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Thyroid issues have long been debated as a possible cause of gall stone disease. The link between hypothyroidism and gallstone disease could be explained in a variety of ways. The main objective of this study is to determine the prevalence of hypothyroidism in gallstone patients and to rule out hypothyroidism as a probable cause of gallstone formation. A prospective study was conducted in surgical wards of Department of surgery sree balaji medical college from 2016 to 2017. All patients were evaluated using a comprehensive clinical history and examination, as well as suitable investigations such as abdominal USG, thyroid function tests, and lipid profiles. Out of 22 patients 19 patients (86.4%) had normal TSH, 2 patients (9.1%) had increased TSH, 1 patient (4.5%) had decreased TSH. Raised TSH was more in the AGE Group of 61- 75 years, which is comparable to other studies. Out of 22 patients, (100%) had normal T3 levels. 19 patients (86.4%) had normal T4 levels and Ultrasound examination of neck, 2 patients (9.1%) had decreased T4 level and 1 patient (4.5%) had increased T4 levels and 3 patients (13.6%) had abnormal Ultrasound Neck findings. Hence In this Study Cholelithiasis is most commonly seen in Females of age group of 41-60 years and prevalence of raised TSH level in cholelithiasis patient was 9% and most were found in the age group of 61-80 years.

The interaction between thyroid status and brown adipose tissue (BAT) activation is complex. We assessed the effect of autoimmune hypothyroidism (ATD) in female children on BAT activation, measured using infrared thermography. Participants with ATD had lower resting (hypothyroid, 34.9 +- 0.7°C; control, 35.4 +- 0.5°C; P = 0.03) and stimulated (hypothyroid, 35.0 +- 0.6°C; control, 35.5 +- 0.5°C; P = 0.04) supraclavicular temperatures compared with controls, but there was no difference between groups in the temperature increase with stimulation. BAT activation, calculated as the relative temperature change comparing the supraclavicular temperature to a sternal reference region, was reduced in participants with ATD (hypothyroid, 0.1 +- 0.1°C; control, 0.2 +- 0.2°C; P = 0.04). Children with ATD were frequently biochemically euthyroid due to replacement therapy, but, despite this, increased relative supraclavicular temperature was closely associated with increased TSH (r = 0.7, P = 0.01) concentrations. Girls with ATD had an attenuated thermogenic response to cold stimulation compared with healthy controls, but, contrary to expectation, those with suboptimal biochemical control (with higher TSH) showed increased BAT activation. This suggests that the underlying disease process may have a negative effect on BAT response, but high levels of TSH can mitigate, and even stimulate, BAT activity. In summary, thyroid status is a complex determinant of BAT activity in girls with ATD., This work was supported by a pump-priming grant from Nottingham University Hospitals Charity (Grant PP-Law-Nov12).

Background The incidence of congenital hypothyroidism (CH) differs significantly among different ethnicities and regions, and early differentiation of transient CH is important to avoid unnecessary prolonged treatment with L-T4. Objective To investigate the incidence of CH based on the newborn screening program in Guangxi Zhuang Autonomous Region, China, and to analyze the predictors that might allow for an early differentiation between permanent (P) and transient (T) CH. Design and methods Data from newborn screening program over a seven-year period (January 2009 to January 2016) at Guangxi Maternal and Child Health Hospital are analyzed. Blood samples were collected on filter paper between 3 and 7 days after birth, and TSH level was measured by time-resolved fluorescence assay. Individuals with increased TSH (TSH ≥ 8 IU/L) levels detected by newborn screening were recalled for further evaluation. Serum TSH, FT3 and FT4 were determined by electrochemiluminescence assay using venous blood samples. Diagnosis of CH is based on elevated TSH levels (>10 IU/L) and decreased FT4 levels (4 levels were diagnosed as hyperthyrotropinemia. Permanent or transient CH was determined by using the results of thyroid function tests after temporary withdrawal of L-T4 therapy at approximately 2–3 years of age. Results Among 1,238,340 infants in the newborn screening program, 14,443 individuals were recalled for reevaluation (re-call rate 1.18%), 911 and 731 individuals were subsequently determined to have hyperthyrotropinemia and CH respectively; thus, a prevalence of 1:1359 and 1:1694 for hyperthyrotropinemia and CH. Of the 731 patients with CH, 161 patients were diagnosed with permanent CH (PCH), and 159 patients were diagnosed with transient CH (TCH), the other 411 patients are too young to determine their subtypes. Patients with PCH required an increasing dose of L-T4 during the first few years, whereas patients with TCH required a decreased dose of L-T4. The TSH levels at diagnosis and the dose of L-T4 used were significantly higher in PCH cases than in transient cases. The FT4 levels at diagnosis were significantly lower in PCH cases than in TCH cases. The TSH levels at diagnosis, FT4 levels at diagnosis and L-T4 doses at 90 days were evaluated as predictors for differentiating PCH and TCH, and their accuracy at their respective optimal cutoffs were determined to be 60.6%, 66.7% and 93.9%, respectively. Conclusions The CH incidence in Guangxi Zhuang Autonomous Region is slightly higher (1:1694) compared to the worldwide levels (1/2000–1/4000). The PCH and TCH ratio is close to 1; thus, the estimated PCH incidence is 1/3388, which is similar to reported worldwide average incidence (1/3000). The L-T4 dose required at 90 days (>30 μg/day) has the highest predictive value for PCH. Earlier differentiation of PCH and TCH helps to determine appropriate treatment course.

Setiap tahun terdapat 39 juta bayi baru lahir beresiko memiliki kapasitas intelektual rendah akibat defisiensi yodium. Terdapat 5% ibu hamil yang kadar TSH dan TPO-Abnya meningkat. Konsekuensi defisiensi yodium dapat dihindari jika pada saat hamil ibu sejak awal mengkonsumsi yodium secara adekuat. Sumber yodium yang tersedia dan cukup murah adalah garam yang difortifikasi yodium. Namun, waktu penyimpanan, kondisi penyimpanan, dan jenis garam berpengaruh terhadap penurunan kandungan yodium dalam garam beryodium. Tujuan penelitian untuk mengetahui kandungan iodium pada garam beryodium dengan berbagai wadah penyimpanan selama penyimpanan 6 hari. Jenis penelitian ini merupakan penelitian deskriptif. Sampel garam diambil secara acak di toko kelontong dengan merk dagang yang paling banyak digunakan konsumen di kota Palu dan sekitarnya. Wadah yang digunakan adalah wadah plastik dan wadah kaca. Setiap wadah dibagi dua, ada wadah transparan dan ada wadah yang tidak transparan (dibungkus). Penyimpanan dilakukan selama 6 hari dengan analisa kandungan yodium garam dilakukan pada hari ke 0, hari ke-2, hari ke-4 dan hari ke-6. Hasil penelitian menunjukan bahwa baik wadah plastik maupun wadah kaca, terdapat penurunan kandungan yodium. Rata-rata persentase penurunan kandungan yodium terbesar terjadi pada penyimpanan dalam wadah plastik dan kaca yang transparan (9,49% dan 4,75%). Sedangkan pada wadah yang tidak transparan rata-rata penurunan kandungan yodiumnya sebesar 4,99% pada wadah plastik dan 3,18 % pada wadah kaca. Persentase penurunan kandungan yodium terbesar setiap dua hari penyimpanan terdapat pada garam yang disimpan dalam wadah plastik transparan yakni rata-rata sebesar 4,77%. Kesimpulan; Penyimpanan garam beryodium yang terbaik adalah dalam wadah kaca yang tidak transparan

Our aims were to investigate the presence of pituitary glycoprotein hormones in preterm and donor milk, and to examine the effects of Holder pasteurization and refrigeration on the levels of these hormones. We measured follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH) in milk samples from mothers who delivered prematurely (n = 27) and in samples of mothers who delivered at term and donated milk to the Mother&rsquo, s Milk Bank of Iowa (n = 30). The gonadotropins and TSH were present in similar amounts within human milk produced for preterm and term infants. FSH increased 21% after refrigeration (p &lt, 0.05), while LH declined by 39% (p &lt, 0.05). Holder pasteurization decreased LH by 24% (p &lt, 0.05) and increased TSH by 17% (p &lt, 0.05). Holder pasteurization followed by refrigeration resulted in a 21% increase in FSH and a 41% decrease in LH (both p &lt, 0.05), resulting in more than a 3-fold increase in donor milk FSH:LH ratios (p &lt, 0.05 versus fresh donor milk). Despite structural similarities, the gonadotropins are differentially impacted by Holder pasteurization and refrigeration, and this results in marked alterations in the relative amount of FSH and LH that may be administered to preterm infants, potentially swinging hormonal balance towards ovarian hyperstimulation in females and hypogonadism in males.

This study was conducted at the Fertility Center at Al-Sadr Teaching Hospital in Najaf Governorate from 16/10/2016 to 10/3/2017 to determine the relationship between thyroid disorders and polycystic ovary syndrome in women of reproductive age. There was no significant difference in body mass and age for thyroid function. The study as well showed not significant difference in T3 and T4 levels when comparing the two groups, but there was a significant difference (P less than 0.05) in the TSH level, which is higher in the patients. It is concluded that there is a relationship between thyroid disorders and PCOS due to increased TSH in women with the syndrome.

International audience; AIM: This study aimed to determine whether the association between thyroid-stimulating hormone (TSH) and body mass index (BMI) is related to leptin concentration in obese individuals. METHODS: Plasma TSH and leptin assays were performed in 800 consecutive patients, hospitalized for a nutritional checkup, with a BMI \textgreater/= 30 kg/m(2). Various anthropometric, hormonal and metabolic parameters, including age, weight, BMI, insulin, leptin and TSH, were measured or calculated. Univariate and multivariate regression analyses were performed to identify any significant relationships between these parameters. Also, characteristics of the patients in the lowest and highest quartiles of TSH distribution were compared. RESULTS: TSH was positively correlated with both BMI and leptin. When multiple regression analysis was performed, TSH and leptin maintained a significant association independent of BMI. Patients in the fourth quartile of TSH distribution displayed higher BMI and higher leptin levels in comparison to the first quartile. CONCLUSION: Our study has confirmed an increase in TSH in conjunction with BMI in obese subjects. This increase was correlated with leptin independently of BMI. It is hypothesized that the increase in TSH observed in obese subjects was the consequence of both fat mass accumulation and a positive energy-balance.

Summary This study was conducted to determine the effects of 8-week administration of testosterone enanthate (TE) in conjunction with resistance training on thyroid hormones and lipid profiles. Sixty male adult Wistar rats were randomly divided into six groups: C: olive oil, RT: resistance training + olive oil, LD: TE (20 mg/kg), HD: TE (50 mg/kg), RT + LD: RT + TE (20 mg/kg), RT + HD: RT + TE (50 mg/kg). The RT consisted of climbing (5 reps/3 sets) a ladder carrying a load suspended from the tail. At the end, blood specimens were obtained from the orbital sinus and serum concentration of T4, T3, TSH and lipid profiles was determined. The serum concentration of TSH significantly increased in RT + HD group compared to C, and the serum concentration of T4 significantly decreased in LD, HD, RT + LD and RT + HD groups compared to the C and RT groups (p

Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT4, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (10 mU/l. In younger SCH patients (serum TSH 80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter.

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis and health problem and cause of death worldwide. MDR-TB occurs in patients who are inadequate and irregular in treatment. WHO strategy for MDR-TB is taking anti-tuberculosis (OAT) which has the effect of second-line heavier. Ethionamide one second-line OAT is administered orally and has a side effect of hypothyroidism. A cross-sectional descriptive study was conducted on 18 patients with MDR-TB from July 2012–March 2013. One patient has been excluded due to hypothyroidism. Increased TSH levels exceeded the cut-off occurred in 2 of 4 people after 1 month of treatment, 3 of 3 people after the 5th month of treatment, 1 of 4 people after 6 months of treatment and 1 of 3 people after month 9 treatment. Only 1 person who had increased levels of TSH>10 μIU/ mL. Conclusion: in patients with MDR-TB evaluation is required to determine the levels of TSH hypothyroidism.

The diagnosis of subclinical hypothyroidism--serum TSH levels above and T(4) levels within the laboratory reference ranges--depends critically on the upper limit of the TSH reference interval. Calls have been made to lower the current upper TSH reference limit of 4.0 mU/l to 2.5 mU/l to exclude patients with occult hypothyroidism. However, data from population studies do not indicate that the distribution of TSH is altered owing to inclusion of such individuals. The opposite suggestion has also been put forward; the TSH upper reference limit is often too low, especially in the elderly, in women and in white individuals, which may lead to unnecessary or even harmful therapy. Studies in elderly individuals have shown that although aging may be associated with increased TSH levels, paradoxically, overt hypothyroidism in this population may be associated with a less robust TSH response than in young individuals. This Review highlights the interindividual and intraindividual variability of TSH levels and discusses the current controversy that surrounds the appropriateness of reference ranges defined on the basis of age, race, sex and amount of iodine intake. Moreover, the current evidence on lowering or increasing the upper limit of the TSH reference interval is reviewed and the need to individualize levothyroxine treatment in patients with elevated TSH levels is discussed.

Background: Association of hypothyroidism and cardiovascular diseases are important in development of Atherosclerosis. Hypothyroidism and sub clinical hypothyroidism reported highly risk factors due to lipid levels dearranged. Present study to demonstre of correlation of hypothyroidism and cardiovascular disease.Methods: The present study has carried out in the department of medicine and Biochemistry SRG Hospital and associated hospital, Jhalawar Medical College Jhalawar (Raj.) Total 100 Hypothyroidism cases and 100 euthyroidism subject were included in the study Information regarding clinical history were recorded in self Constructed present questionnaires Patients were examined and estimated TSH, T3, T4 total Cholesterol, LDLc, HDCc, TG data were analyzed by SPPS version 20.0.Results: Present study demonstrated increased levels of total cholesterol, LDH, VLDLC and TG and decreased level of HDLC and increased TSH level and decreased T3 and T4 Level in hypothyroidism cases when compared with euthyroid cases It was found significant.Conclusions: In present study hypothyroidism and hormone Level (TSH, T3, T4) and lipid level dearranged values are associated with development cardiovascular disease atherosclerosis.

Aim: To determine if neonates exposed to iodinated contrast media are at risk of hypothyroidism. Methods: A systematic review was conducted by searching electronic databases (e.g. MEDLINE), contacting experts and scanning reference lists. Studies examining the effects of contrast media on neonatal thyroid function were included. Two reviewers independently screened the literature and assessed the risk of bias, while one reviewer abstracted data. Results: Eleven studies were included; nine studies directly examined the risk of hypothyroidism (n = 182 neonates exposed to contrast media). All were highly affected by bias. In the three studies including term infants, one showed a trend towards increased thyroid-stimulating hormone (TSH) and decreased free thyroxine (FT4) among exposed groups. Six of 72 (8.3%) term infants exposed were treated for hypothyroidism. In studies of premature infants, there was a trend towards increased TSH (n = 3/7 studies), lower total thyroxine (n = 1), decreased triidothyronine and FT4 (n = 3) and hypothyroidism (n = 5). Twenty of 110 (18.2%) premature infants exposed were treated for hypothyroidism. Conclusion: Hospitalized neonates exposed to iodinated contrast media are at risk for abnormal thyroid function and development of hypothyroidism. Premature infants might be at increased risk. Well-controlled studies are required to replicate our findings because the included studies were highly affected by bias.

Summary Aim Subclinical hypothyroidism (SCHT) is defined by the combination of an increased TSH level and a normal free thyroxin concentration. The aim of this survey is the description of the prevalence, the symptoms and the quality of life in SCHT diagnosed in a group of hypercholesterolemic women. Methods A total of 1610 female patients aged 50 or more with hypercholesterolemia (total cholesterol between 240 and 400 mg/dl, receiving or not a lipid-lowering treatment) were enrolled by 347 general practitioners (GPs). A clinical form including symptoms, clinical history, and treatments was completed by GPs while a SF-36 QOL form was filled up by the patients. Further GPs’ prescriptions for tests and treatments were also recorded. Results Full data leading to subclinical hypothyroidism are available in 721 patients (44.8%) who were selected into the study. Among these patients, the prevalence of SCHT (SCHT+) is 16.6% (120 patients) and 76.3% of the patients have at least one symptom. Most frequent symptoms are physical and intellectual asthenia, muscular weakness, and sensitivity to cold but those symptoms are present in patients without SCHT (SCHT-) too and there is no significant difference between the two groups. TSH level was 4 to 10 mUI/l in 90% of SCHT+ patients. 38.6% of hypercholesterolemic SCHT+ patients never had any TSH measurement. QOL is affected in SCHT+ compared to SCHT- patients with a significantly decreased mental summary score of 36.21 ± 9.4 versus 39.4 ± 12.18 ( p Conclusions SCHT is frequent in a population of hypercholesterolemic female patients aged 50 or more. In the presence of suggestive symptoms, screening is important especially as QOL is affected even when TSH is

Increased TSH values (greater than or equal to 20 microU/ml) were found in 422 of 168,660 neonates born in Southern Bavaria. In 40 neonates the diagnosis of congenital hypothyroidism was confirmed (1: 4,200). The iodine excretion of healthy neonates and their mothers was on average significantly lower in the Munich than the Hamburg region. No relationship between iodine supply and congenital hypothyroidism was demonstrated. On the other hand, iodine excretion in children with neonatal goiter (17% of those with hyperthyrotropinaemia detected by screening) and their mothers was significantly lower than in control groups in the same regions. In addition, there was a significant correlation between iodine excretion of the mothers and neonates. The results confirm the need for iodine prophylaxis which should also take into account the higher needs during pregnancy. Apart from prophylactic aspects, these measures would also be in the interest of greater effectiveness and selectivity of TSH screening since it would reduce the number of cost-intensive follow-up examinations.

OBJETIVO: verificar a presença de anticorpos antitireoperoxidase (anti-TPO) e antitireoglobulina (anti-TG) e as concentrações plasmáticas de tireotrofina (TSH) e tiroxina livre (T4L) em gestantes normais. MÉTODOS: estudo transversal realizado no ambulatório de Pré-Natal da Santa Casa de Misericórdia de São Paulo (SP), no período de janeiro de 2003 a setembro de 2004. Foram incluídas 127 grávidas, residentes em São Paulo, com idades entre 14 e 44 anos e idade gestacional igual ou superior a 16 semanas, determinada por ultra-sonografia realizada antes da 20ª semana de gestação. Foram excluídas gestantes em uso de medicamentos ou história de tireoidopatia. Foram quantificados os anticorpos antitireoperoxidase e antitireoglobulina por imunoensaio quimioluminescente. A técnica de imunofluorimetria por tempo resolvido foi empregada para a determinação de tireotrofina e tiroxina livre. Para análise dos resultados, aplicou-se o teste t de Student, com significância de 5%. RESULTADOS: a freqüência dos anticorpos antitireoidianos foi 12,6% (8,6% de anticorpos anti-TPO, 4,6% de anticorpos anti-TG). A média das concentrações de TSH foi de 2,1±1,0 µU/mL e a média de T4L foi de 0,9±0,5 ng/dL. Observou-se alteração da função tireoidiana em dez gestantes (8%). Três delas tiveram diagnóstico de hipotireoidismo: uma na forma clínica da doença, com TSH aumentado e T4L diminuído; duas na forma subclínica, com TSH aumentado e T4L normal. Cinco mostraram valores de TSH diminuídos e de T4L aumentados, compatíveis com hipertireoidismo clínico, e duas tiveram diagnosticado hipertireoidismo subclínico, apenas com concentrações de TSH diminuídas. CONCLUSÕES: a freqüência de anticorpos antitireoidianos foi de 12,6% em gestantes, sendo os anticorpos antitireoperoxidase predominantes sobre os anticorpos antitireoglobulina. Verificaram-se disfunções da tireóide em 8% dos casos, com alterações de TSH e/ou T4L.

Directly Observed Therapy (DOT) that is used for tuberculosis treatment, where a trained health worker watches the patient swallow every dose can be used for patients receiving doses of Levothyroxine of more than 2micrograms/kg with persistently increased TSH levels who are considered as having thyroid deficiency that is refractory to treatment. Poor adherence is the most common cause of failure of therapy and if this is suspected, a supervised test may be helpful.

We report a case of a male patient thyroidectomized for follicular thyroid carcinoma and presenting extremely elevated serum thyrotropin levels under L-T4 suppressive therapy. Administration of L-T3 in increasing amounts resulted in a significant decrease of serum TSH levels. The nature of the possible molecular defects underlying this unusual condition and pitfalls arising from the failure of L-T4 therapy to inhibit TSH secretion in a patient in post-surgical follow-up for follicular carcinoma are discussed.

Objectives The objective was to examine the effectiveness of levothyroxine treatment in hypothyroid patients in achieving normal thyroid stimulating hormone (TSH), T4 and T3. Material and methods Results of the treatment of 2448 hypothyroid patients treated with LT4 for at least 12 months between 2006 and 2011 (1920 with spontaneous hypothyroidism and 528 with hypothyroidism following surgery or 131I) are presented. Serum TSH, T4 and T3 were analyzed and referred as normal, increased or decreased. Results Normal TSH was found in 75 and 68% of patients respectively. In subgroups with increased TSH, 15% and 14% of patients showed borderline or only mildly increased TSH (4.1–5.5 mIU/L). T4 (94 and 86%) and T3 (93 and 90% respectively) were normal in the majority of patients from both groups. LT4 over-treatment is observed in only 4 and 6% of patients respectively. Conclusion The results are less favorable for the group with hypothyroidism following surgery or 131 I than in spontaneous hypothyroidism, but in about 90% of patients with spontaneous hypothyroidism and 82% with hypothyroidism following surgery or 131 I, the LT4 dose could remain unchanged. It is discussed whether standard LT4 replacement could render normal TSH and thyroid hormone patterns in all hypothyroid patients.

It is claimed that inappropriate requesting of thyroid function tests (TFTs) is common in acutely ill patients. Consecutive inpatient TFTs ( n=129) were assessed in relation to clinical history and common symptoms and signs of thyroid disease. Requests were justified in 69% of cases, most commonly on the basis of atrial fibrillation and/or tachycardia. There were no clear reasons for requesting TFTs in the remaining cases, although the yield of abnormal results in these patients was similar to that in those with justified requests. Thyroid stimulating hormone (TSH) concentration was increased (median 7·5 mU/L, range 4·8-38·6 mU/L) in 22 patients, six of whom had biochemical and/or clinical evidence of hypothyroidism (previously undiagnosed) and five of whom had pre-existing hypothyroidism. Of the remaining 11 patients with increased TSH levels, three were confirmed to have compensated hypothyroidism; non-thyroidal illness (NTI) (including the effect of drugs) accounted for four cases. In four patients (one of whom died during the admission) follow-up was not possible. Of six patients with reduced TSH concentration (range < 0·05-0·35 mU/L), one was thyrotoxic on carbimazole, one was receiving thyroxine for hypothyroidism, one had NTI and three were lost to follow-up (two of whom died during their admission). Manifestations of thyroid disease are protean and often subtle, and TFTs are thus clinically justified in many unwell inpatients. Although NTI contributes to some cases of abnormal TSH levels, a significant number of TFT abnormalities are consistent with underlying thyroid abnormality requiring investigation/treatment.

The aim of neonatal screening programs for congenital hypothyroidism is to ensure early treatment in order to prevent brain dysfunction. There are several reasons why infants are missed in the screening program. We report on three patients with congenital hypothyroidism, who had a pathological screening result and initiation of therapy was delayed. The first patient had an increased TSH level, but she was missed because of mistakes in the confirmatory serum test. During the follow-up the patient showed typical symptoms of hypothyroidism and got a thyroxine supplementation not before the age of three years. The second patient did not get a therapy before the age of six months because of the noncompliance of the parents and physicians. The third patient had a central hypothyroidism. The neonatal screening-program revealed no measurable TSH activity. Although the child had clinical signs of a severe hypothyroidism diagnosis was not made before the age of 5.5 months. Although different reasons are known for screening errors, all these 3 patients were missed because of failures in the follow-up of a pathological screening result, indicating a poor quality in the follow-up procedure.

Objetivo: describir los niveles de TSH en pacientes con cefalea crónica diaria (CCD) que asistieron a la consulta externa de neurología en los hospitales de San José y Santa Clara entre mayo 2008 y mayo 2010. Métodos: serie de casos de pacientes que asistieron a consulta y cumplieron criterios para CCD, se excluyeron los que tuviesen causa secundaria sistémica o estructural, o que consumieran medicamentos que alteraran la TSH. Se interrogaron síntomas frecuentes asociados con hipotiroidismo. Resultados: se incluyeron 201 pacientes, 50 % tenían 53 años o menos (RIQ: 43-63). Se encontró TSH anormal en 79 (39%), la alteración del sueño fue el síntoma asociado más frecuente (50%), la cefalea más común con TSH elevada de tipo tensión en 48 (61.6%) y migraña en 15 (19.2%). Conclusión: en los pacientes con CCD que a pesar de recibir tratamientos de primera línea la cefalea persiste y se torna crónica, conviene explorar alteraciones en la homeostasis como hipotiroidismo y determinar cifras de TSH debido a que hay un porcentaje que no cumplen los criterios de las cefaleas crónicas más frecuentes. El estudio no permite establecer una asociación entre ésta y el hipotiroidismo.

Alcelik, Aytekin/0000-0002-3156-1076 WOS: 000309036000007 PubMed: 22825898 Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients. (Cardiol J 2012; 19, 4: 374-380)

A 59-year-old woman was examined because of weight gain, increasing fatigue and secondary amenorrhoea, which occurred after a complicated delivery at age 18. The finding of an increased TSH concentration was initially considered as primary hypothyroidism and substitution therapy was commenced. Because of the concomitant secondary amenorrhoea the patient was referred for additional endocrinological investigations.

OBJECTIVE We evaluated pulsatile and circadian TSH secretion in primary hypothyroidism. DESIGN In a prospective study, blood was sampled every 10 minutes during 24 hours for assay of TSH (IRMA). Thyroid hormones and TSH responsiveness to TRH were then measured. SUBJECTS Nine patients with overt primary hypothyroidism, seven patients with subclinical hypothyroidism and 16 healthy controls. MEASUREMENTS Computer-assisted analysis by the Desade and Cluster programs. RESULTS Both computer-assisted programs revealed an increased TSH pulse amplitude in both overt and subclinical hypothyroidism versus controls (Desade: 36.9 +/- 31.4 (mean +/- SD) (P < 0.001) and 2.8 +/- 1.9 (P < 0.001) vs 0.4 +/- 0.2 mU/l; Cluster: 25.6 +/- 25.1 (P < 0.001) and 2.4 +/- 1.4 (P < 0.001) vs 0.4 +/- 0.2 mU/l). TSH pulse frequency remained unchanged with approximately 10 pulses/24 hours. A highly significant correlation was found between the mean 24-hour TSH concentration and the TSH pulse amplitude in all controls and patients but not to TSH pulse frequency. The nocturnal TSH surge was absent in six out of nine patients with overt primary hypothyroidism. The deficient nocturnal rise of TSH in primary hypothyroidism vs controls (22 +/- 51 vs 82 +/- 41%, P < 0.001), was associated with a loss of the usual nocturnal increase in TSH pulse amplitude and frequency. CONCLUSIONS Mean 24-hour TSH pulse amplitude is increased in primary hypothyroidism, but TSH pulse frequency remains unchanged. The decrease of the nocturnal TSH increase in primary hypothyroidism is associated with a loss of the usual nocturnal increase in TSH pulse amplitude and frequency.

PURPOSE: We assessed potential health effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) concentration in serum on thyroid function in US Air Force veterans involved in Operation Ranch Hand, the unit responsible for the aerial spraying of herbicides, including TCDD-contaminated Agent Orange, during the Vietnam War from 1962 to 1971. Other Air Force veterans who were not involved with spraying herbicides were included as Comparisons. METHODS: We analyzed thyroxine (total T4), thyroid stimulating hormone (TSH), triiodothyronin percent uptake (T3% uptake), the free thyroxine index (FTI), and thyroid diseases against serum TCDD levels. Data was available for 1,009 Ranch Hand and 1,429 Comparison veterans compliant to any of five examinations in 1982, 1985, 1987, 1992, and 1997. Each veteran was assigned to one of four exposure categories based on serum TCDD levels, named Comparison, Ranch Hand Background, Ranch Hand Low Elevated, and Ranch Hand High Elevated. RESULTS: Cross-sectional analyses found statistically significantly increased TSH means at the 1985 and 1987 examinations in the High category and a significant increasing trend across the three Ranch Hand TCDD categories in 1982, 1985, 1987 and 1992. A repeated-measures analysis found significantly increased TSH means in the High TCDD category. We found no significant relation between the occurrence of thyroid disease and TCDD category. CONCLUSIONS: These findings suggest that TCDD affects thyroid hormone metabolism and function in Ranch Hand veterans. Further follow-up will be necessary to understand the relation, if any, between thyroid disease and TCDD levels.

Emerging from a stimulating encounter over fifty years ago between Dr. S. M. Seidlin and a celebrated patient at Montefiore Hospital in New York City are a number of findings that bear significantly on the contemporary practice of medicine relating to targeted radioisotope therapy. In 1943, Seidlin administered radioiodine to this patient, who was hyperthyroid although previously thyroidectomized, but who had several metastases from adenocarcinoma of the thyroid which localized the radioisotope. Seidlin recognized early that some thyroid metastases would take up radioiodine (i.e., function), but only after the normal thyroid gland was ablated, an essential preliminary procedure before radioiodine therapy should be administered, the clinical practice followed to this day. He held that removing the normal thyroid increased TSH production and eliminated the gland's competition for radioiodine, inducing the metastases to function. From 1942 until his death in 1955, Seidlin and his group followed many patients having metastatic thyroid carcinoma, conducting fruitful investigations concerned with the induction of function, dosimetry, and the occurrence of leukemia in some massively treated patients.

Newman et al. (1) have described a factitious increase in thyrotropin in 2 infants and their mothers, detected by newborn screening using a blood-spot thyroid-stimulating hormone (TSH) assay. The authors do not positively identify the cause of this increase in TSH, but they describe its disappearance from one infant’s serum as consistent with an immunoglobulin. Most cases of a factitious increase in TSH in newborns are attributable to the presence in sera of heterophilic antibodies. Equipment manufacturers, to protect their assays from these effects, include nonimmune serum or immunoglobulin in their reagents, giving a very low incidence of TSH increase. Newman et al. suggest that their case is unusual because no treatments were administered to the mother that would account for the increased TSH, and she had not been exposed to animals. A similar …

Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

In order to assess neonatal thyroid function in the endemic goitre areas of Greece, T4 and TSH have been measured. Previous studies had shown that in these endemic areas, adults had low T4 but normal TSH values, probably because of an increase in the serum T3 level. In this study, T4 and TSH were measured in dried blood spots from 259 neonates. The fifty-four full-term neonates from the Greek endemic villages had a lower T4 value (8.8 +/- 0.66 micrograms/dl SE) but a higher TSH (15.37 +/- 1.12 mu/l) than the seventy-three full-term neonates from the non-endemic villages (T4:10.0 +/- 0.33 micrograms/dl, TSH:11.93 +/- 0.59 mu/l) or the ninety-eight from Athens (T4:10.0 +/- 0.33 micrograms/dl, TSH:10.96 +/- 0.64 mu/l). Premature neonates, both from Athens and from the endemic areas, have significantly lower T4 and significantly lower TSH values than the full-term ones from the same areas, probably because of the immaturity of the pituitary-thyroidal axis. It is concluded from these observations that (a) Neonates suffer more from the consequences of iodine deficiency than adults. The biochemical hypothyroidism reported here may be relevant to the delayed skeletal maturation previously reported from children of these same areas. This emphasizes the need for correcting even moderate iodine deficiency. (b) The occurrence of non-toxic goitre with normal TSH levels in adults is best explained by assuming that increased TSH stimulation is necessary for goitre formation during neonatal life, but not for goitre maintainance during adulthood. (c) Newborn screening programmes in these areas should take into account the present findings.

Serum levels of thyroxine (T4), 3,3',5-triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3), 3,5-diiodothyronine (3,5-T2), 3,3'-diiodothyronine (3,3'-T2) and 3',5'-diiodothyronine (3',5'-T2) were studied in 80 patients with endogenous depression before and after electroconvulsive treatment (ECT). Compared to the values found after recovery, the patients when depressed had significant increased serum levels of T4, rT3, 3,3'-T2 and 3',5'-T2. Serum concentrations of T3 and 3,5-T2 were not significantly altered. Similarly the free T4 index (FT4I) was increased, while the free T3 index (FT3I) was unaffected. Previous studies have shown a reduced TSH response to TRH in patients with endogenous depression and that the long-term outcome after ECT is strongly related to changes in the TSH response. However, patients with increased TSH response to TRH (n = 23) had a pattern of serum iodothyronine concentrations similar to those (n = 57) with an unchanged TSH response. A similar pattern was also found in 7 patients with non-endogenous psychosis, in whom the TSH response to TRH was unchanged after recovery. It is concluded that the alterations of the TSH response to TRH found in endogenous depression cannot be explained by changes of FT4I or FT3I.

A 20-year-old female presented with thyrotoxicosis associated with amenorrhoea and galactorrhoea after oral contraceptive withdrawal. Serum TSH was persistently elevated (mean: 28 +/- 3.1 microU/ml during 24-h sampling and did not vary significantly after TRH, bromocriptine or somatostatin. Prolactin levels remained constantly at the upper limit of normal (mean: 20.6 +/- 2.1 ng/ml, with a minimal increase after TRH, a slight decrease after somatostatin (54%) and a marked decrease after bromocriptine (88.5%). Surgical exploration revealed an unusually firm tumour adherant to the wall of the sella turcia; electron microscopic study showed that it was composed almost exclusively of thyrotrophs. After a transient period of euthyroidism post-operatively, T3 toxicosis occurred with an increased TSH level (15.5 microU/ml) and a rise in TSH and alpha subunit in response to TRH. An increase in T4 followed while prolactin remained low.

Studies of thyroid activity following hypothalamic lesions have provided indirect evidence of TSH influence on the pars distalis of birds. The present study examined the influence of hypothalamic lesions on TSH assays of the rostral and caudal lobes of the pars distalis. Lesions of the septomesencephalic tract increased TSH levels in the rostral lobe but had no influence on the caudal lobe. Lesions of the supraoptic or ventrolateral nuclei neither stimulated nor depressed TSH in either lobe of the pars distalis.

In a pilot screening programme for congenital hypothyroidism, PKU filter paper blood samples from 20 000 infants born in Stockholm were analysed for TSH and T4 to identify optimal conditions for routine nationwide screening. Among 160 infants with positive screening tests, 7 infants (group I) had true-positive results, 6 had primary and one secondary hypothyroidism. The 153 infants with false-positive tests were divided into group II:74 infants with an isolated increased TSH level; group III: 71 infants with an isolated decreased T4 concentration; and group IV: 8 infants with increased TSH and decreased T4 levels. In group I the clinical signs and symptoms of hypothyroidism varied when the diagnosis was made at 3 weeks of age. The median hypothyroid index score was 8 (range 0--18). In groups II-IV most infants showed very few signs of hypothyroidism. The median hypothyroid index scores were 1, 1, and 0, respectively. Clinical findings were of little value in the individual case for distinguishing true from false positive screening tests. We suggest that nation-wide screening should be based on TSH analyses of PKU blood samples, with a cut-off level corresponding to 50 mU/l of plasma. Recall frequency will be less than 0.1%.

Thyroid levels were estimated in 15 patients with endogenous depressions. Before electroconvulsive treatment (ECT), serum thyroxine (T4) and free T4 index values were elevated (P less than .02). After recovery from depression, the levels were normal. Serum triiodothyronine (T3) and free T3 index were normal both before and after ECT. Serum thyrotropin (TSH) levels were also normal and not substantially altered by the ECT procedure. The mean maximal TSH response to protirelin (thyrotropin-releasing hormone) was diminished in the depressed patients and normal after recovery. In three patients, the increase in TSH response to protirelin after recovery did not occur and they relapsed within six months, while in seven patients with increased TSH response to protirelin after recovery only one relapse occurred. The disturbances in the free T4 index, T4, and the protirelin test may in some depressed patients resemble hyperthyroidism, but this condition can be excluded by means of serum, T3 and free T3 index.

The object of this study was to investigate TSH receptors in hyperfunctioning thyroid nodules (HFN). In HFN, obtained from seven patients, 125-I-TSH binding as determined by equilibrium binding analysis on particulate membrane preparations, was found to be significantly increased as compared with normal thyroid tissues (five patients; P less than 0.001). Scatchard analysis of TSH-binding revealed two kinds of binding sites for both normal thyroid tissue and HFN, and displayed significantly increased association constants of high- and low-affinity binding sites in HFN (Ka = 11.75 +/- 6.8 10(9) M-1, P less than 0.001 and Ka = 2.1 +/- 1.0 10(7) M-1, P less than 0.025; x +/- SEM) as compared with normal thyroid tissue (Ka = 0.25 +/- 0.06 10(9) M-1, Ka = 0.14 +/- 0.03 10(7) M-1; x +/- SEM). The capacity of the high-affinity binding sites in HFN was found to be decreased (1.8 +/- 1.1 pmol/mg protein, x +/- SEM) in comparison with normal thyroid tissue (4.26 +/- 1.27 pmol/mg protein; x +/- SEM). TSH-receptor autoradiography applied to cryostatic tissue sections confirmed increased TSH binding of the follicular epithelium in HFN. These data suggest that an increased affinity of TSH-receptor sites in HFN in iodine deficient areas may be an important event in thyroid autonomy.

Large doses of iodide (500 mg three times a day) administered to normal men for 10--12 days caused a rise in basal serum TSH and a concomitant rise in the peak TSH response to TRH. The basal and peak levels of TSH were highly correlated (p less than 0.001). However, the iodide-induced rise in the peak TSH after TRH was poorly correlated with concomitant changes in serum thyroid hormones. Serum T3 wa not lower after iodide and, while serum T4 was somewhat lower, the fall in serum T4 was unexpectedly inversely rather than directly correlated with the rise in the peak TSH response to TRH. Thus, increased TSH secretion after iodide need not always be directly correlated with decreased concentrations of circulating thyroid hormones even when large doses of iodide are used. Clinically, a patient taking iodide may have an increased TSH response in a TRH stimulation test even though there is little or no change in the serum level of T3 or T4.

To the Editor. —The article by Sawin et al 1 in the August 1985 issue of theArchivesdemonstrates that screening for hypothyroidism in the elderly by measuring serum thyrotropin (TSH) levels is much more sensitive than screening by checking thyroxine levels. While this is certainly true, screening for hypothyroidism in the elderly by checking TSH levels may also miss cases of hypothyroidism. Ordene et al 2 reported that when elderly patients were administered iodine to interfere with their normal thyroid function, approximately half of the patients failed to mount an increased TSH response to thyrotropin-releasing hormone, while the young control patients did. These results indicate that the true incidence of hypothyroidism in the elderly may be even higher than the 4.4% reported by Sawin et al, because elderly patients may have an impaired ability to mount a TSH response to hypothyroidism.

In an attempt to analyze thyroid stimulators in serum we developed an assay procedure using hTSH radioimmunoassay (RIA) in combination with receptor competition. The principle of this method is the determination by RIA of hTSH displaced by other thyroid stimulators from a thyroidal receptor preparation which previously bound unlabelled hTSH. Practically 4 microunits of hTSH were bound with human or bovine receptor, and then hTSH displaced by addition of test serum (0.1 ml) or samples dissolved in serum (0.1 ml) was measured by RIA. This assay can determine the thyroid stimulators other than hTSH in serum that has the displacement activity of 0.5-4.0 microunits of hTSH in the useful range, such as mU/ml level of bovine TSH or rat TSH. Cholera toxin that has the thyroid stimulating activity like TSH also showed the displacement of the bound hTSH. This assay is not applicable for the human serum with more than 5 microunits/ml of TSH, because the assay value is over estimated by the free hTSH derived from the test serum. On the other hand, eighteen sera with high LATS activity and 42 sera with negative LATS activity from patients with untreated hyperthyroidism did not show any displacement. This might be due to the lower binding activity of LATS with hTSH receptor or the lower sensitivity of this assay method. Although it is difficult to use this assay clinically because of its low sensitivity, increased TSH in animal serum can be determined by this assay. The principle of this method may be also useful for examining the receptor binding of other peptide hormone that can be determined by an RIA method.

TSH levels were measured by radioimmunoassay in the sera of 60 Belgian euthyroid subjects, aged from 4 to 32 years. A significantly higher TSH level was found in children aged from 7 to 15 years, when compared to the level obtained in adults. This increased TSH concentration and various indications of increased thyroid function during the growth spurt suggest a hyperstimulation of the thyroid at that period of life. Copyright © 1971, Wiley Blackwell. All rights reserved, SCOPUS: ar.j, FLWNA, info:eu-repo/semantics/published

SummaryEffects of pure TRF on male rat pituitary tissue were studied using standard organ culture techniques and chemically defined media. Addition of 40 pg of TRF caused increased TSH activity in both media and tissues, in comparison with controls. Under the conditions used, TRF seemed to stimulate the production of about 4 mU of TSH activity/pg of TRF used. This suggests that TRF can induce both the release and synthesis of TSH.

We investigated the thyroid function of 151 children with Down syndrome. Compared with a control group of 89 siblings nearest in age to their brother or sister with Down syndrome the mean TSH value was significantly higher in children with Down syndrome than in the non-Down syndrome children (8.49 μU/ml vs. 3.55 μU/ml). However, the mean T4, levels in both groups were nearly the same (8.36 μg/dl and 8.60 μg/dl). In the Down syndrome group there was a trend for TSH values to increase and for T4 values to decrease with advancing age. Of the 151 patients with Down syndrome, 10 had both significantly elevated TSH levels ( > 9.5 μU/ml) and significantly decreased T4 levels ( 9.5 μU/ml), 7 had markedly increased T4 levels (> 12.0 μg/dl), and 3 had significantly decreased T4 levels (< 5.5 μg/dl). The intellectual functioning of children with both abnormal TSH and T4 levels was significantly lower (mean IQ 41.7) than that of Down syndrome children with only increased TSH values (mean IQ 53.8) and that of Down syndrome children with normal thyroid function (mean IQ 55.3). This study provides evidence that there is an increased prevalence of thyroid dysfunction in children with Down syndrome. Therefore, children with Down syndrome should have thyroid function studies performed at regular intervals and prompt treatment should be instituted if thyroid dysfunction has been identified.

Progression of CLT in T4 treated children has been poorly documented. The response of endogenous T4, T3 and TSH to withdrawal after 2 to 9 yrs of therapy in 6 children, 7-18 yrs, was studied with weekly levels for 4-20 wks. At Dx. of CLT 5 had hypothyroid values. Results indicated 3 patterns of response: 1) clinical and lab evidence of hypothyroidism in 6 wks, 2) increased TSH with normal T4 followed by return of goiter 8 wks off therapy, 3) clinical & chemical euthyroidism in 3 with no return of goiter 12-20 wks off therapy. This group demonstrated a reduction in agglutinating antibody (Ab) titers from initial levels. Two had hypothyroid lab data at dx. of CLT. Normal TSH, T4 & T3 occurred 3 wks after discontinuing therapy. A reduction in Ab titers with normal TSH accompanied euthyroidism. Hypothyroidism coincided with unchanged Ab. In contrast to adults treated for 10 yrs, with deterioration in thyroid function noted 6 wks off therapy (Papapetrou et al, Lancet, Nov.72), these studies indicated that the child may recover function after a period of replacement.

In Reply. —Drs Green and Kane correctly pointed out that differences in sleep patterns are possible sources of variance in TSH response to protirelin. They hypothesized that the blunted TSH response to protirelin in manic patients compared with normal controls and patients with schizophrenic psychosis that we reported may be an artifact of differences in sleep onset. This hypothesis is based on two assumptions. First, they assumed that increased TSH release after delay of sleep onset that has been reported in one study can result in a blunted TSH response to protirelin. Second, they assumed that the delay in sleep onset is significantly greater in mania than in schizophrenic psychosis. The first assumption could be tested

• Symptoms suggestive of hypothyroidism are common in primary care practice, but the yield of this disorder from symptom-based testing has not been adequately evaluated. We attempted to determine this yield and examine the effect of various patient factors on its magnitude. The records of 982 consecutive primary care health maintenance organization patients who had a thyroid-stimulating hormone (TSH) determination for suspicion of hypothyroidism were reviewed. Forty-two (4.3%) had an increased TSH concentration on initial testing, but only 17 (1.7%) had a TSH level 5 mU/L or more above normal. Abnormal thyroid examination results and white vs black race were independently associated with a TSH concentration 5 mU/L or more above normal. Female sex and age did not significantly affect the odds of an elevated TSH concentration. The yield of hypothyroidism from symptom-based testing in this setting was quite low. Although increasing age and female sex are both strong determinants of the risk of hypothyroidism in the general population, neither factor permitted risk stratification in symptom-based testing. The strong racial association noted was not anticipated and requires confirmation. ( Arch Intern Med . 1989;149:861-864)