Thyroid disorders diagnosis

Approximately one-third of patients with MDD do not respond satisfactorily to their first antidepressant medication.37 In such cases, the clinician must evaluate the adequacy of antidepressant therapy, including dosage, duration, and patient compliance.17 Treatment reappraisal also should include verification of the patient s diagnosis and reconsideration of clinical factors that could be impeding successful therapy, such as concurrent medical conditions (e.g., thyroid disorder), comorbid psychiatric conditions (e.g., alcohol abuse), and psychosocial issues (e.g., marital stress).16... 

O In most patients with thyroid hormone disorders, the measurement of a serum thyroid-stimulating hormone (TSH) level is adequate for the diagnosis of hypothyroidism and hyperthyroidism. The target TSH for most patients being treated for thyroid disorders should be the mean normal value of 1.4 milliunits/L or 1.4 microunits/mL (target range 0.5-2.5 milliunits/L or 0.5-2.5 microunits/mL). 

Fisher DA. Fetal thyroid function Diagnosis and management of fetal thyroid disorders. Chn Obstet Gynecol 1997 40 16-31. 

Mestman JH. Diagnosis and management of maternal and fetal thyroid disorders. Curr Opin Obstet Gynecol 1999 11 167-175. 

Assays of thyroid function Advances in thyroid function tests (TFTs), including the development of sensitive assays for TSH and the use of analog assays that provide a reasonable estimate of the free level, have markedly improved the diagnosis and treatment of thyroid disorders. These assays nonetheless can be misleading, as the TSH level can remain low for weeks to months after a hyperthyroid patient is restored to a euthyroid state and the analog assays of free T can provide misleading results in certain settings such as critical iUness. 

Other possibilities for identification (ID) of patients with thyroid disorders are searching in different records or databases, such as records of diagnoses of discharge from hospitals, prescriptions of thyroid medicaments (antithyroid drugs and levothyroxine), and records of treatments for thyroid disorders including thyroid surgery and radioiodine treatments. Finally, diagnosis of overt thyroid dysfunction is based on a biochemical thyroid function test, and laboratory databases with results of analyses of thyrotrophin (TSH) and thyroid hormones in a population cohort, and records of serum TSH in newborns may be used to identify new patients (Kempers et al., 2006). 

Radioiodine plays an important role in the diagnosis and treatment of various thyroid disorders. Production methods for various iodine isotopes, namely, and are briefly described in this paper. The chemistry of iodine and radiation effects in aqueous solutions and isotopic exchange reactions are also reviewed. An understanding of the chemistry of iodine is essential in isotope production, and for developing the procedure to prepare the radioactive iodine labeled pharmaceuticals. In radiochemical analysis of iodine, most environmental and biological samples can be accurately analyzed by neutron activation at trace levels. The use of potassium iodide (KI) has become an important remedy to prevent the harmful effects of radioiodine exposure under nuclear accident conditions. The inhibitory effect of KI administration on thyroid radioactive iodine uptake is discussed. 

Radioiodine plays an important role in the diagnosis and treatment of various thyroid disorders. Treatment of thyroid carcinoma and hyperthyroidism with I-pharmaceuticals has been practiced for years, but other isotopes, i.e., I, >231, 1241 and are also produced and used in various medical apphcations. Radioiodine concentrated by the thyroid in large amounts can cause cell death, primarily because of 3ils beta radiation. Large doses of 3il are, therefore, given to treat patients with hyperthyroidism. In contrast, low-dose exposure damage does not kill thyroid cells, but can induce radiation damage and mutations, which can result in thyroid cancer. 

THE LABORATORY DIAGNOSIS OF THYROID DISORDERS Maurice L. Wellby... 

Recent reviews on the laboratory aspects of thyrotropin (TSH) assay have been published by Hall (H4) and Raud and Odell (Rl), so that it is only necessary here to discuss some aspects of the application of TSH assay. The key role of TSH in the control of thyroid secretion has been outlined in Section 2.4, and it is clear that TSH assays are of importance in the diagnosis of thyroid disorders, especially where thyroid hypofunction is involved. When combined with some form of stimulus, such as thyrotropin-releasing hormone (TRH), TSH levels are also useful in the investigation of thyrotoxicosis. 

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