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Clinical Thyroidology / Original Paper

Free Access

Relational Stability of Thyroid Hormones in Euthyroid Subjects and Patients with Autoimmune Thyroid Disease

Hoermann R.a · Midgley J.E.M.b · Larisch R.a · Dietrich J.W.c, d

Author affiliations

aDepartment of Nuclear Medicine, Klinikum Luedenscheid, Luedenscheid, Germany; bNorth Lakes Clinical, Ilkley, UK; cMedical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, and dRuhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany

Corresponding Author

Prof. Dr. Rudolf Hoermann

Department of Nuclear Medicine, Klinikum Luedenscheid

Paulmannshoeher Strasse 14

DE-58515 Luedenscheid (Germany)

E-Mail rudolf.hoermann@gmail.com

Related Articles for ""

Eur Thyroid J 2016;5:171-179

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Background/Aim: Operating far from its equilibrium resting point, the thyroid gland requires stimulation via feedback-controlled pituitary thyrotropin (TSH) secretion to maintain adequate hormone supply. We explored and defined variations in the expression of control mechanisms and physiological responses across the euthyroid reference range. Methods: We analyzed the relational equilibria between thyroid parameters defining thyroid production and thyroid conversion in a group of 271 thyroid-healthy subjects and 86 untreated patients with thyroid autoimmune disease. Results: In the euthyroid controls, the FT3-FT4 (free triiodothyronine-free thyroxine) ratio was strongly associated with the FT4-TSH ratio (tau = -0.22, p < 0.001, even after correcting for spurious correlation), linking T4 to T3 conversion with TSH-standardized T4 production. Using a homeostatic model, we estimated both global deiodinase activity and maximum thyroid capacity. Both parameters were nonlinearly and inversely associated, trending in opposite directions across the euthyroid reference range. Within the panel of controls, the subgroup with a relatively lower thyroid capacity (<2.5 pmol/s) displayed lower FT4 levels, but maintained FT3 at the same concentrations as patients with higher functional and anatomical capacity. The relationships were preserved when extended to the subclinical range in the diseased sample. Conclusion: The euthyroid panel does not follow a homogeneous pattern to produce random variation among thyroid hormones and TSH, but forms a heterogeneous group that progressively displays distinctly different levels of homeostatic control across the euthyroid range. This suggests a concept of relational stability with implications for definition of euthyroidism and disease classification.

© 2016 European Thyroid Association Published by S. Karger AG, Basel

Article / Publication Details

Received: March 17, 2016
Accepted: June 21, 2016
Published online: August 18, 2016
Issue release date: September 2016

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 2

ISSN: 2235-0640 (Print)
eISSN: 2235-0802 (Online)

For additional information: http://www.karger.com/ETJ

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