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thyroid function testing in primary care

William Grey, Rosaline Hulse, Anna Yakovleva, Dilyana Genkova, Benjamin Whitelaw, Ellen Solomon, Salvador J Diaz-Cano, Louise Izatt
The REarranged during Transfection (RET) proto-oncogene is a receptor tyrosine kinase involved in growth and differentiation during embryogenesis and maintenance of the urogenital and nervous systems in mammals. Distinct mutations across hotspot RET exons can cause Multiple Endocrine Neoplasia Type 2A (MEN2A) characterised by development of medullary thyroid cancer (MTC), phaeochromocytoma (PCC) and primary hyperparathyroidism (PHPT), with a strong correlation between genotype and phenotype. Here, we report a 42-year-old man presented in the clinic with a unilateral PCC, with subsequent investigations revealing a nodular and cystic thyroid gland...
October 5, 2016: Endocrine Pathology
Mette Nygaard Andersen, Anne-Marie Schjerning Olsen, Jesper Clausager Madsen, Søren Lund Kristensen, Jens Faber, Christian Torp-Pedersen, Gunnar H Gislason, Christian Selmer
CONTEXT: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function. OBJECTIVE: To examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease. DESIGN: Register-based historical cohort study. SETTING AND PARTICIPANTS: Danish primary care patients and hospital outpatients aged 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997 - 2011...
August 29, 2016: Journal of Clinical Endocrinology and Metabolism
M Nazou, E Parlapani, E-I Nazlidou, P Athanasis, V P Bozikas
Thyroid hormones are crucial in adult brain metabolic activity. As a result, abnormal thyroid gland function and in particular hypofunction, might cause principally depression and neurocognitive dysfunction. Psychosis, presented mainly with thought disorders and perceptual disturbances, is a much rarer manifestation of hypothyreoidism. A correlation between hypothyreoidism and psychosis has been described since 1888, especially in cases of advanced hypothyreoidism. A few years later (1949), Asher first added the terminology "myxedema madness" to the literature...
April 2016: Psychiatrikē, Psychiatriki
Michael T Sheehan
Disorders of thyroid function are common, and screening, diagnosis, and management are often performed by primary care providers. While management of significant biochemical abnormalities is reasonably straight forward, laboratory tests only slightly outside, or even within, the normal range are becoming more difficult to appropriately manage. A large part of this increasing difficulty in appropriate management is caused by patients requesting, and even demanding, certain tests or treatments that may not be indicated...
June 2016: Clinical Medicine & Research
Jun-He Li, Hong-Hong He, Yuan Cheng, Wen-Jing He
Most thyroid lymphomas are B-lineage, and T-cell lymphomas are rare. None of primary thyroid extranasal NK/T-cell lymphoma (NKTCL) has been reported in the literature. Here, we report a case of extranasal NKTCL exclusively arising in the thyroid in an 18-year-old Chinese.The patient presented with rapid anterior swelling at the neck and aggravated dyspnea for 2 months. Neck computer tomography scan revealed diffuse thyroid enlargement in the left lobe compressing the trachea. The thyroid function test was indicative of hypothyroidism...
May 2016: Medicine (Baltimore)
Julian H Barth, Jennifer D Spencer, Stephen R Goodall, Ahai Luvai
INTRODUCTION: Laboratories are recommended to determine their own local reference intervals (RIs) to embrace the variations in local populations. We have assessed local RIs for thyroid function tests using two different approaches to selection of reference populations and also searched the literature for studies using the Advia Centaur methods. METHODS: Two independent populations were made of redundant serum samples from primary care in which exclusion criteria were used to reduce the inclusion of patients with thyroid disease...
May 2016: Annals of Clinical Biochemistry
Jaya Prakash Sahoo, Jayakumar Selviambigapathy, Sadishkumar Kamalanathan, K Nagarajan, Muthupillai Vivekanandan
BACKGROUND: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism...
March 2016: Indian Journal of Endocrinology and Metabolism
Maria Salinas, Maite López-Garrigós, Francisco J Pomares, Emilio Flores, Joaquín Uris, Carlos Leiva-Salinas
BACKGROUND AND OBJECTIVES: Laboratory tests are crucial for diagnosis and monitoring of thyroid disorders. It is therefore necessary to study the pattern and variability in requests of thyroid function tests. The study objectives were to compare the inter-regional variability in the request of laboratory thyroid tests by general practitioners (GPs) in Spain, and to investigate the potential economic savings if the goals set for some suitability indicators were reached. METHODS: Test requests per 1,000 inhabitants and test ratios (free thyroxine (FT4)/thyrotropin (TSH), free triiodothyronine (FT3)/TSH, thyroglobulin antibody (TgAb)/peroxidase antibody (TPOAb)) were compared between the different areas, according to their setting, location, and management...
January 2016: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Faiza Abdulaziz Qari
BACKGROUND: Thyroid hormone has the a major role in the cardiovascular system function and cardiac a As well as to maintain the cardiovascular homeostasis A slightly change ind thyroid status actually affects cardiovascular mortality hemodynamic. The background of this study was to define the prevalence of thyroid dysfunction in acute coronary syndrome (ACS). OBJECTIVES: The primary objective was to define the prevalence of thyroid dysfunction in acute coronary syndrome, including Non-ST Segment Elevation Myocardial Infarction (NSTEMI), ST-segment Elevation Myocardial Infarction (STEMI), and unstable angina groups...
July 2015: Iranian Red Crescent Medical Journal
Zehra Yasar, Cenk Kirakli, Pınar Cimen, Zeynep Zeren Ucar, Fahrettin Talay, Gultekin Tibet
INTRODUCTION: Non-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in intensive care unit (ICU) patients. In this study, we evaluated the association between NTIS and prolonged weaning in chronic obstructive pulmonary disease (COPD) patients admitted to the ICU. MATERIALS AND METHODS: In total, 125 patients with COPD admitted to our ICU who underwent invasive mechanical ventilation (MV) were enrolled. We collected each patient's baseline characteristics including Acute Physiology and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and thyroid hormones 24 h after ICU admission...
2015: International Journal of Clinical and Experimental Medicine
Linda M Thienpont, James D Faix, Graham Beastall
Given the prevalence of thyroid disorders and the subtle signs and symptoms that may accompany subclinical disease, reliable laboratory testing for serum TSH and free thyroid hormones is important for both primary care physicians and endocrinologists. The laboratory community has recognized the need for standardization of thyroid function tests to achieve comparability of measurement results between methods. This applies in particular to tests for free T4 (FT4), which may be considered controversial in terms of clinical and analytical validity...
2015: Endocrine Journal
Linda M Thienpont, James D Faix, Graham Beastall
No abstract text is available yet for this article.
July 23, 2015: Clinical Endocrinology
Kim S Griswold, Paula A Del Regno, Roseanne C Berger
Psychosis is a symptom complex that may include hallucinations, delusions, disorders of thought, and disorganized speech or behavior. Acute psychosis is primary if it is symptomatic of a psychiatric disorder, or secondary if caused by a specific medical condition. Patients with primary psychiatric disorders are likely to have auditory hallucinations, prominent cognitive disorders, and complicated delusions. If psychosis is caused by a medical condition, the patient may exhibit cognitive changes and abnormal vital signs, and may have visual hallucinations...
June 15, 2015: American Family Physician
Mette Nygaard Andersen, Anne-Marie Schjerning Olsen, Jesper Clausager Madsen, Jens Faber, Christian Torp-Pedersen, Gunnar Hilmar Gislason, Christian Selmer
BACKGROUND: Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. METHODS AND RESULTS: Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled...
2015: PloS One
Rebecca Hardwick, Janet Heaton, Glyn Griffiths, Bijay Vaidya, Sue Child, Simon Fleming, William Trevor Hamilton, Julie Tomlinson, Zhivko Zhelev, Anthea Patterson, Chris Hyde
BACKGROUND: The ordering of thyroid function tests (TFTs) is increasing but there is not a similar increase in thyroid disorders in the general population, leading some to query whether inappropriate testing is taking place. Inconsistent clinical practice is thought to be a cause of this, but there is little evidence of the views of general practitioners, practice nurses or practice managers on the reasons for variation in the ordering of TFTs. AIM: To find out the reasons for variation in ordering of TFTs from the perspective of primary healthcare professionals Methods: Fifteen semi-structured interviews were carried out with primary healthcare professionals (general practitioners, practice nurses, practice managers) that used one laboratory of a general hospital in South West England for TFTs...
2014: Quality in Primary Care
Caroline Chua, Shilpa Gurnurkar, Yahdira Rodriguez-Prado, Victoria Niklas
Congenital hypothyroidism (CH) is the most common endocrine disorder affecting the newborn. Universal newborn screening (NBS) has virtually eliminated the static encephalopathy and devastating neurodevelopmental syndrome known as cretinism. This report describes the presentation of an infant referred by the primary pediatrician to our hospital at 12 days of age for confirmatory testing after the NBS was consistent with CH. The infant had hypoglycemia secondary to lethargy and poor feeding and required transfer to the neonatal intensive care unit for worsening abdominal distension despite normalization of serum thyroid function tests following hormone replacement...
2015: Case Reports in Pediatrics
Michael J Tidman
Urticaria is characterised by transient wheals that consist of a swollen palpable centre often surrounded by an erythematous flare, associated with itching or, less commonly, a burning sensation. Individual wheals usually disappear within 1 to 24 hours leaving normal skin. Wheals may be accompanied by angioedema, a more deep-seated flesh-coloured or erythematous swelling of skin or mucous membrane, which may last longer than 24 hours. Urticaria is classified as acute when it resolves within six weeks and chronic when its duration exceeds six weeks...
February 2015: Practitioner
Alexander Werhun, William Hamilton
BACKGROUND AND AIM: Diagnostic testing is increasing in primary care, including for thyroid disease. This study examined which clinical features were associated with an abnormal thyroid stimulating hormone (TSH) result. DESIGN AND SETTING: This was a cross-sectional study in one general practice of 16,487 patients in Exeter, Devon, UK. METHODS: We examined the primary care records relating to every TSH test taken in the year from August 2012, and extracted symptoms and/or the indication for testing...
April 2015: Family Practice
Chiara Sabbadin, Gabriella Donà, Luciana Bordin, Maurizio Iacobone, Valentina Camozzi, Caterina Mian, Decio Armanini
BACKGROUND: Primary hyperparathyroidism (PHPT) is often found on routine blood tests, at a relatively asymptomatic stage. However many studies suggest different systemic effects related to PHPT, which could be enhanced by an abnormal cortisol release due to chronic stress of hyperparathyroidism. Being PHPT frequently found in the 6(th) to 7(th) decade of life, a careful and multifaceted approach should be taken. CASE PRESENTATION: We report the case of an elderly patient with symptomatic PHPT and incidental pulmonary embolism...
2015: BMC Endocrine Disorders
Ce Tan, Ky Loh
Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided...
2013: Malaysian Family Physician
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