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Free Thyroxine Index

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61. Special Endocrine Testing

: Diagnoses and Monitoring of Thyroid Function Disorders in Adults. Free Thyroxine (fT4) MSP cost: $12.12 Indications Non-Indications Used to screen for all causes of primary hypothyroidism and hyperthyrodism. Monitoring of patients treated with thyroid hormone. Not for use in an initial screen for thyroid dysfunction except in the unusual circumstance that there is specific reason to suspect pituitary disease. Free Triiodothyronine (fT3) MSP cost: $9.35 Indications Non-Indications Rarely indicated (...) . Reserved for situations where hyperthyroidism is suspected clinically and TSH is suppressed, but fT4 is not elevated. Not for use in an initial screen for thyroid dysfunction. Total thyroxine/ triiodothyronine (Total T4/T3) Indications Non-Indications Not currently offered by any lab in BC. Replaced by free hormone determination. Anti-thyroid peroxidase MSP cost: $20.22 Indications Non-Indications Used for the diagnosis of Hashimoto’s thyroiditis in the investigation of primary hypothyroidism. Serial

2016 Clinical Practice Guidelines and Protocols in British Columbia

62. Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. (PubMed)

, or have specific indications for prescribing.The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old).A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence (...) with standards for trustworthy guidelines using the GRADE approach.The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only

2019 BMJ

63. Free leptin index and thyroid function in male highly trained athletes. (PubMed)

Free leptin index and thyroid function in male highly trained athletes. Exercise training may cause changes in thyroid function. This thyroid response may be due to exercise-induced modulation of energy metabolism but also of the adipocytes endocrine function. In particular, the role of leptin and of circulating soluble leptin receptor (sOB-R) was unexplored. The aim of this study was to assess the relationships between thyroid function, whole body energy metabolism, and adipokines--mainly (...) leptin and its receptor, sOB-R.We measured serum TSH, free tri-iodothyronine (FT(3)), free thyroxine, leptin, and sOB-R and assessed energy homeostasis by means of indirect calorimetry, in 27 highly trained athletes and 27 sedentary, healthy men.TSH-FT(3) ratio was lower in athletes (P<0.03), either in sustained power or anaerobic power-sprint athletes (n=13) or marathon runners (n=14). Whole body respiratory quotient was lower in athletes. Fasting serum sOB-R was higher and leptin lower in athletes

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2009 European Journal of Endocrinology

64. Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guidelines

prednisolone 0.5 mg/kg and taper If unwell, withhold ICPi and consider restarting when symptoms controlled Figure 5. ICPi monitoring and management: thyroid function. Ab, antibody; CT, computed tomography; CTLA4, cytotoxic T-lymphocyte associated antigen 4; DDx, differential diagnosis; FT4, free thyroxine; ICPi, immune checkpoint inhibitor; PD-1, pro- grammed death 1; PD-L1, programmed death ligand 1; T3, triiodothyronine; T4, thyroxine; TFT, thyroid function test; TPO, thyroid peroxidase; TSH, thyroid (...) cycle; If symptoms, consider thyroxine if TSH > 10 If no symptoms, repeat next cycle; If symptoms, initiate thyroxine Low Elevated FT4 Low FT4 If no symptoms, repeat next cycle; If symptoms hyperthyroidism: beta blocker, thyroid Abs and uptake scan Check 9 am cortisol (may indicate hypopituitarism) Baseline Endocrine Panel: TSH, FT4, T3* TFTs Baseline abnormal values do not preclude treatment; discuss with endocrinologist if uncertain *when indicated Monitoring during treatment: Anti-CTLA4

2017 European Society for Medical Oncology

65. AACE/ACE/AME Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

; FNA-PTH = parathyroid hormone measurement in fine-needle aspiration washout; FNA-Tg = thyroglobulin measure- ment in fine-needle aspiration washout; FN/SFN = pure follicular patterned lesion, suggesting a follicular neo- plasm; FTC = follicular thyroid cancer; FT 3 = free triio- dothyronine; FT 4 = free thyroxine; GEC = gene expres- sion classifier; IMAX = maximum intensity of peak; LTA = laser thermal ablation; LT 4 = levothyroxine; MEN2 = multiple endocrine neoplasia type 2; MeSH = Medical (...) of serum TSH is the best initial laboratory test of thyroid function and should be followed by measurement of free thyroxine (FT 4 ) and free triiodothyronine (FT 3 ) when the TSH value is decreased, and measurement of thyroid peroxidase anti- bodies (TPOAbs) and FT 4 when the TSH value is above the reference range. A single, nonstimulated serum calci- tonin measurement should be performed only when med- ullary thyroid carcinoma (MTC) is suspected due to FNA results or history. Thyroid nodules

2016 American Association of Clinical Endocrinologists

66. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

, there is evidence that cardiotoxicity can be seen at much lower doses than previously thought. The early detection of cardiotoxic- ity related to anthracyclines has improved significantly over the years, and this is the likely explanation for identification of cardiotoxicity at lower doses. In highly susceptible patients, even 1 dose could be enough. The probability of developing impaired myocardial function based on a combined index of signs, symptoms, and decline in LVEF is estimated to be ˜5%, 16%, and 26 (...) factors that influence LVEF in patients receiving anthracycline-containing regimens include fluid overload, sepsis, ischemic heart disease, and use of other chemotherapy drugs. Prevention of anthracycline- induced myocardial damage by use of free radical scav- engers and antioxidants could reduce cardiotoxicity in some patients. Other therapeutic agents known to result in cardio- myopathy include trastuzumab 119–121 and certain anti– vascular endothelial growth factor inhibitors, 122–124

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2016 American Heart Association

67. Hormonal Replacement in Hypopituitarism in Adults

addresses special circumstances that may affect the treatment of patients with hypopituitarism, including pregnancy care, post-surgical care following pituitary or other operations, treatment in combination with anti-epilepsy medication, and care following pituitary apoplexy—a serious condition that occurs when there is bleeding into the gland or blood flow to it is blocked. Recommendations from the guideline include: Measurements of both free thyroxine and thyroid-stimulating hormone are needed (...) to evaluate central hypothyroidism, a condition where the thyroid gland does not produce enough hormones because it isn’t stimulated by the pituitary gland. People who have central hypothyroidism should be treated with levothyroxine in doses sufficient to raise levels of the thyroid hormone free thyroxine to the upper half of the reference range. Growth hormone stimulation testing should be used to diagnose patients with suspected growth hormone deficiency. People who have proven cases of growth hormone

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2016 The Endocrine Society

68. Management of Carpal Tunnel Syndrome

Pollicis Brevis Manual Muscle Testing ? 2-point discrimination ? Semmes-Weinstein Monofilament Test ? CTS-Relief Maneuver (CTS-RM) ? Pin Prick Sensory Deficit; thumb or index or middle finger ? ULNT Criterion C ? Tethered median nerve stress test ? Vibration perception – tuning fork ? Scratch collapse test ? Luthy sign ? Pinwheel Strength of Recommendation: Moderate Evidence Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High (...) Ratio/Index c. Rheumatoid Arthritis d. Psychosocial factors e. Distal upper extremity tendinopathies f. Gardening g. ACGIH Hand Activity Level at or above threshold h. Assembly line work i. Computer work j. Vibration k. Tendonitis l. Workplace forceful grip/exertion Strength of Recommendation: Moderate Evidence Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. C

2016 American Academy of Orthopaedic Surgeons

69. Clinical Practice Guidelines on Obesity

• Fasting plasma glucose • Alanine transaminase / aspartate transaminase • ECG (if > 50 years)3 Assessment for secondary causes: • Thyroid function tests: Thyroid stimulating hormone / free thyroxine • Cushing’s syndrome: Screen only if clinically suspected • Hypogonadism: Screen only if clinically suspected BMI: body mass index; ECG: electrocardiography; HDL: high-density lipoprotein; LDL: low-density lipoprotein GPP C Patient motivation – an important prerequisite in weight loss management – should (...) be defined as a condition of abnormal or excessive accumulation of body fat to the extent that health may be adversely affected 1 and is associated with various major chronic diseases including cardiovascular disease, Type 2 diabetes mellitus and cancer. These are discussed in greater detail in Chapter 3. 2.2 Overweight and obesity in Singaporean adults The prevalence of overweight (body mass index [BMI] = 25 kg/m 2 ) among all Singapore adults in 2013 was 34.3% with 40.2% of males and 28.6% of females

2016 Ministry of Health, Singapore

71. Exercise training improves quality of life in women with subclinical hypothyroidism: a randomized clinical trial. (PubMed)

Exercise training improves quality of life in women with subclinical hypothyroidism: a randomized clinical trial. The aim was to evaluate the quality of life (HRQoL) in women with subclinical hypothyroidism (sHT) after 16 weeks of endurance training.In the first phase, a cross-sectional study was conducted in which 22 women with sHT (median age: 41.5 (interquartile range: 175) years, body mass index: 26.2 (8.7) kg/m2, thyroid stimulating hormone > 4.94 mIU/L and free thyroxine between 0.8

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2018 Archives of endocrinology and metabolism Controlled trial quality: uncertain

72. Guideline on the management of premature ovarian insufficiency

:// (Archived by WebCite at Aydin ZD. Determinants of age at natural menopause in the Isparta Menopause and Health Study: premenopausal body mass index gain rate and episodic weight loss. Menopause 2010;17: 494-505. Baron JA. Smoking and estrogen-related disease. Am J Epidemiol 1984;119: 9-22. Bromberger JT, Matthews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P. Prospective study of the determinants of age at menopause. Am J Epidemiol (...) , Butterworth S, Kok H, Richards M, Hardy R, Wadsworth ME, Leon DA. Childhood cognitive ability and age at menopause: evidence from two cohort studies. Menopause 2005;12: 475-482. Luborsky JL, Meyer P, Sowers MF, Gold EB, Santoro N. Premature menopause in a multi-ethnic population study of the menopause transition. Hum Reprod 2003;18: 199-206. Morris DH, Jones ME, Schoemaker MJ, McFadden E, Ashworth A, Swerdlow AJ. Body mass index, exercise, and other lifestyle factors in relation to age at natural

2015 European Society of Human Reproduction and Embryology

73. Thyroid Cancer Treatment (PDQ®): Health Professional Version

, and Radiotherapy. Philadelphia, Pa: Lippincott-Raven, 1997, pp 127-175. American Cancer Society: Cancer Facts and Figures 2019. Atlanta, Ga: American Cancer Society, 2019. . Last accessed January 23, 2019. Tennvall J, Biörklund A, Möller T, et al.: Is the EORTC prognostic index of thyroid cancer valid in differentiated thyroid carcinoma? Retrospective multivariate analysis of differentiated thyroid carcinoma with long follow-up. Cancer 57 (7): 1405-14, 1986. [ ] Khoo ML, Asa SL, Witterick IJ, et al.: Thyroid (...) . [ ] Lennard CM, Patel A, Wilson J, et al.: Intensity of vascular endothelial growth factor expression is associated with increased risk of recurrence and decreased disease-free survival in papillary thyroid cancer. Surgery 129 (5): 552-8, 2001. [ ] van Herle AJ, van Herle KA: Thyroglobulin in benign and malignant thyroid disease. In: Falk SA: Thyroid Disease: Endocrinology, Surgery, Nuclear Medicine, and Radiotherapy. Philadelphia, Pa: Lippincott-Raven, 1997, pp 601-618. Ruiz-Garcia J, Ruiz de Almodóvar

2018 PDQ - NCI's Comprehensive Cancer Database

75. Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ®): Health Professional Version

–56 y; P < .05) in family members diagnosed by predictive genetic testing.[ ] Nonetheless, the lag time between the diagnosis of MEN1 in an and the diagnosis of MEN1 in family members can be significant, leading to increased morbidity and mortality.[ ] This was demonstrated in a Dutch MEN1 Study Group analysis, which showed that 10% to 38% of non-index cases already had an MEN1-related manifestation at diagnosis; 4% of these individuals died of an MEN1-related cause that developed during or before (...) found that screening MEN1 patients with fluorine F 18-fludeoxyglucose positron emission tomography–computed tomography (18F-FDG PET-CT) identified those NETs with an increased malignant potential; the FDG avidity correlated with a Ki-67 index.[ ] Tumor size does seem to influence patient survival, with patients with smaller tumors having increased survival after resection.[ ] While more-extensive surgical approaches (e.g., pancreatoduodenectomy) have been associated with higher cure rates

2018 PDQ - NCI's Comprehensive Cancer Database

76. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

most of the day nearly every day or hospitalisation Marked impairment (Mania only) Yes BD II Hypomania +Depression 2 Weeks Marked Impairment Hypomania b 4 consecutive days, present most of the day nearly every day. No marked impairment In depression but not in hypomania Cyclothymia d Subthreshold c hypomania + subthreshold c depression 2 years with no more than two months symptom- free Clinically significant impairment 2 years with no more than two months symptom-free Clinically significant (...) impairment No MDD e Depression 2 Weeks Marked Impairment N/A N/A Yes PDD d Depression 2 Weeks Clinically significant impairment N/A N/A No DMDD f* Chronic irritability and temper outbursts >12 mths with no more than 3 mths symptom- free =3 Temper outbursts per week. Present in =2 settings N/A N/A No PMDD g * Depression Final week before menses to a few days after. Causes distress or interference with functioning N/A N/A No Note: For full criteria for manic, hypomanic and depressive episodes, refer to DSM

2015 Royal Australian and New Zealand College of Psychiatrists

77. Hypothyroidism

deficiency or an abnormality within the gland itself. [ ; ]. It is categorised into: Overt hypothyroidism (OH) TSH levels are above the normal reference range (usually above 10 mU/L) and free thyroxine (FT4) is below the normal reference range [ ]. OH may or may not be symptomatic [ ; ]. OH in pregnancy is defined as TSH above 10 mU/L regardless of the level of T4 [ ; ]. Subclinical hypothyroidism (SCH) TSH levels are above the normal reference range but T3 and T4 are within the normal reference range (...) on . Signs of other autoimmune disease such as vitiligo. Signs of . Arrange investigations including: Blood tests for thyroid stimulating hormone (TSH) and free thyroxine (FT4): Diagnose overt hypothyroidism (OH) if TSH is greater than 10 mU/L and FT4 is below the reference range. Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result

2018 NICE Clinical Knowledge Summaries

78. Polycystic ovary syndrome

is unknown. It is likely to be multifactorial, with both genetic and environmental factors playing a part. Complications include: Metabolic disorders, such as impaired glucose tolerance and type 2 diabetes. Cardiovascular disease. Infertility. Pregnancy complications, such as pre-eclampsia and gestational diabetes. Endometrial cancer. Psychological disorders, such as anxiety and depression. Obstructive sleep apnoea. To help diagnose PCOS: Free androgen index should be calculated to assess the amount (...) with PCOS and provides a surrogate measurement of the degree of hyperinsulinaemia. Calculate free androgen index (100 multiplied by the total testosterone value divided by the SHBG value) to assess the amount of physiologically active testosterone present — this is normal or elevated in women with PCOS (the normal range is usually less than 5, but this depends on local laboratories). Measure the following to rule out other causes of oligomenorrhoea and amenorrhoea (such as premature ovarian failure

2018 NICE Clinical Knowledge Summaries

79. Body Composition, Resting Energy Expenditure, and Metabolic Changes in Women Diagnosed with Differentiated Thyroid Carcinoma. (PubMed)

(euthyroid state), (2) at 2-3 weeks after thyroidectomy (hypothyroid state), (3) at 2-3 months of levothyroxine (LT4) treatment (exogenous euthyroid state), (4) after 6-9 months, and (5) after 1 year of TSH suppressive LT4 therapy (exogenous subclinical hyperthyroid state). A generalized estimating equation (GEE) analysis was performed to estimate the longitudinal correlations of the total triiodothyronine (TT3)/free thyroxine (fT4) ratio (as an independent variable) with body composition, metabolic (...) , and calorimetric parameter changes (as dependent variables). Results: REE, REE per kilogram of lean body mass (REE/LBM), pulse, and systolic and diastolic blood pressure were significantly higher after TSH suppressive LT4 therapy. The GEE analysis revealed longitudinal negative correlations between the TT3/fT4 ratio and systolic blood pressure, fasting blood glucose, body mass index, android (abdominal wall and visceral mesentery) fat distribution, trunk, and arm fat distribution, REE, and REE/LBM

2019 Thyroid

80. Thyroid Function Screening in Children and Adolescents With Mood and Anxiety Disorders. (PubMed)

with elevated TSH measures, 12.9% (n = 8, mean ± SD age = 16.5 ± 1.5 years, 87.5% female) had an abnormal free/total thyroxine (T₄) level or other biochemical findings consistent with thyroid disease. Patients with thyroid disease (compared to those patients with elevated TSH and normal active thyroid hormone concentrations) were older (16.5 ± 1.5 vs 14.6 ± 2.3 years, P = .020) but did not differ in sex distribution (87.5% vs 63.6% female, P = .444).TSH concentrations are abnormal in approximately 6 (...) of age), and 7 patients had a TSH concentration < 0.36 μIU/mL. Elevated TSH concentrations were associated with a recent weight gain (odds ratio [OR] = 3.60; 95% CI, 1.13-9.61; P = .017), a history of thyroid disease (OR = 6.88; 95% CI, 2.37-10.7; P ≤ .0001), abnormal menstrual bleeding/menometrorrhagia (OR = 2.03; CI, 1.04-3.63; P = .024), and benzodiazepine treatment (OR = 2.29; 95% CI, 1.07-4.52; P = .02). No association was observed for sex, age, or body mass index z score. Among patients

2019 Journal of Clinical Psychiatry

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