1
|
Larisch R, Midgley JEM, Dietrich JW, Hoermann R. Effect of Radioiodine Treatment on Quality of Life in Patients with Subclinical Hyperthyroidism: A Prospective Controlled Study. Nuklearmedizin 2024; 63:176-187. [PMID: 38262472 DOI: 10.1055/a-2240-8087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Radioiodine treatment (RIT) has a high success rate in both the treatment of hyperthyroidism and improving the quality of life (QoL) of symptomatic patients. In asymptomatic patients with subclinical hyperthyroidism thyroid related QoL outcomes are less well known. METHODS Study aim was to evaluate thyroid-related QoL in patients with subclinical hyperthyroidism mostly due to toxic nodular goitre undergoing RIT, compared to a control group of euthyroid subjects. Study design was monocentric, prospective, controlled. Fifty control subjects were enrolled and 51 RIT patients. Most subjects were examined at least twice at an interval of 6 months, with visits immediately before and 6 months after treatment in the RIT group. QoL was estimated with the ThyPRO questionnaire, using its composite scale as primary outcome. Treatment effect was the mean adjusted difference (MAD) between groups over time, using repeated? measures mixed? effects models. RESULTS TSH concentrations were lower in the RIT group prior to treatment and recovered thereafter slightly above the level of the control group. Correspondingly, QoL improved significantly after 6 months from a worse level in the RIT group, compared to controls (MAD -10.3 [95% CI -14.9, -5.7], p<0.001). QoL improvements were strong for general items, but less pronounced for the hyperthyroid domain. Compared to controls, thyroid volume, thyroid functional capacity (SPINA-GT) and deiodinase activity (SPINA-GD) were significantly reduced in the RIT group. CONCLUSION Patients with subclinical hyperthyroidism improve both biochemically and in their QoL after RIT, compared to controls. QoL assessment should have a wider role in clinical practice to complement biochemical tests and help with treatment decisions.
Collapse
Affiliation(s)
- Rolf Larisch
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - John E M Midgley
- North Lakes Clinical, Ilkley LS29 8PT, United Kingdom of Great Britain and Northern Ireland
| | - Johannes W Dietrich
- Medical Hospital I, Endocrinology and Diabetes Department, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Bochum, Germany
| | - Rudolf Hoermann
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| |
Collapse
|
2
|
Duntas LH. Focusing on the Critical Role of Age and Sex in the Diagnosis of Subclinical Hypothyroidism and Associated Levothyroxine Prescription. Thyroid 2023; 33:1011-1012. [PMID: 37470221 DOI: 10.1089/thy.2023.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Leonidas H Duntas
- Unit of Endocrinology, Diabetes, and Metabolism, Thyroid Section, Evgenideion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
3
|
Hoermann R, Pekker MJ, Midgley JEM, Dietrich JW. The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic-pituitary-thyroid axis. Ther Adv Endocrinol Metab 2023; 14:20420188231158163. [PMID: 36936128 PMCID: PMC10017955 DOI: 10.1177/20420188231158163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/18/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Thyroid hormones are controlled by the hypothalamic-pituitary-thyroid (HPT) axis through a complex network of regulatory loops, involving the hormones TRH, TSH, FT4, and FT3. The relationship between TSH and FT4 is widely used for diagnosing thyroid diseases. However, mechanisms of FT3 homeostasis are not well understood. OBJECTIVE We used mathematical modelling to further examine mechanisms that exist in the HPT axis regulation for protecting circulating FT3 levels. METHODS A mathematical model consisting of a system of four coupled first-order parameterized non-linear ordinary differential equations (ODEs) was developed, accounting for the interdependencies between the hormones in the HPT axis regulation. While TRH and TSH feed forward to the pituitary and thyroid, respectively, FT4 and FT3 feed backward to both the pituitary and hypothalamus. Stable equilibrium solutions of the ODE system express homeostasis for a particular variable, such as FT3, if this variable stays in a narrow range while certain other parameter(s) and system variable(s) may vary substantially. RESULTS The model predicts that (1) TSH-feedforward protects FT3 levels if the FT4 production rate declines and (2) combined negative feedback by FT4 and FT3 on both TSH and TRH production rates keeps FT3 levels insensitive to moderate changes in FT4 production rates and FT4 levels. The optimum FT4 and FT3 feedback and TRH and TSH-feedforward ranges that preserve FT3 homeostasis were found by numerical continuation analysis. Model predictions were in close agreement with clinical studies and individual patient examples of hypothyroidism and hyperthyroidism. CONCLUSIONS These findings further extend the concept of HPT axis regulation beyond TSH and FT4 to integrate the more active sister hormone FT3 and mechanisms of FT3 homeostasis. Disruption of homeostatic mechanisms leads to disease. This provides a perspective for novel testable concepts in clinical studies to therapeutically target the disruptive mechanisms.
Collapse
Affiliation(s)
| | - Mark J. Pekker
- Mathematical Sciences Department, University of Alabama, Huntsville, AL, USA
| | | | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr University Hospitals, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, Blankenstein Hospital, Hattingen, Germany
- Centre for Diabetes Technology (ZDT), Catholic Hospitals Bochum, Bochum, Germany
- Centre for Rare Endocrine Diseases (ZSEK), Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| |
Collapse
|
4
|
Hoermann R, Pekker MJ, Midgley JEM, Larisch R, Dietrich JW. Principles of Endocrine Regulation: Reconciling Tensions Between Robustness in Performance and Adaptation to Change. Front Endocrinol (Lausanne) 2022; 13:825107. [PMID: 35757421 PMCID: PMC9219553 DOI: 10.3389/fendo.2022.825107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
Endocrine regulation in the hypothalamic-pituitary-thyroid (HPT) axis is orchestrated by physiological circuits which integrate multiple internal and external influences. Essentially, it provides either of the two responses to overt biological challenges: to defend the homeostatic range of a target hormone or adapt it to changing environmental conditions. Under certain conditions, such flexibility may exceed the capability of a simple feedback control loop, rather requiring more intricate networks of communication between the system's components. A new minimal mathematical model, in the form of a parametrized nonlinear dynamical system, is here formulated as a proof-of-concept to elucidate the principles of the HPT axis regulation. In particular, it allows uncovering mechanisms for the homeostasis of the key biologically active hormone free triiodothyronine (FT3). One mechanism supports the preservation of FT3 homeostasis, whilst the other is responsible for the adaptation of the homeostatic state to a new level. Together these allow optimum resilience in stressful situations. Preservation of FT3 homeostasis, despite changes in FT4 and TSH levels, is found to be an achievable system goal by joining elements of top-down and bottom-up regulation in a cascade of targeted feedforward and feedback loops. Simultaneously, the model accounts for the combination of properties regarded as essential to endocrine regulation, namely sensitivity, the anticipation of an adverse event, robustness, and adaptation. The model therefore offers fundamental theoretical insights into the effective system control of the HPT axis.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Mark J. Pekker
- Mathematical Sciences Department, University of Alabama, Huntsville, AL, United States
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr-University of Bochum, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| |
Collapse
|
5
|
Li E, Yen PM, Dietrich JW, Leow MKS. Profiling retrospective thyroid function data in complete thyroidectomy patients to investigate the HPT axis set point (PREDICT-IT). J Endocrinol Invest 2021; 44:969-977. [PMID: 32808162 DOI: 10.1007/s40618-020-01390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The homeostatic euthyroid set point of the hypothalamus-pituitary-thyroid axis of any given individual is unique and oscillates narrowly within substantially broader normal population ranges of circulating free thyroxine (FT4) and thyroid-stimulating hormone (TSH), otherwise termed 'thyroid function test (TFT)'. We developed a mathematical algorithm codenamed Thyroid-SPOT that effectively reconstructs the personalized set point in open-loop situations and evaluated its performance in a retrospective patient sample. METHODS We computed the set points of 101 patients who underwent total thyroidectomy for non-functioning thyroid disease using Thyroid-SPOT on each patient's own serial post-thyroidectomy TFT. Every predicted set point was compared against its respective healthy pre-operative euthyroid TFT per individual and their separation (i.e. predicted-observed TFT) quantified. RESULTS Bland-Altman analysis to measure the agreement between each pair of an individual's predicted and actual set points revealed a mean difference in FT4 and TSH of + 3.03 pmol/L (95% CI 2.64, 3.43) and - 0.03 mIU/L (95% CI - 0.25, 0.19), respectively. These differences are small compared to the width of the reference intervals. Thyroid-SPOT can predict the euthyroid set point remarkably well, especially for TSH with a 10-16-fold spread in magnitude between population normal limits. CONCLUSION Every individual's equilibrium euthyroid set point is unique. Thyroid-SPOT serves as an accurate, precise and reliable targeting system for optimal personalized restoration of euthyroidism. This algorithm can guide clinicians in L-thyroxine dose titrations to resolve persistent dysthyroid symptoms among challenging cases harbouring "normal TFT" within the laboratory ranges but differing significantly from their actual euthyroid set points.
Collapse
Affiliation(s)
- E Li
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore.
| | - P M Yen
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - J W Dietrich
- Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - M K-S Leow
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore, Singapore
- Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital (TTSH), Singapore, Singapore
| |
Collapse
|
6
|
Hoermann R, Pekker MJ, Midgley JEM, Larisch R, Dietrich JW. Triiodothyronine secretion in early thyroid failure: The adaptive response of central feedforward control. Eur J Clin Invest 2020; 50:e13192. [PMID: 31815292 DOI: 10.1111/eci.13192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/06/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Defined by thyroid-pituitary feedback control, clinical diagnosis of hypothyroidism and hyperthyroidism has become synonymous with TSH measurement. We combined in silico analysis and in vivo data to explore the central influences on thyroidal T3 production. MATERIALS & METHODS A system of five coupled first-order nonlinear parameterised ordinary differential equations (ODEs) is used to model the feedback control of TSH and TRH by thyroid hormones together with the feedforward control of thyroidal T3 secretion and enzymatic T4-T3 conversion. Dependencies of the stable equilibrium solutions of this ODE system, that is the homeostasis of the underlying physiological process, on the system parameters were investigated whether they accounted for clinical observations. RESULTS During the modelled transition to hypothyroidism, central control imposed an increasing influence in maintaining serum FT3 levels, compared to peripheral conversion efficiency. Numerical continuation analysis revealed dependencies of T3 production on different elements of TSH feedforward control. While T4-T3 conversion provided the main T3 source in euthyroidism, this was overtaken by increasing glandular T3 secretion when thyroid reserve declined. The computational results were in good agreement with data from untreated patients with autoimmune thyroiditis. CONCLUSIONS Dependencies revealed in the expression of control differ in thyroid health and disease, using a physiologically based mathematical model of combined feedback-feedforward control of the hypothalamic-pituitary-thyroid regulation. Strong T3-protective mechanisms of the control system emerge with declining thyroid function, when glandular T3 secretion becomes increasingly influential over conversion efficiency. This has wide-ranging implications for the utility of TSH in clinical decision-making.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Mark J Pekker
- Mathematical Sciences Department, University of Alabama, Huntsville, AL, USA
| | | | - 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
| |
Collapse
|
7
|
Krysiak R, Kowalcze K, Wolnowska M, Okopień B. The impact of oral hormonal contraception on metformin action on hypothalamic‐pituitary‐thyroid axis activity in women with diabetes and prediabetes: A pilot study. J Clin Pharm Ther 2020; 45:937-945. [DOI: 10.1111/jcpt.13105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology Medical University of Silesia Katowice Poland
| | - Karolina Kowalcze
- Department of Paediatrics in Bytom School of Health Sciences in Katowice Medical University of Silesia Katowice Poland
| | - Monika Wolnowska
- Department of Pediatrics Municipal Integrated Hospital in Częstochowa Częstochowa Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology Medical University of Silesia Katowice Poland
| |
Collapse
|
8
|
Nie X, Shen Y, Ma X, Xu Y, Wang Y, Zhou J, Bao Y. Associations Between Thyroid Hormones and Glycated Albumin in Euthyroid and Subclinical Hypothyroid Individuals: Results of an Observational Study. Diabetes Metab Syndr Obes 2020; 13:915-923. [PMID: 32273743 PMCID: PMC7104252 DOI: 10.2147/dmso.s236698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Although overt thyroid dysfunction has been found to influence the level of glycated albumin (GA), the associations between thyroid hormones and GA in individuals with euthyroidism and subclinical hypothyroidism (SHypo) are still unknown. The present study aimed to investigate whether thyroid hormones were related to GA in euthyroid and SHypo individuals. METHODS We recruited 685 euthyroid and 103 SHypo subjects with normal weight from communities in Shanghai. Electrochemiluminescence immunoassay was used to detect the serum levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone. GA was detected by the enzymatic method. Glycated hemoglobin (HbA1c) was detected by high-performance liquid chromatography. RESULTS Among the 788 subjects (age range 31-81 years old), 307 were men and 481 were women. In the Spearman correlation analysis and multiple stepwise regression analysis, FT3 was negatively correlated with both GA and GA/HbA1c in euthyroid subjects (all P < 0.05). The values of GA and GA/HbA1c were reduced by approximately 0.30 and 0.05, respectively, for each 0.50 pmol/L increment in FT3. In SHypo subjects, FT4 was negatively associated with both GA and GA/HbA1c (all P < 0.05). The values of GA and GA/HbA1c were reduced by approximately 0.23 and 0.03, respectively, for each 1.00 pmol/L increment in FT4. CONCLUSION In euthyroid and SHypo subjects, more attention should be paid to the potential effects of individual differences in thyroid hormones on GA.
Collapse
Affiliation(s)
- Xiaomin Nie
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
- Correspondence: Xiaojing Ma; Yuqian Bao Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai200233, People’s Republic of ChinaTel +86-21-64369181Fax +86-21-64368031 Email ;
| | - Yiting Xu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai200233, People’s Republic of China
| |
Collapse
|
9
|
Krysiak R, Kowalcze K, Okopień B. The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency. Pharmacol Rep 2019; 71:798-803. [PMID: 31377561 DOI: 10.1016/j.pharep.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Autoimmune (Hashimoto's thyroiditis) is characterized by a strong female preponderance, which may suggest that sex hormones have an impact on thyroid autoimmunity. The aim of this study was to investigate whether testosterone determines vitamin D action on thyroid antibody titers and thyroid function tests in men with autoimmune thyroiditis and low testosterone levels. METHODS The study included 36 men with testosterone deficiency, 17 of whom had been treated for at least 26 weeks with oral testosterone undecanoate (120 mg daily). Because of coexistent euthyroid Hashimoto's thyroiditis, all participants were then treated with vitamin D (100 μg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, serum levels of thyrotropin, free thyroid hormones, testosterone and 25-hydroxyvitamin D, as well as Jostel's thyrotropin index, SPINA-GT and SPINA-GD were assessed before vitamin D treatment and 26 weeks later. RESULTS With the exception of testosterone levels, there were no significant differences between both study groups in serum hormone levels, antibody titers and thyroid function tests. All participants completed the study. In addition to increasing 25-hydroxyvitamin D levels, vitamin D increased SPINA-GT and reduced thyroid peroxidase and thyroglobulin antibody titers. In testosterone-treated men, vitamin D increased testosterone levels. Vitamin D did not affect serum levels of thyrotropin, free thyroid hormones, Jostel's thyrotropin index and SPINA-GD. Treatment-induced changes in thyroid antibody titers and SPINA-GT were more pronounced in testosterone-treated than testosterone-naïve men. CONCLUSIONS The obtained results suggest that the beneficial effect on thyroid autoimmunity and thyroid secretory function is stronger in men receiving testosterone therapy.
Collapse
Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
| | - Karolina Kowalcze
- Department of Paediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
10
|
Krysiak R, Kowalcze K, Okopień B. The effect of spironolactone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis. J Clin Pharm Ther 2019; 45:152-159. [PMID: 31520539 DOI: 10.1111/jcpt.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/27/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hashimoto's thyroiditis, also referred to as autoimmune thyroiditis, is characterized by sexual dimorphism, suggesting an important role of sex hormones in its development. No interventional study has investigated whether drugs exerting antiandrogen properties affect thyroid antibody titres and thyroid function tests in subjects with autoimmune thyroiditis. METHODS This study included 35 levothyroxine-naïve men with euthyroid Hashimoto's thyroiditis. At the physician's discretion, 18 men were then treated with spironolactone (50-200 mg daily), while the remaining patients (n = 17) received other diuretics. Serum levels of thyrotropin, free thyroid hormones, testosterone and 25-hydroxyvitamin D, as well as titres of thyroid peroxidase and thyroglobulin, were measured at the beginning of the study and 6 months later. Based on hormone levels, constant structure parameters of thyroid homeostasis were calculated. RESULTS AND DISCUSSION At baseline, there was no difference between the treatment arms in terms of thyroid antibody titres, hormone levels and the calculated parameters of thyroid homeostasis. Thirty-two patients completed the study. Spironolactone increased thyroid antibody titres, decreased testosterone and 25-hydroxyvitamin D levels and reduced SPINA-GT. The drug produced a neutral effect on serum levels of thyrotropin, free thyroid hormones, Jostel's thyrotropin index and SPINA-GD. The effect of spironolactone on antibody titres correlated with treatment-induced changes in SPINA-GT, testosterone and 25-hydroxyvitamin D. No significant changes in antibody titres, hormone levels and the calculated parameters of thyroid homeostasis were observed in spironolactone-naïve men. WHAT IS NEW AND CONCLUSION The obtained results indicate that spironolactone may exert an unfavourable effect on progression of autoimmune thyroiditis in men.
Collapse
Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalcze
- Department of Paediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
11
|
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Drugs Context 2019; 8:212597. [PMID: 31516533 PMCID: PMC6726361 DOI: 10.7573/dic.212597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
Levothyroxine (LT4) therapy has a long history, a well-defined pharmacological profile and a favourable safety record in the alleviation of hypothyroidism. However, questions remain in defining the threshold for the requirement of treatment in patients with subclinical hypothyroidism, assessing the dose adequacy of the drug, and selecting the best treatment mode (LT4 monotherapy versus liothyronine [LT3]/LT4 combinations) for subpopulations with persisting complaints. Supplied as a prodrug, LT4 is enzymatically converted into the biologically more active thyroid hormone, triiodothyronine (T3). Importantly, tetraiodothyronine (T4) to T3 conversion efficiency may be impaired in patients receiving LT4, resulting in a loss of thyroid-stimulating hormone (TSH)-mediated feed-forward control of T3, alteration of the interlocking equilibria between serum concentrations of TSH, free thyroxine (FT4), and free triiodothyonine (FT3), and a decrease in FT3 to FT4 ratios. This downgrades the value of the TSH reference system derived in thyroid health for guiding the replacement dose in the treatment situation. Individualised conditionally defined setpoints may therefore provide appropriate biochemical targets to be clinically tested, together with a stronger focus on clinical presentation and future endpoint markers of tissue thyroid state. This cautionary note encompasses the use of aggregated statistical data from clinical trials which are not safely applicable to the individual level of patient care under these circumstances.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 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, 44789 Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
| |
Collapse
|
12
|
Lei Y, Yang J, Li H, Zhong H, Wan Q. Changes in glucose-lipid metabolism, insulin resistance, and inflammatory factors in patients with autoimmune thyroid disease. J Clin Lab Anal 2019; 33:e22929. [PMID: 31350776 PMCID: PMC6757119 DOI: 10.1002/jcla.22929] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background Autoimmune thyroid disease (AITD) is a common organ‐specific autoimmune disorder, and genetic, environmental, and endogenous factors are responsible for initiation of thyroid autoimmunity. Some AITD patients suffer from a certain degree of glucose‐lipid metabolism disorder. This study aims to explore the changes in glucose‐lipid metabolism, insulin resistance, and inflammatory factors in patients with AITD. Methods A total of 91 patients with Hashimoto's thyroiditis were retrospectively analyzed and divided into hypothyroidism group (n = 42) and normal thyroid group (n = 49), while 50 healthy people were selected as control group. The changes in glucose‐lipid metabolism, insulin resistance, and inflammatory factors in each group were compared, and their correlations with the thyroid function were analyzed. Results The levels of serum interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), IL‐12, IL‐10, (FINS), and homeostasis model assessment of insulin resistance (HOMA‐IR) were gradually declined in sequence of hypothyroidism group, normal thyroid group, and control group (P < 0.05). In hypothyroidism group, the levels of serum‐free triiodothyronine (FT3), free thyroxine (FT4), (TC), triglyceride (TG), and low‐density lipoprotein cholesterol (LDL‐C) were significantly lower than those in normal thyroid group (P < 0.05), while the level of serum thyroid stimulating hormone (TSH) was significantly higher than that in normal thyroid group (P < 0.05). However, the fasting blood glucose and 2‐hour postprandial blood glucose levels had no statistically significant differences among the three groups (P > 0.05). Conclusion Autoimmune thyroid disease patients are prone to fat metabolism disorder, and the serum thyroid hormone level has a close correlation with blood lipid metabolism, insulin metabolism, and inflammatory factors.
Collapse
Affiliation(s)
- Yi Lei
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jun Yang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Hua Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Haihua Zhong
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qin Wan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| |
Collapse
|
13
|
Krysiak R, Kowalcze K, Okopień B. The effect of testosterone on thyroid autoimmunity in euthyroid men with Hashimoto's thyroiditis and low testosterone levels. J Clin Pharm Ther 2019; 44:742-749. [PMID: 31183891 DOI: 10.1111/jcpt.12987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 01/23/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Thyroid autoimmune diseases occur much more frequently in women than men. Unfortunately, no previous study has determined whether sex hormones produce any effect on thyroid antibody titres. The primary study aim was to assess whether exogenous testosterone affects thyroid autoimmunity in men with Hashimoto's thyroiditis and low testosterone levels. METHODS The study population consisted of 34 euthyroid men with autoimmune thyroiditis and testosterone deficiency. On the basis of patient preference, these patients were either treated with oral testosterone undecanoate (120 mg daily; n = 16) or remained untreated (n = 18). Circulating levels of thyrotropin, free thyroxine, free triiodothyronine, prolactin and total testosterone, as well as serum titres of thyroid peroxidase and thyroglobulin antibodies, were measured at the beginning of the study and 6 months later. The structure parameters of thyroid homeostasis (Jostel's thyrotropin index, SPINA-GT and SPINA-GD) were also calculated. Moreover, semen analyses were performed in eight patients in each group. RESULTS AND DISCUSSION In testosterone-naïve men, serum hormone levels and antibody titres remained at the similar levels throughout the study. Apart from increasing serum testosterone levels, testosterone undecanoate reduced titres of thyroid peroxidase and thyroglobulin antibodies and increased SPINA-GT. The drug produced a neutral effect on circulating levels of thyrotropin, free thyroid hormones, prolactin and testosterone, Jostel's thyrotropin index, SPINA-GD and semen parameters. Testosterone-induced changes in antibody titres correlated with the effect of treatment on SPINA-GT and with serum testosterone levels. WHAT IS NEW AND CONCLUSION This study is the first one to have shown that exogenous testosterone may have a protective effect on thyroid autoimmunity in men with Hashimoto's thyroiditis and testosterone deficiency.
Collapse
Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalcze
- Department of Paediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
14
|
Krysiak R, Kowalcze K, Okopień B. The Effect of Selenomethionine on Thyroid Autoimmunity in Euthyroid Men With Hashimoto Thyroiditis and Testosterone Deficiency. J Clin Pharmacol 2019; 59:1477-1484. [DOI: 10.1002/jcph.1447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical PharmacologyMedical University of Silesia Katowice Poland
| | - Karolina Kowalcze
- Department of Paediatrics in BytomSchool of Health Sciences in KatowiceMedical University of Silesia Katowice Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical PharmacologyMedical University of Silesia Katowice Poland
| |
Collapse
|
15
|
Midgley JEM, Toft AD, Larisch R, Dietrich JW, Hoermann R. Time for a reassessment of the treatment of hypothyroidism. BMC Endocr Disord 2019; 19:37. [PMID: 30999905 PMCID: PMC6471951 DOI: 10.1186/s12902-019-0365-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the treatment for hypothyroidism, a historically symptom-orientated approach has given way to reliance on a single biochemical parameter, thyroid stimulating hormone (TSH). MAIN BODY The historical developments and motivation leading to that decision and its potential implications are explored from pathophysiological, clinical and statistical viewpoints. An increasing frequency of hypothyroid-like complaints is noted in patients in the wake of this directional shift, together with relaxation of treatment targets. Recent prospective and retrospective studies suggested a changing pattern in patient complaints associated with recent guideline-led low-dose policies. A resulting dramatic rise has ensued in patients, expressing in various ways dissatisfaction with the standard treatment. Contributing factors may include raised problem awareness, overlap of thyroid-related complaints with numerous non-specific symptoms, and apparent deficiencies in the diagnostic process itself. Assuming that maintaining TSH anywhere within its broad reference limits may achieve a satisfactory outcome is challenged. The interrelationship between TSH, free thyroxine (FT4) and free triiodothyronine (FT3) is patient specific and highly individual. Population-based statistical analysis is therefore subject to amalgamation problems (Simpson's paradox, collider stratification bias). This invalidates group-averaged and range-bound approaches, rather demanding a subject-related statistical approach. Randomised clinical trial (RCT) outcomes may be equally distorted by intra-class clustering. Analytical distinction between an averaged versus typical outcome becomes clinically relevant, because doctors and patients are more interested in the latter. It follows that population-based diagnostic cut-offs for TSH may not be an appropriate treatment target. Studies relating TSH and thyroid hormone concentrations to adverse effects such as osteoporosis and atrial fibrillation invite similar caveats, as measuring TSH within the euthyroid range cannot substitute for FT4 and FT3 concentrations in the risk assessment. Direct markers of thyroid tissue effects and thyroid-specific quality of life instruments are required, but need methodological improvement. CONCLUSION It appears that we are witnessing a consequential historic shift in the treatment of thyroid disease, driven by over-reliance on a single laboratory parameter TSH. The focus on biochemistry rather than patient symptom relief should be re-assessed. A joint consideration together with a more personalized approach may be required to address the recent surge in patient complaint rates.
Collapse
Affiliation(s)
| | | | - 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
| | | |
Collapse
|
16
|
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Functional and Symptomatic Individuality in the Response to Levothyroxine Treatment. Front Endocrinol (Lausanne) 2019; 10:664. [PMID: 31616383 PMCID: PMC6775211 DOI: 10.3389/fendo.2019.00664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background: For significant numbers of patients dissatisfied on standard levothyroxine (LT4) treatment for hypothyroidism, patient-specific responses to T4 could play a significant role. Aim: To assess response heterogeneity to LT4 treatment, identifying confounders and hidden clusters within a patient panel, we performed a secondary analysis using data from a prospective cross-sectional and retrospective longitudinal study. Methods: Multivariate and multivariable linear models adjusted for covariates (gender, age, and BMI) were stratified by disease-specific treatment indication. During follow-up, pooled observations were compared from the same patient presenting either with or without self-reported symptoms. Statistical analysis was extended to multilevel models to derive intra-class correlation coefficients and reliability measures during follow-up. Results: Equilibria between TSH, FT4, and FT3 serum concentrations in 342 patients were examined by treatment indication (benign goiter, autoimmune thyroiditis, thyroid carcinoma), consequently displaying complex interactive response patterns. Seventy-seven patients treated with LT4 and monitored for thyroid carcinoma presented, in association with changes in LT4 dose, either with hypothyroid symptoms or symptom-free. Significant biochemical differences appeared between the different presentations. Leveled trajectories by subject to relief from hypothyroid symptoms differed significantly, indicating distinct responses, and denying a single shared outcome. These were formally defined by a high coefficient of the intraclass correlation (ICC1, exceeding 0.60 in all thyroid parameters) during follow-up on multiple visits at the same LT4 dose, when lacking symptoms. The intra-personal clusters were clearly differentiated from random variability by random group resampling. Symptomatic change in these patients was strongly associated with serum FT3, but not with FT4 or TSH concentrations. In 25 patients transitioning from asymptomatic to symptomatically hyperthyroid, FT3 concentrations remained within the reference limits, whilst at the same time marked biochemical differences were apparent between the presentations. Conclusions: Considerable intra-individual clustering occurred in the biochemical and symptomatic responses to LT4 treatment, implying statistically multileveled response groups. Unmasking individual differences in the averaged treatment response hereby highlights clinically distinguishable subgroups within an indiscriminate patient panel. This, through well-designed larger clinical trials will better target the different therapeutic needs of individual patients.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
- *Correspondence: Rudolf Hoermann
| | | | - 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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Dietrich JW, Midgley JEM, Hoermann R. Editorial: "Homeostasis and Allostasis of Thyroid Function". Front Endocrinol (Lausanne) 2018; 9:287. [PMID: 29922229 PMCID: PMC5996081 DOI: 10.3389/fendo.2018.00287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Johannes W. Dietrich
- Medical Department 1, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, North Rhine-Westphalia, Germany
- Ruhr Centre of Rare Diseases (CeSER), Ruhr University of Bochum, Bochum, North Rhine-Westphalia, Germany
- Ruhr Centre of Rare Diseases (CeSER), Witten/Herdecke University, Bochum, North Rhine-Westphalia, Germany
- *Correspondence: Johannes W. Dietrich,
| | | | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| |
Collapse
|
19
|
Hoermann R, Midgley JEM, Larisch R, Dietrich JWC. Advances in applied homeostatic modelling of the relationship between thyrotropin and free thyroxine. PLoS One 2017; 12:e0187232. [PMID: 29155897 PMCID: PMC5695809 DOI: 10.1371/journal.pone.0187232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The relationship between pituitary TSH and thyroid hormones is central to our understanding of thyroid physiology and thyroid function testing. Here, we generated distribution patterns by using validated tools of thyroid modelling. METHODS We simulated patterns of individual set points under various conditions, based on a homeostatic model of thyroid feedback control. These were compared with observed data points derived from clinical trials. RESULTS A random mix of individual set points was reconstructed by simulative modelling with defined structural parameters. The pattern displayed by the cluster of hypothetical points resembled that observed in a natural control group. Moderate variation of the TSH-FT4 gradient over the functional range introduced further flexibility, implementing a scenario of adaptive set points. Such a scenario may be a realistic possibility for instance in treatment where relationships and equilibria between thyroid parameters are altered by various influences such as LT4 dose and conversion efficiency. CONCLUSIONS We validated a physiologically based homeostatic model that permits simulative reconstruction of individual set points. This produced a pattern resembling the observed data under various conditions. Applied modelling, although still experimental at this stage, shows a potential to aid our physiological understanding of the interplay between TSH and thyroid hormones. It should eventually benefit personalised clinical decision making.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr, Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr, Lüdenscheid, Germany
| | - Johannes Wolfgang Christian 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, Alexandrinenstr. 5, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Witten/Herdecke University, Alexandrinenstr. 5, Bochum, Germany
| |
Collapse
|
20
|
Yu D, Zhou H, Zou L, Jiang Y, Wu X, Jiang L, Zhou Q, Yang Y, Xu L, Mao R. Hippocampal Administration of Levothyroxine Impairs Contextual Fear Memory Consolidation in Rats. Front Cell Neurosci 2017; 11:223. [PMID: 28824379 PMCID: PMC5534464 DOI: 10.3389/fncel.2017.00223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/13/2017] [Indexed: 12/17/2022] Open
Abstract
Thyroid hormone (TH) receptors are highly distributed in the hippocampus, which plays a vital role in memory processes. However, how THs are involved in the different stages of memory process is little known. Herein, we used hippocampus dependent contextual fear conditioning to address the effects of hippocampal THs on the different stages of fear memory. First, we found that a single systemic levothyroxine (LT4) administration increased the level of free triiodothyronine (FT3) and free tetraiodothyroxine (FT4) not only in serum but also in hippocampus. In addition, a single systemic LT4 administration immediately after fear conditioning significantly impaired fear memory. These results indicated the important role of hippocampal THs in fear memory process. To further confirm the effects of hippocampal THs on the different stages of fear memory, LT4 (0.4 μg/μl, 1 μl/side) was injected bilaterally into hippocampus. Rats given LT4 into hippocampus before training or tests had no effect on the acquisition or retrieval of fear memory, however rats given LT4 into hippocampus either immediately or 2 h after training showed being significantly impaired fear memory, which demonstrated LT4 administration into hippocampus impairs the consolidation but has no effect on the acquisition and retrieval of fear memory. Furthermore, hippocampal injection of LT4 did not affect rats’ locomotor activity, thigmotaxis and THs level in prefrontal cortex (PFC) and serum. These findings may have important implications for understanding mechanisms underlying contribution of THs to memory disorders.
Collapse
Affiliation(s)
- Dafu Yu
- Department of Nuclear Medicine, First People's Hospital of Yunnan ProvinceKunming, China.,Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China
| | - Heng Zhou
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China.,School of Life Sciences, University of Science and Technology of ChinaHefei, China
| | - Lin Zou
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yong Jiang
- Department of Nuclear Medicine, First People's Hospital of Yunnan ProvinceKunming, China
| | - Xiaoqun Wu
- Respiratory Department, First People's Hospital of Yunnan ProvinceKunming, China
| | - Lizhu Jiang
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China.,Department of Neuropsychopathy, Clinical Medical School, Dali UniversityDali, China
| | - Qixin Zhou
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China
| | - Yuexiong Yang
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China
| | - Lin Xu
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China
| | - Rongrong Mao
- Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of SciencesKunming, China
| |
Collapse
|
21
|
Park SY, Park SE, Jung SW, Jin HS, Park IB, Ahn SV, Lee S. Free triiodothyronine/free thyroxine ratio rather than thyrotropin is more associated with metabolic parameters in healthy euthyroid adult subjects. Clin Endocrinol (Oxf) 2017; 87:87-96. [PMID: 28374508 DOI: 10.1111/cen.13345] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The interrelation between TSH, thyroid hormones and metabolic parameters is complex and has not been confirmed. This study aimed to determine the association of TSH and thyroid hormones in euthyroid subjects and the relationship between thyroid function and metabolic risk factors. Furthermore, this study examined whether thyroid function has predictive power for metabolic syndrome. DESIGN This is a cross-sectional study that included subjects in a medical health check-up programme at a single institution. PATIENTS The study included 132 346 participants (66 991 men and 65 355 women) aged over 18 years who had TSH, free T4 (FT4) and free T3 (FT3) levels within the institutional reference ranges. MEASUREMENTS Thyrotropin, FT4, FT3 and metabolic parameters including height, weight, waist circumference, blood pressure, serum levels of total cholesterol, triglyceride, high-density lipoprotein cholesterol, insulin and glucose were measured. RESULTS There was a positive association between FT3/FT4 ratio and TSH in both men and women after adjusting for age, body mass index, smoking status and menopausal status (in women). The FT3/FT4 ratio and TSH were positively associated with risk of metabolic syndrome parameters including insulin resistance. The FT3/FT4 ratio had a greater predictive power than TSH for metabolic syndrome in both men and women. CONCLUSIONS Thyrotropin levels were positively associated with FT3/FT4 ratio within the euthyroid range. The higher FT3/FT4 ratio is associated with increased risk of metabolic syndrome parameters and insulin resistance. FT3/FT4 ratio has a better predictive power for metabolic syndrome than TSH.
Collapse
Affiliation(s)
- So Young Park
- Department of Internal Medicine, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Jung
- Department of Internal Medicine and Laboratory of Genomics and Translational Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Hyun Seok Jin
- Department of Biomedical Laboratory Science, College of Life and Health Sciences, Hoseo University, Asan, Korea
| | - Ie Byung Park
- Department of Internal Medicine and Laboratory of Genomics and Translational Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Song Vogue Ahn
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sihoon Lee
- Department of Internal Medicine and Laboratory of Genomics and Translational Medicine, Gachon University School of Medicine, Incheon, Korea
| |
Collapse
|
22
|
Hoermann R, Midgley JEM, Dietrich JW, Larisch R. Dual control of pituitary thyroid stimulating hormone secretion by thyroxine and triiodothyronine in athyreotic patients. Ther Adv Endocrinol Metab 2017; 8:83-95. [PMID: 28794850 PMCID: PMC5524252 DOI: 10.1177/2042018817716401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/29/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patient responses to levothyroxine (LT4) monotherapy vary considerably. We sought to differentiate contributions of FT4 and FT3 in controlling pituitary thyroid stimulating hormone (TSH) secretion. METHODS We retrospectively assessed the relationships between TSH and thyroid hormones in 319 patients with thyroid carcinoma through 2914 visits on various LT4 doses during follow-up for 5.5 years (median, IQR 4.2, 6.9). We also associated patient complaints with the relationships. RESULTS Under varying dose requirements (median 1.84 µg/kg, IQR 1.62, 2.11), patients reached TSH targets below 0.4, 0.1 or 0.01 mIU/l at 73%, 54% and 27% of visits. While intercept, slope and fit of linearity of the relationships between lnTSH and FT4/FT3 varied between individuals, gender, age, LT4 dose and deiodinase activity influenced the relationships in the cohort (all p < 0.001). Deiodinase activity impaired by LT4 dose significantly affected the lnTSH-FT4 relationship. Dose increase and reduced conversion efficiency displaced FT3-TSH equilibria. In LT4-treated patients, FT4 and FT3 contributed on average 52% versus 38%, and by interaction 10% towards TSH suppression. Symptomatic presentations (11%) accompanied reduced FT3 concentrations (-0.23 pmol/l, p = 0.001) adjusted for gender, age and BMI, their relationships being shifted towards higher TSH values at comparable FT3/FT4 levels. CONCLUSIONS Variation in deiodinase activity and resulting FT3 levels shape the TSH-FT4 relationship in LT4-treated athyreotic patients, suggesting cascade control of pituitary TSH production by the two hormones. Consequently, measurement of FT3 and calculation of conversion efficiency may identify patients with impaired biochemistry and a resulting lack of symptomatic control.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department of Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshoeher Str 14, D-58515 Luedenscheid, 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
| | - Rolf Larisch
- Department of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| |
Collapse
|
23
|
Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, Abood A, Klein HH, Dietrich JW. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne) 2017; 8:163. [PMID: 28775711 PMCID: PMC5517413 DOI: 10.3389/fendo.2017.00163] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
The hypothalamus-pituitary-thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. The non-thyroidal illness syndrome (NTIS) or thyroid allostasis in critical illness, tumors, uremia, and starvation (TACITUS), commonly observed in hospitalized patients, displays a historically well-studied pattern of allostatic thyroid response. This is characterized by decreased total and free thyroid hormone concentrations and varying levels of thyroid-stimulating hormone (TSH) ranging from decreased (in severe cases) to normal or even elevated (mainly in the recovery phase) TSH concentrations. An acute versus chronic stage (wasting syndrome) of TACITUS can be discerned. The two types differ in molecular mechanisms and prognosis. The acute adaptation of thyroid hormone metabolism to critical illness may prove beneficial to the organism, whereas the far more complex molecular alterations associated with chronic illness frequently lead to allostatic overload. The latter is associated with poor outcome, independently of the underlying disease. Adaptive responses of thyroid homeostasis extend to alterations in thyroid hormone concentrations during fetal life, periods of weight gain or loss, thermoregulation, physical exercise, and psychiatric diseases. The various forms of thyroid allostasis pose serious problems in differential diagnosis of thyroid disease. This review article provides an overview of physiological mechanisms as well as major diagnostic and therapeutic implications of thyroid allostasis under a variety of developmental and straining conditions.
Collapse
Affiliation(s)
- Apostolos Chatzitomaris
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- *Correspondence: Apostolos Chatzitomaris,
| | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| | | | - Steffen Hering
- Department for Internal Medicine, Cardiology, Endocrinology, Diabetes and Medical Intensive Care Medicine, Krankenhaus Bietigheim-Vaihingen, Bietigheim-Bissingen, Germany
| | - Aline Urban
- Department for Anesthesiology, Intensive Care and Palliative Medicine, Eastern Allgäu-Kaufbeuren Hospitals, Kaufbeuren, Germany
| | | | - Assjana Abood
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Harald H. Klein
- 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
| | - 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
| |
Collapse
|
24
|
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Recent Advances in Thyroid Hormone Regulation: Toward a New Paradigm for Optimal Diagnosis and Treatment. Front Endocrinol (Lausanne) 2017; 8:364. [PMID: 29375474 PMCID: PMC5763098 DOI: 10.3389/fendo.2017.00364] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022] Open
Abstract
In thyroid health, the pituitary hormone thyroid-stimulating hormone (TSH) raises glandular thyroid hormone production to a physiological level and enhances formation and conversion of T4 to the biologically more active T3. Overstimulation is limited by negative feedback control. In equilibrium defining the euthyroid state, the relationship between TSH and FT4 expresses clusters of genetically determined, interlocked TSH-FT4 pairs, which invalidates their statistical correlation within the euthyroid range. Appropriate reactions to internal or external challenges are defined by unique solutions and homeostatic equilibria. Permissible variations in an individual are much more closely constrained than over a population. Current diagnostic definitions of subclinical thyroid dysfunction are laboratory based, and do not concur with treatment recommendations. An appropriate TSH level is a homeostatic concept that cannot be reduced to a fixed range consideration. The control mode may shift from feedback to tracking where TSH becomes positively, rather than inversely related with FT4. This is obvious in pituitary disease and severe non-thyroid illness, but extends to other prevalent conditions including aging, obesity, and levothyroxine (LT4) treatment. Treatment targets must both be individualized and respect altered equilibria on LT4. To avoid amalgamation bias, clinically meaningful stratification is required in epidemiological studies. In conclusion, pituitary TSH cannot be readily interpreted as a sensitive mirror image of thyroid function because the negative TSH-FT4 correlation is frequently broken, even inverted, by common conditions. The interrelationships between TSH and thyroid hormones and the interlocking elements of the control system are individual, dynamic, and adaptive. This demands a paradigm shift of its diagnostic use.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
- *Correspondence: Rudolf Hoermann,
| | | | - 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, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Witten/Herdecke University, Bochum, Germany
| |
Collapse
|
25
|
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Relational Stability in the Expression of Normality, Variation, and Control of Thyroid Function. Front Endocrinol (Lausanne) 2016; 7:142. [PMID: 27872610 PMCID: PMC5098235 DOI: 10.3389/fendo.2016.00142] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/21/2016] [Indexed: 12/31/2022] Open
Abstract
Thyroid hormone concentrations only become sufficient to maintain a euthyroid state through appropriate stimulation by pituitary thyroid-stimulating hormone (TSH). In such a dynamic system under constant high pressure, guarding against overstimulation becomes vital. Therefore, several defensive mechanisms protect against accidental overstimulation, such as plasma protein binding, conversion of T4 into the more active T3, active transmembrane transport, counter-regulatory activities of reverse T3 and thyronamines, and negative hypothalamic-pituitary-thyroid feedback control of TSH. TSH has gained a dominant but misguided role in interpreting thyroid function testing in assuming that its exceptional sensitivity thereby translates into superior diagnostic performance. However, TSH-dependent thyroid disease classification is heavily influenced by statistical analytic techniques such as uni- or multivariate-defined normality. This demands a separation of its conjoint roles as a sensitive screening test and accurate diagnostic tool. Homeostatic equilibria (set points) in healthy subjects are less variable and do not follow a pattern of random variation, rather indicating signs of early and progressive homeostatic control across the euthyroid range. In the event of imminent thyroid failure with a reduced FT4 output per unit TSH, conversion efficiency increases in order to maintain FT3 stability. In such situations, T3 stability takes priority over set point maintenance. This suggests a concept of relational stability. These findings have important implications for both TSH reference limits and treatment targets for patients on levothyroxine. The use of archival markers is proposed to facilitate the homeostatic interpretation of all parameters.
Collapse
Affiliation(s)
- Rudolf Hoermann
- Department of Nuclear Medicine, Klinikum Luedenscheid, Luedenscheid, Germany
| | | | - Rolf Larisch
- Department of Nuclear Medicine, Klinikum Luedenscheid, Luedenscheid, 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, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Witten/Herdecke University, Bochum, Germany
| |
Collapse
|