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Chatzivasileiou P, Armeni E, Chedraui P, Kontou L, Augoulea A, Palaiologou A, Kaparos G, Panoulis K, Alexandrou A, Vlachos N, Lambrinoudaki I. Postmenopausal women with higher TSH values within the normal range present improved handgrip strength: a pilot study. Gynecol Endocrinol 2024; 40:2333432. [PMID: 38567465 DOI: 10.1080/09513590.2024.2333432] [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: 11/06/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To evaluate the possible association between thyroid function within the euthyroid range and musculoskeletal parameters as well as body composition in a sample of postmenopausal women. METHODS This cross-sectional study included 96 postmenopausal women with serum thyroid-stimulating hormone (TSH) within the normal laboratory reference range. Fasting venous blood samples were obtained for biochemical/hormonal assessment. Bone status and body composition were measured using Dual Energy X-ray absorptiometry (DXA). Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ) index. RESULTS Serum TSH correlated with handgrip strength (HGS, r-coefficient = 0.233, p = .025), and total body bone mineral density (BMD) T-score values (r-coefficient = 0.321, p = .003). HGS measures were associated with BMD (r-coefficient = 0.415, p < .001), with bone mineral content (BMC, r-coefficient = 0.427, p < .001), and lean mass (r-coefficient = 0.326, p = .003). Women with low muscle strength, defined as HGS < 16 kg, had lower TSH levels than women with normal muscle strength (low vs. normal muscle strength, ANCOVA 1.13 ± 0.49 mU/L vs. 1.60 ± 0.83 mU/L, p = 0.024) independently of age, BMD, percentage of body fat or absolute lean mass. Multivariable linear regression analysis showed that HGS values were associated with TSH measurements (β-coefficient = 0.246, p = .014) and BMD T-score values (β-coefficient = 0.306, p = .002). All models were adjusted for age, body mass index (BMI), vitamin D, low-density lipoprotein cholesterol, current smoking, physical activity, and homeostasis model assessment of insulin resistance. CONCLUSIONS In this sample of postmenopausal women, lower serum TSH values, within normal range, were associated with lower muscle strength compared to higher normal TSH values. Further research is needed to elucidate the significance of our preliminary findings.
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Affiliation(s)
- Panagiota Chatzivasileiou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
- Royal Free Hospital, NHS Foundation Trust, University College London Medical School, London, UK
| | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Loraina Kontou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Anastasia Palaiologou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - George Kaparos
- Biochemical Laboratory, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Nikolaos Vlachos
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
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El-Nawawy A, Elwafa RAHA, Khalil Abouahmed A, Rasheed RA, Omar OM. Evaluation of non-thyroidal illness syndrome in shock patients admitted to pediatric intensive care unit in a developing country. Eur J Pediatr 2024; 183:769-778. [PMID: 37994931 PMCID: PMC10912421 DOI: 10.1007/s00431-023-05338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
During critical illness, children my experience various changes in their thyroid hormone levels. Such changes are termed non-thyroidal illness syndrome (NTI). The extent of change correlates with the severity of the illness and its outcomes in critically ill patients. This study aimed to investigate the correlation between the severity of shock and thyroid hormone derangement. This prospective observational study included forty patients aged one month to five years who were admitted to the pediatric intensive care unit (PICU) with shock. Thyroid function tests were conducted on admission, after shock reversal, and five days later. NTI patterns were observed in 70% of patients. The PIM2 score showed a significant negative correlation with T3 (r = - 0.353, p = 0.026) and FT3 levels on admission (r = - 0.417, p = 0.007). Furthermore, after shock reversal, the PIM2 score continued to exhibit significant negative correlations with T4 (r = - 0.444, p = 0.004), T3 (r = - 0.329, p = 0.038), FT3 (r = - 0.355, p = 0.025), and FT4 levels (r = - 0.379, p = 0.016). Conclusion: This study underscores the high prevalence of NTI in PICU shock patients and suggests monitoring thyroid hormone levels for outcome prediction and treatment guidance. Further research is needed to optimize NTI management in critically ill children. What is Known: • Non-thyroidal illness syndrome (NTIS) is a condition observed in critically ill patients. • There has been limited research on NTI in children, and existing studies have generated conflicting results regarding the relationship between thyroid hormones and clinical outcomes in cases of sepsis and septic shock. What is New: • The study has revealed dynamic changes in free triiodothyronine (FT3) levels during the process of shock reversal and recovery in children who experienced shock. • A significant negative correlation was found between the Pediatric Index of Mortality 2 (PIM2) score and several thyroid hormone levels, including FT3 on admission and T4, FT3, and FT4 on shock reversal.
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Affiliation(s)
- Ahmed El-Nawawy
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | | | - Ahmed Khalil Abouahmed
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | - Rehab Atef Rasheed
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt
| | - Omneya Magdy Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, 21321, Egypt.
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Yao Y, Li J, Sun W, Ma C, Ning N, Li J, Ni T, Gui M, Chen Y, Zhao B, Zhang J, Zhu J, Gao C, Sheng H, Mao E. Association Between Nonthyroidal Illness Syndrome and Disseminated Intravascular Coagulation in Sepsis. J Inflamm Res 2024; 17:497-506. [PMID: 38304414 PMCID: PMC10832446 DOI: 10.2147/jir.s442598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Both nonthyroidal illness syndrome (NTIS) and disseminated intravascular coagulation (DIC) are commonly occurred in sepsis. The objective of this study is to evaluate the association between NTIS and DIC, as well as their impacts on the mortality in adults with sepsis. Patients and methods A total of 1219 septic patients in two Chinese academic centers from October 2012 and October 2022 were enrolled in analysis. We conduct logistic regression models to analyze the independent risk factors for DIC. Modified Poisson regression models are used to estimate the relative risk (RR) of NTIS on the 28 days mortality in septic patients with DIC. Correlation analysis between thyroid function parameters and coagulation parameters is performed with Pearson coefficient be reported. Results DIC is diagnosed on 388 (31.8%) of all the 1219 enrolled septic patients within 72 hours after admission. In multivariate logistic regression models, NTIS (OR 3.19; CI 2.31-4.46; p<0.001) is a statistically significant independent risk factor for DIC after adjustment for potential confounders. Twenty-eight days mortality is significantly higher in DIC patients complicated with NTIS compared with the other DIC patients (23.2% vs 14.0%, p=0.024). This result is also robust in different modified Poisson regression models (Model 1: RR 1.46; CI 1.25-1.70; p<0.001; Model 2: RR 1.35; CI 1.14-1.60; p<0.001; Model 3: RR 1.18; CI 1.02-1.37; p=0.026). Correlation analysis reveals that the thyroid function parameters of FT3, FT4 and TSH only have weak correlations with coagulation parameters of platelet count, fibrinogen, FDP, D-dimers, PT, APTT and INR in sepsis. Conclusion NTIS is an independent risk factor for DIC in adults with sepsis. DIC patients complicated with NTIS have significantly higher severity and higher rate of mortality.
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Affiliation(s)
- Yi Yao
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Juan Li
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Wenwu Sun
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Chaoping Ma
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Ning Ning
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Jiaoyan Li
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Tongtian Ni
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Menglu Gui
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Ying Chen
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Bing Zhao
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Jiyuan Zhang
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Jiyue Zhu
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Chengjin Gao
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Huiqiu Sheng
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
| | - Enqiang Mao
- Departments of Emergency, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China
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Duan L, Chen D, Shi Y, Ye S, Dou S, Feng Y. Rheumatoid arthritis and hypothyroidism: a bidirectional Mendelian randomization study. Front Immunol 2023; 14:1146261. [PMID: 37600807 PMCID: PMC10433205 DOI: 10.3389/fimmu.2023.1146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Object Though significant correlations between rheumatoid arthritis (RA) and hypothyroidism have been found in earlier observational studies, their underlying causal relationship is still unknown. Mendelian randomization (MR) was used in the current study to assess the bidirectional causation between RA and hypothyroidism. Method We gathered summary data from genome-wide association studies (GWASs) of RA and hypothyroidism in people of European descent. Then, using data from the FinnGen consortium, we replicated our findings. Three approaches were employed to assess the causal link between RA and hypothyroidism: MR-Egger, weighted median (WM), and inverse variance weighted (IVW). The pleiotropy and heterogeneity were examined using a variety of techniques, including the MR-Egger intercept, the MR-PRESSO approach, the leave-one-out method, and the Cochran's Q test. Results The study looked at a bidirectional incidental relationship between RA and hypothyroidism. The risk of hypothyroidism increased with RA (IVW odds ratio (OR) = 1.28, 95% confidence interval (CI) = 1.18-1.39, P = 8.30E-10), as did the risk of secondary hypothyroidism (IVW OR = 1.12, 95% CI = 1.05-1.21, P = 9.64E-4). The results of reverse MR analysis revealed that hypothyroidism (IVW OR = 1.68, 95% CI = 1.51-1.88, P = 4.87E-21) and secondary hypothyroidism (IVW OR = 1.74, 95% CI = 1.50-2.01, P = 1.91E-13) were linked to an increased risk of RA. Additionally, we obtain the same results in the duplicated datasets as well, which makes our results even more reliable. This study revealed no evidence of horizontal pleiotropy. Conclusion The present study established a bidirectional causal link between RA and hypothyroidism. However, it differs slightly from the findings of prior observational studies, suggesting that future research should concentrate on the interaction mechanisms between RA and hypothyroidism.
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Affiliation(s)
- Lincheng Duan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongqing Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Shi
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Senlin Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shulin Dou
- Meishan Hospital of Traditional Chinese Medicine, Affiliated Meishan Hospital of Chengdu University of Traditional Chinese Medicine, Meishan, China
| | - Yue Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Schneider SA, Tschaidse L, Reisch N. Thyroid Disorders and Movement Disorders-A Systematic Review. Mov Disord Clin Pract 2023; 10:360-368. [PMID: 36949803 PMCID: PMC10026317 DOI: 10.1002/mdc3.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
Background There is overlap between movement disorders and neuroendocrine abnormalities. Objectives and methods To provide a systematic review on the association of thyroid dysfunction and movement disorders. Thyroid physiological function and classical thyroid disorders highlighting typical and atypical manifestations including movement disorders, as well as diagnostic procedures, and treatments are discussed. Results Hypothyroidism may be associated with hypokinetic and hyperkinetic disorders. There is debate whether their concomitance reflects a causal link, is coincidence, or the result of one unmasking the other. Hypothyroidism-associated parkinsonism may resemble idiopathic Parkinson's disease. Hypothyroidism-associated hyperkinetic disorders mainly occur in the context of steroid-responsive encephalopathy with autoimmune thyroiditis, that is, Hashimoto disease, mostly manifesting with tremor, myoclonus, and ataxia present in 28-80%, 42-65% and 33-65% in larger series. Congenital hypothyroidism manifesting with movement disorders, mostly chorea and dystonia, due to Mendelian genetic disease are rare.Hyperthyroidism on the other hand mostly manifests with hyperkinetic movement disorders, typically tremor (present in three quarters of patients). Chorea (present in about 2% of hyperthyroid patients), dystonia, myoclonus, ataxia and paroxysmal movement disorders, as well as parkinsonism have also been reported, with correlation between movement intensity and thyroid hormone levels.On a group level, studies on the role of thyroid dysfunction as a risk factor for the development of PD remain non-conclusive. Conclusions In view of the treatability of movement disorders associated with thyroid disease, accurate diagnosis is important. The pathophysiology remains poorly understood. More detailed case documentation and systematic studies, along with experimental studies are needed.
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Affiliation(s)
| | - Lea Tschaidse
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
| | - Nicole Reisch
- Medizinische Klinik und Poliklinik IVKlinikum der Universität MünchenMunichGermany
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Müller P, Leow MKS, Dietrich JW. Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence. Front Cardiovasc Med 2022; 9:942971. [PMID: 36046184 PMCID: PMC9420854 DOI: 10.3389/fcvm.2022.942971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.
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Affiliation(s)
- Patrick Müller
- Department for Electrophysiology, Medical Hospital I, Klinikum Vest, Recklinghausen, NRW, Germany
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, NRW, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, NRW, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, NRW, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, Bochum, NRW, Germany
- *Correspondence: Johannes W. Dietrich
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Davies TF. The Scientific Contributions of Martin Surks, MD, MACP: A Pioneer in Thyroid Hormone Physiology, Subclinical Hypothyroidism, and Endocrine Education. Thyroid 2022; 32:745-749. [PMID: 35236092 DOI: 10.1089/thy.2022.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Terry F Davies
- Thyroid Research Unit, Department of Medicine, Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center, New York, New York, USA
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Turkal R, Turan CA, Elbasan O, Aytan S, Çakmak B, Gözaydınoğlu B, Takır DC, Ünlü O, Bahramzada G, Tekin AF, Çevlik T, Büyükbayrak EE, Şirikçi Ö, Gözü H, Haklar G. Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)? BMC Pregnancy Childbirth 2022; 22:271. [PMID: 35361138 PMCID: PMC8973886 DOI: 10.1186/s12884-022-04608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria. Methods Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1a, T1b, T2a, T2b, T3a, T3b. The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method. Results The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1b subgroup was significantly lower than the T1a subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2a, T2b, and T3b subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001). Conclusions We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required.
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Affiliation(s)
- Rana Turkal
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
| | - Cem Armağan Turan
- Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Onur Elbasan
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Serenay Aytan
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Burcu Çakmak
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Büşra Gözaydınoğlu
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Duygu Ceyda Takır
- Medical Student, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Ünlü
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Günel Bahramzada
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Faruk Tekin
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tülay Çevlik
- Biochemistry Laboratory, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Esra Esim Büyükbayrak
- Department of Gynecology and Obstetrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Önder Şirikçi
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hülya Gözü
- Subdepartment of Endocrinology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Goncagül Haklar
- Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey
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Stagi S, Municchi G, Ferrari M, Wasniewska MG. An Overview on Different L-Thyroxine (l-T 4) Formulations and Factors Potentially Influencing the Treatment of Congenital Hypothyroidism During the First 3 Years of Life. Front Endocrinol (Lausanne) 2022; 13:859487. [PMID: 35757415 PMCID: PMC9218053 DOI: 10.3389/fendo.2022.859487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
Congenital hypothyroidism (CH) is a relatively frequent congenital endocrine disorder, caused by defective production of thyroid hormones (THs) at birth. Because THs are essential for the development of normal neuronal networks, CH is also a common preventable cause of irreversible intellectual disability (ID) in children. Prolonged hypothyroidism, particularly during the THs-dependent processes of brain development in the first years of life, due to delays in diagnosis, inadequate timing and dosing of levothyroxine (l-thyroxine or l-T4), the non-compliance of families, incorrect follow-up and the interference of foods, drugs and medications affecting the absorption of l-T4, may be responsible for more severe ID. In this review we evaluate the main factors influencing levels of THs and the absorption of l-T4 in order to provide a practical guide, based on the existing literature, to allow optimal follow-up for these patients.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
- *Correspondence: Stefano Stagi,
| | - Giovanna Municchi
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Marta Ferrari
- Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy
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Shu Z, Chen M, Wang Q, Lai J, Zhao J, Zhuo C, Huang Y, Lv N, Wu M, Zheng L. High-Normal Thyroid Function and Recurrence of Atrial Fibrillation after Catheter Ablation: A Prospective Observational Study. Cardiology 2021; 146:607-615. [PMID: 34237718 DOI: 10.1159/000517092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid function is increasingly recognized as an important modifiable factor for atrial fibrillation (AF); however, it is unclear if the changes in thyroid hormones, even within the normal range, are associated with AF recurrence after catheter ablation. METHODS Consecutive paroxysmal AF patients who underwent catheter ablation were enrolled. Patients with abnormal thyroid hormones or previous thyroid illnesses were excluded. Patients were followed for 12 months or until they presented with the first episode of atrial tachyarrhythmia after a blanking period. RESULTS The study included 448 patients with a mean age of 61 (14) years, and 46% were women. After a 1-year follow-up, 104 (23.2%) patients experienced atrial tachyarrhythmia recurrences after an ablation procedure. Recurrence was significantly different among quartile groups of thyroid function, with highest FT4 and FT3 levels associated with the greatest risk of recurrence (p < 0.001 and p = 0.024, respectively). FT4 and FT3 levels were independent predictors of atrial tachyarrhythmia recurrence (hazard ratio 1.07 per 1 pmol/L increase in FT4, 95% confidence interval [CI] 1.01-1.15, p = 0.036 and 1.31 per 1 pmol/L increase in FT3, 95% CI 1.01-1.71, p = 0.032). CONCLUSIONS High-normal FT3 and FT4 levels are associated with AF recurrence after catheter ablation in this Chinese population. Attention to thyroid hormones could be valuable to assist in the management of AF.
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Affiliation(s)
- Zheyue Shu
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Miao Chen
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qiqi Wang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiangtao Lai
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jianqiang Zhao
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chengui Zhuo
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yuan Huang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ning Lv
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Minglan Wu
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Research Center for Clinical Pharmacy, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Liangrong Zheng
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
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11
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Schweiger BM, Lao AJ, Tavyev J. A Case Series of Patients With Central Hypothyroidism From Oxcarbazepine Therapy. J Child Neurol 2021; 36:237-242. [PMID: 33030389 DOI: 10.1177/0883073820962926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many medications can impact thyroid function. Antiseizure medications have been shown to disrupt thyroid function in adults, but information is limited about how antiseizure medications may affect thyroid function in children. Oxcarbazepine is an analog of carbamazepine designed to minimize effects from the hepatic P450 metabolic enzymes. We have found that in the pediatric population, serum free thyroxine is reduced and thyroid-stimulating hormone concentrations are unchanged in patients taking oxcarbazepine with the mechanism thus being central hypothyroidism.
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Affiliation(s)
| | - Aaron-James Lao
- 22494Cedars-Sinai Medical Center, South Tower, Los Angeles, CA, USA
| | - Jane Tavyev
- 22494Cedars-Sinai Medical Center, South Tower, Los Angeles, CA, USA
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12
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A review of species differences in the control of, and response to, chemical-induced thyroid hormone perturbations leading to thyroid cancer. Arch Toxicol 2021; 95:807-836. [PMID: 33398420 DOI: 10.1007/s00204-020-02961-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
This review summarises the current state of knowledge regarding the physiology and control of production of thyroid hormones, the effects of chemicals in perturbing their synthesis and release that result in thyroid cancer. It does not consider the potential neurodevelopmental consequences of low thyroid hormones. There are a number of known molecular initiating events (MIEs) that affect thyroid hormone synthesis in mammals and many chemicals are able to activate multiple MIEs simultaneously. AOP analysis of chemical-induced thyroid cancer in rodents has defined the key events that predispose to the development of rodent cancer and many of these will operate in humans under appropriate conditions, if they were exposed to high enough concentrations of the affecting chemicals. There are conditions however that, at the very least, would indicate significant quantitative differences in the sensitivity of humans to these effects, with rodents being considerably more sensitive to thyroid effects by virtue of differences in the biology, transport and control of thyroid hormones in these species as opposed to humans where turnover is appreciably lower and where serum transport of T4/T3 is different to that operating in rodents. There is heated debate around claimed qualitative differences between the rodent and human thyroid physiology, and significant reservations, both scientific and regulatory, still exist in terms of the potential neurodevelopmental consequences of low thyroid hormone levels at critical windows of time. In contrast, the situation for the chemical induction of thyroid cancer, through effects on thyroid hormone production and release, is less ambiguous with both theoretical, and actual data, showing clear dose-related thresholds for the key events predisposing to chemically induced thyroid cancer in rodents. In addition, qualitative differences in transport, and quantitative differences in half life, catabolism and turnover of thyroid hormones, exist that would not operate under normal situations in humans.
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13
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Wang D, Osser DN. The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on bipolar depression. Bipolar Disord 2020; 22:472-489. [PMID: 31650675 DOI: 10.1111/bdi.12860] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Psychopharmacology Algorithm Project at the Harvard South Shore Program (PAPHSS) published algorithms for bipolar depression in 1999 and 2010. Developments over the past 9 years suggest that another update is needed. METHODS The 2010 algorithm and associated references were reevaluated. A literature search was conducted on PubMed for recent studies and review articles to see what changes in the recommendations were justified. Exceptions to the main algorithm for special patient populations, including those with attention-deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), substance use disorders, anxiety disorders, and women of childbearing potential, and those with common medical comorbidities were considered. RESULTS Electroconvulsive therapy (ECT) is still the first-line option for patients in need of urgent treatment. Five medications are recommended for early usage in acute bipolar depression, singly or in combinations when monotherapy fails, the order to be determined by considerations such as side effect vulnerability and patient preference. The five are lamotrigine, lurasidone, lithium, quetiapine, and cariprazine. After trials of these, possible options include antidepressants (bupropion and selective serotonin reuptake inhibitors are preferred) or valproate (very small evidence-base). In bipolar II depression, the support for antidepressants is a little stronger but depression with mixed features and rapid cycling would usually lead to further postponement of antidepressants. Olanzapine+fluoxetine, though Food and Drug Administration (FDA) approved for bipolar depression, is not considered until beyond this point, due to metabolic side effects. The algorithm concludes with a table of other possible treatments that have some evidence. CONCLUSIONS This revision incorporates the latest FDA-approved treatments (lurasidone and cariprazine) and important new studies and organizes the evidence systematically.
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Affiliation(s)
- Dana Wang
- Rivia Medical PLLC, New York, NY, USA
| | - David N Osser
- Department of Psychiatry, Harvard Medical School, VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
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14
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The effect of antiepileptic drugs on thyroid hormonal function: valproic acid and phenobarbital. Acta Neurol Belg 2020; 120:615-619. [PMID: 29508221 DOI: 10.1007/s13760-018-0908-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 11/08/2022]
Abstract
The aim of this study was to evaluate the thyroid function alterations in a group of epileptic children taking antiepileptic drugs. The study included a total of 183 pediatric epilepsy patients, aged 15 months-16 years, comprising 114 patients treated with valproic acid, 69 patients treated with phenobarbital, and 151 age-matched healthy volunteers as the control group. Serum levels of thyroid hormones were measured before the beginning of the antiepileptic therapy and after 12 months of treatment. Thyroid-stimulating hormone levels were significantly higher in the 12th month of phenobarbital and valproic acid treatment. The level of free triiodothyronine before treatment was higher in epileptic patients than in the control group. Subclinical hypothyroidism at month 12 was determined in 15.2% of the valproic acid group and in 2.9% of the phenobarbital group. When compared with the pre-treatment values, there was a statistically significant difference in the incidence of subclinical hypothyroid in the valproic acid group and no significant difference in the phenobarbital group. Symptomatic hypothyroidism was not detected. It was concluded that the thyroid functions of patients using valproic acid and phenobarbital for a long time should be regularly monitored.
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Abstract
Thyroid hormone is essential for normal fetal brain development in utero and for the first 2 years of life. The developing fetus is initially reliant upon maternal thyroid hormones that cross the placenta, until the fetal thyroid begins to supply thyroid hormone for the fetus. Maternal thyroid status affects fetal thyroid function and maternal thyroid dysfunction can have a significant impact on the fetus and neonate. There are also several neonatal factors that can influence thyroid function. Here, we describe thyroid function in the fetus and neonate and discuss the most common thyroid disorders seen in neonates.
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16
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Klionsky Y, Antonelli M. Thyroid Disease in Lupus: An Updated Review. ACR Open Rheumatol 2020; 2:74-78. [PMID: 32043833 PMCID: PMC7011406 DOI: 10.1002/acr2.11105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/05/2019] [Indexed: 01/25/2023] Open
Abstract
In the following review, we seek to provide an overview of the current understanding of various thyroid manifestations affecting patients with systemic lupus erythematosus (SLE), including topics ranging from thyroid‐related complications to SLE in pregnancy. Autoimmune diseases tend to coincide, and an association between thyroid disease and SLE has been reported for more than 50 years. There is no evidence that the coexistence of thyroid disease and lupus alters the disease course or manifestations of either. Both hypothyroidism and thyroid nodules are seen more frequently in patients with SLE than in the general population. The rate of thyroid cancer is twice as prevalent in patients with SLE compared with those without SLE. Several forms of thyroid disease are more common among patients with SLE, with adverse consequences in pregnancy. Future work will require delineating the mechanism behind these associations and understanding the role of antirheumatic agents with concomitant thyroid disease.
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Affiliation(s)
- Yael Klionsky
- Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
| | - Maria Antonelli
- Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
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17
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Duntas LH, Jonklaas J. Levothyroxine Dose Adjustment to Optimise Therapy Throughout a Patient's Lifetime. Adv Ther 2019; 36:30-46. [PMID: 31485977 PMCID: PMC6822824 DOI: 10.1007/s12325-019-01078-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Indexed: 12/12/2022]
Abstract
Levothyroxine is the standard therapy for patients with hypothyroidism, a condition that affects up to 5% of people worldwide. While levothyroxine therapy has substantially improved the lives of millions of hypothyroid patients since its introduction in 1949, the complexity of maintaining biochemical and clinical euthyroidism in patients undergoing treatment with levothyroxine cannot be underestimated. Initial dosing of levothyroxine can vary greatly and may be based on the amount of residual thyroid function retained by the patient, the body weight or lean body mass of the patient, and thyroid-stimulating hormone levels. As levothyroxine is usually administered over a patient’s lifetime, physiological changes throughout life will affect the dose of levothyroxine required to maintain euthyroidism. Furthermore, dose adjustments may need to be made in patients with concomitant medical conditions, in patients taking certain medications, as well as in elderly patients. Patients who have undergone any weight or hormonal changes may require dose adjustments, and the majority of pregnant women require increased doses of levothyroxine. Optimal treatment of hypothyroidism requires a partnership between patient and physician. The physician is tasked with vigilant appraisal of the patient’s status based on a thorough clinical and laboratory assessment and appropriate adjustment of their levothyroxine therapy. The patient in turn is tasked with medication adherence and reporting of symptomatology and any changes in their medical situation. The goal is consistent maintenance of euthyroidism, without the patient experiencing the adverse events and negative health consequences of under- or overtreatment. Funding Merck. Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
- Leonidas H Duntas
- Unit of Endocrinology, Diabetes, and Metabolism, Thyroid Section, Evgenidion Hospital, Athens, Greece.
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18
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Li AA, Makris SL, Marty MS, Strauss V, Gilbert ME, Blacker A, Zorrilla LM, Coder PS, Hannas B, Lordi S, Schneider S. Practical considerations for developmental thyroid toxicity assessments: What's working, what's not, and how can we do better? Regul Toxicol Pharmacol 2019; 106:111-136. [PMID: 31018155 DOI: 10.1016/j.yrtph.2019.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 12/26/2022]
Abstract
Thyroid hormones (THs; T3 and T4) play a role in development of cardiovascular, reproductive, immune and nervous systems. Thus, interpretation of TH changes from rodent studies (during pregnancy, in fetuses, neonates, and adults) is critical in hazard characterization and risk assessment. A roundtable session at the 2017 Society of Toxicology (SOT) meeting brought together academic, industry and government scientists to share knowledge and different perspectives on technical and data interpretation issues. Data from a limited group of laboratories were compiled for technical discussions on TH measurements, including good practices for reliable serum TH data. Inter-laboratory historical control data, derived from immunoassays or mass spectrometry methods, revealed: 1) assay sensitivities vary within and across methodologies; 2) TH variability is similar across animal ages; 3) laboratories generally achieve sufficiently sensitive TH quantitation levels, although issues remain for lower levels of serum TH and TSH in fetuses and postnatal day 4 pups; thus, assay sensitivity is critical at these life stages. Best practices require detailed validation of rat serum TH measurements across ages to establish assay sensitivity and precision, and identify potential matrix effects. Finally, issues related to data interpretation for biological understanding and risk assessment were discussed, but their resolution remains elusive.
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Affiliation(s)
- Abby A Li
- Exponent Inc., 1010 14th Street, San Francisco, CA, 94114, USA.
| | - Susan L Makris
- US Environmental Protection Agency Office of Research and Development, 1200 Pennsylvania Ave NW 8623R, Washington, DC, 20460, USA.
| | - M Sue Marty
- The Dow Chemical Company, Toxicology & Environmental Research and Consulting, 1803 Building, Midland, MI, 48674, USA.
| | - Volker Strauss
- BASF SE, Experimental Toxicology and Ecology, 67056, Ludwigshafen, Germany.
| | - Mary E Gilbert
- US Environmental Protection Agency, National Health Environmental Effects Research Lab, 109 T.W. Alexander Drive, MD B105 05, Research Triangle Park, NC, 27711, USA.
| | - Ann Blacker
- Bayer CropScience, P.O. Box 12014, RTP, NC, 27709, USA.
| | | | - Pragati S Coder
- Charles River Laboratories, Developmental and Reproductive Toxicology, 1407 George Road, Ashland, OH, 44805, USA.
| | - Bethany Hannas
- The Dow Chemical Company, Toxicology & Environmental Research and Consulting, 1803 Building, Midland, MI, 48674, USA.
| | - Sheri Lordi
- Charles River Laboratories International, 251 Ballardvale Street, Wilmington, MA, 01887, USA.
| | - Steffen Schneider
- BASF SE, Experimental Toxicology and Ecology, 67056, Ludwigshafen, Germany.
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El-Ella SSA, El-Mekkawy MS, El-Dihemey MA. Prevalence and prognostic value of non-thyroidal illness syndrome among critically ill children. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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20
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Kim RB, Kim M, Cho YY, Kim SK, Jung JH, Jung J, Kim CY, Kang D, Hahm JR. Thyroid function tests in patients at the emergency department compared to a prior healthy setting. PLoS One 2018; 13:e0202422. [PMID: 30125325 PMCID: PMC6101387 DOI: 10.1371/journal.pone.0202422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023] Open
Abstract
We examined the changes in thyroid hormone levels in patients with an acute clinical condition and compared these to levels in the healthy subjects. Serum total triiodothyronine (T3), thyroid stimulating hormone (TSH), and free thyroxine (fT4) measurements were recorded from 555 patients (mean age: 55.0 years, men: 65.9%) admitted to the emergency department (ED) 1-91 months (median: 34 months) after a regular health examination (HE). Serological data were analyzed; mean change in hormone levels was stratified by emergency classification system and quintiles of changes in inflammatory marker values, such as neutrophil lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (CRP). The mean decrease in T3 levels from HE and ED samples was 10.6 ng/dL (p< 0.001). Mean decrease in T3 levels was 21.6 ng/dL among patients classified as having an infection status and 11.0 ng/dL among patients classified as having an urgency status. A decrease 3.7 ng/dL among emergency patients was observed. TSH and fT4 levels did not change across all groups. When patients were stratified into quintiles according to changes in NLR values, mean decreases in T3 were 6.21, 8.14, 14.37, 12.76, and 21.98 ng/dL and showed significant linear reduction (p<0.001). For quintiles of changed CRP values, mean decreased T3 levels were 10.57, 3.05, 4.47, 7.68, and 28.07 ng/dL. TSH and fT4 were not associated with significant changes (p = 0.100, p = 0.561, respectively). In this study, thyroid function changes in individuals with an acute condition revealed that T3 significantly decreased, more markedly in infectious diseases compared to their healthy counterparts, and decline in T3 measurements correlated with inflammatory markers. TSH and fT4 levels remained stable. It is necessary to consider the severity of acute conditions when abnormal T3 levels are detected in subjects with emergent status.
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Affiliation(s)
- Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Minji Kim
- Department of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yoon Young Cho
- Department of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Soo Kyoung Kim
- Department of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung Hwa Jung
- Department of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jaehoon Jung
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Chi Yeon Kim
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Dermatology, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Dawon Kang
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Physiology, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jong Ryeal Hahm
- Department of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
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21
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El-Ella SSA, El-Mekkawy MS, El-Dihemey MA. [Prevalence and prognostic value of non-thyroidal illness syndrome among critically ill children]. An Pediatr (Barc) 2018; 90:237-243. [PMID: 29628400 DOI: 10.1016/j.anpedi.2018.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. MATERIALS AND METHODS A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24hours of PICU admission. Primary outcome was 30-day mortality. RESULTS NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P=.028). NTIS independently predicted mortality (OR=3.91; 95% CI=1.006-15.19; P=.0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR=16.9; 95% CI=1.40-203.04; P=.026). TSH was negatively correlated with length of PICU stay (rs=-0.35, P=.011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1±0.66 versus 2.76±0.91pg/mL, P=.011). CONCLUSION NTIS is common among critically ill children and appears to be associated with mortality and illness severity.
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Affiliation(s)
- Sohair Sayed Abu El-Ella
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto
| | - Muhammad Said El-Mekkawy
- Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto.
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22
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Wei SB, Wang W, Liu N, Chen J, Guo XY, Tang RB, Yu RH, Long DY, Sang CH, Jiang CX, Li SN, Wen SN, Wu JH, Bai R, Du X, Dong JZ, Ma CS. U-shaped association between serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. J Interv Card Electrophysiol 2018; 51:263-270. [PMID: 29480346 DOI: 10.1007/s10840-018-0337-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 02/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Thyroid dysfunction affects the outcomes of atrial fibrillation (AF) catheter ablation. However, it remains unclear if the variations in thyroid function, especially in the triiodothyronine levels, are associated with AF recurrence in euthyroid subjects. This study investigated the associations of thyroid hormone levels with arrhythmia recurrence after AF catheter ablation in euthyroid patients. METHODS A total of 1115 consecutive AF patients who underwent catheter ablation were prospectively enrolled and had their thyroid function measured prior to the procedure. The serum free triiodothyronine (FT3), free tetraiodothyronine (FT4), and thyroid-stimulating hormone (TSH) levels were assessed as predictors of recurrence and were adjusted for potential confounders. The subjects were divided into five quintile groups according to the FT3, FT4, and TSH levels, respectively. RESULTS After a median follow-up of 723 days (interquartile range, 180-1070), 47.2% of patients experienced recurrence. After multivariate adjustment, subject in the lowest and highest FT3 quintiles showed increased risk of recurrence (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.26-2.03, P < 0.01, and HR 1.47, 95% CI 1.16-1.87, P < 0.01, respectively), compared to the median quintile of FT3 levels. Regarding the FT4 level, the highest quintile group showed a higher risk of recurrence (HR 1.27, 95% CI 1.01-1.60, P = 0.04). The TSH levels were not associated with AF recurrence. CONCLUSIONS Both high and low FT3 levels were associated with AF recurrence after catheter ablation. High-normal FT4 levels were also related to AF recurrence; however, no association was found between normal TSH levels and AF recurrence.
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Affiliation(s)
- Shao-Bin Wei
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ji Chen
- School of Statistics, East China Normal University, 500 Dongchuan Road, Shanghai, 200241, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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23
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Yoon JH, Kang HC. Interpretation of puzzling thyroid function tests. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.4.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Lee YJ, Nam SO, Kim KM, Kim YM, Yeon GM. Longitudinal Change in Thyroid Hormone Levels in Children with Epilepsy on a Ketogenic Diet: Prevalence and Risk Factors. J Epilepsy Res 2017; 7:99-105. [PMID: 29344467 PMCID: PMC5767495 DOI: 10.14581/jer.17015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/27/2017] [Indexed: 01/26/2023] Open
Abstract
Background and Purpose The aim of this study is to evaluate the prevalence of hypothyroidism and the change of thyroid hormone level in the children with epilepsy on a ketogenic diet (KD). Methods The levels of serum free thyroxine (fT4) and thyroid-stimulation hormone (TSH) were measured at the start of the KD and at 6- to 12-month intervals in children with intractable epilepsy. Hypothyroidism was defined as fT4 level < 0.8 ng/dL and TSH level > 6.0 μIU/mL. Results A total of 28 children (17 boys and 11 girls) were enrolled in the study. The mean age of onset of seizure was 1.4 ± 1.6 years, the mean age of the start of the KD was 3.2 ± 2.4 years, and the mean duration of KD was 1.9 ± 1.5 years. Overall, there was no significant longitudinal change in the mean fT4 (0.99 ± 0.25 vs. 0.94 ± 0.71 ng/dL, p = 0.28) and TSH (2.94 ± 1.32 vs. 3.18 ± 1.21 μIU/mL, p = 0.44) levels from the start of the KD to last follow-up. The patients with a younger age of seizure onset, earlier initiation of KD, and higher serum levels of cholesterol and triglyceride had a significant decrease in fT4 levels and increase in TSH levels during the KD. Sex, duration of the seizure or KD therapy, seizure types, seizure frequency, seizure outcomes, brain lesion, ratio of KD, and being overweight did not affect the longitudinal change of fT4 and TSH levels during KD. Conclusion Thyroid function had no significant longitudinal decrease in pediatric epilepsy during KD therapy. However, careful monitoring of the serum levels of fT4/TSH should be recommended in children on KDs, especially in those with earlier seizure onset, earlier start of KD, and higher levels of lipid profiles.
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Affiliation(s)
- Yun-Jin Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Ook Nam
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung-Min Kim
- Department of Pediatrics, Good Gang-An Hospital, Busan, Korea
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Gyu Min Yeon
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University, Busan, Korea
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Lu N, He Z, Xu T, Chen X, Chen X, Ma X, Tan X. Association of Thyroid Function with Early/Mid-term Aorta-Related Adverse Events and Readmissions after Thoracic Endovascular Aortic Repair. Sci Rep 2017; 7:14730. [PMID: 29116203 PMCID: PMC5676739 DOI: 10.1038/s41598-017-15370-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The prognosis of patients after thoracic endovascular aortic repair (TEVAR) is affected by several clinical characteristics. This study aimed to evaluate whether thyroid hormones predicts early (30 days) and mid-term (12 months) aorta-related adverse events (ARAE) and readmissions (ARAR) in patients after TEVAR. A total of 338 continuous patients who underwent TEVAR were included and stratified based on quartile of free thyroxine (FT4) levels examined before surgery. The relationship of FT4 levels with early or mid-term ARAE and ARAR were assessed using univariate and multiple logistic regression analysis. The incidence of ARAE and ARAR were 2.7% and 4.1% within 30 days, and 8.9% and 13.5% within 12 months, respectively. After adjusting for confounders, the lowest FT4 quartile group were noted to be at significantly greater risk than the highest FT4 quartile group in early (OR 10.105, 95% CI 1.103 to 92.615, P = 0.041) and mid-term (OR 5.687, 95% CI 1.708 to 18.935, P = 0.005) ARAR, but not significantly different in early (OR 2.097, 95% CI 0.228 to 19.307, P = 0.513) and mid-term (OR 0.695, 95% CI 0.207 to 2.332, P = 0.556) ARAE. Thus, patients with low-normal FT4 levels after TEVAR are at greater risk of ARAR, but not ARAE, in both the early and the mid-term follow-up periods.
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Affiliation(s)
- Nan Lu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Zhuoqiao He
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xin Chen
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xianfeng Chen
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xiaojing Ma
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China.
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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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Ribichini D, Fiorini G, Repaci A, Castelli V, Gatta L, Vaira D, Pasquali R. Tablet and oral liquid L-thyroxine formulation in the treatment of naïve hypothyroid patients with Helicobacter pylori infection. Endocrine 2017; 57:394-401. [PMID: 27848196 DOI: 10.1007/s12020-016-1167-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 12/20/2022]
Abstract
To compare the clinical efficacy of tablet and oral liquid L-thyroxine (LT4) formulation in naïve hypothyroid subjects with Helicobacter pylori infection. Forty-seven adult naïve hypothyroid subjects with dyspeptic symptoms were investigated with upper endoscopy and divided into: 28 patients with Helicobacter pylori infection (Group A); 15 patients without gastric alterations (group B); 4 patients with autoimmune gastritis were excluded from the study. Subjects were randomly treated with a same dose of LT4 tablet (TAB) or oral liquid formulation (SOL), for 9 months on group A and 6 months on group B. Helicobacter pylori infection was eradicated after 3 months of LT4 treatment. On group A, after 3 months (before Helicobacter pylori eradication), subjects treated with SOL showed a greater thyroid-stimulating hormone reduction (ΔTSH3-0: TAB = -4.1 ± 4.6 mU/L; SOL = -7.7 ± 2.5 mU/L; p = 0.029) and a greater homogeneity in the thyroid-stimulating hormone values (TSH3mo: TAB = 5.7 ± 4.9 mU/L; SOL = 4.1 ± 2.0 mU/L; p = 0.025), compared to LT4 tablet. At 9 months (after 6 months of Helicobacter pylori eradication) mean thyroid-stimulating hormone values were lower in subjects treated with LT4 tablet (TSH9mo: TAB = 1.8 ± 1.2 mU/L; SOL = 3.2 ± 1.7 mU/L; p = 0.006). On group B no difference were observed, at each time point, in the mean thyroid-stimulating hormone values and thyroid-stimulating hormone variations between two LT4 formulations. LT4 liquid formulation may produce a better clinical response compared to the tablet formulation in hypothyroid subjects with Helicobacter pylori infection.
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Affiliation(s)
- Danilo Ribichini
- Division of Endocrinology (DE), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy.
| | - Giulia Fiorini
- Division of Internal Medicine (IM), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology (DE), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy
| | - Valentina Castelli
- Division of Internal Medicine (IM), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy
| | - Luigi Gatta
- Gastroenterogy & Endoscopy Unit, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Dino Vaira
- Division of Internal Medicine (IM), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy
| | - Renato Pasquali
- Division of Endocrinology (DE), Department of Medical & Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, 40126, Bologna, Italy.
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Abstract
This article summarizes the main principles for the appropriate use of laboratory testing in the diagnosis and management of thyroid disorders, as well as controversies that have arisen in association with some of these biochemical tests. To place a test in perspective, its sensitivity and accuracy should be taken into account. Ordering the correct laboratory tests facilitates the early diagnosis of a thyroid disorder and allows for timely and appropriate treatment. This article focuses on a comprehensive update regarding thyroid-stimulating hormone, thyroxine/triiodothyronine, thyroid autoantibodies, thyroglobulin, and calcitonin. Clinical uses of these biochemical tests are outlined.
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Affiliation(s)
- Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms Lobby C, Suite 1300, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms Lobby G, Room 1649, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.
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Abstract
OBJECTIVE Review physiologic thyroid function changes with aging and emphasize careful interpretation of tests in the aging population. METHODS Literature review. RESULTS Using age-specific thyroid-stimulating hormone (TSH) reference ranges should minimize or avoid the unnecessary diagnosis of thyroid disease in elderly patients. Subclinical thyroid dysfunction and abnormal TSH with normal thyroid levels may improve with time, so careful monitoring of thyroid function is recommended. Overt thyroid disease should always be treated. CONCLUSION Clinical judgement is always warranted to decide how and when to treat subclinical thyroid disease in the elderly. ABBREVIATIONS FT4 = free thyroxine; rT3 = reverse triiodothyronine; T3 = triiodothyronine; T4 = thyroxine; TFT = thyroid function test; TSH = thyroid-stimulating hormone.
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Changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation. J Perinatol 2017; 37:906-910. [PMID: 28448064 DOI: 10.1038/jp.2017.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid hormone concentrations can be disturbed during critical illness. Our aim was to determine changes in thyroid hormone concentrations during neonatal extracorporeal membrane oxygenation (ECMO). STUDY DESIGN We included 21 ECMO-treated neonates. Age-specific s.d. scores (SDS) of free and total thyroxine (FT4; TT4), reverse and total triiodothyronine (rT3; TT3), thyroid-stimulating hormone (TSH) and thyroxine-binding globulin (TBG) were determined at six fixed time-points. Data were analyzed using general linear models. RESULTS At baseline, mean SDS FT4 (-0.78, 95% CI: -1.37 to -0.19), TT4 (-1.97, 95% CI: -2.76 to -1.18), TT3 (-0.88, 95% CI: -1.13 to -0.63), TSH (-2.14, 95% CI: -2.93 to -1.35) and TBG (-3.52, 95% CI: -4.55 to -2.50) were low with high mean SDS rT3 (0.53, 95% CI: 0.28 to 0.78). One hour after start ECMO, TT4, TSH and TBG had further declined; 12 h after start ECMO TT3 had declined (all P<0.05). After this decline, mean SDS TSH increased to the baseline level 12 h after start ECMO (-2.50, 95% CI: -3.22 to -1.79), and was higher than baseline 48 h after start ECMO (-0.56, 95% CI: -1.29 to 0.17). This TSH increase was followed by increases in TT4 and TT3. FT4 remained constant within the normal range during ECMO. CONCLUSIONS Thyroid hormone concentrations before ECMO were suggestive of non-thyroidal illness syndrome (NTIS). During ECMO, increases in TSH, TT4 and TT3 after an initial decline possibly reflect spontaneous restoration of the hypothalamic-pituitary-thyroid axis. FT4 remained constant within the normal range. This suggests that thyroxine therapy is not required during ECMO.
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Kuman Tunçel Ö, Akdeniz F, Özbek SS, Kavukçu G, Ünal Kocabaş G. Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls. Noro Psikiyatr Ars 2017; 54:108-115. [PMID: 28680307 DOI: 10.5152/npa.2017.12457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/30/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lithium has many effects on thyroid physiology. Although these side effects have been known for a long time, large sample studies of lithium-treated patients using ultrasonography are lacking. The aim of this study is to investigate the detailed thyroid morphologies, hormone levels, and antibodies of lithium-treated patients compared with healthy controls. METHODS This cross-sectional study involved 84 lithium-treated patients with bipolar disorder and 65 gender and age similar controls who had never been exposed to lithium. Subjects between 18 and 65 years of age were eligible for the study. Venous blood samples were acquired to determine the levels of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid antibodies; also, ultrasonographic examinations of the patients' thyroid glands were performed. RESULTS There were no statistically significant differences in smoking habits, known thyroid disease, thyroid medication use, familial thyroid disease, fT4 level, autoimmunity, thyroid nodule presence, or Hashimoto's thyroiditis between the lithium and control groups. The median TSH level and thyroid volume were significantly higher in the lithium group. In the lithium group, 14 cases (16.7%) of hypothyroidism, seven cases (8.3%) of subclinical hypothyroidism, and one case (1.2%) of subclinical hyperthyroidism were defined; in the control group, seven cases (10.8%) of hypothyroidism and two cases (3.1%) of subclinical hyperthyroidism were defined. Thyroid dysfunction, goiter, parenchymal abnormality, ultrasonographically defined thyroid abnormality, and thyroid disorder were found to be more prevalent in the lithium group. 90% of patients with goiter and 74.3% of patients with ultrasonographic pathologies were euthyroid. CONCLUSION It is important to note that 90% of the patients with goiter were euthyroid. This indicates that monitoring by blood test alone is insufficient. The prevalence rates of 47.6% for goiter and 83.3% for ultrasonographic pathology demonstrate that ultasonographic follow-up may be useful in lithium-treated patients. To determine whether routine ultrasonographic examination is necessary, large sample prospective studies are necessary due to the limitations of this study.
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Affiliation(s)
- Özlem Kuman Tunçel
- Department of Psychiatry, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | | | - Süha Süreyya Özbek
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Gülgün Kavukçu
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Gökçen Ünal Kocabaş
- Department of Endocrinology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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Okuroglu N, Ozdemir A, Sertbas Y, Sancak S. The relationship between thyroid antibody titer and levothyroxine dose in patients with overt primary hypothyroidism. Ann Saudi Med 2017; 37:189-193. [PMID: 28578356 PMCID: PMC6150584 DOI: 10.5144/0256-4947.2017.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Both excess and insufficient thyroid hormone replacement may produce adverse effects in various target tissues; therefore, understanding factors that affect achievement of target TSH levels is crucial. OBJECTIVE Investigate the relationship between antibody titers and levothyroxine dose. DESIGN Retrospective, review of data in medical records. SETTING Thyroid center of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey. PATIENTS AND METHODS The study population consisted of patients that had been diagnosed as having overt primary hypothyroidism and were taking levothyroxine for at least one year. The serum TSH level for an euthyroid state was between 0.5-4 mIU/L. The levels of anti-thyroid peroxidase (TPOAb) considered positive for antibodies were < 5.6 IU/mL and for anti-thyroglobulin (TgAb) autoantibodies < 4.10 IU/ mL. MAIN OUTCOME MEASURE Daily levothyroxine doses of antibody-positive and negative patients and association of daily drug requirement with antibody titers. RESULTS The study population consisted of the 303 patients (273 females and 30 males with the mean [SD] age of 46.6 [13.2] years). In the antibody-positive group (n=210) average daily levothyroxine dose was statistically significantly higher than in the antibody-negative group (n=93) (mean of 78.8 [36.7] vs 64.2 [27.1] mg/day, P=.001, respectively). There was a low but statistically significant positive relationship between the TPOAb (r=0.217, P < .01) and TgAb levels (r=0.158, P < .05) and levothyroxine doses in the antibody-positive group. CONCLUSION Antibody titers are positively associated with larger levothyroxine (LT-4) replacement dosing in patients with autoimmune thyroiditis. LIMITATION Unknown antibody titers before starting levothyroxine use.
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Affiliation(s)
| | - Ali Ozdemir
- li Ozdemir, Department of Internal Medicine,, Faith Sultan Mehmet Egitim, ve Arastirma Hastanesi, E-5 Ylu Uzeri Bostanci Atasehir,, Istanbul 34752, Turkey, T: +905322844663 /, +902165750406, , http://orcid.org/0000-0002-8087-9654
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Leeuwen L, van Heijst AFJ, Vijfhuize S, Beurskens LWJE, Weijman G, Tibboel D, van den Akker ELT, IJsselstijn H. Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation. Neonatology 2017; 111:93-99. [PMID: 27639769 PMCID: PMC5296890 DOI: 10.1159/000448238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO). OBJECTIVES To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations. METHODS In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35). RESULTS CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p < 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result. CONCLUSIONS Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO.
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Affiliation(s)
- Lisette Leeuwen
- Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Perfluoroalkyl substances, thyroid hormones, and neuropsychological status in older adults. Int J Hyg Environ Health 2016; 220:679-685. [PMID: 28065522 DOI: 10.1016/j.ijheh.2016.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/08/2016] [Accepted: 12/21/2016] [Indexed: 01/09/2023]
Abstract
Minimal data exist regarding the neurotoxicity of perfluoroalkyl substances (PFASs) in aging populations and the possible mediating effects of thyroid hormones (THs). Hence, the aims of this study were to: (i) assess associations between PFASs and neuropsychological function, and (ii) determine if such associations are mediated by changes in circulating THs in an aging population. We measured perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), total thyroxine (T4) and free thyroxine (fT4) in serum and performed neuropsychological tests in 126 men and women aged 55-74 years and living in upper Hudson River communities. Multivariable linear regressions were conducted to assess associations between PFASs and neuropsychological test scores. Mediation analyses were performed in a subset of 87 participants for whom information was available on both PFASs and THs. We calculated TH-mediated, non-TH mediated, and total effects of PFASs on neuropsychological test scores. Higher PFOA was associated with better performance in tasks of the California Verbal Learning Test and the Wisconsin Card Sorting Test. Higher PFOS was associated with improved performance in a Wechsler Memory Scale subtest and Block Design Subtest (BDT) total scores. There was no evidence of mediation by THs for PFOA-neuropsychological function associations. However, T4 and fT4 partially mediated the protective effect of PFOS on BDT total scores. Our findings do not suggest that PFASs are associated with poor neuropsychological function. There was some evidence of mediation for the association between PFASs and neuropsychological functions by THs, although some other modes of action also appear likely.
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Brusca N, Virili C, Cellini M, Capriello S, Gargano L, Salvatori R, Centanni M, Santaguida MG. Early detection of biochemically occult autonomous thyroid nodules. Eur J Endocrinol 2016; 175:615-622. [PMID: 27647872 DOI: 10.1530/eje-16-0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach. DESIGN AND METHODS In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I131) uptake (RAIU). RESULTS The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425). CONCLUSIONS The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients.
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Affiliation(s)
- N Brusca
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - C Virili
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - M Cellini
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - S Capriello
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
| | - L Gargano
- Endocrinology UnitAUSL Latina, Latina, Italy
| | - R Salvatori
- Department of Nuclear MedicineAUSL Latina, Latina, Italy
| | - M Centanni
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
- Endocrinology UnitAUSL Latina, Latina, Italy
| | - M G Santaguida
- Department of Medico-Surgical Sciences and Biotechnologies'Sapienza' University of Rome, Latina, Italy
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Cho EB, Min JH, Cho HJ, Seok JM, Lee HL, Shin HY, Lee KH, Kim BJ. Low T3 syndrome in neuromyelitis optica spectrum disorder: Associations with disease activity and disability. J Neurol Sci 2016; 370:214-218. [DOI: 10.1016/j.jns.2016.09.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/04/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
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Elhaj ET, Adam I, Ahmed MA, Lutfi MF. Trimester-specific thyroid hormone reference ranges in Sudanese women. BMC PHYSIOLOGY 2016; 16:5. [PMID: 27795209 PMCID: PMC5087113 DOI: 10.1186/s12899-016-0025-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/13/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Trimester-specific reference ranges for T3, T4, and TSH need to be established in different communities. Neither Sudan nor other African countries have established trimester-specific reference ranges for TSH, free T3 (FT3), and free T4 (FT4) in healthy pregnant women. This study aimed to establish trimester-specific reference ranges for TSH, FT3, and FT4 in healthy pregnant Sudanese women. RESULTS We performed a longitudinal study, which included 63 women with singleton pregnancies who were followed since early pregnancy until the third trimester. The study was performed in Saad Abu-Alela Hospital, Khartoum, Sudan, during January to October 2014. An equal number of age- and parity-matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3, and FT4 levels were measured. Median (5th-95th centile) values of TSH, FT3, and FT4 were 1.164 IU/ml (0.079-2.177 IU/ml), 4.639 nmol/l (3.843-6.562 nmol/l), and 16.86 pmol/l (13.02-31.48 pmol/l) in the first trimester. Median values of TSH, FT3, and FT4 were 1.364 IU/ml (0.540-2.521 IU/ml), 4.347 nmol/l (3.425-5.447 nmol/l), and 13.51 pmol/l (11.04-31.07 pmol/l) in the second trimester. These values were 1.445 IU/ml (0.588-2.460 IU/ml), 4.132 nmol/l (3.176-5.164 nmol/l), and 12.87 pmol/l (9.807-23.78 pmol/l) in the third trimester, respectively. TSH levels increased throughout the trimesters. FT3 and FT4 levels were significantly higher in the first trimester compared with the second and third trimesters. TSH, FT3, and FT4 levels were significantly lower in pregnant women compared with non-pregnant women (P < 0.001). CONCLUSIONS The present study is the first to establish trimester-specific reference ranges of TSH, FT3, and FT4 in Sudanese women with normal pregnancies. Our results suggest that pregnancy is likely to suppress TSH, T3, and T4 levels in healthy women.
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Affiliation(s)
- Enaam T Elhaj
- Faculty of Applied Medical Science, Gezira University, Wad Madani, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed A Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed F Lutfi
- Faculty of Medicine and Health Sciences, Alneelain University, Khartoum, Sudan.
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Morelli S, Reboldi G, Moretti S, Menicali E, Avenia N, Puxeddu E. Timing of breakfast does not influence therapeutic efficacy of liquid levothyroxine formulation. Endocrine 2016; 52:571-8. [PMID: 26537478 DOI: 10.1007/s12020-015-0788-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
Oral levothyroxine (L-T4) is the mainstay of hypothyroidism treatment. Many factors may influence its absorption, including the timing of administration. Objective of the study is to demonstrate the therapeutic equivalence of administering liquid L-T4 with breakfast or 10 min before breakfast. This was a pilot study conducted with a crossover design AB/BA where A stays for L-T4 with breakfast and B for L-T4 10 min before breakfast. A post hoc analysis was conducted to compare L-T4 administered at breakfast or 10 min before breakfast with L-T4 administered 30 min before breakfast. Sixty-one hypothyroid patients were enrolled and assigned to one of the two treatment sequences. All patients were evaluated for TSH levels at the end of each period. Fifty-nine patients completed the study. The mean thyrotropin concentration was 1.52 ± 0.73 µU/ml when L-T4 was administered with breakfast and 1.46 ± 0.81 µU/ml when it was taken 10 min before breakfast, without clinically and statistically significant differences (P = 0.59), regardless of treatment sequence and period. The mean thyrotropin concentration was 1.54 ± 0.9 µU/ml when L-T4 was administered at 0-10 min intervals before breakfast and 1.25 ± 0.7 µU/ml when it was taken 30 min before breakfast (ratio = 1.23, within our definition of equivalence set at 0.8-1.25). There is therapeutic equivalence between liquid L-T4 administration at breakfast or 10 min before breakfast. We can also hypothesize that there are no clinically relevant differences between liquid L-T4 administration 30 min before breakfast or at shorter intervals.
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Affiliation(s)
- Silvia Morelli
- Department of Medicine, University of Perugia, Perugia, Italy
- Research Centre of Thyroid Proteomics and Genomics (CRiProGeT), University of Perugia, Terni, Italy
| | | | - Sonia Moretti
- Department of Medicine, University of Perugia, Perugia, Italy
- Research Centre of Thyroid Proteomics and Genomics (CRiProGeT), University of Perugia, Terni, Italy
| | - Elisa Menicali
- Department of Medicine, University of Perugia, Perugia, Italy
- Research Centre of Thyroid Proteomics and Genomics (CRiProGeT), University of Perugia, Terni, Italy
| | - Nicola Avenia
- Research Centre of Thyroid Proteomics and Genomics (CRiProGeT), University of Perugia, Terni, Italy
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Efisio Puxeddu
- Department of Medicine, University of Perugia, Perugia, Italy.
- Research Centre of Thyroid Proteomics and Genomics (CRiProGeT), University of Perugia, Terni, Italy.
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Zevenbergen C, Korevaar TIM, Schuette A, Peeters RP, Medici M, Visser TJ, Schomburg L, Visser WE. Association of antiepileptic drug usage, trace elements and thyroid hormone status. Eur J Endocrinol 2016; 174:425-32. [PMID: 26701870 DOI: 10.1530/eje-15-1081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/23/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Levels of thyroid hormone (TH) and trace elements (copper (Cu) and selenium (Se)) are important for development and function of the brain. Anti-epileptic drugs (AEDs) can influence serum TH and trace element levels. As the relationship between AEDs, THs, and trace elements has not yet been studied directly, we explored these interactions. METHOD In total 898 participants, from the Thyroid Origin of Psychomotor Retardation study designed to investigate thyroid parameters in subjects with intellectual disability (ID), had data available on serum Se, Cu, thyroid stimulating hormone (TSH), free thyroxine (FT4), tri-iodothyronine (T3), reverse T3, T4, and thyroxine-binding globulin (TBG); 401 subjects were on AED treatment. Differences in trace elements according to medication usage was investigated using ANOVA, and associations between trace elements and thyroid parameters were analysed using (non-) linear regression models. RESULTS Study participants were not deficient in any of the trace elements analyzed. AED (carbamazepine, valproate and phenytoin) usage was negatively associated with serum Se and showed compound-specific associations with Cu levels. After correction for drug usage, Se was positively associated with TSH levels, negatively associated with FT4 levels, and positively with T3 levels. Cu was positively associated with T4, T3, and rT3, which was largely dependent on TBG levels. CONCLUSION The subjects with ID did not display profound deficiencies in trace element levels. AEDs were associated with serum Se and Cu levels, while serum Se and Cu were also associated with thyroid parameters. Further studies on the underlying mechanisms and potential clinical importance are warranted.
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Affiliation(s)
- Chantal Zevenbergen
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Tim I M Korevaar
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Andrea Schuette
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Robin P Peeters
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Marco Medici
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Theo J Visser
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Lutz Schomburg
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - W Edward Visser
- Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany Department of Internal MedicineRotterdam Thyroid CenterErasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The NetherlandsInstitut für Experimentelle EndokrinologieCharité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
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Fierabracci P, Martinelli S, Tamberi A, Piaggi P, Basolo A, Pelosini C, Ricco I, Magno S, Querci G, Ceccarini G, Scartabelli G, Salvetti G, Vitti P, Santini F. Weight Loss and Variation of Levothyroxine Requirements in Hypothyroid Obese Patients After Bariatric Surgery. Thyroid 2016; 26:499-503. [PMID: 26895690 DOI: 10.1089/thy.2015.0473] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obesity and hypothyroidism are both common disorders within the general population. Obese hypothyroid subjects require higher doses of levothyroxine (LT4) compared with normal weight individuals. Previous studies on the effects of bariatric surgery on LT4 dose requirements in hypothyroid subjects have provided conflicting results. The aim of this study was to evaluate the LT4 requirements in a group of obese subjects with acquired hypothyroidism, before and after weight loss achieved by bariatric surgery. METHODS Ninety-three obese hypothyroid subjects (mean age = 48 ± 9 years; mean body mass index = 45.9 ± 5.6 kg/m(2)), were evaluated before and 28 ± 8 months after bariatric surgery. Changes in the LT4 dose, anthropometric measures, and hormone values were evaluated. In 20 patients, data of body composition, assessed by dual energy X-ray absorptiometry, were also analyzed. RESULTS On average, after weight loss, a significant reduction of the total dose of LT4 was documented (from 130.6 ± 48.5 to 116.2 ± 38.6 μg/day; p < 0.001). The LT4 dose had to be reduced in 47 patients, was unchanged in 34, and had to be increased in 12 patients affected by autoimmune thyroiditis. Reduction of the LT4 dose was proportional to reduction of the lean body mass. CONCLUSIONS The weight loss achieved with modern surgical bariatric procedures is associated with a reduction of LT4 requirements in most hypothyroid subjects, which appears to be related to a decrease of the lean body mass. Occasionally, a concurrent decline of residual thyroid function, as it occurs in autoimmune thyroiditis, can counteract this phenomenon and eventually produce an increase of LT4 needs. It is believed that during the weight loss phase that follows bariatric surgery, there is no need for preventive adjustments of the LT4 dose, but serum thyroid hormones and thyrotropin should be periodically monitored in order to detect possible variations of LT4 requirements and to allow proper corrections of the therapy.
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Affiliation(s)
- Paola Fierabracci
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Silvia Martinelli
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Anna Tamberi
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Paolo Piaggi
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Alessio Basolo
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Caterina Pelosini
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Ilaria Ricco
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Silvia Magno
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Giorgia Querci
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Giovanni Ceccarini
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | | | - Guido Salvetti
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Paolo Vitti
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
| | - Ferruccio Santini
- Obesity Center, Endocrinology Unit 1, University Hospital of Pisa , Pisa, Italy
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Joshi P, Agarwal A, Vyas S, Kumar R. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Trop Doct 2016; 47:6-10. [PMID: 26792597 DOI: 10.1177/0049475515627235] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To analyse the prevalence of hypothyroidism in rheumatoid arthritis (RA) patients and to elucidate its correlation with disease activity. METHODS A total of 52 RA patients were enrolled in this study. All patients were assessed fully clinically and underwent routine laboratory investigation including thyroid function testing. RESULTS Hypothyroidism (defined as having a TSH level >4.20 μIU/mL) was observed in 20/52 (38.4%). Erythrocyte sedimentation rates (ESR) were found significantly elevated in patients with hypothyroidism compared to those without (36.3 ± 24.2 vs. 24.6 ± 9.0 mm/h). Disease activity parameters such as DAS-28-ESR, tender joint count; VAS scores were also significantly higher in the former. A significant correlation with serum TSH levels was observed with ESR and DAS-28-ESR. CONCLUSION Thyroid function test should be included in clinical evaluation of RA patients.
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Affiliation(s)
- Prakash Joshi
- Assistant Professor, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Abhishek Agarwal
- Junior Resident, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Sony Vyas
- Junior Resident, Department of Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
| | - Ravindra Kumar
- Scientist Central Research Laboratory, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India
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Shu M, Zai X, Zhang B, Wang R, Lin Z. Hypothyroidism Side Effect in Patients Treated with Sunitinib or Sorafenib: Clinical and Structural Analyses. PLoS One 2016; 11:e0147048. [PMID: 26784451 PMCID: PMC4718448 DOI: 10.1371/journal.pone.0147048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/28/2015] [Indexed: 12/30/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) provide more effective targeted treatments for cancer, but are subject to a variety of adverse effects, such as hypothyroidism. TKI-induced hypothyroidism is a highly complicated issue, because of not only the unrealized toxicological mechanisms, but also different incidences of individual TKI drugs. While sunitinib is suspected for causing thyroid dysfunction more often than other TKIs, sorafenib is believed to be less risky. Here we integrated clinical data and in silico drug-protein interactions to examine the pharmacological distinction between sunitinib and sorafenib. Statistical analysis on the FDA Adverse Event Reporting System (FAERS) confirmed that sunitinib is more concurrent with hypothyroidism than sorafenib, which was observed in both female and male patients. Then, we used docking method and identified 3 proteins specifically binding to sunitinib but not sorafenib, i.e., retinoid X receptor alpha, retinoic acid receptors beta and gamma. As potential off-targets of sunitinib, these proteins are well known to assemble with thyroid hormone receptors, which can explain the profound impact of sunitinib on thyroid function. Taken together, we established a strategy of integrated analysis on clinical records and drug off-targets, which can be applied to explore the molecular basis of various adverse drug reactions.
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Affiliation(s)
- Mao Shu
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Xiaoli Zai
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Beina Zhang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Rui Wang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
| | - Zhihua Lin
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing 400054, China
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing 400044, China
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Sousa PA, Providência R, Albenque JP, Khoueiry Z, Combes N, Combes S, Boveda S. Impact of Free Thyroxine on the Outcomes of Left Atrial Ablation Procedures. Am J Cardiol 2015; 116:1863-8. [PMID: 26514301 DOI: 10.1016/j.amjcard.2015.09.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 01/08/2023]
Abstract
The prevalence of atrial fibrillation (AF) is increased in hyperthyroidism. The degree to which thyroid hormones affect the outcomes of left atrial (LA) ablation is still unclear. From September 2010 to September 2013, 1,095 patients who underwent LA ablation (59.7% paroxysmal AF, 32.3% persistent AF, and 8.0% LA tachycardia) had their serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels measured in the 48 hours before the procedure. Patients were followed until they presented the first AF relapse after a blanking period of 3 months. TSH and FT4 were assessed as predictors of arrhythmia relapse and were adjusted for possible confounders. During a mean follow-up of 12.5 ± 7.9 months, 28.9% of patients presented an atrial arrhythmia relapse. TSH was not a predictor of relapse. In contrast, after adjustment, FT4 (median = 11.8 ng/L and interquartile range 10.6 to 14.6 ng/L) remained a predictor of relapse with 15% increase per quartile (hazard ratio 1.15, 95% confidence interval 1.03 to 1.29, p = 0.014). In conclusion, FT4 levels influence the success rate of LA ablation procedures, even when in the normal range.
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Khan MA, Bhurani D, Agarwal NB. Alteration of Thyroid Function in Indian HER 2-Negative Breast Cancer Patients Undergoing Chemotherapy. Asian Pac J Cancer Prev 2015; 16:7701-5. [PMID: 26625784 DOI: 10.7314/apjcp.2015.16.17.7701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thyroid hormones (TH) are regulated by the hypothalamic-pituitary axis, which plays an important role in cell growth, differentiation, development and other aspects of metabolism. It is believed that an active hypothalamic-pituitary axis increases the susceptibility of thyroid dysfunction during systemic chemotherapy. In order to investigate the relation between thyroid function and chemotherapy the present study was designed to investigate TH in breast cancer patients receiving at least three cycles of chemotherapy. The levels of TH were measured at the baseline and before each cycle of chemotherapy. MATERIALS AND METHODS Blood samples for estimation of TH levels were collected from 80 (pre-menopausal-40; post-menopausal-40) breast cancer patients just before they were undergoing--1st, 2nd, 3rd and 4th cycle of chemotherapy. The serum was separated and T3, T4 and TSH levels were determined by chemiluminescence method. RESULTS T3 and T4 were found significantly decreased and TSH was found significantly increased after 1st (p<0.001), 2nd (p<0.0001) and 3rd cycle of chemotherapy (p<0.0001). The variation of T3 levels (decreased) and TSH levels (increased) was found more in post-menopausal (p<0.0001) women then in pre-menopausal women after 3rd cycle of chemotherapy as compared to baseline (p<0.001). CONCLUSIONS TH were remarkably altered after each cycle of chemotherapy leading to decline in thyroid function of breast cancer patients. Further, the results also indicated that post- menopausal women were more prone towards decline in thyroid function then pre-menopausal women. The present study proposes the monitoring of TH after each cycle of chemotherapy in breast cancer patients.
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Affiliation(s)
- Mohd Ashif Khan
- Department of Pharmaceutical Medicine, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), India E-mail : ;
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Mirjanic-Azaric B, Stojakovic-Jelisavac T, Vukovic B, Stojanovic D, Vujnic M, Uletilovic S. The impact of time of sample collection on the measurement of thyroid stimulating hormone values in the serum. Clin Biochem 2015; 48:1347-9. [DOI: 10.1016/j.clinbiochem.2015.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
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Balla M, Jhingan RM, Rubin DJ. Rapid Levothyroxine Absorption Testing: A Case Series of Nonadherent Patients. Int J Endocrinol Metab 2015; 13:e31051. [PMID: 26633982 PMCID: PMC4659333 DOI: 10.5812/ijem.31051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 07/28/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nonadherence to levothyroxine therapy is one cause of persistent hypothyroidism. To distinguish nonadherence from malabsorption, a levothyroxine absorption test is required. Typically, this test measures the serum free thyroxine (FT4) response to 1000 mcg of oral levothyroxine over 4 to 24 hours. Published data indicate that serum levels of FT4 are at or near their peak 2 hours after levothyroxine ingestion. OBJECTIVES We present the successful completion of 2-hour levothyroxine absorption testing in 3 patients as a retrospective case series. PATIENTS AND METHODS Serum levels of thyroid stimulating hormone (TSH), FT4, and free triiodothyronine (FT3) were drawn at 0, 60, and 120 minutes after 1000 mcg of oral levothyroxine. RESULTS In all 3 cases, baseline thyroid function indicated the patients had taken their prescribed doses of levothyroxine prior to the absorption test. Despite high baseline levels both FT3 and FT4 increased during each absorption test, providing more evidence of adequate levothyroxine absorption. Subsequently, patients achieved normal TSH levels on lower doses of levothyroxine. CONCLUSIONS Levothyroxine absorption testing over 2 hours may offer a more rapid alternative to the commonly used longer protocols to rule out malabsorption. Scheduling a levothyroxine absorption test may induce some patients to start adhering to levothyroxine therapy.
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Affiliation(s)
| | | | - Daniel J. Rubin
- School of Medicine, Temple University, Philadelphia, USA
- Corresponding author: Daniel J. Rubin, School of Medicine, Temple University, Philadelphia, USA. Tel: +1-2157074746, Fax: +1-2157075599, E-mail:
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Santaguida MG, Virili C, Del Duca SC, Cellini M, Gatto I, Brusca N, De Vito C, Gargano L, Centanni M. Thyroxine softgel capsule in patients with gastric-related T4 malabsorption. Endocrine 2015; 49:51-7. [PMID: 25595886 DOI: 10.1007/s12020-014-0476-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/04/2014] [Indexed: 02/06/2023]
Abstract
The key role of an intact gastric acid secretion for subsequent intestinal T4 absorption is supported by an increased requirement of thyroxine in patients with gastric disorders. A better pH-related dissolution profile has been described in vitro for softgel T4 preparation than for T4 tablets. Our study was aimed at comparing softgel and tablet T4 requirements in patients with gastric disorders. A total of 37 patients with gastric-related T4 malabsorption were enrolled, but only 31 (28F/3M; median age = 50 years; median T4 dose = 2.04 μg/kg/day) completed the study. All patients were in long-lasting treatment (>2 years) with the same dose of T4 tablets when treatment was switched to a lower dose of softgel T4 capsules (-17 %; p = 0.0002). Assessment of serum FT4 and TSH was carried out at baseline and after 3, 6, 12, and 18 months after the treatment switch. In more than 2/3 of patients (good-responders n = 21), despite the reduced dose of T4, median TSH values were similar at each time point (p = 0.3934) with no change in FT4 levels. In the remaining patients (poor-responders n = 10), TSH levels were significantly higher at each time point than at baseline (p < 0.0001). To note, in five of them intestinal comorbidity was subsequently detected. Comorbidity associated with poor-responders status was the only significant predictor in multivariate analysis (OR = 11.333). Doses of softgel T4 capsules lower than T4 tablet preparation are required to maintain the therapeutic goal in 2/3 of patients with impaired gastric acid secretion.
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Affiliation(s)
- Maria Giulia Santaguida
- Department of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
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Kawashima J, Naoe H, Sasaki Y, Araki E. A rare case showing subacute thyroiditis-like symptoms with amyloid goiter after anti-tumor necrosis factor therapy. Endocrinol Diabetes Metab Case Rep 2015; 2015:140117. [PMID: 25969738 PMCID: PMC4424874 DOI: 10.1530/edm-14-0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 11/22/2022] Open
Abstract
Anti-tumor necrosis factor (TNF)-α therapy is established as a new standard for the treatment of various autoimmune inflammatory diseases. We report the first case showing subacute thyroiditis-like symptoms with an amyloid goiter after anti-TNF-α therapy. A 56-year-old man with Crohn's disease presented with fever and a diffuse, tender goiter. To control the diarrhea, anti-TNF therapy (infliximab) was administered 4 weeks before the thyroid symptoms emerged. The patient reported a swollen neck with tenderness on the right side and fever 4 days after the second infliximab injection. An elevated serum C-reactive protein (CRP) and serum thyroid hormone level with suppressed serum thyrotropin were observed. The thyroid-stimulating antibody was not elevated. An ultrasonograph of the thyroid revealed an enlarged goiter with posterior echogenicity attenuation and a low echoic region that was tender. The thyroid uptake value on technetium-99m scintigraphy was near the lower limit of the normal range. The patient was initially diagnosed with thyrotoxicosis resulting from subacute thyroiditis. Administration of oral prednisolone improved the fever, thyroid pain, and thyroid function, but his thyroid remained swollen. The patient developed diarrhea after prednisolone withdrawal; therefore, adalimumab, another TNF inhibitor, was administered. After three injections, his abdominal symptoms were alleviated, but the thyroid pain and fever recurred. Elevated serum CRP levels in the absence of thyroid dysfunction were observed. The patient's symptoms resolved after prednisolone retreatment, but an elastic, firm goiter persisted. A fine-needle biopsy revealed amyloid deposition in the thyroid.
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Affiliation(s)
- Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Hideaki Naoe
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Yutaka Sasaki
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan
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Nomogram-based evaluation of thyroid function in appropriate-for-gestational-age neonates in intensive care unit. J Perinatol 2015; 35:204-7. [PMID: 25297003 DOI: 10.1038/jp.2014.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to help neonatologists to interpret the thyroid hormone results accurately, and also to provide reference ranges and/or nomograms of FT4 (free thyroxine) and thyrotropin against gestational age at postnatal 1 week and 1 month in order to assess thyroid function in AGA (appropriate for gestational age) neonates in intensive care unit. STUDY DESIGN This is a retrospective study. We included a total number of 515 AGA neonates between 24 and 42 weeks of gestation. Routine results of serum FT4 and TSH that had been analyzed with an immunoassay were collected from existing laboratory data. Least square regression analyses were used to estimate both the mean and the s.d. curves as polynomial functions of gestational age. RESULT Free T4 levels were correlated with gestational age both at postnatal 1 week (r=0.39, P<0.001) and 1 month (r=0.26, P<0.001). Serum TSH levels at postnatal 1 week and 1 month did not show any correlation with gestational age. Scatterplots of FT4 levels against gestational age at 1 week and 1 month, showing the predicted 2.5th, 50th and 97.5th percentiles and central 95% reference ranges for TSH were provided. CONCLUSION Gestational age-specific nomograms for FT4 and reference ranges for TSH at postnatal 1 week and 1 month in AGA neonates have been developed. This can help neonatologists to interpret the thyroid hormone results accurately. Further studies providing reference ranges/nomograms for thyroid function in small-for-gestational-age neonates are needed.
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Maleki N, Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med 2015; 32:206-12. [PMID: 25186500 DOI: 10.1111/dme.12580] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/17/2014] [Accepted: 08/22/2014] [Indexed: 12/29/2022]
Abstract
AIMS To evaluate thyroid dysfunction and autoimmunity in women with gestational diabetes and to investigate the frequency of postpartum thyroiditis in women with gestational diabetes. MATERIALS AND METHODS A total of 350 women with gestational diabetes and 350 healthy pregnant women were enrolled in the study. We studied the thyroid hormone profiles of the women in each group during pregnancy (at 24-28 weeks' gestation) and after delivery (at 6 weeks, 3, 6 and 9 months, and 1 year postpartum). RESULTS A total of 342 women with gestational diabetes and 313 healthy pregnant women completed the follow-up during pregnancy and 1 year after delivery. Of the women with gestational diabetes, 16.6% had thyroid dysfunction, while of the healthy pregnant women, 6.1% had thyroid dysfunction. The prevalence of postpartum thyroiditis was higher in the women with a history of gestational diabetes (19.6%) than in the healthy pregnant women (10.2%), and this difference was statistically significant. CONCLUSION According to the results of the present study, the prevalence of postpartum thyroiditis was higher in women with a history of gestational diabetes than in healthy women. We recommend that all women with gestational diabetes and women who have previous thyroid dysfunction should be screened for thyroid hormonal abnormalities during pregnancy and for 1 year after pregnancy.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmunity
- Cross-Sectional Studies
- Diabetes, Gestational/blood
- Diabetes, Gestational/immunology
- Diabetes, Gestational/physiopathology
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Hospitals, Public
- Hospitals, University
- Hospitals, Urban
- Humans
- Iran/epidemiology
- Postpartum Period
- Pregnancy
- Prevalence
- Prospective Studies
- Risk
- Thyroid Gland/immunology
- Thyroid Gland/physiopathology
- Thyroiditis/diagnosis
- Thyroiditis/epidemiology
- Thyroiditis/etiology
- Thyroiditis/immunology
- Thyroiditis, Autoimmune/diagnosis
- Thyroiditis, Autoimmune/epidemiology
- Thyroiditis, Autoimmune/etiology
- Thyroiditis, Autoimmune/immunology
- Young Adult
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Affiliation(s)
- N Maleki
- Department of Internal Medicine, Shohadaye Khalije Fars Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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