SCREENING TESTS FOR THYROID DYSFUNCTION; IS TSH SUFFICIENT?
Received: 17th July 2021; Revised: 31st July 2021, 11th November 2021; Accepted: 13th November 2021
DOI:
https://doi.org/10.20319/lijhls.2021.7.111122Keywords:
Thyroid, Ultrasound, TPO Antibodies, Hypothyroidism, TSHAbstract
There are different recommendations on how to screen for thyroid gland problems and TSH is the most ordered test. Anti TPO antibodies are usually tested when TSH is not within the normal range, but their presence before TSH changes has not been appreciated. This study aims to evaluate the role of anti-TPO and thyroid ultrasound for the early detection of thyroid pathologies, especially in the subclinical phase. This is a cross-sectional study in 458 individuals (80% females and 20% males). Thyroid laboratory tests and thyroid ultrasound was done. Statistical analysis was performed to assess the prevalence of thyroid dysfunction, thyroid antibodies and their correlation with thyroid ultrasound changes. 88.6 % (406) of subjects resulted in euthyroid. Subclinical hypothyroidism and hyperthyroidism were observed in 5.5% and 1.7% of the population, respectively. The prevalence of positive thyroid antibodies was 26.5% in females and 11.8 % in males. Hypoechoic structure, heterogenicity and micronodular pattern in ultrasound were associated with significantly higher TPO antibodies activity p<.001. Undiagnosed biochemical thyroid dysfunctions were common in our country. Measurement of anti-TPO in individuals with normal TSH is valuable in determining individuals at risk for thyroid pathologies.
References
Allan, W., Haddow, J., Palomaki, G., Williams, J., Mitchell, M., Hermos, R., Faix, J., & Klein, R. (2000). Maternal thyroid deficiency and pregnancy complications: implications for population screening. Journal of Medical Screening, 7 (3), 127–130. https://doi.org/10.1136/jms.7.3.127
Brochmann, H., Bjøoro, T., Gaarder, P. I., Hanson, F., & Frey, H. M. (1988). Prevalence of thyroid dysfunction in elderly subjects. Acta Endocrinologica, 117 (1), 7–12. https://doi.org/10.1530/acta.0.1170007
Canaris, G. J., Manowitz, N. R., Mayor, G., & Ridgway, E. C. (2000). The Colorado Thyroid Disease Prevalence Study. Archives of Internal Medicine, 160 (4), 526. https://doi.org/10.1001/archinte.160.4.526
Ceylan, I., Yener, S., Bayraktar, F., & Secil, M. (2014). Roles of ultrasound and power Doppler ultrasound for the diagnosis of Hashimoto thyroiditis in anti-thyroid marker-positive euthyroid subjects. Quantitative imaging in medicine and surgery, 4 (4), 232–238.https://doi.org/10.3978/j.issn.2223-4292.2014.07.13
Li, C., Zhou, J., Huang, Z., Pan, X., Leung, W., Chen, L., Zhang, Y., Wang, L., Sima, Y., Gober, H., Zhang, N., Qiu, X., Li, L., Guan, L. & Wang, L. (2020). "The Clinical Value and Variation of Antithyroid Antibodiesduring Pregnancy", Disease Markers, Vol. 2020, https://doi.org/10.1155/2020/8871951
Flynn, R. W. V., MacDonald, T. M., Morris, A. D., Jung, R. T., & Leese, G. P. (2004). The Thyroid Epidemiology, Audit, and Research Study: Thyroid Dysfunction in the General Population. The Journal of Clinical Endocrinology & Metabolism, 89 (8), 3879–3884. https://doi.org/10.1210/jc.2003-032089
Haddow, J. E., Palomaki, G. E., Allan, W. C., Williams, J. R., Knight, G. J., Gagnon, J., O’Heir, C. E., Mitchell, M. L., Hermos, R. J., Waisbren, S. E., Faix, J. D., & Klein, R. Z. (1999). Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child. New England Journal of Medicine, 341 (8), 549–555. https://doi.org/10.1056/nejm199908193410801
McDermott, M. T., & Ridgway, E. C. (2001). Subclinical Hypothyroidism Is Mild Thyroid Failure and Should be Treated. The Journal of Clinical Endocrinology & Metabolism, 86 (10), 4585–4590. https://doi.org/10.1210/jcem.86.10.7959
McGrogan, A., Seaman, H. E., Wright, J. W., & de Vries, C. S. (2008). The incidence of autoimmune thyroid disease: a systematic review of the literature. Clinical Endocrinology, 69 (5), 687–696. https://doi.org/10.1111/j.1365-2265.2008.03338.x
Palmieri, E. A., Fazio, S., Lombardi, G., & Biondi, B. (2004). Subclinical Hypothyroidism and Cardiovascular Risk. Treatments in Endocrinology, 3 (4), 233–244. https://doi.org/10.2165/00024677-200403040-00005
Pedersen, I. B., Knudsen, N., Carlé, A., Vejbjerg, P., Jørgensen, T., Perrild, H., Ovesen, L., Rasmussen, L. B., & Laurberg, P. (2011). A cautious iodization program bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population. Clinical Endocrinology, 75 (1), 120–126. https://doi.org/10.1111/j.1365-2265.2011.04008.x
Prummel, M. F., & Wiersinga, W. M. (2005). Thyroid peroxidase autoantibodies in euthyroid subjects. Best Practice & Research Clinical Endocrinology & Metabolism, 19(1), 1–15. https://doi.org/10.1016/j.beem.2004.11.003
Rugge, J. B., Bougatsos, C., & Chou, R. (2015). Screening and Treatment of Thyroid Dysfunction: An Evidence Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 162 (1), 35. https://doi.org/10.7326/m14-1456
Strickland, D. M., Whitted, W. A., & Wians, F. H. (1990). Screening infertile women for subclinical hypothyroidism. American Journal of Obstetrics and Gynecology, 163 (1), 262–263. https://doi.org/10.1016/s0002-9378(11)90744-3
Strieder T. G. A, Tijssen J. G. P., Wenzel B. E., Endert E. & Wiersinga W. M. (2008). Prediction of Progression to Overt Hypothyroidism or Hyperthyroidism in Female Relatives of Patients with Autoimmune Thyroid Disease Using the Thyroid Events Amsterdam (THEA) score. Arch Intern Med. 2008;168 (15):1657–1663. https://doi.org/10.1001/archinte.168.15.1657
Thangaratinam, S., Tan, A., Knox, E., Kilby, M. D., Franklyn, J., & Coomarasamy, A. (2011). Association between thyroid autoantibodies and miscarriage and preterm birth: a meta-analysis of the evidence. BMJ, 342 (may09 1), d2616. https://doi.org/10.1136/bmj.d2616
Siriwardhane, T. , Krishna, K., Ranganathan, V., Jayaraman, V., Wang, T., Bei, K., Ashman, S., Rajasekaran, K., Rajasekaran, J. J. & Krishnamurthy, H. (2019). Significance of Anti-TPO as an Early Predictive Marker in Thyroid Disease", vol. 2019, https://doi.org/10.1155/2019/1684074
Tunbridge, W. M. G., Evered, D. C., Hall, R., Appleton, D., Brewis, M., Clark, F., Evans, J. G., Young, E., Bird, T., & Smith, P. A. (1977). The Spectrum of Thyroid Disease in A Community: The Whickham Survey. Clinical Endocrinology, 7(6), 481–493. https://doi.org/10.1111/j.1365-2265.1977.tb01340.x
Vanderpump M. P. J. (2019) Epidemiology of Thyroid Disorders. In: Luster M., Duntas L., Wartofsky L. (eds) The Thyroid and Its Diseases. Springer, Cham.https://doi.org/10.1007/978-3-319-72102-6_6
Vanderpump, M. P. J. (2011b). The Epidemiology Of Thyroid Disease. British Medical Bulletin, 99(1), 39–51. https://doi.org/10.1093/bmb/ldr030
Zimmermann, M. B., Connolly, K., Bozo, M., Bridson, J., Rohner, F., & Grimci, L. (2006). Iodine Supplementation Improves Cognition In Iodine-Deficient School Children In Albania: A Randomized, Controlled, Double-Blind Study. The American Journal of Clinical Nutrition, 83(1), 108–114. https://doi.org/10.1093/ajcn/83.1.108
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of Published Articles
Author(s) retain the article copyright and publishing rights without any restrictions.
All published work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
