New Treatment of Hypothyroidism
Congenital hypothyroidism results from a deficiency of thyroid hormone. Risk Factors Etiology. Congenital hypothyroidism occurs in about 1 4000 births. The majority of cases occur because of thyroid dysgenesis. This is either caused by complete absence of or ectopic thyroid tissue. Congenital hypothyroidism is twice as common in females. Diagnostic Tests. Serum levels of T4 are low, whereas thyrotropin (TSH) levels are elevated. Newborn screening tests detect most cases of congenital hypothyroidism. Retardation of osseous development can be shown on radiographs. Thyroid scans with technetium or radiolabeled iodine detect absence of or ectopic thyroid tissue.
Thyroiditis is the most common cause of acquired hypothyroidism. Down, Turner, and Klinefelter syndromes carry a higher risk for autoimmune thyroid disease. Irradiation and ingestion of iodides can also lead to hypothyroidism. Presentation. Growth deceleration is usually the first sign, but may be subtle. Patients also develop constipation, cold intolerance, and decreased energy. Schoolwork and grades do not suffer. Osseous maturation is delayed. In lymphocytic thyroiditis, growth retardation and goiter are the first signs. Diagnostic Tests. Diagnostic tests are the same as for congenital hypothyroidism. Treatment. Treatment consists of replacement therapy.
In a similar set of experiments, Wondisford and colleagues targeted expression of the D337T mutant form of TRp to pituitary, using the 4.6-kb mouse a-subunit promoter (89). This promoter directs high-level expression to both thyrotropes and gonadotropes (37). The mutant used in this study also corresponds to a mutation found in severe RTH. Mice harboring the transgene developed profound PRTH. Although T4 levels were slightly elevated, serum levels of TSH and pituitary content of TSHp were markedly induced (89). In addition, induction of hypothyroidism resulted in an attenuated response of TSH compared to wild-type controls (89). Thus, either the form of the receptor or the utilization of the a-subunit promoter resulted in a more useful model of PRTH, and demonstrated that transgenic mice can be used to accurately model this disease. Although not a transgenic system, the hyt hyt mouse that harbors a mutation in the TSH-receptor gene (175) has been useful as a model of hypothyroidism....
Hypothyroidism occurs when there is not enough thyroxin being secreted into the bloodstream. Depending on the age of the individual affected, various problems can result because of hypothyroidism. a. Cretinism. Cretinism is the hyposecretlon of thyroxin in the newborn. This lack of thyroxin causes retardation of skeletal and nervous system growth. Untreated, this hyposecretion of thyroxin in a newborn can result in a mentally retarded dwarf. Early diagnosis and treatment of hypothyroidism is critical. Once detected, the newborn or infant can be given thyroxin so that development can be normal.
The answer is a Fauci 14e pp 14511455 Massive lifethreatening hemoptysis is 100 cc of blood in 24 h The most common
The answer is e. (Seidel, 4 e, p 184, 371.) Clubbing is associated with cystic fibrosis, lung cancer, congenital heart disease, cirrhosis, colitis, and thyroid disease. Clubbing is due to the formation of new periosteal bone and the development of synovial effusions. Emphysema and asthma do not cause clubbing.
Elevated LDL levels increase the individual's risk for ASHD and peripheral vascular disease. Other diseases associated with increased LDLs include type IIA familial hyperlipidemia, multiple myeloma, hypothyroidism, kidney and liver syndromes, and diabetes.
The answer is d. (Scott, 8 e, pp 767-768.) As patients age, the incidence of vesicle instability or unstable bladder increases dramatically. Although estrogen has been reported to decrease urgency, frequency, and nocturia in menopausal women, its effect on correction of stress urinary incontinence or vesicle instability is unclear. In the elderly population there are also many transient causes of incontinence that the physician should consider. These include dementia, medications (especially a-adrenergic blockers), decreased patient mobility, endocrine abnormalities (hypercalcemia, hypothyroidism), stool impaction, and urinary tract infections.
The answer is a. (Braunwald, 15 e, pp 2228-2229.) A positive family history of osteoporosis is a risk factor for the development of osteoporosis. There is a definite relationship between prolonged hyperthyroidism or over-supplementation of hypothyroid patients, but hypothyroidism per se is not associated with the development of osteoporosis. A body weight under 70 kg, not obesity, is associated with osteoporosis. Hormone replacement therapy has an FDA indication for prevention and treatment of osteoporosis and therefore is not a contributor to the development of this disease. 492. The answer is d. (Braverman, 8 e, pp 578-589.) The patient's clinical presentation is most consistent with postpartum thyroiditis, a form of autoimmune-induced thyrotoxicosis that occurs 3 to 6 months after delivery. The hyperthyroid state usually lasts for 1 to 3 months and is generally followed by a hypothyroid state of limited duration. The patient's thyroid gland would not be enlarged if she were...
Many patients are concerned that they have a metabolic or glandular cause for their obesity. This may be a reflection of the frustration that some of these individuals feel over the difficulties that they have had in battling a weight problem over many years. They may be looking for a medical explanation of why they have not succeeded in their goal of losing weight. Endocrine causes of serious obesity are not common. The three most commonly cited are hypothyroidism, Cushing's syndrome, and hypothalamic obesity. To evaluate the patient for hypothyroidism, questions can be asked about cold intolerance, constipation, irregular menses, fatigue, or depression. The presence of easy bruisability, proximal muscle weakness (difficulty getting out of a chair, trouble getting things out of a high cupboard), a change in appearance, or osteoporosis may be signs of hypercortisolism. The patient can be examined for signs of hypothyroidism including bradycardia, cool dry skin, a firm palpable...
TRH is expressed in the hypothalamus as well as a number of other organs. The tripeptide was originally characterized for its ability to regulate serum levels of TSH, but it also appears to function as a neurotransmitter or neuromodulator. Although TRH is a well-known regulator of TSH synthesis and secretion, its role in regulating thyrotrope development was unknown. To assess the thyrotrope-specific effects as well as any other biological target of TRH, the gene was specifically disrupted in mice. Mice lacking the TRH gene exhibit hyperglycemia, because of a profound decrease in insulin secretion, and tertiary hypothyroidism (105). Unexpectedly, although TRH levels were non-detectable in these mice, serum levels of TSH were nearly twice that of a wild-type mouse (105). This suggests that negative feedback by thyroid hormones plays a more significant role than TRH in regulating TSH levels. In other words, the loss of negative regulation by thyroid hormones was sufficient to overcome...
One should always consider organic reasons for failure to thrive such as heart failure, cystic fibrosis, hypothyroidism, diabetes, malabsorption, and psychological and central nervous system problems before assuming that the diagnosis is nonorganic failure to thrive.
Graves' disease refers to autoimmune thyroid disease characterized by diffuse toxic goitre and caused by the production of antibodies to TSH receptors (and thus loss of endogenous TSH control). Other associated features of an autoimmune nature may sometimes be seen, particularly including ophthalmopathy and pretibial myxoedema.
Case Mrs A., a middle-aged, smartly dressed woman who prided herself on her homemaker skills, came to see her family practitioner, Dr B., complaining of tiredness, depressed mood, anxiety, disturbed sleep, and weight gain. Dr B. knew that her husband, a well-known local politician, had recently left her for a younger woman, so he tactfully avoided that subject, asking instead after her grown children who lived out of state. After questioning Mrs A. about her symptoms, Dr B. concluded that she might be hypothyroid, depressed, anemic, or all three, and ran the appropriate tests. Several visits later, after normal test results and a failed trial of antidepressants, Dr B. was feeling baffled until Mrs A. finally broke down in tears and revealed the cause of her symptoms. She had been a heavy drinker in her youth but had managed to stop when she had decided to have children. However, the recent stress and humiliation of her husband's desertion and subsequent loss of self-esteem, social...
Age.24' Genetic factors, including haplotypes found in association with the DR4 haplotype (more common in type 1 diabetes), may increase the risk of early menopause two-fold. The long-term effects of premature menopause, in addition to a shorter time for childbearing, include a higher risk of cardiovascular disease, abnormal lipid profile, and increased risk of osteoporosis. Earlymenopause may occur in women with type 1 diabetes from autoimmune premature ovarian failure (similar to the autoimmune thyroiditis seen more commonly in patients with type 1 diabetes), from peripheral hyperinsuline-mia and hyperandrogenemia seen in polycystic ovary syndrome, and from hypothalamic dysfunction from poorly controlled diabetes. A good menstrual history will help with the early detection of premature menopause in these women.
Overfolding upper helix, and small or absent earlobes. Hypoplastic teeth are common. Hand findings include short metacarpals and fingers, clinodactyly (60 ), simian crease (45 ), and characteristic prints. They exhibit a wide gap between the first and second toes. Cardiac abnormalities are present in 49 , with endocardial cushion defects, ventricular septal defects (VSDs), patent ductus arteriosus (PDA), and atrial septal defects (ASDs). Cutaneous manifestations include dry skin, cutis marmorata, fine, soft sparse hair, and straight pubic hair. Occasionally, patients have seizures, strabismus, and low-set ears. Patients are at higher risk for duodenal atresia, atlantoaxial instability, leukemia, and thyroid disease.
Is the accumulation of fluid in the pericardial sac in amounts sufficient to cause obstruction of blood flow back to the heart. Cardiac tamponade may follow trauma or surgery. It may be a complication of malignancy (i.e., lung, breast, lymphoma), chronic renal failure, or hypothyroidism. The patient has the classic signs of cardiac tamponade, including pulsus para-doxus, JVD, and distant heart sounds. Patients may also present with hypotension. ECG may show low voltage and pulsus alternans. Chest radiograph may show enlargement of the cardiac shadow. Pulsus paradoxus is an inspiratory drop (from expiration) in systolic blood pressure of 10 mm Hg (normal 10 mm Hg). Pulsus paradoxus may also be seen in severe asthma and constrictive pericarditis.
The assessment of thyroid function is difficult in the seriously ill patient. This is because a variety of abnormalities of thyroid function tests may be found which seemingly reflect hypothyroidism, even in the absence of intrinsic thyroid disease. This state has thus been referred to as the euthyroid sick syndrome, and it may reflect the neuroendocrine effects of cytokines. It can occur very early in the course of serious illness, especially sepsis. The TSH is of course low if there is secondary hypothyroidism. Nevertheless, the diagnosis of genuine hypothyroidism is important because it is curable, though the erroneous treatment of a euthyroid patient is potentially dangerous. The most practical approach is to rely on the TSH level, which if elevated generally indicates hypothyroidism and if low generally indicates euthyroidism. While hypothyroidism will not be overdiagnosed in this way, it may be underdiagnosed if one of the other causes of a low TSH is present, as described...
Likewise, the absence of thyrotropin results in hypothyroid mice that have rudimentary thyroid glands and severely suppressed levels of thyroid hormone. Pituitaries from these deficient mice display thyrotrope hypertrophy and hyperplasia (11) a result of the absence of negative feedback by thyroid hormone (16). In addition, somatotrope and lactotrope cell numbers are reduced (11). This supports the hypothesis that development of lactotropes is dependent upon free a-subunit (17). However, treatment with thyroid hormone causes repopulation of the pituitary by somatotropes and lactotropes, and
Measuring thyroxine levels provides a reliable test of thyroid function, assists in ruling out hypothyroidism and hyperthyroidism, and is useful in the evaluation of thyroid hormone replacement therapy. Variations from Normal. Increased thyroxine levels are associated with various conditions known as hyperthyroid states. Hyperthyroid states can be caused by overactive thyroid nodules and or thyroid tumors, which are diseases in and of themselves. These conditions, which usually result in an elevated thyroxine secretion, contribute to other disease processes. Specific diseases include thyrotoxicosis, Graves' disease, which is characterized by an enlarged thyroid and exophthalmos Plummer's disease, also called toxic nodular goiter and acute thyroiditis. Decreased thyroxine levels are associated with various conditions known as hypothyroid states. Since thyroxine is necessary for many bodily functions, manifestation of thyroxine deficiencies may be evidenced in many systems. Patients may...
Consistently elevated Cortisol levels are found in patients with Cushing's syndrome and those individuals under the stress of trauma or surgery. Other conditions associated with an increased Cortisol level include hyperthyroidism, adrenal adenoma, and an overproduction of adrenocorticotropic hormone (ACTH). Decreased levels are seen in Addison's disease, hypopituitarism, hypothyroidism, hepatitis, and cirrhosis.
Thyroid stimulating hormone (TSH) is secreted by the anterior lobe of the pituitary gland and, as the name implies, stimulates the thyroid gland to produce and secrete thyroxine (T4) and triiodothyronine (T3). Measuring TSH levels is the most sensitive test for identifying and differentiating primary and secondary hypothyroidism. Primary hypothyroidism is a result of thyroid gland malfunction or disease. In secondary hypothyroidism, the thyroid gland is unable to secrete adequate levels of T3 and T4 due to the failure of the pituitary gland or hypothalamus to secrete appropriate amounts of thyroid-related hormones. Variations from Normal. Increased TSH levels are indicative of primary hypothyroidism, thyroiditis, and lack of thyroid growth or development. Decreased TSH levels are associated with secondary hypothyroidism, hyperthyroidism, and pituitary dysfunction.
The circulating levels of Lp(a) are largely genetically determined therefore, it is difficult to influence this variable. Nicotinic acid can lower Lp(a) levels but compliance may be a problem because of side-effects (e.g. flushing). Correcting hypothyroidism or administering hormone replacement therapy may also lower Lp(a) levels. Since the risk attributed to Lp(a) is influenced by the LDL-C level, it may be that the overall risk of a vascular event can be decreased by aggressively lowering the LDL-C levels (e.g. with a statin 7 ).
A 32-year-old woman undergoes a thyroidectomy because of papillary carcinoma. She is given thyroid replacement therapy to avoid the development of hypothyroidism. She returns to the physician a month after the surgery complaining of sadness, generalized weakness, and muscle spasms. Gende tapping over the fecial nerve shows a fecial twitch. Inflation of a blood pressure cuff above her systolic pressure for 3 minutes shows a car-popedal spasm. An electrocardiogram shows an increased QT interval. None of these findings were present before the surgery. Laboratory studies will most likely show which of the following
The QRS is naturally the largest complex on the ECG because it corresponds to depolarization of the ventricles, with their larger muscle mass. Therefore, QRS amplitude may normally reach as high as 25 mm or more (five big boxes) in large individuals, or in those with thin chest walls that actually allow the precordial electrodes to be closer to the heart. Amplitudes 25 mm are frequently associated with chamber enlargement (ventricular hypertrophy), as seen in Figure 2.5. Conversely, very low QRS amplitudes are also abnormal and may be seen with diffuse, severe cardiac disease or illnesses such as pericardial effusion and hypothyroidism.
All of the following statements about hypothyroidism are TRUE EXCEPT (C) in secondary hypothyroidism, thyroid-stimulating hormone (TSH) levels are usually low (D) although hypothyroidism is common in those older than 60 years, a paucity of symptoms may make the diagnosis difficult (E) postablation hypothyroidism is a cause of primary hypothyroidism
As it is (like vitiligo) associated with several autoimmune diseases, especially Addison's disease, thyroiditis and pernicious anaemia, it is probably an autoimmune phenomenon itself. It may also accompany specific diseases, such as iron deficiency, thyroid disease and secondary syphilis.
The answer is a. (Stobo, 23 e, pp 298-302.) In primary hypothyroidism, autoimmune thyroiditis is the most common insult. Primary hypothyroidism can result from surgery or radiation therapy, but there is no such history in this patient. Thyroid cancer does not cause hypothy-roidism.
Frequent visits to physicians provided no relief. She was diagnosed in the past as having a variety of physical problems, such as hypothyroidism, and psychological problems. However, neither medication she was at various times placed on thyroid hormone, tranquilizers, and other medications nor psychotherapy provided any relief, and her symptoms gradually became worse.
A 47-year-old woman begins to have difficulty swallowing food at dinner. Over the following 3 h, she develops diplopia, dysarthria, and ultimately anarthria. She has a history of hypothyroidism and is on thyroid hormone replacement. There is no history of exposure to ticks or recent travel. On exam, she nods her head appropriately to questions, and she can write. Forced vital capacity is 500 mL, and she is intubated. She is afebrile, tachy-cardic, and normotensive. Bilateral ptosis and ophthalmoparesis are present pupils are 6 mm in diameter and minimally reactive. Facial sensation is intact. Bifacial paresis is present, and the tongue is weak. Extremity muscle bulk and tone are normal, and proximal strength is 4 5 in her arms and legs. Finger and toe movements are rapid and symmetric. Plantar responses are flexor. Blood tests are normal. Motor nerve conduction studies show low-amplitude compound muscle action potentials with normal velocities. Sensory nerve action potentials are...
Angiotensin-converting enzyme calcitonin Conn's syndrome Cushing's syndrome ectopic hormone production euthyroid sick syndrome hirsutism hypertrichosis hypercalcaemia hyperparathyroidism hyperphosphataemia hyperthyroidism hypocalcaemia hypoparathyroidism hypophosphataemia hypothyroidism multiple endocrine neoplasia myxoedema pituitary
Result of chronic inflammation of a mucosa normally devoid of lymphoid tissue 3,58 . Examples include Helicobacter pylori-associated gastritis and Hashimoto thyroiditis. There is evidence to suggest that, at least early in its course, MALT lymphoma may be partially dependent on antigen and T-cell-mediated stimulation occurring in such a microenvironment 58 . Although no studies have specifically investigated the biology of MALT lymphoma arising in the bladder, the lack of convincing native lymphoid tissue in the bladder, the clinical or histological evidence of antecedent chronic cystitis in many patients, and the higher incidence in women than in men of both MALT lymphoma of the bladder and chronic cystitis suggests a similar pathogenesis at this site, in which chronic cystitis is a nonobligate precursor for MALT lymphoma 53,55-57 .
Side effects of IFN-a therapies are the development of anti-thyroid antibodies, sometimes leading to thyroiditis, and anti-DNA antibodies. Since increased IFN-a and anti-DNA antibodies are also found in patients with lupus erythema-todes, it is a major concern that IFN-a treatment even has the potential to induce SLE. Most patients experience flu-like symptoms, which resolve spontaneously.
Elevated levels arise from both genetic defects affecting the transsul-furation or remethylation pathways as well as with folate, B6 and B12 deficiency, renal failure, hypothyroidism, increased age, and smoking. Homozygotes for cystathionine b-synthase deficiency and methylene-tetrahydrofolate re-ductase may have severe vascular disease and appear even in childhood. As many as 60 have thromboembolic events before age 40 and 50 by age 29. Heterozygotes have a high incidence of premature arterial occlusive disease, which may represent as much as 1 70 of the normal population. However, the most common cause is dietary folate and B6 and B12 deficiencies, which account for around two thirds of the cases of hyperhomocystinemia. Measuring fasting homocysteine plasma levels establishes the diagnosis. The mechanism of thrombosis is thought to involve several mechanisms including induction of endothelial cell tissue factor activity, inhibition of thrombomodulin, decreased...
Kocher was not the first person to observe the connection of cretinoid characteristics with abnormalities in thyroid function others, including Plater, Paracelsus, Curling, Gull, and Ord, had linked cretinism with goitre and thyroid deficiency. Kocher's observations, though, brought all the previous knowledge on the function of the thyroid gland together. Kocher was able to prove that hypothyroidism can be caused by the lack of glandular material and also that it can be caused by a lack of function of present thyroid tissue. Due to the work of Kocher, others were able to treat patients with the products of the thyroid gland in order to treat deficiencies.
Levothyroxine is a synthetic source of the T4 hormone. Once taken, approximately 30 percent of the levothyroxine is converted to the T3 hormone. Levothyroxine is used in the treatment of hypothyroidism. Like Thyroid, USP, the dosage of levothyroxine must be individualized to meet the patient's needs. The usual dosage prescribed is from 0.1 milligram to 0.2 milligram taken daily in a single dose. Side effects associated with this agent include changes in appetite, chest pain, diarrhea, and hand tremors. c. Sodium Liothyronine (Cytomel ). Liothyronine is a synthetic source of the T3 hormone. This product is used in the treatment of hypothyroidism and male sterility due to hypothyroidism. As with the other thyroid preparations, the dosage of this product must be tailored to meet the needs of the individual patient. The dose usually prescribed is 25 to 50 micrograms daily in a single dose. Changes in appetite, chest pain, diarrhea, and hand tremors are side...
Another form of goiter is called Graves' Disease. Graves' Disease is the result of an overactivity of the thyroid (or hyperthyroidism). It is also called exophthalmic goiter because of the protruding eyeballs that are characteristic of the disease. Other symptoms associated with Graves' Disease include nervous tension, fatigue, fast and irregular heart beat, and eventually, congestive heart failure. The cause of Graves' disease is unknown. The result of Graves' disease is an enlarged and hyperactive thyroid gland. Graves' disease is treated by the use of antithyroid drugs and or surgical removal of part of the thyroid gland. Many of the clinical signs and symptoms typical of Graves' Disease may also be seen in patients who take an overdose of a thyroid drug.
Several systemic disorders occur more often in patients with vitiligo, including thyroid disease (e.g., hyperthyroidism, Graves' disease and thyroiditis), Addison's disease, pernicious anemia, alopecia areata, uveitis, and diabetes mellitus. Vitiligo may be inherited as an autosomal-dominant trait with incomplete penetrance and variable expression. Most studies, however, point to an autoimmune basis (circulating complement binding anti-melanocyte antibodies have been detected).
Hashimoto and subacute thyroiditis (transient hyperthyroidism) C. Hypothyroidism 1. General features of hypothyroidism ii. 1 hypothyroidism elevated TSH iii. 2 and 3 hypothyroidism decreased TSH 2. Iatrogenic hypothyroidism a. Most common cause of hypothyroidism in the United States 3. Congenital hypothyroidism (cretinism) i. Endemic regions iodine deficiency during intrauterine and neonatal life D. Thyroiditis 1. Hashimoto thyroiditis a. Definition chronic autoimmune disease characterized by immune destruction of the thyroid gland and hypothyroidism b. Most common noniatrogenic nonidiopathic cause of hypothyroidism in the United States iii. Hypothyroidism 2. Subacute thyroiditis a. Synonyms De Quervain thyroiditis, granulomatous thyroiditis i. Second most common form of thyroiditis c. Micro granulomatous thyroiditis 3. Riedel thyroiditis
Patient must remain in the supine position, with the neck well exposed so that the scanner can be passed over the area of the thyroid. Thyroid scanning assists in the identifications and evaluation of masses in the thyroid gland and other areas of the neck, as well as abnormalities associated with hyperthyroidism or hypothyroidism. Thyroid scans are particularly useful in evaluating thyroid nodules. Pregnant women are not candidates for radionuclide thyroid scans. Variations from Normal. Abnormalities, such as goiters, cancer of the thyroid, Graves' disease, Plummer's disease, Hashimoto's thyroiditis, as well as hyperthyroidism and hypothyroidism, can be identified using the radionuclide thyroid scan. The radioactive iodine uptake (RAIU) test is a nuclear medicine study that evaluates thyroid gland function. The percentage of the radionuclide (radioactive iodine) absorbed over time provides information about hyperthyroidism and hypothyroidism. Hyperthyroidism is indicated by an...
To directly evaluate the function of the T3Ra gene, it has also been mutated in mice. In contrast to the T3RP-deficient mice, those lacking T3Ra are hypothyroid, exhibit growth arrest, and die by 5 wk of age (157). These mice do live long enough to measure TSHp mRNA levels in the pituitary. Surprisingly, expression of the TSHp gene was reduced threefold (157). For unknown reasons, disruption of the T3Ra gene by another group resulted in a much milder hypothyroid phenotype, with only reduced heart rate and body temperature (158). TSH levels were only slightly reduced in these mice (158). These data suggest that the p form of T3R may predominate in negative regulation of TSH and that the a form may be a necessary positive regulator of TSH. This implies that the a and p forms of the receptor may cooperate to modulate circulating levels of TSH. To assess this directly, mice lacking all thyroid-hormone receptors were produced by intercrossing mice heterozygous for each disruption. The...
Increased calcitonin levels are indicative of medullary carcinoma of the thyroid. Other diseases associated with increased calcitonin include oat cell carcinoma of the lung breast and pancreatic cancers thyroiditis and pernicious anemia. Decreased calcitonin levels may not be diagnostically significant.
High levels of cholesterol are associated with atherosclerosis and an increased risk of coronary artery disease. Other diseases linked to elevated cholesterol include uncontrolled diabetes, obesity, and hypothyroidism. Type II familial hypercholesterolemia is an inherited disorder characterized by high levels of plasma cholesterol and early evidence of atherosclerosis. Hyperlipidemia type IIA is another name for type II familial hypercholesterolemia.
Disruption of the gene for the a-subunit has resulted in mice that did not produce FSH, LH, or TSH. The homozygous mutant mice are hypogonadal, and suffer from severe hypothyroidism resulting in dwarfism (8). The a-subunit-deficient male mice are infer- sex-reversal at the gonad level in females Female infertility folliculogenesis block prior to antral follicle stage males fertile but with decreased testis size Infertile hypogonadal and hypothyroid Partial homeotic transformation of vas deferens to epididymis failure of testicular descent absence of uterine stromal, decidual, and glandular cells in females
Increased triiodothyronine levels are associated with hyperthyroidism, T3 thyrotoxicosis, thyroiditis, and thyroid tumor. Decreased levels are seen in hypothyroidism, starvation, and chronic illnesses. Interfering Circumstances. Iodinated contrast studies, pregnancy, and drugs such as estrogens, heroin, methadone, and oral contraceptives may cause elevated triiodothyronine levels. Decreased levels are associated with anabolic steroids, lithium, and antithyroid drugs.
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