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Does Smoking Affect Thyroid Blood Test

What Is Hashimoto’s Disease

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Hashimoto’s is an autoimmune disorder that involves chronic inflammation of the thyroid. This autoimmune condition is the most common cause of hypothyroidism in the United States. Hashimoto’s tends to run in families and most often occurs in middle-aged women. However, anyone can develop Hashimoto’s at any age, including children.

Hashimoto’s is often a silent disease for many years. Thyroid inflammation goes undetected, and there are rarely any symptoms that suggest an inflammatory process is at work. With time and factors that worsen inflammation, Hashimoto’s can impair thyroid hormone production in the gland, resulting in a decline in thyroid function. When the thyroid cannot produce enough thyroid hormone to support the body’s metabolic needs, you can develop hypothyroidism.

Thyroid Hormone Levels Associated With Active And Passive Cigarette Smoking

1Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia.

2Department of Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia.

3Department of Physiology and Biophysics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia.

Challenges In Interpreting Thyroid Stimulating Hormone Results In The Diagnosis Of Thyroid Dysfunction

Salman Razvi

1Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne NE1 3BZ, UK

2Department of Internal Medicine, Division of Endocrinology and Diabetes, University of the Witwatersrand, Johannesburg, South Africa

3Medical Affairs EMEA, Merck Serono Middle East FZ-LLC, Dubai, UAE

Abstract

1. Introduction

The prevalence of treated hypothyroidism is increasing in both the United Kingdom and the United States . Furthermore, the global prevalence of undiagnosed thyroid dysfunction, at least in the developed world, is falling, probably due to a combination of iodine supplementation in iodine-deficient areas, widespread and frequent thyroid function assessment, and lower thresholds to commence treatment . Approximately, 13% of the population has hypothyroidism in iodine-replete areas, with much higher prevalence in older persons and in women .

2. Overview of TSH and Relationship with Thyroid Hormones

3. Serum TSH as the Principal Diagnostic Marker of Systemic Thyroid Status

3.1. Evolution of the TSH Test
3.2. Limitations of TSH as a Diagnostic Marker of Thyroid Function
3.2.1. Age and Gender
3.2.2. Ethnicity
3.2.3. Medications and Supplements
3.2.4. Interference with Assays
3.2.5. Individual Set Points for Thyroid Hormones and Risk of End-Organ Damage
3.2.6. Diurnal and Circannual Variations in TSH Levels
3.2.7. Pregnancy
3.2.8. Obesity
3.2.9. Methodological Issues Relating to the Calculation of Reference Ranges
3.2.10. Smoking
3.2.12. Endocrine Disruptors

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Need For Performing Alcohol Blood Test

The need for performing the alcohol blood test is know all the signs and symptom of intoxication in a person. These signs and symptoms are

  • Changes in mood
  • Nausea with vomiting due to hyperacidity
  • Judgment becomes poor

These are common signs and symptoms for intoxication with alcohol. If the quantity is taken more than there can be alcohol poisoning. The symptoms include

  • Confusion state
  • Breathing becomes irregular and may be slow
  • Convulsions
  • Body temperature can be lowered

If one found the above symptoms than doctor consultation is required otherwise there can be many more symptoms which can be present and can even lead to patient death.

Effect Of Chronic And Withdrawal From Chronic Nicotine On Serum Thyroid Hormone Levels

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Chronic nicotine caused no significant change in serum levels of either T3 or T4: t = 0.5196, p = .6105 and t = 0.7958, p = .4378, respectively . Withdrawal from chronic nicotine produced no significant change in serum levels of T3: t = 0.5831, p = .5679, but it significantly decreased serum T4 levels: t = 2.237, p< .05 . Interestingly, chronic nicotine did produce a significant increase in the serum T3/T4 ratio: t = 2.612, p< .05 , as did withdrawal from chronic nicotine: t = 2.985, p< .05 , which may indicate subtle alterations in thyroid hormone homeostasis.

The Effect of Chronic and Withdrawal From Chronic Nicotine Administration on Serum Thyroid Hormone Levels. Chronic Nicotine had no Effect on Either Secreted or Active Thyroid Hormone but did Increase the T3/T4 ratio. Withdrawal From Chronic Nicotine Significantly Decreased T4 Levels Without Affecting T3 Levels and Also Increased the T3/T4 Ratio. Positive Control of L-T4 Treatment is Also Included to Show Proof of Principle That L-T4 Increases Serum Thyroid Hormone Levels

Treatment group .;

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Bottom Line What Can You Do

You will only know how you;really feel without coffee when you get off it for 3 to 5 days .

The first 2 days will be tough, but that;tells you something important;about this addictive substance, does it not?

Many women who have given up coffee and caffeine report better sleep within days, fewer hot flashes, less depression and anxiety, and many more other benefits over time.

Obesity Or High Body Weight

Obesity is another health issue that affects the results of various blood tests.

For example, obese men have greater BMI, and they usually have lower PSA concentrations. That’s because obese men usually have a larger blood volume where PSA can get diluted. As a result, a prostate test can return false PSA results which affect the diagnosis set by the doctor.

Similarly, obesity can also affect the results of rheumatoid arthritis tests. During those tests, various inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate are checked to detect the level of inflammation in the body.

Some studies show that obese people tend to have higher levels of ESR and CRP in their bodies, and this can interfere with the results, leading to false diagnosis.

Another blood test that can be affected by body weight is creatinine . This test result may be artificially elevated in people with higher body weight or lean mass.;Cystatin C may be a better indicator of kidney function in those patients.

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Which Drugs Can Cause Thyroid Dysfunction And Should This Be Treated

Amiodarone

Amiodarone can cause transient alterations of thyroid function tests, as well as overt hypothyroidism or hyperthyroidism. The incidence of amiodarone-induced thyroid dysfunction varies with iodine nutrition. In iodine-sufficient populations, hypothyroidism is more common, whereas in iodine-deficient populations, hyperthyroidism is more common. In most cases of hyperthyroidism, amiodarone should be withdrawn if agreed upon by the cardiologist. Amiodarone impairs the peripheral de-iodination of T4 to generate T3.

Following amiodarone administration, TSH levels transiently increase with a subsequent increase of T4. A new steady state is achieved, and TSH returns to normal. In euthyroid amiodarone-treated patients, the T4 and FT4 concentrations are high normal or slightly increased and the T3 and FT3 concentrations are in the lower range of normal. The half-life of amiodarone is extremely long, and elimination from adipose tissue may take several months.

Color-flow Doppler thyroid ultrasound may demonstrate increased blood flow in an enlarged, frequently nodular goiter or decreased blood flow in a normal or small-sized thyroid . Treatment of type 1 AIT with large doses of methimazole and beta-blockers is recommended, and if a poor response is seen, the addition of 200 mg perchlorate every 8 hours.

Lithium
Interferons
Tyrosine Kinase Inhibitors
Alemtuzumab
Iodine-containing medications and agents

Hashimotos Disease Reduces Production Of Thyroid Hormones

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The thyroid gland makes two main hormones thyroxine and tri-iodothyronine . Two brain structures, the pituitary gland and the hypothalamus, regulate the hormones released by the thyroid gland. The steps in the process are:

  • The chain of command begins at the hypothalamus, which prompts the pituitary gland to make a chemical called thyroid-stimulating hormone .
  • The pituitary gland checks the amount of T4 and T3 in the blood and releases TSH if the T4 and T3 levels need to be topped up.
  • The thyroid gland secretes T4 and T3 depending on the order it receives from the pituitary gland. Generally speaking, the more TSH the thyroid receives, the more T4 and T3 it secretes.
  • The pituitary gland may order the thyroid gland to make T4 and T3 but, in the case of Hashimotos disease, the thyroid gland cant deliver.
  • The immune system creates antibodies that attack thyroid tissue. The thyroid gland becomes inflamed and thyroid cells become permanently damaged, which hampers the thyroids ability to make T4 and T3.
  • In response, the pituitary gland secretes more thyroid-secreting hormone .
  • The thyroid may enlarge as it attempts to obey the pituitary gland.

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Alcohol And Trh Abnormalities

In contrast to the conflicting fluctuations in peripheral thyroid hormone levels, a blunting of the plasma TSH response after stimulation with TRH has been reported more consistently in patients of alcohol dependence when compared to healthy control subjects .3]. The TSH blunting was more frequent in early abstinence for less than 3 weeks, but was also observed after longer period of abstinence in some studies. TSH blunting also correlated positively with the severity of withdrawal symptoms in early abstinence, but not after 5-8 weeks.

Although a statistically significant abnormality of the TRH response was shown in most of these studies, only 2035% of all assessed patients showed blunting of the TRH response. It is not currently known as to why only some alcoholics have TRH response abnormality. Loosen et al. in 1993 classified patients with TRH abnormality according to the classification of Cloninger , but failed to show association with Type II alcoholism, a subtype of alcoholism with a high hereditary component. Other studies too explored the possible genetic contribution for altered TRH tests by focusing on patients with a positive family history of alcoholism or on high-risk children of alcoholic fathers. However, none of these studies found a possible genetic contribution.

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Assuming everything about the body is healthy, a person weighing in at 150 pounds will need an average of two hours for the liver to process a single alcoholic drink. The more alcohol the person consumes, the more preoccupied the liver will be.

Issues in the liver often compound with frequent alcohol consumption. Alcohol abuse would severely impact the livers ability to filter and expel toxins from the body. Moreover, it would exacerbate the breakdown of both T4 and alcohol in the liver.

In other words, if a person is already suffering from thyroid issues, alcohol abuse can cause T3 levels to plummet. Then, when the body isnt producing enough of this hormone, it could result in hypothyroidism and a slew of uncomfortable symptoms.

People suffering from hypothyroidism exhibit:

  • fatigue
  • muscle aches and stiffness
  • increased blood cholesterol

Its important to note that many medications for thyroid problems require a healthy liver. Methimazole, for example, is a medication that requires regular liver filtration to treat the symptoms of hyperthyroidism. So, any time the liver is strained, the medication becomes less effective.

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Smoking Protects Against Thyroid Peroxidase Antibodies

There are now three studies that all imply that smoking may protect against the development of thyroid peroxidase antibodies . In 2003 Strieder and co-workers reported on risk factors for AITD in 759 euthyroid females with at least one relative with documented AITD . Current smoking was more prevalent in subjects without TPO-Ab than in subjects with TPO-Ab 100 kU/l . The frequency of ever smoking was similar between both groups . Current smoking was an independent determinant for the presence of TPO-Ab with an odds ratio of 0.688 . In 2004 Goh et al. likewise observed a lower prevalence of TPO-Ab in smokers than in non-smokers among 102 patients with newly diagnosed GH .

AITD is thought to develop in relation to a particular genetic background and to be triggered by environmental factors. Based on recently obtained epidemiological data it could be speculated that the smoking behaviour of those individuals genetically susceptible to AITD determines, to some extent, whether they will develop HH or GH. In view of the manifold but poorly understood effects of smoking on the immune system, such a hypothesis might not be too speculative. It could be tested experimentally whether or not smoke exposure directs thyroid autoimmunity away from cell-mediated towards humoral immune reactions.

Best Practice Tips When Advising About Marijuana Use

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Dr. Christofides welcomes studies that focus on marijuana use, considering the drugs popularity and increasing legal status.

Im glad to see that some of the prejudices about looking at marijuana use are going by the wayside, she said. However, clinicians must be prepared to address the temptation for use as an educational opportunity.

She recommended that endocrinologists do the following:

  • Ask about marijuana use in all patients, particularly the ones with diabetes and/or who are obese. Dr. Christofides finds that these patients tend to be unaware of their particular risks.
  • Actively recommend against marijuana use if patients are diabetic and/or obese.
  • Be nonjudgmental. Recognize that the stigma of marijuana is receding and invite open discussion.
  • Let patients know that the medical community is still largely unaware of the impact of marijuana on the endocrine system.
  • If patients indicate that they may want to begin smoking marijuana , recommend regular blood work that can be used as a baseline for new symptoms or abnormal lab results down the road.;

1.;;; Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008;4:245259.

2.;; Malhotra S, Heptulla RA, Homel P, Motaghedi R. Effect of Marijuana Use on Thyroid Function and Autoimmunity. Thyroid. 2016 Published online ahead of print. December 5, 2016.

3.;; Bancks MP, Pletcher MJ, Kertesz SG, Sidney S, Rana JS, Schreiner PJ. . Diabetologia. 2015;58:2736-44.

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Which Drugs Can Lower Tsh Without Inducing True Thyroid Dysfunction

  • Glucocorticoids in high doses during initial treatment; in contrast, prolonged exposure to glucocorticoid therapy or endogenous hypercortisolism do not result in thyroid dysfunction

  • Dopamine or dobutamine

These drugs do not generally cause clinically significant central hypothyroidism, and their suppressant effect on TSH production is transient. An exception is bexarotene, in which the associated central hypothyroidism that is occasionally seen normalizes after the discontinuation of the medication.

Symptoms In Infants And Children

In the United States, nearly all babies are screened for hypothyroidism in order to prevent cognitive developmental problems that can occur if treatment is delayed. Symptoms of hypothyroidism in children vary depending on when the problem first develops.

  • Most children who are born with a defect that causes congenital hypothyroidism initially have no obvious symptoms. Symptoms that sometimes appear in newborns may include jaundice , noisy breathing, and an enlarged tongue.
  • Early symptoms of undetected and untreated hypothyroidism in infants include feeding problems, failure to thrive, constipation, hoarseness, and sleepiness.
  • Later symptoms in untreated children include protruding abdomen; rough, dry skin; and delayed teething. In advanced cases, yellow raised bumps may appear under the skin, the result of cholesterol buildup.
  • If children with hypothyroidism do not receive proper treatment in time, they may be extremely short for their age; have a puffy, bloated appearance; and have intellectual disabilities. Any child whose growth is abnormally slow should be examined for hypothyroidism.

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Alcohol And Autoimmune Thyroid Diseases

Alcohol is known to decrease the frequency of autoimmune disorders like rheumatoidarthritis and systemic lupus erythematosus. One recent prospective Danish study reported significant protective role of alcohol in preventing autoimmune hypothyroidism. The study diagnosed 140 cases of autoimmune hypothyroid from 2,027,208 person-years of observation and reported a negative association between alcohol consumption and the incidence of overt autoimmune hypothyroidism. One interesting finding of the study was that though modest to high alcohol consumption of 1-20 units/week protects from developing autoimmune overt hypothyroidism, a higher consumption of 21 units/week did not show the protective effect.

How Biotin Affects Test Results

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Although supplementing with biotin can be beneficial for the body, this substance can greatly interfere with test results. The FDA mentioned that biotin could alter blood test results and cause incorrect diagnosis for certain health conditions.

It is recommended that you stop biotin supplementation at least 72 hours before offering a blood or saliva sample.

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Cigarette Smoking Linked To Overactive Thyroid

Researchers Say Smoking May Be New Risk Factor for Graves’ Disease in Women

July 26, 2005 — Women who smoke are twice as likely to develop an overactive thyroid caused by Graves’ disease, a study shows.

Researchers say the results suggest that cigarette smoking should be considered a major risk factor for the mysterious disorder.

Graves’ disease is a common cause of an overactive thyroid , but researchers say little is known about what risk factors are associated with the disease. It affects up to one in 1,000 women.

Smoking Doubles Graves’ Disease Risk

Studies in twins suggest that genetics play a major role in Graves’ disease risk. But environmental and lifestyle risk factors have also been proposed, including cigarette smoking, stress, and traumatic life events. Some studies have also suggested that alcohol use may have a protective effect.

In this study, published in the current issue of the Archives of Internal Medicine, researchers looked at the effect of lifestyle factors on the risk of Graves’ disease in more than 115,000 women.

Researchers analyzed information provided by the participants.

During the follow-up period, 543 of the women developed Graves’ disease.

The results showed that women who currently smoked were nearly twice as likely to have Graves’ disease compared with nonsmokers.

The more women smoked, the more likely they were to develop Graves’ disease. Heavy smokers were nearly three times more likely to have the disease.

Alcohol And Thyroid Cancer

Several studies report a decrease in thyroid cancer risk with alcohol use. A large prospective study following up 1,280,296 women with 421 new cases of thyroid cancer showed a clear reduction in risk of thyroid cancer with greater alcohol consumption, and two smaller prospective studies similarly reported a small reduction in risk, albeit not reaching statistical significance. Comorbid tobacco use, which also causes a reduction of thyroid cancer, has been a consistent confounding factor in these studies, and in a pooled analysis of 2725 thyroid cancer cases, from 14 casecontrol studies, the statistical association of decreased cancer in alcohol consumption disappeared after adjusting for smoking.

A theoretical hypothesis for this protective phenomenon stems from the fact that TSH is known to increase the proliferation of follicular thyroid cells in laboratory studies. Alcohol may prevent the proliferative effect of TSH on the thyroid follicle, thereby reducing the occurrence of cancer.

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