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Abnormalities in Thyroid Function Tests in Patients Admitted to a Medical Service

Abnormalities in Thyroid Function Tests in Patients Admitted to a Medical Service Abstract • Serum thyroid hormone, thyrotropin (TSH) and thyroxinebinding globulin (TBG) concentrations, free thyroxine index values, and free thyroxine concentrations were measured at the time of admission in all 77 patients hospitalized on a medical service on four separate days. Serum thyroxine (T4) concentrations and serum free T4 index values were decreased in 19.5% and 11.7%, respectively, and increased in 3.9% and 11.7%, respectively; serum free T4 concentrations were decreased in 6.8% and increased in 5.4%. Six patients (7.8%) had increased serum TSH concentrations. Serum triiodothyronine (T3) concentrations were decreased in 26.0% and reverse triiodothyronine (rT3) concentrations were increased in 29.9%. None had manifestations of thyroid disease. These results indicate that available thyroid function tests may give misleading results in patients with nonthyrold illness and suggest that caution be exercised in diagnosing thyroid disease in hospitalized patients. (Arch Intern Med 1982;142:1801-1805) References 1. Cavalieri RR, Rapoport B: Impaired peripheral conversion of thyroxine. Ann Rev Med 1977;28:57-65.Crossref 2. Schimmel M, Utiger RD: Thyroidal and peripheral production of thyroid hormones. Ann Rev Med 1977;87:760-768. 3. Larsen PR, Silva JE, Kaplan MM: Relationships between circulating and intracellular thyroid hormones: Physiological and clinical implications. Endocr Rev 1981;2:87-102.Crossref 4. Chopra IJ, Solomon DH, Chopra U, et al: Alterations in circulating thyroid hormones and thyrotropin in hepatic cirrhosis: Evidence for euthyroidism despite subnormal serum triiodothyronine. J Clin Endocrinol Metabol 1974;39:501-510.Crossref 5. Bermudez F, Surks MI, Oppenheimer JH: High incidence of decreased serum triiodothyronine concentrations in patients with nonthyroidal disease. J Clin Endocrinol Metabol 1975;41:27-40.Crossref 6. Chopra IJ, Chopra U, Smith SR, et al: Reciprocal changes in serum concentrations of 3,3′,5′-triiodothyronine (T3) in systemic illnesses. J Clin Endocrinol Metabol 1975;41:1043-1049.Crossref 7. Spector DA, Davis PJ, Helderman JH, et al: Thyroid function and metabolic state in chronic renal failure. Ann Intern Med 1976;85:724-730.Crossref 8. Rudman D, Fleisher AS, Kutner MH, et al: Suprahypophyseal hypothyroidism and hypogonadism during prolonged coma after head trauma. J Clin Endocrinol Metabol 1977;45:749-754. 9. Birkhauser M, Burer T, Busset R, et al: Diagnosis of hyperthyroidism when serum-thyroxine alone is raised. Lancet 1977;2:53-55.Crossref 10. Engler D, Donaldson ED, Stockigt JR, et al: Hyperthyroidism without triiodothyronine excess: An effect of severe non-thyroidal illness. J Clin Endocrinol Metabol 1978;46:77-82.Crossref 11. Helenius T, Liewendahl K: Abnormal thyroid function tests in severe non-thyroidal illness: Diagnostic and pathophysiologic aspects. Scand J Clin Lab Invest 1979;39:389-397.Crossref 12. Pittman CS, Suda AK, Chambers JB Jr, et al: Abnormalities of thyroid hormone turnover in patients with diabetes mellitus before and after insulin therapy. J Clin Endocrinol Metabol 1979;48:840-860. 13. Gavin LA, Rosenthal M, Cavalieri RR: The diagnostic dilemma of isolated hyperthyroxinemia in acute illness. JAMA 1979;242:251-253.Crossref 14. Chopra IJ, Solomon DH, Hepner GW, et al: Misleadingly low free thyroxine index and usefulness of reverse triiodothyronine measurement in nonthyroidal illness. Ann Intern Med 1979;90:905-912.Crossref 15. Wood DG, Cyrus J, Samols E: Low T4 and low FT4I in seriously ill patients: Concise communication. J Nucl Med 1980;21:432-435. 16. Slag MF, Morley JE, Elson MK, et al: Hypothyroxinemia in critically ill patients as predictor of high mortality. JAMA 1981;245:43-45.Crossref 17. Slag MF, Morley JE, Elson MK, et al: Free thyroxine levels in critically ill patients: A comparison of currently available assays. JAMA 1981;246:2702-2706.Crossref 18. Kaplan MM, Larsen PR, Crantz FR, et al: Prevalence of abnormal thyroid function test results in patients with acute medical illnesses. Am J Med 1982;72:9-16.Crossref 19. Cohen KL, Swigar ME: Thyroid function screening in psychiatric patients. JAMA 1979;242:254-257.Crossref 20. Levy RP, Jensen JB, Laus VG, et al: Serum thyroid hormone abnormalities in psychiatric disease. Metabolism 1981;30:1060-1064.Crossref 21. Chopra IJ: A radioimmunoassay for the measurement of thyroxine in unextracted serum. J Clin Endocrinol Metabol 1972;34:938-947.Crossref 22. Lieblich J, Utiger RD: Triiodothyronine radioimmunoassay. J Clin Invest 1972;51:157-166.Crossref 23. Kaplan MM, Schimmel M, Utiger RD: Changes in serum 3,3′,5′-triiodothyronine (reverse T3) concentrations with altered thyroid hormone secretion and metabolism. J Clin Endocrinol Metabol 1977;45:447-456.Crossref 24. Utiger RD: Thyrotropin , in Jaffe B, Behrman H (eds): Methods of Hormone Radioimmunoassay . New York, Academic Press Inc, 1979, pp 315-325. 25. Uhrman S, Marks KH, Maisels MJ, et al: Thyroid function in the preterm infant: A longitudinal assessment. J Pediatr 1978;92:968-973.Crossref 26. Cavalieri RR, Ingbar SH: Methods for measuring the thyroxine-binding proteins and free thyroid hormone concentration in serum , in O'Malley B, Hardman J (eds): Methods in Enzymology . New York, Academic Press Inc, 1975, vol 36, pp 126-132. 27. Wong ET, Bradley SU, Schultz AL: Elevations of thyroid-stimulating hormone during acute nonthyroidal illness. Arch Intern Med 1981;141: 873-875.Crossref 28. Kaptein EM, Spencer CA, Kamiel MB, et al: Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects. J Clin Endocrinol Metabol 1980;51:387-393.Crossref 29. Croxon MS, Hall TD, Kletsky OA, et al: Decreased serum thyrotropin induced by fasting. J Clin Endocrinol Metabol 1977;45:560-568.Crossref 30. Burman KD, Smallridge RC, Osburne R, et al: Nature of suppressed TSH secretion during undernutrition: Effect of fasting and refeeding on TSH responses to prolonged TRH infusions. Metabolism 1980;29:48-52.Crossref 31. Kaptein EM, Grieb DA, Spencer CA, et al: Thyroxine metabolism in the low thyroxine state of critical nonthyroidal illness. J Clin Endocrinol Metabol 1981;53:764-770.Crossref 32. Melmed S, Geola FL, Reed AW, et al: A comparison of methods for assessing thyroid function in nonthyroidal illness. J Clin Endocrinol Metabol 1982;54:300-306.Crossref 33. Oppenheimer JH, Squef R, Surks MI, et al: Binding of thyroxine by serum proteins evaluated by equilibrium, dialysis and electrophoretic techniques: Alterations in nonthyroidal illness. J Clin Invest 1963;42: 1769-1782.Crossref 34. Lutz JH, Gregerman RI, Spaulding SW, et al: Thyroxine binding proteins, free thyroxine and thyroxine turnover relationships during acute infectious illness in man. J Clin Endocrinol Metabol 1972;35:230-249.Crossref 35. Burgi H, Wimpfheimer C, Burger A, et al: Changes of circulating thyroxine, triiodothyronine and reverse triiodothyronine after radiographic contrast agents. J Clin Endocrinol Metabol 1976;43:1203-1210.Crossref 36. Wu S-Y, Chopra IJ, Solomon DH, et al: Changes in circulating iodothyronines in euthyroid and hyperthyroid subjects given ipodate (Oragrafin), an agent for oral cholecystography. J Clin Endocrinol Metabol 1978;46:691-697.Crossref 37. Felicetta JV, Green WL, Nelp WB: Inhibition of hepatic binding of thyroxine by cholecystographic agents. J Clin invest 1980;65:1032-1040.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Abnormalities in Thyroid Function Tests in Patients Admitted to a Medical Service

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340230041008
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Abstract

Abstract • Serum thyroid hormone, thyrotropin (TSH) and thyroxinebinding globulin (TBG) concentrations, free thyroxine index values, and free thyroxine concentrations were measured at the time of admission in all 77 patients hospitalized on a medical service on four separate days. Serum thyroxine (T4) concentrations and serum free T4 index values were decreased in 19.5% and 11.7%, respectively, and increased in 3.9% and 11.7%, respectively; serum free T4 concentrations were decreased in 6.8% and increased in 5.4%. Six patients (7.8%) had increased serum TSH concentrations. Serum triiodothyronine (T3) concentrations were decreased in 26.0% and reverse triiodothyronine (rT3) concentrations were increased in 29.9%. None had manifestations of thyroid disease. These results indicate that available thyroid function tests may give misleading results in patients with nonthyrold illness and suggest that caution be exercised in diagnosing thyroid disease in hospitalized patients. (Arch Intern Med 1982;142:1801-1805) References 1. Cavalieri RR, Rapoport B: Impaired peripheral conversion of thyroxine. Ann Rev Med 1977;28:57-65.Crossref 2. Schimmel M, Utiger RD: Thyroidal and peripheral production of thyroid hormones. Ann Rev Med 1977;87:760-768. 3. Larsen PR, Silva JE, Kaplan MM: Relationships between circulating and intracellular thyroid hormones: Physiological and clinical implications. Endocr Rev 1981;2:87-102.Crossref 4. Chopra IJ, Solomon DH, Chopra U, et al: Alterations in circulating thyroid hormones and thyrotropin in hepatic cirrhosis: Evidence for euthyroidism despite subnormal serum triiodothyronine. J Clin Endocrinol Metabol 1974;39:501-510.Crossref 5. Bermudez F, Surks MI, Oppenheimer JH: High incidence of decreased serum triiodothyronine concentrations in patients with nonthyroidal disease. J Clin Endocrinol Metabol 1975;41:27-40.Crossref 6. Chopra IJ, Chopra U, Smith SR, et al: Reciprocal changes in serum concentrations of 3,3′,5′-triiodothyronine (T3) in systemic illnesses. J Clin Endocrinol Metabol 1975;41:1043-1049.Crossref 7. Spector DA, Davis PJ, Helderman JH, et al: Thyroid function and metabolic state in chronic renal failure. Ann Intern Med 1976;85:724-730.Crossref 8. Rudman D, Fleisher AS, Kutner MH, et al: Suprahypophyseal hypothyroidism and hypogonadism during prolonged coma after head trauma. J Clin Endocrinol Metabol 1977;45:749-754. 9. Birkhauser M, Burer T, Busset R, et al: Diagnosis of hyperthyroidism when serum-thyroxine alone is raised. Lancet 1977;2:53-55.Crossref 10. Engler D, Donaldson ED, Stockigt JR, et al: Hyperthyroidism without triiodothyronine excess: An effect of severe non-thyroidal illness. J Clin Endocrinol Metabol 1978;46:77-82.Crossref 11. Helenius T, Liewendahl K: Abnormal thyroid function tests in severe non-thyroidal illness: Diagnostic and pathophysiologic aspects. Scand J Clin Lab Invest 1979;39:389-397.Crossref 12. Pittman CS, Suda AK, Chambers JB Jr, et al: Abnormalities of thyroid hormone turnover in patients with diabetes mellitus before and after insulin therapy. J Clin Endocrinol Metabol 1979;48:840-860. 13. Gavin LA, Rosenthal M, Cavalieri RR: The diagnostic dilemma of isolated hyperthyroxinemia in acute illness. JAMA 1979;242:251-253.Crossref 14. Chopra IJ, Solomon DH, Hepner GW, et al: Misleadingly low free thyroxine index and usefulness of reverse triiodothyronine measurement in nonthyroidal illness. Ann Intern Med 1979;90:905-912.Crossref 15. Wood DG, Cyrus J, Samols E: Low T4 and low FT4I in seriously ill patients: Concise communication. J Nucl Med 1980;21:432-435. 16. Slag MF, Morley JE, Elson MK, et al: Hypothyroxinemia in critically ill patients as predictor of high mortality. JAMA 1981;245:43-45.Crossref 17. Slag MF, Morley JE, Elson MK, et al: Free thyroxine levels in critically ill patients: A comparison of currently available assays. JAMA 1981;246:2702-2706.Crossref 18. Kaplan MM, Larsen PR, Crantz FR, et al: Prevalence of abnormal thyroid function test results in patients with acute medical illnesses. Am J Med 1982;72:9-16.Crossref 19. Cohen KL, Swigar ME: Thyroid function screening in psychiatric patients. JAMA 1979;242:254-257.Crossref 20. Levy RP, Jensen JB, Laus VG, et al: Serum thyroid hormone abnormalities in psychiatric disease. Metabolism 1981;30:1060-1064.Crossref 21. Chopra IJ: A radioimmunoassay for the measurement of thyroxine in unextracted serum. J Clin Endocrinol Metabol 1972;34:938-947.Crossref 22. Lieblich J, Utiger RD: Triiodothyronine radioimmunoassay. J Clin Invest 1972;51:157-166.Crossref 23. Kaplan MM, Schimmel M, Utiger RD: Changes in serum 3,3′,5′-triiodothyronine (reverse T3) concentrations with altered thyroid hormone secretion and metabolism. J Clin Endocrinol Metabol 1977;45:447-456.Crossref 24. Utiger RD: Thyrotropin , in Jaffe B, Behrman H (eds): Methods of Hormone Radioimmunoassay . New York, Academic Press Inc, 1979, pp 315-325. 25. Uhrman S, Marks KH, Maisels MJ, et al: Thyroid function in the preterm infant: A longitudinal assessment. J Pediatr 1978;92:968-973.Crossref 26. Cavalieri RR, Ingbar SH: Methods for measuring the thyroxine-binding proteins and free thyroid hormone concentration in serum , in O'Malley B, Hardman J (eds): Methods in Enzymology . New York, Academic Press Inc, 1975, vol 36, pp 126-132. 27. Wong ET, Bradley SU, Schultz AL: Elevations of thyroid-stimulating hormone during acute nonthyroidal illness. Arch Intern Med 1981;141: 873-875.Crossref 28. Kaptein EM, Spencer CA, Kamiel MB, et al: Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects. J Clin Endocrinol Metabol 1980;51:387-393.Crossref 29. Croxon MS, Hall TD, Kletsky OA, et al: Decreased serum thyrotropin induced by fasting. J Clin Endocrinol Metabol 1977;45:560-568.Crossref 30. Burman KD, Smallridge RC, Osburne R, et al: Nature of suppressed TSH secretion during undernutrition: Effect of fasting and refeeding on TSH responses to prolonged TRH infusions. Metabolism 1980;29:48-52.Crossref 31. Kaptein EM, Grieb DA, Spencer CA, et al: Thyroxine metabolism in the low thyroxine state of critical nonthyroidal illness. J Clin Endocrinol Metabol 1981;53:764-770.Crossref 32. Melmed S, Geola FL, Reed AW, et al: A comparison of methods for assessing thyroid function in nonthyroidal illness. J Clin Endocrinol Metabol 1982;54:300-306.Crossref 33. Oppenheimer JH, Squef R, Surks MI, et al: Binding of thyroxine by serum proteins evaluated by equilibrium, dialysis and electrophoretic techniques: Alterations in nonthyroidal illness. J Clin Invest 1963;42: 1769-1782.Crossref 34. Lutz JH, Gregerman RI, Spaulding SW, et al: Thyroxine binding proteins, free thyroxine and thyroxine turnover relationships during acute infectious illness in man. J Clin Endocrinol Metabol 1972;35:230-249.Crossref 35. Burgi H, Wimpfheimer C, Burger A, et al: Changes of circulating thyroxine, triiodothyronine and reverse triiodothyronine after radiographic contrast agents. J Clin Endocrinol Metabol 1976;43:1203-1210.Crossref 36. Wu S-Y, Chopra IJ, Solomon DH, et al: Changes in circulating iodothyronines in euthyroid and hyperthyroid subjects given ipodate (Oragrafin), an agent for oral cholecystography. J Clin Endocrinol Metabol 1978;46:691-697.Crossref 37. Felicetta JV, Green WL, Nelp WB: Inhibition of hepatic binding of thyroxine by cholecystographic agents. J Clin invest 1980;65:1032-1040.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1982

References