Palabras clave
T3
Hipotiroidismo
Perfil tiroideo
hypothyroidism
thyroid test
Thyroid function test
Cómo citar
Resumen
El objetivo de este estudio es evaluar el papel de la T3 en la valoración o diagnóstico de pacientes con hipotiroidismo primario.
Se evaluaron 206 registros de pacientes. El 31,6% fueron hombres y el 68,4% mujeres. La edad promedio fue de 46,2, para los hombres 47,8 ±16,6 (rango entre 16 y 87 años) y para las mujeres 45,5±17,5 (rango entre 17 y 83). El valor promedio de TSH fue 75,3± 89 mUI/L (rango entre 10,5 y 490).
En los pacientes con TSH entre 10 y 19,9 mUI/L, los valores de T4 libre estuvieron por debajo del rango normal en 31,2%, con un promedio de 0,77±0,06 ng/dl y con un valor promedio de TSH de 17,36 mUI/L. En este grupo (n=48 pacientes), todas las mediciones de T3 (libre o total) estuvieron dentro del rango normal.
Los valores bajos de T3 se encontraron en 78 de 206 pacientes (37,8%), cuyo valor promedio de TSH fue 136±115 en el grupo de T3 libre (46 de 124) y 124±123 mUI/L en el grupo de T3 total (32 de 82). En cinco pacientes (6,4%) se encontró T3 baja, con T4 libre dentro del rango normal de referencia, con un valor promedio de TSH de 28,1±11,9 mUI/L, promedio de T4 libre 1,07±0,02 ng/dl.
Se confirma la falta de utilidad de medir la T3 en el diagnóstico del hipotiroidismo primario. Los valores bajos de T3 se encontraron en aquellos pacientes con hipotiroidismo primario avanzado (TSH promedio de 136 mUI/L)
Abstract
The objective of this study is to evaluate the role of T3 in the evaluation or diagnosis of patients with primary hypothyroidism. Two hundred and six patients with primary hypothyroidism were included in the study. 31.6% were male and 68.4% were female. The mean age was 46.2 years for men 47.8 ±16.6 (range 16-87 years) and for women 45.5±17.5 (range 17-83). The mean value of TSH was 75.3± 89 mUI/L (between 10.5 y 490).
In the group of patients with TSH level between 10 and 10.9 mUI/L the T4 was low in 31.2%, with a median of 0.77±0.06 ng/ dl, and mean TSH value of 17.36 mUI/L. In that group (n: 48) the T3 measurements was normal in all patients.
Low T3 was found in 78 of 206 patients (37.8%), with a mean of TSH of 136±115 in the free T3 group (46 of 124) and mean TSH: 124±123 mUI/L in the total T3 group (32 de 82). In 5 patients (6.4%) we found low T3 with normal free T4 with a mean TSH of 28.1±11.9 mUI/L, free T4 mean 1.07±0.02 ng/ dl.
This study confirms the lack of utility of measurement of T3 for the diagnosis of primary hypothyroidism. Low T3 levels were found in cases of severe hypothyroidism ( mean TSH: 136 mUI/L).
Citas
2. Koulori O, Moran C, Halsall D, Chatterjee K et al. Pitfalls in the measurement and interpretation of thyroid function test. Best practice & research clinical endocrinology and Metabolism. 2013; 27: 745-762.
3. Gaitonde D, Rowlwy K, Sweeney L. Hypothyroidism: An update. Am Fam Physician. 2012; 86 (3):244-251
4. Almandoz JP, Gharib H. Hypothyroidism: etiology, diagnosis and management. Med Clin North Am. 2012; 96 (2):203-221.
5. Biondi B. Natural history, diagnosis and management of subclinical thyroid dysfunction. Best Pract Res Clin Endocrinol Metab 2012;26(4):431-46
6. Cooper D, Biondi B. Subclinical thyroid disease. The Lancet 2012; 379: 1142–54.
7. Persani L, Ferretti E, Borgato S, Faglia G, Beck-Peccoz P. Circulating thy- rotropin bioactivity in sporadic central hypothyroidism. J Clin Endocrinol Metab 2000;85:3631-5.
8. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by The American Association of Clinical Endocrinologist and The American Thyroid Association. Endocrine Practice Vol 18, No. 6 November/December 2012, 1200-1235.
9. Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A. Thyroid function during critical illness. Hormones (Athens). 2011;10(2):117-24
10. Bao S, Oiknine R, Fisher SJ. Differentiating nonthyroidal illness syndrome from central hypothyroidism in the acutely ill hospitalized patient. Endocrine. 2012;42(3):758-60.
11. Koulori O, Moran C, Halsall D, Chatterjee K et al. Pitfalls in the measurement and interpretation of thyoid function test. Best practice & research clinical endocrinology & metabolism. 2013. 27:745-762.
12. Koulouri O, Gurnell M. How to interpret thyroid function test. Clinical Medicine. 2013. 13 (3):282-6.
13. Wartofsky L. Combination L-T3 and L t4 therapy for hypothyroidism. Curr opin Endocrinol Diabetes Obes 2013; 20 (5): 460-6.
14. Barbesino G, Drugs affecting thyroid function. Thyroid. 2010; 20 (7): 763- 70.