Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study

BackgroundThyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood.AimTo establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction.Design and settingLongitudinal follow-up in 19 general practices in the UK.MethodA total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled.ResultsParticipants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8).ConclusionHigh stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.

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THYROID FUNCTION TESTS: A REVIEW

10.36106/ijsr/2502260 ◽

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.

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Association between ultrasonography echogenicity and heterogeneity and thyroid function in autoimmune diffuse thyroid diseases in children and adolescents

10.21203/rs.3.rs-557677/v1 ◽

2021 ◽

Author(s):

Ji Eun Park ◽

Sook Min Hwang ◽

Ji-Young Hwang ◽

Jin Hee Moon ◽

Ik Yang ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Diseases ◽

Overt Hypothyroidism ◽

Thyroid Ultrasound ◽

Thyroid Status ◽

Children And Adolescent ◽

Overt Hyperthyroidism

Abstract Purpose: To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD).Methods: From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades.Results: Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p=0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p=0.035) and hypothyroid (p=0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US.Conclusions: In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

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Thyroid dysfunction in preeclampsia and related fetomaternal outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191944 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1928

Author(s):

Puja Banik ◽

R. K. Praneshwari Devi ◽

Aheibam Bidya ◽

Akoijam Tamphasana ◽

M. Agalya ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Birth Asphyxia ◽

Normal Pregnancy ◽

Thyroid Stimulating Hormone ◽

Severe Preeclampsia ◽

Intrauterine Fetal Death ◽

Overt Hypothyroidism ◽

Thyroid Function Tests ◽

Cross Sectional

Background: Changes in thyroid function in normal pregnancy are well-documented but in complicated pregnancy like preeclampsia, very little is known. Studies have shown evidences of hypothyroidism in preeclampsia necessitating thyroid function tests to be done in preeclampsia. The study was done to analyze the fetomaternal outcome of preeclampsia with coexisting thyroid dysfunction.Methods: A cross-sectional analytical study was done over 18 months on 95 preeclamptic patients admitted at the antenatal ward and fetomaternal outcomes were analyzed according to thyroid status.Results: Out of 95 patients with preeclampsia, 42 (44.2%) had thyroid dysfunction. Among these 42 patients, 37 (38.9%) patients had subclinical hypothyroidism, 4 (4.2%) had overt hypothyroidism and 1 (1%) had hyperthyroidism. Severe preeclampsia was seen in 64.3% of the patients with thyroid dysfunction compared with 39.6% in euthyroid patients. The mean thyroid stimulating hormone (TSH) level was significantly higher and means free thyroxine (fT4) level was significantly lower in severe preeclampsia compared with non-severe preeclampsia. Complications like abruption, intrauterine fetal death (IUD), intrauterine growth restriction (IUGR), oligohydramnios, preterm deliveries, postpartum hemorrhage (PPH), low birth weight babies, birth asphyxia in babies and subsequent neonatal intensive care unit (NICU) admissions were significantly higher (p <0.05) in the preeclampsia patients with thyroid dysfunction in comparison with euthyroid ones.Conclusions: Hypothyroidism may be a modifiable risk factor for preeclampsia. Thyroid screening early in pregnancy may be helpful in predicting the occurrence of preeclampsia and timely thyroid hormone administration can reduce the maternal and perinatal morbidity and mortality associated with preeclampsia.

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The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases

Scientific Reports ◽

10.1038/s41598-021-99016-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ji Eun Park ◽

Sook Min Hwang ◽

Ji-Young Hwang ◽

Jin Hee Moon ◽

Ik Yang ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Diseases ◽

Overt Hypothyroidism ◽

Children And Adolescent ◽

Ultrasound Findings ◽

The Relationship ◽

Overt Hyperthyroidism

AbstractTo evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

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Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study

Hormone and Metabolic Research ◽

10.1055/s-0043-121031 ◽

2017 ◽

Vol 50 (01) ◽

pp. 37-43 ◽

Cited By ~ 6

Author(s):

Maryam Tohidi ◽

Arash Derakhshan ◽

Samaneh Akbarpour ◽

Atieh Amouzegar ◽

Ladan Mehran ◽

...

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Middle Eastern ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Subclinical Hyperthyroidism ◽

Significant Difference ◽

Middle Eastern Population

AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.

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Management of thyroid disease in pregnancy – Room for improvement in the first trimester

Obstetric Medicine ◽

10.1177/1753495x16629773 ◽

2016 ◽

Vol 9 (3) ◽

pp. 126-129 ◽

Cited By ~ 1

Author(s):

Helen Robinson ◽

Philip Robinson ◽

Michael D’Emden ◽

Kassam Mahomed

Keyword(s):

General Practitioner ◽

Thyroid Function ◽

Thyroid Disease ◽

Thyroid Dysfunction ◽

First Trimester ◽

Antenatal Clinic ◽

Thyroid Stimulating Hormone ◽

Thyroid Function Tests ◽

In Pregnancy ◽

Stimulating Hormone

Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.

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Status of Thyroid Function among Patients of National Medical College and Teaching Hospital

Med Phoenix ◽

10.3126/medphoenix.v5i1.31420 ◽

2020 ◽

Vol 5 (1) ◽

pp. 64-70

Author(s):

Anup Shamsher Budhathoki ◽

Suprita Gupta ◽

Sanjay Kumar Sah ◽

Navin Kumar Sah ◽

...

Keyword(s):

Thyroid Function ◽

Teaching Hospital ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Central Laboratory ◽

National Medical College ◽

Medical College ◽

National Medical ◽

High Prevalence

Background: Thyroid dysfunction is one of the most common endocrinopathies after Diabetes Mellitus. Thyroid dysfunction is defined as the alteration in Thyroid Stimulating Hormone (TSH) with normal or abnormal thyroid hormones. Nepalese population have a high risk for thyroid dysfunction with a high prevalence of iodine deficiency. Objective: To study the prevalence of thyroid dysfunction among the patients visiting National Medical College, Birgunj, Nepal for checkup and suggested to assess thyroid function. Materials and Methods: The hospital-based study was conducted in Central Laboratory, National Medical College and Teaching Hospital (NMCTH), Birgunj in collaboration with the Department of Biochemistry. Total 7040 patients visiting Central Laboratory for thyroid function assessment were included in the study between July 2017 to December 2019. The venous blood sample was collected and serum-free triiodothyronine(fT3), free tetraiodothyronine(fT4) and thyroid stimulating hormone (TSH) was estimated by Chemiluminescence Immunoassay (CLIA) method using Access 2 Beckman Coulter analyser. (Beckman Coulter Inc., California, USA). Results: Among 7040 subjects under study, 2138(30%) were found to have thyroid dysfunction with 13% having subclinical hypothyroidism, about 8% of overt hypothyroidism, about 4% with subclinical hyperthyroidism and 5% with overt hyperthyroidism. Majority of the thyroid dysfunction study group belonged to the 16-30 years age group followed by 31-45 years. Mean±SE for TSH, fT4 and fT3 levels show statistically significant differences in different thyroid disorders. Conclusion: The study revealed a high prevalence of subclinical hypothyroidism followed by overt hypothyroidism among the patients visiting National Medical College and Teaching Hospital, Birgunj, Nepal. A higher percentage of females were found to have thyroid dysfunction compared to male.

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Thyroid function in patients with Prader-Willi syndrome: an Italian multicenter study of 339 patients

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0388 ◽

2019 ◽

Vol 32 (2) ◽

pp. 159-165 ◽

Cited By ~ 7

Author(s):

Lorenzo Iughetti ◽

Giulia Vivi ◽

Antonio Balsamo ◽

Andrea Corrias ◽

Antonino Crinò ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Genetic Disorder ◽

Hypogonadotropic Hypogonadism ◽

Thyroid Stimulating Hormone ◽

Hormone Deficiency ◽

Published Data ◽

Prader Willi Syndrome ◽

Thyroid Function Tests ◽

Central Hypothyroidism

AbstractBackgroundPrader-Willi syndrome (PWS) is a genetic disorder due to loss of expression of paternally transcribed genes of the imprinted region of chromosome 15q11-13. PWS is characterized by peculiar signs and symptoms and many endocrine abnormalities have been described (growth hormone deficiency, hypogonadotropic hypogonadism). The abnormalities of thyroid function are discussed in literature and published data are discordant. The aim of our study was to report the thyroid function in patients with PWS to identify the prevalence of thyroid dysfunction.MethodsThyroid function tests were carried out in 339 patients with PWS, aged from 0.2 to 50 years. A database was created to collect personal data, anthropometric data, thyroid function data and possible replacement therapy with L-thyroxine. Subjects were classified according to thyroid function as: euthyroidism (EuT), congenital hypothyroidism (C-HT), hypothyroidism (HT – high thyroid-stimulating hormone [TSH] and low free thyroxine [fT4]), central hypothyroidism (CE-H – low/normal TSH and low fT4), subclinical hypothyroidism (SH – high TSH and normal fT4), and hyperthyroidism (HyperT – low TSH and high fT4).ResultsTwo hundred and forty-three out of 339 PWS patients were younger than 18 years (71.7%). The prevalence of thyroid dysfunction was 13.6%. Specifically, C-HT was found in four children (1.18%), HT in six patients (1.77%), CE-H in 23 patients (6.78%), SH in 13 patients (3.83%), and HyperT in none. All other subjects were in EuT (86.4%).ConclusionsHypothyroidism is a frequent feature in subjects with PWS. Thyroid function should be regularly investigated in all PWS patients both at the diagnosis and annually during follow-up.

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Obesity and hypothyroidism

Obesity and metabolism ◽

10.14341/2071-8713-4826 ◽

2013 ◽

Vol 10 (2) ◽

pp. 54-58 ◽

Cited By ~ 1

Author(s):

S M Zakharova ◽

L V Savelieva ◽

M I Fadeeva

Keyword(s):

Weight Loss ◽

Energy Expenditure ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Obese Patients ◽

Common Diseases ◽

The Relationship ◽

Stimulating Hormone

Obesity and hypothyroidism are common diseases, and consequently clinicians should be particularly alert to the possibility of thyroid dysfunction in obese patients. The relationship between thyroid function and obesity is likely to be bidirectional, with hypothyroidism affecting weight, but obesity also influencing thyroid function. Both serum thyroid-stimulating hormone and fT3 are typically increased in obese individuals, an effect likely mediated by leptin. Following L-T4 treatment for overt hypothyroidism, weight loss appears to be modest and mediated primarily by loss of water weight rather than fat. Selected thyroid analogs might be a means by which to improve weight loss by increasing energy expenditure in obese patients during continued caloric deprivation

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Overt Hypothyroidism Induced by Prolonged Therapy With Imatinib

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1932 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A945-A946

Author(s):

Ally W Wang ◽

Emily V Nosova

Keyword(s):

Tyrosine Kinase ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Case Reports ◽

Myelogenous Leukemia ◽

Prolonged Treatment ◽

Overt Hypothyroidism ◽

Imatinib Treatment ◽

Thyroid Function Tests ◽

History Of

Abstract Background: Imatinib, a tyrosine kinase inhibitor (TKI), is commonly used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. TKI-induced thyroid dysfunction is recognized as an adverse class effect with most cases occurring between six to twelve months after treatment initiation. Clinical Case: 76-year-old man with hypertension and CML on Imatinib that had been started twenty months prior was admitted for confusion. The patient also reported constipation, cold intolerance, and weight gain despite no change in diet, appetite, or physical activity. On evaluation, his responses to questioning were noticeably delayed, however he was not lethargic. His vital signs were normal and he was otherwise euthyroid on physical exam. He had no known history of thyroid dysfunction. Labs showed a TSH of 94.7 (0.4 - 4.2 uIU/mL), Free T4 0.4 (0.8 - 1.5 ng/dL), and Total T3 30 (87 - 178 ng/dL). Thyroglobulin antibody was 1016 (0.0 - 4.1 U/mL) and TPO antibody was >2000 (0.0 - 5.6 IU/mL). A TSH checked two months before admission was 1.1. Antibody levels had not been checked previously. Thyroid ultrasound demonstrated a hyperemic and heterogeneous thyroid, consistent with thyroiditis. Levothyroxine at a dose of 50 mcg daily was advised, due to patient’s advanced age as well as history of arrhythmia. The patient’s confusion resolved on hospital day three. Repeat thyroid function tests will be checked four to six weeks after Levothyroxine initiation. Discussion: As a class, tyrosine kinase inhibitors are known to cause thyroid dysfunction with the most common medication being Sunitinib. Data related to the effects of thyroid function during Imatinib treatment are limited. Previous cases of Imatinib-induced thyroid dysfunction report only hypothyroidism in thyroidectomized patients and no clinically significant change in thyroid function among patients who were euthyroid prior to therapy initiation. Our case reports a patient with no prior thyroidectomy who developed overt hypothyroidism while on Imatinib for nearly two years. The mechanism for TKI-induced thyroid dysfunction has not been elucidated. Due to relatively acute onset and markedly positive TPO and thyroglobulin antibodies, we suspect that TKI may alter HLA recognition on thyroid follicular cells, thereby inducing autoimmunity. Our case showcases the need to maintain awareness and continuous surveillance for thyroid dysfunction when patients are on long term TKI as overt hypothyroidism may be induced by prolonged treatment.

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