scholarly journals Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated?

2018 ◽  
Vol 2 (9) ◽  
pp. 1024-1039 ◽  
Author(s):  
Maria Cristina Vigone ◽  
Donatella Capalbo ◽  
Giovanna Weber ◽  
Mariacarolina Salerno
Keyword(s):  
Reference Range ◽  
Neonatal Period ◽  
Normal Serum ◽  
Serum Concentrations ◽  
Free T4 ◽  
Patient Factors ◽  
Neurocognitive Development ◽  
Upper Limit ◽  
Mild Hypothyroidism ◽  
Serum Tsh

Abstract Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.

scholarly journals TSH reference range in older adults: a Brazilian study

2014 ◽  
Vol 58 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Maria Regina Calsolari
Keyword(s):  
Older Adults ◽  
Thyroid Dysfunction ◽  
Elderly Population ◽  
Thyroid Nodules ◽  
Reference Range ◽  
Adult Population ◽  
Free T4 ◽  
Upper Limit ◽  
Thyroperoxidase Antibodies ◽  
Serum Tsh

Objective: To establish serum TSH reference values for a population of Brazilian elderly, and to compare them to those found in the adult population. Subjects and methods: Healthy volunteers aged 70 to 85 years, without known thyroid disease or risk factors for thyroid dysfunction, who did not use any medication that could potentially interfere with TSH, were selected. Subjects with goiter, palpable thyroid nodules, anti-thyroperoxidase antibodies, or altered free T4 were excluded. The sample consisted of 360 older adults (180 per sex). Results: TSH values corresponding to the 2.5th and 97.5th percentile of the sample were 0.2 and 4.62 mIU/L, respectively. TSH > 2.5 mIU/L was seen in 25.26% of the volunteers, > 3 mIU/L in 15.26%, and > 4 mIU/L in 6.1% of them. TSH values were slightly higher than those previously reported for adults (18-60 years). Conclusion: This study suggests an upper limit for normal TSH of approximately 4.6 mIU/L for the Brazilian elderly population.

Could Thyroid Disorders Be Better Understood and Dealt as a Thyroid Syndrome

2020 ◽  
Vol 5 (08) ◽  
pp. 326-328
Author(s):  
Dr. Sushma Patil ◽  
Dr. Vikrant Patil
Keyword(s):  
Reference Range ◽  
Well Being ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Disorder ◽  
Serum Concentrations ◽  
Comorbid Conditions ◽  
Free T4 ◽  
Research Perspective ◽  
Wide Range

Thyroid disorders are common worldwide. Thyroid dysfunction, both hypo- and hyperthyroidism may increase the risk of cardiovascular disorders. Current thyroid function tests may have limitations since they only measure the total or free T4 and/or T3 and TSH serum concentrations in peripheral blood and not the effect of T4 or T3 serum on different specific target tissues. Several comorbid conditions can interfere with the absorption or increase the clearance of levothyroxine. Among patients treated with thyroid replacement, under or overmedicated may-be at risk for adverse health consequences. A wide range of drugs may interfere with levothyroxine absorption, metabolism, and action. Patients report a lack of well-being, despite reaching euthyroid reference range of TSH, with psychological distress. If we will consider Thyroid related conditions as a syndrome then research perspective at the pathophysiology, interrelation between symptoms and comorbidities will be much broader that can lead researchers to get insights of different pathways in which thyroid gland functioning can be perceived and dealt therapeutically. The deliberation of thyroid disorder as a syndrome can affluence our knowledge of correlating cofounders, action of thyroid hormones on target tissues, underlying cause and thyroid health.

scholarly journals Does foetal gender influence maternal thyroid parameters in pregnancy?

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Georgiana Sitoris ◽  
Flora Veltri ◽  
Pierre Kleynen ◽  
Malika Ichiche ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Reference Range ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Free T4 ◽  
Cross Sectional ◽  
Maternal Thyroid ◽  
Serum Tsh ◽  
Tsh Levels

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.

Low but detectable serum thyroid-stimulating hormone concentrations in ambulant subjects not receiving thyroxine

2003 ◽  
Vol 40 (6) ◽  
pp. 639-642 ◽  
Author(s):  
S Chatterjee ◽  
BP O'Malley ◽  
DE Price ◽  
AM Fielding ◽  
R Aitken
Keyword(s):  
Reference Range ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Third Generation ◽  
Assay Sensitivity ◽  
Free Thyroid Hormones ◽  
Isotope Scanning ◽  
Detectable Serum ◽  
Serum Tsh ◽  
Stimulating Hormone

Background: In laboratories employing 'front-line' sensitive thyroid-stimulating hormone (TSH) measurement, it is generally accepted that a fully suppressed serum TSH concentration (third-generation assay) alongside normal serum concentrations of free thyroid hormones indicates subclinical hyperthyroidism. However, other explanations are often provided for low but detectable serum TSH concentrations, such as drug effects or non-thyroidal illness. Methods: We investigated 25 consecutive ambulant individuals, identified over an 18-month period as having low but not fully suppressed TSH concentrations (third-generation assay; sensitivity 0.003 mIU/L) with additional free thyroxine (T4), free tri-iodothyronine (T3) and thyroid microsomal antibody estimations and thyroid isotope scanning (technetium). Results: Concentrations of serum hormones (median, inter-quartile range) were: TSH, 0.23, 0.17-0.26 mIU/L (reference range 0.34-5.6 mIU/L); free T4, 14.6, 10.6- 17.6 pmol/L (reference range 10-25 pmol/L); free T3, 6.1, 5.7-6.6 pmol/L (reference range 4.5-7.5 pmol/L). Thyroid antibodies were negative in all but one individual. On isotope scanning, nine individuals had hot nodules and ten individuals had multinodular goitres (MNG). Of the six with normal scans, ultrasound scanning showed a definite MNG ( n = 1) and early MNG ( n = 2). Conclusions: A low but detectable serum TSH concentration, obtained using a third-generation assay, found in an ambulant individual, is frequently a pointer to underlying thyroid disease.

Associations Between Thyroid and Blood Pressure in Euthyroid Adults: A 9-Year Longitudinal Study

2018 ◽  
Vol 50 (03) ◽  
pp. 236-241 ◽  
Author(s):  
Hengameh Abdi ◽  
Safoora Gharibzadeh ◽  
Erfan Tasdighi ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Reference Range ◽  
Estimating Equation ◽  
Population Based ◽  
Free T4 ◽  
Men And Women ◽  
Increased Risk ◽  
Dichotomous Outcomes ◽  
Serum Tsh

AbstractLongitudinal studies considering associations between thyroid function in the reference range (RR) with blood pressure (BP) are scarce and contradictory. We aimed to investigate the associations of serum thyrotropin (TSH) and free T4 (FT4) with different components of BP also incident prehyperetension (preHTN) and HTN during a 9-year follow-up. A sum of 2282 euthyroid individuals from an ongoing population-based cohort study were selected. A sex-stratified multivariate generalized estimating equation (GEE) method was employed. Moreover, a multivariate transitional model was used considering preceding BP status as a predictor of dichotomous outcomes of preHTN and HTN. Multivariate-adjusted GEE analysis revealed a decreasing trend for systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP) throughout the study period in both men and women, either adjusted for serum TSH or FT4 levels. Serum FT4 within the RR was positively associated with all BP parameters in total population and in men, but serum TSH had a statistically significant mild increasing effect only on SBP, DBP and MAP of men. Multivariate transitional model found no association between serum TSH levels within the reference range (RR) and BP status; regarding serum FT4, a 1 ng/dl higher FT4 was associated with 40% increased risk of preHTN [OR (95% CI), 1.40 (1.02–1.90)], but not with HTN [OR (95% CI), 0.93 (0.80–1.09)]. It is concluded that serum FT4 within the RR is more strongly associated with BP parameters compared to TSH. This association is not consistent between men and women. Moreover, higher FT4 is associated with increased risk of preHTN.

Relationship between Serum Concentrations and Urinary Excretions of Monoclonal Free Light Chains (mFLC) Detectable as Bence Jones Proteins (BJP) by Immunofixation Electrophoresis (IFE) in Patients with Multiple Myeloma (MM).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5060-5060
Author(s):  
M.R. Nowrousian ◽  
D. Brandhorst ◽  
C. Sammet ◽  
M. Kellert ◽  
R. Daniels ◽  
...  
Keyword(s):  
Renal Function ◽  
Reference Range ◽  
High Serum ◽  
Serum Concentrations ◽  
Serum Samples ◽  
Paired Samples ◽  
Upper Limit ◽  
Median Serum ◽  
Positive Urine ◽  
Automated Immunoassay

Abstract Introduction. mFLC are important markers for the diagnosis and monitoring of MM. This study for the first time determines serum concentrations of mFLC which are required to produce renal overflow and BJP in urine detectable by IFE and evaluates the relationship between urinary excretions of mFLC and renal function. Patients and methods. 378 paired samples of serum and 24-h-urine from 82 patients were evaluated during the course of their disease. Serum FLC concentrations were measured nephelometrically using an automated immunoassay. Urine samples were tested for clonal bands using agarose gel electrophoresis, scanning densitometry and visual checking of electrophoretic gels. BJP were identified by urine IFE. Results. Among the 378 serum samples, 173 (46%) were normal and 205 (54%) were abnormal for FLC k/l ratios, indicating the presence of mFLC, 98 of kappa and 107 of lambda type. In 98 serum samples with mFLC kappa, 48 (49%) were associated with negative urine IFE analysis and 50 (51%) had positive urine tests. The median serum kappa concentrations were 40 mg/L (range 6–710) for negative urines and 113 mg/L (range 7–39500) for positive urines (p=0.001), indicating an almost threefold greater median value which was approximately six times the upper limit of the reference range (3.3.–19.4 mg/L) for samples with positive urine IFE analysis. In 107 serum samples with mFLC lambda, 70 (65%) were negative in urine and 37 (35%) were positive. The median serum concentrations associated with negative urine IFE tests were 44 mg/L (range 3–561) and were 278 mg/L (range 5–7060) for positive urines (p=0.0001), indicating an almost sixfold difference. This was approximately 2.5-fold greater than for kappa, and approximately 11 times the upper limit of the reference range (5.7–26.3 mg/L) for samples with positive urine IFE analysis. Renal excretions of mFLC, in addition, were determined primarily by serum concentrations for lambda, but by serum concentrations, renal function and, probably, molecular changes for kappa. For both, renal excretions significantly decreased at high serum concentrations combined with renal dysfunction. Conclusion. Based on these results, relatively high serum concentrations of mFLC are required to produce renal overflow and positive urine IFE tests for BJP. Furthermore, urine excretions of mFLC are determined primarily by serum concentrations, but also by renal function, particularly for kappa.

scholarly journals TSH reference values for adult Brazilian population

2010 ◽  
Vol 54 (7) ◽  
pp. 603-606 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Arthur Cezar Malard Xavier ◽  
Maria Regina Calsolari
Keyword(s):  
Thyroid Disease ◽  
Clinical Biochemistry ◽  
Normal Serum ◽  
Brazilian Population ◽  
Free T4 ◽  
Clinical Criteria ◽  
History Of ◽  
Thyroperoxidase Antibodies ◽  
Serum Tsh

OBJECTIVE: To establish limits of normal serum TSH for the adult (18 to 60 years) Brazilian population according to recommendations of the National Academy of Clinical Biochemistry. SUBJECTS AND METHODS: Healthy volunteers were evaluated and those fulfilling the following clinical criteria were selected: absence of known thyroid disease; no use of any interfering medications; no history of head and neck external radiotherapy, type 1 diabetes or autoimmune disease; no family history of thyroid disease, and absence of goiter or palpable nodules. Subjects with anti-thyroperoxidase antibodies and/or altered free T4 were excluded. The sample consisted of 960 subjects (480 males and 480 females). RESULTS: TSH values corresponding to the 2.5th and 97.5th percentiles of the sample were 0.43 and 3.24 mIU/L, respectively. TSH values > 2.5 mIU/L were observed in 9.15% of the volunteers and levels > 3 mIU/L in 3.11%. CONCLUSION: The present study suggests an upper limit of normal TSH of approximately 3.5 mIU/L.

scholarly journals Subclinical Hypothyroidism in Children: A Review

2021 ◽  
Vol 36 (2) ◽  
pp. 146-151
Author(s):  
Rabi Biswas
Keyword(s):  
Subclinical Hypothyroidism ◽  
Reference Range ◽  
Serum Levels ◽  
Free T4 ◽  
Factors Associated ◽  
Scientific Investigations ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Levothyroxine Treatment ◽  
Mild Hypothyroidism

Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range in the presence of normal concentrations of total T4 or free T4. This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals. DS (Child) H J 2020; 36(2): 146-151

Graves'-Basedow disease in pregnancy

2015 ◽  
Vol 54 (03) ◽  
pp. 106-111 ◽  
Author(s):  
S. L. Andersen ◽  
P. Laurberg
Keyword(s):  
Side Effects ◽  
Birth Defects ◽  
Thyroid Dysfunction ◽  
National Study ◽  
Antithyroid Drugs ◽  
Upper Limit ◽  
Special Concern ◽  
Maternal Thyroid ◽  
Toxic Reactions ◽  
Serum Tsh

SummaryThyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth.A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.

scholarly journals Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Samer El-Kaissi ◽  
Jack R. Wall
Keyword(s):  
Extraocular Muscle ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Thyroid Scintigraphy ◽  
Free T4 ◽  
Receptor Antibody ◽  
Tsh Receptor Antibody ◽  
Antibody Positivity ◽  
Serum Tsh

Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves’ hyperthyroidism.Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves’ disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement.Results. 31/39 patients had one or more enlarged EOM, of whom only 2 patients had clinical EOM dysfunction. Compared to Graves’ disease patients with normal EOM volumes, those with EOM enlargement had significantly higher mean serum TSH (0.020±0.005versus0.007±0.002mIU/L;Pvalue 0.012), free-T4 (52.9±3.3versus41.2±1.7 pmol/L;Pvalue 0.003) and technetium uptake on thyroid scintigraphy (13.51±1.7%versus8.55±1.6%;Pvalue 0.045). There were no differences between the 2 groups in anti-TSH-receptor antibody positivity, the proportion of males, tobacco smokers, or those with active ophthalmopathy.Conclusions. Patients with recently diagnosed Graves’ disease and EOM volume enlargement have higher serum TSH and more severe hyperthyroidism than patients with normal EOM volumes, with no difference in anti-TSH-receptor antibody positivity between the two groups.

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