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Thyroid function tests - the test of choice

Jamaluddin M

Family Practitioner, 1988;11:56-58.

Matched MeSH terms: Thyroid Function Tests
Thyroid function tests: limitations and problems in interpretation

Mafauzy M

Family Practitioner, 1988;11:16-17.

Matched MeSH terms: Thyroid Function Tests
Association between thyroid function tests and anti-thyroid peroxidase (TPO) antibodies in pregnancy

Loh TP, Tee JC, Tee NW, Cheng WL, Thevarajah M, Sabir N, et al.

Endocrine, 2016 Sep;53(3):865-7.
PMID: 26725315 DOI: 10.1007/s12020-015-0844-y
Matched MeSH terms: Thyroid Function Tests*
Prevalens Goiter dan Performans Mental di Kalangan Orang Asli di Sinderut, Pahang (Goitre Prevalence and Mental Performance Amongst the Aborigines in Sinderut, Pahang)

Zaleha M.I., Osman A., Iskandar Z.A., Zainuddin B., Mohd. Ali M., Khalid B.A.K.

Sains Malaysiana, 1996;25(2):51-58.

Goitre prevalence and mental performance were determined amongst the Aborigines in Sinderut, a remote rural area in Pahang. A total of 196 subjects aged 4 to 60 years old were selected for study. Goitre status was determined by an experienced endocrinologist using classification suggested by World Health Organization; while mental performance was measured using Raven's test (Oxford Psychologists Press). Blood specimen was also taken for thyroxine (T4) and thyroid stimulating hormone (TSH) measurement. It was found that goitre prevalence was 26.5% (52/196); with visible goitre prevalence of 42.3% (22152). The overall mean of goitre volume was 21.4 ± 19.1 ml (range: 3.0 - 90.8 ml), while the prevalence of mental performance for the percentile value of more than 5.0 was 26.5% (range: 5.0 - 50.0). Mean thyroxine levels was 75.4 ± 19.3 nmol/L (range: 19.9 - 138.1 nmol/ L) while mean levels of thyroid stimulating hormone was 4.9 ± 3.2 mU/L (range: 0.4 - 18.9 mU/L). There was no significant correlation between hormone levels and mental performance score (Pearson Correlation; T4 : r=-0.002, p=0.9736; TSH : r=0.10, p=0.1843). goitre volume and mental performance score (Pearson Correlation; r=-0.02, p=0.8395). Goitre prevalence of more than 20% in this area indicates a moderate endemia, while mental performance showed a low thinking level in the Aborigines particularly those who lived in remote areas.

Matched MeSH terms: Thyroid Function Tests*
Fulltext Association between Serum Free Thyroxine and Anemia in Euthyroid Adults: A Nationwide Study (Endocrinol Metab 2020;35:106-14, Mijin Kim et al.)

Ma ZF

Endocrinol Metab (Seoul), 2020 06;35(2):484-485.
PMID: 32615733 DOI: 10.3803/EnM.2020.35.2.484
Matched MeSH terms: Thyroid Function Tests
Fulltext Misleading free thyroxine (FT4): a case report

Nurul Hidayah Hashim, Intan Nureslyna Samsudin, Ana Dalila Masiman, Subashini C. Thambiah

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):320-322.
MyJurnal

Interpretation of thyroid function test (TFT) is often straightforward but in certain scenarios, discordance between the clinical impression and the laboratory results exists. A 50-year-old woman with a ten years history of hypothyroidism on levothyroxine presented with a recent notable change in TFT [elevated free thyroxine (FT4) and thyroid-stimulat- ing hormone (TSH)], in an otherwise clinically euthyroid and previously stable TFT, leading to levothyroxine being withheld. This case report highlights the possibility of assay interference as a cause of discordant TFT. It also draws the importance of close collaboration between clinicians and the laboratory to avoid unnecessary investigations and inappropriate management of such a case.

Matched MeSH terms: Thyroid Function Tests
Fulltext Metastatic Follicular Thyroid Carcinoma as a Cause of Low Serum Thyroxine with a Normal Thyroid Stimulating Hormone Level

Loh LT, Lim V

J ASEAN Fed Endocr Soc, 2017;32(1):57-59.
PMID: 33442087 DOI: 10.15605/jafes.032.01.11

Thyroid function is usually normal in differentiated thyroid carcinoma. We describe a case of a female patient who had metastatic follicular thyroid carcinoma (FTC) to the spine and lungs, who was clinically euthyroid but had very low free tetraiodothyronine (fT4) and normal thyroid stimulating hormone (TSH). Free triiodothyronine (fT3) and total T3 (TT3) were normal. Levothyroxine treatment increased fT4 marginally but caused a two- to three-fold rise in fT3 and TT3 along with suppressed TSH. This is likely due to hyperconversion of T4 to T3 from elevation in D2 deiodinase activity in the tumor. This phenomenon has been reported to occur in about 20% of metastatic FTC.

Matched MeSH terms: Thyroid Function Tests
Fulltext Depression symptoms level among thyroid disorders patients at Central region of Peninsular Malaysia

Siti Nur Illiani, J., Azlina, D., Sanisah, S., Ramli, M., Nik Noor Fatnoon, N.A.

Malaysian Journal of Psychiatry, 2017;26(1):0-0.
MyJurnal

Background of Study: Patients with thyroid disorders were found to have
continued to experience symptoms of depression despite the great of treatment has
been given to the patient to balance the thyroid hormones. Objective: The aim of
this study is to determine the level of depression symptoms among various types
of thyroid disorders patients.

Methods: A cross sectional study was carried out at
one of the government hospital at central region of Peninsular Malaysia from
August to October 2016. Patients were diagnosed as thyroid disorders, Malaysian
citizen, above 18 years old and did not have any psychiatric disorders were
included in this study.Depression Anxiety Stress Scale-42 (DASS-42) was
selected to determine the severity of depression symptoms and interpreted as
follow: less than 9-no depression, between 10 and 13-mild depression, between
14-20-moderate depression, between 21 and 27- severe depression and more than
28-extreme severe depression. Descriptive statistic was analysed by IBM
Statistical Package for the Social Sciences (SPSS) version 21.0.

Results: About
15% (23) out of 153 thyroid patients had varies degree of depression symptoms
from mild to severe extremely depression. Patients who had hyperthyroid were
found to have more depressed, followed by hypothyroid and thyroid cancer group.

Conclusion: These findings would suggest that the depression score was higher in
the patients who have hyperthyroid. A more detail and thorough study is
recommended to be done, in order to confirm these findings.

Matched MeSH terms: Thyroid Function Tests
Fulltext Hyperthyroidism presenting as ST Elevation Myocardial Infarction with Normal Coronaries - A Case Report

Krishnan GD, Yahaya N, Yahya M

J ASEAN Fed Endocr Soc, 2019;34(1):92-94.
PMID: 33442142 DOI: 10.15605/jafes.034.01.14

A 31-year-old male, apparently well, presented with typical chest pain. His ECG showed ST-elevation from V1-V4 and echocardiogram revealed anteroseptal wall hypokinesia with ejection fraction of 45%. Normal coronary arteries were seen on coronary angiogram. A thyroid function test showed elevated free T4 levels with suppressed thyroid stimulating hormone (TSH). Treatment with thionamides and beta-blockers improved symptoms. Upon review 4 months later he was well. Repeat echocardiogram showed good ejection fraction with no hypokinetic area.

Matched MeSH terms: Thyroid Function Tests
PRACTICAL BARRIERS TO IMPLEMENTATION OF THYROID CANCER GUIDELINES IN THE ASIA-PACIFIC REGION

Yang SP, Ying LS, Saw S, Tuttle RM, Venkataraman K, Su-Ynn C

Endocr Pract, 2015 Nov;21(11):1255-68.
PMID: 26247114 DOI: 10.4158/EP15850.OR

OBJECTIVE: Numerous published guidelines have described the optimal management of thyroid cancer. However, these rely on the clinical availability of diagnostic and therapeutic modalities. We hypothesized that the availability of medical resources and economic circumstances vary in Asia-Pacific countries, making it difficult to implement guideline recommendations into clinical practice.
METHODS: We surveyed participants at the 2009 and 2013 Congresses of the Association of Southeast Asian Nations Federation of Endocrine Societies by distributing questionnaires to attendees at registration.
RESULTS: Responses were obtained from 268 respondents in 2009 and 163 respondents in 2013. Similar to the high prevalence of low-risk thyroid cancer observed in the Surveillance, Epidemiology, and End Results database, across the Asia-Pacific countries surveyed in 2009 and 2013, 50 to 100% of the respondents from the Philippines, Malaysia, Singapore, China, Taiwan, Thailand, Hong Kong, Korea, and Sri Lanka reported that more than 50% of the patients had low-risk thyroid cancer on follow-up. Importantly, there was much variation with regards to the perceived availability of investigation and treatment modalities.
CONCLUSION: We found a wide variation in clinicians' perception of availability of diagnostic and therapeutic modalities in the face of a rise in thyroid cancer incidence and thyroid cancer management guidelines that emphasized their importance. The lack of availability of management tools and treatments will prove to be a major barrier to the implementation of thyroid cancer management guidelines in Southeast Asia, and likely in other parts of the world as well.

Matched MeSH terms: Thyroid Function Tests/standards; Thyroid Function Tests/statistics & numerical data
High prevalence of thyroid function test abnormalities in chronic schizophrenia

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N

Aust N Z J Psychiatry, 1994 Dec;28(4):620-4.
PMID: 7794205

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n = 152, p = 0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n = 449, p = 0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT41 and FT31 were significantly lower in those with low or high TSH (p < 0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.

Matched MeSH terms: Thyroid Function Tests*
α-thalassemia-associated hydrops fetalis: A rare cause of thyrotoxic cardiomyopathy

Tumian NR, Wong M, Wong CL

J Obstet Gynaecol Res, 2015 Jun;41(6):967-70.
PMID: 25510540 DOI: 10.1111/jog.12648

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.

Matched MeSH terms: Thyroid Function Tests
Thyroid hormones and mortality risk in euthyroid individuals: the Kangbuk Samsung health study

Zhang Y, Chang Y, Ryu S, Cho J, Lee WY, Rhee EJ, et al.

J Clin Endocrinol Metab, 2014 Jul;99(7):2467-76.
PMID: 24708095 DOI: 10.1210/jc.2013-3832

CONTEXT: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear.
OBJECTIVE: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints.
SETTING AND DESIGN: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records.
RESULTS: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95, comparing the highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints.
CONCLUSIONS: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.

Matched MeSH terms: Thyroid Function Tests
Fulltext Autoimmune polyglandular syndrome presenting with jaundice and thrombocytopenia

Norasyikin AW, Rozita M, Mohd Johan MJ, Suehazlyn Z

Med Princ Pract, 2014;23(4):387-9.
PMID: 24401542 DOI: 10.1159/000357645

OBJECTIVE: To report an uncommon presentation of a rare case of autoimmune polyglandular syndrome type IIIb in an elderly woman.
CLINICAL PRESENTATION AND INTERVENTION: A 62-year-old woman presented with anaemic symptoms and jaundice. Blood tests showed macrocytic anaemia due to vitamin B12 deficiency with Coombs negative haemolysis. A thyroid function test was consistent with hypothyroidism. Autoimmune antibody assays were positive for anti-parietal cell, anti-intrinsic factor and anti-thyroid peroxidase antibodies. A final diagnosis of autoimmune thyroiditis with pernicious anaemia, which constituted autoimmune polyglandular syndrome type IIIb, was made and the patient was treated with L-thyroxine, vitamin B12 injection and a blood transfusion. She was discharged uneventfully after a week of hospitalization.
CONCLUSION: This case showed that the presence of one autoimmune endocrine disease should prompt clinicians to look for other coexisting autoimmune diseases which may be asymptomatic despite positive autoantibodies.

Matched MeSH terms: Thyroid Function Tests
Effect of iodized oil supplementation on thyroid hormone levels and mental performance among Orang Asli schoolchildren and pregnant mothers in an endemic goitre area in Peninsular Malaysia

Isa ZM, Alias IZ, Kadir KA, Ali O

Asia Pac J Clin Nutr, 2000 Dec;9(4):274-81.
PMID: 24394503

Although endemic goitre is no longer a major public health problem in Malaysia, iodine deficiency still remains a significant problem in a few remote settlements. The aim of this study was to determine the effectiveness of iodized oil intervention in the prevention of endemic goitre among the indigenous people in Malaysia. A pretest and post-test controlled trial was conducted among primary schoolchildren and pregnant mothers in Lasah, Sungai Siput and Perak. Legap Post and Yum Post were selected as the intervention areas, while Perwor Post and Poi Post were taken as controls. The variables studied included thyroid hormone concentrations, thyroid volume, urinary iodine excretions and mental performance. A baseline and two follow-up visits were conducted in both intervention and control areas. Intervention subjects were given iodized oil in the form of capsules which were taken orally (Laboratoire Guerbet, Paris, France). There was a significant increase in serum thyroxine hormone (T4) concentrations (p<0.0001) and a significant decrease in thyroid stimulating hormone (TSH) concentrations (p<0.05) in the schoolchildren following the intervention, however, pregnant mothers did not show any significant changes in T4 and TSH concentrations. Thyroid size was significantly reduced in both groups (p<0.05). Urinary iodine excretions showed a significant increase in both groups following the intervention (p<0.01). However, mental performance in schoolchildren was not affected. In conclusion, iodized oil (oral) is effective in reducing thyroid size, as well as improving the supply of iodine among schoolchildren and pregnant mothers in endemic goitre areas; however, its long-term effects need to be monitored closely. This method can be considered as an alternative while awaiting national coverage for the salt iodization program.

Matched MeSH terms: Thyroid Function Tests
The supplementation of levothyroxine among indigenous people in endemic goitre areas: The impact of therapy

Zaleha MI, Osman A, Iskandar ZA, Sazali S, Ali MM, Roslan I, et al.

Asia Pac J Clin Nutr, 1998 Jun;7(2):138-50.
PMID: 24393641

In order to study the effect of levothyroxine in the treatment of endemic goitre, a longitudinal study was conducted among the Aborigines in Lanai Post and Sinderut Post, situated in an iodine-deficient area located in the district of Kuala Lipis, Pahang. All subjects in the treatment group (Lanai Post) were given 100 µg of levothyroxine per day and were followed for 1 1/2 years. A total of 311 subjects were examined at baseline, 323 on the first, 256 on the second, 239 on the third and 184 on the fourth visit following levothyroxine supplementation. Goitre prevalence, thyroid hormones, thyroid volume, nutritional status, urinary iodine levels, arterial blood pressure and mental performance were determined. Following the intervention, goitre prevalence was significantly reduced in the treatment group (baseline 42.8% vs final visit 13.0%, p<0.0001); however, no significant difference was noted in the control group. Total T4 levels were increased in the treatment group (p<0.0001), while a significant reduction was noted in the control group (p<0.0001). Thyroid-stimulating hormone levels increased significantly in the treatment group following 1 year of intervention, while no significant changes were observed in the control group. As for the thyroid volume, both groups showed a significant increment following the intervention (p<0.0001). With respect to the nutritional status, the treatment group showed a significant increase in body weight following the intervention (p<0.05). In addition, the mid-arm circumference and body mass index also increased after 1 year of intervention. However, the control group showed a reduction in the waist-hip ratio (p<0.0001). Although there was no statistical difference in the waist-hip ratio in the treatment group, there has been a significant reduction observed after 1 year of intervention. At 1 year, a reduction in skinfold thickness was noted in the treatment group while only the triceps and subscapular were increased in the control group. The body fat was decreased in the treatment group following 1 year of intervention (p<0.0001). No particular trend was noted in the urinary iodine excretion in the treatment group, but surprisingly, the levels were increased in the control group (p<0.0001). A significant increase in both systolic and diastolic blood pressures was observed in the treatment group following 1 year of intervention, but the controls showed a reduction in the systolic blood pressure (p<0.0001). Both groups showed a remarkable increase in mental performance, with a more pronounced effect in the treatment group (p<0.05). The correction of iodine deficiency by levothyroxine supplementation has a short-term beneficial effect in reducing the prevalence of goitre and improving the mental ability among the Aborigines in endemic areas; however, proper monitoring and close supervision are needed to maintain compliance.

Matched MeSH terms: Thyroid Function Tests
Effect of iodination of a village water-supply on goitre size and thyroid function

Maberly GF, Eastman CJ, Corcoran JM

Lancet, 1981 Dec 05;2(8258):1270-2.
PMID: 6118679

An iodinator was fitted to the existing gravity-fed water-supply of a remote village in Sarawak, Malaysia, where goitre was endemic. Within nine months, the prevalence of goitre had been reduced from 61% to 30%, with 79% of goitres showing visible reduction in size. All subjects were clinically euthyroid before and nine months after the start of iodination, although pre-treatment serum thyroid-stimulating hormone (TSH) concentrations varied from normal up to 24 mU/l. Before treatment basal serum triiodothyronine (T3) and thyroxine (T4) concentrations were typical of endemic goitre with a low mean serum T4 (80 +/- 30 [SD] nmol/l) and a slightly raised mean serum T3 (2.3 +/- 0.7 nmol/l). After iodination, circulating TSH concentration was generally undetectable (less than 0.1 mU/l), mean T3 concentration was unchanged, but the mean T4 rose significantly to 109 +/- 41 nmol/l (p less than 0.01). Urinary iodine concentrations fluctuated; this largely reflected intermittent blockage of the iodinator, but concentrations became consistent with a return to the iodine-replete state. There was no evidence of the Jod Basedow effect in the group studied. Iodinated water was more convenient to distribute than iodised salt and is less likely to cause Jod Basedow phenomenon than are injections of iodised oil. Moreover, iodination of water is effective in killing most microorganisms and this additional benefit could contribute significantly to village health.

Matched MeSH terms: Thyroid Function Tests
Heterophilic antibody interference affecting multiple hormone assays: Is it due to rheumatoid factor?

Mongolu S, Armston AE, Mozley E, Nasruddin A

Scand J Clin Lab Invest, 2016 May;76(3):240-2.
PMID: 26924790 DOI: 10.3109/00365513.2016.1143113

Assay interference with heterophilic antibodies has been well described in literature. Rheumatoid factor is known to cause similar interference leading to falsely elevated hormone levels when measured by immunometric methods like enzyme-linked immunosorbent assay (ELISA) or multiplex immunoasays (MIA). We report a case of a 60-year-old male patient with a history of rheumatoid arthritis referred to our endocrine clinic for investigation of hypogonadism and was found to have high serum levels of LH, FSH, SHBG, Prolactin, HCG and TSH. We suspected assay interference and further tests were performed. We used Heteroblock tubes and PEG precipitation to eliminate the interference and the hormone levels post treatment were in the normal range. We believe the interference was caused by high serum levels of rheumatoid factor. Although he was treated with thyroxine for 3 years, we believe he may have been treated inappropriately as his Free T4 level was always normal despite high TSH due to assay interference. Our case illustrates the phenomenon of heterophilic antibody interference likely due to high levels of rheumatoid factor. It is essential for clinicians and endocrinologists in particular to be aware of this possibility when making treatment decisions in these groups of patients.

Matched MeSH terms: Thyroid Function Tests
Fulltext An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre

Mohamed N, Mohd Zin F, Mohd Yusoff SS

Malays Fam Physician, 2017;12(2):29-31.
PMID: 29423128

Introduction: The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.

Case Summary: A 26-year-old Malay female with persistent hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year of follow-ups, her hyperthyroidism and fatigability symptoms improved with treatment. She was later counselled for total thyroidectomy and thymectomy.

Conclusion: Myasthenia gravis and hyperthyroidism may present with similar symptoms such as dysphagia due to neuromuscular weakness or fatigue. When the diseases occur together, one of the diagnoses may be missed. Therefore, the occurrence of new symptoms in a patient with underlying ATD should should trigger the early identification of other autoimmune diseases by primary care doctors.

Matched MeSH terms: Thyroid Function Tests
Treatment of chronic urticaria with thyroxine in an euthyroid patient with thyroglobulin and microsomal antibodies

Koh CK, Hew FL, Chiu CL

Ann Acad Med Singap, 2000 Jul;29(4):528-30.
PMID: 11056786

INTRODUCTION: The association of chronic urticaria and thyroid autoimmunity is not well recognised and the potential use of thyroxine in the treatment of chronic urticaria in patients with thyroid autoimmunity is even less well known.
CLINICAL PICTURE: We report a case of chronic urticaria in an euthyroid patient with evidence of significantly elevated levels of thyroglobulin and microsomal antibodies.
TREATMENT AND OUTCOME: Treatment with thyroxine has brought about clinical remission of the chronic urticaria but no change in the thyroid antibody levels could be demonstrated.
CONCLUSION: Patients with chronic urticaria should be screened for evidence of thyroid autoimmunity. A closely monitored trial of thyroxine therapy for those who have thyroid autoimmunity can be rewarding.

Matched MeSH terms: Thyroid Function Tests

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