Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation.
Pericardial Effusion ; Thyroxine ; Triiodothyronine

OBJECTIVETo investigate the influencing factors of transient hypothyroxinemia (THT) and low T3 syndrome (LT3S) in premature infants.

METHODWe have studied 418 premature infants whose gestational age was between 26 and 36 weeks.Serum thyronine (T4), triiodothyronine (T3) and thyrotropin (TSH) of them were detected on the fourteenth day approximately after birth. The patients were divided according to their serum T4, T3 and TSH into 3 groups (transient hypothyroxinemia, low T3 syndrome and normal). Then 20 Perinatal factors which may be associated with THT and LT3S were collected. The factors were analyzed by using Chi-square test and Logistic regression.

RESULTForty-nine infants were found suffering from THT, 35 infants suffering from LT3S, and 334 infants in normal group. The prevalence rate of THT was 11.7%, and the prevalence rate of LT3S was 8.4%. Among the 20 factors, the factors related to the incidence of THT were male gender (OR = 1.863, 95%CI 0.966-3.594), albumin (OR = 2.401, 95%CI 1.294-4.455), dopamine (OR = 3.295, 95%CI 1.110-9.783) and those related to the incidence of LT3S were male gender (OR = 2.592, 95%CI 1.171-5.736), gestational age ≤ 28 wk (OR = 3.503, 95%CI 1.275-9.627).

CONCLUSIONMale gender, albumin and dopamine are perinatal risk factors of THT, meanwhile, male gender and gestational age ≤ 28 wk are perinatal risk factors of LT3S.With the use of risk factors identified in our study, it may be possible to separate infants having the highest risk of THT and LT3S, so as to form optimizing treatment strategies.

Case-Control Studies ; Dopamine ; adverse effects ; Euthyroid Sick Syndromes ; blood ; epidemiology ; etiology ; Female ; Gestational Age ; Humans ; Hypothyroidism ; blood ; epidemiology ; etiology ; Infant, Newborn ; Infant, Premature ; blood ; Infant, Premature, Diseases ; blood ; epidemiology ; etiology ; Logistic Models ; Male ; Risk Factors ; Sex Factors ; Thyroid Function Tests ; Thyronines ; blood ; Thyroxine ; blood ; Triiodothyronine ; blood

OBJECTIVE: It is generally thought that thyroxine-binding globulin (TBG)-deficient individuals are euthyroid and do not require treatment. However, there have been case reports of TBG deficiency combined with hypothyroidism. The purpose of this study was to investigate the relationship between TBG deficiency and thyroid function. METHODS: We reviewed the medical records of 32 patients diagnosed with TBG deficiency between 1997 and 2008 in Soonchunhyang University Seoul Hospital. All were partial TBG deficiency. Eighteen patients had combined hypothyroidism, and 14 patients had normal thyroid function. We compared the TBG, thyroid-stimulating hormone, free thyroxine, and total triiodothyronine levels between these 2 groups. Eighteen patients with TBG deficiency with hypothyroidism started thyroxine medication and continued for 2-3 years. After, they were followed up with thyroid function tests after discontinuing medication for 4 weeks at 2-3 years of age. RESULTS: The TBG level in TBG deficiency with hypothyroidism patients was significantly lower than that in TBG deficiency with normal thyroid function (4.43+/-2.22 mg/L vs. 6.23+/-1.81 mg/L; P=0.02). The percent TBG compared with normal mean TBG level according to age in the hypothyroidism patients was also significantly lower than that of patients with normal thyroid function (13.42%+/-6.92% vs. 19.08%+/-4.87%; P=0.014). Sixteen of 18 patients diagnosed with TBG deficiency with hypothyroidism showed persistent hypothyroidism at 2-3 years of age. CONCLUSION: We conclude that TBG-deficient patients should be observed closely and undergo thyroid function testing in order not to miss hypothyroidism. More investigations of TBG deficiency and thyroid function are needed in the future.
Humans ; Hypothyroidism ; Medical Records ; Seoul ; Thyroid Function Tests ; Thyroid Gland* ; Thyrotropin ; Thyroxine ; Thyroxine-Binding Globulin* ; Triiodothyronine

BACKGROUND: The analytical performance of the Vitros ECi(R) Immunodiagnostic System on the thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and estradiol (E2) assays, which are based on electrochemical luminescence to replace the radioimmunoassay was evaluated. METHODS: The precision as measured by the NCCLS protocol and a comparison of the method were done for each TSH, FT3, FT4, and E2 assay. The functional sensitivity and linearity tests were performed for both TSH and E2. The free hormone validity test was performed for both the FT3 and FT4. RESULTS: All four analytes showed an acceptable precision. The functional sensitivities of TSH and E2 were 0.007 mIU/L, and 87 pmol/L, respectively. TSH and E2 showed excellent linearity up to 78 mIU/mL, and up to 7,700 pmol/L, respectively. The free hormone validity test showed acceptable results demonstrating accurate free hormone determination. The E2 showed a significant proportion-al bias requiring an adjustment of the reference range, However, the other analytes showed good agreement with a slight proportional bias. CONCLUSIONS: The TSH, FT3, FT4, and E2 assay by Vitros ECi(R) exhibited excellent performance overcoming the drawbacks of a conventional radioimmunoassay.
Bias (Epidemiology) ; Estradiol* ; Luminescence ; Radioimmunoassay ; Reference Values ; Thyrotropin ; Thyroxine* ; Triiodothyronine*

We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.
Anesthesia ; Conversion Disorder ; Hemodynamics ; Humans ; Hyperthyroxinemia* ; Hypothyroidism ; Sodium ; Thyroxine ; Triiodothyronine

PURPOSE: Radioimmunoassay (RIA) was usually performed by the batch assay. To improve the efficiency of RIA without increase of the cost and time, random assay could be a choice. We investigated the possibility of the random assay using automatic dispenser by assessing the agreement between batch assay and random assay. MATERIALS AND METHODS: The experiments were performed with four items; Triiodothyronine (T3), free thyroxine (fT4), Prostate specific antigen (PSA), Carcinoembryonic antigen (CEA). In each item, the sera of twenty patients, the standard, and the control samples were used. The measurements were done 4 times with 3 hour time intervals by random assay and batch assay. The coefficient of variation (CV) of the standard samples and patients' data in T3, fT4, PSA, and CEA were assessed. ICC (Intraclass correlation coefficient) and coefficient of correlation were measured to assessing the agreement between two methods. RESULTS: The CVs (%) of T3, fT4, PSA, and CEA measured by batch assay were 3.2+/-1.7%, 3.9+/-2.1%, 7.1+/-6.2%, 11.2+/-7.2%. The CVs by random assay were 2.1+/-1.7%, 4.8+/-3.1%, 3.6+/-4.8%, and 7.4+/-6.2%. The ICC between the batch assay and random assay were 0.9968 (T3), 0.9973 (fT4), 0.9996 (PSA), and 0.9901 (CEA). The coefficient of correlation between the batch assay and random assay were 0.9924(T3), 0.9974 (fT4), 0.9994 (PSA), and 0.9989 (CEA) (p<0.05). CONCLUSION: The results of random assay showed strong agreement with the batch assay in a day. These results suggest that random assay using automatic dispenser could be used in radioimmunoassay.
Carcinoembryonic Antigen ; Humans ; Prostate-Specific Antigen ; Radioimmunoassay ; Thyroxine ; Triiodothyronine

No abstract available.
Apolipoproteins* ; Thyroxine*

AIMTo know the effect of cysteamine (CS) on the plasma levels of somatostatin (SS) and some metabolic hormones in adult geese.

METHODSFourteen adult crossbred geese (Chuan white x Tai lake) fitted with chronic wing vein cannulas were used in this study to evaluate the effect of CS on SS, TSH, T3 and T4 levels. The experiment was consisted of control and treated phase. The diet was added CS at dosage of 100 mg/kg bw on the first day of the treated phase. The blood samples were collected from the cannulas and analyzed by radioimmunoassay.

RESULTSThe plasma SS concentration was (1.87 +/- 0.10) microg/L in control phase. Whereas SS concentrations on day 1, 3, 5, 7 of treated phase were decreased markedly (P < 0.05 or P < 0.01). Thereafter it was rose on the seventh day, however it was still lower than that of control. The thyroid stimulating hormone (TSH) content (2.45 +/- 0.31 mIU/L) was significantly decreased by 21.63% (P < 0.01) on day 1, and 18.37% (P > 0.05) on day 3 and day 5. Comparing with control phase (5.41 +/- 0.98 microg/L), T4 contents were elevated by 60.26% (P < 0.01), 43.25% (P < 0.01), 37.15% (P < 0.01) and 16. 82% (P < 0.01) respectively on day 1, 3, 5, 7. T3 level was (1.05 +/- 0.06) microg/L in control phase, whereas the levels was significantly increased by 36.19% (P < 0.01) on day 3. Also, the insulin concentration was higher than that of control (4.43 +/- 0.41 mU/ L) by 18.28% (P < 0.05) on the day 5.

CONCLUSIONThese results indicate that CS can decrease the plasma SS and TSH levels, whereas increase the levels of T4, T3 and insulin, therefore change metabolism, improve the nutrition transform and accelerate the growth in geese.

Animals ; Cysteamine ; pharmacology ; Diet ; Geese ; Insulin ; blood ; Somatostatin ; blood ; Thyrotropin ; blood ; Thyroxine ; blood ; Triiodothyronine ; blood

BACKGROUND: Elecsys 2010 immunoassay system is based on the electrochemiluminescence immunoassay using a ruthenium (II) tris (bipyridyl) label. Since it was the first time to use the system in our laboratory, we would like to evaluate the analytical performances (precision, linearity and recovery rate) and correlation with radioimmunoassay (RIA) and microparticle enzyme immunoassay (MEIA) methods. METHODS: We used precicontrol tumor marker (TM1, TM2) for alpha-fetoprotein (AFP), prostatic specific antigen (PSA) and carcinoembryonic antigen (CEA), Precicontrol universal (Ul, U2) for triiodothyronine (T3) and thyroxine (T4), Precicontrol-TSH for thyrotropin (TSH) and pooled serum for the evaluation of precision and recovery rate. Patients' sera were used for the linearity and comparison study. RESULTS: The coefficients of variatron of Imprecision study were below; 4.0%, 8.7% and 10.2%, respectively in the within-run, within-day and between-day analysis. The recovery rates were 100.5%, 96.1% and 102.5%, respectively in T4, TSH, and AFP. The linearity were y=1.02x-0.182(r=0.99) for T4, y=1.01x+0.12 (r=0.99) for TSH and y=1.01x+0.54(r=1.00) for AFP. T3, T4, TSH, CEA and PSA results showed good correlation with RIA (r>0.90), but AFP showed r=0.88. Also, AFP, CEA and PSA results showed excellent correlation with AxSYM (r>0.99). CONCLUSION: Elecsys 2010 immunoassay system showed excellent precision, recovery rate, clinically acceptable linearity and good correlation with the results obtained by RIA and MEIA methods.
alpha-Fetoproteins ; Carcinoembryonic Antigen ; Immunoassay* ; Immunoenzyme Techniques ; Radioimmunoassay ; Ruthenium ; Thyrotropin ; Thyroxine ; Triiodothyronine

BACKGROUND: Plastic tubes have recently been used for blood collection tubes in clinical laboratories. The silicone coated plastic tube is said to be very similar with the glass tube and to show no difference with the glass tube in routine blood test except for some tests such as hormone tests and drug monitoring. So, we investigated the influence of plastic tube on the thyroid hormone test using two types of plastic vacuum tubes. METHODS: A total of 105 cases for the total triiodothyronine (T3), total thyroxine (T4), and thyroid stimulating hormone (TSH) were studied. The glass tube was a plain glass tube, and the plastic tube was a serum separator tube with gel. The plastic vacuum tubes used in this study were the SST II plus tube (Becton Dickinson, Franklin Lakes, USA) and the Vacuette tube (Greiner Bio-One, Kremsmunster, Austria). An IMMULITE 2000 analyzer (Diagnostic Products Corporation, Los Angeles, USA) was used to measure the total T3, total T4 and TSH. RESULTS: Comparisons of the measured values within 1 hour of blood collection in the plastic tube with that in the glass tube are as follows. There was no difference between the Vacuette tube and the glass tube for the three tests, while there was statistically significant difference between the SST II plus tube and the glass tube for the total T3 and total T4. CONCLUSIONS: It might need more cautious interpretation of the results by a solid-phase, competitive chemiluminescent enzyme immunoassay, when the plastic vacuum tube is used as a blood collection tube instead of the glass tube.
Drug Monitoring ; Glass* ; Hematologic Tests ; Immunoenzyme Techniques ; Lakes ; Plastics* ; Silicones ; Thyroid Gland* ; Thyrotropin ; Thyroxine ; Triiodothyronine ; Vacuum*