Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

Bahn, Rebecca S.; Burch, Henry B.; Cooper, David S.; Garber, Jeffrey R.; Greenlee, M. Carol; Klein, Irwin; Laurberg, Peter; McDougall, I. Ross; Montori, Víctor M.; Rivkees, Scott A.; Ross, Douglas S.; Sosa, Julie Ann; Stan, Marius N.

doi:10.1089/thy.2010.0417

Cited by 768 publications

(526 citation statements)

References 334 publications

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“…Also, an increased morbidity due to venous thromboembolism was observed (1,2,17). Though no controlled intervention studies confirming benefit of subclinical hyperthyroidism treatment are available (18), the recent guidelines advocate treatment, particularly in older patients (R65 years) and those with clearly suppressed TSH (!0.1 mIU/l) (19).…”

Section: Discussionmentioning

confidence: 96%

Prothrombotic changes due to an increase in thyroid hormone levels

Horáček

Malý

Svilias

et al. 2015

European Journal of Endocrinology

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Objective: With increasing free thyroxine levels, a gradually rising risk of venous thromboembolism has been described in case-control studies. However, reports on the influence of thyroid hormones on haemostasis, while suggesting a hypercoagulable state in thyrotoxicosis, have often been inconclusive. This study evaluates multiple markers of haemostasis and fibrinolysis in a paired design, making it more sensitive to changes in thyroid hormone levels. Design: We analysed multiple variables in patients who shifted from severe hypothyroidism to mild hyperthyroidism during thyroid cancer treatment. Those with possible residual disease were excluded. Methods: Ninety patients following total thyroidectomy were tested on two occasions: i) before radioiodine remnant ablation and ii) 6 weeks later, on levothyroxine (LT 4 ) suppression treatment, and the results were compared using the Wilcoxon's test for paired data. Results: During LT 4 treatment, significant increases (all P!0.001) in fibrinogen (from median 3.4 to 3.8 g/l), von Willebrand factor (from 85 to 127%), factor VIII (from 111 to 148%) and plasminogen activator inhibitor 1 (from 6.5 to 13.9 mg/l) were observed. In addition, the activation times of platelet adhesion and aggregation stimulated with collagen and epinephrine (EPI)/ADP, i.e. closure times in platelet function analyser (PFA-100), were significantly shortened (P!0.001): for EPI from median 148 to 117 s and for ADP from 95 to 80 s. Changes in other tests were less prominent or insignificant. Conclusions: An increase in thyroid hormone levels shifts the haemostatic balance towards a hypercoagulable, hypofibrinolytic state. This may contribute to the increased cardiovascular morbidity and mortality observed even in mild thyrotoxicosis.

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Section: Discussionmentioning

confidence: 96%

Prothrombotic changes due to an increase in thyroid hormone levels

Horáček

Malý

Svilias

et al. 2015

European Journal of Endocrinology

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“…Because TSH is normally the most sensitive measure of thyroid function, initial biochemical diagnosing of hyperthyroidism often consists of measuring TSH, and if this is below the reference interval, then total T 4 /free T 4 and total T 3 /free T 3 (21). Such type of biochemical diagnosing of thyroid dysfunction depends on the normal function of the thyroid pituitary feedback system, and the fact that small changes in T 4 and T 3 leads to relatively larger changes in serum TSH (22).…”

Section: Changes In Thyroid Function and Test Reference Limits In Prementioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

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Thyroid hormones are essential developmental factors, and Graves' disease (GD) may severely complicate a pregnancy. This review describes how pregnancy changes the risk of developing GD, how early pregnancy by several mechanisms leads to considerable changes in the results of the thyroid function tests used to diagnose hyperthyroidism, and how these changes may complicate the diagnosing of GD. Standard therapy of GD in pregnancy is anti-thyroid drugs. However, new studies have shown considerable risk of birth defects if these drugs are used in specific weeks of early pregnancy, and this should be taken into consideration when planning therapy and control of women who may in the future become pregnant. Early pregnancy is a period of major focus in GD, where pregnancy should be diagnosed as soon as possible, and where important and instant change in therapy may be warranted. Such change may be an immediate stop of anti-thyroid drug therapy in patients with a low risk of rapid relapse of hyperthyroidism, or it may be an immediate shift from methimazole/carbimazole (with risk of severe birth defects) to propylthiouracil (with less risk), or maybe to other types of therapy where no risk of birth defects have been observed. In the second half of pregnancy, an important concern is that not only the mother with GD but also her foetus should have normal thyroid function.Thyroid hormones are essential developmental factors as first shown by Gudernatsch when he, in 1912, fed tadpoles thyroid tissue and observed metamorphosis (1). In mammals, thyroid hormones are especially of importance for brain development (2, 3), and even a few months with lack of thyroid hormones in infant life may lead to irreversible brain damage. This is the background for the universal screening for congenital hypothyroidism performed in many countries. However, thyroid hormones are also important for normal pregnancy, and maternal thyroid disease may severely increase the risk of pregnancy complications, including Invited author's profile Peter Laurberg was Clinical Professor of Internal Medicine and Endocrinology, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark. His research mainly focused on thyroid disease prevention, epidemiology, diagnosing and therapy, including studies on iodine and thyroid, and pregnancy and thyroid. He had special research interest on the risk from and optimal management of autoimmune hypo-and hyperthyroidism in pregnancy and post-partum, management of Graves' disease in general, and how the burden of thyroid disease can be minimized by adjusting the population's iodine intake. He has coauthored several international guidelines on thyroid disease management, including management of thyrotoxicosis, and thyroid disease in pregnancy. Peter Laurberg died June 20, 2016.

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“…In human patients, measurement of serum thyrotropin (thyroid stimulating hormone, TSH) concentration is performed routinely as the first‐line test of thyroid function and is the single best screening test for overt and subclinical hyperthyroidism 10, 11. Physiologically, even slight increases in circulating T 4 and T 3 will suppress pituitary TSH secretion through the negative feedback loop of the HPT axis, leading to low or undetectable serum TSH concentrations 12, 13.…”

mentioning

confidence: 99%

“…Physiologically, even slight increases in circulating T 4 and T 3 will suppress pituitary TSH secretion through the negative feedback loop of the HPT axis, leading to low or undetectable serum TSH concentrations 12, 13. Recent development of ultrasensitive human TSH assays that can clearly distinguish truly low from low‐normal concentrations has facilitated diagnosis of patients with mild and occult (subclinical) hyperthyroidism 10, 11…”

mentioning

confidence: 99%

Evaluation of Serum Thyroid‐Stimulating Hormone Concentration as a Diagnostic Test for Hyperthyroidism in Cats

Peterson

Guterl

Nichols

et al. 2015

Veterinary Internal Medicne

112

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BackgroundIn humans, measurement of serum thyroid‐stimulating hormone (TSH) concentration is commonly used as a first‐line discriminatory test of thyroid function. Recent reports indicate that canine TSH (cTSH) assays can be used to measure feline TSH and results can help diagnose or exclude hyperthyroidism.ObjectivesTo investigate the usefulness of cTSH measurements as a diagnostic test for cats with hyperthyroidism.AnimalsNine hundred and seventeen cats with untreated hyperthyroidism, 32 euthyroid cats suspected of having hyperthyroidism, and 131 clinically normal cats.MethodsProspective study. Cats referred to the Animal Endocrine Clinic for suspected hyperthyroidism were evaluated with serum T4, T3, free T4 (fT 4), and TSH concentrations. Thyroid scintigraphy was used as the gold standard to confirm or exclude hyperthyroidism.ResultsMedian serum TSH concentration in the hyperthyroid cats (<0.03 ng/mL) was significantly (P < .001) lower than concentrations in clinically normal cats (0.05 ng/mL) or euthyroid cats with suspected thyroid disease (0.06 ng/mL). Only 18 (2.0%) hyperthyroid cats had measurable TSH concentrations (≥0.03 ng/mL), whereas 114 (69.9%) of the 163 euthyroid cats had detectable concentrations. Combining serum TSH with T4 or fT 4 concentrations lowered the test sensitivity of TSH from 98.0 to 97.0%, but markedly increased overall test specificity (from 69.9 to 98.8%).Conclusions and Clinical ImportanceSerum TSH concentrations are suppressed in 98% of hyperthyroid cats, but concentrations are measurable in a few cats with mild‐to‐moderate hyperthyroidism. Measurement of serum TSH represents a highly sensitive but poorly specific test for diagnosis of hyperthyroidism and is best measured in combination with T4 and fT 4.

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Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

Abstract: One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.

Cited by 768 publications

References 334 publications

Prothrombotic changes due to an increase in thyroid hormone levels

Prothrombotic changes due to an increase in thyroid hormone levels

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Evaluation of Serum Thyroid‐Stimulating Hormone Concentration as a Diagnostic Test for Hyperthyroidism in Cats

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