Alkaline Phosphatase Isoenzyme Patterns in Hyperthyroidism

COOPER, DAVID S.; KAPLAN, MARSHALL M.; RIDGWAY, E. CHESTER; MALOOF, FARAHE; DANIELS, GILBERT H.

doi:10.7326/0003-4819-90-2-164

Cited by 95Thyroid Disorders and TreatmentsAlkaline Phosphatase Research StudiesParathyroid Disorders and Treatments

Alkaline Phosphatase Isoenzyme Patterns in Hyperthyroidism

COOPER, DAVID S., KAPLAN, MARSHALL M., RIDGWAY, E. CHESTER, MALOOF, FARAHE, DANIELS, GILBERT H.·1979·Annals of Internal Medicine

DOI 10.7326/0003-4819-90-2-164

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Abstract

Fifteen of 36 hyperthyroid patients had elevation in serum alkaline phosphatase activity. There was no difference in mean thyroxine (T4), triiodothyronine (T3), age, or duration of illness between the groups with high alkaline phosphatase and normal alkaline phosphatase levels. After treatment, serum alkaline phosphatase levels rose as T4 levels declined; at 3 months, the mean serum alkaline phosphatase value rose from 7.1 Bodansky units to 10.3 Bodansky units (P less than 0.005), while the mean T4 value fell from 18 microgram/dl to 7.2 microgram/dl (P less than 0.005). In some patients, serum alkaline phosphatase values have remained elevated for more than 1 year, despite continued normality in thyroid variables. Before therapy, isoenzyme patterns analyzed by polyacrylamide gel electrophoresis were qualitatively normal. As therapy was instituted, the isoenzyme patterns changed markedly, with increased amounts of bone alkaline phosphatase appearing in the serum as T4 levels were declining and total alkaline phosphatase was rising. Thyroid tissue homogenates from patients with Graves' disease were found to have very low levels of alkaline phosphatase activity and an isoenzyme pattern quite distinct from that found in the serum.

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In patients with improving thyrotoxicosis, a rising alkaline phosphatase with normalization of other liver function does not indicate worsening hepatic toxicity because the origin of the alkaline phosphatase is from bone, not liver.
“In patients with improving thyrotoxicosis, a rising alkaline phosphatase with normalization of other liver function does not indicate worsening hepatic toxicity (156) because the origin of the alkaline phosphatase is from bone, not liver.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [156]

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Authors: COOPER, D. S., KAPLAN, M. M., RIDGWAY, E. C., MALOOF, F., & DANIELS, G. H.
Affiliations: Harvard University (US)
Boston, Massachusetts
Corresponding author: COOPER, DAVID S.
ORCID: COOPER, DAVID S.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1979-02-01
Volume: 90
Issue: 2
Pages: 164-168
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-90-2-164
OpenAlex: W1996246140
Cited by: 95
References: 26
Citations by year: 2025: 2 · 2024: 2 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 1 · 2016: 1 · 2015: 1 · 2013: 2 · 2012: 4
FWCI: 1.63
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Alkaline Phosphatase Research Studies
Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
Keywords: hyperthyroidism, alkaline phosphatase, isoenzyme patterns, bone-specific alkaline phosphatase, Graves' disease, thyroxine, triiodothyronine, antithyroid drug therapy, serum enzyme elevation
MeSH terms: Adolescent, Adult, Aged, Alkaline Phosphatase, Female, Graves Disease, Humans, Hyperthyroidism, Isoenzymes, Male, Middle Aged, Thyroid Gland, Thyroxine, Triiodothyronine

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Alkaline Phosphatase Isoenzyme Patterns in Hyperthyroidism

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