آزمون های عملکرد تیروئید

Recent studies indicate a relationship between β - hCG and thyroid dysfunction. The aim of this study were evaluation of thyroid dysfunction in patients with hyperemesis gravidarum, evaluation of severity of hyperthyroidism, relation between β - hCG and hyperemesis gravidarum and outcomes of patients. 135 patients with hyperemesis gravidarum admitted to Ob- Gyn hospital were selected and based on exclusion criteria, 103 pregnant women with hyperemesis gravidarum without any history of anti thyroid drugs consumption or other diseases were chosen. Each woman was examined for clinical signs of thyroid disease and underwent investigations for urine keton Na, k, liver function test, thyroid function test and diluted β -hCG. 35 women had abnormal thyroid function tests with FT4I 4.74±0.54 and this in another group of 68 women was 2.9±0.39 (P<0.0001). β-hCG in the first group was 59406±14800 mU/mL and in the second was 6750±3476 mU/mL (P<0.0001). In 5 patients PTU was started due to the severe signs and symptoms of hyperthyroidism. Thyroid function tests (TFTS) were rechecked for other patients after 4 weeks routine therapy for hyperemesis gravidarum TFTS normalized in 11 patients with hyperemesis gravidarum, but were abnormal in 22 patients, and PTU was started and anti-TPO anti-body was measured, which was positive in 3. Monthly TFT’s were done and PTU was adjusted. Mean therapy was 2.76 months and 60.63 mg/d for Anti-TPO negative and 5.33 months and 170 mg/d for Anti-TPO positive patients. One month after delivery, thyroid function test was performed. PTU was continued in Anti-TPO positive patients but was discontinued in Anti-TPO negative during pregnancy with normal (TFTS) in all of the subjects following delivery. The prevalence of thyroid dysfunction in women with hyperemesis gravidarum was 35% of whom 20% needed low dose anti-thyroid theraphy of short duration, which resulted in significant improvement. A female predominance among offspring of mothers with hyperemesis gravidarum was seen, smilar to findings of other studies.

It has been shown that Continuous ambulatory peritoneal dialysis (CAPD) changes serum protein levels, and can lead to changes in thyroid function tests (TFTs). At present limited literature is available regarding this topic the aim of this study therefore was to compare the TFTs results of CAPD and HD patients with those of a control grop. In a case control study, 24 CAPDs,36 HDs and 36 controls were randomly selected from among individuals who had undergone at least 3 months of dialysis, and had no history of thyroid disorders or related drug use, which could influence the TFTs. Fasting samples were collected between changes of peritoneal dialysis fluid, and just before initiating of hemodialysis and heparin injections. The TT4, TT3, FT4, FT3, TBG (RIA), TSH(IRMA), were measured. Data presented as Mean±SE and Median, IQ75-25 range. Data were analyzed by ANOVA, Post hoc test (Tukey test) and KruskalWallis using SPSS 10 software. The mean ages of participants in the CAPD, HD and normal groups were (51±3), (54±3) and (40±2) years, respectively. The means for TT4 in CAPD, HD and normal subjects were (6.6±0.3), (6.6±0.2) and (8.8±0.3) µgr/dl, respectively (p<0.0001). The TT4 mean was lower in CAPD and HD than in normal subjects (p<0.01). The means of TT3 in CAPD, HD and normal subjects were (106±3.4), (113±5.5) and (112±3,4) ng/dL, respectively, and were not statistically significant. The means of FT4 in CAPD, HD and normal subjects were (19.2±1.3), (15.8±1) and (14.3±0.6) pmol/l, respectively (p<0.02). The mean for FT4 in CAPD was higher than that of HD and normal subjects (p<0.001). The means of FT3 in CAPD, HD and normal subjects were (2.9±0.1), (3.1±0.1) and (3.8±0.1) pmol/L respectively (p<0.0001). In CAPD patients, FT3 was lower than in normal subjects (p<0.01), but no statistically significant difference with HD was seen. The TBG levels in the dialysate was 3.6±0.3 IU/ml, and its serum level in CAPD group was significantly higher than in others (16.7±0.8, 7.5±0.5 and 8.5±0.4IU/mL respectively p<0.001). TSH (Median,IQ25-75) in CAPD, HD and normal subjects were 1.4 (0.95–2.45), 1.2 (0.9–1.7) and 0.8 (0.6-1.1) mIU/ml respectively. TSH levels were higher in the CAPD group as compared with controls (p<0.001). Two cases of high TSH were observed in the CAPD group. The means of serum albumin in CAPD, HD and normal subjects were (3.6± 0.2) (3.8± 0.1) and (4.2±0.03) gr/dL respectively (p<0.0001), and these levels, in CAPD and HD patients, were lower than in normal subjects (p<0.0001). Apart from FT4 and TBG, all other thyroid function tests did not differ statistically between CAPD and HD individuars / patients. Considering the similarity in changes in TFTs in the CAPD and HD groups, it would seem that CAPD in comparison to HD would shows no additional changes in TFT.

Hypo and hyperthyroidism can both cause mental disorders, but the effects of psychiatric disorders on thyroid function has not been determined. In acute psychosis, thyroid function tests are temporarily impaired. So that total and free T4 are increased in 35% and 20%, respectively, and TSH and T3 are changeable. All patients with different acute psychiatric disorders were studied. These included 144 patients (80 female, 64 male, aged 27.88±10.67 and 27.69±9.19, respectively). Patients were avaluated according to disease type, drugs, and the presence of goiter, and thyroid function tests were done during the acute attack. The tests were repeated 3 weeks later in those with abnormal results. 21 patients (14.5%) had abnormal TSH during disease attack. TSH was suppressed in 14 (TSH<0.3 mU/L, mean: 0.121±0.043), and increased in 7 (TSH>5.5 mU/L, mean: 13.8±10.8). T4 level was abnormal in 13 patients (9%), 12 of whom had high T4 (T4>12.8 μg/dl, mean: 16±3.85) and 1 had low T4 (T4<4.8 μg/dl). In eleven patients (8%) T3 was increased (T3>3nmol/L, mean: 5.8±3.08). Ten patients (7%) had abnormal FTI FTI was increased in 8 (FTI>4.4, mean: 7.55±1.66) and decreased in 2 (FTI<1.2, mean: 0.18±0.08). 7 patients had thyroid dysfunction (4 hyperthyroid, 3 hypothyroid) at the time of diagnosis of psychiatric disorder. When these were excluded, 14 patients (9.7%) with acute psychosis had abnormal TSH (suppressed in 10 and above normal in 4) and T4, FTI and T3 were abnormal in 8 (5.5%), 4 (2.7%), and 7 (5%) patients, respectively. Three weeks later, all thyroid function tests returned to normal. The prevalence of hyperthyroxinemia in acute psychotic patients was 2.7% in this study, which is much less than other studies. In management of acute psychosis, thyrotoxicosis must be considered as a possible cause of psychosis.