Bin Yang ◽

Yan Zhong Li ◽

Qi Wang ◽

Xin Sheng Guo ◽

Ying Zhao ◽

...

Keyword(s):

Bipolar Disorder ◽

Thyroid Function ◽

Bipolar Depression ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

Free Triiodothyronine ◽

Cross Sectional ◽

Female Patients ◽

Previous Hospitalization

Abstract Background Bipolar disorder is a common mental illness with serious consequences. Clinical studies have found that thyroid function may have an impact on patients with bipolar disorder, but there are few relevant studies in China. So this study explores the characteristics of thyroid function in patients with bipolar disorder in China.Methods Using retrospective cohort study and a cross-sectional study, thyroid function tests were performed in inpatients from September 2015 to January 2018 in the Second Affiliated Hospital of Xinxiang Medical University, who were diagnosed with bipolar disorder and were not treated with medications for at least three months before hospitalization.Results We found that the triiodothyronine (T3) and free triiodothyronine (FT3) levels were significantly higher in bipolar mania than in bipolar depression (P < 0.01). The thyroid stimulating hormone (TSH) levels were significantly lower in male than female patients, while the FT3, free thyroxine (FT4) levels were higher in male than female patients (P < 0.01). Patients were divided into two groups: those who used lithium and those who did not. Both groups had a tendency of hypothyroidism after treatment. In addition, the T3 and FT3 levels were significantly higher in manic than in depressive status in those patients who had a transition between mania and depression in 28 patients compared with previous hospitalization (P < 0.05).Conclusion Patients with bipolar disorder may develop thyroid dysfunction at different stages and in male/female sexes.

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