Thyroid disease awareness is associated with high rates of identifying subjects with previously undiagnosed thyroid dysfunction

Knowledge of Thyroid Disease Manifestation and Risk Factors Among the General Population in the Tabuk Region of Saudi Arabia

Background Thyroid disorders are caused either by excessive or inadequate thyroid hormone production or by the enlargement of the thyroid gland. Various types of thyroid disorders exist, including primary (related directly to the gland itself), secondary (related to thyroid function), and other types. This study aimed to assess the knowledge of thyroid disease manifestation and its risk factors among individuals living in Tabuk, Saudi Arabia. Methodology An observational cross-sectional study was conducted among 400 adults living in Tabuk city of Saudi Arabia aged 18 years or above. Data was collected using an electronic questionnaire through a simple random sampling method. Data was then coded, entered, and analyzed using both descriptive and inferential statistical methods using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results A total of 403 participants were enrolled in this study. More than half (n=265, 65.8%) were females, and 188 (46.7%) were in the age group of 18-35 years. The educational level of the majority of them was a bachelor's degree (n=296, 73.4%). Hypothyroidism was the most common thyroid disorder among family members (n=51, 62.4%). Inadequate iodine intake was thought to be a risk factor for thyroid disorders, as mentioned by 276 (68.5%) participants. Exact 284 (70.5%) participants believed that females are more at risk of having thyroid disease. The mean total knowledge score was found to be 25.1±4.48 out of a total of 34. Exact 216 (53.6%) participants had good knowledge about thyroid disorders. The female gender had significantly higher levels of knowledge as compared to males (p-value=0.002) regarding the manifestation and risk factors of thyroid disorders. In terms of educational level, a bachelor's or above was found to be significantly associated with a higher level of knowledge (p-value=0.003). Conclusion A good level of knowledge and awareness about thyroid disorders was observed among more than half of the participants. Few knowledge gaps were identified regarding knowledge about symptoms of hypothyroidism and certain medications which might cause thyroid disorders.

Prevalence and risk factors of untreated thyroid dysfunctions in the older Caucasian adults: Results of PolSenior 2 survey

Introduction

To determine the prevalence of treated and untreated thyroid dysfunction and to identify factors associated with increased risk of undiagnosed thyroid dysfunction in older adults.

Methods

The population of 5987 community-dwelling Polish Caucasian seniors aged 60 years and above who participated in the PolSenior 2 study (2018–2019). Population-based cross-sectional multidisciplinary study in design. Data from structured questionnaires, geriatric tests, and scales were obtained from all study participants who underwent anthropometric and blood pressure measurements during three home visits. Assessment of thyroid function was based on TSH serum measurements.

Results

The prevalence of thyroid dysfunction in the Polish population aged 60 years or above was estimated at 15.5% (21.5% in women and 7.2% in men), with 3.2% of undiagnosed individuals among them. The prevalence of hypothyroidism and hyperthyroidism in the studied group was 13.9% (19.4% in women and 6.3% in men) and 1.6% (2.1% in women and 0.9% in men) respectively, untreated hypothyroidism was revealed in 21.9% (in 160 out of 732 subjects) and untreated hyperthyroidism in 34.2% of subjects (in 41 out of 120 participants). In multiple regression analysis independent risk factors for thyroid disorders being untreated were older age (> 75 years), male sex, a low education level (primary or lower), and low utilization of medical services.

Conclusions

One-fifth of Polish Caucasian seniors with hypothyroidism and one-third with hyperthyroidism are untreated. Older, poorly educated and rarely utilizing medical services seniors, especially men, are more frequently untreated for thyroid dysfunction and some of them do not benefit from contemporary achievements in medicine.

Knowledge of Thyroid Disease Manifestations and Risk Factors Among Residents of the Eastern Province, Saudi Arabia

BACKGROUND

Thyroid disorders are worldwide common endocrine disorders. These disorders are frequently under-diagnosed. In general, lack of knowledge and understanding of thyroid disorder effects can lead patients to go undiagnosed. This study aims to figure out the level of the general knowledge about thyroid disease manifestations, risk factors, and preventive behaviors among the general population.  Method: This cross-sectional study was conducted among 882 participants in the Eastern province of Saudi Arabia from July 2020 to October 2020, and were selected randomly. The representative sample included Saudi and non-Saudi males and females of different age groups (18-60 years).

RESULT

The overall mean knowledge score was 8.67 (SD 3.69) with 44.7%, 41.2%, and 14.2% were classified into low, average, and high knowledge, respectively. In the comparison of mean knowledge score among the socio-demographic profiles and previous history of thyroid disease, the current study shows that being a female, living in Al Ahsa, being a student, those with a previous history of thyroid disease, family history of the disease, and those who underwent thyroid gland examination were significantly more associated with having better knowledge toward thyroid diseases.

CONCLUSION

Nearly, half of the studied sample has low awareness scores regarding thyroid disease manifestations and its risk factors. The health authorities should hold more successful health education methods to improve the public and their caregivers' awareness of the various aspects of thyroid disorders and the value of their early detection and adequate control.

Hypothyroid Symptoms in Levothyroxine-Treated Patients

Purpose

Approximately 15% of patients with hypothyroidism are dissatisfied with their treatment due to persistence of residual symptoms associated with hypothyroidism. The purpose of this study was to compare thyroid symptoms using the hypothyroid symptom scale (HSS) in patients receiving stable thyroid therapy for 6 months to patients without hypothyroidism. The HSS was used to identify the percentage of levothyroxine-treated hypothyroid patients with residual or persistent hypothyroid symptoms.

Methods

Patients included in the study had hypothyroidism and were receiving a stable/maintenance dose of levothyroxine sodium therapy, unchanged for at least 6 months. A control group of patients were included if they did not have an active prescription for thyroid hormone therapy. The HSS was administered via phone or face-to-face interactions. Patients were asked to score 10 symptoms over the past month on a scale of 0 to 4 (e.g., 0, absence of, to 4, severe symptoms). Results were analyzed using descriptive and inferential statistics. T-tests and chi-squared analysis were used to assess differences in continuous and categorical variables.

Results

A total of 68% of the contacted patients responded to the survey. A total of 302 patients were in the intervention group and 273 were in the control group. The mean total HSS scores between groups were significantly higher in the treatment compared to the control group (13.92 ± 10.91 vs.10.07 ± 7.85; P < 0.001).

Conclusion

Significantly more patients receiving thyroid hormone therapy experienced residual thyroid symptoms compared to control patients. Attempts should be made to offer alternatives for hypothyroid patients with persistent symptoms.

Hypothyroidism in Context: Where We've Been and Where We're Going

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.

Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen

Background: Increased public attention toward health and quality-of-life issues has led to more intensified screening for various medical conditions, including hypothyroidism. A falling serum thyrotropin (s-TSH) at initiation of levothyroxine (LT4) treatment has been reported in the United Kingdom between 2001 and 2009, indicating a falling TSH threshold, which may lead to less benefit from therapy and possibly overtreatment. The aim of this study was to investigate changes in s-TSH threshold used by general practitioners to initiate LT4 therapy between 2001 and 2015 in Copenhagen. Methods: Retrospective analysis was conducted of all s-TSH measurements between 2001 and 2015 performed at the general practitioners' joint laboratory merged with The Danish Register of Medicinal Products Statistics and The Danish National Patient Registry. For each year, both the median s-TSH at therapy initiation and the estimated treatment threshold were calculated from all s-TSH measurements performed in that year, representing the s-TSH level where the estimated probability of starting LT4 therapy was 50%. Results: A total of 929,684 individuals with 2,975,277 s-TSH measurements were included in the calculations. The size and composition of the study population remained virtually unchanged. During the study period, the number of performed s-TSH measurements increased from 110,886 to 292,911 (164%), and the number of patients initiating LT4 therapy increased from 786 to 1825 (132%), though this was comparably unchanged from 2010 to 2015. The median s-TSH at therapy initiation decreased from 10 mIU/L (interquartile range 5.2-29.7 mIU/L) in 2001 to 6.8 mIU/L (interquartile range 5.1-11 mIU/L) in 2015, while the estimated treatment threshold decreased from 28.3 mIU/L [confidence interval 21.0-40.2 mIU/L] in 2001 to 14.2 mIU/L [confidence interval 12.0-18.0 mIU/L] in 2007. In 2015, 25% of patients started LT4 therapy with s-TSH ≤5 mIU/L, and during the entire period, 50% of patients started therapy with a single s-TSH measurement >5 mIU/L. Conclusions: This study performed on a sizeable primary care population demonstrates a considerable fall in the threshold for initiating LT4 therapy in hypothyroid patients. This increases the risk of futile treatment as well as overtreatment.

Spontaneous primary hypothyroidism in 7 adult cats

BACKGROUND

Naturally occurring hypothyroidism in adult cats is rare, with only 4 cases reported.

OBJECTIVES

To describe the historical, clinical, laboratory, and scintigraphic features of adult cats with spontaneous hypothyroidism.

ANIMALS

Seven adult cats referred for suspected hypothyroidism.

METHODS

Prospective case series. We collected data on cats' signalment, clinical signs, results of physical examination, routine laboratory and thyroid hormone testing, and thyroid imaging (thyroid scintigraphy or ultrasound). We subsequently treated cats with levothyroxine and evaluated their response to treatment.

RESULTS

Cats ranged from 3.5 to 11 years, with no apparent breed predilection; 6/7 cats were male. Only 2/7 cats were initially tested because of signs of hypothyroidism (hair-coat changes, lethargy, obesity); others were tested for routine thyroid monitoring or palpable thyroid nodules. Four were azotemic (serum creatinine, 2.2-3.4 mg/dL). Six of the cats had low serum thyroxine (T4 ) and free T4 (fT4 ) concentrations, whereas all 7 cats had high thyroid-stimulating hormone (TSH) concentrations. In 6/7 cats, thyroid scintigraphy revealed bilateral goiter with intense radionuclide uptake; imaging showed no visible thyroid tissue in the other. After levothyroxine treatment, serum concentrations of T4 and fT4 increased and TSH fell; high serum creatinine normalized in azotemic cats; and repeat imaging showed reduction in goiter size.

CONCLUSIONS AND CLINICAL IMPORTANCE

Primary hypothyroidism develops in adult cats, with a higher prevalence than previously thought. Most cats appear to develop a goitrous form of hypothyroidism associated with thyroid hyperplasia, whereas thyroid atrophy appears to be less common. With levothyroxine replacement, clinical and laboratory abnormalities improve or resolve.

Demographic associations for autoantibodies in disease-free individuals of a European population

The presence of autoantibodies usually precedes autoimmune disease, but is sometimes considered an incidental finding with no clinical relevance. The prevalence of immune-mediated diseases was studied in a group of individuals from the Estonian Genome Project (n = 51,862), and 6 clinically significant autoantibodies were detected in a subgroup of 994 (auto)immune-mediated disease-free individuals. The overall prevalence of individuals with immune-mediated diseases in the primary cohort was 30.1%. Similarly, 23.6% of the participants in the disease-free subgroup were seropositive for at least one autoantibody. Several phenotypic parameters were associated with autoantibodies. The results suggest that (i) immune-mediated diseases are diagnosed in nearly one-third of a random European population, (ii) 6 common autoantibodies are detectable in almost one-third of individuals without diagnosed autoimmune diseases, (iii) tissue non-specific autoantibodies, especially at high levels, may reflect preclinical disease in symptom-free individuals, and (iv) the incidental positivity of anti-TPO in men with positive familial anamnesis of maternal autoimmune disease deserves further medical attention. These results encourage physicians to evaluate autoantibodies in addition to treating a variety of patient health complaints to detect autoimmune-mediated disease early.

Mitochondrial disease and endocrine dysfunction

Mitochondria are critical organelles for endocrine health; steroid hormone biosynthesis occurs in these organelles and they provide energy in the form of ATP for hormone production and trafficking. Mitochondrial diseases are multisystem disorders that feature defective oxidative phosphorylation, and are characterized by enormous clinical, biochemical and genetic heterogeneity. To date, mitochondrial diseases have been found to result from >250 monogenic defects encoded across two genomes: the nuclear genome and the ancient circular mitochondrial genome located within mitochondria themselves. Endocrine dysfunction is often observed in genetic mitochondrial diseases and reflects decreased intracellular production or extracellular secretion of hormones. Diabetes mellitus is the most frequently described endocrine disturbance in patients with inherited mitochondrial diseases, but other endocrine manifestations in these patients can include growth hormone deficiency, hypogonadism, adrenal dysfunction, hypoparathyroidism and thyroid disease. Although mitochondrial endocrine dysfunction frequently occurs in the context of multisystem disease, some mitochondrial disorders are characterized by isolated endocrine involvement. Furthermore, additional monogenic mitochondrial endocrine diseases are anticipated to be revealed by the application of genome-wide next-generation sequencing approaches in the future. Understanding the mitochondrial basis of endocrine disturbance is key to developing innovative therapies for patients with mitochondrial diseases.

Fluoridation and hypothyroidism--a commentary on Peckham et al

In many countries around the world community water fluoridation is a key element in the campaign for better dental public health. Its safety and effectiveness have been confirmed through decades of research, and the practice has been strongly endorsed by reputable health authorities. A strong evidence base is critical for the implementation of fluoridation and other public health measures. Health professionals must ensure that the highest quality evidence is promoted, and weak evidence identified and discredited.