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PubMed1996

Incorrect diagnosis of thyroid disease by junior doctors.

Thyroid function tests (TFTs) are commonly performed on elderly patients admitted to hospital. Several diseases and commonly used drugs may alter thyroid function test results. We assessed the knowledge of such interactions among 50 junior doctors in our departments: 60% were unaware that (in our laboratory) the normal range for TFTs is the same in those above 65 years as in those below; 72% correctly noted the effect of an acute illness, while only 48% correctly noted the effect of a chronic illness on test results; 72% were well aware of common drug effects such as those of the oral contraceptive pill, but only 22% and 42% knew of the potentially more important interactions in the elderly with the salicylates and phenytoin respectively. Thyroid screening in elderly people is important. The knowledge of interactions between drugs, disease states and the normal range of biochemical assays used in routine thyroid screening needs to be improved if thyroid function tests are to be interpreted appropriately.

Clinical Competence↗
PubMed1989

Thyroid disease in pregnancy.

Thyroid disease may be pre-existing or rarely may arise de novo during pregnancy. It may have profound effects on the feto-maternal unit. Diagnosis depends on clinical suspicion and confirmation by biochemical tests of thyroid function. However, pregnancy masks the signs of thyroid disease and may alter the interpretation of thyroid function tests.

Female↗
PubMed1983

Ordering of laboratory tests in a teaching hospital. Can it be improved?

A review of ordering patterns for thyroid function tests and for measurements of creatine kinase (CK) isoenzyme and lactate dehydrogenase (LDH) isoenzyme levels indicated considerable misuse. We employed an educational program for both types of tests, but changed the request form only for ordering the thyroid function tests. No changes were made in the forms for ordering CK and LDH isoenzyme tests. The effect was a prompt decrease in ordering triiodothyronine radioimmunoassay and thyrotropin tests to 38% and 61%, respectively, of baseline rates. There was no effect on rates of ordering CK and LDH isoenzyme tests, which were 102% and 96%, respectively, of baseline rates. The improved use of thyroid function tests was likely because of the change in the laboratory request form, since the educational strategy by itself had no effect on the ordering of CK and LDH isoenzyme tests.

California↗
PubMed1998

A randomized trial of short-term treatment of Graves' disease with high-dose carbimazole plus thyroxine versus low-dose carbimazole.

OBJECTIVE: The optimal treatment regimen with thionamide drugs remains a matter for debate. We have investigated whether high doses of carbimazole, when compared with low doses, reduce relapse rates of Graves' disease. DESIGN: In an open label, randomized, prospective trial of treatment of Graves' disease we compared high doses of carbimazole (6 months of 100 mg carbimazole per day plus thyroxine) to low-dose carbimazole treatment (starting at 25 mg and titrating the carbimazole dose with the aim to maintain serum thyroid function test results within the normal reference range). PATIENTS: Thirty-seven patients with a first episode of Graves' disease were enrolled. MEASUREMENTS: During the 6 months of treatment we evaluated the rate of normalization of serum thyroid function tests, changes in serum thyroid auto-antibody levels and the rate of side-effects during treatment. After completion of the 6-month treatment course patients were observed for 2 years for evidence of relapse of Graves' disease. RESULTS: There were no differences between the two groups either in the rate of normalization of serum thyroid function tests or in serum thyroid auto-antibody levels during treatment. Of the 17 patients randomized to high-dose treatment seven suffered treatment side-effects, compared to only one of the 20 patients receiving low-dose treatment (P < 0.006). There was no significant difference in 2-year post-treatment remission rates on an intention-to-treat basis between the two treatment groups (18.7% vs. 5.9%, P = NS). However, for those patients who completed 6 months of treatment (high-dose group = 9, low-dose group = 16), multivariate survival analysis demonstrated a significantly longer median relapse-free interval (P < 0.04) in the high-dose group (27 weeks; 25th percentile: 9.6 weeks, 75th percentile: 75 weeks) versus the low-dose group (6 weeks; 25th percentile: 4.8 weeks, 75th percentile: 13.1 weeks). CONCLUSIONS: High-dose carbimazole treatment delays, but does not prevent, relapse from Graves' disease in those patients able to tolerate the treatment. However, it leads to more frequent side-effects than conventional dose treatment.

Adult↗
PubMed1990

Prevalence of thyroid abnormalities in patients with dermatitis herpetiformis and in control subjects with HLA-B8/-DR3.

PURPOSE: The prevalence of thyroid dysfunction as measured by the presence of overt thyroid disease, abnormal results of thyroid function tests, or antithyroid antibodies was compared in patients with dermatitis herpetiformis (DH) and a normal control group who had the HLA-B8/-DR3 haplotype. PATIENTS AND METHODS: The study population consisted of 56 patients with DH and 26 control subjects with the HLA-B8/-DR3 haplotype. All were examined for thyroid function abnormalities and thyroid autoantibodies. RESULTS: Patients with DH had a statistically significant increase in the prevalence of abnormal thyroid function test results and autoantibodies: 32% versus 4% for controls (Z = 2.01, p less than 0.02). In patients with DH, hypothyroidism was the most common thyroid abnormality (12 of 56) followed by hyperthyroidism (four of 56). Two patients had normal thyroid function test results with thyroid autoantibodies. Risk factors for thyroid abnormalities in patients with DH were increasing age (chi 2 = 6.55, p less than 0.02, significant) and the presence of thyroid microsomal antibodies. The HLA-B8/-DR3 haplotype was not a risk factor for thyroid abnormalities. CONCLUSION: The findings suggest that thyroid disease is independently associated with DH. Examination of patients with DH should include thyroid function tests along with assays for antithyroid antibodies.

Adult↗
PubMed1981

Solitary thyroid nodule. 2. Selective approach to management.

Ordinarily, the history and physical examination and routine tests, including thyroid function tests, iodine 123 or technetium Tc 99m scans, and echography, will determine the best therapeutic approach to a solitary thyroid nodule. In the case of an asymptomatic, hypofunctional solid nodule, thyroid hormone suppression and fine-needle aspiration biopsy may be necessary to further delineate the best therapy.

Biopsy↗
PubMedDate not supplied

Pulmonary function tests and thyroid hormone concentrations in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the relationship between pulmonary function tests, arterial blood gases, and thyroid gland functions in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Thirty-two patients (mean age 64.1 +/- 7.3 years, range 53-84 years) with stable COPD (mean duration of disease 11.1 +/- 9.1 years, range 1-30 years) and 15 healthy control cases participated in the study. Pulmonary function, arterial blood gas, and thyroid hormone concentration were measured, and thyroid ultrasonography and scintigraphy were also performed. RESULTS: The values of the pulmonary function tests (vital capacity, forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow) and PaO2 were lower in the study than control group (p < 0.001), but the values of PaCO2 and concentration of free 3,5,3'-triiodothyronine (fT3) were higher in the study than control group (p < 0.01) although thyroid hormone concentrations were within normal limits in all cases. However, there was no difference between the values of thyroid-stimulating hormone and free thyroxine in both the study and control groups and therefore association could not be established between them on the one hand and pulmonary function test and arterial blood gases on the other hand. Only the values of PaCO2 and fT3 were positively associated; all other values were negatively associated with fT3. CONCLUSION: Changes in pulmonary function tests and arterial blood gases seem to be associated with fT3 concentrations in patients with COPD. Increased respiratory workload could affect thyroid functions.

Aged↗
PubMed1994

Thyroid function screening in newly admitted psychiatric inpatients.

Thyroid function tests (T4, T3RU, free thyroxine index) were performed upon admission in 269 acute psychiatric patients during a 2-year period. Thyroid disease was detected in 3% and euthyroid abnormalities in 9.3%. T4 and free thyroxine index were significantly lower in depressed patients than those with mania or schizophrenia. The rate of abnormal thyroid tests was lower in this study than in previously reported surveys of psychiatric admissions. Laboratory techniques or differences in population may be responsible for the difference. The differences in thyroid function test values between psychiatric diagnoses are relatively new findings, and appear worthy of investigation.

Adult↗
PubMed1991

Effect of cocaine on thyroid functions.

Results of routine thyroid function tests in heavy cocaine abusers at the time of treatment admission were not statistically different from normal values for our laboratory or from a similar group of other substance abuse patients in treatment. This suggests that heavy cocaine use per se does not affect thyroid function. Therefore, if the thyroid function tests are abnormal in a cocaine abuser, then a true thyroid dysfunction should be considered and completely evaluated. In addition, nonspecific alterations in thyroid function tests in nonthyroidal illnesses should be kept in mind.

Adult↗
PubMed1991

Thyroid stimulating and thyrotrophin binding-inhibitory immunoglobulin activity in patients with systemic lupus erythematosus having thyroid function abnormalities.

In order to determine whether thyroid function abnormalities seen in patients with systemic lupus erythematosus (SLE) are associated with autoantibodies directed against the TSH receptor, 28 patients with SLE who demonstrated abnormal thyroid function tests were evaluated for the presence of anti-TSH receptor antibodies. Anti-TSH receptor antibody activity was evaluated by assessing cAMP production in vitro in FRTL-5 (rat thyroid) cells (TSI) and the ability of the subjects' IgG to block the binding of thyrotrophin to its receptor in vitro (TBII). Complete thyroid function tests, including TRH testing, also were performed. Ten of the 28 patients demonstrated TSI activity, ranging from 133% to 183% of control. Five patients also had evidence of TBII activity, ranging from 22% to 90% inhibition (of control TSH binding levels), with 2 patients having evidence of both types of antibodies. Neither the TSI nor TBII activity in these patients was associated with the abnormal thyroid function tests. However, there were significantly more patients with TBII activity who had elevated TSH levels (3 of 4 vs 1 of 24, p less than 0.05), suggesting a potential physiologic response to TSH receptor blockade. These results indicate that patients with SLE and thyroid function abnormalities can demonstrate TBII and TSI activity in their serum. However, these antibodies do not necessarily correlate with specific abnormalities of thyroid function.

Antibodies, Antinuclear↗
PubMedDate not supplied

Influence of drugs on thyroid function in dogs.

Several drugs can affect thyroid function test results in humans and eventually lead to an erroneous evaluation of thyroid function. These medications can alter the synthesis, secretion, transport, or metabolism of thyroid hormones. Some drugs also directly inhibit the hypothalamic-pituitary-thyroid axis. The effects of drugs on thyroid function in dogs have long been underestimated and have most likely contributed to the overdiagnosis of hypothyroidism in this species. This manuscript 1st reviews pertinent thyroid physiology followed by an overview of drugs for which the effects on canine thyroid function have been studied. The effects of glucocorticoids, propranolol, sulfonamides, phenobarbital, potassium bromide, and nonsteroidal anti-inflammatory agents (NSAIDs) on canine thyroid function are summarized here. Knowledge of the potential effect of these medications on thyroid function should contribute to a more reliable interpretation of thyroid function test results in dogs.

Animals↗
PubMed1994

Abnormal endocrine tests in a hemodialysis patient.

A home hemodialysis patient with abnormal thyroid function tests and hyperprolactinemia is presented. Abnormal thyroid tests included low total triiodothyronine and low total thyroxine and free thyroxine; the latter was documented by the use of both RIA and direct dialysis equilibrium techniques. Serum thyroid-stimulating hormone was normal, and the thyroid-stimulating hormone response to thyrotropin-releasing hormone stimulation was in the low-normal range. Serum prolactin was elevated to more than twice the normal level, and the prolactin response to thyrotropin-releasing hormone was also blunted. The interpretation, pathogenesis, physiologic significance, and management of these abnormalities are discussed.

Diagnosis, Differential↗
PubMed1995

[Thyroid involvement in systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) is a rare disease in childhood, and is characterized by widespread inflammation of blood vessels and connective tissue. Although the disease affects a number of different organs, thyroid involvement is not included in the classification criteria set of SLE. We describe two cases of irls with SLE who developed thyroiditis with goitre, thyroid autoantibodies, elevated serum TSH and decreased thyroid function tests. One patient had thyroiditis eighteen months before SLE was diagnosed and the other developed thyroiditis six months after the onset of SLE. Recent prospective studies have shown that thyroid involvement in SLE presenting either as hyper- or hypothyroidism is more common among children than adults. We therefore recommend that thyroid function tests should regularly be performed in juvenile SLE patients and, conversely, that child patients with Hashimoto's thyroiditis should be examined for symptoms and serology of SLE.

Adolescent↗
PubMed1995

Drug-induced thyroid disorders.

Many drugs can interfere with biochemical tests of thyroid functions by interfering with the synthesis, transport and metabolism of thyroid hormones, or by altering the synthesis and secretion of thyrotrophin (thyroid-stimulating hormone; TSH). Only rarely, however, do these effects cause overt, clinically apparent thyroid disease. Lithium therapy causes overt hypothyroidism in 5 to 15% of patients, and goitre in up to 37%. Thyroid function tests should be performed prior to initiating lithium therapy, and at 6-monthly intervals thereafter. Iodine and iodine-containing drugs (e.g. radiographic contrast media, iodinated glycerol and amiodarone) can have profound and variable effects on thyroid function.

Amiodarone↗
PubMed2000

[Thyrotoxicosis and coexistent diseases in atrial fibrillation.].

OBJECTIVE: To evaluate the prevalence of thyrotoxicosis and coexistent diseases in patients with atrial fibrillation admitted to a general medicine ward. MATERIAL AND METHODS: All patients with the discharge diagnosis of atrial fibrillation were studied. The study design was retrospective for the years 1993-1994 and prospective from April 1995 through December 1997. Information on thyroid function tests was obtained from medical records in the retrospective part, but TSH, T4 and T3 were measured for patients admitted during the prospective part. Coexistent diseases were recorded. RESULTS: Atrial fibrillation was diagnosed in 167 patients (58 in the retrospective part and 109 in the prospective part). Males were predominant (59.3%) and the average age was 73.7 years (span 26-100). Adequate information on thyroid function tests was available for 135 patients (58.6% of the retrospective part and 92.7% of the prospective part). 24 (17.8%) had abnormal thyroid function tests, predominantly women (71%). Ten had an isolated elevation of TSH, seven an isolated depression of TSH, two hypothyroidism and five other abnormalities. Hypertension was the most common coexistent disease (76 of 167 patients (45.5%). Ischemic heart disease was found in 44 (26.3%) and valvular heart disease in 27 (16.2%). No known coexistent disease was found in 32 (19.2%). CONCLUSIONS: 1) Thyrotoxicosis is rare in patients with atrial fibrillation who are admitted to a general medicine ward. Routine measurement of thyroid function tests in this patient population is therefore not warrented. 2) Unspecific abnormalities of thyroid function tests are common and are most likely due to diseases outside the thyroid gland or medications. 3) Hypertension, ischemic heart disease and heart valve disease are the most common coexistent diseases in this group of patients.

English Abstract↗