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Rachman A, Purnamasari D, Hardianti MS, Priantono D, Rumondor BB, Irawan C. The role of Zulewski’s clinical score in screening for hypothyroidism in post-radiation therapy nasopharyngeal carcinoma patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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2
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Lam-Chung CE, Cuevas-Ramos D. The promising role of risk scoring system for Cushing syndrome: Time to reconsider current screening recommendations. Front Endocrinol (Lausanne) 2022; 13:1075785. [PMID: 36482998 PMCID: PMC9725023 DOI: 10.3389/fendo.2022.1075785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Despite the current screening approach for Cushing syndrome (CS), delayed diagnosis is common due to broad spectrum of presentation, poor discriminant symptoms featured in diabetes and obesity, and low clinical index of suspicion. Even if initial tests are recommended to screen CS, divergent results are not infrequent. As global prevalence of type 2 diabetes and obesity increases, CS may not be frequent enough to back routine screening to avoid false-positive results. This represents a greater challenge in countries with limited health resources. The development of indexes incorporates clinical features and biochemical data that are largely used to provide a tool to predict the presence of disease. In clinical endocrinology, indexes have been used in Graves' ophthalmology, hirsutism, and hypothyroidism. The use of clinical risk scoring system may assist clinicians in discriminating CS in the context of at-risk populations and, thus, may provide a potential intervention to decrease time to diagnosis. Development and validation of clinical model to estimate pre-test probability of CS in different geographic source population may help to establish regional prediction model for CS. Here, we review on the latest progress in clinical risk scoring system for CS and attempt to raise awareness for the use, validation, and/or development of clinical risk scores in CS.
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Affiliation(s)
- CE. Lam-Chung
- Department of Endocrinology and Metabolism, Complejo Hospitalario Dr. Manuel Amador Guerrero, Colón, Panama
| | - D. Cuevas-Ramos
- Neuroendocrinology Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- *Correspondence: D. Cuevas-Ramos,
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3
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Aldhafiri FK, Abdelgawad FE, Bakri GMM, Saber T. Thyroid Function Assessment in Saudi Males with Metabolic Syndrome. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:352-359. [PMID: 35399801 PMCID: PMC8985841 DOI: 10.4103/jpbs.jpbs_745_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022] Open
Abstract
Background Metabolic Syndrome (MetS) is a multifactor condition associated with cardiovascular risk. Thyroid hormones regulate MetS components via controlling energy homeostasis, lipids, and glucose metabolism. The risk ratio for MetS and related disorders changes between males and females. Aim and Objectives: Study aim to access thyroid functions in Saudi population with metabolic syndrome. Materials and Methods The current study sought to evaluate the impact of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) in predicting the risk of MetS. A total of 200 (MetS 100 and control 100) Saudi Arabian males were enrolled for the study, and after applying eligibility criteria, the eligible study size was examined for the physical test (chest, abdominal, and general examination with stress on blood pressure measurement) and anthropometric parameters (bodyweight, body mass index, and waist circumference). Results In the present study, the biochemical parameters, such as TSH, FT3, FT4, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), high-density lipoprotein (LDL), fasting glucose, and fasting insulin were measured in the study group, and statistical analysis was also performed. The results revealed that the MetS and control differ in terms of physical, anthropometric, and biochemical markers. The study showed that thyroid dysfunction (TD) and MetS are closely associated with the difference in physical, anthropometric, and metabolic characteristics. Conclusion The result demonstrated hypothyroidism major risk factor due to TD in MetS. These findings provide a scientific basis for diagnosis and the management of TD, associated MetS, and cardiovascular disease (CVD).
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Affiliation(s)
- Fahad Khalid Aldhafiri
- Department of Public Health, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Fathy Elsayed Abdelgawad
- Medical Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Chemistry, Faculty of Science, Islamic University of Madinah, Madinah, KSA
| | | | - Tamer Saber
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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4
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Seife Hassen S, Salih Ali M, Khan A, Mohammed AM, Altermanini M, Al Mohanadi DHSH, Zahid M. Recurrent thyrotoxic periodic paralysis with normokalemia in a 36-year-old man: A case report. Clin Case Rep 2021; 9:e04849. [PMID: 34584714 PMCID: PMC8457415 DOI: 10.1002/ccr3.4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/11/2021] [Accepted: 08/29/2021] [Indexed: 12/29/2022] Open
Abstract
Among patients with thyrotoxicosis and proximal muscle weakness, some patients with TPP may present with apparent normokalemia in whom a careful administration of potassium may lead to rapid reversal of muscle weakness.
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Affiliation(s)
- Sara Seife Hassen
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Salih Ali
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Adeel Khan
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Areej Marwan Mohammed
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Altermanini
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | | | - Mohamed Zahid
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
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5
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Correlations Between Auricular Tenderness and Symptoms in Korean Adults. Holist Nurs Pract 2020; 34:180-186. [PMID: 32282494 DOI: 10.1097/hnp.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine the correlation between auricular tenderness and subjective symptoms. A descriptive correlational study design was followed, which was also the second analysis of a randomized controlled trial. This study was performed in the Republic of Korea from September 2013 to February 2017. The Patient Health Questionnaire-9, the Constipation Assessment Scale, and the Nicotine Dependence Syndrome Scale were used. One hundred thirty-three participants displayed ear tenderness, whereas 84 participants did not. Adults with auricular tenderness reported more symptoms, such as sputum, rhinitis, constipation, stress, mood swings, and depressive symptoms compared with adults without (with tenderness: 4.14 ± 2.94, without tenderness: 2.92 ± 2.45; t = 3.32, P = .001). Finally, auricular acupressure points were positively correlated with various symptoms such as sputum, constipation, nicotine addiction, stress, cough, and rhinitis. Auricular palpation could be used to detect a disease at an early stage.
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6
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Borzouei S, Mahjub H, Sajadi NA, Farhadian M. Diagnosing thyroid disorders: Comparison of logistic regression and neural network models. J Family Med Prim Care 2020; 9:1470-1476. [PMID: 32509635 PMCID: PMC7266255 DOI: 10.4103/jfmpc.jfmpc_910_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The main goal of this study was to diagnose the two most common thyroid disorders, namely, hyperthyroidism and hypothyroidism, based on multinomial logistic regression and neural network models. In addition, the study evaluated the predictive ability of laboratory tests against the individual clinical symptoms score. MATERIALS AND METHODS In this study, the data from patients with thyroid dysfunction who referred to Imam Khomeini Clinic and Shahid Beheshti Hospital in Hamadan were collected. The data contained 310 subjects in one of three classes-euthyroid, hyperthyroidism, and hypothyroidism. Collected variables included demographics and symptoms of hypothyroidism and hyperthyroidism, as well as laboratory tests. To compare the predictive ability of the clinical signs and laboratory tests, different multinomial logistic regression and neural network models were fitted to the data. These models were compared in terms of the mean of the accuracy and area under the curve (AUC). RESULTS The results showed better performance of neural network model than multinomial logistic regression in all cases. The best predictive performance for logistic regression (with a mean accuracy of 91.4%) and neural network models (with a mean accuracy of 96.3%) was when all variables were included in the model. In addition, the predictive performance of two models based on symptomatic variables was superior to laboratory variables. CONCLUSIONS Both neural network and logistic regression models have a high predictive ability to diagnose thyroid disorder, although neural network performance is better than logistic regression. In addition, as achieving less error prediction model has always been a matter of concern for researchers in the field of disease diagnosis, predictive nonparametric techniques, such as neural networks, provide new opportunities to obtain more accurate predictions in the field of medical research.
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Affiliation(s)
- Shiva Borzouei
- Clinical Research Development Unit of Shahid Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Mahjub
- Research Center for Health Sciences, Hamadan, Iran
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Negar Asaad Sajadi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farhadian
- Research Center for Health Sciences, Hamadan, Iran
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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7
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Khare J, Srivastava P, Rai S, Ghanekar J. Zulewski's clinical score and its validation in hypothyroid patients: Experience in a tertiary care center in Western India. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_14_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Diagnosis of hypothyroidism using a fuzzy rule-based expert system. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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9
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Gourmelon R, Donadio-Andréi S, Chikh K, Rabilloud M, Kuczewski E, Gauchez AS, Charrié A, Brard PY, Andréani R, Bourre JC, Waterlot C, Guédel D, Mayer A, Disse E, Thivolet C, Boullay HD, Falandry C, Gilbert T, François-Joubert A, Vignoles A, Ronin C, Bonnefoy M. Subclinical Hypothyroidism: is it Really Subclinical with Aging? Aging Dis 2019; 10:520-529. [PMID: 31164997 PMCID: PMC6538219 DOI: 10.14336/ad.2018.0817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 01/16/2023] Open
Abstract
No recent study has focused on clinical features of subclinical hypothyroidism (SCH), especially in older patients. TSH measurement has remarkably evolved these last 20 years and thus reconsideration is needed. In our prospective multicenter study (2012-2014) including 807 subjects aged <60 years (<60y) and 531 subjects ≥60 years (≥60y), we have monitored 11 hypothyroidism-related clinical signs (hCS) together with TSH, FT4, FT3 and anti-thyroperoxidase antibodies values. hCS expression has been compared in patients with SCH vs euthyroidism in each age group. The number of hCS above 60y of age were found to be more elevated in the euthyroid population (1.9 vs 1.6, p<0.01) than in the SCH population (2.3 vs 2.6, p=0.41) while increase in hCS is limited to SCH subjects in the <60y group (p<0.01). The percentage of subjects with at least 3 signs increased with SCH in the <60y group (42.6% vs 25.0%, p<0.01) but not ≥60y (34.4% vs 33.9%, p=0.96). In older individuals, only three hCS could be related to both SCH and a decreased T3/T4-ratio (0.26 vs 0.27, p<0.01), suggesting either a reduced activity of TSH, or an adaptive response with aging. While hCS are clearly associated with SCH in patients <60y, they are not so informative in older subjects. TSH measurements carried out on the basis of hCS need to be interpreted with caution in aged patients. A reassessment of the TSH reference range in older patients is clearly needed and should be associated to more appropriate monitoring of thyroid dysfunction
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Affiliation(s)
- Robin Gourmelon
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | | | - Karim Chikh
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.,3Hospices Civils de Lyon, 69002 Lyon, France.,4Laboratoire de Biochimie et Biologie Moléculaire, Centre de Biologie Sud, Centre Hospitalier Lyon Sud 69 495 Pierre Bénite Cedex, France.,5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France
| | - Muriel Rabilloud
- 6Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France
| | | | - Anne-Sophie Gauchez
- 5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France.,7UMR-S INSERM 1039, 38000 Grenoble, France.,8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France.,10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Anne Charrié
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.,3Hospices Civils de Lyon, 69002 Lyon, France.,4Laboratoire de Biochimie et Biologie Moléculaire, Centre de Biologie Sud, Centre Hospitalier Lyon Sud 69 495 Pierre Bénite Cedex, France.,5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France
| | - Pierre-Yves Brard
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Raphaëlle Andréani
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Jean-Cyril Bourre
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Christine Waterlot
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Domitille Guédel
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Anne Mayer
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Emmanuel Disse
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Charles Thivolet
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Hélène Du Boullay
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Claire Falandry
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Thomas Gilbert
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Anne François-Joubert
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Antoine Vignoles
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Catherine Ronin
- 2Siamed'Xpress, Hôtel Technologique Morandat, 13120 Gardanne, France
| | - Marc Bonnefoy
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
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10
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Lee JE, Lee DH, Oh TJ, Kim KM, Choi SH, Lim S, Park YJ, Park DJ, Jang HC, Moon JH. Clinical Feasibility of Monitoring Resting Heart Rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study. JMIR Mhealth Uhealth 2018; 6:e159. [PMID: 30006328 PMCID: PMC6064040 DOI: 10.2196/mhealth.9884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/30/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background Symptoms and signs of thyrotoxicosis are nonspecific and assessing its clinical status is difficult with conventional physical examinations and history taking. Increased heart rate (HR) is one of the easiest signs to quantify this, and current wearable devices can monitor HR. Objective We assessed the association between thyroid function and resting HR measured by a wearable activity tracker (WD-rHR) and evaluated the clinical feasibility of using this method in patients with thyrotoxicosis. Methods Thirty patients with thyrotoxicosis and 10 controls were included in the study. Participants were instructed to use the wearable activity tracker during the study period so that activity and HR data could be collected. The primary study outcomes were verification of changes in WD-rHR during thyrotoxicosis treatment and associations between WD-rHR and thyroid function. Linear and logistic model generalized estimating equation analyses were performed and the results were compared to conventionally obtained resting HR during clinic visits (on-site resting HR) and the Hyperthyroidism Symptom Scale. Results WD-rHR was higher in thyrotoxic patients than in the control groups and decreased in association with improvement of thyrotoxicosis. A one standard deviation–increase of WD-rHR of about 11 beats per minute (bpm) was associated with the increase of serum free T4 levels (beta=.492, 95% CI 0.367-0.616, P<.001) and thyrotoxicosis risk (odds ratio [OR] 3.840, 95% CI 2.113-6.978, P<.001). Although the Hyperthyroidism Symptom Scale showed similar results with WD-rHR, a 1 SD-increase of on-site rHR (about 16 beats per minute) showed a relatively lower beta and OR (beta=.396, 95% CI 0.204-0.588, P<.001; OR 2.114, 95% CI 1.365-3.273, P<.001) compared with WD-rHR. Conclusions Heart rate data measured by a wearable device showed reasonable predictability of thyroid function. This simple, easy-to-measure parameter is clinically feasible and has the potential to manage thyroid dysfunction. Trial Registration ClinicalTrials.gov NCT03009357; https://clinicaltrials.gov/ct2/show/NCT03009357 (Archived by WebCite at http://www.webcitation.org/70h55Llyg)
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Affiliation(s)
- Jie-Eun Lee
- Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul, Republic Of Korea
| | - Dong Hwa Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam-si, Republic Of Korea
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11
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Nazarpour S, Ramezani Tehrani F, Rahmati M, Minooee S, Simbar M, Noroozzadeh M, Azizi F. Validation of Billewicz Scoring System for Detection of Overt Hypothyroidism During Pregnancy. Int J Endocrinol Metab 2018; 16:e64249. [PMID: 30323849 PMCID: PMC6174609 DOI: 10.5812/ijem.64249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/12/2018] [Accepted: 06/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Currently, various clinical and laboratory diagnostic methods are used to detect overt hypothyroidism during pregnancy. The Billewicz scoring index, as a clinical scale for detection of hypothyroidism, has been applied in general populations; however, its application during pregnancy remains a controversial subject of ongoing research. OBJECTIVES The purpose of this study was to evaluate the diagnostic value of Billewicz scoring index for overt hypothyroidism in a general population of Iranian pregnant women. METHODS This study was conducted on 1843 pregnant women. A comprehensive questionnaire, including Billewicz scoring items, was completed, and relevant clinical examinations were performed. The participants underwent serum measurements of thyroxine (T4), thyroid hormone uptake, thyroid-stimulating hormone (TSH), and thyroid peroxidase antibody (TPOAb). Using the receiver operating characteristic (ROC) curve analysis, the optimal sensitivity and specificity were determined as values with maximum yields on the Youden and Rsquo's Index (sensitivity + specificity-1). RESULTS The prevalence of overt hypothyroidism and subclinical hypothyroidism was 3.3% and 28.6%, respectively. Overall, 3.6%, 18.9%, and 50% of euthyroid, subclinical hypothyroid, and overt hypothyroid women were TPOAb-positive, respectively. The mean Billewicz scores of euthyroid, overt hypothyroid, and subclinical hypothyroid women were -41.16 (11.16), -17.11 (13.63), and -40.1 (11.2), respectively. Based on the Billewicz scale, at least one sign of hypothyroidism was reported in 38.84% (n, 491) of euthyroid women. Scores ≤ -26.5 (sensitivity, 100%; specificity, 90.82%) were considered as the optimal scores for predicting overt hypothyroidism (Ldquo, Norisk, and Rsquo). CONCLUSIONS The Billewicz clinical scoring system, as a reliable and inexpensive clinical tool, used along with laboratory measurements, can help screen overt hypothyroidism during pregnancy, primarily in low-resource settings.
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Affiliation(s)
- Sima Nazarpour
- Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, IR Iran
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Fahimeh Ramezani Tehrani, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, IR Iran. Tel: +98-2122439982, Fax: +98-2122439784, E-mail:
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Sonia Minooee
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mahsa Noroozzadeh
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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12
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Lee JE, Lee DH, Oh TJ, Kim KM, Choi SH, Lim S, Park YJ, Park DJ, Jang HC, Moon JH. Validity and Reliability of the Korean Version of the Hyperthyroidism Symptom Scale. Endocrinol Metab (Seoul) 2018; 33:70-78. [PMID: 29589389 PMCID: PMC5874198 DOI: 10.3803/enm.2018.33.1.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/15/2017] [Accepted: 12/26/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Thyrotoxicosis is a common disease resulting from an excess of thyroid hormones, which affects many organ systems. The clinical symptoms and signs are relatively nonspecific and can vary depending on age, sex, comorbidities, and the duration and cause of the disease. Several symptom rating scales have been developed in an attempt to assess these symptoms objectively and have been applied to diagnosis or to evaluation of the response to treatment. The aim of this study was to assess the reliability and validity of the Korean version of the hyperthyroidism symptom scale (K-HSS). METHODS Twenty-eight thyrotoxic patients and 10 healthy subjects completed the K-HSS at baseline and after follow-up at Seoul National University Bundang Hospital. The correlation between K-HSS scores and thyroid function was analyzed. K-HSS scores were compared between baseline and follow-up in patient and control groups. Cronbach's α coefficient was calculated to demonstrate the internal consistency of K-HSS. RESULTS The mean age of the participants was 34.7±9.8 years and 13 (34.2%) were men. K-HSS scores demonstrated a significant positive correlation with serum free thyroxine concentration and decreased significantly with improved thyroid function. K-HSS scores were highest in subclinically thyrotoxic subjects, lower in patients who were euthyroid after treatment, and lowest in the control group at follow-up, but these differences were not significant. Cronbach's α coefficient for the K-HSS was 0.86. CONCLUSION The K-HSS is a reliable and valid instrument for evaluating symptoms of thyrotoxicosis in Korean patients.
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Affiliation(s)
- Jie Eun Lee
- Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hwa Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Ale AO, Ogbera AO, Ebili HO, Adeyemo OL, Afe TO. Prevalence, Predictive Factors, and Characteristics of Osteoporosis in Hyperthyroid Patients. Int J Endocrinol 2018; 2018:3540256. [PMID: 29849614 PMCID: PMC5907485 DOI: 10.1155/2018/3540256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/14/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The osteoporosis in thyroid disorder has the lowest report especially in sub-Saharan Africa. This study aims to determine the prevalence, predictive factors, and characteristics of osteoporosis in hyperthyroid patients. METHOD Forty (40) hyperthyroid patients and healthy controls ages 21-50 years were recruited in this study. Questionnaires were administered to capture bio- and clinical data. Biochemical tests included blood, thyroid functions, intact parathyroid hormone, corrected calcium, and 25-hydroxyvitamin D tests. Bone mineral density (BMD) was also evaluated. Data were analyzed using the SPSS 21. A p value < 0.05 was regarded as significant. RESULTS Osteoporosis was observed in 18 (45%) of study subjects, 13 (72.2%) females and 5 (27.8%) males, respectively. The BMD of the hyperthyroid patients had a negative correlation with free triiodothyronine, FT3 (r = -0.49, p = 0.005), FT4 (r = -0.33, p = 0.009), corrected calcium (r = -0.31, p = 0.039), alkaline phosphatase (r = -0.53, p < 0.001), and osteocalcin (r = -0.61, p < 0.001). Conversely, a positive association with thyroid-stimulating hormone (TSH) (r = 0.54, p < 0.001) was observed. Multiple regression showed osteocalcin (p < 0.001) and TSH (p = 0.015) as independent predictors of osteoporosis. CONCLUSION Thyrotoxicosis is a risk factor for osteoporosis occurrence, and we recommend routine screening for this bone disease in persons over 20 years old with this disorder.
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Affiliation(s)
- Ayotunde O. Ale
- Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Anthonia O. Ogbera
- Department of Medicine, College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Henry O. Ebili
- Department of Morbid Anatomy and Histopathology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Olusola L. Adeyemo
- Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ago-Iwoye, Ogun State, Nigeria
| | - Taiwo O. Afe
- Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Gangappa RB, Kenchannavar MB, Chowdary PB, Patanki AM, Ishwar M. Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid? J Clin Diagn Res 2016; 10:PC04-7. [PMID: 27504342 DOI: 10.7860/jcdr/2016/18733.7991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/27/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Total thyroidectomy has been used to treat patients with malignant thyroid disease. But for patients with benign thyroid disease, the safety and efficacy of total thyroidectomy is a matter of debate. Subtotal thyroidectomy that was previously the treatment of choice for benign thyroid disease has been associated with high recurrence rates. The risk of permanent complications is greatly increased in patients who undergo surgery for recurrence of benign thyroid disease. Total thyroidectomy is an operation that can be safely performed, with low incidence of permanent complications, which allows one to broaden its indications in various benign thyroid diseases, thus avoiding future recurrences and reoperations. AIM To assess the benefits of total thyroidectomy for benign thyroid diseases. MATERIALS AND METHODS This randomized prospective study was conducted between Feb 2013 and Nov 2014 in the Department of General Surgery at Bangalore Medical College and Research Institute. It included 116 patients undergoing total thyroidectomy procedure for benign thyroid disease. All cases were followed-up for a period of 6 months for incidence of RLN palsy, hypoparathyroidism, disease recurrence and number of incidental malignancies detected on postoperative histological analyses of the thyroid specimens. RESULTS Most of the patients were in the third decade of their lives. The female to male ratio was 6.7:1. Total thyroidectomy was done for 116 benign thyroid diseases with multinodular goiter as the most common diagnosis. The incidence of postoperative hypocalcaemia was 16.37% (however, only 1 patient developed permanent hypocalcaemia) and that of wound infection was 2.58% and seroma formation was 2.58%. None of the patients included in this study had haematoma formation or RLN paralysis. An incidental malignancy was identified in 11.20% patients. CONCLUSION Total thyroidectomy shows benefits in eradicating multinodular goiter, alleviating Grave's opthalmopathy, treating Hashimoto's thyroiditis and preventing recurrence. It decreases the likelihood of future operations for recurrent disease or completion thyroidectomy for incidental thyroid cancer thus decreasing the associated risks of increased morbidity associated with second operation. Therefore, for benign thyroid diseases requiring surgical management total thyroidectomy can be considered the treatment of choice.
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Affiliation(s)
- Rajashekara Babu Gangappa
- Associate Professor, Department of General Surgery, Bangalore Medical College and Research Institute , Bangalore, India
| | | | - Prashanth Basappa Chowdary
- Resident, Department of General Surgery, Bangalore Medical College and Research Institute , Bangalore, India
| | - Adithya Malolan Patanki
- Resident, Department of General Surgery, Bangalore Medical College and Research Institute , Bangalore, India
| | - Mahalakshmi Ishwar
- Resident, Department of General Surgery, Bangalore Medical College and Research Institute , Bangalore, India
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Zakavi SR, Khazaei G, Sadeghi R, Ayati N, Davachi B, Bonakdaran S, Jabbari Nooghabi M, Moosavi Z. Methimazole discontinuation before radioiodine therapy in patients with Graves' disease. Nucl Med Commun 2015; 36:1202-7. [PMID: 26426965 DOI: 10.1097/mnm.0000000000000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although radioiodine therapy (RIT) has been used for the treatment of hyperthyroidism for many decades, there is no consensus on the optimal time of methimazole (MMI) discontinuation before RIT. The aim of this clinical trial is to study the effect of three different time points of MMI discontinuation on response to RIT. METHOD AND PATIENTS Overall, 151 patients (18-65 years old), with Graves' disease who were taking MMI and referred to I-131 therapy, were consecutively assigned to one of three groups, and MMI was discontinued for 24-48, 48.1-72, and 72.1-168 h in group, 1, 2, and 3, respectively. Radioiodine uptake was measured in all patients and the radioiodine dose was calculated according to the Quimby formula to deliver 7.4 MBq of I-131 per gram of thyroid weight. Response to RIT was assessed at 1, 3, 6, and 12 months after RIT. RESULTS A total of 102 women and 49 men were included in the study. The mean administered dose of I-131 was 362.9±188.7 MBq (9.8±5.1 mCi) and the mean time to response for radioiodine was 4.1±3.6 months. There was no significant difference between the three groups in age, thyroid weight, anti-TPO level, radioactive iodine uptake level, and radioiodine dose (P>0.1). Response to RIT at 1, 3, 6, and 12 months after administration was also not different between the three groups (P>0.57). CONCLUSION No difference was found in the response to treatment between patients with MMI discontinuation for 24-48, 48.1-72, and 72.1-96 h before RIT. Shorter discontinuation of MMI before RIT may be preferable in most patients. Video Abstract: http://links.lww.com/NMC/A39.
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Affiliation(s)
- Seyed R Zakavi
- aNuclear Medicine Research Center bEndocrine Research Center cRadiology Department, Ghaem Hospital dSurgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences eDepartment of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
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Kim H, Kim J, Huh R, Cho SY, Jin DK. Elevation of serum creatine kinase during methimazole treatment of Graves disease in a 13-year-old girl and a literature review of similar cases. Ann Pediatr Endocrinol Metab 2015; 20:106-9. [PMID: 26191516 PMCID: PMC4504990 DOI: 10.6065/apem.2015.20.2.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 01/18/2023] Open
Abstract
We report a 13-year-old girl with Graves disease, who showed an increased level of serum creatine kinase (CK) accompanied by myalgia after methimazole (MMI) treatment. This patient developed muscular pain two weeks after MMI administration, along with increased CK levels. The level of thyroid hormone was within the normal range when she showed increased CK levels. After the MMI dose was decreased and levo-thyroxine was added, serum CK levels decreased to normal and the myalgia improved. The pathophysiologic mechanism of this effect has not yet been elucidated. An acute relatively hypothyroid state occurs secondary to antithyroid drug (ATD) administration in chronic hyperthyroidism, which may cause changes in the CK levels. In this report, we present a rare pediatric case, along with a literature review of similar cases. In the initial state of MMI treatment, myalgia should be detected and when it occurs, CK levels should be measured. The clinical strategy of monitoring CK levels with the aim of normalizing thyroid hormones is helpful in case of the development of adverse reactions, such as myalgia, during ATD treatment for Graves disease in children.
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Affiliation(s)
- Hyeseon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsup Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Rimm Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Symptoms and signs associated with postpartum thyroiditis. J Thyroid Res 2014; 2014:531969. [PMID: 25405057 PMCID: PMC4227325 DOI: 10.1155/2014/531969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background. Postpartum thyroiditis (PPT) is a common triphasic autoimmune disease in women with thyroid peroxidase (TPO) autoantibodies. This study evaluated women's thyroid disease symptoms, physical findings, stress levels, and thyroid stimulating hormone (TSH) levels across six postpartum months in three groups, TPO negative, TPO positive, and PPT positive women. Methods. Women were recruited in midpregnancy (n = 631) and TPO status was determined which then was used to form the three postpartum groups. The three groups were compared on TSH levels, thyroid symptoms, weight, blood pressure, heart rate, a thyroid exam, and stress scores. Results. Fifty-six percent of the TPO positive women developed PPT. Hypothyroid group (F (2, 742) = 5.8, P = .003) and hyperthyroid group (F (2, 747) = 6.6, P = .001) subscale scores differed by group. Several symptoms and stress scores were highest in the PPT group. Conclusions. The normal postpartum is associated with many symptoms that mimic thyroid disease symptoms, but severity is greater in women with either TPO or PPT positivity. While the most severe symptoms were generally seen in PPT positive women, even TPO positive women seem to have higher risk for these signs and symptoms.
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Sahay R, Kalra S, Magon N. Ensuring an intelligent India: Managing hypothyroidism in pregnancy. Indian J Endocrinol Metab 2011; 15:S76-S77. [PMID: 21966657 PMCID: PMC3169871 DOI: 10.4103/2230-8210.83327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, India
| | - Navneet Magon
- Department of Obstetrics and Gynaecology, Air Force Hospital, Kanpur, India
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