American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism

Baskin, H. Jack; Cobin, Rhoda H.; Duick, Daniel S.; Gharib, Hossein; Guttler, Richard; Kaplan, Michael M.; Segal, Robert; Garber, Jeffrey R.; Hamilton, Carlos R.; Handelsman, Yehuda; Hellman, Richard; Kukora, John S.; Levy, Philip; Palumbo, Pasquale; Petak, Steven M.; Rettinger, Herbert I.; Rodbard, Helena W.; Service, F. John; Shankar, Talla P.; Stoffer, Sheldon S.; Tourtelot, John B.

doi:10.4158/1934-2403-8.6.457

Cited by 534 publications

(267 citation statements)

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“…Commonly done tests to diagnose thyroid disorders include estimation of thyroid stimulating hormone (TSH) along with thyroid hormones, tri iodothyronine (T3) & tetra iodothyronine (T4) either in total or free form. The guidelines of American thyroid association and American Association of Clinical Endocrinologists recommend serum TSH measurement as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism particularly in the ambulatory setting [6,7]. Thyroid stimulating hormone confirms or excludes the diagnosis in all patients with primary hypothyroidism, an elevated concentration being present in both overt and mild hypothyroidism [4].…”

Section: Introductionmentioning

confidence: 99%

Are we using Thyroid Function Tests Appropriately?

et al. 2011

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Thyroid function tests are very important for the diagnosis and monitoring of patients with thyroid dysfunction. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism. The aim of this study was to analyze the ordering pattern for thyroid function tests by physicians and the analysis of results based on the clinical history. The mean age of the patients was 32.5 ± 6.5 years. Majority of samples (87.7% of total) were received from the departments of Medicine and Gynae. Thyroid profiles (47.5%) were ordered more frequently as compared to TSH only (46%). There was no significant difference in the percentage of normal reports for both types of tests. 77.8% of TFT and 76.6% of TSH samples had results within the reference range. The percentage of abnormal results was 13.7% in the patients who were screened for thyroid disorders. There is a need to redefine the case definition for thyroid dysfunction and order the appropriate test in a rational and cost effective manner.

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Section: Introductionmentioning

confidence: 99%

Are we using Thyroid Function Tests Appropriately?

et al. 2011

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“…TSH then acts via specific receptors on the membrane of thyroid follicular cells to facilitate compensatory stimulation of thyroid hormone production and secretion, which involves a number of thyroid hormone synthesis-related molecules, such as sodium/iodide symporter (NIS), thyroglobulin (Tg), and thyroperoxidase (TPO). The combined measurements of serum TT4, FT4, and TSH levels are widely recommended to fully assess thyroid function [13,14] .…”

Section: Introductionmentioning

confidence: 99%

Dietary high-fat lard intake induces thyroid dysfunction and abnormal morphology in rats

et al. 2014

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Aim: Excess dietary fat intake can induce lipotoxicity in non-adipose tissues. The aim of this study was to observe the effects of dietary high-fat lard intake on thyroid in rats. Methods: Male Sprague-Dawley rats were fed a high-fat lard diet for 24 weeks, and then the rats were fed a normal control diet (acute dietary modification) or the high-fat lard diet for another 6 weeks. The serum lipid profile, total thyroxine (TT4), free thyroxine (FT4) and thyrotropin (TSH) levels were determined at the 12, 18, 24 and 30 weeks. High-frequency ultrasound scanning of the thyroid glands was performed at the 24 or 30 weeks. After the rats were sacrificed, the thyroid glands were collected for histological and immunohistochemical analyses. Results: The high-fat lard diet significantly increased triglyceride levels in both the serum and thyroid, and decreased serum TT4 and FT4 levels in parallel with elevated serum TSH levels. Ultrasonic imaging revealed enlarged thyroid glands with lowered echotexture and relatively heterogeneous features in the high-fat lard fed rats. The thyroid glands from the high-fat lard fed rats exhibited enlarged follicle cavities and flattened follicular epithelial cells under light microscopy, and dilated endoplasmic reticulum cisternae, twisted nuclei, fewer microvilli and secretory vesicles under transmission electron microscopy. Furthermore, the thyroid glands from the highfat lard fed rats showed markedly low levels of thyroid hormone synthesis-related proteins TTF-1 and NIS. Acute dietary modification by withdrawal of the high-fat lard diet for 6 weeks failed to ameliorate the high-fat lard diet-induced thyroid changes. Conclusion: Dietary high-fat lard intake induces significant thyroid dysfunction and abnormal morphology in rats, which can not be corrected by short-term dietary modification.

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“…A large-scale epidemiological survey reported that "greater than 95% of healthy euthyroid subjects have a serum TSH concentration <2.5μIU/mL [3]. Therefore, the recommended upper limit of TSH need to be reduce to 2.5μIU/mL [4][5][6].…”

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confidence: 99%