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Thyroid Function in Patients with Type 2 Diabetes Mellitus and Diabetic Nephropathy: A Single Center Study. J Thyroid Res 2019; 2018:9507028. [PMID: 30631416 PMCID: PMC6304540 DOI: 10.1155/2018/9507028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus is a common metabolic disease and the prevalence is increasing rapidly. Thyroid disorders including subclinical hypothyroidism (SCH) and low triiodothyronine (T3) syndrome are frequently observed in diabetic patients. We conducted a study to explore thyroid function in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN). Methods We included 103 healthy volunteers, 100 T2DM patients without DN, and 139 with DN. Physical examinations including body mass index and blood pressure and laboratory measurements including renal function, thyroid function, and glycosylated hemoglobin were conducted. Results Patients with DN had higher thyroid stimulating hormone (TSH) levels and lower free T3 (FT3) levels than those without DN (p < 0.01). The prevalence of SCH and low FT3 syndrome in patients with DN was 10.8% and 20.9%, respectively, higher than that of controls and patients without DN (p < 0.05). Through Pearson correlation or Spearman rank correlation analysis, in patients with DN, there were positive correlations in TSH with serum creatinine (r = 0.363, p = 0.013) and urinary albumin-to-creatinine ratio (r = 0.337, p = 0.004), and in FT3 with estimated glomerular filtration rate (eGFR) with statistical significance (r = 0.560, p < 0.001). Conclusions High level of TSH and low level of FT3 were observed in T2DM patients with DN. Routine monitoring of thyroid function in patients with DN is necessary, and management of thyroid dysfunction may be a potential therapeutic strategy of DN.
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302
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Association between subclinical hypothyroidism and depression: an updated systematic review and meta-analysis. BMC Psychiatry 2019; 19:12. [PMID: 30621645 PMCID: PMC6325749 DOI: 10.1186/s12888-018-2006-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/27/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although depression is associated with changes in the hypothalamic-pituitary-thyroid axis, its relationship with subclinical hypothyroidism (SCH) is controversial. To date, there is a lack of data on the improvement of depressive symptoms with levothyroxine therapy among individuals with coexistent SCH. METHODS We conducted a meta-analysis to evaluate the association between SCH and depression including 1) the prevalence of depression in SCH (with a sub-analysis of the geriatric cohort), 2) thyroid stimulating hormone (TSH) level among patients with depression and 3) the effect of levothyroxine therapy among patients with SCH and coexistent depression. RESULTS In a pooled analysis of 12,315 individuals, those with SCH had higher risk of depression than euthyroid controls (relative risk 2.35, 95% confidence intervals [CI], 1.84 to 3.02; p < 0.001). Geriatric cohort with SCH had a 1.7-fold higher risk of depression compared with healthy controls (odds ratio 1.72, CI, 1.10 to 2.70; p = 0.020). There was no difference in the mean TSH level between individuals with depression and healthy controls (2.30 ± 1.18 vs. 2.13 ± 0.72 mIU/L, p = 0.513). In individuals with SCH and coexistent depression, levothyroxine therapy was neither associated with improvement in the Beck Depression Inventory scoring (pooled d + = - 1.05, CI -2.72 to 0.61; p = 0.215) nor Hamilton Depression Rating Scale (pooled d + = - 2.38, CI -4.86 to 0.10; p = 0.060). CONCLUSION SCH has a negative impact on depression. Early and routine screening of depression is essential to prevent morbidity and mortality. However, the use of levothyroxine among patients with SCH and coexistent depression needs to be individualized.
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303
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Wang J, Li H, Tan M, Gao G, Zhang Y, Ding B, Su X, Kong X, Ma J. Association between thyroid function and diabetic nephropathy in euthyroid subjects with type 2 diabetes mellitus: a cross-sectional study in China. Oncotarget 2019; 10:88-97. [PMID: 30719205 PMCID: PMC6349442 DOI: 10.18632/oncotarget.26265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
Previous studies have suggested that even in euthyroid subjects, thyroid function may affect the risk factors of diabetic nephropathy (DN). Thus, we investigated the association between thyroid parameters and DN in euthyroid subjects with type 2 diabetes mellitus (T2DM). This was a cross-sectional study of 1,071 euthyroid subjects with T2DM (mean age of 61.90 ± 12.74 years; 622 men). Clinical factors, including levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid autoantibodies, albumin excretion rate were measured. DN was present in 400 (37.35%) individuals. Patients with DN exhibited higher serum TSH and lower serum FT3 and FT4 levels than those without DN (P<0.05). After adjusting traditional risk factors of DN, the levels of both FT3 (per-SD increase, odds ratio [OR] 0.606 [95% confidence interval (CI), 0.481-0.762], P<0.001) and FT4 (per-SD increase, OR 0.944 [0.894-0.998], P = 0.040) were inversely correlated with DN. Meanwhile, we found that serum TSH levels were positively correlated with DN (per-SD increase, OR1.179 [1.033-1.346], P = 0.015). Low-to-normal thyroid hormones (THs) were also associated with the presence of macroalbuminuria. In conclusion, the relatively low levels of THs were significantly associated with DN in euthyroid subjects with T2DM.
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Affiliation(s)
- Jian Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Mingjuan Tan
- Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Gu Gao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Ying Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Xiaocen Kong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
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304
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Autoimmune Thyroid Diseases. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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305
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Calsolaro V, Niccolai F, Pasqualetti G, Calabrese AM, Polini A, Okoye C, Magno S, Caraccio N, Monzani F. Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? Front Endocrinol (Lausanne) 2019; 10:177. [PMID: 30967841 PMCID: PMC6438852 DOI: 10.3389/fendo.2019.00177] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with aging, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT4, particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Neurology Imaging Unit, Imperial College, London, United Kingdom
- *Correspondence: Valeria Calsolaro
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Polini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity Center at the Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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306
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Livadas S, Bothou C, Androulakis I, Boniakos A, Angelopoulos N, Duntas L. Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach. Thyroid 2018; 28:1580-1586. [PMID: 30351232 DOI: 10.1089/thy.2018.0014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Levothyroxine (LT4) is one of the most prescribed drugs worldwide. Once started, approximately 90% of patients continue treatment long term. However, accumulating evidence suggests that many patients, for whom the indication for its administration is not adequately established and the diagnosis is not well documented, are overusing it. This study aimed to evaluate the necessity for and determine potential prognostic factors of long-term LT4 supplementation. METHODS A prospective clinical cohort follow-up study was carried out. In 291 subjects (84% females) aged 48 ± 16 years on LT4 replacement therapy without a solid diagnosis of hypothyroidism being provided, the treatment was paused. At the beginning and after six to eight weeks of treatment discontinuation, thyrotropin (TSH) and free thyroxine levels were assessed, and thyroid ultrasound was performed. A TSH value of ≥4.5 IU/mL was considered as underlying hypothyroidism. RESULTS Among the 291 individuals, 114 became hypothyroid (group A), while 177 subjects remained euthyroid off LT4 (group B; 39.2% vs. 60.8%, p < 0.001). The groups were comparable regarding sex, family history, age, body mass index, duration of treatment, basal TSH and free thyroxine values, thyroid volume, and presence of thyroid autoantibodies. However, diffuse inhomogeneous echogenicity on ultrasound examination was significantly higher (p < 0.001) in group A. CONCLUSIONS These findings suggest considerable overuse of thyroxine therapy. The results underline the initial need to establish the diagnosis firmly before treatment initiation and to undertake periodic evaluation of all patients on chronic LT4 treatment as to the necessity for treatment continuation. In all patients on long-term LT4 therapy in whom the diagnosis has not been definitively established, it appears rational to introduce a six- to eight-week period of LT4 replacement therapy discontinuation, preceded and followed by TSH tests, as the first-line approach-a procedure that could be implemented as part of a common strategy among the scientific community to decrease current LT4 overuse.
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Affiliation(s)
| | - Christina Bothou
- 2 Division of Endocrinology, Diabetes and Metabolism, Medical Department 1, University Hospital, Goethe University , Frankfurt am Main, Germany
| | | | | | | | - Leonidas Duntas
- 3 Endocrine Unit, Evgenidion Hospital, University of Athens , Athens, Greece
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307
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Calsolaro V, Niccolai F, Pasqualetti G, Tognini S, Magno S, Riccioni T, Bottari M, Caraccio N, Monzani F. Hypothyroidism in the Elderly: Who Should Be Treated and How? J Endocr Soc 2018; 3:146-158. [PMID: 30607373 PMCID: PMC6309133 DOI: 10.1210/js.2018-00207] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Hypothyroidism is among the most frequent chronic diseases in the elderly, and levothyroxine (l-T4) is worldwide within the 10 drugs more prescribed in the general population. Hypothyroidism is defined by increased serum thyroid-stimulating hormone (TSH) values and reduced circulating free thyroid hormones, whereas subclinical hypothyroidism (sHT) is characterized by free hormone fractions within the normal ranges and has been divided into two classes, depending on circulating TSH levels (above or below 10 mIU/L). Given that during aging, a natural trend toward higher values of circulating TSH has been reported, it is necessary to verify carefully the diagnosis of sHT to tailor an appropriate follow-up and ad hoc therapy, avoiding unnecessary or excessive treatment. In the current review, we evaluate the state of the art on hypothyroidism in the elderly with special focus on the effect of sHT on cognition and the cardiovascular system function. We also summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with an elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly therapy. In conclusion, personalized therapy is crucial in good clinical practice, and in the management of older patients with sHT, multiple factors must be considered, including age-dependent TSH cutoffs, thyroid autoimmunity, the burden of comorbidities, and the possible presence of frailty. l-T4 is the drug of choice for the treatment of hypothyroid older people, but the risk of overtreatment, potential adverse drug reactions, and patient compliance should always be considered and thyroid status periodically reassessed.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Tognini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity Center at the Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Riccioni
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marina Bottari
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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308
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Bruyneel M, Veltri F, Poppe K. Prevalence of newly established thyroid disorders in patients with moderate-to-severe obstructive sleep apnea syndrome. Sleep Breath 2018; 23:567-573. [PMID: 30368659 DOI: 10.1007/s11325-018-1746-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hypothyroidism can directly cause obstructive sleep apnea (OSA) but may also contribute to it through its impact on the metabolic syndrome. The purpose of this study was to establish the prevalence of known and newly diagnosed overt and subclinical hypothyroidism (SCH) among patients with OSA. METHODS We prospectively included all consecutive moderate or severe OSA patients referred for CPAP therapy. A fasting blood sample was collected to determine thyroid-stimulating hormone (TSH) and free T4 (FT4) levels. RESULTS A total of 280 patients were included (70% male). Mean ± SD body mass index (BMI) and apnea-hypopnea index (AHI) were 33 ± 7 kg/m2 and 49 ± 25, respectively. Median (range) serum TSH levels and mean ± SD FT4 levels were comparable between severe and moderate OSA (1.7 (1.3-2.6) vs 2.1 (1.2-2.8); p = 0.378 and 15.3 ± 2.3 vs 15.3 ± 2.3; p = 0.981). TSH and FT4 levels were not correlated with AHI (p = 0.297 and p = 0.370, respectively), but TSH was correlated with BMI (p = 0.049).Of all patients, 8.9% had increased serum TSH levels (severe and moderate OSA patients had similar levels (p = 0.711)) and 8.2% were newly diagnosed patients (no differences were observed between severe and moderate OSA (p = 0.450)). A total of 16.4% of patients had some type of thyroid disorder. Thyroid function parameters were associated with BMI but not with the severity of OSA. CONCLUSION In our population of moderate or severe OSA, 16% of patients had a thyroid problem and 8% of these were newly diagnosed with SCH.
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Affiliation(s)
- Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium. .,Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Flora Veltri
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
| | - Kris Poppe
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
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309
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Barić A, Brčić L, Gračan S, Škrabić V, Brekalo M, Šimunac M, Lovrić VT, Anić I, Barbalić M, Zemunik T, Punda A, Boraska Perica V. Thyroglobulin Antibodies are Associated with Symptom Burden in Patients with Hashimoto's Thyroiditis: A Cross-Sectional Study. Immunol Invest 2018; 48:198-209. [PMID: 30332318 DOI: 10.1080/08820139.2018.1529040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is the most common form of autoimmune thyroid disorders characterized by lower production of thyroid hormones and positivity to autoantibodies to thyroglobulin (TgAb) and/or thyroid peroxidase (TPOAb). We performed a comprehensive phenotypic characterization of patients with HT, with specific focus on thyroid autoimmunity, to get better understanding of disease manifestation. METHODS We collected information on thyroid-specific phenotypes (TSH, T3, T4, fT4, TgAb, TPOAb, thyroid volume) and other clinical phenotypes (age, body surface area, number of hypothyroidism symptoms, blood pressure) from 290 patients with HT without levothyroxine (LT4) therapy with the aim to test for correlations between thyroid-specific and clinical phenotypes. RESULTS Our key and novel finding is the existence of significant positive correlation between TgAb levels and the number of symptoms (r = 0.25, p = 0.0001) in HT patients without LT4 therapy that remained significant after adjustment for TPOAb, T3, TSH levels and thyroid volume (β = 0.66, SE = 0.3, p = 0.0299). Increased TgAb levels are significantly associated with fragile hair (p = 0.0043), face edema (p = 0.0061), edema of the eyes (p = 0.0293) and harsh voice (p = 0.0349). CONCLUSIONS Elevated TgAb levels are associated with symptom burden in HT patients, suggesting a role of thyroid autoimmunity in clinical manifestations of HT. Based on these results, we recommend screening for TgAb antibodies in HT patients with symptom burden. We also suggest that further work on understandings of symptoms appearance due to their autoimmune or hypothyroid causation is needed.
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Affiliation(s)
- Ana Barić
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Luka Brčić
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Sanda Gračan
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Veselin Škrabić
- c Department of Pediatrics , University Hospital Split , Split , Croatia
| | - Marko Brekalo
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Marta Šimunac
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | | | - Iva Anić
- d School of Medicine , University of Split , Split , Croatia
| | - Maja Barbalić
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Tatijana Zemunik
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Ante Punda
- a Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Vesna Boraska Perica
- b Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
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310
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Abstract
The interpretation of thyroid function tests should be cautiously made during the perimenopause and postmenopause period bearing in mind that physiologic changes do exist in this group of women in terms of secretion and metabolism of thyrotropin and thyroid hormones. Moreover the incidence of thyroid disorders increases in postmenopausal and elderly women. There is no consensus for screening postmenopausal women even though there is well-known evidence about the effect of thyroid status on cognitive function, cardiovascular risk, bone turnover, and longevity. The diagnosis of any thyroid disorder is challenging in these patients because the symptoms are more subtle and attributed to menopausal symptoms. Management requires more attention in this population than that of younger groups, because high doses of L-thyroxine can lead to cardiac complications and increased bone turnover. Furthermore radio-iodine is preferred in treatment of hyperthyroidism in older patients. The risk of nodular thyroid disease and thyroid cancers increases in this group. Although the diagnostic approach is the same as for young patients, the risk of surgery is high and disease prognosis is worse. Women with any form of thyroid disease should be treated according to the current guidelines. Decision for menopausal hormonal therapy should be individualized regardless of the concomitant presence of thyroid disorders.
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Affiliation(s)
- M M Uygur
- a Sirnak State Hospital , Internal Medicine Clinic , Sirnak , Turkey.,c Department of Internal Medicine, Division of Metabolic Diseases and Endocrinology , Marmara University Hospital , Istanbul , Turkey
| | - T Yoldemir
- b Department of Obstetrics and Gynecology , Marmara University Hospital , Istanbul , Turkey
| | - D G Yavuz
- c Department of Internal Medicine, Division of Metabolic Diseases and Endocrinology , Marmara University Hospital , Istanbul , Turkey
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311
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Wang B, Song R, He W, Yao Q, Li Q, Jia X, Zhang JA. Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults. Front Physiol 2018; 9:1397. [PMID: 30337885 PMCID: PMC6180185 DOI: 10.3389/fphys.2018.01397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
There is an intensive link between obesity and thyroid dysfunction, but this relationship in Asians is still unclear. This study was conducted to define the impact of obesity on risk of hypothyroidism and thyroid autoimmunity among Chinese adults. A population-based, cross-sectional study was carried out, which enrolled a total of 2,808 Chinese adults. To assess the associations of obesity with hypothyroidism and thyroid autoimmunity, odds ratio (ORs) with 95% confidence intervals (95%CIs) were calculated through logistic regression model, and the correlations of body mass index (BMI) with TPOAb and TGAb were also analyzed. Obese females had higher risk of hypothyroidism (22.7 vs. 15.0%; OR = 1.66, 95%CI 1.10–2.53; P = 0.02) and higher risk of subclinical hypothyroidism (22.1 vs. 13.4%; OR = 1.83, 95%CI 1.20–2.80; P = 0.005) than non-obese females. Multivariate logistic regression analysis found significant associations of obesity with hypothyroidism (Adjusted OR = 1.54, 95%CI 1.00–2.38; P = 0.05) and subclinical hypothyroidism (Adjusted OR = 1.69, 95%CI 1.09–2.63; P = 0.02) in females after adjustment for confounding factors. No association between obesity and hypothyroidism was observed in male participants. Spearman's correlation analysis suggested BMI was significantly and positively correlated with TPOAb (Spearman's r = 0.062, P = 0.022) in men but not in women. Linear regression analysis suggested an obviously positive correlation of BMI with TPOAb in men (β = 0.018, P = 0.015) and an obviously negative correlation of BMI with TGAb in women (β = −0.025, P = 0.012), respectively. The study suggests sex differences in the associations of obesity with hypothyroidism and thyroid autoimmunity among Chinese adults. Further studies are needed to better understand the exact mechanism of sex difference in the obesity-thyroid relationship.
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Affiliation(s)
- Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Ronghua Song
- Department of Endocrinology & Rheumatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Weiwei He
- Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qian Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xi Jia
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
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312
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Feller M, Snel M, Moutzouri E, Bauer DC, de Montmollin M, Aujesky D, Ford I, Gussekloo J, Kearney PM, Mooijaart S, Quinn T, Stott D, Westendorp R, Rodondi N, Dekkers OM. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA 2018; 320:1349-1359. [PMID: 30285179 PMCID: PMC6233842 DOI: 10.1001/jama.2018.13770] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The benefit of thyroid hormone therapy for subclinical hypothyroidism is uncertain. New evidence from recent large randomized clinical trials warrants an update of previous meta-analyses. OBJECTIVE To conduct a meta-analysis of the association of thyroid hormone therapy with quality of life and thyroid-related symptoms in adults with subclinical hypothyroidism. DATA SOURCES PubMed, EMBASE, ClinicalTrials.gov, Web of Science, Cochrane Library, CENTRAL, Emcare, and Academic Search Premier from inception until July 4, 2018. STUDY SELECTION Randomized clinical trials that compared thyroid hormone therapy with placebo or no therapy in nonpregnant adults with subclinical hypothyroidism were eligible. Two reviewers independently evaluated eligibility based on titles and abstracts of all retrieved studies. Studies not excluded in this first step were independently assessed for inclusion after full-text evaluation by 2 reviewers. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, assessed risk of bias (Cochrane risk-of-bias tool), and evaluated the quality of evidence (GRADE tool). For synthesis, differences in clinical scores were transformed (eg, quality of life) into standardized mean differences (SMDs; positive values indicate benefit of thyroid hormone therapy; 0.2, 0.5, and 0.8 correspond to small, moderate, and large effects, respectively). Random-effects models for meta-analyses were applied. MAIN OUTCOMES AND MEASURES General quality of life and thyroid-related symptoms after a minimum follow-up of 3 months. RESULTS Overall, 21 of 3088 initially identified publications met the inclusion criteria, with 2192 adults randomized. After treatment (range, 3-18 months), thyroid hormone therapy was associated with lowering the mean thyrotropin value into the normal reference range compared with placebo (range, 0.5-3.7 mIU/L vs 4.6 to 14.7 mIU/L) but was not associated with benefit regarding general quality of life (n = 796; SMD, -0.11; 95% CI, -0.25 to 0.03; I2=66.7%) or thyroid-related symptoms (n = 858; SMD, 0.01; 95% CI, -0.12 to 0.14; I2=0.0%). Overall, risk of bias was low and the quality of evidence assessed with the GRADE tool was judged moderate to high. CONCLUSIONS AND RELEVANCE Among nonpregnant adults with subclinical hypothyroidism, the use of thyroid hormone therapy was not associated with improvements in general quality of life or thyroid-related symptoms. These findings do not support the routine use of thyroid hormone therapy in adults with subclinical hypothyroidism.
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Affiliation(s)
- Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
| | - Marieke Snel
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | - Maria de Montmollin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Jacobijn Gussekloo
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Center, Leiden, the Netherlands
| | | | - Simon Mooijaart
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Institute for Evidence-based Medicine in Old Age, Leiden University Center, Leiden, the Netherlands
| | - Terry Quinn
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - David Stott
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - Rudi Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Olaf M. Dekkers
- Departement of Endocrinology/General Internal Medicine, Leiden University Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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313
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Andrade MN, Santos-Silva AP, Rodrigues-Pereira P, Paiva-Melo FD, de Lima Junior NC, Teixeira MP, Soares P, Dias GRM, Graceli JB, de Carvalho DP, Ferreira ACF, Miranda-Alves L. The environmental contaminant tributyltin leads to abnormalities in different levels of the hypothalamus-pituitary-thyroid axis in female rats. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 241:636-645. [PMID: 29902746 DOI: 10.1016/j.envpol.2018.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 06/08/2023]
Abstract
Tributyltin is a biocide used in nautical paints, aiming to reduce fouling of barnacles in ships. Despite the fact that many effects of TBT on marine species are known, studies in mammals have been limited, especially those evaluating its effect on the function of the hypothalamus-pituitary-thyroid (HPT) axis. The aim of this study was to investigate the effects of subchronic exposure to TBT on the HPT axis in female rats. Female Wistar rats received vehicle, TBT 200 ng kg-1 BW d-1 or 1000 ng kg-1 BW d-1 orally by gavage for 40 d. Hypothalamus, pituitary, thyroid, liver and blood samples were collected. TBT200 and TBT1000 thyroids showed vacuolated follicular cells, with follicular hypertrophy and hyperplasia. An increase in epithelial height and a decrease in the thyroid follicle and colloid area were observed in TBT1000 rats. Moreover, an increase in the epithelium/colloid area ratio was observed in both TBT groups. Lower TRH mRNA expression was observed in the hypothalami of TBT200 and TBT1000 rats. An increase in Dio1 mRNA levels was observed in the hypothalamus and thyroid in TBT1000 rats only. TSH serum levels were increased in TBT200 rats. In TBT1000 rats, there was a decrease in total T4 serum levels compared to control rats, whereas T3 serum levels did not show significant alterations. We conclude that TBT exposure can promote critical abnormalities in the HPT axis, including changes in TRH mRNA expression and serum TSH and T4 levels, in addition to affecting thyroid morphology. These findings demonstrate that TBT disrupts the HPT axis. Additionally, the changes found in thyroid hormones suggest that TBT may interfere with the peripheral metabolism of these hormones, an idea corroborated by the observed changes in Dio1 mRNA levels. Therefore, TBT exposition might interfere not only with the thyroid axis but also with thyroid hormone metabolism.
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Affiliation(s)
- Marcelle Novaes Andrade
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Farmacologia e Química Medicinal, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Ana Paula Santos-Silva
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Fisiologia Endócrina Doris Rosenthal, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Paula Rodrigues-Pereira
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil
| | - Francisca Diana Paiva-Melo
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil
| | - Niedson Correa de Lima Junior
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Fisiologia Endócrina Doris Rosenthal, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Mariana Pires Teixeira
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Fisiologia Endócrina Doris Rosenthal, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Patologia, Universidade Federal Fluminense, Brazil
| | - Paula Soares
- Institute for Research and Innovation in Health, University of Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) - Cancer Biology, Porto, Portugal; Medical Faculty, University of Porto, Porto, Portugal; Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Glaecir Roseni Munstock Dias
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Fisiologia Endócrina Doris Rosenthal, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Jones Bernardes Graceli
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Endocrinologia e Toxicologia Celular, Departamento de Morfologia, Universidade Federal do Espírito Santo, Brazil
| | - Denise Pires de Carvalho
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Fisiologia Endócrina Doris Rosenthal, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Andrea Claudia Freitas Ferreira
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Farmacologia e Química Medicinal, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Polo de Xerém/NUMPEX, Universidade Federal do Rio de Janeiro, Brazil
| | - Leandro Miranda-Alves
- Grupo de Pesquisa, Desenvolvimento e Inovação em Endocrinologia Experimental-GPDIEEx, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Programa de Pós-graduação em Farmacologia e Química Medicinal, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil.
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314
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. The role of functional thyroid capacity in pituitary thyroid feedback regulation. Eur J Clin Invest 2018; 48:e13003. [PMID: 30022470 DOI: 10.1111/eci.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/08/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thyroid feedback regulation and equilibria between thyroid hormones differ in the presence or absence of a functioning thyroid remnant. MATERIALS AND METHODS This study examines the relationship between the sensitivity of TSH feedback and thyroid capacity in untreated patients with thyroid autoimmune disease (n = 86) and healthy controls (n = 271). Functional capacity was estimated at maximum TSH stimulation, and pituitary TSH response was FT4-standardised with two established indices, the TSH index and the thyrotroph thyroid hormone resistance index. RESULTS The two indices correlated inversely with thyroid volume and functional thyroid capacity. Relationships were shifted upwards in patients with thyroid autoimmune disease. This positioned patients with thyroid autoimmune disease predominantly at the lower capacity range and upper part of TSH index. The relationship was modulated by serum FT3 concentrations, shifting 0.19 [95%CI: 0.12, 0.26] mIU/L per pmol FT3 increase. FT3 correlated with TSH index in total group ( τ = 0.09, P = 0.009) and both subgroups. FT3 levels were maintained despite a substantial capacity loss by progressively increasing conversion rates of T3 from T4, only collapsing at capacities below <1.5 pmol/s. CONCLUSION Functional thyroid capacity and preferential T3 generation are essential elements in adjusting the sensitivity of hypothalamic-pituitary-thyroid feedback control and balancing system equilibria. This suggests that the indirect regulatory role of glandular T3 co-secretion exceeds its quantitative contribution to the thyroid hormone pool. Implications for clinical practice extend to the diagnostic use of TSH in patients with impaired thyroid reserve.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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315
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Kim HI, Oh HK, Park SY, Jang HW, Shin MH, Han JM, Bae JC, Kim SW, Kim TH, Chung JH. Non-immune-related hypothyroidism and its relationship with excess iodine. Eur J Nutr 2018; 58:2851-2858. [PMID: 30276524 DOI: 10.1007/s00394-018-1837-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/26/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE In iodine-sufficient areas, autoimmune hypothyroidism has been regarded as the major subtype of hypothyroidism. Non-immune-related hypothyroidism has received little attention because it is considered to be rare. The aim of this study was to evaluate the prevalence of non-immune-related hypothyroidism in Korea and to identify its associating factors. METHODS A total of 6434 participants in the Korea National Health and Nutrition Examination Survey VI (2013-2015) without known thyroid disease who were examined for thyroid stimulating hormone, free thyroxine, TPO Ab, and urine iodine concentration (UIC) were enrolled. The weighted proportions, demographic variables, and severity of immune-related and non-immune-related hypothyroidism were compared. To assess the effect of iodine on hypothyroidism in TPO Ab positive or negative populations, the weighted prevalence of hypothyroidism was assessed in each population according to UIC or estimated iodine intake subgroups. RESULTS The prevalence of undetected hypothyroidism in Korea was 3.8% (n = 233). Of these 233 cases, 171 (71.8%) were non-immune-related. In the TPO Ab negative population, the prevalence of hypothyroidism was increased significantly in the subgroup with UIC between 250 and 749 µg/L (HR 2.12 [1.17, 3.83]) and ≥ 750 µg/L (HR 3.42 [1.93, 6.04]) or the subgroups with estimated iodine intake ≥ 750 µg/day (HR 2.81 [1.64, 4.80]). CONCLUSIONS This nationwide study demonstrated that most cases of hypothyroidism in iodine-sufficient areas are non-immune-related and are associated with excess iodine above a certain level. More attention to this unrecognized but widespread potential health risk is needed.
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Affiliation(s)
- Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyun-Kyung Oh
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Min Han
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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316
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Hansen MP, Kahaly GJ. [Managing hypothyroidism in general practice]. MMW Fortschr Med 2018; 160:42-46. [PMID: 30302683 DOI: 10.1007/s15006-018-0983-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Martin P Hansen
- Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Deutschland
| | - George J Kahaly
- Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Deutschland.
- I. Medizinische Klinik und Poliklinik, Labor Prof. G. J. Kahaly, Gebäude 402 UG, Univ.-Medizin der Johannes-Gutenberg-Universität, Langenbeckstr. 1, D-55131, Mainz, Deutschland.
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317
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Djurovic M, Pereira AM, Smit JWA, Vasovic O, Damjanovic S, Jemuovic Z, Pavlovic D, Miljic D, Pekic S, Stojanovic M, Asanin M, Krljanac G, Petakov M. Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement. Endocrine 2018; 62:136-143. [PMID: 29959689 DOI: 10.1007/s12020-018-1649-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status. DESIGN Retrospective cross-sectional study. PATIENTS AND MEASUREMENTS One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20-49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations. RESULTS FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20-49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score). CONCLUSION Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.
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Affiliation(s)
- Marina Djurovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.
| | - Alberto M Pereira
- Department of Endocrinology and Metabolic Diseases, and Centre for Endocrine Tumors Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes W A Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Vasovic
- Institute for Gerontology and Palliative Care, Belgrade, Belgrade, Serbia
| | - Svetozar Damjanovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Zvezdana Jemuovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragan Pavlovic
- Institute of Neurology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragana Miljic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milika Asanin
- Clinic for Cardiology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Krljanac
- Clinic for Cardiology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milan Petakov
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
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318
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Substitution mit Schilddrüsenhormonen im höheren Lebensalter. Internist (Berl) 2018; 59:1114-1118. [DOI: 10.1007/s00108-018-0458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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319
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Kaličanin D, Brčić L, Barić A, Zlodre S, Barbalić M, Torlak Lovrić V, Punda A, Boraska Perica V. Evaluation of Correlations Between Food-Specific Antibodies and Clinical Aspects of Hashimoto's Thyroiditis. J Am Coll Nutr 2018; 38:259-266. [PMID: 30265836 DOI: 10.1080/07315724.2018.1503103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We have comprehensively evaluated an immunologic response to food antigens, mediated by immunoglobulin G (IgG) antibodies, on clinical aspects of Hashimoto's thyroiditis (HT). METHODS IgG antibodies to 125 food antigens were measured in serum samples of 74 HT patients and 245 controls using microarray-based enzyme-linked immunosorbent assay (ELISA) test. We analyzed differences in IgG levels between two groups and evaluated correlations between food-specific IgG levels and HT-related clinical phenotypes (thyroid hormones/antibodies, symptoms of hypothyroidism, measures of body size and blood pressure) and food consumption in HT patients. RESULTS We observed increased IgG levels to 12 different food antigens in either HT cases or controls, of which plum-specific IgG antibodies were significantly higher (p = 1.70 × 10-8), and almond-specific IgG antibodies were significantly lower (p = 8.11 × 10-5) in HT patients in comparison to controls, suggesting their possible roles in HT etiology or symptomatology. There was no significant correlation between any of 12 increased food-specific IgG antibodies, along with gluten-specific IgG, with clinically important phenotypes, such as thyroid hormones/antibodies or symptoms. Among other tested correlations, the most interesting is the negative correlation between coffee and tea combined IgG levels and number of symptoms, suggesting possible beneficial effect of tea and coffee on disease symptoms. We also found that food consumption is not correlated with IgG levels. CONCLUSIONS Distribution of food-specific IgG antibodies is comparable between HT patients and controls, with the exception of plum and almond. There is no evidence that increased food-specific IgG antibodies are associated with clinical aspects of HT. Clarification of biology behind formation of these antibodies is needed.
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Affiliation(s)
- Dean Kaličanin
- a Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Luka Brčić
- a Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | - Ana Barić
- b Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Sanja Zlodre
- c Laboratory for Biochemistry , Polyclinic Analiza , Dugopolje , Croatia
| | - Maja Barbalić
- a Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
| | | | - Ante Punda
- b Department of Nuclear Medicine , University Hospital Split , Split , Croatia
| | - Vesna Boraska Perica
- a Department of Medical Biology , University of Split, School of Medicine , Split , Croatia
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320
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Abstract
OBJECTIVES Possible effects of HIV on thyroid function in the modern combination antiretroviral therapy (cART) era are largely unknown. We aimed to investigate the prevalence and associated risk factors of thyroid dysfunction in well treated people living with HIV (PLWH) and matched uninfected controls and to examine whether HIV is independently associated with thyroid dysfunction. DESIGN AND METHODS Thyroid-stimulating hormone (TSH), free thyroxine, total thyroxine, and free triiodothyronine were measured in 826 PLWH from the Copenhagen co-morbidity in HIV infection (COCOMO) Study and in 2503 matched uninfected controls, and medical treatment for hypothyroidism or hyperthyroidism was recorded. Multinomial logistic regression adjusting for known risk factor was used to examine the association between HIV and thyroid dysfunction and multivariate linear regression to study the association between HIV and serum TSH concentrations. RESULTS The PLWH were generally well treated, with 95% having undetectable viral replication. Among PLWH and controls 31 (3.8%) and 114 (4.6%) had hypothyroidism, and 7 (0.8%) and 21 (0.8%) had hyperthyroidism, respectively. In adjusted analyses, we found no significant associations between HIV and hypothyroidism OR 0.8 [95% confidence interval (CI) 0.6-1.3], P = 0.40 or between HIV and hyperthyroidism OR 1.1 (95% CI 0.5-2.5), P = 0.91. Furthermore, serum TSH concentration was unrelated to HIV status (P = 0.6). CONCLUSION There was no difference in the prevalence of hyperthyroidism or hypothyroidism in well treated PLWH compared with uninfected controls. HIV status was not associated with thyroid dysfunction or serum TSH concentration.
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Skøtt JW, Lauritsen J, Kreiberg M, Daugaard G, Bandak M. Quality of Life in Long-Term Testicular Cancer Survivors With Compensated Leydig Cell Dysfunction. Clin Genitourin Cancer 2018; 17:e65-e71. [PMID: 30293923 DOI: 10.1016/j.clgc.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Compensated Leydig cell (LC) dysfunction, defined by elevated serum levels of luteinizing hormone (LH) in combination with normal total testosterone levels, is common in testicular cancer (TC) survivors. The association between this condition and quality of life is unknown. We aimed to clarify if TC survivors with compensated LC dysfunction have impaired quality of life. PATIENTS AND METHODS In total, 147 long-term TC survivors were included. On the basis of a single measurement of testosterone and LH, compensated LC dysfunction was defined by age-adjusted levels of LH above normal range combined with testosterone levels within the normal range. Quality-of-life outcomes including sexual function, anxiety and depression, fatigue, and overall self-evaluated quality of life were compared between patients with and without compensated LC dysfunction with adjustment for age. RESULTS In total, 60 TC survivors had compensated LC dysfunction and 87 TC survivors had normal LC function. TC survivors with compensated LC dysfunction had lower serum levels of total testosterone (11 vs. 13 nmol/L, P = .016). There were no significant differences in the investigated quality-of-life outcomes (anxiety, depression, sexual function, fatigue) between the 2 groups. CONCLUSION Compensated LC dysfunction in TC survivors was not associated with symptoms of depression, anxiety, sexual dysfunction, fatigue, or impaired overall self-evaluated quality of life. Limitations include the few cases of symptoms of depression (n = 7). Our findings do not suggest that testosterone substitution is indicated in TC survivors with compensated LC dysfunction.
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Affiliation(s)
- Julie Wang Skøtt
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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322
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Moon S, Kim MJ, Yu JM, Yoo HJ, Park YJ. Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Thyroid 2018; 28:1101-1110. [PMID: 29978767 DOI: 10.1089/thy.2017.0414] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the impact of subclinical hypothyroidism (SCH) on the risk of cardiovascular disease (CVD) and all-cause mortality, a comprehensive meta-analysis was performed according to the age or coexisting CVD risk status of the participants. METHODS Studies regarding the association of SCH with all-cause mortality from PubMed and Embase databases were included. The pooled relative risk (RR) of CVD and all-cause mortality was calculated using the Mantel-Haenszel method. A subgroup analysis of participants with high CVD risk was conducted, including history of coronary, cerebral, or peripheral artery disease; dilated cardiomyopathy; heart failure; atrial fibrillation; venous thromboembolism; diabetes mellitus; or chronic kidney disease. RESULTS In total, 35 eligible articles incorporating 555,530 participants were included. SCH was modestly associated with CVD and all-cause mortality (RR for CVD = 1.33 [confidence interval (CI) 1.14-1.54]; RR for all-cause mortality = 1.20 [CI 1.07-1.34]). However, the association was not observed in participants aged ≥65 years. Subgroup analysis showed that participants with SCH and high CVD risk showed a significantly higher risk of all-cause mortality (RR for CVD = 2.20 [CI 1.28-3.77]; RR for all-cause mortality = 1.66 [CI 1.41-1.94]), whereas those with SCH and low CVD risk did not. Additional subgroup analysis of six studies with a mean participant age of ≥65 years and high CVD risk showed a significant high risk of all-cause mortality in the SCH group (RR = 1.41 [CI 1.08-1.85]; I2 = 0%). CONCLUSIONS SCH is associated with an increased CVD risk and all-cause mortality, particularly in participants with high CVD risk.
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Affiliation(s)
- Shinje Moon
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
- 2 Department of Internal Medicine, Graduate School, Hanyang University , Seoul, Republic of Korea
| | - Min Joo Kim
- 3 Department of Internal Medicine, Seoul National University Hospital , Seoul, Republic of Korea
| | - Jae Myung Yu
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
| | - Hyung Joon Yoo
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
| | - Young Joo Park
- 3 Department of Internal Medicine, Seoul National University Hospital , Seoul, Republic of Korea
- 4 Department of Internal Medicine, Seoul National University , Seoul, Republic of Korea
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323
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Chaker L, Cappola AR, Mooijaart SP, Peeters RP. Clinical aspects of thyroid function during ageing. Lancet Diabetes Endocrinol 2018; 6:733-742. [PMID: 30017801 DOI: 10.1016/s2213-8587(18)30028-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 01/07/2023]
Abstract
Globally, populations are ageing at a rapid rate. The increase in the number of older citizens is accompanied by an increased prevalence of thyroid dysfunction, one of the most common disorders in older people. However, the diagnosis of thyroid dysfunction in older people is hindered by several factors, including the scarcity of thyroid dysfunction symptoms in older people. We describe the physiological changes in thyroid function that occur with increasing age, focusing on literature regarding changes in thyroid function test results in older populations. We also discuss treatment considerations for clinical and subclinical thyroid dysfunction according to international guidelines for older people. Finally, we discuss the relationship between variations in thyroid function and common diseases of old age including cardiovascular disease, osteoporosis, cognitive impairment, and frailty and suggest directions for future research.
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Affiliation(s)
- Layal Chaker
- Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anne R Cappola
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands; Institute for Evidence-based Medicine in Old Age, Leiden, Netherlands
| | - Robin P Peeters
- Rotterdam Thyroid Center, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.
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324
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Moon S, Kong SH, Choi HS, Hwangbo Y, Lee MK, Moon JH, Jang HC, Cho NH, Park YJ. Relation of Subclinical Hypothyroidism is Associated With Cardiovascular Events and All-Cause Mortality in Adults With High Cardiovascular Risk. Am J Cardiol 2018; 122:571-577. [PMID: 29980273 DOI: 10.1016/j.amjcard.2018.03.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 01/07/2023]
Abstract
The aim of this study was to determine the association between subclinical hypothyroidism and cardiovascular (CVD) events, and mortality using the atherosclerotic CVD risk score. We carried out an observational study in a prospective cohort that was followed up for 12 years. The study included 3,021 participants aged ≥ 40 years at baseline from the Ansung cohort, part of the Korean Genome and Epidemiology Study. Cox regression models were constructed to evaluate the hazards ratio (HR) and 95% confidence interval (CI) for all-cause mortality and CVD events in groups classified according to thyroid status. Subgroup analysis was performed with a cut-off age of 65 years or 7.5% of the 10-year atherosclerotic CVD risk score. The subclinical hypothyroidism group in the highest quartile of thyroid-stimulating hormone (>6.57 mIU/L) had a significantly increased risk of all-cause mortality (HR 2.12, 95% CI 1.27 to 3.56) and CVD events (HR 1.92, 95% CI 1.21 to 3.04) compared with euthyroid participants. Subgroup analysis by CVD risk revealed that participants with high CVD risk only had a high risk of all-cause mortality (HR 2.18, 95% CI 1.22 to 3.87) and CVD events (HR 2.42, 95% CI 1.35 to 4.33). Further analysis showed that participants aged <65 years with high CVD risk had the highest risk of all-cause mortality (HR 3.50, 95% CI 1.50 to 8.16) and CVD events (HR 3.37, 95% CI 1.46 to 9.57). Our results demonstrated that high thyroid-stimulating hormone levels were associated with a greater risk of mortality and new CVD risks, particularly among subjects with high CVD risk.
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325
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A case report of a novel, integrative approach to Hashimoto’s thyroiditis with unexpected results. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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326
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Blum MR, Gencer B, Adam L, Feller M, Collet TH, da Costa BR, Moutzouri E, Dopheide J, Depairon M, Sykiotis GP, Kearney P, Gussekloo J, Westendorp R, Stott DJ, Bauer DC, Rodondi N. Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly With Subclinical Hypothyroidism: A Randomized Trial. J Clin Endocrinol Metab 2018; 103:2988-2997. [PMID: 29846630 DOI: 10.1210/jc.2018-00279] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/23/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist. OBJECTIVE To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis. DESIGN AND SETTING Randomized, double-blind, placebo-controlled trial nested within the Thyroid Hormone Replacement for Subclinical Hypothyroidism trial. PARTICIPANTS Participants aged ≥65 years with SHypo [thyroid-stimulating hormone (TSH), 4.60 to 19.99 mIU/L; free thyroxine level within reference range]. INTERVENTION Levothyroxine dose-titrated to achieve TSH normalization or placebo, including mock titrations. MAIN OUTCOME MEASURES Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound. RESULTS One hundred eighty-five participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH ± SD was 6.35 ± 1.95 mIU/L at baseline and decreased to 3.55 ± 2.14 mIU/L with levothyroxine compared with 5.29 ± 2.21 mIU/L with placebo (P < 0.001). After a median treatment of 18.4 months (interquartile range 12.2 to 30.0 months), mean CIMT was 0.85 ± 0.14 mm under levothyroxine and 0.82 ± 0.13 mm under placebo [between-group difference = 0.02 mm; 95% CI, -0.01 to 0.06; P = 0.30]. The proportion of carotid plaque was similar (n = 135; 70.8% under levothyroxine and 75.3% under placebo; P = 0.46). Maximum carotid plaque thickness was 2.38 ± 0.92 mm under levothyroxine and 2.37 ± 0.91 mm under placebo (between-group difference -0.03; 95% CI, -0.34 to 0.29; P = 0.86). There were no significant interactions between levothyroxine treatment and mean CIMT, according to sex, baseline TSH (categories 4.6 to 6.9, 7.0 to 9.9, and ≥10 mIU/L), or established cardiovascular disease (all P for interaction ≥ 0.14). CONCLUSION Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.
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Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baris Gencer
- Cardiology Division, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elisavet Moutzouri
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jörn Dopheide
- Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Bern, Switzerland
| | - Michèle Depairon
- Service of Angiology, Department of Heart and Vessels, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | | | - Rudi Westendorp
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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327
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Tozzoli R, D'Aurizio F, Metus P, Steffan A, Mazzon C, Bagnasco M. Reference intervals for thyrotropin in an area of Northern Italy: the Pordenone thyroid study (TRIPP). J Endocrinol Invest 2018; 41:985-994. [PMID: 29340973 DOI: 10.1007/s40618-018-0825-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/03/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Thyrotropin (TSH) is the most accurate marker of thyroid dysfunction in the absence of pituitary or hypothalamic disease. Studies on TSH reference intervals (RIs) showed wide inter-individual variability and prompted an intense debate about the best estimation of TSH RIs. DESIGN We performed a population study on TSH RIs, using current data stored in the laboratory information system (LIS), at the Hospital Department of Laboratory Medicine, Pordenone (Italy), historically an area of mild-moderate iodine deficiency with a relatively high goiter prevalence. METHODS 136,650 individuals constituted the final sample. A TSH immunoassay was performed on fasting serum samples with the Dimension Vista 1500 analyzer (Siemens Healthineers). We adopted the Kairisto's procedure to analyze TSH data downloaded by the LIS, applying the indirect strategy for deriving RIs. RESULTS TSH RIs of the entire population were 0.32-3.36 mIU/L with a distribution skewed towards higher values. RIs were 0.26-3.61 mIU/L for females, and 0.32-3.01 mIU/L for males. Unlike other studies, TSH median levels progressively decreased from 0-4 to 85-104 years in the overall population, both in male and in female subgroups, showing an inverse correlation between TSH and age in all groups. CONCLUSIONS This study is the first to analyze a high percentage (40%) of individuals from an ethnically homogenous Caucasian population. The results obtained emphasize the opportunity to define the TSH RIs according to age, gender and race, in addition to assay methods, and provide further insight about the possible role of iodine status.
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Affiliation(s)
- R Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria n. 5, Friuli Occidentale, Pordenone Hospital, Pordenone, Italy
| | - F D'Aurizio
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - P Metus
- Clinical Pathology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria n. 5, Friuli Occidentale, Pordenone Hospital, Pordenone, Italy
| | - A Steffan
- Immunopathology and Tumor Biomarkers Laboratory, National Cancer Institute, Aviano Hospital, Aviano, Italy
| | - C Mazzon
- Endocrinology Unit, Department of Internal Medicine, Azienda per l'Assistenza Sanitaria n. 5, Friuli Occidentale, Pordenone Hospital, Pordenone, Italy
| | - M Bagnasco
- Endocrinology and Autoimmunity Laboratory, Department of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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328
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Vigone MC, Capalbo D, Weber G, Salerno M. Mild Hypothyroidism in Childhood: Who, When, and How Should Be Treated? J Endocr Soc 2018; 2:1024-1039. [PMID: 30187015 PMCID: PMC6117400 DOI: 10.1210/js.2017-00471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Mild hypothyroidism, also known as subclinical hypothyroidism (SH), is biochemically defined as serum TSH levels above the upper limit of the reference range, in the presence of normal serum concentrations of total T4 and free T4 (FT4). In the neonatal period, mild hypothyroidism can be defined by the presence of a TSH value between 6 and 20 mIU/L and normal FT4 levels. After the neonatal period, SH can be defined mild if TSH ranges between 4.5 and 10 mIU/L. The management of mild hypothyroidism in childhood is challenging. The major concern is to establish whether this condition should always be considered an expression of mild thyroid dysfunction. Indeed, the effects of untreated mild hypothyroidism are still not completely defined. In the neonatal period, concern exists about neurocognitive outcome; in children, although there is no clear evidence of alterations in growth or neurocognitive development, subtle cardiovascular abnormalities have been documented. Therefore, there is still uncertainty about the need of treatment across all ages, and the management should be based on the age of the child, the etiology, and the degree of TSH elevation, as well as on other patient factors. This review updates current evidences on diagnosis and management of mild hypothyroidism in childhood.
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Affiliation(s)
| | - Donatella Capalbo
- Department of Pediatrics, University Hospital Federico II, Naples, Italy
| | - Giovanna Weber
- Department of Pediatrics, Vita-Salute San Raffaele University, Milano, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences-Pediatric Section, University of Naples Federico II, Naples, Italy
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329
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Girotra M, Hansen A, Farooki A, Byun DJ, Min L, Creelan BC, Callahan MK, Atkins MB, Sharon E, Antonia SJ, West P, Gravell AE. The Current Understanding of the Endocrine Effects From Immune Checkpoint Inhibitors and Recommendations for Management. JNCI Cancer Spectr 2018; 2:pky021. [PMID: 30057972 PMCID: PMC6054022 DOI: 10.1093/jncics/pky021] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/03/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022] Open
Abstract
Clinical trials in the past decade have established the antitumor effects of immune checkpoint inhibition as a revolutionary treatment for cancer. Namely, blocking antibodies to cytotoxic T-lymphocyte antigen 4 and programmed death 1 or its ligand have reached routine clinical use. Manipulation of the immune system is not without side effects, and autoimmune toxicities often known as immune-related adverse events (IRAEs) are observed. Endocrine IRAEs, such as hypophysitis, thyroid dysfunction, and insulin-dependent diabetes mellitus, can present with unique profiles that are not seen with the use of traditional chemotherapeutics. In this Review, we discuss the current hypotheses regarding the mechanism of these endocrinopathies and their clinical presentations. Further, we suggest guidelines and algorithms for patient management and future clinical trials to optimize the detection and treatment of immune checkpoint–related endocrinopathies.
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Affiliation(s)
- Monica Girotra
- Endocrine Division, Department of Medicine, Weill Cornell Medical College
- Correspondence to: Monica Girotra, MD, Endocrine Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (e-mail: )
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Azeez Farooki
- Endocrine Division, Department of Medicine, Weill Cornell Medical College
| | | | - Le Min
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA
| | | | | | | | - Elad Sharon
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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330
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Is only Thyroid Peroxidase Antibody Sufficient for Diagnosing Chronic Lymphocytic Thyroiditis? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:97-102. [PMID: 32595380 PMCID: PMC7315066 DOI: 10.14744/semb.2017.36450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Abstract
Objectives: Recently, only anti-thyroid peroxidase (anti-TPO) has been suggested as an autoantibody in the diagnosis of chronic lymphocytic thyroiditis (CLT). In contrast, anti-thyroglobulin (anti-Tg) positivity has also been reported to be important. To evaluate this relationship more clearly, we planned to retrospectively investigate the autoantibody levels of the patients who underwent thyroid surgery for various reasons and those with CLT in postoperative pathology. Methods: We evaluated 670 patients who underwent thyroid surgery (total/subtotal thyroidectomy) for various reasons at our hospital between January 2015 and March 2017. Patients with indications of Graves’ disease, toxic multinodular goiter, and all malignancies except for thyroid papillary carcinoma (TPC) were excluded. Eighty-nine patients whose pathology findings were compatible with CLT and preoperative thyroid autoantibodies were identified enrolled in to the study. Patients with absence and presence of thyroid antibodies were included in the seronegative CLT group and seropositive CLT group, respectively. In addition, patients were divided into thyroid papillary carcinoma (TPC) and benign groups. Results: According to the study criteria, 89 (83 females, six males) (mean age, 46.08±11.19 years) patients who had preoperatively identified autoantibodies were detected. Anti-TPO positivity was found in 47 (52.8%) cases, whereas anti-Tg positivity was found in 49 (55.1%). Only anti-TPO positivity was found in 18 (20.2%) cases, whereas only anti-Tg positivity was detected in 20 (22.5%). Twenty-two (24.7%) of the patients were seronegative. On comparing the seronegative and seropositive groups, seronegativity was more frequent in male patients (p=0.03). Thyroid-stimulating hormone was found to be significantly higher in the seropositive group (p=0.01). TPC was detected in 36 (40.4%) of all cases. No difference regarding age, thyroid function tests, and antibody levels was found between the benign and TPC groups. Conclusion: Although all of our cases were histopathologically diagnosed with CLT, serologically, 75.3% of thyroid autoimmunities could be shown when both antibodies were evaluated together. When only anti-TPO was considered, this rate decreased to 52.8%. Therefore, anti-Tg appears to be still important in showing autoimmunity. Prospective studies are needed to evaluate this relationship more clearly.
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331
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Abstract
The diagnosis of hypothyroidism is primarily based on clinical signs and symptoms as well as measurement of thyroid-stimulating hormone (TSH) concentration. Subclinical hypothyroidism is characterized by elevated TSH with normal serum free thyroxine (fT4) and triiodothyronine (fT3) levels, while in manifest hypothyroidism serum fT4 and fT3 levels are reduced. Common causes of primary hypothyroidism are autoimmune thyroiditis as well as therapeutic interventions, such as thyroid surgery or radioiodine therapy. Signs and symptoms of hypothyroidism include fatigue, bradycardia, constipation and cold intolerance. In subclinical hypothyroidism, symptoms may be absent. Initiation of levothyroxine (T4) therapy not only depends on the level of TSH elevation, but also on other factors, such as patient age, presence of pregnancy or comorbidities. Treatment of patients with subclinical hypothyroidism is still a controversial topic. In general, thyroid hormone replacement therapy in non-pregnant adults ≤ 70 years is clearly indicated if the TSH concentration is >10 mU/l. Standard of care for treatment of hypothyroidism is T4 monotherapy. The biochemical treatment goal for T4 replacement in primary hypothyroidism is a TSH level within the reference range (0.4-4.0 mU/l). In contrast, in secondary hypothyroidism, serum fT4 levels are the basis for adjusting thyroid hormone dosage. Inadequate replacement of T4 resulting in subclinical or even manifest hyperthyroidism should urgently be avoided. T4/liothyronine (T3) combination therapy is still a matter of debate and not recommended as standard therapy, but may be considered in patients with persistence of symptoms, despite optimal T4 treatment, based on expert opinion.
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332
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Decallonne B, Bartholomé E, Delvaux V, D'haeseleer M, El Sankari S, Seeldrayers P, Van Wijmeersch B, Daumerie C. Thyroid disorders in alemtuzumab-treated multiple sclerosis patients: a Belgian consensus on diagnosis and management. Acta Neurol Belg 2018; 118:153-159. [PMID: 29372482 PMCID: PMC5971042 DOI: 10.1007/s13760-018-0883-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/15/2018] [Indexed: 01/21/2023]
Abstract
This paper deals with thyroid disease that can occur after treatment with alemtuzumab (humanized monoclonal anti-CD52) for relapsing–remitting multiple sclerosis (MS). The 5-year incidence of thyroid adverse events in phase 3 clinical trials is up to 40.7%. In most cases, the thyroid dysfunction is mild and easily manageable and only few serious thyroid adverse events have been reported. The need for patient education on the risk of thyroid dysfunction, as well as regular clinical and biochemical thyroid function screening is well described. However, practical clinical guidance in case of abnormal thyroid-related findings prior to or after alemtuzumab treatment is currently lacking. Therefore, a Belgian taskforce consisting of MS and thyroid experts was created in 2016, with the objective of issuing a clinical thyroid management algorithm based on available scientific evidence and personal experience with regard to alemtuzumab treatment-related thyroid adverse events.
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Affiliation(s)
- Brigitte Decallonne
- Department of Endocrinology, Universitair Ziekenhuis Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | | | - Valérie Delvaux
- Department of Neurology, CHU de Liège, site CHR, Liège, Belgium
| | - Miguel D'haeseleer
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Nationaal MS Centrum, Melsbroek, Belgium
| | - Souraya El Sankari
- Department of Neurology, Cliniques Universitaires St Luc, Brussels, Belgium
| | | | | | - Chantal Daumerie
- Department of Endocrinology, Cliniques Universitaires St Luc, Brussels, Belgium
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333
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de Carvalho GA, Paz-Filho G, Mesa Junior C, Graf H. MANAGEMENT OF ENDOCRINE DISEASE: Pitfalls on the replacement therapy for primary and central hypothyroidism in adults. Eur J Endocrinol 2018; 178:R231-R244. [PMID: 29490937 DOI: 10.1530/eje-17-0947] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 01/07/2023]
Abstract
Hypothyroidism is one of the most common hormone deficiencies in adults. Most of the cases, particularly those of overt hypothyroidism, are easily diagnosed and managed, with excellent outcomes if treated adequately. However, minor alterations of thyroid function determine nonspecific manifestations. Primary hypothyroidism due to chronic autoimmune thyroiditis is largely the most common cause of thyroid hormone deficiency. Central hypothyroidism is a rare and heterogeneous disorder characterized by decreased thyroid hormone secretion by an otherwise normal thyroid gland, due to lack of TSH. The standard treatment of primary and central hypothyroidism is hormone replacement therapy with levothyroxine sodium (LT4). Treatment guidelines of hypothyroidism recommend monotherapy with LT4 due to its efficacy, long-term experience, favorable side effect profile, ease of administration, good intestinal absorption, long serum half-life and low cost. Despite being easily treatable with a daily dose of LT4, many patients remain hypothyroid due to malabsorption syndromes, autoimmune gastritis, pancreatic and liver disorders, drug interactions, polymorphisms in DIO2 (iodothyronine deiodinase 2), high fiber diet, and more frequently, non-compliance to LT4 therapy. Compliance to levothyroxine treatment in hypothyroidism is compromised by daily and fasting schedule. Many adult patients remain hypothyroid due to all the above mentioned and many attempts to improve levothyroxine therapy compliance and absorption have been made.
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Affiliation(s)
- Gisah Amaral de Carvalho
- Department of Endocrinology and Metabolism, SEMPR, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Cleo Mesa Junior
- Department of Endocrinology and Metabolism, SEMPR, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Hans Graf
- Department of Endocrinology and Metabolism, SEMPR, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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334
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Lamine F, De Giorgi S, Marino L, Michalaki M, Sykiotis GP. Subclinical hypothyroidism: new trials, old caveats. Hormones (Athens) 2018; 17:231-236. [PMID: 29858848 DOI: 10.1007/s42000-018-0004-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022]
Abstract
The indications for levothyroxine replacement therapy for subclinical hypothyroidism (SH) remain a subject of debate, especially when prescribed for older adults. The results of the recent TRUST trial indicate that levothyroxine does not improve clinical symptom scores among elderly patients with SH. While there is much concern regarding the dilemma of introducing or withholding levothyroxine, less attention may be paid to the differential diagnosis of an elevated TSH level, which is the prerequisite for diagnosing SH. Herein, we review these issues facing endocrinologists and internists/generalists either in practice or in training. When a patient presents abnormal thyroid test results compatible with SH, a series of issues need to be addressed before the implementation of replacement therapy is considered: first, an isolated TSH elevation not linked to a primary thyroid pathology should be excluded; second, the persistent nature of the patient's TSH elevation and SH profile should be verified; third, SH symptoms and potential complications relevant for the specific patient should be documented; fourth, expectations from levothyroxine substitution therapy for SH in the specific patient should be clarified. Only then can the decision be made whether levothyroxine substitution should be introduced or not.
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Affiliation(s)
- Faiza Lamine
- Service of Endocrinology, Diabetology and Metabolism - CHUV, Lausanne University Hospital, Ave de la Sallaz 8, SA08/02/250, 1011, Lausanne, Switzerland
| | - Sara De Giorgi
- Service of Endocrinology, Diabetology and Metabolism - CHUV, Lausanne University Hospital, Ave de la Sallaz 8, SA08/02/250, 1011, Lausanne, Switzerland
| | - Laura Marino
- Service of Endocrinology, Diabetology and Metabolism - CHUV, Lausanne University Hospital, Ave de la Sallaz 8, SA08/02/250, 1011, Lausanne, Switzerland
| | - Marina Michalaki
- Division of Endocrinology, Patras University Medical School, Patras, Greece
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism - CHUV, Lausanne University Hospital, Ave de la Sallaz 8, SA08/02/250, 1011, Lausanne, Switzerland.
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335
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Maekura T, Naito M, Tahara M, Ikegami N, Kimura Y, Sonobe S, Kobayashi T, Tsuji T, Minomo S, Tamiya A, Atagi S. Predictive Factors of Nivolumab-induced Hypothyroidism in Patients with Non-small Cell Lung Cancer. ACTA ACUST UNITED AC 2018; 31:1035-1039. [PMID: 28882978 DOI: 10.21873/invivo.11166] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although immune checkpoint inhibitors play an important role in the therapy of lung cancer, they are associated with various immune-related adverse events and predictive factors of them are unclear. In this study, we investigated predictive factors of nivolumab-induced hypothyroidism which is one of the adverse events in patients with lung cancer. PATIENTS AND METHODS Patients with non-small-cell lung cancer who were administered nivolumab at our hospital between December 2015 and May 2016 were retrospectively enrolled. The thyroid-stimulating hormone, free triiodothyronine, free thyroxine, thyroid peroxidase (TPO) antibody, and thyroglobulin antibody levels of each patient were analyzed. RESULTS Of the 64 patients enrolled, 5 (7.8%) developed hypothyroidism after treatment with nivolumab. The TPO and thyroglobulin antibodies were significantly positive in patients who developed primary hypothyroidism. CONCLUSION TPO and thyroglobulin antibody levels at baseline may be predictive of hypothyroidism.
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Affiliation(s)
- Toshiya Maekura
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Maiko Naito
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Masahiro Tahara
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Naoya Ikegami
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Yohei Kimura
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shoko Sonobe
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Taisuke Tsuji
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shojiro Minomo
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shinji Atagi
- Department of Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
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Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, Okosieme OE. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018; 14:301-316. [PMID: 29569622 DOI: 10.1038/nrendo.2018.18] [Citation(s) in RCA: 644] [Impact Index Per Article: 107.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Diana Albrecht
- University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
| | - Anna Scholz
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Gala Gutierrez-Buey
- Clinica Universidad de Navarra, Department of Endocrinology and Nutrition, Pamplona, Spain
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Colin M Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Onyebuchi E Okosieme
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
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337
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Schneider C, Feller M, Bauer DC, Collet TH, da Costa BR, Auer R, Peeters RP, Brown SJ, Bremner AP, O’Leary PC, Feddema P, Leedman PJ, Aujesky D, Walsh JP, Rodondi N. Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary? PLoS One 2018; 13:e0196631. [PMID: 29709030 PMCID: PMC5927436 DOI: 10.1371/journal.pone.0196631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/15/2018] [Indexed: 01/07/2023] Open
Abstract
Objective Guidelines for thyroid function evaluation recommend testing TSH first, then assessing fT4 only if TSH is out of the reference range (two-step), but many clinicians initially request both TSH and fT4 (one-step). Given limitations of previous studies, we aimed to compare the two-step with the one-step approach in an unselected community-dwelling study population, and develop a prediction score based on clinical parameters that could identify at-risk patients for thyroid dysfunction. Design Cross-sectional analysis of the population-based Busselton Health Study. Methods We compared the two-step with the one-step approach, focusing on cases that would be missed by the two-step approach, i.e. those with normal TSH, but out-of-range fT4. We used likelihood ratio tests to identify demographic and clinical parameters associated with thyroid dysfunction and developed a clinical prediction score by using a beta-coefficient based scoring method. Results Following the two-step approach, 93.0% of all 4471 participants had normal TSH and would not need further testing. The two-step approach would have missed 3.8% of all participants (169 of 4471) with a normal TSH, but a fT4 outside the reference range. In 85% (144 of 169) of these cases, fT4 fell within 2 pmol/l of fT4 reference range limits, consistent with healthy outliers. The clinical prediction score that performed best excluded only 22.5% of participants from TSH testing. Conclusion The two-step approach may avoid measuring fT4 in as many as 93% of individuals with a very small risk of missing thyroid dysfunction. Our findings do not support the simultaneous initial measurement of both TSH and fT4.
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Affiliation(s)
- Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bruno R. da Costa
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Suzanne J. Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Alexandra P. Bremner
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Peter C. O’Leary
- School of Women's and Infants' Health, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Peter J. Leedman
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- UWA Centre for Medical Research, Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John P. Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
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338
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Reindl M, Feistritzer HJ, Reinstadler SJ, Mueller L, Tiller C, Brenner C, Mayr A, Henninger B, Mair J, Klug G, Metzler B. Thyroid-stimulating hormone and adverse left ventricular remodeling following ST-segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:717-726. [PMID: 29637788 DOI: 10.1177/2048872618770600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adverse left ventricular remodeling is one of the major determinants of heart failure and mortality in patients surviving ST-segment elevation myocardial infarction (STEMI). The hypothalamic-pituitary-thyroid axis is a key cardiovascular regulator; however, the relationship between hypothalamic-pituitary-thyroid status and post-STEMI left ventricular remodeling is unclear. We aimed to investigate the association between thyroid-stimulating hormone concentrations and the development of left ventricular remodeling following reperfused STEMI. METHODS In this prospective observational study of 102 consecutive STEMI patients, thyroid-stimulating hormone levels were measured at the first day after infarction and 4 months thereafter. Cardiac magnetic resonance scans were performed within the first week as well as at 4 months follow-up to determine infarct characteristics, myocardial function and as primary endpoint left ventricular remodeling, defined as a 20% or greater increase in left ventricular end-diastolic volume. RESULTS Patients with left ventricular remodeling (n=15, 15%) showed significantly lower concentrations of baseline (1.20 [0.92-1.91] vs. 1.73 [1.30-2.60] mU/l; P=0.02) and follow-up (1.11 [0.86-1.28] vs. 1.51 [1.15-2.02] mU/l; P=0.002) thyroid-stimulating hormone. The association between baseline thyroid-stimulating hormone and left ventricular remodeling remained significant after adjustment for major clinical (peak high-sensitivity cardiac troponin T and C-reactive protein, heart rate; odds ratio (OR) 5.33, 95% confidence interval (CI) 1.52-18.63; P=0.01) and cardiac magnetic resonance predictors of left ventricular remodeling (infarct size, microvascular obstruction, ejection fraction; OR 4.59, 95% CI 1.36-15.55; P=0.01). Furthermore, chronic thyroid-stimulating hormone was related to left ventricular remodeling independently of chronic left ventricular remodeling correlates (infarct size, ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume; OR 9.22, 95% CI 1.69-50.22; P=0.01). CONCLUSIONS Baseline and chronic thyroid-stimulating hormone concentrations following STEMI were independently associated with left ventricular remodeling, proposing a novel pathophysiological axis in the development of post-STEMI left ventricular remodeling.
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Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | | | - Lukas Mueller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Christoph Brenner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Austria
| | - Johannes Mair
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria
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Diffuse Myocardial Injuries are Present in Subclinical Hypothyroidism: A Clinical Study Using Myocardial T1-mapping Quantification. Sci Rep 2018; 8:4999. [PMID: 29567964 PMCID: PMC5864753 DOI: 10.1038/s41598-018-22970-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/02/2018] [Indexed: 12/31/2022] Open
Abstract
Subclinical hypothyroidism (SHT) is a common disorder that may represent early thyroid dysfunction and is related to adverse cardiovascular events. However, myocardial injuries induced by SHT are difficult to detect. Our previous study demonstrated that the cardiac magnetic resonance (CMR) myocardial longitudinal relaxation time (T1) mapping technique is a useful tool for assessing diffuse myocardial injuries in overt hypothyroidism patients. This study was designed to detect whether diffuse myocardial injuries were present in SHT by using the T1 mapping technique. We found that SHT participants had significantly increased native T1 values within four segments of the left ventricle (all p < 0.01), especially patients with thyroid-stimulating hormone (TSH) levels ≥10 µIU/mL, compared with those in the controls. In addition, the native T1 values were negatively correlated with free thyroxine (FT4) (r = −0.476, p = 0.003) and were positively correlated with TSH (r = 0.489, p = 0.002). Furthermore, left ventricular diastolic function estimated by the peak filling rate (PFR) was significantly lower in patients with TSH levels ≥10 µIU/mL than that in the controls (p < 0.05). In conclusion, diffuse myocardial injuries were present in SHT, and T1 mapping may be a useful tool for evaluating mild myocardial injuries in SHT at an early stage. Our study is the first to confirm myocardial injuries in SHT patients using T1 mapping.
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340
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Therapie der latenten Hypothyreose bei Älteren. Internist (Berl) 2018; 59:304-306. [DOI: 10.1007/s00108-018-0381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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341
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Rosario PWS, Calsolari MR. Impact of subclinical hypothyroidism with TSH ≤10 mIU/L on glomerular filtration rate in adult women without known kidney disease. Endocrine 2018; 59:694-697. [PMID: 29327299 DOI: 10.1007/s12020-017-1496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
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342
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Møllehave LT, Linneberg A, Skaaby T, Knudsen N, Ehlers L, Jørgensen T, Thuesen BH. Trends in Costs of Thyroid Disease Treatment in Denmark during 1995-2015. Eur Thyroid J 2018; 7:75-83. [PMID: 29594058 PMCID: PMC5869578 DOI: 10.1159/000485973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Iodine fortification (IF) may contribute to changes in costs of thyroid disease treatment through changes in disease patterns. From a health economic perspective, assessment of the development in costs of thyroid disease treatment in the population is pertinent. OBJECTIVES To assess the trends in annual medicine and hospital costs of thyroid disease treatment during 1995-2015 in Denmark, i.e., before and after the introduction of mandatory IF in 2000. METHODS Information on treatments for thyroid disease (antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment) was obtained from nationwide registers. Costs were valued at 2015 prices using sales prices for medicines and the Danish Diagnosis-Related Group (DRG) and Danish Ambulatory Grouping System (DAGS) tariffs of surgeries/radioiodine treatments. Results were adjusted for changes in population size and age and sex distribution. RESULTS The total direct medicine and hospital costs of thyroid disease treatment increased from EUR ∼190,000 per 100,000 persons in 1995 to EUR ∼270,000 per 100,000 persons in 2015. This was mainly due to linearly increased costs of thyroid hormone therapy and increased costs of thyroid surgery since 2008. Costs of antithyroid medication increased slightly and transiently after IF, while costs of radioiodine treatment remained constant. Costs of thyroid hormone therapy and thyroid surgery did not follow the development in the prevalence of hypothyroidism and structural thyroid diseases observed in concurrent studies. CONCLUSION The costs of total direct medicine and hospital costs for thyroid disease treatment in Denmark increased from 1995 to 2015. This is possibly due to several factors, e.g., changes in treatment practices, and the direct effect of IF alone remains to be estimated.
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Affiliation(s)
- Line Tang Møllehave
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- *Line Tang Møllehave, Research Centre for Prevention and Health, The Capital Region of Denmark, Nordre Ringvej 57, Building 84/85, Glostrup, DK–2600 Copenhagen (Denmark), E-Mail
| | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Tea Skaaby
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Betina Heinsbæk Thuesen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Copenhagen, Denmark
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343
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Gallizzi R, Crisafulli C, Aversa T, Salzano G, De Luca F, Valenzise M, Zirilli G. Subclinical hypothyroidism in children: is it always subclinical? Ital J Pediatr 2018; 44:25. [PMID: 29454373 PMCID: PMC5816505 DOI: 10.1186/s13052-018-0462-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
Aim of this commentary is to report current knowledges on the main clinical and metabolic abnormalities which might be observed in children with longstanding and untreated subclinical hypothyroidism (SH) and to comment the most recent views about natural evolution of thyroid function in the cases with either idiopathic or Hashimoto’s thyroiditis-related SH. On the basis of these preliminary remarks, the essential guidelines for an appropriate and tailored management of SH children are also proposed.
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Affiliation(s)
- R Gallizzi
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - C Crisafulli
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - T Aversa
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - G Salzano
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - F De Luca
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
| | - M Valenzise
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy.
| | - G Zirilli
- UOC Pediatria, Department of Human Pathology of Adulthood and Childhood, University of Messina, via Consolare Valeria, 98125, Messina, Italy
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Pearce SHS, Gan EH. Low-dose levothyroxine did not improve symptoms in asymptomatic older people with subclinical hypothyroidism. BMJ Evid Based Med 2018; 23:39-40. [PMID: 29367328 DOI: 10.1136/ebmed-2017-110819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Simon H S Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Earn H Gan
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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345
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Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J 2018; 13:55-59. [PMID: 28740582 DOI: 10.14797/mdcj-13-2-55] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters.
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346
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Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism and hypertension: fact or myth? - Authors' reply. Lancet 2018; 391:30. [PMID: 29323655 DOI: 10.1016/s0140-6736(17)33321-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Layal Chaker
- Academic Centre for Thyroid Disease, Erasmus University Medical Centre, Rotterdam 3015 CE, Netherlands
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, IL, USA
| | | | - Robin P Peeters
- Academic Centre for Thyroid Disease, Erasmus University Medical Centre, Rotterdam 3015 CE, Netherlands.
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347
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He W, Li S, Zhang JA, Zhang J, Mu K, Li XM. Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2018; 9:454. [PMID: 30154757 PMCID: PMC6103239 DOI: 10.3389/fendo.2018.00454] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Patients with subclinical hypothyroidism (SCH) have elevated blood pressure, but the effect of levothyroxine (LT4) therapy on blood pressure among those patients is still unclear. This study aimed to assess whether LT4 therapy could reduce blood pressure in SCH patients through a systematic review and meta-analysis. Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched. Randomized controlled trials (RCTs) assessing the effect of LT4 therapy on blood pressure or prospective follow-up studies comparing the blood pressure level before and after LT4 treatment were included, and the mean difference of systolic blood pressure (SBP) or diastolic blood pressure (DBP) was pooled using random-effect meta-analysis. Results: Twenty-nine studies including 10 RCTs and 19 prospective follow-up studies were eligible for the analysis. Meta-analysis of 10 RCTs suggested that LT4 therapy could significantly reduce SBP in SCH patients by 2.48 mmHg (95% CI -4.63 to -0.33, P = 0.024). No heterogeneity was observed among these 10 RCTs (I2 = 0%). Meta-analysis of the 19 prospective follow-up studies found that LT4 therapy significantly decreased SBP and DBP by 4.80 mmHg (95%CI -6.50 to -3.09, P < 0.001) and 2.74 mmHg (95%CI -4.06 to -1.43, P < 0.001), respectively. Conclusion: The findings suggest that LT4 replacement therapy can reduce blood pressure in SCH patients, which needs to be validated in more clinical trials with larger samples.
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Affiliation(s)
- Weiwei He
- Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
| | - Sheli Li
- Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
| | - Jin-an Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jing Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Kaida Mu
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xin-ming Li
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- *Correspondence: Xin-ming Li
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348
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Mujer, corazón y tiroides. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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349
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Parent S, Cujec B. Subclinical Hypothyroidism and Heart Failure: Chicken or Egg? Can J Cardiol 2018; 34:11-12. [DOI: 10.1016/j.cjca.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022] Open
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350
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Sato Y, Yoshihisa A, Kimishima Y, Kiko T, Watanabe S, Kanno Y, Abe S, Miyata M, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Ishida T, Takeishi Y. Subclinical Hypothyroidism Is Associated With Adverse Prognosis in Heart Failure Patients. Can J Cardiol 2018; 34:80-87. [DOI: 10.1016/j.cjca.2017.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 01/07/2023] Open
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