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3. American Thyroid Association guidelines for use of laboratory test in thyroid disorders

Author

Surks, Martin I., Chopra, Inder J., Mariash, Cary N., Nicoloff, John T., and Solomon, David H.

Subjects
Thyroid diseases, Thyrotropin -- Testing, Thyroid gland function tests -- Analysis, Thyroxine -- Measurement
Abstract

In recent years a large number of new laboratory tests for the detection of thyroid disorders have become available, which may cause some confusion. To help the clinician select the most efficient and specific diagnostic test, the American Thyroid Association has created guidelines to simplify patient evaluation; these are outlined in this article. Testing of the general population is not recommended because of the relatively low incidence of undiagnosed thyroid disorder. Specific targets for screening include those with a family history of thyroid disease, elderly patients, and women who have recently given birth. Two principal laboratory tests are: the estimation of free thyroxine, a hormone produced by the thyroid gland; and a sensitive thyrotropin (a thyroid-stimulating hormone produced in the pituitary gland) assay test. Hypothyroidism (deficient secretion of the thyroid hormones) hyperthyroidism (excessive secretion of thyroid hormones) and the optimal treatments for both conditions are discussed, as are the effects of several frequently prescribed drugs on thyroid function. Pregnancy is also often complicated by thyroid abnormalities. Hypothyroidism is indicated by a decrease in serum free thyroxine and an increase serum thyrotropin. Thyrotoxicosis is indicated by an increase in free thyroxin, along with a reduced serum-sensitive thyrotropin level. Patients that are very ill with other conditions may show elevated serum free thyroxine with normal serum thyrotropin, which is not necessarily symptomatic of thyroid disease. Some drug treatments may result in thyroid symptoms and unusual thyroid disorders typically result in confusing laboratory results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

17. Stimulation of Fibroblast Biosynthetic Activity by Serum of Patients with Pretibial Myxedema.

Author

Herman S. Cheung, George R., Nicoloff, John T., Kamiel, Michael B., Spolter, Leonard, and Nimni, Marcel E.

Subjects
*FIBROBLASTS, *BIOSYNTHESIS, *SERUM, *MYXEDEMA, *HYPOTHYROIDISM, *CONNECTIVE tissue cells
Abstract

Skin fibroblasts from the shoulder and lower extremities of normal individuals, as well as from patients with pretibial myxedema (PTM) were grown in culture. When cells reached the monolayer stage, they were labeled with 3H-glucosamine and tested for hyaluronic acid synthesis in the presence of either serum from PTM patients or normal human serum. All the fibroblasts from the pretibial area synthesized 2 to 3 times more hyaluronic acid when incubated with PTM sera than when incubated in normal human serum. Fibroblasts cultured from skin of the back or prepuce did not respond to PTM sera. This heat-stable, protease-sensitive, and dialyzable, fibroblast-stimulating factor is not a 7Sγ-globulin. The enhanced sensitivity to PTM sera exhibited by fibroblasts from the lower extremities may explain why the lesions in this disease are restricted primarily to that area. [ABSTRACT FROM AUTHOR]

Published
1978
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24. Thyroid Hypofunction After Exposure to Fallout From a Hydrogen Bomb Explosion

Author

Larsen, P. Reed, Conard, Robert A., Knudsen, Knud D., Robbins, Jacob, Wolff, Jan, Rall, J. Edward, Nicoloff, John T., and Dobyns, Brown M.

Abstract

Thyroid function was evaluated in the Marshallese who were accidentally exposed to fallout-containing radioiodine isotopes in 1954. Measurements of thyrotrophin (TSH, thyroid-stimulating hormone) levels and free thyroxine (T4) index (FT4I) have revealed that, among 86 persons exposed on Rongelap and Ailingnae atolls, 14 have shown evidence of thyroid hypofunction. This was first noted in some individuals about ten years after exposure. Only two of these showed clinical evidence of hypothyroidism. The most marked TSH elevations were noted in nine persons exposed when younger than 6 years, with estimated doses to the thyroid from 390 to 2,100 rad. Most of this group subsequently had surgery for removal of thyroid nodules. The remaining five cases have been noted more recently among 36 surviving adults exposed at an older age who showed no other detectable thyroid abnormalities. This group had received estimated thyroid doses ranging from 135 to 335 rad and showed modest elevation of serum TSH levels (6 to 9 μU/mL) and a slightly subnormal FT4I. No abnormalities were found in persons on Utirik who received substantially less radiation, and hypothyroidism was present in less than 1% of the control, unexposed Marshallese. The high prevalence of a thyroid hypofunction in these persons indicates that this condition, as well as thyroid nodularity, can be a delayed complication of exposure to early fallout from a nuclear explosion. The fact that a significant fraction of the radiation to the thyroid was from short-lived radioiodine isotopes (132I,133I,135I), as opposed to131I, may account for the severity of the thyroid damage.(JAMA 1982;247:1571-1575)

Published
1982
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25. Serum Triiodothyronine Values: Prognostic Indicators of Acute Mortality due to Pneumocystis carinii Pneumonia Associated With the Acquired Immunodeficiency Syndrome

Author

Fried, Jeffrey C., LoPresti, Jonathan S., Micon, Monica, Bauer, Madeline, Tuchschmidt, James A., and Nicoloff, John T.

Abstract

• A feasibility study was undertaken prospectively to identify early clinical and laboratory factors predictive of acute hospital mortality in patients with the acquired immunodeficiency syndrome and concurrent Pneumocystis carinii pneumonia. Twentysix patients hospitalized with bronchoscopy-proved P carinii pneumonia were studied. Nineteen patients survived their episode of P carinii pneumonia, while 7 subjects did not. The only clinical factor associated with mortality was a history of a shorter duration of pulmonary symptoms. Univariate analysis showed decreased total CD8 cell count, total lymphocyte count, serum hemoglobin, serum albumin, total thyroxine, and total triiodothyronine values consistent with a poor outcome. Multivariate logistic regression analysis showed that the single best prognostic indicator of acute mortality appeared to be a total serum triiodothyronine value less than 0.70 nmol/L obtained early in the hospital course, and that the combination of serum triiodothyronine and hemoglobin values provided a better indication for survival. These preliminary observations would appear to justify the further exploration of serial serum triiodothyronine measurements as a potentially valuable prognostic indicator for the treatment of patients with acquired immunodeficiency syndrome infected with P carinii and possibly other intercurrent infectious illnesses.(Arch Intern Med. 1990;150:406-409)

Published
1990
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27. Treatment of Myxedema Coma With Intravenous Thyroxine

Author

HOLVEY, DAVID N., GOODNER, CHARLES J., NICOLOFF, JOHN T., and DOWLING, J. THOMAS

Abstract

Although coma as a terminal manifestation of myxedema was first described in 1879, it received little further emphasis until the last decade. During this period 51 cases were reported in English-language journals.1-33 Despite the increased interest in this complication, more than 80% of patients died during treatment in the period 1953-1961. The discovery of triiodothyronine and the characterization of its potent and rapid action in man held forth the hope that a useful agent was now available for treatment of myxedema coma. Although repeated small doses of triiodothyronine failed in the treatment of three of four patients with terminal myxedema who were treated in this way by Nickerson, Hill, McNeil, and Barker in 1960, the following year Catz and Russell reported the survival of seven of 12 cases of myxedema coma after systematic use of triiodothyronine by either the oral or the intravenous route.24That the appalling mortality

Published
1964
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29. Influence of Nonthyroidal Illnesses on Serum Thyroid Hormone Indices in Hyperthyroidism

Author

Lum, Steven M. C., Kaptein, Elaine M., and Nicoloff, John T.

Subjects
Adult, Diabetes Complications, Thyroid Hormones, endocrine system diseases, Myocardial Infarction, Humans, Female, Original Articles, Middle Aged, Hyperthyroidism, Pneumococcal Infections, Hepatitis
Abstract

Severe intercurrent nonthyroidal illnesses (diabetic ketoacidosis, myocardial infarction, fulminant hepatitis and bacterial pneumonia) in four thyrotoxic patients were associated with depression of total serum thyroxine (T(4)) and triiodothyronine (T(3)) values into the normal or even subnormal range. A diagnosis of hyperthyroidism was established by a combination of elevated radioactive iodine uptake, absent thyroid-stimulating hormone response to thyrotropin-releasing hormone or an elevated free T(4) by dialysis values. In the two of four cases that had a fatal outcome, there was a progressive decline in total T(4) and total T(3) values. In contrast, the two surviving patients had a progressive increase of total T(3) and total T(4) values into the hyperthyroid range as their underlying illness resolved. As has been seen with severe nonthyroidal illnesses, pronounced depression of total T(3) and total T(4) levels in hyperthyroid patients may also portend a poor prognosis.

Published
1983

30. IODINE METABOLISM DURING HUMAN PREGNANCY IN AN AREA OF IODINE ABUNDANCE

Author

WASHINGTON UNIV SEATTLE, Dowling,J. Thomas, Appleton,William G., Nicoloff,John T., WASHINGTON UNIV SEATTLE, Dowling,J. Thomas, Appleton,William G., and Nicoloff,John T.

Abstract

A significant proportion of I132 as iodide leaves the circulation of pregnant women into a compartment other than thyroid or urine, presumably the conceptus. The compartment is obliterated by sodium thiocyanate, indicating an active transport mechanism. Thyroid and renal clearances of I132 are increased, the former to a proportionately greater degree than the latter, late in pregnancy. The net daily turnover of thyroxine iodine expressed in terms of body surface area is not increased by pregnancy. In the geographic area of the study, urinary iodine excretion and plasma iodide concentrations are higher, while thyroid iodide clearances are lower than in many locales. The data imply that a relative deficiency of iodide induced by hemodynamic changes and by the growing conceptus and its turnover of organic iodide contribute to the apparent hyperfunction of the thyroid during normal human pregnancy. (Author), Available only for reference use at DDC Field services. Copy is not available for public sale.

Published
1964

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