Diagnosis of thyroid dysfunction in ambulatory patients: primacy of the supersensitive thyroid-stimulating hormone assay.
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Humans↗
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Red blood cell catechol O-methyltransferase activity in thyroid dysfunction.
Using a modification of the method of Mannl et al. (Mannl, H.F.K., Hempel, K., and Kubler, W. 1972. Catechol O-methyltransferase in human erythrocytes. Arch. Pharmacol. 272, 265-276), we have measured the activity of catechol O-methyltransferase (COMT) (EC 2.1.1.6) in red blood cells (RBC) of patients with hyperthyroidism and hypothyroidism to establish whether thyroid dysfunction is associated with alterations in catecholamine catabolism. The activity of COMT averaged 4.4+/-0.54 nmol/ml RBC per hour of incubation (mean+/-SEM) in euthyroid subjects compared to 4.76+/-0.64 nmol/ml RBC per hour of incubation in hyperthyroidism and 4.42+/-0.81 nmol/ml RBC per hour of incubation in hypothyroidism; these values are not significantly different. There were no significant differences observed in urinary excretion of vanillylmandelic acid, epinephrine, and norepinephrine among the three groups. These data are compatible with the possibility that thyroid status has little influence on the degradation of circulating catecholamines and suggest that hypothyroidism, with its attendant elevations in serum norepinephrine concentration, may be related to a compensatory noradrenergic response.
Catechol O-Methyltransferase↗
[Arrhythmogenic implications of non-iatrogenic thyroid dysfunction].
We studied all patients with hyperkinetic and hypokinetic arrhythmias, who were recovered in the Cardiology Department and Arrhythmologic Centre of S. Chiara Hospital in Trento between 1983 and 1987. From these we selected all the patients who, on admission, had clinical and biochemical symptoms of dysthyroidism. Of the 2465 patients with cardiac arrhythmias, 93 (3.8%) had an evident thyroid pathology which was due to chronic amiodarone treatment in 42 (44.6%) and was primary and non-iatrogenic in 51 (55.4%). In the latter the thyroid pathology consisted of hyperthyroidism in 43 cases (toxic nodular goitre or Graves' disease), and of hypothyroidism in 8. As regard the types of arrhythmias, hyperthyroidism is predominant in patients with atrial fibrillation (70%) and in those with paroxysmal supra-ventricular reciprocating tachycardia (11.5%), but it is also present in patients with hyperkinetic ventricular arrhythmias (14%). Hypothyroidism is found in patients with hyperkinetic ventricular arrhythmias (25%), atrial fibrillation (37.5%) and atrio-ventricular block (37.5%). The average age of the hyperthyroid population with atrial fibrillation is higher than that of patients with paroxysmal supraventricular reciprocating tachycardia. The control of the thyroid pattern, especially as regards atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia results in absence of arrhythmic episodes even without treatment in 40% of cases, and in an easier drug control in the other cases. Our study indicates that it is necessary to carry out systematic research of a thyroid dysfunction in all patients with cardiac arrhythmias, especially as regards women, atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia. It is also evident that in order to achieve long-term control over hyperkinetic arrhythmia it is very important to overcome hyperthyroidism.
Adolescent↗
Postpartum thyroid dysfunction and HLA status.
Nine-hundred-and-one women presenting in an antenatal clinic at the 60th week of pregnancy were tested for antithyroid antibodies. A group of 113 antibody-positive women and 108 antibody-negative age-matched controls were HLA typed and followed prospectively at 6-weekly intervals through pregnancy and for 12 months postpartum. Forty-five of the women developed biochemical evidence of postpartum thyroid dysfunction (PPTD) of whom 36 were antibody positive. Compared with a local control population (n = 600), and using multiplex analysis, there was a significant increase in the combinations HLA B8, DR3 and HLA A1, B8, DR3 from 22.5% to 40.0% (P less than 0.02) and from 18.6% to 35.6% (P less than 0.01) respectively in the women who developed PPTD. The well-recognized association of these haplotypes with other organ-specific autoimmune diseases provides further support for autoimmune events being implicated in the development of PPTD.
Autoantibodies↗
Thyroid dysfunction and hypercholesterolaemia in the general population of Glasgow, Scotland.
As part of a screening programme for coronary heart disease risk factors, fasting plasma cholesterol was measured in 2,250 people from the east-end of Glasgow. Plasma thyrotropin (TSH) was measured in the 90 individuals (4% of the population studied) who had a cholesterol level greater than or equal to 8.0 mmol/l. Four had unequivocal biochemical evidence of hypothyroidism-TSH greater than 34 mU/l and a low plasma thyroxine (T4) less than or equal to 45 nmol/l. A further 8 were found to have raised TSH levels suggesting they may have subclinical hypothyroidism. These data indicate that thyroid dysfunction may make a significant contribution to hypercholesterolaemia in the general population.
Adult↗
Influence of mild thyroid dysfunction on antipyrine clearance and metabolite formation in man.
The salivary kinetics and rates of metabolite formation of antipyrine were studied in 6 hyperthyroid and 6 hypothyroid out-patients on 2 occasions, on admission and when T3 and T4 levels had returned to normal after treatment with carbimazole (hyperthyroidism) or l-thyroxine (hyperthyroidism). In hyperthyroidism the half-life of antipyrine was significantly shorter (p less than 0.05) than after recovery (9.3 +/- 1.0 versus 10.6 +/- 0.9 h). Hypothyroid patients showed a significantly longer elimination half-life before treatment than after recovery (12.7 +/- 2.6 versus 10.3 +/- 2.6 h). Antipyrine clearance in hyperthyroid patients was decreased after treatment from 2.7 +/- 0.3 to 2.4 +/- 0.3 l/h, and it was increased in hypothyroid patients from 2.1 +/- 0.4 to 2.5 +/- 0.5 l/h (p less than 0.05). The changes in clearances for the production of the antipyrine metabolites 4-hydroxyantipyrine (OHA), norantipyrine (NORA) and 3-hydroxymethylantipyrine (HMA) were of the same order of magnitude as total antipyrine clearance, and no selectivity towards any of the metabolic pathways of antipyrine was apparent. Mild thyroid dysfunction seems to affect oxidative drug metabolizing enzyme activity in a non-selective manner and only to a small extent (10-30%). It is suggested that adjustment of the therapeutic regimens of various drugs in mild thyroid disease will only rarely by required on the basis of pharmacokinetic considerations.
Adult↗
Thyroid hormones and thermogenesis: a microcalorimetric study of overall cell metabolism in lymphocytes from patients with different degrees of thyroid dysfunction.
We used microcalorimetry to measure lymphocyte heat production rate in patients with clinical and laboratory hyperthyroidism (serum TSH decreases, serum FT4 increases, serum FT3 increases), subclinical hyperthyroidism (serum TSH decreases, serum FT1 increases, serum FT3 =), and subclinical hypothyroidism (serum TSH increases, serum FT4 decreases, serum FT3 =) compared with healthy controls (N = 13). The lymphocyte heat production rate was significantly correlated to the free thyroxine level (r = 0.53, p less than 0.01) and to the free triiodothyronine level (r = 0.51, p less than 0.01) when calculated from pooled data for the three patients groups. The hyperthyroid patients (N = 8) had a significantly increased lymphocyte heat production rate, 3.43 +/- 0.25 pW/cell, as compared with 2.31 +/- 0.12 pW/cell in the control group (p less than 0.001). The groups with subclinical hyperthyroidism (N = 7) and subclinical hypothyroidism (N = 9) had lymphocyte heat production rates of 2.14 +/- 0.11 and 2.56 +/- 0.15 pW/cell, respectively, not significantly different from that in the controls. Consistently, there was no significant difference between patients with subclinical hyperthyroidism (N = 5) and controls (N = 5) with regard to lymphocyte energy production as calculated from separately measured oxygen consumption rates in vitro, 1.36 +/- 0.20 and 1.56 +/- 0.12 pW/cell, respectively. Thus microcalorimetry seems to be suitable for studying the influence of thyroid hormones on cellular metabolism. Subclinical thyroid dysfunction does not seem to alter the overall rate of lymphocyte metabolism.
Adult↗
Thyroxine administration during radiation therapy to the neck does not prevent subsequent thyroid dysfunction.
In an attempt to reduce the incidence of hypothyroidism following irradiation of the neck, we administered oral L-thyroxine in doses sufficient to suppress serum TSH to 20 patients receiving radiation therapy for Hodgkin's disease or other lymphomas. L-thyroxine was discontinued when radiation therapy was completed. Twenty similar patients who did not receive L-thyroxine during radiation therapy served as a control group. After a mean follow-up period of 33 months, seven patients (35%) in the L-thyroxine group developed elevation of serum TSH and were started on chronic L-thyroxine therapy. In the control group, after mean follow-up of 19 months, five patients (25%) developed elevation of TSH and were started on chronic L-thyroxine. We conclude that suppression of serum TSH during neck irradiation does not prevent subsequent thyroid dysfunction.
Adolescent↗
High-density lipoprotein cholesterol, hepatic lipase and lipoprotein lipase activities in thyroid dysfunction--effects of treatment.
We have investigated the effects of hyper- and hypothyroidism (clinical and subclinical) on lipid metabolism, with special emphasis on serum high-density lipoprotein cholesterol, post-heparin plasma hepatic lipase and lipoprotein lipase activities. In 16 patients with hyperthyroidism, increased post-heparin plasma hepatic lipase activity, decreased serum total cholesterol and serum high-density lipoprotein cholesterol were found while lipoprotein lipase activity and serum triglyceride were normal. In six patients with overt hypothyroidism serum total cholesterol and triglyceride were increased, post-heparin plasma hepatic lipase and lipoprotein lipase were decreased while serum high-density lipoprotein cholesterol was normal. In six patients with subclinical hypothyroidism, serum total cholesterol was increased, serum high-density lipoprotein cholesterol was decreased, while serum triglyceride, post-heparin plasma hepatic lipase and lipoprotein lipase were normal. When the three groups of patients became euthyroid, serum total cholesterol, serum triglyceride, post-heparin plasma hepatic lipase, lipoprotein lipase, and serum high-density lipoprotein cholesterol reverted to normal except for serum high-density lipoprotein cholesterol in the hyperthyroid group which showed no significant change with treatment. A positive correlation was found between serum T3 and post-heparin plasma hepatic lipase while negative correlations were found between serum total cholesterol and serum T3, post-heparin plasma hepatic lipase and serum total cholesterol, lipoprotein lipase and serum triglyceride respectively. Thus in these patients with thyroid dysfunction, significant reversible alterations in serum total cholesterol, triglyceride and high-density lipoprotein cholesterol were found and could be correlated with the observed changes in the activities of hepatic lipase and lipoprotein lipase.
Adult↗
Thyroid dysfunction in chronic renal failure. A study of the pituitary-thyroid axis and peripheral turnover kinetics of thyroxine and triiodothyronine.
Thyroid function was evaluated in 46 patients with end-stage kidney disease and 42 normal subjects. Patients were studied before and after the institution of maintenance hemodialysis (HD) and after renal transplantation (RT). Serum total triiodothyronine concentrations (TT(3), ng/100 ml, mean+/-SD) were 63+/-17 and 83+/-22 in the non-HD and HD groups, respectively. Values from normal subjects were 128+/-25 and from RT patients 134+/-20. The TT(3) was in the hypothyroid range (<78 ng/100 ml; 2 SD below normal mean) in 80% of non-HD and 43% of HD patients. Mean serum total thyroxine concentration (TT(4)), although within the normal range, was lower than the control value. T(4)-binding globulin capacity was also slightly lower but the difference was not statistically significant. Among patients whose TT(4) was 1 SD below the normal mean, the free T(4) index was equally depressed, suggesting that factors other than decreased binding capacity might be responsible for the low TT(4). In addition, there was a 37% incidence of goiter. Mean serum thyroid-stimulating hormone (TSH) was not elevated and the TSH response to thyrotropin-releasing hormone (TRH) was distinctly blunted, suggesting the possibility of pituitary dysfunction as well. In vivo (125)I-l-T(4) and (131)I-l-T(3) kinetics during 0.2 mg/day of l-T(4) replacement showed marked reduction in T(3) turnover rate in the uremic patients, both before and during HD; the values (mug T(3)/day, mean+/-SD) for the different groups were as follows: normal, 33.8+/-6.1; non-HD, 13.5+/-2.6; HD, 12.9+/-3.1; and RT, 30.3+/-7.1. The low T(3) turnover rate was due to impaired extrathyroidal conversion of T(4) to T(3). The mean percent+/-SD of metabolized T(4) converted to T(3) was 37.2+/-5.8 in normal subjects, 15.7+/-3.1 in non-HD, 12.8+/-1.7 in HD, and 34.0+/-14.7 in RT patients. In contrast, thyroidal T(3) secretion rate was not different between the control and the three patient groups. Thus, it appears that uremia affects thyroid function at several levels: (a) subnormal pituitary TSH response to TRH; (b) possible intrathyroidal abnormalities as suggested by slightly decreased TT(4) and high incidence of goiter; and (c) abnormal peripheral generation of T(3) from T(4). Restoration of renal function with RT resulted in normalization of all parameters of thyroid function with the exception of blunted or absent TSH response to TRH. The latter may be a direct consequence of glucocorticoid administration.
Adult↗
[Ability to diagnose a thyroid dysfunction].
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Humans↗
Persistent pituitary-thyroid dysfunction patients following renal transplantation.
Pituitary-thyroid function, which is known to be altered in patients with chronic renal insufficiency, has been evaluated after successful kidney transplantation in 36 patients and compared with that in 15 healthy subjects. Thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was in the low range of normal in 24, and markedly decreased in 12 patients (< 0.0005). In the former group serum thyroxine was normal, whereas triiodothyronine was lowered; in the latter group thyroxine, although within the normal range, and triiodothyronine levels were reduced when compared with that of healthy controls. This differential TSH response to TRH was unrelated to kidney transplant function, duration of renal insufficiency or duration of the preceding hemodialysis, or to the dose and dosing schedule of prednisolone therapy. However, a slight negative correlation between the dose of prednisolone administered and TSh responsiveness to TRH as well as serum triiodothyronine was established (P < 0.05). Thus, corticoid treatment may in part be responsible for the alteration in TSH secretion and in the peripheral conversion of thyroxine to triiodothyronine. Other, as yet undefined factors, such as patients' variability in pituitary susceptibility to the polypragmatic therapy administered, have to be suspected as the major causes of the persistent pathological pituitary-thyroid function tests observed after renal transplantation.
Adolescent↗
Thyroid dysfunction in 85-year-old men and women. Influence of non-thyroidal illness and drug treatment.
Serum TSH and free T4 were determined by chemiluminometric assays in 601 women and 285 men aged 85 years from the population study "70-year-old people in Gothenburg, Sweden". For individuals with serum TSH concentration above 6.0 mU/l, "antimicrosomal" antibodies were determined, to assess the etiology of the elevated TSH concentration. Clinical follow-up was done of survivors until the age of 88, and records were inspected also for individuals who died before that age. On the basis of these evaluations the prevalence of previously undetected hypothyroidism was estimated to 4.0% in women and 2.5% in men. Previously undetected hyperthyroidism was found in 2, at the most 4, out of 601 women; in one out of 285 men the diagnosis could not be excluded. Possible confounding factors for the evaluation of TSH and/or free T4 concentrations were analysed by permutation t-test followed by multiple regression analysis, which revealed correlations of log TSH concentration to body mass index (p less than 0.05), serum creatinine concentration (p less than 0.05), and diabetes mellitus (inverse relationship, p less than 0.01). Correlation was found of free T4 concentration to treatment with non-selective beta-blocking agents (p less than 0.001) and digitalis glycosides (p less than 0.01). However, none of the factors influencing TSH and/or free T4 concentrations had any major influence on reference limits, nor could they account for individuals with "out-lier" values.
Adrenergic beta-Antagonists↗
Autoimmune thyroid dysfunction in the postpartum period.
The prevalence of thyroid disease was investigated in 460 Caucasian women after delivery. Thyroid microsomal antibodies (MsAb) were found in 44 (9.6%) of the women. These women appeared to have autoimmune thyroiditis. The changes in MsAb titers followed a predictable pattern with maximal values around 5-7 months postpartum. At this time 20 of these women had transient hypothyroidism and in some this was preceded by a thyrotoxic episode. The extent of postpartum hypothyroidism correlated well with the titers of MsAb in early pregnancy and in the postpartum period. Transient thyrotoxicosis occurred in eight women 5-7 months postpartum. TSH-receptor stimulating antibodies and/or high radioiodine uptake, suggesting Graves' disease, were detected in four of these women. Thus, after delivery, manifestations of autoimmune thyroid disorders, are remarkably common. In patients with autoimmune thyroiditis measurements of MsAb provide a good prognostic marker for the development of transient hypothyroidism.
Adult↗
Thyroid dysfunction in patients on regular hemodialysis: evaluation of the stable intrathyroidal iodine pool, incidence of goiter and free thyroid hormone concentration.
Thyroid function tests and stable intrathyroidal iodine were evaluated in 17 patients on regular hemodialysis treatment (RHD). Triiodothyronine levels in the hypothyroid range, thyroxine levels in the low normal range, but normal levels of thyroid-stimulating hormone, free thyroxine and free triiodothyronine were found. Normal values of stable intrathyroidal iodine and a normal incidence of goiter for our region were also found. It is concluded that in patients on RHD: (1) free thyroid hormone levels are normal and probably represent the most meaningful way of evaluating thyroid function; (2) in our RHD population goiter is no more prevalent than in normal persons; (3) the iodine storage function of the thyroid is not always altered.
Adult↗
Thyroid dysfunction and rheumatic diseases.
Musculoskeletal symptoms developing during the treatment of thyroid disease were studied in 150 patients; 17 developed a symptom complex of early morning stiffness together with shoulder girdle pain and weakness; similar symptoms were seen in only 3 of 100 controls. A prospective study of 16 patients with recent onset rheumatoid arthritis followed during the first 6 months of penicillamine therapy showed no changes in thyroid function tests. It is suggested that changing or abnormal thyroid status may precipitate or exacerbate musculoskeletal disease. Finally, in a retrospective study of 26 patients with both thyroid disease and rheumatoid arthritis, 4 patients had a simultaneous onset of both myxoedema and rheumatoid arthritis, the activity of which was greatly improved by correction of the hypothyroid state.
Adolescent↗
Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking.
The prevalence of thyroid disease and the concentration of thyroid hormones and thyrotropin were studied in a random population sample of 1154 women, aged 50-72 years, with special reference to the effect of age and smoking. The prevalence of spontaneous hypothyroidism was 3.3% (previously unknown overt and mild disease 1.3%) and the prevalence of hyperthyroidism was 2.5% (previously unknown disease 0.2%). Clinically suspected hyper- or hypothyroidism (very weak to strong) was recorded in 288 women, but was only verified in three cases. The prevalence of visible and palpable thyroid enlargement was 2.1% and 13-14%, respectively. Total thyroxine concentrations increased and free tri-iodothyronine levels decreased significantly with age (P less than 0.001). The serum thyrotropin concentrations were lower in smoking women than in non-smokers in the 50- and 58-year age groups (P less than 0.05). There was no increase in the prevalence of thyroid disease or goitre in the women who were smokers at the time of the study.
Age Factors↗
Errors in a report: thyroid dysfunction detection strategy.
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Humans↗