Elevated Serum Thyroid-stimulating Hormone Concentration Research Articles

Clinical study to evaluate the efficacy of Commiphora muku (Muqil) on thyroid function in hypothyroidism

Background: Hypothyroidism is a common endocrine disorder in which there is deficient production of thyroid hormone. Even though hormone replacement therapy is the mainstay treatment of hypothyroidism, but due to adverse effects on long term use, safe and effective Unani herbal drugs need to be researched. A decrease in serum concentrations of thyroid hormone causes an increased secretion of thyroid stimulating hormone (TSH), thus resulting in elevated serum TSH concentration. Methods: The methods used to determine thyroid dysfunction are still serum thyroid stimulating hormone and the main circulating thyroid hormones thyroxine and triiodothyronine either as total or estimated free concentrations, and it is indeed the improved assay sensitivities and specificities that have made it possible to diagnose these milder forms. TSH, T3 and T4 with safety parameters tests were done before treatment and after completion of treatment in both the groups in order to make the proper diagnosis, to exclude other systemic ailments and to assess the efficacy/safety of the proposed herbal drug. Results: The effects of test drug on lowering the raised serum TSH are attributed to the thyroid activities of the test drug which shoes highly significance p<0.01 before and after intervention. In respect of thyroxin there were no significant results between the test and control group. Conclusions: The study concluded that the efficacy of Commiphora mukul (Muqil) on thyroid function was designed to explore the role of Unani herbal drugs in the management of hypothyroidism on Unani principles is effective, safe and cost effective.

Association between thyroid dysfunction and dysglycaemia: a prospective cohort study.

To compare the incidence of hyperglycaemia among participants with low, elevated and normal serum thyroid-stimulating hormone concentration, as well as the incidence of abnormal thyroid function test results among participants with normal blood glucose and those with hyperglycaemia. In a prospective study, a cohort of 72 003 participants with normal, low and elevated serum thyroid-stimulating hormone concentration were followed from the study beginning to the first report of diabetes and prediabetes. A proportional hazards regression model was used to calculate the hazard ratios and 95% CIs for each outcome, adjusting for age, sex, education level, smoking, alcohol consumption and obesity. Analyses for the association between dysglycaemia and incident abnormal thyroid function test were also conducted. During a median 2.6 year follow-up, the incident rates for dysglycaemia, particularly prediabetes, were substantially higher in participants with elevated thyroid-stimulating hormone concentrations at baseline, while the rates for participants with normal and low thyroid-stimulating hormone were similar. After controlling for risk factors, participants with elevated thyroid-stimulating hormone retained a 15% increase in risk of prediabetes (adjusted hazard ratio 1.15, 95% CI 1.04-1.26), but were not at greater risk of diabetes (adjusted hazard ratio 0.96, 95% CI 0.64-1.44). By contrast, participants with normal and low thyroid-stimulating hormone concentrations had similar dysglycaemia risks. Participants with diabetes and prediabetes were not at greater risks of developing abnormal thyroid function test results when compared with participants with euglycaemia. People with elevated serum thyroid-stimulating hormone concentration are at greater risk of developing prediabetes. Whether this includes a greater risk of developing frank diabetes may require an extended period of follow-up to clarify.

Naturally occurring acquired primary hypothyroidism in a cat due to lymphocytic thyroiditis

A five-year-old ovariohysterectomised female Bengal cat was presented for investigation of weight gain, despite dietary modification, and a dry, poor quality hair coat with diffuse scaling of the skin. Initial...

An immunoglobulin G complexed form of thyroid-stimulating hormone (macro thyroid-stimulating hormone) is a cause of elevated serum thyroid-stimulating hormone concentration

Macrocomplexes can be the cause of elevated serum hormone concentrations and may cause diagnostic confusion. This is well recognized for prolactin and commonly screened for using polyethylene glycol (PEG) precipitation. The phenomenon and a suitable screening method is less familiar with respect to thyroid-stimulating hormone (TSH). Samples sent to the laboratory for routine analysis of thyroid function and found to have a TSH >10 mU/L were evaluated to determine the prevalence of macro-TSH in the Roche Elecsys assay, using PEG precipitation with confirmation by gel filtration chromatography. Of 495 samples tested, 3 (0.6%) were found to have macro-TSH. From the distribution of recoveries, a cut-off <25% was determined for identifying samples requiring further investigation for the presence of macro-TSH. The prevalence of elevated TSH due to macro-TSH was found to be 0.6%. Laboratories should be aware of this cause of assay interference.

Oncofetal Fibronectin mRNA Is Highly Abundant in the Blood of Patients with Papillary Thyroid Carcinoma and Correlates with High-Serum Thyroid-Stimulating Hormone Levels

Papillary thyroid carcinoma (PTC) cells express oncofetal fibronectin (onfFN) mRNA, which may be useful to detect circulating tumor cells. The objective of this study was to determine the fraction of PTC patients having onfFN mRNA in their peripheral blood and to determine if onfFN mRNA levels are correlated with the status of the disease or with thyroid-stimulating hormone (TSH) serum concentrations. This study included 95 PTC patients, who were previously treated by thyroidectomy and radioactive iodine administration. Patients were examined by cervical sonography, whole-body (131)I scintigraphy, thyroglobulin measurement, and onfFN mRNA quantification both when they were being treated with L-thyroxine (L-T4) and after L-T4 withdrawal. The mean value for onfFN mRNA in blood from 25 healthy subjects was used as control for the onfFN mRNA assay. After L-T4 withdrawal, serum TSH levels rose and onfFN mRNA was found in the peripheral blood of 33 of 64 (52%) disease-free patients, 15 of 23 (65%) patients with local residual disease, and 6 of 8 (75%) patients with known local or distant metastases. Continuous administration of L-T4 repressed serum TSH. In this state none of 17 (0%) disease-free patients and 1 of 4 (25%) patients with local residual disease had an elevated onfFN mRNA level, and 2 of 4 (50%) patients with metastasis had positive tests for serum onfFN mRNA. onfFN transcripts are highly abundant in the peripheral blood of patients with PTC. L-T4 withdrawal, which produced elevated serum TSH concentrations in these athyroidic patients, markedly increased the fraction with positive tests for serum onfFN mRNA at all stages of the disease. Analyzing onfFN mRNA in the absence of a TSH stimulus allows a much better discrimination of different states of PTC disease and, based on current concepts of the significance of circulating mRNA, may be a useful tool to detect circulating thyroid cancer cells.

The upper limit of the reference range for thyroid-stimulating hormone should not be confused with a cut-off to define subclinical hypothyroidism

The upper limit of the reference range for serum thyroid-stimulating hormone (TSH) is used to assist in identifying individuals with hypothyroidism. Improvements in TSH assays have led to better definition of the lower limit of the reference range, but the upper limit of the range for a healthy population is currently a topic of some debate. Population studies have improved our understanding of the clinical implications of elevated serum TSH concentrations in terms of future progression to hypothyroidism, but have not yet fully elucidated the correlation of modestly elevated TSH levels with long-term morbidity. This paper will review the current debate including the arguments for and against reducing the upper limit of the TSH range, whether such a level should be based on evidence from epidemiological studies, and the implications of categorizing large numbers of people with subclinical hypothyroidism. The impact of using different methodologies for the measurement of TSH and the inherent variability of results on reference ranges is also discussed. We argue that the reference range for TSH should be assay-specific and be determined by standard techniques in normal populations as recommended by the National Academy of Clinical Biochemistry. In contrast, we suggest that a decision level be determined separately from epidemiological studies to identify a population with subclinical hypothyroidism. Serial monitoring of TSH in this population deserves further study as a means of identifying those at risk of progressing to frank hypothyroidism and meriting treatment.

Subclinical hypothyroidism

Mild or subclinical hypothyroidism is characterized by normal serum free thyroxine concentrations with elevated serum thyroid-stimulating hormone concentrations. Subclinical hypothyroidism is relatively prevalent in the general population, especially among women and the elderly. The main cause of subclinical hypothyroidism is autoimmune chronic thyroiditis. The present report reviews the most important and recent studies on subclinical hypothyroidism, and discusses the most controversial aspects of this topic. Several studies have demonstrated that subclinical hypothyroidism may affect both diastolic and systolic cardiac function. It may also worsen many risk factors for cardiovascular disease, including hypertension, abnormal endothelial function, and elevated low-density lipoprotein cholesterol concentrations. Furthermore, a growing body of evidence suggests that subclinical hypothyroidism may cause symptoms or progress to symptomatic overt hypothyroidism. Prompt treatment of subclinical hypothyroidism in pregnant women is mandatory to decrease risks for pregnancy complications and impaired cognitive development in offspring. Children with subclinical hypothyroidism should be treated to prevent growth retardation. Whether nonpregnant adult patients with subclinical hypothyroidism should be treated, and at what thyroid-stimulating hormone values, is debatable.

Subclinical Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women

Recent findings suggest that thyroid stimulating hormone (TSH) is a negative regulator of skeletal remodeling by reducing both differentiation of osteoblasts and formation of osteoclasts. In addition, increased fracture risk in untreated hypothyroid patients has been reported to begin up to 8 years before diagnosis. The aim of the present study was to evaluate the effect of subclinical hypothyroidism on bone structure by using the heel QUS. Subjects were outpatients without any past or present history of thyroid disease. Among 210 postmenopausal women, 22 of 33 patients (Hypo), who had elevated serum TSH concentration (TSH>or=4 microU/ml) with normal serum free thyroxine (FT4) concentration, agreed to join to this study. We also randomly selected 24 control subjects (Cont) from 176 postmenopausal women with normal thyroid status. Calcaneus osteo sono assessment indices (OSI) of right feet were measured using the ultrasound bone densitometry AOS-100. Serum TSH concentrations in Hypo patients (5.31 +/- 1.3 microU/ml) were higher than those in Cont patients (2.05 +/- 1.1 microU/ml), and there was significant difference of FT(4) concentrations (Cont 1.33 +/- 0.15 ng/dl; Hypo 1.19 +/- 0.17 ng/dl). OSI and its Z-score in Hypo subjects (OSI, 2.138 +/- 0.152; Z-Score -0.322 +/- 0.504 SD, Mean SD) were significantly lower than those in Cont subjects (OSI, 2.347 +/- 0.243; Z-Score 0.322 +/- 0.91 SD, Mean +/- SD). Simple regression statistical analysis showed that OSI decreased according to the increase of serum TSH concentration (n = 47, P<0.037). In addition, multiple regression analysis showed that the elevation of serum TSH concentration was associated with the decrease of OSI. These results suggest that the elevation of serum TSH concentration in subclinical hypothyroidism affects not bone turnover but bone structure as assessed by QUS.

Tiroiditis subaguda: revisión a partir de un caso clínico

Subacute thyroiditis is known also as subacute granulomatous thyroiditis or de Quervain's thyroiditis, it's an inflammation of the thyroid gland of presumed viral aetiology. It's a disorder non frecuently (5%), but is themost common cause of a painful thyroid gland. The symptoms beginning with an intensive asthenia, malaise, and frecuently pain in the region of the thyroid gland secondary to distention of the gland capsule 1 . The most important laboratory data in the acute phase is the relation with the degree of thyroid damage caused: ERS (erythrocyte sedimentation rate) elevated serum leves of the T4 L and T3 L, elevated serum TSH (Thyroid-Stimulating Hormone) and low concentration to undetectable and depressed RAIU (radioactive iodine uptake). When the symptoms are not very intensive, are indicated drugs as NSAID (nonsteroidal anti-inflamatory drugs), but in transient hyperthyroidism or more severe disease may be indicated beta blockers and oral steroids 2 . The disease progress in a few months, after retourning to normality and the relapse is rare 3 , Below we descibe the clinical case of a woman that attends to consultation by asthenia, fever and pain in the previous face of the neck on one week evolution; we accomplish a bibliographical review of the disease.

Effects of afternoon injections of melatonin in hypothyroid male Syrian hamsters.

Male Syrian hamsters were kept under either 14 h light/10 h dark (lights on at 06.30 h) or 2 h light/22 h dark (lights on at 14.30 h) photoperiods. Groups of hamsters under each photoperiod were rendered hypothyroid by addition of 0.4% thiourea to the drinking water. These hamsters received, in addition, either a daily evening injection of saline or a daily injection of 25 micrograms melatonin in saline. Groups of intact controls and pinealectomized control hamsters were also maintained under the two photoperiodic conditions. After 10 weeks under the different conditions the hamsters were killed by decapitation, and serum samples assayed for thyroxin, thyroid-stimulating hormone (TSH), and prolactin (PRL). Pituitary extracts were assayed for TSH and PRL. Hypothyroidism in hamsters receiving thiourea was confirmed by radio-immunoassay data showing low serum thyroxin and greatly elevated serum TSH concentrations. Melatonin injections resulted in significant depression of serum TSH in thiourea-treated hamsters under short photoperiod compared to saline-injected controls. Both melatonin injections and short photoperiod resulted in a significant reduction of pituitary TSH in hamsters on thiourea compared to values obtained from similarly treated animals under the 14 h light/10 h dark photoperiod. Hypothalamic concentrations of thyrotropin-releasing hormone (TRH) were significantly elevated by melatonin injections and by short photoperiodic conditions, but not by thiourea administration. The short photoperiod resulted in testicular involution which was completely reversed by pinealectomy and partially reversed (to 53% of controls) by thiourea treatment. Involution of gonads was complete in thiourea-treated animals under short photoperiod, if they received melatonin injections.(ABSTRACT TRUNCATED AT 250 WORDS)

Thyroid dysfunction following external irradiation to the neck for Hodgkin's disease in childhood

Thyroid function was studied in 32 patients who had received neck irradiation during childhood for Hodgkin's disease. All except one patient received a dose of 2500-3000 rad over a period of 19-25 days. In 12 patients lymphangiography was performed. Clinically all patients were considered euthyroid. One had a thyroid swelling which was cystic in nature. Five (16%) patients were biochemically hypothyroid, 17 (53%) were euthyroid with an elevated basal serum TSH concentration and a further seven (22%) were euthyroid with a normal basal serum TSH level but an augmented thyroid-stimulating hormone (TSH) response to thyrotrophin-releasing hormone (TRH). Only three (9%) patients had completely normal thyroid function tests. The basal serum TSH concentration and the peak serum TSH response to TRH were significantly greater in the patients who received neck irradiation and lymphangiography than in those who received neck irradiation alone. In addition the free thyroxine index decreased significantly as the time interval between treatment and study increased in the lymphangiography group. These data demonstrate that the normal thyroid gland is vulnerable to the damaging effects of external irradiation, and that the combination of neck irradiation and lymphangiography is more likely to result in thyroid dysfunction than is neck irradiation alone. Furthermore, in view of the deterioration in thyroid function with time, periodic clinical and biochemical assessment of thyroid function is clearly indicated.