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PubMed1989

Thyroid disease in the emergency department. Thyroid function tests and hypothyroidism and myxedema coma.

The recognition of hypothyroidism may not always be easy in the emergency department setting. Laboratory evaluations of thyroid function are not usually performed on a 24-hour basis, and therefore the emergency physician, although suspecting the presence of hypothyroidism, may be unable to confirm the diagnosis while the patient is in the Emergency Department. It is not always the responsibility of the emergency physician to diagnose hypothyroidism, but in some clinical settings it may be important to include thyroid function tests in laboratory evaluation of patients to ensure adequate patient care and followup. Careful attention to nonspecific complaints, myxedematous changes, and signs of dysfunction of any organ system, especially in older female patients, may lead to the ultimate correct diagnosis. Myxedema coma is potentially fatal and must be recognized and treated emergently, usually prior to laboratory confirmation. Ventilatory support and thyroid hormone replacement are the two most important therapeutic maneuvers in the treatment of myxedema coma.

Coma↗
PubMed2001

Thyroid function tests in pregnant women with and without goiter in the eastern Black Sea region.

Maternal thyroid function was investigated in 29 pregnant women with goiter and 51 pregnant women without goiter in the eastern Black Sea region of Turkey, which is an endemic goiter area. Ten women with goiter and 10 healthy women without goiter were used as controls in the study. In all of the pregnant women, increased concentrations of total and free thyroxine, total and free tri-iodothyronine and thyroxine-binding globulin were found. Serum thyroid-stimulating hormone levels showed a decrease in pregnant women without goiter compared with non-pregnant women without goiter.

Adult↗
PubMed1997

Frequency and necessity of thyroid function tests in neonates and infants with congenital hypothyroidism.

OBJECTIVE: The American Academy of Pediatrics recommends frequent thyroid function tests in infants and children with congenital hypothyroidism (CH). Data supporting the recommended frequency are lacking. This review was conducted to assess the validity of these recommendations. METHODS: The thyroxine (T4) and thyroid-stimulating hormone (TSH) levels of 50 neonates diagnosed between 1988 to 1993 were reviewed to assess the length of time on a specific dose of levothyroxine. RESULTS: 1) Changes in the dose of levothyroxine occurred 35 times during the first year of life for the 39 children treated with .025 mg/day, five times during the first year of life for the 9 children treated with .0375 mg/day, and three times during the first year of life for the 2 children treated with .050 mg/day. 2) These dose changes occurred at varying time intervals. 3) The T4 and TSH levels obtained at visits requiring dose changes were statistically different from the T4 and TSH levels obtained at the previous two visits. The T4 and TSH levels at the two visits before the change in dosage did not differ statistically. CONCLUSIONS: 1) An initial levothyroxine dose of .0375 mg/day requires fewer dose changes than a dose of .025 mg/day. 2) A lack of statistical change in T4 or TSH levels obtained at visits before the change-in-dose visit and the variable time span between dose changes necessitate frequent monitoring regardless of the dose of levothyroxine, the previous T4 or TSH levels, or the length of time at a specific dose. 3) These data support the recommendations of the American Academy of Pediatrics regarding the frequency of thyroid function studies during the first 2 years of life.

Congenital Hypothyroidism↗
PubMed1989

Routine thyroid function tests as a case-finding tool.

A comprehensive, multiphasic blood panel was used as a case-finding tool for 738 patients. The thyroid function tests T4 (total thyroxine), rT3U (resin T3 uptake), and FTI (free thyroxine index) were included in this panel. Among the 711 patients found to be clinically euthyroid without known thyroid disorder, 54 had at least one abnormal parameter. Of these patients, four new diagnoses of thyroid dysfunction were made. All four cases had an abnormal T4 and FTI. Two patients had a slightly elevated FTI and normal T4, and have remained clinically euthyroid. All other patients had a normal FTI, and no thyroid dysfunction was noted. This gives FTI in this study a sensitivity of 1.0 and specificity of 0.993, which is camparable to what others have found (1). The prevalence of unsuspected thyroid dysfunction was 0.56 per cent, again comparable to other studies (1-3). It would seem the high sensitivity/specificity of FTI offsets the relatively low prevalence of unsuspected thyroid dysfunction. Since FTI is a sensitive predictor of thyroid dysfunction, consideration should be given to the inclusion of thyroid function studies in existing multiphasic case-finding panels.

Family Practice↗
PubMed1994

Appraisal of the thyroid function tests: the Ludhiana experience.

In a series of 4,366 patients screened at Ludhiana, Punjab, the incidence of hypothyroidism was of the order of about 20 per cent and of hyperthyroidism about 15 per cent in both sexes. The female-to-male ratio was a little over 3:1. These statistics conform broadly to conventional Western figures. The relevance of the thyroid function tests in detecting subclinical thyroid disorders in relation to other systems cannot be overemphasised.

Female↗
PubMed2006

Evaluation of recombinant human thyroid-stimulating hormone to test thyroid function in dogs suspected of having hypothyroidism.

OBJECTIVE: To evaluate the use of recombinant human (rh) thyroid-stimulating hormone (TSH) in dogs with suspected hypothyroidism. ANIMALS: 64 dogs with clinical signs of hypothyroidism. PROCEDURES: Dogs received rhTSH (75 microg/dog, IV) at a dose independent of their body weight. Blood samples were taken before and 6 hours after rhTSH administration for determination of total serum thyroxine (T(4)) concentration. Dogs were placed into 1 of 3 groups as follows: those with normal (ie, poststimulation values indicative of euthyroidism), unchanged (ie, poststimulation values indicative of hypothyroidism; no thyroid gland stimulation), or intermediate (ie, poststimulation values between unchanged and normal values) post-TSH T(4) concentrations. Serum canine TSH (cTSH) concentration was determined in prestimulation serum (ie, before TSH administration). RESULTS: 14, 35, and 15 dogs had unchanged, normal, and intermediate post-TSH T(4) concentrations, respectively. Basal T(4) and post-TSH T(4) concentrations were significantly different among groups. On the basis of basal serum T(4) and cTSH concentrations alone, 1 euthyroid (normal post-TSH T(4), low basal T(4), and high cTSH concentrations) and 1 hypothyroid dog (unchanged post-TSH T(4) concentration and low to with-in reference range T(4) and cTSH concentrations) would have been misinterpreted as hypothyroid and euthyroid, respectively. Nine of the 15 dogs with intermediate post-TSHT(4) concentrations had received medication known to affect thyroid function prior to the test, and 2 of them had severe nonthyroidal disease. CONCLUSIONS AND CLINICAL RELEVANCE: The TSH-stimulation test with rhTSH is a valuable diagnostic tool to assess thyroid function in selected dogs in which a diagnosis of hypothyroidism cannot be based on basal T(4) and cTSH concentrations alone.

Animals↗
PubMedDate not supplied

Three clinical problems: weird thyroid function tests, difficult gout, and dementia.

Speakers at the course were given vignettes describing one or more clinical scenarios on which to base their talks, selected because they represent common but challenging problems likely to be encountered by any physician practising in general internal medicine. Three of the subjects covered--weird thyroid function tests, difficult gout, and dementia--are presented here.

Acute Disease↗
PubMed1989

Thyroid function tests in acute viral hepatitis: relative reduction in serum thyroxine levels due to T4-TBG binding inhibitors in patients with severe liver cell necrosis.

Thyroid function tests were evaluated in 34 patients with acute viral hepatitis (AVH) and in 38 healthy controls (C). As expected, AVH patients displayed a significant increase in T4, rT3 and TBG serum levels with respect to C, while FT4 and TSH concentrations were similar. A positive correlation between TBG and T4 was evident in C, but not in AVH. In this group there was, instead, an inverse correlation between the sum of serum levels of GOT + GPT and T4 concentrations. When AVH patients were divided in "high necrosis" (HN, serum GOT + GPT greater than 2000 UI/l) and "low necrosis" (LN, serum GOT + GPT less than 2000 UI/ml) groups, we found a significant reduction in both T4 and T3 serum concentrations in HN with respect to LN, despite similar levels of TBG, albumin, FT4 and TSH. The hypothesis that thyroid-hormone binding inhibitors (THBI), released during severe liver cell injury, accounted for an impaired serum binding capacity in HN-AVH, was confirmed by the significant increase in FT4/T4 ratio and by the demonstration of THBI activity in pooled sera of these patients, with respect to LN subgroup. Our present finding may clarify the unexplained observation of reduced T4 levels in patients with fulminant hepatitis and the ominous prognostic significance of a "low T4 syndrome" in subjects with severe liver disease and/or other systemic illnesses.

Acute Disease↗