Scientific Letter
Elevated thyroid hormone levels following low molecular weight heparin administration
Elevación de los niveles de hormonas tiroideas tras administración de heparina de bajo peso molecular
Iñigo de Noriega Echevarríaa, Alberto García-Salidob, M. Teresa Muñoz-Calvoa,c,d,
, Jesús Argentea,c,d
Corresponding author
a Servicios de Pediatría y Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Servicio de Cuidados Intensivos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
c Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain
d CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
Read
11177
Timeswas read the article
2236
Total PDF
8941
Total HTML
Share statistics
array:24 [ "pii" => "S2341287917300959" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.09.006" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "2159" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:50-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2016 "formatos" => array:3 [ "EPUB" => 139 "HTML" => 1543 "PDF" => 334 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403316302661" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2016.09.006" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "2159" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:50-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5851 "formatos" => array:3 [ "EPUB" => 121 "HTML" => 5016 "PDF" => 714 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Elevación de los niveles de hormonas tiroideas tras administración de heparina de bajo peso molecular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "51" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Elevated thyroid hormone levels following low molecular weight heparin administration" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iñigo de Noriega Echevarría, Alberto García-Salido, M. Teresa Muñoz-Calvo, Jesús Argente" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Iñigo" "apellidos" => "de Noriega Echevarría" ] 1 => array:2 [ "nombre" => "Alberto" "apellidos" => "García-Salido" ] 2 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "Muñoz-Calvo" ] 3 => array:2 [ "nombre" => "Jesús" "apellidos" => "Argente" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287917300959" "doi" => "10.1016/j.anpede.2016.09.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300959?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302661?idApp=UINPBA00005H" "url" => "/16954033/0000008700000001/v1_201706270007/S1695403316302661/v1_201706270007/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287917300911" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.09.005" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "2160" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;87:51-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1276 "formatos" => array:3 [ "EPUB" => 128 "HTML" => 788 "PDF" => 360 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Rituximab therapy for refractory thrombocytopenia in patients with antiphospholipid antibodies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de rituximab para trombocitopenia refractaria en pacientes con anticuerpos antifosfolípidos" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1146 "Ancho" => 1621 "Tamanyo" => 151838 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution over time of platelet counts in both patients based on the received treatments.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Felisa Vázquez Gómez, María Prieto Arce, Luis Ignacio González-Granado, Eugenia Enríquez Merayo, Jaime de Inocencio Arocena" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Felisa" "apellidos" => "Vázquez Gómez" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Prieto Arce" ] 2 => array:2 [ "nombre" => "Luis Ignacio" "apellidos" => "González-Granado" ] 3 => array:2 [ "nombre" => "Eugenia" "apellidos" => "Enríquez Merayo" ] 4 => array:2 [ "nombre" => "Jaime" "apellidos" => "de Inocencio Arocena" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316302673" "doi" => "10.1016/j.anpedi.2016.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302673?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300911?idApp=UINPBA00005H" "url" => "/23412879/0000008700000001/v1_201706270007/S2341287917300911/v1_201706270007/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287917300960" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.07.004" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "2139" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;87:42-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1684 "formatos" => array:3 [ "EPUB" => 137 "HTML" => 1173 "PDF" => 374 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Aetiology and outcomes of potentially serious infections in febrile infants less than 3 months old" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "49" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Etiología y evolución de las infecciones potencialmente graves en lactantes menores de 3 meses febriles" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1387 "Ancho" => 1617 "Tamanyo" => 87958 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the patients included in the study.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mercedes de la Torre, Nieves de Lucas, Roberto Velasco, Borja Gómez, Santiago Mintegi" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Mercedes" "apellidos" => "de la Torre" ] 1 => array:2 [ "nombre" => "Nieves" "apellidos" => "de Lucas" ] 2 => array:2 [ "nombre" => "Roberto" "apellidos" => "Velasco" ] 3 => array:2 [ "nombre" => "Borja" "apellidos" => "Gómez" ] 4 => array:2 [ "nombre" => "Santiago" "apellidos" => "Mintegi" ] 5 => array:1 [ "colaborador" => "Group for the Study of Febrile Infant of the RISeuP-SPERG Network (RISeuP-SPERG)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316302302" "doi" => "10.1016/j.anpedi.2016.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302302?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300960?idApp=UINPBA00005H" "url" => "/23412879/0000008700000001/v1_201706270007/S2341287917300960/v1_201706270007/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Elevated thyroid hormone levels following low molecular weight heparin administration" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "50" "paginaFinal" => "51" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Iñigo de Noriega Echevarría, Alberto García-Salido, M. Teresa Muñoz-Calvo, Jesús Argente" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Iñigo" "apellidos" => "de Noriega Echevarría" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Alberto" "apellidos" => "García-Salido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "M. Teresa" "apellidos" => "Muñoz-Calvo" "email" => array:2 [ 0 => "munozmaite@yahoo.es" 1 => "maitemunozcalvo@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Jesús" "apellidos" => "Argente" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicios de Pediatría y Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cuidados Intensivos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Elevación de los niveles de hormonas tiroideas tras administración de heparina de bajo peso molecular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the presence of elevated serum levels of thyroid hormones combined with normal levels of thyroid stimulating hormone (TSH) in the absence of signs or symptoms compatible with hyperthyroidism, clinicians need to consider the possibility of an error or interference in the interpretation of laboratory test results.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Thyroid test results may be altered by the presence of heterophile antibodies or rheumatoid factor, or from the use of various pharmaceuticals (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We proceed to describe a case of artefactual alteration of thyroid hormone levels due to the administration of heparin. Subsequently, we will describe the underlying pharmacological mechanism.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Male infant aged 8 months with a history of early neonatal epileptic encephalopathy secondary to a mutation in the KCNQ2 potassium channel gene and severe psychomotor retardation admitted to the paediatric intensive care unit (PICU) due to irritability and suspected sepsis. The family history was unremarkable. The patient was currently being treated with phenytoin, carbamazepine, vigabatrin and ketogenic diet. Past thyroid function tests found levels of free thyroxine (fT4) and thyroid stimulating hormone (TSH) within normal ranges. During his stay in the PICU, he experienced multiple episodes of deep and superficial vein thrombosis in the superior vena cava region associated with the presence of a central venous catheter. After removal of the catheter, treatment was initiated with low-molecular weight heparin (1<span class="elsevierStyleHsp" style=""></span>mg/kg every 12<span class="elsevierStyleHsp" style=""></span>h).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Twenty-four hours after the initial dose of heparin, routine tests showed overall fT4 and fT3 levels above those expected when the level of TSH is normal (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Since the patient exhibited no manifestations indicative of hyperthyroidism, this finding was attributed to the administration of heparin. For this reason, serial measurements of thyroid hormone levels were performed, which showed a gradual decrease with normalisation at day 10 despite the continued use of heparin. There were no changes in coagulation tests and the levels of anti-factor Xa (used to assess heparin activity against coagulation factor X) remained within the normal range. The patient did not have any more abnormal thyroid function test results.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Heparin, in both its fractionated and unfractionated forms, can interfere with the interpretation of thyroid function tests, producing an asymptomatic elevation of the free fraction of thyroid hormones.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some authors have proposed mechanisms that could account for these findings.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Although at present this is just speculation, the elevation may be due to a heparin-induced release of lipoprotein lipase from the vascular endothelium, which would result in an elevation in free fatty acids that would in turn inhibit the binding of thyroid hormones to their plasma transport proteins.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The potential interference of heparin with thyroid hormone levels has been described occasionally in adult patients.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In 1996 Jain and Uy<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> published the cases of four adult patients with asymptomatic elevation of thyroid hormones detected in samples collected 12<span class="elsevierStyleHsp" style=""></span>h after heparin administration. A single patient underwent a subsequent thyroid function test, which showed that levels had normalised after discontinuation of heparin.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Only one case has been published in the paediatric literature.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> It concerned a preterm boy born at 35 weeks’ gestation admitted to the PICU due to thrombosis secondary to a peripheral venous access that was treated with heparin and exhibited an asymptomatic elevation of thyroid hormones that normalised after the treatment was discontinued.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case under study, the patient had an initial elevation of serum-free thyroid hormones that normalised spontaneously despite continuing treatment, something that has not been reported in the past. The interaction between the administration and dosage of heparin, the release of fatty acids and their association with thyroid hormone levels, of which we lack detailed knowledge, may account for the variability observed in patients and in a single patient at different times. On the other hand, phenytoin and carbamazepine may alter thyroid function, but the resulting changes would involve an asymptomatic decrease in serum-free levels of thyroid hormones rather than an elevation<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) like the one observed in our patient.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, we must remain aware of the potential of heparin to cause a spurious elevation in thyroid hormone levels in order to avoid unnecessary treatments or tests. Clinical observation, monitoring of laboratory test results and discontinuation of the involved drug, if necessary, should be the elements considered to guide the interpretation of this laboratory finding.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: De Noriega Echevarría I, García-Salido A, Muñoz-Calvo MT, Argente J. Elevación de los niveles de hormonas tiroideas tras administración de heparina de bajo peso molecular. An Pediatr (Barc). 2017;87:50–51.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Metabolism \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Thyroid function \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phenobarbital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↑ T4 metabolism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ T4 and FT4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Furosemide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ T4 binding of TBG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ T4 and FT4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dopamine (>1<span class="elsevierStyleHsp" style=""></span>μg/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ TSH secretion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ TSH, ↓ thyroid hormone secretion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucocorticoids (high-dose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ TSH secretion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ T4, T3 and TSH \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Activation of lipoprotein lipase<br>↑ serum concentration of free fatty acids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Displacement of T4 from TBG and ↑ free T4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Octreotide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">↓ thyroid hormone secretion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Iatrogenic hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Povidone-iodine and other contrasts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blocks incorporation of iodide to thyroglobulin and release of T4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Iatrogenic hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1448093.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Drugs that can alter thyroid function in euthyroid patients.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day +1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day +2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day +10 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T3 (0.65–2.5<span class="elsevierStyleHsp" style=""></span>ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>8.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T4L (0.61–1.5<span class="elsevierStyleHsp" style=""></span>ng/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>5.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TSH (0.45–7<span class="elsevierStyleHsp" style=""></span>UI/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1448094.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Changes in thyroid function tests in the days following initiation of heparin treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How medications affect thyroid function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.B. Dong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "West J Med" "fecha" => "2000" "volumen" => "172" "paginaInicial" => "102" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10693372" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extremely low doses of heparin release lipase activity into the plasma and can thereby cause artifactual elevations in the serum-free thyroxine concentration as measured by equilibrium dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.C. Jaume" 1 => "C.M. Mendel" 2 => "P.H. Frost" 3 => "F.S. Greenspan" 4 => "C.W. Laugthon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/thy.1996.6.79" "Revista" => array:6 [ "tituloSerie" => "Thyroid" "fecha" => "1996" "volumen" => "6" "paginaInicial" => "79" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8733876" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormal serum free thyroid levels due to heparin administration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Laji" 1 => "B. Rhidha" 2 => "R. John" 3 => "J. Lazarus" 4 => "J.S. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Q J Med" "fecha" => "2001" "volumen" => "94" "paginaInicial" => "471" "paginaFinal" => "473" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase in serum free thyroxin levels related to intravenous heparin treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Jain" 1 => "H.L. Uy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1996" "volumen" => "124" "paginaInicial" => "74" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7503487" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated free thyroxin levels following low molecular weight heparin in a premature neonate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Haim" 1 => "J.P. Chanoine" 2 => "S. Albersheim" 3 => "T. Mock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1651-2227.2008.01047.x" "Revista" => array:5 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2008" "volumen" => "97" "paginaInicial" => "1601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18811681" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal serum free thyroid hormone concentrations in patients treated with phenytoin or carbamazepine. A paradox resolved" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.I. Surks" 1 => "C.R. DeFesi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "1996" "volumen" => "275" "paginaInicial" => "1495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8622224" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008700000001/v1_201706270007/S2341287917300959/v1_201706270007/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008700000001/v1_201706270007/S2341287917300959/v1_201706270007/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300959?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 7 | 24 |
| 2024 October | 161 | 38 | 199 |
| 2024 September | 149 | 32 | 181 |
| 2024 August | 154 | 62 | 216 |
| 2024 July | 170 | 37 | 207 |
| 2024 June | 154 | 24 | 178 |
| 2024 May | 170 | 50 | 220 |
| 2024 April | 129 | 38 | 167 |
| 2024 March | 92 | 26 | 118 |
| 2024 February | 137 | 34 | 171 |
| 2024 January | 141 | 26 | 167 |
| 2023 December | 142 | 25 | 167 |
| 2023 November | 131 | 27 | 158 |
| 2023 October | 141 | 22 | 163 |
| 2023 September | 119 | 27 | 146 |
| 2023 August | 115 | 20 | 135 |
| 2023 July | 115 | 30 | 145 |
| 2023 June | 110 | 30 | 140 |
| 2023 May | 175 | 21 | 196 |
| 2023 April | 77 | 15 | 92 |
| 2023 March | 160 | 17 | 177 |
| 2023 February | 158 | 20 | 178 |
| 2023 January | 110 | 25 | 135 |
| 2022 December | 124 | 28 | 152 |
| 2022 November | 110 | 26 | 136 |
| 2022 October | 149 | 55 | 204 |
| 2022 September | 93 | 31 | 124 |
| 2022 August | 120 | 53 | 173 |
| 2022 July | 109 | 51 | 160 |
| 2022 June | 105 | 38 | 143 |
| 2022 May | 92 | 48 | 140 |
| 2022 April | 129 | 41 | 170 |
| 2022 March | 124 | 49 | 173 |
| 2022 February | 135 | 34 | 169 |
| 2022 January | 137 | 32 | 169 |
| 2021 December | 123 | 41 | 164 |
| 2021 November | 125 | 42 | 167 |
| 2021 October | 191 | 66 | 257 |
| 2021 September | 256 | 54 | 310 |
| 2021 August | 209 | 60 | 269 |
| 2021 July | 127 | 33 | 160 |
| 2021 June | 121 | 31 | 152 |
| 2021 May | 125 | 51 | 176 |
| 2021 April | 272 | 75 | 347 |
| 2021 March | 176 | 48 | 224 |
| 2021 February | 152 | 27 | 179 |
| 2021 January | 141 | 22 | 163 |
| 2020 December | 109 | 12 | 121 |
| 2020 November | 96 | 20 | 116 |
| 2020 October | 83 | 24 | 107 |
| 2020 September | 93 | 32 | 125 |
| 2020 August | 103 | 21 | 124 |
| 2020 July | 116 | 27 | 143 |
| 2020 June | 83 | 12 | 95 |
| 2020 May | 91 | 21 | 112 |
| 2020 April | 65 | 18 | 83 |
| 2020 March | 64 | 17 | 81 |
| 2020 February | 47 | 14 | 61 |
| 2020 January | 62 | 15 | 77 |
| 2019 December | 70 | 13 | 83 |
| 2019 November | 93 | 13 | 106 |
| 2019 October | 111 | 15 | 126 |
| 2019 September | 99 | 14 | 113 |
| 2019 August | 85 | 14 | 99 |
| 2019 July | 68 | 18 | 86 |
| 2019 June | 95 | 22 | 117 |
| 2019 May | 100 | 29 | 129 |
| 2019 April | 75 | 31 | 106 |
| 2019 March | 55 | 12 | 67 |
| 2019 February | 52 | 18 | 70 |
| 2019 January | 55 | 14 | 69 |
| 2018 December | 53 | 21 | 74 |
| 2018 November | 72 | 28 | 100 |
| 2018 October | 119 | 11 | 130 |
| 2018 September | 73 | 17 | 90 |
| 2018 August | 6 | 0 | 6 |
| 2018 July | 6 | 0 | 6 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 6 | 0 | 6 |
| 2018 April | 19 | 0 | 19 |
| 2018 March | 18 | 0 | 18 |
| 2018 February | 12 | 0 | 12 |
| 2018 January | 14 | 0 | 14 |
| 2017 December | 24 | 0 | 24 |
| 2017 November | 12 | 0 | 12 |
| 2017 October | 8 | 0 | 8 |
| 2017 September | 23 | 0 | 23 |
| 2017 August | 15 | 0 | 15 |
| 2017 July | 4 | 5 | 9 |
| 2017 June | 11 | 19 | 30 |
Show all
