scholarly journals A Case of Euthyroid Graves’ Ophthalmopathy in a Patient Sero-Negative for TSH Receptor Autoantibody

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Asami Hotta ◽  
Tomohiro Tanaka ◽  
Haruka Kato ◽  
Shota Kakoi ◽  
Yuki Shimizu ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Pulse Therapy ◽  
Tsh Receptor ◽  
Thyroid Autoantibodies ◽  
Thyroid Function Tests ◽  
Normal Thyroid Function ◽  
Function Tests ◽  
Graves Ophthalmopathy ◽  
History Of ◽  
Serum Tsh

We report of a case of Graves’ ophthalmopathy presented solely with symptoms of the eyes with normal thyroid function tests and negative immunoreactive TSH receptor autoantibody. 40-year-old male was referred to our hospital due to 2-month history of ocular focusing deficit without any signs or symptoms of hyper- or hypothyroidism. Serum thyroid function tests and 99mTc uptake were both within the normal range. Anti-thyroid autoantibodies were all negative except for the cell-based assay for serum TSH receptor stimulating activity. Since orbital CT scan and MRI gave typical results compatible with Graves’ ophthalmopathy, we treated the patients with corticosteroid pulse therapy and orbital radiation therapy, leading to a partial improvement of the symptoms. This case gives insights into the potential pathophysiologic mechanism underlying Graves’ ophthalmopathy and casts light upon the difficulties of establishing the diagnosis in a euthyroid case with minimal positive results for anti-thyroid autoantibodies.

The differential diagnostic problems in unilateral euthyroid Graves' ophthalmopathy

1984 ◽  
Vol 106 (4) ◽  
pp. 471-476 ◽  
Author(s):  
Hans Perrild ◽  
Ulla Feldt-Rasmussen ◽  
Karine Bech ◽  
Preben Ahlgren ◽  
Jens Mølholm Hansen
Keyword(s):  
Ct Scan ◽  
Thyroid Function ◽  
Thyroid Autoantibodies ◽  
Thyroid Function Tests ◽  
Trh Test ◽  
Normal Thyroid Function ◽  
Thyroid Stimulating Immunoglobulins ◽  
Function Tests ◽  
Graves Ophthalmopathy ◽  
Suppression Test

Abstract. Nine consecutive patients with unilateral ophthalmopathy with suspected endocrine pathogenesis were investigated with a TRH test, a T3 suppression-test, thyroid autoantibodies and a subsequent computerized tomography (CT)-scan. All patients were clinically and biochemically euthyroid. Seven of 9 patients had a normal TRH test and 6 of 7 had a normal T3 suppression test. Slightly to moderately elevated microsomal and thyroglobulin (determined with radioimmunoassay) autoantibodies were found in 5 of 8 patients and in 1 patient thyroid stimulating immunoglobulins (TSI) were found. Three of the patients had normal thyroid function tests and no detectable thyroid autoantibodies. The subsequent CT-scan revealed that one of these had a maxillary tumour protruding into the orbita. The remaining 8 patients had enlargement of one (3 patients) or more (5 patients) eyemuscles. Two of the 8 patients had bilaterally enlarged eyemuscles, one of which was the patient with positive TSI. The remaining 6 patients had unilateral extraocular muscle enlargement. Thus, 2 of 9 patients had ophthalmopathy without thyroid dysfunction so-called isolated autoimmune ophthalmopathy or Graves' ophthalmopathy. Thyroid function tests seem to be of limited value in the diagnosis between endocrine and non-endocrine eye disease, and we recommend the use of diagnostic imaging (e.g. CT-scan) in patients with unilateral exophthalmus in order to diagnose malignant processes.

Subclinical hypothyroidism

2011 ◽  
pp. 543-547
Author(s):  
Jayne A. Franklyn
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Expert Panel ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Thyroid Function Tests ◽  
Free Triiodothyronine ◽  
Function Tests ◽  
Serum Tsh

Subclinical hypothyroidism is defined biochemically as the association of a raised serum thyroid-stimulating hormone (TSH) concentration with normal circulating concentrations of free thyroxine (T4) and free triiodothyronine (T3). The term subclinical hypothyroidism implies that patients should be asymptomatic, although symptoms are difficult to assess, especially in patients in whom thyroid function tests have been checked because of nonspecific complaints such as tiredness. An expert panel has recently classified individuals with subclinical hypothyroidism into two groups (1): (1) those with mildly elevated serum TSH (typically TSH in the range 4.5–10.0 mU/l) and (2) those with more marked TSH elevation (serum TSH >10.0 mU/l).

When thyroid labs do not add up, physicians should ask patients about biotin supplements

2020 ◽  
Vol 13 (3) ◽  
pp. e231337
Author(s):  
Michael S Lundin ◽  
Ahmad Alratroot ◽  
Fawzi Abu Rous ◽  
Saleh Aldasouqi
Keyword(s):  
Thyroid Function ◽  
Dose Adjustment ◽  
Radioactive Iodine ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Medication List ◽  
Function Tests ◽  
Extensive Evaluation ◽  
History Of ◽  
Radioactive Iodine Ablation

A 69-year-old woman with a remote history of Graves’ disease treated with radioactive iodine ablation, who was maintained on a stable dose of levothyroxine for 15 years, presented with abnormal and fluctuating thyroid function tests which were confusing. After extensive evaluation, no diagnosis could be made, and it became difficult to optimise the levothyroxine dose, until we became aware of the recently recognised biotin-induced lab interference. It was then noticed that her medication list included biotin 10 mg two times per day. After holding the biotin and repeating the thyroid function tests, the labs made more sense, and the patient was easily made euthyroid with appropriate dose adjustment. We also investigated our own laboratory, and identified the thyroid labs that are performed with biotin-containing assays and developed strategies to increase the awareness about this lab artefact in our clinics.

EFFECT OF INCREASED IODIDE INTAKE ON THYROID FUNCTION IN SUBJECTS ON CHRONIC LITHIUM THERAPY

1977 ◽  
Vol 84 (2) ◽  
pp. 290-296 ◽  
Author(s):  
S. W. Spaulding ◽  
G. N. Burrow ◽  
J. N. Ramey ◽  
R. K. Donabedian
Keyword(s):  
Thyroid Function ◽  
Potassium Iodide ◽  
Lithium Therapy ◽  
Thyroid Function Tests ◽  
Fourth Patient ◽  
Function Tests ◽  
Before And After ◽  
Serum Tsh

ABSTRACT Thyroid function tests were obtained in 10 patients on chronic lithium therapy before and after the administration of potassium iodide 250 mg q. i. d. Mean serum TSH rose by 8.9 μU/ml and mean serum T3 rose from 70 to 101 ng/dl. Two patients became hypothyroid; a third showed a rise in TSH without any change in T3 or T4. A fourth patient developed hyperthyroidism probably secondary to the Jod-Basedow phenomenon. Pharmacologic doses of iodine should be administered with caution to patients on chronic lithium therapy.

scholarly journals Transient cold nodule of the thyroid due to localized postpartum thyroiditis

1998 ◽  
pp. 562-564 ◽  
Author(s):  
R Luboshitzky ◽  
G Qupti ◽  
A Ishai ◽  
M Dharan
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Function ◽  
Needle Aspiration ◽  
Thyroid Function Tests ◽  
Thyroid Scintigraphy ◽  
Postpartum Thyroiditis ◽  
Normal Thyroid Function ◽  
Function Tests ◽  
Needle Aspiration Cytology ◽  
Cold Nodule

A 27-year-old woman with no previous personal or family history of thyroid disease was referred to us for the evaluation of thyroid nodule, five months postpartum. Thyroid scintigraphy demonstrated a left cold nodule. Fine needle aspiration cytology of the nodule showed a mixture of colloid, follicular cells and lymphocytes, suggesting lymphocytic thyroiditis. Thyroid function tests were normal and thyroid autoantibodies were negative. After two months the thyroid nodule was not palpated and thyroid scintigraphy returned to normal. Thyroid function tests remained normal twelve months after delivery. These findings suggest that postpartum thyroiditis may present as a localized transient form and should be considered in the differential diagnosis of painless solitary nodule that appears postpartum.

scholarly journals Enlarged Thyroid Gland with Normal Thyroid Function Tests

2008 ◽  
Vol 21 (2) ◽  
pp. 179-182
Author(s):  
Carol F. Adair ◽  
John T. Preskitt ◽  
Kristin L. Joyner ◽  
Robin W. Dobson
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Normal Thyroid ◽  
Normal Thyroid Function ◽  
Function Tests

scholarly journals Genetic variation in thyroid hormone pathway genes; polymorphisms in the TSH receptor and the iodothyronine deiodinases

2006 ◽  
Vol 155 (5) ◽  
pp. 655-662 ◽  
Author(s):  
Robin P Peeters ◽  
Wendy M van der Deure ◽  
Theo J Visser
Keyword(s):  
Genetic Variation ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Individual Variability ◽  
Tsh Receptor ◽  
Thyroid Function Tests ◽  
Mineral Density ◽  
Clinical Endpoints ◽  
Iodothyronine Deiodinases ◽  
Function Tests

Serum thyroid parameters show substantial inter-individual variability, in which genetic variation is a major factor. Findings in patients with subclinical hyper- and hypothyroidism illustrate that even minor alterations in serum thyroid function tests can have important consequences for a variety of thyroid hormone-related clinical endpoints, such as atherosclerosis, bone mineral density, obesity, and heart rate. In the last few years, several studies described polymorphisms in thyroid hormone pathway genes that alter serum thyroid function tests. In this review, we discuss the genetic variation in the TSH receptor and iodothyronine deiodinases. We discuss the possible consequences of these studies for the individual patient and also the new insights in thyroid hormone action that can be obtained from these data.

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