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Metwalley KA, Farghaly HS. Refractory hypothyroidism in children: an overview. J Pediatr Endocrinol Metab 2024; 37:841-849. [PMID: 39242350 DOI: 10.1515/jpem-2024-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
Refractory hypothyroidism (RF) defined as raised serum levels of thyroid stimulating hormone (TSH) above upper limit of the reference range with or without the persistence of hypothyroid symptoms following a 6-week interval after the dosage was last increased to upper limits of dose per age. The most common cause of RH is inadequate compliance. In addition, diet, concomitant medication interactions, and gastrointestinal diseases can all result in l-thyroxine (LT4) malabsorption, which can cause RH. Moreover, weight gain, switching brands of LT4, poor storage of LT4, chronic liver disorders, cystic fibrosis, nephrotic syndrome, consumptive hypothyroidism, Addison's disease are significant contributors to RF in children. RH in children is frequently asymptomatic, when symptoms do occur, they are typically minor and resemble those of hypothyroidism. It is essential to identify RH early and treat its underlying cause in order to avoid overusing LT4, which can lead to cardiac and bone problems. Endocrinologists should handle children who they suspect of having RH methodically after making sure there is enough compliance. Searching for undiagnosed illnesses and/or other factors that can affect LT4 absorption could be part of this. We present this review after an extensive literature search and long-standing clinical experience. This review's objective is to shed light on the causes, clinical manifestations, investigations, and treatment of RH in children.
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Affiliation(s)
- Kotb Abbass Metwalley
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, 68796 Assiut University , Assiut, Egypt
| | - Hekma Saad Farghaly
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, 68796 Assiut University , Assiut, Egypt
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Oteri V, Volpe S, Lopes M, Sceusa G, Tumminia A, Belfiore A, Frasca F, Gullo D. Therapeutic efficacy and patient compliance of levothyroxine liquid and softgel formulations taken with meals: a systematic review. Endocrine 2024:10.1007/s12020-024-04016-7. [PMID: 39215906 DOI: 10.1007/s12020-024-04016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Levothyroxine (L-T4) is the drug of choice for treating primary hypothyroidism. L-T4 tablets should be taken at least 30 min before breakfast. Several studies have suggested that serum thyroid profile is not affected by concomitant intake of liquid/softgel L-T4 with meals. Our aim is to review the evidence on therapeutic efficacy and patient compliance with the liquid and softgel formulation of L-T4 taken with meals, also compared with the standard tablet therapy regimen, in hypothyroid patients. METHODS We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the RoB 2 and ROBINS tools. The methodological quality was assessed following the GRADE criteria. RESULTS We included 13 studies, accounting for a total of 1697 patients. The timing of liquid L-T4 intake from breakfast did not affect the therapeutic efficacy of the treatment. No significant differences in the absorption of liquid L-T4 were found when administered together with different foods, beverages, drugs, or other supplements. TSH levels are not influenced by taking softgel L-T4 at breakfast; the efficacy of softgel and liquid formulation is similar when they are taken with a meal, but superior to that of tablet formulation. Shifting from L-T4 tablets taken 30 min before breakfast to liquid/softgel formulation taken with the meal improved medication adherence and perceived quality of life of patients. CONCLUSION Liquid and softgel formulation of L-T4 can be taken at breakfast or close to meals, without losing therapeutic efficacy. These formulations could also improve patient compliance and quality of life compared to L-T4 tablet therapy taken 30 min before breakfast.
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Affiliation(s)
- Vittorio Oteri
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy.
| | - Salvatore Volpe
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Mariarita Lopes
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Giulia Sceusa
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Andrea Tumminia
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Antonino Belfiore
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Francesco Frasca
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Damiano Gullo
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
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Ryu HJ, Choi MS, Park H, Kim TH, Chung JH, Park SY, Kim SW. Adequate Dose of Levothyroxine for Thyroid-Stimulating Hormone Suppression after Total Thyroidectomy in Patients with Differentiated Thyroid Cancer. Endocrinol Metab (Seoul) 2024; 39:615-621. [PMID: 39111780 PMCID: PMC11375304 DOI: 10.3803/enm.2023.1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/02/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGRUOUND The adequate dose of levothyroxine (LT4) for patients who have undergone total thyroidectomy (TT) for differentiated thyroid cancer (DTC) is uncertain. We evaluated the LT4 dose required to achieve mild thyroid-stimulating hormone (TSH) suppression in DTC patients after TT. METHODS The electronic medical records of patients who underwent TT for DTC and received mild TSH suppression therapy were reviewed. Linear regression analysis was performed to evaluate the association between LT4 dose (μg/kg) and an ordinal group divided by body mass index (BMI). We also evaluated the trend in LT4 doses among groups divided by BMI and age. RESULTS In total, 123 patients achieved mild TSH suppression (0.1 to 0.5 mIU/L). The BMI variable was divided into three categories: <23 kg/m2 (n=46), ≥23 and <25 kg/m2 (n=30), and ≥25 kg/m2 (n=47). In the linear regression analysis, BMI was negatively associated with the LT4 dose after adjusting for age and sex (P<0.001). The LT4 doses required to achieve mild TSH suppression based on the BMI categories were 1.86, 1.71, and 1.71 μg/kg, respectively (P for trend <0.001). Further analysis with groups divided by age and BMI revealed that a higher BMI was related to a lower LT4 dose, especially in younger patients aged 20 to 39 (P for trend=0.011). CONCLUSION The study results suggest an appropriate LT4 dose for mild TSH suppression after TT based on body weight in patients with DTC. Considering body weight, BMI, and age in estimating LT4 doses might help to achieve the target TSH level promptly.
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Affiliation(s)
- Hyun Jin Ryu
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunju Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim M. Levothyroxine Dosing for Thyroid-Stimulating Hormone Suppression in Patients with Differentiated Thyroid Cancer after Total Thyroidectomy. Endocrinol Metab (Seoul) 2024; 39:576-578. [PMID: 39223872 PMCID: PMC11375302 DOI: 10.3803/enm.2024.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Mijin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Concepción-Urteaga LA, Pecho-Silva S, Rodríguez-Hidalgo LA, Concepción-Zavaleta MJ. Drug-induced hypothyroidism in tuberculosis. Expert Rev Endocrinol Metab 2024; 19:199-206. [PMID: 38258451 DOI: 10.1080/17446651.2024.2307525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse reactions to tuberculosis treatment can impact patient adherence and prognosis. Hypothyroidism is a frequent adverse reaction caused using ethionamide, prothionamide, and para-aminosalicylic acid and is often underdiagnosed. AREAS COVERED We searched Scielo, Scopus, and EMBASE databases, including 67 articles. Antitubercular drug-induced hypothyroidism has a prevalence of 17%. It occurs after 2 to 3 months of treatment and resolves within 4 to 6 weeks after discontinuation. It is postulated to result from the inhibition of thyroperoxidase function, blocking thyroid hormone synthesis. Symptoms are nonspecific, necessitating individualized thyroid-stimulating hormone measurement for detection. Specific guidelines for management are lacking, but initiation of treatment with levothyroxine, as is customary for primary hypothyroidism, is recommended. Discontinuation of antitubercular drugs is discouraged, as it may lead to unfavorable consequences. EXPERT OPINION Antitubercular drug-induced hypothyroidism is more common than previously thought, affecting one in six MDR-TB patients. Despite diagnostic and treatment recommendations, implementation is hindered in low-income countries due to the lack of certified laboratories. New drugs for tuberculosis treatment may affect thyroid function, requiring vigilant monitoring for complications, including hypothyroidism.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | - Samuel Pecho-Silva
- Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Perú
- Division of Pneumology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Dawn Paul E, T V S, Sulaiman SV. Optimizing Thyroxine Dosage After Total Thyroidectomy: Understanding the Factors at Play. Cureus 2024; 16:e58430. [PMID: 38765445 PMCID: PMC11099504 DOI: 10.7759/cureus.58430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Total thyroidectomy is evolving as the choice of treatment for non-malignant thyroid conditions. Therefore, an ideal method of thyroxine replacement is necessary to avoid the ill effects of under- and over-replacement in such patients. AIM To assess the correlation between optimal thyroxine dose and potential variables like lean body mass (LBM), body surface area (BSA), body mass index (BMI), body weight, age, and sex in patients who underwent total thyroidectomies for benign multinodular goiters in our institute. MATERIALS AND METHODS A longitudinal cohort study was undertaken at the Government Medical College Thrissur, a tertiary care provider in India, between October 2018 and September 2019. One hundred adult patients who underwent a total thyroidectomy for various benign thyroid conditions were included. They were initially given thyroxine 75 µg upon discharge and received follow-up doses every two months until they achieved euthyroid status on two consecutive visits. The variables evaluated at this stage included age, sex, actual body weight, lean body weight, BMI, and biochemical data (triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH)). Correlation, multiple step-wise regression, and variance were carried out using EPI INFO version 7.2.2.6. RESULTS The best predictors for optimum thyroxine dose were BSA (0.923, P < 0.01) and LBM (0.921, P < 0.01), compared with body weight (0.833, P < 0.01) and BMI (0.523, P < 0.01). In our study, the least significant factor was the age of the patient (r = 0.117, P < 0.01). There was no significant association between gender and thyroxine dose. The mean thyroxine dose was 1.87 µg/kg of the patient's body weight. CONCLUSION The optimum thyroxine replacement based on BSA or LBM is a more ideal method than based on BMI or body weight alone.
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Affiliation(s)
- Edwin Dawn Paul
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | - Santhosh T V
- General Surgery, Government Medical College Thrissur, Thrissur, IND
| | - Sumin V Sulaiman
- General Surgery, Government Medical College Thrissur, Thrissur, IND
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Zhang Q, Zhang Y, Zhu H, Liu K, Lou P, Kong P, Su L, Wang S. Replacement Dose for Overt Hypothyroidism Induced by Programmed Cell Death Protein 1 Antibodies May Be Higher than Recommended. Endocr Metab Immune Disord Drug Targets 2024; 24:1169-1179. [PMID: 37605413 DOI: 10.2174/1871530323666230821102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/01/2023] [Accepted: 07/06/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The present recommendations, consensus, or guidelines for the replacement dosage for hypothyroidism induced by programmed cell death protein 1 (PD-1) therapy are not uniform, and there are very few special clinical trials that have examined the replacement dosage for it. OBJECTIVES This article illustrates the clinical characteristics of hypothyroidism induced by PD-1 antibodies (Abs) and reports the recommended replacement dosage for hypothyroidism. METHODS Eighteen patients with overt primary hypothyroidism induced by PD-1 Abs (group 1) were selected from 655 patients with different tumor types. Retrospective analysis was performed on patients in group 1 and 18 patients with natural courses of overt primary hypothyroidism who were age- and sex-matched with the patients in group 1 (group 2). The replacement dosages required for the patients in the two groups were compared. RESULTS Thyroid dysfunction occurred in group 1 after approximately 3.0 ± 1.4 cycles of PD-1 therapy (1-6 stages), with a median time of 61.5 days. The median time of onset of hypothyroidism among all patients was 87.5 days (30-240 days). Most of the patients with hypothyroidism were asymptomatic, and the onset of hypothyroidism was independent of age, sex, TPOAb, TgAb and TSH in group 1 (P>0.05). The average replacement dosage for patients in group 1 was 1.8 ± 0.6 μg/kg/d (0.6-3.2 μg/kg/d). Multiple linear regression analysis showed that sex, age, TPOAb, TgAb and TSH were not correlated with drug dosage. CONCLUSION It seemed that the average maintenance dosage of levothyroxine might need to be 1.8 μg/kg/day for patients with overt hypothyroidism induced by PD-1 Abs.
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Affiliation(s)
- Qian Zhang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, Hebei, 071000, China
| | - Yao Zhang
- Department of Endocrinology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Kuanzhi Liu
- Department of Endocrinology, the 3rd Hospital of Hebei Medical University, Shijia Zhuang, Hebei, 050051, China
| | - Pingping Lou
- Department of Endocrinology, the 3rd Hospital of Hebei Medical University, Shijia Zhuang, Hebei, 050051, China
| | - Peixuan Kong
- Department of Endocrinology, the 3rd Hospital of Hebei Medical University, Shijia Zhuang, Hebei, 050051, China
| | - Lei Su
- Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Shuchang Wang
- Department of Endocrinology, the 3rd Hospital of Hebei Medical University, Shijia Zhuang, Hebei, 050051, China
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Quiroz-Aldave JE, Concepción-Zavaleta MJ, Durand-Vásquez MDC, Concepción-Urteaga LA, Gamarra-Osorio ER, Suárez-Rojas J, Rafael-Robles LDP, Paz-Ibarra J, Román-González A. Refractory Hypothyroidism: Unraveling the Complexities of Diagnosis and Management. Endocr Pract 2023; 29:1007-1016. [PMID: 37714332 DOI: 10.1016/j.eprac.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Refractory hypothyroidism (RH) represents a challenge in the diagnosis and treatment within the field of thyroidology. It is defined as the inability to achieve disease control despite using levothyroxine (LT4) doses of 1.9 μg/kg/d or higher. METHODS A comprehensive review, encompassing 103 articles, was conducted using the Scielo, Scopus, and EMBASE databases, providing an approach to evaluation and diagnosis of this condition. RESULTS LT4 disintegrates and dissolves within an acidic gastric environment before being absorbed in the jejunum and ileum. It then extensively binds to serum transporter proteins and undergoes deiodination to yield tri-iodothyronine, the biologically active hormone. There are various nonpathological causes of RH, such as noncompliance with treatment, changes in the brand of LT4, food and drug interferences, as well as pregnancy. Pathological causes include lactose intolerance, Helicobacter pylori infection, giardiasis, among others. The diagnosis of RH involves conducting a thorough medical history and requesting relevant laboratory tests to rule out causes of treatment resistance. The LT4 absorption test allows for the identification of cases of malabsorption. The treatment of RH involves identifying and addressing the underlying causes of noncompliance or malabsorption. In cases of pseudomalabsorption, supervised and weekly administration of LT4 may be considered. DISCUSSION Early recognition of RH and correction of its underlying cause are of utmost importance, as this avoids the use of excessive doses of LT4 and prevents cardiovascular and bone complications associated with this condition.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-Communicable Diseases, Endocrinology Research Line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | | | | | | | - José Paz-Ibarra
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Alejandro Román-González
- Division of Endocrinology, Hospital Universitario de San Vicente Fundación, Medellín, Colombia; Division of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
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Martínez-Montoro JI, Doulatram-Gamgaram VK, Olveira G, Valdés S, Fernández-García JC. Management of thyroid dysfunction and thyroid nodules in the ageing patient. Eur J Intern Med 2023; 116:16-26. [PMID: 37394383 DOI: 10.1016/j.ejim.2023.06.005] [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: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10-15%. However, this rate is even higher in older adults, with an estimated prevalence of ≈25% in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Moreover, thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. On the other hand, thyroid nodules are also a prevalent condition in older adults, and its incidence increases with age. The assessment and management of thyroid nodules in the ageing patient should take into account several factors, as risk stratification, thyroid cancer biology, patient´s overall health, comorbidities, treatment preferences, and goals of care. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients and we also review how to identify and manage thyroid nodules in this population.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Viyey Kishore Doulatram-Gamgaram
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Sergio Valdés
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain.
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AlEjielat R, Khaleel A, Batarseh YS, Abu-Qatouseh L, Al-Wawi S, AlSunna T. SNP rs11185644 in RXRA gene and SNP rs2235544 in DIO1 gene predict dosage requirements in a cross-sectional sample of hypothyroid patients. BMC Endocr Disord 2023; 23:167. [PMID: 37563580 PMCID: PMC10413766 DOI: 10.1186/s12902-023-01425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Primary hypothyroidism due to abnormality in the thyroid gland is the most common endocrine disease The recommended starting dose of levothyroxine replacement therapy is 1.6 µg/kg. This dose however is not optimal for every patient and dose adjustments are frequently done. Genetic polymorphisms in the absorption and metabolism pathway of levothyroxine are likely to influence its dose requirements. This study aimed to study the influence of genetic polymorphisms on levothyroxine replacement requirements. METHODS This was a cross-sectional study. Participants were recruited through a private nutrition clinic and through announcements distributed in the University of Petra in Amman, Jordan between September 2020 and February 2021. Hypothyroid patients had already been on stable doses of levothyroxine for the previous 3 months. A questionnaire was distributed to collect demographic and clinical information and a blood sample was taken for DNA extraction and clinical biochemistry analysis. rs11249460, rs2235544, rs225014, rs225015, rs3806596, rs11185644, rs4588, rs602662 were analyzed using Applied Biosystems TaqMan™ SNP Genotyping Assays on Rotor-Gene® Q and rs3064744 by direct sequencing. SPSS and Excel were used to perform analysis. RESULTS 76 patients were studied. The equation we calculated to find predicted daily dose of levothyroxine (mcg/kg) is 3.22+ (0.348 for CT genotype of rs11185644, 0 for other genotypes) + 0.027*disease duration (years) - 0.014*age (years) - 0.434*T3 (pmol/L) levels+ (0.296 for CC genotype of rs2235544, 0 for other genotypes). CONCLUSION SNP rs11185644 in RXRA gene and SNP rs2235544 in DIO1 affect dose requirement in hypothyroid patients and if confirmed in larger trials they can be used to individualize thyroxine starting doses.
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Affiliation(s)
- Rowan AlEjielat
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan.
| | - Anas Khaleel
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Yazan S Batarseh
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Luay Abu-Qatouseh
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Suzan Al-Wawi
- Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
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Gavigan C, Abbey EJ, McGready J, Simonsick EM, Mammen JS. Levothyroxine Dosing in Older Adults: Recommendations Derived From The Baltimore Longitudinal Study of Aging. Endocr Pract 2023; 29:612-617. [PMID: 37391043 PMCID: PMC10527945 DOI: 10.1016/j.eprac.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE As thyroid hormone metabolism slows with advancing age, treatment dosing requirements change. Guidelines recommend titration from a low starting dose for older adults with hypothyroidism while providing weight-based estimates for younger populations. However, rapid replacement may be appropriate with acute onset of overt hypothyroidism. Therefore, a weight-based recommendation specific to older adults is needed. METHODS We determined mean levothyroxine dose using actual and ideal body weight (IBW) ratios for the outcome of euthyroid on therapy relative to assay-specific and proposed age-specific ranges for independently living participants aged ≥65 years in the Baltimore Longitudinal Study of Aging. We examined risk factors to identify those at highest risk of overtreatment using regression analyses adjusted for potential covariables and clustering to account for multiple visits per individual. RESULTS One hundred eighty-five participants aged ≥65 years were on levothyroxine at 645 eligible visits. At euthyroid visits, participants were on an average dose of 1.09 μg/kg (1.35 μg/kg IBW), with 84% of euthyroid individuals on a dose of <1.6 μg/kg. Average euthyroid dose did not differ by sex using either actual body weight (ABW) or IBW. For obese individuals, mean euthyroid dose was lower if calculated using ABW (0.9 μg/kg vs 1.14 μg/kg; P < .01) but similar if calculated using IBW (1.42 vs 1.32 μg/kg IBW; P = .41) compared with those with a body mass index of <30. CONCLUSION Thyroid hormone dose per body weight estimates for replacement in older adults (1.09 μg/kg ABW or 1.35 μg/kg IBW) are one-third lower than current weight-based dose recommendations for younger populations.
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Affiliation(s)
- Colleen Gavigan
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Endocrinology, Diabetes and Metabolic Diseases, Medical University of South Carolina, Charleston, South Carolina
| | - Enoch J Abbey
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Internal Medicine, Harlem Hospital/Columbia University Irving Medical Center, New York, New York
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eleanor M Simonsick
- Longitudinal Studies Section, Gerontology Research Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jennifer S Mammen
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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12
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Csiha S, Molnár I, Halmi S, Hutkai D, Lőrincz H, Somodi S, Katkó M, Harangi M, Paragh G, Nagy EV, Berta E, Bodor M. Advanced glycation end products and their soluble receptor (sRAGE) in patients with Hashimoto's thyroiditis on levothyroxine substitution. Front Endocrinol (Lausanne) 2023; 14:1187725. [PMID: 37305044 PMCID: PMC10250717 DOI: 10.3389/fendo.2023.1187725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Advanced glycation end products (AGEs) are heterogenous group of irreversible chemical moieties originated from non-enzymatic glycation and oxidation of proteins, nucleic acids, and lipids. The engagement of AGEs with their chief cellular receptor (RAGE) activates a myriad of signaling pathways contributing to the progression of chronic diseases like autoimmune thyroiditis, type 2 diabetes mellitus and its complications. Soluble RAGE (sRAGE) prevents AGE-RAGE interaction in a competitive manner. Objective We investigated the association between serum AGE, sRAGE and thyroid function in 73 Hashimoto thyroiditis patients (HT) on levothyroxine substitution, and in 83 age, BMI and gender-matched healthy controls. Methods The serum AGEs levels were determined by autofluorescence on a multi-mode microplate reader, and the serum sRAGE levels by ELISA method. Results Mean AGE level was lower (10.71 vs 11.45 AU/µg protein; p=0.046), while mean sRAGE level was higher (923 vs 755 pg/mL; p<0.0005) in the serum of HT patients than the controls. AGE correlated with age, while sRAGE correlated negatively with BMI in both groups. We found negative correlation between AGE and fT3 levels (r=-0.32; p=0.006) and sRAGE and TSH levels (r=-0.27; p=0.022) in HT patients, while we failed to find association between AGE, sRAGE and parameters of thyroid function in the control group. Median AGE/sRAGE ratio was lower in HT patients than in controls (2.4, IQR 1.9 - 3.1 vs 3.3, IQR 2.3 - 4.1 AU/pg; p < 0.001). In HT patients, the AGE/sRAGE ratio correlated positively with BMI and correlated negatively with fT3. Conclusion According to our results in HT patients lower TSH and higher fT3 levels within the reference range is accompanied by a favorable AGE/RAGE balance. Further investigations are needed to confirm these results.
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Affiliation(s)
- Sára Csiha
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Clinical Basics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - István Molnár
- Department of Clinical Basics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Halmi
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Dávid Hutkai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Hajnalka Lőrincz
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Somodi
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mónika Katkó
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Harangi
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Institute of Health Studies, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - György Paragh
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Berta
- Department of Clinical Basics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
- Division of Metabolism, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Bodor
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Clinical Basics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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13
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Costa MM, Da Silva AP, Santos C, Ferreira J, Mascarenhas MR, Bicho M, Barbosa AP. Influence of the TAS2R38 Gene Single Nucleotide Polymorphisms in Metabolism and Anthropometry in Thyroid Dysfunction. Nutrients 2023; 15:2214. [PMID: 37432370 DOI: 10.3390/nu15092214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/12/2023] Open
Abstract
The gene TAS2R38 single nucleotide polymorphisms (SNPs-P49A, A262V and V296I) can condition bitter tasting by PAV (proline-alanine-valine) and non-bitter-tasting by AVI (alanine-valine-isoleucine) homozygosity. We evaluated this polymorphisms association with thyroid function, metabolism and anthropometry parameters determined by: Endpoint analysis (SNPs); DXA (fat mass-%, total fat mass-kg, lean mass-kg); Standard methods (lipid metabolism parameters, HbA1c-%, glycemia-mg/dL, insulinemia-µIU/mL, HOMA-IR, uricemia-mg/dL, calcemia-mg/dL and BMI-kg/m2); ELISA (leptinemia-ng/mL); Spectrophotometry (Angiotensin Converting Enzyme activity-UI/L). Statistics: SPSS program; OR [IC95%]; p < 0.05. Sample: 114 hypothyroid, 49 hyperthyroid, and 179 controls. An association between A262V-valine-valine and hypothyroidism/hyperthyroidism was verified (OR = 2.841; IC95% [1.726-4.676]), p < 0.001/OR = 8.915; IC95% [4.286-18.543]), p < 0.001). Protector effect from thyroid dysfunction: A262V-alanine-valine (OR = 0.467; IC95% [0.289-0.757], p = 0.002/OR = 0.132; IC95% [0.056-0.309], p < 0.001) and PAV (OR = 0.456; IC95% [0.282-0.737], p = 0.001/OR = 0.101; IC95% [0.041-0.250], p < 0.001). Higher parameter values associated with genotypes were: fat-mass-% (V296I-valine-isoleucine), lean-mass (P49A-proline-proline; PVI), leptin (AVI), HbA1c (A262V-alanine-valine) and lower values in lean-Mass (AVI; PVV), leptin (A262V-alanine-alanine), HbA1c (PVV), uricemia (V296I-valine-isoleucine), glycemia (A262V-alanine-alanine; AAV) and plasma triglycerides (PVV). In conclusion, TAS2R38 influences thyroid function, body composition and metabolism. Bitter taste perception (PAV) and the genotype A262V-alanine-valine can protect from thyroid dysfunction. AVV, PVV and genotype A262V-valine-valine may confer higher predisposition for thyroid dysfunction, particularly PVV for hyperthyroidism.
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Affiliation(s)
- Marta Mendes Costa
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
| | - Alda Pereira Da Silva
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
- Faculty of Medicine, University Clinic for General and Family Medicine, Lisbon University,1649-028 Lisbon, Portugal
| | - Carolina Santos
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
| | - Joana Ferreira
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
- Institute for Scientific Research Bento Rocha Cabral, Calçada Bento da Rocha Cabral 14, 1250-012 Lisbon, Portugal
| | - Mário Rui Mascarenhas
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
- Clinic of Endocrinology (CEDML), Diabetes and Metabolism of Lisbon Lda, 1050-017 Lisbon, Portugal
| | - Manuel Bicho
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
- Institute for Scientific Research Bento Rocha Cabral, Calçada Bento da Rocha Cabral 14, 1250-012 Lisbon, Portugal
| | - Ana Paula Barbosa
- Ecogenetics and Human Health Unity, Institute for Environmental Health (ISAMB), Genetics Laboratory, Associate Laboratory TERRA, Faculty of Medicine, Lisbon University, 1649-028 Lisbon, Portugal
- Clinic of Endocrinology (CEDML), Diabetes and Metabolism of Lisbon Lda, 1050-017 Lisbon, Portugal
- Faculty of Medicine, University Clinic of Endocrinology, Lisbon University, 1649-028 Lisbon, Portugal
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14
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Kotwal A, Perlman JE, Goldner WS, Marr A, Mammen JS. Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management. JCO Oncol Pract 2023:OP2300023. [PMID: 37023383 DOI: 10.1200/op.23.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICPis) have proven extremely efficacious in cancer therapy but also lead to a plethora of immune-related adverse events (irAEs). The endocrine irAEs are not only quite common but also may pose a challenge to the clinician while managing a patient with cancer treated with ICPis. The clinical features of endocrine dysfunction are usually nonspecific and may overlap with concurrent illnesses, underlying the importance of accurate hormone testing and efforts toward case-finding. The management of endocrine irAEs is unique in the focus being on hormone replacement rather than curtailing the autoimmune process. Although the management of thyroid irAEs appears straightforward, adrenal insufficiency and insulin-dependent diabetes can be life-threatening if not promptly recognized and treated. This clinical review synthesizes the studies to provide pearls and pitfalls in the evaluation and management of endocrine irAEs with specific reference to guidelines from oncologic societies.
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Affiliation(s)
- Anupam Kotwal
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jordan E Perlman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | - Whitney S Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Alissa Marr
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer S Mammen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
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15
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Le Moli R, Malandrino P, Russo M, Tumino D, Piticchio T, Naselli A, Rapicavoli V, Belfiore A, Frasca F. Levothyroxine therapy, calculated deiodinases activity and basal metabolic rate in obese or nonobese patients after total thyroidectomy for differentiated thyroid cancer, results of a retrospective observational study. Endocrinol Diabetes Metab 2023; 6:e406. [PMID: 36722311 PMCID: PMC10000637 DOI: 10.1002/edm2.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Therapy for hypothyroid obese patients is still under definition since the thyrotropin-stimulating hormone (TSH) level is a less reliable marker of euthyroidism than nonobese patients. Indeed, TSH levels positively correlate with body mass index (BMI), and this increase may be a compensatory mechanism aimed at increasing energy expenditure in obese people. In contrast, the correlation of BMI with thyroid hormone levels is not completely clear, and conflicting results have been obtained by several studies. The L-T4 replacement dose is more variable in obese hypothyroid patients than in nonobese patients, and a recent study indicated that the L-T4 replacement dose is related to lean body mass in obese thyroidectomized patients. We aimed to study the correlations of L-T4-administered dose, thyroid hormone levels and TSH secretion with basal metabolic rate (BMR) and total calculated deiodinase activity (GD) in obese and nonobese athyreotic patients. We also looked for individualized L-T4 replacement dose set points to be used in clinical practice. METHODS We studied retrospectively 160 athyreotic patients, 120 nonobese and 40 obese. GD was calculated by SPINA Thyr 4.2, the responsiveness of the hypothalamic/pituitary thyrotrope by Jostel's thyrotropin (TSH) index and BMR by the Mifflin-St. Jeor formula, the interplay of GD and BMR with L-T4, thyroid hormones and TSH index (TSHI) was also evaluated. RESULTS In our study, the L-T4 dose was an independent predictor of GD, and approximately 30% of athyreotic patients under L-T4 therapy had a reduced GD; FT4 levels were higher and negatively modulated by BMR in obese athyreotic patients respect to nonobese, in these patients a T4 to T3 shunt, in terms of TSHI suppression is observed suggesting a defective hypothalamic pituitary T4 to T3 conversion and a resistance to L-T4 replacement therapy. CONCLUSIONS L-t4 dose is the most important predictor of GD, BMR modulates T4 levels in obese athyreotic patients that are resistant to L-T4 replacement therapy.
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Affiliation(s)
- Rosario Le Moli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Pasqualino Malandrino
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Marco Russo
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Dario Tumino
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Tommaso Piticchio
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Adriano Naselli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Valentina Rapicavoli
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Antonino Belfiore
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
| | - Francesco Frasca
- Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi Nesima HospitalCataniaItaly
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16
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Russo M, Gullo D, Tumino D, Leonardi D, Malandrino P, Frasca F. Different FT3/TSH correlation in acquired and congenital hypothyroid patients reveals a different hypothalamic set-point. Clin Endocrinol (Oxf) 2023; 98:117-122. [PMID: 35419870 PMCID: PMC10083972 DOI: 10.1111/cen.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To understand differences in thyroid hormone replacement therapy with levo-thyroxine (l-T4) between acquired and congenital hypothyroid (CH) patients. DESIGN We compared biochemical thyroid parameters between euthyroid subjects (EU) and both CH adult patients and thyroidectomized patients (TP) under replacement therapy. PATIENTS AND MEASUREMENTS A retrospective analysis was performed on a series of 98 consecutive adult CH patients (27 males and 71 females) with a median age of 24 years (range 18-58). Serum TSH, FT3, FT4, l-T4 dose and body weight were assessed. For comparison purposes, large series of 461 TP for thyroid cancer and 1852 EU followed at our Thyroid Clinic were used as control groups. RESULTS The daily weight-based l-T4 dose was significantly higher in CH than TP group (1.9 vs. 1.7 mcg/kg, p = .03). FT3/FT4 ratio was significantly higher in the EU group, intermediate in CH and lower in TP groups (0.32, 0.28 and 0.24, respectively). Linear regression analysis displayed an inverse correlation between FT4 and TSH in all the groups. An inverse correlation between FT3 and TSH was observed in the TP group, but not in the EU and CH group suggesting that CH patients, under replacement therapy, display biochemical thyroid parameters similar to EU subjects. CONCLUSIONS Adult CH patients require a higher daily l-T4 dose than adult TP. However, the different correlation of TSH and FT3 values between CH and TP patients suggests an adaptive and different hypothalamic-pituitary-thyroid axis regulation that may depend on the early timing of the onset of hypothyroidism in CH.
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Affiliation(s)
- Marco Russo
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Damiano Gullo
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Dario Tumino
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Daniela Leonardi
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Pasqualino Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Francesco Frasca
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
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17
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Trimboli P, Ossola N, Torre A, Mongelli F, Quarenghi M, Camponovo C, Lucchini B, Rotondi M, Ruinelli L, Garofalo F. The performance of levothyroxine tablet is impaired by bariatric surgery. Endocrine 2022; 80:563-569. [PMID: 36581744 PMCID: PMC10199827 DOI: 10.1007/s12020-022-03289-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim was to evaluate if bariatric surgery can affect the LT4 performance. The endpoints were the following: 1) difference between LT4 daily dose before and 1 year after surgery, 2) difference between LT4 dose per weight before and 1 year after surgery, 3) difference among LT4 preparations. METHODS The study period was between January 2018 and May 2022. Inclusion criteria were a) adults undergone bariatric surgery, b) with proven autoimmune hypothyroidism, c) on LT4 therapy before bariatric surgery, d) using any commercialized LT4 preparation. Excluded were patients a) proven to have or suspected for pre-surgical intestinal malabsorption, b) with other potential interfering factors on LT4 absorption; c) with heart, renal, and/or hepatic failure, d) with recent/current infection/inflammation, e) in pregnancy, f) with incomplete data about LT4 therapy. RESULTS According to the selection criteria, 40 patients were included. Both TSH and LT4 daily doses were not significantly different with respect to baseline values. On the contrary, the LT4 dose per weight was significantly increased, especially in RYGB patients. An increased LT4 dose per weight was observed with the reduction of weight. CONCLUSION One year after bariatric surgery 1) the daily dose of LT4 remains unchanged, and 2) despite the significant weight reduction, LT4 dose per weight increases. Most data are referred to LT4 tablet and the performance of LT4 caps should be further investigated.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - Nicola Ossola
- Servizio di Nutrizione Clinica e Dietetica, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Alessandro Torre
- Servizio di Chirurgia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Francesco Mongelli
- Servizio di Chirurgia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Massimo Quarenghi
- Servizio di Nutrizione Clinica e Dietetica, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Chiara Camponovo
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Servizio di Nutrizione Clinica e Dietetica, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Barbara Lucchini
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Lorenzo Ruinelli
- Team Data Science & Research, Area ICT, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Fabio Garofalo
- Servizio di Chirurgia, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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Fierabracci P, Basolo A, Scartabelli G, Bechi Genzano S, Salvetti G, Sotgia G, Rotondi M, Chiovato L, Ceccarini G, Santini F. Possible added value of thyroglobulin antibody (TgAb) testing in the evaluation of thyroidal status of subjects with overweight or obesity. J Endocrinol Invest 2022; 45:2077-2084. [PMID: 35781791 PMCID: PMC9525400 DOI: 10.1007/s40618-022-01839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/28/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE An increase in serum TSH concentrations in the absence of thyroid disease, named isolated hyperthyrotropinemia, is frequently observed in subjects with obesity. It is directly associated with body mass index, and it is reversible following weight loss. Autoimmune hypothyroidism is frequently associated with obesity, it is usually progressive and needs replacement treatment with L-thyroxine. The aim of this study was to investigate the role of thyroglobulin antibodies (TgAb) to define the thyroidal status in subjects with overweight or obesity. METHODS This is a retrospective study including 749 consecutive adult patients with overweight or obesity. Of those, 76 were excluded from the analysis due to hyperthyroidism, previous thyroidectomy or radioiodine therapy for hyperthyroidism, hemiagenesis or drug-induced hypothyroidism. Serum thyrotropin (TSH), free thyroxine (FT4), free 3,5,3'-triiodothyronine (FT3), TgAb and thyroperoxidase antibodies (TPOAb) were measured in all patients. RESULTS Out of 673 patients, 408 did not have thyroid disease. Among patients with thyroid disease (n = 265), 130 had nodular disease with no humoral signs of thyroid autoimmunity and 135 (20%) had autoimmune thyroiditis, defined by the presence of TPOAb and/or TgAb. The prevalence of hyperthyrotropinemia, either directly measured or presumed based on L-thyroxine treatment at the time of data collection, was 63.9% in patients with both TgAb and TPOAb, 47.1% in those with isolated positivity of TPOAb, 42.8% in patients with isolated positivity of TgAb, and 14.5% in those with no detectable TgAb or TPOAb. CONCLUSIONS Our results confirm a high prevalence of autoimmune thyroiditis (20%) in patients with obesity. TgAb may be associated with hypothyroidism in the absence of TPOAb. TgAb measurement may turn helpful to unravel a proportion of subjects that may have or may develop primary hypothyroidism requiring specific substitutive treatment.
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Affiliation(s)
- P. Fierabracci
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - A. Basolo
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - G. Scartabelli
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - S. Bechi Genzano
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - G. Salvetti
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - G. Sotgia
- Consorzio Metis, University Hospital of Pisa, 56124 Pisa, PI Italy
| | - M. Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, PV Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100 Pavia, PV Italy
| | - L. Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, PV Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100 Pavia, PV Italy
| | - G. Ceccarini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - F. Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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19
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Matrone A, Basolo A, Santini F, Elisei R. Understanding the effect of obesity on papillary thyroid cancer: is there a need for tailored diagnostic and therapeutic management? Expert Rev Endocrinol Metab 2022; 17:475-484. [PMID: 36203362 DOI: 10.1080/17446651.2022.2131529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/29/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Several studies have focused on the relationship between obesity and differentiated thyroid carcinoma (DTC), particularly papillary histotype (PTC). However, the association of obesity with both incidence and aggressiveness of PTC is still incompletely understood. AREAS COVERED We reviewed the mechanisms underlying the cross talk between obesity and thyroid carcinomas and described the most recent evidence evaluating the effect of obesity on the development of PTC, as well as the impact of excessive body weight on the clinicopathologic features and outcome of this type of cancer. EXPERT OPINION Available evidence suggests that excessive body weight is linked with a higher risk of getting PTC, while its impact on the aggressiveness of the disease, if present, is still not clear. Therefore, while attention should be paid to discover thyroid cancer in patients with obesity earlier, once diagnosed it should be managed following a conventional workup as in normal weight patients, based on the clinical presentation of the disease and including active surveillance if appropriate, as recommended by referral guidelines.
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Affiliation(s)
- Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa - via Paradisa 2, Pisa, Italy
| | - Alessio Basolo
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa - via Paradisa 2, Pisa, Italy
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa - via Paradisa 2, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa - via Paradisa 2, Pisa, Italy
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Virili C, Bruno G, Santaguida MG, Gargano L, Stramazzo I, De Vito C, Cicenia A, Scalese G, Porowska B, Severi C, Centanni M. Levothyroxine treatment and gastric juice pH in humans: the proof of concept. Endocrine 2022; 77:102-111. [PMID: 35477833 PMCID: PMC9242941 DOI: 10.1007/s12020-022-03056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Despite the absorption of oral thyroxine (T4) occurs in the small bowel, several patients with gastric disorders show an increased need for T4. In vitro evidence suggested that medium pH variations interfere with T4 dissolution. This study was aimed at finding the proof of concept of a direct relationship between the minimal effective dose of T4 and the actual gastric juice pH. PATIENTS AND METHODS Among 311 consecutively thyroxine-treated patients, 61 bearing Hashimoto's thyroiditis (52 F/9 M; median age = 51 years) who complained persistent dyspepsia and/or upper abdominal symptoms following a noninvasive workup for gastrointestinal disorders, underwent EGDS with multiple biopsies and gastric juice pH measurement. All patients accepted to take thyroxine in fasting conditions, abstaining from eating or drinking for one hour. RESULTS Thyroxine requirement increased along with the rising gastric pH (ρ = 0.4229; p = 0.0007). A multivariate analysis revealed that gastric pH was, beside body mass index, the far more important independent variable in determining the effective dose of T4 (p = 0.001). The ROC curve revealed that the pH threshold for an increased thyroxine requirement was at 2.28, being the AUC by 78%. Subdividing patients by the histologic findings, it appeared a significant increase (p = 0.0025) along with the progressive damage of gastric mucosa. CONCLUSION The in vivo measurement of gastric pH highlighted its key role in determining the minimal effective dose of oral T4 and may explain the interference of food, of some drugs and gut disorders on levothyroxine treatment.
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Affiliation(s)
- Camilla Virili
- Department of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Giovanni Bruno
- Department of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy
| | | | | | - Ilaria Stramazzo
- Department of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, University of Rome, Rome, Italy
| | - Alessia Cicenia
- Department of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy
| | - Giulia Scalese
- Department of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy
| | - Barbara Porowska
- General and Specialistic Surgery 'Paride Stefanini', University of Rome, Rome, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Gastroenterology Unit, 'Sapienza" University of Rome, Rome, Italy
| | - Marco Centanni
- Department of Medico-surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy.
- Endocrine Unit, AUSL Latina, Latina, Italy.
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Wiggins B, Knight KT, Banno F, Minaudo M. Myxedema Secondary to Levothyroxine Malabsorption in Newly Diagnosed Celiac Disease. Cureus 2022; 14:e25491. [PMID: 35783876 PMCID: PMC9242287 DOI: 10.7759/cureus.25491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Celiac disease (CD) is an autoimmune disorder that predominantly affects the small intestine and is related to antibodies created against gluten when the substance is ingested. It is uncommon comorbidity in patients with Hashimoto's thyroiditis (HT). Myxedema is a severe form of hypothyroidism that is commonly related to new diagnoses, medication non-compliance, or malabsorption of thyroid supplementation that can have life-threatening associated conditions like heart failure and coma. In this article, we will describe a case of myxedema secondary to levothyroxine malabsorption in the setting of a newly diagnosed CD.
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Abstract
Objectives. This study aims to evaluate the need to modify the total and weight-adjusted doses of levothyroxine after bariatric surgery, identify predictors, and assess the influence of the weight loss on the levothyroxine requirements. Methods. A retrospective study in patients with treated hypothyroidism that underwent bariatric surgery. The modification of the levothyroxine dose and its association with the weight loss and other potential predictors were evaluated at 6, 12, and 24 months post-surgery. Results. Among the 63 patients included, 82.54% needed an adjustment of levothyroxine dose during the follow-up. The total weekly dose of levothyroxine (µg) decreased post-surgery at 6 months (β= -49.1; 95%CI-93.7 to -4.5; p=0.031) and 12 months (β=-54.9; 95%CI-102 to -7.8; p=0.022), but did not significantly change at 24 months (p=0.114). The weekly weight-adjusted dose (µg/k) increased at 6 months (β=1.37; 95%CI 0.91 to 1.83; p<0.001), 12 months (β=2.05; 95%CI 1.43 to 2.67; p<0.001), and 24 months (β=2.52; 95%CI 1.74 to 3.30; p<0.001). The weight loss showed association with the weight-adjusted dose (OR=1.07; 95%CI 1.02 to 1.12; p=0.004), but not the total dose (p=0.320). Conclusions. This study shows a significant decrease in the total dose of levothyroxine requirements change after bariatric surgery during the first year of the follow-up and an increase in the weight-adjusted dose over the first two years. No predictors of modification of the total dose of levothyroxine were identified.
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Dominguez LJ, Barbagallo M. Thyroid disorders. PATHY'S PRINCIPLES AND PRACTICE OF GERIATRIC MEDICINE 2022:1041-1058. [DOI: 10.1002/9781119484288.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
Hypothyroidism is a common endocrinopathy, and levothyroxine is frequently prescribed. Despite the basic tenets of initiating and adjusting levothyroxine being agreed on, there are many nuances and complexities to consistently maintaining euthyroidism. Understanding the impact of patient weight and residual thyroid function on initial levothyroxine dosage and consideration of age, comorbidities, thyrotropin goal, life stage, and quality of life as levothyroxine is adjusted can be challenging and continually evolving. Because levothyroxine is a lifelong medication, it is important to avoid risks from periods of overtreatment or undertreatment. For the subset of patients not restored to baseline health with levothyroxine, causes arising from all aspects of the patient's life (coexistent medical conditions, stressors, lifestyle, psychosocial factors) should be broadly considered. If such factors do not appear to be contributing, and biochemical euthyroidism has been successfully maintained, there may be benefit to a trial of combination therapy with levothyroxine and liothyronine. This is not supported by the majority of randomized clinical trials, but may be supported by other studies providing lower-quality evidence and by animal studies. Given this discrepancy, it is important that any trial of combination therapy be continued only as long as a patient benefit is being enjoyed. Monitoring for adverse effects, particularly in older or frail individuals, is necessary and combination therapy should not be used during pregnancy. A sustained-release liothyronine preparation has completed phase 1 testing and may soon be available for better designed and powered studies assessing whether combination therapy provides superior therapy for hypothyroidism.
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Cordido M, Juiz-Valiña P, Urones P, Sangiao-Alvarellos S, Cordido F. Thyroid Function Alteration in Obesity and the Effect of Bariatric Surgery. J Clin Med 2022; 11:jcm11051340. [PMID: 35268429 PMCID: PMC8911439 DOI: 10.3390/jcm11051340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/26/2022] Open
Abstract
The most common endocrine disease in obesity is hypothyroidism and secondary endocrine alterations, including abnormal thyroid function, are frequent in obesity. It is unclear whether impaired thyroid function is the cause or the consequence of increased adiposity; furthermore, there are no clear data regarding the best way to dose levothyroxine for patients with both hypothyroidism and obesity, and the effect of bariatric surgery (BS). The aim of the present article is to review some controversial aspects of the relation between obesity and the thyroid: (1) Thyroid function in obesity and the effect of BS (2) Thyroid hormone treatment (THT) in obese patients with hypothyroidism and the effect of BS. In summary: In morbidly obese patients, TSH is moderately increased. Morbid obesity has a mild central resistance to the thyroid hormone, reversible with weight loss. In morbidly obese hypothyroid patients, following weight loss, the levothyroxine dose/kg of ideal weight did not change, albeit there was an increment in the levothyroxine dose/kg of actual weight. From a clinical practice perspective, in morbid obesity, diagnosing mild hypothyroidism is difficult, BS improves the altered thyroid function and THT can be adapted better if it is based on ideal weight.
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Affiliation(s)
- María Cordido
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Servicio Urgencias, Hospital Universitario A Coruña, 15006 A Coruña, Spain
| | - Paula Juiz-Valiña
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Paula Urones
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Susana Sangiao-Alvarellos
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981178127 (S.S.-A. & F.C.); Fax: +34-981178204 (S.S.-A. & F.C.)
| | - Fernando Cordido
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Servicio Endocrinología y Nutrición, Hospital Universitario A Coruña, 15006 A Coruña, Spain
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981178127 (S.S.-A. & F.C.); Fax: +34-981178204 (S.S.-A. & F.C.)
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Basolo A, Poma AM, Giannini R, Ceccarini G, Pelosini C, Fierabracci P, Castany MU, Bechi Genzano S, Ambrosini CE, Materazzi G, Chiovato L, Basolo F, Santini F, Torregrossa L. Histological pattern and gene expression profiling of thyroid tissue in subjects with obesity. J Endocrinol Invest 2022; 45:413-423. [PMID: 34392500 DOI: 10.1007/s40618-021-01662-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/10/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Subjects with obesity may exhibit an increase in serum TSH concentrations. Several mechanisms have been proposed to explain this association, including the presence of a compensatory mechanism to counterbalance an accelerated turnover of thyroid hormones in subjects with obesity. This study aimed at evaluating whether the thyroids of subjects with obesity differs from those of normal-weight individuals regarding histology and gene expression profiling. METHODS Ninety-eight patients were selected among those scheduled for thyroidectomy. At histology, thyroid tissue samples were investigated for the presence of adipocytes and/or lymphocyte infiltration. In a subset of patients, the expression at mRNA level of several genes involved in metabolic pathways and immune cell-related mechanisms was quantified by NanoString Technology. RESULTS The presence of adipose cells was documented in thyroid specimens from 40% normal weight, 52.9% overweight and 73.5% patients with obesity. The number of infiltrating adipocytes was greater in specimens of patients with overweight or obesity compared to normal weight. The lymphocytes common antigen (CD45) and mast cell (MC) scores, and the number of CD3+ and CD8+ lymphocytes were higher in patients with overweight and obesity than in normal-weight subjects. Several genes involved in metabolic pathways were differently expressed in patients with overweight or obesity compared to normal weight, with upregulation of Leptin receptor and downregulation of Fatty Acid-Binding Protein 5. CONCLUSIONS Increased BMI is associated with adipocyte and lymphocyte infiltration of the thyroid, not related to an autoimmune process, which might affect thyroid function in subjects with obesity. A differential gene expression profiling of metabolic and immune pathways in thyroid tissues of patients with obesity was also observed.
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Affiliation(s)
- A Basolo
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A M Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - R Giannini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - G Ceccarini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - C Pelosini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
- Chemistry and Endocrinology Laboratory, University Hospital of Pisa, Pisa, Italy
| | - P Fierabracci
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - M U Castany
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - S Bechi Genzano
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - C E Ambrosini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - G Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - L Chiovato
- Laboratory for Endocrine Disruptors, Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Via S. Maugeri 4, 27100, Pavia, PV, Italy
| | - F Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - F Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - L Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
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Cruz-Loya M, Chu BB, Jonklaas J, Schneider DF, DiStefano J. Optimized Replacement T4 and T4+T3 Dosing in Male and Female Hypothyroid Patients With Different BMIs Using a Personalized Mechanistic Model of Thyroid Hormone Regulation Dynamics. Front Endocrinol (Lausanne) 2022; 13:888429. [PMID: 35909562 PMCID: PMC9330449 DOI: 10.3389/fendo.2022.888429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE A personalized simulation tool, p-THYROSIM, was developed (1) to better optimize replacement LT4 and LT4+LT3 dosing for hypothyroid patients, based on individual hormone levels, BMIs, and gender; and (2) to better understand how gender and BMI impact thyroid dynamical regulation over time in these patients. METHODS p-THYROSIM was developed by (1) modifying and refining THYROSIM, an established physiologically based mechanistic model of the system regulating serum T3, T4, and TSH level dynamics; (2) incorporating sex and BMI of individual patients into the model; and (3) quantifying it with 3 experimental datasets and validating it with a fourth containing data from distinct male and female patients across a wide range of BMIs. For validation, we compared our optimized predictions with previously published results on optimized LT4 monotherapies. We also optimized combination T3+T4 dosing and computed unmeasured residual thyroid function (RTF) across a wide range of BMIs from male and female patient data. RESULTS Compared with 3 other dosing methods, the accuracy of p-THYROSIM optimized dosages for LT4 monotherapy was better overall (53% vs. 44%, 43%, and 38%) and for extreme BMI patients (63% vs. ~51% low BMI, 48% vs. ~36% and 22% for high BMI). Optimal dosing for combination LT4+LT3 therapy and unmeasured RTFs was predictively computed with p-THYROSIM for male and female patients in low, normal, and high BMI ranges, yielding daily T3 doses of 5 to 7.5 μg of LT3 combined with 62.5-100 μg of LT4 for women or 75-125 μg of LT4 for men. Also, graphs of steady-state serum T3, T4, and TSH concentrations vs. RTF (range 0%-50%) for untreated patients showed that neither BMI nor gender had any effect on RTF predictions for our patient cohort data. Notably, the graphs provide a means for estimating unmeasurable RTFs for individual patients from their hormone measurements before treatment. CONCLUSIONS p-THYROSIM can provide accurate monotherapies for male and female hypothyroid patients, personalized with their BMIs. Where combination therapy is warranted, our results predict that not much LT3 is needed in addition to LT4 to restore euthyroid levels, suggesting opportunities for further research exploring combination therapy with lower T3 doses and slow-releasing T3 formulations.
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Affiliation(s)
- Mauricio Cruz-Loya
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Benjamin B. Chu
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, DC, United States
| | - David F. Schneider
- Department of Surgery, Division of Endocrine Surgery, University of Wisconsin, Madison, WI, United States
| | - Joseph DiStefano
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- *Correspondence: Joseph DiStefano III,
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [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: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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Homšek A, Roganović M, Kovačević M, Jovanović M. Role of pharmacists in management of patients with thyroid disorders. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-39948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Thyroid dysfunction is one of the most prevalent endocrine disorders, especially common in female patients. If patients are not diagnosed in time or adequately treated, the patients' quality of life can be significantly impaired and additional health problems may occur, considering the key roles of thyroid hormones in the body. Therefore, it is necessary to raise awareness about the importance of recognition of symptoms that may indicate a potential problem with the thyroid gland and help to identify possible causes. For patients who are already being treated with levothyroxine (hypothyroidism), or thiamazole, carbimazole or propylthiouracil (hyperthyroidism), it is necessary to point out the necessity of proper, regular use of the drugs and implementation of accompanying nonpharmacological measures, as well as the potential for the occurrence of adverse reactions and interactions with other drugs or food. A significant role in the mentioned activities should be played by the pharmacist, as the most accessible member of the health team, who can, if necessary, refer the patient to a doctor for diagnosis, monitor the effectiveness and safety of the therapy, and provide appropriate patient counseling.
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Pustilnik E, Schwarzstein D, Feldman R, Mancinelli L, Paladini L, Pellizzón NA, Ramírez Stieben LA. The influence of age and body weight on levothyroxine replacement dosage to achieve euthyroidism in patients with primary hypothyroidism. ENDOCRINOL DIAB NUTR 2021; 68:542-547. [PMID: 34872637 DOI: 10.1016/j.endien.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/08/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Although, it is generally held that the levothyroxine (LT4) dose tends to decrease with age, this theory remains controversial. Our objective was to assess whether the LT4 dose required to achieve euthyroid status varies according to age, body weight (BW), sex, menopausal status, or antibody status. MATERIALS AND METHODS A cross-sectional study was performed from the retrospective review of the charts of patients with a previous diagnosis of primary hypothyroidism in treatment with LT4 and in a euthyroid state. Sex, age, actual body weight (ABW), TSH, and LT4 dose were recorded. Patients were grouped according to age ranges (18-44, 45-65, and over 65 years). A euthyroid state was defined as a serum TSH within the range of 0.4-4μIU/ml. A multiple linear regression model was performed to assess the LT4 dose and age, gender, antibody status, and ABW. RESULTS A total of 882 charts of patients were reviewed. 586 patients met the inclusion criteria. The median age was 55 years. There was no correlation between the LT4 dose and age. A positive correlation was observed between the LT4 dose and ABW, but not with the ideal BW. Linear regression analysis showed that positivity antibody and ABW have a significant effect on the LT4 dose. Comparison of the LT4 dose between the different age groups showed no difference. CONCLUSION Our study demonstrates that the dose of LT4 necessary to achieve euthyroidism is influenced by ABW and the presence of antibodies. Age and menopause did not influence the required daily dose of LT4.
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Affiliation(s)
- Estefanía Pustilnik
- Servicio de Endocrinología del Hospital Privado de Rosario, Rosario, Argentina
| | - Diego Schwarzstein
- Servicio de Endocrinología de Consultorios Integrados de Rosario, Rosario, Argentina
| | - Rodolfo Feldman
- Servicio de Endocrinología del Hospital Privado de Rosario, Rosario, Argentina
| | - Laura Mancinelli
- Servicio de Endocrinología de Imágenes Centro Médico, Casilda, Argentina
| | - Luciana Paladini
- Servicio de Endocrinología del Instituto Médico Fisherton, Rosario, Argentina
| | - Noelia Andrea Pellizzón
- Servicio de Medicina General del Centro Médico del Sindicato de Conductores de Camiones, Rosario, Argentina
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Juiz-Valiña P, Cordido M, Outeiriño-Blanco E, Pértega S, Urones P, García-Brao MJ, Mena E, Pena-Bello L, Sangiao-Alvarellos S, Cordido F. Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss. J Clin Med 2021; 10:jcm10163685. [PMID: 34441981 PMCID: PMC8396870 DOI: 10.3390/jcm10163685] [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: 07/15/2021] [Revised: 08/05/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022] Open
Abstract
The most frequent endocrine disease in obese patients is hypothyroidism. To date, there are no clear data regarding what happens to the dose of levothyroxine (LT4) after bariatric surgery (BS). The objective of the present study was to evaluate thyroid hormone replacement dose in morbidly obese hypothyroid patients after BS-induced weight loss. We explore the best type of measured or estimated body weight for LT4 dosing. We performed an observational study evaluating patients with morbid obesity and hypothyroidism who underwent BS. We included 48 patients (three men). In morbidly obese hypothyroid patients 12 months after BS-induced weight loss, the total LT4 dose or the LT4 dose/kg ideal body weight did not change, while there was a significant increase in LT4 dose/body surface area, LT4 dose/kg weight, LT4 dose/kg adjusted body weight, LT4 dose/kg body fat, and LT4 dose/kg lean body weight. There were no differences in LT4 dose and its variation between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The present study strongly suggests that LT4 dosing in obese hypothyroid patients can be individually adapted more precisely if it is based on ideal body weight.
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Affiliation(s)
- Paula Juiz-Valiña
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - María Cordido
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Elena Outeiriño-Blanco
- Servicio Endocrinología y Nutrición, Hospital Universitario A Coruña, 15006 A Coruña, Spain;
| | - Sonia Pértega
- Unidad Epidemiologia Clínica y Bioestadística, Hospital Universitario A Coruña, 15006 A Coruña, Spain;
| | - Paula Urones
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - María Jesús García-Brao
- Servicio Cirugía General y Digestiva, Hospital Universitario A Coruña, 15006 A Coruña, Spain; (M.J.G.-B.); (E.M.)
| | - Enrique Mena
- Servicio Cirugía General y Digestiva, Hospital Universitario A Coruña, 15006 A Coruña, Spain; (M.J.G.-B.); (E.M.)
| | - Lara Pena-Bello
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Susana Sangiao-Alvarellos
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981-178-127 (S.S.-A. & F.C.); Fax: +34-981-178-204 (S.S.-A. & F.C.)
| | - Fernando Cordido
- Grupo Fisiopatoloxía Endocrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (P.J.-V.); (M.C.); (P.U.); (L.P.-B.)
- Instituto de Investigación Biomedica (INIBIC) and Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Servicio Endocrinología y Nutrición, Hospital Universitario A Coruña, 15006 A Coruña, Spain;
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981-178-127 (S.S.-A. & F.C.); Fax: +34-981-178-204 (S.S.-A. & F.C.)
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Kaur N, Suryanarayanan R. Levothyroxine sodium pentahydrate tablets - formulation considerations. J Pharm Sci 2021; 110:3743-3756. [PMID: 34384799 DOI: 10.1016/j.xphs.2021.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022]
Abstract
Even though levothyroxine sodium pentahydrate tablets have been in the market since 1955, there continue to be recalls due to sub potency. We have comprehensively reviewed the factors affecting its stability in solid oral dosage forms. A compilation of marketed formulation compositions enabled the identification of the potential 'problem excipients'. Two excipient properties, hygroscopicity and microenvironmental acidity, appeared to be responsible for inducing drug instability. In drug products, depending on the formulation composition and storage conditions, the pentahydrate can dehydrate to highly reactive levothyroxine sodium monohydrate, or undergo salt disproportionation to the free acid form of the drug. The USP assay method (HPLC based) is insensitive to these different physical forms of the drug. The influence of physical form of levothyroxine on its chemical stability is incompletely understood. The USP has five product-specific dissolution tests reflecting the complexity in its evaluation.
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Affiliation(s)
- Navpreet Kaur
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota-Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States
| | - Raj Suryanarayanan
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota-Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States.
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Appropriate dose of levothyroxine replacement therapy for hypothyroid obese patients. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2021; 25:100264. [PMID: 34401353 PMCID: PMC8350177 DOI: 10.1016/j.jcte.2021.100264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background Athyreotic patients require a daily levothyroxine (LT4) doses of 1.6-1.8 mcg/kg of actual body weight (BW) to achieve normal thyroid stimulating hormone (TSH) levels. Lean body mass (LBM) calculation may be a more accurate determination of LT4 dose in obese patients. Previous studies were mainly investigated in Caucasians and LBM is markedly different between various ethnic groups. We aim to identify the optimal dose of LT4 replacement therapy in hypothyroid Thai patients including obese subjects. Methods We retrospectively reviewed the medical records of Thai adults with hypothyroidism at the thyroid clinic. Patients had been received LT4 (Brand: Euthyrox) at a stable dose ≥ 75 mcg/day for at least 1 year. Patients with thyroid cancer, pregnant, and lactating women were excluded. LBM was calculated by the Hume formula. Results Two hundred patients (80% females) with a mean age of 48.6 ± 14.8 years and a body mass index (BMI) of 24.5 ± 4.6 kg/m2 were included. Daily LT4 dose/kg of actual BW according to BMI 18.5-24.9, 25-29.9, and ≥ 30 kg/m2 were 1.67 ± 0.27, 1.51 ± 0.28 and 1.39 ± 0.34 mcg/kg, respectively. In contrast, LT4 dose/kg of LBM were 2.31 ± 0.39, 2.35 ± 0.45 and 2.36 ± 0.51 mcg/kg, respectively. Conclusions LBM is considered a better indicator for calculating an appropriate LT4 replacement dose than actual BW in hypothyroid obese Thai patients. The recommended daily dose of LT4 is 2.3 mcg/kg of LBM that could be applied for all ranges of BMI.
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Samec B, Setnikar G, Gaberscek S, Kocjan T. Patients with Central Hypothyroidism are Less Sufficiently Treated with Levothyroxine than Patients with Primary Hypothyroidism. Exp Clin Endocrinol Diabetes 2021; 130:223-228. [PMID: 34331306 DOI: 10.1055/a-1543-8826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contrary to patients with hypothyroidism after radioiodine (HRI) or after thyroidectomy (HTh), patients with central hypothyroidism (CH) cannot rely on thyrotropin (TSH) level to guide their treatment with L-thyroxine (L-T4). Consequently, they are at constant risk of under- or overtreatment. We aimed to establish the adequacy of L-T4 treatment in patients with CH in our cohort. METHODS Consecutive patients with CH on L-T4 treatment were compared with patients adequately treated for HRI or HTh. Levels of free thyroxine (fT4) and free triiodothyronine (fT3) were evaluated and the fT4/fT3 ratio was calculated. RESULTS Forty patients with CH, 136 patients with HRI and 43 patients with HTh were included in this study. Patients with HRI were significantly younger than patients with HTh and CH (p<0.001 for both). Levels of fT4 were significantly lower in CH than in adequately treated patients with HRI and HTh (median (range), 15.6 (12.7-21.3), 18.4 (12.2-28.8), and 18.7 (13.8-25.5) pmol/L, respectively, p<0.001 for both comparisons). Levels of fT3 did not differ significantly (p=0.521) between CH, HRI and HTh (median (range), 4.5 (2.7-5.9), 4.3 (3.2-6.2), and 4.4 (2.9-5.5) pmol/L, respectively). Accordingly, the fT4/fT3 ratio was significantly lower in the CH group than in HRI and HTh groups (median (range), 3.7 (2.5-5.2), 4.2 (1.2-7.7), and 4.4 (2.5-6.1), respectively, p<0.001 for both comparisons). CONCLUSIONS Patients with CH have lower fT4 levels and lower fT4/fT3 ratios than patients adequately treated for HRI or HTh. The cause for this difference may be the unreliable TSH levels in patients with CH.
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Affiliation(s)
- Barbara Samec
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gaja Setnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Gaberscek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomaz Kocjan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Guarnotta V, Pillitteri G, Gambino G, Radellini S, Vigneri E, Pizzolanti G, Giordano C. Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study. J Endocrinol Invest 2021; 44:1387-1394. [PMID: 33099763 PMCID: PMC8195810 DOI: 10.1007/s40618-020-01421-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively. METHODS Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH. RESULTS Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p < 0.001) and U/Kg (p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH. At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH. CONCLUSION Patients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.
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Affiliation(s)
- V Guarnotta
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - G Pillitteri
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - G Gambino
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - S Radellini
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - E Vigneri
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - G Pizzolanti
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - C Giordano
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. d'Alessandro" (PROMISE), Sezione di Malattie Endocrine, del Ricambio e della Nutrizione, Università di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
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Predictors of Improvement in Quality of Life When Treating Hypothyroidism. J Thyroid Res 2021; 2021:5577217. [PMID: 34194721 PMCID: PMC8214493 DOI: 10.1155/2021/5577217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Primary hypothyroidism is characterized by reduced quality of life (QoL). Although thyrotropin (TSH) is utilized as the primary indicator of thyroid disease and treatment adequacy, no simple correlation between QoL and TSH has been shown. This study aimed to investigate changes in clinically relevant predictors during initiation of levothyroxine (L-T4) therapy and their ability to predict improvement in QoL. Method Quality of life was measured in patients with newly diagnosed hypothyroidism, during the initial 12 months of L-T4 therapy, by the thyroid-related patient-reported outcome questionnaire, ThyPRO-39. The main outcome measures were the Composite QoL scale and the Tiredness and Emotional Susceptibility subscales (0–100, higher scores worse). Clinical variables (resting energy expenditure (REE), body composition, thyroid function, L-T4 dose, and cognitive function tests) were evaluated as predictors of improvement in QoL by univariate and multiple regression analysis. Results Thirty-seven hypothyroid patients with a baseline median TSH of 30 mU/l and a median QoL score of 29 were included. After twelve months of L-T4 treatment, the ThyPRO-39 QoL score had significantly improved to a median score of 14, while REE per kg fat-free mass (FFM) increased significantly from a mean of 26.5 to 28.7 kcal/day/kg (p < 0.001). Change in ThyPRO-39 was not associated with a change in REE/FFM (unstandardized coefficient (USC): 0.09 with confidence interval (CI): −1.93 to 2.11, p=0.93) but was positively predicted by baseline body mass index (BMI) (USC: 1.54 with CI: 0.59 to 2.49, (p=0.002), without association with weight loss (USC: 0.33 with CI: −1.21 to 1.27, p=0.96). Conclusion Improvement in QoL as measured by ThyPRO-39 after initiation of L-T4 therapy for hypothyroidism was not associated with changes in REE. High baseline BMI, but not weight loss during therapy, was associated with improvement in QoL. This trail is registered with www.Clinicaltrials.gov (registration no. https://clinicaltrials.gov/ct2/show/NCT02891668).
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Singh R, Tandon A, Awasthi A. Development and Prospective Validation of the Levothyroxine Dose Prediction Model in Primary Hypothyroidism. Horm Metab Res 2021; 53:264-271. [PMID: 33440432 DOI: 10.1055/a-1336-3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multiple visits are needed to achieve euthyroidism on levothyroxine in newly detected primary hypothyroidism. We aimed to develop a levothyroxine dose estimation algorithm for primary hypothyroidism. Adults with newly diagnosed hypothyroidism were enrolled prospectively, first in the training cohort, followed by the validation cohort separated by time and person. We developed a predictive algorithm from Training Cohort and validated the model in Validation Cohort. Training Cohort: In this cohort, 358 subjects (259 women and 99 men) were enrolled. The median duration needed to achieve euthyroidism was 4±0.5 months. The mean levothyroxine daily dose was 60.5±34.1 μg. Data of euthyroid subjects within 6 months of treatment initiation and age range 18-65 years were used for algorithm development. In the multivariable linear regression algorithm, pretreatment serum thyrotropin level, and sex formed the best-fit predictive model (adjusted R2 0.73, p-value <0.001). Validation Cohort: Eighty-four subjects (61 women and 23 men) were enrolled and started on an estimated levothyroxine dose derived from the developed prediction model. On the first follow-up on treatment, 34/50 participants achieved euthyroidism (68%) at 1.5 months. In conclusion, the proposed prediction model for levothyroxine dose estimation effectively achieves early euthyroidism in two-third subjects in the age range of 18-65 years.
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Affiliation(s)
- Rekha Singh
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, India
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ashwani Tandon
- Nizam's Institute of Medical Sciences, Hyderabad, India
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal India
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, India
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
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Guo J, Cai P, Li P, Cao C, Zhou J, Dong L, Yang Y, Xuan Q, Wang J, Zhang Q. Body Composition as a Predictor of Toxicity and Prognosis in Patients with Diffuse Large B-Cell Lymphoma Receiving R-CHOP Immunochemotherapy. ACTA ACUST UNITED AC 2021; 28:1325-1337. [PMID: 33806839 PMCID: PMC8025815 DOI: 10.3390/curroncol28020126] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Our study measured the body composition of Diffuse large B-cell lymphoma (DLBCL) patients receiving rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimen by computed tomographic (CT) and assessed their correlation with treatment-related toxicity and other adverse outcomes. METHODS We retrospectively analyzed 201 DLBCL patients who underwent pre-treatment abdominal CT examination. CT images were used to assess body composition metrics at the third lumbar vertebrae including fat tissues and muscle. Based on the skeletal muscle area (SMA) and density (SMD), skeletal muscle index (SMI), skeletal muscle gauge (SMG = SMI × SMD) and lean body mass (LBM) were calculated. Also analyzed were the toxicity, adverse events and survival. RESULTS We found that SMG, SMD, SMI and LBM were correlated with any grade 3-4 toxicity, dose reduction, hospitalization or termination of the treatment due to immunochemotherapy and worse survival. However, multivariate analysis demonstrated SMG [progression-free survival (PFS): hazard ratio (HR), 2.889; 95% CI, 1.401-5.959; p = 0.004; overall survival (OS): HR, 2.655; 95% CI, 1.218-5.787; p = 0.014] was the best predictor of poor prognosis. CONCLUSIONS SMG, SMD, SMI and LBM were identified as predictors of adverse reactions and poor survival. SMG was an innovative and valuable indicator of immunochemotherapy toxicity and other adverse outcomes. Additionally, it can be used to individualize antineoplastic drug dosing.
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Affiliation(s)
- Jiaxun Guo
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Panpan Cai
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Pengfei Li
- Radiology Department, Harbin Medical University Cancer Hospital, Harbin 150040, China;
| | - Cong Cao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Jing Zhou
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Lina Dong
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Yan Yang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Qijia Xuan
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
| | - Jingxuan Wang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
- Correspondence: (J.W.); (Q.Z.)
| | - Qingyuan Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, China; (J.G.); (P.C.); (C.C.); (J.Z.); (L.D.); (Y.Y.); (Q.X.)
- Correspondence: (J.W.); (Q.Z.)
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Pustilnik E, Schwarzstein D, Feldman R, Mancinelli L, Paladini L, Pellizzón NA, Ramírez Stieben LA. The influence of age and body weight on levothyroxine replacement dosage to achieve euthyroidism in patients with primary hypothyroidism. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00039-2. [PMID: 33750680 DOI: 10.1016/j.endinu.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although, it is generally held that the levothyroxine (LT4) dose tends to decrease with age, this theory remains controversial. Our objective was to assess whether the LT4 dose required to achieve euthyroid status varies according to age, body weight (BW), sex, menopausal status, or antibody status. MATERIALS AND METHODS A cross-sectional study was performed from the retrospective review of the charts of patients with a previous diagnosis of primary hypothyroidism in treatment with LT4 and in a euthyroid state. Sex, age, actual body weight (ABW), TSH, and LT4 dose were recorded. Patients were grouped according to age ranges (18-44, 45-65, and over 65 years). A euthyroid state was defined as a serum TSH within the range of 0.4-4μIU/ml. A multiple linear regression model was performed to assess the LT4 dose and age, gender, antibody status, and ABW. RESULTS A total of 882 charts of patients were reviewed. 586 patients met the inclusion criteria. The median age was 55 years. There was no correlation between the LT4 dose and age. A positive correlation was observed between the LT4 dose and ABW, but not with the ideal BW. Linear regression analysis showed that positivity antibody and ABW have a significant effect on the LT4 dose. Comparison of the LT4 dose between the different age groups showed no difference. CONCLUSION Our study demonstrates that the dose of LT4 necessary to achieve euthyroidism is influenced by ABW and the presence of antibodies. Age and menopause did not influence the required daily dose of LT4.
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Affiliation(s)
- Estefanía Pustilnik
- Servicio de Endocrinología del Hospital Privado de Rosario, Rosario, Argentina
| | - Diego Schwarzstein
- Servicio de Endocrinología de Consultorios Integrados de Rosario, Rosario, Argentina
| | - Rodolfo Feldman
- Servicio de Endocrinología del Hospital Privado de Rosario, Rosario, Argentina
| | - Laura Mancinelli
- Servicio de Endocrinología de Imágenes Centro Médico, Casilda, Argentina
| | - Luciana Paladini
- Servicio de Endocrinología del Instituto Médico Fisherton, Rosario, Argentina
| | - Noelia Andrea Pellizzón
- Servicio de Medicina General del Centro Médico del Sindicato de Conductores de Camiones, Rosario, Argentina
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Heinrich K, Modest DP, Ricard I, Fischer von Weikersthal L, Decker T, Kaiser F, Graeven U, Uhlig J, Schenk M, Freiberg-Richter J, Peuser B, Denzlinger C, Giessen-Jung C, Stahler A, Michl M, Held S, Jung A, Kirchner T, Stintzing S, Heinemann V. Gender-dependent survival benefit from first-line irinotecan in metastatic colorectal cancer. Subgroup analysis of a phase III trial (XELAVIRI-study, AIO-KRK-0110). Eur J Cancer 2021; 147:128-139. [PMID: 33647548 DOI: 10.1016/j.ejca.2021.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND XELAVIRI compared sequential (Arm A) versus initial (Arm B) irinotecan in combination with fluoropyrimidine plus bevacizumab in patients with metastatic colorectal cancer, trial identification: NCT01249638. In the full analysis set of the study, non-inferiority of time to failure of strategy (TFS) was not shown. The present analysis was performed to evaluate the effect of gender on treatment outcome and tolerability. METHODS The study end-points overall response rate (ORR), progression-free survival (PFS), TFS and overall survival (OS) were evaluated in female versus male patients and in molecular subgroups (i.e. RAS mutational status). Interaction of treatment and gender was tested by likelihood ratio tests. RESULTS In total, 281 male and 140 female patients (n = 421) were evaluated. Among the male patients, the ORR was 33.6% without and 58.3% with initial irinotecan (P < 0.001). PFS (hazard ratio [HR] 0.54; 95% confidence interval [CI] 0.42-0.69; P < 0.001) and OS (HR 0.63; 95% CI 0.47-0.85; P = 0.002) were also significantly better with initial irinotecan. Among the female patients, the ORR was 42.7% in Arm A and 43.1% in Arm B, PFS was similar (HR 1.09; 95% CI 0.76-1.55; P = 0.649) without and with initial irinotecan. A strong trend for inferior outcome with regard to OS with initial irinotecan was observed (HR 1.46; 95% CI 0.95-2.24; P = 0.081) and the trend reached significance in the multivariate analysis (HR 1.78; 95% CI 1.08-2.95; P = 0.02). Formal interaction of treatment and gender was observed for ORR (P = 0.018), PFS (P = 0.002) and OS (P = 0.001). Treatment-related adverse events were not significantly different between male and female patients. CONCLUSIONS The present analysis suggests that gender interacts with efficacy of initial irinotecan when used in combination with fluoropyrimidines and bevacizumab. Although male patients derived a significant and clinically meaningful benefit from initial combination chemotherapy, this was not observed in female patients.
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Affiliation(s)
- Kathrin Heinrich
- Department of Medicine III, University Hospital, LMU Munich, München, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - Dominik P Modest
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Medical Department, Division of Oncology and Hematology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ingrid Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, München, Germany
| | | | | | | | - Ullrich Graeven
- Kliniken Maria Hilf GmbH, Krankenhaus St. Franziskus, Mönchengladbach, Germany
| | | | - Michael Schenk
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | | | - Bettina Peuser
- Onkologische Praxis Am Diakonissenhaus, Leipzig, Germany
| | | | - Clemens Giessen-Jung
- Department of Medicine III, University Hospital, LMU Munich, München, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Arndt Stahler
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Medical Department, Division of Oncology and Hematology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Marlies Michl
- Department of Medicine III, University Hospital, LMU Munich, München, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Andreas Jung
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institut für Pathologie, Ludwig-Maximilians-Universität, München, Germany
| | - Thomas Kirchner
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Institut für Pathologie, Ludwig-Maximilians-Universität, München, Germany
| | - Sebastian Stintzing
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Medical Department, Division of Oncology and Hematology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, München, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Comprehensive Cancer Center, University Hospital, LMU Munich, München, Germany
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Croce L, De Martinis L, Pinto S, Coperchini F, Dito G, Bendotti G, Pasquali D, Cappelli C, Latrofa F, Magri F, Chiovato L, Rotondi M. Compared with classic Hashimoto's thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 2020; 43:1631-1636. [PMID: 32319047 DOI: 10.1007/s40618-020-01249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Serum-negative-chronic-autoimmune-thyroiditis (SN-CAT) is considered a milder variant of classic Hashimoto's thyroiditis (CHT). However, its prevalence remains unknown and it is still unclear whether SN-CAT behaves differently in terms of L-thyroxine (LT4) substitution treatment of hypothyroidism. Aims of this study were to estimate the prevalence of SN-CAT in a large series of hypothyroid patients and to compare LT4 requirements in hypothyroid patients with SN-CAT and CHT. METHODS Five-hundred-eighty-one consecutive patients with primary-autoimmune-hypothyroidism were enrolled in a cross-sectional study. LT4 requirements and thyroid-volume changes were longitudinally evaluated in 49 hypothyroid patients with SN-CAT and in 98 sex and age-matched hypothyroid patients with CHT. RESULTS In our series the prevalence of SN-CAT was 20.8%. At diagnosis, patients in the CHT and SN-CAT groups had similar male/female ratio, age and BMI, while serum TSH and thyroid-volume were significantly greater in the CHT group. In the longitudinal study, during a follow-up of 8.9 ± 4.6 years, 8 out of 49 (16.3%) SN-CAT patients developed positive tests for of circulating TPO-Ab and/or Tg-Ab. Thyroid-volume significantly decreased in CHT patients, but not in those with SN-CAT. The maximum daily substitution dose of LT4 was smaller in SN-CAT patients as compared with the CHT ones. Multivariate analysis showed that age, BMI, basal TSH and thyroid antibody status independently and significantly predicted the maximum daily substitution dose of LT4. CONCLUSIONS SN-CAT accounts for a significant proportion of patients with autoimmune hypothyroidism. Compared with hypothyroid patients diagnosed with CHT, the SN-CAT ones require smaller doses of LT4 to correct their hypothyroidism.
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Affiliation(s)
- L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
- PhD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - L De Martinis
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - S Pinto
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Dito
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Bendotti
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - D Pasquali
- Department of Advanced Medical and Surgical Science, A.O.U. Vanvitelli, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - F Latrofa
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - F Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
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Richou M, Gilly O, Taillard V, Paul De Brauwere D, Donici I, Guedj AM. Levothyroxine dose adjustment in hypothyroid patients following gastric sleeve surgery. ANNALES D'ENDOCRINOLOGIE 2020; 81:500-506. [PMID: 32445637 DOI: 10.1016/j.ando.2020.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 02/04/2023]
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Abstract
Hypothyroidism is a common condition in which the thyroid gland provides insufficient amounts of thyroid hormone for the needs of peripheral tissues. The most common cause in adults is chronic lymphocytic thyroiditis (Hashimoto thyroiditis), but there are many other causes. Because most of the clinical features of hypothyroidism are nonspecific, the diagnosis requires laboratory testing. Serum thyroid-stimulating hormone (TSH) measurement is the best diagnostic test; an elevated TSH level almost always signals primary hypothyroidism. Serum free thyroxine levels may be below the reference range (overt hypothyroidism) or within the reference range (subclinical hypothyroidism). All patients with overt hypothyroidism should be treated, but those with subclinical hypothyroidism do not always benefit from treatment, especially elderly patients and those with baseline TSH levels below 10 mU/L. Oral L-thyroxine is the treatment of choice because of its well-demonstrated efficacy, safety, and ease of use. Therapy goals are symptom relief and maintenance of serum TSH levels within the reference range. Myxedema coma is a life-threatening form of decompensated hypothyroidism that must be treated with aggressive L-thyroxine replacement and other supportive measures in the inpatient setting.
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Frey S, Blanchard C, Caillard C, Drui D, Hamy A, Trésallet C, Mirallié É. Thyroid surgery in obese patients: A review of the literature. J Visc Surg 2020; 157:401-409. [PMID: 32591245 DOI: 10.1016/j.jviscsurg.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of obesity in the general population has tripled in the past four decades. The number of bariatric surgeries performed annually has quadrupled in the past ten years due to this obesity epidemic. Concomitantly, the number of patients who are obese or who have undergone bariatric surgery and have become candidates for thyroid surgery has also increased considerably. Among patients undergoing thyroidectomy in the French population, the proportion of obese patients currently represents 10 to 20%. In addition, the frequency of benign and malignant thyroid pathologies seems to be increased by obesity, with a Hazard Ratio of around 1.8 for thyroid cancers in obese women. While obesity does not seem to influence the specific post-operative morbidity of thyroidectomy, a history of malabsorptive bariatric surgery should encourage the greatest caution in patients who need to undergo thyroid surgery since it is associated with a significant risk of severe hypocalcemia (>60% in some studies) requiring intravenous calcium supplementation in about 20% of cases. In the latter situation, peri-operative vitamin D-calcium supplementation is essential. In addition, the replacement dose of Levothyroxine (T4) intended for replacement must also be adapted in obese patients, calculated not from the actual weight but from the ideal weight. The objective of this review is to discuss the influence of obesity on the evolution of nodular and neoplastic thyroid pathologies, on the morbidity of thyroid surgery as well as on post-operative drug treatments. The impact of bariatric surgery on these different aspects is also discussed.
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Affiliation(s)
- S Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France
| | - C Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France; L'institut du thorax, inserm, CNRS, UNIV Nantes, Nantes, France
| | - C Caillard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France
| | - D Drui
- L'institut du thorax, inserm, CNRS, UNIV Nantes, Nantes, France; Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes, Hôpital Laënnec, Boulevard Jacques Monod, 44800 Saint-Herblain, France
| | - A Hamy
- Chirurgie Digestive et Endocrinienne, CHU d'Angers, 49933 Angers cedex 09, France
| | - C Trésallet
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne. Hôpitaux Universitaires Paris Seine-Saint-Denis. Avicenne Hospital, 125, rue de Stalingrad, 93000 Bobigny, France
| | - É Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France.
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Zattarin E, Vernieri C. Sarcopenia and monocyte-to-lymphocyte ratio as prognostic factors in early-stage breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:737. [PMID: 32647662 PMCID: PMC7333145 DOI: 10.21037/atm.2020.03.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Emma Zattarin
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Claudio Vernieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.,Unit of Metabolic Reprogramming in Solid Tumors, IFOM, the FIRC Institute of Molecular Oncology, Milan, Italy
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Matrone A, Ceccarini G, Beghini M, Ferrari F, Gambale C, D'Aqui M, Piaggi P, Torregrossa L, Molinaro E, Basolo F, Vitti P, Santini F, Elisei R. Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2020; 105:5687038. [PMID: 31875910 DOI: 10.1210/clinem/dgz312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/23/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. METHODS We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. RESULTS No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. CONCLUSIONS In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.
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Affiliation(s)
- Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Giovanni Ceccarini
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Marianna Beghini
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Federica Ferrari
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Carla Gambale
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Mariaida D'Aqui
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Paolo Piaggi
- Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health-Phoenix, Arizona US
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa, Pisa, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
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Mele C, Tagliaferri MA, Pagano L, Soranna D, Scacchi M, Aimaretti G, Biondi B, Marzullo P. Levothyroxine Replacement in Obese Adults: The Role of Metabolic Variables and Aging on Thyroid Testing Abnormalities. J Clin Endocrinol Metab 2019; 104:6265-6274. [PMID: 31265068 DOI: 10.1210/jc.2019-00773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/26/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT General rates of over- and underreplacement in levothyroxine (LT4) users with primary hypothyroidism are variably high. No information on LT4 adequacy exists in obesity. OBJECTIVE We explored rates and factors relating to LT4 adequacy in obese patients with primary hypothyroidism. SETTING Tertiary care center. DESIGN Among 4954 consecutive obese patients admitted between 2011 and 2014, 691 hypothyroid patients receiving LT4 therapy and 691 body mass index (BMI)-, age-, and sex-matched euthyroid controls underwent analysis of thyroid function, glucolipid profile, body composition, and indirect calorimetry. LT4 users were classified into low TSH (<0.27 mU/L), euthyroid (0.27 to 4.2 mU/L), and high TSH (>4.2 mU/L). RESULTS LT4 users constituted 13.9% of the incident population. TSH was low in 7.5%, high in 17.2%, and normal in 75.2% of LT4 users. Overtreatment decreased with aging and more LT4 users ≥65 years of age had normal TSH than those <65 years of age (P < 0.05). Compared with the euthyroid obese group, LT4 users showed higher adiposity, similar insulin resistance, but a healthier lipid profile. In multivariable analyses, LT4 dose was predicted by fat-free mass, hypothyroidism cause, and sex (P < 0.0001 to < 0.05). Risk of LT4 overreplacement increased with younger age (OR 0.96; 95% CI 0.94 to 0.99), higher LT4 dose (OR 2.98; 95% CI 1.44 to 6.14), and lower BMI (OR 0.93; 95% CI 0.88 to 0.99). Male sex increased the likelihood of LT4 underreplacement (OR 2.37; 95% CI 1.10 to 5.11). CONCLUSIONS Obesity is associated with milder rates of inadequate LT4 treatment compared with nonobese populations. LT4 adequacy increases with aging. Age, body composition, and sex are main determinants of LT4 requirements in obesity.
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Affiliation(s)
- Chiara Mele
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Maria Antonella Tagliaferri
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Loredana Pagano
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Soranna
- Statistics Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Massimo Scacchi
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Piancavallo, Verbania, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Marzullo
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, Piancavallo, Verbania, Italy
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Grani G, Tumino D, Ramundo V, Ciotti L, Lomonaco C, Armillotta M, Falcone R, Lucia P, Maranghi M, Filetti S, Durante C. Changes in TSH levels in athyreotic patients with differentiated thyroid cancer during levothyroxine therapy: influence on dose adjustments. J Endocrinol Invest 2019; 42:1485-1490. [PMID: 31203497 DOI: 10.1007/s40618-019-01074-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of the study was to describe the spontaneous TSH level variations and levothyroxine dose adjustments in athyreotic patients with differentiated thyroid cancer (DTC) in real-life practice. METHODS Patients with DTC were retrospectively evaluated at a tertiary referral center between October 2006 and November 2013. Hormone measurements (TSH and FT4 serum levels), L-T4 prescription information (dose per kg per day) and other medications were recorded at 1 month and 3, 12, 24, 36 and 48 months after primary treatment (surgery ± radioiodine therapy). RESULTS The cohort was composed of 452 patients; about 20% of patients with stable levothyroxine dose have clinically meaningful spontaneous TSH variations (defined as ΔTSH > 2 mcUI/mL) at yearly follow-up visit. Furthermore, about 25% of athyreotic DTC patients with stable dose have a ΔTSH > 1.5 mcUI/mL and about 40% a ΔTSH > 1 mcUI/mL during each follow-up visit. We further investigated whether this TSH variation would lead to subsequent dose changes. About 19.9-37.7% of DTC patients on stable LT4 dose on the previous visit had their levothyroxine dose reduced, while 7.8-14.9% increased due to TSH variations. We further evaluated the decision to change the dose in relation with the age-specific TSH range. Up to 77.2% of patients had their dose adjusted due to TSH falling below the age-specific range. CONCLUSIONS Spontaneous serum TSH variations determine levothyroxine replacement therapy in athyreotic patients with DTC, requiring multiple dose changes.
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Affiliation(s)
- G Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Tumino
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - V Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - L Ciotti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Lomonaco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Armillotta
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - R Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - P Lucia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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49
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Papoian V, Ylli D, Felger EA, Wartofsky L, Rosen JE. Evaluation of Thyroid Hormone Replacement Dosing in Overweight and Obese Patients After a Thyroidectomy. Thyroid 2019; 29:1558-1562. [PMID: 31573413 DOI: 10.1089/thy.2019.0251] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Initiation of thyroid hormone replacement (THR) after a total thyroidectomy has traditionally relied on the weight of the patient, regardless of the patient's body mass index (BMI). Current literature suggests that THR in obese patients differs from nonobese patients. This can lead to overdosing of levothyroxine (LT4) and delay in achievement of euthyroid state. Methods: We retrospectively identified patients on THR after total thyroidectomy with a benign postoperative diagnosis. Patients who achieved euthyroidism with THR were included in the analysis. Patient demographic and THR dosing information was collected. Regression analysis was performed to identify appropriate THR dosing at varying BMIs. This study aimed to evaluate the appropriate dosing of THR in overweight and obese patients. Results: Our cohort consisted of 114 patients achieving euthyroidism while on THR. Mean age was 55 years (range 28-77 years) with 84% females. Of the 114 patients, the number of patients with a BMI less than 25, 25-29, 30-34, 35-39, and greater than 40 were 26 (23%), 33 (29%), 23 (20%), 19 (17%), and 13 (11%), respectively. Of the entire cohort, a mean of 50 weeks elapsed after surgery to achieve euthyroidism, with no significant difference between the BMI categories (p = 0.58). In obese patients (BMI >30), 35% were overdosed with LT4 on initial dosing. The cohort lost a mean of 3 kg until euthyroidism was achieved, with no significant difference in the weight loss based on BMI category (p = 0.61). Patients with a higher BMI did require a higher dose (mcg) of LT4 to achieve euthyroidism (p < 0.01), but the dose was significantly lower in relation to their weight (mcg/kg) (p < 0.01). The LT4 dose required to achieve euthyroidism based on the previously mentioned BMI categories were 1.76, 1.47, 1.42, 1.27, and 1.28 mcg/kg. Conclusion: The current weight-based dosing of THR inappropriately overdoses overweight and obese patients. A more appropriate formula for THR titration should consider both the weight and BMI of the patient.
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Affiliation(s)
- Vardan Papoian
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Dorina Ylli
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Erin A Felger
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Leonard Wartofsky
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jennifer E Rosen
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
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50
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Pedro J, Cunha F, Souteiro P, Neves JS, Guerreiro V, Magalhães D, Bettencourt-Silva R, Oliveira SC, Costa MM, Queirós J, Freitas P, Varela A, Carvalho D. The Effect of the Bariatric Surgery Type on the Levothyroxine Dose of Morbidly Obese Hypothyroid Patients. Obes Surg 2019; 28:3538-3543. [PMID: 30008061 DOI: 10.1007/s11695-018-3388-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Doubts exist about the effect of different bariatric surgery (BS) types on levothyroxine (Lt4) absorption. We compared Lt4 doses and their variation (ΔLt4) in patients with hypothyroidism that underwent malabsorptive (MS) or restrictive (RS) surgery and studied predictors of Lt4 dose change. METHODS Retrospective study of morbidly obese hypothyroid patients submitted to BS. We compared RS ("sleeve" gastrectomy or adjustable gastric banding) with MS (Roux-en-Y gastric bypass) patients. We built a multivariable logistic regression and a linear regression model to study predictors of Lt4 dose changes and ΔLt4, respectively. RESULTS Fifty-seven patients: 35 MS and 22 RS. Mean age 47 years; 7% men. Patients submitted to MS had lower BMI at 1 year than those submitted to RS. Lt4 dose remained unchanged in 61.4%, increased in 12.3%, and decreased in 26.3% of patients. Initial and 1-year Lt4 dose were not different between surgical groups. Relative Lt4 dose, but not absolute (p = 0.07), increased at 1 year (p < 0.001). Neither BS nor BMI variation were predictors of Lt4 dose variation. BMI variation was associated with relative Lt4 dose change independently of initial BMI and BS type: β (95%CI) - 0.03 (- 0.05; 0.00); p = 0.03. CONCLUSIONS There were no differences in Lt4 dose and its variation between restrictive and malabsorptive techniques 1 year after surgery. Malabsorptive procedures may not affect Lt4 absorption differently from restrictive ones. Bariatric surgery type was not predictive of Lt4 dose changes. BMI variation is associated with relative Lt4 dose (dose per weight) variation and its association was independent of bariatric surgery type.
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Affiliation(s)
- Jorge Pedro
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal.
| | - Filipe Cunha
- Department of Endocrinology of Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Pedro Souteiro
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - João Sérgio Neves
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Vanessa Guerreiro
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Daniela Magalhães
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Rita Bettencourt-Silva
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Sofia Castro Oliveira
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Maria Manuel Costa
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Joana Queirós
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Paula Freitas
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Ana Varela
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
| | - Davide Carvalho
- Service of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, EPE, Porto, Portugal
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