Diagnosis Of Hypothyroidism In Patients Research Articles

Social and clinical factors associated with the early diagnosis of hypothyroidism in Down syndrome

Objective: To establish the social and clinical factors associated with the early diagnosis of hypothyroidism in patients with Down syndrome in a highly complex hospital in Colombia. Methodology: An observational, cross-sectional and analytic study was conducted in patients with hypothyroidism and Down syndrome aged three years old or younger, attended between the years 2017 - 2018. We had as secondary source the information of the clinical histories and as primary source a telephone survey carried out to the caregiver of the patient, we evaluated demographic, social and clinical variables. Results: 144 clinical histories were evaluated, of which 78 were able to comply with the variables; 32 patients presented hypothyroidism and with them the investigation was carried out. The early diagnosis of hypothyroidism, understood as that before 6 months of age, was 59. 4%. Clinical hypothyroidism was 71. 1% with connection to the subclinical, 87. 5% had thyroid stimulating hormone (TSH) levels lower than 15 mU/L neonatal and 3% of the population had congenital hypothyroidism. 50% of cases were diagnosed with hypothyroidism in the first three months of life. The height at birth in relation to the early diagnosis of hypothyroidism presented an RP: 14, IC 95%: 1.06-186. Conclusions: Early diagnosis of hypothyroidism has an association by the size of the patients at birth. Continuous monitoring of thyroid function in the first months and years of life of patients with Down syndrome, independent of neonatal TSH values, should be performed.

Study of TSH level at the time of diagnosis of Hypothyroidism in patients with Diabetes Mellitus- A Retrospective Study

Background: To evaluate the difference in the level of TSH in diabetic and non diabetic patients at the time of the diagnosis of hypothyroidism.
 Methods: 100 diagnosed cases of hypothyroidism, 50 with diabetes and 50 without diabetes were studied. The level of TSH at the time of diagnosis and other information were obtained from the medical records.
 Results: The mean TSH in patients with the history of diabetes at the diagnosis of hypothyroidism was 19.9616±26.990 and in those without the history of the diabetes was 10.4797±6.503 (p value 0.018). The females with diabetes had higher level of TSH level at the time of diagnosis of hypothyroidism than females without diabetes (p value 0.045). There was no statistically significant difference in the level of TSH in males with and without diabetes at the time of diagnosis of hypothyroidism.
 Conclusion: Patients with diabetes mellitus had higher level of TSH at the time of diagnosis of hypothyroidism in comparison to those without diabetes. Early identification of the raised TSH levels in diabetic patients and timely intervention will help to reduce the chances of adverse cardiovascular outcomes and diabetic kidney disease in this group of patients.

Deficient nocturnal surge of thyrotropin in central hypothyroidism.

In normal individuals, serum TSH concentrations have a circadian pattern characterized by a nocturnal surge which begins in the late afternoon and reaches its peak after midnight. We assessed the nocturnal surge of TSH in 16 patients with pituitary and/or hypothalamic diseases, 6 of whom were judged to be hypothyroid. To assess the magnitude of the nocturnal surge in individual patients, TSH was measured in 5 serum samples obtained during the normal time of the TSH nadir in the late afternoon and in 5 samples obtained during the normal time of the peak of serum TSH after midnight. A significant nocturnal surge of TSH was defined as a significantly greater mean nighttime TSH level than the mean daytime TSH concentration. The nocturnal TSH surge was absent in the 6 patients with central hypothyroidism, while it was present in the 10 euthyroid patients with central lesions. In 6 hypothyroid patients who did not have pituitary or hypothalamic lesions, the nocturnal TSH surge was intact, indicating that hypothyroidism per se does not account for the deficient nocturnal TSH surge in central hypothyroidism. We conclude that central hypothyroidism is characterized by a deficient nocturnal surge of TSH, and accordingly, we suggest that evaluation of the circadian pattern of TSH may be a useful adjunct in making the diagnosis of hypothyroidism in patients with diseases involving the pituitary or hypothalamus.