[Survey the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction]

The liver played an important role in the metabolism of thyroid hormones and was involved in their conjugation, excretion and peripheral deiodination in synthesizing Thyroid Binding Globulin [TBG]. Thus liver dysfunction can be influenced thyroid function. Determine the changes of thyroid functional tests in patients with liver cirrhosis due to hepatitis B and C and correlation of thyroid hormone levels with severity of liver dysfunction. Sixty Four Cirrhotic patients due to hepatitis B and C referring to Razi hospital were studied during 2007-2009 years. Data were collected by prepared questionnaire. Thyroid hormone levels were measured in a unit laboratory. Liver dysfunction was scored by MELD and child pugh scoring systems. Mann-Whitney U, chi square and kruskal wallis test were used for measuring severity of liver dysfunction. Among 64 patients, [42 patients were male and 22 patients were female]. Mean age of patients was 55.03 +/- 12.05. Level of TT3 TT4 and FT3 had decreased in the majority of patients, TT3, TT4 and FT3 levels. There was a correlation between level of TT3 and severity of liver dysfunction base on Child score [p=0.0001] and MELD [p=0.02].There was a reciprocal correlation between TT3 level and probability of the history of digestive systems bleedings, Ascites and encephalopathy [P=0.01, P=0.011, P=0.009] .It means that when TT3 level was low probability of this complication was high. This study showed that liver disease is accompanied by changes in thyroid hormone levels specially decrease the level of TT3, TT4, FT3 and it is indicated that TT3 level can be used as liver function index in cirrhotic patients due to hepatitis B and C

Avaliação tireoidiana de pacientes infectados pelo vírus da hepatite C: correlação com polimorfismos do gene CTLA4 / Thyroid evaluation of patients infected by hepatitis C virus: correlation with polymorphisms of CTLA4 gene

INTRODUÇÃO: Manifestações auto-imunes são frequentes na infecção pelo vírus da hepatite C (VHC). Apesar da associação com doenças auto-imunes de tireóide (DAIT) ser controversa, sabe-se que distúrbios tireoidianos podem surgir ou piorar com tratamento com IFN e ribavirina. Os objetivos deste estudo foram avaliar a função tireoidiana em pacientes infectados pelo VHC, caracterizar distúrbios tireoidianos antes, durante e após tratamento com IFN e estudar as frequências dos genótipos dos polimorfismos do gene CTLA4, correlacionando-os com características clínicas e laboratoriais, presença de disfunção tireoidiana e evolução durante tratamento com IFN. MÉTODOS: Avaliação prospectiva de 112 indivíduos com infecção crônica pelo VHC, 30 tratados com IFN, e 183 controles. Realizaram-se avaliações clínica, hormonal e de auto-imunidade tireoidiana e ultra-sonografia de tireóide no início e durante tratamento. Avaliações de globulina transportadora de hormônios tireoidianos (TBG), de CXCL10 e de biópsia hepática foram feitas pré-tratamento. Análises dos polimorfismos do gene CTLA4 -318C>T, A49G e CT60 foram realizadas por PCR-RFLP e de AT(n) por análise de fragmento através de eletroforese capilar. RESULTADOS: A frequência de DAIT entre infectados por VHC não diferiu dos controles (10,7 vs 13,5%, p=0,585). Os limites de distribuição dos níveis de T3 (T3T) e T4 (T4T) totais foram superiores aos de referência (T3T 112-246 ng/dL; T4T 7,8-15,2 g/dL), assim como de TBG (17-47 mg/L). TBG correlacionou-se com T3T (r=0,654, p<0,001) e T4T (r=0,741, p<0,001). Heterogeneidade (p=0,027) e hipoecogenicidade de parênquima (p=0,002) foram mais frequentes nos pacientes com DAIT. Aumento de vascularização esteve presente em 49,2% dos infectados sem distúrbio tireoidiano. CXCL10 esteve aumentada nos infectados (p=0,006), mas não se relacionou com disfunção tireoidiana. Sua elevação correspondeu ao grau de atividade necro-inflamatória na biópsia hepática...

INTRODUCTION: Autoimmune disorders are frequent in patients infected by the hepatitis C virus (HCV). Although the association with autoimmune thyroid diseases (AITD) is controversial, thyroid disturbance could occur or worsen with IFN and ribavirin treatment. The aims of the study were evaluate thyroid function in HCV-infected patients, characterize thyroid disturbance prior and after IFN treatment and analyze the frequency of the genotypes of the polymorphisms of CTLA4 gene, and their relation to clinical and laboratorial features, presence of thyroid dysfunction and disturbance along IFN treatment. METHODS: Prospective evaluation of 112 chronically HCV-infected subjects, 30 treated with IFN, and 183 controls. Clinical, hormonal, thyroid autoimmunity and ultrasound exams were performed before and during treatment. Thyroxine-binding globulin (TBG), CXCL10 and hepatic biopsies were also evaluated before treatment. Analysis of polymorphisms of CTLA4 gene -318C>T, A49G and CT60 were made by PCR-RFLP and AT(n) polymorphism analysis by capillary electrophoresis in automatic sequencer. RESULTS: The frequency of AITD among HCV-infected subjects was similar to the rate among controls (10.7 vs 13.5%, p=0.585). Total T3 (T3T) and T4 (T4T) distributions were right shifted (T3T 112-246 ng/dL; T4T 7.8-15.2 g/dL), as was TBG (17-47 mg/L). TBG correlated to both T3T (r=0.654, p<0.001) and T4T (r=0.741, p<0.001). Thyroid heterogeneity (p=0.027) and hipoechogenicity (p=0.002) were associated with AITD and, most notably, increased vascularization was present in 49.2% of HCV-infected patients without thyroid disturbance. CXCL10 was higher in HCV-infected group (p=0.006) but was not related to thyroid dysfunction. Increase in CXCL10 levels were consistent with hepatic necroinflammatory activity (p=0.006) and correlated to T3T (r=0.388, p=0.003), T4T (r=0.444, p=0.001) and TBG (r=0.551, p<0.001). Nineteen percent of subjects treated with IFN presented autoimmune thyroiditis and...

A family with familial dysalbuminaemic hyperthyroxinaemia / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To report a family of familial dysalbuminaemic hyperthyroxinaemia(FDH).</p><p><b>METHODS</b>Four members, including the female proband, mother, daughter and brother, went through the measurement of thyroid hormone and thyroid-stimulating hormone (TSH). Electrophoretic analysis of the patient's serum proteins was carried out after the patient's serum being incubated with fluorescein isothiocyanate (FITC) labeled thyroxine(T4), The point mutation of Alb gene was determined in all members.</p><p><b>RESULTS</b>The measurements of thyroid hormane and TSH showed that in three members (the proband, her mother and her daughter), the total thyroxine(TT4) serum level was high, the total triiodothyronine(TT3), FT4, FT3 and TSH serum levels were normal. And the enhanced albumin binding of fluorescenced T4 by electrophoresis showed a mutation transition 653 G-->A on DNA coding region of albumin. But in the proband's brother, the thyroid function and the results of electrophoresis of thyroxine-binding protein and determination of albumin gene were normal.</p><p><b>CONCLUSION</b>A family with FDH in China is firstly reported here, a mutation at albumin gene DNA coding region 653G-->A causing enhanced albumin binding of T4 results in high T4 level.</p>

Epidemiological study of T4, T3 and TSH mean concentrations in four Iranian populations

T4 and T3, two major hormones of thyroid gland, are responsible for regulation of "basal metabolism" in the body. Thyroid function is regulated primarily by variation in the pituitary TSH. In this study, about four hundred individuals were considered from four Iranian populations. They were selected randomly in their cities; Shiraz, Mashhad, Rasht, and Ilam. Essential family information was asked to achieve native belonging of each person to related population. Blood specimens were collected, by separating serums, freezed serums were transferred immediately to Tehran for hormone assay. Assay of T4 and T3 concentrations was carried out by 'RIA-magnetic' kits and of TSH by 'IRMA-magnetic' kits. Analysis of variance has been taken into account among days of sampling in each city to calculate mean concentrations for T4, T3 and TSH. Analysis of association between age and hormones concentrations in each population was done by the regression and the correlation tests. Significant differences were detected at T4 mean concentration in each of these populations [P=0.0001]. Differences for T3 mean concentration were observed only between Shiraz and Mashhad [P=0.021]; and Shiraz and Rasht [P=0.003]. By increasing age of individuals, there were also a negative correlation at mean concentrations of T4 and T3 in Ilam [P=0.022], and Mashhad [P=0.016] respectively. According to these data, and specificity of environmental and genetic factors to each popualtions, specific 'normal reference' of T4 and T3 homones should be considred for each of these populations. Correlation study of mean concentrations of these hormones and genetic variations of some critical genes such as thyroid peroxidase [TPO] and iodothyronine deiodinase can open new window of epidimiology among Iranian popualltions

Thyroid hormone binding protein abnormalities in patients referred for thyroid disorders.

BACKGROUND & OBJECTIVES: Thyroid hormone binding protein (THBP) abnormalities are the major cause of discordance in commonly performed total thyroxine (T4) and thyrotropin (TSH) estimations, though these do not interfere with thyroid hormone action. Determination of such abnormalities in patients showing discordant thyroid function tests (TFTs) is diagnostically important as it eliminates equivocal assessment of thyroid function and treatment especially where proper methodology for free T4 (FT4) estimation is not available. This study was undertaken to analyse the THBP abnormalities in the population attending thyroid clinic. Family members of affected patients were also screened to study the inheritance of quantitative TBG abnormalities. METHODS: Blood samples of 15000 consecutive patients over a period of 4 years (1994-1997) were tested for thyroid function. THBP abnormalities were studied using polyacrylamide gel electrophoresis autoradiography. Serum thyroxine binding globulin (TBG), free and total T4, total tri-iodothyronine (TT3) were assayed by radioimmunoassay methods. RESULTS: In our screening of 15,000 thyroid patients over a four year period, we found the presence of complete and partial TBG deficiency and TBG excess to be 1:2,500, 1:200 and 1:15,000 respectively. Our study on the families of three affected patients revealed X-chromosome linked inheritance pattern of TBG deficiency in two families and TBG excess in one family. INTERPRETATION & CONCLUSION: Our study suggests that it would be beneficial to rule out THBP abnormalities before interpreting results of TFTs, particularly when there is large discrepancy between T4 and TSH levels. In case of inherited THBP abnormalities, the family members of the affected individual should also be screened to avoid misdiagnosis and erroneous treatment in case they develop thyroid dysfunction in future.

Effect of antituberculous drugs on thyroid function tests

The aim of this study was to measure serum thyroid hormones [triiodothyronine [T3], thyroxine [T4], thyrotropin [TSH] and thyroxine-binding globulin [TBG]] in children suffering from tuberculosis in order to determine the effect of the disease and its treatment on the thyroid function. The results of the study were presented in details

Estudo da função tiroideana em uma população com mais de 50 anos / Thyroid function studies in a population sample over 50 years of age

Com objetivo de analisar a freqüência de disfunção tiroideana e de identificar possíveis alterações hormonais decorrentes do envelhecimento, estudamos 198 indivíduos com idade variando de 50 a 85 anos e 106 filhos com idade entre 11 e 49 anos. A prevalência de disfunção tiroideana foi semelhante em ambos grupos (12,6por cento no grupo de estudo e 14,1 por cento entre os filhos). A presença de um ou dois anticorpos anti-tiroideanos positivos foi também semelhante entre os grupos (9,1 por cento e 12,3 por cento para os idosos e filhos respectivamente), embora sem correlação disfunção tiroideana. nos idosos. Os níveis séricos de T3 e FT4 foram significantemente menores entre os indivíduos mais velhos quando comparados com os filhos (1,27ñ0,27 x 1,39ñ0,31 ng/ml e 0,97ñ0,29 x 1,18ñ0,76 ng/dl, respectivamente). Não houve diferença entre os grupos quanto aos níveis de TSH, T4 total e TBG. Concluímos que a prevalência de disfunção tiroideana não foi diferente entre os grupos e que a presença de anticorpos antitiroideanos esteve associada com disfunção da tiróide apenas nos indivíduos mais jovens. A correlação inversa dos níveis de T3 e FT4 com a idade pode refletir uma adaptação à menor necessidade dos hormônios com o envelhecimento.

Descriçäo e elucidaçäo molecular de duas formas de deficiência completa da proteína ligadora da tiroxina (TBG) / Description and elucidation molecular the two forms of the complete thyroxine-binding globulin(TBG)deficiency

Foram avaliados 21 pacientes braquicefálicos, com idade inferior a 10 anos, provenientes da Disciplina de Neurocirurgia da Universidade Federal de São Paulo Escola Paulista de Medicina (UNIFESP-EPM), no período de 1994 a 1998, e submetido a avaliação pré-operatória com tomografia computadorizada helicoidal de crânio reconstrução tridimensional (TC3D), realizadas no Laboratório Fleury. A idade d pacientes foi considerada no momento do exame radiológico. Treze pacientes eram d sexo feminino, e oito do masculino. O paciente mais jovem tinha 14 dias de vida e mais velho dez anos. Doze pacientes eram portadores da síndrome de Crouzon, cinco d síndrome de Apert, um apresentava a síndrome de Jackson-Weiss, e três era braquicefalias isoladas. A base do crânio destes pacientes foi comparada com um grupo controle, estudado com TC3D, e provenientes do museu de Craniologia da Disciplina de Anatomia da UNIFESP-EPM. Nesses 63 crânios, foram estudadas sete distâncias e seis ângulos. Para compararmos as diferentes medidas nos dois grupos, usamos o teste de Mann-Whitney, e para compararmos as diferenças dentro do mesmo grupo, nas diferentes faixas etárias, usamos o teste de Kruskal-Wallis, complementado quando necessário, pelo teste de comparações múltiplas. Pudemos verificar que nos pacientes com braquicefalia, a distância interorbitária é muito grande ao nascimento, sugerindo um quadro de hipertelorismo. Com o passar da idade esta distância progressivamente se estabiliza igualando-se ao grupo normal. A distância násio-sela aumentou nos dois grupos, de maneira mais acentuada no grupo normal. O crescimento da fossa anterior do crânio nos portadores de braquicefalia, verificado através das distâncias sela-frontal e esfenofrontal, não demonstrou um crescimento significativo, determinando uma fossa anterior curta. A distância bipterional foi significantemente maior no grupo de braquicéfalos, desde o nascimento, demonstrando um fator compensatório ainda intra-útero. Os resultados das medidas das distâncias pteriorbitária direita e esquerda também foram significantes, demonstrando que nos portadores desta malformação, os ptérios estão anteriorizados. O inverso acontece com a distância ptérigo-básio, também diminuída no grupo afetado, demonstrando uma posteriorização desta estrutura. Com estes resultados pudemos concluir que a asa do esfenóide aderida aos processos pterigóides, atuam como duas lavancas, uma de cada lado, modulando o crescimento do ...(au)

Carcinoma de tireóide: estudo retrosptectivo de 84 casos / Thyroid carcinoma: a retrospective study of 84 cases

Avaliamos 84 pacientescom carcinoma de tireóide atendidos no Hospital de Clínicas da Universidade Federal do Paraná no período compreendido entre janeiro de 1990 e dezembro de 1996. A idade média dos pacientes foi de 40,6 anos (DP 17,4), com predomínio do sexo feminino (82 por cento). Encontramos em nossos pacientes uma elevada associaçäo com doença auto-imune de tereóide (8,5 por cento), 6 pacientes com tireoidite de Hashimoto e 1 com Doença de Graves concomitante. A palpaçäo da tereóide por ocasiäo do diagnóstico do carcinoma, revelou em 84 por cento dos pacientes um nódulo único, sendo a glândula multinodular nos outros 16 por cento. A cintilografia revelou nódulo hipocaptante em 82 por cento dos casos. A PAAF (punçäo aspirativa com agulha fina) diagnosticou a presença de neoplasia em cerca de 82 por cento das vezes. O precedimento cirúrgico foi tireoidectomia total em 90,5 por cento dos casos e subtotal nos restantes. O estudo anatomopatológico mostrou carcinoma papilífero em 64,3 por cento, carcinoma folicular em 32,1 por cento, carcinoma anaplásico em 2,4 por cento e carcinoma medular em 1,2 por cento dos pacientes. O controle para presença de metástase realizado com PCI (pesquisa de corpo inteiro) e/ou tireoglobulina sérica mostrou a presen

Thyroxin binding globulin [TBG] and prealbumin [TBPA] levels in healthy subjects

This study was carried out on 120 carefully selected normal healthy subjects [56 males and 49 females in addition to 15 newborns]. Their ages ranged from newborn to Geriatric. Estimation of plasma TBG and prealbumin by RIA and immunoturbidimetric methods respectively was performed. Plasma TBG levels were nearly constant in females up to the age of 7.5 years and then showed progressive decrease, together with that of the male group, till the age of 16 years and then showed a slight gradual increase till the age of 65 years. The highest levels of TBG were observed at birth and at the age of 65 years and the lowest one was at age group of 15-18 years [about two thirds the highest levels]. No significant sex difference was encountered in TBC levels among all age groups. Pre albumin levels were nearly constant till the age of 8 years in males and decrease slightly in females. In both sexes, a marked increase was noted from 8-14 years, then the increase was much slower till the age of 24 years. The level started to decline slightly from age 24 to 40 years and markedly till age of 65 years. The highest level of prealbumin was in age of 15-35 years which was two and half folds that obtained for newborns and old age [65 years]. Prealbumin was significantly higher in male than females at the age range 15-50 years. Significant negative correlation was demonstrated between plasma TBC and prealbumin levels in all age groups

Tiroxina libre y globulinas transportadoras en la exploración funcional del tiroides / Free thyroxine and binding globulin in evaluation of thyroid function

1. Se analizan las interrelaciones entre T4 total, tiroxina libre y globulinas transportadoras. 2. Se resalta la importancia del perfil tiroideo parcial en el diagnóstico correcto de la función tiroidea. 3. Se fundamenta la importancia de la relación T4/T4L en el establecimiento de los niveles de TBG. 4. Se analiza la incidencia de las 11 posibilidades diagnósticas que se pueden establecer con el perfil tiroideo parcial. 5. Se compara el diagnóstico por el Laboratorio con el diagnóstico Clínico

Thyroid function in the alcoholic.

Se estudio la funcion tiroidea y el eje hipotalamo-hipofisis-tiroides en 54 enfermos alcoholicos y los resultados se compararon con los obtenidos en un grupo de 42 sujetos sanos. Todos los pacientes se encontraron clinicamente eutiroideos y en ninguno se observo evidencia clinica de dano hepatico severo. Los niveles circulantes de T3 en los alcoholicos fueron menores que los encontrados en el grupo testigo. Se discuten los posibles mecanismos que pueden haber contribuido a este hallazgo. La secrecion de TSH inducida por TRH en 7 pacientes se encontro francamente disminuida. Estudios subsecuentes en esta misma direccion pueden aclarar el significado real de las observaciones aqui descritas