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Does TSH Reliably Detect Hypothyroid Patients? TSH能可靠地检测甲状腺功能减退患者吗？

Annals of thyroid research Pub Date : 2018-01-01 Epub Date: 2018-02-20

C Ling, Q Sun, J Khang, M Felipa Lastarria, J Strong, B Stolze, X Yu, T P Parikh, M A Waldman, K Welsh, J Jonklaas, L Masika, S J Soldin

{"title":"Does TSH Reliably Detect Hypothyroid Patients?","authors":"C Ling, Q Sun, J Khang, M Felipa Lastarria, J Strong, B Stolze, X Yu, T P Parikh, M A Waldman, K Welsh, J Jonklaas, L Masika, S J Soldin","doi":"","DOIUrl":"","url":null,"abstract":"Objectives: To evaluate the reliability of normal Thyroid Stimulating Hormone (TSH) as a thyroid function test and assess the effect of Adrenocorticotropic Hormone (ACTH) on serum TSH concentration.Design and methods: Patients presenting to the National Institutes of Health Department of Endocrinology outpatient clinic with symptoms consistent with hypothyroidism were identified. Thyroid hormone concentrations were measured by liquid chromatography/tandem mass spectrometry and immunoassay. Patients with normal TSH concentrations were assessed for both clinical and biochemical hypothyroidism.We evaluated the effect of ACTH stimulation (performed on patients for assessment of adrenal function) on TSH concentration.Results: Patients with symptoms consistent with hypothyroidism but with normal TSH values in the range of 1-4 IU/mL and normal free T4 (FT4) values by immunoassay measurements were confirmed to be biochemically hypothyroid following measurements of thyroid hormones by mass spectrometry. We present case studies of two patients, a 76-year-old male and a 58-year-old female. Improvement in the male patient's hypothyroid symptoms, including afternoon fatigue, constipation, alopecia, dry skin and high cholesterol, was documented after initiating thyroid hormone replacement.ACTH stimulation resulted in an average decrease of 17% in TSH between time 0 and 60 minutes post stimulation.Conclusion: Although measurement of TSH is a convenient screen for thyroid function, it is influenced by many factors which may affect its overall reliability. We believe thyroid function should be assessed by more than a single test. We recommend measurement of thyroid hormone concentrations by mass spectrometry if the patient's clinical presentation is discordant with their TSH levels.","PeriodicalId":92001,"journal":{"name":"Annals of thyroid research","volume":"4 1","pages":"122-125"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847294/pdf/nihms947336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35915291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary Care Provider Management of Congenital Hypothyroidism Identified Through Newborn Screening. 通过新生儿筛查确定的先天性甲状腺功能减退症的初级保健提供者管理。

Annals of thyroid research Pub Date : 2017-01-01 Epub Date: 2017-04-18

N A Rosenthal, E Bezar, S Mann, L K Bachrach, S Banerjee, M E Geffner, M Gottschalk, S K Shapira, L Hasegawa, L Feuchtbaum

{"title":"Primary Care Provider Management of Congenital Hypothyroidism Identified Through Newborn Screening.","authors":"N A Rosenthal, E Bezar, S Mann, L K Bachrach, S Banerjee, M E Geffner, M Gottschalk, S K Shapira, L Hasegawa, L Feuchtbaum","doi":"","DOIUrl":"","url":null,"abstract":"Objective: To assess Primary Congenital Hypothyroidism (CH) management patterns and feasibility of providing long-term care for patients with CH identified through newborn screening by Primary Care Providers (PCPs) in California and Hawaii.Study design: A survey was mailed to all physicians (N=823) listed as the referral doctor for confirmed patients with CH identified through newborn screening programs in both states between 01/01/2009-12/31/2013. Information was collected on CH management patterns, barriers to providing care, and knowledge on CH treatment. Descriptive statistics and bivariate logistic regression results were reported.Results: 206 PCPs completed the survey. Among these, 78% currently have patients with CH and 91% indicated willingness to provide long-term care to new patients with CH. Among PCPs currently caring for patients with CH, 17% managed CH by themselves with limited assistance from endocrinologists; 63% were involved in managing CH but endocrinologists played a larger role than PCPs; 19% were not involved in CH care. Only 49% of PCPs correctly answered questions regarding recommended follow-up frequencies and 23% knew the correct age for a trial off levothyroxine for suspected transient CH. Top two perceived barriers to providing long-term care included \"need guidance or support from endocrinologists\" (61%) and \"not familiar with CH treatment guidelines\" (28%).Conclusion: The majority of PCPs surveyed are willing to provide long-term care to patients with CH, but need support from endocrinologists and increased knowledge about current treatment guidelines.","PeriodicalId":92001,"journal":{"name":"Annals of thyroid research","volume":"3 1","pages":"95-101"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580838/pdf/nihms897940.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35371263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0