Thyroid function tests

Thyroid function tests
MeSHD013960
MedlinePlus003444

Thyroid function tests (TFTs) is a collective term for blood tests used to check the function of the thyroid.[1] TFTs may be requested if a patient is thought to suffer from hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid), or to monitor the effectiveness of either thyroid-suppression or hormone replacement therapy. It is also requested routinely in conditions linked to thyroid disease, such as atrial fibrillation and anxiety disorder.

A TFT panel typically includes thyroid hormones such as thyroid-stimulating hormone (TSH, thyrotropin) and thyroxine (T4), and triiodothyronine (T3) depending on local laboratory policy.

Thyroid-stimulating hormone

Thyroid-stimulating hormone (TSH, thyrotropin) is generally increased in hypothyroidism and decreased in hyperthyroidism,[2] making it the most important test for early detection of both of these conditions.[3][4] The result of this assay is suggestive of the presence and cause of thyroid disease, since a measurement of elevated TSH generally indicates hypothyroidism, while a measurement of low TSH generally indicates hyperthyroidism.[2] However, when TSH is measured by itself, it can yield misleading results, so additional thyroid function tests must be compared with the result of this test for accurate diagnosis.[4][5][6]

TSH is produced in the pituitary gland. The production of TSH is controlled by thyrotropin-releasing hormone (TRH), which is produced in the hypothalamus. TSH levels may be suppressed by excess free T3 (fT3) or free T4 (fT4) in the blood.[citation needed]

History

First-generation TSH assays were done by radioimmunoassay and were introduced in 1965.[3] There were variations and improvements upon TSH radioimmunoassay, but their use declined as a new immunometric assay technique became available in the middle of the 1980s.[3][4] The new techniques were more accurate, leading to the second, third, and even fourth generations of TSH assay, with each generation possessing ten times greater functional sensitivity than the last.[7] Third generation immunometric assay methods are typically automated.[3] Fourth generation TSH immunometric assay has been developed for use in research.[4]

Modern standard

Third generation TSH assay is the requirement for modern standards of care. TSH testing in the United States is typically carried out with automated platforms using advanced forms of immunometric assay.[3] Nonetheless, there is no international standard for measurement of thyroid-stimulating hormone.[4]

Interpretation

Accurate interpretation takes a variety of factors into account, such as the thyroid hormones i.e. thyroxine (T4) and triiodothyronine (T3), current medical status (such as pregnancy[3]),[4] certain medications like propylthiouracil,[4] temporal effects including circadian rhythm[8] and hysteresis,[9] and other past medical history.[10]

Thyroid hormones

Total thyroxine

Total thyroxine is rarely measured, having been largely superseded by free thyroxine tests. Total thyroxine (Total T4) is generally elevated in hyperthyroidism and decreased in hypothyroidism.[2] It is usually slightly elevated in pregnancy secondary to increased levels of thyroid binding globulin (TBG).[2]

Total T4 is measured to see the bound and unbound levels of T4. The total T4 is less useful in cases where there could be protein abnormalities. The total T4 is less accurate due to the large amount of T4 that is bound. The total T3 is measured in clinical practice since the T3 has decreased amount that is bound as compared to T4.[citation needed]

Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are:

Lower limit Upper limit Unit
4,[11] 5.5[12] 11,[11] 12.3[12] μg/dL
60[11][13] 140,[11] 160[13] nmol/L

Free thyroxine

Free thyroxine (fT4 or free T4) is generally elevated in hyperthyroidism and decreased in hypothyroidism.[2]

Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are:

Patient type Lower limit Upper limit Unit
Normal adult 0.7,[14] 0.8[12] 1.4,[14] 1.5,[12] 1.8[15] ng/dL
9,[16][17] 10,[11] 12 [13] 18,[16][17] 23[13] pmol/L
Infant 0–3 d 2.0[14] 5.0[14] ng/dL
26[17] 65[17] pmol/L
Infant 3–30 d 0.9[14] 2.2[14] ng/dL
12[17] 30[17] pmol/L
Child/Adolescent
31 d – 18 y		 0.8[14] 2.0[14] ng/dL
10[17] 26[17] pmol/L
Pregnant 0.5[14] 1.0[14] ng/dL
6.5[17] 13[17] pmol/L

Total triiodothyronine

Total triiodothyronine (Total T3) is rarely measured, having been largely superseded by free T3 tests. Total T3 is generally elevated in hyperthyroidism and decreased in hypothyroidism.[2]

Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are:

Test Lower limit Upper limit Unit
Total triiodothyronine 60,[12] 75[11] 175,[11] 181[12] ng/dL
0.9,[16] 1.1[11] 2.5,[16] 2.7[11] nmol/L

Free triiodothyronine

Free triiodothyronine (fT3 or free T3) is generally elevated in hyperthyroidism and decreased in hypothyroidism.[2]

Reference ranges depend on the method of analysis. Results should always be interpreted using the range from the laboratory that performed the test. Example values are:

Patient type Lower limit Upper limit Unit
Normal adult 3.0[11] 7.0[11] pg/mL
3.1[18] 7.7[18] pmol/L
Children 2–16 y 3.0[19] 7.0[19] pg/mL
1.5[18] 15.2[18] pmol/L

Carrier proteins

Thyroxine-binding globulin

Main article: Thyroxine-binding globulin

An increased thyroxine-binding globulin results in an increased total thyroxine and total triiodothyronine without an actual increase in hormonal activity of thyroid hormones.

Reference ranges:

Lower limit Upper limit Unit
12[12] 30[12] mg/L

Thyroglobulin

Reference ranges:

Lower limit Upper limit Unit
1.5[11] 30[11] pmol/L
1[11] 20 [11] μg/L

Other binding hormones

Protein binding function

Thyroid hormone uptake

Thyroid hormone uptake (Tuptake or T3 uptake) is a measure of the unbound thyroxine binding globulins in the blood, that is, the TBG that is unsaturated with thyroid hormone.[2] Unsaturated TBG increases with decreased levels of thyroid hormones. It is not directly related to triiodothyronine, despite the name T3 uptake.[2]

Reference ranges:

Patient type Lower limit Upper limit Unit
Females 25[2] 35[2] %
In pregnancy 15[2] 25[2] %
Males 25[2] 35[2] %

Other protein binding tests

Mixed parameters

Free thyroxine index

The Free Thyroxine Index (FTI or T7) is obtained by multiplying the total T4 with T3 uptake.[2] FTI is considered to be a more reliable indicator of thyroid status in the presence of abnormalities in plasma protein binding.[2] This test is rarely used now that reliable free thyroxine and free triiodothyronine assays are routinely available.

FTI is elevated in hyperthyroidism and decreased in hypothyroidism.[2]

Patient type Lower limit Upper limit Unit
Females 1.8[2] 5.0[2]
Males 1.3[2] 4.2[2]

Calculated and structure parameters

Reference ranges for thyroid's secretory capacity (SPINA-GT) and Jostel's TSH index (TSHI or JTI) compared to univariable reference ranges for thyrotropin (TSH) and free thyroxine (FT4), shown in the two-dimensional phase plane defined by serum concentrations of TSH and FT4.
Reference ranges for thyroid's secretory capacity (SPINA-GT) and Jostel's TSH index (TSHI or JTI) compared to univariable reference ranges for thyrotropin (TSH) and free thyroxine (FT4), shown in the two-dimensional phase plane defined by serum concentrations of TSH and FT4.

Derived structure parameters that describe constant properties of the overall feedback control system may add useful information for special purposes, e.g. in diagnosis of nonthyroidal illness syndrome or central hypothyroidism.[20][21][22][23]

Secretory capacity (GT)

Main article: Thyroid's secretory capacity

Thyroid's secretory capacity (GT, also referred to as SPINA-GT) is the maximum stimulated amount of thyroxine the thyroid can produce in one second.[24] GT is elevated in hyperthyroidism and reduced in hypothyroidism.[25]

GT is calculated with

or

: Dilution factor for T4 (reciprocal of apparent volume of distribution, 0.1 l−1)
: Clearance exponent for T4 (1.1e-6 sec−1)
K41: Dissociation constant T4-TBG (2e10 L/mol)
K42: Dissociation constant T4-TBPA (2e8 L/mol)
DT: EC50 for TSH (2.75 mU/L)[24]

Lower limit Upper limit Unit
1.41[24] 8.67[24] pmol/s

Sum activity of peripheral deiodinases (GD)

Main article: Sum activity of peripheral deiodinases

The sum activity of peripheral deiodinases (GD, also referred to as SPINA-GD) is reduced in nonthyroidal illness with hypodeiodination.[21][22][26]

GD is obtained with

or

: Dilution factor for T3 (reciprocal of apparent volume of distribution, 0.026 L−1)
: Clearance exponent for T3 (8e-6 sec−1)
KM1: Dissociation constant of type-1-deiodinase (5e-7 mol/L)
K30: Dissociation constant T3-TBG (2e9 L/mol)[24]

Lower limit Upper limit Unit
20[24] 40[24] nmol/s

TSH index

Main article: Jostel's TSH index

Jostel's TSH index (JTI or TSHI) helps to determine thyrotropic function of anterior pituitary on a quantitative level.[27] It is reduced in thyrotropic insufficiency[27] and in certain cases of non-thyroidal illness syndrome.[26]

It is calculated with

.

Additionally, a standardized form of TSH index may be calculated with

.[27]

Parameter Lower limit Upper limit Unit
TSHI 1.3[27] 4.1[27]
sTSHI -2[27] 2[27]

TTSI

Main article: Thyrotroph Thyroid Hormone Sensitivity Index

The Thyrotroph Thyroid Hormone Sensitivity Index (TTSI, also referred to as Thyrotroph T4 Resistance Index or TT4RI) was developed to enable fast screening for resistance to thyroid hormone.[28][29] Somewhat similar to the TSH Index it is calculated from equilibrium values for TSH and FT4, however with a different equation.

Lower limit Upper limit Unit
100 150

TFQI

Main article: Thyroid Feedback Quantile-based Index

The Thyroid Feedback Quantile-based Index (TFQI) is another parameter for thyrotropic pituitary function. It was defined to be more robust to distorted data than JTI and TTSI. It is calculated with

from quantiles of FT4 and TSH concentration (as determined based on cumulative distribution functions).[30] Per definition the TFQI has a mean of 0 and a standard deviation of 0.37 in a reference population.[30] Higher values of TFQI are associated with obesity, metabolic syndrome, impaired renal function, diabetes, and diabetes-related mortality.[30][31][32][33][34][35][36] TFQI results are also elevated in takotsubo syndrome,[37] potentially reflecting type 2 allostatic load in the situation of psychosocial stress. Reductions have been observed in subjects with schizophrenia after initiation of therapy with oxcarbazepine, potentially reflecting declining allostatic load.[38]

Lower limit Upper limit Unit
–0,74 +0.74

Reconstructed set point

In healthy persons, the intra-individual variation of TSH and thyroid hormones is considerably smaller than the inter-individual variation.[39][40][41] This results from a personal set point of thyroid homeostasis.[42] In hypothyroidism, it is impossible to directly access the set point,[43] but it can be reconstructed with methods of systems theory.[44][45][46]

A computerised algorithm, called Thyroid-SPOT, which is based on this mathematical theory, has been implemented in software applications.[47] In patients undergoing thyroidectomy it could be demonstrated that this algorithm can be used to reconstruct the personal set point with sufficient precision.[48]

Effects of drugs

Drugs can profoundly affect thyroid function tests. Listed below is a selection of important effects.

Effects of some drugs on Tests of Thyroid function[49][23][50]
Cause Drug Effect on hormone concentrations Effect on structure parameters
Inhibited TSH secretion Dopamine, L-DOPA, glucocorticoids, somatostatin ↓T4; ↓T3; ↓TSH ↔SPINA-GT; ↓JTI
Inhibited synthesis or release of thyroid hormone Iodine, lithium ↓T4; ↓T3; ↑TSH ↓SPINA-GT; ↔JTI
Inhibited conversion of T4 to T3 (Step-up hypodeiodination) Amiodarone, glucocorticoids, propranolol, propylthiouracil, radiographic contrast agents ↓T3; ↑rT3; ↓, ↔, ↑T4 and fT4; ↔, ↑TSH ↓SPINA-GD
Inhibited binding of T4/T3 to serum proteins Salicylates, phenytoin, carbamazepine, furosemide, nonsteroidal anti-inflammatory agents, heparin (in vitro effect) ↓T4; ↓T3; ↓fT4E, ↔, ↑fT4; ↔TSH ↓T4/fT4 ratio
Stimulated metabolism of iodothyronines Phenobarbital, phenytoin, carbamazepine, rifampicin ↓T4; ↓fT4; ↔TSH
Inhibited absorption of ingested T4 Aluminium hydroxide, ferrous sulfate, cholestyramine, colestipol, iron sucralfate, soybean preparations, kayexalate ↓T4; ↓fT4; ↑TSH
Increase in concentration of T4-binding proteins Estrogen, clofibrate, opiates (heroin, methadone), 5-fluorouracil, perphenazine ↑T4; ↑T3; ↔fT4; ↔TSH ↔SPINA-GT; ↔SPINA-GD; ↔JTI; ↑T4/fT4 ratio
Decrease in concentration of T4-binding proteins Androgens, glucocorticoids ↓T4; ↓T3; ↔fT4; ↔TSH ↔SPINA-GT; ↔SPINA-GD; ↔JTI; ↓T4/fT4 ratio

↓: reduced serum concentration or structure parameter; ↑: increased serum concentration or structure parameter; ↔: no change; TSH: Thyroid-stimulating hormone; T3: Total triiodothyronine; T4: Total thyroxine; fT4: Free thyroxine; fT3: Free triiodothyronine; rT3: Reverse triiodothyronine

See also

Reference ranges for blood tests, sorted by mass and molar concentration, with thyroid function tests marked in purple boxes in left half of diagram.

References

  1. ^ Dayan CM (February 2001). "Interpretation of thyroid function tests". Lancet. 357 (9256): 619–24. doi:10.1016/S0140-6736(00)04060-5. PMID 11558500. S2CID 3278073.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v Military Obstetrics & Gynecology > Thyroid Function Tests In turn citing: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300 "Normal Reference Range Table". Archived from the original on 25 December 2011. Retrieved 2011-12-25.
  3. ^ a b c d e f Spencer, Carole (2000). "Assay of Thyroid Hormones and Related Substances". Endotext [Internet]. PMID 25905337.
  4. ^ a b c d e f g Toft, Anthony; Beckett, Geoffrey (2005). Werner & Ingbar's The Thyroid: A Fundamental & Clinical Text (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 329–344. ISBN 978-0-7817-5047-9. Archived from the original on 2020-05-06. Retrieved 2018-04-07.
  5. ^ Hoermann, Rudolf; Midgley, John E. M.; Larisch, Rolf; Dietrich, Johannes W. (22 December 2017). "Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment". Frontiers in Endocrinology. 8: 364. doi:10.3389/fendo.2017.00364. PMC 5763098. PMID 29375474.
  6. ^ Midgley, JEM; Toft, AD; Larisch, R; Dietrich, JW; Hoermann, R (18 April 2019). "Time for a reassessment of the treatment of hypothyroidism". BMC Endocrine Disorders. 19 (1): 37. doi:10.1186/s12902-019-0365-4. PMC 6471951. PMID 30999905.
  7. ^ Spencer, Carole; Takeuchi, Michael; Kazarosyan, Margarita (1996). "Current status and performance goals for serum thyrotropin (TSH) assays". Clinical Chemistry. 42 (1): 141–145. PMID 8565217. Retrieved 5 November 2013.
  8. ^ Hoermann, Rudolf; Midgley, John E. M.; Larisch, Rolf; Dietrich, Johannes W. (2015). "Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment". Frontiers in Endocrinology. 6: 177. doi:10.3389/fendo.2015.00177. PMC 4653296. PMID 26635726.
  9. ^ Leow, Melvin Khee-Shing (2016). "A Review of the Phenomenon of Hysteresis in the Hypothalamus–Pituitary–Thyroid Axis". Frontiers in Endocrinology. 7: 64. doi:10.3389/fendo.2016.00064. PMC 4905968. PMID 27379016.
  10. ^ Dayan, Colin (24 February 2001). "Interpretation of thyroid function tests" (PDF). The Lancet. 357 (9256): 619–624. doi:10.1016/s0140-6736(00)04060-5. PMID 11558500. S2CID 3278073. Archived from the original (PDF) on 25 June 2013. Retrieved 5 November 2013.
  11. ^ a b c d e f g h i j k l m n o Table 4: Typical reference ranges for serum assays Archived July 1, 2011, at the Wayback Machine - Thyroid Disease Manager
  12. ^ a b c d e f g h Normal Reference Range Table Archived 2011-12-25 at the Wayback Machine from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to Pathologic basis of disease.
  13. ^ a b c d van der Watt G, Haarburger D, Berman P (July 2008). "Euthyroid patient with elevated serum free thyroxine". Clin. Chem. 54 (7): 1239–41. doi:10.1373/clinchem.2007.101428. PMID 18593963.
  14. ^ a b c d e f g h i j Free T4; Thyroxine, Free; T4, Free Archived 2010-12-22 at the Wayback Machine UNC Health Care System
  15. ^ Derived from molar values using molar mass of 776.87 g/mol
  16. ^ a b c d Reference range list from Uppsala University Hospital ("Laborationslista"). Artnr 40284 Sj74a. Issued on April 22, 2008
  17. ^ a b c d e f g h i j Derived from mass values using molar mass of 776.87 g/mol
  18. ^ a b c d Derived from mass values using molar mass of 650.98 g/mol
  19. ^ a b Cioffi M, Gazzerro P, Vietri MT, et al. (2001). "Serum concentration of free T3, free T4 and TSH in healthy children". J. Pediatr. Endocrinol. Metab. 14 (9): 1635–9. doi:10.1515/JPEM.2001.14.9.1635. PMID 11795654. S2CID 34910563.
  20. ^ Dietrich JW, Stachon A, Antic B, Klein HH, Hering S (2008). "The AQUA-FONTIS study: protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome". BMC Endocr Disord. 8: 13. doi:10.1186/1472-6823-8-13. PMC 2576461. PMID 18851740.
  21. ^ a b Rosolowska-Huszcz D, Kozlowska L, Rydzewski A (August 2005). "Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure". Endocrine. 27 (3): 283–8. doi:10.1385/ENDO:27:3:283. PMID 16230785. S2CID 25630198.
  22. ^ a b Liu S, Ren J, Zhao Y, Han G, Hong Z, Yan D, Chen J, Gu G, Wang G, Wang X, Fan C, Li J (2012). "Nonthyroidal Illness Syndrome: Is it Far Away From Crohn's Disease?". J Clin Gastroenterol. 47 (2): 153–9. doi:10.1097/MCG.0b013e318254ea8a. PMID 22874844. S2CID 35344744.
  23. ^ a b Dietrich, Johannes W.; Landgrafe-Mende, Gabi; Wiora, Evelin; Chatzitomaris, Apostolos; Klein, Harald H.; Midgley, John E. M.; Hoermann, Rudolf (9 June 2016). "Calculated Parameters of Thyroid Homeostasis: Emerging Tools for Differential Diagnosis and Clinical Research". Frontiers in Endocrinology. 7: 57. doi:10.3389/fendo.2016.00057. PMC 4899439. PMID 27375554.
  24. ^ a b c d e f g Dietrich, J. W. (2002). Der Hypophysen-Schilddrüsen-Regelkreis. Berlin, Germany: Logos-Verlag Berlin. ISBN 978-3-89722-850-4. OCLC 50451543. OL 24586469M. 3897228505.
  25. ^ Dietrich, J., M. Fischer, J. Jauch, E. Pantke, R. Gärtner und C. R. Pickardt (1999). "SPINA-THYR: A Novel Systems Theoretic Approach to Determine the Secretion Capacity of the Thyroid Gland." European Journal of Internal Medicine 10, Suppl. 1 (5/1999): S34.
  26. ^ a b Fan, S; Ni, X; Wang, J; Zhang, Y; Tao, S; Chen, M; Li, Y; Li, J (February 2016). "Low Triiodothyronine Syndrome in Patients With Radiation Enteritis: Risk Factors and Clinical Outcomes an Observational Study". Medicine. 95 (6): e2640. doi:10.1097/MD.0000000000002640. PMC 4753882. PMID 26871787.
  27. ^ a b c d e f g Jostel A, Ryder WD, Shalet SM (October 2009). "The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index". Clin. Endocrinol. 71 (4): 529–34. doi:10.1111/j.1365-2265.2009.03534.x. PMID 19226261. S2CID 10827131.
  28. ^ Yagi H, Pohlenz J, Hayashi Y, Sakurai A, Refetoff S (1997). "Resistance to thyroid hormone caused by two mutant thyroid hormone receptors beta, R243Q and R243W, with marked impairment of function that cannot be explained by altered in vitro 3,5,3'-triiodothyroinine binding affinity". J. Clin. Endocrinol. Metab. 82 (5): 1608–14. doi:10.1210/jcem.82.5.3945. PMID 9141558.
  29. ^ Pohlenz J, Weiss RE, Macchia PE, Pannain S, Lau IT, Ho H, Refetoff S (1999). "Five new families with resistance to thyroid hormone not caused by mutations in the thyroid hormone receptor beta gene". J. Clin. Endocrinol. Metab. 84 (11): 3919–28. doi:10.1210/jcem.84.11.6080. PMID 10566629.
  30. ^ a b c Laclaustra, M; Moreno-Franco, B; Lou-Bonafonte, JM; Mateo-Gallego, R; Casasnovas, JA; Guallar-Castillon, P; Cenarro, A; Civeira, F (February 2019). "Impaired Sensitivity to Thyroid Hormones Is Associated With Diabetes and Metabolic Syndrome". Diabetes Care. 42 (2): 303–310. doi:10.2337/dc18-1410. PMID 30552134.
  31. ^ "Schilddrüsenhormonresistenz und Risiko für Diabetes und metabolisches Syndrom". Diabetologie und Stoffwechsel. 14 (2): 78. 16 April 2019. doi:10.1055/a-0758-5718. S2CID 243074371.
  32. ^ Paschou, Stavroula A.; Alexandrides, Theodoros (19 October 2019). "A year in type 2 diabetes mellitus: 2018 review based on the Endorama lecture". Hormones. 18 (4): 401–408. doi:10.1007/s42000-019-00139-z. PMID 31630372. S2CID 204786351.
  33. ^ Guan, Haixia (April 2019). "Mild Acquired Thyroid Hormone Resistance Is Associated with Diabetes-Related Morbidity and Mortality in the General Population". Clinical Thyroidology. 31 (4): 138–140. doi:10.1089/ct.2019;31.138-140. S2CID 145947179.
  34. ^ Lou-Bonafonte, José Manuel; Civeira, Fernando; Laclaustra, Martín (20 February 2020). "Quantifying Thyroid Hormone Resistance in Obesity". Obesity Surgery. 30 (6): 2411–2412. doi:10.1007/s11695-020-04491-7. PMID 32078724. S2CID 211217245.
  35. ^ "甲状腺素抵抗与糖尿病和代谢综合征有关？看TFQI怎么说". www.medinfo-sanofi.cn. Retrieved 14 April 2020.[permanent dead link‍]
  36. ^ Yang, S; Lai, S; Wang, Z; Liu, A; Wang, W; Guan, H (December 2021). "Thyroid Feedback Quantile-based Index correlates strongly to renal function in euthyroid individuals". Annals of Medicine. 53 (1): 1945–1955. doi:10.1080/07853890.2021.1993324. PMC 8567884. PMID 34726096.
  37. ^ Aweimer, A; El-Battrawy, I; Akin, I; Borggrefe, M; Mügge, A; Patsalis, PC; Urban, A; Kummer, M; Vasileva, S; Stachon, A; Hering, S; Dietrich, JW (12 November 2020). "Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study". Journal of Internal Medicine. 289 (5): 675–687. doi:10.1111/joim.13189. PMID 33179374.
  38. ^ Zhai, D; Chen, J; Guo, B; Retnakaran, R; Gao, S; Zhang, X; Hao, W; Zhang, R; Zhao, Y; Wen, SW (1 December 2021). "Oxcarbazepine was associated with risks of newly developed hypothyroxinemia and impaired central set point of thyroid homeostasis in schizophrenia patients". British Journal of Clinical Pharmacology. 88 (5): 2297–2305. doi:10.1111/bcp.15163. PMID 34855997. S2CID 244818801.
  39. ^ Andersen, S; Pedersen, KM; Bruun, NH; Laurberg, P (March 2002). "Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease". The Journal of Clinical Endocrinology and Metabolism. 87 (3): 1068–72. doi:10.1210/jcem.87.3.8165. PMID 11889165.
  40. ^ Larisch, R; Giacobino, A; Eckl, W; Wahl, HG; Midgley, JE; Hoermann, R (2015). "Reference range for thyrotropin. Post hoc assessment". Nuklearmedizin. Nuclear Medicine. 54 (3): 112–7. doi:10.3413/Nukmed-0671-14-06. PMID 25567792. S2CID 9607904.
  41. ^ Hoermann, R; Midgley, JEM; Larisch, R; Dietrich, JW (2019). "Functional and Symptomatic Individuality in the Response to Levothyroxine Treatment". Frontiers in Endocrinology. 10: 664. doi:10.3389/fendo.2019.00664. PMC 6775211. PMID 31616383.
  42. ^ Cappola, AR; Desai, AS; Medici, M; Cooper, LS; Egan, D; Sopko, G; Fishman, GI; Goldman, S; Cooper, DS; Mora, S; Kudenchuk, PJ; Hollenberg, AN; McDonald, CL; Ladenson, PW (13 May 2019). "Thyroid and Cardiovascular Disease Research Agenda for Enhancing Knowledge, Prevention, and Treatment". Circulation. 139 (25): 2892–2909. doi:10.1161/CIRCULATIONAHA.118.036859. hdl:10150/633369. PMC 6851449. PMID 31081673.
  43. ^ Hoermann, R; Midgley, JEM; Larisch, R; Dietrich, JW (2019). "Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options". Drugs in Context. 8: 212597. doi:10.7573/dic.212597. PMC 6726361. PMID 31516533.
  44. ^ Goede, SL; Leow, MK; Smit, JW; Dietrich, JW (March 2014). "A novel minimal mathematical model of the hypothalamus-pituitary-thyroid axis validated for individualized clinical applications". Mathematical Biosciences. 249: 1–7. doi:10.1016/j.mbs.2014.01.001. PMID 24480737.
  45. ^ Goede, SL; Leow, MK; Smit, JW; Klein, HH; Dietrich, JW (June 2014). "Hypothalamus-pituitary-thyroid feedback control: implications of mathematical modeling and consequences for thyrotropin (TSH) and free thyroxine (FT4) reference ranges". Bulletin of Mathematical Biology. 76 (6): 1270–87. doi:10.1007/s11538-014-9955-5. PMID 24789568. S2CID 23894743.
  46. ^ Leow, MK; Goede, SL (8 August 2014). "The homeostatic set point of the hypothalamus-pituitary-thyroid axis--maximum curvature theory for personalized euthyroid targets". Theoretical Biology & Medical Modelling. 11: 35. doi:10.1186/1742-4682-11-35. PMC 4237899. PMID 25102854.
  47. ^ Sim, Jia-Zhi; Zang, Yu; Nguyen, Phi-Vu; Leow, Melvin Khee-Shing; Gan, Samuel Ken-En (December 2017). "Thyroid-SPOT for mobile devices: personalised thyroid treatment management app". Scientific Phone Apps and Mobile Devices. 3 (1): 4. doi:10.1186/s41070-017-0016-y.
  48. ^ Li, E; Yen, PM; Dietrich, JW; Leow, MK (17 August 2020). "Profiling retrospective thyroid function data in complete thyroidectomy patients to investigate the HPT axis set point (PREDICT-IT)". Journal of Endocrinological Investigation. 44 (5): 969–977. doi:10.1007/s40618-020-01390-7. PMID 32808162. S2CID 221146170.
  49. ^ Burtis CA, Ashwood ER, Bruns DE (2012). Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5th edition. Elsevier Saunders. p. 1920. ISBN 978-1-4160-6164-9.
  50. ^ Chatzitomaris, Apostolos; Hoermann, Rudolf; Midgley, John E.; Hering, Steffen; Urban, Aline; Dietrich, Barbara; Abood, Assjana; Klein, Harald H.; Dietrich, Johannes W. (20 July 2017). "Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming". Frontiers in Endocrinology. 8: 163. doi:10.3389/fendo.2017.00163. PMC 5517413. PMID 28775711.

Further reading

CDC laboratory procedure manuals

The Centers for Disease Control and Prevention has published the following laboratory procedure manuals for measuring thyroid-stimulating hormone:


Read other articles:

Keuskupan Cahors

Keuskupan CahorsDioecesis CadurcensisDiocèse de CahorsKatolik Katedral CahorsLokasiProvinsi gerejawiToulouseStatistikLuas5.216 km2 (2.014 sq mi)Populasi- Total- Katolik(per 2013)181.200 (perkiraan)169,900 (perkiraan) (93.8%)Paroki89Imam67 (diosesan)7 (Ordo Relijius)InformasiDenominasiKatolik RomaGereja sui iurisGereja LatinRitusRitus RomaPendirianAbad ke-3KatedralKatedral Santo Stefanus di CahorsPelindungSanto StefanusKepemimpinan kiniPausFransiskusUskupLau...

 

 

Agustinus Wibowo

Agustinus WibowoLahir08 Agustus 1981 (umur 42)Lumajang, IndonesiaKebangsaan IndonesiaWarga negaraIndonesiaPekerjaanPenulisSitus webagustinuswibowo.com Agustinus Wibowo adalah seorang penulis dan fotografer perjalanan Indonesia yang (lahir 08 Agustus 1981. Setelah menyelesaikan kuliah di bidang Ilmu Komputer di Universitas Tsinghua Beijing. Tahun 2005 Agustinus memulai petualangan keliling Asia melalui darat. Berawal tanggal 31 Juli 2005 dari China kemudian melintasi negara-negara Asia S...

 

 

الدوري الأيرلندي 1938–39

يفتقر محتوى هذه المقالة إلى الاستشهاد بمصادر. فضلاً، ساهم في تطوير هذه المقالة من خلال إضافة مصادر موثوق بها. أي معلومات غير موثقة يمكن التشكيك بها وإزالتها. (نوفمبر 2019) الدوري الأيرلندي 1938–39 تفاصيل الموسم الدوري الأيرلندي  النسخة 17  البلد جمهورية أيرلندا  المنظم ا�...

Dewan Perwakilan Rakyat Kabupaten Aceh Timur

Dewan Perwakilan Rakyat Kabupaten Aceh Timur DPRK Aceh Timur2019-2024JenisJenisUnikameral Jangka waktu5 tahunSejarahSesi baru dimulai2 September 2019PimpinanKetuaFattah Fikri (PA) sejak 11 November 2021 Wakil Ketua IMuhammad Nur, S.Pd., M.H. (Gerindra) sejak 10 Desember 2019 Wakil Ketua IIMuhammad Adam, S.Sos. (NasDem) sejak 10 Desember 2019 KomposisiAnggota40Partai & kursi  NasDem (5)   Demokrat (3)   Golkar (2)   Gerindra (5)  ...

 

 

NASCAR Seri Piala Sprint musim 2014

NASCAR Seri Piala Sprint 2014 Sebelum: 2013 Sesudah: 2015 Kevin Harvick (foto 2022) sebagai juara musim 2014. NASCAR Seri Piala Sprint 2014 merupakan musim ke 66 dari NASCAR Seri Piala Sprint. Musim ini berlangsung dari bulan Februari 2013 lewat Daytona 500 di Daytona International Speedway dan berakhir pada bulan November dalam Ford 400 di Homestead-Miami Speedway. Jimmie Johnson bersama tim Hendrick Motorsports adalah juara bertahan di musim 2014. Kevin Harvick tampil sebagai juara di akhi...

 

 

Frédéric Jousset

Frédéric JoussetFrédéric JoussetLahir3 Mei 1970 (umur 53)Paris, Republik Keempat PrancisKebangsaanPrancisAlmamaterHEC ParisPekerjaanPebisnisGelarChairman dan CEO, Webhelp Frédéric Jousset (lahir 3 Mei 1970) adalah seorang pengusaha dan dermawan Prancis. Dia adalah pendiri dan salah satu presiden Webhelp, sebuah perusahaan outsourcing bisnis yang berbasis di Prancis. Ia juga menjadi administrator Museum Louvre sejak Desember 2016.[1] Biografi Jousset adalah putra Marie-Laur...

Août 1795

Août 1795 Nombre de jours 31 Premier jour Samedi 1er août 17956e jour de la semaine 31 Dernier jour Lundi 31 août 17951er jour de la semaine 36 Calendrier août 1795 Sem Lu Ma Me Je Ve Sa Di 31 1er 2 32 3 4 5 6 7 8 9 33 10 11 12 13 14 15 16 34 17 18 19 20 21 22 23  35 24 25 26 27 28 29 30  36 31 1795 • Années 1790 • XVIIIe siècle Mois précédent et suivant Juillet 1795 Septembre 1795 Août précédent et suivant Août 1794 Août 1796 Chronologies par z...

 

 

Messico

Disambiguazione – Se stai cercando altri significati, vedi Messico (disambigua). Messico (dettagli) (dettagli) Messico - Localizzazione Dati amministrativiNome completoStati Uniti Messicani Nome ufficialeEstados Unidos Mexicanos Lingue ufficialiSpagnolo, Nahuatl e altre 68 lingue native Capitale Città del Messico  (9 209 944 ab. / 2020) PoliticaForma di governoRepubblica presidenziale federale PresidenteAndrés Manuel López Obrador Indipendenzadalla Spagna,1...

 

 

Peppermint - L'angelo della vendetta

Peppermint - L'angelo della vendettaJennifer Garner in una scena del filmTitolo originalePeppermint Lingua originaleinglese Paese di produzioneStati Uniti d'America Anno2018 Durata102 minuti Genereazione, thriller RegiaPierre Morel SoggettoChad St. John SceneggiaturaChad St. John ProduttoreGary Lucchesi, Tom Rosenberg, Richard S. Wright Produttore esecutivoGary Lucchesi Casa di produzioneLakeshore Entertainment, Huayi Brothers, Tang Media Productions Distribuzione in italianoSTX Films, Lu...

Michael Spence

Canadian-American economist For other people named Michael Spence, see Michael Spence (disambiguation). Michael SpenceSpence in 2008Born (1943-11-07) November 7, 1943 (age 80)[2]Montclair, New Jersey, USAcademic careerInstitutionHarvard UniversityStanford UniversitySDA Bocconi School of ManagementNew York UniversityFieldMicroeconomics, labor economicsAlma materHarvard University, (Ph.D.)University of Oxford, (B.A.)Princeton University, (B.A.)DoctoraladvisorKenneth Arrow[...

 

 

Grumman JF Duck

Artikel ini perlu diwikifikasi agar memenuhi standar kualitas Wikipedia. Anda dapat memberikan bantuan berupa penambahan pranala dalam, atau dengan merapikan tata letak dari artikel ini. Untuk keterangan lebih lanjut, klik [tampil] di bagian kanan. Mengganti markah HTML dengan markah wiki bila dimungkinkan. Tambahkan pranala wiki. Bila dirasa perlu, buatlah pautan ke artikel wiki lainnya dengan cara menambahkan [[ dan ]] pada kata yang bersangkutan (lihat WP:LINK untuk keterangan lebih lanjut...

 

 

هاينريش كريستيان فريدريش شوماخر

هاينريش كريستيان فريدريش شوماخر   معلومات شخصية الميلاد 15 نوفمبر 1757(1757-11-15)غلوكشتات  الوفاة 9 ديسمبر 1830 (73 سنة)كوبنهاغن  مواطنة دوقية هولشتاين الدنمارك  عضو في الأكاديمية البافارية للعلوم والإنسانيات،  والأكاديمية الملكية الدنماركية للعلوم والآداب،  والأك�...

Sierra Prieta

Landform in Yavapai County, Arizona This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.Find sources: Sierra Prieta – news · newspapers · books · scholar · JSTOR (December 2021) (Learn how and when to remove this message) Sierra PrietaThumb Butte, at Prescott's west sideHighest pointPeakGranite MountainElevation7,626...

 

 

Andrea Petagna

Andrea Petagna Informasi pribadiNama lengkap Andrea PetagnaTanggal lahir 30 Juni 1995 (umur 28)Tempat lahir Trieste, ItaliaTinggi 190 cm (6 ft 3 in)[1]Posisi bermain StrikerInformasi klubKlub saat ini NapoliNomor 37Karier junior MilanKarier senior*Tahun Tim Tampil (Gol)2012–2016 Milan 3 (0)2013–2014 → Sampdoria (pinjaman) 3 (0)2014–2015 → Latina (pinjaman) 10 (0)2015 → Vicenza (pinjaman) 14 (1)2015–2016 → Ascoli (pinjaman) 32 (7)2016–2019 Atalant...

 

 

Little League Baseball

Youth sports organization Little League Baseball, IncorporatedMost recent season or competition:2024SportBaseball, softballFounded1939 in Williamsport, Pennsylvania, U.S.FounderCarl E. StotzFirst season1939CEOStephen D. KeenerCOOPatrick WilsonDirectorDavid Houseknecht, CFOClaim to fameLargest organized youth sports organization in the worldMottoCharacter, Courage, and LoyaltyNo. of teamsover 180,000Competitors2,600,000QualificationLittle League International TournamentTV partner(s)ESPN, ESPN2...

Gibraltar Archives

Gibraltar ArchivesLambang Pemerintah GibraltarPintu masuk Gibraltar Archives di Governor's Lane, Gibraltar.Informasi lembagaDibentuk1969(etc.)Wilayah hukumPemerintah GibraltarKantor pusatGovernor's Lane, Gibraltar36°08′14″N 5°21′14″W / 36.137233°N 5.353913°W / 36.137233; -5.353913Koordinat: 36°08′14″N 5°21′14″W / 36.137233°N 5.353913°W / 36.137233; -5.353913Menteri(etc.)Pejabat eksekutifDennis Beiso, Pengarsip(etc.)Lembag...

 

 

Bishop of the Isles

Arms of the Diocese of the Isles. The Bishop of the Isles or Bishop of Sodor was the ecclesiastical head of the Diocese of the Isles (or Sodor), one of Scotland's thirteen medieval bishoprics. The bishopric, encompassing both the Hebrides and Mann, probably traces its origins as an ecclesiastical unity to the careers of Olaf, King of the Isles, and Bishop Wimund. Previously, there had been numerous bishoprics and recorded bishoprics include Kingarth, Iona, Skye and Mann. There were very like...

 

 

Фукидид

У этого термина существуют и другие значения, см. Фукидид (значения). Фукидиддр.-греч. Θουκυδίδης Бюст Фукидида Дата рождения около 460 до н. э. (-460) Место рождения Галимунт, Афины Дата смерти около 400 до н. э. Место смерти Афины, Аттика Страна Древние Афины[1]...

Alexander Pierce

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.Find sources: Alexander Pierce – news · newspapers · books · scholar · JSTOR (April 2014) (Learn how and when to remove this message) Comics character Alexander Goodwin PiercePublication informationPublisherMarvel ComicsFirst appearanceNick Fury vs. S.H.I.E.L.D. #3 (August 1...

 

 

1976 United States Senate election in Hawaii

For related races, see 1976 United States Senate elections. 1976 United States Senate election in Hawaii ← 1970 November 2, 1976 1982 →   Nominee Spark Matsunaga William Quinn Party Democratic Republican Popular vote 162,305 122,724 Percentage 53.73% 40.62% County resultsMatsunaga:      50–60%      60–70% U.S. senator before election Hiram Fong Republican Elected U.S. Senator Spark Matsunaga Democratic Elec...