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Bablis P, Day RR, Bablis S, Pollard H. Treatment of Hypothyroidism and Stress Using Neuro-Emotional Technique (NET): A Case Study. Cureus 2024; 16:e58231. [PMID: 38745794 PMCID: PMC11092426 DOI: 10.7759/cureus.58231] [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: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Hypothyroidism is generally considered an autoimmune condition, and typical medical management involves taking levothyroxine (synthetic thyroid hormone) for life. This case report details the results of a mind-body intervention (MBI) called the Neuro-Emotional Technique (NET) used to treat a 28-year-old Caucasian female presenting with symptoms and bloodwork markers associated with two years of hypothyroidism and a long history of stress. The patient's medical doctor provided a diagnosis of hypothyroidism after blood tests showed that thyroid-stimulating hormone (TSH) levels were high at 6.87 mIU/L (where the acceptable range is 0.40-3.50 mIU/L) and free T4 (FT4) levels were low at 8.6 pmol/L (where the acceptable range is 9.0-19.0 pmol/L). Psychometric tests were completed at baseline and after 12 weeks of treatment to evaluate changes in mental health and emotional well-being. The Adverse Childhood Experiences Questionnaire (ACE-Q) revealed a high degree of childhood trauma that may have predisposed to the underlying autoimmune thyroid dysfunction. At the conclusion of the treatment period, serum thyroid-stimulating hormone (TSH) and free T4 were within normal ranges and psychometric indicators normalized. We hypothesize that these changes may be due to the stress-reducing mechanism of NET and outline possible mechanisms via the Psycho-Immune-Neuroendocrine (PINE) network. The PINE network model asserts that chronic stress acts as a potential driver of pathophysiology that can lead to one or more medical and mental health conditions. While further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, the results of this case suggest that it may be pertinent to consider co-management of subclinical hypothyroidism with a relatively quick and cost-effective MBI such as NET.
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Affiliation(s)
- Peter Bablis
- Department of Maternal and Child Health and Precision Medicine, University Research Institute, Athens, GRC
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, AUS
| | - Ryan R Day
- Department of Chiropractic, Universal Health, Sydney, AUS
| | - Sophia Bablis
- Department of Psychology, Universal Health, Sydney, AUS
| | - Henry Pollard
- Faculty of Health Sciences, Durban University of Technology, Durban, ZAF
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Pietrzak S, Marciniak W, Derkacz R, Matuszczak M, Kiljańczyk A, Baszuk P, Bryśkiewicz M, Sikorski A, Gronwald J, Słojewski M, Cybulski C, Gołąb A, Huzarski T, Dębniak T, Lener MR, Jakubowska A, Kluz T, Scott RJ, Lubiński J. Correlation between Selenium and Zinc Levels and Survival among Prostate Cancer Patients. Nutrients 2024; 16:527. [PMID: 38398851 PMCID: PMC10891521 DOI: 10.3390/nu16040527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
The most prevalent type of cancer among males is prostate cancer. Survival is considered quite good, but it can be further improved when risk factors are optimized. One of these factors is micronutrients, including Se and Zn. To our knowledge, the interaction between Se and Zn and prostate cancer remains undescribed. This study aimed to investigate the optimal levels of selenium (Se) and zinc (Zn) and their impact on the survival of individuals diagnosed with prostate cancer. A total of 338 prostate cancer patients were enrolled in this study, which was conducted in Poland between 2009 and 2015. Mass spectrometry, which uses inductively coupled plasma mass, was used to assess serum element levels before treatment. The study participants were categorized into quartiles (QI-QIV) based on the distributions of Se and Zn levels observed among surviving participants. Cox regression was used to assess the association between serum Se and Zn levels and the survival of prostate cancer patients. Our results reveal the effect of combined Se and Zn levels on survival in prostate cancer patients (SeQI-ZnQI vs. SeQIV-ZnQIV; HR = 20.9). These results need further research to establish Se/Zn norms for different populations.
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Affiliation(s)
- Sandra Pietrzak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Wojciech Marciniak
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
| | - Róża Derkacz
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
| | - Milena Matuszczak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Adam Kiljańczyk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Piotr Baszuk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
| | - Marta Bryśkiewicz
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Andrzej Sikorski
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Cezary Cybulski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Tomasz Huzarski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
- Department of Clinical Genetics and Pathology, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
| | - Tadeusz Dębniak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Marcin R. Lener
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Anna Jakubowska
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Tomasz Kluz
- Department of Gynecology, Gynecology Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszow, Poland;
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Rodney J. Scott
- Priority Research Centre for Cancer Research, Innovation and Translation, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia;
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Division of Molecular Medicine, Pathology North, John Hunter Hospital, New Lambton, NSW 2305, Australia
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra, Poland; (W.M.); (R.D.)
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Rooney MK, Andring LM, Corrigan KL, Bernard V, Williamson TD, Fuller CD, Garden AS, Gunn B, Lee A, Moreno AC, Morrison WH, Phan J, Rosenthal DI, Spiotto M, Frank SJ. Hypothyroidism following Radiotherapy for Head and Neck Cancer: A Systematic Review of the Literature and Opportunities to Improve the Therapeutic Ratio. Cancers (Basel) 2023; 15:4321. [PMID: 37686597 PMCID: PMC10486996 DOI: 10.3390/cancers15174321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Radiotherapy (RT) is a central component for the treatment of many head and neck cancers. In this systematic review of the literature, we aimed to characterize and quantify the published evidence on RT-related hypothyroidism, including estimated incidence, clinical risk factors, and dosimetric parameters that may be used to guide clinical decision making. Furthermore, we aimed to identify potential areas of improvement in the prevention and clinical management of RT-induced hypothyroidism, including the role of modern advanced therapeutic techniques. (2) Methods: We conducted a systemic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed and Google Scholar were searched to identify original research articles describing the incidence, mechanism, dosimetry, treatment, or prevention of radiation-related hypothyroidism for adults receiving RT for the treatment of head and neck cancers. The snowball method was used to identify additional articles. For identified articles, we tabulated several datapoints, including publication date, patient sample size, estimated hypothyroidism incidence, cancer site/type, follow-up period, radiation modality and technique, use of multimodality therapy, method of thyroid function evaluation, and proposed dosimetric predictors of hypothyroidism. (3) Results: One hundred and eleven articles met inclusion criteria, reflecting a range of head and neck cancer subtypes. There was a large variation in the estimated incidence of RT-related hypothyroidism, with a median estimate of 36% (range 3% to 79%). Reported incidence increased in later publication dates, which was likely related to improved screening and longer follow up. There were a wide variety of predictive metrics used to identify patients at high risk of hypothyroidism, the most common of which were volumetric and mean dosimetrics related to the thyroid gland (Vxx%, Dmean). More recently, there has been increasing evidence to suggest that the thyroid gland volume itself and the volume of the thyroid gland spared from high-dose radiation (VSxx) may better predict thyroid function after RT. There were no identified studies investigating the role of advanced radiotherapeutic techniques such as MRI-guided RT or particle therapy to decrease RT-related hypothyroidism. Conclusions: Hypothyroidism is a common toxicity resulting from therapeutic radiation for head and neck cancer with recent estimates suggesting 40-50% of patients may experience hypothyroidism after treatment. Dosimetric predictive models are increasingly able to accurately identify patients at risk of hypothyroidism, especially those utilizing thyroid VS metrics. Further investigation regarding the potential for advanced radiotherapeutic therapies to decrease RT-induced thyroid dysfunction is needed.
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Affiliation(s)
- Michael K. Rooney
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA (V.B.); (T.D.W.); (S.J.F.)
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Brenta G, Nepote A, Barreto A, Musso C, Faingold C, Fossati P, Antonelli A, Fallahi P, Famá F, Meroño T. Low glomerular filtration rate values are associated with higher TSH in an elderly population at high cardiovascular disease risk. Front Endocrinol (Lausanne) 2023; 14:1162626. [PMID: 37664833 PMCID: PMC10469594 DOI: 10.3389/fendo.2023.1162626] [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: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Hypothyroidism is associated with impaired glomerular filtration rate (GFR), a recognized cardiovascular disease (CVD), and mortality risk factor. In older adults, this association remains unexplored. We aimed to determine the relationship of elevated TSH with GFR in an elderly population at high CVD risk. Methods Older adults (age>65ys) with high CVD risk defined by two or more CVD risk factors: smoking (S), high blood pressure (HBP), high total cholesterol, low HDL cholesterol, diabetes (DM), metabolic syndrome or previous cardiovascular event, were prospectively included at our ambulatory Endocrine Clinic. Patients under levothyroxine or thyroid disease were excluded. TSH> 6mU/l defined subclinical hypothyroidism (ScH) with normal free T4 levels. Estimated GFR was calculated by the Berlin-Initiative Study (BIS)-1 formula for elderly population. Urinary albumin to creatinine ratio (uACR), IL-6 and TNF-α, and Carotid intima-media thickness (CIMT) were also determined. The U Mann-Whitney test, the Spearman test, and multiple linear regression were used as statistical tests. Results Finally 246 patients (68% females) were included and 20 (8%) had ScH. This group, was older (median, Q1-Q3: 77,72-78; 72,68-77 years, p=0.01) and DM was less frequent than in the euthyroid group (35 vs 58%, p=0.039). Lower fasting glucose (-20%,p=0.01), GFR (-14%,p=0.01) and freeT4 (-10%,p<0.001) were found compared to euthyroid patients. A higher prevalence of Kidney failure was found in ScH (80 vs. 46%, p=0.003) vs. euthyroid individuals. Significant correlations with GFR were detected: age (r-0.482,p<0.001), TSH (r-0.172,p=0.004), IL-6 (r-0.150,p=0.047), TNF-α (r-0.274,p<0.001), uACR (r-0.170,p=0.009) and CIMT(r-0.189,p=0.004). By multiple linear regression, in a model adjusted by age, sex, BMI, uACR, S, DM, TNF-α and HBP, TSH (Bst -0.14, p=0.023, R2 = 0.25) was found an independent predictor of GFR. Conclusion In older adults with high CVD risk, ScH is associated with lower renal function, and this relationship is present regardless of other cardiometabolic risk factors. These results suggest that ScH could contribute to low GFR and excess CVD risk, although this hypothesis should be addressed in longitudinal studies.
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Affiliation(s)
- Gabriela Brenta
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Alejandra Nepote
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Adriana Barreto
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Carla Musso
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Cristina Faingold
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Pía Fossati
- Endocrine Division, Unidad Asistencial Dr Cesar Milstein, Buenos Aires, Argentina
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fausto Famá
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Tomás Meroño
- Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
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Chen D, Lou X, Bao J, Wang Y, Fan Y, Chen Q, Jin J, Chen L. Polychlorinated naphthalene concentrations and temporal trends in serum from the general Chinese adult population and effects of polychlorinated naphthalenes on thyroid function. ENVIRONMENTAL RESEARCH 2023:116309. [PMID: 37301498 DOI: 10.1016/j.envres.2023.116309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Polychlorinated naphthalenes (PCNs) have stopped being produced and used but have been detected in human serum around the world. Investigating temporal trends in PCN concentrations in human serum will improve our understanding of human exposure to PCNs and the risks posed. We determined the PCN concentrations in serum collected from 32 adults in five consecutive years (2012-2016). The total PCN concentrations in the serum samples were 0.00-5443 pg/g lipid weight. We found no significant decreases in the total PCN concentrations in human serum and even found that the concentrations of some PCN congeners (e.g., CN20) increased over time. We found differences in the PCN concentrations in serum from males and females, the CN75 concentration being significantly higher in serum from females than males, meaning CN75 poses more serious risks to females than males. We found, using molecular docking techniques, that CN75 interferes with thyroid hormone transport in vivo and that CN20 affects thyroid hormone binding to receptors. These two effects are synergistic and can cause hypothyroidism-like symptoms.
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Affiliation(s)
- Dan Chen
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China
| | - Xinyu Lou
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China
| | - Junsong Bao
- State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, Beijing, 100875, China
| | - Ying Wang
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China; Engineering Research Center of Food Environment and Public Health, Beijing, 100081, China
| | - Yuhao Fan
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China
| | - Qianhui Chen
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China
| | - Jun Jin
- College of Life and Environmental Sciences, Minzu University of China, Beijing, 100081, China; Engineering Research Center of Food Environment and Public Health, Beijing, 100081, China.
| | - Limei Chen
- Wuxi Center for Disease Control and Prevention, Wuxi, 214023, China; Research Base for Environment and Health in Wuxi, Chinese Center for Disease Control and Prevention, Wuxi, 214023, China.
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Sahin M, Demirci I, Haymana C, Tasci I, Emral R, Cakal E, Unluturk U, Satman I, Demir T, Ata N, Ertugrul D, Atmaca A, Salman S, Sahin I, Dagdelen S, Celik O, Caglayan M, Sonmez A. The Clinical Characteristics and Outcomes of COVID-19 Patients with Pre-Existing Thyroid Dysfunction: A Nationwide Study. Horm Metab Res 2023; 55:25-30. [PMID: 36328149 DOI: 10.1055/a-1971-8781] [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: 11/05/2022]
Abstract
To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02-2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99-1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism.
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Affiliation(s)
- Mustafa Sahin
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ibrahim Demirci
- University of Health Sciences, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Cem Haymana
- University of Health Sciences, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ilker Tasci
- University of Health Sciences, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey
| | - Rıfat Emral
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Erman Cakal
- University of Health Sciences, Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ugur Unluturk
- Hacettepe University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ilhan Satman
- Istanbul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Tevfik Demir
- Dokuz Eylul University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Naim Ata
- Department of Strategy Development, Ministry of Health, Ankara, Turkey
| | - Derun Ertugrul
- University of Health Sciences, Faculty of Medicine, Kecioren Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Aysegul Atmaca
- Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Serpil Salman
- Medica Clinic, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Ibrahim Sahin
- Inonu University, Faculty of Medicine, Department of Endocrinology and Metabolism, Malatya, Turkey
| | - Selcuk Dagdelen
- University of Health Sciences, Faculty of Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Osman Celik
- Public Hospitals General Directorate, Republic of Turkey, Ministry of Health, Ankara, Turkey
| | | | - Alper Sonmez
- University of Health Sciences, Gulhane Faculty of Medicine and Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
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Krysiak R, Kowalcze K, Okopień B. Differences in levothyroxine action on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity between metformin- and myo-inositol-treated women with autoimmune subclinical hypothyroidism. J Clin Pharm Ther 2022; 47:1704-1710. [PMID: 35768336 DOI: 10.1111/jcpt.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Insulin resistance impairs the impact of levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity. Both metformin and myo-inositol were found to improve insulin sensitivity and to reduce thyrotropin levels in individuals with hypothyroidism. The aim of the present study was to compare the effect of levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity between women receiving metformin and myo-inositol. METHODS The study included two groups of women with autoimmune hypothyroidism, treated for at least 6 months with either metformin (group A; n = 25) or myo-inositol (group B; n = 25). Both groups were matched for age, insulin sensitivity, hormone levels and antibody titers. For the following 6 months, all women received levothyroxine. Plasma levels of glucose, insulin, thyrotropin, free thyroid hormones, prolactin, 25-hydroxyvitamin D and high-sensitivity C-reactive protein (hsCRP), as well as titers of thyroid peroxidase and thyroglobulin antibodies were assessed at the beginning and at the end of the study. RESULTS AND DISCUSSION At baseline there were not differences between the study groups. Although levothyroxine reduced thyrotropin levels, increased free thyroid hormone levels and decreased antibody titers in both study groups, these effects were more pronounced in group A than group B. Only in group A, levothyroxine increased 25-hydroxyvitamin D, decreased hsCRP and improved insulin sensitivity. The impact of levothyroxine on thyrotropin and free thyroid hormones correlated with treatment-induced changes in insulin sensitivity, antibody titers, 25-hydroxyvitamin D and hsCRP. WHAT IS NEW AND CONCLUSION The present study suggests that the impact of levothyroxine on thyroid autoimmunity and hypothalamic-pituitary-thyroid axis activity is stronger in women receiving metformin than in women treated with myo-inositol.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Karolina Kowalcze
- Department of Pediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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8
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Pavlatou MG, Žarković M, Hegedüs L, Priestley J, McMullan C, Perros P. A survey on the psychological impact and access to health care of thyroid patients during the first SARS-COV-2 lockdown. Clin Endocrinol (Oxf) 2022; 96:869-877. [PMID: 34881433 DOI: 10.1111/cen.14649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Information on the impact of SARS-COV-2 on the daily life of thyroid patients during lockdown is sparse. The main objective was explorative, focusing on how SARS-COV-2 affected thyroid patients. DESIGN Cross-sectional, questionnaire-based, using an online platform. PATIENTS Patients >18 years with a history of thyroid disease. MEASUREMENTS Demographic data, psychological impact of SARS-COV-2, medical care during the pandemic. RESULTS Valid responses were received from 609 responders. The median age was 50 years, 94% were female and 98.5% were UK residents. The commonest diagnosis was primary hypothyroidism (52.2%). Negative psychological effects following the lockdown were reported by 45.6%-58.7%. Cancellations of appointments with thyroid specialists were reported by 43.8%, although cancellations of thyroid investigations and treatments were relatively infrequent (12.9%-14.1%). Overall satisfaction rates for thyroid services were low (satisfaction score 40.1-42.8 out of 100), but nearly 80% were satisfied with remote consultations. Responder ratings of online information sources about SARS-COV-2 and thyroid diseases were lowest for government sites. Unmet needs during lockdown were: more remote access to thyroid specialists, more online information in 'plain English', and psychological support. In multivariate analyses, younger age, female gender, history of depression, hyperthyroidism, not having contracted SARS-COV-2 and multiple comorbidities were risk factors for a negative psychological impact of lockdown. CONCLUSIONS This survey identified a significant negative impact of SARS-COV-2 and lockdown on psychological wellbeing, particularly in some groups of patients defined by demographic factors, history of hyperthyroidism and comorbidities. Low satisfaction with healthcare services among thyroid patients was noted, but remote consultations were rated favourably.
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Affiliation(s)
- Maria G Pavlatou
- Department of Endocrinology, Diabetes and Metabolism, Athens Medical Center, Athens, Greece
| | - Miloš Žarković
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia
- Department of Endocrinology, University of Belgrade, Belgrade, Serbia
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | | | | | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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9
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Vardarli I, Brandenburg T, Hegedüs L, Attanasio R, Nagy E, Papini E, Perros P, Weidemann F, Herrmann K, Führer D. A Questionnaire Survey of German Thyroidologists on the Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: The THESIS (Treatment of Hypothyroidism in Europe by Specialists: An International Survey) Collaborative. Exp Clin Endocrinol Diabetes 2022; 130:577-586. [PMID: 35640637 DOI: 10.1055/a-1832-0644] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify the attitudes of German thyroid specialists towards the clinical treatment of hypothyroidism using thyroid hormones (TH). METHODS All members of the thyroid section of the German Endocrine Society (DGE) were e-mailed an invitation to participate in a web-based survey about substitution with TH. RESULTS Out of 206 members of the DGE's thyroid section, 163 (79.1%) responses were received and included in the analysis. Of responding members, 98.6% used levothyroxine (LT4) as the treatment of choice, and 45.4% also prescribed combination therapy with liothyronine (LT4+LT3) in their clinical practice (p<0.001). LT4+LT3 combination was favored in patients with persistent hypothyroidism symptoms despite biochemical euthyroidism on LT4 treatment (p<0.001). Of all respondents, 26.4% never indicated TH therapy for euthyroid patients (p<0.001), while the remainder would consider THs for one or more indications (62.9% for euthyroid infertile women with high anti-thyroid antibody levels (p<0.001), 7.1% in patients with severe hypercholesterolemia, as complementary treatment (p=0.007), and 57.1% in patients with simple goiter (p<0.001)). In conditions that could interfere with LT4 absorption, most respondents still preferred tablets and did not expect a significant difference when switching from one LT4 formulation to another. CONCLUSION For German thyroid specialists, LT4 is the treatment of choice for hypothyroidism. Combination therapy with LT4+LT3 was considered for patients with persistent symptoms. Even in conditions that could affect bioavailability, German thyroid specialists prefer LT4 tablets rather than other LT4 formulations, such as liquid or soft-gel capsules. The widespread use of thyroid hormone for non-hypothyroid conditions is not consistent with current evidence and needs further study.
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Affiliation(s)
- Irfan Vardarli
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany
| | - Tim Brandenburg
- Department of Endocrinology, Diabetes, and Metabolism, Clinical Chemistry - Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Denmark
| | - Roberto Attanasio
- Scientific Committee Associazione Medici Endocrinologi, Milan, Italy
| | - EndreV Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Frank Weidemann
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes, and Metabolism, Clinical Chemistry - Division of Laboratory Research; Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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10
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Aweimer A, Schiedat F, Schöne D, Landgrafe-Mende G, Bogossian H, Mügge A, Patsalis PC, Gotzmann M, Akin I, El-Battrawy I, Dietrich JW. Abnormal Cardiac Repolarization in Thyroid Diseases: Results of an Observational Study. Front Cardiovasc Med 2021; 8:738517. [PMID: 34888359 PMCID: PMC8649843 DOI: 10.3389/fcvm.2021.738517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The relationship between thyroid function and cardiac disease is complex. Both hypothyroidism and thyrotoxicosis can predispose to ventricular arrhythmia and other major adverse cardiovascular events (MACE), so that a U-shaped relationship between thyroid signaling and the incidence of MACE has been postulated. Moreover, recently published data suggest an association between thyroid hormone concentration and the risk of sudden cardiac death (SCD) even in euthyroid populations with high-normal FT4 levels. In this study, we investigated markers of repolarization in ECGs, as predictors of cardiovascular events, in patients with a spectrum of subclinical and overt thyroid dysfunction. Methods: Resting ECGs of 100 subjects, 90 patients (LV-EF > 45%) with thyroid disease (60 overt hyperthyroid, 11 overt hypothyroid and 19 L-T4-treated and biochemically euthyroid patients after thyroidectomy or with autoimmune thyroiditis) and 10 healthy volunteers were analyzed for Tp-e interval. The Tp-e interval was measured manually and was correlated to serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and thyroxine (FT4). Results: The Tp-e interval significantly correlated to log-transformed concentrations of TSH (Spearman's rho = 0.30, p < 0.01), FT4 (rho = −0.26, p < 0.05), and FT3 (rho = −0.23, p < 0.05) as well as log-transformed thyroid's secretory capacity (SPINA-GT, rho = −0.33, p < 0.01). Spearman's rho of correlations of JT interval to log-transformed TSH, FT4, FT3, and SPINA-GT were 0.51 (p < 1e−7), −0.45 (p < 1e−5), −0.55 (p < 1e−8), and −0.43 (p < 1e−4), respectively. In minimal multivariable regression models, markers of thyroid homeostasis correlated to heart rate, QT, Tp-e, and JT intervals. Group-wise evaluation in hypothyroid, euthyroid and hyperthyroid subjects revealed similar correlations in all three groups. Conclusion: We observed significant inverse correlations of Tp-e and JT intervals with FT4 and FT3 over the whole spectrum of thyroid function. Our data suggest a possible mechanism of SCD in hypothyroid state by prolongation of repolarization. We do not observe a U-shaped relationship, so that the mechanism of SCD in patients with high FT4 or hyperthyroidism seems not to be driven by abnormalities in repolarization.
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Affiliation(s)
- Assem Aweimer
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Fabian Schiedat
- Department of Cardiology, St. Mary's Hospital, University of Duisburg-Essen, Gelsenkirchen, Germany
| | - Dominik Schöne
- Department of Cardiology, St. Mary's Hospital, University of Duisburg-Essen, Gelsenkirchen, Germany
| | - Gabi Landgrafe-Mende
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Harilaos Bogossian
- Cardiology and Rhythmology Department, EvK Hospital Hagen-Haspe, Witten-Herdecke University, Witten, Germany
| | - Andreas Mügge
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Department of Cardiology, University Hospital St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Polykarpos C Patsalis
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Michael Gotzmann
- Department of Cardiology, University Hospital St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef Hospital, Ruhr-University of Bochum, Bochum, Germany.,Ruhr Centre of Rare Diseases, Ruhr University of Bochum, Bochum, Germany.,Ruhr Centre of Rare Diseases, Witten-Herdecke University, Witten, Germany.,Diabetes Centre Bochum/Hattingen, Blankenstein Hospital, Hattingen, Germany
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11
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Шепелькевич АП, Дыдышко ЮВ, Юреня ЕB, Лобашова ВЛ, Аттанасио Р, Хегедюс Л, Надь Э, Негро Р, Папини Э, Перрос П. [Features of the use of synthetic analogues of thyroid hormones: а 2020 THESIS* questionnaire survey of members of the Belarusian Public Medical Association of Endocrinology and Metabolism]. PROBLEMY ENDOKRINOLOGII 2021; 68:18-26. [PMID: 35262294 PMCID: PMC9112860 DOI: 10.14341/probl12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The standard treatment for hypothyroidism is levothyroxine (LT4), which in the Republic of Belarus is available in tablet form whereas liothyronine (LT3) is not registered, but patients can purchase them on their own abroad. AIM This study aimed to investigate Belarusian endocrinologists' attitude of thyroid hormones in hypothyroid and euthyroid patients. MATERIALS AND METHODS An online survey was conducted, for which members of the Belarusian Medical Association of Endocrinology and Metabolism were invited by posting information in the group chat and by e-mail. The research period was from October 1 to December 26, 2020. 210 questionnaires were received, 146 of which were used. RESULTS The majority of participants, 145 (99.3%), indicated that they were using LT4 as the first-choice drug for the treatment hypothyroidism. Sixty-one (41.8%) doctors answered that LT3 + LT4 combination likely can be used in patients with long-term untreated hypothyroidism and 15 (10.3%) - in patients with persistent symptoms of hypothyroidism, despite biochemical euthyroidism on therapy LT4. Over half of the respondents 84 (57.5%) answered that thyroid hormone therapy was never indicated for euthyroid patients, but 50 (34.2%) would consider it for female infertility with high level of thyroid antibodies and 36 (24.7%) for simple goiter growing over time. In various conditions that could interfere with absorption of LT4, most responding Belarusian endocrinologists do not expect a significant difference with different formulations (tablets+"I do not expect major changes in different forms" vs. "soft gel capsules"+"liquid solution"; p <0.001). Persistent symptoms of hypothyroidism on the background of LT4 replacement therapy with the achievement of the target TSH can mainly be caused by psychosocial factors, concomitant diseases, unrealistic patient expectations, chronic fatigue syndrome, and the burden of chronic disease. CONCLUSION The method of choice of Belarusian endocrinologists in the treatment of hypothyroidism is LT4 replacement therapy, but the appointment of LT4 + LT3 combination therapy can be considered in certain clinical situations. As a rule, endocrinologists do not prescribe LT4 in patients with euthyroidism and do not expect a significant difference when using other forms of levothyroxine.
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Affiliation(s)
| | - Ю. В. Дыдышко
- Белорусский государственный медицинский университет;
Республиканский центр медицинской реабилитации и бальнеолечения
| | - Е. B. Юреня
- Минский городской клинический эндокринологический центр
| | - В. Л. Лобашова
- Республиканский центр медицинской реабилитации и бальнеолечения
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12
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Smyczynska U, Grabia S, Nowicka Z, Papis-Ubych A, Bibik R, Latusek T, Rutkowski T, Fijuth J, Fendler W, Tomasik B. Prediction of Radiation-Induced Hypothyroidism Using Radiomic Data Analysis Does Not Show Superiority over Standard Normal Tissue Complication Models. Cancers (Basel) 2021; 13:cancers13215584. [PMID: 34771747 PMCID: PMC8582656 DOI: 10.3390/cancers13215584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Radiation-induced hypothyroidism (RIHT) commonly develops in cancer survivors that receive radiation therapy for cancers in the head and neck region. The state-of-art normal tissue complication probability (NTCP) models perform satisfactorily; however, they do not use the whole spectrum of information that can be obtained from imaging techniques. The radiomic approach offers the ability to efficiently mine features, which are imperceptible to the human eye, but may provide crucial data about the patient’s condition. We gathered CT images and clinical data from 98 patients undergoing radiotherapy for head and neck cancers, 27 of whom later developed RIHT. For them, we created machine-learning models to predict RIHT using automatically extracted radiomic features and appropriate clinical and dosimetric parameters. We also validated the well-established external state-of-art NTCP models on our datasets and observed that our radiomic-based models performed very similarly to them. This shows that automated tools may perform as well as the current standard but can be theoretically applied faster and be implemented into existing imaging software used when planning radiotherapy. Abstract State-of-art normal tissue complication probability (NTCP) models do not take into account more complex individual anatomical variations, which can be objectively quantitated and compared in radiomic analysis. The goal of this project was development of radiomic NTCP model for radiation-induced hypothyroidism (RIHT) using imaging biomarkers (radiomics). We gathered CT images and clinical data from 98 patients, who underwent intensity-modulated radiation therapy (IMRT) for head and neck cancers with a planned total dose of 70.0 Gy (33–35 fractions). During the 28-month (median) follow-up 27 patients (28%) developed RIHT. For each patient, we extracted 1316 radiomic features from original and transformed images using manually contoured thyroid masks. Creating models based on clinical, radiomic features or a combination thereof, we considered 3 variants of data preprocessing. Based on their performance metrics (sensitivity, specificity), we picked best models for each variant ((0.8, 0.96), (0.9, 0.93), (0.9, 0.89) variant-wise) and compared them with external NTCP models ((0.82, 0.88), (0.82, 0.88), (0.76, 0.91)). We showed that radiomic-based models did not outperform state-of-art NTCP models (p > 0.05). The potential benefit of radiomic-based approach is that it is dose-independent, and models can be used prior to treatment planning allowing faster selection of susceptible population.
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Affiliation(s)
- Urszula Smyczynska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (S.G.); (Z.N.); (B.T.)
| | - Szymon Grabia
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (S.G.); (Z.N.); (B.T.)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (S.G.); (Z.N.); (B.T.)
| | - Anna Papis-Ubych
- Department of Radiotherapy, N. Copernicus Memorial Regional Specialist Hospital, 93-513 Lodz, Poland; (A.P.-U.); (J.F.)
| | - Robert Bibik
- Department of Radiation Oncology, Oncology Center of Radom, 26-600 Radom, Poland;
| | - Tomasz Latusek
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO)—Branch in Gliwice, 44-101 Gliwice, Poland;
| | - Tomasz Rutkowski
- I Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO)—Branch in Gliwice, 44-101 Gliwice, Poland;
| | - Jacek Fijuth
- Department of Radiotherapy, N. Copernicus Memorial Regional Specialist Hospital, 93-513 Lodz, Poland; (A.P.-U.); (J.F.)
- Department of Radiotherapy, Chair of Oncology, Medical University of Lodz, 93-509 Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (S.G.); (Z.N.); (B.T.)
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
- Correspondence:
| | - Bartlomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland; (U.S.); (S.G.); (Z.N.); (B.T.)
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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13
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Riis KR, Frølich JS, Hegedüs L, Negro R, Attanasio R, Nagy EV, Papini E, Perros P, Bonnema SJ. Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society. J Endocrinol Invest 2021; 44:2435-2444. [PMID: 33774809 PMCID: PMC8004561 DOI: 10.1007/s40618-021-01555-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The standard treatment of hypothyroidism is levothyroxine (LT4), which is available as tablets or soft-gel capsules in Denmark. This study aimed to investigate Danish endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients. METHODS An e-mail with an invitation to participate in an online survey investigating practices about substitution with thyroid hormones was sent to all members of the Danish Endocrine Society (DES). RESULTS Out of 488 eligible DES members, a total of 152 (31.2%) respondents were included in the analysis. The majority (94.1%) of responding DES members use LT4 as the treatment of choice. Other treatment options for hypothyroidism are also used, as 58.6% prescribe combination therapy with liothyronine (LT3) + LT4 in their clinical practice. LT4 + LT3 combination is preferred in patients with persistent symptoms of hypothyroidism despite biochemical euthyroidism on LT4 treatment. Over half of the respondents answered that thyroid hormone therapy is never indicated for euthyroid patients, but 42.1% will consider it for euthyroid infertile women with high antibody levels. In various conditions that could interfere with the absorption of LT4, most responding Danish endocrinologists prefer tablets and do not expect a significant difference when switching from one type of tablet formulation to another. CONCLUSION The treatment of choice for hypothyroidism is LT4. Combination therapy with LT4 + LT3 is considered for patients with persistent symptoms. Even in the presence of conditions affecting bioavailability, responding Danish endocrinologists prefer LT4 tablets rather than newer LT4 formulations, such as soft-gel capsules.
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Affiliation(s)
- K R Riis
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | - J S Frølich
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - L Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - R Negro
- Division of Endocrinology, V. Fazzi Hospital, Lecce, Italy
| | - R Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy
| | - E V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - E Papini
- Department of Endocrinology and Metabolism, Opsedale Regina Apostolorum, Rome, Italy
| | - P Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - S J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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14
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Thvilum M, Brandt F, Lillevang-Johansen M, Folkestad L, Brix TH, Hegedüs L. Increased risk of dementia in hypothyroidism: A Danish nationwide register-based study. Clin Endocrinol (Oxf) 2021; 94:1017-1024. [PMID: 33484007 DOI: 10.1111/cen.14424] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Globally, the prevalence of individuals with dementia is increasing, and identification of risk factors is of paramount interest. Using population-based registers, we evaluated whether hypothyroidism is a risk factor for dementia. DESIGN Register-based cohort study. PATIENTS AND METHODS Risk of dementia was evaluated in two cohorts. The DNPR cohort comprises 111,565 hypothyroid patients, diagnosed between 1995 and 2012, and 446,260 euthyroid age- and sex-matched individuals (median follow-up 6.2 years). The OPENTHYRO cohort comprises 233,844 individuals with at least one measurement of serum thyrotropin (TSH) between 1995 and 2011, of whom 2,894 had hypothyroidism (median follow-up 7.2 years). Primary outcome was dementia defined as an International Classification of Diseases 10 code, or prescription of medicine for dementia. RESULTS In the DNPR cohort, risk of dementia was significantly increased in subjects with hypothyroidism (HR 1.22; 95% CI: 1.17-1.27), which attenuated after adjusting for pre-existing comorbidity (HR 0.82; 95% CI: 0.79-0.86). Stratification of age into ≤56 and >56 years showed an inverse relationship between age and risk of dementia (HR≤56 years. 2.03; 95% CI: 1.62-2.53 and HR>56 years . 1.00; 95% CI: 0.96-1.05). In the OPENTHYRO cohort, the risk of dementia was significantly increased for each 6 months of elevated TSH (HR 1.12; 95% CI: 1.07-1.16). CONCLUSIONS Hypothyroidism is associated with increased risk of dementia. The association is influenced by comorbidity and age. Every 6 months of elevated TSH increased the risk of dementia by 12%, suggesting that also the length of hypothyroidism influences the risk of dementia.
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Affiliation(s)
- Marianne Thvilum
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mads Lillevang-Johansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas H Brix
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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15
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Mitchell AL, Hegedüs L, Žarković M, Hickey JL, Perros P. Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation. Clin Endocrinol (Oxf) 2021; 94:513-520. [PMID: 32978985 DOI: 10.1111/cen.14340] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. DESIGN AND PATIENTS We conducted an online survey of individuals with self-reported hypothyroidism. RESULTS Nine hundred sixty-nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L-T4) and liothyronine (L-T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L-T4 or L-T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L-T4 + L-T3 or L-T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L-T4 (P < .001) and expectations for more support from the GP (P < .001), for L-T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L-T3 independently (P = .014), negative experiences with L-T4 (P = .013), having expectations for L-T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006). CONCLUSIONS Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.
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Affiliation(s)
- Anna L Mitchell
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- British Thyroid Foundation, Harrogate, UK
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Miloš Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- British Thyroid Foundation, Harrogate, UK
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Nordqvist SF, Boesen VB, Rasmussen ÅK, Feldt-Rasmussen U, Hegedüs L, Bonnema SJ, Cramon PK, Watt T, Groenvold M, Bjorner JB. Determining minimal important change for the thyroid-related quality of life questionnaire ThyPRO. Endocr Connect 2021; 10:316-324. [PMID: 33617467 PMCID: PMC8052573 DOI: 10.1530/ec-21-0026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE ThyPRO is the standard thyroid patient-reported outcome (PRO). The change in scores that patients perceive as important remains to be ascertained. The purpose of this study was to determine values for minimal important change (MIC) for ThyPRO. METHODS A total of 435 patients treated for benign thyroid diseases completed ThyPRO at baseline and 6 weeks following treatment initiation. At 6 weeks follow-up, patients also completed Global Rating of Change items. For each 0-100 scale, two MIC values were identified: An MIC for groups, using the receiver operating characteristic (ROC) curve method and an MIC for individual patients, using the Reliable Change Index. RESULTS ROC analyses provided group-MIC estimates of 6.3-14.3 (score range 0-100). Evaluation of area under the curve (AUC) supported the robustness for 9 of 14 scales (AUC > 0.7). Reliable Change Index estimates of individual-MIC were 8.0-21.1. For all scales but two, the individual-MIC values were larger than the group-MIC values. CONCLUSIONS Interpretability of ThyPRO was improved by the establishment of MIC values, which was 6.3-14.3 for groups and 8.0-21.1 for individuals. Thus, estimates of which changes are clinically relevant, are now available for future studies. We recommend using MIC values found by ROC analyses to evaluate changes in groups of patients, whereas MIC values identified by a dual criterion, including the reliability of changes, should be used for individual patients, for example, to identify individual responders in clinical studies or practice.
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Affiliation(s)
- Selma Flora Nordqvist
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Herlev Gentofte Hospital, Copenhagen, Denmark
- Correspondence should be addressed to T Watt:
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
- QualityMetric Incorporated, LLC, Johnston, Rhode Island, USA
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Nagy EV, Perros P, Papini E, Katko M, Hegedüs L. New Formulations of Levothyroxine in the Treatment of Hypothyroidism: Trick or Treat? Thyroid 2021; 31:193-201. [PMID: 33003978 DOI: 10.1089/thy.2020.0515] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Levothyroxine (LT4) as a medication is used by up to 5.3% of the adult population. For optimal efficacy, the traditional tablet formulation (LT4tab) requires that patients avoid concomitant ingestion with food, drinks, and certain medications, as well as excellent patient compliance. Some comorbidities influence bioavailability of LT4 and may mandate repeated dose adjustments. Summary: New LT4 formulations (soft gel [LT4soft] and liquid [LT4liq]) containing predissolved LT4 are claimed to improve bioavailability, presumably by facilitating absorption. Thus, these formulations may well be more suitable than LT4tab for patients whose daily requirements are subjected to variations in bioavailability. Here, we review the evidence and indications for use of new LT4 formulations and highlight areas of uncertainty that are worthy of further investigation. While bioequivalence is established for LT4soft and LT4liq administered to healthy volunteers compared with LT4tab in pharmacokinetic (PK) studies, therapeutic equivalence of the new formulations seems to be different in several clinical settings. Some evidence suggests that new formulations of LT4 may mitigate against the strict requirements relating to concomitant ingestion with food, drinks, and certain medications, which apply to traditional LT4 tablets. The principal indication is in selected patients with disease fluctuations and intermittent therapies with interfering medications, where the need for frequent dose adjustments and office visits may be diminished. Whether the use of LT4soft or LT4liq in patients with impaired gastric acid secretion results in better control of hypothyroidism than LT4tab remains unclear. Conclusions: The evidence in favor of using LT4soft and LT4liq in clinical practice over LT4tab is weak, and the underlying putative PK mechanisms unclear. Additional studies to investigate these potential benefits, define the cost-effectiveness, and understand the PK mechanisms involved with new LT4 formulations are needed.
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Affiliation(s)
- Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Monika Katko
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Obling ML, Nicolaisen P, Brix TH, Winther KH, Hansen S, Hegedüs L, Hermann AP, Bonnema SJ. Restoration of euthyroidism in women with Hashimoto's thyroiditis changes bone microarchitecture but not estimated bone strength. Endocrine 2021; 71:397-406. [PMID: 32623638 DOI: 10.1007/s12020-020-02398-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Fracture risk in hypothyroid patients is debated, and since the effects of hypothyroidism on bone microarchitecture and strength are unclarified, we investigated these characteristics by high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Two approaches were used: a cross-sectional control study, comparing 32 hypothyroid women (mean age; 47 ± 12 years) suffering from Hashimoto's thyroiditis with 32 sex-, age-, and menopause-matched healthy controls; a prospective study, where 27 of the women were reexamined 1 year after restoration of euthyroidism. HR-pQCT of the distal radius and tibia, and dual-energy X-ray absorptiometry (DXA) of the spine and hip were performed. Bone strength was estimated using a finite element analysis (FEA). RESULTS Cross-sectional control study: in the radius, total (mean 14.6 ± 29.3% (SD); p = 0.04) and trabecular bone areas (19.8 ± 37.1%, p = 0.04) were higher, and cortical volumetric bone mineral density (vBMD) lower (-2.2 ± 6.5%, p = 0.032) in hypothyroid patients than in controls. All indices of tibia cortical and trabecular vBMD, microarchitecture, and estimated bone strength were similar between groups, as was hip and spine areal BMD (aBMD). Prospective study: in the radius, mean cortical (-0.9 ± 1.8%, p = 0.02) and trabecular (-1.5 ± 4.6%, p = 0.02) vBMD decreased, and cortical porosity increased (18.9 ± 32.7%, p = 0.02). In the tibia, mean total vBMD (-1.1 ± 1.9%, p = 0.01) and cortical vBMD (-0.8 ± 1.4%, p = 0.01) decreased, while cortical porosity (8.2 ± 11.5%, p = 0.002) and trabecular area (0.2 ± 0.6%, p = 0.047) increased. No changes in FEA were detected. Lumbar spine aBMD decreased (-1.3 ± 3.0%, p = 0.04). CONCLUSIONS Hypothyroidism was associated with an increased trabecular bone area and a lower mineral density of cortical bone in the radius, as assessed by HR-pQCT. Restoration of euthyroidism mainly increased cortical porosity, while estimated bone strength was unaffected.
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Affiliation(s)
- Maria Lohman Obling
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pia Nicolaisen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Stinus Hansen
- Department of Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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19
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Planck T, Lantz M, Perros P, Papini E, Attanasio R, Nagy EV, Hegedüs L. Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A 2020 THESIS Questionnaire Survey of Members of the Swedish Endocrine Society. Front Endocrinol (Lausanne) 2021; 12:795111. [PMID: 34938274 PMCID: PMC8687360 DOI: 10.3389/fendo.2021.795111] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The standard treatment of hypothyroidism is levothyroxine (LT-4). However, there are several controversies regarding treatment of hypothyroid patients. AIM To investigate the Swedish endocrinologists' use of thyroid hormones in hypothyroid and euthyroid individuals. METHODS Physician members of the Swedish Endocrine Society (SEF) were invited by e-mail to participate in an online survey investigating this topic. RESULTS Out of the eligible 411 members, 116 (28.2%) responded. The majority (98.9%) stated that L-T4 is the treatment of choice. However, around 50% also prescribed liothyronine (L-T3) or a combination of L-T4+L-T3 in their practice. Combination therapy was mostly (78.5%) used in patients with persistent hypothyroid symptoms despite biochemical euthyroidism on L-T4 treatment. Most respondents prescribed L-T4 tablets and did not expect any major changes with alternative formulations such as soft-gel capsules or liquid formulations in situations influencing the bioavailability of L-T4. In euthyroid patients, 49.5% replied that treatment with thyroid hormones was never indicated, while 47.3% would consider L-T4 for euthyroid infertile women with high thyroid peroxidase (TPO) antibody levels. CONCLUSION The treatment of choice for hypothyroidism in Sweden is L-T4 tablets. Combination therapy with L-T4+L-T3 tablets was considered for patients with persistent symptoms despite biochemical euthyroidism. Soft-gel capsules and liquid solutions of L-T4 were infrequently prescribed. Swedish endocrinologists' deviation from endocrine society guidelines merits further study.
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Affiliation(s)
- Tereza Planck
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- *Correspondence: Tereza Planck,
| | - Mikael Lantz
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Roberto Attanasio
- Endocrine Unit, Institutes for Care and Scientific Research (IRCCS) Orthopedic Institute Galeazzi, Milan, Italy
| | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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20
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Sohn SY, Seo GH, Chung JH. Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study. Front Endocrinol (Lausanne) 2021; 12:680647. [PMID: 34054737 PMCID: PMC8155625 DOI: 10.3389/fendo.2021.680647] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although hypothyroidism is associated with various comorbidities, its relationship with increased all-cause mortality remains controversial. The aim of this nationwide retrospective cohort study was to investigate whether hypothyroid patients treated with levothyroxine had increased mortality compared to controls. METHODS Hypothyroid subjects were identified through the Korean National Health Insurance Service Claims database between 2008 and 2017. Hypothyroidism in this study was defined as overt hypothyroidism treated with long-term prescription of levothyroxine (>6 months). After 1:3 age-, sex- and index year-matching, 501,882 patients with newly diagnosed hypothyroidism and 1,505,646 controls without hypothyroidism were included. RESULTS During a mean follow-up of 6 years, 25,954 (5.2%) hypothyroid patients and 59,105 (3.9%) controls died. Hypothyroidism was significantly associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI] 1.12-1.16) even with levothyroxine treatment. When stratified by age, sex, and cardiovascular disease risk, independent associations between hypothyroidism and mortality remained significant in all subgroups. The risk of mortality was higher in the < 65 age group (HR: 1.25, 95% CI: 1.22-1.29), men (HR: 1.28, 95% CI: 1.25-1.31), and the high cardiovascular disease risk group (HR: 1.31, 95% CI: 1.29-1.34). The mortality rate of hypothyroid patients was highest within 1 year of treatment and decreased with time. CONCLUSION This nationwide, population-based cohort study showed that all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls. This association remained significant regardless of age, sex, and cardiovascular disease risk.
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Affiliation(s)
- Seo Young Sohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Gi Hyeon Seo
- Department of Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine and Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jae Hoon Chung,
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21
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Al Quran T, Bataineh Z, Al-Mistarehi AH, Okour A, Beni Yonis O, Khassawneh A, AbuAwwad R, Al Qura'an A. Quality of life among patients on levothyroxine: A cross-sectional study. Ann Med Surg (Lond) 2020; 60:182-187. [PMID: 33163174 PMCID: PMC7607046 DOI: 10.1016/j.amsu.2020.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/17/2020] [Accepted: 10/18/2020] [Indexed: 10/25/2022] Open
Abstract
Background Thyroid disorders affect the life quality of patients in various aspects. The present work aims at investigating the effect of thyroid hormonal status on the quality of life (QoL) among patients receiving Levothyroxine at the level of primary healthcare. Methods All patients receiving Levothyroxine at an academic primary healthcare center were included in a cross-sectional evaluation. QoL was measured by the Thyroid-Related Patient-Reported Outcome questionnaire (ThyPRO). The conducted analysis was based on the last thyroid hormones level during the last year and questionnaire scores where higher scores indicated lower QoL. Results We included 127 patients; all domains of their QoL questionnaire were affected. The highest scored domain of the ThyPRO was tiredness, while the least was goiter symptoms. An association between the affected QoL and thyroid hormones could not be built. Certain domains of the ThyPRO were influenced by the existence of comorbid diseases. Conclusions QoL was impacted in patients receiving Levothyroxine, regardless of hormonal status. Management of comorbid diseases and patients' concerns are advised to be taken into consideration to achieve a satisfying treatment. We highly recommend the integration of health life quality assessments in primary health care systems.
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Affiliation(s)
- Thekraiat Al Quran
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Bataineh
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulhakeem Okour
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Othman Beni Yonis
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Adi Khassawneh
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana AbuAwwad
- Department of Public Health and Family medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Anood Al Qura'an
- Department of Internal Medicine, Jordanian Royal Medical Services, Amman, Jordan
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Radiation-Induced Hypothyroidism in Patients with Oropharyngeal Cancer Treated with IMRT: Independent and External Validation of Five Normal Tissue Complication Probability Models. Cancers (Basel) 2020; 12:cancers12092716. [PMID: 32971838 PMCID: PMC7563778 DOI: 10.3390/cancers12092716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/12/2020] [Accepted: 09/19/2020] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Hypothyroidism is a common complication of therapeutic irradiation in the neck area. Several dose-response models have been proposed to predict its’ occurrence based on clinical and radiomic features. We aimed to externally validate the results of five such models in a prospectively recruited cohort of 108 patients with oropharyngeal cancer. Two of the evaluated models, published by Rønjom et al. and by Boomsma et al., had satisfactory performance. Both models are based on mean thyroid dose and thyroid volume. Three remaining models, by Cella et al., Bakhshandeh et al. and Vogelius et al., performed significantly worse. Short-term change in the level of thyroid-stimulating hormone (TSH) after radiation therapy was not indicative of hypothyroidism development in long term. We conclude that the models by Rønjom et al. and by Boomsma et al. are feasible for long-term prediction of hypothyroidism in oropharyngeal cancer survivors treated with intensity-modulated radiation therapy. Abstract We aimed to externally validate five normal tissue complication probability (NTCP) models for radiation-induced hypothyroidism (RIHT) in a prospectively recruited cohort of 108 patients with oropharyngeal cancer (OPC). NTCP scores were calculated using original published formulas. Plasma thyrotropin (TSH) level was additionally assessed in the short-term after RT. After a median of 28 months of follow-up, thirty one (28.7%) patients developed RIHT. Thyroid mean dose and thyroid volume were significant predictors of RIHT: odds ratio equal to 1.11 (95% CI 1.03–1.19) for mean thyroid dose and 0.87 (95%CI 0.81–0.93) for thyroid volume in univariate analyses. Two of the evaluated NTCP models, published by Rønjom et al. and by Boomsma et al., had satisfactory performance with accuracies of 0.87 (95%CI 0.79–0.93) and 0.84 (95%CI: 0.76–0.91), respectively. Three remaining models, by Cella et al., Bakhshandeh et al. and Vogelius et al., performed significantly worse, overestimating the risk of RIHT in this patient cohort. A short-term TSH level change relative to baseline was not indicative of RIHT development in the follow-up (OR 0.96, 95%CI: 0.65–1.42, p = 0.825). In conclusion, the models by Rønjom et al. and by Boomsma et al. demonstrated external validity and feasibility for long-term prediction of RIHT in survivors of OPC treated with Intensity-Modulated Radiation Therapy (IMRT).
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Alam MA, Quamri MA, Sofi G, Ansari S. Update of hypothyroidism and its management in Unani medicine. J Basic Clin Physiol Pharmacol 2020; 32:1-10. [PMID: 32776903 DOI: 10.1515/jbcpp-2020-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
Hypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.
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Affiliation(s)
- Md Anzar Alam
- Department of Moalajat, National Institute of Unani Medicine, Bangalore, India
| | | | - Ghulamuddin Sofi
- Department of Ilmul Advia, National Institute of Unani Medicine, Bangalore, India
| | - Shabnam Ansari
- Department of Biotechnology, Natural Sciences, Jamia Millia Islamia, Central University, New Delhi, India
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Tsai TY, Tu YK, Munir KM, Lin SM, Chang RHE, Kao SL, Loh CH, Peng CCH, Huang HK. Association of Hypothyroidism and Mortality in the Elderly Population: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5661569. [PMID: 31829418 DOI: 10.1210/clinem/dgz186] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT The evidence of whether hypothyroidism increases mortality in the elderly population is currently inconsistent and conflicting. OBJECTIVE The objective of this meta-analysis is to determine the impact of hypothyroidism on mortality in the elderly population. DATA SOURCES PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched from inception until May 10, 2019. STUDY SELECTION Studies evaluating the association between hypothyroidism and all-cause and/or cardiovascular mortality in the elderly population (ages ≥ 60 years) were eligible. DATA EXTRACTION Two reviewers independently extracted data and assessed the quality of the studies. Relative risk (RR) was retrieved for synthesis. A random-effects model for meta-analyses was used. DATA SYNTHESIS A total of 27 cohort studies with 1 114 638 participants met the inclusion criteria. Overall, patients with hypothyroidism experienced a higher risk of all-cause mortality than those with euthyroidism (pooled RR = 1.26, 95% CI: 1.15-1.37); meanwhile, no significant difference in cardiovascular mortality was found between patients with hypothyroidism and those with euthyroidism (pooled RR = 1.10, 95% CI: 0.84-1.43). Subgroup analyses revealed that overt hypothyroidism (pooled RR = 1.10, 95% CI: 1.01-1.20) rather than subclinical hypothyroidism (pooled RR = 1.14, 95% CI: 0.92-1.41) was associated with increased all-cause mortality. The heterogeneity primarily originated from different study designs (prospective and retrospective) and geographic locations (Europe, North America, Asia, and Oceania). CONCLUSIONS Based on the current evidence, hypothyroidism is significantly associated with increased all-cause mortality instead of cardiovascular mortality among the elderly. We observed considerable heterogeneity, so caution is needed when interpreting the results. Further prospective, large-scale, high-quality studies are warranted to confirm these findings.
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Affiliation(s)
- Tou-Yuan Tsai
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Kashif M Munir
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shu-Man Lin
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Sheng-Lun Kao
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ching-Hui Loh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Carol Chiung-Hui Peng
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland
| | - Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Møllehave LT, Skaaby T, Linneberg A, Knudsen N, Jørgensen T, Thuesen BH. The association of thyroid stimulation hormone levels with incident ischemic heart disease, incident stroke, and all-cause mortality. Endocrine 2020; 68:358-367. [PMID: 32040823 DOI: 10.1007/s12020-020-02216-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Thyroid dysfunction may affect the risk of cardiovascular disease and mortality through effects on myocardial and vascular tissue and metabolism. Levels of thyroid stimulating hormone (TSH) indicates thyroid function. We aimed to assess the association between TSH-levels and incident ischemic heart disease (IHD), incident stroke, and all-cause mortality. METHODS We included 13,865 participants (18-71 years, 51.6% women) from five cohort studies conducted during 1974-2008 were included. TSH was measured at the baseline examination and classified as <0.4; 0.4-2.5 (ref.); 2.5-5.0; 5.0-10, or >10 mU/l. Incident IHD, incident stroke, and all-cause mortality were identified in registries until ultimo 2013. Data were analysed by multivariate Cox regression with age as underlying time axis. Results from the individual cohorts were pooled by random-effects meta-analysis. RESULTS The crude incidence rate was for IHD 7.8 cases/1000 person years (PY); stroke 5.4 cases/1000 PY; and all-cause mortality 11.3 deaths/1000 PY (mean follow-up: 14 years). Analyses showed no statistically significant associations between TSH-levels and incident IHD or incident stroke in the partly or fully adjusted models. There was a statistically significant association between TSH of 2.5-5 mU/l and all-cause mortality (hazard ratio 1.145 (95% CI 1.004-1.306) compared with TSH of 0.4-2.5 mU/l in the fully adjusted model. CONCLUSION The results do not provide evidence of a harmful effect of decreased or increased TSH on IHD or stroke in the general population. However, there is some indication of an elevated risk for all-cause mortality with TSH 2.5-5 mU/l compared with 0.4-2.5 mU/l.
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Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark.
| | - Tea Skaaby
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Betina Heinsbæk Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Capital Region, Denmark
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the association of thyroid function with metabolic syndrome (MetS). RECENT FINDINGS Although thyroid hormones even within low normal range are associated with various metabolic abnormalities, the risk of MetS remains a controversial issue. Hyperthyroid state might be associated only with insulin resistance and dysglycemia. Autoimmune thyroid diseases may be a potential risk factor for metabolic abnormalities even in those with low normal thyroid function. SUMMARY The interrelation between thyroid stimulating hormone, free T3, freeT4 and metabolic parameters is complex and might be affected by age, sex, BMI, insulin resistance, smoking, iodine intake and inflammatory markers.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto’s disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world’s most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4–4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine. Funding: Merck. Plain Language Summary: Plain language summary available for this article. Hypothyroidism is one of the most common diseases worldwide, and levothyroxine is the usual medication prescribed to manage it. Hypothyroidism occurs when the thyroid gland, located in the neck, does not produce enough thyroid hormone for the body’s requirements. This can result in heart disease, infertility, and poor brain development in children. People with hypothyroidism may have changes in body weight, and feel tired, weak or unhappy, all of which can reduce their quality of life. In underdeveloped parts of the world, the main reason why people develop hypothyroidism is that they not getting enough iodine from food. Thus, many countries try to increase iodine intake by adding iodine to salt. In areas of the world where people ingest enough iodine, the most common cause of hypothyroidism is Hashimoto’s disease. This is an autoimmune disease in which the person’s immune system produces cells and antibodies that attack the thyroid gland. Most people with hypothyroidism will need to take levothyroxine for a long time, perhaps even for the rest of their lives. Levothyroxine replaces the person’s levels of thyroid hormone and makes them feel better, but the dose often needs to be adjusted for the best effect. In addition, many people with hypothyroidism do not know they have it. Research is ongoing to ensure that more people with hypothyroidism are diagnosed and are given effective treatment, and to work out the best way to use levothyroxine so that patients get the best results.
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Affiliation(s)
- Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
| | - Flavia Magri
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Heiberg Brix T, Ferløv-Schwensen C, Thvilum M, Hegedüs L. Death by unnatural causes, mainly suicide, is increased in patients with Hashimoto's thyroiditis. A nationwide Danish register study. Endocrine 2019; 65:616-622. [PMID: 31065912 DOI: 10.1007/s12020-019-01946-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Hashimoto's thyroiditis (HT) is associated with excess psychiatric in addition to reduced quality of life. However, little is known about risk of unnatural manners of death in HT. We investigated the risk of death by accidents, suicide, violence/homicide, and unknown causes in patients with HT, compared to a matched control population. METHODS Register study covering all adult Danes diagnosed with HT during 1995-2012. In total, 111,565 HT cases were identified and matched for age and sex with four euthyroid controls. The hazard ratios (HR) for mortality were calculated using Cox regression analyses, adjusted for pre-existing morbidity. Median follow-up time was 5.9 years (range 0-17.5). RESULTS Compared to controls, HT patients had an increased frequency of death by suicide (0.10% vs 0.07%, p < 0.001) and unknown manners (0.05% vs 0.02%, p < 0.001). There were no significant differences between controls and HT patients in risk of death by accidents (0.36% vs 0.37%, p = 0.384) or violence (0.004% vs 0.005%, p = 0.749). After adjustment for pre-existing somatic and psychiatric morbidity HT patients still had an increased risk of suicide and death by unknown causes, whereas risk of death caused by accidents was reduced. CONCLUSIONS Mortality due to suicide and unknown causes, but not accidents and violence, was increased in HT. This indicates that HT may have a significant role in the pathophysiological mechanisms of suicidal behavior. This suggests that physicians caring for HT patients should be vigilant when facing expressions of suicidal ideation or signs and symptoms of self-harm as a first step towards prevention.
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Affiliation(s)
- Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, DK-5000, Odense, Denmark
| | - Charlotte Ferløv-Schwensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, DK-5000, Odense, Denmark
| | - Marianne Thvilum
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, DK-5000, Odense, Denmark.
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, DK-5000, Odense, Denmark
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Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L. Duration of over- and under-treatment of hypothyroidism is associated with increased cardiovascular risk. Eur J Endocrinol 2019; 180:407-416. [PMID: 31035256 DOI: 10.1530/eje-19-0006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/26/2019] [Indexed: 01/07/2023]
Abstract
Objective To investigate the association between hypothyroidism and cardiovascular disease (CVD) in both treated and untreated hypothyroid patients, and the consequences of over- and under-treatment with respect to cardiovascular risk. Design A registry-based case-control study nested within a population-based cohort of 275 467 individuals with at least one serum thyroid stimulating hormone (TSH) measurement in the period of 1995-2011. Methods Incident cases of CVD were matched with controls according to gender, age and year of birth. Conditional logistic regression analyses were performed to calculate CVD risks associated with exposure to hypothyroidism, with adjustment for 19 pre-existing comorbidities, including cardiovascular disease and diabetes, using the Charlson Comorbidity Index. Results Overall, 20 487 individuals experienced CVD (9.4%, incidence rate 13.1 per 1000 person-years, 95% confidence interval (CI), 13.0-13.3). Risk of CVD was increased in untreated hypothyroidism compared to euthyroidism (odds ratio (OR): 1.83 (95% CI: 1.43-2.35; P < 0.001)). Cardiovascular risk was increased in both treated and untreated hypothyroid individuals per half year of elevated TSH (OR: 1.11 (95% CI: 1.06-1.16; P < 0.001) and OR: 1.15 (95% CI: 1.09-1.23; P = 0.001), respectively). In patients treated with levothyroxine, OR for CVD was 1.12 (95% CI: 1.06-1.18; P < 0.001) for each 6 months of decreased TSH. Conclusion Cardiovascular risk is increased in untreated, but not in treated hypothyroid patients. Among those with treated hypothyroidism, duration of decreased TSH (overtreatment) had a similar impact on cardiovascular risk as duration of elevated TSH (under-treatment), highlighting the importance of initiating treatment and maintaining biochemical euthyroidism in hypothyroid patients in order to reduce the risk of CVD and death.
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Affiliation(s)
- Mads Lillevang-Johansen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network OPEN, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henrik Løvendahl Jørgensen
- Department of Clinical Biochemistry, Hvidovre Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Functional and Symptomatic Individuality in the Response to Levothyroxine Treatment. Front Endocrinol (Lausanne) 2019; 10:664. [PMID: 31616383 PMCID: PMC6775211 DOI: 10.3389/fendo.2019.00664] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background: For significant numbers of patients dissatisfied on standard levothyroxine (LT4) treatment for hypothyroidism, patient-specific responses to T4 could play a significant role. Aim: To assess response heterogeneity to LT4 treatment, identifying confounders and hidden clusters within a patient panel, we performed a secondary analysis using data from a prospective cross-sectional and retrospective longitudinal study. Methods: Multivariate and multivariable linear models adjusted for covariates (gender, age, and BMI) were stratified by disease-specific treatment indication. During follow-up, pooled observations were compared from the same patient presenting either with or without self-reported symptoms. Statistical analysis was extended to multilevel models to derive intra-class correlation coefficients and reliability measures during follow-up. Results: Equilibria between TSH, FT4, and FT3 serum concentrations in 342 patients were examined by treatment indication (benign goiter, autoimmune thyroiditis, thyroid carcinoma), consequently displaying complex interactive response patterns. Seventy-seven patients treated with LT4 and monitored for thyroid carcinoma presented, in association with changes in LT4 dose, either with hypothyroid symptoms or symptom-free. Significant biochemical differences appeared between the different presentations. Leveled trajectories by subject to relief from hypothyroid symptoms differed significantly, indicating distinct responses, and denying a single shared outcome. These were formally defined by a high coefficient of the intraclass correlation (ICC1, exceeding 0.60 in all thyroid parameters) during follow-up on multiple visits at the same LT4 dose, when lacking symptoms. The intra-personal clusters were clearly differentiated from random variability by random group resampling. Symptomatic change in these patients was strongly associated with serum FT3, but not with FT4 or TSH concentrations. In 25 patients transitioning from asymptomatic to symptomatically hyperthyroid, FT3 concentrations remained within the reference limits, whilst at the same time marked biochemical differences were apparent between the presentations. Conclusions: Considerable intra-individual clustering occurred in the biochemical and symptomatic responses to LT4 treatment, implying statistically multileveled response groups. Unmasking individual differences in the averaged treatment response hereby highlights clinically distinguishable subgroups within an indiscriminate patient panel. This, through well-designed larger clinical trials will better target the different therapeutic needs of individual patients.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
- *Correspondence: Rudolf Hoermann
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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Hansen L, Judge A, Javaid MK, Cooper C, Vestergaard P, Abrahamsen B, Harvey NC. Social inequality and fractures-secular trends in the Danish population: a case-control study. Osteoporos Int 2018; 29:2243-2250. [PMID: 29946757 PMCID: PMC6140998 DOI: 10.1007/s00198-018-4603-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED We examined links between markers of social inequality and fracture risk in the Danish population, demonstrating that high income and being married are associated with a significantly lower risk. INTRODUCTION We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries. METHODS All patients 50 years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10 S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate. RESULTS A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality. CONCLUSION In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.
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Affiliation(s)
- L Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - A Judge
- University of Bristol, Bristol, England
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - C Cooper
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - P Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - B Abrahamsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Odense Exploratory Patient Network (OPEN), University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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Huang HK, Wang JH, Kao SL. Association of Hypothyroidism With All-Cause Mortality: A Cohort Study in an Older Adult Population. J Clin Endocrinol Metab 2018; 103:3310-3318. [PMID: 29947768 DOI: 10.1210/jc.2018-00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Although hypothyroidism is associated with many comorbidities, the evidence for its association with all-cause mortality in older adults is limited. OBJECTIVE To evaluate the association between hypothyroidism and all-cause mortality in older adults. DESIGN Population-based retrospective cohort study. SETTING National Health Insurance Research Database in Taiwan. PATIENTS After 1:10 age/sex/index year matching, 2029 patients aged ≥65 years who received a new diagnosis of hypothyroidism between 2001 and 2011 and 20,290 patients without hypothyroidism or other thyroid diseases were included in the hypothyroidism and nonhypothyroidism cohorts, respectively. MAIN OUTCOME MEASURES All-cause mortality was defined as the primary outcome. Cox proportional hazards regression models were used to calculate the hazard ratios of mortality. To further evaluate the effect of thyroxine replacement therapy (TRT) on mortality, we divided patients with hypothyroidism into two groups: patients who received TRT and those who did not. RESULTS Hypothyroidism was associated with an increased risk of all-cause mortality [adjusted hazard ratio (aHR), 1.82; 95% CI, 1.68 to 1.98; P < 0.001]. Patients with hypothyroidism who received TRT had a lower risk of mortality than patients who did not receive TRT (aHR, 0.57; 95% CI, 0.49 to 0.66; P < 0.001). Similar results were obtained after further propensity score matching in age-, sex-, and comorbidity-stratified analyses. CONCLUSIONS Hypothyroidism was independently associated with increased all-cause mortality in older adults. In patients with hypothyroidism, TRT was associated with a lower risk of all-cause mortality.
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Affiliation(s)
- Huei-Kai Huang
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Sheng-Lun Kao
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L. Over- and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality: A Register-Based Cohort Study. Thyroid 2018; 28:566-574. [PMID: 29631518 DOI: 10.1089/thy.2017.0517] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study investigated the association between hypothyroidism and mortality in both treated and untreated hypothyroid patients, and the consequences of over- and under-treatment with respect to mortality. PATIENTS AND METHODS This was a register-based cohort study of 235,168 individuals who had at least one serum thyrotropin (TSH) during 1995-2011 (median follow-up 7.2 years). Hypothyroidism was defined as at least two measurements of TSH >4.0 mIU/L within a half year spaced by at least 14 days, or one measurement of TSH >4.0 mIU/L and two filled prescriptions of levothyroxine the following year. All-cause mortality rates were calculated using multivariable Cox regression analysis adjusted for age, sex, and comorbidities using the Charlson Comorbidity Index. RESULTS Mortality was increased in untreated hypothyroid individuals (n = 673; hazard ratio [HR] = 1.46 [confidence interval (CI) 1.26-1.69]; p < 0.001) compared to euthyroid controls. Results remained significant even when subdividing according to mild (TSH >4.0 mIU/L and ≤10 mIU/L; p < 0.001) and marked hypothyroidism (TSH >10 mIU/L; p = 0.002). Mortality was increased in both treated and untreated hypothyroid individuals for each six months a patient had increased TSH (HR = 1.05 [CI 1.02-1.07], p < 0.0001, and HR = 1.05 [CI 1.02-1.07], p = 0.0009, respectively). In patients who received levothyroxine, the HR for mortality increased by a factor 1.18 ([CI 1.15-1.21]; p < 0.0001) for each six months a patient exhibited decreased TSH. This finding was essentially unchanged after stratification by disease severity (mild or marked hypothyroidism) and age (older and younger than 65 years). CONCLUSIONS Mortality was increased in untreated but not in treated hypothyroid individuals, independently of age and severity of hypothyroidism. Duration of decreased TSH in treated individuals had a greater impact on mortality than did duration of elevated TSH. These results stress the need for close monitoring of treatment in individuals receiving thyroid hormone replacement therapy.
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Affiliation(s)
- Mads Lillevang-Johansen
- 1 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
- 2 Institute of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - Bo Abrahamsen
- 2 Institute of Clinical Research, University of Southern Denmark , Odense, Denmark
- 3 Odense Patient data Explorative Network OPEN, University of Southern Denmark , Odense, Denmark
- 4 Department of Medicine, Holbæk Hospital , Holbæk, Denmark
| | - Henrik Løvendahl Jørgensen
- 5 Department of Clinical Biochemistry, Hvidovre Hospital , Copenhagen, Denmark
- 6 Department of Clinical Medicine, University of Copenhagen , Denmark
| | - Thomas Heiberg Brix
- 1 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Laszlo Hegedüs
- 1 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
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Zahan A, Watt T, Pascanu I, Rasmussen A, Hegedüs L, Bonnema S, Feldt-Rasmussen U, Bjorner J, Nadasan V, Boila A, Merlan I, Borda A. THE ROMANIAN VERSION OF THE THYROID-RELATED PATIENT-REPORTED OUTCOMES THYPRO AND THYPRO-39. TRANSLATION AND ASSESSMENT OF RELIABILITY AND CROSS-CULTURAL VALIDITY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:192-200. [PMID: 31149257 PMCID: PMC6516517 DOI: 10.4183/aeb.2018.192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND ThyPRO is a recently developed thyroid-specific quality of life (QoL) questionnaire applicable to patients with benign thyroid disorders(BTD). The aim of the present study was to translate ThyPRO and ThyPRO-39 into Romanian, and to evaluate reliability and cross-cultural validity. METHODS Standard methodology for translation and linguistic validation of patient-reported outcomes (PRO) was applied. The questionnaire was completed by 130 patients with benign thyroid diseases seen at Department of Endocrinology in the Emergency County Hospital, Tîrgu Mureş, Romania, between October 2015 and March 2016. Internal reliability of the Romanian version of the ThyPRO (ThyPROro) scales was assessed for multi-item scales using Cronbach's alpha coefficient. An efficient method for testing cross-cultural validity is analysis of differential item functioning (DIF). Uniform DIF between the Romanian and the original Danish sample was investigated using ordinal logistic regression. The translation process proceeded without difficulties, and any disagreements were revised by one of the developers and the language coordinator. RESULTS Internal reliability for ThyPRO was satisfactory. Cronbach`s alpha coefficients for the 13 scales ranged from 0.78 to 0.93 for the ThyPROro and 0.78 to 0.87 for the ThyPROro-39. In the 85-item ThyPRO, nine instances of DIF were found. Most were minor, explaining <3% of the variation in scale score, but DIF in positively worded items were larger, with explained variance (R2's) around 10-15%. CONCLUSION The ThyPROro questionnaire is ready for assessment of health-related quality of life in Romanian patients with benign thyroid diseases.
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Affiliation(s)
- A.E. Zahan
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - T. Watt
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - I. Pascanu
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - A.K. Rasmussen
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - L. Hegedüs
- Odense Universitetshospital, Odense, Denmark
| | | | - U. Feldt-Rasmussen
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - J.B. Bjorner
- Institute of Public Health, University of Copenhagen, Copenhagen,Denmark
| | - V. Nadasan
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Hygiene, Tirgu Mures, Romania
| | - A. Boila
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
| | - I. Merlan
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - A. Borda
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
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No evidence of a causal relationship between hypothyroidism and glaucoma: A Danish nationwide register-based cohort study. PLoS One 2018; 13:e0192311. [PMID: 29444121 PMCID: PMC5812610 DOI: 10.1371/journal.pone.0192311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background An interrelationship between hypothyroidism and glaucoma, due to a shared autoimmune background or based on deposition of mucopolysaccharides in the trabecular meshwork in the eye, has been suggested but is at present unsubstantiated. Therefore, our objective was to investigate, at a nationwide and population-based level, whether there is such an association. Subjects and methods Observational cohort study using record-linkage data from nationwide Danish health registers. 121,799 individuals diagnosed with a first episode of hypothyroidism were identified and were matched with 4 non-hypothyroid controls according to age and sex. Prevalence of glaucoma was recorded and cases and controls were followed over a mean of 7.1 years (range 0–17). Logistic and Cox regression models were used to assess the risk of glaucoma before and after the diagnosis of hypothyroidism, respectively. Results Overall, we found a higher prevalence of glaucoma in subjects with hypothyroidism as compared to controls (4.6% vs. 4.3%, p < 0.001). Prior to the diagnosis of hypothyroidism, the odds ratio (OR) was significantly increased for glaucoma [1.09; 95% confidence interval (CI): 1.04–1.13]. Based on the Cox regression model, there was no increased risk of glaucoma after the diagnosis of hypothyroidism [hazard ratio (HR) 1.00; 95% CI: 0.96–1.06], and the HR decreased further after adjusting for pre-existing co-morbidity (0.88; 95% CI: 0.84–0.93). Conclusions There was an increased risk of glaucoma before but not after the diagnosis of hypothyroidism, suggesting that screening for glaucoma in hypothyroid individuals is unwarranted.
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Brandt F, Thvilum M, Hegedüs L, Brix TH. Hyperthyroid patients without Graves' orbitopathy are not at increased risk of developing glaucoma: a nationwide Danish register-based case-control study. Endocrine 2018; 59:137-142. [PMID: 29198022 DOI: 10.1007/s12020-017-1485-0] [Citation(s) in RCA: 2] [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: 08/05/2017] [Accepted: 11/24/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Graves' disease (GD) and toxic nodular goiter (TNG) are associated with various comorbidities. However, it is unclarified whether TNG and GD without orbitopathy are associated with glaucoma. METHODS This was a case-control study using record-linkage data from nationwide Danish health registers. 28,461 patients with GD and 17,283 with TNG were included. Each case was age and sex matched with four non-hyperthyroid controls and followed over a mean period of 8 years. Data on glaucoma was obtained by record linkage within the National Danish Patient Register and/or the Danish National Prescription Registry. Logistic and Cox regression models were used to assess the risk of glaucoma before and after the diagnosis of GD and TNG. RESULTS Compared to controls, there was a significantly increased frequency of glaucoma in patients with GD (4.6 vs. 4.2%, P = 0.006) and in patients with TNG (6.2 vs. 5.7%, P = 0.003). Prior to the diagnosis of hyperthyroidism, the odds ratio (OR) for glaucoma was non-significant in GD (1.09, 95% CI: 1.00-1.18) but slightly increased in TNG (1.13, 95% CI: 1.02-1.24). However, in TNG the OR attenuated completely when only including patients without co-morbidity in the analysis (1.03, 95% CI: 0.93-1.14). After adjustment for pre-existing co-morbidity, the hazard ratio (HR) for glaucoma following GD and TNG was not significantly increased (HR 1.08, 95% CI: 0.98-1.18 and HR 1.10, 95% CI: 0.99-1.21, respectively). CONCLUSIONS Neither prior to nor following the diagnosis of GD and TNG had any significant association with glaucoma.
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Affiliation(s)
- F Brandt
- Department of Internal Medicine, Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark.
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000, Odense, Denmark.
| | - M Thvilum
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000, Odense, Denmark
| | - L Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000, Odense, Denmark
| | - T H Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000, Odense, Denmark
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Jørgensen P, Langhammer A, Krokstad S, Forsmo S. Mortality in persons with undetected and diagnosed hypertension, type 2 diabetes, and hypothyroidism, compared with persons without corresponding disease - a prospective cohort study; The HUNT Study, Norway. BMC FAMILY PRACTICE 2017; 18:98. [PMID: 29212453 PMCID: PMC5719734 DOI: 10.1186/s12875-017-0672-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
Background Suggested strategies in reducing the impact of non-communicable diseases (NCD) are early diagnosing and screening. We have limited proof of benefit of population screening for NCD. Increased mortality in persons with diagnosed NCD has been shown for decades. However, mortality in undetected NCD has barely been studied. This paper explores whether all-cause mortality differed between persons with diagnosed hypothyroidism, type 2 diabetes (T2DM), and hypertension, compared with persons with undetected-, and with persons without the corresponding disease. Methods A prospective cohort study of the general population in Nord-Trøndelag, Norway. Persons ≥20 years at baseline 1995–97 were followed until death or June 15, 2016. Cox proportional hazards models were used to compute age and multiple adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between disease status and all-cause mortality. The number of participants in the hypothyroidism study was 31,960, in the T2DM study 37,957, and in the hypertension study 63,371. Results Mortality was increased in persons with diagnosed type 2 diabetes and hypertension, compared to persons without corresponding disease; HR 1.69 (95% CI 1.55–1.84) and HR 1.23 (95% CI 1.09–1.39), respectively. Among persons with undetected T2DM, the HR was 1.21 (95% CI 1.08–1.37), whilst among undetected hypothyroidism and hypertension, mortality was not increased compared with persons without the diseases. Further, the association with mortality was stronger in persons with long duration of T2DM (HR 1.96 (95% CI 1.57–2.44)) and hypertension (HR 1.32 (95% CI 1.17–1.49)), compared with persons with short duration (HR 1.29 (1.09–1.53) and HR 1.16 (1.03-1-30) respectively). Conclusions Mortality was increased in persons with diagnosed T2DM and hypertension, and in undetected T2DM, compared with persons without the diseases. The strength of the association with mortality in undetected T2DM was however lower compared with persons with diagnosed T2DM, and mortality was not increased in persons with undetected hypothyroidism and hypertension, compared with persons without the diseases. Thus, future research needs to test more thoroughly if early diagnosing of these diseases, such as general population screening, is beneficial for health.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600, Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
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Thvilum M, Brandt F, Brix TH, Hegedüs L. The interrelation between hypothyroidism and glaucoma: a critical review and meta-analyses. Acta Ophthalmol 2017; 95:759-767. [PMID: 28211200 DOI: 10.1111/aos.13412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/07/2017] [Indexed: 01/12/2023]
Abstract
Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case-control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757 patients) as exposure and hypothyroidism as outcome. Among these, we found a non-significantly increased risk of hypothyroidism associated with glaucoma (RR 1.65; 95% confidence interval [CI]: 0.97-2.82). Based on five studies (168 006 patients) with hypothyroidism as exposure and glaucoma as outcome, we found the risk of glaucoma to be significantly increased (RR 1.33; 95% CI: 1.13-1.58). Based on these meta-analyses, there seems to be an association between hypothyroidism and glaucoma, which does not seem to be the case between glaucoma and hypothyroidism. However, larger scale studies with better phenotype classification, longer follow-up and taking comorbidity and other biases into consideration are needed to address a potential causal relationship.
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Affiliation(s)
- Marianne Thvilum
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense C Denmark
| | - Frans Brandt
- Department of Internal Medicine; Hospital of Southern Denmark; Sonderborg Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense C Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism; Odense University Hospital; Odense C Denmark
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Akirov A, Shochat T, Shechvitz A, Shimon I, Diker-Cohen T, Robenshtok E. Pre-admission TSH levels predict long-term mortality in adults treated for hypothyroidism. Endocrine 2017; 58:481-487. [PMID: 29058108 DOI: 10.1007/s12020-017-1453-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Limited data is available regarding the association between pre-admission thyroid function and prognosis of hospitalized patients treated for hypothyroidism. OBJECTIVE Evaluate an association between thyroid stimulating hormone (TSH) levels and mortality in hospitalized levothyroxine-treated patients. DESIGN AND SETTING Observational data of patients admitted to medical wards between 2011 and 2013. TSH levels obtained up to 180 days prior to admission were stratified as follows: low (≤0.5 mIU/L), normal (0.5-5 mIU/L), high (>5 mIU/L). PATIENTS Patients aged 60-80 years with available thyroid function tests were matched with controls without hypothyroidism. MAIN OUTCOME All-cause mortality up to 66-months following discharge. RESULTS One thousand and fifty seven patients (73% females, mean (SD) age 71 ± 6 years) were matched with controls without hypothyroidism. Mean hospital stay and in-hospital mortality were not different between groups. Mortality risk at the end-of-follow-up was 41% (438/1057) and 37% (392/1057) for patients with and without hypothyroidism (p < 0.05). TSH levels were classified as follows: low, 84 patients (8%); normal, 667 patients (63%); high, 306 patients (29%). Length of hospitalization and in-hospital mortality were not different between TSH categories. Mortality risk at the end-of-follow-up was 30, 39, and 50% with low, normal and elevated TSH, respectively. Adjusted hazard ratio (95% CI) of mortality at the end-of-follow-up was of 2.2 (1.2-3.8) for high vs. low TSH levels, and 1.4 (1.1-1.9) for high vs. normal TSH levels. CONCLUSION In treated hypothyroid adult patients, increased TSH up to 6 months prior to admission is associated with increased mortality. Treatment should aim at achieving euthyroidism to improve survival.
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Affiliation(s)
- Amit Akirov
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tzipora Shochat
- Statistical Consulting Unit, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
| | - Amir Shechvitz
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Diker-Cohen
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine A, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
| | - Eyal Robenshtok
- Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Thvilum M, Brandt F, Brix TH, Hegedüs L. Month of birth is associated with the subsequent diagnosis of autoimmune hypothyroidism. A nationwide Danish register-based study. Clin Endocrinol (Oxf) 2017; 87:832-837. [PMID: 28727153 DOI: 10.1111/cen.13425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/28/2017] [Accepted: 07/15/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The triggering of thyroid autoimmunity in the genetically susceptible remains a conundrum. Environmental exposures during gestation and/or early postnatally have proponents, as suggested in diabetes mellitus, with a higher incidence of births during spring and summer. Whether the development of autoimmune hypothyroidism (AIT) is influenced by month or season of birth is less clear. METHOD Nationwide cohort study of 111 565 individuals diagnosed with AIT and four euthyroid controls per case, matched according to age and sex, were identified from Danish health registers. Differences in month of birth across the year were evaluated by the Walter-Elwood test. The risk of patients with AIT being born in a certain month or season of the year was calculated using a Cox regression model. RESULTS There was a significant difference in birth month between cases and controls, P<.001. Individuals with AIT had a significantly increased risk of being born in June (Hazard ratio 1.04; 95% Confidence interval (CI): 1.02-1.08) and in the summer (June-August; HR 1.02; 95%CI: 1.01-1.04). CONCLUSION In this large-scale nationwide cohort study, we found a higher risk of AIT when born in the summer season or more specifically in June, supporting the hypothesis that seasonal variations in exposures-gestationally and/or early postnatally-may contribute to the development of AIT.
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Affiliation(s)
- Marianne Thvilum
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense C, Denmark
| | - Frans Brandt
- Department of Internal Medicine, Hospital of Southern Denmark, Sonderborg, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense C, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense C, Denmark
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Bano A, Dhana K, Chaker L, Kavousi M, Ikram MA, Mattace-Raso FUS, Peeters RP, Franco OH. Association of Thyroid Function With Life Expectancy With and Without Cardiovascular Disease: The Rotterdam Study. JAMA Intern Med 2017; 177:1650-1657. [PMID: 28975207 PMCID: PMC5710266 DOI: 10.1001/jamainternmed.2017.4836] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Variations in thyroid function within reference ranges are associated with an increased risk of cardiovascular disease (CVD) and mortality. However, the impact of thyroid function on life expectancy (LE) and the number of years lived with and without CVD remains unknown. OBJECTIVE To investigate the association of thyroid function with total LE and LE with and without CVD among euthyroid individuals. DESIGN, SETTING, AND PARTICIPANTS The Rotterdam Study, a population-based, prospective cohort study. We included participants without known thyroid disease and with thyrotropin and free thyroxine (FT4) levels within the reference ranges. MAIN OUTCOMES AND MEASURES Multistate life tables were used to calculate total LE and LE with and without CVD among thyrotropin and FT4 tertiles. Life expectancy estimates in men and women aged 50 years and older were obtained using prevalence, incidence rates, and hazard ratios for 3 transitions (healthy to CVD, healthy to death, and CVD to death), adjusting for sociodemographic and cardiovascular risk factors. RESULTS The mean (SD) age of the 7785 participants was 64.7 (9.8) years, and 52.5% were women. Over a median follow-up of 8.1 (interquartile range, 2.7-9.9) years, we observed 789 incident CVD events and 1357 deaths. Compared with those in the lowest tertile, men and women in the highest thyrotropin tertile lived 2.0 (95% CI, 1.0 to 2.8) and 1.4 (95% CI, 0.2 to 2.4) years longer, respectively, of which, 1.5 (95% CI, 0.2 to 2.6) and 0.9 (95% CI, -0.2 to 2.0) years longer without CVD. Compared with those in the lowest tertile, the difference in life expectancy for men and women in the highest FT4 tertile was -3.2 (95% CI, -5.0 to -1.4) and -3.5 (95% CI, -5.6 to -1.5) years, respectively, of which, -3.1 (95% CI, -4.9 to -1.4) and -2.5 (95% CI, -4.4 to -0.7) years without CVD. CONCLUSIONS AND RELEVANCE At the age of 50 years, participants with low-normal thyroid function live up to 3.5 years longer overall and up to 3.1 years longer without CVD than participants with high-normal thyroid function. These findings provide supporting evidence for a reevaluation of the current reference ranges of thyroid function and can help inform preventive and clinical care.
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Affiliation(s)
- Arjola Bano
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Section of Geriatric Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW This review provides an appraisal of recent evidence for or against selenium supplementation in patients with autoimmune thyroid diseases, and discusses possible effect mechanisms. RECENT FINDINGS Epidemiological data suggest an increased prevalence of autoimmune thyroid diseases under conditions of low dietary selenium intake. Two systematic reviews have evaluated controlled trials among patients with autoimmune thyroiditis and report that selenium supplementation decreases circulating thyroid autoantibodies. The immunomodulatory effects of selenium might involve reducing proinflammatory cytokine release. However, clinically relevant effects of selenium supplementation, including improvement in quality of life, are more elusive. In Graves' disease, some, but not all, trials indicate that adjuvant selenium supplementation enhances the restoration of biochemical euthyroidism, and might benefit patients with mild Graves' orbitopathy. SUMMARY The use of selenium supplementation as adjuvant therapy to standard thyroid medication may be widespread, but a growing body of evidence yields equivocal results. The available evidence from trials does not support routine selenium supplementation in the standard treatment of patients with autoimmune thyroiditis or Graves' disease. However, correction of moderate to severe selenium deficiency may offer benefits in preventing, as well as treating, these disorders. Molecular mechanisms have been proposed, but further studies are needed.
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Affiliation(s)
- Kristian H Winther
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Affiliation(s)
- Brian M Casey
- University of Texas Southwestern Medical, Dallas, TX
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44
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Williams WV. Hormonal contraception and the development of autoimmunity: A review of the literature. LINACRE QUARTERLY 2017; 84:275-295. [PMID: 28912620 PMCID: PMC5592309 DOI: 10.1080/00243639.2017.1360065] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Estrogens and progestins are known to have profound effects on the immune system and may modulate the susceptibility to autoimmune diseases. A comprehensive literature search was carried out using PubMed for any of 153 autoimmune disease terms and the terms contraception, contraceptive, or their chemical components with limits of Humans + Title or Abstract. Over 1,800 titles were returned and scanned, 352 papers retrieved and reviewed in depth and an additional 70 papers retrieved from the bibliographies. Based on this review, substantial evidence exists linking the use of combined oral contraceptives to a lower incidence of hyperthyroidism, an increase in multiple sclerosis, ulcerative colitis, Crohn's disease, Systemic Lupus Erythematosus, and interstitial cystitis. Progesterone only contraceptives are linked to progesterone dermatitis and in one large developing world concurrent cohort study are associated with increases in arthropathies and related disorders, eczema and contact dermatitis, pruritis and related conditions, alopecia, acne, and urticaria. Hormonal contraceptives modulate the immune system and may influence the susceptibility to autoimmune diseases with significant increases in risk for several autoimmune diseases. SUMMARY Hormonal contraceptives (HCs), such as the "pill," Norplant, and vaginal rings, are very potent hormones that have effects on the immune system, which is made up of white blood cells and lymph nodes and normally defends the body against invading bacteria, viruses and parasites. This review looked at the association of HC use to the development of autoimmune diseases, where the immune system turns against the body and causes damage to organs. There is good evidence that HC use is associated with an increased risk of several serious autoimmune diseases such as Crohn's disease (which causes inflammation of the bowels), Lupus (which causes inflammation in many organs), and interstitial cystitis (which causes inflammation in the bladder). Several other rarer autoimmune diseases are also linked to HC use. People contemplating the use of HCs should be informed of these risks.
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Affiliation(s)
- William V Williams
- BriaCell Therapeutics Corporation, Havertown, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
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Journy NM, Bernier MO, Doody MM, Alexander BH, Linet MS, Kitahara CM. Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women. Thyroid 2017; 27:1001-1010. [PMID: 28578598 PMCID: PMC5564026 DOI: 10.1089/thy.2017.0063] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of hyperthyroidism and hypothyroidism is 0.5-4% in iodine-replete communities, but it is 5-10 times higher in women than in men. Those conditions are associated with a broad range of metabolic disorders and cardiovascular diseases. Biological evidence of a role of thyroid hormones in carcinogenesis also exists. However, the association between thyroid dysfunction and cardiovascular disease or cancer mortality risk remains controversial. In a large cohort of women, the associations of hyperthyroidism and hypothyroidism with cause-specific mortality were evaluated after nearly 30 years of follow-up. METHODS The prospective study included 75,076 women aged 20-89 years who were certified as radiologic technologists in the United States in 1926-1982, completed baseline questionnaires in 1983-1998 from which medical history was ascertained, and reported no malignant disease or benign thyroid disease except thyroid dysfunction. A passive follow-up of this cohort was performed through the Social Security Administration database and the National Death Index-Plus. Cause-specific mortality risks were compared according to self-reported thyroid status, with proportional hazards models adjusted for baseline year and age, race/ethnicity, body mass index, family history of breast cancer, and life-style and reproductive factors. RESULTS During a median follow-up of 28 years, 2609 cancer, 1789 cardiovascular or cerebrovascular, and 2442 other non-cancer deaths were recorded. Women with hyperthyroidism had an elevated risk of breast cancer mortality after 60 years of age (hazard ratio [HR] = 2.04 [confidence interval (CI) 1.16-3.60], 13 cases in hyperthyroid women) compared to women without thyroid disease. Hypothyroid women had increased mortality risks for diabetes mellitus (HR = 1.58 [CI 1.03-2.41], 27 cases in hypothyroid women), cardiovascular disease (HR = 1.20 [CI 1.01-1.42], 179 cases), and cerebrovascular disease (HR = 1.45 [CI 1.01-2.08], 35 cases, when restricting the follow-up to ≥10 years after baseline). Other causes of death were not associated with hyperthyroidism or hypothyroidism, though there was a suggestion of an elevated risk of ovarian cancer mortality in hyperthyroid women based on very few cases. CONCLUSION The excess mortality risks observed in a large, prospective 30-year follow-up of patients with thyroid dysfunction require confirmation, and, if replicated, further investigation will be needed because of the clinical implications.
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Affiliation(s)
- Neige M.Y. Journy
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marie-Odile Bernier
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- Laboratoire d'épidémiologie des rayonnements ionisants, Service de Radiobiologie et d'Epidémiologie, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Michele M. Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Wang J, Yang Z, Hu W, Chen Z, Yu X, Guo X. Intensity modulated radiotherapy with fixed collimator jaws for locoregional left-sided breast cancer irradiation. Oncotarget 2017; 8:33276-33284. [PMID: 28402279 PMCID: PMC5464867 DOI: 10.18632/oncotarget.16634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/08/2017] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study is to evaluate the intensity modulated radiotherapy (IMRT) with the fixed collimator jaws technique (FJT) for the left breast and regional lymph node. The targeted breast tissue and the lymph nodes, and the normal tissues were contoured for 16 left-sided breast cancer patients previously treated with radiotherapy after lumpectomy. For each patient, treatment plans using different planning techniques, i.e., volumetric modulated arc therapy (VMAT), tangential IMRT (tangential-IMRT), and IMRT with FJT (FJT-IMRT) were developed for dosimetric comparisons. A dose of 50Gy was prescribed to the planning target volume. The dose-volume histograms were generated, and the paired t-test was used to analyze the dose differences. FJT-IMRT had similar mean heart volume receiving 30Gy (V30 Gy) with tangential-IMRT (1.5% and 1.6%, p = 0.41), but inferior to the VMAT (0.8%, p < 0.001). In the average heart mean dose comparison, FJT-IMRT had the lowest value, and it was 0.6Gy lower than that for the VMAT plans (p < 0.01). A significant dose increase in the contralateral breast and lung was observed in VMAT plans. Compared with tangential-IMRT and VMAT plans, FJT-IMRT reduced the mean dose of thyroid, humeral head and cervical esophageal by 47.6% (p < 0.01) and 45.7% (p < 0.01), 74.3% (p = < 0.01) and 73% (p = < 0.01), and 26.7% (p = < 0.01) and 29.2% (p = < 0.01). In conclusion, compared with tangential-IMRT and VMAT, FJT-IMRT plan has the lowest thyroid, humeral head and cervical esophageal mean dose and it can be a reasonable treatment option for a certain subgroup of patients, such as young left-breast cancer patients and/or patients with previous thyroid disease.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
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Winther KH, Wichman JEM, Bonnema SJ, Hegedüs L. Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis. Endocrine 2017; 55:376-385. [PMID: 27683225 PMCID: PMC5272877 DOI: 10.1007/s12020-016-1098-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
By a systematic review and meta-analysis to investigate clinically relevant effects of selenium supplementation in patients with chronic autoimmune thyroiditis. Controlled trials in adults (≥18 years) with autoimmune thyroiditis, comparing selenium with or without levothyroxine substitution, versus placebo and/or levothyroxine substitution, were eligible for inclusion. Identified outcomes were serum thyrotropin (thyroid stimulating hormone) levels in LT4-untreated patients, thyroid ultrasound and health-related quality of life. Eleven publications, covering nine controlled trials, were included in the systematic review. Random effects model meta-analyses were performed in weighted mean difference for thyroid stimulating hormone, ultrasound and health-related quality of life. Quality of evidence was assessed per outcome, using GRADE. Meta-analyses showed no change in thyroid stimulating hormone, or improvements in health-related quality of life or thyroid echogenicity (ultrasound), between levothyroxine substitution-untreated patients assigned to selenium supplementation or placebo. Three trials found some improvement in wellbeing in patients receiving levothyroxine substitution, but could not be synthesized in a meta-analysis. The quality of evidence ranged from very low to low for thyroid stimulating hormone as well as ultrasound outcomes, and low to moderate for health-related quality of life, and was generally downgraded due to small sample sizes. We found no effect of selenium supplementation on thyroid stimulating hormone, health-related quality of life or thyroid ultrasound, in levothyroxine substitution-untreated individuals, and sporadic evaluation of clinically relevant outcomes in levothyroxine substitution-treated patients. Future well-powered RCTs, evaluating e.g. disease progression or health-related quality of life, are warranted before determining the relevance of selenium supplementation in autoimmune thyroiditis.
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Affiliation(s)
- Kristian Hillert Winther
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
| | - Johanna Eva Märta Wichman
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
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Akirov A, Gimbel H, Grossman A, Shochat T, Shimon I. Elevated TSH in adults treated for hypothyroidism is associated with increased mortality. Eur J Endocrinol 2017; 176:57-66. [PMID: 27760792 DOI: 10.1530/eje-16-0708] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/08/2022]
Abstract
CONTEXT Numerous studies investigated the link between hypothyroidism and mortality, but a definite conclusion is hard to reach as these were limited by a number of factors, including age of participants, comorbidities and single measurement of thyroid function. OBJECTIVE To evaluate the association between TSH and fT4 levels and mortality in patients with levothyroxine-treated hypothyroidism. DESIGN AND SETTING Observational data of hospitalized patients (2011-2014). TSH and fT4 levels obtained between at least 30 days after discharge and until death or end of follow-up were collected. Median TSH and fT4 levels were stratified into categories. PATIENTS In total, 611 patients with treated hypothyroidism, aged 60-80 years (72% females, mean age 71 ± 6 years) were included in the study. MAIN OUTCOME MEASURE All-cause mortality up to 66 months after discharge, by TSH and fT4 categories. RESULTS During follow-up, the average numbers of TSH and fT4 measurements were 5.5 ± 3.8 and 2.5 ± 4.2 per patient respectively. Mortality rates were 28%, 29% and 54% with median TSH of 0.5-2.5, 2.5-5.0 and 5.0-10.0 IU/L respectively. Adjusted hazard ratios for mortality with median TSH between 5.0 and 10.0 IU/L were 2.3 (95% CI: 1.6-3.4) and 2.2 (95% CI: 1.6-3.2) compared with patients with TSH between 0.5-2.5 IU/L and 2.5-5 IU/L respectively. There was no difference in mortality between patients with median fT4 10-15 or 15-20 pmol/L. CONCLUSION In treated hypothyroid adult patients and serial measurements of thyroid function tests, median TSH levels of 5-10 IU/L are associated with increased mortality with no effect of fT4 levels. Treatment should aim at achieving euthyroidism to improve survival.
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Affiliation(s)
- Amit Akirov
- Institute of EndocrinologyRabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
- Sackler School of MedicineTel Aviv University, Tel Aviv, Israel
| | - Hannah Gimbel
- Sackler School of MedicineTel Aviv University, Tel Aviv, Israel
| | - Alon Grossman
- Sackler School of MedicineTel Aviv University, Tel Aviv, Israel
- Internal Medicine E
| | - Tzipora Shochat
- Statistical Consulting UnitRabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Ilan Shimon
- Institute of EndocrinologyRabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
- Sackler School of MedicineTel Aviv University, Tel Aviv, Israel
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Wichman J, Winther KH, Bonnema SJ, Hegedüs L. Selenium Supplementation Significantly Reduces Thyroid Autoantibody Levels in Patients with Chronic Autoimmune Thyroiditis: A Systematic Review and Meta-Analysis. Thyroid 2016; 26:1681-1692. [PMID: 27702392 DOI: 10.1089/thy.2016.0256] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Selenium supplementation may decrease circulating thyroid autoantibodies in patients with chronic autoimmune thyroiditis (AIT), but the available trials are heterogenous. This study expands and critically reappraises the knowledge on this topic. METHODS A literature search identified 3366 records. Controlled trials in adults (≥18 years of age) with AIT, comparing selenium with or without levothyroxine (LT4), versus placebo and/or LT4, were eligible. Assessed outcomes were serum thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) autoantibody levels, and immunomodulatory effects. After screening and full-text assessment, 16 controlled trials were included in the systematic review. Random-effects meta-analyses in weighted mean difference (WMD) were performed for 3, 6, and 12 months of supplementation in two different populations: one receiving LT4 therapy and one newly diagnosed and LT4-untreated. Heterogeneity was estimated using I2, and quality of evidence was assessed per outcome, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS In LT4-treated populations, the selenium group had significantly lower TPOAb levels after three months (seven studies: WMD = -271 [confidence interval (CI) -366 to -175]; p < 0.0001; I2 = 45.4%), which was consistent at six months (three studies) and 12 months (one study). TgAb decreased at 12 months, but not at three or six months. In LT4-untreated populations, the selenium group showed a decrease in TPOAb levels after three months (three studies: WMD = -512 [CI -626 to -398]; p < 0.0001, I2 = 0.0%), but not after 6 or 12 months. TgAb decreased at 3 months, but not at 6 or 12 months. Quality of evidence was generally assessed as low. Study participants receiving selenium had a significantly higher risk than controls of reporting adverse effects (p = 0.036). CONCLUSIONS Selenium supplementation reduced serum TPOAb levels after 3, 6, and 12 months in an LT4-treated AIT population, and after three months in an untreated AIT population. Whether these effects correlate with clinically relevant measures remains to be demonstrated.
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Affiliation(s)
- Johanna Wichman
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Kristian Hillert Winther
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
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Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory Manifestations of Hypothyroidism: A Systematic Review. Thyroid 2016; 26:1519-1527. [PMID: 27673426 DOI: 10.1089/thy.2015.0642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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 Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. METHODS PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used. RESULTS A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls. CONCLUSION Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore open for retesting hypotheses, using appropriate study designs and methods.
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Affiliation(s)
- Jesper Roed Sorensen
- 1 Department of ORL Head & Neck Surgery, Odense University Hospital , Odense, Denmark
| | | | - Steen Joop Bonnema
- 2 Department of Endocrinology, Odense University Hospital , Odense, Denmark
| | - Christian Godballe
- 1 Department of ORL Head & Neck Surgery, Odense University Hospital , Odense, Denmark
| | - Laszlo Hegedüs
- 2 Department of Endocrinology, Odense University Hospital , Odense, Denmark
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