Artículos de revistas
The Clinical Use Of Thyroid Function Tests [utilização Dos Testes De Função Tireoidiana Na Prática Clínica]
Registro en:
Arquivos Brasileiros De Endocrinologia E Metabologia. , v. 57, n. 3, p. 193 - 204, 2013.
42730
10.1590/S0004-27302013000300005
2-s2.0-84878073818
Autor
de Carvalho G.A.
Silva Perez C.L.
Sterian Ward L.
Institución
Resumen
Laboratory tests are essential for the accurate diagnosis and cost-effective monitoring of thyroid dysfunction. Hormone levels can only confirm a diagnosis when there is a high level of clinical suspicion. For most patients, symptoms are nonspecific and subtle, so biochemical tests are necessary to identify the disorder. The purpose of this article is to critically analyze the use of standard thyroid function tests, which include measuring the levels of serum thyroid-stimulating hormone (TSH), thyroid hormones and antithyroid antibodies. The pitfalls of and impediments to the routine use of these tests are discussed based on a Medline database survey, and recommendations are presented to optimize the use of these diagnostic tools in clinical practice. 57 3 193 204 Ladenson, P.W., Singer, P.A., Ain, K.B., Bagchi, N., Bigos, S.T., Levy, E.G., American Thyroid Association guidelines for detection of thyroid dysfunction (2000) Arch Intern Med., 160, pp. 1573-1575 Baloch, Z., Carayon, P., Conte-Devolx, B., Demers, L.M., Feldt-Rasmussen, U., Henry, J.F., Guidelines Committee, National Academy of Clinical Biochemistry, Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease (2003) Thyroid., 13, pp. 3-126 Spencer, C.A., LoPresti, J.S., Patel, A., Guttler, R.B., Eigen, A., Shen, D., Applications of a new chemiluminometric thyrotropin assay to subnormal measurement (1990) J Clin Endocrinol Metab., 70, pp. 453-460 Andersen, S., Pedersen, K.M., Bruun, N.H., Laurberg, P., Narrow individual variations in serum T(4) and T(3) in normal subjects: A clue to understanding of subclinical thyroid disease (2002) J Clin Endocrinol Metab., 87, pp. 1068-1072 Chin, W.W., Carr, F.E., Burnside, J., Darling, D.S., Thyroid hormone regulation of thyrotropin gene expression (1993) Recent Prog Horm Res., 48, pp. 393-414 Wardle, C.A., Fraser, W.D., Squire, C.R., Pitfalls in the use of thyrotropin concentration as a first-line thyroid-function test (2001) Lancet., 357, pp. 1013-1014 van Herle, A.J., Uller, R.P., Matthews, N.I., Brown, J., Radioimmunoassay for measurement of thyroglobulin in human serum (1973) J Clin Invest., 52, pp. 1320-1327 de Rosa, G., Testa, A., Giacomini, D., Carrozza, C., Maussier, M.L., Valenza, V., Comparison between TRH-stimulated TSH and basal TSH measurement by a commercial immunoradiometric assay in the management of thyroid disease (1996) Q J Nucl Med., 40, pp. 182-187 Sánchez-Carbayo, M., Mauri, M., Alfayate, R., Miralles, C., Soria, F., Analytical and clinical evaluation of TSH and thyroid hormones by electrochemiluminescent immunoassays (1999) Clin Biochem., 32, pp. 395-403 Hershman, J.M., Pekary, A.E., Berg, L., Solomon, D.H., Sawin, C.T., Serum thyrotropin and thyroid hormone levels in elderly and middleaged euthyroid persons (1993) J Am Geriatr Soc., 41, pp. 823-828 Brabant, G., Prank, K., Ranft, U., Schuermeyer, T., Wagner, T.O., Hauser, H., Physiological regulation of circadian and pulsatile thyrotropin secretion in normal man and woman (1990) J Clin Endocrinol Metab., 70, pp. 403-409 Biondi, B., Cooper, D.S., The clinical significance of subclinical thyroid dysfunction (2008) Endocr Rev., 29, pp. 76-131 Surks, M.I., Ortiz, E., Daniels, G.H., Sawin, C.T., Col, N.F., Cobin, R.H., Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management (2004) JAMA., 291, pp. 228-238 Wartofsky, L., Dickey, R.A., The evidence for a narrower thyrotropin reference range is compelling (2005) J Clin Endocrinol Metab., 90, pp. 5483-5488 Vanderpump, M.P., Tunbridge, W.M., French, J.M., Appleton, D., Bates, D., Clark, F., The incidence of thyroid disorders in the community: A twenty-year follow-up of the Whickham Survey (1995) Clin Endocrinol (Oxf)., 43, pp. 55-68 Völzke, H., Alte, D., Kohlmann, T., Lüdemann, J., Nauck, M., John, U., Reference intervals of serum thyroid function tests in a previously iodine-deficient area (2005) Thyroid., 15, pp. 279-285 Hollowell, J.G., Staehling, N.W., Flanders, W.D., Gunter, E.W., Spencer, C.A., Braverman, L.E., Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) (2002) J Clin Endocrinol Metab., 87, pp. 489-499 Surks, M.I., Goswami, G., Daniels, G.H., The thyrotropin reference range should remain unchanged (2005) J Clin Endocrinol Metab., 90, pp. 5489-5496 Brabant, G., Beck-Peccoz, P., Jarzab, B., Laurberg, P., Orgiazzi, J., Szabolcs, I., Is there a need to redefine the upper normal limit of TSH? (2006) Eur J Endocrinol., 154, pp. 633-637 Rodondi, N., den Elzen, W.P., Bauer, D.C., Cappola, A.R., Razvi, S., Walsh, J.P., Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality (2010) JAMA., 304, pp. 1365-1374 Gussekloo, J., van Exel, E., de Craen, A.J., Meinders, A.E., Frölich, M., Westendorp, R.G., Thyroid status, disability and cognitive function, and survival in old age JAMA, 292, pp. 2591-2599 Atzmon, G., Barzilai, N., Hollowell, J.G., Surks, M.I., Gabriely, I., Extreme longevity is associated with increased serum thyrotropin (2009) J Clin Endocrinol Metab., 94, pp. 1251-1254 Surks, M.I., Hollowell, J.G., Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: Implications for the prevalence of subclinical hypothyroidism (2007) J Clin Endocrinol Metab., 92, pp. 4575-4582 Kapelari, K., Kirchlechner, C., Högler, W., Schweitzer, K., Virgolini, I., Moncayo, R., Pediatric reference intervals for thyroid hormone levels from birth to adulthood: A retrospective study (2008) BMC Endocr Disord., 8, p. 15 Hübner, U., Englisch, C., Werkmann, H., Butz, H., Georgs, T., Zabransky, S., Continuous age-dependent reference ranges for thyroid hormones in neonates, infants, children and adolescents established using the ADVIA Centaur Analyzer (2002) Clin Chem Lab Med., 40, pp. 1040-1047 Elmlinger, M.W., Kühnel, W., Lambrecht, H.G., Ranke, M.B., Reference intervals from birth to adulthood for serum thyroxine (T4), triiodothyronine (T3), free T3, free T4, thyroxine binding globulin (TBG) and thyrotropin (TSH) (2001) Clin Chem Lab Med., 39, pp. 973-979 Verburg, F.A., Kirchgässner, C., Hebestreit, H., Steigerwald, U., Lentjes, E.G., Ergezinger, K., Reference ranges for analytes of thyroid function in children (2011) Horm Metab Res., 43, pp. 422-426 Boucai, L., Hollowell, J.G., Surks, M.I., An approach for development of age, gender, and ethnicity-specific thyrotropin reference limits (2011) Thyroid., 21, pp. 5-11 Haddow, J.E., Palomaki, G.E., Allan, W.C., Williams, J.R., Knight, G.J., Gagnon, J., Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child (1999) N Engl J Med., 341, pp. 549-555 Allan, W.C., Haddow, J.E., Palomaki, G.E., Williams, J.R., Mitchell, M.L., Hermos, R.J., Maternal thyroid deficiency and pregnancy complications: Implications for population screening (2000) J Med Screen., 7, pp. 127-130 Leung, A.S., Millar, L.K., Koonings, P.P., Montoro, M., Mestman, J.H., Perinatal outcomes in hypothyroid pregnancies (1993) Obstet Gynecol., 81, pp. 349-353 Radetti, G., Gentili, L., Paganini, C., Oberhofer, R., Deluggi, I., Delucca, A., Psychomotor and audiological assessment of infants born to mothers with subclinical thyroid dysfunction in early pregnancy (2000) Minerva Pediatr., 52, pp. 691-698 Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum (2011) Thyroid., 21, pp. 1081-1125 Cerbone, M., Bravaccio, C., Capalbo, D., Polizzi, M., Wasniewska, M., Cioffi, D., Linear growth and intellectual outcome in children with long-term idiopathic subclinical hypothyroidism (2011) Eur J Endocrinol., 164, pp. 591-597 de Luca, F., Wasniewska, M., Zirilli, G., Aversa, T., Arrigo, T., At the end of a two-year follow-up elevated TSH levels normalize or remain unchanged in most the children with subclinical hypothyroidism (2010) Ital J Pediatr., 36, p. 11 Banerjee, J., Bhojani, S., Emcy, N., Co-existence of ADHD, autoimmune hypothyroidism and pituitary macroadenoma presenting in a behaviour clinic: A case report and brief review of the literature (2011) J Pediatr Endocrinol Metab., 24, pp. 229-231 Simic, N., Asztalos, E.V., Rovet, J., Impact of neonatal thyroid hormone insufficiency and medical morbidity on infant neurodevelopment and attention following preterm birth (2009) Thyroid., 19, pp. 395-401 Toft, A.D., Drug therapy: Thyroxine therapy (1994) N Engl J Med., 331, pp. 174-180 Uy, H.L., Reasner, C.A., Samuels, M.H., Pattern of recovery of the hypothalamic-pituitary-thyroid axis following radioactive iodine therapy in patients with Grave's disease (1995) Am J Med., 99, pp. 173-179 Hamblin, P.S., Dyer, S.A., Mohr, V.S., Le Grand, B.A., Lim, C.F., Tuxen, D.V., Relationship between thyrotropin and thyroxine changes during recovery from severe hypothyroxinemia of critical illness (1986) J Clin Endocrinol Metab., 62, pp. 717-722 Young, R., Worthley, L.I., Diagnosis and management of thyroid disease and the critically ill patient (2004) Crit Care Resusc., 6, pp. 295-305 Lazarus, J.H., Lithium and thyroid (2009) Best Pract Res Clin Endocrinol Metab., 23, pp. 723-733 Eskes, S.A., Wiersinga, W.M., Amiodarone and thyroid (2009) Best Pract Res Clin Endocrinol Metab., 23, pp. 735-751 Lee, H.Y., Suhl, J., Pekary, A.E., Hershman, J.M., Secretion of thyrotropin with reduced concanavalin-A-binding activity in patients with severe nonthyroid illness (1987) J Clin Endocrinol Metab., 65, pp. 942-945 Spencer, C., Eigen, A., Shen, D., Duda, M., Qualls, S., Weiss, S., Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients (1987) Clin Chem., 33, pp. 1391-1396 Goldman, A.M., Mestman, J.H., Transient non-autoimmune hyperthyroidism of early pregnancy (2011) J Thyroid Res., 2011, p. 142413. , Epub 2011 Jul 15 Kaptein, E.M., Spencer, C.A., Kamiel, M.B., Nicoloff, J.T., Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects (1980) J Clin Endocrinol Metab., 51, pp. 387-393 Re, R.N., Kourides, I.A., Ridgway, E.C., Weintraub, B.D., Maloof, F., The effect of glucocorticoid administration on human pituitary secretion of thyrotropin and prolactin (1976) J Clin Endocrinol Metab., 43, pp. 338-346 Bartalena, L., Recent achievements in studies on thyroid hormonebinding proteins (1990) Endocr Rev., 11, pp. 47-64 Carvalho, G.A., Weiss, R.E., Vladutiu, A.O., Refetoff, S., Complete deficiency of thyroxine-binding globulin (TBG-CD Buffalo) caused by a new nonsense mutation in the thyroxine-binding globulin gene (1998) Thyroid., 8, pp. 161-165 Schussler, G.C., The thyroxine-binding proteins (2000) Thyroid., 10, pp. 141-149 Stockigt, J.R., Free thyroid hormone measurement: A critical appraisal (2001) Endocrinol Metab Clin North Am., 30, pp. 265-289 Sarne, D.H., Refetoff, S., Nelson, J.C., Linarelli, L.G., A new inherited abnormality of thyroxine-binding globulin (TBG-San Diego) with decreased affinity for thyroxine and triiodothyronine (1989) J Clin Endocrinol Metab., 68, pp. 114-119 Wang, R., Nelson, J.C., Weiss, R.M., Wilcox, R.B., Accuracy of free thyroxine measurements across natural ranges of thyroxine binding to serum proteins (2000) Thyroid., 10, pp. 31-39 Chopra, I.J., A radioimmunoassay for measurement of thyroxine in unextracted serum (1972) J Clin Endocrinol Metab., 34, pp. 938-947 Klee, G.G., Clinical usage recommendations and analytic performance goals for total and free triiodothyronine measurements (1996) Clin Chem., 42, pp. 155-159 Chopra, I.J., van Herle, A.J., Teco, G.N., Nguyen, A.H., Serum free thyroxine in thyroidal and nonthyroidal illnesses: A comparison of measurements by radioimmunoassay, equilibrium dialysis, and free thyroxine index (1980) J Clin Endocrinol Metab., 51, pp. 135-143 Chopra, I.J., Simultaneous measurement of free thyroxine and free 3,5,3'-triiodothyronine in undiluted serum by direct equilibrium dialysis/radioimmunoassay: Evidence that free triiodothyronine and free thyroxine are normal in many patients with the low triiodothyronine syndrome (1998) Thyroid., 8, pp. 249-257 Jahreis, G., Kauf, E., Fröhner, G., Schmidt, H.E., Influence of intensive exercise on insulin-like growth factor I, thyroid and steroid hormones in female gymnasts (1991) Growth Regul., 1, pp. 95-99 Turkay, S., Kus, S., Gokalp, A., Baskin, E., Onal, A., Effects of protein energy malnutrition on circulating thyroid hormones (1995) Indian Pediatr., 32, pp. 193-197 Poehlman, E.T., McAuliffe, T.L., van Houten, D.R., Danforth Jr., E., Influence of age and endurance training on metabolic rate and hormones in healthy men (1990) Am J Physiol., 259, pp. E66-E72 Stone, E., Leiter, L.A., Lambert, J.R., Silverberg, J.D., Jeejeebhoy, K.N., Burrow, G.N., L-thyroxine absorption in patients with short bowel (1984) J Clin Endocrinol Metab., 59, pp. 139-141 Carvalho, G.A., Weiss, R.E., Refetoff, S., Complete thyroxine-binding globulin (TBG) deficiency produced by a mutation in acceptor splice site causing frameshift and early termination of translation (TBGKankakee) (1998) J Clin Endocrinol Metab., 83, pp. 3604-3608 Burger, A., Dinichert, D., Nicod, P., Jenny, M., Lemarchand-Beraud, T., Vallotton, M.B., Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin, and thyrotropin: A drug influencing peripheral metabolism of thyroid hormones (1976) J Clin Invest., 58, pp. 255-259 Glinoer, D., Fernandez-Deville, M., Ermans, A.M., Use of direct thyroxine-binding globulin measurement in the evaluation of thyroid function (1978) J Endocrinol Invest., 1, pp. 329-335 Gross, H.A., Appleman Jr., M.D., Nicoloff, J.T., Effect of biologically active steroids on thyroid function in man (1971) J Clin Endocrinol Metab., 33, pp. 242-248 Larsen, P.R., Salicylate-induced increases in free triiodothyronine in human serum: Evidence of inhibition of triiodothyronine binding to thyroxine-binding globulin and thyroxine-binding prealbumin (1972) J Clin Invest., 51, pp. 1125-1134 Lim, C.F., Bai, Y., Topliss, D.J., Drug and fatty acid effects on serum thyroid hormone binding (1988) J Clin Endocrinol Metab., 67, p. 682 Hansen, J.M., Skovsted, L., Lauridsen, U.B., Kirkegaard, C., Siersbaek-Nielsen, K., The effect of diphenylhydantoin on thyroid function (1974) J Clin Endocrinol Metab., 39, pp. 785-789 Rootwelt, K., Ganes, T., Johannessen, S.I., Effect of carbamazapine, phenytoin and phenobarbitone on serum levels of thyroid hormones and thyrotropin in humans (1978) Scand J Clin Lab Invest., 38, pp. 731-736 Mendel, C.M., Frost, P.H., Kunitake, S.T., Cavalieri, R.R., Mechanism of the heparin induced increase in the concentration of free thyroxine in plasma (1987) J Clin Endocrinol Metab., 65, pp. 1259-1264 Sakata, S., Matsuda, M., Ogawa, T., Takuno, H., Matsui, I., Sarui, H., Prevalence of thyroid hormone autoantibodies in healthy subjects (1994) Clin Endocrinol., 41, pp. 365-370 Vyas, S.K., Wilkin, T.J., Thyroid hormone autoantibodies and their implications for free thyroid hormone measurement (1994) J Endocrinol Invest., 17, pp. 15-21 Roti, E., Gardini, E., Minelli, R., Bianconi, L., Flisi, M., Thyroid function evaluation by different commercially available free thyroid hormone measurement kits in term pregnant women and their newborns (1991) J Endocrinol Invest., 14, pp. 1-9 Glinoer, D., de Nayer, P., Bourdoux, P., Lemone, M., Robyn, C., van Steirteghem, A., Regulation of maternal thyroid function during pregnancy (1990) J Clin Endocrinol Metab., 71, pp. 276-287 Nissim, M., Giorda, G., Ballabio, M., D'Alberton, A., Bochicchio, D., Orefice, R., Maternal thyroid function in early and late pregnancy (1991) Horm Res., 36, pp. 196-202 DeGroot, L.J., Mayor, G., Admission screening by thyroid function tests in an acute general care teaching hospital (1992) Amer J Med., 93, pp. 558-564 Wartofsky, L., Burman, K.D., Alterations in thyroid function in patients with systemic illness: The "euthyroid sick syndrome" (1982) Endocrinol Rev., 3, pp. 164-217 Adler, S.M., Wartofsky, L., The nonthyroidal illness syndrome (2007) Endocrinol Metab Clin North Am., 36, pp. 657-672 Economidou, F., Douka, E., Tzanela, M., Nanas, S., Kotanidou, A., Thyroid function during critical illness (2011) Hormones (Athens)., 10, pp. 117-124 Franklyn, J.A., Black, E.G., Betteridge, J., Sheppard, M.C., Comparison of second and third generation methods for measurement of serum thyrotropin in patients with overt hyperthyroidism, patients receiving thyroxine therapy, and those with nonthyroidal illness (1994) J Clin Endocrinol Metab., 78, pp. 1368-1371 Mariotti, S., Pisani, S., Russova, A., Pinchera, A., A new solid-phase immunoradiometric assay for anti-thyroglobulin autoantibody (1982) J Endocrinol Invest., 5, pp. 227-233 Maia, A.L., Ward, L.S., Carvalho, G.A., Graf, H., McIel, R.M., McIel, L.M., Thyroid nodules and differentiated thyroid cancer: Brazilian consensus (2007) Arq Bras Endocrinol Metabol., 51, pp. 867-893 Mariotti, S., Caturegli, P., Piccolo, P., Barbesino, G., Pinchera, A., Antithyroid peroxidase autoantibodies in thyroid diseases (1990) J Clin Endocrinol Metab., 71, pp. 661-669 Marcocci, C., Vitti, P., Cetani, F., Catalano, F., Concetti, R., Pinchera, A., Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism (1991) J Clin Endocrinol Metab., 72, pp. 209-213 McChia, E., Concetti, R., Borgoni, F., Cetani, F., Fenzi, G.F., Pinchera, A., Assays of TSH receptor antibodies in 576 patients with various thyroid disorders: Their incidence, significance and clinical usefulness (1989) Autoimmunity., 3, pp. 103-112 Nohr, S.B., Jorgensen, A., Pedersen, K.M., Laurberg, P., Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibodypositive women living in an area with mild to moderate iodine deficiency: Is iodine supplementation safe? (2000) J Clin Endocrinol Metab., 85, pp. 3191-3198 Bussen, S., Steck, T., Dietl, J., Increased prevalence of thyroid antibodies in euthyroid women with a history of recurrent in-vitro fertilization failure (2000) Hum Reprod., 15, pp. 545-548 Martino, E., Aghini-Lombardi, F., Bartalena, L., Grasso, L., Loviselli, A., Velluzzi, F., Enhanced susceptibility to amiodarone induced hypothyroidism in patients with thyroid autoimmune disease (1994) Arch Intern Med., 154, pp. 2722-2726 Johnston, A.M., Eagles, J.M., Lithium-associated clinical hypothyroidism. Prevalence and risk factors (1999) Br J Psychiatry., 175, pp. 336-339 Ward, D.L., Bing-You, R.G., Autoimmune thyroid dysfunction induced by interferon-alfa treatment for chronic hepatitis C: Screening and monitoring recommendations (2001) Endoc Pract., 7, pp. 52-58 Chiovato, L., Marcocci, C., Mariotti, S., Mori, A., Pinchera, A., L-thyroxine therapy induces a fall of thyroid microsomal and thyroglobulin antibodies in idiopathic myxedema and in hypothyroid, but not in euthyroid Hashimoto's thyroiditis (1986) J Endocrinol Invest., 9, pp. 299-305 Feldt-Rasmussen, U., Schleusener, H., Carayon, P., Meta-analysis evaluation of the impact of thyrotropin receptor antibodies on long term remission after medical therapy of Graves' disease (1994) J Clin Endocrinol Metab., 78, pp. 98-103 Takasu, N., Yamashiro, K., Ochi, Y., Sato, Y., Nagata, A., Komiya, I., TSBAb (TSH stimulation blocking antibody) and TSAb (thyroid stimulating antibody) in TSBAb positive patients with hypothyroidism and Graves' patients with hyperthyroidism (2001) Horm Metab Res., 33, pp. 232-237 Takasu, N., Oshiro, C., Akamine, H., Komiya, I., Nagata, A., Sato, Y., Thyroid stimulating antibody and TSH-binding inhibitor immunoglobulin in 277 Graves' patients and in 686 normal subjects (1997) J Endocrinol Invest., 20, pp. 452-461 Bahn Chair, R.S., Burch, H.B., Cooper, D.S., Garber, J.R., Greenlee, M.C., Klein, I., Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists (2011) Thyroid., 21, pp. 593-646 Orgiazzi, J., Anti-TSH receptor antibodies in clinical practice (2000) Endocrinol Metab Clin North Am., 29, pp. 339-355 Orunesu, E., Bagnasco, M., Salmaso, C., Altrinetti, V., Bernasconi, D., del Monte, P., Use of an artificial neural network to predict Graves' disease outcome within 2 years of drug withdrawal (2004) Eur J Clin Invest., 34, pp. 210-217 Orgiazzi, J., Madec, A.M., Reduction of the risk of relapse after withdrawal of medical therapy for Graves' disease (2002) Thyroid, 12, pp. 849-853 Laurberg, P., Nygaard, B., Glinoer, D., Grussendorf, M., Orgiazzi, J., Guidelines for TSH-receptor antibody measurements in pregnancy: Results of an evidence-based symposium organized by the European Thyroid Association (1998) Eur J Endocrinol., 139, pp. 584-586 Brown, R.S., Bellisario, R.L., Botero, D., Fournier, L., Abrams, C.A., Cowger, M.L., Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptor-blocking antibodies in over one million babies (1996) J Clin Endocrinol Metab., 81, pp. 1147-1151 Chiovato, L., Vitti, P., Santini, F., Lopez, G., Mammoli, C., Bassi, P., Incidence of antibodies blocking thyrotropin effect in vitro in patients with euthyroid or hypothyroid autoimmune thyroiditis (1990) J Clin Endocrinol Metab., 71, pp. 40-45