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Abdolmohammadi-Vahid S, Samaie V, Hashemi H, Mehdizadeh A, Dolati S, Ghodrati-Khakestar F, Niafar M, Yousefi M. Anti-thyroid antibodies and underlying generalized immunologic aberrations in patients with reproductive failures. J Reprod Immunol 2022; 154:103759. [PMID: 36332368 DOI: 10.1016/j.jri.2022.103759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
The link between autoimmune thyroid diseases and reproductive failures, including implantation failure and pregnancy loss, has been attracted a great deal of attention in the last two decades. In this regard, a considerable progress has been achieved in understanding the etiopathogenesis of the adverse pregnancy consequences related to the presence of anti-thyroid antibodies, however, the exact action mechanisms of these antibodies are not fully comprehended. Thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs) and TSH receptor antibodies (TRAbs) are the anti-thyroid antibodies which are present in autoimmune thyroid disorder (AITD) patients, such as Hashimoto's thyroiditis. In this condition, the thyroid hormones production, which are essential for normal implantation and pregnancy, are disrupted, and compromise the embryo or fetus development. In addition, a hypothesis suggests that there is underlying generalized immune abnormalities behind the presence of these antibodies. On the other hand, similar immunologic aberrations have been observed in thyroid autoimmunity and reproductive complications, which are postulated to be the proper answer for the scientists who seek for the pathophysiology behind the presence of these antibodies. Elevated inflammatory responses and decreased immunoregulatory actions, seem to be the main interfering pathologic factors in maternal tolerance toward fetus. In addition, cross reactivity of these antibodies with antigenic determinants of egg, embryo and placenta is another suggested mechanism, causing implantation and pregnancy complications. The ability of anti-thyroid antibodies in passing through the placental barrier and affecting the fetal thyroid gland, makes them more threatening for maintenance of a pregnancy.
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Affiliation(s)
- Samaneh Abdolmohammadi-Vahid
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vajihe Samaie
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Huriyeh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Amir Mehdizadeh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mitra Niafar
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Sert UY, Celik HK, Karakaya BK, Caglar AT, Erdogan G, Engin-Ustun Y. The Impact of First Trimester TSH Level on Fetal Growth and Post-Term Pregnancy. Fetal Pediatr Pathol 2022; 41:584-591. [PMID: 34106035 DOI: 10.1080/15513815.2021.1933280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: First trimester thyroid-stimulating hormone (TSH) level is an important determiner of neonatal outcome. In this study we investigated the relationship between first-trimester TSH level and fetal birthweight. Materials-Methods: First-trimester serum TSH, age, gravidity, parity, body mass index (BMI), gestational age, and birth weight were analyzed. Patients were divided two ways. The first division- group 1 with TSH < 2.5 mU/l, group 2 with TSH > 2.5 mU/l). The second division- group 3 with TSH < 4 mU/l and group 4 with TSH > 4 mU/l). Results: The study included 302 patients. High TSH levels are associated with an increased risk of macrosomic and post-term babies. A significant association was found for both thresholds of 2.5 and 4.0 mU/l. However, this relation was not significant after binary logistic regression. Conclusion: High maternal first trimester TSH levels are not associated with birth weight after separating out macrosomia-related factors.
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Affiliation(s)
- Umit Yasemin Sert
- Department of Obstetrics and Gynecology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Hatice Kansu Celik
- Department of Obstetrics and Gynecology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Burcu Kısa Karakaya
- Ankara Medical Park Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Ali Turhan Caglar
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım, Education and Research Hospital, Ankara, Turkey
| | - Gokcen Erdogan
- Department of Obstetrics and Gynecology, Near East University, Cyprus
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım, Education and Research Hospital, Ankara, Turkey
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Ilias I, Milionis C, Koukkou E. Further understanding of thyroid function in pregnant women. Expert Rev Endocrinol Metab 2022; 17:365-374. [PMID: 35831988 DOI: 10.1080/17446651.2022.2099372] [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: 01/10/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Normal thyroid status throughout pregnancy is important for both maternal and fetal health. Despite the bulk of contemporary research honing on thyroid function in gestation and the relevant disorders, there are still gaps in our current knowledge about the etiology and treatment of thyroid diseases in pregnant women. AREAS COVERED This article analyzes the adaptation of the thyroid gland to gestational physiological changes and attempts to explain the effect of several factors on thyroid function in pregnancy. It also stresses proper utilization and interpretation of thyroid tests during pregnancy and underlines the significance of proper screening and treatment of pregnant women aiming at favorable health outcomes. EXPERT OPINION Appropriate strategies for diagnosing and treating thyroid disease in pregnancy are important. Laboratory thyroid testing plays a leading role, but test results should be interpreted with caution. Given the possible serious maternal and fetal/neonatal complications of thyroid disease in pregnancy, we recommend universal screening with TSH measurements of all pregnant women. Additional assessment with determination of the levels of free thyroid hormones and thyroid antibodies may be necessary under certain conditions. The economic burden of such interventions should be considered.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Vrachnis N, Tsonis O, Vrachnis D, Antonakopoulos N, Paltoglou G, Barbounaki S, Mastorakos G, Paschopoulos M, Iliodromiti Z. The Effect of Thyrotropin-Releasing Hormone and Antithyroid Drugs on Fetal Thyroid Function. CHILDREN (BASEL, SWITZERLAND) 2021; 8:454. [PMID: 34071168 PMCID: PMC8228147 DOI: 10.3390/children8060454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/06/2023]
Abstract
A euthyroid pregnant woman will normally have a fetus that displays normal fetal development. However, studies have long demonstrated the role of T3 (Triiodothyronine), T4 (Thyroxine), and TSH (Thyroid Stimulating Hormone) and their degree of penetrability into the fetal circulation. Maternal thyrotropin-releasing hormone (TRH) crosses the placental site and, from mid-gestation onward, is able to promote fetal TSH secretion. Its origin is not only hypothalamic, as was believed until recently. The maternal pancreas, and other extraneural and extrahypothalamic organs, can produce TRH variants, which are transported through the placenta affecting, to a degree, fetal thyroid function. Antithyroid drugs (ATDs) also cross the placenta and, because of their therapeutic actions, can affect fetal thyroid development, leading in some cases to adverse outcomes. Furthermore, there are a number of TRH analogues that share the same properties as the endogenous hormone. Thus, in this narrative review, we highlight the interaction of all the above with fetal growth in uncomplicated pregnancies.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 157 72 Athens, Greece;
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, University of Ioannina Medical School, University Hospital of Ioannina, 455 00 Ioannina, Greece; (O.T.); (M.P.)
| | - Dionisios Vrachnis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 157 72 Athens, Greece;
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 157 72 Athens, Greece;
| | - George Paltoglou
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece; (G.P.); (G.M.)
| | | | - George Mastorakos
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece; (G.P.); (G.M.)
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, University of Ioannina Medical School, University Hospital of Ioannina, 455 00 Ioannina, Greece; (O.T.); (M.P.)
| | - Zoi Iliodromiti
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece;
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Long V, Mathieu S, Fiset C. Pregnancy-induced increased heart rate is independent of thyroid hormones. Heart Rhythm O2 2021; 2:168-173. [PMID: 34113919 PMCID: PMC8183852 DOI: 10.1016/j.hroo.2021.03.001] [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] [Indexed: 11/29/2022] Open
Abstract
Background The heart rate increases by 10–20 beats per minute (bpm) throughout pregnancy in women, reaching maximum heart rate in the third trimester. During pregnancy, important changes in thyroid hormones also occur, with increases of up to 50% in the levels of triiodothyronine (T3), the biological active thyroid hormone. In addition, T3 has been shown to regulate cardiac electrophysiology. Objective Thus, in the present study the potential contribution of T3 in pregnancy-induced increased heart rate was explored. Methods We compared the heart rate between nonpregnant and pregnant mice under control conditions and after altering thyroid hormone levels with T3 and propylthiouracil (PTU, an antithyroid drug) treatments. Results Consistent with the clinical data, we found a 58% rise in T3 levels during pregnancy in mice. Although pregnant mice had a higher baseline heart rate (607 ± 8 bpm, P = .004) and higher T3 levels (1.9 ± 0.4 nM, P = .0005) than nonpregnant mice (heart rate: 546 ± 16 bpm; T3 levels: 1.2 ± 0.1 nM), their heart rate responded similarly to T3 treatment as nonpregnant mice (nonpregnant: Δ130 ± 22 bpm; pregnant: Δ126 ± 17 bpm, P = .858). Additionally, the heart rate remained significantly elevated (607 ± 11 bpm, P = .038) and comparable to untreated pregnant mice, after the use of the antithyroid drug PTU, although T3 levels (1.3 ± 0.2 nM, P = .559) returned to nonpregnant values. Conclusion Based on these results, it is unlikely that T3 contributes significantly to the pregnancy-induced increased heart rate.
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Affiliation(s)
- Valérie Long
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Sophie Mathieu
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Céline Fiset
- Research Center, Montreal Heart Institute, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
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Chen D, Li L, Ren F, Huang R, Gan H, Deng H, Wang H. Maternal hypothyroidism during pregnancy alters the function of the retinol-binding protein 4-mediated mitochondrial permeability conversion pore in the kidneys of offspring rats. Clinics (Sao Paulo) 2021; 76:e2096. [PMID: 33503180 PMCID: PMC7811836 DOI: 10.6061/clinics/2021/e2096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/15/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To determine the role of the RBP4/PiC/SIRT3 signaling pathway in the opening of the mitochondria permeability transition pore (mPTP) in offspring rats with hypothyroidism during pregnancy. METHODS Sixty Sprague-Dawley (SD) rats were employed in this study. Pregnancy was deemed successful when a sperm was found in the uterus. After one week of pregnancy, offspring rats were divided into the following groups: overall hypothyroidism group (OH group), subclinical hypothyroidism group (SCH group), and normal control group (CON group). The establishment of the hypothyroidism model was confirmed when the serum thyroid stimulating hormone (TSH) levels were higher than normal value and TT4 level was within the normal range. The renal mitochondria of offspring rats were extracted on the 14th postnatal day (P14) and 35th postnatal day (P35). RESULTS At P14, no significant differences in the degree of mPTP opening and expression of phosphoric acid carrier vector (PiC) were detected between the rats in the OH group and the SCH group. However, the expression level of silent mating-type information regulation 3 homolog (SIRT3) was markedly reduced. Retinol-binding protein 4 (RBP4) expression increased in the rats from the OH group, relative to that in those from the SCH group. At P35, the degree of mPTP opening and the expression levels of PiC and RBP4 in the OH group were higher than those in the SCH group. However, SIRT3 expression in the OH group was lower than that observed in the SCH group. CONCLUSION RBP4 plays an important role in early renal mitochondrial damage and renal impairment in rats suffering from hypothyroidism during pregnancy. The RBP4/PiC/SIRT3 pathway is thus involved in the opening of the renal mPTP in offspring rats with hyperthyroidism.
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Affiliation(s)
- Danyan Chen
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Departments of EndocrinologyChongqing General HospitalUniversity of Chinese Academy of SciencesChinaChina
- *Corresponding author. E-mail:
| | - Li Li
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Departments of EndocrinologyChongqing General HospitalUniversity of Chinese Academy of SciencesChinaChina
| | - Fang Ren
- Departments of Emergency, Chongqing General Hospital, University of Chinese Academy of Sciences, Departments of EmergencyChongqing General HospitalUniversity of Chinese Academy of SciencesChinaChina
| | - Rongxi Huang
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Departments of EndocrinologyChongqing General HospitalUniversity of Chinese Academy of SciencesChinaChina
| | - Hua Gan
- Departments of Nephrology, the First Affiliated Hospital of Chongqing Medical University, Departments of Nephrologythe First Affiliated Hospital of Chongqing Medical UniversityChinaChina
| | - Huacong Deng
- Departments of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Departments of Endocrinologythe First Affiliated Hospital of Chongqing Medical UniversityChinaChina
| | - Hongman Wang
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Departments of EndocrinologyChongqing General HospitalUniversity of Chinese Academy of SciencesChinaChina
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Turunen S, Vääräsmäki M, Lahesmaa-Korpinen AM, Leinonen MK, Gissler M, Männistö T, Suvanto E. Maternal hyperthyroidism and pregnancy outcomes: A population-based cohort study. Clin Endocrinol (Oxf) 2020; 93:721-728. [PMID: 32657434 DOI: 10.1111/cen.14282] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Maternal hyperthyroidism and antithyroid medications have been associated with adverse pregnancy and perinatal outcomes. This nationwide register-based study investigated the association of maternal hyperthyroidism and antithyroid drug (ATD) use with pregnancy outcomes and included all singleton births in Finland between 2004 and 2013 (N = 571 785). DESIGN, PATIENTS AND MEASUREMENTS Hyperthyroid mothers were identified in the Medical Birth Register, and data on ATD use before and/or during pregnancy were collected from the Prescription Register. The odds ratios, with 95% confidence intervals, for adverse outcomes among hyperthyroid mothers and mothers without thyroid disease were compared using logistic regression. RESULTS In total, 2144 (0.37%) of all the women had diagnoses of hyperthyroidism, and 580 (27%) of these women had used ATDs before and/or during pregnancy. Compared to the mothers without thyroid disease, maternal hyperthyroidism was associated with older age, multiparity, smoking, previous miscarriages, and overweight or obesity. The mothers diagnosed with hyperthyroidism also had increased odds of gestational hypertensive disorders, caesarean sections, placental abruptions, preterm births, small-for-gestational-age newborns and neonatal intensive care unit treatment. The odds of pregnancy and/or perinatal complications were higher among those who had used ATDs (indicative of active disease), but those who had not received ATD treatment also had increased odds of such complications compared to the mothers without thyroid disease. CONCLUSIONS Women with active hyperthyroidism and those with histories of hyperthyroidism should be considered at risk of developing pregnancy and perinatal complications and should therefore be monitored during pregnancy.
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Affiliation(s)
- Suvi Turunen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Maarit K Leinonen
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tuija Männistö
- Northern Finland Laboratory Centre Nordlab, Oulu University Hospital, Oulu, Finland
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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The Clinical Value and Variation of Antithyroid Antibodies during Pregnancy. DISEASE MARKERS 2020; 2020:8871951. [PMID: 33144894 PMCID: PMC7599418 DOI: 10.1155/2020/8871951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
Antithyroid antibodies, which include thyroid-stimulating hormone receptor antibodies (TRAbs), thyroid peroxidase antibodies (TPOAbs), and thyroid globulin antibodies (TgAbs), are widely known for their tight association with thyroid autoimmune diseases. The variation in all three kinds of antibodies also showed different trends during and after pregnancy (Weetman, 2010). This article reviewed the the physiological changes, while focusing on the variation of thyroid antibodies concentration in women during and after pregnancy, and adverse consequences related to their elevation. Since abnormal elevations of these antithyroid antibodies may lead to adverse outcomes in both mothers and fetuses, special attention must be paid to the titer of the antibodies during pregnancy. The molecular mechanisms of the variations in those antibodies have yet to be explained. The frequency and timing of thyroid antibody measurement, as well as different reference levels, also remain to be elucidated.
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Maternal Thyroid-Stimulating Hormone Level and Thyroid Peroxidase Antibody Status in the First and Second Trimester of Pregnancy and Their Relationship with the Risk of Gestational Diabetes Mellitus. MATERNAL-FETAL MEDICINE 2019. [DOI: 10.1097/fm9.0000000000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Ruck T, Schulte-Mecklenbeck A, Pfeuffer S, Heming M, Klotz L, Windhagen S, Kleinschnitz C, Gross CC, Wiendl H, Meuth SG. Pretreatment anti-thyroid autoantibodies indicate increased risk for thyroid autoimmunity secondary to alemtuzumab: A prospective cohort study. EBioMedicine 2019; 46:381-386. [PMID: 31371192 PMCID: PMC6711888 DOI: 10.1016/j.ebiom.2019.07.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alemtuzumab is approved for the treatment of active relapsing-remitting multiple sclerosis (RRMS). Alemtuzumab-related secondary autoimmune disorders (sAID) are common, with thyroid sAID being the most frequent, and fundamentally affect the risk-benefit ratio. Therefore, biomarkers indicating the development of sAID are urgently needed to instruct clinical decisions. METHODS We evaluated whether the anti-thyroid autoantibodies (ThyAb) anti-thyroglobulin (anti-TG) and anti-thyroid-peroxidase (anti-TPO) detected at baseline by standard testing are able to indicate increased risk for thyroid sAID following alemtuzumab treatment in a multicentre prospective cohort of 106 alemtuzumab-treated RRMS patients. We here present an interim-analysis with a median follow-up of 36 months. FINDINGS Baseline characteristics demonstrated no significant differences between patients with or without thyroid sAID. 29/106 (27·4%) patients developed thyroid sAID between 5 and 51 months following alemtuzumab treatment initiation. 14/29 patients (48·3%) were positive for ThyAb at baseline and developed thyroid sAID. Hazard ratio for time to thyroid autoimmunity was 12.15 (95% CI 4.73-31.2) indicating a highly increased risk for ThyAb positive patients. Baseline ThyAb were associated with shorter time to sAID, but not with a specific disease entity of thyroid sAID. Hazard ratios for age, sex, previous treatment, disease duration, disability and smoking status demonstrated no significant association with thyroid autoimmunity. INTERPRETATION Standard ThyAb-testing for anti-TPO and anti-TG antibodies at baseline was able to indicate increased risk for clinically manifest thyroid sAID and should therefore be used in clinical decisions concerning alemtuzumab treatment initiation. FUND: German Ministry of Education, Science, Research and Technology and the German Research foundation.
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Affiliation(s)
- Tobias Ruck
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany.
| | | | - Steffen Pfeuffer
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Michael Heming
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Luisa Klotz
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | | | - Catharina C Gross
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Clinic of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
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11
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Sahajpal R, Ahmed RA, Hughes CA, Foisy MM. Probable interaction between levothyroxine and ritonavir: Case report and literature review. Am J Health Syst Pharm 2019; 74:587-592. [PMID: 28389458 DOI: 10.2146/ajhp160200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of probable interaction of levothyroxine and ritonavir is presented along with a review of the relevant literature and recommendations on clinical management. SUMMARY A 37-year-old woman with human immunodeficiency virus infection who had recently undergone thyroidectomy for a benign multinodular goiter presented to a clinic with hypothyroidism (she was also found to be pregnant), and treatment with levothyroxine 75 μg daily was initiated. While receiving antiretroviral therapy (abacavir-lamivudine and lopinavir-ritonavir) during pregnancy, the patient had persistently elevated serum thyroid-stimulating hormone (TSH) concentrations (up to 125.89 μIU/mL) despite gradual escalation of the levothyroxine dosage to 175 μg daily. An interaction between ritonavir and levothyroxine was suspected, and dolutegravir was substituted for lopinavir-ritonavir. Within 4 months, the TSH concentration had normalized. The daily levothyroxine dose was tapered over a 5-month period and stabilized at 125 μg, and TSH concentrations remained within the normal range over an 18-month follow-up period. Scoring of the case using the Drug Interaction Probability Scale yielded a score of 6 out of 11, indicating a probable interaction between levothyroxine and ritonavir. A literature search identified 4 reported cases of interactions involving levothyroxine and ritonavir. CONCLUSION A potentially serious and underrecognized drug interaction between ritonavir and levothyroxine was observed in a pregnant woman with postthyroidectomy-related hypothyroidism. This case and a review of other cases reported in the literature indicate that higher-than-usual doses of levothyroxine may be required in patients who are taking ritonavir concurrently.
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Affiliation(s)
| | - Rabia A Ahmed
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Michelle M Foisy
- Northern Alberta Program, Royal Alexandra Hospital, Edmonton, Canada.
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12
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Guo J, Lv N, Tang J, Zhang X, Peng L, Du X, Li S, Luo Q, Zhang D, Chen G. Associations of blood metal exposure with thyroid hormones in Chinese pregnant women: A cross-sectional study. ENVIRONMENT INTERNATIONAL 2018; 121:1185-1192. [PMID: 30385064 DOI: 10.1016/j.envint.2018.10.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Few epidemiological studies have investigated associations of exposure to multiple metals with thyroid hormone homeostasis, especially for the pregnant women. METHODS Among all the 1644 participants enrolled in Hangzhou Birth Cohort Study (HBCS) at baseline, a total of 915 pregnant women with complete data of interest were analyzed. Eleven metals were measured in blood samples collected around 25 weeks gestation. Serum levels of thyroid hormones including free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), total thyroxine (TT4) and thyroid-stimulating hormone (TSH) were abstracted from the medical records. Relationships between tertiles of metal levels (setting the lowest tertile as the reference) and percent changes in thyroid hormones were estimated by multivariable adjusted linear regression models. RESULTS Five metals [arsenic (As), selenium (Se), manganese (Mn), nickel (Ni), antimony (Sb)] were significantly linked to decreased levels of one or more thyroid hormones based on trend tests in the single-metal models. Percent changes [95% confidence intervals (CIs)] in thyroid hormones for the third tertiles of metals remained significant between FT3 and As [-3.53% (-5.48%, -1.54%)]; and between TT3 and As [-4.19% (-7.00%, -1.31%)]; and between FT4 and Mn [-2.05% (-3.49%, -0.58%)], Sb [-1.99% (-3.44%, -0.52%)] in the multiple-metal models. CONCLUSIONS Thyroid hormone concentrations were reversely related to the levels of blood metals of As, Mn and Sb among Chinese pregnant women. Additional prospective studies are warranted to confirm the causality. Paper capsule: Exposure to multiple metals was reversely associated with one or more thyroid hormones in the Chinese pregnant women.
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Affiliation(s)
- Jing Guo
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Lv
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xue Zhang
- Jiashan County Center for Disease Control and Prevention, Jiashan, China
| | - Lihe Peng
- Jiashan County Center for Disease Control and Prevention, Jiashan, China
| | - Xiaofu Du
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shuai Li
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guangdi Chen
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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13
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Park CE. Evaluation of Pregnancy and Thyroid Function. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
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14
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15
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Woitek R, Prayer D, Hojreh A, Helbich T. Radiological staging in pregnant patients with cancer. ESMO Open 2016; 1:e000017. [PMID: 27843585 PMCID: PMC5070210 DOI: 10.1136/esmoopen-2015-000017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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