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Otsuka E, Kitamura M, Funakoshi S, Mukae H, Nishino T. Roxadustat has risks of reversible central hypothyroidism in patients undergoing hemodialysis: a single-center retrospective cohort study. Ren Fail 2024; 46:2410375. [PMID: 39378117 DOI: 10.1080/0886022x.2024.2410375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/21/2024] [Accepted: 09/24/2024] [Indexed: 10/10/2024] Open
Abstract
Roxadustat, a hypoxia-inducible factor-prolyl hydroxylase inhibitor, has proven efficacy in the treatment of renal anemia; however, evidence indicates that it may cause central hypothyroidism. The prevalence and reversibility of roxadustat-induced central hypothyroidism in patients undergoing hemodialysis remain unclear. Here, we retrospectively analyzed thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels in 51 patients (mean age: 72.3 ± 10.7 years; 58.8% male) undergoing hemodialysis before, during, and after halting roxadustat treatment. TSH levels were significantly decreased from a median of 2.46 (interquartile range:1.60-4.51) mU/L before roxadustat treatment to 1.36 (0.72-2.41) mU/L during treatment (p < 0.001), and improved to 2.56 (1.78-4.63) mU/L after halting roxadustat (p < 0.001). Similarly, FT4 levels decreased from 1.11 (0.97-1.24) ng/dL before roxadustat treatment to 0.92 (0.71-1.03) ng/dL during treatment (p < 0.001) and improved to 1.05 (0.93-1.17) ng/dL after halting roxadustat (p < 0.001). FT3 levels were 2.04 (1.78-2.31) pg/mL before starting roxadustat, 1.97 (1.69-2.27) pg/mL during treatment, and 1.90 (1.63-2.18) pg/mL after halting roxadustat, with no significant difference between each group. Moreover, 2.0% of patients exhibited extremely low TSH levels (≤0.1 mU/L) and low TSH levels (>0.1 mU/L to <0.4 mU/L) before starting roxadustat and that percentage increased to 5.9% and 7.8%, respectively, during treatment. After roxadustat cessation, extremely low or low TSH levels recovered in all patients. Taken together, the results indicate that roxadustat can cause reversible central hypothyroidism in patients undergoing hemodialysis.
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Affiliation(s)
- Emiko Otsuka
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Renal Center, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki Renal Center, Nagasaki, Japan
| | | | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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2
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Ursem SR, Boelen A, Bruinstroop E, Elders PJM, Gussekloo J, Poortvliet RKE, Heijboer AC, den Elzen WPJ. A systematic review of subclinical hyperthyroidism guidelines: a remarkable range of recommendations. Eur Thyroid J 2024; 13:e240036. [PMID: 38758966 PMCID: PMC11227059 DOI: 10.1530/etj-24-0036] [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: 02/08/2024] [Accepted: 05/17/2024] [Indexed: 05/19/2024] Open
Abstract
Background Subclinical thyroid diseases are often the subject of debate concerning their clinical significance, the appropriateness of diagnostic testing, and possible treatment. This systematic review addresses the variation in international guidelines for subclinical hyperthyroidism, focusing on diagnostic workup, treatment, and follow-up recommendations. Methods Following the PRISMA guidelines, we searched PubMed, Embase, and guideline-specific databases and included clinical practice guidelines with recommendations on subclinical hyperthyroidism. Guideline recommendations were extracted, and quality assessment was performed using selected questions of the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Results Of the 2624 records screened, 22 guidelines were included, which were published between 2007 and 2021. Guideline quality was generally intermediate to low. Diagnostic approaches differed substantially, particularly in the extent of recommended testing. Treatment initiation depended on TSH levels, age, and comorbidities, but the level of detail regarding defining precise comorbidities varied. Recommendations for monitoring intervals for follow-up ranged from 3 to 12 months. Conclusion This review underscores the existing variability in (inter)national guidelines concerning subclinical hyperthyroidism. There isa need for clear recommendations in guidelines considering diagnostic workup, treatment, and follow-up of subclinical hyperthyroidism. In order to establish this, future research should focus on determining clear and evidence-based intervention thresholds.
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Affiliation(s)
- Stan R Ursem
- Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Anita Boelen
- Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Eveline Bruinstroop
- Department of Endocrinology and Metabolism, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, The Netherlands
| | - Jacobijn Gussekloo
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemieke C Heijboer
- Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Endocrine Laboratory, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan, Amsterdam, The Netherlands
| | - Wendy P J den Elzen
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Meibergdreef, Amsterdam, The Netherlands
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3
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Ulndreaj A, Brinc D, Altan M, Pons-Belda OD, Fernandez-Uriarte A, Mu-Mosley H, Fattah F, von Itzstein MS, Soosaipillai A, Kulasingam V, Palaskas NL, Gerber DE, Diamandis EP, Heymach JV, Prassas I. Quantitation of cardiac troponin I in cancer patients treated with immune checkpoint inhibitors: a case-control study. Clin Chem Lab Med 2023; 61:154-161. [PMID: 36287134 DOI: 10.1515/cclm-2022-0471] [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: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) cause a variety of toxicities, including immune-related adverse events (irAEs), but there are no biomarkers to predict their development. Guidelines recommend measuring circulating cardiac troponin I (cTnI) during ICI therapy to detect related cardiotoxicities. Moreover, elevated cTnI has also been associated with worse outcomes in non-cardiac patients, including cancer. Thus here, we investigated whether cTnI levels were higher in patients with irAEs. METHODS The study consisted of three groups; 21 cancer patients undergoing ICI immunotherapies who presented with irAEs, four patients without irAEs, and 20 healthy controls. Patient samples were assessed at baseline (n=25), during ICI treatment (n=25, median=6 weeks of treatment) and at toxicity (n=6, median=13 weeks of treatment). In addition to blood high sensitivity cardiac troponin I (hs-cTnI), anti-thyroglobulin (TG) and anti-thyroid peroxidase (TPO) antibodies were also quantitated to detect thyroid dysfunction, constituting the second leading toxicity (23.8%) after pneumonitis (28.6%). RESULTS Four patients with irAEs (n=4/21; 19%) and one without irAEs (n=1/4; 25%) showed higher hs-cTnI levels at any time-point; the remaining had physiological levels. None of these patients developed cardiotoxicity. Concurrent elevated levels of anti-thyroid antibodies and hs-cTnI were detected in one patient with thyroid dysfunction (n=1/5, 20%). However, these antibodies were also elevated in three patients (n=3/16, 19%) with non-thyroid irAEs and in up to 40% of healthy controls. CONCLUSIONS hs-cTnI was not elevated in patients with irAEs, but larger studies are needed to confirm these observations.
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Affiliation(s)
- Antigona Ulndreaj
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Davor Brinc
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Oscar D Pons-Belda
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Hong Mu-Mosley
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farjana Fattah
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mitchell S von Itzstein
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Antoninus Soosaipillai
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vathany Kulasingam
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Nicolas L Palaskas
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David E Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine (Division of Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eleftherios P Diamandis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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4
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Wang HX, Gao WY, Yang Y, Li YF, Zhang Y, Zhang XY, Li YX. Preliminary observation of thyroid function changes in subclinical thyroid diseases. Technol Health Care 2023; 31:1715-1722. [PMID: 37092191 DOI: 10.3233/thc-220562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND It is estimated that 1.95% and 5.55% of adults in China suffer from subclinical thyroid diseases, which is difficult to diagnose and treat. OBJECTIVE This study aimed to explore the development and prognosis of subclinical thyroid diseases to provide a reference from our single center experience. METHODS A total of 240 cases from April 2019 to August 2021 in the laboratory information system database of Huanghua Development Boai Hospital were retrospectively analyzed. Binary logistic regression was conducted to analyze odds ratio (OR) of subclinical thyroid disease types returning to a normal state. RESULTS Among the patients hypothyroidism Ia and hyperthyroidism Ia were the most common type with conversion to the normal state (P< 0.001). TSH level of patients with conversion to a normal state was significantly lower than that of those who developed to abnormal disease (P= 0.015). The OR values of hyperthyroidism Ia and hypothyroidism Ia that returned to a normal state compared with hyperthyroidism Ib were 2.659 (1.159 ∼ 6.096, P= 0.021) and 3.138 (1.1.278 ∼ 7.709, P= 0.013), respectively. The OR value of hypothyroidism Ib that returned to normal compared with hyperthyroidism Ib was 0.629 (0.131 ∼ 3.010, P= 0.561). Thyroid hormone levels, age, and gender at first diagnosis were not impact factor for prognosis of subclincal thyroid disease (P> 0.05). CONCLUSION Cases with grade hypothyroidism Ia and hyperthyroidism Ia are more likely to revert to normal state than other subclinical thyroid diseases. TSH reference range should be explored for diagnosis and treatment.
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Affiliation(s)
- Hua-Xin Wang
- Clinical Laboratory, Huanghua Boai Hospital, Cangzhou, Hebei, China
| | - Wen-Yu Gao
- Clinical Laboratory, Huanghua Boai Hospital, Cangzhou, Hebei, China
| | - Yang Yang
- Clinical Laboratory, Huanghua Boai Hospital, Cangzhou, Hebei, China
| | - Yun-Feng Li
- Clinical Laboratory, Huanghua Boai Hospital, Cangzhou, Hebei, China
| | - Yan Zhang
- Cangzhou Medical College, Cangzhou, Hebei, China
| | - Xin-Yi Zhang
- Cangzhou Hospital of Integrated TCM-WM, Cangzhou, Hebei, China
| | - Yu-Xia Li
- Clinical Laboratory, Huanghua Boai Hospital, Cangzhou, Hebei, China
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5
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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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6
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Hegedüs L, Bianco AC, Jonklaas J, Pearce SH, Weetman AP, Perros P. Primary hypothyroidism and quality of life. Nat Rev Endocrinol 2022; 18:230-242. [PMID: 35042968 PMCID: PMC8930682 DOI: 10.1038/s41574-021-00625-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
In the 1970s, treatment with thyroid extract was superseded by levothyroxine, a synthetic L form of tetraiodothyronine. Since then, no major innovation has emerged for the treatment of hypothyroidism. The biochemical definition of subclinical hypothyroidism is a matter of debate. Indiscriminate screening for hypothyroidism has led to overdiagnosis and treatment initiation at lower serum levels of thyroid-stimulating hormone (TSH) than previously. Adverse health effects have been documented in individuals with hypothyroidism or hyperthyroidism, and these adverse effects can affect health-related quality of life (QOL). Levothyroxine substitution improves, but does not always normalize, QOL, especially for individuals with mild hypothyroidism. However, neither studies combining levothyroxine and liothyronine (the synthetic form of tri-iodothyronine) nor the use of desiccated thyroid extract have shown robust improvements in patient satisfaction. Future studies should focus not only on a better understanding of an individual's TSH set point (the innate narrow physiological range of serum concentration of TSH in an individual, before the onset of hypothyroidism) and alternative thyroid hormone combinations and formulations, but also on autoimmunity and comorbidities unrelated to hypothyroidism as drivers of patient dissatisfaction. Attention to the long-term health consequences of hypothyroidism, beyond QOL, and the risks of overtreatment is imperative.
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Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | - Antonio C Bianco
- Section of Adult and Paediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Simon H Pearce
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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7
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Ranhulova T. Non-Alcoholic Fatty Liver Disease and Hypothyroidism: Review of Clinical and Experimental Studies. GALICIAN MEDICAL JOURNAL 2021. [DOI: 10.21802/gmj.2021.4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hypothyroidism is a widespread condition affecting people of different socio-economic background and geographical location. A lot of studies highlight the effect of hypothyroidism on the metabolic processes in various organs, including the liver. On the other hand, liver damage often results in the development of non-alcoholic fatty liver disease; however, the data on the impact of hypothyroidism on liver morphology, which can serve as a direct indicator and marker of liver condition and function, are limited and controversial. In this report, we reviewed the relationship between non-alcoholic fatty liver disease and hypothyroidism with an accent on morphological alteration of the liver discovered in clinical and experimental studies.
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8
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Karakatsoulis GN, Tsapakis EM, Mitkani C, Fountoulakis KN. Subclinical thyroid dysfunction and major depressive disorder. Hormones (Athens) 2021; 20:613-621. [PMID: 34427900 DOI: 10.1007/s42000-021-00312-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/20/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE This review attempts to investigate the link between subclinical thyroid dysfunction (SCH) and major depressive disorder (MDD). It has been speculated that SCH may be related to MDD through an autoimmune mechanism. METHODS A comprehensive literature search was conducted in the PubMed database for relevant research and review articles. RESULTS There appears to be an association between an autoimmune mechanism, possibly involving the thyroid gland, and depressive disorders, but the available evidence is so far inconclusive. CONCLUSION Lifetime prevalence of depression is significantly higher in patients with SCH, a finding reflecting a possible effect of SCH in lowering the threshold for the emergence of MDD. The relationship between SCH and MDD is, however, not clear, with large and well-designed studies investigating possible links between reference-range thyroid hormone levels and MDD having as yet found no relation between the two.
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Affiliation(s)
- Grigorios N Karakatsoulis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, University General Hospital AHEPA, Stilponos Kyriakidi Str. 1, Thessaloniki, Greece.
- , Thessaloniki, Greece.
| | - Eva-Maria Tsapakis
- 1st Department of Psychiatry, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 564 29, Thessaloniki, Greece
- "Agios Charalambos" Mental Health Clinic, 71305, Heraklion, Crete, Greece
| | - Calypso Mitkani
- "Agios Pavlos" General Hospital, Ethnikis Antistaseos Ave. 161, Thessaloniki, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, University General Hospital AHEPA, Stilponos Kyriakidi Str. 1, Thessaloniki, Greece
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9
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Kasipovich BY, Kakenovna ON, Kanatovna AM, Vladimirovna PY, Kabdollovna MA, Iltaevna UA, Toleutayevna AD, Minbaevich AO, Sarsenbaevna BL. The Prevalence of Signs of Thyroid Pathology among Students of the Karaganda Medical University According to the Survey. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The objectives of the study were to study the signs of thyroid dysfunction in students at the Karaganda Medical University.
MATERIALS AND METHODS: The survey was conducted among students of the Karaganda Medical University in the amount of two hundred people. Statistical methods were used for comparison among students of different courses.
RESULTS: Among junior students, signs of thyroid dysfunction were more pronounced than among senior students. More than half of the examined students had a diagnosed thyroid pathology, which was more pronounced in students of one and two courses.
CONCLUSION: Undergraduates are more likely to exhibit signs of stress-related thyroid dysfunction.
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10
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Leese G, Soto-Pedre E. Time to refresh thinking on the terminology and management of hypothyroidism? Clin Endocrinol (Oxf) 2021; 95:574-575. [PMID: 33990990 DOI: 10.1111/cen.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Graham Leese
- University of Dundee - Endocrinology, Dundee, UK
| | - Enrique Soto-Pedre
- University of Dundee - Division of Molecular and Clinical Medicine, Dundee, UK
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11
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Effraimidis G, Watt T, Feldt-Rasmussen U. Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Front Endocrinol (Lausanne) 2021; 12:641560. [PMID: 33790867 PMCID: PMC8006441 DOI: 10.3389/fendo.2021.641560] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/06/2023] Open
Abstract
Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Section, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Considerations for Use of Immune Checkpoint Inhibitors in Cancer Therapy for Patients with Co-Existing Thyroid Eye Disease. Ophthalmol Ther 2020; 10:5-12. [PMID: 33146864 PMCID: PMC7886920 DOI: 10.1007/s40123-020-00317-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionised the field of oncology. While most ICIs are well-tolerated, severe and fatal immune-related adverse events (irAEs) have been documented, likely related to the strengthened immunity harnessed by ICIs against tumours. Endocrinopathies are some of the most common irAEs, with both hypothyroidism and hyperthyroidism encountered after ICI use. As such, patients with pre-existing autoimmune conditions, such as Graves' disease (GD) with clinically active thyroid eye disease (TED), are excluded from most clinical trials studying ICIs due to concerns of exacerbating pre-existing autoimmune conditions or of increasing the potential for irAE development. The limited information currently available on the safety and efficacy of ICIs in this population poses a clinical challenge for oncologists. The objective of this commentary is to highlight these challenges and provide treatment recommendations pertaining to two specific cohorts of patients with GD, namely GD patients with minimal eye complications and GD patients with previous TED who underwent radiotherapy, surgery or pulse methylprednisolone and whose disease is now quiescent, and to patients with subclinical autoimmune thyroid disease.
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Trovato M. A historical excursus of diagnostic methods for Hashimoto thyroiditis and Graves' disease. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04176-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoermann R, Midgley JE, Larisch R, Dietrich JW. Heterogenous biochemical expression of hormone activity in subclinical/overt hyperthyroidism and exogenous thyrotoxicosis. J Clin Transl Endocrinol 2020; 19:100219. [PMID: 32099819 PMCID: PMC7031309 DOI: 10.1016/j.jcte.2020.100219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Subclinical hyperthyroidism/thyrotoxicosis originates from different causes and clinical conditions, sharing the laboratory constellation of a suppressed TSH in the presence of thyroid hormone concentrations within the reference range. Aim Presentation of hyperthyroidism can manifest itself in several ways. We questioned whether there is either a consistent biochemical equivalence of thyroid hormone response to these diagnostic categories, or a high degree of heterogeneity may exist both within and between the different clinical manifestations. Methods This secondary analysis of a former prospective cross-sectional trial involved 461 patients with untreated thyroid autonomy, Graves’ disease or on levothyroxine (LT4) after thyroidectomy for thyroid carcinoma. TSH response and biochemical equilibria between TSH and thyroid hormones were contrasted between endogenous hyperthyroidism and thyrotoxicosis (LT4 overdose). Results Concentrations of FT4, FT3, TSH, deiodinase activity and BMI differed by diagnostic category. Over various TSH strata, FT4 concentrations were significantly higher in LT4-treated thyroid carcinoma patients, compared to the untreated diseases, though FT3 levels remained comparable. They were concentrated in the upper FT4- but low deiodinase range, distinguishing them from patients with thyroid autonomy and Graves’ disease. In exogenous thyrotoxicosis, TSH and FT3 were less responsive to FT4 concentrations approaching its upper normal/hyperthyroid range. Conclusions The presence or lack of TSH feedforward activity determines the system response in the thyroid-active (hyperthyroidism) and no-thyroid response to treatment (thyrotoxicosis). This rules out a consistent thread of thyroid hormone response running through the different diagnostic categories. TSH measurements should therefore be interpreted conditionally and differently in subclinical hyperthyroidism and thyrotoxicosis.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
- Corresponding author at: Klinikum Lüdenscheid, Paulmannshöher Str 14, D-58515 Lüdenscheid, Germany.
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, D-44791 Bochum, Germany
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Rashed YK, Khalaf FA, Kotb SE. Thyroid disturbances in children treated with combined pegylated interferon-alpha and ribavirin for chronic hepatitis C. Clin Exp Pediatr 2020; 63:52-55. [PMID: 32024338 PMCID: PMC7029667 DOI: 10.3345/kjp.2018.07150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 08/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Immunomodulatory properties of interferon (IFN) have been documented. It may induce autoimmune diseases such as autoimmune thyroiditis with hypo- or hyperthyroidism. In addition, it may impair thyroid hormone synthesis through affecting iodide organification in thyroid gland. PURPOSE The aim of this study was to describe thyroid function tests disturbances in children with chronic hepatitis C (CHC) receiving pegylated interferon-alpha (PEG IFN-α) plus ribavirin. METHODS Fifty children with CHC virus infection who received combined pegylated interferon-alpha with ribavirin were selected. Other 50 apparently healthy children of matched age and sex (considered as control group) were selected. All children (100) were subject to liver function tests, virological studies, and follow-up of thyroid function test during and after the treatment course. RESULTS Our study showed that 28% of children received combined PEG IFN-α plus ribavirin showed subclinical hypothyroidism. After 24 weeks treatment with combined therapy of IFN plus ribavirin, the mean level of thyroid stimulating hormone (TSH) was 3.23±88 mU/mL, while TSH was 1.16± 0.77 mU/mL before starting treatment. On the other hand, mean TSH was 1.09±0.92 mU/mL in normal control group. CONCLUSION This study revealed an association between subclinical thyroid dysfunction and treatment with IFN-alpha and ribavirin in children. Further studies on larger number of patients and longer follow-up duration are recommended for further confirmation.
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Affiliation(s)
- Yasser K Rashed
- Department of Pediatric Hepatology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Fatma A Khalaf
- Department of Clinical Biochemistry, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Sobhy E Kotb
- Department of Pediatric Medicine, Ministry of Health Hospital, Menoufia, Egypt
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Bel Lassen P, Kyrilli A, Lytrivi M, Corvilain B. Graves' disease, multinodular goiter and subclinical hyperthyroidism. ANNALES D'ENDOCRINOLOGIE 2019; 80:240-249. [PMID: 31427038 DOI: 10.1016/j.ando.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/27/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
Subclinical hyperthyroidism is a common clinical entity, defined by serum TSH below the reference range, with normal FT4 and FT3 levels in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional and longitudinal population-based studies demonstrate association of subclinical hyperthyroidism with risk of atrial fibrillation and osteoporosis, and with cardiovascular and all-cause mortality. However, there are no randomized clinical trials addressing whether long-term health outcomes are improved by treating subclinical hyperthyroidism; in the absence of evidence one way or the other, it seems appropriate to use decision trees taking account of TSH concentration and presence of risk factors (age>65 years or post-menopause, osteoporosis and cardiac disease).
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Affiliation(s)
- Pierre Bel Lassen
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium; UMRS 1166 (Inserm), 91, boulevard de l'Hôpital, 75013 Paris, France.
| | - Aglaia Kyrilli
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Maria Lytrivi
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Bernard Corvilain
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
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Selmer C, Faber J. Editorial commentary: Subclinical thyroid dysfunction and cardiovascular risk: Nothing to lose, everything to gain? Trends Cardiovasc Med 2019; 30:70-71. [PMID: 31126700 DOI: 10.1016/j.tcm.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Christian Selmer
- Amager and Hvidovre University Hospital, Department of Endocrinology, University of Copenhagen, Italiensvej 1, Copenhagen, 2300, Denmark.
| | - Jens Faber
- Herlev and Gentofte University Hospital, Department of Endocrinology, University of Copenhagen, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Volkova AR, Dygun OD, Zhdanova ON, Lukichev BG, Belyakova LA, Sereda EM. Detectability of Subclinical Hypothyroidism and Thyroid Stimulating Hormone Levels Associated with Cardiovascular Diseases in Patients of North-West Region Hospital. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-2-174-179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A. R. Volkova
- Pavlov First Saint Petersburg State Medical University
| | - O. D. Dygun
- Pavlov First Saint Petersburg State Medical University
| | | | | | | | - E. M. Sereda
- Pavlov First Saint Petersburg State Medical University
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. The role of functional thyroid capacity in pituitary thyroid feedback regulation. Eur J Clin Invest 2018; 48:e13003. [PMID: 30022470 DOI: 10.1111/eci.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/08/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thyroid feedback regulation and equilibria between thyroid hormones differ in the presence or absence of a functioning thyroid remnant. MATERIALS AND METHODS This study examines the relationship between the sensitivity of TSH feedback and thyroid capacity in untreated patients with thyroid autoimmune disease (n = 86) and healthy controls (n = 271). Functional capacity was estimated at maximum TSH stimulation, and pituitary TSH response was FT4-standardised with two established indices, the TSH index and the thyrotroph thyroid hormone resistance index. RESULTS The two indices correlated inversely with thyroid volume and functional thyroid capacity. Relationships were shifted upwards in patients with thyroid autoimmune disease. This positioned patients with thyroid autoimmune disease predominantly at the lower capacity range and upper part of TSH index. The relationship was modulated by serum FT3 concentrations, shifting 0.19 [95%CI: 0.12, 0.26] mIU/L per pmol FT3 increase. FT3 correlated with TSH index in total group ( τ = 0.09, P = 0.009) and both subgroups. FT3 levels were maintained despite a substantial capacity loss by progressively increasing conversion rates of T3 from T4, only collapsing at capacities below <1.5 pmol/s. CONCLUSION Functional thyroid capacity and preferential T3 generation are essential elements in adjusting the sensitivity of hypothalamic-pituitary-thyroid feedback control and balancing system equilibria. This suggests that the indirect regulatory role of glandular T3 co-secretion exceeds its quantitative contribution to the thyroid hormone pool. Implications for clinical practice extend to the diagnostic use of TSH in patients with impaired thyroid reserve.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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Ruiz-Núñez B, Tarasse R, Vogelaar EF, Janneke Dijck-Brouwer DA, Muskiet FAJ. Higher Prevalence of "Low T3 Syndrome" in Patients With Chronic Fatigue Syndrome: A Case-Control Study. Front Endocrinol (Lausanne) 2018; 9:97. [PMID: 29615976 PMCID: PMC5869352 DOI: 10.3389/fendo.2018.00097] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/27/2018] [Indexed: 12/23/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a heterogeneous disease with unknown cause(s). CFS symptoms resemble a hypothyroid state, possibly secondary to chronic (low-grade) (metabolic) inflammation. We studied 98 CFS patients (21-69 years, 21 males) and 99 age- and sex-matched controls (19-65 years, 23 males). We measured parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. Most remarkably, CFS patients exhibited similar thyrotropin, but lower free triiodothyronine (FT3) (difference of medians 0.1%), total thyroxine (TT4) (11.9%), total triiodothyronine (TT3) (12.5%), %TT3 (4.7%), sum activity of deiodinases (14.4%), secretory capacity of the thyroid gland (14.9%), 24-h urinary iodine (27.6%), and higher % reverse T3 (rT3) (13.3%). FT3 below the reference range, consistent with the "low T3 syndrome," was found in 16/98 CFS patients vs. 7/99 controls (OR 2.56; 95% confidence interval = 1.00-6.54). Most observations persisted in two sensitivity analyses with more stringent cutoff values for body mass index, high-sensitive C-reactive protein (hsCRP), and WBC. We found possible evidence of (chronic) low-grade metabolic inflammation (ferritin and HDL-C). FT3, TT3, TT4, and rT3 correlated positively with hsCRP in CFS patients and all subjects. TT3 and TT4 were positively related to hsCRP in controls. Low circulating T3 and the apparent shift from T3 to rT3 may reflect more severely depressed tissue T3 levels. The present findings might be in line with recent metabolomic studies pointing at a hypometabolic state. They resemble a mild form of "non-thyroidal illness syndrome" and "low T3 syndrome" experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation and extension by others. If confirmed, trials with, e.g., T3 and iodide supplements might be indicated.
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Affiliation(s)
- Begoña Ruiz-Núñez
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
- Healthy Institute, Madrid, Spain
- *Correspondence: Begoña Ruiz-Núñez,
| | - Rabab Tarasse
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - D. A. Janneke Dijck-Brouwer
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Frits A. J. Muskiet
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Gallo D, Piantanida E, Veronesi G, Lai A, Sassi L, Lombardi V, Masiello E, Premoli P, Bianconi E, Cusini C, Rosetti S, Tanda ML, Toniolo A, Ferrario M, Bartalena L. Physical performance in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest 2017; 40:1099-1106. [PMID: 28434158 DOI: 10.1007/s40618-017-0661-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/22/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Hypothyroidism is complicated by neuromuscular symptoms (myalgias, slowness of movements, and tiredness) and signs (easy fatigability and cramps), which may have a negative impact on general well-being and quality of life. In a pilot, prospective, controlled study, we investigated the features of muscle dysfunction in hypothyroidism by disease questionnaire, biochemical measures, and physical performance tests. MATERIALS AND METHODS Fifty-seven consecutive patients with newly diagnosed hypothyroidism were enrolled, 27 subclinical (S-Hypo) and 30 overt (O-Hypo). A series of 30 euthyroid subjects, with similar demographic characteristics, served as controls. Patients were administered a short disease questionnaire and underwent laboratory exams and standardized physical tests, both at baseline and after restoration of biochemical euthyroidism. RESULTS Compared to euthyroid controls, the O-Hypo group showed significantly higher prevalence of neuromuscular symptoms and significantly higher serum creatine phosphokinase (CPK) levels (p value < 0.0001). S-Hypo had slightly higher CPK levels and prevalence of neuromuscular symptoms than controls. Both S-Hypo and O-Hypo patients performed worse than controls in the six-minute walking test. Differences between patients and controls in handgrip strength test and timed chair standing test failed to reach statistical significance (although a trend was noticeable), possibly due to the small sample size. In O-Hypo, an inverse correlation was found between CPK levels and the handgrip strength test (p value < 0.001). Restoration of euthyroidism was associated with normalization of questionnaire responses, six-minute walking test, as well as serum CPK levels. CONCLUSION In addition to neuromuscular symptoms, hypothyroidism is associated with abnormalities of physical performance. The six-minute walking test is the most valuable test to assess this aspect. In the pilot study, levothyroxine therapy could reverse muscle functional abnormalities.
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Affiliation(s)
- D Gallo
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - E Piantanida
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy.
| | - G Veronesi
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100, Varese, Italy
| | - A Lai
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - L Sassi
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - V Lombardi
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - E Masiello
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - P Premoli
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - E Bianconi
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - C Cusini
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - S Rosetti
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - M L Tanda
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - A Toniolo
- Department of Biotechnology and Life Science, University of Insubria, 21100, Varese, Italy
| | - M Ferrario
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy
| | - L Bartalena
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy.
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Ruggeri RM, Trimarchi F, Biondi B. MANAGEMENT OF ENDOCRINE DISEASE: l-Thyroxine replacement therapy in the frail elderly: a challenge in clinical practice. Eur J Endocrinol 2017; 177:R199-R217. [PMID: 28566447 DOI: 10.1530/eje-17-0321] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 12/11/2022]
Abstract
The number of elderly people, mostly aged over 85 years (the 'oldest old'), is increasing worldwide. As a consequence, accompanying morbidity and disability have been increasing, and frailty, defined as an age-related condition of decline of physiological reserves and vulnerability, represents an emerging problem. Caring for older frail people may represent a challenge, since the elderly differ significantly from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions. Specific criteria of therapeutic appropriateness and modified goals of care are needed in such patients, also in endocrine care settings. Indeed, thyroid dysfunctions are among the most common conditions in older, multimorbid populations. The prevalence of overt and subclinical hypothyroidism is as high as 20% and thyroid hormone prescription is common in the elderly, with a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism. In addition, older patients have the highest rate of overtreatment during replacement therapy and are more susceptible to developing adverse effects from thyroid hormone excess. Recently, results of a multicentric randomized controlled trial, the TRUST-IEMO collaboration trial, added further insights to the debated question of whether and when levothyroxine treatment is required and if it is beneficial in the elderly. With this in mind, we revised the relevant literature on the impact of thyroid dysfunction and replacement therapy among older people, with the aim to better define indications, benefits and risks of l-T4 replacement therapy in the frail elderly.
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Affiliation(s)
- R M Ruggeri
- Department of Clinical and Experimental Medicine, UOC Endocrinology, University of Messina, Italy
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy
| | - B Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Saric MS, Jurasic MJ, Sovic S, Kranjcec B, Glivetic T, Demarin V. Dyslipidemia in subclinical hypothyroidism requires assessment of small dense low density lipoprotein cholesterol (sdLDL-C). ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2017; 55:159-166. [PMID: 28384120 DOI: 10.1515/rjim-2017-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Usually both hypothyroidism and hyperthyroidism are related to the cardiovascular and cerebrovascular disease development. The relationship between subclinical hypothyroidism has been widely investigated but the findings remain controversial. The aim of the present study was to evaluate the lipid profile in patients with subclinical hypothyroidism (SHypo) in comparison to controls and to determine the association of SHypo and dyslipidemia in attempt to find importance of small dense low-density lipoprotein cholesterol (sdLDL-C) in atherosclerosis. MATERIAL AND METHODS In this study we included 100 women, aged 30 to 70 years that were divided into subgroups according to their age. According to the values of levels of thyroid hormones they were divided into euthyroid (control) group (n = 64) and (newly discovered) subclinical hypothyroidism (SHypo) group (n = 36). A high-sensitivity C-reactive protein (hs-CRP) and lipid profile, including small dense low-density lipoprotein cholesterol (sdLDL-C) were determined. Body weight and height were measured and BMI calculated. History of the current illness, medication, alcohol consumption and cigarettes smoking were noted. RESULTS Changed lipid profile as well as elevated triglycerides and sdLDL-C were observed in the group with subclinical hypothyroidism compared to the control group. CONCLUSIONS It is important to determine serum lipid levels, especially serum sdLDL-C levels at an early stage of subclinical hypothyroidism, since they represent atherogenic LDL particles and are better indicators for dyslipidaemia in subclinical hypothyroidism and the development of atherosclerosis with potential complications such as cardiovascular and cerebrovascular diseases.
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Carlé A, Andersen SL, Boelaert K, Laurberg P. MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy. Eur J Endocrinol 2017; 176:R325-R337. [PMID: 28274949 DOI: 10.1530/eje-16-0276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 12/23/2016] [Accepted: 03/08/2017] [Indexed: 12/25/2022]
Abstract
Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven.
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Affiliation(s)
| | - Stine Linding Andersen
- Department of Endocrinology
- Department of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
| | - Kristien Boelaert
- Institute of Metabolism and Systems ResearchSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Laurberg
- Department of Endocrinology
- Department of Clinical MedicineAalborg University, Aalborg, Denmark
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Vargas-Uricoechea H, Bonelo-Perdomo A. Thyroid Dysfunction and Heart Failure: Mechanisms and Associations. Curr Heart Fail Rep 2017; 14:48-58. [DOI: 10.1007/s11897-017-0312-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Yoo WS, Chung HK. Recent Advances in Autoimmune Thyroid Diseases. Endocrinol Metab (Seoul) 2016; 31:379-385. [PMID: 27586448 PMCID: PMC5053048 DOI: 10.3803/enm.2016.31.3.379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 12/13/2022] Open
Abstract
Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs.
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Affiliation(s)
- Won Sang Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Kyung Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
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Rosario PWS, Mourão GF, Calsolari MR. Is Confirmed Elevation of the Serum TSH with Normal Concentrations of Circulating Thyroid Hormones Sufficient for the Diagnosis of Subclinical Hypothyroidism? Eur Thyroid J 2015; 4:273-4. [PMID: 26835433 PMCID: PMC4716410 DOI: 10.1159/000441416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pedro Weslley Souza Rosario
- *Pedro Weslley Rosário, Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia, Belo Horizonte, MG, 30150-240 (Brazil), E-Mail
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