Diagnostic value of thyrotrophin releasing hormone tests in elderly patients with atrial fibrillation.

Davies, Anthony B.; Williams, I.K.; John, Rhys; Hall, R.; Scanlon, M. F.

doi:10.1136/bmj.291.6498.773

Cited by 20 publications

(7 citation statements)

References 12 publications

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“…These biochemi cal abnormalities occurred in the absence of clinical manifestations of thyroid disease and tended to correct spontaneously on re covery, reflecting the physiological response of the hypothalmic-pituitary-thyroidal axis to acute illness. In support of our findings, two other studies, with different study design to ours, have described similar abnormali ties of TSH secretion following TRH stimu lation (10,11]. The mechanism by which these 'non-specific' biochemical changes are mediated and their clinical relevance are largely speculative.…”

Section: Discussionsupporting

confidence: 78%

Longitudinal Study of Thyroid Function in Acutely Ill Elderly Patients Using a Sensitive TSH Assay-Defer Testing until Recovery

Bhakri

Fisher²,

Khadri³

et al. 1990

Gerontology

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A prospective longitudinal study of thyroid function was conducted in 180 consecutive admissions to an acute geriatric unit. The rest strategy included assay of TSH and TRH testing when appropriate. On admission TSH was suppressed ( < 0.1 mU/l) in 17 patients (9.4%) and elevated ( > 4.0 mU/l) in 8 (4.4%). Follow-up of these initial abnormalities showed resolution in almost all cases. Our findings suggest that acute illness may interfere with the hypothalamic-pituitary-thyroid axis, causing either temporary suppression or stimulation of TSH release. Although no new cases of thyroid disease were diagnosed, the prevalence of established dysfunction was 3.3% (2.7% hypothyroid; 0.6% hyperthyroid). To avoid misleading results, testing of thyroid dysfunction should be delayed until recovery from illness.

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Section: Discussionsupporting

confidence: 78%

Longitudinal Study of Thyroid Function in Acutely Ill Elderly Patients Using a Sensitive TSH Assay-Defer Testing until Recovery

Bhakri

Fisher²,

Khadri³

et al. 1990

Gerontology

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“…23 Moreover, Davies et al demonstrated that elderly patients with atrial fibrillation who showed no thyroid-stimulating hormone response to thyrotropin-releasing hormone at the beginning of their study recovered their response to thyrotropin-releasing hormone six weeks later. 24 With the availability of the new generation of sensitive thyroid-stimulating hormone immunoassays, the thyroliberin test has become regarded as redundant. Current second and third generation assays have detection limits of 0.05 and 0.005 mU/l, respectively.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

2003

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“…Subsequently she was found to be both biochemically and clinically euthyroid without antithyroid medication ( Table 1). It is notable that both patients failed to show a detectable TSH response to TRH, but such a response is not specific for hyperthyroidism in the elderly sick (Davies et a/., 1985).…”

Section: Resultsmentioning

confidence: 83%

Effect of Oral Frusemide on Diagnostic Indices of Thyroid Function

Newnham¹,

Hamblin²,

Long³

et al. 1987

Clinical Endocrinology

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We studied the acute effect of standard therapeutic doses of oral frusemide on indices of thyroid function in 34 hospital in-patients with congestive cardiac failure. A transient decrease in total T4, elevation in the T3 resin uptake and consequent increase in the free T4 index (FT4I) were seen 2-5 h after ingestion of frusemide at a chronic morning dosage of 80, 120 or 250 mg. The FT4I pre-vs post-frusemide values after 250 mg of drug were 109 +/- 12 vs 129 +/- 18 (P less than 0.05) after 120 mg 92 +/- 14 vs 119 +/- 12 (P less than 0.01), and after 80 mg 102 +/- 6 vs 112 +/- 4 (P less than 0.01) (mean +/- SEM). Similar increases in apparent free T4 measured by an analogue tracer assay (free T4 RIA sol, Henning, Berlin) were seen after frusemide. In a time course study, the major change in the T3 uptake 120 min after frusemide ingestion correlated with the change in serum frusemide concentration. When frusemide was added to serum in vitro its influence was greatest in methods that involved least dilution of serum. In two of the patients difficulty in clinical assessment of thyroid status was compounded by the effect of oral frusemide on FT4I. We conclude that oral frusemide may influence biochemical assessments of thyroid function in patients with congestive cardiac failure. It is necessary to consider the time interval between ingestion of high doses of oral frusemide and blood sampling in evaluating such results.

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Diagnostic value of thyrotrophin releasing hormone tests in elderly patients with atrial fibrillation.

Cited by 20 publications

References 12 publications

Longitudinal Study of Thyroid Function in Acutely Ill Elderly Patients Using a Sensitive TSH Assay-Defer Testing until Recovery

Longitudinal Study of Thyroid Function in Acutely Ill Elderly Patients Using a Sensitive TSH Assay-Defer Testing until Recovery

Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

Effect of Oral Frusemide on Diagnostic Indices of Thyroid Function

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