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Fukuda T, Tachibana S, Osako T, Mori Y, Shindo H, Takahashi H, Satoh S, Nagayama Y, Yamashita H. Alterations in Body Weight and Composition in Patients With Graves' Disease Treated with Total Thyroidectomy. Cureus 2024; 16:e63338. [PMID: 39070443 PMCID: PMC11283590 DOI: 10.7759/cureus.63338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Thyrotoxicosis causes excess energy expenditure, resulting in weight loss, despite increased appetite, and changes in body composition, which are typically reversible with the normalization of thyroid hormone levels. However, patients with hyperthyroidism due to Graves' disease are sometimes hesitant to undergo treatment because of the perceived morbidity associated with weight gain. Therefore, obtaining data to explain the details of such weight gain to these patients is important. This study aimed to investigate changes in body weight and composition in patients with Graves' disease after total thyroidectomy. METHODS In total, 21 patients with Graves' disease who underwent total thyroidectomy were enrolled. Among them, nine patients were hyperthyroid (group A) and 12 were euthyroid (group B, control) immediately before surgery. Body weight, height, and body composition using bioelectrical impedance were measured preoperatively and five months postoperatively. RESULTS In all patients, body weight, body mass index, and skeletal muscle mass, but not fat mass, significantly increased postoperatively. In individual groups, a significant increase in skeletal muscle and fat masses was observed solely in groups A and B, respectively. Furthermore, a significant positive correlation between preoperative thyroid function and differences in skeletal muscle mass preoperatively and postoperatively was found. CONCLUSION Our study shows that the normalization of thyroid function using thyroidectomy in patients with Graves' disease is accompanied by weight gain, mainly due to an increase in skeletal muscle mass. These data are clinically significant because they enable physicians to explain to patients that weight gain after surgical treatment for Graves' disease is favorable and reassure them of their concern.
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Affiliation(s)
- Takashi Fukuda
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Seigo Tachibana
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Tomohiro Osako
- Department of Endocrinology, Tomo Thyroid Clinic, Kagoshima City, JPN
| | - Yusuke Mori
- Department of Endocrinology, Tomo Thyroid Clinic, Kagoshima City, JPN
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Hiroshi Takahashi
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Shinya Satoh
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka City, JPN
| | - Yuji Nagayama
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, JPN
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Calissendorff J, Cramon PK, Hallengren B, Khamisi S, Lantz M, Planck T, Sjölin G, Wallin G, Holmberg M. Long-Term Outcome of Graves' Disease: A Gender Perspective. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:487-496. [PMID: 37818181 PMCID: PMC10561747 DOI: 10.1089/whr.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 10/12/2023]
Abstract
Introduction In gender-skewed conditions such as Graves' disease (GD), the outcome naturally becomes dominated by the majority. This may lead to gender-biased misunderstandings regarding treatment outcomes. This especially holds true when complications, such as depression, are unevenly distributed. We have, therefore, studied the long-term outcome of GD from a gender perspective. Materials and Methods A cohort of 1186 patients with GD was included in a follow-up 6-10 years after inclusion. Choice of treatment, the feeling of recovery, long-term treatment, comorbidity, and quality of life were investigated with questionnaires. All results were studied sex-divided. Results We included 973 women and 213 men. There was no difference between men and women in the choice of treatment. At follow-up, women scored significantly worse in the general questionnaire 36-item Short-Form Health Status (SF-36) domain bodily pain and in the thyroid-specific Thyroid-Related Patient-Reported Outcome (ThyPRO) domains depression, impaired sex life, and cosmetic complaints, all p < 0.05. Women were twice as likely (29.5%) to be treated with levothyroxine after successful treatment with antithyroid drugs (ATD) compared with men (14.9%, p < 0.05). Conclusion After treatment for GD, women were more affected by depression, impaired sex life, cosmetic issues, and bodily pain despite successful cure of hyperthyroidism. The prevalence of hypothyroidism was also doubled in women. Whether these observed gender differences reflect a worse outcome of GD in women or a natural consequence of a higher prevalence of these symptoms and autoimmunity in the female population is difficult to disentangle. Nevertheless, several years after GD, women reveal more persistent symptoms.
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Affiliation(s)
- Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Bengt Hallengren
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Selwan Khamisi
- Department of Endocrinology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mikael Lantz
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Tereza Planck
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gabriel Sjölin
- Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Göran Wallin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Mats Holmberg
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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Croce L, Pallavicini C, Busca N, Calì B, Bellastella G, Coperchini F, Magri F, Chiovato L, Cena H, Rotondi M. Pre-surgery dietician counseling can prevent post-thyroidectomy body weight gain: results of an intervention trial. Endocrine 2023:10.1007/s12020-023-03365-z. [PMID: 37074559 PMCID: PMC10293335 DOI: 10.1007/s12020-023-03365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE It is widely accepted that patients experience weight gain after total thyroidectomy, and preventive measures should be recommended. METHODS A prospective study was designed to assess the efficacy of a dietetic intervention to prevent post-thyroidectomy weight gain in patients undergoing surgery for both benign and malignant thyroid conditions. Patients undergoing total thyroidectomy were prospectively and randomly assigned to receive a personalized pre-surgery diet counseling (GROUP A) or no intervention (GROUP B), according to a 1:2 ratio. All patients underwent follow-up with body-weight measurement, thyroid function evaluation and lifestyle and eating habits assessment at baseline (T0), 45 days (T1) and 12 months (T2) post-surgery. RESULTS The final study group encompassed 30 patients in Group A and 58 patients in Group B. The two groups were similar in terms of age, sex, pre-surgery BMI, thyroid function and underlying thyroid condition. The evaluation of body weight variations showed that patients in Group A did not experience significant body weight changes at either T1 (p = 0.127) nor T2 (p = 0.890). At difference, patients in Group B underwent a significant body weight increase from T0 to both T1 (p = 0.009) and T2 (p = 0.009). TSH levels were similar in the two groups, both at T1 and T2. Lifestyle and eating habits questionnaires failed to register any significant difference between the two groups, apart from an increase in sweetened beverages consumption in Group B. CONCLUSIONS A dietician counseling is effective in preventing the post-thyroidectomy weight gain. Further studies in larger series of patients with a longer follow-up appear worthwhile.
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Affiliation(s)
- Laura Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy
| | - Cristina Pallavicini
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Noemi Busca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Benedetto Calì
- Istituti Clinici Scientifici Maugeri IRCCS, Department of General and Minimally Invasive Surgery, Pavia, 27100, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Hellas Cena
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Clinical Nutrition and Dietetics Service, Unit of Endocrinology, 27100, Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy.
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy.
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy.
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Wiersinga WM, Poppe KG, Effraimidis G. Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol 2023; 11:282-298. [PMID: 36848916 DOI: 10.1016/s2213-8587(23)00005-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 02/26/2023]
Abstract
Hyperthyroidism is a common condition with a global prevalence of 0·2-1·3%. When clinical suspicion of hyperthyroidism arises, it should be confirmed by biochemical tests (eg, low TSH, high free thyroxine [FT4], or high free tri-iodothyonine [FT3]). If hyperthyroidism is confirmed by biochemical tests, a nosological diagnosis should be done to find out which disease is causing the hyperthyroidism. Helpful tools are TSH-receptor antibodies, thyroid peroxidase antibodies, thyroid ultrasonography, and scintigraphy. Hyperthyroidism is mostly caused by Graves' hyperthyroidism (70%) or toxic nodular goitre (16%). Hyperthyroidism can also be caused by subacute granulomatous thyroiditis (3%) and drugs (9%) such as amiodarone, tyrosine kinase inhibitors, and immune checkpoint inhibitors. Disease-specific recommendations are given. Currently, Graves' hyperthyroidism is preferably treated with antithyroid drugs. However, recurrence of hyperthyroidism after a 12-18 month course of antithyroid drugs occurs in approximately 50% of patients. Being younger than 40 years, having FT4 concentrations that are 40 pmol/L or higher, having TSH-binding inhibitory immunoglobulins that are higher than 6 U/L, and having a goitre size that is equivalent to or larger than WHO grade 2 before the start of treatment with antithyroid drugs increase risk of recurrence. Long-term treatment with antithyroid drugs (ie, 5-10 years of treatment) is feasible and associated with fewer recurrences (15%) than short-term treatment (ie, 12-18 months of treatment). Toxic nodular goitre is mostly treated with radioiodine (131I) or thyroidectomy and is rarely treated with radiofrequency ablation. Destructive thyrotoxicosis is usually mild and transient, requiring steroids only in severe cases. Specific attention is given to patients with hyperthyroidism who are pregnant, have COVID-19, or have other complications (eg, atrial fibrillation, thyrotoxic periodic paralysis, and thyroid storm). Hyperthyroidism is associated with increased mortality. Prognosis might be improved by rapid and sustained control of hyperthyroidism. Innovative new treatments are expected for Graves' disease, by targeting B cells or TSH receptors.
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Affiliation(s)
- Wilmar M Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Netherlands
| | - Kris G Poppe
- Endocrine Unit, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Grigoris Effraimidis
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Kirkgoz T, Abali S, Seker A, Gurpinar Tosun B, Eltan M, Helvacioglu D, Haliloglu B, Kaygusuz SB, Yavas Abali Z, Seven Menevse T, Bozkurt S, Ones T, Guran T, Dagcinar A, Bereket A, Turan S. Challenges in the Management of a 7-Year-Old Child with Thyrotropin-Secreting Pituitary Adenoma and the Review of the Literature. Horm Res Paediatr 2023; 96:527-537. [PMID: 36630941 DOI: 10.1159/000529070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representing less than 1% of the pituitary tumours and presenting with elevated thyroid hormones and normal/high TSH concentrations. CASE PRESENTATION A 7-year-old boy with nervousness was referred by his psychiatrist for elevated free T4, T3, and TSH levels. Initial evaluation revealed an elevated α-subunit. Pituitary magnetic resonance imaging (MRI) demonstrated a macroadenoma. The patient underwent a trans-sphenoidal tumour resection (TSS) which showed positive immunohistochemical staining for TSH, growth hormone, and prolactin in tumoral tissue. Euthyroidism was achieved for 1 year after TSS, then recurrence of tumour with elevated TSH and thyroid hormone levels necessitated a re-operation with TSS followed by gamma-knife radiosurgery. The euthyroid state was achieved and lasted for 2.5 years this time, but due to the recurrence, medical treatment had been commenced with cabergoline and octreotide. Euthyroidism was maintained for the last 4 years on monthly octreotide treatment. A repeat MRI demonstrated no pituitary mass, but a mass in the sphenoidal sinus had been detected. Removal of this mass by surgery did not achieve euthyroidism. 68Ga-DOTA-TATE positron emission tomography/computed tomography showed residual tissue extending from the pituitary region to the sphenoid sinus. The patient's bone age was advanced by 2 years at diagnosis which became 4 years in 1 year after the diagnosis and remained so throughout follow-up, leading to a final height of -3.3 SDS below his target height at the age of 16 years. CONCLUSION The diagnosis, treatment, and follow-up of TSHomas are challenging, and short stature due to accelerated bone maturation is a complication of paediatric TSHomas.
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Affiliation(s)
- Tarik Kirkgoz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Saygin Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Askin Seker
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Busra Gurpinar Tosun
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Eltan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Helvacioglu
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Belma Haliloglu
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Sare Betul Kaygusuz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Zehra Yavas Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Tuba Seven Menevse
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tunc Ones
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdullah Bereket
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Turan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
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Celik SU, Konca C. Body composition changes following total thyroidectomy: A one-year follow-up study. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:14-20. [PMID: 36764744 DOI: 10.1016/j.endien.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Thyroid hormones play an important role in body weight regulation. In this study, we investigated which body composition parameters cause a change in body weight after total thyroidectomy. MATERIALS AND METHOD We performed a retrospective cohort study of a prospectively maintained database of patients who underwent total thyroidectomy. Demographics, thyroid function tests, indications for surgery, final pathology, and postoperative thyroid status were collected. Body composition analyses measured by the bioelectrical impedance analysis method were recorded at two-time points, 12 months apart. RESULTS Forty-four patients were included in the study with a mean age of 51.6 years. There were statistically significant increases in weight (p=0.049), body mass index (p=0.021), and fat mass (p=0.001) over time. While 12 patients (27.3%) lost or maintained weight, 32 patients (72.7%) gained weight. There was no significant difference in age, sex, preoperative thyroid function tests, postoperative thyroid status, or pathology between those who gained weight and those who did not. Although changes in all body composition parameters were higher in males than in females, these differences were not significant overall. Multivariable regression analysis revealed a significant positive relationship between increase in fat mass and baseline free-T3 (p=0.041) and found that lower baseline percent body fat was a significant factor for greater fat mass gain (p=0.016). However, no predictors of change in weight were identified. CONCLUSION We conclude that total thyroidectomy results in a significant change in body weight and fat mass. Higher free-T3 and lower percent body fat at baseline were significant factors of fat mass gain.
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Affiliation(s)
- Suleyman Utku Celik
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey; Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Can Konca
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Kyriacou A, Syed AA, Sawicka-Gutaj N, Picolos M, Economides P, Kyriacou A. Body weight change trajectories following the treatment of hyperthyroidism: A prospective cohort study. Clin Endocrinol (Oxf) 2022; 98:738-740. [PMID: 36574980 DOI: 10.1111/cen.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Angelos Kyriacou
- Department of Endocrinology & Diabetes, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- Department of Endocrinology & Diabetes, Medical School, European University Cyprus, Nicosia, Cyprus
- Department of Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation & University Teaching Trust, Salford, UK
| | - Akheel A Syed
- Department of Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation & University Teaching Trust, Salford, UK
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Michalis Picolos
- Dpeartment of Endocrinology, Diabetes & General Internal Medicine, Alithias Endocrinology Center, Nicosia, Cyprus
| | - Panayiotis Economides
- Department of Endocrinology & Diabetes, Medical School, European University Cyprus, Nicosia, Cyprus
| | - Alexis Kyriacou
- Department of Endocrinology & Diabetes, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- Faculty of Health Sciences, University of Stirling, Stirling, UK
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Kim HJ. Long-term management of Graves disease: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 40:12-22. [PMID: 36329661 PMCID: PMC9946914 DOI: 10.12701/jyms.2022.00444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient's drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.
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Affiliation(s)
- Hyo-Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea,Corresponding author: Hyo-Jeong Kim, MD, PhD Thyroid-Endocrine Center, Nowon Eulji University Hospital, Annex, 1st floor, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea Tel: +82-2-970-8558 • Fax: +82-2-970-8878 • E-mail:
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9
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Jin YJ, Hah JH, Kwon MJ, Kim JH, Kim JH, Kim SK, Park B, Choi HG. Association between Thyroid Cancer and Weight Change: A Longitudinal Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116753. [PMID: 35682332 PMCID: PMC9180614 DOI: 10.3390/ijerph19116753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate body mass index (BMI) and systolic blood pressure (SBP)/diastolic blood pressure (DBP) between Korean adults who underwent thyroidectomy and comparison groups. METHODS Data were included from the Korean National Health Insurance Service-Health Screening Cohort (2002-2015). BMI and SBP/DBP were measured before thyroidectomy, 1 and 2 years after thyroidectomy (n = 1995 in study I, n = 2162 in study II), comparing 1:4 matched participants (n = 7980 in study I, n = 8648 in study II). The paired t-test and linear mixed model were used to identify the differences between groups. RESULTS DBP in both thyroid cancer II and comparison II group were significantly lower after thyroidectomy than before thyroidectomy. However, the interaction effect of thyroidectomy in study I and study II did not reach statistical significance. CONCLUSION BMI, SBP and DBP were not significantly different between the thyroidectomy group and the matched comparison group.
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Affiliation(s)
- Young Ju Jin
- Department of Otorhinolaryngology—Head & Neck Surgery, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan 54538, Korea;
| | - Jeong Hun Hah
- ThanQ Seoul Thyroid—Head and Neck Surgery Center, Seoul 06150, Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Sung-Kyun Kim
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University College of Medicine, Dongtan 18450, Korea;
| | - Bumjung Park
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Hyo Geun Choi
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea
- Correspondence:
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Sengupta J, Das H, Chellaiyan D VG, S S, Britto J J. An observational study of incidence of metabolic syndrome among patients with controlled Grave’s disease. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101010] [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] Open
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11
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Yotsapon T, Waralee C, Hussamon P, Panita S, Siriwan B, Soontaree N, Ekgaluck W, Rajata R, Thep H. Duration of antithyroid drug treatment may predict weight gain after radioactive iodine therapy in patients with Graves' disease. Heliyon 2022; 8:e09471. [PMID: 35615430 PMCID: PMC9124706 DOI: 10.1016/j.heliyon.2022.e09471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Weight gain post-radioiodine (RAI) treatment is observed in patients with hyperthyroid Graves’ disease. Previous studies, mostly in Caucasian patients, demonstrated excessive weight gain averaging 5–7 kg from initial presentation. Aim The aim of this study was to determine the extent and risk factors of weight gain in Thai patients with RAI-treated Graves’ disease. Methods This was a 5-year retrospective study of patients with hyperthyroid Graves’ disease who received RAI treatment during 2016–2020. The proportion and associated risk factors of weight gain ≥5% in patients who was followed for at least 3 months when compared with weight at RAI administration were analyzed. Results There were 347 patients with Graves’ disease (females 81.0%, mean age 38.8 ± 12.1 years, BMI 23.3 ± 4.0 kg/m2) who were treated with RAI. Almost all RAI-treated patients (91.9%) eventually developed hypothyroidism. During the median follow-up period of 25 months, 73.1% of them had weight gain. The mean weight change was +2.5 ± 4.9 kgs when compared with weight at the time RAI administration and +3.4 ± 6.5 kgs when compared with recalled body weight before the onset of hyperthyroidism. The proportion of patient in the obesity class I (BMI 25.0–29.9 kg/m2) increased from 23.6% to 28.0% and obesity class II (BMI ≥30.0 kg/m2) increased from 5.2% to 8.9%. Duration of antithyroid drug treatment less than 6 months after the diagnosis of hyperthyroidism was the only factor associated with weight gain ≥5%. Conclusions Weight gain post-RAI treatment was common, and a significant proportion of patients went on to develop obesity. Early intervention with weight management support should be employed in patients with less than 6 months of antithyroid drug treatment before RAI.
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Affiliation(s)
| | | | | | | | - Butadej Siriwan
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
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12
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Lustig RH, Collier D, Kassotis C, Roepke TA, Ji Kim M, Blanc E, Barouki R, Bansal A, Cave MC, Chatterjee S, Choudhury M, Gilbertson M, Lagadic-Gossmann D, Howard S, Lind L, Tomlinson CR, Vondracek J, Heindel JJ. Obesity I: Overview and molecular and biochemical mechanisms. Biochem Pharmacol 2022; 199:115012. [PMID: 35393120 PMCID: PMC9050949 DOI: 10.1016/j.bcp.2022.115012] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Obesity is a chronic, relapsing condition characterized by excess body fat. Its prevalence has increased globally since the 1970s, and the number of obese and overweight people is now greater than those underweight. Obesity is a multifactorial condition, and as such, many components contribute to its development and pathogenesis. This is the first of three companion reviews that consider obesity. This review focuses on the genetics, viruses, insulin resistance, inflammation, gut microbiome, and circadian rhythms that promote obesity, along with hormones, growth factors, and organs and tissues that control its development. It shows that the regulation of energy balance (intake vs. expenditure) relies on the interplay of a variety of hormones from adipose tissue, gastrointestinal tract, pancreas, liver, and brain. It details how integrating central neurotransmitters and peripheral metabolic signals (e.g., leptin, insulin, ghrelin, peptide YY3-36) is essential for controlling energy homeostasis and feeding behavior. It describes the distinct types of adipocytes and how fat cell development is controlled by hormones and growth factors acting via a variety of receptors, including peroxisome proliferator-activated receptor-gamma, retinoid X, insulin, estrogen, androgen, glucocorticoid, thyroid hormone, liver X, constitutive androstane, pregnane X, farnesoid, and aryl hydrocarbon receptors. Finally, it demonstrates that obesity likely has origins in utero. Understanding these biochemical drivers of adiposity and metabolic dysfunction throughout the life cycle lends plausibility and credence to the "obesogen hypothesis" (i.e., the importance of environmental chemicals that disrupt these receptors to promote adiposity or alter metabolism), elucidated more fully in the two companion reviews.
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Affiliation(s)
- Robert H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, CA 94143, United States
| | - David Collier
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Christopher Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI 48202, United States
| | - Troy A Roepke
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901, United States
| | - Min Ji Kim
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Etienne Blanc
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Robert Barouki
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Amita Bansal
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Matthew C Cave
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY 40402, United States
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, University of South Carolina, Columbia, SC 29208, United States
| | - Mahua Choudhury
- College of Pharmacy, Texas A&M University, College Station, TX 77843, United States
| | - Michael Gilbertson
- Occupational and Environmental Health Research Group, University of Stirling, Stirling, Scotland, United Kingdom
| | - Dominique Lagadic-Gossmann
- Research Institute for Environmental and Occupational Health, University of Rennes, INSERM, EHESP, Rennes, France
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, United States
| | - Lars Lind
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Craig R Tomlinson
- Norris Cotton Cancer Center, Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, United States
| | - Jan Vondracek
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, Brno, Czech Republic
| | - Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, United States.
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Vieira IH, Rodrigues D, Paiva I. The Mysterious Universe of the TSH Receptor. Front Endocrinol (Lausanne) 2022; 13:944715. [PMID: 35903283 PMCID: PMC9315062 DOI: 10.3389/fendo.2022.944715] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/10/2022] [Indexed: 12/25/2022] Open
Abstract
The thyroid-stimulating hormone receptor (TSH-R) is predominantly expressed in the basolateral membrane of thyrocytes, where it stimulates almost every aspect of their metabolism. Several extrathyroidal locations of the receptor have been found including: the pituitary, the hypothalamus, and other areas of the central nervous system; the periorbital tissue; the skin; the kidney; the adrenal; the liver; the immune system cells; blood cells and vascular tissues; the adipose tissue; the cardiac and skeletal muscles, and the bone. Although the functionality of the receptor has been demonstrated in most of these tissues, its physiological importance is still a matter of debate. A contribution to several pathological processes is evident in some cases, as is the case of Grave's disease in its multiple presentations. Conversely, in the context of other thyroid abnormalities, the contribution of the TSH-R and its ligand is still a matter of debate. This article reviews the several different sites of expression of the TSH-R and its potential role in both physiological and pathological processes.
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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15
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Comarella AP, Vilagellin D, Bufalo NE, Euflauzino JF, de Souza Teixeira E, Miklos ABPP, Dos Santos RB, Romaldini JH, Ward LS. The polymorphic inheritance of DIO2 rs225014 may predict body weight variation after Graves' disease treatment. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:787-795. [PMID: 33049131 PMCID: PMC10528618 DOI: 10.20945/2359-3997000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to investigate the role of DIO2 polymorphisms rs225014 and rs12885300 in Graves' disease patients, mainly for controlling body weight following treatment. METHODS We genotyped 280 GD patients by the time of diagnosis and 297 healthy control individuals using a TaqMan SNP Genotyping technique. We followed up 141 patients for 18.94 ± 6.59 months after treatment. RESULTS There was no relationship between the investigated polymorphisms with susceptibility to GD and gain or loss of weight after GD treatment. However, the polymorphic inheritance (CC+CT genotype) of DIO2 rs225014 was associated with a lower body weight variation after GD treatment (4.26 ± 6.25 kg) when compared to wild type TT genotype (6.34 ± 7.26 kg; p = 0.0456 adjusted for the follow-up time). This data was confirmed by a multivariate analysis (p = 0.0138) along with a longer follow-up period (p = 0.0228), older age (p = 0.0306), treatment with radioiodine (p-value = 0.0080) and polymorphic inheritance of DIO2 rs12885300 (p = 0.0306). CONCLUSION We suggest that DIO2 rs225014 genotyping may have an auxiliary role in predicting the post-treatment weight behavior of GD patients.
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Affiliation(s)
- Ana Paula Comarella
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil,
| | - Danilo Vilagellin
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Natassia Elena Bufalo
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Jessica Ferreira Euflauzino
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Elisangela de Souza Teixeira
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | | | - Roberto Bernardo Dos Santos
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - João H Romaldini
- Endocrinologia e Metabolismo, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil
| | - Laura S Ward
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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Torlinska B, Hazlehurst JM, Nirantharakumar K, Thomas GN, Priestley JR, Finnikin SJ, Saunders P, Abrams KR, Boelaert K. wEight chanGes, caRdio-mEtabolic risks and morTality in patients with hyperthyroidism (EGRET): a protocol for a CPRD-HES linked cohort study. BMJ Open 2021; 11:e055219. [PMID: 34598995 PMCID: PMC8488707 DOI: 10.1136/bmjopen-2021-055219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hyperthyroidism is a common condition affecting up to 3% of the UK population. Treatment improves symptoms and reduces the risk of atrial fibrillation and stroke that contribute to increased mortality. The most common symptom is weight loss, which is reversed during treatment. However, the weight regain may be excessive, contributing to increased risk of obesity. Current treatment options include antithyroid drugs, radioiodine and thyroidectomy. Whether there are differences in either weight change or the long-term cardiometabolic risk between the three treatments is unclear. METHODS AND ANALYSIS The study will establish the natural history of weight change in hyperthyroidism, investigate the risk of obesity and risks of cardiometabolic conditions and death relative to the treatment. The data on patients diagnosed with hyperthyroidism between 1 January 1996 and 31 December 2015 will come from Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office of National Statistics Death Registry. The weight changes will be modelled using a flexible joint modelling, accounting for mortality. Obesity prevalence in the general population will be sourced from Health Survey for England and compared with the post-treatment prevalence of obesity in patients with hyperthyroidism. The incidence and time-to-event of major adverse cardiovascular events, other cardiometabolic outcomes and mortality will be compared between the treatments using the inverse propensity weighting model. Incidence rate ratios of outcomes will be modelled with Poisson regression. Time to event will be analysed using Cox proportional hazards model. A competing risks approach will be adopted to estimate comparative incidences to allow for the impact of mortality. ETHICS AND DISSEMINATION The study will bring new knowledge on the risk of developing obesity, cardiometabolic morbidity and mortality following treatment for hyperthyroidism to inform clinical practice and public health policies. The results will be disseminated via open-access peer-reviewed publications and directly to the patients and public groups (Independent Scientific Advisory Committee protocol approval #20_000185).
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Affiliation(s)
- Barbara Torlinska
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan M Hazlehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Samuel J Finnikin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Keith R Abrams
- Department of Statistics, University of Warwick, Coventry, UK
- Centre for Health Economics, University of York, York, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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17
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El Kawkgi OM, Ross DS, Stan MN. Comparison of long-term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature. Clin Endocrinol (Oxf) 2021; 95:3-12. [PMID: 33283314 DOI: 10.1111/cen.14374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of Graves' disease (GD) in the US is shifting towards increased use of anti-thyroid drugs (ATD). If patients fail to achieve remission after a standard course of therapy of 12-18 months, long-term treatment with ATD (≥24 months) may be chosen over definitive therapy with radioiodine (RAI) or surgery. Clinicians will need to contrast this strategy to ablative therapies as they help patients in decision making. SUMMARY Review of the literature illustrates that long-term ATD delivers euthyroidism with minimal complications, low financial cost and with an advantageous profile regarding quality of life (QoL) and other biological outcomes. CONCLUSIONS Long-term ATD is a viable alternative to ablative therapies in the management of GD offering advantages across multiple patient centred outcomes. Decision making must factor differences in this approach compared to ablative therapies and ultimately be tailored to individualized patient situations.
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Affiliation(s)
- Omar M El Kawkgi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Douglas S Ross
- Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
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18
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Huynh CN, Pearce JV, Kang L, Celi FS. Weight Gain After Thyroidectomy: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2021; 106:282-291. [PMID: 33106852 PMCID: PMC7765639 DOI: 10.1210/clinem/dgaa754] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Weight gain is a major driver of dissatisfaction and decreased quality of life in patients with hypothyroidism. Data on the changes in body weight following thyroidectomy are conflicting. OBJECTIVE To perform a systematic review of the literature and a meta-analysis of weight changes following total thyroidectomy. DATA SOURCES Literature search on PubMed. STUDY SELECTION Studies in English published between September 1998 and May 2018 reporting post-thyroidectomy weight changes. DATA EXTRACTION Data were reviewed and compared by 3 investigators; discrepancies were resolved by consensus. Meta-analyses were performed using fixed and random effect models. Univariable and multivariable meta-regression models for weight change were implemented against study follow-up, gender, and age. Exploratory subgroup analyses were performed for indication for surgery. DATA SYNTHESIS Seventeen studies (3164 patients) with 23.8 ± 23.6 months follow-up were included. Severe heterogeneity across studies was observed. Using a random effect model, the estimated overall weight change was a gain of 2.13 kg, 95% confidence interval (CI; 0.95, 3.30). Age was negatively associated with weight change (β = -0.238, P < 0.001). In subgroup analyses, weight gain was more evident in patients undergoing thyroidectomy for hyperthyroidism: 5.19 kg, 95% CI (3.21, 7.17) vs goiter or malignancy 1.55 kg, 95% CI (0.82, 2.27) and 1.30 kg, 95% CI (0.45, 2.15), respectively. CONCLUSIONS Patients undergoing thyroidectomy experience possible mild weight gain, particularly younger individuals and those with hyperthyroidism as the indication for surgery. Prospective studies directed to assess the pathophysiology of weight gain post-thyroidectomy, and to test novel treatment modalities, are needed to better characterize post-thyroidectomy weight changes.
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Affiliation(s)
- Christine N Huynh
- Honors College, Virginia Commonwealth University, Richmond, Virginia
| | - Janina V Pearce
- Center for Clinical and Translational Research, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Le Kang
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Francesco S Celi
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Correspondence and Reprint Requests: Francesco S. Celi, MD, MHSc, 1101 East Marshall Street 7-007, Richmond, VA 23298, USA. E-mail:
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Yousefzadeh N, Jeddi S, Ghasemi A. Impaired Cardiovascular Function in Male Rats with Hypo- and Hyperthyroidism: Involvement of Imbalanced Nitric Oxide Synthase Levels. Endocr Metab Immune Disord Drug Targets 2021; 21:526-533. [PMID: 32384042 DOI: 10.2174/1871530320666200508115543] [Citation(s) in RCA: 1] [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: 02/19/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE All three isoforms of nitric oxide (NO) synthase (NOS) are targets for thyroid hormones in the cardiovascular system. The aim of this study was to assess the effects of hypo- and hyperthyroidism on inducible (iNOS), endothelial (eNOS), and neural (nNOS) NOS levels in aorta and heart tissues of male rats. METHODS Rats were divided into control, hypothyroid, and hyperthyroid groups; hypo- and hyperthyroidism were induced by adding propylthiouracil (500 mg/L) and L-thyroxine (12 mg/L) to drinking water for a period of 21 days. On day 21, systolic blood pressure, heart rate, left ventricular developed pressure (LVDP), peak rate of positive and negative (±dp/dt) changes in left ventricular pressure as well as NO metabolites (NOx) and iNOS, eNOS, and nNOS protein levels in aorta and heart, were all measured. RESULTS Compared to controls, LVDP and ±dp/dt were lower in both hypo- and hyperthyroid rats. Compared to controls, heart rate and systolic blood pressure were lower in hypothyroid and higher in hyperthyroid rats. NOx levels in the heart of hypothyroid rats were lower (53%), whereas that in hyperthyroid rats were higher (56% and 40%) than controls. Compared to controls, hypothyroid rats had lower levels of eNOS, iNOS, and nNOS in the aorta (16%, 34%, and 15%, respectively) and lower iNOS and higher nNOS in heart tissue (27% and 46%). In hyperthyroid rats, eNOS levels were lower (54% and 30%) and iNOS were higher (63%, and 35%) in the aorta and heart while nNOS was lower in the aorta (18%). CONCLUSION Hypothyroidism increased while hyperthyroidism decreased the ratio of eNOS/iNOS in aorta and heart; these changes of NOS levels were associated with impaired cardiovascular function.
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Affiliation(s)
- Nasibeh Yousefzadeh
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajad Jeddi
- Endocrine Physiology Research Center, Research institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Cho HR, Song RY, Kang KH. Weight change in patients with differentiated thyroid carcinoma after total thyroidectomy versus lobectomy. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2020; 16:127-130. [PMID: 36945722 PMCID: PMC9942726 DOI: 10.14216/kjco.20019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/02/2023]
Abstract
Purpose Thyroid hormone is an important hormone in maintaining metabolism and homeostasis in the body. There exists a common perception among patients that thyroid surgery will cause weight gain. Prevention of any undesired weight gain could be important for the maintenance of well-being in most patients. Our study compares changes in body mass index (BMI) and weight after total thyroidectomy or lobectomy in thyroid cancer patients. Methods A total of 967 patients with differentiated thyroid carcinoma were enrolled in the study, from March 2011 to July 2016 at Chung-Ang University Hospital. Exclusion criteria were less than lobectomy, modified radical neck dissection, recurred operation, and combined operation for other causes. Primary endpoints were change in body weight and BMI at 2 years after surgery. A subgroup analysis was performed for patients with significant weight change. Results There were no differences between both groups in BMI after 2 years of thyroid operation. Thyroid stimulating hormone (TSH) levels were not significantly different. Fifteen percent of patients showed significant change in body weight after 2 years of operation. The subgroup analysis of these patients showed no significant differences in gender, age, or extent of operation between those who had gained weight compared to those who had lost weight. There were also no differences in postoperative TSH levels, levothyroxine supplementation, or radioactive iodine treatment. Conclusion There was a minimal postoperative increase in mean BMI over the years in patients undergoing thyroidectomy for differentiated thyroid cancer. However, weight change did not differ in those undergoing thyroid lobectomy or total thyroidectomy.
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Affiliation(s)
- Hae-Ryong Cho
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ra-Yeong Song
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Ho Kang
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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21
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Yang H, Holowko N, Grassmann F, Eriksson M, Hall P, Czene K. Hyperthyroidism is associated with breast cancer risk and mammographic and genetic risk predictors. BMC Med 2020; 18:225. [PMID: 32838791 PMCID: PMC7446157 DOI: 10.1186/s12916-020-01690-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the biological link between thyroid hormones and breast cancer cell proliferation shown in experimental studies, little is known about the association between hyperthyroidism and breast cancer, as well as its association with the most common mammographic and genetic risk predictors for breast cancer. METHODS This study estimates the incidence rate ratios (IRRs) of breast cancer among women diagnosed with hyperthyroidism, compared to those who are not, using two cohorts: a Swedish national cohort of the general female population (n = 3,793,492, 2002-2011) and the Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA, n = 69,598, 2002-2017). We used logistic regression to estimate the odds ratios (ORs) of hyperthyroidism according to the mammographic and genetic risk predictors for breast cancer. RESULTS An increased risk of breast cancer was observed in patients in the national cohort with hyperthyroidism (IRR = 1.23, 95% CI = 1.12-1.36), particularly for toxic nodular goiter (IRR = 1.38, 95% CI = 1.16-1.63). Hyperthyroidism was associated with higher body mass index, early age at first birth, and lower breastfeeding duration. Higher mammographic density was observed in women with toxic nodular goiter, compared to women without hyperthyroidism. Additionally, among genotyped women without breast cancer in the KARMA cohort (N = 11,991), hyperthyroidism was associated with a high polygenic risk score (PRS) for breast cancer overall (OR = 1.98, 95% CI = 1.09-3.60) and for estrogen receptor-positive specific PRS (OR = 1.90, 95% CI = 1.04-3.43). CONCLUSION Hyperthyroidism is associated with an increased risk of breast cancer, particularly for patients with toxic nodular goiter. The association could be explained by higher mammographic density among these women, as well as pleiotropic genetic variants determining shared hormonal/endocrine factors leading to the pathology of both diseases.
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Affiliation(s)
- Haomin Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Xuefu North Road 1, University Town, Fuzhou, 350122 China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Natalie Holowko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Felix Grassmann
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
- Department of Oncology, South General Hospital, SE-11883 Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Okosieme OE, Taylor PN, Dayan CM. Should radioiodine now be first line treatment for Graves' disease? Thyroid Res 2020; 13:3. [PMID: 32165924 PMCID: PMC7061474 DOI: 10.1186/s13044-020-00077-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/27/2020] [Indexed: 01/04/2023] Open
Abstract
Background Radioiodine represents a cost-effective treatment option for Graves’ disease. In the UK, it is traditionally reserved for patients who relapse after initial thionamide therapy. In a change from current practice, the new guidelines of the National Institute for Health and Care Excellence (NICE) recommends that radioiodine should now be first line therapy for Graves’ disease. However, the safety of radioiodine with respect to long-term mortality risk has been the subject of recent debate. This analysis examines evidence from treatment related mortality studies in hyperthyroidism and discusses their implications for future Graves’ disease treatment strategies. Main body Some studies have suggested an excess mortality in radioiodine treated cohorts compared to the background population. In particular, a recent observational study reported a modest increase in cancer-related mortality in hyperthyroid patients exposed to radioiodine. The interpretation of these studies is however constrained by study designs that lacked thionamide control groups or information on thyroid status and so could not distinguish the effect of treatment from disease. Two studies have shown survival advantages of radioiodine over thionamide therapy, but these benefits were only seen when radioiodine was successful in controlling hyperthyroidism. Notably, increased mortality was associated with uncontrolled hyperthyroidism irrespective of therapy modality. Conclusions Early radioiodine treatment will potentially reduce mortality and should be offered to patients with severe disease. However, thionamides are still suitable for patients with milder disease, contraindications to radioiodine, or individuals who choose to avoid permanent hypothyroidism. Ultimately, a patient individualised approach that prioritises early and sustained control of hyperthyroidism will improve long-term outcomes regardless of the therapy modality used.
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Affiliation(s)
- Onyebuchi E Okosieme
- 1Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK.,2Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Gurnos Estate, Merthyr Tydfil, CF47 9DT UK
| | - Peter N Taylor
- 1Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Colin M Dayan
- 1Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
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23
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Ito A, Ando T, Nozaki A, Haraguchi A, Horie I, Kawakami A. VISCERAL AND SUBCUTANEOUS FAT INCREASED AFTER TREATMENT OF GRAVES DISEASE. Endocr Pract 2020; 26:484-491. [PMID: 31968183 DOI: 10.4158/ep-2019-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Patients with Graves disease (GD) tend to gain weight after treatment, but it remains unknown if weight gain is associated with an increase in the visceral and/or subcutaneous fat areas (VFA, SFA). Methods: We enrolled 25 newly diagnosed GD patients (22 females, median age 33.0 years) and studied their clinical parameters, and VFA and SFA measured by a dual bioelectric impedance analysis. We divided them into 2 groups based on the rates of change in the VFA and SFA, and we compared clinical parameters at the baseline between the groups to evaluate factors that influence increases in the VFA and/or SFA with treatment. Results: The patients' body weight (BW), VFA, and SFA were significantly increased after a 6-month treatment (BW: from 54.3 ± 10.3 kg to 58.0 ± 11.2 kg; P<.001; VFA: from 47.1 ± 21.3 cm2 to 54.7 ± 23.4 cm2; P = .004; SFA: from 159.8 ± 85.9 cm2 to 182.2 ± 82.9 cm2; P = .008). The percent changes of BW correlated with the SFA (ρ = .591, P = .002), but not with the VFA. The patients with larger VFA increases had significantly less VFA at the baseline compared to those with smaller increases, expressed as median and interquartile range (33.9 cm2 [22.7 to 47.5 cm2] versus 54.5 cm2 [45.2 to 64.0], respectively; P = .011). A larger increase in the SFA was negatively associated with serum alkaline phosphatase. An increase in the SFA was associated with free triiodothyronine (T3) in a multivariate logistic analysis (odds ratio: 0.80 [0.59 to 0.97]; P = .013). Conclusion: The patients' BW, VFA, and SFA were increased after GD treatment. The increase in SFA seemed to contribute to weight gain and was associated with a low baseline level of free T3. Abbreviations: ALP = alkaline phosphatase; BMI = body mass index; BW = body weight; GD = Graves disease; SFA = subcutaneous fat area; T3 = triiodothyronine; T4 = thyroxine; TG = triglycerides; VFA = visceral fat areas.
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Li ZM, Albrecht M, Fromme H, Schramm KW, De Angelis M. Persistent Organic Pollutants in Human Breast Milk and Associations with Maternal Thyroid Hormone Homeostasis. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:1111-1119. [PMID: 31867966 DOI: 10.1021/acs.est.9b06054] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Epidemiological studies have indicated the thyroid-disrupting effects of persistent organic pollutants (POPs). However, the association of low-exposure POPs with thyroid hormones (THs) remains unclear. Here, we aim to assess the association of low exposure of POPs, including polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), and polybrominated dibenzo-p-dioxins and furans, with THs [total L-thyroxine (TT4), total 3,3',5-triiodo-L-thyronine (TT3), and total 3,3',5'-triiodo-L-thyronine (TrT3)] measured in human breast milk. Ninety-nine breast milk samples were collected from the LUPE cohort (2015-2016, Bavaria, Germany). Fourteen PBDEs, 17 PCBs, and 5 PCDD/Fs had quantification rates of >80%. Nonmonotonic associations were observed. In adjusted single-pollutant models, (1) TT4 was inversely associated with BDE-99, -154, and -196; (2) TT3 was inversely associated with BDE-47, -99, -100, -197, -203, -207, and OCDD; and (3) TrT3 was inversely associated with BDE-47, -99, -183, and -203. Multipollutant analysis using principal component analysis and hierarchical clustering revealed inverse associations of PBDEs (BDE-28, -47, -99, -100, -154, -183, and -197) with TT4 and TrT3. These results indicate that POPs at low levels might be related to reduced THs. This study shows that human breast milk might be an appropriate specimen to evaluate the thyroid disruption of POPs.
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Affiliation(s)
- Zhong-Min Li
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Molecular EXposomics , Ingolstädter Landstr. 1 , 85764 Neuherberg , Germany
- School of Life Sciences Weihenstephan (Nutrition) , Technische Universität München , 85354 Freising , Germany
| | - Michael Albrecht
- Department of Dioxins, Irradiation, Nitrosamines, Radioactivity , Bavarian Health and Food Safety Authority , Veterinaerstr. 2 , D-85764 Oberschleissheim , Germany
| | - Hermann Fromme
- Department of Chemical Safety and Toxicology , Bavarian Health and Food Safety Authority , Pfarrstrasse 3 , D-80538 Munich , Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital , LMU Munich , Ziemssenstrasse 1 , D-80336 Munich , Germany
| | - Karl-Werner Schramm
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Molecular EXposomics , Ingolstädter Landstr. 1 , 85764 Neuherberg , Germany
- Department für Biowissenschaftliche Grundlagen , Technische Universität München , Weihenstephaner Steig 23 , 85350 Freising , Germany
| | - Meri De Angelis
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Molecular EXposomics , Ingolstädter Landstr. 1 , 85764 Neuherberg , Germany
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Abbara A, Clarke SA, Brewster R, Simonnard A, Eng PC, Phylactou M, Papadopoulou D, Izzi-Engbeaya C, Sam AH, Wernig F, Jonauskyte E, Comninos AN, Meeran K, Kelsey TW, Dhillo WS. Pharmacodynamic Response to Anti-thyroid Drugs in Graves' Hyperthyroidism. Front Endocrinol (Lausanne) 2020; 11:286. [PMID: 32477269 PMCID: PMC7236601 DOI: 10.3389/fendo.2020.00286] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/16/2020] [Indexed: 12/31/2022] Open
Abstract
Objective: Graves' disease is the commonest cause of hyperthyroidism in populations with sufficient dietary iodine intake. Anti-thyroid drugs (ATD) are often used as the initial treatment for Graves' hyperthyroidism, however there is a paucity of data relating the dose of ATD therapy to the effect on thyroid hormone levels, increasing the risk of both over- and under-treatment. We aimed to determine the pharmacodynamic response to the ATD carbimazole. Design: Retrospective cohort study. Methods: Participants were patients (n = 441) diagnosed with Graves' disease at Imperial College Healthcare NHS Trust between 2009 and 2018. The main outcome measure was change in thyroid hormone levels in response to ATD. Results: Baseline thyroid hormone levels were positively associated with TSH receptor antibody titres (P < 0.0001). Baseline free triiodothyronine (fT3) were linearly related to free thyroxine (fT4) levels in the hyperthyroid state (fT3 = fT4*0.97-11), and fell proportionately with carbimazole. The percentage falls in fT4 and fT3 per day were associated with carbimazole dose (P < 0.0001). The magnitude of fall in thyroid hormones after the same dose of carbimazole was lower during follow up than at the initiation visit. The fall in thyroid hormone levels approximated to a linear response if assessed at least 3 weeks after commencement of carbimazole. Following withdrawal of antithyroid drug treatment, the risk of relapse was greater in patients with higher initial fT4, initial TSH receptor antibody titre, males, smokers, and British Caucasian ethnicity. Conclusion: We identify a dose-response relationship for fall in thyroid hormones in response to carbimazole to aid in the selection of dose for Graves' hyperthyroidism.
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Affiliation(s)
- Ali Abbara
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sophie A. Clarke
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rosalind Brewster
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Alexia Simonnard
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Deborah Papadopoulou
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chioma Izzi-Engbeaya
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amir H. Sam
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Eliza Jonauskyte
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Alexander N. Comninos
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Karim Meeran
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tom W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Waljit S. Dhillo
- Section of Endocrinology and Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Hammersmith Hospital, Imperial College London, London, United Kingdom
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Waljit S. Dhillo
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Hayashi A, Takano K, Kawakami Y, Hitomi M, Ohata Y, Suzuki A, Kamata Y, Shichiri M. Short-term Change in Resting Energy Expenditure and Body Compositions in Therapeutic Process for Graves' Disease. Intern Med 2020; 59:1827-1833. [PMID: 32741892 PMCID: PMC7474983 DOI: 10.2169/internalmedicine.4462-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective In the medical treatment of Graves' disease, we sometimes encounter patients who gain weight after the onset of the disease. To estimate the energy required during the course of treatment when hyperthyroidism ameliorates, we measured the resting energy expenditure (REE) and body composition in patients with Graves' disease before and during treatment in the short-term. Methods Twenty patients with newly diagnosed Graves' disease were enrolled, and our REE data of 19 healthy volunteers were used. The REE was measured by a metabolic analyzer, and the basal energy expenditure (BEE) was estimated by the Harris-Benedict formula. The body composition, including body weight, fat mass (FM), muscle mass (MM) and lean body mass (LBM), were measured by a multi-frequency body composition analyzer. We tailored the nutritional guidance based on the measured REE. Results Serum thyrotropin levels were significantly increased at three and six months. Serum free thyroxine, free triiodothyronine and REE values were significantly decreased at one, three and six months. The REE/BEE ratio was 1.58±0.28 at the onset and significantly declined to 1.34±0.34, 1.06±0.19 and 1.01±0.16 at 1, 3 and 6 months, respectively. Body weight, MM and LBM significantly increased at three and six months. Conclusion The REE significantly decreased during treatment of Graves' disease. The decline was evident as early as one month after treatment. The REE after treatment was lower than in healthy volunteers, which may lead to weight gain. These data suggest that appropriate nutritional guidance is necessary with short-term treatment before the body weight normalizes in order to prevent an overweight condition and the emergence of metabolic disorders.
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Affiliation(s)
- Akinori Hayashi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
| | - Yuko Kawakami
- Department of Nutrition, Kitasato University Hospital, Japan
| | - Mamiko Hitomi
- Department of Nutrition, Kitasato University Hospital, Japan
| | - Yasuhiro Ohata
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
| | - Agena Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
| | - Yuji Kamata
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Japan
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Torlinska B, Nichols L, Mohammed MA, McCabe C, Boelaert K. Patients Treated for Hyperthyroidism Are at Increased Risk of Becoming Obese: Findings from a Large Prospective Secondary Care Cohort. Thyroid 2019; 29:1380-1389. [PMID: 31375059 DOI: 10.1089/thy.2018.0731] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The most commonly reported symptom of hyperthyroidism is weight loss; successful treatment increases weight. Weight gain faced by patients with hyperthyroidism is widely considered a simple reaccumulation of premorbid weight, whereas many patients feel there is a significant weight "overshoot" attributable to the treatment. We aimed to establish if weight gain seen following treatment for hyperthyroidism represents replenishment of premorbid weight or "overshoot" beyond expected regain and, if there is excessive weight gain, whether this is associated with the applied treatment modality. Methods: We calculated the risk of becoming obese (body mass index [BMI] >30 kg/m2) following treatment for hyperthyroidism by comparing BMI of 1373 patients with overt hyperthyroidism seen in a secondary care setting with the age- and sex-matched background population (Health Survey for England, 2007-2009). Next, we investigated the effect of treatment with an antithyroid drug (ATD) alone in regard to ATD with radioactive iodine (131I) therapy. We modeled the longitudinal weight data in relation to the treatment pathway to thyroid function and the need for long-term thyroxine replacement. Results: During treatment of hyperthyroidism, men gained 8.0 kg (standard deviation ±7.5) and women 5.5 kg (±6.8). At discharge, there was a significantly increased risk of obesity in male (odds ratio = 1.7 [95% confidence interval 1.3-2.2], p < 0.001) and female (1.3, 1.2-1.5, p < 0.001) patients with hyperthyroidism compared with the background population. Treatment with 131I was associated with additional weight gain (0.6 kg, 0.4-0.8, p < 0.001), compared with ATD treatment alone. More weight gain was seen if serum thyrotropin (TSH) was markedly increased (TSH >10 mIU/L; 0.5 kg, 0.3-0.7, p < 0.001) or free thyroxine (fT4) was reduced (fT4 ≤ 10 pmol/L (0.8 ng/dL); 0.3 kg, 0.1-0.4, p < 0.001) during follow-up. Initiation of levothyroxine was associated with further weight gain (0.4 kg, 0.2-0.6, p < 0.001) and the predicted excess weight gain in 131I-induced hypothyroidism was 1.8 kg. Conclusions: Treatment for hyperthyroidism is associated with significant risks of becoming obese. 131I treatment and subsequent development of hypothyroidism were associated with small but significant amounts of excess weight gain compared with ATD alone. We advocate that the discussion over the weight "overshoot" risk forms part of the individualized treatment decision-making process.
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Affiliation(s)
| | - Linda Nichols
- Institute of Applied Health Research; Birmingham, United Kingdom
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | | | - Chris McCabe
- Institute of Metabolism and Systems Research; University of Birmingham, Birmingham, United Kingdom
| | - Kristien Boelaert
- Institute of Metabolism and Systems Research; University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Edgbaston, Birmingham, United Kingdom
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Kyriacou A, Kyriacou A, Makris KC, Syed AA, Perros P. Weight gain following treatment of hyperthyroidism-A forgotten tale. Clin Obes 2019; 9:e12328. [PMID: 31267667 DOI: 10.1111/cob.12328] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/12/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Abstract
Hyperthyroidism causes weight loss in the majority, but its effect is variable and 10% of patients gain weight. Its treatment usually leads to weight gain and some studies have reported an excess weight regain. However, there is considerable inter-individual variability and a differential effect on body weight by different treatments, with some studies reporting more weight increase with radioiodine, and perhaps surgery, compared with anti-thyroid drugs. The excess weight regain may relate to treatment-induced hypothyroidism. Furthermore, the transition from hyperthyroidism to euthyroidism may unmask, or exacerbate, the predisposition that some patients have towards obesity. Other risk factors commonly implicated for such weight increase include the severity of thyrotoxicosis at presentation and underlying Graves' disease. Conflicting data exist whether lean body mass or fat mass or both are increased post-therapy and whether such increments occur concurrently or in a sequential manner; this merits clarification. In any case, clinicians need to counsel their patients regarding this issue at presentation. Limited data on the effect of dietary interventions on weight changes with treatment of hyperthyroidism are encouraging in that they cause significantly lesser weight gain compared to standard care. More research is indicated on the impact of the treatment of hyperthyroidism on various anthropometric indices and the predisposing factors for any excessive weight gain. Regarding the impact of dietary management or other weight loss interventions, there is a need for well-designed and, ideally, controlled intervention studies.
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Affiliation(s)
- Angelos Kyriacou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
- Department of Endocrinology & Dietetics, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alexis Kyriacou
- Department of Endocrinology & Dietetics, CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Akheel A Syed
- Diabetes, Endocrinology & Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Petros Perros
- Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Human Genetics, University of Newcastle, Newcastle upon Tyne, UK
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Song E, Ahn J, Oh HS, Jeon MJ, Kim WG, Kim WB, Shong YK, Kim TY. Sex-Dependent Association between Weight Change and Thyroid Dysfunction: Population-Level Analysis Using the Korean National Health and Nutrition Examination Survey. Eur Thyroid J 2019; 8:202-207. [PMID: 31602363 PMCID: PMC6738229 DOI: 10.1159/000499961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/25/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although body weight change (BWC) is a common manifestation of thyroid dysfunction, solid evidence for whether to perform or on whom to perform thyroid function test in subjects complaining of BWC is lacking. OBJECTIVE To evaluate the association between thyroid dysfunction and BWC using a nationwide survey. METHOD Data was obtained from the Korea National Health and Nutrition Examination Survey VI 2013-2015 and 5,456 subjects without previous thyroid disease were included. Serum thyroid-stimulating hormone (TSH), free T4, and self-reported BWC during the previous year were used for the evaluation. Weight loss or gain was defined as weight change of at least 3 kg. RESULTS In total, 1,017 men (37.3%) and 1,175 women (43.0%) reported BWCs during the previous year. The overall weighted prevalence of thyroid dysfunction was not significantly associated with the extent of BWC in men (p = 0.705) or women (p = 0.094). However, when the impact of TSH levels on weight change was separately evaluated for weight gain and loss after adjusting for age and body mass index in each sex, weight loss in women was significantly associated with TSH levels (hazard ratio 0.64, 95% CI 0.47-0.85, p = 0.03). No association of thyroid dysfunction was observed for weight gain in women (p = 0.23) or any changes in men (p = 0.875 in weight gain, p = 0.923 in weight loss). CONCLUSIONS This study highlights the necessity of performing thyroid function testing in women who complain of weight loss, but such testing may be less vital in women with weight gain or men with any changes in weight.
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Affiliation(s)
| | | | | | | | | | | | | | - Tae Yong Kim
- *Tae Yong Kim, PhD, Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 (Republic of Korea), E-Mail
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Jeddi S, Gholami H, Gheibi S, Kashfi K, Ghasemi A. Altered gene expression of hydrogen sulfide-producing enzymes in the liver and muscles tissues of hyperthyroid rats. J Cell Physiol 2019; 234:17937-17945. [PMID: 30825200 DOI: 10.1002/jcp.28426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 01/25/2023]
Abstract
Thyroid hormones have a role in the regulation of hydrogen sulfide (H2 S) biosynthesis. In this study, we determined the effects of hyperthyroidism on H2 S levels in various tissues and messenger RNA (mRNA) expression of cystathionine-β-synthase (CBS), cystathionine-γ-lyase (CSE), and 3-mercaptopyruvate sulfurtransferase (3-MST) in the liver and muscles of the rat. Sixteen male Wistar rats were divided into the hyperthyroid and the control groups. Hyperthyroidism was induced by adding l-thyroxine (12 mg/L) to drinking water for a period of 21 days. H2 S concentrations in serum, liver, aorta, heart, and soleus muscles, as well as mRNA expressions of CBS, CSE, and 3-MST in these tissues were measured at Day 21. Hyperthyroid rats had lower H2 S levels in the serum compared with controls (14.7 ± 1.4 vs. 25.7 ± 1.6 µmol/L, p < 0.001). Compared with controls, hyperthyroid rats had lower levels of H2 S in the aorta (89%), heart (80%), and soleus (103%) muscles, but higher levels in the liver (35%). Hyperthyroidism decreased the ratio of CBS/CSE mRNA expression in the liver and the CSE/CBS mRNA expression in the muscles by decreasing CBS levels in liver (34% cf. controls) and CSE levels in the aorta, heart, and soleus muscles (respectively, 51%, 7%, and 52% cf.). In addition, hyperthyroidism decreased the mRNA expression of 3-MST in the liver (51%) and aorta (33%), and increased it in the heart (300%) and soleus muscle (182%). In conclusion, hyperthyroidism increased H2 S levels in the liver and decreased it in muscles; these effects are at least in part due to increases and decreases in expression of CSE in the liver and muscles, respectively. These data indicate an association between thyroid hormone status and gene expression of the H2 S-producing enzymes in the rat.
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Affiliation(s)
- Sajad Jeddi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Gholami
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sevda Gheibi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosrow Kashfi
- Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, New York, New York
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kassotis CD, Stapleton HM. Endocrine-Mediated Mechanisms of Metabolic Disruption and New Approaches to Examine the Public Health Threat. Front Endocrinol (Lausanne) 2019; 10:39. [PMID: 30792693 PMCID: PMC6374316 DOI: 10.3389/fendo.2019.00039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/17/2019] [Indexed: 01/29/2023] Open
Abstract
Obesity and metabolic disorders are of great societal concern and generate substantial human health care costs globally. Interventions have resulted in only minimal impacts on disrupting this worsening health trend, increasing attention on putative environmental contributors. Exposure to numerous environmental contaminants have, over decades, been demonstrated to result in increased metabolic dysfunction and/or weight gain in cell and animal models, and in some cases, even in humans. There are numerous mechanisms through which environmental contaminants may contribute to metabolic dysfunction, though certain mechanisms, such as activation of the peroxisome proliferator activated receptor gamma or the retinoid x receptor, have received considerably more attention than less-studied mechanisms such as antagonism of the thyroid receptor, androgen receptor, or mitochondrial toxicity. As such, research on putative metabolic disruptors is growing rapidly, as is our understanding of molecular mechanisms underlying these effects. Concurrent with these advances, new research has evaluated current models of adipogenesis, and new models have been proposed. Only in the last several years have studies really begun to address complex mixtures of contaminants and how these mixtures may disrupt metabolic health in environmentally relevant exposure scenarios. Several studies have begun to assess environmental mixtures from various environments and study the mechanisms underlying their putative metabolic dysfunction; these studies hold real promise in highlighting crucial mechanisms driving observed organismal effects. In addition, high-throughput toxicity databases (ToxCast, etc.) may provide future benefits in prioritizing chemicals for in vivo testing, particularly once the causative molecular mechanisms promoting dysfunction are better understood and expert critiques are used to hone the databases. In this review, we will review the available literature linking metabolic disruption to endocrine-mediated molecular mechanisms, discuss the novel application of environmental mixtures and implications for in vivo metabolic health, and discuss the putative utility of applying high-throughput toxicity databases to answering complex organismal health outcome questions.
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Zhou Y, Dong Z, A R, Liao Z, Guo J, Liu C, Sun X. The prevalence of impaired glucose regulation in anxiety disorder patients and the relationship with hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis activity. J Evid Based Med 2019; 12:51-55. [PMID: 27792263 DOI: 10.1111/jebm.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/27/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the prevalence of impaired glucose regulation (IGR) in patients with anxiety disorders and the relationship with hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes function. METHODS From September 2013 to May 2015, a total of 646 patients with anxiety disorders who matched the criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems participated in our study, which was conducted in the Psychiatric Inpatient Department of the West China Hospital of Sichuan University. The results from 75-g glucose tolerance tests, and morning (8:00 am) serum cortisol (PTC), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), TT3, TT4, FT3, and FT4 levels were collected. The Hamilton Anxiety Scale was administered to assess the severity of anxiety. SPSS 17.0 software was used for statistical analysis. RESULTS The crude prevalence of impaired glucose regulation was 24.61% in patients with anxiety disorders patients. In the 18- to 40-year age group with impaired glucose regulation (IGR), both ACTH and PTC levels were higher than the control group (P < 0.05). In the 61- to 75-year age group with IGR, the TSH level was lower and the FT4 level was higher than the control group (P < 0.05). CONCLUSION The results herein partially confirm that the prevalence of IGR in patients with anxiety disorders is high. Impaired glucose in the younger age group is closely associated with HPA axis function, while impaired glucose in the older age group is closely associated with HPT axis alteration. Therefore, routine blood glucose and endocrine function testing in patients with anxiety disorder is of clinical importance to prevent the development of diabetes.
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Affiliation(s)
- Yaling Zhou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruhan A
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zongbing Liao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cancan Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xueli Sun
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Lertrit A, Chailurkit LO, Ongphiphadhanakul B, Aekplakorn W, Sriphrapradang C. Thyroid function is associated with body mass index and fasting plasma glucose in Thai euthyroid population. Diabetes Metab Syndr 2019; 13:468-473. [PMID: 30641746 DOI: 10.1016/j.dsx.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Abstract
AIMS Several population-based studies found the associations between body mass index and thyroid function within the normal range. Furthermore, these thyroid functions are related with insulin resistance and plasma glucose levels. This study aimed to investigate the associations between thyroid functions and metabolic parameters in Thai euthyroid population. METHODS Participants from the Thai National Thai Health Examination Survey were randomly measured for TSH, FT4, anti-thyroperoxidase, and anti-thyroglobulin. Euthyroidism was defined by TSH 0.27-4.20 mIU/L and FT4 0.93-1.71 ng/dL. RESULTS A total of 2242 euthyroid participants were included. Fifty-one percent were female. Mean age, fasting plasma glucose, and body mass index were 55 ± 21 years, 93 ± 29 mg/dL, and 23.4 ± 4.6 kg/m2, respectively. Multivariate regression analysis after age and sex adjustment showed a negative association of serum FT4 with body mass index (β = -0.070, p = 0.001) and the relationship was still significant after subjects with positive anti-thyroperoxidase were excluded (β = -0.068, p = 0.003). In contrast, serum TSH was positively associated with body mass index (β = 0.052, p = 0.012). Moreover, serum FT4 was positively associated with fasting plasma glucose levels (β = 0.097, p < 0.001). CONCLUSIONS Small variations of serum TSH and FT4 within the reference range may contribute to the differences in metabolic indexes such as body mass index and fasting plasma glucose.
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Affiliation(s)
- Amornpan Lertrit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - La-Or Chailurkit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Boonsong Ongphiphadhanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Aung ET, Zammitt NN, Dover AR, Strachan MWJ, Seckl JR, Gibb FW. Predicting outcomes and complications following radioiodine therapy in Graves' thyrotoxicosis. Clin Endocrinol (Oxf) 2019; 90:192-199. [PMID: 30291728 DOI: 10.1111/cen.13873] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Radioiodine (RAI) is an effective treatment for Graves' thyrotoxicosis but is associated with a failure rate of 15% and may be a risk factor for thyroid eye disease (TED) and weight gain. We sought to examine predictors of RAI failure, weight gain, TED and patient satisfaction. DESIGN Retrospective cohort study. PATIENTS A total of 655 episodes of RAI in Graves' thyrotoxicosis patients (2006-2015). MEASUREMENTS Biochemical assessment, including TFTs and thyrotropin receptor antibodies (TRAb), clinical features (eg, TED, weight and thionamide use) and patient questionnaire. RESULTS The treatment failure rate was 17%. Failure was greater with higher fT4 (P = 0.002) and higher TRAb (P = 0.004). Failure rate was 42.2% when TRAb >40 U/L. Median weight gain was 3.2 kg in those with normal fT4 prior to RAI and 5.8 kg when fT4 was elevated (P < 0.001). New TED developed in 7.6% but was not associated with post-RAI dysthyroidism. Treatment satisfaction was generally high (median response 8/10). CONCLUSIONS Treatment failure after RAI occurs in predictable groups and this should be reflected in the information provided to patients. Weight gain is common and may not entirely be explained by a return to pre-thyrotoxic baseline. We were unable to detect any significant impact of post-RAI dysthyroidism on weight gain, TED or thyroid symptoms in this large cohort.
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Affiliation(s)
- Ei Thuzar Aung
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicola N Zammitt
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology and Diabetes, Western General Hospital, Edinburgh, UK
| | - Jonathan R Seckl
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queen's Medical Research Unit, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
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Al Majdoub M, Lantz M, Spégel P. Alterations in levels of intermediate-chained acylcarnitines associate with weight-gain following reestablishment of euthyroidism in Graves' disease. Endocrine 2019; 63:164-166. [PMID: 30178436 DOI: 10.1007/s12020-018-1735-9] [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: 05/15/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mahmoud Al Majdoub
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Mikael Lantz
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Peter Spégel
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
- Department of Chemistry, Centre for Analysis and Synthesis, Lund University, Lund, Sweden.
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Singh Ospina N, Castaneda-Guarderas A, Hamidi O, Ponce OJ, Zhen W, Prokop L, Montori VM, Brito JP. Weight Changes After Thyroid Surgery for Patients with Benign Thyroid Nodules and Thyroid Cancer: Population-Based Study and Systematic Review and Meta-Analysis. Thyroid 2018; 28:639-649. [PMID: 29631475 PMCID: PMC6117738 DOI: 10.1089/thy.2017.0216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A key concern among patients who undergo thyroid surgery is postoperative weight gain. Yet, the impact of thyroid surgery on weight is unclear. METHODS The population-based Rochester Epidemiology Project was used to examine weight and body mass index (BMI) changes at one, two, and three years of follow-up in (i) patients with thyroid cancer and benign thyroid nodules after thyroid surgery, and (ii) patients with thyroid nodules who did not have surgery. A comprehensive systematic review of the published literature from inception to February 2016 was also conducted. The results were pooled across studies using a random effects model. RESULTS A total of 435 patients were identified: 181 patients with thyroid cancer who underwent surgery (group A), 226 patients with benign thyroid nodules without surgery (group B), and 28 patients with benign thyroid nodules undergoing surgery (group C). Small changes in mean weight, BMI, and the number of patients whose weight increased between 5 and 10 kg were similar during each year of follow-up between patients in groups A and B. Furthermore, age >50 years, female sex, baseline BMI >25 kg/m2, and thyrotropin value at one to two years were not predictors of a 5% weight change. In the meta-analysis, 11 studies were included. One to two years after surgery for thyroid cancer or thyroid nodules, patients gained on average 0.94 kg [confidence interval (CI) 0.58-1.33] and 1.07 kg [CI 0.26-1.87], respectively. Patients with benign thyroid nodules who did not have surgery gained 1.50 kg [CI 0.60-2.4] at the longest follow-up. CONCLUSIONS On average, patients receiving care for thyroid nodules or cancer gain weight, but existing evidence suggests that surgery for these conditions does not contribute significantly to further weight gain. Clinicians and patients can use this information to discuss what to expect after thyroid surgery.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism, Department of Medicine, University of Florida, Gainesville, Florida
- Knowledge and Evaluation Research Unit (KER-ENDO), Mayo Clinic, Rochester, Minnesota
| | | | - Oksana Hamidi
- Knowledge and Evaluation Research Unit (KER-ENDO), Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Oscar J. Ponce
- Knowledge Synthesis Unit, Mayo Clinic, Rochester, Minnesota
| | - Wang Zhen
- Knowledge Synthesis Unit, Mayo Clinic, Rochester, Minnesota
| | - Larry Prokop
- Mayo Medical Libraries, Mayo Clinic, Rochester, Minnesota
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit (KER-ENDO), Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit (KER-ENDO), Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Address correspondence to:Juan P. Brito, MD, MScKnowledge and Evaluation Research UnitDivision of Endocrinology, Diabetes, Metabolism, and NutritionMayo Clinic200 1st Street SWRochester, MN 55905
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Glick R, Chang P, Michail P, Serpell JW, Grodski S, Lee JC. Body weight change is unpredictable after total thyroidectomy. ANZ J Surg 2018; 88:162-166. [DOI: 10.1111/ans.14421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/15/2017] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ron Glick
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
| | - Paula Chang
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
| | - Peter Michail
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
| | - Jonathan W. Serpell
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - James C. Lee
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
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Alonso GT, Rabon S, White PC. Weight gain after treatment of Graves' disease in children. Clin Endocrinol (Oxf) 2018; 88:66-70. [PMID: 29023978 DOI: 10.1111/cen.13493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/18/2017] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The frequency of and risk factors for weight gain in children treated for Graves' disease have not been described. We evaluated change in BMI-Z score and predictors of weight gain in this population. DESIGN Retrospective review of data from January 2000 to July 2011. PATIENTS Two hundred and twenty two children and adolescents with Graves' disease (ages 2-18 years) evaluated following radioactive iodine administration (RAI); (n = 101), thyroidectomy (n = 9) and initiation of medical therapy (n = 112). MEASUREMENTS Changes in body mass index Z score over 12 months (ΔBMI-Z0-12 ). RESULTS All treatment groups in each gender and race increased BMI-Z (median ΔBMI-Z0-12 was positive). T3 levels following RAI (P = .04) and weight lost at the time of administration (P = .02) in the RAI group and free T4 levels in the medical therapy group (P = .03) were positively correlated with ΔBMI-Z0-12 . Race was a significant predictor only in the medical therapy group (P = .01). Age negatively correlated with ΔBMI-Z0-12 in both the RAI (P < .001) and medical therapy groups (P = .003). Gender, maximum TSH in the 12 months after RAI and initial dose of LT4 replacement did not correlate with ΔBMI-Z0-12 . The prevalence of overweight and obesity in our cohort was similar to US children. CONCLUSIONS Weight gain during treatment for Graves' disease is common in children, and many children become overweight or obese during treatment. Risk factors include greater degree of hyperthyroidism at presentation and time of RAI and younger age. Weight lost upon presentation may also predict greater weight gain. Control of subsequent hypothyroidism does not appear to affect weight gain.
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Affiliation(s)
| | - Shona Rabon
- UT Southwestern Medical Center, Dallas, TX, USA
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Jacobson MH, Darrow LA, Barr DB, Howards PP, Lyles RH, Terrell ML, Smith AK, Conneely KN, Marder ME, Marcus M. Serum Polybrominated Biphenyls (PBBs) and Polychlorinated Biphenyls (PCBs) and Thyroid Function among Michigan Adults Several Decades after the 1973-1974 PBB Contamination of Livestock Feed. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097020. [PMID: 28953452 PMCID: PMC5915188 DOI: 10.1289/ehp1302] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND In 1973-1974, Michigan residents were exposed to polybrominated biphenyls (PBBs) through an accidental contamination of the food supply. Residents were enrolled in a registry assembled after the incident, and they and their children participated in follow-up studies to assess subsequent health outcomes. OBJECTIVES We evaluated associations between serum PBBs and polychlorinated biphenyls (PCBs) and markers of thyroid function among Michigan adults. METHODS Serum concentrations of four PBB and four PCB congeners were measured at least once in 753 adults, including 79 women who participated in a 2004-2006 study and 683 women and men with follow-up during 2012-2015. Participants completed questionnaires on health conditions (including physician-diagnosed thyroid disease), behaviors, and demographics. Thyroid hormones were measured in a subset without thyroid disease (n=551). In multivariable linear regression models, PBB and PCB congener concentrations, on both the volume (nanogram/milliliter) and lipid (nanogram/gram lipid) basis, were assessed in relation to thyroid hormones. Logistic regression models were used to estimate associations between serum PBBs and PCBs and thyroid disease. RESULTS Thyroid disease was common (18% overall; 25% among women). Among women, all odds ratios (ORs) for PBB-153 and thyroid disease were positive for quintiles above the reference level, but estimates were imprecise and were without a monotonic increase. For an interquartile range (IQR) increase in PBB-153 (0.43 ng/mL), the OR (any thyroid disease)=1.12; (95% CI: 0.83, 1.52) (n=105 cases); for hypothyroidism, OR=1.35 (95% CI: 0.86, 2.13) (n=49 cases). There were 21 cases of thyroid disease in men [OR=0.69 (95% CI: 0.33); 1.44 for an IQR increase (0.75 ng/mL) in serum PBB-153]. PCB congeners were statistically significantly associated with greater total and free thyroxine and total triiodothyronine among women and with total and free triiodothyronine among men in lipid-standardized models. CONCLUSIONS We found some evidence to support associations of PBBs and PCBs with thyroid disease and thyroid hormone levels. https://doi.org/10.1289/EHP1302.
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Affiliation(s)
- Melanie H Jacobson
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University , Atlanta, Georgia, USA
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University , Atlanta, Georgia, USA
- Department of Environmental Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
- School of Community Health Sciences, University of Nevada , Reno, Nevada, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University , Atlanta, Georgia, USA
| | - Robert H Lyles
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
| | - Metrecia L Terrell
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University , Atlanta, Georgia, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University School of Medicine , Atlanta, Georgia, USA
| | - Karen N Conneely
- Department of Human Genetics, Emory University School of Medicine , Atlanta, Georgia, USA
| | - M Elizabeth Marder
- Department of Environmental Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University , Atlanta, Georgia, USA
- Department of Environmental Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
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40
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Chen M, Lash M, Nebesio T, Eugster E. Change in BMI after radioactive iodine ablation for graves disease. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2017; 2017:5. [PMID: 28588625 PMCID: PMC5455212 DOI: 10.1186/s13633-017-0044-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/17/2017] [Indexed: 11/24/2022]
Abstract
Background We aimed to determine the extent of post-treatment weight gain that occurs in pediatric patients in the first year following radioactive iodine (RAI) therapy for Graves disease (GD) and its relationship to clinical characteristics. Methods A retrospective chart review of patients receiving RAI therapy for GD between 1998–2015 was performed. Change in BMI SDS (∆BMI SDS) from baseline to one year after treatment was determined. We also investigated whether individual clinical and/or biochemical factors were associated with the weight trajectory in these patients. Results One hundred fifty seven patients aged 12.7 ± 3 years (80% girls) were included in the analysis. Average ∆BMI SDS was 0.70 ± 0.71 (p < 0.001) at 1 year. Patients with weight loss at presentation had a greater ∆BMI SDS than those without (0.92 vs 0.56, p = 0.005), whereas no association was seen with gender, pubertal status, use of antithyroid drugs, history of ADHD, or Down syndrome. Baseline BMI SDS was negatively correlated with ∆BMI SDS, with a stronger correlation in males. From baseline to 1 year, the proportion of overweight and obese patients increased from 9.6% to 18.5% and from 6.4% to 21%, respectively. In a subset of 81 patients, a positive correlation was noted between time to euthyroidism and ∆BMI SDS, particularly in boys. Conclusions The number of our patients in the overweight category doubled and the number in the obese category more than tripled in the first year following RAI treatment for GD. Anticipatory guidance regarding this important issue is badly needed.
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Affiliation(s)
- Melinda Chen
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
| | - Matthew Lash
- Department of Pediatrics, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Todd Nebesio
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
| | - Erica Eugster
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
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Bel Lassen P, Kyrilli A, Lytrivi M, Ruiz Patino M, Corvilain B. Total thyroidectomy: a clue to understanding the metabolic changes induced by subclinical hyperthyroidism? Clin Endocrinol (Oxf) 2017; 86:270-277. [PMID: 27651121 DOI: 10.1111/cen.13237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The effects of endogenous subclinical hyperthyroidism (eSCH) on heart and bone have been well documented. There are only limited data available regarding the impact of eSCH on weight regulation and lipid metabolism. Our aim was to evaluate the changes in body weight and metabolic parameters after total thyroidectomy in patients with pre-operative eSCH compared with pre-operative patients with euthyroid (EUT). DESIGN A retrospective study of 505 patients who underwent total thyroidectomy for benign multinodular goitre in an academic hospital in Brussels (Belgium) was performed. PATIENT'S MEASUREMENTS Two hundred and 25 patients were included (eSCH group: n = 74; EUT group: n = 151). The mean follow-up time was 26·1 ± 0·8 months and was similar in both groups. RESULTS Absolute BMI gain was significantly greater in the eSCH group than in the EUT group (1·11 ± 0·17 vs 0·33 ± 0·13 kg/m2 ; P = 0·003). A significant increase in LDL cholesterol was observed in the eSCH group (16·1 ± 3·8 mg/dl; P < 0·001) but not in the EUT group (0·0 ± 3·0 mg/dl; P = 0·88). In a multivariate model, pre-operative TSH levels were the main factor significantly associated with increases in BMI or LDL cholesterol. Post-operative median TSH levels and L-thyroxine substitution were similar in both groups. CONCLUSION After total thyroidectomy, increases in weight and serum cholesterol were observed in the eSCH group. Given that post-operative TSH levels were similar in the two groups, these observations are probably due to the correction of eSCH, suggesting a direct effect of eSCH on body weight regulation and lipid metabolism.
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Affiliation(s)
- Pierre Bel Lassen
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Aglaia Kyrilli
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Lytrivi
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Ruiz Patino
- Department of Thoracic Surgery - Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
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Draman MS, Stechman M, Scott-Coombes D, Dayan CM, Rees DA, Ludgate M, Zhang L. The Role of Thyrotropin Receptor Activation in Adipogenesis and Modulation of Fat Phenotype. Front Endocrinol (Lausanne) 2017; 8:83. [PMID: 28469599 PMCID: PMC5395630 DOI: 10.3389/fendo.2017.00083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/31/2017] [Indexed: 01/15/2023] Open
Abstract
Evidence from clinical and experimental data suggests that thyrotropin receptor (TSHR) signaling is involved in energy expenditure through its impact on white adipose tissue (WAT) and brown adipose tissue (BAT). TSHR expression increases during mesenchymal stem cell (MSC) differentiation into fat. We hypothesize that TSHR activation [TSHR*, elevated thyroid-stimulating hormone, thyroid-stimulating antibodies (TSAB), or activating mutation] influences MSC differentiation, which contributes to body composition changes seen in hypothyroidism or Graves' disease (GD). The role of TSHR activation on adipogenesis was first investigated using ex vivo samples. Neck fat (all euthyroid at surgery) was obtained from GD (n = 11, TSAB positive), toxic multinodular goiter (TMNG, TSAB negative) (n = 6), and control patients with benign euthyroid disease (n = 11, TSAB negative). The effect of TSHR activation was then analyzed using human primary abdominal subcutaneous preadipocytes (n = 16). Cells were cultured in complete medium (CM) or adipogenic medium [ADM, containing thiazolidinedione (TZD), PPARγ agonist, which is able to induce BAT formation] with or without TSHR activation (gain-of-function mutant) for 3 weeks. Adipogenesis was evaluated using oil red O (ORO), counting adipogenic foci, qPCR measurement of terminal differentiation marker (LPL). BAT [PGC-1α, uncoupling protein 1 (UCP1), and ZIC1], pre-BAT (PRDM16), BRITE- (CITED1), or WAT (LEPTIN) markers were analyzed by semiquantitative PCR or qPCR. In ex vivo analysis, there were no differences in the expression of UCP1, PGC-1α, and ZIC1. BRITE marker CITED1 levels were highest in GD followed by TMNG and control (p for trend = 0.009). This was associated with higher WAT marker LEPTIN level in GD than the other two groups (p < 0.001). In primary cell culture, TSHR activation substantially enhanced adipogenesis with 1.4 ± 0.07 (ORO), 8.6 ± 1.8 (foci), and 5.5 ± 1.6 (LPL) fold increases compared with controls. Surprisingly, TSHR activation in CM also significantly increased pre-BAT marker PRDM16; furthermore, TZD-ADM induced adipogenesis showed substantially increased BAT markers, PGC-1α and UCP1. Our study revealed that TSHR activation plays an important role in the adipogenesis process and BRITE/pre-BAT formation, which leads to WAT or BAT phenotype. It may contribute to weight loss as heat during hyperthyroidism and later transforms into WAT posttreatment of GD when patients gain excess weight.
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Affiliation(s)
| | - Michael Stechman
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
| | | | | | - Dafydd Aled Rees
- School of Medicine, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Marian Ludgate
- Thyroid Research Group, Cardiff University, Cardiff, UK
- *Correspondence: Marian Ludgate, ; Lei Zhang,
| | - Lei Zhang
- Thyroid Research Group, Cardiff University, Cardiff, UK
- *Correspondence: Marian Ludgate, ; Lei Zhang,
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43
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Rabon S, Burton AM, White PC. Graves' disease in children: long-term outcomes of medical therapy. Clin Endocrinol (Oxf) 2016; 85:632-5. [PMID: 27169644 DOI: 10.1111/cen.13099] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/14/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. METHODS This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. RESULTS A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. CONCLUSIONS Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild.
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Affiliation(s)
- Shona Rabon
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amy M Burton
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Perrin C White
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Chng CL, Lim AYY, Tan HC, Kovalik JP, Tham KW, Bee YM, Lim W, Acharyya S, Lai OF, Chong MFF, Yen PM. Physiological and Metabolic Changes During the Transition from Hyperthyroidism to Euthyroidism in Graves' Disease. Thyroid 2016; 26:1422-1430. [PMID: 27465032 DOI: 10.1089/thy.2015.0602] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serum metabolomic profile and its relationship to physiological changes during hyperthyroidism and restoration to euthyroidism are not known. This study aimed to examine the physiological, adipokine, and metabolomic changes that occur when subjects with Graves' disease transition from hyperthyroidism to euthyroidism with medical treatment. METHODS Chinese women between 21 and 50 years of age and with newly diagnosed Graves' disease attending the endocrine outpatient clinics in a single institution were recruited between July 2012 and September 2014. All subjects were treated with thioamides to achieve euthyroidism. Clinical parameters (body weight, body composition via bioelectrical impedance analysis, resting energy expenditure and respiratory quotient via indirect calorimetry, and reported total energy intake via 24 h food diary), biochemical parameters (thyroid hormones, lipid profile, fasting insulin and glucose levels), serum leptin, adiponectin, and metabolomics profiles were measured during hyperthyroidism and repeated in early euthyroidism. RESULTS Twenty four Chinese women with an average age of 36.3 ± 8.6 years were included in the study. The average duration of treatment that was required to reach euthyroidism for these subjects was 38 ± 16.3 weeks. There was a significant increase in body weight (52.6 ± 9.0 kg to 55.3 ± 9.4 kg; p < 0.001) and fat mass (14.3 ± 6.9 kg to 16.8 ± 6.5 kg; p = 0.005). There was a reduction in resting energy expenditure corrected for weight (28.7 ± 4.0 kcal/kg to 21.5 ± 4.1 kcal/kg; p < 0.001) and an increase in respiratory quotient (0.76 to 0.81; p = 0.037). Resting energy expenditure increased significantly with increasing free triiodothyronine levels (p = 0.007). Significant increases in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were noted. There was no significant change in leptin levels, but adiponectin levels increased significantly (p = 0.018). Significant reductions in fasting C2, medium-chain, long-chain, and total acylcarnitines were observed, but no changes in the fat-free mass, branched chain amino acid levels, or insulin sensitivity during recovery from hyperthyroidism were noted. CONCLUSIONS Serum metabolomics profile changes complemented the physiological changes observed during the transition from hyperthyroidism to euthyroidism. This study provides a comprehensive and integrated view of the changes in fuel metabolism and energy balance that occur following the treatment of hyperthyroidism.
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Affiliation(s)
- Chiaw-Ling Chng
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | | | - Hong Chang Tan
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Jean-Paul Kovalik
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
| | - Kwang Wei Tham
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Yong Mong Bee
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Weiying Lim
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Sanchalika Acharyya
- 3 Centre for Quantitative Medicine, Duke-NUS Graduate Medical School , Singapore
| | - Oi Fah Lai
- 4 Department of Clinical Research, Singapore General Hospital , Singapore
| | - Mary Foong-Fong Chong
- 5 Singapore Institute for Clinical Sciences (SICS) , A*star, Brenner Centre for Molecular Medicine, Singapore
| | - Paul Michael Yen
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
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45
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Abstract
Objectives: The main purpose of this study is to examine if body weight change is a potential risk factor for the onset of functional impairment across time among various functional domains. Methods: Using longitudinal data from the Health and Retirement Study, logistic regression models on the onset of functional impairment over three time points are estimated for young old adults. Results: Results indicate that weight gain is associated with greater risk of lower body mobility impairment. An increase in body mass index of greater than 5% increases the likelihood of the onset of lower body mobility functional impairment. Discussion: Study findings support the promotion of healthy weight management. Future studies in this area may want to investigate effective interventions that contribute to healthy weight maintenance among this cohort.
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Affiliation(s)
- Kristi R Jenkins
- University of Michigan, Institute for Social Research, Ann Arbor, MI 48106-1248, USA.
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Lang BHH, Zhi H, Cowling BJ. Assessing perioperative body weight changes in patients thyroidectomized for a benign nontoxic nodular goitre. Clin Endocrinol (Oxf) 2016; 84:882-8. [PMID: 26384591 DOI: 10.1111/cen.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following thyroidectomy, patients often complain of weight gain. Our study aimed to evaluate the extent of weight change in patients thyroidectomized for a nontoxic benign goitre after adjusting for patient demographics and pre-operative weight changes. METHODS Three different patient groups were studied. The first comprised 898 patients who underwent thyroidectomy for benign nontoxic nodular goitre (group I). The second comprised 179 patients who had benign nontoxic goitre but did not undergo thyroidectomy (group II), and the third comprised 80 patients who underwent a simple excision of a parathyroid adenoma (group III). All patients were weighed 12 months preceding baseline, at baseline and 6 months after baseline. RESULTS Baseline characteristics were comparable between groups. Patients in Group I who gained the least weight in the year leading to surgery gained the most weight 12 months after surgery (P = 0·030). After adjusting for demographics and pre-operative weight changes, Group I gained significantly more weight at post 6 and 12 months (0·71 (95% CI=0·46-0·95) kg and 1·21 (95% CI = 0·96-1·46) kg, respectively). Weight gain at post 12 months appeared similar between hemithyroidectomy and total thyroidectomy (1·32 vs 1·16 kg, P = 0·197). Younger age (ß coefficient -0·100, 95% CI = -0·030 to 0·003, P = 0·015) and higher baseline thyroid stimulating hormone (ß coefficient -0·315, 95% CI = -1·468 to 0·134, P = 0·020) were significant factors for weight gain at post 12 months. CONCLUSIONS Compared to nonthyroidectomized patients, thyroidectomized patients experienced significant weight increases at post 6 and 12 months. The extent of thyroidectomy did not affect the extent of weight gain. Younger age and higher baseline thyroid stimulating hormone were significant factors of weight gain at post 12 months.
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Affiliation(s)
- Brian H-H Lang
- Division of Endocrine Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Helen Zhi
- Biostatistics and Clinical Research Methodology Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Taylor PN, Richmond R, Davies N, Sayers A, Stevenson K, Woltersdorf W, Taylor A, Groom A, Northstone K, Ring S, Okosieme O, Rees A, Nitsch D, Williams GR, Smith GD, Gregory JW, Timpson NJ, Tobias JH, Dayan CM. Paradoxical Relationship Between Body Mass Index and Thyroid Hormone Levels: A Study Using Mendelian Randomization. J Clin Endocrinol Metab 2016; 101:730-8. [PMID: 26595101 PMCID: PMC4880123 DOI: 10.1210/jc.2015-3505] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Free T3 (FT3) has been positively associated with body mass index (BMI) in cross-sectional studies in healthy individuals. This is difficult to reconcile with clinical findings in pathological thyroid dysfunction. OBJECTIVE We aimed to investigate whether childhood adiposity influences FT3 levels. DESIGN Mendelian randomization using genetic variants robustly associated with BMI. SETTING Avon Longitudinal Study of Parents and Children, a population-based birth cohort. PARTICIPANTS A total of 3014 children who had thyroid function measured at age 7, who also underwent dual x-ray absorptiometry scans at ages 9.9 and 15.5 years and have genetic data available. MAIN OUTCOME MEASURES FT3. RESULTS Observationally at age 7 years, BMI was positively associated with FT3: β-standardized (β-[std]) = 0.12 (95% confidence interval [CI]: 0.08, 0.16), P = 4.02 × 10(-10); whereas FT4 was negatively associated with BMI: β-(std) = -0.08 (95% CI: -0.12, -0.04), P = 3.00 × 10(-5). These differences persisted after adjustment for age, sex, and early life environment. Genetic analysis indicated 1 allele change in BMI allelic score was associated with a 0.04 (95% CI: 0.03, 0.04) SD increase in BMI (P = 6.41 × 10(-17)). At age 7, a genetically determined increase in BMI of 1.89 kg/m(2) was associated with a 0.22 pmol/L (95% CI: 0.07, 0.36) increase in FT3 (P = .004) but no substantial change in FT4 0.01 mmol/L, (95% CI: -0.37, 0.40), P = .96. CONCLUSION Our analysis shows that children with a genetically higher BMI had higher FT3 but not FT4 levels, indicating that higher BMI/fat mass has a causal role in increasing FT3 levels. This may explain the paradoxical associations observed in observational analyses. Given rising childhood obesity levels, this relationship merits closer scrutiny.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Rebecca Richmond
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Neil Davies
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Adrian Sayers
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Kirsty Stevenson
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Wolfram Woltersdorf
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Andrew Taylor
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Alix Groom
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Kate Northstone
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Susan Ring
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Onyebuchi Okosieme
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Aled Rees
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Dorothea Nitsch
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Graham R Williams
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - George Davey Smith
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - John W Gregory
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Nicholas J Timpson
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Jonathan H Tobias
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
| | - Colin M Dayan
- Thyroid Research Group (P.N.T., O.O., J.W.G., C.M.D.) and Institute of Molecular and Experimental Medicine (A.R.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Medical Research Council Integrative Epidemiology Unit (R.R., N.D., G.D.S., N.J.T.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Social and Community Medicine (A.S., A.G., K.N., S.R.), University of Bristol, Bristol, BS8 2BN United Kingdom; Department of Biochemistry (K.S.), Bristol Royal Infirmary University Hospitals Bristol National Health Service Foundation Trust, Bristol, BS2 8HW United Kingdom; Geschäftsleiter Medizinisches Versorgungszentrum Labor Dr. Reising-Ackermann und Kollegen (W.W.), D-04289 Leipzig, Germany; Department of Biochemistry (A.T.), Royal United Hospital, Bath, BA1 3NG United Kingdom; Department of Non-Communicable Disease Epidemiology (D.N.), Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, CF14 4XN United Kingdom; Molecular Endocrinology Group (G.R.W.), Department of Medicine, Imperial College London, London, WC1E 7HT United Kingdom; and Musculoskeletal Research Unit (J.H.T.), University of Bristol, Learning and Research Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB United Kingdom
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Kelderman-Bolk N, Visser TJ, Tijssen JP, Berghout A. Quality of life in patients with primary hypothyroidism related to BMI. Eur J Endocrinol 2015; 173:507-15. [PMID: 26169304 DOI: 10.1530/eje-15-0395] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/13/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Many patients treated for primary hypothyroidism have an unexplained reduced quality of life (QOL). We studied the relation between QOL and various parameters in treated hypothyroid patients. DESIGN AND METHODS QOL analysis was done in 90 consecutive patients (77.8% females) treated for primary hypothyroidism. QOL was measured by the questionnaires Short-Form 36, Hospital Anxiety and Depression Scale and MFI20. Post hoc analysis was performed on the relation of QOL at baseline and BMI, thyroid hormones and other serum values. QOL in patients was also compared to the general population. RESULTS QOL was decreased compared to the general population. We found an inverse relationship between QOL and BMI. A relationship between QOL and serum thyroid parameters or auto-antibodies could not be found. Higher sex hormone binding globulin (SHBG) levels corresponded with a better QOL, which is explained by the negative association of SHBG with body weight and BMI. CONCLUSIONS A decreased QOL in hypothyroid patients on thyroxine treatment is related to a higher body weight (BMI). Weight gain needs more attention in the treatment of hypothyroidism.
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Affiliation(s)
- Nienke Kelderman-Bolk
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Theo J Visser
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan P Tijssen
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Arie Berghout
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
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50
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Sohn SY, Joung JY, Cho YY, Park SM, Jin SM, Chung JH, Kim SW. Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression. Endocrinol Metab (Seoul) 2015; 30:343-51. [PMID: 26248858 PMCID: PMC4595360 DOI: 10.3803/enm.2015.30.3.343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/20/2015] [Accepted: 03/11/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are limited data about whether patients who receive initial treatment for differentiated thyroid cancer (DTC) gain or lose weight during long-term follow-up under thyroid stimulating hormone (TSH) suppression. This study was aimed to evaluate whether DTC patients under TSH suppression experience long-term weight gain after initial treatment. We also examined the impact of the radioactive iodine ablation therapy (RAIT) preparation method on changes of weight, comparing thyroid hormone withdrawal (THW) and recombinant human TSH (rhTSH). METHODS We retrospectively reviewed 700 DTC patients who underwent a total thyroidectomy followed by either RAIT and levothyroxine (T4) replacement or T4 replacement alone. The control group included 350 age-matched patients with benign thyroid nodules followed during same period. Anthropometric data were measured at baseline, 1 to 2 years, and 3 to 4 years after thyroidectomy. Comparisons were made between weight and body mass index (BMI) at baseline and follow-up. RESULTS Significant gains in weight and BMI were observed 3 to 4 years after initial treatment for female DTC but not in male patients. These gains among female DTC patients were also significant compared to age-matched control. Women in the THW group gained a significant amount of weight and BMI compared to baseline, while there was no increase in weight or BMI in the rhTSH group. There were no changes in weight and BMI in men according to RAIT preparation methods. CONCLUSION Female DTC patients showed significant gains in weight and BMI during long-term follow-up after initial treatment. These changes were seen only in patients who underwent THW for RAIT.
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Affiliation(s)
- Seo Young Sohn
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Ji Young Joung
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Young Cho
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Mi Park
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Man Jin
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Thyroid Center, Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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