Rapid Differential Diagnosis of Graves' Disease and Painless Thyroiditis Using Total T3/T4 Ratio, TSH, and Total Alkaline Phosphatase Activity
When thyrotoxic patients are first seen in an outpatient clinic, it is important to make a differential diagnosis of Graves' disease (GD) and painless thyroiditis (PT). Using the three parameters of total T3/T4 ratio, TSH and T-ALP activity, all of which can be obtained within one hour in our h...
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| Veröffentlicht in: | ENDOCRINE JOURNAL 2005, Vol.52(1), pp.29-36 |
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| creator | YANAGISAWA, Tetsuo SATO, Kanji KATO, Yoshiyuki SHIMIZU, Satoru TAKANO, Kazue |
| description | When thyrotoxic patients are first seen in an outpatient clinic, it is important to make a differential diagnosis of Graves' disease (GD) and painless thyroiditis (PT). Using the three parameters of total T3/T4 ratio, TSH and T-ALP activity, all of which can be obtained within one hour in our hospital, 173 untreated patients with thyrotoxicosis were evaluated for the ratio of each parameter. For GD vs. PT, total T3/T4 (ng/μg) ratio (>20), TSH ( |
| doi_str_mv | 10.1507/endocrj.52.29 |
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Using the three parameters of total T3/T4 ratio, TSH and T-ALP activity, all of which can be obtained within one hour in our hospital, 173 untreated patients with thyrotoxicosis were evaluated for the ratio of each parameter. For GD vs. PT, total T3/T4 (ng/μg) ratio (>20), TSH (<0.005 μU/ml) and elevated T-ALP had a likelihood ratio of 2.14, 2.12 and 4.07, respectively. When a patient had all three positive parameters, the likelihood ratio increased to 5.81, which showed effective synergy. These data suggest that, in addition to total T3/T4 ratio and TSH value, T-ALP activity is a useful parameter for the rapid differentiation of GD. The lower T-ALP activity seen in PT is probably due to the fact that patients develop less severe thyrotoxicosis or visit hospital earlier than patients with GD. Therefore, the diagnostic accuracy for Graves' disease might be increased by using the three parameters in combination.</description><identifier>ISSN: 0918-8959</identifier><identifier>EISSN: 1348-4540</identifier><identifier>DOI: 10.1507/endocrj.52.29</identifier><identifier>PMID: 15758555</identifier><language>eng</language><publisher>Japan: The Japan Endocrine Society</publisher><subject>Adult ; Alkaline phosphatase ; Alkaline Phosphatase - blood ; Female ; Graves Disease - blood ; Graves Disease - diagnosis ; Graves' disease ; Humans ; Likelihood Functions ; Male ; Middle Aged ; Pain - physiopathology ; Painless thyroiditis ; Subacute thyroiditis ; Thyroiditis - blood ; Thyroiditis - diagnosis ; Thyroiditis - physiopathology ; Thyrotropin - blood ; Thyroxine - blood ; Triiodothyronine - blood</subject><ispartof>Endocrine Journal, 2005, Vol.52(1), pp.29-36</ispartof><rights>The Japan Endocrine Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c644t-fead1d79a1d08f4fc3e51049ba9454742bc33a0a768b1cae362a95013d5d399c3</citedby><cites>FETCH-LOGICAL-c644t-fead1d79a1d08f4fc3e51049ba9454742bc33a0a768b1cae362a95013d5d399c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15758555$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>YANAGISAWA, Tetsuo</creatorcontrib><creatorcontrib>SATO, Kanji</creatorcontrib><creatorcontrib>KATO, Yoshiyuki</creatorcontrib><creatorcontrib>SHIMIZU, Satoru</creatorcontrib><creatorcontrib>TAKANO, Kazue</creatorcontrib><creatorcontrib>Department of Hygiene and Public Health</creatorcontrib><creatorcontrib>Institute of Clinical Endocrinology</creatorcontrib><creatorcontrib>Department of Medicine</creatorcontrib><creatorcontrib>Tokyo Women's Medical University</creatorcontrib><title>Rapid Differential Diagnosis of Graves' Disease and Painless Thyroiditis Using Total T3/T4 Ratio, TSH, and Total Alkaline Phosphatase Activity</title><title>ENDOCRINE JOURNAL</title><addtitle>Endocr J</addtitle><description>When thyrotoxic patients are first seen in an outpatient clinic, it is important to make a differential diagnosis of Graves' disease (GD) and painless thyroiditis (PT). Using the three parameters of total T3/T4 ratio, TSH and T-ALP activity, all of which can be obtained within one hour in our hospital, 173 untreated patients with thyrotoxicosis were evaluated for the ratio of each parameter. For GD vs. PT, total T3/T4 (ng/μg) ratio (>20), TSH (<0.005 μU/ml) and elevated T-ALP had a likelihood ratio of 2.14, 2.12 and 4.07, respectively. When a patient had all three positive parameters, the likelihood ratio increased to 5.81, which showed effective synergy. These data suggest that, in addition to total T3/T4 ratio and TSH value, T-ALP activity is a useful parameter for the rapid differentiation of GD. The lower T-ALP activity seen in PT is probably due to the fact that patients develop less severe thyrotoxicosis or visit hospital earlier than patients with GD. Therefore, the diagnostic accuracy for Graves' disease might be increased by using the three parameters in combination.</description><subject>Adult</subject><subject>Alkaline phosphatase</subject><subject>Alkaline Phosphatase - blood</subject><subject>Female</subject><subject>Graves Disease - blood</subject><subject>Graves Disease - diagnosis</subject><subject>Graves' disease</subject><subject>Humans</subject><subject>Likelihood Functions</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pain - physiopathology</subject><subject>Painless thyroiditis</subject><subject>Subacute thyroiditis</subject><subject>Thyroiditis - blood</subject><subject>Thyroiditis - diagnosis</subject><subject>Thyroiditis - physiopathology</subject><subject>Thyrotropin - blood</subject><subject>Thyroxine - blood</subject><subject>Triiodothyronine - blood</subject><issn>0918-8959</issn><issn>1348-4540</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkU1vEzEQhlcIREPhyBX5BJdu6s_d9TEtkCJVoirbszWxvYnDZp3aTqX8CX4z3m74OMyM7Hn8jmemKN4TPCcC15d2MF6H7VzQOZUvihlhvCm54PhlMcOSNGUjhTwr3sS4xZgxwdnr4oyIWjRCiFnx6x72zqDPrutssENy0OcDrAcfXUS-Q8sATzZ-ypfRQrQIBoPuwA29jRG1m2PwzriU2YfohjVqfcoKLbtsObqH5PwFan_cXDw_m3KL_if0brDobuPjfgNpVF3o5J5cOr4tXnXQR_vuFM-Lh69f2uub8vb78tv14rbUFeep7CwYYmoJxOCm451mVhDM5Qpkbr3mdKUZAwx11ayIBssqClJgwowwTErNzouPk-4--MeDjUntXNS272Gw_hBVVWe6qmUGywnUwccYbKf2we0gHBXBalyAOi1ACaroyH84CR9WO2v-0aeJZ2A5ATnrNPR-GIehtv4Qhtyx0o_Vs6KiGAuVjWKSA89GZXasIlwQisdSV5PSNiZY27-lICSne_v_x8jkssCfpN5AyAT7DW1nsgs</recordid><startdate>2005</startdate><enddate>2005</enddate><creator>YANAGISAWA, Tetsuo</creator><creator>SATO, Kanji</creator><creator>KATO, Yoshiyuki</creator><creator>SHIMIZU, Satoru</creator><creator>TAKANO, Kazue</creator><general>The Japan Endocrine Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2005</creationdate><title>Rapid Differential Diagnosis of Graves' Disease and Painless Thyroiditis Using Total T3/T4 Ratio, TSH, and Total Alkaline Phosphatase Activity</title><author>YANAGISAWA, Tetsuo ; SATO, Kanji ; KATO, Yoshiyuki ; SHIMIZU, Satoru ; TAKANO, Kazue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c644t-fead1d79a1d08f4fc3e51049ba9454742bc33a0a768b1cae362a95013d5d399c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Alkaline phosphatase</topic><topic>Alkaline Phosphatase - blood</topic><topic>Female</topic><topic>Graves Disease - blood</topic><topic>Graves Disease - diagnosis</topic><topic>Graves' disease</topic><topic>Humans</topic><topic>Likelihood Functions</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pain - physiopathology</topic><topic>Painless thyroiditis</topic><topic>Subacute thyroiditis</topic><topic>Thyroiditis - blood</topic><topic>Thyroiditis - diagnosis</topic><topic>Thyroiditis - physiopathology</topic><topic>Thyrotropin - blood</topic><topic>Thyroxine - blood</topic><topic>Triiodothyronine - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>YANAGISAWA, Tetsuo</creatorcontrib><creatorcontrib>SATO, Kanji</creatorcontrib><creatorcontrib>KATO, Yoshiyuki</creatorcontrib><creatorcontrib>SHIMIZU, Satoru</creatorcontrib><creatorcontrib>TAKANO, Kazue</creatorcontrib><creatorcontrib>Department of Hygiene and Public Health</creatorcontrib><creatorcontrib>Institute of Clinical Endocrinology</creatorcontrib><creatorcontrib>Department of Medicine</creatorcontrib><creatorcontrib>Tokyo Women's Medical University</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>ENDOCRINE JOURNAL</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>YANAGISAWA, Tetsuo</au><au>SATO, Kanji</au><au>KATO, Yoshiyuki</au><au>SHIMIZU, Satoru</au><au>TAKANO, Kazue</au><aucorp>Department of Hygiene and Public Health</aucorp><aucorp>Institute of Clinical Endocrinology</aucorp><aucorp>Department of Medicine</aucorp><aucorp>Tokyo Women's Medical University</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rapid Differential Diagnosis of Graves' Disease and Painless Thyroiditis Using Total T3/T4 Ratio, TSH, and Total Alkaline Phosphatase Activity</atitle><jtitle>ENDOCRINE JOURNAL</jtitle><addtitle>Endocr J</addtitle><date>2005</date><risdate>2005</risdate><volume>52</volume><issue>1</issue><spage>29</spage><epage>36</epage><pages>29-36</pages><issn>0918-8959</issn><eissn>1348-4540</eissn><abstract>When thyrotoxic patients are first seen in an outpatient clinic, it is important to make a differential diagnosis of Graves' disease (GD) and painless thyroiditis (PT). Using the three parameters of total T3/T4 ratio, TSH and T-ALP activity, all of which can be obtained within one hour in our hospital, 173 untreated patients with thyrotoxicosis were evaluated for the ratio of each parameter. For GD vs. PT, total T3/T4 (ng/μg) ratio (>20), TSH (<0.005 μU/ml) and elevated T-ALP had a likelihood ratio of 2.14, 2.12 and 4.07, respectively. When a patient had all three positive parameters, the likelihood ratio increased to 5.81, which showed effective synergy. These data suggest that, in addition to total T3/T4 ratio and TSH value, T-ALP activity is a useful parameter for the rapid differentiation of GD. The lower T-ALP activity seen in PT is probably due to the fact that patients develop less severe thyrotoxicosis or visit hospital earlier than patients with GD. Therefore, the diagnostic accuracy for Graves' disease might be increased by using the three parameters in combination.</abstract><cop>Japan</cop><pub>The Japan Endocrine Society</pub><pmid>15758555</pmid><doi>10.1507/endocrj.52.29</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Alkaline phosphatase Alkaline Phosphatase - blood Female Graves Disease - blood Graves Disease - diagnosis Graves' disease Humans Likelihood Functions Male Middle Aged Pain - physiopathology Painless thyroiditis Subacute thyroiditis Thyroiditis - blood Thyroiditis - diagnosis Thyroiditis - physiopathology Thyrotropin - blood Thyroxine - blood Triiodothyronine - blood |
| title | Rapid Differential Diagnosis of Graves' Disease and Painless Thyroiditis Using Total T3/T4 Ratio, TSH, and Total Alkaline Phosphatase Activity |
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