Pitfalls of TFTs Interpretation

Size: px
Start display at page:

Download "Pitfalls of TFTs Interpretation"

Transcription

1 Mohammad Reza Bakhtiari DCLS, PhD Pitfalls of TFTs Interpretation CME July 2006 Vol.24 No.7, HPT axis physiology Log-linear relationship between TSH and FT4 Patient Specific Set Point 1

2 New RI for TSH? Effects of Iodine Deficiency? J Clin Endocrinol Metab 90: , 2005) FT4 vs TSH Hypo Hyper FT4 and TSH (Hypo) THE LANCET Vol 357 February 24,

3 FT4 and TSH (Hyper) THE LANCET Vol 357 February 24, 2001 Subclinical Thyroid States Subclinical hypothyroidism Subclinical hyperthyroidism Importance of Subclinical Thyroid Dysfunction Clin Biochem Rev Vol 24 November

4 FT4 vs TSH 2 Hypo Hyper FT4 and TSH (Zone 1) Rare (with discordant FT4 versus FT3) Interfering Abs to thyroid hormones (usually anti-tpo Abs) Hypo FDH=Familial dysalbuminaemic hyperthyroxinaemia Drugs (e.g. amiodarone, heparin) 1 1 Rare-other Intermittent T4 therapy / T4 overdose NTI (including acute psychiatric disorders) Neonatal period TSH-secreting pituitary adenoma (Hyper) Resistance to thyroid hormone Hyper Disorders of thyroid hormone transport or metabolism Resistance to thyroid hormone (RTH) vs TSH-secreting pituitary tumor (TSHoma) 1. Best Practice & Research Clinical Endocrinology & Metabolism 23, 5, 2009, Clinical Endocrine Oncology. John Wiley & Sons, Jan 26,

5 FT4 and TSH (Zone 2) Common Subclinical hypothyroidism Rare Heterophile (interfering) antibody Poor compliance with thyroxine Malabsorption of thyroxine Drugs (e.g. amiodarone, sertraline, cholestyramine) NTI recovery phase Hypo 2 Congenital TSH-receptor defects Resistance to TSH associated with other (unspecified) defects Pendred s syndrome some cases (associated with sensineural deafness and goitre) Hyper FT4 and TSH (Zone 3) Common Subclinical hyperthyroidism T3 Thyrotoxicosis Hypo Rare Recent treatment for hyperthyroidism Drugs (e.g. steroids, dopamine) NTI 3 Hyper FT4 and TSH * (Zone 4) Common NTI Recent treatment for hyperthyroidism y (TSH remains suppressed) Rare Central hypothyroidism Isolated TSH / TRH deficiency Hypo 4 4 Hyper 5

6 TSH Assay Interference (Heterophilic Antibodies) TSH Assay Interference (Heterophilic Antibodies Sources) Exposure to animals (e.g. animal technicians, veterinarians, animal handlers) Alternate animal contact therapy (e.g. thymic cells, sheep cells, embryonic cells) Exposure to animal products (e.g. food preparation) Special diets (e.g. cheese) Deliberate immunization (e.g. therapies, vaccinations, certain imaging treatments) Blood transfusions Autoimmune diseases Dialysis Patent medicines (OKT3) Maternal transfer Cardiac Myopathy G.I. Disease (E. Coli) Rheumatoid factors can also act as heterophilic antibodies Heterophilic Antibodies (Existence confirmation) 1. Discordant TSH results in an assay that utilizes different antibody pairs; 2. Altered TSH result following immunosubtraction [using polyethylene glycol (PEG) or protein G/A]; 3. Nonlinear TSH measurement following sample dilution Clinical Endocrinology (2011) 74,

7 Thyroid hormone autoantibodies (THAAb) Prevalence: up to 40% in autoimmune thyroid diseases; not necessarily lead to assay interference. autoantibody titer, specificity, and affinity, single-antibody technique: low hormone concentrations doubleantibody technique: apparent concentration of hormone will be spuriously high. 4 major approaches can assist in evaluation of assay interference: (a) measure TSH by a sensitive immunometric method; (b) measure thyroid hormone concentrations after immunoglobulin depletion; (c) use a comparative method (however, interference may be seen in more than one method; for suspected interference with FT4 assays, measure by equilibrium dialysis); (d) test for the presence of THAAb against the hormone or analog tracer used in the assay reagents. Clinical Endocrinology (2011) 74, FT4 / FT3 Displacement Heparin Effect: can cause an artefactual elevation in measured concentrations of FT4/FT3 by displacement of T4 and T3 from their carrier proteins. Altered serum binding proteins Clin Biochem Rev Vol 24 November 2003 Altered serum binding proteins Quantitative (TBG excess) 1. Pregnancy, estrogens (OCPs, HRT, tamoxifen) 2. hepatic disorders 3. hereditary TBG excess Qualitative 1. familial dysalbuminaemic hyperthyroxinaemia (FDH) 2. transthyretin-associated hyperthyroxinaemia (TTR- AH)] Effects on RT3U Clinical Endocrinology (2011) 74,

8 Concept of Steady State Conditions Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: Thyroxin Replacement Therapy and Poor compliance of Thyroxine therapy Intermittent hormone ingestion may result in normal or even elevated TH levels, but fails to normalize TSH. Normal or Elevated T4 but Non-suppressed TSH Clinical Endocrinology (2011) 74, Some Examples Non Thyroidal Illness (NTI) Euthyroid sick syndrome Gastrointestinal diseases Pulmonary diseases Cardiovascular diseases Renal diseases Infiltrative and metabolic disorders Inflammatory conditions Myocardial infarction Starvation Sepsis Burns Trauma Surgery Malignancy Bone marrow transplantation 8

9 Mechanisms of TFTs changes in NTI Journal of Endocrinology (2010) 205, 1 13 Pregnancy Induced TFTs Changed 9

10 Pregnancy Induced TFTs Changed Oct Factors affecting Thyroid Physiology during normal Pregnancy Physiologic Change Increased renal I - clearance Decreased plasma I - and placental I - transport to the fetus Thyroid-related consequences Increased 24-hr RAIU In I- deficient women, decreased T4, increased TSH, and goiter formation Increased O2 consumption by fetoplacental unit, gravid uterus and mother Increased BMR First-trimester increase in hcg Increased serum TBG Increased plasma volume Inner-ring deiodination of T4 and T3 by placenta Increased free T4 and T3 Decreased basal TSH (partial blunting of the pituitary-thyroid axis) Increased total T4 and T3 Increased T4 and T3 pool size Accelerated rates of T4 and T3 degradation and production Oct Changes of TFTs after Birth THYROID FUNCTION TESTING, Springer,

11 Normal range for thyroid function tests in infants, children and adults THYROID FUNCTION TESTING, Springer, 2010 Relationship between serum T4 and T3 in various disorders* Serum T4 Serum T3 Low Normal High Low Severe hypothyroidism. TBG deficiency. # Severe nonthyroidal illness. Euthyroid hypothyroxinemia Nonthyroidal illness. Medications. Fetus. Restricted nutrition. Hyperthyroidism with severe nonthyroidal illness. Amiodarone. Normal Iodine deficiency. T3 treatment. Hypothyroidism. T4 treatment. t t Euthyroid hyper- thyroxinemia. Hyperthyroidism with nonthyroidal illness. T4 binding autoantibodies. High Iodine deficiency T3 treatment Antithyroid drugs T3 toxicosis T3 binding autoantibodies Hyperthyroidism. Excess T4 ingestion Hormone resistance. TBG excess # * Excludes short term changes related to initiation or cessation of therapy # Effect on total hormone concentration; free hormone concentration remains normal. Indications for measurement of serum free T3 Clin Biochem Rev Vol 24 November

12 Drug Effects on TFTs The South African Medicines Formulary (SAMF), Vol 24, No 7 (2006) Mechanisms of Drug Effects on TFTs Inhibit pituitary TSH secretion Dopamine, dobutamine, glucocorticoids, octreotide Iodine load increases thyroid hormone synthesis Contrast agents, amiodarone, topical preparations Impair thyroid hormone release Iodine excess, lithium, glucocorticoids, aminoglutethimide Inhibit T4-T3 5' deiodination Amiodarone, glucocorticoids, beta blockers * Contrast agents, e.g. iopanoic acid, ipodate Augment abnormal immune function Interleukin 1, interferon α, interferon β, Monoclonal antibody therapy Mechanisms of Drug Effects on TFTs (cont.) Modify binding of T4, T3 to plasma proteins a. Increase concentration of T4 binding globulin Estrogen, heroin, methadone Clofibrate, 5-fluorouracil, perphenazine, tamoxifen b. Decrease concentration of T4 binding globulin Glucocorticoids, androgens, l-asparaginase c. Displace T4 and T3 from binding proteins Furosemide, salicylates, phenytoin, carbamazepine Non-steroidal antiinflammatory agents # Heparin ψ Displace T4 from tissue pool Oral cholecystographic agents, some alkylating agents Modify thyroid hormone action Amiodarone, phenytoin Increase clearance of T4,T3 Barbiturates, phenytoin, carbamazepine, rifampicin Sertraline?, fluoxetine?, dothiepin? Impair absorption of ingested T4 Aluminium hydroxide, ferrous sulfate, cholestyramine, calcium carbonate, Colestipol, sucralfate, soya preparations,kayexalate 12

13 In a case of Discordant or Anomalous Results (Conclusion) After review of the clinical context, the following steps are helpful in evaluating anomalous thyroid results: a. Review of the medication history. b. Confirmation of serum TSH by an alternative method that identifies the degree of TSH suppression. c. Follow-up sampling to establish whether the abnormality is transient or persistent. d An alternative estimation of serum free T4, avoiding one-step methods that are known to frequently give spurious results, especially during critical illness. e. Measurement of serum total T4 to establish whether the serum free T4 estimate is disproportionately high or low, due to a pre-analytical or method-dependent artefact. f. Evaluation of the sample for possible heterophilic antibody interference; note that there are no established criteria that rule out such interference. g. Investigation of propositus and family members for evidence of unusual binding abnormalities or hormone resistance. Clin Biochem Rev Vol 24 November 2003 Thank you for your Attention Bakhtiari09@gmail.com 13

Challenging TFTs (Definition)

Challenging TFTs (Definition) Thyroid Function Tests (Interpretation Challenges) Mohammad Reza Bakhtiari, DCLS, PhD 1/80 Challenging TFTs (Definition) Discordant Results vs. Clinical Picture Inharmonious Results 2/80 1 Challenging

More information

Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017

Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017 Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017 I will not be discussing this Outline of discussion Laboratory tests for thyroid function Diagnosis of hypothyroidism Treatment of

More information

Chapter I.A.1: Thyroid Evaluation Laboratory Testing

Chapter I.A.1: Thyroid Evaluation Laboratory Testing Chapter I.A.1: Thyroid Evaluation Laboratory Testing Jennifer L. Poehls, MD and Rebecca S. Sippel, MD, FACS THYROID FUNCTION TESTS Overview Thyroid-stimulating hormone (TSH) is produced by the anterior

More information

Clinical evaluation of. Thyroid function tests

Clinical evaluation of. Thyroid function tests In the name of God Dr.m.omidi Endocrinologist Assistant stant professor of medicine 25 APR 2012 Clinical evaluation of Thyroid function tests Goal of TFT Evaluation of function of thyroid Monitoring

More information

LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS

LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS Maryam Tohidi Anatomical & clinical pathologist Research Institute for Endocrine Sciences THYROID GLAND (15-25 gr), (12-20 gr), 2 lobes connected by

More information

Endocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy

Endocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Endocrine part two Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Cushing's disease: increased secretion of adrenocorticotropic

More information

Thyroid disorder for Resident

Thyroid disorder for Resident Thyroid disorder for Resident Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Topics Abnormal thyroid function test Euthyroid

More information

Thyroid Disease. I have no disclosures. Overview TSH. Matthew Kim, M.D. July, 2012

Thyroid Disease. I have no disclosures. Overview TSH. Matthew Kim, M.D. July, 2012 Thyroid Disease I have no disclosures Matthew Kim, M.D. July, 2012 Overview Thyroid Function Tests Hyperthyroidism Hypothyroidism Subclinical Thyroid Disease Thyroid Nodules Questions TSH Best single screening

More information

Euthyroid sick syndrome

Euthyroid sick syndrome Euthyroid sick syndrome Background Euthyroid sick syndrome can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI) without preexisting

More information

An Approach to: Thyroid Function Tests. Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital

An Approach to: Thyroid Function Tests. Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital An Approach to: Thyroid Function Tests Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital Regulation of Thyroid axis Hypothalamus TRH T3,T4 ---- TRH Median Eminence (base of brain)

More information

Understanding thyroid function tests. Dr. Colette George

Understanding thyroid function tests. Dr. Colette George Understanding thyroid function tests Dr. Colette George Disclosures No financial disclosure I will present fictitious cases and thyroid function tests (TFTs) that are based on scenarios I commonly encounter.

More information

university sciences of Isfahan university Com

university sciences of Isfahan university   Com Introduce R. Gholamnezhad Lecturer of school of nursing & midwifery of Iran university Ph.D student tof Immunology, Sh School of medical sciences of Isfahan university E-Mail: Gholami278@gmail. Com Interpreting

More information

Lecture title. Name Family name Country

Lecture title. Name Family name Country Lecture title Name Family name Country Nguyen Thy Khue, MD, PhD Department of Endocrinology HCMC University of Medicine and Pharmacy, MEDIC Clinic Hochiminh City, Viet Nam Provided no information regarding

More information

Thyroid and Antithyroid Drugs. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014

Thyroid and Antithyroid Drugs. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014 Thyroid and Antithyroid Drugs Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed

More information

Thyroid Function TSH Analyte Information

Thyroid Function TSH Analyte Information Thyroid Function TSH Analyte Information 1 2013-05-01 Thyroid-stimulating hormone (TSH) Introduction Thyroid-stimulating hormone (thyrotropin, TSH) is a glycoprotein with molecular weight of approximately

More information

Index. Graves disease, 111 thyroid autoantigens, 110 Autoimmune thyroiditis, 11, 58, 180, 181. B Bamforth Lazarus syndrome, 27

Index. Graves disease, 111 thyroid autoantigens, 110 Autoimmune thyroiditis, 11, 58, 180, 181. B Bamforth Lazarus syndrome, 27 Index A Adrenergic activation, 77 Allan Herndon Dudley syndrome, 31 Ambulatory practice choice of test, 156, 157 screening general population, thyroid dysfunction, 163, 164 targeted population, 164 167

More information

None. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives

None. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives Thyroid Potpourri for the Primary Care Physician Ramya Vedula DO, MPH, ECNU Endocrinology, Diabetes and Metabolism Princeton Medical Group Assistant Professor of Clinical Medicine Rutgers Robert Wood Johnson

More information

Decoding Your Thyroid Tests and Results

Decoding Your Thyroid Tests and Results Decoding Your Thyroid Tests and Results Wondering about your thyroid test results? Learn about each test and what low, optimal, and high results may mean so you can work with your doctor to choose appropriate

More information

Requesting and Management of abnormal TFTs.

Requesting and Management of abnormal TFTs. Requesting and Management of abnormal TFTs. At the request of a number of GPs I have produced summary guidelines surrounding thyroid testing. These have been agreed with our Endocrinology leads Dr Bell

More information

Laboratory assessment of thyroid function. Nahid Shirazian MD. Internist, Endocrinologist

Laboratory assessment of thyroid function. Nahid Shirazian MD. Internist, Endocrinologist Laboratory assessment of thyroid function Nahid Shirazian MD. Internist, Endocrinologist Physiology Thyroid gland produces Thyroxine Converted to active form T3 in tissue Scattered dc cells within ihi

More information

Hypothyroidism. Definition:

Hypothyroidism. Definition: Definition: Hypothyroidism Primary hypothyroidism is characterized biochemically by a high serum thyroidstimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration. Subclinical

More information

B-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor.

B-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor. Disorders of the endocrine system 38 Disorders of endocrine system mainly are caused by: A-Deficiency or an excess of a single hormone or several hormones: - deficiency :can be congenital or acquired.

More information

Guidance for Thyroid Function Testing in Primary Care in Lothian

Guidance for Thyroid Function Testing in Primary Care in Lothian Guidance for Thyroid Function Testing in Primary Care in Lothian In July 2006 following a lengthy consultation process, a joint working group comprising representatives from the Association of Clinical

More information

The Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital

The Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital The Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital Presentation Today: Common thyroid problems and treatments Pregnancy related thyroid problems The suppressed

More information

Southern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism

Southern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism Southern Derbyshire Shared Care Pathology Guidelines Hypothyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hypothyroidism in adults. Background Hypothyroidism

More information

Underactive Thyroid. Diagnosis, Treatment & Controversies

Underactive Thyroid. Diagnosis, Treatment & Controversies Underactive Thyroid Diagnosis, Treatment & Controversies Dr. Asif Malik Humayun Consultant Endocrinologist Milton Keynes University Hospital NHS Foundation Trust Thyroid Hormone Control of metabolism

More information

The interpretation and management of thyroid disorders

The interpretation and management of thyroid disorders Journal of Endocrinology, Metabolism and Diabetes of South Africa 2015 ; 20(2) http://dx.doi.org/10.1080/16089677.2015.1056468 Open Access article distributed under the terms of the Creative Commons License

More information

Invecchiamento e Tiroide

Invecchiamento e Tiroide Simposio La patologia Tiroidea nell Anziano Invecchiamento e Tiroide Fabio Monzani Sezione Geriatria, Dipartimento di Medicina Clinica & Sperimentale, Università di Pisa THE EFFECT OF AGING ON THYROID

More information

THYROID HORMONES & THYROID FUNCTION TESTS

THYROID HORMONES & THYROID FUNCTION TESTS THYROID HORMONES & THYROID FUNCTION TESTS SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY CLINICAL BIOCHEMISTRY LECTURE BMLS III

More information

Thyrotoxicosis in Pregnancy: Diagnose and Management

Thyrotoxicosis in Pregnancy: Diagnose and Management Thyrotoxicosis in Pregnancy: Diagnose and Management Yuanita Asri Langi email: meralday@yahoo.co.id Endocrinology & Metabolic Division, Internal Medicine Department, Prof.dr.R.D. Kandou Hospital/ Sam Ratulangi

More information

Thyroid function testing in pregnancy: 2017 ATA guidelines update. Dr Simon Forehan

Thyroid function testing in pregnancy: 2017 ATA guidelines update. Dr Simon Forehan Thyroid function testing in pregnancy: 2017 ATA guidelines update Dr Simon Forehan Several factors are known to tax gravid thyroid economy: Increased plasma volume TBG pool increased Renal clearance Feto-placental

More information

THYROID HORMONES: An Overview

THYROID HORMONES: An Overview 1 SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY PBL SEMINAR MBBS III; BMLS & BDS Year 3 What are the Thyroid Hormones? THYROID

More information

Occurrence and management of an aberrant free T4 in combination with a normal TSH

Occurrence and management of an aberrant free T4 in combination with a normal TSH ORIGINAL ARTICLE Occurrence and management of an aberrant free T4 in combination with a normal TSH K.M. van Veggel 1 *, J.M. Rondeel 2, S. Anten 3 1 Department of Internal Medicine, Isala Hospital (previously

More information

Approach to thyroid dysfunction

Approach to thyroid dysfunction Approach to thyroid dysfunction Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or

More information

Thyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb,

Thyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb, Thyroid and Antithyroid Drugs Dr. Alia Shatanawi Feb, 24 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed of epithelial cells which

More information

Thyroid and Antithyroid Drugs

Thyroid and Antithyroid Drugs Thyroid and Antithyroid Drugs Dr. Yunita Sari Pane, MSi Department of Pharmacology HYPOTHALAMIC PITUITARY THYROID AXIS T3 and T4 are synthesized in the thyroid gland. Inorganic iodine is trapped with great

More information

THROID ABNORMALITIES AMIR ZIAEE

THROID ABNORMALITIES AMIR ZIAEE THROID ABNORMALITIES AMIR ZIAEE 1 Thyroid Hormone Synthesis Table 330-2. Characteristics of Circulating T4 and T3 Hormone Property T4 T3 Serum concentrations Total hormone 8 μg/dl 0.14 μg/dl Fraction of

More information

Pregnancy & Thyroid. Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University. Imam Reza weeky Conferance

Pregnancy & Thyroid. Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University. Imam Reza weeky Conferance Pregnancy & Thyroid Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University Imam Reza weeky Conferance Objectives Thyroid Disorders & Pregnancy Normal thyroid phsyiology

More information

Table 1: Thyroid panel. Result (reference interval) TSH 89.5 miu/l ( ) Total T4 5.2 µg/dl ( ) T3 uptake 39% (22-35)

Table 1: Thyroid panel. Result (reference interval) TSH 89.5 miu/l ( ) Total T4 5.2 µg/dl ( ) T3 uptake 39% (22-35) Introduction Thyroid disease is the second most common endocrine disorder (behind diabetes), and its prevalence increases with increasing age. The incidence of newly diagnosed thyroid cancer is increasing

More information

DRUGS. 4- Two molecules of DIT combine within the thyroglobulinto form L-thyroxine (T4)' One molecule of MIT & one molecule of DIT combine to form T3

DRUGS. 4- Two molecules of DIT combine within the thyroglobulinto form L-thyroxine (T4)' One molecule of MIT & one molecule of DIT combine to form T3 THYROID HORMONEs & ANTITHYROID The thyroid secretes 2 types of hormones: DRUGS 1- Iodine containing amino acids (are important for growth, development and metabolism) and these are: triodothyronine, tetraiodothyronine,(

More information

Hypothalamo-Pituitary-Thyroid Axis

Hypothalamo-Pituitary-Thyroid Axis SMGr up Hypothalamo-Pituitary-Thyroid Axis Orluwene Chituru Godwill 1 * and Ohiri John U 1 1 Chemical Pathology Department, University of Port Harcourt Teaching Hospital, Nigeria *Corresponding author:

More information

C. Thyrotropin/Thyroid Stimulating Hormone (TSH)

C. Thyrotropin/Thyroid Stimulating Hormone (TSH) C. Thyrotropin/Thyroid Stimulating Hormone (TSH) For more than twenty-five years, TSH methods have been able to detect the TSH elevations that are characteristic of primary hypothyroidism. Modern-day TSH

More information

Thyroid Hormones (T 4 & T 3 )

Thyroid Hormones (T 4 & T 3 ) 1 Thyroid Hormones (T 4 & T 3 ) Normalize growth and development, body temperature, and energy levels. Used as thyroid replacement therapy in hypothyroidism. Thyroxine (T 4 ) is peripherally metabolized

More information

Understanding Thyroid Labs

Understanding Thyroid Labs Understanding Thyroid Labs Chris Sadler, MA, PA-C, CDE, DFAAPA Senior Medical Science Liaison CVM Janssen Scientific Affairs Diabetes and Endocrine Associates La Jolla, CA Disclosures Employee of Janssen

More information

STRANGE THYROID FUNCTION TESTS: REAL PATHOLOGY OR BIOLOGICAL PITFALL? Agnès Burniat, MD, PhD

STRANGE THYROID FUNCTION TESTS: REAL PATHOLOGY OR BIOLOGICAL PITFALL? Agnès Burniat, MD, PhD STRANGE THYROID FUNCTION TESTS: REAL PATHOLOGY OR BIOLOGICAL PITFALL? Agnès Burniat, MD, PhD Concordant thyroid tests: respecting the hypothalamus-pituitarythyroid axis regulation Discordant thyroid tests:

More information

Reference intervals are derived from the statistical distribution of values in the general healthy population.

Reference intervals are derived from the statistical distribution of values in the general healthy population. Position Statement Subject: Thyroid Function Testing for Adult Diagnosis and Monitoring Approval Date: July 2017 Review Date: July 2019 Review By: Chemical AC, Board of Directors Number: 1/2017 Introduction:

More information

How to manage hypothyroid disease in pregnancy

How to manage hypothyroid disease in pregnancy For mass reproduction, content licensing and permissions contact Dowden Health Media. FIRST OF 2 PARTS How to manage hypothyroid disease in pregnancy Pregnancy complicated by hypothyroidism puts mother

More information

Update on Gestational Thyroid Disease. Aidan McElduff The Discipline of Medicine, The University of Sydney

Update on Gestational Thyroid Disease. Aidan McElduff The Discipline of Medicine, The University of Sydney IADPSG 2016 Update on Gestational Thyroid Disease Aidan McElduff The Discipline of Medicine, The University of Sydney IADPSG 2016 DISCLOSURES and AIM Nil to disclose Aim: to provide an overview 2017 Guidelines

More information

Pearls and Pitfalls of Thyroid Diagnosis. Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS

Pearls and Pitfalls of Thyroid Diagnosis. Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS Pearls and Pitfalls of Thyroid Diagnosis Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS Thyroid Anatomy Isthmus of gland located 1 fingerbreadth below cricoid cartilage

More information

Thyroid hormone. Functional anatomy of thyroid gland

Thyroid hormone. Functional anatomy of thyroid gland Thyroid hormone ส ว ฒณ ค ปต ว ฒ ต กจ ฑาธ ช ห อง 101 Aims Functional anatomy of thyroid gland Synthesis, secretion and metabolism of the thyroid hormones The mechanism of thyroid hormone action Role of

More information

DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID

DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID OBJECTIVES DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT Stephanie Blackburn, MHS, MLS(ASCP) CM LSU Health Shreveport Clinical Laboratory Science Program Discuss the synthesis and action

More information

Timothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, :30 PM

Timothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, :30 PM Thyroxine Deficiency in Pregnancy Timothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, 2006 1:30 PM WHI Estrogen recap In http://courses.washington.edu/bonephys/opestrogen.html. from:

More information

Common Thyroid Disorders

Common Thyroid Disorders Common Thyroid Disorders Louie Riesch MSN, MPH, RN, ACNS-BC, CDE Texas Diabetes and Endocrinology Anatomy of the Thyroid Gland Hypothalamic-Pituitary-Thyroid Axis Physiology Hypothalamus TRH Pituitary

More information

Hyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D.

Hyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D. Hyperthyroidism Diagnosis and Treatment Family Practice Refresher Course April 2015 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any

More information

NIH Public Access Author Manuscript Ther Drug Monit. Author manuscript; available in PMC 2013 April 14.

NIH Public Access Author Manuscript Ther Drug Monit. Author manuscript; available in PMC 2013 April 14. NIH Public Access Author Manuscript Published in final edited form as: Ther Drug Monit. 2006 February ; 28(1): 8 11. Thyroid Function Testing in Pregnancy and Thyroid Disease: Trimester-specific Reference

More information

Hyperthyroidism. Objectives. Clinical Manifestations. Slide 1. Slide 2. Slide 3. Implications for Primary Care. hyperthyroidism

Hyperthyroidism. Objectives. Clinical Manifestations. Slide 1. Slide 2. Slide 3. Implications for Primary Care. hyperthyroidism 1 Hyperthyroidism Implications for Primary Care Laura A. Ruby, DNP, CRNP Wellspan Endocrinology 2 Objectives! Discuss the clinical manifestations of hyperthyroidism! Review the use of the diagnostic studies!

More information

Grave s disease (1 0 )

Grave s disease (1 0 ) THYROID DYSFUNCTION Grave s disease (1 0 ) Autoimmune - activating AB s to TSH receptor High concentrations of circulating thyroid hormones Weight loss, tachycardia, tiredness Diffuse goitre - TSH stimulating

More information

NEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015

NEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015 NEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015 CHIEF COMPLAINT 35 6/7 week F with goiter, born to a mother with Graves disease (GD) HPI 35 6/7 week F born

More information

Iodine and Thyroid Hormones

Iodine and Thyroid Hormones Iodine and Thyroid Hormones Iodine and Thyroid Hormones feed-back Iodine Deficiency Characteristics Iodine Deficiency None Mild Mode Severe Median urine iodine >100 50-99 20-49

More information

The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on Dec2013

The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on Dec2013 The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on Dec2013 Summary of Product Characteristics 1. NAME OF THE MEDICINAL PRODUCT Eltroxin

More information

Icd 10 low tsh level. Icd 10 low tsh level. Search

Icd 10 low tsh level. Icd 10 low tsh level. Search Search Icd 10 low tsh level Icd 10 low tsh level 1-10-2012 The 2012 updates to the Current Procedural Terminology 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level

More information

The Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2.

The Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2. The Thyroid and Pregnancy Francis S. Greenspan March 19, 2010 OUTLINE OF DISCUSSION 1. Normal Physiology 2. Hypothyroidism 3. Hyperthyroidism 4. Thyroid Nodules and Cancer NORMAL PHYSIOLOGY Iodine Requirements:

More information

Back to the Basics: Thyroid Gland Structure, Function and Pathology

Back to the Basics: Thyroid Gland Structure, Function and Pathology Back to the Basics: Thyroid Gland Structure, Function and Pathology JANELLE M. CHIASERA LEARNING OBJECTIVES 1. Explain the HPT feedback system involving the thyroid gland. Include the hormone produced

More information

Learning Objectives. The role of the laboratory in thyroid disease. Thyroid hormones 7/4/2014

Learning Objectives. The role of the laboratory in thyroid disease. Thyroid hormones 7/4/2014 Learning Objectives The role of the laboratory in thyroid disease Eleanor Burchell Describe the structure and function of the thyroid gland Explain the function of thyroid hormones Outline the action of

More information

Hypothyroidism in pregnancy. Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah

Hypothyroidism in pregnancy. Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah Hypothyroidism in pregnancy Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah Agenda 1. Epidemiology and clinical characteristics of maternal hypothyroidism 2. Prevention and

More information

Southern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism

Southern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism Southern Derbyshire Shared Care Pathology Guidelines Hyperthyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hyperthyroidism. Background Hyperthyroidism

More information

The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on February 2016.

The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on February 2016. The format of this leaflet was determined by the Ministry of Health and its content was checked and approved by it on February 2016. Summary of Product Characteristics 1. NAME OF THE MEDICINAL PRODUCT

More information

Endocrinology in Primary Care. HN Buch

Endocrinology in Primary Care. HN Buch Endocrinology in Primary Care HN Buch Endocrinology in Primary Care Death by Powerpoint HN Buch Agenda Endocrine Condition Primary v Secondary Care Initial management Follow up Focus of Discussion Hypothyroidism

More information

HYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3

HYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 HYPERTHYROIDISM Hypothalamus Thyrotropin-releasing hormone (TRH) Anterior pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 In hyperthyroidism, there is an increased production of

More information

Thyroid Function. Thyroid Antibodies. Analyte Information

Thyroid Function. Thyroid Antibodies. Analyte Information Thyroid Function Thyroid Antibodies Analyte Information - 1-2013-04-30 Thyroid Antibodies Determination of thyroid autoantibodies are, besides TSH and FT4, one of the most important diagnostic parameters.

More information

Common Thyroid Disorders

Common Thyroid Disorders 8/29/16 Anatomy of the Thyroid Gland Common Thyroid Disorders Heather Cuevas PhD, RN, ACNS- BC Texas Diabetes and Endocrinology The University of Texas at Austin School of Nursing Hypothalamic- Pituitary-

More information

Neonatal Thyrotoxicosis Management of babies born to mothers with a history of hyperthyroidism (Grave s Disease)

Neonatal Thyrotoxicosis Management of babies born to mothers with a history of hyperthyroidism (Grave s Disease) MCN for Neonatology West of Scotland Neonatal Guideline Neonatal Thyrotoxicosis Management of babies born to mothers with a history of hyperthyroidism (Grave s Disease) This document is applicable to all

More information

The Effect of Medications on Thyroid Function Tests

The Effect of Medications on Thyroid Function Tests The Effect of Medications on Thyroid Function Tests Priya Kundra, MD a,b, *, Kenneth D. Burman, MD a,b KEYWORDS Thyroid function Medication Hormone Euthyroid state Abnormal results of thyroid function

More information

Icd 10 low tsh level. Cari untuk: Cari Cari

Icd 10 low tsh level. Cari untuk: Cari Cari Cari untuk: Cari Cari Icd 10 low tsh level AMMONIUM PERCHLORATE is a white, crystalline solid or powder. Classified as a division 1.1 explosive if powdered into particles smaller than 15 microns in diameter

More information

Pathophysiology of Thyroid Disorders. PHCL 415 Hadeel Alkofide April 2010

Pathophysiology of Thyroid Disorders. PHCL 415 Hadeel Alkofide April 2010 Pathophysiology of Thyroid Disorders PHCL 415 Hadeel Alkofide April 2010 1 Learning Objectives Understand the pathophysiology of hyperthyroidism & hypothyroidism Describe the signs & symptoms of hyperthyroidism

More information

Thyroid hormones derived from two iodinated tyrosine molecules

Thyroid hormones derived from two iodinated tyrosine molecules Thyroid Hormones OBJECTIVES Chemical nature of the thyroid hormones How different enzymes play a role in thyroid hormone formation? And what drugs affect them? Describe Function & Metabolism of thyroid

More information

Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy

Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy Early diagnosis and good management of maternal thyroid dysfunction are essential to ensure minimal adverse effects on

More information

Psychiatric illness or thyroid disease? Richard A. Bermudes, MD

Psychiatric illness or thyroid disease? Richard A. Bermudes, MD Primary care update Psychiatric illness or thyroid disease? D on t be misled by false lab tests Richard A. Bermudes, MD Departments of family medicine and psychiatry University of Cincinnati College of

More information

SUMMARY OF PRODUCT CHARACTERISTICS

SUMMARY OF PRODUCT CHARACTERISTICS SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Levothyroxine Sodium {Aspen}{Vale} 25 microgram tablets Levothyroxine Sodium {Aspen}{Vale} 50 microgram tablets Levothyroxine Sodium

More information

SUMMARY OF PRODUCT CHARACTERISTICS

SUMMARY OF PRODUCT CHARACTERISTICS SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Euthyrox 50 microgram tablets Euthyrox 100 microgram tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 tablet Euthyrox 50 microgram

More information

SUMMARY OF PRODUCT CHARACTERISTICS

SUMMARY OF PRODUCT CHARACTERISTICS SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Euthyrox 50 µg tablets Euthyrox 100 µg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 tablet Euthyrox 50 µg contains 50 microgram

More information

TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY

TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY ENDOCRINE DISORDERS IN THE ELDERLY (part 2) TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY Pituitary axis Target organs of the pituitary gland Negative feedback Hypothalamus-Pituitary-Thyroid axis Thyroid

More information

Patient Diary: Treatment Tracker

Patient Diary: Treatment Tracker Patient Diary: Treatment Tracker A tool to help you log your experience with LEVOXYL and communicate with your doctor When you are taking LEVOXYL, your doctor will monitor your symptoms and check your

More information

Alvin C. Powers, M.D. 1/27/06

Alvin C. Powers, M.D. 1/27/06 Thyroid Histology Follicular Cells ECF side Apical lumen Thyroid Follicles -200-400 um Parafollicular or C-cells Colloid Photos from University of Manchester and tutorial created by Dr. James Crimando,

More information

PEDIATRIC PHARMACOTHERAPY A Monthly Newsletter for Health Care Professionals from the University of Virginia Children s Hospital

PEDIATRIC PHARMACOTHERAPY A Monthly Newsletter for Health Care Professionals from the University of Virginia Children s Hospital PEDIATRIC PHARMACOTHERAPY A Monthly Newsletter for Health Care Professionals from the University of Virginia Children s Hospital Volume 14 Number 10 October 2008 Levothyroxine Use in Infants and Children

More information

Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47

Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47 Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47 ESPE Code Diagnosis OMIM ICD10 7 THYROID DISORDERS 7A HYPOTHYROIDISM

More information

Thyroid gland defects. Dr. Tara Husain

Thyroid gland defects. Dr. Tara Husain Thyroid gland defects Dr. Tara Husain Thyroid Pituitary Axis TRH secreted in the hypothalamus stimulates production and Secretion of TSH TSH stimulates secretion of T3,T4 T4 has negative feed back on secretion

More information

Summary of Product Characteristics

Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT Levothyroxine Sodium Aspen 125 microgram tablets Summary of Product Characteristics 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet of Levothyroxine Sodium Aspen

More information

For the use only of Registered Medical Practitioners or a Hospital or a Laboratory

For the use only of Registered Medical Practitioners or a Hospital or a Laboratory For the use only of Registered Medical Practitioners or a Hospital or a Laboratory ELTROXIN 25mcg/ 50mcg/ 75mcg/ 88mcg/ 100mcg/ 125mcg TABLETS Thyroxine Sodium Tablets I.P. 25mcg/ 50mcg/ 75mcg/ 88mcg/

More information

4) Thyroid Gland Defects - Dr. Tara

4) Thyroid Gland Defects - Dr. Tara 4) Thyroid Gland Defects - Dr. Tara Thyroid Pituitary Axis TRH secreted in the hypothalamus stimulates production and Secretion of TSH TSH stimulates secretion of T3, T4 T4 has negative feedback on secretion

More information

DRUGS, PREGNECY & NEWBORN

DRUGS, PREGNECY & NEWBORN DRUGS, PREGNANCY & NEWBORN DRUGS, PREGNECY & NEWBORN By- Dr Raghuveer Ist By- PG Dept of Rasashastra Dr Raghuveer Dept of Rasashastra KVG Ayurvedic Medical College Sullia ayuraghu@rediffmail.com Introduction

More information

Important Facts about LEVOXYL (Lev-OX-il) (levothyroxine sodium tablets)

Important Facts about LEVOXYL (Lev-OX-il) (levothyroxine sodium tablets) Important Facts about LEVOXYL (Lev-OX-il) (levothyroxine sodium tablets) The risk information provided herein is not comprehensive. To learn more about LEVOXYL, talk to your healthcare provider or pharmacist.

More information

THYROID FUNCTION TESTING

THYROID FUNCTION TESTING THYROID FUNCTION TESTING ENDOCRINE UPDATES Shlomo Melmed, M.D., Series Editor For further volumes: http://www.springer.com/series/5917 THYROID FUNCTION TESTING Edited by Gregory A. Brent Professor of Medicine

More information

Pediatric Thyroid Conundrums

Pediatric Thyroid Conundrums Learning Objectives Pediatric Thyroid Conundrums Harvey Chiu, MD Associate Clinical Professor of Pediatrics UCLA Mattel Children s Hospital Division of Pediatric Endocrinology Understand the urgency of

More information

Critical illness and endocrinology. ICU Fellowship Training Radboudumc

Critical illness and endocrinology. ICU Fellowship Training Radboudumc Critical illness and endocrinology ICU Fellowship Training Radboudumc Critical illness Ultimate form of severe physical stress Generates an orchestrated endocrine response to provide the energy for fight

More information

Canadian Endocrine Review Course 2014

Canadian Endocrine Review Course 2014 Canadian Endocrine Review Course 2014 Amiodarone & Thyrotoxicosis Iodine, A Catch 22 Ally P.H. Prebtani Associate Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University

More information

The department of Endocrinology and metabolism Huashan Hospital, Fudan University Dr. Hongying Ye

The department of Endocrinology and metabolism Huashan Hospital, Fudan University Dr. Hongying Ye The department of Endocrinology and metabolism Huashan Hospital, Fudan University Dr. Hongying Ye dryehongying@hotmail.com Main contents Basic knowledge of thyroid Overview of thyroid diseases Hyperthyroidism/Graves

More information

VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology

VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology The most common forms of hyperthyroidism include Graves disease, Plummer disease, and toxic adenoma; but approximately 1-2% of

More information

Disorders of the Thyroid Gland

Disorders of the Thyroid Gland Disorders of the Thyroid Gland István Takács MD., PhD, 1st Department of Medicine, Semmelweis University Connection to the dentistry: close to each other higher operation risk radiating pain macroglossia

More information

Should every pregnant woman be screened for thyroid disease?

Should every pregnant woman be screened for thyroid disease? Should every pregnant woman be screened for thyroid disease? Tal Biron-Shental Rinat Gabbay-Benziv Is there a debate? Thyroid screening Guidelines Targeted case finding criteria Age > 30 years Personal

More information