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Hegazy W, Sakr HI, Abdul Hamid M, Abdelaziz MA, Salah M, Abdel Rehiem ES, Abdel Moneim A. Hesperidin Attenuates Hypothyroidism-Induced Lung Damage in Adult Albino Rats by Modulating Oxidative Stress, Nuclear Factor Kappa-B Pathway, Proliferating Cell Nuclear Antigen and Inflammatory Cytokines. Biomedicines 2023; 11:1570. [PMID: 37371665 DOI: 10.3390/biomedicines11061570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
The occurrence of worsening pulmonary function has been connected to hypothyroidism (HPO). Hesperidin (HES) was suggested to have antioxidant, anti-proliferative, and anti-inflammatory potential. Our study's objective was to determine whether HES could reduce carbimazole (CBZ)-induced lung injury more effectively than Eltroxin (ELT) in adult male albino rats or not. At random, 32 rats were distributed into four groups: Group I: normal control, to induce HPO, the remaining three groups were given CBZ (20 mg/kg/day) dissolved in distilled water for 1 week. They were then split up into three groups. Group II: orally administered CBZ (20 mg/kg b.w in water/day), Group III: HES (200 mg/kg/day) dissolved in 1% carboxymethyl-cellulose + CBZ treated, and Group IV: ELT (0.045 mg/kg/day) dissolved in distilled water + CBZ treated. All treatments were delivered for 12 weeks. Blood was collected to assess thyroid-stimulating hormone (TSH) and thyroid hormones (THs). Lung injury was evaluated based on the pulmonary content of interleukin (IL)-35, IL-6, and tumor necrosis factor-alpha (TNF-α), along with the estimation of lipid peroxidation, catalase, glutathione levels, superoxide dismutase, heme oxygenase-1 (HO-1), and nuclear factor erythroid 2-related factor 2 (Nrf2). The histological, ultrastructural, and immunohistochemical study of nuclear factor Kappa-B (NF-κB) and inducible nitric oxide synthase (iNOS), together with estimating the proliferation of cells using Antigen Ki-67 in lung tissue were performed. HES and ELT primarily suppressed variable lung damage mechanisms by suppressing TSH, the NF-κB/TNF-α pathway, iNOS, lipid peroxidation, Ki-67, and inflammatory mediators. On the other hand, they improved THs, antioxidant parameters, and the Nrf2/HO-1 pathway. HES and ELT exhibited an ameliorative effect that was reflected in the histopathological, immunohistochemical, and ultrastructural results. These results indicate that HES is a pneumoprotective agent that could be a promising treatment for oxidative stress, inflammation, and proliferation.
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Affiliation(s)
- Walaa Hegazy
- Histology Division, Basic Science Department, Faculty of Physical Therapy, Nahda University, Beni-Suef 62511, Egypt
| | - Hader I Sakr
- Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
- Department of Medical Physiology, Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
| | - Manal Abdul Hamid
- Cell Biology, Histology and Genetics Division, Zoology Department, Faculty of Science, Beni-Suef University, Salah Salem St., Beni-Suef 62511, Egypt
| | - Mohamed A Abdelaziz
- Basic Medical Sciences Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Medical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt
| | - Marwa Salah
- Cell Biology, Histology and Genetics Division, Zoology Department, Faculty of Science, Beni-Suef University, Salah Salem St., Beni-Suef 62511, Egypt
| | - Eman S Abdel Rehiem
- Molecular Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Salah Salem St., Beni-Suef 62511, Egypt
| | - Adel Abdel Moneim
- Molecular Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Salah Salem St., Beni-Suef 62511, Egypt
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Cao X, Lu M, Xie RR, Song LN, Yang WL, Xin Z, Yang GR, Yang JK. A high TSH level is associated with diabetic macular edema: a cross-sectional study of patients with type 2 diabetes mellitus. Endocr Connect 2022; 11:EC-22-0122. [PMID: 35686715 PMCID: PMC9254322 DOI: 10.1530/ec-22-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
AIMS In this study, we determined the association between thyroid-stimulating hormone (TSH) and diabetic macular edema (DME) by assessing the prevalence and risk factors for DME in type 2 diabetes mellitus (T2DM) patients with different thyroid dysfunctions. METHODS This was a retrospective cross-sectional study including 1003 euthyroid and 92 subclinical hypothyroidism (SCH) T2DM patients. DME status was detected by optical coherence tomography (OCT). The association between TSH and DME and the impact of TSH on DME were analyzed. RESULTS The DME prevalence was 28.3% in the SCH patients and 14.0% in the euthyroid population. The serum FT4 (P = 0.001) and FT3 (P < 0.001) levels were significantly higher in the non-DME group than in the DME group, and the TSH level (P < 0.001) was significantly lower. Four subgroups (G1-G4) were divided by TSH level, and the chi-square test indicated that even in the normal range, the TSH level was positively related to DME prevalence (P = 0.001). Subgroup data indicated that the association between TSH and DME detected by OCT (P = 0.001) was stronger than the correlation between TSH and diabetic retinopathy detected by digital retinal photographs (P = 0.027). The logistic regression model confirmed that elevated TSH was an independent risk factor for DME. The odds ratio was 1.53 (P = 0.02). CONCLUSIONS A high TSH level was an independent risk factor for DME. More attention should be given to the TSH level in T2DM patients due to its relationship with diabetic complications.
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Affiliation(s)
- Xi Cao
- Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming Lu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong-Rong Xie
- Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Li-Ni Song
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei-Li Yang
- Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J-K Yang:
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guang-Ran Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J-K Yang:
| | - Jin-Kui Yang
- Beijing Diabetes Institute, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to J-K Yang:
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Arora H, Collazo I, Palmerola KL, Parmar M, Narasimman M, Hendon N, Eisermann J, Bustillo M. Positive effects of thyroid replacement therapy on assisted reproductive technology outcomes in women with subclinical hypothyroidism with positive thyroid peroxidase autoantibodies. F S Rep 2021; 3:32-38. [PMID: 35386496 PMCID: PMC8978068 DOI: 10.1016/j.xfre.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Himanshu Arora
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
- Reprint requests: Himanshu Arora, Ph.D., Department of Urology, Miller School of Medicine, University of Miami, 1501 NW 10th Ave, Suite 809, Miami, Florida 33136.
| | - Ineabelle Collazo
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | | | - Madhumita Parmar
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Manish Narasimman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nicholas Hendon
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | - Juergen Eisermann
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
| | - Maria Bustillo
- IVFMD, South Florida Institute for Reproductive Medicine, Miami, Florida
- Maria Bustillo, M.D., IVFMD, South Florida Institute for Reproductive Medicine, 7300 SW 62nd Place, 4th Floor, Miami, Florida 33143.
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Cardano M, Rossero E. The making and unmaking of Hashimoto's thyroiditis: On the mismatch between illness and disease. Results from an Italian study. Health (London) 2021; 27:508-524. [PMID: 34715738 DOI: 10.1177/13634593211048370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diagnostic process in contemporary medical practice is increasingly technical, specialised and relying on population-based ranges of biological normalcy. Disease is defined according to a hierarchy of evidence that privileges specialist knowledge and marginalises subjective experiences of illness. Medical and individual definitions of the situation can conflict in two ways: (i) a diagnosis is made in the absence of symptoms, (ii) individual suffering does not constitute 'real' disease if it is not validated by scientific evidence. This article investigates how the discrepancy between specialist and embodied knowledge is experienced and tentatively solved by patients' self-narratives. Starting from the analysis of 22 in-depth interviews with people affected by autoimmune diseases, we focus on the subgroup affected by Hashimoto's thyroiditis. Applying the most-different-systems design, we confront two flesh-and-blood ideal-types of illness narratives characterised by a mismatch between illness and disease. Their diagnostic trajectories are outlined and discussed as poles of a continuum of experiences resulting from different configurations of medical evidence of disease and subjective evidence of illness.
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Blackaller GN, Chávez-Iñiguez JS, Carreón-Bautista EE, González-Torres FJ, Villareal-Contreras M, Barrientos Avalos JR, Aguilera PM, Rosales FR, José Antonio TM, Gómez Fregoso JA, Michel Gonzalez JI, García-García G. A Pilot Trial on the Effect of Levothyroxine on Proteinuria in Patients With Advanced CKD. Kidney Int Rep 2021; 6:110-119. [PMID: 33426390 PMCID: PMC7783574 DOI: 10.1016/j.ekir.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Thyroid hormones can directly affect kidney function; elevated levels of thyroid-stimulating hormone (TSH) and chronic kidney disease (CKD) are associated with proteinuria, decreased estimated glomerular filtration rate (eGFR), and progression to end-stage renal disease. Our hypothesis is that in patients with CKD and TSH at levels considered to be in the low subclinical hypothyroidism (SCH) range, lowering TSH with levothyroxine (LVX) improves the clinical parameters of renal function. METHODS This was a double-blind, randomized, pilot clinical trial in patients with proteinuric CKD (eGFR <60 ml/min per 1.73 m2 and proteinuria >150 mg/d) performed at the Hospital Civil de Guadalajara, with the intention of lowering TSH (levels of 1.25-2.5 μIU/l) in patients with TSH (levels of 2.6-9.9 μIU/ml with FT4 in the range of 0.7-1.8 ng/dl). Patients were randomized 1:1 to receive LVX or placebo for 12 weeks. The primary objective was to evaluate absolute levels of proteinuria at the beginning compared to the end of the study and, as a secondary objective, the changes in serum creatinine (sCr), eGFR, cholesterol, triglycerides, low-density lipoprotein (LDL), and blood pressure, and to assess the tolerability and safety of LVX. RESULTS Between March and November 2018, a total of 163 patients were assessed for eligibility; 119 patients did not meet the inclusion criteria or were excluded, and 32 patients were randomized. The demographic and clinical characteristics of the 2 study groups were essentially not different. Subjects were 66.87 (SD 12.19) years of age, 62.5% were female, 75% were diabetes mellitus, eGFR was 23.55 (±12.91) ml/min per 1.73 m2, TSH was 5.37 ± 2.13 μIU/ml, proteinuria in 24-hour urine collection was 1.52 ± 1.12, and all of them were taking angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). Proteinuria at 12 weeks in the LVX group was 0.89 SD ± 1.28 g/d, and in the placebo group it was 1.35 SD ± 0.85 g/d; when compared to placebo, LVX showed a significant decrease in proteinuria of 1.1 g/d (P = 0.0011). The eGFR in the LVX group showed an improvement of 4 ml/min/1.73 m2 (P = 0.049); in the placebo group, there was a decrease of 1.98 ml/min per 1.73 m2. The sCr, cholesterol, triglycerides, low-density lipoprotein, systolic blood pressure, and diastolic blood pressure were not different between groups. Adverse events were reported in the LVX group in 7.14% of patients and in 11.11% of patients in the placebo group; none left the study because of adverse effects, and there were no serious adverse events. CONCLUSION This single-center, randomized, double-blind, placebo-controlled pilot clinical trial in patients with advanced proteinuric CKD who already used ACEIs or ARBs demonstrated that administering LVX to obtain a TSH range close to 2.5 μIU/ml decreased proteinuria and improved eGFR. Future research is needed to confirm our results and to determine whether our findings generalize to patient groups not explicitly enrolled in this small pilot trial.
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Affiliation(s)
- Guillermo Navarro Blackaller
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Jonathan S. Chávez-Iñiguez
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | | | | | - Miroslava Villareal-Contreras
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - José Roberto Barrientos Avalos
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
- Service of Endocrinology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Pablo Maggiani Aguilera
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Francisco Romo Rosales
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Torres Mayorga José Antonio
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Juan Alberto Gómez Fregoso
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Jorge Isaac Michel Gonzalez
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
| | - Guillermo García-García
- Service of Nephrology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- University of Guadalajara, University Center of Health Sciences CUCS, Guadalajara, Jalisco, Mexico
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Alam MA, Quamri MA, Sofi G, Ansari S. Update of hypothyroidism and its management in Unani medicine. J Basic Clin Physiol Pharmacol 2020; 32:1-10. [PMID: 32776903 DOI: 10.1515/jbcpp-2020-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Hypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.
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Affiliation(s)
- Md Anzar Alam
- Department of Moalajat, National Institute of Unani Medicine, Bangalore, India
| | | | - Ghulamuddin Sofi
- Department of Ilmul Advia, National Institute of Unani Medicine, Bangalore, India
| | - Shabnam Ansari
- Department of Biotechnology, Natural Sciences, Jamia Millia Islamia, Central University, New Delhi, India
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Luna-Sánchez S, Del Campo MT, Morán JV, Fernández IM, Checa FJS, de la Hoz RE. Thyroid Function in Health Care Workers Exposed to Ionizing Radiation. HEALTH PHYSICS 2019; 117:403-407. [PMID: 30913057 DOI: 10.1097/hp.0000000000001071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To analyze possible alterations of thyroid function related to dosimetric values in health care workers exposed to ionizing radiation. MATERIALS AND METHODS Forty-six health care workers exposed to ionizing radiation at a tertiary hospital previously exposed to ionizing radiation were included in the study. Age, sex, history of thyroid diseases, thyroid hormones, work post, service, dosimetric values of previous year, and 5 y period were considered. Alterations of thyroid function and other variables were analyzed by exact logistic regression univariate model. RESULTS 7.1% workers showed an increased serum thyroid-stimulating hormone without free T3 or free T4 alteration. A significant relationship between workers with increased thyroid-stimulating hormone and dosimetric values of previous year (odds ratio 6.35, 95% confidence interval 1.20-98.1, p = 0.021) and previous 5 y period of radiation exposure (odds ratio 1.72, 95% confidence interval 1.12-3.34, p = 0.007) was obtained. CONCLUSION An increased risk of subclinical hypothyroidism related to radiation doses was observed in this pilot study on a group of health care workers exposed to ionizing radiation.
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Affiliation(s)
- Shirley Luna-Sánchez
- Occupational Health and Prevention Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - M T Del Campo
- Occupational Health and Prevention Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Julio Valverde Morán
- Radiological Protection Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Ignacio Mahillo Fernández
- Epidemiology and Biostatistics Unit, Research Institute of Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Fernando José Sancho Checa
- Occupational Health and Prevention Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Rafael E de la Hoz
- Occupational Medicine and Medicine Divisions, Icahn School of Medicine at Mount Sinai, NY
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Abstract
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world’s most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4–4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine. Funding: Merck. Plain Language Summary: Plain language summary available for this article. Hypothyroidism is one of the most common diseases worldwide, and levothyroxine is the usual medication prescribed to manage it. Hypothyroidism occurs when the thyroid gland, located in the neck, does not produce enough thyroid hormone for the body’s requirements. This can result in heart disease, infertility, and poor brain development in children. People with hypothyroidism may have changes in body weight, and feel tired, weak or unhappy, all of which can reduce their quality of life. In underdeveloped parts of the world, the main reason why people develop hypothyroidism is that they not getting enough iodine from food. Thus, many countries try to increase iodine intake by adding iodine to salt. In areas of the world where people ingest enough iodine, the most common cause of hypothyroidism is Hashimoto’s disease. This is an autoimmune disease in which the person’s immune system produces cells and antibodies that attack the thyroid gland. Most people with hypothyroidism will need to take levothyroxine for a long time, perhaps even for the rest of their lives. Levothyroxine replaces the person’s levels of thyroid hormone and makes them feel better, but the dose often needs to be adjusted for the best effect. In addition, many people with hypothyroidism do not know they have it. Research is ongoing to ensure that more people with hypothyroidism are diagnosed and are given effective treatment, and to work out the best way to use levothyroxine so that patients get the best results.
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Affiliation(s)
- Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | - Flavia Magri
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Leung AKC, Leung AAC. Evaluation and management of the child with hypothyroidism. World J Pediatr 2019; 15:124-134. [PMID: 30734891 DOI: 10.1007/s12519-019-00230-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout childhood. Prompt recognition and treatment of hypothyroidism is, therefore, of utmost importance to optimize physical and neurodevelopmental outcomes. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "hypothyroidism". RESULTS Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism, respectively. More than 95% of infants with congenital hypothyroidism have few, if any, clinical manifestations of hypothyroidism. Newborn screening programs allow early detection of congenital hypothyroidism. In developed countries, Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and adolescents. Globally, iodine deficiency associated with goiter is the most common cause of hypothyroidism. Central hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary hormones. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. CONCLUSIONS To optimize neurocognitive outcome in infants with congenital hypothyroidism, treatment with levothyroxine should be started as soon as possible, preferably within the first 2 weeks of life. Children with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive outcome. The target is to keep serum TSH < 5 mIU/L and to maintain serum free T4 or total T4 within the upper half of the age-specific reference range, with elimination of all symptoms and signs of hypothyroidism.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, #200, 233 - 16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
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