Rapid differential diagnosis of thyrotoxicosis using T3/T4 ratio, FT3/FT4 ratio and color doppler of thyroid gland

Narkar, Rukma; Mishra, Ipsita; Choudhury, A. K.

doi:10.4103/ijem.ijem_137_21

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…The relatively lower FT3/TT3 ratio was attributed to the abnormally high TT3 level observed. Under normal conditions, the TT3/TT4 ratio hovers around 2% . In our study, however, the TT3 level was comparable to the TT4 level (Figure a,b), indicating a 50 times higher TT3 concentration than the norm and thus a decreased FT3/TT3 ratio.…”

Section: Resultscontrasting

confidence: 61%

Structure-Related Thyroid Disrupting Effect of Perfluorooctanesulfonate-like Substances in Zebrafish Larvae

Yi,

Wang,

Wang

et al. 2023

Environ. Sci. Technol.

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Chlorinated polyfluorooctane ether sulfonate (6:2 Cl-PFESA), hydrogenated polyfluorooctane ether sulfonate (6:2 H-PFESA), and chlorinated polyfluorooctanesulfonate (Cl-PFOS) share structural similarities with the regulated perfluorooctanesulfonate (PFOS), but their toxic potential is rarely known. Here, the thyroid disrupting potential of these four compounds in zebrafish larvae has been comparably investigated. PFOS, Cl-PFOS, and 6:2 Cl-PFESA were accumulated in the larvae at similar levels, approximately 1.3−1.6 times higher than 6:2 H-PFESA. Additionally, PFOS, Cl-PFOS, and 6:2 Cl-PFESA exhibited stronger disruption than 6:2 H-PFESA on genetic regulation, particularly concerning thyroid hormone (TH) activation and action and on TH homeostasis in both free and total forms of thyroxine (T4) and 3,5,3′triiodothyronine (T3). These results indicate that chlorination or oxygen insertion does not substantially alter the thyrotoxicity of PFOS, but hydrogenation mitigates it. Molecular docking analysis and the luciferase reporter gene assay provided mechanistic perspectives that the PFOSlike substances could competitively replace THs to bind with TH plasma and membrane transporters, thereby disrupting TH transport and action, respectively. Moreover, they are also potent to disrupt TH synthesis and activation through Na + /K + -dependent transport of I − or competitive binding to the sites of deiodinases.

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Section: Resultscontrasting

confidence: 61%

Structure-Related Thyroid Disrupting Effect of Perfluorooctanesulfonate-like Substances in Zebrafish Larvae

Yi,

Wang,

Wang

et al. 2023

Environ. Sci. Technol.

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“…demonstrated the efficacy of Doppler ultrasound in predicting the prognosis of GD and aiding in treatment strategy formulation ( 12 ). ITA-PSV has been proposed as a potential predictor of GD recurrence ( 13 , 14 ), and the flow characteristics in the superior and inferior thyroid arteries have been identified as valuable markers for distinguishing GD from thyroiditis ( 4 , 11 , 15 – 18 ). Recent advancements have further highlighted the diagnostic value of peak systolic flow velocity in thyroid arteries, as evidenced by Peng et al.’s investigation into the sensitivity and specificity of STA-PSV cut-off values ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis: elucidating diagnostic thresholds of peak systolic flow velocities in thyroid arteries for the discrimination of Graves’ disease and destructive thyrotoxicosis

Li,

Ding,

et al. 2024

Front. Endocrinol.

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ObjectiveThis meta-analysis examines peak systolic velocities (PSVs) in thyroid arteries as potential biomarkers for thyroid disorders, which includes treated and untreated Graves’ disease(GD) and destructive thyrotoxicosis(DT).MethodsA search across databases including PubMed, Google Scholar, Embase, and Web of Science identified studies assessing peak systolic flow velocity in the inferior thyroid artery (ITA-PSV) and superior thyroid artery (STA-PSV) diagnostic efficacy in GD and DT.And the search was restricted to publications in the English language.The analysis compared STA-PSV and ITA-PSV across patient groups, evaluating intra-group variances and synthesizing sensitivity and specificity data.ResultsThe analysis covered 18 studies with 1276 GD, 564 DT patients, and 544 controls. The difference of STA-PSV between GD group, DT group and normal group and the difference of ITA-PSV were analyzed in subgroups, and there was no statistical significance between subgroups when comparing any two groups. Normal subjects displayed intra-group ITA-PSV and STA-PSV differences with established cut-off values of 20.33 cm/s (95% CI, 17.48-23.18) for ITA-PSV and 25.61 cm/s (95% CI, 20.37-30.85) for STA-PSV. However, no significant intra-group differences were observed in the STA-PSV and ITA-PSV cut-off values among groups with GD or DT. The combined cut-off values for these patient groups and normal subjects were 68.63 cm/s (95% CI, 59.12-78.13), 32.08 cm/s (95% CI, 25.90-38.27), and 23.18 cm/s (95% CI, 20.09-26.28), respectively. The diagnostic odds ratio(DOR) for these values was 35.86 (95% CI, 18.21-70.60), and the area under the summary receiver operating characteristic (SROC) curve was 0.91, with a sensitivity estimate of 0.842 (95% CI, 0.772-0.866).ConclusionPSVs in thyroid arteries are useful diagnostic tools in distinguishing DT from GD. A PSV above 68.63 cm/s significantly improves GD diagnosis with up to 91% efficacy. No notable differences were found between superior and inferior thyroid arteries in these conditions.

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“…The fT3/fT4 ratio has been reported as a useful indicator in differentiating subacute thyroiditis from Graves' disease (10,11). However, due to the limited number of studies and the heterogeneity of the studies, a clear recommendation cannot be made (12)(13)(14)(15)(16)(17)(18). Therefore, the aim of this study was to evaluate fT3 and fT4 ratios and levels in patients with Graves' disease, toxic nodular goiter and subacute thyroiditis.…”

Section: Introductionmentioning

confidence: 99%

fT3 index/TSH index ratio and free thyroid hormone index in the differential diagnosis of thyrotoxicosis

Sakız¹,

Çalapkulu²,

Sencar³

et al. 2022

Journal of Health Sciences and Medicine

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Aim: Common causes of thyrotoxicosis are hyperthyroidism and destructive thyroiditis. Hyperthyroidism is a condition characterized by high serum thyroid hormone levels as a result of over-synthesis of thyroid hormones, the most common causes of which are Graves' disease (GD) and toxic nodular goiter (TNG). Subacute thyroiditis (SAT) causes thyrotoxicosis due to the circulating thyroid hormones of destructive thyroiditis. Differential diagnosis is important because GD, TNG and SAT treatment approaches are different. The aim of this study was to analyze whether it is possible to make a differential diagnosis for these conditions by examining free thyroid hormones, fT3/fT4 ratio, fT3 index/TSH index (fT3I/TSHI) ratio and Free Thyroid Hormone Index (FTHI). Material and Method: This retrospective study included 150 patients who were diagnosed with GD, TNG and SAT. The fT3 index (fT3I) was calculated as the ratio between the fT3 value and the fT3 upper limit of normal value (fT3I=fT3/4 pg/ml). The fT4 index (fT4I) was calculated as the ratio between the fT4 value and the fT4 upper limit of normal value (fT4I=fT4/1.23 mg/dl). The TSH index (TSHI) was calculated as the ratio between TSH value and the TSH lower limit of normal limit (TSHI=TSH/0.38 mIU/L). The FTHI index was calculated using the formula of (fT3 level/fT3 upper limit of normal) / (fT4 level/fT4 upper limit of normal). Results: The fT3, fT3/fT4 ratio and FTHI were found to be higher in hyperthyroid patients compared to subacute thyroiditis patients. fT4 and fT3I/TSHI levels were similar in hyperthyroid patients and SAT patients (p=0.49, p=0.11, respectively ). The cut-off level of FTHI for hyperthyroidism was determined as 0.97 with sensitivity of 75% and specificity of 76.3% (AUC=0.833, p< 0.001). When hyperthyroidic patients were divided into two groups as GD and TNG, no significant difference was found in fT3/fT4 ratio (p:0.99). The fT3 (p

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Rapid differential diagnosis of thyrotoxicosis using T3/T4 ratio, FT3/FT4 ratio and color doppler of thyroid gland

Cited by 8 publications

References 16 publications

Structure-Related Thyroid Disrupting Effect of Perfluorooctanesulfonate-like Substances in Zebrafish Larvae

Structure-Related Thyroid Disrupting Effect of Perfluorooctanesulfonate-like Substances in Zebrafish Larvae

A meta-analysis: elucidating diagnostic thresholds of peak systolic flow velocities in thyroid arteries for the discrimination of Graves’ disease and destructive thyrotoxicosis

fT3 index/TSH index ratio and free thyroid hormone index in the differential diagnosis of thyrotoxicosis

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