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Hyperthyroidism
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Clinical hyperthyroidism is diagnosed by suppressed TSH and elevated serum-free thyroxine (FT4). Thyroid-stimulating immunoglobulin (TSI) can be obtained, as positive TSI is consistent with Graves’ disease, and values >200–500% indicate higher risk for fetal/neonatal hyperthyroidism.
Case 5
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
The results suggest hyperthyroidism but with normal TPO and TSI antibody status, making the likely cause of the condition a form of inflammatory thyroiditis. It is less likely to be autoimmune, as in conditions such as Graves' disease, it is common for antibodies to be positive, particularly thyroid-stimulating immunoglobulin.
Thyroid disease and pregnancy
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Alisha N. Wade, Susan J. Mandel
Antithyroid Drugs: Effect on the Fetus. The clinician must assume that both PTU and MMI cross the placenta and may decrease fetal thyroid hormone production. For women with Graves’ disease, fetal thyroid status reflects the influence of two maternal factors, both of which cross the placenta: maternal ATD dosage and maternal TRAb activity. Different assays for maternal TRAb exist. The more commonly used radioreceptor assay is the TSH-binding inhibitory immunoglobulin (TBII). This assay does not distinguish between those antibodies that bind to and block the TSH receptor versus those that stimulate the receptor, resulting in increased thyroid hormone production (89). However, in the majority of women with Graves’ disease, TBII levels are reported to represent stimulating antibodies and correlate with maternal disease activity (90). The currently available bioassay is the thyroid stimulating immunoglobulin (TSI), which measures the generation of cyclic adenosine monophosphate by cells that express TSH receptor when incubated with the patient’s serum (90).
Serum thyroid stimulating hormone level for predicting utility of thyroid uptake and scan
Published in Endocrine Research, 2021
Lauren Buehler, Alireza Movahed, Keren Zhou, M. Cecilia Lansang
A total of 137 patients were eligible for inclusion in the study. The median TSH value for the study population was 0.008 µU/mL with an interquartile range (IQR) of 0.005, 0.011 µU/mL (reference range 0.4 to 5.5 µU/mL). The median free T4 value was 1.7 µU/mL (IQR 1.3, 2.8, ref range 0.9–1.7 ng/dL), and the median free T3 value was 4.95 µU/mL (IQR 3.7, 8.7 µU/mL, ref range 2.3 to 4.1 pg/mL). The majority of subjects were female (75%, n = 103), and the mean age at the time of TUS was 50 ± 23 years (SD). Antibodies associated with thyroid disease, including thyroid binding immunoglobulin (TBI), thyroid stimulating immunoglobulin (TSI), anti-microsomal, and anti-thyroglobulin antibodies were tested in 120 (87%) of our patients. Of those tested, 68 patients were positive for TSI, 60 were positive for TBI, 35 were positive for anti-microsomal, and 22 were positive for anti-thyroglobulin antibodies (Table 1, 2). There were two time points for which the scans were read, either around 4 hours (median 4.0 h) or around 24 hours (median 24.1 h). At the 4 h time mark, the median uptake percentage was 34% (IQR 13, 52%), and at the 24 h time mark, the median percentage was 13% (IQR 8, 34%).
Thyroid eye disease presenting with superior rectus/levator complex enlargement
Published in Orbit, 2020
Yao Wang, Pradeep Mettu, Talmage Broadbent, Phillip Radke, Kevin Firl, J. Banks Shepherd, Steven M. Couch, Angeline Nguyen, Amanda D. Henderson, Timothy McCulley, Collin M. McClelland, Ali Mokhtarzadeh, Michael S. Lee, James A. Garrity, Andrew R. Harrison
The majority (89.5%) of patients had unilateral disease (Table 2). Two patients (10.5%) had sight-threatening disease – one from exposure keratopathy and one from optic neuropathy. Mean clinical activity score (CAS) was 2.1 (range: 0–5). Nineteen (100%) patients had relative proptosis on the affected side, with mean exophthalmometry of 21mm (range: 16-28mm) on the affected side versus 17.9mm (range: 15-22mm) on the unaffected side. Of note, the presence or absence of proptosis was based on qualitative documentation (proptosis was documented if the difference between eyes was > 2 mm) upon chart review. Eyelid abnormalities, including upper/lower eyelid retraction and ptosis were more prevalent on the affected side compared to the unaffected side. Eleven (57.9%) patients had vertical misalignment. Seven (36.8%) patients did not have diplopia, five (26.3%) had intermittent diplopia, two (10.5%) had gaze-evoked diplopia, and five (26.3%) had diplopia in primary gaze. Mean thyroid stimulating immunoglobulin (TSI) was 3.7 (range: 1–7.1), with normal ≤ 1.3. Mean thyrotropin receptor antibody (TRAb) was 2.5IU/L (range: 0.9–5.9 IU/L), with normal ≤ 1.75. All patients had orbital imaging demonstrating an enlarged levator/superior rectus complex. Additional information regarding extraocular muscle changes identified by orbital imaging is included in Table 2.
Transient T3 toxicosis associated with Hashimoto’s disease
Published in Baylor University Medical Center Proceedings, 2019
Sarah Jaroudi, Meredith Gavin, Kathryn Boylan, Alan N. Peiris
A 27-year-old woman had evidence of T3 toxicosis 4 to 5 months prior to presentation. No symptoms of weight loss or gain, heat or cold intolerance, palpitations, hair loss, polyuria, or polyphagia were noted. There were no ocular complaints or a family history of thyroid disease. An oral contraceptive was the patient’s only medication. The patient denied taking any over-the-counter supplements. Her physical exam was entirely normal, with no palpable thyroid abnormalities. Her laboratory determinations measured using the Roche Cobas 6000 revealed an elevated free T3 (4.22 pg/mL, normal range 2.3–4.2 pg/mL), a normal free T4 (1.62 pg/mL, normal range 0.93–1.7 pg/mL), and a suppressed TSH (0.01 U/mL, normal range 0.27–4.2 U/mL). A thyroid ultrasound showed a heterogeneous appearance of the thyroid gland without discrete nodules or masses. The patient’s thyroid antibodies were found to be positive with an elevated thyroid peroxidase (664 IU/mL, normal being <9 IU/mL) and an elevated thyroglobulin antibody (2 IU/mL, normal being <1 IU/mL). A thyroid-stimulating immunoglobulin level was not obtained because there was a low suspicion of Graves’ disease and because her T3 toxicosis had resolved spontaneously when she was seen. No treatment was initiated due to the resolution of symptoms. Two subsequent tests, done 2 to 3 months later, revealed normal TSH values along with normal free T3 and free T4 levels. The patient continued to be asymptomatic.