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Bagdade JD, McCurdy CE. Conventional HDL Subclass Measurements Mask Thyroid Hormone-dependent Remodeling Activity Sites in Hypothyroid Individuals. J Endocr Soc 2024; 8:bvae018. [PMID: 38379854 PMCID: PMC10877315 DOI: 10.1210/jendso/bvae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Indexed: 02/22/2024] Open
Abstract
Context Earlier nuclear magnetic resonance spectroscopy (NMR) studies of plasma lipoproteins estimated by size as small, medium, and large particles, demonstrated hypothyroidism was associated with increases in very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and intermediate-density lipoprotein (IDL) subclass particle number but variable changes in the high-density lipoprotein (HDL) subclasses. These disparate changes in HDL might be explained by reduced activity of the thyroid hormone-dependent remodeling proteins whose subclass specificity may be obscured when the 5 HDL subclasses identified by NMR are combined by size. Objective This work aimed to determine whether directional changes in particle number of individually measured HDL subclasses correlate with reduced activity of their thyroid hormone-dependent remodeling proteins in hypothyroid individuals. Methods VLDL, LDL, IDL, and HDL subclasses were measured by NMR in 13 thyroidectomized individuals 1 month following thyroid hormone withdrawal and 3 months after replacement. Changes in particle numbers in each subclass were compared when expressed individually and by size. Results Following thyroid hormone withdrawal, plasma lipids and VLDL, LDL, and IDL subclass particle number increased. HDL particle number nearly doubled in very small HDL-1 (P = .04), declined in small HDL-2 (P = .02), and increased 2-fold in HDL-5 (P = .0009). Conclusion The increment in HDL-1 and decline in HDL-2 subclasses is consistent with their precursor-product relationship and reduced lecithin cholesterol acyltransferase activity while the almost 2-fold increase in large HDL-5 is indicative of diminished action of hepatic lipase, phospholipid transfer protein, and endothelial lipase. These findings are inapparent when the 5 subclasses are expressed conventionally by size. This linking of specific HDL subclasses with HDL remodeling protein function provides new details about the specificity of their interactions.
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Affiliation(s)
- John D Bagdade
- Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA
| | - Carrie E McCurdy
- Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA
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Banyi N, Kwon JJY, Turkdogan S, Milner TD, Prisman E. Incidence and complications of hypothyroidism postlaryngectomy: A systematic review and meta-analysis. Head Neck 2024; 46:249-261. [PMID: 37950641 DOI: 10.1002/hed.27573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Hypothyroidism is common postlaryngectomy and is associated with laryngectomy-specific complications. The objective of this study is to determine the incidence and predictors of hypothyroidism postlaryngectomy and its associated complications. METHODS Systematic review, data extraction, and meta-analyses were performed following the PRISMA protocol. Six databases were searched for studies reporting on postlaryngectomy thyroid status with incidence, risk factors, management, or complications. RESULTS Fifty-one studies with 6333 patients were included. The pooled incidence of postlaryngectomy hypothyroidism is 49% (CI 42%-57%). Subgroup analysis showed postlaryngectomy hypothyroidism rates significantly correlated with hemithyroidectomy and radiotherapy. Patients who underwent laryngectomy, hemithyroidectomy, and radiotherapy had a 65% (CI 59%-71%) rate of hypothyroidism; laryngectomy and hemithyroidectomy 46% (CI 33%-60%); laryngectomy and radiotherapy 26% (CI 19%-35%); and laryngectomy alone 11% (CI 4%-27%) (p < 0.001). CONCLUSIONS Laryngectomized patients with partial thyroidectomy or radiation therapy are at significant risk of postoperative hypothyroidism. Evidence-based protocols for early detection and (prophylactic) treatment should be established.
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Affiliation(s)
- Norbert Banyi
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie J Y Kwon
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sena Turkdogan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Thomas D Milner
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Woody DM, Chen C, Parker J. Catatonia in a Patient With Bipolar Affective Disorder and Hypothyroidism: A Diagnostic and Therapeutic Challenge. Cureus 2023; 15:e46989. [PMID: 38022056 PMCID: PMC10640898 DOI: 10.7759/cureus.46989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
This case report presents the clinical course of a 33-year-old female with a history of bipolar affective disorder (BAD) who presented to the psychiatric emergency department with sudden-onset altered behavior, along with features indicative of catatonia. Before hospitalization, the patient had not been adherent to psychiatric medications for BAD for a period of several months, likely a contributing factor to the patient's presenting symptoms. Over a two-week period before hospitalization, the patient exhibited progressive withdrawal, psychomotor retardation, disorganized behavior, and a lack of response to external stimuli. Initial labs upon admission had findings consistent with a diagnosis of hypothyroidism. The patient had no prior history of thyroid disease and further endocrinology workup was deferred by the hospitalist to outpatient care upon discharge. While initially in the emergency department, the patient received intramuscular lorazepam for immediate symptom relief, the initial response to the Ativan challenge was not fully documented. Upon evaluation by the inpatient team the next morning, a Bush-Francis Catatonia Rating Scale score of 22 highlighted the severity of catatonia, which may have been further exacerbated by concurrent hypothyroidism. As such, thyroid hormone replacement therapy (levothyroxine) was indicated to normalize thyroid function. Combination treatment initially with lorazepam and levothyroxine was administered for the patient's catatonia and olanzapine was chosen as the anti-psychotic. Over the subsequent days, the patient's catatonic symptoms demonstrated positive responses to treatment, prompting adjustments in pharmacotherapy. The patient eventually returned to baseline functioning, with substantial improvements in catatonia as well as mood symptoms. This case underscores the complex interplay between catatonia, bipolar affective disorder, and thyroid dysfunction. The timely identification and management of hypothyroidism in the context of catatonia showcase the potential for favorable outcomes with targeted interventions.
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Affiliation(s)
- Dillon M Woody
- Behavioral Health, Jackson Memorial Hospital, Miami, USA
| | - Charles Chen
- Behavioral Health, Jackson Memorial Hospital, Miami, USA
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Kapoor A, Htut Z, Uduku C. Primary Hypothyroidism Unleashing Severe Pericardial Effusion: Lessons Learnt From an Atypical Presentation of a Common Endocrine Condition. Cureus 2023; 15:e46947. [PMID: 38021716 PMCID: PMC10640698 DOI: 10.7759/cureus.46947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Primary hypothyroidism is a commonly encountered endocrine disorder and can be associated with pericardial effusion and cardiac tamponade in severe cases. Early detection of hypothyroidism is key since it is a potentially treatable and reversible cause of pericardial effusions. A 53-year-old female was admitted following a fall. The clinical history was remarkable, with symptoms of persistent tiredness and fatigue for six months. She had no known medical conditions and was not taking any regular medications. Vital signs were stable. Physical examination revealed bilateral pitting pedal oedema and a tense abdomen with shifting dullness. Cardiovascular and respiratory examinations were normal. Notably, the patient exhibited delayed relaxation of deep-tendon reflexes bilaterally at the patellar and ankle sites. Pertinent laboratory findings showed an elevated thyroid-stimulating hormone (TSH) level of 151.69 milliunits/L, a low free thyroxine (fT4) level of <5.4 pmol/L, a haemoglobin level of 85 g/L, and a markedly high anti-thyroid peroxidase antibody level of 957.35 IU/mL. An electrocardiogram revealed a normal sinus rhythm with a low-voltage QRS complex. Chest X-ray findings indicated cardiomegaly suggestive of left heart failure. An emergent transthoracic echocardiography (TTE) demonstrated a large pericardial effusion measuring 5.4 cm posterior to the left ventricle. The most likely aetiology in this case was severe primary hypothyroidism. She initially received intravenous liothyronine 10 micrograms every four hours, followed by oral liothyronine 5 micrograms twice a day in conjunction with levothyroxine 100 micrograms once a day. The adrenal reserve assessment was satisfactory. An urgent pericardiocentesis was performed, draining a total of 900 mL of serosanguinous fluid. Serial echocardiograms demonstrated the absence of residual effusion. Hypothyroidism is a relatively uncommon cause of pericardial effusion. By ensuring early detection and appropriate treatment, we can optimise patient outcomes and prevent potential complications associated with untreated hypothyroidism.
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Affiliation(s)
- Ashutosh Kapoor
- Diabetes and Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, GBR
| | - Zin Htut
- Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, GBR
| | - Chukwuma Uduku
- Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, GBR
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Gupta R, Choudhary S, Chatterjee T. A Study on Vitamin B12 Levels in Hypothyroid Patients Presenting to a Tertiary Care Teaching Hospital. Cureus 2023; 15:e44197. [PMID: 37767262 PMCID: PMC10521342 DOI: 10.7759/cureus.44197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Background and aims The prevalence of vitamin B12 deficiency is found to coexist in hypothyroid patients, causing the persistence of symptoms concomitant to both diseases even on adequate thyroxine supplementation. Primary objective To study vitamin B12 levels in patients with hypothyroidism. Secondary objective To study the clinical profile of patients with hypothyroidism with special reference to anemia, and to study the association between vitamin B12 deficiency with anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroglobulin (anti-Tg) antibodies in patients with hypothyroidism. Methods and results A single-centric cross-sectional study was carried out over a period of one year. Among 100 hypothyroid patients, 68% were found to be vitamin B12 deficient, among whom 73.5% were females. Of patients with raised anti-TPO antibodies, 78.6% had vitamin B12 deficiency (p = 0.01), while 78% of patients with raised anti-Tg antibodies were vitamin B12 deficient (p = 0.07). The Pearson correlation coefficient (r) of vitamin B12 with anti-TPO and anti-Tg antibodies was -0.302 (p = 0.002) and -0.253 (p = 0.011), respectively. Conclusion There is a predilection of hypothyroid patients toward developing anemia, with vitamin B12 deficiency as a major etiology. This finding can be correlated with the hematopoietic action of thyroid-stimulating hormones as well as autoimmune thyroid disease predisposing to pernicious anemia.
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Affiliation(s)
- Ritu Gupta
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Sushma Choudhary
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Trisha Chatterjee
- Department of General Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
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Lantz R, Naboulsi W, Yu S, Al-Samkari M. Management of Adrenal Deficiency and Shock in a Patient With Polyglandular Autoimmune Syndrome Type II. Cureus 2023; 15:e41440. [PMID: 37546049 PMCID: PMC10403964 DOI: 10.7759/cureus.41440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Polyglandular autoimmune syndrome (PAS) is a rare disorder characterized by the autoimmune destruction of multiple endocrine glands. Type II PAS is the most common of the PAS subtypes and is characterized by Addison's disease, autoimmune thyroid disease, and type I diabetes mellitus. Disease manifestations are predominantly seen in young adulthood with an emerging endocrine disorder; however, a host of other autoimmune conditions can also be present before endocrine organ dysfunction. Due to the complex nature of presentation and management, an important consideration in patient care involves a multidisciplinary team with the addition of an endocrinologist. A 21-year-old African American woman with a medical history of PAS-II presented during three hospitalizations with adrenal crisis, diabetic ketoacidosis (DKA), and myxedema. The common theme across admissions entails a spectrum of adrenal dysfunction, including shock, as well as glucose and thyroid abnormalities. During her first hospitalization, the patient presented with hypotension, hyperglycemia, and hypothyroidism. She received aggressive IV fluid resuscitation, an insulin drip, electrolyte repletion, an up-titration of levothyroxine, and stress-dose corticosteroids. In the second hospitalization, she also had hypotension and electrolyte derangements, along with hypoglycemia and myxedema. She received glucose management, thyroid hormone replacement, and stress steroids again. The third hospitalization involved flu-like symptoms and a positive SARS-CoV-2 test. She was managed similarly for hypotension, hyponatremia, and hyperglycemia. In this case, she presented with non-gap metabolic acidosis and required a bicarbonate drip for a short period. She did not receive antibiotics across these three admissions. We present three hospitalizations where adrenal, pancreatic, and thyroid derangements were seen and managed. It is known that most general providers other than endocrinologists are not comfortable with the management of disease manifestations of PAS-II; therefore, we provide a case review to address the standard of care management and guidelines with further discussion. This patient's maintenance care was complicated by a lack of adherence to outpatient medications, leading to recurrent hospitalizations. We also endorse the importance of doctors pursuing endocrinology fellowships, especially due to the observed waning number of graduates. An endocrinologist's availability and involvement in the care of patients with complex endocrine issues lead to improved outcomes.
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Affiliation(s)
| | - Waseem Naboulsi
- General Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
| | - Sarah Yu
- General Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
| | - Maher Al-Samkari
- Hospital Medicine, Endocrinology, Premier Health Network, Dayton, USA
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A P, Kothari R, S Y, Mittal G, Gheewala S, Bokariya P, Palande A, S DM, Tamrakar S, Vemparala SS. Examining Body Fat Percentage, Galvanic Skin Response, and Muscle Grip Strength in Female Hypothyroid Patients. Cureus 2023; 15:e42023. [PMID: 37593312 PMCID: PMC10431213 DOI: 10.7759/cureus.42023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background The thyroid gland is an indispensable organ exerting control over the activity of multiple organ systems including the autonomic nervous system. This study attempted to monitor the variations in autonomic function parameters such as galvanic skin response (GSR) and muscle grip strength (HGS) in conjunction with changes in body fat percentage (BFP). Methodology This case-control study was conducted among 40 female hypothyroid patients as cases and 40 age-matched female healthy volunteers as controls. Anthropometric data were collected using standard techniques. GSR and HGS were measured using Equivital Sensory Electronic Module and Grip Force Transducer, respectively. Data extraction and analysis were done using the LabChart software. Results The mean age of the 40 female hypothyroid patients was 30.14 ± 5.91 years, whereas the mean age of the female controls was 29.37 ± 6.59 years. The waist circumference of cases was 85.81 ± 10.39 cm while that of controls was 80.90 ± 11.18 cm. The BFP of cases was 35.38% ± 6.74% while that of controls was 31.72% ± 5.63%. The GSR amplitude showed a significant difference between hypothyroid and healthy volunteers with values of 1.34 ± 1.14 μS and 2.40 ± 1.86 μS, respectively. The HGS indices showed no significant difference between the two groups. A statistically negative correlation was noted between BFP and GSR amplitude (-0.32), whereas a positive correlation was noted between BFP and mean handgrip strength (0.31) in hypothyroid patients. Conclusions The changes in BFP and autonomic function through GSR and HGS were evaluated in female hypothyroid patients with respect to healthy females. The interrelationship between anthropometry and autonomic function was also explored in this study. The findings of this study can augment prognosis in patients and ensure timely corrective treatment for improving quality of life.
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Affiliation(s)
- Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
- Research, Rotaract Club of Indian Medicos, Mumbai, IND
| | - Ruchi Kothari
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
- Research, Rotaract Club of Indian Medicos, Mumbai, IND
| | - Yogesh S
- Internal Medicine, Madras Medical College and Hospital, Rajiv Gandhi Government General Hospital, Chennai, IND
| | - Gaurav Mittal
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
- Research, Rotaract Club of Indian Medicos, Mumbai, IND
| | - Shabbir Gheewala
- Anatomy, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Pradeep Bokariya
- Anatomy, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Amisha Palande
- Physiology, Terna Medical College, Mumbai, IND
- Research, Rotaract Club of Indian Medicos, Mumbai, IND
| | - Devupriya M S
- Research, Rotaract Club of Indian Medicos, Mumbai, IND
| | | | - Sai Shanmukh Vemparala
- Physiology, Andhra Medical College, Visakhapatnam, IND
- Physiology, Great Eastern Medical School and Hospital, Visakhapatnam, IND
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Metry M, Yusuf ARS, Lane J, Unwala R, Altisheh R. Urticarial Vasculitis Associated With Levothyroxine. Cureus 2023; 15:e40754. [PMID: 37485155 PMCID: PMC10361698 DOI: 10.7759/cureus.40754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Urticarial vasculitis (UV) is a protean disorder that can be triggered by a myriad of causes although it is often idiopathic. Treatment is often successful with corticosteroids and/or immunosuppressive drugs. However, when a cause is found, specific treatment of the underlying problem or removal of an offending agent will resolve the symptoms. This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto's thyroiditis, which can itself cause UV. In this unusual presentation, rather than thyroiditis, thyroid replacement was the trigger for the vasculitis.
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Affiliation(s)
- Mark Metry
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
| | | | - Jason Lane
- Pathology, Cleveland Clinic Akron General, Akron, USA
| | | | - Roula Altisheh
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
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Yadav A, Katyal R, Mittal S, Kumar Saha T. Correlation of Maternal Thyroid Stimulating Hormone Levels With Lipid Profile in Pregnant Women With Hypothyroidism. Cureus 2023; 15:e37748. [PMID: 37214038 PMCID: PMC10193177 DOI: 10.7759/cureus.37748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Pregnancy leads to changes in hormonal levels and lipid profile. Thyroid hormones play a crucial role in embryonic growth and fetal development. Untreated thyroid disease during pregnancy can lead to a high risk of complications. Aim The aim of the study is to examine the correlation between thyroid stimulating hormone (TSH) and lipid profile in pregnant women with hypothyroidism. Materials and methods This cross-sectional case-control study was conducted at the Biochemistry Department, Alfalah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India. The study consisted of 500 patients (250 cases and 250 controls) who fulfilled the inclusion and exclusion criteria. Of the 250 cases recruited, 23 cases were in the 2nd trimester and 209 cases were in the 3rd trimester. Blood samples were collected from the participants to assess their lipid profile and TSH levels. Results The study showed a statistically significant difference between the mean TSH levels of hypothyroid pregnant females in the 2nd trimester (3.85 ± 0.59) and the 3rd trimester (4.71 ± 0.54). There was a significant positive correlation observed between TSH and Total Cholesterol, Triglycerides, and LDL-C in both the 2nd and 3rd trimesters. In the second trimester, there was a significant positive correlation observed between TSH & TC (r = 0.6634, p<0.0005), TSH & TG (r= 0.7346, p=0.00006), TSH & LDL (r= 0.5322, p= 0.008). In the third trimester, there was a significant positive correlation observed between TSH & TC (r = 0.8929, p<0.00001), TSH & TG (r= 0.430, p<0.00001), TSH & LDL (r= 0.168, p= 0.015). However, no significant correlation was found between TSH levels and HDL-C in either trimester. The correlation coefficient and p-value for TSH & HDL were r = 0.2083, p=0.340 in the second trimester, and r = 0.0189, p=0.2384 in the third trimester. Conclusion A significant increase in TSH levels in hypothyroid pregnant women was observed in the 3rd trimester compared to the second trimester. Moreover, a significant positive correlation was found between TSH and lipid profile (total cholesterol, triglycerides, and LDL) in both trimesters, but not with HDL. These findings highlight the importance of monitoring thyroid hormone levels in the later stages of pregnancy to avoid potential maternal & fetal complications.
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Affiliation(s)
- Alka Yadav
- Biochemistry, Al-Falah School of Medical Science and Research Centre, Faridabad, IND
| | - Ranjan Katyal
- Biochemistry, Al-Falah School of Medical Science and Research Centre, Faridabad, IND
| | - Shilpa Mittal
- Biochemistry, Noida International Institute of Medical Sciences, Noida, IND
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Hanish SJ, Resnick ML, Kim HM, Smith MJ. Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder. J Clin Med 2022; 11:jcm11206212. [PMID: 36294535 PMCID: PMC9605176 DOI: 10.3390/jcm11206212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection.
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Malhotra B, Bhadada SK. Perioperative Management for Non-Thyroidal Surgery in Thyroid Dysfunction. Indian J Endocrinol Metab 2022; 26:428-434. [PMID: 36618525 PMCID: PMC9815191 DOI: 10.4103/ijem.ijem_273_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
Thyroid hormone exerts effects across all organ systems. Hence, patients with thyroid dysfunction are at a risk of numerous complications. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation, and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to optimize the status of thyrotoxic and hypothyroid patients. This article describes the adverse effects of thyroid dysfunction in patients undergoing nonthyroid surgery and recommends treatment approaches aimed at appropriate build-up to decrease perioperative risk.
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Syed W, Samarkandi OA, Alsadoun A, Harbi MKA, Al-Rawi MBA. Evaluation of clinical knowledge and perceptions about the development of thyroid cancer-An observational study of healthcare undergraduates in Saudi Arabia. Front Public Health 2022; 10:912424. [PMID: 36052013 PMCID: PMC9426299 DOI: 10.3389/fpubh.2022.912424] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 01/22/2023] Open
Abstract
Background and objective In the healthcare context, healthcare personnel are available to help patients according to their requirements. However, having sufficient knowledge of many elements of diseases before graduation may have a good impact on clinical practices later in one's career. As a result, the purpose of this study was to assess the clinical knowledge and perceptions of healthcare students in Saudi Arabia about thyroid cancer (TC). Methods A cross-sectional study was conducted in King Saud University from August 2021 to November 2021, using a validated self-reporting online survey. The data collection was carried out among senior healthcare students, including pharmacy, nursing, and medical students of both genders, who were Arabic speakers. The data were analyzed using the Statistical Package for the Social Sciences version 26 for Windows (SPSS). Results There were 141 healthcare students who responded, with 46.8% (n = 66) being pharmacy students, 28.4% (n = 40) being nursing students, and 24.8% (n = 35) being medical students. Male participants made up the majority of them (52.5%). Lump or swelling in the neck was described as the most common early indicator of TC by 54.6% (n = 77), followed by difficulty in swallowing by 34.04% (n = 48), and pain in the neck by 24.8% (n = 35). Female participants accounted for 44.7% (n = 63) of those with thyroid dysfunction, according to the study. About 55.3% of the participants (n = 78), reported that they had sufficient knowledge about TC. The knowledge score differed significantly by gender; female participants (60.3%) (n = 47) were more knowledgeable than male participants (30.7%) (n = 31) (p = 0.049). Conclusion This study depicts that half of the healthcare students thatwere knowledgeable about TC had positive perceptions about the causes of diseases. Furthermore, we also recommend arranging awareness programs for the students by the university officials to overcome the knowledge gap.
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Affiliation(s)
- Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Wajid Syed
| | - Osama A. Samarkandi
- Nursing Informatics Vice Dean for Academic Affairs, Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alsadoun
- Department of Medical Surgical College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad K. Al Harbi
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Monahan B, Farland LV, Shadyab AH, Hankinson SE, Manson JE, Spracklen CN. Birthweight and subsequent risk for thyroid and autoimmune conditions in postmenopausal women. J Dev Orig Health Dis 2022; 13:463-70. [PMID: 34658316 DOI: 10.1017/S204017442100057X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to determine the association between birthweight and risk of thyroid and autoimmune conditions in a large sample of postmenopausal women. Baseline data from the Women's Health Initiative (n = 80,806) were used to examine the associations between birthweight category (<6 lbs., 6-7 lbs. 15 oz, 8-9 lbs. 15 oz, and ≥10 lbs.) and prevalent thyroid (underactive and overactive thyroid and goiter) and autoimmune (lupus, rheumatoid arthritis (RA), multiple sclerosis, ulcerative colitis/Crohn's disease) conditions. Follow-up questionnaire data were used to examine the associations between birthweight and incident underactive and overactive thyroid, lupus, and RA. Logistic and Cox proportional hazards regression models were used to estimate crude and adjusted odds (OR) and hazards ratios (HR), respectively. Overall, women born weighing ≥10 lbs. had an increased risk for underactive thyroid [OR 1.14 (95% CI 1.02, 1.28)] and incident lupus [HR 1.51 (95% CI 1.12, 2.03)] and a decreased risk for overactive thyroid [OR 0.67 (95% CI 0.50, 0.92)] compared to women born weighing 6-7.99 lbs., after adjustment for adult BMI, demographic variables, and lifestyle factors. Further, women born weighing <6 lbs. were at increased risk for underactive thyroid [OR 1.13 (95% CI 1.04, 1.22)]. Birthweight was not associated with other thyroid or autoimmune disorders. High birthweight was associated with later-life thyroid and autoimmune conditions while low birthweight was associated with underactive thyroid. Preconception and prenatal interventions aimed at reducing the risk of both high and low birthweights may reduce the burden of later-life thyroid and autoimmune conditions.
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14
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Yusuf Ali A, Inyang B, Koshy FS, George K, Poudel P, Chalasani R, Goonathilake MR, Waqar S, George S, Jean-Baptiste W, Mohammed L. Elements That Influence the Development of Attention Deficit Hyperactivity Disorder (ADHD) in Children. Cureus 2022; 14:e27835. [PMID: 35982754 PMCID: PMC9376034 DOI: 10.7759/cureus.27835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022] Open
Abstract
Various factors may have a role in the development of attention deficit hyperactivity disorder (ADHD). Although the specific pathophysiology of this disease is still not entirely understood, it is believed to be caused by a mix of genetic, maternal, dietary, and environmental factors. The effect of these factors can determine the severity of ADHD; for example, some of them are dose-dependent, but there is a typical pattern that all are known to be associated with either early childhood exposure or maternal exposure during pregnancy. Some factors share a similar mechanism of affecting pathways and increasing the risk of ADHD. ADHD is not a disorder that can be detected before symptoms appear in a child, making it more challenging to anticipate even if a child has been exposed to a known trigger. Environmental pollutants were investigated, and it was shown that there was a link between ADHD in childhood and exposure to pollutants throughout childhood or during pregnancy. It is well known that maternal health is a significant factor in the unborn child's development in many health aspects. The central nervous system (CNS) is a primary system that can suffer irreversible damage from health conditions, stress, depression, or specific nutritional deficiency when the pregnant mother is subjected to these conditions. Even though numerous studies have been conducted to investigate the probable causes of ADHD, with some of them having robust findings, no conclusive explanation can be provided to identify a definitive cause or a risk factor.
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Affiliation(s)
- Amina Yusuf Ali
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bithaiah Inyang
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Feeba Sam Koshy
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kitty George
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prakar Poudel
- Internal Medicine, Chitwan Medical College of Medical Science, Chitwan, NPL.,Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Roopa Chalasani
- Research, California Institute of Behavioral Neurosciences & Psychology, fairfield, USA
| | - Mastiyage R Goonathilake
- Pediatrics/Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sara Waqar
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sheeba George
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Wilford Jean-Baptiste
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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15
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Shazley O, Shazley A, Alshazley M. Acute Bacterial Hemorrhagic Pyelonephritis in a COVID-19 Patient With a History of Hypothyroidism: A Case Report. Cureus 2022; 14:e21730. [PMID: 35251803 PMCID: PMC8887623 DOI: 10.7759/cureus.21730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/20/2022] Open
Abstract
Since its initial reporting in December 2019, the novel coronavirus SARS-CoV-2 has emerged as a global health problem after its official declaration as a pandemic by the World Health Organization, with an estimated 346 million cases and over 5.9 million fatalities as of January 22, 2022. Studies on the prevalence of COVID-19 among severe cases have shown that comorbidities and risk factors such as obesity, increased aging, and chronic cardiovascular and respiratory diseases play a role in the severity of SARS-CoV-2 infections. The interactions between such factors and their involvement with the progression of infection and mortality remain unclear. While it is known that SARS-CoV-2 damages the lungs, various morbidities such as acute kidney disease and thyroid dysregulation have recently emerged in symptomatic COVID-19 patients. Conditions that alter thyroid hormones, which play a critical role in regulating metabolic pathways, have a role in the level of infectivity of the SARS-CoV-2. The capability of the SARS-CoV-2 to invade and affect any organ system is dependent on its access to the angiotensin-converting enzyme II (ACE2) commonly expressed among various host cells. This binding puts any system at high risk of direct viral injury, inevitably creating an excessively high concentration of anti-inflammatory mediators and cytokines to predispose COVID-19 patients to a state of severe immunosuppression. This case report describes a 62-year-old female who tested positive for COVID-19, with a medical history of hypothyroidism, who presented with a unique combination of acute bacterial hemorrhagic pyelonephritis and ureteral obstruction. She experienced intermittent dysuria, urinary urgency, and hematuria over the past five days. She developed chills, diaphoresis, nausea, and vomiting after administering acetaminophen for her headache. Ageusia and anosmia accompanied her respiratory illnesses despite receiving the Pfizer double dose vaccine six months before her arrival. A computerized tomography (CT) scan revealed severe to moderate inflammation surrounding the enlarged kidney with a 1 mm ureteral stone. Blood and urine cultures showed the growth of Escherichia coli gram-negative bacilli. Chest X-rays displayed a patchy appearance in the right infrahilar airspace, reflecting atelectasis in part for the diagnosis of COVID-19 with additional laboratory findings of profoundly elevated C-reactive protein, fibrinogen, and d-dimer levels. Abdominal CT scans revealed a hemorrhagic ureteral obstruction and massive swelling of the renal parenchyma persistent to pyelonephritis and hydronephrosis.
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Affiliation(s)
- Omar Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Ameer Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Moudar Alshazley
- Emergency Medicine, Internal Medicine, Santa Rosa Medical Center, Pensacola, USA
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16
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Wong PS, Lim SW, Tong CV, Mohamad M, Hussein Z. Use of Combination of Oral Levothyroxine and Liothyronine in Severe Hypothyroidism With Massive Pericardial Effusion. J ASEAN Fed Endocr Soc 2022; 37:106-12. [PMID: 36578894 DOI: 10.15605/jafes.037.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation.
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17
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Haymart MR. Year in Thyroidology-Recent Developments and Future Challenges: Clinical Science Review. Thyroid 2022; 32:9-13. [PMID: 34806424 DOI: 10.1089/thy.2021.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The 2021 Year in Thyroidology-Recent Developments and Future Challenges: Clinical Science Review featured key clinical research within five categories: Thyroid Nodules and Cancer, Thyroid Function and Thyroid Eye Disease, Thyroid and Pregnancy, Thyroid and Pediatrics, and Disparities in Thyroid. Methods: A literature search of PubMed from November 2019 to August 2021 was performed to identify relevant peer-reviewed articles published in English and with a focus on human subjects. Results: There were three nominees for each of the five categories and one featured article per category. The featured articles had the most potential to change clinical practice, focused on a novel topic, and/or included of strong methodology. Conclusions: There were many strong publications on thyroid between November 2019 and August 2021; the 15 nominees and 5 featured articles span a breadth of topics and methodological approaches. The featured articles all have potential to change practice patterns or to stimulate further research that will ultimately change practice patterns.
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Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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18
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Uchida K, Suzuki M. Congenital Hypothyroidism and Brain Development: Association With Other Psychiatric Disorders. Front Neurosci 2021; 15:772382. [PMID: 34955723 PMCID: PMC8695682 DOI: 10.3389/fnins.2021.772382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 12/20/2022] Open
Abstract
Thyroid hormones play an important role in brain development, and thyroid hormone insufficiency during the perinatal period results in severe developmental delays. Perinatal thyroid hormone deficiency is clinically known as congenital hypothyroidism, which is caused by dysgenesis of the thyroid gland or low iodine intake. If the disorder is not diagnosed or not treated early, the neuronal architecture is perturbed by thyroid hormone insufficiency, and neuropathological findings, such as abnormal synapse formation, defects in neuronal migration, and impairment of myelination, are observed in the brains of such patients. Furthermore, the expression of psychiatric disorder-related molecules, especially parvalbumin, is significantly decreased by thyroid hormone insufficiency during the perinatal period. Animal experiments using hypothyroidism models display decreased parvalbumin expression and abnormal brain architecture, and these experimental results show reproducibility and stability. These basic studies reinforce the results of epidemiological studies, suggesting the relevance of thyroid dysfunction in psychiatric disorders. In this review, we discuss the disruption of brain function associated with congenital hypothyroidism from the perspective of basic and clinical research.
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Affiliation(s)
- Katsuya Uchida
- Laboratory of Information Biology, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Mao Suzuki
- Laboratory of Biomodeling, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
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19
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Chen L, Doodnauth AV, Guo US, Patel KH, Qu YS, Mitre CA. The Abnormal Sinus Rhythm: Myxedema Coma Complicated by Subacute Cardiac Tamponade. Cureus 2021; 13:e19535. [PMID: 34934554 PMCID: PMC8668145 DOI: 10.7759/cureus.19535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Subacute cardiac tamponade (SCT) is a potentially life-threatening condition that requires immediate medical attention. Combining careful history taking, focused physical exam, and the use of point of care ultrasound (POCUS) for early diagnosis with aggressive management can minimize potential complications. In patients with severe hypothyroidism and myxedema coma, clinical signs of cardiac tamponade may be masked and lead to delayed diagnosis. We present a case of a 67-year-old female with SCT secondary to myxedema coma, necessitating emergent pericardiocentesis following the identification of a large pericardial effusion with tamponade physiology. This case highlights the importance of thorough history taking with focused diagnostic workup, including POCUS in patients with an insidious presentation of SCT.
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Affiliation(s)
- Lu Chen
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Andrew V Doodnauth
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Uta S Guo
- Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Krunal H Patel
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Yongxia S Qu
- Cardiology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Cristina A Mitre
- Cardiology, Veterans Affairs New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, USA
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20
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Alvin Mathew A, Papaly R, Maliakal A, Chandra L, Antony MA. Elevated Graves' Disease-Specific Thyroid-Stimulating Immunoglobulin and Thyroid Stimulating Hormone Receptor Antibody in a Patient With Subacute Thyroiditis. Cureus 2021; 13:e19448. [PMID: 34912598 PMCID: PMC8664564 DOI: 10.7759/cureus.19448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Subacute thyroiditis can be rarely associated with autoimmune thyroid disorders. It includes Graves' disease which is characterized by the presence of a highly specific antibody known as thyroid-stimulating hormone (TSH) receptor antibody (TRAb). There are three types of TRAb: TSH receptor stimulating antibody (TSAb) which stimulates the TSH receptor causing Graves' disease, TSH receptor blocking antibody (TBAb) which blocks the TSH receptor causing hypothyroidism, and a neutralizing antibody which does not alter the thyroid function. There are two assays used to check the TRAb: the thyroid-stimulating immunoglobulin (TSI) assay and the TSH receptor-binding inhibitor immunoglobulin (TBII) assay out of which the TSI assay measures the stimulating antibody which is specific for graves' disease. Although autoimmune thyroid disorders can rarely occur following subacute thyroiditis, their clinical presentation is usually compatible with the type of antibody detected in the patient’s serum. We present a unique case of a 44-year-old patient who presented with subacute thyroiditis followed by the development of persistent hypothyroidism even in the presence of elevated Graves' disease-specific TSI and TRAb.
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Affiliation(s)
- Anu Alvin Mathew
- Endocrinology, Amala Institute of Medical Sciences, Thrissur, IND
| | - Roshin Papaly
- Endocrinology, University of Oklahoma College of Medicine, Oklahoma City, USA
| | - Alvin Maliakal
- Internal Medicine, Southern Tennessee Internal Medicine, Lawrenceburg, USA
| | - Lakshya Chandra
- Internal Medicine, Bon Secour St. Francis Hospital, Greenville, USA
| | - Mc Anto Antony
- Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, Anderson, USA
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21
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Uma D, Rabbani R, Lee JH, Gavini DR, Shah PH, Hamid P. Does Hormone Supplementation With Levothyroxine Improve Hypothyroid Impaired Cognitive Dysfunction? Cureus 2021; 13:e17885. [PMID: 34660084 PMCID: PMC8503702 DOI: 10.7759/cureus.17885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/21/2022] Open
Abstract
Hypothyroidism is a widespread condition in the United States, affecting approximately 5% of the adult population. Although the clinical use of levothyroxine is well understood, its effect on preventing dementia is not well established. While the exact role of thyroid hormones in the adult brain is unknown, it is apparent that poor thyroid function can lead to mood swings, cognitive impairment, and other psychiatric symptoms. Most studies demonstrate an association between thyroid health and cognition, specifically slow processing of information, decreased effectiveness of executive functions, and lack of learning. This study aims to review the effect of levothyroxine on dementia. We searched electronic databases such as PubMed, Google Scholar, Science Direct, Cochrane, gray literature, and the references of included articles to find relevant articles. Two investigators independently identified eligible studies, screened title/abstract, and extracted data. We identified a total of 319 citations through a database search with six studies (case-control, longitudinal, cross-sectional, randomized controlled trials) meeting the inclusion criteria. Studies with moderate to low risk of bias were evaluated using their respective quality check tools. Five of six studies showed a positive impact of levothyroxine (LT-4) on dementia. According to these studies, the plausible rationale behind the reversal of memory with LT-4 treatment is restoring thyroid-stimulating hormone (TSH), thyroxine (T4) levels, and gamma-aminobutyric acid (GABA) concentrations. People with abnormal thyroid function should be screened for cognitive dysfunction using specific neurocognitive tests and start treatment with LT-4 regardless of symptom presentation. Multi-dose randomized placebo-controlled intervention studies are recommended to assess the effect of LT-4 on lowering the risk of dementia in hypothyroid patients.
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Affiliation(s)
- Davuluri Uma
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Rizwan Rabbani
- Nephrology, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Jun Hee Lee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Divya R Gavini
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Prutha H Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
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22
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Jawed M, Osella J, Bani Hani D. A Case of Myxedema Coma Crisis Induced by Inhalation Injury. Cureus 2021; 13:e17049. [PMID: 34522527 PMCID: PMC8428158 DOI: 10.7759/cureus.17049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Myxedema coma is a life-threatening, critical condition in which many organ systems can be severely affected. It is considered the most severe presentation of hypothyroidism and should be treated immediately. Here, we discuss the case of a 58-year-old patient who presented with altered mental status, bradycardia, and hypothermia, the critical characteristics considered in this disorder after inhalation injury. In order to avoid a fatal outcome, aggressive therapy should be initiated upon presentation. This case will depict the typical presentation, the specific cause pertinent to this patient’s condition, and the management of the acute condition of myxedema coma.
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Affiliation(s)
- Muzamil Jawed
- Internal Medicine, Lincoln Medical Center, New York, USA
| | - Julieta Osella
- Internal Medicine, Lincoln Medical Center, New York, USA
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23
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Ibrahim SI, Khalafalla AM, Safan AS, Alsaud AE, B Batia T, Yassin MA. Acute psychosis secondary to steroid responsive encephalopathy associated with autoimmune Hashimoto's thyroiditis. Clin Case Rep 2021; 9:e04644. [PMID: 34504694 PMCID: PMC8418675 DOI: 10.1002/ccr3.4644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/20/2021] [Accepted: 06/12/2021] [Indexed: 12/03/2022] Open
Abstract
Approach to Hashimoto thyroiditis encephalopathy. Approach to Hashimoto thyroiditis encephalopathy
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24
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Khoodoruth MAS, Abdo AKA, Ouanes S. Quetiapine-Induced Thyroid Dysfunction: A Systematic Review. J Clin Pharmacol 2021; 62:20-35. [PMID: 34467533 DOI: 10.1002/jcph.1960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022]
Abstract
Thyroid abnormalities are documented consequences of quetiapine treatment. This may have clinical implications as changes in thyroid hormones may deteriorate a person's affective state. Yet less is known about the clinical factors and underlying mechanisms associated with thyroid hormones on quetiapine therapy. We therefore systematically reviewed the published literature of evidence of quetiapine-induced thyroid abnormalities. We searched MEDLINE, PsycINFO, Google Scholar, and EMBASE for articles in which individuals developed biochemically confirmed thyroid abnormalities (with or without clinical symptoms) while on quetiapine treatment. We included case reports, case series, observational, and experimental studies. We included 32 studies, 20 of which were observational and experimental studies. There were 10 case reports and 1 case series. All the research designs suggested an association between quetiapine and hypothyroidism. However, these findings were limited by the quality of the included studies and the general lack of either a clear temporal relationship or dose response. Quetiapine has been associated with thyroid abnormalities, mainly with hypothyroidism. Drug imputability in these abnormalities is not always clear, and the underlying pathophysiology may include immunological and nonimmunological mechanisms. Large prospective studies are required to clarify this association and to further inform the management of patients treated with quetiapine where hypothyroidism occurs.
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Affiliation(s)
| | | | - Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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25
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Liang Y, Zhao D, Wang R, Dang P, Xi Y, Zhang D, Wang W, Shan Z, Teng X, Teng W. Generation and Characterization of a New Resistance to Thyroid Hormone Mouse Model with Thyroid Hormone Receptor Alpha Gene Mutation. Thyroid 2021; 31:678-691. [PMID: 32924834 DOI: 10.1089/thy.2019.0733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: In humans, resistance to thyroid hormone (RTH) caused by mutations in the thyroid hormone receptor alpha (THRA) gene, RTHα, manifests as tissue-specific hypothyroidism and circulating thyroid hormone levels exhibit hypothyroid-like clinical features. Before the identification of patients with RTHα, several Thrα1 knock-in mouse models were generated to clarify the function of TRα1. However, the phenotypes of these mice were not consistent with the clinical presentation of RTHα in humans. For the present study, we generated an RTHα mouse model that carries the Thra1E403X mutation found in human RTHα patients. Here, we report the gross phenotypes of this mouse RTHα model. Methods: Traditional homologous recombination gene targeting techniques were used to introduce a mutation (Thra1E403X) in the mouse Thra gene. The phenotypes of the resulting mice were studied and compared with clinical features observed for RTHα with THRAE403X. Results: Thrα1E403X/E403X homozygous mice exhibited severe neurological phenotypes, such as spasticity and motor ataxia, which were similar to those observed in endemic cretinism. Thrα1E403X/+ heterozygous mice reproduced most clinical manifestations of patient with RTHα, such as a normal survival rate and male fertility, as well as delayed postnatal growth and development, neurological and motor coordination deficits, and anemia. The mice had typical thyroid function with a modest increase in serum triiodothyronine (T3) levels, a low thyroxine (T4)/T3 ratio, and low reverse T3 (rT3) levels. Conclusions: The Thrα1E403X/+ mice faithfully recapitulate the clinical features of human RTHα and thus can provide a useful tool to dissect the role of TRα1 in development and to determine the pathological mechanisms of RTHα.
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Affiliation(s)
- Yue Liang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Defa Zhao
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Ranran Wang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Pingping Dang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Yue Xi
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Dan Zhang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Wei Wang
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Xiaochun Teng
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, China
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26
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Badavi M, Grootveld M, Jafari F, Dianat M, Faraji Shahrivar F. Supplement therapy with apelin for improving the TSH level and lipid disorders in PTU-induced hypothyroid rats. Biotechnol Appl Biochem 2021; 69:668-675. [PMID: 33660355 DOI: 10.1002/bab.2142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/22/2021] [Indexed: 11/09/2022]
Abstract
Hyperlipidemia is a common metabolic disorder in the general population, which may arise in hypothyroidism. Apelin is an endogenous ligand that acts as an adiponectin, and is involved in energy storage and metabolism. This study evaluated the effects of apelin administration per se or in combination with T4 on the serum level of thyroid-stimulating hormone (TSH), body weight, and lipid profile, along with the serum level of apelin, and its mRNA expression in heart, in 6-propyl-2-thiouracil (PTU)-induced hypothyroid rats. Male Wistar rats were assigned to five different groups: control, H (hypothyroid), H+A, H+T, and H+A+T. All groups except the control one received PTU (0.05%) in the drinking water for 6 weeks. In addition to PTU, the H+A, H+T, and H+A+T groups received apelin (200 μg/kg/day, i.p.), l-thyroxin (T4) (20 μg/kg/day, via gavage tube), and apelin+T4 during the last 14 days of the trial, respectively. A combined application of T4 and apelin in the H+A+T group effectively diminished mean TSH level, low-density-lipoprotein cholesterol/high-density-lipoprotein cholesterol ratio, and atherogenic index in these animals when compared with these values for the H group. Coadministration of apelin with T4 may offer valuable therapeutic benefits, specifically lowering blood plasma TSH, lipid disorder, and atherosclerosis biomarkers in PTU-induced hypothyroid rats.
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Affiliation(s)
- Mohammad Badavi
- Physiology Research Center, Department of Physiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Martin Grootveld
- Leicester School of Pharmacy, The Gateway, Leicester, United Kingdom
| | - Fereshteh Jafari
- Leicester School of Pharmacy, The Gateway, Leicester, United Kingdom
| | - Mahin Dianat
- Physiology Research Center, Department of Physiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farzaneh Faraji Shahrivar
- Department of Physiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
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Haroon SM, Khan K, Maqsood M, Iqbal S, Aleem M, Khan TU. Exploring the Effect of Metformin to Lower Thyroid-Stimulating Hormone in Euthyroid and Hypothyroid Type-2 Diabetic Patients. Cureus 2021; 13:e13283. [PMID: 33728216 PMCID: PMC7949621 DOI: 10.7759/cureus.13283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Metformin is one of the safest, first-line oral hypoglycemic agents used in type-2 diabetes mellitus patients. This study aims to study the effect of metformin on thyroid-stimulating hormone (TSH) in hypothyroid and euthyroid individuals, as both these diseases have an increased prevalence and coexistence. Method This hospital-based study was conducted in Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/Jinnah Hospital Lahore, Pakistan, from October 2019 to April 2020. One hundred and sixty type-2 diabetic participants, aged 25-60 years and meeting the inclusion criteria were enrolled in the study after informed consent. They were divided into two groups, the hypothyroid group who were already on levothyroxine therapy and had a stable TSH in the normal range, and a euthyroid group who had no thyroid dysfunction. Both the groups were started on metformin therapy for the control of type-2 diabetes mellitus and followed for six months. Their blood samples for TSH and free thyroid hormone (fT4) were drawn both prior to and after the study period. Results Out of the 160 type-2 diabetic patients, TSH levels showed a significant reduction in the hypothyroid patients (2.33 ± 0.70, p < 0.001) with no significant changes in the euthyroid patients (3.87 ± 0.40, p = 0.206) following six months of metformin therapy. However, there was no significant difference in the fT4 levels in either of the groups. Conclusion Metformin has the effect of significantly lowering TSH levels in hypothyroid individuals. However, no such effect was observed in euthyroid patients.
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Affiliation(s)
- Sundus Mariyum Haroon
- Internal Medicine, Jinnah Hospital, Lahore, PAK.,Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Jinnah Hospital, Lahore, PAK
| | - Khurshid Khan
- Medicine, Fatima Memorial College of Medicine and Dentistry, Lahore, PAK
| | - Muhammad Maqsood
- Internal Medicine, Jinnah Hospital, Lahore, PAK.,Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Jinnah Hospital, Lahore, PAK
| | - Sadaf Iqbal
- Internal Medicine, Jinnah Hospital, Lahore, PAK.,Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Jinnah Hospital, Lahore, PAK
| | - Muhammad Aleem
- Internal Medicine, Jinnah Hospital, Lahore, PAK.,Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Jinnah Hospital, Lahore, PAK
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Mat Ali MH, Tuan Ismail TS, Wan Azman WN, Yaacob NM, Yahaya N, Draman N, Wan Mohamed WMI, Abdullah MS, Ibrahim HA, Wan Nik WNFH, Mohamed M. Comparison of Vitamin D Levels, Bone Metabolic Marker Levels, and Bone Mineral Density among Patients with Thyroid Disease: A Cross-Sectional Study. Diagnostics (Basel) 2020; 10:E1075. [PMID: 33322284 DOI: 10.3390/diagnostics10121075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 02/05/2023] Open
Abstract
Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm2). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.
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Tabasi M, Eybpoosh S, Sadeghpour Heravi F, Siadat SD, Mousavian G, Elyasinia F, Soroush A, Bouzari S. Gut Microbiota and Serum Biomarker Analyses in Obese Patients Diagnosed with Diabetes and Hypothyroid Disorder. Metab Syndr Relat Disord 2020; 19:144-151. [PMID: 33232646 DOI: 10.1089/met.2020.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Variations of serum biomarkers and bacterial diversity of the gastrointestinal tract in obese patients with diabetes or hypothyroid are poorly understood. The aim of this study was to provide recent findings in this regard. Methods: A total of 119 obese patients [17 with diabetes, 23 with hypothyroid, and 79 patients without either diabetes or hypothyroid (control)] were recruited in this study. Serum biomarkers such as biochemical, hormonal (insulin and glucagon), and cytokine levels [interleukin (IL)-6, IL-1β, tumor necrosis factor-alpha, IL-10, and transforming growth factor beta-1 (TGF-β1)] were measured under fasting conditions. Bacterial abundance of gut microbiota was also quantitated by real-time polymerase chain reaction using 16S rRNA gene-based specific primers. Results: Average value of blood sugar (P: 0.0184), hemoglobin A1c, insulin, homeostasis model assessment insulin resistance, TGF-β 1, IL-6, IL-1β, interferon gamma (Pfor each < 0.001), and phylum Actinobacteria [odds ratio (OR): 1.5, P: 0.032] was significantly higher in diabetic versus control group. In contrast, the levels of IL-10 (P < 0.001), Firmicutes (OR: 0.6, P: 0.058), and Akkermansia muciniphila (OR: 0.4, P: 0.053) were significantly lower in diabetic versus control group. However, there was no statistically significant difference between the values in hypothyroid versus control group either in crude or adjusted models. Conclusion: While there are some relationships between serum biomarkers or bacterial abundance with diabetes prediction in obese patients, this prognostication is less likely in obese patients with hypothyroid. Further investigation is warranted in the application of identified preclinical biomarkers in the diagnosis of diabetes or hypothyroid in obese patients.
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Affiliation(s)
- Mohsen Tabasi
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran.,Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Sana Eybpoosh
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemah Sadeghpour Heravi
- Surgical Infection Research Group, Faculty of Medicine and Health Science, Macquarie University, Sydney, Australia
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fezzeh Elyasinia
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Soroush
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Bouzari
- Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran
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Sanyal D, Bhattacharjee K. High Thyroid-stimulating Hormone Level in Down's Syndrome: A Mere Resetting of Hypothalamopituitary Axis in Subclinical Hypothyroidism? Indian J Endocrinol Metab 2020; 24:406-409. [PMID: 33489845 PMCID: PMC7810049 DOI: 10.4103/ijem.ijem_422_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/15/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Hyperthyrotropinemia (HT) or reduced thyroid function in Down syndrome (DS) is not uncommon, causes range from glandular dysgenesis to altered hypothalamopituitary axis. In the present study, we have compared hypothyroid Indian children with and without DS (NDS), especially focusing on family history, goiter, and biochemical features. METHODS We conducted this retrospective observational study from previous medical records of children with DS (1-17 years) having an elevated TSH (≥5 mIU/L) who were consecutively referred for with HT to Endocrinology OPD of a tertiary care hospital in India. Records from hypothyroid children (1-17 years) without Down Syndrome (NDS) were evaluated as controls. Free thyroxine (FT4), anti-thyroid peroxidase (TPO) antibody were measured and congenital hypothyroidism was excluded in all subjects. RESULTS Thirty-four DS cases [median age 8 years (IQR: 2-14), M: F = 13:21] and 34 controls [median age 10.5 years (IQR: 7-13.25), M: F = 13:21] were comparable in terms of age and sex, Median age of presentation was significantly earlier in case of DS vs NDS [7 years vs. 10 years]. DS children had significantly less family history of thyroid disorders compared to NDS [14.7% vs 64.7%]. Goiter was significantly less common in patients with DS [DS - 32.25% vs. NDS - 73.5%, P = 0.001]. Anti-TPO antibody positivity was significantly less common in patients with DS [DS- 41% vs. NDS- 73.5%, P = 0.014]. CONCLUSION There is a significant difference in presentation in hypothyroid children with DS compared to NDS. DS children with hypothyroidism compared to NDS, had earlier presentation, lower incidence of traceable family history, goiter, and anti-TPO-antibody positivity.
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Affiliation(s)
- Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, India
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Abstract
Arecoline is known to cause endocrine dysfunction. In the current article role of arecoline on pineal-testis activity was investigated in hypothyroid rats induced by propylthiouracil (PTU). PTU treatment caused thyroid dysfunction ultrastructurally with a fall in T3 and T4 levels followed by a rise of thyroid stimulating hormone (TSH) level. Pineal activity was impaired by PTU treatment, as evident from degenerated synaptic ribbons and mitochondria of the pinealocytes with depletion of pineal and serum N-acetyl serotonin and melatonin levels. Leydig cell function was suppressed, evident from reduced smooth endoplasmic reticulum and depletion of testosterone level. Sex accessories function was impaired by showing scanty rough endoplasmic reticulum with depletion of fructose and sialic acid levels. Arecoline treatment that caused pineal dysfunction and testicular stimulation in control rats, suppressed both pineal and testis functions after PTU treatment. The findings suggest that arecoline inhibits pineal-testis function in experimentally induced hypothyroid rats.
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Affiliation(s)
- Indraneel Saha
- Department of Zoology, University of Calcutta, Calcutta, India
| | | | | | | | - Urmi Chatterji
- Department of Zoology, University of Calcutta, Calcutta, India
| | - B R Maiti
- Department of Zoology, University of Calcutta, Calcutta, India
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Hawkins J, Hires CY, Dunne EW, Keenan LA. Aromatherapy reduces fatigue among women with hypothyroidism: A randomized placebo-controlled clinical trial. J Complement Integr Med 2019; 17:/j/jcim.ahead-of-print/jcim-2018-0229/jcim-2018-0229.xml. [PMID: 31437124 DOI: 10.1515/jcim-2018-0229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/27/2019] [Indexed: 06/10/2023]
Abstract
Background This randomized, blinded, placebo-controlled clinical trial identifies the effect of an aromatherapy blend of essential oils on fatigue, which is one of the most commonly unaddressed symptoms of hypothyroidism, by evaluating the effects of daily aromatherapy inhalation. Methods Participants included women aged 18-55 with a diagnosis of hypothyroidism. Women who had a history of thyroid cancer were excluded, due to the confounding effects of cancer on fatigue as the outcome of interest. Participants were randomized into two groups: the aromatherapy group, treated with inhalation of the essential oil blend, and the control group, treated with an odorless vegetable oil blend. The primary outcome was change from baseline in fatigue scores as measured by the Multidimensional Fatigue Symptom Inventory (MFSI), a validated instrument which measures multiple patterns of fatigue. Results After adjusting for baseline scores, no significant difference was found between the aromatherapy group and the control group at midpoint. Both groups experienced a reduction in symptoms during the first week of the intervention. At the endpoint, participants in the aromatherapy group had improved fatigue scores across all ten subscales, as compared to the control group. Not all improvements achieved statistical significance, indicating that the aromatherapy treatment has a greater effect on the subscales of global, affective, and general fatigue. Conclusions This is the first study to evaluate the effects of aromatherapy on fatigue among women with hypothyroidism. These findings provide evidence that regular inhalation of an aromatherapy blend may reduce fatigue among women with hypothyroidism, particularly in the areas of global, affective, and general fatigue.
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Affiliation(s)
- Jessie Hawkins
- Franklin School of Integrative Health Sciences, Aromatherapy, 504 Autumn Springs Ct ste 6, 37067 Franklin, United States of America
| | - Christy Y Hires
- Franklin School of Integrative Health Sciences, Aromatherapy, 504 Autumn Springs Ct ste 6, 37067 Franklin, United States of America
| | - Elizabeth W Dunne
- Franklin School of Integrative Health Sciences, University of Alabama in Birmingham, 504 Autumn Springs Ct ste 6, 37067 Franklin, United States of America
| | - Lindsey A Keenan
- Middle Tennessee State University, 1301 E Main Street, Murfreesboro, TN37132, USA
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Abstract
Novel immune-based cancer therapies such as programmed death 1 (PD-1) inhibitors continue to emerge for both curative and palliative intent. Post-market data of PD-1 inhibitors indicate that there are a wide range of side effects associated with these drugs, including ones that have relevance to symptom control and represent a diagnostic challenge at the end of life. We present a case of pembrolizumab-induced hypothyroidism causing extreme fatigue and persistent hypoglycemia.
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Affiliation(s)
- Kelvin Lou
- Department of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - Shalini Nayar
- Department of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
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Covey HL, Chang YM, Elliott J, Syme HM. Changes in thyroid and renal function after bilateral thyroidectomy in cats. J Vet Intern Med 2019; 33:508-515. [PMID: 30758070 PMCID: PMC6430951 DOI: 10.1111/jvim.15450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/28/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Iatrogenic hypothyroidism might worsen the prognosis of cats with azotemic CKD after thyroidectomy. Varying thyroxine concentrations influence utility of creatinine in assessing renal function. Symmetric dimethylarginine (SDMA) has limited studies in cats with changing thyroid status. OBJECTIVES Thyroid status is stable 6 months post-thyroidectomy. Symmetric dimethylarginine and creatinine are linearly associated without influence from total thyroxine concentration (tT4). ANIMALS Electronic records of 2 first opinion practices were searched using the term "thyroidectomy" to include 81 client-owned cats that had undergone bilateral thyroidectomy. METHODS Retrospective cross-sectional study assessing thyroid hormone concentrations of 68 cats within 6 months of surgery. A longitudinal study of thyroid status in 23 cats with >18 months follow-up post-thyroidectomy. A generalized estimating equation assessed the associations of bodyweight, tT4 and creatinine concentrations on SDMA concentration. RESULTS Sixty-eight cats had follow-up within 6 months. Fifteen cats (22%) had persistent, or recurrent, hyperthyroidism and 33 cats (49%) were hypothyroid. Twenty-three of the euthyroid/hypothyroid cats had long-term follow-up (595-1955 days); 4 cats (17%) remained hypothyroid, 19 cats (83%) were euthyroid (often transiently), and 9 of 23 cats (44%) developed recurrent hyperthyroidism. Symmetric dimethylarginine and creatinine were linearly associated, but hyperthyroid cats had higher SDMA concentrations, relative to creatinine (P = .003). CONCLUSIONS AND CLINICAL IMPORTANCE Cats have changes in thyroid function for years after bilateral thyroidectomy, with a high incidence of recurrent hyperthyroidism. Both SDMA and creatinine are affected by thyroxine concentrations, and the effect is greater in hyperthyroid cats.
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Affiliation(s)
- Heather L Covey
- Department of Clinical Science and Services, Small Animal Medicine and Surgery Group, The Royal Veterinary College, Hertfordshire, United Kingdom
| | - Yu-Mei Chang
- Research Support Office, The Royal Veterinary College, London, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
| | - Harriet M Syme
- Department of Clinical Science and Services, Small Animal Medicine and Surgery Group, The Royal Veterinary College, Hertfordshire, United Kingdom
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Patel VJ, Joharapurkar AA, Kshirsagar SG, Sutariya BK, Patel MS, Bahekar RH, Jain MR. Activation of GLP-1 and Glucagon Receptors Regulates Bile Homeostasis Independent of Thyroid Hormone. Curr Mol Pharmacol 2019; 12:139-146. [PMID: 30747091 DOI: 10.2174/1874467212666190212112402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Balanced coagonists of glucagon-like peptide-1 (GLP-1) and glucagon receptors are emerging therapies for the treatment of obesity and diabetes. Such coagonists also regulate lipid metabolism, independent of their body weight lowering effects. Many actions of the coagonists are partly mediated by fibroblast growth factor 21 (FGF21) signaling, with the major exception of bile homeostasis. Since thyroid hormone is an important regulator of bile homeostasis, we studied the involvement of thyroid hormone in coagonist-induced changes in lipid and bile metabolism. METHODS We evaluated the effect of a single dose of coagonist Aib2 C24 chimera2 at 150 to 10000 µg/kg on tetraiodothyronine (T4) and triiodothyronine (T3) in high-fat diet-induced obese (DIO) mice and chow-fed mice. Repeated dose treatment of coagonist (150 µg/kg, subcutaneously) was assessed in four mice models namely, on lipid and bile homeostasis in DIO mice, propylthiouracil (PTU)-treated DIO mice, methimazole (MTM)-treated DIO mice and choline-deficient, L-amino acid-defined, highfat diet (CDAHFD)-induced nonalcoholic steatohepatitis (NASH). RESULTS Single dose treatment of coagonist did not alter serum T3 and T4 in chow-fed mice and DIO mice. Coagonist treatment improved lipid metabolism and biliary cholesterol excretion. Chronic treatment of GLP-1 and glucagon coagonist did not alter serum T3 in hypothyroid DIO mice and CDAHFDinduced NASH. Coagonist increased serum T4 in DIO mice after 4 and 40 weeks of treatment, though no change in T4 levels was observed in hypothyroid mice or mice with NASH. CONCLUSION Our data demonstrate that coagonist of GLP-1 and glucagon receptors does not modulate bile homeostasis via thyroid signaling.
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Affiliation(s)
- Vishal J Patel
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Amit A Joharapurkar
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Samadhan G Kshirsagar
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Brijesh K Sutariya
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Maulik S Patel
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Rajesh H Bahekar
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
| | - Mukul R Jain
- Zydus Research Centre, Cadila Healthcare Limited, Sarkhej-Bavla N.H.No.8A, Moraiya, Ahmedabad, 382210, India
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El-Zawawy HT. Serum leptin in male hypothyroid prediabetic patients: Association with cardiovascular risk. Cardiovasc Endocrinol Metab 2018; 7:84-7. [PMID: 31646289 DOI: 10.1097/XCE.0000000000000157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 01/26/2023]
Abstract
Introduction Hyperliptenemia is a risk factor for coronary heart disease (CHD). Hypothyroidism and prediabetes confer an increased cardiovascular risk. Few studies have addressed the role of leptin in hypothyroid prediabetic patients and its effect on CHD risk factors. Objective The aim of this study was to detect serum levels of leptin in hypothyroid prediabetic patients and their relationship with risk factors for CHD. Patients and methods The study included three groups; group A included 120 hypothyroid male patients with normal glucose tolerance, group B included 120 hypothyroid male patients with prediabetes, and group C included 120 healthy individuals matched for age and sex as a control group. All groups were subjected to assessment of history, clinical examination, and laboratory investigations including fasting and 2 h postprandial blood glucose, serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), free T3, free T4, thyroid-stimulating hormone, and fasting serum leptin. Results Serum leptin was significantly higher in groups A and B compared with group C (P=0.0001), whereas there was no significant difference in serum leptin between groups A and B. In comparison with group A, the patients in group B had significantly higher serum TC (P=0.02), LDL (P=0.04), and lower serum HDL (P=0.02). In group B, serum leptin correlated positively with serum TC (P=0.0001), TG (P=0.041), and LDL (P=0.036), and negatively with serum HDL (P=0.039). Conclusion Hypothyroidism is associated with high serum leptin independent of prediabetic state. Serum leptin in hypothyroid prediabetic patients showed a direct relationship with some primary markers of metabolic syndrome; thus, leptin may predict the development of CHD in those patients.
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Liu J, Guo M, Hu X, Weng X, Tian Y, Xu K, Heng D, Liu W, Ding Y, Yang Y, Zhang C. Effects of Thyroid Dysfunction on Reproductive Hormones in Female Rats. CHINESE J PHYSIOL 2018; 61:152-162. [PMID: 29742817 DOI: 10.4077/cjp.2018.bag551] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 11/24/2022] Open
Abstract
Thyroid hormones (THs) play a critical role in the development of ovarian cells. Although the
effects of THs on female reproduction are of great interest, the mechanism remains unclear. We
investigated the effects of TH dysregulation on reproductive hormones in rats. Propylthiouracil (PTU)
and L-thyroxine were administered to rats to induce hypo- and hyperthyroidism, respectively, and the
reproductive hormone profiles were analyzed by radioimmunoassay (RIA). Ovarian histology was
evaluated with hematoxylin and eosin (H&E) staining, and gene protein level or mRNA content was
analyzed by western blotting or reverse transcription polymerase chain reaction (RT-PCR). The serum
levels of gonadotropin releasing hormone (GnRH) and follicle stimulating hormone (FSH) in both rat
models were significantly decreased on day 21, although there were no significant changes at earlier
time points. There were no significant differences in luteinizing hormone (LH) or progesterone (P4)
levels between the treatment and the control groups. Both PTU and L-thyroxine treatments downregulated
estradiol (E2) concentrations; however, the serum testosterone (T) level was increased only in
hypothyroid rats at day 21. In addition, the expression levels of FSH receptor, cholesterol side-chain
cleavage enzyme (P450scc), and steroidogenic acute regulatory protein (StAR) were decreased in both
rat models. Moreover, the onset of puberty was significantly delayed in the hypothyroid group. These
results provide evidence that TH dysregulation alters reproductive hormone profiles, and that the
initiation of the estrous cycle is postponed in hypothyroidism.
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Affiliation(s)
- Juan Liu
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China.,State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy
of Sciences, Beijing 100101, Peoples’ Republic of China
| | - Meng Guo
- Department of Laboratory Animal Science, School of Basic Medical Science, Capital Medical University, Beijing 100069, Peoples' Republic of China
| | - Xusong Hu
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Xuechun Weng
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Ye Tian
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Kaili Xu
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Dai Heng
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Wenbo Liu
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Yu Ding
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
| | - Yanzhou Yang
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Key Laboratory of Reproduction and Genetics in Ningxia, Department of Histology and Embryology, Ningxia Medical
University, Ningxia 750004, Peoples’ Republic of China
| | - Cheng Zhang
- College of Life Science, Capital Normal University, Beijing 100048, Peoples’ Republic of China
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38
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Abstract
BACKGROUND Iodine deficiency is the most common cause of acquired hypothyroidism worldwide. Although uncommon in the Western world, the incidence of iodine deficiency may be rising due to the increased use of restrictive diets. CASE PRESENTATION We present a 23-month-old boy diagnosed with iodine deficiency hypothyroidism, induced by a vegan diet. CONCLUSIONS This case highlights the risk for iodine deficiency in children on a vegan diet after discontinuation of breast/formula feeding that could lead to acquired hypothyroidism.
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Affiliation(s)
- Olga Yeliosof
- Goreyb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Lawrence A Silverman
- Pediatric Endocrinology, Goryeb Children's Hospital, Atlantic Health System, 100 Madison Ave., Morristown, NJ 07962, USA
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39
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Segarra AB, Prieto I, Martínez-Cañamero M, de Gasparo M, Luna JDD, Ramírez-Sánchez M. Thyroid Disorders Change the Pattern of Response of Angiotensinase Activities in the Hypothalamus-Pituitary-Adrenal Axis of Male Rats. Front Endocrinol (Lausanne) 2018; 9:731. [PMID: 30555423 PMCID: PMC6283893 DOI: 10.3389/fendo.2018.00731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022] Open
Abstract
Thyroid disorders affect the hypothalamic-pituitary-adrenal axis with important consequences on the cardiovascular function in which the renin-angiotensin system plays a major role. Hypo and hyperthyroidism influence the classic main components of the renin-angiotensin system. However, the behavior of other elements of the renin-angiotensin system such as Ang III, Ang 2-10, Ang IV, or AT4, regulated by angiotensinase enzymes such as alanyl- (AlaAP), cystinyl- (CysAP), glutamyl- (GluAP), or aspartyl-aminopeptidase (AspAP), has not yet been described. In order to obtain a comprehensive view on the response of the renin-angiotensin system in the hypothalamic-pituitary-adrenal axis of animals with thyroid disorders, these enzyme activities were simultaneously analyzed fluorometrically, using arylamide derivatives as substrates in hypothalamus, anterior and posterior pituitary, adrenals and plasma of euthyroid, hypothyroid, and hyperthyroid rats, and their intra- and inter-tissue correlations were evaluated. The response is depending on the type of enzyme studied, its location and the thyroid status. Anterior pituitary, adrenals and plasma were mainly affected by the thyroid disorders. In the anterior pituitary, GluAP and AspAP increased in hypothyroid rats. In adrenals, AlaAP and CysAP decreased in hypothyroid whereas GluAP and AspAP decreased in hyperthyroid rats. In plasma, while AlaAP increased in hypo- and hyperthyroid rats, CysAP and GluAP decreased only in hyperthyroid. In comparison with euthyroid, intra-tissue correlations decreased in hypothyroid but inter-tissue correlations decreased mainly in hyperthyroid rats. Thyroid disorders also produced a disruption in the pattern of inter-tissue correlations observed in euthyroid. These results suggest that thyroid hormone levels hit components of the renin-angiotensin system and may influence the paracrine and endocrine cross talk between cells.
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Affiliation(s)
- Ana B. Segarra
- Department of Health Sciences, University of Jaén, Jaén, Spain
| | - Isabel Prieto
- Department of Health Sciences, University of Jaén, Jaén, Spain
| | | | - Marc de Gasparo
- Cardiovascular and Metabolic Syndrome Adviser, Rossemaison, Switzerland
| | - Juan de Dios Luna
- Department of Biostatistics, Medical School, University of Granada, Granada, Spain
| | - Manuel Ramírez-Sánchez
- Department of Health Sciences, University of Jaén, Jaén, Spain
- *Correspondence: Manuel Ramírez-Sánchez
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40
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Hatsukano T, Kurisu J, Fukumitsu K, Fujishima K, Kengaku M. Thyroid Hormone Induces PGC-1α during Dendritic Outgrowth in Mouse Cerebellar Purkinje Cells. Front Cell Neurosci 2017; 11:133. [PMID: 28536504 PMCID: PMC5422430 DOI: 10.3389/fncel.2017.00133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/20/2017] [Indexed: 11/26/2022] Open
Abstract
Thyroid hormone 3,3′,5-Triiodo-L-thyronine (T3) is essential for proper brain development. Perinatal loss of T3 causes severe growth defects in neurons and glia, including strong inhibition of dendrite formation in Purkinje cells in the cerebellar cortex. Here we show that T3 promotes dendritic outgrowth of Purkinje cells through induction of peroxisome proliferator-activated receptor gamma (PPARγ) co-activator 1α (PGC-1α), a master regulator of mitochondrial biogenesis. PGC-1α expression in Purkinje cells is upregulated during dendritic outgrowth in normal mice, while it is significantly retarded in hypothyroid mice or in cultures depleted of T3. In cultured Purkinje cells, PGC-1α knockdown or molecular perturbation of PGC-1α signaling inhibits enhanced dendritic outgrowth and mitochondrial generation and activation caused by T3 treatment. In contrast, PGC-1α overexpression promotes dendrite extension even in the absence of T3. PGC-1α knockdown also downregulates dendrite formation in Purkinje cells in vivo. Our findings suggest that the growth-promoting activity of T3 is partly mediated by PGC-1α signaling in developing Purkinje cells.
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Affiliation(s)
- Tetsu Hatsukano
- Kengaku Group, Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto UniversityKyoto, Japan.,Kengaku Group, Graduate School of Biostudies, Kyoto UniversityKyoto, Japan
| | - Junko Kurisu
- Kengaku Group, Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto UniversityKyoto, Japan
| | - Kansai Fukumitsu
- Kengaku Group, Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto UniversityKyoto, Japan.,Kengaku Group, Graduate School of Biostudies, Kyoto UniversityKyoto, Japan
| | - Kazuto Fujishima
- Kengaku Group, Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto UniversityKyoto, Japan
| | - Mineko Kengaku
- Kengaku Group, Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto UniversityKyoto, Japan.,Kengaku Group, Graduate School of Biostudies, Kyoto UniversityKyoto, Japan
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41
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Abstract
Due to the manifold effects of thyroid hormone across virtually all organ systems, the complications associated with thyroid dysfunction are numerous and diverse. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to be cognizant of the most effective means of optimizing the status of thyrotoxic and hypothyroid patients perioperatively. This article describes the adverse effects of thyroid dysfunction as they relate to the patient undergoing both thyroid and nonthyroid surgery and recommends treatment approaches aimed at decreasing perioperative risk.
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Affiliation(s)
- Marcia Rashelle Palace
- Division of Endocrinology, Bronx-Lebanon Hospital Center, Bronx, NY, USA.,Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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42
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Abstract
Background: Hepatitis C virus (HCV) infection is common worldwide. The treatment typically involves a combination of interferon-alpha (IFN-α) and ribavirin (RBV) therapy; however, the use of IFN-α is well documented to be associated with thyroid disease, the most common autoimmune disorder associated with IFN-α. Aim: The aim of the present study was to know the prevalence of thyroid abnormality in the HCV-positive patients on IFN and antiviral therapy. Materials and Methods: Fifty known HCV positive patients were enrolled for the study. All the patients were on IFN (3 million unit subcutaneously 3 times/week) and antiviral therapy (oral RBV 1000–1200 mg/day). Thyroid function tests were performed first at the start of treatment and then after 12 weeks of treatment. Results: 13 (26%) of the patients were found to develop hypothyroidism, and 1 (2%) patient developed hyperthyroidism in the course of 12 weeks therapy. Conclusion: HCV patients on IFN and antiviral therapy have an effect on the thyroid gland, so these patients should be regularly screened for thyroid disorders and appropriately treated to maintain euthyroid status.
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Affiliation(s)
- Gitanjali Goyal
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
| | - Kmds Panag
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
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43
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Sanghi V, Kapoor A. Unusual Presentation of Central Diabetes Insipidus in a Patient With Neurosarcoidosis. J Investig Med High Impact Case Rep 2016; 4:2324709616667511. [PMID: 27652275 PMCID: PMC5019196 DOI: 10.1177/2324709616667511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 01/03/2023] Open
Abstract
Hypernatremia is a frequent cause of intensive care unit admission. The patient presented in this article had hypernatremia refractory to D5W (dextrose 5% water) therapy, which led to a complex investigation. Workup revealed central diabetes insipidus most likely secondary to flare up of neurosarcoidosis. The challenge in terms of diagnosis was a presentation with low urine output in the setting of hypernatremia resistant to treatment with desmopressin. This case unfolded the role of hypothyroidism causing secondary renal dysfunction and hence needed continued treatment with thyroxine in addition to treatment for hypernatremia.
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Affiliation(s)
- Vedha Sanghi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aanchal Kapoor
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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44
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Abstract
CONTEXT The association between depression and thyroid function is well known. Both conditions express many similar symptoms, thus making the diagnosis and treatment difficult. AIMS To find the prevalence of anxiety and depressive symptoms among patients with hypothyroid. SETTINGS AND DESIGN Cross-sectional study. MATERIALS AND METHODOLOGY A total of 100 patients diagnosed as hypothyroidism were evaluated using Hamilton depression rating scale (HDRS) and Hamilton scale for anxiety (HAM-A). STATISTICAL ANALYSIS USED The data were analyzed using the SPSS for Windows version 17.0 software. The quantitative data were expressed in number and percentage. The results obtained were compared using the Chi-square test. RESULTS Females constituted 70% of the sample. A total of 60% reported some degree of depression based on HDRS (males - 56.63% and females - 64.29%) whereas about 63% out of the total patients screened showed some degree of anxiety (males -56.66% and females - 65.72%) based on HAM-A. The most common depressive symptom among the males was depressed mood (73.33%) and among females was gastrointestinal somatic symptoms (68.54%). The most common anxiety symptom among the males was depressed mood (70.0%) and among females was anxious mood (92.85%). CONCLUSIONS Psychiatric symptoms/disorders are common in patients with thyroid dysfunction.
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Affiliation(s)
- Manish Bathla
- Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Jandheri, Haryana, India
| | - Manpreet Singh
- Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Jandheri, Haryana, India
| | - Pankaj Relan
- Department of Medicine, MM Institute of Medical Sciences and Research, Mullana, Jandheri, Haryana, India
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45
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Sajadian M, Hashemi M, Salimi S, Nakhaee A. The Effect of Experimental Thyroid Dysfunction on Markers of Oxidative Stress in Rat Pancreas. Drug Dev Res 2016; 77:199-205. [PMID: 27241437 DOI: 10.1002/ddr.21312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/08/2016] [Indexed: 11/07/2022]
Abstract
Preclinical Research The aim of the present study was to evaluate the effects of thyroid dysfunction on markers of oxidative stress in rat pancreas. Hypothyroidism and hyperthyroidism were, respectively, induced in rats via administration of propylthiouracil (PTU) and L-thyroxine sodium salt in drinking water for 45 days. The activities of superoxide dismutase (SOD), catalase (CAT), glutathioen peroxidase (GPx), glutathione reductase (GR), glucose-6-phosphate dehydrogenase (G6PD), xanthine oxidase (XO), and nonenzymatic markers of oxidative stress including malondialdehyde (MDA), protein carbonyl (PC), reduced glutathione (GSH), and total thiols (T-SH) were determined in the rat pancreas. In hyperthyroid rats, pancreatic CAT, SOD, GPx, GR, XO, G6PD activities were increased compared with those in hypothyroid and control groups. There were no differences in activities of antioxidant enzymes between hypothyroid and control rats. Pancreatic MDA and PC in hyperthyroid rats increased compared with hypothyroid and the control animals. Whereas, hyperthyroid rats had decreased levels of tissue GSH and T-SH compared with hypothyroid and the control groups. The findings showed that only GSH level has decreased significantly in the hypothyroid group compared with control groups. In conclusion, our results showed that experimental hyperthyroidism induces oxidative stress in pancreas of rats, but hypothyroidism has no major impact on oxidative stress markers. Drug Dev Res 77 : 199-205, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mojtaba Sajadian
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hashemi
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeedeh Salimi
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Nakhaee
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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46
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Srichomkwun P, Admoni O, Refetoff S, de Vries L. A Novel Mutation (S54C) of the PAX8 Gene in a Family with Congenital Hypothyroidism and a High Proportion of Affected Individuals. Horm Res Paediatr 2016; 86:137-142. [PMID: 27207603 PMCID: PMC5061635 DOI: 10.1159/000445891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital hypothyroidism (CH) is a common endocrine disorder in newborns. The cause of CH is thyroid dysgenesis in 80-85% of patients. Paired box gene 8 (PAX8) is a thyroid transcription factor that plays an important role in thyroid organogenesis and development. To date, 22 different PAX8 gene mutations have been reported. METHODS Four generations of a Hungarian Jewish family were affected, and in the 3 generations studied, 9 males and 4 females were affected and 3 first-degree relatives were unaffected. Six were diagnosed at birth [thyroid-stimulating hormone (TSH) level 59-442 mU/l] and 7 at 2-48 years of age (TSH level 6-223 mU/l). One affected patient had thyroid hemiagenesis on ultrasound. RESULTS Direct sequencing of the PAX8 gene revealed a novel single nucleotide substitution (c.162 A>T) in exon 2 that resulted in the substitution of the normal serine 54 with a cysteine (S54C), which segregated with elevated serum TSH levels. Other mutations of the same amino acid (S54G and S54R) have also been shown to produce functional impairment. CONCLUSION We report a large family with a novel mutation in the PAX8 gene presenting with variable phenotype and with a high proportion of affected family members.
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Affiliation(s)
| | - Osnat Admoni
- Pediatric Endocrine Unit, Ha'Emek Medical Center, Afula, Israel
| | - Samuel Refetoff
- Department of Medicine, The University of Chicago, Chicago, Illinois,Department of Pediatrics and the Committee on Genetics, The University of Chicago, Chicago, Illinois
| | - Liat de Vries
- Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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47
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Kido N, Itagaki I, Ono K, Omiya T, Matsumoto R. FOLLICULAR CELL CARCINOMA OF THE THYROID GLAND IN THREE CAPTIVE AGED RACCOON DOGS (NYCTEREUTES PROCYONOIDES). J Zoo Wildl Med 2015; 46:889-94. [PMID: 26667546 DOI: 10.1638/2015-0013.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The clinical and histologic features of thyroid carcinoma in raccoon dogs have not been previously reported. Three of four raccoon dogs (Nyctereutes procyonoides) over 8 yr of age at the Nogeyama Zoological Gardens developed thyroid follicular cell carcinomas that were detected at necropsy. The affected raccoon dogs were rescued from the wild and were housed at the Nogeyama Zoological Gardens for 8 yr 8 mo, 8 yr 10 mo, and 10 yr 3 mo, respectively. Although all of them appeared lethargic and developed partial alopecia or desquamation of their skin, they did not display any other specific clinical signs associated with a thyroid lesion. Serum thyroid hormone values were examined in two of the affected raccoon dogs and the average and standard deviation values (free-thyroxin [FT4]: 0.078 ± 0.077 pM/L and 0.062 ± 0.0039 pM/L; free-triiodothyronine [FT3]: 3.261 ± 0.765 pM/L and 3.407 ± 0.919 pM/L) were lower than the reference range (FT4: 0.141 ± 0.117 pM/L; FT3: 5.139 ± 2.412 pM/L) derived from a clinically normal raccoon dog. On necropsy, the thyroid lobes were markedly enlarged bilaterally. Histopathologically, the neoplastic cells in the thyroid gland appeared round or oval and columnar or cuboidal with minimal heteromorphism. Moreover, mostly small (but occasionally large) follicles were identified, and the neoplastic cells had infiltrated into the surrounding capsule and blood vessels. The histopathologic features of the thyroid tumors in the raccoon dogs revealed that the tumors were derived from follicular cells.
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48
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Abstract
PURPOSE OF REVIEW Overt hypothyroidism has major effects on neuropsychiatric function, but patients with mild hypothyroidism may attribute unrelated neuropsychiatric symptoms to their thyroid condition. This review will summarize data on neuropsychiatric effects of hypothyroidism, and provide guidelines regarding the relationship between hypothyroidism and neuropsychiatric issues, and treatment indications. RECENT FINDINGS Clinical investigations and functional imaging studies confirm that overt hypothyroidism is associated with affective and cognitive decrements, largely reversible with treatment. In contrast, subclinical hypothyroidism is not associated with major neuropsychiatric deficits, although studies utilizing sensitive measures show small deficits in memory and executive function. Neuropsychiatric complaints are more common when patients are aware of their thyroid disease, regardless of their thyroid function at the time of testing. SUMMARY Neuropsychiatric dysfunction is common in overt hypothyroidism and will improve (perhaps not completely resolve) with therapy. Deficits related to thyroid dysfunction are usually mild in subclinical hypothyroidism, and realistic expectations need to be set regarding symptom reversibility with treatment. Patients with mild hypothyroidism and significant distress related to neuropsychiatric symptoms, most likely, have independent diagnoses that should be evaluated separately.
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Affiliation(s)
- Mary H Samuels
- Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, CR107, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, 503-494-5242,
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49
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Rhee CM, Kalantar-Zadeh K, Streja E, Carrero JJ, Ma JZ, Lu JL, Kovesdy CP. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant 2014; 30:282-7. [PMID: 25246335 DOI: 10.1093/ndt/gfu303] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent studies have shown an increasing risk of hypothyroidism with incrementally lower estimated glomerular filtration rate (eGFR) in cohorts comprised of patients with normal to mildly impaired kidney function. We sought to confirm these findings in a nationally representative cohort of Veterans Affairs patients with moderate-to-severe chronic kidney disease (CKD). METHODS This study examined the association between kidney function and hypothyroidism among 461 607 veterans with Stage 3 to 5 CKD who underwent repeated measurements of serum creatinine and thyrotropin (TSH) at identical time points between October 2004 and September 2006. Kidney function was defined by eGFR using the Chronic Kidney Disease Epidemiology Collaboration formula. In primary analyses, the association between eGFR and hypothyroidism (defined as serum TSH > 5 mIU/L and/or receipt of thyroid hormone supplementation) was estimated using multivariable random effects logistic regression. In secondary analyses, the association between eGFR and serum TSH level was estimated using multivariable random effects linear regression. RESULTS At baseline, 68.9, 25.5, 5.3 and 0.3% of patients had Stage 3A, 3B, 4 and 5 CKD, respectively. For every 10 mL/min/1.73 m(2) lower eGFR, there was an 18% higher risk of hypothyroidism: adjusted odds ratio 1.18 [95% confidence interval (CI) 1.17-1.20, P < 0.001]. In secondary analyses, we observed that a 10 mL/min/1.73 m(2) lower eGFR was associated with a 0.11 mIU/L higher serum TSH (95% CI 0.10-0.11 mIU/L higher serum TSH, P < 0.001). CONCLUSIONS In a nationally representative cohort of patients with moderate-to-severe CKD, there is an inverse association between eGFR and risk of hypothyroidism.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | | | - Jennie Z Ma
- Division of Nephrology, University of Virginia, Charlottesville, VA, USA
| | - Jun L Lu
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
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50
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Oncel M, Kıyıcı A, Onen S. Evaluation of the Relationship Between Ischemia-Modified Albumin Levels and Thyroid Hormone Levels. J Clin Lab Anal 2014; 29:427-31. [PMID: 24953331 DOI: 10.1002/jcla.21789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 05/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A novel ischemia marker named ischemia modified albumin was previously considered as an early marker of myocardial ischemia, however due to recent reports, its contribution was demonstrated in different pathologies such as oxidative stress, diabetes, stroke and cancer. We aimed to investigate the relation between oxidative stress and thyroid dysfunctions determining IMA levels since IMA is closely related with increased oxidative stress. METHODS A total of 88 individuals were participated in this study: 34 cases in hypothyroid, 27 cases in hyperthyroid and 27 cases in euthyroid group. Ischemia-modified albumin levels were measured by albumin cobalt binding test and thyroid hormone levels were determined with electrochemiluminescent method. RESULTS Ischemia modified albumin levels were significantly decreased in hypothyroid group compared to hyperthyroid and euthyroid groups (p < 0.001). In hyperthyroid individuals ischemia modified albumin levels were higher compared to euthyroid ones (p < 0.001). Ischemia modified albumin was negatively correlated with TSH levels (r = -0.473, p < 0.001), and positively correlated with FT4 and FT3 levels (r = 0.496, p < 0.001 and r = 0.275, p = 0.010, respectively). CONCLUSION We suggest that albumin adjusted IMA levels are significantly lower in hypothyroid group than hyperthyroid and euthyroid groups.
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Affiliation(s)
- Mufide Oncel
- Department of Biochemistry, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Aysel Kıyıcı
- Department of Biochemistry, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Serife Onen
- Department of Internal Medicine, Beyhekim State Hospital, Konya, Turkey
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