• Qisong Peng, Kangli Kong, Qiang Tu, Yuzhong Wang, and Xiaoyan Wang.
• Department of Clinical Laboratory, Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, 211100, China.
• Am. J. Med. Sci. 2022 Jun 1; 363 (6): 495-501.

BackgroundThe differential diagnosis of tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE) is challenging due to similar clinical manifestations and body fluid biochemical profiles. Thyroid hormone levels change in response to lymphocyte proliferation in the peripheral blood of patients with mycobacterial infections such as tuberculosis; therefore, this study aimed to investigate the utility of assessing thyroid hormone levels to aid in the differential diagnosis of TPE and PPE.MethodsWe measured free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels in the pleural effusions of 59 newly admitted patients (32 and 27 with TPE and PPE, respectively). Hormone levels were assessed using an electrochemiluminescence technique, and the diagnostic parameters for tuberculosis were evaluated. Differences in hormone levels between patients with TPE and PPE were assessed by t-tests, and their diagnostic value for a differential diagnosis was evaluated by receiver operating characteristic curve analyses.ResultsFT3 and FT4 levels in patients with TPE were significantly higher than those in patients with PPE (p < 0.01 and p < 0.05, respectively), whereas TSH expression did not significantly differ between the two groups (p > 0.05). FT3 and FT4 levels showed no correlation with sex or history of smoking, although FT3 levels decreased with age. The highest sensitivity was observed for the quantification of FT3 levels (84.38%).ConclusionsIncreased FT3 and FT4 levels could potentially be used for the differential diagnosis of TPE and PPE.Copyright © 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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