Subclinical hypothyroidism: a comparison of strategies to achieve                adherence to treatment guidelines

Lock, R J; Marden, NA; Kemp, H. G.; Thomas, P; Goldie, D. J.; Gompels, MM

doi:10.1258/000456304323019550

Cited by 14 publications

(10 citation statements)

References 16 publications

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“…Importantly, 45 of the 61 subclinical hypothyroid patients also had elevated anti-TPO (73%). This is a crucial finding suggesting to the clinician to initiate treatment in these patients as raised anti-TPO identifies an autoimmune etiology for thyroid dysfunction and would predict a higher risk of developing overt hypothyroidism (7). In the present scenario of the post -iodination status in India, the high prevalence of subclinical hypothyroidism is significant as similar findings were reported from other countries stating hypothyroidism is more prevalent and marked in subjects consuming excessive amounts of iodine.…”

Section: Resultsmentioning

confidence: 52%

Diagnostic strategies for subclinical hypothyroidism

Mohanty

Amruthlal

Reddy

et al. 2008

Indian J Clin Biochem

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Section: Resultsmentioning

confidence: 52%

Diagnostic strategies for subclinical hypothyroidism

Mohanty

Amruthlal

Reddy

et al. 2008

Indian J Clin Biochem

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“…3 Reportedly, patients with subclinical hypothyroidism and antithyroid peroxidase (TPO) antibodies convert to overt hypothyroidism more frequently than those without these clinical fi ndings. 24 The present patient demonstrated slight elevations of TSH (approximately 4-10 μIU/ml) (Fig. 6).…”

Section: In 2007supporting

confidence: 51%

A case of dual ectopic thyroid accompanied by positive antithyroid antibodies

Fujioka

Fujioka²,

Ban

et al. 2008

J Med Ultrasonics

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Ectopic thyroid tissue is an uncommon congenital aberration that is seldom present at two different sites simultaneously. The patient was a 32-year-old woman with dual ectopic thyroid accompanied by positive antithyroid antibodies. The simultaneous occurrence of dual ectopic thyroid and positive antithyroid antibodies has been documented in only two cases: the case discussed here and one previous case. The cervical ectopic thyroid was followed up by ultrasound, which showed an increase in the size of the lesion and an internal echo texture that became slightly heterogeneous after the patient had her second child. We speculated that these changes resulted from the changes in hormone demand brought on by pregnancy and parturition.

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“…11 However, this practice does have ethical considerations if tests seemingly unrelated to the presenting symptoms are added by laboratory staff. Our experiences 12 and those of others 13 are that the laboratory should play an active role in this process. It is, of course, very likely that the diagnoses of PBC would have been made regardless of the laboratory's involvement in some of the cases illustrated here.…”

Section: Discussionmentioning

confidence: 72%

Can the laboratory affect the investigation and diagnosis of primary biliary cirrhosis?: Table 1

Sinclair

Spedding²,

Young³

2006

J Clin Pathol

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Background: Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterised by the presence of various laboratory abnormalities but the precise role of laboratory staff in initiating clinical referral and subsequent biopsy is not clear. Objective: To examine the impact of laboratory abnormalities in the investigation of PBC. Methods: In a retrospective study of laboratory results over nine years from 1996, computer records were reviewed to identify how many referrals for biopsy were initiated and subsequent diagnoses made as a result of clinical signs, raised serum alkaline phosphatase activity (ALP), raised IgM concentration, or positive mitochondrial antibodies accompanied by a clinical comment from the laboratory suggesting further action. Results: 22 diagnoses of PBC were confirmed by histopathology. Eleven had high ALP activity which had follow up tests initiated by the laboratory (mitochondrial antibodies or IgM or both) and a comment added suggesting further investigation into the possibility of PBC. Seven had abnormal liver antibodies and one had a high polyclonal IgM concentration which prompted the relevant follow on testing and comments. One had an earlier diagnosis made on serological/clinical grounds and the biopsy was a confirmatory measure. One had no liver related antibodies. One had a request by laboratory staff for follow on tests but these were not asked for in subsequent samples by the requesting clinician. Conclusions: There is a positive role for laboratory staff in the diagnosis of PBC. Unexplained rises in ALP activity, positive mitochondrial antibodies, or raised IgM concentrations should be investigated more fully by laboratory staff and advice given to prompt a clinical referral for review and biopsy.

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Subclinical hypothyroidism: a comparison of strategies to achieve adherence to treatment guidelines

Cited by 14 publications

References 16 publications

Diagnostic strategies for subclinical hypothyroidism

Diagnostic strategies for subclinical hypothyroidism

A case of dual ectopic thyroid accompanied by positive antithyroid antibodies

Can the laboratory affect the investigation and diagnosis of primary biliary cirrhosis?: Table 1

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