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Li M, Yang X, Li R, Wu B, Hao J, Qi Y, Bai T, Yang L, Zhang Y, Liu Y. Visceral Fat Area and Subcutaneous Fat Area Increase in Hyperthyroidism Patients After Treatment-A Single-Group Repeated-Measures Trial. Diabetes Metab Syndr Obes 2024; 17:2165-2176. [PMID: 38827164 PMCID: PMC11141577 DOI: 10.2147/dmso.s458486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose There is evidence that long-term vascular risk remains increased in patients with hyperthyroidism even after normalization of thyroid function, and the mechanisms that regulate this risk are unclear. The aim of this study was to assess how visceral fat area and subcutaneous fat area change after hyperthyroidism treatment, and to further explore the relationship between thyroid hormones, abdominal fat area (visceral fat area and subcutaneous fat area), and lipids. Patients and Methods 50 patients with newly diagnosed Graves' disease were selected. Anthropometric parameters (weight, height, body mass index, waist circumference, neck circumference), laboratory parameters (thyroid hormones, lipid metabolism indices), abdominal fat area (visceral fat area and subcutaneous fat area), and drug dose were collected. Measurements were made at baseline, 6 and 12 months after treatment. We used linear mixed-effects models for analysis. Results The results showed that the following indexes changed significantly at different time points: visceral fat area, subcutaneous fat area, free triiodothyronine, free thyroxine, thyroid stimulating hormone, total cholesterol, high-density lipoprotein, low-density lipoprotein, body weight, neck circumference, body mass index, waist circumference, and drug dose (All P<0.001). We found that free triiodothyronine and free thyroxine were significantly negatively associated with abdominal fat area (P<0.01). There was no significant correlation between drug dose and abdominal fat area (P>0.05). Total cholesterol and low-density lipoprotein were significantly positively associated with abdominal fat area (P<0.01). However, high-density lipoprotein (P=0.06) was not correlated with abdominal fat area. Moreover, the results showed a significant negative correlation between thyroid hormones and lipids (P<0.001). Conclusion After anti-thyroid medicine treatment, patients had elevated visceral fat area and subcutaneous fat area and altered lipid profiles. These changes may be one of the reasons why metabolic and cardiovascular diseases remain increased after thyroid function is restored.
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Affiliation(s)
- Mengnan Li
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Xifeng Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Ru Li
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Baofeng Wu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jinxuan Hao
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yijie Qi
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Tao Bai
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Luyang Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yi Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yunfeng Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Clinical Research Center of Endocrine and Metabolic Diseases in Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
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Chen Y, Dong H, Qu B, Ma X, Lu L. Protective effect of higher free thyroxine levels within the reference range on biliary tract cancer risk: a multivariable mendelian randomization and mediation analysis. Front Endocrinol (Lausanne) 2024; 15:1379607. [PMID: 38686204 PMCID: PMC11056546 DOI: 10.3389/fendo.2024.1379607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Background Hepatobiliary cancer (HBC), including hepatocellular carcinoma (HCC) and biliary tract cancer (BTC), is currently one of the malignant tumors that mainly cause human death. Many HBCs are diagnosed in the late stage, which increases the disease burden, indicating that effective prevention strategies and identification of risk factors are urgent. Many studies have reported the role of thyroid hormones on HBC. Our research aims to assess the causal effects and investigate the mediation effects between thyroid function and HBC. Methods Utilizing the Mendelian randomization (MR) approach, the study employs single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) to explore causal links between thyroid function [free thyroxine (FT4), thyroid stimulating hormone (TSH), hyperthyroidism and hypothyroidism] and HBC. Data were sourced from the ThyroidOmic consortium and FinnGen consortium. The analysis included univariable and multivariable MR analysis, followed by mediation analysis. Results The study found a significant causal association between high FT4 levels and the reduced risk of BTC, but not HCC. However, TSH, hyperthyroidism and hypothyroidism had no causal associations with the risk of HBC. Notably, we also demonstrated that only higher FT4 levels with the reference range (FT4-RR) could reduce the risk of BTC because this protective effect no longer existed under the conditions of hyperthyroidism or hypothyroidism. Finally, we found that the protective effect of FT4-RR on BTC was mediated partially by decreasing the risk of metabolic syndrome (MetS) and reducing the waist circumference (WC). Conclusion The findings suggest that higher FT4-RR may have a protective effect against BTC, which is partially mediated by decreased risk of MetS and a reduction in WC. This study highlights the potential role of FT4 in the pathogenesis of BTC and underscores that MetS and WC may play mediation effects as two mediators in this process.
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Affiliation(s)
- Yuxian Chen
- College of Medicine, Qingdao University, Qingdao, China
| | - Hao Dong
- College of Medicine, Qingdao University, Qingdao, China
| | - Baozhen Qu
- Qingdao Cancer Prevention and Treatment Research Institute, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| | - Xuezhen Ma
- Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
| | - LinLin Lu
- Qingdao Cancer Prevention and Treatment Research Institute, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, China
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Riis T, Bonnema SJ, Brix TH, Folkestad L. Hyperthyroidism and the risk of non-thyroid cancer: a Danish register-based long-term follow-up study. Eur Thyroid J 2024; 13:e230181. [PMID: 38367342 PMCID: PMC11046354 DOI: 10.1530/etj-23-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/16/2024] [Indexed: 02/19/2024] Open
Abstract
Objective Cancer is the second most common cause of death worldwide. It is currently debated whether thyroid dysfunction is a modifiable cancer risk factor. Our aim was to evaluate the risk of cancer in patients with hyperthyroidism. Methods This is a register-based nationwide cohort study of individuals with a diagnosis of hyperthyroidism. Each hyperthyroid case was matched with four reference individuals according to age and sex. Using Fine and Gray competing risk regression models, we studied the association of hyperthyroidism and subsequent all-cause cancer diagnoses, adjusted for preexisting morbidity. Sub-analyses were stratified for cause of hyperthyroidism (Graves' disease and toxic nodular goiter, age when diagnosed with hyperthyroidism, sex, and cancer localization (lung, prostate, breast, and colorectal cancer)). Results The cohort consisted of 95,469 patients with hyperthyroidism (followed for a median of 10.9 years (range: 5.2-17.2)), and 364,494 reference individuals (followed for a median of 11.2 years (range: 5.4-17.4)). Hyperthyroidism was associated with increased all-cause cancer risk (sub-distribution hazard ratio (SHR): 1.12; 95% CI: 1.10-1.14), as well as an increased risk of breast (SHR: 1.07; 95% CI: 1.02-1.13), lung (SHR: 1.20; 95% CI: 1.16-1.26), and prostate cancer (SHR: 1.10; 95% CI: 1.02-1.19), but not colorectal cancer (SHR: 1.04; 95% CI: 0.99-1.09). Sub-analyses stratified for age when diagnosed with hyperthyroidism and cause of hyperthyroidism yielded similar results. Conclusion In this register-based study, patients with hyperthyroidism had an increased risk of cancer, in particular lung, prostate, and breast cancer. Whether a causal link exists remains to be proven.
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Affiliation(s)
- Thea Riis
- Department of Endocrinology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Iglesias P, Benavent M, López G, Arias J, Romero I, Díez JJ. Hyperthyroidism and cardiovascular disease: an association study using big data analytics. Endocrine 2024; 83:405-413. [PMID: 37581746 DOI: 10.1007/s12020-023-03482-9] [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: 04/11/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The cardiovascular (CV) system is profoundly affected by thyroid hormones. Both hypo- and hyperthyroidism can increase the risk of severe CV complications. OBJECTIVE To assess the association of hyperthyroidism with major CV risk factors (CVRFs) and CV diseases (CVDs) using a big data methodology with the Savana Manager platform. MATERIAL AND METHODS This was an observational and retrospective study. The data were obtained from the electronic medical records of the University Hospital Puerta de Hierro Majadahonda (Spain). Artificial intelligence techniques were used to extract the information from the electronic health records and Savana Manager 3.0 software was used for analysis. RESULTS Of a total of 540,939 patients studied (53.62% females; mean age 42.2 ± 8.7 years), 5504 patients (1.02%; 69.9% women) had a diagnosis of hyperthyroidism. Patients with this diagnosis had a significantly (p < 0.0001) higher frequency of CVRFs than that found in non-hyperthyroid subjects. The higher frequency of CVRFs in patients with hyperthyroidism was observed in both women and men and in patients younger and older than 65 years of age. The total frequency of CVDs was also significantly (p < 0.0001) higher in patients diagnosed with hyperthyroidism than that found in patients without this diagnosis. The highest odds ratio values obtained were 6.40 (4.27-9.61) for embolic stroke followed by 5.99 (5.62-6.38) for atrial fibrillation. The frequency of all CVDs evaluated in patients with a diagnosis of hyperthyroidism was significantly higher in both women and men, as well as in those younger and older than 65 years, compared to subjects without this diagnosis. A multivariate regression analysis showed that hyperthyroidism was significantly and independently associated with all the CVDs evaluated except for embolic stroke. CONCLUSION The data from this hospital cohort suggest that there is a significant association between the diagnosis of hyperthyroidism and the main CVRFs and CVDs in our population, regardless of the age and gender of the patients. Our study, in addition to confirming this association, provides useful information for understanding the applicability of artificial intelligence techniques to "real-world data and information".
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, University Hospital Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain.
- Departament of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | | | | | | | | | - Juan J Díez
- Department of Endocrinology and Nutrition, University Hospital Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
- Departament of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Smith TJ, Hegedüs L, Lesser I, Perros P, Dorris K, Kinrade M, Troy-Ott P, Wuerth L, Nori M. How patients experience thyroid eye disease. Front Endocrinol (Lausanne) 2023; 14:1283374. [PMID: 38027128 PMCID: PMC10665908 DOI: 10.3389/fendo.2023.1283374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To determine the impact of thyroid eye disease (TED) on patients in various stages of the disease. Background TED is a debilitating and potentially sight-threatening inflammatory autoimmune disease that is frequently misdiagnosed. Challenging quality-of-life (QoL) issues can persist long after the active phase of disease has subsided. Methods A 62-question survey was designed as a hypothesis-generating instrument to identify key issues confronting patients ≥18 years old with physician-diagnosed TED. Questions focused primarily on physical and emotional status, and QoL experiences in the 2 months prior to the survey. Data for individual questions are presented as summary statistics. Correlations between questions were determined using χ2 analyses. Results The 443 respondents were 18 to >80 years old; >90% female, and >80% from the United States. Time since TED diagnosis ranged from <1 year to >10 years. Participants provided >500 free-form responses describing experiences of living with TED. Physical signs/symptoms were experienced by 307/443 (69%) patients. Of those responding to the QoL questions (N = 394), 53 (13%) reported symptoms improving, 73 (19%) reported symptoms worsening, and 255 (65%) reported no change in the 2 months prior to the survey. The most bothersome signs/symptoms were dry/gritty eyes, light sensitivity, bulging eyes, and pressure or pain behind the eyes. Respondents <60 years were significantly (p < 0.0001) more likely to report symptomatic TED than older patients. Of 394 respondents, 179 (45%) reported feeling depressed and/or anxious, 174 (44%) reported concern about their appearance, and 73 (19%) avoided public situations; 192 (49%) reported declines in confidence or feelings of general well-being, and 78 (20%) reported an inability to achieve goals. Activities limited by TED included reading, driving, and socializing. The proportion of respondents experiencing these negative QoL measures was higher when patients reported experiencing >5 symptoms, had been diagnosed within the last 5 years, or were <60 years of age. Conclusions Physical manifestations of TED impact QoL for patients through all phases of the disease. It is essential that physicians and healthcare professionals become more familiar with patient experiences such as those described here to better help patients manage their disease.
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Affiliation(s)
- Terry J. Smith
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ira Lesser
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Petros Perros
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kimberly Dorris
- Graves’ Disease and Thyroid Foundation, Rancho Santa Fe, CA, United States
| | - Michele Kinrade
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Patti Troy-Ott
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Laura Wuerth
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
| | - Mukund Nori
- Scientific Solutions, RareLife Solutions, Inc., Westport, CT, United States
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6
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Cassemiro JF, Ilera V, Batalles S, Reyes A, Nagy EV, Papini E, Perros P, Hegedüs L, Ramos HE. Use of thyroid hormones in hypothyroid and euthyroid patients: a 2022 THESIS questionnaire survey of members of the Latin American Thyroid Society (LATS). Thyroid Res 2023; 16:40. [PMID: 37773072 PMCID: PMC10542243 DOI: 10.1186/s13044-023-00182-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Inconsistencies in the medical management of hypothyroidism have been reported between endocrinologists in different countries. This study aimed to identify the attitudes of Latin America thyroid specialists towards the use of thyroid hormones. METHODS Online survey of members of the Latin America Thyroid Society. RESULTS 81/446 (18.2%) completed the questionnaire. Levothyroxine (LT4) was the initial treatment of choice for all respondents. 56.8% would consider LT4 use in biochemically euthyroid patients: infertile women with elevated anti-thyroid antibodies (46.9%), resistant depression (17.3%) and growing goiter (12%). Most respondents preferred tablets (39.5%) over liquid formulations (21.0%) or soft gel capsules (22.2%) and would not consider switching formulations in patients with persistent symptoms. 39.5% would never use LT4 + liothyronine (LT3) combination therapy in symptomatic euthyroid patients, due to low quality evidence for benefit. 60.5% reported that persistence of symptoms despite normal TSH is rare (below 5% of patients) and its prevalence has been stable over the last five years. Psychosocial factors (84.0%), comorbidities (86.4%) and the patient unrealistic expectation (72.8%) were considered the top three explanations for this phenomenon. CONCLUSION LT4 tablets is the treatment of choice for hypothyroidism. A significant proportion of respondents would use LT4 in some groups of euthyroid individuals, contrasting the recommendations of the major clinical practice guideline indications. LT4 + LT3 combination treatment in euthyroid symptomatic patients was considered by nearly 50%. Practices based on weak or absent evidence included use of thyroid hormones for euthyroid subjects by 56.8% of respondents and use of LT4 + LT3 treatment by 60.5% of respondents for patients with persistent symptoms. In contrast to many European countries, LATS respondents report a low and unchanged proportion of dissatisfied patients over the last five years.
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Affiliation(s)
- Jessica F Cassemiro
- Department of Bioregulation, Health & Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 325, Salvador, Bahia, Brazil
| | - Veronica Ilera
- Department of Endocrinology, Hospital Ramos Mejía, Caba, Argentina
| | | | - Adriana Reyes
- Department of Endocrinology, Hospital Ramos Mejía, Caba, Argentina
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Helton Estrela Ramos
- Department of Bioregulation, Health & Science Institute, Federal University of Bahia, Avenida Reitor Miguel Calmon, S/N. Vale do Canela. Room 325, Salvador, Bahia, Brazil.
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Zheng S, Wang Z, Yang L, Zhang X. Clinical correlates and thyroid hormones of metabolic syndrome in first-episode and drug-naïve major depressive disorder outpatients with and without hyperglycemia: a comprehensive cross-sectional study. BMC Psychiatry 2023; 23:649. [PMID: 37667222 PMCID: PMC10478374 DOI: 10.1186/s12888-023-05150-8] [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: 06/20/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
Hyperglycemia and metabolic syndrome (MetS) are common in patients with major depressive disorder (MDD). This study aimed to explore the prevalence and clinical factors of MetS in first-episode and drug-naïve MDD (FEDND) patients with and without hyperglycemia. A total of 1,718 FEDND patients' symptoms were assessed using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS). Blood glucose levels, metabolic index, and thyroid hormones were measured during fasting. The prevalence of MetS in FEDND patients with hyperglycemia was 35.67 times higher than in FEDND patients without hyperglycemia. FEDND patients with MetS were older, had later age of onset, and were predominantly married than those without MetS (p < 0.05). Among FEDND patients without hyperglycemia, suicide attempts, severe anxiety, HAMD, HAMA, PANSS subscale scores, thyroid stimulating hormone, antithyroglobulin, and total cholesterol levels were all higher in patients with MetS than those without MetS (all p < 0.05). In FEDND patients without hyperglycemia, the combination of age and TgAb distinguished those patients with and without MetS. Our results suggest a high prevalence of MetS in FEDND patients with hyperglycemia. Several clinical variables and thyroid function-related hormones impact MetS in patients with FEDND.
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Affiliation(s)
- Siyang Zheng
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
| | - Zhiyang Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
| | - Limin Yang
- School of Medicine, Dalian University, Dalian, 116622, Liaoning, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.
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Xing Y, Xuan F, Wang K, Zhang H. Aging under endocrine hormone regulation. Front Endocrinol (Lausanne) 2023; 14:1223529. [PMID: 37600699 PMCID: PMC10433899 DOI: 10.3389/fendo.2023.1223529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Aging is a biological process in which the environment interacts with the body to cause a progressive decline in effective physiological function. Aging in the human body can lead to a dysfunction of the vital organ systems, resulting in the onset of age-related diseases, such as neurodegenerative and cardiovascular diseases, which can seriously affect an individual's quality of life. The endocrine system acts on specific targets through hormones and related major functional factors in its pathways, which play biological roles in coordinating cellular interactions, metabolism, growth, and aging. Aging is the result of a combination of many pathological, physiological, and psychological processes, among which the endocrine system can achieve a bidirectional effect on the aging process by regulating the hormone levels in the body. In this paper, we explored the mechanisms of growth hormone, thyroid hormone, and estrogen in the aging process to provide a reference for the exploration of endocrine mechanisms related to aging.
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Affiliation(s)
| | | | | | - Huifeng Zhang
- Second Hospital of Hebei Medical University, Shijiazhuang, China
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Kruger EM, Shehata SA, Toraih EA, Abdelghany AA, Fawzy MS. Type 2 diabetes and thyroid cancer: Synergized risk with rising air pollution. World J Diabetes 2023; 14:1037-1048. [PMID: 37547591 PMCID: PMC10401455 DOI: 10.4239/wjd.v14.i7.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023] Open
Abstract
Diabetes is a complex condition, and the causes are still not fully understood. However, a growing body of evidence suggests that exposure to air pollution could be linked to an increased risk of diabetes. Specifically, exposure to certain pollutants, such as particulate Matter and Ozone, has been associated with higher rates of diabetes. At the same time, air pollution has also been linked to an increased risk of thyroid cancer. While there is less evidence linking air pollution to thyroid cancer than to diabetes, it is clear that air pollution could have severe implications for thyroid health. Air pollution could increase the risk of diabetes and thyroid cancer through several mechanisms. For example, air pollution could increase inflammation in the body, which is linked to an increased risk of diabetes and thyroid cancer. Air pollution could also increase oxidative stress, which is linked to an increased risk of diabetes and thyroid cancer. Additionally, air pollution could increase the risk of diabetes and thyroid cancer by affecting the endocrine system. This review explores the link between diabetes and air pollution on thyroid cancer. We will discuss the evidence for an association between air pollution exposure and diabetes and thyroid cancer, as well as the potential implications of air pollution for thyroid health. Given the connections between diabetes, air pollution, and thyroid cancer, it is essential to take preventive measures to reduce the risk of developing the condition.
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Affiliation(s)
- Eva M Kruger
- School of Medicine, Tulane University, New Orleans, LA 70112, United States
| | - Shaimaa A Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, United States
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ahmed A Abdelghany
- Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 1321, Saudi Arabia
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10
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Soares MN, Borges-Canha M, Neves C, Neves JS, Carvalho D. The role of Graves' disease in the development of thyroid nodules and thyroid cancer. Eur Thyroid J 2023; 12:e230055. [PMID: 37235699 PMCID: PMC10388649 DOI: 10.1530/etj-23-0055] [Citation(s) in RCA: 2] [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: 03/23/2023] [Accepted: 05/26/2023] [Indexed: 05/28/2023] Open
Abstract
Aim The prevalence of thyroid nodules and the risk of thyroid cancer in patients with Graves' disease is uncertain. We aimed to evaluate the prevalence of thyroid nodules and cancer in patients with Graves' disease. Methods Retrospective observational study of adult subjects with Graves' disease (positive autoantibodies thyrotropin receptor antibodies (TRAbs)) between 2017 and 2021 at our center was done. We evaluated the prevalence of thyroid nodules and cancer in this population and characterized the predictive factors for thyroid malignancy using linear and logistic regression models. Results We evaluated a total of 539 patients with Graves' disease during a median follow-up of 3.3 years (25th-75th percentiles 1.5-5.2 years). Fifty-three percent had thyroid nodules and 18 (3.3%) were diagnosed with thyroid cancer (12 papillary microcarcinomas). All tumors were classified using TNM classification as T1, and only one had lymph node metastasis; there were no recordings of distant metastasis. Sex, age, body mass index, smoking, TSH, and TRAbs levels were not significantly different between patients with and without thyroid cancer. Patients with multiple nodules on ultrasound (OR 1.61, 95%CI 1.04-2.49) and with larger nodules (OR 2.96, 95%CI 1.08-8.14, for 10 mm increase in size) had a greater risk of thyroid cancer diagnosis. Conclusion Patients with Graves' disease had a high prevalence of thyroid nodules and their nodules had a significant risk of thyroid cancer. The risk was higher in those with multiple and larger nodules. Most had low-grade papillary thyroid cancer. More studies are needed to clarify the clinical relevance of these findings.
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Affiliation(s)
| | - Marta Borges-Canha
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine from the University of Porto, Porto, Portugal
| | - Celestino Neves
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Institute for Research Innovation in Health, University of Porto, Porto, Portugal
| | - João Sérgio Neves
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine from the University of Porto, Porto, Portugal
| | - Davide Carvalho
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Institute for Research Innovation in Health, University of Porto, Porto, Portugal
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11
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Chopra R, Kalaria T, Gherman-Ciolac C, Raghavan R, Buch HN, Kar N. Impact of hyperthyroidism and its treatment on the outcome of mental health, occupational functioning, and quality of life: A naturalistic, prospective study. Indian J Psychiatry 2023; 65:586-594. [PMID: 37397837 PMCID: PMC10309261 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_474_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 04/12/2023] [Indexed: 07/04/2023] Open
Abstract
Context Background Hyperthyroidism has a major impact on mental health. Aims We intended to determine the magnitude of the unmet need for mental health support in patients with hyperthyroidism attending an endocrinology clinic. Settings and Design General Hospital Endocrine Department, Prospective Study. Methods and Material In a naturalistic, prospective study, consecutive (n = 176) hyperthyroid patients were assessed for anxiety (generalized anxiety disorder, GAD-7), depression (Patient Health Questionnaire PHQ-9), functional impairment (work and social adjustment scale, WSAS), and quality of life (EuroQol ED5D) using standardized instruments. Statistical Analysis Used Percentages, mean and standard deviation (SD), Chi-square, Student's t-test, ANOVA, Spearman's correlation. Results A considerable proportion (40.5%) of patients had moderate and severe anxiety, around half (50.6%) had moderate or severe depression, and 20.8% had severe functional impairment at presentation. Mean EQ5D score was 59.6 ± 23.5. The scores of anxiety, depression, and functional impairment were significantly correlated with each other and negatively correlated with QOL. Following treatment of hyperthyroidism, improvement in psychiatric symptoms was noted which could be correlated with the lowering of T4. However, a significant proportion of patients continued to have psychiatric symptoms and functional impairment despite achieving euthyroidism. There was no correlation between the severity of hyperthyroidism to persistence of mental health parameters. Conclusions Our findings of high prevalence and persistence of impairment of mental health and functional status of patients with hyperthyroidism have highlighted the unmet needs for these patients.
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Affiliation(s)
- Roopa Chopra
- Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - Tejas Kalaria
- Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - Carolina Gherman-Ciolac
- Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - Rajeev Raghavan
- Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - Harit Narendra Buch
- Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - Nilamadhab Kar
- Department of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, Steps to Health, Showell Circus, Low Hill, Wolverhampton, WV10 9TH, UK
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12
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Chen J, Liang H, Tan Y, Wen L, Guo Z, Nie J, Lin X, Huang F, Wang J, Xing P, Nie L, Wang L, Jing C. Association of urinary iodine concentration with prediabetes/diabetes in adults: Analysis of the NHANES 2005-2016. J Trace Elem Med Biol 2023; 77:127144. [PMID: 36907050 DOI: 10.1016/j.jtemb.2023.127144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND & AIMS Iodine is required for synthesizing thyroid hormones and regulating human metabolism. Iodine deficiency can lead to thyroid function abnormalities, which are closely associated with disturbances in glucose-insulin homeostasis. Research on the relationship between iodine and diabetes/prediabetes in adults was sparse and inconsistent. We assessed trends in urinary iodine concentration (UIC) and diabetes/prediabetes prevalence and focused on the association between iodine and diabetes/prediabetes among U.S. adults. METHODS We analyzed the National Health and Nutrition Examination Survey (NHANES) data from the 2005-2016 cycles. Linear regression was employed to evaluate UIC and prediabetes/diabetes prevalence trends over time. Both multiple logistic regression and restricted cubic splines (RCS) were performed to evaluate the association of UIC with diabetes/prediabetes. RESULTS A distinctly declining trend in median UIC and a significant increase in diabetes prevalence in U.S. adults from 2005 to 2016 were observed. The fourth quartile of UIC was associated with a 30% lower risk for prediabetes, compared with the first quartile (OR=0.70, 95% CI: 0.56-0.86, Ptrend=0.001). However, UIC was not significantly associated with the prevalence of diabetes. The RCS model suggested a significant nonlinear relationship between UIC and the risk of diabetes (P for nonlinearity =0.0147). Stratification analysis showed that the negative associations of UIC with the risk of prediabetes were more pronounced in participants who were men, aged 46-65, overweight, light alcohol drinkers, and nonactive smokers. CONCLUSIONS Overall, the adults' median UIC in the U.S. population was a declining trend. However, diabetes prevalence increased significantly from 2005 to 2016. Higher UIC was associated with a lower risk of prediabetes.
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Affiliation(s)
- Jingmin Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Huanzhu Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Yuxuan Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Lin Wen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Ziang Guo
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Jiyu Nie
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Xiaoxiao Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Feng Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Jie Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Puyi Xing
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China
| | - Lihong Nie
- Department of Endocrine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lihong Wang
- Department of Endocrine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Chunxia Jing
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Ave West, Guangzhou 510632, Guangdong, China; Guangdong Key Laboratory of Environmental Exposure and Health, Jinan University, Guangzhou 510632, Guangdong, 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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14
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Choi YJ, Han K, Cho WK, Jung MH, Suh BK. Cancer and Mortality Risks of Graves' Disease in South Korea Based on National Data from 2010 to 2019. Clin Epidemiol 2023; 15:535-546. [PMID: 37159800 PMCID: PMC10163882 DOI: 10.2147/clep.s406361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose This study aimed to investigate Graves' disease (GD) associated cancer and mortality risk using a Korean population-based study. Patients and Methods We included 6435 patients with GD using the Korean National Health Insurance Service-National Sample Cohort database from 2010 to 2019. Data concerning such patients were compared in a 1:5 ratio with age- and sex-matched non-GD group (n=32,175). Eighteen subdivided types of cancer and cancers-in-total were analyzed. In addition to the mortality analysis, subgroup analyses were performed according to age and sex. Results After adjustment, the hazard ratio (HR) of the GD group for cancer-in-total was 1.07 (95% confidence interval [CI], 0.91-1.27), showing no difference when compared to the non-GD group. However, among different types of cancer, the thyroid cancer risk of the GD group was higher than that of the non-GD group (HR=1.70; 95% CI, 1.20-2.39). When subdivided by age and sex, the thyroid cancer risk of the GD group in males aged 20-39 years was higher than that of the non-GD group (HR=7.00; 95% CI, 1.48-33.12). The mortality risk of the GD group was not different from that of the non-GD group (HR=0.86; 95% CI, 0.70-1.05). Conclusion In South Korea, patients with GD had a higher risk of thyroid cancer than the non-GD group. In particular, males aged 20-39 years with GD were more likely to have thyroid cancer than the non-GD group.
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Affiliation(s)
- Young Ju Choi
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, College of Natural Sciences, Soongsil University, Seoul, Republic of Korea
| | - Won Kyoung Cho
- Department of Pediatrics, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Won Kyoung Cho, Department of Pediatrics, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea, Tel +82-31-249-8869, Fax +82-2-783-2589, Email
| | - Min Ho Jung
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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15
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Ali SA, Ersbøll M, Vinding NE, Butt JH, Rørth R, Selmer C, Westergaard LM, Mogensen UM, Weeke PE, Jøns C, Gustafsson F, Fosbøl E, Køber L, Kristensen SL. Incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without heart failure: a nationwide cohort study. Europace 2022; 25:291-299. [PMID: 36504263 PMCID: PMC9935049 DOI: 10.1093/europace/euac217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Thyroid dysfunction is considered the most frequent complication to amiodarone treatment, but data on its occurrence outside clinical trials are sparse. The present study aimed to examine the incidence of thyroid dysfunction following initiation of amiodarone treatment in a nationwide cohort of patients with and without heart failure (HF). METHODS AND RESULTS In Danish registries, we identified all patients with first-time amiodarone treatment during the period 2000-18, without prior thyroid disease or medication. The primary outcome was a composite of thyroid diagnoses and initiation of thyroid drugs. Outcomes were assessed at 1-year follow-up, and for patients free of events in the first year, in a landmark analysis for the subsequent 5 years. We included 43 724 patients with first-time amiodarone treatment, of whom 16 939 (38%) had HF. At 1-year follow-up, the cumulative incidence and adjusted hazard ratio (HR) of the primary outcome were 5.3% and 1.37 (95% confidence interval 1.25-1.50) in patients with a history of HF and 4.2% in those without HF (reference). In the 1-year landmark analysis, the subsequent 5-year cumulative incidences and adjusted HRs of the primary outcome were 5.3% (reference) in patients with 1-year accumulated dose <27.38 g [corresponding to average daily dose (ADD <75 mg)], 14.0% and HR 2.74 (2.46-3.05) for 27.38-45.63 g (ADD 75-125 mg), 20.0% and HR 4.16 (3.77-4.59) for 45.64-63.88 g (ADD 126-175 mg), and 24.5% and HR 5.30 (4.82-5.90) for >63.88 g (ADD >175 mg). CONCLUSION Among patients who initiated amiodarone treatment, around 5% had thyroid dysfunction at 1-year follow-up, with a slightly higher incidence in those with HF. A dose-response relationship was observed between the 1-year accumulated amiodarone dose and the subsequent 5-year cumulative incidence of thyroid dysfunction.
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Affiliation(s)
- Sam Aiyad Ali
- Corresponding author. Tel: +45 93603832. E-mail address:
| | - Mads Ersbøll
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Naja Emborg Vinding
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Christian Selmer
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lucas Malta Westergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | | | - Peter E Weeke
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Søren Lund Kristensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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16
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Xian W, Wu D, Liu B, Hong S, Huo Z, Xiao H, Li Y. Graves' disease and inflammatory bowel disease: A bidirectional Mendelian randomization. J Clin Endocrinol Metab 2022; 108:1075-1083. [PMID: 36459455 PMCID: PMC10099169 DOI: 10.1210/clinem/dgac683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
CONTEXT Both Graves' disease (GD) and inflammatory bowel disease (IBD) are common autoimmune diseases that severely damage patients' quality of life. Previous epidemiological studies have suggested associations between GD and IBD. However, whether a causal relationship exists between these two diseases remains unknown. OBJECTIVE To infer a causal relationship between GD and IBD using bidirectional two-sample Mendelian randomization(MR). METHODS We performed bidirectional two-sample MR to infer a causal relationship between GD and IBD using GWAS summary data obtained from Biobank Japan (BBJ) and the International Inflammatory Bowel Disease Genetic Consortium (IIBDGC). Several methods (random-effect inverse variance weighted, weighted median, MR‒Egger regression, and MR-PRESSO) were used to ensure the robustness of the causal effect. Heterogeneity was measured based on Cochran's Q value. Horizontal pleiotropy was evaluated by MR‒Egger regression and leave-one-out analysis. RESULTS Genetically predicted IBD may increase the risk of GD by 24% (OR 1.24, 95% CI 1.01-1.52, p = 0.041). Crohn's disease (CD) may increase the risk of GD, whereas ulcerative colitis (UC) may prevent patients from developing GD. Conversely, genetically predicted GD may slightly increase the risk of CD, although evidence indicating that the presence of GD increased the risk of UC or IBD was lacking. Outlier-corrected results were consistent with raw causal estimates. CONCLUSIONS Our study revealed a potentially higher comorbidity rate for GD and CD. However, UC might represent a protective factor for GD. The underlying mechanism and potential common pathways await discovery.
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Affiliation(s)
- Wei Xian
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Dide Wu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Boyuan Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Shubin Hong
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zijun Huo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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17
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Díez JJ, Iglesias P. Prevalencia de diabetes en personas con disfunción tiroidea. Med Clin (Barc) 2022; 160:333-340. [PMID: 36528402 DOI: 10.1016/j.medcli.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the prevalence and relative risk of diabetes in the population with hypothyroidism and hyperthyroidism. METHODS A retrospective study was carried out using the Primary Care Clinical Database (BDCAP) of the Ministry of Health. Relative risks (OR) and their 95% confidence intervals (CI) were calculated for type1 (T1D) and type2 (T2D) diabetes. RESULTS In the group of 2,596,041 hypothyroid patients, we found an OR of 1.77 (95%CI: 1.75-1.80) for T1D, and 1.77 (95%CI: 1.76-1.78) for T2D. This elevated risk was observed in both men and women. Hypothyroid people over 65years of age had a near neutral risk of T1D (0.96 [95%CI: 0.94-0.99]) and T2D (0.99 [95%CI: 0.98-0.99]). Hypothyroid patients receiving replacement therapy showed a higher risk of T1D (1.32 [95%CI: 1.28-1.36]) and T2D (1.23 [95%CI: 1.22-1.24]) compared to untreated hypothyroid patients. In the group of 418,772 people with hyperthyroidism, an increased risk of T1D (1.66 [95%CI: 1.60-1.72]) and T2D (1.71 [95%CI: 1.70-1.73]) was also noticed. This risk was observed in both sexes. Those over 65years of age did not present a high risk of T1D (0.89 [95%CI: 0.83-0.95]) and their risk of T2D was close to neutrality (1.03 [95%CI: 1.02-1.05]). Hyperthyroid patients treated with antithyroid agents had a higher risk of T1D (1.26 [95%CI: 1.14-1.40]) and T2D (1.32 [95%CI: 1.28-1.36]) than those without therapy. CONCLUSION People registered in BDCAP of both sexes, under 65years of age, with thyroid dysfunction have an increased risk of suffering from diabetes, especially those on thyroid medication.
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18
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Brito JP, Nagy EV, Singh Ospina N, Zˇarković M, Dosiou C, Fichter N, Lucarelli MJ, Hegedüs L. A Survey on the Management of Thyroid Eye Disease Among American and European Thyroid Association Members. Thyroid 2022; 32:1535-1546. [PMID: 35946071 DOI: 10.1089/thy.2022.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: The thyroid eye disease (TED) treatment landscape is rapidly evolving. How new treatment options have impacted practice is unknown. Methods: We conducted a cross-sectional electronic survey of American and European Thyroid Association members between June 2 and June 30, 2021. The survey included TED questions about resources for its management, index cases for different severities and presentations of TED, barriers for the management of TED, and participants' concerns about TED. We classified respondents into three geographic categories: North America, Europe, or other regions. Results: Two hundred fifty-two eligible participants started the survey (15% response rate), and 227 completed it. Participants were mostly men (50.2%, 114/227), white (79.7%, 181/227), endocrinologists with a thyroid focus (66.1%, 150/227), practicing in a tertiary academic center (46.7%, 106/227), caring for 10 or more TED patients over the last 12 months (40.5%, 92/227), and reported not having a multidisciplinary TED clinic in their institution (52.8%, 120/227). The majority reported that new TED cases per annum have not changed in the past 10 years (47.5%, 108/227), and that TED patients are found in practice during the management of hyperthyroidism (41.8%, 95/227). For mild active TED, participants from Europe reported a higher use of selenium (73%[96/132] vs. 32%[20/62] of respondents from North America and 24%[8/33] of respondents from other regions). For moderate-to-severe active TED, there was a modest preference for teprotumumab as first-line therapy (37%, 23/62) among North American participants and intravenous (IV) steroids (73%[96/132], and 42%[14/33]) for participants from Europe and other regions, respectively. These treatment preferences did not change in patients with moderate-to-severe active TED with poorly controlled diabetes. In contrast, participants from the three geographic categories preferred IV steroids for optic neuropathy and women planning pregnancy. The three top "very important" concerns about TED management according to participants were: the cost of TED treatment (31.3%, 71/227), lack of effective TED treatments (19.8%, 45/227), and difficulty in predicting whether TED will develop (18.9%, 43/227). Conclusions: There is a marked geographic practice variation in the management of TED. Clinicians' concerns about TED management demand ongoing research on more effective treatment, TED predictive tools, and policy changes to improve the affordability of new TED therapies.
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Affiliation(s)
- Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida
| | | | - Chrysoula Dosiou
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicole Fichter
- ADMEDICO Orbital Centre, Olten and University Eye Department, Basel, Switzerland
| | - Mark J Lucarelli
- Oculoplastic, Facial Cosmetic and Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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19
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Huang D, Niu Y, Zhang W, Li X, Lin N, Yang Z, Qin L, Su Q, Ran H, Zhang H. OPG
is associated with thyroid nodule development in type 2 diabetes. J Clin Lab Anal 2022; 36:e24615. [PMID: 35870175 PMCID: PMC9459264 DOI: 10.1002/jcla.24615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 07/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Thyroid nodule prevalence is increasing lately, especially in diabetes, but the mechanism of which is not clear. In this study, we investigated if osteoprotegerin (OPG) is involved in the pathogenesis of thyroid nodules in diabetes. Methods A total of 7568 individuals with detailed information and ultrasound examination results were studied for the prevalence of thyroid nodules. Among them, 1883 were with type 2 diabetes and 5685 were non‐diabetic. Then, 1120 individuals were randomly selected for the measurement of OPG. Diabetic rats were made by feeding a high‐fat‐high‐fructose diet for 28 weeks. Rats fed with a normal diet were as controls. Fresh thyroid tissues were obtained and fixed, dehydrated, and embedded in paraffin for hematoxylin‐eosin staining and observing pathological changes. qPCR and western blot were used to detect OPG expression in rat thyroid tissues. Results We found that HbA1c is an independent risk factor for thyroid nodules (Exp [β] = 1.158, p < 0.001). The prevalence of thyroid nodules in type 2 diabetes was higher than that in non‐diabetes (53.9% vs. 46.7%, p < 0.001). Serum OPG levels were significantly elevated in the diabetes group than in the non‐diabetes group (3160.17 pg/ml vs. 2819.39 pg/ml, p < 0.01). The expression of OPG increased significantly in the thyroid tissues of diabetic rats. Conclusion Osteoprotegerin may be associated with thyroid nodule development in diabetes.
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Affiliation(s)
- Dazhi Huang
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Pudong New Area Gaoqiao community health center Shanghai China
| | - Yixin Niu
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Weiwei Zhang
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Ning Lin
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Zhen Yang
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Li Qin
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
- Department of Endocrinology, Xinhua Hospital Chongming Branch Shanghai Jiaotong University School of Medicine Shanghai China
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Hui Ran
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua Hospital Shanghai Jiaotong University School of Medicine Shanghai China
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20
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Roa Dueñas OH, Van der Burgh AC, Ittermann T, Ligthart S, Ikram MA, Peeters R, Chaker L. Thyroid Function and the Risk of Prediabetes and Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:1789-1798. [PMID: 35137143 PMCID: PMC9315162 DOI: 10.1210/clinem/dgac006] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT Thyroid hormones are important regulators of glucose metabolism, and studies investigating the association between thyroid function and type 2 diabetes incidence have shown conflicting results. OBJECTIVE We aimed to combine the evidence from prospective studies addressing the association between thyroid function and type 2 diabetes risk. METHODS We systematically searched in Embase, Medline (Ovid), Web of Science, Cochrane, and Google Scholar for prospective studies assessing the association of thyroid function and incident type 2 diabetes. Data extraction was performed using a standardized protocol by 2 independent reviewers. We assessed study quality using the Newcastle-Ottawa Scale and pooled hazard ratios (HRs) and 95% CI using random-effects models. RESULTS From the 4574 publications identified, 7 met our inclusion criteria and were included in the qualitative synthesis. Six publications were included in the meta-analysis. Studies assessed hypothyroidism (6 studies), hyperthyroidism (5 studies), thyrotropin (TSH) in the reference range (4 studies), and free thyroxine (FT4) in the reference range (3 studies) in relation to incident type 2 diabetes. The pooled HR for the risk of type 2 diabetes was 1.26 (95% CI, 1.05-1.52) for hypothyroidism, 1.16 (95% CI, 0.90-1.49) for hyperthyroidism, 1.06 (95% CI, 0.96-1.17) for TSH in the reference range, and 0.95 (95% CI, 0.91-0.98) for FT4 in the reference range. CONCLUSION Current evidence suggests an increased type 2 diabetes risk in people with hypothyroidism and lower FT4 levels in the reference range. Further population-based studies are needed to address this association given the limited evidence.
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Affiliation(s)
- Oscar H Roa Dueñas
- Correspondence: Oscar H. Roa Dueñas, MD, Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Anna C Van der Burgh
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald,Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Symen Ligthart
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robin Peeters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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21
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Perros P, Hegedus L. Enhanced Well-Being Associated with Thyrotoxicosis: A Neglected Effect of Thyroid Hormones? Int J Endocrinol Metab 2022; 20:e127230. [PMID: 35993034 PMCID: PMC9375936 DOI: 10.5812/ijem-127230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Thyrotoxicosis may be associated with a better sense of well-being than in the euthyroid state, though this is not widely recognised. EVIDENCE ACQUISITION A comprehensive literature search in PubMed and Google Scholar, was performed to identify studies investigating factors influencing well-being, mood, and psychological features associated with elevated thyroid hormones. RESULTS Enhanced well-being associated with thyrotoxicosis has been described, although the evidence is observational and anecdotal. CONCLUSIONS Enhanced well-being associated with thyrotoxicosis is probably experienced in a minority of patients and may explain why some seek overtreatment with thyroid hormones and report significant improvement on larger than physiological thyroid hormone replacement regimens. It may also explain why some patients with hyperthyroidism (usually due to Graves' disease) are reluctant to adhere to anti-thyroid medication.
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Affiliation(s)
- Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
- Corresponding Author: Department of Endocrinology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
| | - Laszlo Hegedus
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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22
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Burlacu MC, Attanasio R, Hegedüs L, Nagy EV, Papini E, Perros P, Sawadogo K, Bex M, Corvilain B, Daumerie C, Decallonne B, Gruson D, Lapauw B, Reyes RM, Petrossians P, Poppe K, Van den Bruel A, Unuane D. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* survey of Belgian specialists *THESIS: treatment of hypothyroidism in Europe by specialists: an international survey. Thyroid Res 2022; 15:3. [PMID: 35248144 PMCID: PMC8897091 DOI: 10.1186/s13044-022-00121-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Hypothyroidism is a topic that continues to provoke debate and controversy with regards to specific indications, type of thyroid hormone substitution and efficacy. We investigated the use of thyroid hormones in clinical practice in Belgium, a country where currently only levothyroxine (LT4) tablet formulations are available. Method Members of the Belgian Endocrine Society were invited to respond to an online questionnaire. Results were compared with those from other THESIS surveys. Results Eighty (50%) of the invited 160 individuals, completed the questionnaire. LT4 was the first treatment of choice for all respondents. As secondary choice, some also prescribed liothyronine (LT3) and LT4 + LT3 combinations (2 and 7 respondents, respectively). Besides hypothyroidism, 34 and 50% of respondents used thyroid hormones for infertile euthyroid TPOAb positive women and the treatment of a growing non-toxic goiter, respectively. Had alternative formulations of LT4 to tablets been available (soft gel or liquid L-T4), 2 out of 80 (2.5%) participants would consider them for patients achieving biochemical euthyroidism but remaining symptomatic. This proportion was higher in case of unexplained poor biochemical control of hypothyroidism (13.5%) and in patients with celiac disease or malabsorption or interfering drugs (10%). In symptomatic euthyroid patients, 20% of respondents would try combined LT4 + LT3 treatment. Psychosocial factors were highlighted as the main contributors to persistent symptoms. Conclusions LT4 tablets is the preferred treatment for hypothyroidism in Belgium. A minority of the respondents would try combined LT4 + LT3 in symptomatic but biochemically euthyroid patients. Thyroid hormones are prescribed for euthyroid infertile women with thyroid autoimmunity and patients with non-toxic goiter, a tendency noted in other European countries, despite current evidence of lack of benefit. Supplementary Information The online version contains supplementary material available at 10.1186/s13044-022-00121-9.
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Affiliation(s)
- Maria-Cristina Burlacu
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.
| | - Roberto Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrine Unit, 20161, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Kiswendsida Sawadogo
- Statistical support unit, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marie Bex
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Chantal Daumerie
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | | | - Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Rodrigo Moreno Reyes
- Department of Nuclear Medecine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Petrossians
- Department of Endocrinology, CHU de Liège, Université de Liège, Liège, Belgium
| | - Kris Poppe
- Endocrine Unit, CHU Saint- Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - David Unuane
- Department of Internal Medicine, Endocrine Unit, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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23
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Eom YS, Wilson JR, Bernet VJ. Links between Thyroid Disorders and Glucose Homeostasis. Diabetes Metab J 2022; 46:239-256. [PMID: 35385635 PMCID: PMC8987680 DOI: 10.4093/dmj.2022.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Thyroid disorders and diabetes mellitus often coexist and are closely related. Several studies have shown a higher prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. Thyroid hormone affects glucose homeostasis by impacting pancreatic β-cell development and glucose metabolism through several organs such as the liver, gastrointestinal tract, pancreas, adipose tissue, skeletal muscles, and the central nervous system. The present review discusses the effect of thyroid hormone on glucose homeostasis. We also review the relationship between thyroid disease and diabetes mellitus: type 1, type 2, and gestational diabetes, as well as guidelines for screening thyroid function with each disorder. Finally, we provide an overview of the effects of antidiabetic drugs on thyroid hormone and thyroid disorders.
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Affiliation(s)
- Young Sil Eom
- Division of Endocrinology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jessica R. Wilson
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
| | - Victor J. Bernet
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author: Victor J. Bernet https://orcid.org/0000-0002-2477-5631 Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA E-mail:
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24
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Yang B, Li J, Haller MJ, Schatz DA, Rong L. The progression of secondary diabetes: A review of modeling studies. Front Endocrinol (Lausanne) 2022; 13:1070979. [PMID: 36619543 PMCID: PMC9812520 DOI: 10.3389/fendo.2022.1070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Mathematical modeling has provided quantitative information consistent with experimental data, greatly improving our understanding of the progression of type 1 and type 2 diabetes. However, diabetes is a complex metabolic disease and has been found to be involved in crosstalk interactions with diverse endocrine diseases. Mathematical models have also been developed to investigate the quantitative impact of various hormonal disorders on glucose imbalance, advancing the precision treatment for secondary diabetes. Here we review the models established for the study of dysglycemia induced by hormonal disorders, such as excessive glucocorticoids, epinephrine, and growth hormone. To investigate the influence of hyperthyroidism on the glucose regulatory system, we also propose a hyperthyroid-diabetes progression model. Model simulations indicate that timely thyroid treatment can halt the progression of hyperglycemia and prevent beta-cell failure. This highlights the diagnosis of hormonal disorders, together withblood sugar tests, as significant measures for the early diagnosis and treatment of diabetes. The work recapitulates updated biological research on the interactions between the glucose regulatory system and other endocrine axes. Further mathematical modeling of secondary diabetes is desired to promote the quantitative study of the disease and the development of individualized diabetic therapies.
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Affiliation(s)
- Boya Yang
- Department of Mathematics, University of Florida, Gainesville, FL, United States
| | - Jiaxu Li
- Department of Mathematics, University of Louisville, Louisville, KY, United States
| | - Michael J. Haller
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Desmond A. Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Libin Rong
- Department of Mathematics, University of Florida, Gainesville, FL, United States
- *Correspondence: Libin Rong,
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25
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Song E, Koo MJ, Noh E, Hwang SY, Park MJ, Kim JA, Roh E, Choi KM, Baik SH, Cho GJ, Yoo HJ. Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study. Endocrinol Metab (Seoul) 2021; 36:1277-1286. [PMID: 34915605 PMCID: PMC8743588 DOI: 10.3803/enm.2021.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies. METHODS The risk of diabetes in patients with Graves' disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group. RESULTS A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019). CONCLUSION The risk of diabetes was significantly higher in patients with long-standing Graves' disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Min Ji Koo
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eunjin Noh
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul,
Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul,
Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
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26
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Brix TH, Hegedüs L. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and thyroid disease. An update. Curr Opin Endocrinol Diabetes Obes 2021; 28:525-532. [PMID: 34224435 PMCID: PMC8452244 DOI: 10.1097/med.0000000000000654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with excess morbidity and mortality in patients with hypertension and diabetes but little is known about thyroid diseases. Thus, our goal was to review the literature with respect to: (i) Are patients with underlying hypo- or hyperthyroidism at increased risk of contracting SARS-CoV-2 infection? (ii) do underlying hypo- and hyperthyroidism impact the prognosis of SARS-CoV-2 infection? (iii) does SARS-CoV-2 infection cause de novo thyroid dysfunction? RECENT FINDINGS Patients with hypo- or hyperthyroidism do not have an increased risk of contracting SARS-CoV-2, and a diagnosis of hypo- or hyperthyroidism is not associated with a worsened prognosis of SARS-CoV-2 infection. SARS-CoV-2 infection has been associated with subsequent thyrotoxicosis, euthyroid sick syndrome, subacute thyroiditis, and autoimmune thyroid disease. SUMMARY These findings suggest that receiving treatment for thyroid dysfunction does not per se impact the patients' risk of acquiring SARS-CoV-2 infection, or the management of those who already contracted it. Additional studies with larger numbers of patients and long-term follow-up are required in order to clarify whether patients with SARS-CoV-2 infection are more or less prone to develop thyroid dysfunction and/or thyroid autoimmunity than patients recovering from other virus infections.
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Affiliation(s)
- Thomas H Brix
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
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27
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Bardugo A, Derazne E, Zucker I, Bendor CD, Puris G, Lutski M, Pinhas-Hamiel O, Cukierman-Yaffe T, Mosenzon O, Schechter M, Tzur D, Afek A, Tirosh A, Gerstein HC, Raz I, Twig G. Adolescent Thyroid Disorders and Risk for Type 2 Diabetes in Young Adulthood. J Clin Endocrinol Metab 2021; 106:e3426-e3435. [PMID: 34050759 DOI: 10.1210/clinem/dgab382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT Thyroid hormones play a key role in systemic metabolism, yet the relationship between thyroid dysfunction and risk for type 2 diabetes is unclear. OBJECTIVE To assess type 2 diabetes risk in adulthood among adolescents with thyroid disorders. DESIGN AND SETTING A nationwide, population-based study of Israeli adolescents who were examined before military recruitment during 1988 to 2007 and were followed until December 31, 2016. PARTICIPANTS 1 382 560 adolescents (mean age 17.3 years). INTERVENTIONS The diagnosis of thyroid disorders was based on recent thyroid function tests. Data were linked to the Israeli National Diabetes Registry. Cox proportional hazard models were applied. MAIN OUTCOME MEASURES Type 2 diabetes incidence. RESULTS During a mean follow-up of 18.5 years, 1.12% (69 of 6,152) of adolescents with thyroid disorders were diagnosed with type 2 diabetes vs 0.77% of adolescents without thyroid disorders. The hazard ratio (HR) for type 2 diabetes was 2.3 (95% CI, 1.8-2.9) among those with thyroid disorders, after adjustment for sex, birth-year, body mass index, and sociodemographic confounders. The increased diabetes risk was observed in both men and women, with the presence or absence of obesity, and in the absence of other health conditions and was associated with different types of thyroid disorders. It was also similar when the outcome was defined as type 2 diabetes diagnosed at or before the age of 30 years (HR 2.3, 95% CI, 1.5-3.5). CONCLUSIONS Thyroid disorders diagnosed in adolescence are a risk factor for early-onset type 2 diabetes in both men and women.
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Gal Puris
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Miri Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Meir Schechter
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | | | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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28
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The Effects of Previous Thyroid Disease on the Susceptibility to, Morbidity of, and Mortality Due to COVID-19: A Nationwide Cohort Study in South Korea. J Clin Med 2021; 10:jcm10163522. [PMID: 34441818 PMCID: PMC8396860 DOI: 10.3390/jcm10163522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 01/22/2023] Open
Abstract
This study aimed to investigate the associations of the susceptibility to, morbidity of, and mortality due to coronavirus disease 2019 (COVID-19) with thyroid diseases. Korea National Health Insurance Database Coronavirus disease 2019 (NHID-COVID-19) medical claim code data from 2015 to 2020 were analyzed. A total of 8070 COVID-19 patients and 32,280 matched control participants were evaluated for histories of hypothyroidism, hyperthyroidism, Graves’ disease, thyroiditis, and autoimmune thyroiditis. The relationships of susceptibility to, morbidity of, and mortality due to COVID-19 with hypothyroidism, hyperthyroidism, Graves’ disease, thyroiditis, and autoimmune thyroiditis were analyzed using a conditional logistic regression. Hypothyroidism, hyperthyroidism, Graves’ disease, thyroiditis, and autoimmune thyroiditis were not associated with susceptibility to, morbidity of, or mortality due to COVID-19. Graves’ disease was related to higher odds of mortality due to COVID-19 in the adjusted model but the confidence interval (CI) was wide, probably due to the small number of deaths among patients with Graves’ disease (aOR = 11.43, 95% CI = 1.29–101.22, p = 0.029). Previous histories of hypothyroidism, hyperthyroidism, Graves’ disease, thyroiditis, and autoimmune thyroiditis were not related to susceptibility to COVID-19. In addition, prior histories of thyroid diseases were not related to increased risks of COVID-19-related morbidity and mortality.
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Tan S, Chen L, Jin L, Fu X. The efficiency and safety of methimazole and propylthiouracil in hyperthyroidism: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26707. [PMID: 34397700 PMCID: PMC8322508 DOI: 10.1097/md.0000000000026707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficiency and safety of methimazole (MMI) and propylthiouracil (PTU) in the treatment of hyperthyroidism. METHODS Articles were searched through the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and QVIP. The primary outcomes were clinical efficacy and thyroid hormone levels in MMI and PTU groups. The secondary outcomes were liver function indexes and adverse reactions in MMI and PTU groups. Results were expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs). The Begg test was applied to assess the publication bias. RESULTS Totally, 16 randomized controlled trials were retained in this meta-analysis with 973 patients receiving MMI and 933 receiving PTU. The levels of triiodothyronine (T3) (WMD = -1.321, 95% CI: -2.271 to -0.372, P = .006), thyroxine (T4) (WMD = -37.311, 95% CI: -61.012 to -13.610, P = .002), Free T3 (FT3) (WMD = -1.388, 95% CI: -2.543 to -0.233, P = .019), Free T4 (FT4) (WMD = -3.613, 95% CI: -5.972 to -1.255, P = .003), and the risk of liver function damage (OR = 0.208, 95% CI: 0.146-0.296, P < .001) in the MMI group were lower than those in the PTU group. The thyroid-stimulating hormone level (WMD = 0.787, 95% CI: 0.380-1.194, P < .001) and the risk of hypothyroidism (OR = 2.738, 95% CI: 1.444-5.193, P = .002) were higher in the MMI group than those in the PTU group. CONCLUSIONS Although MMI might have higher risk of hypothyroidism than PTU, the efficacy of MMI may be better than PTU in patients with hyperthyroidism regarding reducing T3, T4, FT3, and FT4 levels, decreasing the risk of liver function damage and increasing the level of thyroid-stimulating hormone. REGISTER NUMBER osf.io/ds637 (https://osf.io/search/).
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Affiliation(s)
- Shuang Tan
- Department of Acupuncture and Moxibustion, Huguo Temple Hospital of Traditional Chinese medicine affiliated to Beijing University of Chinese Medicine, Beijing
| | - Long Chen
- Department of Chinese medicine, Inner Mongolia Qingshuihe Hospital of Chinese and Mongolian medicine, Inner Mongolia
| | - Likun Jin
- Department of Orthopaedics, Beijing Fengsheng Special Hospital of Traditional Medical Traumatology and Orthopaedics, Beijing, China
| | - Xiaomin Fu
- Department of Acupuncture and Moxibustion, Huguo Temple Hospital of Traditional Chinese medicine affiliated to Beijing University of Chinese Medicine, Beijing
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Liew H, Watt T, Nan L, Tan AWK, Chan YH, Chew DEK, Dalan R. Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves' disease. J Patient Rep Outcomes 2021; 5:54. [PMID: 34236563 PMCID: PMC8266927 DOI: 10.1186/s41687-021-00309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Graves' disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves' hyperthyroidism. METHODS Forty-seven consecutive Graves' hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach's alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen's effect size. RESULTS Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21-0.64 (p < 0.05). There was high internal consistency between the items in this instrument, Cronbach's alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20-0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). CONCLUSION This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves' disease patients in Singapore population with the potential to complement clinical care.
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Affiliation(s)
- Huiling Liew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin W K Tan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Ek Kwang Chew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rinkoo Dalan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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31
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Larsen CB, Riis KR, Winther KH, Larsen EL, Ellervik C, Hegedüs L, Brix TH, Poulsen HE, Bonnema SJ. Treatment of Hyperthyroidism Reduces Systemic Oxidative Stress, as Measured by Markers of RNA and DNA Damage. J Clin Endocrinol Metab 2021; 106:e2512-e2520. [PMID: 33901280 DOI: 10.1210/clinem/dgab273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Whole-body oxidative stress can be estimated by the urine excretion of oxidized guanosine species, 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), derived from RNA and DNA, respectively. These oxidative stress markers are not well explored in thyroid disorders. OBJECTIVE We aimed to determine whether treatment of hyperthyroid patients affects the levels of these oxidative stress markers. METHODS Urinary excretion of 8-oxoGuo and 8-oxodG was measured in 51 hyperthyroid patients (toxic nodular goiter [TNG], n = 30; Graves disease [GD], n = 21) before or shortly after initiation of therapy and when stable euthyroidism had been achieved for at least 12 months. RESULTS Adjusting for age, the baseline urinary excretion of oxidative stress markers correlated positively with plasma thyroxine (8-oxoGuo, P = 0.002; 8-oxodG, P = 0.021) and was significantly higher in GD than in TNG patients (P = 0.001 for both oxidative stress markers). Restoration of euthyroidism significantly affected the excretion of the oxidative stress markers. In TNG, 8-oxoGuo decreased from geometric mean 2.11 nmol/mmol creatinine (95% CI, 1.85-2.39) to 1.91 nmol/mmol (95% CI, 1.67-2.19; P = 0.001), while 8-oxodG decreased from 1.65 nmol/mmol (95% CI, 1.41-1.93) to 1.48 nmol/mmol (95% CI, 1.27-1.74; P = 0.026). In GD, 8-oxoGuo decreased from 2.25 nmol/mmol (95% CI, 1.95-2.59) to 1.79 nmol/mmol (95% CI, 1.63-1.97; P = 0.0003), while 8-oxodG decreased from 2.02 nmol/mmol (95% CI, 1.73-2.38) to 1.54 nmol/mmol (95% CI, 1.31-1.81; P = 0.001). In the euthyroid state, there were no differences between groups. CONCLUSION Restoration of euthyroidism in patients with hyperthyroidism significantly decreased the systemic oxidative stress load by 10% to 25%. Our findings may help to explain the higher morbidity and mortality linked to hyperthyroid diseases, as shown in observational studies.
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Affiliation(s)
- Camilla B Larsen
- Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kamilla R Riis
- Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Emil L Larsen
- Department of Clinical Pharmacology, Bispebjerg Frederiksberg Hospital, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Research, Region Zealand, Sorø, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Thomas H Brix
- Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Henrik E Poulsen
- Department of Clinical Pharmacology, Bispebjerg Frederiksberg Hospital, Copenhagen, Denmark
| | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
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Li H, Zeng RL, Liao YF, Fu MF, Zhang H, Wang LF, Li YM. Association of Plasma Connective Tissue Growth Factor Levels with Hyperthyroid Heart Disease. Curr Med Sci 2021; 41:348-355. [PMID: 33877553 DOI: 10.1007/s11596-021-2354-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
Hyperthyroid heart disease (HHD) is one of the most severe complications of overt hyperthyroidism and increases the risk of mortality in affected patients. Early identification of patients at a higher risk of developing HHD can improve clinical outcomes through active surveillance and management. Connective tissue growth factor (CTGF), a secreted extracellular protein, plays a significant role in cardiac remodeling and dysfunction. We aimed to investigate the association between plasma CTGF level and the risk of HHD in this study. A total of 142 overt hyperthyroid patients without HHD and 99 patients with HHD were included. The plasma CTGF levels were measured using ELISA kits. Routine clinical medical data and echocardiography parameters were recorded for analysis. The plasma CTGF level was significantly higher in patients with HHD than in those without HHD (P=0.002). The plasma CTGF level was positively correlated with free triiodothyronin, tryrotropin receptor antibody, troponin I and lactate dehydrogenase levels and the left atrium diameters, right atrium diameters, and right ventricular end-diastolic diameters (all P<0.05). Logistic regression analysis showed that quartiles 3 and 4 of plasma CTGF levels were significantly associated with the increased risk of HHD (crude OR: 2.529; 95% CI: 1.188-5.387). However, after adjustment for the potentially confounding variables, quartile 4 alone was significantly associated with the higher risk of HHD relative to quartile 1. Hyperthyroid patients with HHD display higher plasma CTGF levels. Furthermore, CTGF is an independent risk factor for HHD. Therefore, the plasma CTGF level may be a potential biomarker for the risk of HHD.
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Affiliation(s)
- Huan Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China
| | - Ren-Li Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China
| | - Yun-Fei Liao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China
| | - Meng-Fei Fu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China
| | - Huan Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China
| | - Lin-Fang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yu-Ming Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, 430022, China.
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Gu L, Yang J, Gong Y, Ma Y, Yan S, Huang Y, Wang Y, Peng Y. Lower free thyroid hormone levels are associated with high blood glucose and insulin resistance; these normalize with metabolic improvement of type 2 diabetes. J Diabetes 2021; 13:318-329. [PMID: 32981234 DOI: 10.1111/1753-0407.13118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This study aimed to explore the relationship of thyroid function and glucose metabolism and to investigate the changes in thyroid function after National Metabolic Management Center (MMC) management in type 2 diabetic mellitus (T2DM). METHODS A total of 2000 euthyroid participants from MMC in Shanghai General Hospital and a community physical examination were recruited. They were categorized into four groups: normal glucose tolerance (NGT, n = 132), prediabetes (N = 147), DM well-controlled (T2DM with glycosylated hemoglobin [HbA1c] ≤ 7%, n = 505), and DM uncontrolled (T2DM with HbA1c > 7%, n = 1216). The parameters were compared among the groups and their changes before and after MMC follow-up in DM uncontrolled group were observed. RESULTS Free triiodothyronine (FT3) and free thyroxine (FT4) levels varied significantly among groups. FT3 and FT4 levels negatively correlated with HbA1c level (P < 0.05), and positively correlated with the estimated glucose disposal rate (eGDR) (P < 0.05). Following MMC management, blood glucose and insulin resistance in the DM uncontrolled group were dramatically improved (P < 0.001). Meanwhile, FT3 was elevated compared to the baseline (from 4.51 ± 0.78 pmol/L to 4.68 ± 0.87 pmol/L, P < 0.05), and reverse triiodothyronine (r-T3) decreased from 1.03 ± 0.24 nmol/L to 0.92 ± 0.25 nmol/L (P < 0.001). Thyroid-stimulating hormone significantly decreased as well (P < 0.001). CONCLUSIONS Decreased free thyroid hormone levels in normal range were associated with high glucose and insulin resistance. After MMC management, improvement of blood glucose and insulin resistance were accompanied by the restoration of low-normal thyroid function.
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Affiliation(s)
- Liping Gu
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaying Yang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujia Gong
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhang Ma
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Yan
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhong Huang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nicolaisen P, Obling ML, Winther KH, Hansen S, Hermann AP, Hegedüs L, Bonnema SJ, Brix TH. Consequences of Hyperthyroidism and Its Treatment for Bone Microarchitecture Assessed by High-Resolution Peripheral Quantitative Computed Tomography. Thyroid 2021; 31:208-216. [PMID: 32703114 DOI: 10.1089/thy.2020.0084] [Citation(s) in RCA: 10] [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] [Indexed: 12/31/2022]
Abstract
Background: Hyperthyroidism is associated with bone mass reduction and increased fracture risk, but the effects on other important bone parameters have been sparsely examined. Therefore, we investigated bone microarchitecture and estimated bone strength by high-resolution peripheral quantitative computed tomography (HR-pQCT) in hyperthyroid patients at diagnosis and after being euthyroid for at least one year. Methods: Two approaches were used: (A) a case-control study comparing 61 hyperthyroid women with 61 euthyroid women matched for age and menopause status; (B) a follow-up study, in which 46 of the 61 women were re-examined after having been euthyroid for one year. HR-pQCT of the distal radius and tibia, and dual-energy X-ray absorptiometry (DXA) of the lumbar spine and the hip were performed. Results: In analysis A: In the radius, compared with the healthy controls, hyperthyroid patients had higher total area (16.9% ± 29.5%; p < 0.001), trabecular area (28.6% ± 45.7%; p < 0.001), and lower cortical area (-11.7% ± 23.2%; p < 0.001). Total volumetric bone mineral density (vBMD) (-13.9% ± 26.5%; p < 0.001), cortical vBMD (-5.8% ± 7.9%; p < 0.001), cortical thickness (-16.7% ± 26.0%; p < 0.001), and estimated bone strength (-6.6% ± 19.5%; p < 0.01) were lower. No significant differences were found in the tibia or in the DXA parameters. In analysis B: In the radius, significant improvements were observed in the cortical area (2.1% ± 4.6%; p < 0.01), cortical thickness (2.5% ± 5.1%; p < 0.001), and total vBMD (0.8% ± 3.0%; p < 0.05). Trabecular area decreased (-0.5% ± 1.0%; p < 0.01) and trabecular separation increased (2.0% ± 8.3%; p < 0.05). In the tibia, cortical area (3.6% ± 7.3%; p < 0.01) and cortical thickness (3.8% ± 7.6%; p < 0.01) increased, and trabecular area decreased (-0.5% ± 1.1%; p < 0.01). Areal BMD, measured by DXA, increased in the spine (1.1% ± 3.4%; p < 0.05) and in the hip (2.0% ± 3.8%; p < 0.01). Conclusions: Compared with the healthy control group, hyperthyroid women had lower vBMD, lower estimated bone strength, and compromised cortical microarchitecture in the radius. After restoration of euthyroidism, significant improvements in vBMD and cortical microarchitecture were observed, highlighting the importance of achieving and maintaining euthyroidism.
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Affiliation(s)
- Pia Nicolaisen
- Department of Endocrinology, Odense University Hospital, 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
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Yan D, Chen C, Yan H, Liu T, Yan H, Yuan J. Mortality Risk After Radioiodine Therapy for Hyperthyroidism: A Systematic Review and Meta-Analysis. Endocr Pract 2020; 27:362-369. [PMID: 33616040 DOI: 10.1016/j.eprac.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Radioiodine has been increasingly used to treat hyperthyroidism for many years. Although widely regarded as an effective therapy, radioiodine treatment for hyperthyroidism has been suspected to be associated with the risk of mortality. This study aimed to quantify the mortality outcomes in patients who were treated for hyperthyroidism with radioiodine. METHODS Systematic search and meta-analysis were performed to determine the risk of mortality in patients treated with radioiodine for hyperthyroidism. Relevant studies were searched through August 2020 and selected in accordance with the inclusion criteria. RESULTS A total of 13 studies were identified. The summary odds ratios (ORs) showed an increased risk of all-cause mortality in patients who were treated with radioiodine for hyperthyroidism (OR = 1.20; 95% CI = 1.07-1.35). The risk of death attributed to all forms of circulatory, respiratory, and endocrine and metabolic diseases was significantly increased, with summary ORs of 1.23 (95% CI, 1.12-1.35), 1.43 (95% CI, 1.17-1.75), and 2.38 (95% CI, 1.85-3.06), respectively. The summary ORs revealed no significant association between radioiodine treatment for hyperthyroidism and the risk of cancer mortality (OR = 1.03; 95% CI, 0.98-1.09). Radioiodine treatment for hyperthyroidism was not associated with the risk of mortality from breast, respiratory system, gastrointestinal, and genitourinary cancers. CONCLUSION Radioiodine treatment for hyperthyroidism is associated with the risk of all-cause mortality but not cancer mortality. Future research needs to address the causes of hyperthyroidism, effects of radioiodine therapy, and potential effects of confounding to identify causality.
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Affiliation(s)
- Dandan Yan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Honglin Yan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Tian Liu
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China
| | - Hong Yan
- Department of Health Toxicology, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong-Road, Wuhan, 430030, P.R. China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, 238 Jiefang-Road, Wuchang District, Wuhan, 430060, P.R. China.
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Gauthier BR, Sola‐García A, Cáliz‐Molina MÁ, Lorenzo PI, Cobo‐Vuilleumier N, Capilla‐González V, Martin‐Montalvo A. Thyroid hormones in diabetes, cancer, and aging. Aging Cell 2020; 19:e13260. [PMID: 33048427 PMCID: PMC7681062 DOI: 10.1111/acel.13260] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/27/2020] [Accepted: 09/13/2020] [Indexed: 12/18/2022] Open
Abstract
Thyroid function is central in the control of physiological and pathophysiological processes. Studies in animal models and human research have determined that thyroid hormones modulate cellular processes relevant for aging and for the majority of age‐related diseases. While several studies have associated mild reductions on thyroid hormone function with exceptional longevity in animals and humans, alterations in thyroid hormones are serious medical conditions associated with unhealthy aging and premature death. Moreover, both hyperthyroidism and hypothyroidism have been associated with the development of certain types of diabetes and cancers, indicating a great complexity of the molecular mechanisms controlled by thyroid hormones. In this review, we describe the latest findings in thyroid hormone research in the field of aging, diabetes, and cancer, with a special focus on hepatocellular carcinomas. While aging studies indicate that the direct modulation of thyroid hormones is not a viable strategy to promote healthy aging or longevity and the development of thyromimetics is challenging due to inefficacy and potential toxicity, we argue that interventions based on the use of modulators of thyroid hormone function might provide therapeutic benefit in certain types of diabetes and cancers.
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Affiliation(s)
- Benoit R. Gauthier
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
- Biomedical Research Network on Diabetes and Related Metabolic Diseases‐CIBERDEM Instituto de Salud Carlos III Madrid Spain
| | - Alejandro Sola‐García
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
| | - María Ángeles Cáliz‐Molina
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
| | - Petra Isabel Lorenzo
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
| | - Nadia Cobo‐Vuilleumier
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
| | - Vivian Capilla‐González
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
| | - Alejandro Martin‐Montalvo
- Department of Cell Therapy and Regeneration Andalusian Center for Molecular Biology and Regenerative Medicine‐CABIMER Junta de Andalucía‐University of Pablo de Olavide‐University of Seville‐CSIC Seville Spain
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Kwon H, Moon BI. Prognosis of papillary thyroid cancer in patients with Graves' disease: a propensity score-matched analysis. World J Surg Oncol 2020; 18:266. [PMID: 33050937 PMCID: PMC7557089 DOI: 10.1186/s12957-020-02044-x] [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: 06/26/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Patients with Graves’ disease (GD) are at a 2.5 times higher risk of developing thyroid cancer than the general population. Previous studies reported conflicting results about the prognosis of thyroid cancer concomitant with GD. This study aimed to investigate the effect of GD to the recurrence rates of papillary thyroid carcinoma (PTC). Methods We reviewed 3628 patients who underwent total thyroidectomy for PTC at the Ewha Womans University Medical Center from January 2006 to June 2014. Of those, 114 patients had non-occult PTC with concomitant GD. To reduce potential confounding effects and selection bias, we conducted 1:5 propensity score matching and analyzed the recurrence-free survival. Results Thyroid cancer in patients with GD showed lower rate of lymphatic invasion (1.8% vs. 6.7%; p = 0.037), microscopic resection margin involvement (0.9% vs. 5.8%; p = 0.024), and lymph node metastasis (29.8% vs. 37.3%; p = 0.001) than in patients without GD, respectively. During the median follow-up of 94.1 months, recurrence occurred in one patient (0.9%) with GD. After propensity score matching for adjusting clinicopathological features, 5-year recurrence-free survival was comparable between patients with GD and euthyroid patients (100% vs. 98.4%, p = 0.572). Both tumor size [hazard ratio (HR) 1.585, p < 0.001] and lymph node metastasis (HR for N1a 3.067, p = 0.024; HR for N1b 15.65, p < 0.001) were predictive factors for recurrence-free survival, while GD was not associated with the recurrence. Conclusions Our data suggest that GD does not affect the prognosis of PTC. Thyroid cancer in patients with GD is not more aggressive than in euthyroid patients.
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Affiliation(s)
- Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, South Korea.
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, South Korea
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Li Y, Pan Q, Gao M, Guo L, Yan H, Li S. Secular trends and rural-urban differences in endocrine and metabolic disease mortality in China: an age-period-cohort modeling of National Data. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kim HJ, Kang T, Kang MJ, Ahn HS, Sohn SY. Incidence and Mortality of Myocardial Infarction and Stroke in Patients with Hyperthyroidism: A Nationwide Cohort Study in Korea. Thyroid 2020; 30:955-965. [PMID: 32093587 DOI: 10.1089/thy.2019.0543] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Hyperthyroidism is associated with various cardiovascular risk factors. However, the relationship between hyperthyroidism and myocardial infarction (MI) or stroke has not been fully elucidated; only a few studies have investigated the association of hyperthyroidism with survival after MI or stroke. Methods: We included 59,021 hyperthyroid patients and a control cohort with 1,180,420 age- and sex-matched subjects from the Korean National Health Insurance database. Blood pressure, body mass index (BMI), glucose and cholesterol levels, and smoking history were obtained during National Health screening examination. We compared the incidence of MI, stroke, and survival after cardiovascular events between subjects with hyperthyroidism and the control cohort. Results: Subjects with hyperthyroidism had higher blood pressure, fasting glucose, and smoking rate, but lower cholesterol levels and a lower obesity rate compared with the control cohort. After adjusting these differences, as well as atrial fibrillation, hyperthyroidism was associated with increased risk of MI and ischemic stroke. Adjusted hazard ratios (HRs) for MI and ischemic stroke with hyperthyroidism was 1.16 [95% confidence interval, CI 1.03-1.30] and 1.12 [CI 1.04-1.20], respectively. In age-, sex-, and BMI-stratified analyses, an increased risk of MI and ischemic stroke remained significant in females, the older age group (≥50 years), and nonobese subjects (BMI <25 kg/m2), but not in males, the younger age group (<50 years), and obese subjects (BMI ≥25 kg/m2). The risk of hemorrhagic stroke was not different between subjects with hyperthyroidism and controls. Adjusted HRs for mortality in subjects with hyperthyroidism who developed MI, ischemic stroke, and hemorrhagic stroke were 1.11 ([CI 0.86-1.43], p = 0.44), 0.89 ([CI 0.75-1.05], p = 0.16), and 1.13 ([CI 0.88-1.47], p = 0.34), respectively. Conclusions: Hyperthyroidism is associated with increased risk of MI and ischemic stroke, independent of cardiovascular risk factors. This association is prominent in subjects with age ≥50 years, in females, and in the nonobese group. Hyperthyroidism did not significantly affect the mortality secondary to cardiovascular events.
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Affiliation(s)
- Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine; Graduate School; Korea University, Seoul, Republic of Korea
| | - Taeuk Kang
- National Health Institute Service, Health Insurance Policy Research Institute, Wonju, Republic of Korea
| | - Min Ji Kang
- Department of Public Health, Graduate School; Korea University, Seoul, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine; Graduate School; Korea University, Seoul, Republic of Korea
| | - Seo Young Sohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
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Turan E, Karaaslan O. The Relationship between Iodine and Selenium Levels with Anxiety and Depression in Patients with Euthyroid Nodular Goiter. Oman Med J 2020; 35:e161. [PMID: 32802419 PMCID: PMC7418102 DOI: 10.5001/omj.2020.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/21/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Selenium and iodine are essential microelements for normal body functions. These two elements play important roles in thyroid metabolism. The potential relationship between thyroid diseases and mental disorders have been demonstrated. We aimed to investigate the relationship between selenium and iodine levels with anxiety and depression in patients with euthyroid nodular goiter (ENG). METHODS In this cross-sectional study, we enrolled 102 consecutive patients with ENG who attended the endocrine outpatient clinic between January 2018 and June 2018. We noted the patient's demographics, thyroid ultrasound imaging, thyroid hormones, and urinary iodine concentration (UIC) results. We also obtained venous blood samples for serum selenium measurement. The same psychiatrist completed the Beck Anxiety Inventory (BAI) and Hamilton Depression Rating Scale (HDRS) for all participants. The study population was dichotomized according to the median values of selenium levels and UIC. RESULTS BAI and HDRS scores were significantly higher in the low selenium group than the high selenium group (p = 0.032 and p = 0.042, respectively). BAI scores were significantly higher in the low UIC group than the high UIC group (p = 0.007). CONCLUSIONS Low selenium and UIC levels may contribute to the development of anxiety and depression, independent of thyroid functions, in patients with ENG. In these patients, selenium and iodine replacement may be useful for the prevention of anxiety and depression, especially in deficient regions.
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Affiliation(s)
- Elif Turan
- Department of Endocrinology and Metabolic Disease, Medical School of Yozgat Bozok University, Yozgat, Turkey
| | - Ozgul Karaaslan
- Department of Psychiatry, Medical School of Yozgat Bozok University, Yozgat, Turkey
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Folkestad L, Brandt F, Lillevang-Johansen M, Brix TH, Hegedüs L. Graves' Disease and Toxic Nodular Goiter, Aggravated by Duration of Hyperthyroidism, Are Associated with Alzheimer's and Vascular Dementia: A Registry-Based Long-Term Follow-Up of Two Large Cohorts. Thyroid 2020; 30:672-680. [PMID: 31984866 DOI: 10.1089/thy.2019.0672] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Dementia is an increasing burden to the health care system. It is currently debated whether hyperthyroidism is associated with a risk of dementia. Our aim was to determine the risk of dementia in hyperthyroid individuals and whether this was associated with duration of hyperthyroidism. Methods: Risk of dementia in hyperthyroid individuals was evaluated in two cohorts and matched reference populations. The Danish National Patient Registry (DNPR) cohort is a registry-based Danish nationwide cohort followed for a median of 7.2 years (from 1995 to 2013), whereas the OPENTHYRO registry cohort comprises 235,547 individuals who had at least one serum thyrotropin (TSH) measurement in the period from 1995 to 2011 and was followed for a median of 7.3 years. Each hyperthyroid case was matched with four controls according to age and sex using density sampling. Hyperthyroidism was defined as either an International Classification of Diseases Version 10 (ICD-10) diagnosis of toxic nodular goiter (TNG) or Graves' disease (GD), or two measurements of a TSH below 0.3 mU/L in the DNPR and OPENTHYRO registry cohort, respectively. The primary outcome was all-cause dementia, defined as either an ICD-10 code of dementia or prescription of medicine for dementia, with subgroup analyses of vascular dementia and Alzheimer's disease. Results: The DNPR cohort had 56,128 patients with hyperthyroidism, 2689 of whom were registered with dementia. The reference population had 224,512 individuals, of whom 10,199 had dementia (hazard ratio 1.17; 95% confidence interval [CI]: 1.12-1.23). Risk of dementia, whether Alzheimer's or vascular, was higher in both GD and TNG. The OPENTHYRO registry cohort constituted 2688 hyperthyroid individuals and 10,752 euthyroid control individuals of whom 190 and 473 individuals, respectively, were subsequently diagnosed with dementia (HR 1.06; 95% CI: 0.89-1.26). For each 6 months of decreased TSH, the risk of all-cause dementia was significantly higher (HR 1.16; 95% CI: 1.12-1.22). Conclusions: Using large-scale registry-based data, we found increased risk of dementia in hyperthyroid individuals. Every 6 months of decreased TSH was associated with increased risk of dementia by 16%, compared with individuals with normal TSH. Our data support early diagnosis and intervention in patients with hyperthyroidism.
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Affiliation(s)
- Lars Folkestad
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Frans Brandt
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Hospital of Southern Jutland, Sønderborg, Denmark
| | - Mads Lillevang-Johansen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Ito A, Ando T, Nozaki A, Haraguchi A, Horie I, Kawakami A. VISCERAL AND SUBCUTANEOUS FAT INCREASED AFTER TREATMENT OF GRAVES DISEASE. Endocr Pract 2020; 26:484-491. [PMID: 31968183 DOI: 10.4158/ep-2019-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Patients with Graves disease (GD) tend to gain weight after treatment, but it remains unknown if weight gain is associated with an increase in the visceral and/or subcutaneous fat areas (VFA, SFA). Methods: We enrolled 25 newly diagnosed GD patients (22 females, median age 33.0 years) and studied their clinical parameters, and VFA and SFA measured by a dual bioelectric impedance analysis. We divided them into 2 groups based on the rates of change in the VFA and SFA, and we compared clinical parameters at the baseline between the groups to evaluate factors that influence increases in the VFA and/or SFA with treatment. Results: The patients' body weight (BW), VFA, and SFA were significantly increased after a 6-month treatment (BW: from 54.3 ± 10.3 kg to 58.0 ± 11.2 kg; P<.001; VFA: from 47.1 ± 21.3 cm2 to 54.7 ± 23.4 cm2; P = .004; SFA: from 159.8 ± 85.9 cm2 to 182.2 ± 82.9 cm2; P = .008). The percent changes of BW correlated with the SFA (ρ = .591, P = .002), but not with the VFA. The patients with larger VFA increases had significantly less VFA at the baseline compared to those with smaller increases, expressed as median and interquartile range (33.9 cm2 [22.7 to 47.5 cm2] versus 54.5 cm2 [45.2 to 64.0], respectively; P = .011). A larger increase in the SFA was negatively associated with serum alkaline phosphatase. An increase in the SFA was associated with free triiodothyronine (T3) in a multivariate logistic analysis (odds ratio: 0.80 [0.59 to 0.97]; P = .013). Conclusion: The patients' BW, VFA, and SFA were increased after GD treatment. The increase in SFA seemed to contribute to weight gain and was associated with a low baseline level of free T3. Abbreviations: ALP = alkaline phosphatase; BMI = body mass index; BW = body weight; GD = Graves disease; SFA = subcutaneous fat area; T3 = triiodothyronine; T4 = thyroxine; TG = triglycerides; VFA = visceral fat areas.
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de Vries TI, de Valk HW, van der Graaf Y, de Borst GJ, Cramer MJM, Jaap Kappelle L, Visseren FLJ, Westerink J. Normal-range thyroid-stimulating hormone levels and cardiovascular events and mortality in type 2 diabetes. Diabetes Res Clin Pract 2019; 157:107880. [PMID: 31628967 DOI: 10.1016/j.diabres.2019.107880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Abstract
AIMS Thyroid dysfunction is a risk factor for cardiovascular disease. Whether thyroid function within the normal range is a risk factor for cardiovascular disease remains uncertain. The aim of this study is to evaluate whether plasma thyroid-stimulating hormone (TSH) levels in the normal range are a risk factor for cardiovascular disease and mortality in participants with type 2 diabetes mellitus with high cardiovascular risk. METHODS We included 1265 participants with high cardiovascular risk, type 2 diabetes, and TSH within the normal range (0.35-5.00 mIU/L) from the Second Manifestations of ARTerial disease cohort. The primary outcome was major cardiovascular events (MACE; vascular death, stroke and myocardial infarction). Secondary outcomes of interest were the separate vascular outcomes and all-cause mortality. Cox proportional hazard models were used to evaluate the risk of plasma TSH levels on all outcomes. RESULTS A total of 191 MACE occurred during a total follow-up of 8183 years. Plasma TSH levels were not associated with MACE (hazard ratio (HR) per mIU/L TSH increase 0.93; 95% confidence interval (95%CI) 0.80-1.08). With a total of 54 strokes during the study period, plasma TSH was associated with a lower risk of stroke (HR per mIU/L 0.64, 95% CI 0.45-0.89). There was no association between plasma TSH levels and risk of myocardial infarction, vascular death, or all-cause mortality. CONCLUSIONS Higher TSH levels within the normal range are associated with a lower risk of stroke in high-risk patients with type 2 diabetes, but not associated with the risk of other cardiovascular events or mortality.
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Affiliation(s)
- Tamar I de Vries
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Maarten J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
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Lin CH, Chang CK, Shih CW, Li HY, Chen KY, Yang WS, Tsai KS, Wang CY, Shih SR. Serum fibroblast growth factor 23 and mineral metabolism in patients with euthyroid Graves' diseases: a case-control study. Osteoporos Int 2019; 30:2289-2297. [PMID: 31384956 DOI: 10.1007/s00198-019-05116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study investigated the alterations of mineral metabolism in patients with Graves' disease (GD) who achieved euthyroidism. They had higher fibroblast growth factor 23 (FGF23) and phosphorus as compared with healthy subjects. Serum FGF23 was negatively correlated with serum phosphorus. These indicated abnormal mineral metabolism even after 1.6 years of euthyroid status. INTRODUCTION FGF23 is involved in the mineral homeostasis, especially the regulation of serum phosphorus. Graves' disease (GD) is associated with accelerated bone turnover, hyperphosphatemia, and elevated serum FGF23. Evidence suggested that serum FGF23 decreased after a 3-month treatment of GD. However, it remains unclear whether serum FGF23, serum phosphorus, and other markers of mineral metabolism will be normalized after euthyroid status achieved. METHODS A total of 62 patients with euthyroid GD and 62 healthy control subjects were enrolled, and the median duration of euthyroid status was 1.6 years. Endocrine profiles including thyroid function test, autoantibodies, serum FGF23, and bone turnover markers were obtained and compared between the two groups. RESULTS Euthyroid GD patients had significantly higher serum FGF23 and phosphorus, and lower 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH) levels as compared with the control group. Serum FGF23 was significantly and negatively correlated with phosphorus level after adjusted for age, gender, calcium, iPTH, and 25(OH)D in the euthyroid GD group. CONCLUSION Serum phosphorus and FGF23 levels remain higher in GD patients even after euthyroid status has been achieved for a median of 1.6 years. Serum FGF23 was negatively correlated with serum phosphorus in euthyroid GD patients. Underlying mechanisms warrant further investigations. TRIAL REGISTRATION Registration number: NCT01660308 and NCT02620085.
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Affiliation(s)
- C-H Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - C-K Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - C-W Shih
- Department of Ophthalmology, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
| | - H-Y Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 1, Ren-Ai Road, Taipei, 10051, Taiwan
| | | | - W-S Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 1, Ren-Ai Road, Taipei, 10051, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - K-S Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 1, Ren-Ai Road, Taipei, 10051, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - C-Y Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 1, Ren-Ai Road, Taipei, 10051, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - S-R Shih
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 1, Ren-Ai Road, Taipei, 10051, Taiwan.
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Center of Anti-Aging and Health Consultation, National Taiwan University Hospital, Taipei, Taiwan.
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Kim SW, Jeon JH, Moon JS, Jeon EJ, Kim MK, Lee IK, Seo JB, Park KG. Low-Normal Free Thyroxine Levels in Euthyroid Male Are Associated with Prediabetes. Diabetes Metab J 2019; 43:718-726. [PMID: 30968614 PMCID: PMC6834837 DOI: 10.4093/dmj.2018.0222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 11/08/2022] Open
Abstract
Abnormal thyroid function is associated with impaired glucose homeostasis. This study aimed to determine whether free thyroxine (FT4) influences the prevalence of prediabetes in euthyroid subjects using a cross-sectional survey derived from the Korea National Health and Nutrition Examination Survey, conducted between 2013 and 2015. We studied 2,399 male participants of >20 years of age who were euthyroid and non-diabetic. Prediabetic participants had lower FT4 concentrations than those without prediabetes, but their thyrotropin concentrations were similar. We stratified the population into tertiles according to FT4 concentration. After adjusting for multiple confounding factors, glycosylated hemoglobin (HbA1c) levels significantly decreased with increasing FT4 tertile, whereas fasting plasma glucose (FPG) levels were not associated with FT4 tertiles (HbA1c, P<0.01 in T3 vs. T1; FPG, P=0.489 in T3 vs. T1). The prevalence of prediabetes was significantly higher in T1 (odds ratio, 1.426; 95% confidence interval, 1.126 to 1.806; P<0.01) than in T3. In conclusion, subjects with low-normal serum FT4 had high HbA1c and were more likely to have prediabetes. These results suggest that low FT4 concentration is a risk factor for prediabetes in male, even when thyroid function is within the normal range.
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Affiliation(s)
- Sung Woo Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Han Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Sung Moon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eon Ju Jeon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Mi Kyung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - In Kyu Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Beom Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Keun Gyu Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
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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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de Vries TI, Kappelle LJ, van der Graaf Y, de Valk HW, de Borst GJ, Nathoe HM, Visseren FLJ, Westerink J. Thyroid-stimulating hormone levels in the normal range and incident type 2 diabetes mellitus. Acta Diabetol 2019; 56:431-440. [PMID: 30259116 PMCID: PMC6420678 DOI: 10.1007/s00592-018-1231-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the relationship between thyroid-stimulating hormone (TSH) levels within the normal range and the risk of type 2 diabetes mellitus (T2DM) in a cohort of patients at high cardiovascular risk, and to perform a systematic review and meta-analysis of previous studies. METHODS We included 5542 patients without T2DM from the prospective Secondary Manifestations of ARTerial disease study with TSH levels between 0.35 and 5.0 mIU/L without anti-thyroid medication or thyroid-hormone replacement therapy. Cox regression was used to investigate the relationship between baseline plasma TSH levels and incident T2DM. MEDLINE, EMBASE, and Cochrane were searched for prospective cohorts assessing TSH and incident T2DM. Hazard ratios (HR) from included prospective cohort studies were pooled using a random-effects model. RESULTS In patients at high cardiovascular risk, higher plasma TSH levels in the normal range were not associated [HR 1.07 per mIU/L increase in TSH (95% confidence interval (95% CI) 0.95-1.22)] with an increased risk of T2DM, adjusted for age, sex, smoking, total and HDL cholesterol, and triglycerides. In the meta-analysis involving three prospective cohort studies, including the present study, including 29,791 participants with 1930 incident events, there was no relation between plasma TSH levels in the normal range and incident T2DM [pooled HR 1.06 (95% CI 0.99-1.14)]. CONCLUSION There is no apparent relation between plasma TSH levels in the normal range and incident T2DM in patients at high cardiovascular risk.
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Affiliation(s)
- T I de Vries
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - L J Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L. Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk. Thyroid 2019; 29:332-340. [PMID: 30648498 DOI: 10.1089/thy.2018.0320] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cardiovascular disease remains the most prevalent cause of death in hyperthyroidism. However, the impact on cardiovascular events of varying thyroid status and of treatment remains unclarified. The aims of this study were to investigate the association between hyperthyroidism and cardiovascular events in treated and untreated hyperthyroid individuals, as well as exploring the impact of cumulative periods of hyperthyroidism as a proxy for undertreatment on cardiovascular events. METHOD This was a case-control study nested within a population-based cohort of individuals attending health services in Funen County, Denmark, in the period from 1995 to 2011. Data on comorbidities and mortality were collected from The Danish National Patient Register and The Danish Register of Causes of Death. Participants were 275,467 individuals with at least one serum thyrotropin (TSH) measurement in the study period. Hyperthyroidism was defined as at least two measurements of decreased serum TSH within six months, separated by at least 14 days. Incident cases of cardiovascular disease (myocardial infarction, atrial fibrillation, heart failure, stroke, and cardiovascular death) were matched with controls. Conditional logistic regression analyses were performed to calculate odds ratios (OR) for exposure to hyperthyroidism, adjusting for preexisting comorbidities. RESULTS A total of 20,651 individuals experienced a cardiovascular event (9.5% incidence rate 13.2/1000 person-years [confidence interval (CI) 13.0-13.4]) compared to euthyroid individuals, conditional logistic regression showed increased cardiovascular risk in untreated hyperthyroid patients (OR = 1.25 [CI 1.06-1.48], p = 0.007) but not in treated hyperthyroid patients (OR = 1.04 [CI 0.90-1.22], p = 0.57)]. The OR for cardiovascular events per six months of decreased TSH was 1.09 ([CI 1.05-1.14], p < 0.001) in treated hyperthyroid individuals, and 1.10 ([CI 1.05-1.15], p < 0.001) in untreated hyperthyroid individuals. CONCLUSIONS The risk of cardiovascular disease was found to be increased in untreated hyperthyroid patients, and the duration of decreased TSH associated with increasing risk of cardiovascular outcomes in both treated and untreated hyperthyroid individuals. This suggests that increased cardiovascular risk is driven not only by lack of treatment but also by insufficient therapy. The results support timely treatment and careful monitoring of hyperthyroid patients in order to reduce cardiovascular risk.
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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 and University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- 2 Institute of Clinical Research and 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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Kwon H, Kim JK, Lim W, Moon BI, Paik NS. Increased risk of postoperative complications after total thyroidectomy with Graves' disease. Head Neck 2018; 41:281-285. [PMID: 30537006 DOI: 10.1002/hed.25484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The effect of Graves' disease on the risk of postoperative complications in patients undergoing total thyroidectomy is unclear. METHODS The incidence of recurrent laryngeal nerve (RLN) injury and hypoparathyroidism were analyzed between 165 patients with Graves' disease (GD group) and 1:1 matched patients with euthyroid states (control group). RESULTS The matched cohorts did not differ in age, sex, body mass index, pathologic diagnosis, and extent of operation. Excised thyroid weight was higher in the Graves' disease than in the control group (60.1 g vs 22.6 g; P < .001). Multivariate analysis showed that Graves' disease significantly increased risks of transient RLN injury (odds ratio [OR] = 4.7, 95% confidence interval [CI] = 1.5-15.5; P = .010) and transient hypoparathyroidism (OR = 2.8, 95% CI = 1.3-5.8; P = .007). Rates of permanent complications were comparable in the Graves' disease and control groups. CONCLUSIONS Graves' disease can be a predictive factor for postoperative RLN injury and hypoparathyroidism after total thyroidectomy.
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Affiliation(s)
- Hyungju Kwon
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Jong-Kyu Kim
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Woosung Lim
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Nam Sun Paik
- Department of Surgery, Ewha Womans University Medical Center, Seoul, South Korea
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