RESUMO
Las pruebas de función tiroidea (PFT) son esenciales para el diagnóstico preciso y el seguimiento eficaz de la disfunción tiroidea. Existe un incremento progresivo y estable de los pedidos de PFT, incluso se han incorporado las mismas a los exámenes de salud anuales en niños sanos. Representan más del 60% de las pruebas realizadas en el laboratorio de endocrinología, tanto en adultos como en los laboratorios especializados en pediatría. Para hacer un uso eficiente de las PFT, antes de solicitarlas debemos preguntarnos ¿Para quién? ¿Cuándo solicitarlas? ¿Qué pruebas solicitar? ¿Cómo solicitarlas? y ¿Cómo interpretar correctamente los resultados? Un resultado anormal en las PFT no siempre implica patología tiroidea asociada. Las PFT tienen importante variabilidad intra e interindividual lo que hace más compleja su correcta interpretación. La pesquisa de enfermedad tiroidea neonatal es un importante aporte a la prevención de la deficiencia mental en la infancia, su aplicación obligatoria posibilita un diagnóstico temprano, para asegurar su éxito debe considerarse en el marco de un programa integral de detección con estrategias de confirmación, tratamiento temprano y seguimiento a corto, mediano y largo plazo. No debe hacerse un uso indiscriminado de la prueba de estímulo con TRH en el diagnóstico de la patología tiroidea. En pediatría la estrategia de tamiz de enfermedad tiroidea es conveniente realizarla mediante la medición de por lo menos TSH y T4 libre e incluir la determinación de ATPO en grupos de riesgo, a diferencia de la determinación aislada de TSH como es recomendado en adultos. (AU)
Thyroid function tests (TFTs) are essential for accurate diagnosis and effective monitoring of thyroid dysfunction. There is a progressive and steady increase in requests for TFTs, and they have even been incorporated into annual health examinations in healthy children. They represent more than 60% of the tests performed in the endocrinology laboratory, both in adults and in specialized pediatric laboratories. To efficiently use TFTs, before requesting them we should ask ourselves... For whom? When to request them? Which tests to request? How to request them? and How to correctly interpret the results? An abnormal TFT result does not always imply thyroid disease. TFTs have significant intra- and inter-individual variability, which makes their correct interpretation more complex. Screening for newborn thyroid disease is an important contribution to the prevention of intellectual disability in childhood and its mandatory use enables early diagnosis; however, to ensure the test to be successful, it should be considered within the framework of a comprehensive screening program with strategies for confirmation, early treatment, and short-, medium-, and long-term follow-up. The TRH stimulation test in the diagnosis of thyroid disease should not be used indiscriminately. In children, the screening strategy for thyroid disease should be performed by measuring at least TSH and free T4 and include the measurement of TPO-ab in risk groups, as opposed to the isolated measurement of TSH as recommended in adults. (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Doenças Autoimunes/diagnóstico , Testes de Função Tireóidea/tendências , Testes de Função Tireóidea/estatística & dados numéricos , Tireotropina/sangue , Técnicas de Diagnóstico Endócrino/tendências , Hipertireoidismo/diagnóstico , Hipotireoidismo/diagnóstico , Procedimentos DesnecessáriosRESUMO
BACKGROUND: Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue. Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management. OBJECTIVE AND METHODS: To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives. PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows: "sars cov 2", "covid 19", "subacute thyroiditis", "atypical thyroiditis", "chronic thyroiditis", "hashimoto's thyroiditis", "graves' disease", "thyroid nodule", "differentiated thyroid cancer", "medullary thyroid cancer", "methimazole", "levothyroxine", "multikinase inhibitor", "remdesivir", "tocilizumab". Data were collected, analyzed, and discussed to answer the following clinical questions: "What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function?"; "Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred?"; "Could medical management of thyroid diseases influence the clinical course of COVID-19?"; "Does medical management of COVID-19 interfere with thyroid function?"; "Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?". RESULTS: SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19. However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden. Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19. High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed. DISCUSSION: Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions. Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures. Telemedicine may be a useful tool for managing patients not requiring in-person visits.
Assuntos
COVID-19/epidemiologia , COVID-19/fisiopatologia , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/fisiopatologia , Glândula Tireoide/fisiopatologia , COVID-19/imunologia , Humanos , Doenças da Glândula Tireoide/imunologia , Testes de Função Tireóidea/tendências , Glândula Tireoide/imunologiaRESUMO
PURPOSE: Evidence of an increased diagnostic pressure on thyroid has emerged over the past decades. This study aimed to provide estimates of a wide spectrum of surveillance indicators for thyroid dysfunctions and diseases in Italy. METHODS: A population-based study was conducted in North-eastern Italy, including 11.7 million residents (20% of the total Italian population). Prescriptions for TSH testing, neck ultrasound or thyroid fine needle aspiration (FNA), surgical procedures, and drugs for hypo- or hyperthyroidism were extracted from regional health databases. Proportions and rates of selected examinations were calculated from 2010 to 2017, overall and by sex, calendar years, age, and region. RESULTS: Between 2010 and 2017 in North-eastern Italy, 24.5% of women and 9.8% of men received at least one TSH test yearly. In 2017, 7.1% of women and 1.5% of men were prescribed drugs for thyroid dysfunction, 94.6% of whom for hypothyroidism. Neck ultrasound examinations were performed yearly in 6.9% of women and 4.6% of men, with a nearly two-fold variation between areas. Thyroid FNA and thyroidectomies were three-fold more frequent in women (394 and 85 per 100,000) than in men (128 and 29 per 100,000) with a marked variation between areas. Both procedures decreased consistently after 2013. CONCLUSIONS: The results of this population-based study describe recent variations over time and between surrounding areas of indicators of 'diagnostic pressure' on thyroid in North-eastern Italy. These results emphasize the need to harmonize practices and to reduce some procedures (e.g., neck ultrasound and total thyroidectomies) in certain areas.
Assuntos
Biópsia por Agulha Fina , Doenças da Glândula Tireoide , Testes de Função Tireóidea , Glândula Tireoide , Tireoidectomia , Ultrassonografia , Adulto , Idoso , Biópsia por Agulha Fina/métodos , Biópsia por Agulha Fina/tendências , Feminino , Humanos , Itália/epidemiologia , Masculino , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Uso Excessivo dos Serviços de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Fatores Sexuais , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/tendências , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Tireoidectomia/métodos , Tireoidectomia/tendências , Ultrassonografia/métodos , Ultrassonografia/tendênciasRESUMO
Background: Active surveillance for low-risk papillary microcarcinoma (PMC) of the thyroid is an accepted and safe management strategy. However, some patients undergo conversion surgery after the initiation of active surveillance for various reasons. We investigated the reasons for conversion surgery and whether and how they changed over time. Methods: We enrolled 2288 patients with PMC who underwent active surveillance. Of these, 162 (7.1%) underwent conversion surgery >12 months after initiating active surveillance due to disease progression (57 patients), patient preference (43 patients), physician preference (31 patients), other associated thyroid or parathyroid diseases (24 patients), and other reasons (7 patients). We analyzed cumulative conversion rates not only in the whole cohort but also in the first three major subsets based on the reasons for surgery. We also divided our whole cohort into two groups based on the period of active surveillance commencement: the first-half group (February 2005-November 2011; 561 patients) and the second-half group (December 2011-June 2017; 1727 patients). Results: The criteria for PMC progression did not differ between the first- and second-half groups. The proportion of female patients in the physician preference group was significantly higher than that in the disease progression and the patient preference groups. Tumor size at surgery was larger, and tumor volume-doubling rate was higher in the disease progression group than in the other two groups. Patients in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group. Furthermore, conversion surgery rates in the second-half group were significantly lower than those in the first-half group in the patient preference, physician preference, and disease progression groups. Conclusions: Patients with PMC in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group regardless of the reason. This is probably because data accumulation of favorable outcomes with active surveillance significantly contributed to physicians' confidence and patients' trust and understanding of this disease.
Assuntos
Carcinoma Papilar/terapia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia/tendências , Conduta Expectante/tendências , Adolescente , Adulto , Idoso , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/secundário , Progressão da Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Testes de Função Tireóidea/tendências , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Ultrassonografia/tendências , Adulto JovemRESUMO
Laboratory testing for markers of thyroid function is essential for the diagnosis of thyroid disease, yet, the landscape of thyroid function testing is complex and inappropriate test orders are common. Reverse T3 (rT3) is frequently seen on thyroid function testing menus as a marker of nonthyroidal illness. However, the diagnostic utility of rT3 for this indication is questionable, and testing of rT3 is not recommended by any professional practice guidelines. We reviewed a set of rT3 orders at our institution, and identified that 11 of 20 orders appeared inappropriate with respect to clinical context. These orders were less likely to have been placed at the recommendation of an endocrinologist relative to appropriate orders. We recommend that all providers refer to professional guidelines for thyroid function testing, and consult with an endocrinologist for appropriate usage of esoteric or non-standard thyroid function tests.
Assuntos
Competência Clínica/estatística & dados numéricos , Testes de Função Tireóidea/tendências , Tri-Iodotironina Reversa/análise , Endocrinologistas , Fidelidade a Diretrizes/tendências , Humanos , Texas , Glândula Tireoide/metabolismo , Tireotropina/análise , Tiroxina/análiseRESUMO
BACKGROUND: Adequate transplacental passage of maternal thyroid hormone is important for normal fetal growth and development. Maternal overt hypothyroidism and hyperthyroidism are associated with low birthweight, but important knowledge gaps remain regarding the effect of subclinical thyroid function test abnormalities on birthweight-both in general and during the late second and third trimester of pregnancy. The aim of this study was to examine associations of maternal thyroid function with birthweight. METHODS: In this systematic review and individual-participant data meta-analysis, we searched MEDLINE (Ovid), Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception to Oct 15, 2019, for prospective cohort studies with data on maternal thyroid function during pregnancy and birthweight, and we issued open invitations to identify study authors to join the Consortium on Thyroid and Pregnancy. We excluded participants with multiple pregnancies, in-vitro fertilisation, pre-existing thyroid disease or thyroid medication usage, miscarriages, and stillbirths. The main outcomes assessed were small for gestational age (SGA) neonates, large for gestational age neonates, and newborn birthweight. We analysed individual-participant data using mixed-effects regression models adjusting for maternal age, BMI, ethnicity, smoking, parity, gestational age at blood sampling, fetal sex, and gestational age at birth. The study protocol was pre-registered at the International Prospective Register of Systematic Reviews, CRD42016043496. FINDINGS: We identified 2526 published reports, from which 36 cohorts met the inclusion criteria. The study authors for 15 of these cohorts agreed to participate, and five more unpublished datasets were added, giving a study population of 48â145 mother-child pairs after exclusions, of whom 1275 (3·1%) had subclinical hypothyroidism (increased thyroid stimulating hormone [TSH] with normal free thyroxine [FT4]) and 929 (2·2%) had isolated hypothyroxinaemia (decreased FT4 with normal TSH). Maternal subclinical hypothyroidism was associated with a higher risk of SGA than was euthyroidism (11·8% vs 10·0%; adjusted risk difference 2·43%, 95% CI 0·43 to 4·81; odds ratio [OR] 1·24, 1·04 to 1·48; p=0·015) and lower mean birthweight (mean difference -38 g, -61 to -15; p=0·0015), with a higher effect estimate for measurement in the third trimester than in the first or second. Isolated hypothyroxinaemia was associated with a lower risk of SGA than was euthyroidism (7·3% vs 10·0%, adjusted risk difference -2·91, -4·49 to -0·88; OR 0·70, 0·55 to 0·91; p=0·0073) and higher mean birthweight (mean difference 45 g, 18 to 73; p=0·0012). Each 1 SD increase in maternal TSH concentration was associated with a 6 g lower birthweight (-10 to -2; p=0·0030), with higher effect estimates in women who were thyroid peroxidase antibody positive than for women who were negative (pinteraction=0·10). Each 1 SD increase in FT4 concentration was associated with a 21 g lower birthweight (-25 to -17; p<0·0001), with a higher effect estimate for measurement in the third trimester than the first or second. INTERPRETATION: Maternal subclinical hypothyroidism in pregnancy is associated with a higher risk of SGA and lower birthweight, whereas isolated hypothyroxinaemia is associated with lower risk of SGA and higher birthweight. There was an inverse, dose-response association of maternal TSH and FT4 (even within the normal range) with birthweight. These results advance our understanding of the complex relationships between maternal thyroid function and fetal outcomes, and they should prompt careful consideration of potential risks and benefits of levothyroxine therapy during pregnancy. FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).
Assuntos
Peso ao Nascer/fisiologia , Hipotireoidismo/fisiopatologia , Complicações na Gravidez/fisiopatologia , Glândula Tireoide/fisiologia , Glândula Tireoide/fisiopatologia , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Gravidez , Testes de Função Tireóidea/tendênciasRESUMO
It is well documented that thyroid hormone (TH) action is critical for normal brain development and is mediated by both nuclear and extranuclear pathways. Given this dependence, the impact of environmental endocrine disrupting chemicals that interfere with thyroid signaling is a major concern with direct implications for children's health. However, identifying thyroid disrupting chemicals in vivo is primarily reliant on serum thyroxine (T4) measurements within greater developmental and reproductive toxicity assessments. These studies do not examine known TH-dependent phenotypes in parallel, which complicates chemical evaluation. Additionally, there exist no recommendations regarding what degree of serum T4 dysfunction is adverse, and little consideration is given to quantifying TH action within the developing brain. This review summarizes current testing strategies in rodent models and discusses new approaches for evaluating the developmental neurotoxicity of thyroid disrupting chemicals. This includes assays to identify adverse cellular effects of the brain by both immunohistochemistry and gene expression, which would compliment serum T4 measures. While additional experiments are needed to test the full utility of these approaches, incorporation of these cellular and molecular assays could enhance chemical evaluation in the regulatory arena.
Assuntos
Disruptores Endócrinos/toxicidade , Transtornos do Neurodesenvolvimento/induzido quimicamente , Glândula Tireoide/efeitos dos fármacos , Hormônios Tireóideos/fisiologia , Animais , Bioensaio/métodos , Bioensaio/tendências , Modelos Animais de Doenças , Humanos , Transtornos do Neurodesenvolvimento/etiologia , Roedores , Transdução de Sinais/efeitos dos fármacos , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/tendências , Glândula Tireoide/patologia , Glândula Tireoide/fisiologia , Hormônios Tireóideos/farmacologiaRESUMO
Introduction: Mole hydatiforme is the most common type of gestational trophoblast disease (GTI) and the aim of this study, is evaluation the frequency of changes in thyroid function test in mole hydatidiform patients. Materials and Methods: In this retrospective study, 63 patients with mole hydatidiform who reffering to gynecolgy ward of Ali ibn Abitaleb Hospital in Zahedan from April 2016 to March 2017, were studied. Information such as age, gravidity and laboratory findings inclluding thyroid function test (TFT) and the presence or absence of clinical sympltoms were recorded in the information forms and analyzed by SPSS software. Results: In this study, 63 patients with mole hydatidiform were studied. The mean age of the patients was 26.6 ± 7.7 years. The most common clinical manifestations of hyperthyroidism in patients with mole hydatidorme was tachycardia (39.7%). There was no relationschip between age and gravidity with the hyperthyroid simptoms and thyroid function test. Conclusion: Overall, the results of this study showed ttat 67% of patients with mole hydatidiform hay reduced TSH and more than 50% of cases hay increased free T3 and T4. There was no relationship between maternal age and gravidity with changes in thyroid functional test (AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Testes de Função Tireóidea/tendências , Mola Hidatiforme/diagnóstico , Estudos Transversais , Estudos Retrospectivos , Idade Materna , Doença Trofoblástica Gestacional/diagnósticoRESUMO
BACKGROUND AND OBJECTIVES: Recent studies show that long-term (LT) antithyroid drugs reduce relapse of hyperthyroidism in patients with Graves' disease. Our objective was to evaluate the effectiveness and safety of LT methimazole treatment and to compare remission rates in Graves' disease patients after LT and short-term (ST) therapy. METHODS: In this randomized, parallel group trial, 66 consecutive patients with untreated juvenile Graves' hyperthyroidism were enrolled. After a median 22 months of methimazole treatment, 56 patients were randomly assigned to either continue low-dose methimazole treatment (n = 24, LT group) or to discontinue treatment (n = 24, ST group). Twenty-four patients in LT group completed 96 to 120 months of methimazole treatment. Patients in both groups were managed for 48 months after discontinuation of treatment. RESULTS: Except for 3 cases of cutaneous reactions, no other adverse events were observed throughout 120 months of methimazole therapy. Serum free thyroxine, triiodothyronine, thyrotropin, and thyrotropin receptor antibody remained normal, and the required daily dosage of methimazole was gradually decreased from 5.17 ± 1.05 mg at 22 months to 3.5 ± 1.3 mg between 96 and 120 months of treatment (P < .001). Hyperthyroidism was cured in 92% and 88% of LT patients and in 46% and 33% of ST patients, 1 and 4 years after methimazole withdrawal, respectively. CONCLUSIONS: LT methimazole treatment of 96 to 120 months is safe and effective for treatment of juvenile Graves' disease. The four-year cure rate of hyperthyroidism with LT methimazole treatment is almost 3 times more than that of ST methimazole treatment.
Assuntos
Antitireóideos/administração & dosagem , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Metimazol/administração & dosagem , Adolescente , Esquema de Medicação , Feminino , Doença de Graves/sangue , Humanos , Masculino , Testes de Função Tireóidea/tendênciasRESUMO
INTRODUCTION: Thyroid Function Tests (TFTs) are among the most commontly ordered tests. Significant overuse of TFTs can occur when instead of using a single TSH test to screen for thyroid disease a full panel (TSH plus FT4 and FT3) is ordered. The aim of our study was to evaluate the effectiveness of the application of a scientifically-established laboratory-controlled algorithm for TFTs to physician's orders for inpatients and to address potential pitfalls of such an approach. MATERIALS AND METHODS: We collected and analyzed Laboratory Information System data of the TFTs performed between April 2009 and March 2016 in a 739-bed tertiary teaching hospital. Between April 2013 and March 2016, we applied a laboratory controlled algorithm for inpatient TFT assays after TSH and did not perform further tests, unless a justified bypass was requested by the treating physician. RESULTS: Algorithm application led to significant reductions of TFTs executed per TSH ordered. Compared to the four years preceding the intervention, executed FT4/TSH tests decreased from 93 to 18%, FT3/TSH from 92 to 18%, anti-TG/TSH from 18 to 4% and anti-TPO/TSH from 11 to 3%. Simultaneously, FT4, FT3, anti-TG, and anti-TPO tests ordered in outpatients also displayed a significant gradual decrease. CONCLUSIONS: Hospital-based laboratories can safely apply a generally accepted TFTs algorithm on physician's orders without any compromise in diagnostic/therapeutic accuracy, thus achieving significant direct cost-reduction and increased physician awareness on current TFT ordering practices. Such an approach, combined with collaboration with ordering physicians, can safeguard patients from the consequences of low-value care practices.
Assuntos
Algoritmos , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea/estatística & dados numéricos , Autoanticorpos/sangue , Grécia , Humanos , Centros de Atenção Terciária , Testes de Função Tireóidea/tendências , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
BACKGROUND AND OBJECTIVES: Iodine is an essential trace element for maintenance of normal thyroid function. Normal thyroid function is a prerequisite for neurocognitive development and growth in children. In the United States, iodine is not routinely added as a trace element in parenteral nutrition (PN). Our objective was to determine the prevalence of iodine deficiency and hypothyroidism in children on chronic PN. METHODS: This was a cross-sectional study of children <17 years of age and using PN for >6 months at a tertiary children's hospital. Primary outcomes were spot urine iodine concentration (UIC), serum thyrotropin, and free thyroxine levels. RESULTS: Twenty-seven patients were identified (74% male). The median age at screening was 48 months (range: 7-213 months). The median duration on PN was 27 months (range: 11-77 months). Seventeen out of 20 patients (85%) were iodine deficient (spot UIC <100 µg/L), whereas 11 out of 20 patients (55%) were severely iodine deficient (spot UIC <20 µg/L). The prevalence of acquired hypothyroidism (elevated thyrotropin, low free thyroxine, and UIC <100 µg/L) was 33% (n = 8). None of the children with hypothyroidism screened for autoimmune thyroiditis had positive test results. There was no statistically significant association between duration of PN use and development of iodine deficiency (P = .08) or hypothyroidism (P = .96). CONCLUSIONS: Children on chronic PN are at risk for developing iodine deficiency and resultant hypothyroidism; hence, these children should be screened for these outcomes. Further studies are needed to define the temporal onset of iodine deficiency and timing to thyroid dysfunction related to PN.
Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/urina , Iodo/deficiência , Iodo/urina , Nutrição Parenteral/tendências , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipotireoidismo/etiologia , Masculino , Nutrição Parenteral/efeitos adversos , Testes de Função Tireóidea/tendênciasRESUMO
BACKGROUND: The aim of this study was to assess the association of plasma free thyroxine (FT4) and serum thyroid stimulating hormone (TSH) concentrations with the past diagnosis of cardiovascular disease and incidence of new cardiovascular events in older men with no known thyroid disease. METHODS: This study involved a cohort of community-recruited older men without known thyroid disease. Plasma FT4 and serum TSH were measured by immunoassay. Past cardiovascular disease diagnosis was defined through questionnaire data. The incidence of major cardiovascular events were assessed using the Western Australian Data Linkage System. The associations of plasma FT4 and serum TSH with the past diagnosis of cardiovascular disease and the incidence of new major cardiovascular events (cardiovascular death, myocardial infarction or stroke) were examined using logistic regression and Cox proportional hazard analyses. RESULTS: 3712 men were followed for a mean of 9.5years. Men with plasma FT4 in the upper quartile, compared to other men, were more likely to have been previously diagnosed with cardiovascular disease but this association did not persist after adjustment for other risk factors. Men with plasma FT4 in the upper quartile, compared to other men, had an increased incidence of major cardiovascular events (adjusted hazard ratio, HR, 1.15, 95% CI 1.00-1.31) and myocardial infarction alone (adjusted HR 1.29, 95% CI 1.06-1.54). CONCLUSION: This study suggests that older men with higher levels of plasma FT4 not meeting current criteria for the diagnosis of hyperthyroidism are at increased risk of major cardiovascular events.
Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Glândula Tireoide/metabolismo , Tiroxina/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Seguimentos , Humanos , Incidência , Masculino , Testes de Função Tireóidea/tendências , Glândula Tireoide/fisiopatologia , Austrália Ocidental/epidemiologiaRESUMO
OBJECTIVE: The hypothalamus-pituitary-thyroid (HPT) axis set point develops during the fetal period and first two years of life. We hypothesized that thyroxine treatment during these first two years, in the context of a randomized controlled trial (RCT) in children with Down syndrome, may have influenced the HPT axis set point and may also have influenced the development of Down syndrome-associated autoimmune thyroiditis. METHODS: We included 123 children with Down syndrome 8.7 years after the end of an RCT comparing thyroxine treatment vs placebo and performed thyroid function tests and thyroid ultrasound. We analyzed TSH and FT4 concentrations in the subgroup of 71 children who were currently not on thyroid medication and had no evidence of autoimmune thyroiditis. RESULTS: TSH concentrations did not differ, but FT4 was significantly higher in the thyroxine-treated group than that in the placebo group (14.1 vs 13.0 pmol/L; P = 0.02). There was an increase in anti-TPO positivity, from 1% at age 12 months to 6% at age 24 months and 25% at age 10.7 years with a greater percentage of children with anti-TPO positivity in the placebo group (32%) compared with the thyroxine-treated group (18.5%) (P = 0.12). Thyroid volume at age 10.7 years (mean: 3.4 mL; range: 0.5-7.5 mL) was significantly lower (P < 0.01) compared with reference values (5.5 mL; range: 3-9 mL) and was similar in the thyroxine and placebo group. CONCLUSION: Thyroxine treatment during the first two years of life led to a mild increase in FT4 almost 9 years later on and may point to an interesting new mechanism influencing the maturing HPT axis set point. Furthermore, there was a trend toward less development of thyroid autoimmunity in the thyroxine treatment group, suggesting a protective effect of the early thyroxine treatment. Lastly, thyroid volume was low possibly reflecting Down-specific thyroid hypoplasia.
Assuntos
Síndrome de Down/sangue , Síndrome de Down/tratamento farmacológico , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/fisiologia , Tiroxina/administração & dosagem , Adulto , Fatores Etários , Criança , Feminino , Seguimentos , Humanos , Masculino , Testes de Função Tireóidea/tendências , Tireotropina/sangue , Tiroxina/sangue , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. OBJECTIVE: To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. DESIGN: We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. KEY RESULTS: During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). CONCLUSIONS: An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.
Assuntos
Diagnóstico Tardio/tendências , Registros Eletrônicos de Saúde/tendências , Hipotireoidismo/sangue , Hipotireoidismo/diagnóstico , Testes de Função Tireóidea/tendências , Idoso , Testes Diagnósticos de Rotina/métodos , Feminino , Seguimentos , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea/métodosRESUMO
Thyroglobulin (Tg) is a high molecular weight glycoprotein located mainly in thyroid follicles, where thyroid hormones are synthesized and stored. In patients with differentiated thyroid cancer of follicular origin, serum Tg levels become undetectable following total thyroidectomy and iodine-131 remnant ablation. It is a key biomarker to follow-up patients with differentiated thyroid cancer, in combination with neck ultrasound monitoring. The measurement of Tg in the wash-out of the needle used for fine needle aspiration biopsy is a valuable aid to the diagnosis of lymph node metastasis. The presence of anti-thyroglobulin antibodies affects reliability of Tg results measured in serum or plasma. Systematic investigation of such antibodies is required to validate any Tg assay. Elevated or rising levels of anti-thyroglobulin antibodies can in turn be used as a surrogate tumor marker of thyroid cancer. The development of second-generation Tg assay (automated, highly sensitive) has enabled significant advances in the management of differentiated thyroid cancer: early detection of persistent or recurrent disease and follow-up care simplified in low-risk patients. Testing of serum Tg can also be useful in evaluating other clinical situations such as congenital hypothyroidism, endemic goiter and thyrotoxicosis factitia.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Tireoglobulina/análise , Tireoglobulina/sangue , Testes de Função Tireóidea/tendências , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Autoanticorpos/análise , Autoanticorpos/sangue , Bioensaio/métodos , Bioensaio/normas , Bioensaio/tendências , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , Humanos , Monitorização Fisiológica/métodos , Prognóstico , Reprodutibilidade dos Testes , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/normas , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/patologiaRESUMO
Given the prevalence of thyroid disorders and the subtle signs and symptoms that may accompany subclinical disease, reliable laboratory testing for serum TSH and free thyroid hormones is important for both primary care physicians and endocrinologists. The laboratory community has recognized the need for standardization of thyroid function tests to achieve comparability of measurement results between methods. This applies in particular to tests for free T4 (FT4), which may be considered controversial in terms of clinical and analytical validity. However, variability is also observed with TSH testing - a fact which has not been emphasized in ongoing discussions regarding lowering the upper limit of normal and/or common decision limits to start treatment for hypothyroidism. In response to this need, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee for Standardization of Thyroid Function Tests worked over the years towards the goal of standardization of FT4 and TSH testing.
Assuntos
Testes de Função Tireóidea , Tireotropina/sangue , Tiroxina/sangue , Química Clínica/métodos , Química Clínica/tendências , Endocrinologia , Humanos , Agências Internacionais , Médicos , Guias de Prática Clínica como Assunto , Reprodutibilidade dos Testes , Medição de Risco , Sociedades Científicas , Testes de Função Tireóidea/normas , Testes de Função Tireóidea/tendências , Recursos HumanosRESUMO
In the BEACH (Bettering the Evaluation and Care of Health) program, between 2001-02 and 2010-11, general practice orders for thyroid function tests increased by 51%.
Assuntos
Medicina Geral/estatística & dados numéricos , Testes de Função Tireóidea/tendências , Austrália , Humanos , Testes de Função Tireóidea/estatística & dados numéricosRESUMO
BACKGROUND: Very few studies have assessed both the incidence and progression of thyroid dysfunction in a single older population-based cohort. In this study, we aimed to assess the 5-year incidence, progression and risk factors for development of thyroid dysfunction in an older Australian population. METHODS: The Blue Mountains Eye Study is a longitudinal population-based cohort study. During 1997-1999, 1768 participants (≥ 55 years) had thyroid function assessed. After excluding participants reporting any form of treatment for their thyroid condition at baseline, 951 participants (91.4%) without thyroid dysfunction and 54 (5.4%) with thyroid dysfunction were re-examined 5 years later. Thyroid dysfunction was defined using serum thyrotropin (thyroid stimulating hormone (TSH)) screen, followed by serum free T4 assessment. RESULTS: The overall 5-year incidence of thyroid dysfunction was 4.7% (95% confidence interval (CI) 3.4-6.1). Obesity (body mass index ≥ 30 kg/m(2) ) and serum TSH > 2 mIU/L at baseline predicted incident overt hypothyroidism (odds ratio (OR) 4.05, CI 1.74-9.41) and (OR 5.46, CI 1.16-25.67) respectively. The 5-year incidence of subclinical hypothyroidism was significantly higher in women than in men, 2.5% versus 0.7% (P= 0.03). Progression to overt hypothyroidism was observed in 17.9% of subjects with subclinical hypothyroidism over 5 years. CONCLUSIONS: The 5-year incidence of thyroid dysfunction in this older population was relatively low, and was associated with obesity and serum TSH level > 2 mIU/L at baseline. Over one in six persons with subclinical hypothyroidism progressed to overt thyroid dysfunction over the 5-year period. Our findings highlight the need for appropriate management of subclinical hypothyroidism among older people.
Assuntos
Progressão da Doença , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/patologia , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Fatores de Risco , Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea/tendênciasRESUMO
Modern assays for TSH and for free thyroid hormones have significantly reduced the need for dynamic testing of the hypothalamo-pituitary-thyroid axis in patients with biochemical thyroid dysfunction. However, under certain conditions, such as isolated TSH deficiency, thyrotropinoma and thyroid hormone resistance, the TRH test remains an important adjunctive diagnostic tool. In recent years, the development of recombinant human TSH (rhTSH) has led to a new dynamic test of thyroglobulin (Tg) secretion as a marker of recurrent or metastatic thyroid cancer. RhTSH provides an alternative to thyroid hormone suppression treatment withdrawal in patients who cannot tolerate hypothyroidism and is the agent of choice in patients unable to mount a TSH response.
Assuntos
Doenças da Glândula Tireoide/diagnóstico , Testes de Função Tireóidea/tendências , Hormônio Liberador de Tireotropina , Tireotropina , Retroalimentação Fisiológica , Previsões , Humanos , Proteínas Recombinantes/análise , Tireoglobulina/metabolismo , Doenças da Glândula Tireoide/fisiopatologia , Tireotropina/metabolismo , Hormônio Liberador de Tireotropina/sangueRESUMO
A questionnaire describing a typical clinical case of Graves' disease and 10 variations on it was mailed to 70 Spanish units of endocrinology with the aim of assessing the new diagnostic and therapeutic trends for hyperthyroidism caused by Graves' disease in Spain and to compare the results obtained from previous studies carried out in Europe and Spain 10 years previously. Responses indicated that thyrotrophin (98%) and free thyroxine (88%) were the most used tests in the in vitro diagnosis of Graves' disease with a significant decrease in the use of total thyroxine, total triiodothyronine, and thyroglobulin in comparison with the surveys conducted 10 years previously in Europe and Spain. The presence of antibodies against the thyrotrophin receptor was the most frequently used immune marker in the diagnosis (78%) and the new use of antithyroperoxidase antibodies (36%) in diagnosis is noteworthy. Antithyroid drugs remain the treatment of choice (98%). Surgery was used mainly for large size goitres (33%) and radioiodine for recurrences after medical (61%) or surgical (80%) treatment. In conclusion, the responses obtained from this questionnaire provide insight into current specialist diagnostic and therapeutic practices with respect to Graves' disease and which could be of value to non-specialist units of endocrinology.