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Kérdezz-felelek
Teljesen kétségbe vagyok esve, a kisfiam most 6 hetes, s emelkedett TSH szintet találtak nála . Kint élek Angliában, itt kicsit más a protokoll, s a betegségekhez való hozzáállás. Az sarokból vett vérpöttyös teszt amit pár naposan vettek le, abban minden negatív lett, az öröklött pajzsmirigybetegségre is. Aztán mivel a sárgasága 14 napon túli volt, ezért vérvételre küldtek minket bilirubinszint megállapítása céljából. Azzal rendben volt minden, viszont ott észrevették hogy magas a TSH szintje a gyereknek, 8,7 azt hiszem, ezért ismétlésre hívtak minket. Annak az eredménye sem lett jobb, emelkedett TSH szintet állapítottak meg, 7,2 volt. Kezelést nem kezdtek, amit egyáltalán nem értem miért nem,( azt mondták még pici, lehet hogy még nem állt be neki a pajzsmirigyműködése) ,így 3 hónappal későbbr kaptunk időpontot, ismét vesznek vért. Meg vagyok ijedve, s nem vagyok nyugodt, azt olvastam, mentális retardációt okozhat a kezeletlen betegség.. az lenne a kérdésem, miért nem kezdhetteknk azonnali kezelést, s mikortól kellene a kezelést elkezdeni, hogy minden rendben legyen a babámmal? Valamint helyrejöhet ez a TSH szint magától ezalatt a 3 hónap alatt? Ez most egy komoly betegség kezdete? Válaszát köszönöm.
A TSH értéke nem állandó, több tényezőtől is függ.
Néhány okot felsorolok, értelemszerűen angolul, ezt az ottani orvosoknak is illik tudnia:
1. "Age- and Race-Based Serum Thyrotropin Reference
Limits. Martin I. Surks and Laura Boucai
Division of Endocrinology, Department of Medicine (M.I.S., L.B.) and Pathology (M.I.S.), Montefiore
Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467
Context: TSH reference limits, particularly the upper limit, are controversial. The traditional and prevailing method for setting limits uses TSH distribution of thyroid disease-free individuals. The
curve is not Gaussian, but skewed to higher concentrations, even after log-transformation; values in the skewed area are assumed to reflect mild hypothyroidism. The underlying assumption for this
traditional approach, which has not previously been tested, is that the limits derived from this curve are applicable to all people. However, recent studies suggest that distinct subpopulations have
unique TSH distribution and reference limits that are significantly different from limits established
by the traditional approach.
Evidence Acquisition: A search was focused on articles that provide the basis for current recommendations
for setting TSH reference limits as well as articles that suggest that the traditional method does not reflect accurately the TSH distribution and reference limits of distinct subpopulations
within the United States. Evidence Synthesis: TSH distribution and reference limits shift to higher concentrations with age,
even up to centenarians, and are unique for different racial/ethnic groups, being at higher concentrations in Caucasians than either Blacks or Hispanics originating from Puerto Rico or the
Dominican Republic. The distribution curve derived by the traditional approach represents a composite of curves from specific subpopulations that do not provide appropriate reference limits for
those unique groups.
Conclusions: Age- and race-specific TSH distribution and reference limits, possibly influenced by genetic
factors, should be employed to provide clinicians accurate limits for specific populations and
guidance for further evaluation of thyroid dysfunction. (J Clin Endocrinol Metab 95: 496–502, 2010)"
2. Nem kizárt a Macro-TSH lehetősége sem.
"Clin Endocrinol (Oxf). 2014 Nov 11. doi: 10.1111/cen.12643. [Epub ahead of print]
Macro TSH in patients with subclinical hypothyroidism.
Hattori N1, Ishihara T, Yamagami K, Shimatsu A.
Author information
1Department of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan.
Abstract
OBJECTIVE:
TSH is a sensitive indicator of thyroid function. In subclinical hypothyroidism, however, serum TSH concentrations are elevated despite normal thyroid hormone levels, and macro TSH is one of the causes. This study aimed to clarify the prevalence and nature of macro TSH in patients with subclinical hypothyroidism.
DESIGN:
We conducted a 2-year cross-sectional observational study.
PATIENTS:
We included 681 patients with subclinical hypothyroidism and 38 patients with overt hypothyroidism (controls).
MEASUREMENTS:
Macro TSH was screened by polyethylene glycol (PEG) method and analysed by gel filtration chromatography and bioassays.
RESULTS:
Among 681 serum samples, 117 exhibited PEG-precipitable TSH ratios greater than 75% (mean + 1•5 SD in controls) and were subjected to gel filtration chromatography. TSH was eluted at a position greater than 100 kDa in 11 patients with subclinical hypothyroidism (1•62%); these patients were diagnosed with macro TSH. The nature of macro TSH included eight anti-TSH autoantibodies of IgG class, two non-IgG-associated and one human anti-mouse antibody (HAMA). Macro TSH showed low bioactivity.
CONCLUSIONS:
Macro TSH was heterogeneous, but it is mostly comprised of TSH and anti-TSH autoantibodies. When PEG-precipitable TSH exceeds 90% in serum samples with TSH above 10 mU/l, clinicians should strongly suspect the presence of macro TSH and confirm it by gel chromatography. Because macro TSH exhibited low bioactivity, thyroid hormone replacement therapy may not be required in patients with subclinical hypothyroidism due to macro TSH except for those with high serum free TSH levels.
© 2014 John Wiley & Sons Ltd."
3.Lényegesen több, ilyen vizsgálatot végeztünk:
"Balázs Csaba dr.1, Rácz Károly dr.2
Diagnostic and therapeutical significance of macro-TSH in patients with Hashimoto’s thyroiditis
Introduction: Structure, importance and incidence and clinical role of macro-TSH not clarified in thyroid diseases. Aim: This study was undertaken to determine the incidence and biological role of macro-TSH in patients with Hashimoto’s thyroiditis. Methods: Blood samples taken from patients with Hashimoto’s thyroiditis were screened for the presence of macro-TSH with the polyethylene glycol method and confirmed with protein G agarose
absorption test and gel filtration chromatography. Stimulatory capacity of macro-TSH was measured by CHO cells transfected with recombinant human TSH receptor. Patents were treated with L-thyroxine (mean 66,5 µg/day) and half of them with selenium (mean 60 µg/day), respectively. Results: 880 patients (728 female, aged 44,8 yr) with Hashimoto’s thyroiditis was involved into study.
Macro-TSH was found in sera of 41 patients (4,6%), the mean TSH 185,4 IU/l was before PEG precipitations and after 5,55 IU/l. Titre of anti-TPO proved to be 445±51 IU/l and gradulally decreased to 212±51 IU/l after one year therapy. Both the precipitation, protein G absorption and gel chromatography supported the presence of anti-TSH antibody in the macro-TSH complex. Stimulatory capacity of macro-TSH on CHO was not proved . The macro-TSH was detected in the selenium not treated group for 18±3.2 months, selenium-treated for 12±1.9 months.. Serum TSH levels returned to normal in the remaining two patients whose macro-TSH disappeared. Conclusions: It is concluded that anti-human TSH autoantibodies are a major components of macro-TSH and may cause diagnostic and therapeutical confusion. The PEG precipitation is a suitable screening method for detection of macro-TSH. Selenium is able to decrease of anti-TPO antibodies and macrtoTSH, respectively. When the TSH level is greater than 40.0 IU/l, without the signs of hypothyroidism, the presence of macro-TSH is to be considered.
Keywords: TSH, macro-TSH, Hashimoto thyroiditis, anti-TPO antibodies, hypothyroidism "
Az okok megkeresését javaslom, többet nem tehetek ilyen távolból.
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