Analytical Variation Between Two Different TSH Reagents from the Same Manufacturer.

Thyroid stimulating hormone (TSH) immunoassays are known for giving varying results based on the platform of testing and the generation of kit used. It is generally expected that the results should not vary to affect clinical diagnosis and management. We aimed to perform method comparison study between two TSH assays by the same manufacturer Siemens Healthineers. Results show that there is a large proportional error between the assays with a bias of -3.71mIu/L indicating that TSH assay gives higher values for TSH for the same patient as measured against the TSH3-Ultra kit. This can affect interpretation of results leading to false increase in patients categorized under hypothyroidism and subclinical hypothyroidism. We strongly suggest, to prevent errors in clinical evaluation of a patient with thyroid dysfunction, validation of the performance of the assay and method comparison should be performed in-house.

Lichen Planopilaris As Part of Multiple Autoimmune Syndrome: A Case Report of New Association.

Lichen planopilaris (LPP) is an uncommon inflammatory scalp condition. Its typical clinical presentation includes scaly, erythematous plaques resulting in irreversible alopecia. In this study, we report a female in her late 30s with hypothyroidism and Crohn's disease. She presented with gradual, localized hair loss that had been ongoing for the past four months. A thorough physical examination, and complemented by dermoscopic evaluation, confirmed the diagnosis of LPP. Individuals who have an autoimmune disease (AID) have a heightened propensity to develop additional AID. The coexistence of three or more AIDs falls under the definition of multiple autoimmune syndrome (MAS). This is the first case, to the best of our knowledge, of LPP being associated with MAS.

Spontaneous Ovarian Hyperstimulation Syndrome Associated With Primary Hypothyroidism.

Ovarian hyperstimulation syndrome is a rare condition in pregnant women. Most cases are associated with the use of ovulation induction and stimulation medications. Some studies have reported cases of this condition in non-pregnant women or women undergoing ovulation therapy. In this case report, we report the case of a 27-year-old pregnant Saudi woman presenting with a picture of severe spontaneous ovarian hyperstimulation syndrome secondary to severe undiagnosed hypothyroidism. Treatment with Eltroxin (thyroxine) led to complete improvement and regression of ovarian enlargement after empirical titrating thyroxin replacement therapy, which proved the presence of this causation. The diagnosis was confirmed by laboratory and imaging findings, which helped prompt management and prevented complications of unneeded surgical intervention.

Severe Hypothyroidism due to the Loss of Therapeutic Efficacy of l-Thyroxine in a Patient with Esophageal Complication Associated with Systemic Sclerosis.

BACKGROUND: Thyroid function abnormalities and thyroid autoantibodies have been frequently described in patients with systemic autoimmune diseases as systemic sclerosis (SSc). Serum TSH levels are higher in SSc patients with more severe skin diseases and a worse modified Rodnan skin score. Asymptomatic esophageal involvement due to SSc has never been described as a cause of severe hypothyroidism due to l-thyroxine (l-T4) malabsorption in patients with Hashimoto's thyroiditis (HT) and SSc. CASE REPORT: Here, we report a case of a 56-year-old female affected by both SSc and HT who developed severe hypothyroidism due to the loss of therapeutic efficacy of l-T4. Therapeutic failure resulted from the altered l-T4 absorption because of SSc esophageal complications. Clinical findings improved after the administration of oral liquid l-T4. Thyroid function completely normalized with a full clinical recovery, the disappearance of the pericardial effusion and the improvement of the pulmonary pressure. CONCLUSION: A recognition of a poor absorption is crucial in patients with hypothyroidism and SSc to reduce the risk of the subsequent adverse events. This case suggests the importance of clinical and laboratory surveillance in patients with SSc and HT because the systemic complications of these dysfunctions may worsen the prognosis of hypothyroid SSc/HT patients.

Neonatal endocrine emergencies: a primer for the emergency physician.

The resuscitation principles of securing the airway and stabilizing hemodynamics remain the same in any neonatal emergency. However, stabilizing endocrine disorders may prove especially challenging. Several organ systems are affected simultaneously and the clinical presentation can be subtle. Although not all-inclusive, the implementation of newborn screening tests has significantly reduced morbidity and mortality in neonates. Implementing routine screening tests worldwide and improving the accuracy of present tests remains the challenge for healthcare providers. With further study of these disorders and best treatment practices we can provide neonates presenting to the emergency department with the best possible outcomes.

The diagnostic signficance of thyroid peroxidase / Эрүүл мэндийн лаборатори

Background:In our country the thyroid diseases usually diagnosed using only laboratory indicators of thyroid hormons such as T3, T4, TSH and medical symptom. It means there are considerably late diagnosing of thyroid failure. In recently hypothyroidism and hypothyroidism are being diagnosed by specific thyroid antibodies which are instead during thyroid disorders in the worldwide. Although this diagnostic method is used in some laboratory in our country but their diagnostic significance have not yet been determined. It is important to lunce diagnostic methods for thyroid antibodies specially essential for endocrine doctors.Objective:To determine the diagnostic significance of thyroglobulin antibody and thyroid peroxidase antibodies in relation with thyroid disease.Research materials and methods:In this research of thyroid peroxidase antybody and thyroglobulin antibody, we use 20-64 age 23 patients who have hypothyrodism diagnostics, 36 patients how have hyperhotyrodism diagnostics, 30 patients who are relatively healthy and their disease was denied on symptom and laboratory test, total 89 people.Results:There were 57 female and 32 male from total 89 people investigated for this study. The traditional determination of thyroid hormones for diagnosis of thyroid diseases still have high diagnostic significance. The newly launched and used in our study anti-TPO and anti-Tg have very high significance for thyroid diagnosis. We found that anti-TPO antibody has primary information indicator and anti-Tg antibody is secondary information indicator for the diagnosis of thyroid disorder.Conclusion:1.Among 59 patients with thyroid diseases 89.8% (n=53) of them determined increased anti-TPO concentration and 61% (n=36) of them increased anti-Tg concentration. It shows increase of these antibodies have high diagnostic significance for thyroid diseases.2.For hyperthytiodism the anti-TPO has strong supportive information indicator (карра=0,64) and anti-Tg has primary information indicator (карра=0,84). 3.For hypothytiodism the anti-TPO has primary information indicator (карра=0,78) and anti-Tg has weak supportive information indicatot (карра=0,24).

The diagnostic signficance of thyroid peroxidase / Эрүүл мэндийн лаборатори

Background: In our country the thyroid diseases usually diagnosed using only laboratory indicators of thyroid hormons such as T3, T4, TSH and medical symptom. It means there are considerably late diagnosing of thyroid failure. In recently hypothyroidism and hypothyroidism are being diagnosed by specific thyroid antibodies which are instead during thyroid disorders in the worldwide. Although this diagnostic method is used in some laboratory in our country but their diagnostic significance have not yet been determined. It is important to lunce diagnostic methods for thyroid antibodies specially essential for endocrine doctors. Objective: To determine the diagnostic significance of thyroglobulin antibody and thyroid peroxidase antibodies in relation with thyroid disease. Research materials and methods: In this research of thyroid peroxidase antybody and thyroglobulin antibody, we use 20-64 age 23 patients who have hypothyrodism diagnostics, 36 patients how have hyperhotyrodism diagnostics, 30 patients who are relatively healthy and their disease was denied on symptom and laboratory test, total 89 people. Results: There were 57 female and 32 male from total 89 people investigated for this study. The traditional determination of thyroid hormones for diagnosis of thyroid diseases still have high diagnostic significance. The newly launched and used in our study anti-TPO and anti-Tg have very high significance for thyroid diagnosis. We found that anti-TPO antibody has primary information indicator and anti-Tg antibody is secondary information indicator for the diagnosis of thyroid disorder. Conclusion: 1.Among 59 patients with thyroid diseases 89.8% (n=53) of them determined increased anti-TPO concentration and 61% (n=36) of them increased anti-Tg concentration. It shows increase of these antibodies have high diagnostic significance for thyroid diseases. 2.For hyperthytiodism the anti-TPO has strong supportive information indicator (карра=0,64) and anti-Tg has primary information indicator (карра=0,84). 3.For hypothytiodism the anti-TPO has primary information indicator (карра=0,78) and anti-Tg has weak supportive information indicatot (карра=0,24).

Rol del eje tirotrópico en enfermedades neurodegenerativas / Thyrotropic Axis Role in Neurodegenerative Disorders

Las hormonas tiroideas actúan como reguladores primarios del metabolismo intermediario en todos los tejidos del organismo; tienen funciones de gran trascendencia a nivel del sistema nervioso, donde ejercen acciones potencialmente neuroprotectoras. Los niveles de las hormonas tiroideas están sujetos a una estrecha regulación en el sistema nervioso y se sugiere que incluso ligeras desviaciones del rango de normalidad pueden estar asociadas a enfermedades neurodegenerativas. En esta revisión se resumieron los hallazgos existentes en torno al papel de las hormonas tiroideas en la fisiología normal y patológica del sistema nervioso, con énfasis en enfermedades neurodegenerativas y los mecanismos moleculares implicados. Las evidencias indican un rol significativo para las hormonas tiroideas en varias enfermedades neurodegenerativas, si bien es necesaria la realización de estudios prospectivos de mayor envergadura para precisar su función y evaluar su utilidad como bio-marcadores y dianas terapéuticas.

Thyroid hormones are primary regulators of intermediate metabolism in all body tissues. Particularly, they have very important functions at the level of nervous system, even having potentially neuro-protective effects. Usually, thyroid hormone levels are under a very close regulation in the nervous system and, because of that, small deviations from the normality range can be associated to neurodegenerative conditions. In this review, evidences about the roles of thyroid hormones in normal and pathological physiology of the nervous system are summarized, with an emphasis in neurodegenerative disorders and the molecular mechanisms involved. Findings suggest a significant role for thyroid hormones in several neurodegenerative diseases, although larger prospective studies are needed to clarify their function and to assess their usefulness as biomarkers and therapeutic targets.

Análise de desempenho do Programa de Triagem Neonatal do Estado do Rio de Janeiro, Brasil, de 2005 a 2007 / Performance analysis of the Rio de Janeiro State Neonatal Screening Program, 2005-2007

As diretrizes enfatizam o momento adequado para a coleta do teste de triagem neonatal entre o 3º e o 7º dias de vida, em 100 por cento dos recém-natos. O tratamento do hipotireoidismo congênito e da fenilcetonúria iniciado até 2 semanas de vida é capaz de evitar as sequelas neurológicas dessas doenças. O programa de triagem neonatal do Estado do Rio de Janeiro foi credenciado para Fase II do Programa Nacional de Triagem Neonatal com dois modelos de programa - modelo A e modelo B. Foi realizada análise de desempenho do PTN de 2005 a 2007. Entre 2002 e 2007, a cobertura foi crescente e chegou a 80,4 por cento, com 33,8 por cento das coletas realizadas até 7 dias. Ambos os modelos tiveram desempenhos semelhantes e aquém das metas preconizadas, com 50 por cento dos casos confirmados obtendo diagnóstico com mais de 48 dias de vida. Os atrasos acumulados nas diversas etapas do processo podem anular os benefícios da detecção precoce, fundamento da triagem neonatal. Os efeitos deletérios de longo prazo transcendem a esfera individual acarretando impacto no sistema de saúde e grande ônus social.

Guidelines emphasize that the appropriate time frame for neonatal screening with the heel stick test is from the 3rd to 7th day of life, in 100 percent of newborns. Treatment for congenital hypothyroidism and phenylketonuria, when initiated in the first two weeks of life, is capable of preventing the neurological sequelae of these diseases. The Rio de Janeiro State Neonatal Screening Program was accredited for Phase 2 of the National Neonatal Screening Program, with two program models (A and B). A performance analysis was conducted for the Neonatal Screening Program, for the years 2005 to 2007. Coverage increased from 2002 to 2007, reaching 80.4 percent, with 33.8 percent of the blood samples drawn in the first 7 days of life. The two models showed similar performance, short of the targets, with 50 percent of the confirmed cases receiving their diagnosis at more than 48 days of life. The delays accumulated in the various stages of the process can impede the benefits of early detection, the cornerstone of neonatal screening. The deleterious long-term effects transcend the individual sphere, with an impact on the health system and a major social burden.

Screening and Study on Etiology for Neonatal Congenital Hypothyroidism in Henan Province / 实用儿科临床杂志

Objective To investigate the screening state and cause of neonatal congenital hypothyroidism(CH) in Henan province.Me-thods Three hundred and thirty-eight thousands no-choice newborns in the 156 hospitals in Henan province from Jan.1998 to Dec.2004 were received screening.The heel peripheral blood samples were taken and the levels of thyroid-stimulating hormone(TSH) were mea-sured by time-resolved fluoroimmunoassay.Positive newborns were recalled and draw out 2 mL venous blood.The levels of TSH,triiodothyronine(T3) and thyroxine(T4) in serum were detected by direct chemiluminescence.The abnormal criterion was that the level of T3,T4 was under the normal range and the level of TSH was above the normal range.Meanwhile their growth and development,intelligence quotient,related medical examination and family histories were investigated in order to find etiological factors and high risk factors.Results The average coverage rate was 5.93% of neonatal screening for CH in Henan province.One hundrend and nine infants were diagnosed CH.The attack rate was about 0.032%.The site and growth of thyroideas of 109 cases with CH were all normal.There were higher morbidity for pregnant women with unhealthy condition or the families with hypertension,diabetes,deformity or dysnoesia.Conclusions Etiology of newborns with CH in Henan province may be not relate with congenital absence and dystopia of thyroidea,but relate with dyssynthesis and receptor deficiency of hormone.And scientific reference is offered for the further study.