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Wu Y, Deng YL, Zhang M, Miao Y, Cui FP, Zeng JY, Liu XY, Li CR, Liu AX, Zhu JQ, Li YJ, Liu C, Zeng Q. Urinary haloacetic acid concentrations and thyroid function among women: Results from the TREE study. Sci Total Environ 2024; 927:172368. [PMID: 38614346 DOI: 10.1016/j.scitotenv.2024.172368] [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] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Disinfection byproducts (DBPs) have been shown to impair thyroid function in experimental models. However, epidemiological evidence is scarce. METHODS This study included 1190 women undergoing assisted reproductive technology (ART) treatment from the Tongji Reproductive and Environmental (TREE) cohort from December 2018 to August 2021. Serum thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured as indicators of thyroid function. FT4/FT3 and TSH/FT4 ratios were calculated as markers of thyroid hormone homeostasis. Dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA), the two most abundant HAAs, in urine were detected to assess individual DBP exposures. RESULTS After adjusting for relevant covariates, positive associations were observed between urinary TCAA concentrations and serum TSH and TSH/FT4 levels (e.g., percent change = 5.82 %, 95 % CI: 0.70 %, 11.21 % for TSH), whereas inverse associations were found for serum FT3 and FT4 (e.g., percent change = -1.29 %, 95 % CI: -2.49 %, -0.07 % for FT3). There also was a negative association between urinary DCAA concentration and serum FT4/FT3 (percent change = -2.49 %, 95 % CI: -4.71 %, -0.23 %). These associations were further confirmed in the restricted cubic spline and generalized additive models with linear or U-shaped dose-response relationships. CONCLUSION Urinary HAAs were associated with altered thyroid hormone homeostasis among women undergoing ART treatment.
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Affiliation(s)
- Yang Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yan-Ling Deng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Min Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Miao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fei-Peng Cui
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jia-Yue Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiao-Ying Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Cheng-Ru Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - A-Xue Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jin-Qin Zhu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yang-Juan Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chong Liu
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China..
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Lutterschmidt DI, Stratton K, Winters TJ, Martin S, Merlino LJ. Neural thyroid hormone metabolism integrates seasonal changes in environmental temperature with the neuroendocrine reproductive axis. Horm Behav 2024; 161:105517. [PMID: 38422864 DOI: 10.1016/j.yhbeh.2024.105517] [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] [Received: 07/21/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
We asked if environmental temperature alters thyroid hormone metabolism within the hypothalamus, thereby providing a neuroendocrine mechanism by which temperature could be integrated with photoperiod to regulate seasonal rhythms. We used immunohistochemistry to assess the effects of low-temperature winter dormancy at 4 °C or 12 °C on thyroid-stimulating hormone (TSH) within the infundibulum of the pituitary as well as deiodinase 2 (Dio2) and 3 (Dio3) within the hypothalamus of red-sided garter snakes (Thamnophis sirtalis). Both the duration and, in males, magnitude of low-temperature dormancy altered deiodinase immunoreactivity within the hypothalamus, increasing the area of Dio2-immunoreactivity in males and females and decreasing the number of Dio3-immunoreactive cells in males after 8-16 weeks. Reciprocal changes in Dio2/3 favor the accumulation of triiodothyronine within the hypothalamus. Whether TSH mediates these effects requires further study, as significant changes in TSH-immunoreactive cell number were not observed. Temporal changes in deiodinase immunoreactivity coincided with an increase in the proportion of males exhibiting courtship behavior as well as changes in the temporal pattern of courtship behavior after emergence. Our findings mirror those of previous studies, in which males require low-temperature exposure for at least 8 weeks before significant changes in gonadotropin-releasing hormone immunoreactivity and sex steroid hormones are observed. Collectively, these data provide evidence that the neuroendocrine pathway regulating the reproductive axis via thyroid hormone metabolism is capable of transducing temperature information. Because all vertebrates can potentially use temperature as a supplementary cue, these results are broadly applicable to understanding how environment-organism interactions mediate seasonally adaptive responses.
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Affiliation(s)
| | - Kalera Stratton
- Department of Biology, Portland State University, OR, United States
| | - Treven J Winters
- Department of Biology, Portland State University, OR, United States
| | - Stephanie Martin
- Department of Biology, Portland State University, OR, United States
| | - Lauren J Merlino
- Department of Biology, Portland State University, OR, United States
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3
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Rodrigo Valero AM, Herranz Antolín S, Bienvenido Villalba M, Cisneros Gutiérrez Del Olmo N. [Reference levels of thyroid hormones in pregnant woman from Guadalajara]. Semergen 2024; 50:102172. [PMID: 38160630 DOI: 10.1016/j.semerg.2023.102172] [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: 09/13/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Thyroid dysfunction during gestation impacts on maternal-fetal health and may influence the neurocognitive development of the child. Thyroid physiology changes during pregnancy and requires the establishment of specific reference levels per trimester and for each population and method. The objectives of our study were to analyse thyroid function throughout pregnancy and to establish reference levels for TSH and T4L in each trimester for our population and methodology. MATERIAL AND METHODS Prospective analytical study of 598 pregnant women from March 2018 to October 2020. TSH, T4L, T3L, ATPO and ATG were determined in all of them. A total of 151 pregnant women were excluded due to positive thyroid immunity, previous thyroid disease in treatment with levothyroxine, twin pregnancy, diagnosis of hypothyroidism and hyperthyroidism in the request or absence of some of the parameters studied, with a reference population of 447 pregnant women. RESULTS The reference levels for TSH were 0.07-3.14mIU/L for the first, 0.66-3.21mIU/L for the second and 0.52-2.97mIU/L for the third trimester. Reference levels for T4L were 0.81-1.19ng/dL for the first, 0.71-1.07ng/dL for the second and 0.69-1.06ng/dL for the third trimester. CONCLUSIONS The reference levels for TSH and T4L obtained in this study differ from those used for the general population, which may have led to misclassification errors and unnecessary treatment in pregnant women.
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Affiliation(s)
- A M Rodrigo Valero
- Servicio de Análisis Clínicos, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - S Herranz Antolín
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Bienvenido Villalba
- Servicio de Análisis Clínicos, Hospital Universitario de Guadalajara, Guadalajara, España
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Schnedl WJ, Michaelis S, Mangge H, Enko D. One sip of water with LT-4 supplementation-a key to euthyroidism in Hashimoto's thyroiditis. Endocrine 2024:10.1007/s12020-024-03829-w. [PMID: 38635065 DOI: 10.1007/s12020-024-03829-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Recommended pharmacotherapy for hypothyroidism in Hashimoto's thyroiditis (HT) is oral supplementation with levothyroxine (LT-4). However, serum thyrotropin (TSH) levels within normal range are not consistently achieved with LT-4 medication. PATIENTS AND METHODS We report on 35 HT patients with LT-4 therapy in this retrospective evaluation. In general, we recommend that a maximum of two sips of water, which would then amount to < 50 mL, be ingested at the same time as LT-4. We report on follow up examinations measuring TSH and antibodies against thyroid peroxidase (TPOAb) after 6 months to five years. RESULTS After median time of 643 days (range 98-1825) we found in 35 HT patients a statistical significant reduction of serum TSH (p < 0.001) and TPOAb (p = 0.006). The patients median body weight was 71 kg (range 48-98) and a daily LT-4 dosage was used with median 69.1 µg (range 25-150). This results in a daily LT-4 dose of median 1.01 µg/kg bodyweight (range 0.3-2.3). CONCLUSIONS The reduction of water ingestion to a maximum of two sips, which is <50 mL, combined with LT-4 supplementation helps to achieve euthyroidism in HT. In addition, it reduces the L-T4 medication dosage needed to lower TSH serum levels and decreases TPO antibodies in HT.
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Affiliation(s)
- Wolfgang J Schnedl
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036, Graz, Austria.
- General Internal Medicine Practice, Dr. Theodor Körnerstrasse 19b, A-8600, Bruck, Austria.
| | - Simon Michaelis
- Institute of Clinical Chemistry and Laboratory Medicine, Hospital Hochsteiermark, Vordernberger Straße 42, A-8700, Leoben, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz 30, A-8036, Graz, Austria
| | - Dietmar Enko
- Institute of Clinical Chemistry and Laboratory Medicine, Hospital Hochsteiermark, Vordernberger Straße 42, A-8700, Leoben, Austria
- Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz 30, A-8036, Graz, Austria
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5
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Wu S, Yang Y, Chen Y, Xie W, Huang J, Liu M, Liu Y, Xu D, Lyu X, Wu H, Lei J, Zhao C, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Wang L, Guan H, Ma X. Husband smoking is associated with Wife's thyrotropin abnormality: A population-based cohort study among Chinese reproductive-aged women. Int J Hyg Environ Health 2024; 257:114338. [PMID: 38354683 DOI: 10.1016/j.ijheh.2024.114338] [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: 09/26/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To comprehensively assess the association of husband smoking with wives' thyrotropin abnormality. METHODS This population-based retrospective cohort study included 2 406 090 Chinese reproductive-aged women who had participated twice in the National Free Pre-pregnancy Checkups Project between 2010 and 2020. Multivariate-adjusted odds ratios and 95% confidence intervals for subnormal and supranormal thyrotropin were estimated according to the husband's smoking status. RESULTS Husband smoking at the first visit was associated with a 17% (15%-20%) and 26% (24%-28%) increased odds of subnormal thyrotropin and supranormal thyrotropin respectively compared to participants in neither-smoker group. In non-smoking participants with normal thyrotropin levels at the first visit, the corresponding increased risk of subnormal thyrotropin and supranormal thyrotropin at the second visit were 15% (12%-18%) and 19% (16%-21%) in contrast to participants without husband-smoking exposure. In non-smoking participants with abnormal thyrotropin levels at their first visit, husband smoking cessation was associated with 27% (17%-35%) and 36% (31%-40%) reduced odds of subnormal thyrotropin and supranormal thyrotropin at the second visit compared with the participants whose husband still smoking at the second visit. CONCLUSION Husband smoking was associated with wives' subnormal thyrotropin and supranormal thyrotropin, and cessation of husband smoking could reduce the odds of thyrotropin abnormality. Couple-focused smoking intervention should be developed to reduce the burden of asymptomatic thyroid disease in females.
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Affiliation(s)
- Siyu Wu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yunzhi Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wenlu Xie
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiaxin Huang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meiya Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Youhong Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Die Xu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hanbin Wu
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Long Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China.
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Chapela SP, Simancas-Racines A, Ceriani F, Martinuzzi ALN, Russo MP, Zambrano AK, Simancas-Racines D, Verde L, Muscogiuri G, Katsanos CS, Frias-Toral E, Barrea L. Obesity and Obesity-Related Thyroid Dysfunction: Any Potential Role for the Very Low-Calorie Ketogenic Diet (VLCKD)? Curr Nutr Rep 2024:10.1007/s13668-024-00528-w. [PMID: 38526760 DOI: 10.1007/s13668-024-00528-w] [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: 03/05/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW This review aims to explore in-depth the different aspects of the association between very low-calorie ketogenic diet (VLCKD), obesity and obesity-related thyroid dysfunction. RECENT FINDINGS The VLCKD, proposed as a non-pharmacological strategy for the management of certain chronic diseases, is becoming increasingly popular worldwide. Initially used to treat epilepsy, it has been shown to be effective in controlling body weight gain and addressing various pathophysiological conditions. Research has shown that a low-calorie, high-fat diet can affect thyroid hormone levels. Weight loss can also influence thyroid hormone levels. Studies have suggested that long-term use of VLCKD for refractory epilepsy may be related to the development of hypothyroidism, with an effect seen in various populations. In particular, women with obesity following VLCKD tend to have reduced T3 levels. We propose further research to unravel the underlying mechanisms linking VLCKD to obesity and obesity-related thyroid dysfunction.
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Affiliation(s)
- Sebastián Pablo Chapela
- Facultad de Medicina, Departamento de Bioquímica Humana, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
- Equipo de Soporte Nutricional, Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alison Simancas-Racines
- Facultad de, Ciencias Agropecuarias y Recursos Naturales, Carrera de Medicina Veterinaria, Universidad Técnica de Cotopaxi, Latacunga, 050108, Ecuador
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Veterinaria y Agronomía, Universidad UTE, Santo Domingo, Ecuador
| | - Florencia Ceriani
- Escuela de Nutrición, Universidad de la República Uruguay, Montevideo, Uruguay
| | | | - María Paula Russo
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Karina Zambrano
- Centro de Investigación Genética y Genómica, Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Quito, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Quito, 170129, Ecuador
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, 80131, Naples, Italy.
| | | | - Evelyn Frias-Toral
- School of Medicine, Universidad Espíritu Santo - Samborondón, 0901952, Samborondón, Ecuador
| | - Luigi Barrea
- Dipartimento di Benessere, Nutrizione e Sport, Università Telematica Pegaso, Centro Direzionale Isola F2, Via Porzio, 80143, Naples, Italy
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Gao R, Lyu X, Yang Y, Fu J, Zhao C, Guan H, Ma X. Evaluating the progression to abnormal thyrotropin in euthyroid preconception women: a population-based study. Thyroid Res 2024; 17:5. [PMID: 38462616 PMCID: PMC10926655 DOI: 10.1186/s13044-024-00192-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Abnormal preconception thyrotropin levels were associated with fecundability and adverse fetomaternal outcomes, however, little is known regarding the natural change of serum thyrotropin in euthyroid preconception women. Thus, we performed a population-based study to evaluate the progression to abnormal thyrotropin in euthyroid preconception women. METHODS This retrospective cohort study used data from the National Free Prepregnancy Checkups Project (NFPCP) collected between 2010 and 2020. Female Han Chinese participants aged 20-49 years who had two repeated NFPCP participations with a time interval of 1.5-3.0 years, confirmed non-pregnant status within this duration, and normal thyrotropin levels during their first participation were included for the analysis of thyrotropin abnormalities during the second NFPCP examination. Data were analyzed between June 1 and October 1, 2023. RESULTS This study included 186,095 euthyroid women of reproductive age (mean ± SD, 26.72 ± 4.70 years) whose preconception thyrotropin levels were between 0.37 and 4.87 mIU/L. The median follow-up time was 2.13 (IQR, 1.85-2.54) years. A total of 8,497 (4.57%) women developed abnormal thyrotropin, including 4,118 (2.21%) subnormal thyrotropin and 4,379 (2.35%) supranormal thyrotropin. Compared with the reference group (thyrotropin 1.01-2.00 mIU/L), the lower baseline thyrotropin group had greater risk of developing subnormal thyrotropin, and the higher baseline thyrotropin group had greater risk of developing supranormal thyrotropin. Moreover, the restricted cubic spline analysis revealed a U-shaped dose-response association of baseline thyrotropin levels or thyrotropin multiples of the median (MOM) levels against risk of subnormal thyrotropin in the follow-up, and a J-shaped dose-response association against risk of supranormal thyrotropin levels in the follow-up. We further found that baseline thyrotropin outside of 1.43-1.93 mIU/L or baseline thyrotropin MOM outside 0.59-1.36 would hava a higher risk of developing of abnormal thyrotropin. CONCLUSIONS Both low and high baseline thyrotropin were associated with a significantly increased risk of developing abnormal thyrotropin outcomes. The optimal preconception baseline thyrotropin levels may be between 1.43 mIU/L and 1.93 mIU/L or baseline thyrotropin MoM between 0.59 and 1.36 to minimize progression toward abnormal thyrotropin after 1.5-3.0 years. These findings may help with counseling of preconception thyroid function monitoring.
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Affiliation(s)
- Rili Gao
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jinrong Fu
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China.
- National Human Genetic Resources Center, Beijing, China.
- Graduate School of Peking Union Medical College, Beijing, China.
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Wang L, Xu H, Yang Y, Guan H, He X, Wu R, Wu J, Yuan N, Guo T, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Song X, Zhang Q, Wang Z, Ma X, Huang W. Association between short-term air pollution exposure and perturbation in thyrotropin levels in 1.38 million Chinese women: A national longitudinal analysis, 2014-2019. J Hazard Mater 2024; 465:133094. [PMID: 38029589 DOI: 10.1016/j.jhazmat.2023.133094] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
Prevalence of subclinical hypothyroidism substantially increased during the last decade in China, which has been commonly/clinically diagnosed as elevation in thyrotropin (thyroid-stimulating hormone [TSH]). Tobacco smoke containing toxic substances has been linked to thyroid dysfunction; however, data on perturbation of TSH following air pollution exposure in human has not been assessed at nationwide population level. We investigated the longitudinal impact of daily ambient air pollution estimated at residential level on serum TSH in 1.38 million women from China's 29 mainland provinces between 2014 and 2019. We observed that particulate matter with aerodynamic diameter ≤ 10 and ≤ 2.5 µm (PM10, PM2.5) and nitrogen dioxide (NO2) at cumulative lag 0-7 days of exposure were associated with percent elevations in TSH (0.88% [95% CI: 0.71, 1.05] per [interquartile range, IQR: 54.8 μg/m3] of PM10; 0.89% [95% CI, 0.71, 1.07] per IQR [40.3 μg/m3] of PM2.5; 2.01% [95% CI: 1.81, 2.22] per IQR [27.4 μg/m3] of NO2). Greater associations were observed in participants living in areas with ≥adequate iodine intake and those with low BMI levels and high inflammation status. Our results suggest that increased concentrations of recent ambient air pollutants at exposure ranges commonly encountered in Asia were associated with increases in TSH, supporting disturbing role of short-term air pollution exposure on the regulation of thyroid hormone homeostasis.
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Affiliation(s)
- Long Wang
- National Research Institute for Family Planning, Beijing, China; Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Haixia Guan
- Department of Endocrinology and Metabolism, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinghou He
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Rongshan Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Jianbin Wu
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China
| | - Ningman Yuan
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Qinghong Zhang
- Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing, China
| | - Zifa Wang
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
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9
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Losa M, Albano L, Barzaghi LR, Bailo M, Mortini P. Gamma knife radiosurgery is effective in patients with thyrotropin-secreting pituitary adenomas. J Endocrinol Invest 2024:10.1007/s40618-023-02291-1. [PMID: 38244141 DOI: 10.1007/s40618-023-02291-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Thyrotropin (TSH)-secreting pituitary adenoma (TSHoma) is a rare cause of TSH-dependent hyperthyroidism. The first therapeutic option is surgery. Medical treatment with somatostatin analogs is also effective. To obviate the need for lifelong drug therapy, gamma knife radiosurgery (GKRS) might be considered in selected patients. We report the largest series of patients with TSHoma treated by GKRS at a single center. METHODS This study was a retrospective analysis of 18 consecutive patients with TSHoma treated by GKRS between 1994 and 2022. Normalization of hyperthyroidism, when present at the time of surgery, and control of tumor growth were the main outcomes of the study. RESULTS The median follow-up after GKRS treatment was 114 months (IQR, 57-213 months; range 17-285 months). No patients had growth of the residual tumor after GKRS. Remission of hyperthyroidism occurred in 9 of the 11 (81.8%) patients who were hyperthyroid before GKRS. The probability of hyperthyroidism remission three years after GKRS was 59.1% (95% CI 27.9-90.3%). No major side effects occurred after GKRS. One patient out of the 15 patients (6.7%) with normal baseline adrenal function and follow-up longer than 3 years developed new onset hypoadrenalism, while hypogonadism did not occur in the 13 patients with baseline normal function. CONCLUSION Our study shows that GKRS is an effective and safe adjuvant treatment for selected patients with residual or recurring TSHoma. The option of GKRS as an alternative treatment to lifelong medical treatment with somatostatin analogs should be thoroughly discussed with the patients.
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Affiliation(s)
- M Losa
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - L Albano
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - L R Barzaghi
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - M Bailo
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - P Mortini
- Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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Lee JK, Ku EJ, Kim SJ, Kim W, Cho JW, Jung KY, Yu HW, Kang YE, Kim M, Kim HK, Ryu J, Choi JY. Effect of thyroid-stimulating hormone suppression on quality of life in thyroid lobectomy patients: interim analysis of a multicenter, randomized controlled trial in low- to intermediate-risk thyroid cancer patients (MASTER study). Ann Surg Treat Res 2024; 106:19-30. [PMID: 38205091 PMCID: PMC10774702 DOI: 10.4174/astr.2024.106.1.19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Current clinical practices favor less or no thyroid-stimulating hormone (TSH) suppression for low- to intermediate-risk thyroid cancer patients who receive thyroid lobectomy. The association of TSH suppression on health-related quality of life (HR-QoL) in patients after thyroid lobectomy is not well studied. This study aimed to evaluate the effect of TSH suppression on patient HR-QoL after thyroid lobectomy. Methods This study included patients enrolled in an ongoing, multicenter, randomized controlled study investigating the effects of TSH suppression. Patients were randomized to either the low-TSH group (TSH target range, 0.3-1.99 µIU/mL) or the high-TSH group (TSH target range, 2.0-7.99 µIU/mL). The HR-QoL, hyperthyroidism symptom, and depression symptom questionnaires performed preoperatively and 2 weeks and 3 months postoperatively were evaluated. Results Total of 669 patients (low-TSH group, 340; high-TSH group, 329) were included. Although total HR-QoL score changes were not different between the 2 groups, the high-TSH group had a significantly higher score in the physical domain at postoperative 3 months (P = 0.046). The 2 groups did not have significant differences in hyperthyroidism and depression scores. Conclusion In the short-term postoperative period, the physical HR-QoL scores in thyroid lobectomy patients were better when they did not receive TSH suppression. This study suggests the importance of considering HR-QoL when setting TSH suppression targets in thyroid lobectomy patients.
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Affiliation(s)
- Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Seoul, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yea Eun Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mijin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Stryhn JKG, Larsen J, Pedersen PL, Gæde PH. Expressions of mitochondria-related genes in pregnant women with subclinical hypothyroidism, and expressions of miRNAs in maternal and cord blood. Thyroid Res 2023; 16:38. [PMID: 37723507 PMCID: PMC10506244 DOI: 10.1186/s13044-023-00180-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/19/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Subclinical hypothyroidism in pregnancy and definition by upper thyrotropin (TSH) cutoff are controversial. As mitochondria are influenced by thyroid hormones, the purpose in this study was to measure expression of mitochondria-related genes in euthyroid and subclinical hypothyroid pregnant women to obtain more knowledge of potential metabolic consequences of maternal subclinical hypothyroidism. In addition, we wished to test if applied TSH-cutoff significantly changed our results of expressed gene-levels. Moreover, we aimed to identify potential microRNA-biomarkers for subclinical hypothyroidism - markers that could be traced to offspring as well. METHODS From a cohort of at-term pregnant women undergoing planned cesarean section, 77 women had expression levels of the mitochondria-related genes Peroxisome Proliferator-activated Receptor-γ coactivator-1β (PGC-1β), mitochondrial Transcription Factor A (TFAM), Superoxide Dismutase 2 (SOD2) and Nuclear Respiratory Factor 2 (NRF-2) determined by qPCR from blood sampled in prior to delivery. Two TSH-cutoff levels defining subclinical hypothyroidism (> 3.0 and > 3.7 mIU/L) were applied for the procession of results, generating two data analyses of the same cohort. In 22 pairwise maternal-cord samples (subclinical hypothyroid/euthyroid-rate 0.5, TSH-cutoff > 3.0 mIU/L), microRNA-expressions (miRNA) were analyzed. RESULTS All gene expressions were lower in the subclinical hypothyroid group regardless of applied TSH-cutoff, but insignificant except for PGC-1β at TSH cutoff > 3.0 mIU/L. Two miRNAs (hsa-let-7d-3p and hsa-miR-345-5p) were upregulated in blood from women and offspring (cord blood) with subclinical hypothyroidism. CONCLUSIONS A trend towards decreased mitochondrial gene expressions in subclinical hypothyroidism were demonstrated. The miRNAs hsa-let-7d-3p and hsa-miR-345-5p might be potential markers of maternal subclinical hypothyroidism. However, larger studies are needed to verify the findings.
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Affiliation(s)
- Julie Kristine Guldberg Stryhn
- Department of Gynecology and Obstetrics, Slagelse Hospital, Fælledvej 13, 4200, Slagelse, Denmark.
- Mitochondria Research Unit, Naestved Hospital, Ringstedgade 61, 4700, Naestved, Denmark.
- Faculty of Health Sciences, University of Southern Denmark, Winsløws Parken, J. B. Winsløws Vej 19, 3, 5000, Odense, Denmark.
| | - Jacob Larsen
- Mitochondria Research Unit, Naestved Hospital, Ringstedgade 61, 4700, Naestved, Denmark
- Department of Clinical Pathology, Roskilde Hospital, Sygehusvej 9, 4000, Roskilde, Denmark
| | - Palle Lyngsie Pedersen
- Mitochondria Research Unit, Naestved Hospital, Ringstedgade 61, 4700, Naestved, Denmark
- Department of Clinical Biochemistry, Naestved Hospital, Ringstedgade 61, 4700, Naestved, Denmark
| | - Peter Haulund Gæde
- Faculty of Health Sciences, University of Southern Denmark, Winsløws Parken, J. B. Winsløws Vej 19, 3, 5000, Odense, Denmark
- Department of Internal Medicine (Endocrinology), Slagelse Hospital, Fælledvej 7, 4200, Slagelse, Denmark
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Bengtsson E, Funkquist A, Agvall B. Observational study of diagnosis and management in adult primary hypothyroidism in southwest of Sweden. Scand J Prim Health Care 2023; 41:189-195. [PMID: 37224192 PMCID: PMC10478599 DOI: 10.1080/02813432.2023.2213748] [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] [Received: 11/24/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE The objective was to explore the management of newly diagnosed hypothyroidism in adults regarding laboratory diagnostics and treatment in Region Halland (RH). In addition, to investigate whether current recommendations were followed regarding diagnostics. DESIGN Retrospective observational study. SETTING A population-based study utilizing healthcare registry data from all public primary health care (PHC) clinics in RH during 2014-2019. SUBJECTS Newly diagnosed patients with hypothyroidism according to ICD-10, aged ≥18 years when diagnosed and living and receiving health care in RH. There were 2494 patients included in the study. MAIN OUTCOME MEASURES Registrations of thyroid laboratory values, diagnostic codes, and drug treatment was collected. Demographic data were also recorded. Laboratory values were checked also after 12-24 months after initial diagnosis. The main outcome was the proportion with elevated TSH and TPO and how the TSH value had changed at the follow-up. RESULTS There were 1431 (61%) patients who had elevated TSH at the onset of the disease and TPO was tested in 1133 (46%) of the patients. Elevated TPO was found in 566 (23%) of the patients. After one year, there were 1908 (76%) patients who obtained a prescription for levothyroxine. In 1127 (45%) patients, TSH had normalized within one year. CONCLUSION There were 39% of the patients diagnosed with hypothyroidism despite normal or subclinical TSH. There was an underuse of TPO in diagnosis and this advocated that the criteria for diagnostics according to current guidelines be followed to avoid unnecessary treatment.
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Affiliation(s)
| | | | - Björn Agvall
- Department of Research and Development, Halmstad, Region Halland, Sweden
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Liu YS, Liu XC, Kuang J, Guan HX. Higher Sensitivity to Thyroid Hormones May Be Linked to Maintaining the Healthy Metabolic Condition in People with Obesity: New Insight from NHANES. Obes Facts 2023; 16:497-506. [PMID: 37573776 PMCID: PMC10601624 DOI: 10.1159/000533157] [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] [Received: 01/31/2023] [Accepted: 05/31/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Obesity contributes to the pathogenesis of diverse metabolic diseases, yet the mechanism underlying metabolically healthy obesity (MHO) remains elusive. Thyroid hormones and sensitivity to them have a major impact on metabolism. Our study aimed to investigate the association between MHO and thyroid hormone sensitivity. METHODS Thyroid hormone indices, including the thyroid-stimulating hormone (TSH) index (TSHI), the Thyrotroph Thyroxine Sensitivity Index (TTSI), the Thyroid Feedback Quantile-Based Index (TFQI), and the Parametric Thyroid Feedback Quantile-Based Index (PTFQI), were calculated based on a non-institutionalized US sample in the National Health and Nutrition Examination Survey (NHANES, 2007-2012). Participants were divided into four groups (metabolically healthy non-obesity [MHNO], metabolically unhealthy non-obesity [MUNO], MHO, and metabolically unhealthy obesity [MUO]) according to their body mass index and metabolic profiles. Linear regression, logistic regression, and restricted cubic splines were employed to analyze the association between thyroid hormone indices and metabolic phenotypes. RESULTS A total of 4,857 participants (49.6% men; mean age, 42.6 years) were included, with 1,539 having obesity and 235 identified as MHO. Participants in the MHO group exhibited lower levels of TSH, TSHI, TTSI, TFQI, and PTFQI compared with the MHNO group (all p < 0.05), while the differences among MHNO, MUNO, and MUO groups were not statistically significant (all p > 0.05). Among participants with obesity, TSH, TSHI, TTSI, TFQI, and PTFQI were positively associated with metabolic abnormality (all p < 0.05). CONCLUSION Participants with MHO exhibited higher thyroid hormone sensitivity among various obesity phenotypes, even when compared with those with MHNO. A positive association was observed between metabolic abnormality and thyroid hormone sensitivity, while the trend of TSH was observed to be consistent with sensitivity to thyroid hormone indices in discriminating metabolic abnormality. Hence, TSH has the potential to serve as a convenient index for detecting sensitivity to thyroid hormones and further metabolic conditions.
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Affiliation(s)
- Ying-shan Liu
- Department of Endocrinology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiao-cong Liu
- Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Institute of Mycology, Jinan University, Guangzhou, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Hai-xia Guan
- Department of Endocrinology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Ku EJ, Yoo WS, Chung HK. Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines. Endocrinol Metab (Seoul) 2023; 38:381-391. [PMID: 37550859 PMCID: PMC10475969 DOI: 10.3803/enm.2023.1778] [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] [Received: 07/15/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.
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Affiliation(s)
- Eu Jeong Ku
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Kyung Chung
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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15
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Lu Y, Zhang WX, Li DH, Wei LH, Zhang YJ, Shi FN, Zhou S. Thyroid Hormone Reference Intervals among Healthy Individuals In Lanzhou, China. Endocrinol Metab (Seoul) 2023:EnM.2023.1638. [PMID: 37312257 DOI: 10.3803/enm.2023.1638] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/21/2023] [Indexed: 06/15/2023] Open
Abstract
Background The common reference intervals (RIs) for thyroid hormones currently used in China are provided by equipment manufacturers. This study aimed to establish thyroid hormone RIs in the population of Lanzhou, a city in the subplateau region of northwest China, and compare them with previous reports and manufacturer-provided values. Methods In total, 3,123 individuals (1,680 men, 1,443 women) from Lanzhou, an iodine-adequate area of China, perceived as healthy were selected. The Abbott Architect analyzer was used to determine the serum concentration of thyroid hormones. The 95% RI was estimated using the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively. Results The serum levels of thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), antithyroglobulin (ATG) antibody, and antithyroid peroxidase (ATPO) antibody levels were significantly correlated with sex (P<0.05). TSH, total thyroxine (TT4), and ATPO levels were significantly correlated with age (P<0.05). The serum levels of TSH, ATG, and ATPO in men were significantly lower than in women; in contrast, the serum TT3 level was significantly higher in men than in women (P<0.05). Serum TSH, TT3, TT4, and ATG levels differed across age groups (P<0.05), but no such variation was observed for ATG levels (P>0.05). The established RIs of TSH, ATG, and ATPO in this study differed between sexes (P<0.05). The thyroid hormone RIs established herein were inconsistent with the manufacturer-provided values. Conclusion: The RIs of thyroid hormones in the healthy population of Lanzhou were inconsistent with those in the manufacturer's manual. Validated sex-specific values are required for diagnosing thyroid diseases.
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Affiliation(s)
- Yan Lu
- Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, China
| | - Wen-Xia Zhang
- Department of Physical Examination Center, Gansu Provincial Hospital, Lanzhou, China
| | - De-Hong Li
- Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, China
| | - Lian-Hua Wei
- Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, China
| | - Yu-Jun Zhang
- Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, China
| | - Fu-Na Shi
- Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou, China
| | - Shen Zhou
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
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16
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Ren X, Wang X, Chen G, Liu X, Guo H, Li M. Coexistence of TSH-secreting adenoma and primary hypothyroidism: a case report and review of literature. BMC Endocr Disord 2023; 23:116. [PMID: 37221515 DOI: 10.1186/s12902-023-01357-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/30/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Thyrotropin-secreting adenoma (TSHoma) is the least common type of pituitary adenoma, these patients often present with symptoms of hyperthyroidism. When TSHoma patients combined with autoimmune hypothyroidism, it is critically difficult to diagnose for the specific confusion in the results of thyroid function test. CASE PRESENTATION One middle-aged male patient was presented with a sellar tumor on cranial MRI for headache symptoms. After hospitalization, a significant increase in thyrotropin (TSH) was revealed by the endocrine tests, while free thyronine (FT3) and free thyroxine (FT4) decreased, and the diffuse destruction of thyroid gland was revealed by thyroid ultrasound. Based on the endocrine test results, the patient was diagnosed as autoimmune hypothyroidism. After the multidisciplinary discussion, the pituitary adenoma was removed by endoscopic transnasal surgery, until the tumor was completely excised, for which TSHoma was revealed by postoperative pathology. A significant decrease of TSH was revealed by the postoperative thyroid function tests, the treatment for autoimmune hypothyroidism was conducted. After 20 months of follow-up, the thyroid function of patient had been improved significantly. CONCLUSION When the thyroid function test results of patients with TSHoma are difficult to interpret, the possibility of combined primary thyroid disease should be considered. TSHoma combined with autoimmune hypothyroidism is rare, which is difficult to diagnose. The multidisciplinary collaborative treatment could help to improve the outcomes of treatment.
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Affiliation(s)
- Xiaolu Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
- Department of Neurosurgery and Laboratory of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
- Institute of Neurology, Lanzhou University, Lanzhou, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Chang Chun St, Beijing, 100053, China.
- International Neuroscience Institute (China-INI), Beijing, China.
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17
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Elsherbiny TM. Impact of fasting on thyrotropin and thyroid status during Ramadan in 292 previously well controlled hypothyroid patients. IFTAR study. Endocrine 2023; 79:484-490. [PMID: 36344762 PMCID: PMC9988775 DOI: 10.1007/s12020-022-03242-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 08/10/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Fasting during Ramadan affects thyrotropin both in healthy subjects and hypothyroid patients on adequate levothyroxine replacement. Few studies have addressed this effect in hypothyroid patients with pre-Ramadan euthyroidism. This study aims to report the impact of fasting in a relatively large cohort. METHODS This was a prospective study including hypothyroid patients who fasted Ramadan during the years 2018, 2019, and 2020 in Alexandria, Egypt. All patients were euthyroid. Patients chosen one of three levothyroxine regimens during Ramadan, regimen 1: 60 min before Iftar, regimen 2: 3-4 h after Iftar, 60 min before Suhor, regimen 3: before the start of next fast, 3-4 h after an early Suhor. Thyroid status was assessed in pre-Ramadan visit and reassessed in post-Ramadan visit within 6 weeks from the end of Ramadan. RESULTS The study included 292 hypothyroid patients. Most patients were adherent, 249 patients (85.3%), one sixth of patients were non-adherent, 43 patients (14.7%). Post-Ramadan TSH was 2.13 ± 1.88 mIU/L versus 1.60 ± 0.96 mIU/L pre-Ramadan [P = 0.001]. Most patients were still euthyroid post-Ramadan, 233 patients (79.8%), while 59 patients (20.2%) were dysthyroid. Post-Ramadan TSH significantly correlated to pre-Ramadan TSH [P < 0.001]. Post-Ramadan TSH was significantly higher in non-adherent patients, 3.57 ± 3.11 mIU/L compared to adherent patients, 1.88 ± 1.44 mIU/L [P < 0.001]. CONCLUSION Fasting Ramadan in well controlled hypothyroid patients resulted in a significant increase in post-Ramadan TSH, yet 80% the patients remain euthyroid after Ramadan. Post-Ramadan TSH and euthyroidism are related to adherence and pre-Ramadan TSH.
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Affiliation(s)
- Tamer Mohamed Elsherbiny
- Alexandria university, Endocrine division - Alexandria faculty of medicine, Khartoum square, Azarita, Alexandria, Egypt.
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18
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Ju Y, Wang L, Cheng F, Huang F, Chen X, Song Q, Xiao J, Zhu X, Jia H. Comparing the efficacy of thyroglobulin and thyroglobulin/ thyroid-stimulating hormone ratio models in predicting a successful response to radioactive iodine therapy. BMC Endocr Disord 2023; 23:19. [PMID: 36670396 PMCID: PMC9854025 DOI: 10.1186/s12902-022-01261-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The thyroglobulin (Tg)/ thyroid-stimulating hormone (TSH) ratio has manifested to be a reliable marker for predicting prognosis in patients with differentiated thyroid carcinoma (DTC). The objective of this study was to compare the efficacy of Tg and Tg/TSH ratio models in predicting a successful response to radioactive iodine therapy. METHODS One thousand six hundred forty-two DTC patients receiving 131I radiotherapy were finally enrolled in this retrospective study. The patients were divided into a training set (n = 973) and a validation set (n = 669) by the patient consultation time (July 2019). A receiver-operating characteristic curve was constructed for Tg and the Tg/TSH ratio to establish their cutoffs. Then, the variables were screened by univariate logistic regression and incorporated into logistic prediction models by stepwise regression, where Tg/TSH was excluded from model 1 and Tg was excluded from model 2. RESULTS In 1642 enrolled DTC patients, the first 131I radiotherapy had an excellent response in 855 patients. The cut-offs for Tg level and Tg/TSH ratio were 3.40 ng/ mL [area under the curve (AUC): 0.789] and 36.03 ng/mIU (AUC: 0.788), respectively. In addition, the AUC of the model including Tg was higher than that of the model including Tg/TSH in both the training set (0.837 vs 0.833) and the testing set (0.854 vs 0.836). CONCLUSIONS Both Tg and Tg/TSH ratios could be considered predictors of the effects of the first 131I ablative therapy. However, the prediction model including Tg performed better than the model including Tg/TSH.
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Affiliation(s)
- Yanli Ju
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Lihua Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Fang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Fengyan Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Xueyu Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Qingqing Song
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China
| | - Juan Xiao
- Center of Evidence-Based Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China
| | - Xiaolu Zhu
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China.
| | - Hongying Jia
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Jinan, Shandong, 250012, China.
- Center of Evidence-Based Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, Shandong, 250033, China.
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Kim NK, Jung MA, Lee SH, Joo NS. Short-term Changes in Thyroid-Stimulating Hormone Level after Body Fat Reduction via Partial Meal Replacement. Korean J Fam Med 2023; 44:58-63. [PMID: 36709962 PMCID: PMC9887445 DOI: 10.4082/kjfm.22.0131] [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: 07/08/2022] [Accepted: 10/25/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Serum thyroid-stimulating hormone (TSH) levels change during body weight reduction. However, the changes that occur during short-term body weight control interventions remain controversial. Thus, this study aimed to evaluate the changes in TSH levels according to body fat reduction. METHODS We performed a 3-month intervention study involving partial meal replacement. Forty-nine participants completed the study. Correlations between changes in TSH levels and other body composition parameters were determined. The subjects were divided into two groups according to their body fat reduction (>1 kg, n=20; <1 kg, n=29). The changes in metabolic parameters, including TSH levels, were compared. For significant values, a multivariate analysis was performed after adjustment to evaluate the relationship between TSH changes and body fat reduction. RESULTS The 3-month intervention caused favorable changes in body proportions and metabolic parameters. TSH levels changed significantly only after changes in total body fat, showing a partial correlation. Changes in TSH levels were significantly different between groups (P=0.014). Moreover, the change in TSH levels was significantly different after adjustment (P=0.012). CONCLUSION A body fat reduction, especially >1 kg, can reduce serum TSH concentrations in subjects with metabolic syndrome after short-term body weight intervention.
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Affiliation(s)
- Nam-Kyu Kim
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Min-Ah Jung
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Seok-Hoon Lee
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Nam-Seok Joo
- Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, Korea,Corresponding Author: Nam-Seok Joo https://orcid.org/0000-0001-5895-1800 Tel: +82-31-219-5324, Fax: +82-31-219-5218, E-mail:
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Azizi F, Saadat N, Takyar MA, Abdi H, Mehran L, Amouzegar A. Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter. Endocrinol Metab (Seoul) 2022; 37:861-869. [PMID: 36415961 PMCID: PMC9816507 DOI: 10.3803/enm.2022.1476] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGRUOUND This study compared the degree of sustained control of hyperthyroidism in patients with toxic multinodular goiter (TMNG) treated with long-term methimazole (LT-MMI) or radioactive iodine (RAI). METHODS In this clinical trial, 130 untreated patients with TMNG were randomized to either LT-MMI or RAI treatment. Both groups were followed for 108 to 148 months, with median follow-up durations of 120 and 132 months in the LT-MMI and RAI groups, respectively. Both groups of patients were followed every 1 to 3 months in the first year and every 6 months thereafter. RESULTS After excluding patients in whom the treatment modality was changed and those who were lost to follow-up, 53 patients in the LT-MMI group and 54 in the RAI group completed the study. At the end of the study period, 50 (96%) and 25 (46%) patients were euthyroid, and two (4%) and 25 (46%) were hypothyroid in LT-MMI and RAI groups, respectively. In the RAI group, four (8%) patients had subclinical hyperthyroidism. The mean time to euthyroidism was 4.3±1.3 months in LT-MMI patients and 16.3± 15.0 months in RAI recipients (P<0.001). Patients treated with LT-MMI spent 95.8%±5.9% of the 12-year study period in a euthyroid state, whereas this proportion was 72.4%±14.8% in the RAI-treated patients (P<0.001). No major treatment-related adverse events were observed in either group. CONCLUSION In patients with TMNG, LT-MMI therapy is superior to RAI treatment, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Saadat
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Alireza Takyar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Hengameh Abdi. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Iran Tel: +98-21-22432500, Fax: +98-21-22402463, E-mail:
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding authors: Atieh Amouzegar. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4763, Tehran, Iran Tel: +98-21-22432500, Fax: +98-21-22402463 E-mail:
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Sen HE, Ceylan EC, Atayev S, Sozen M, Bayrak BY, Cetinarslan B, Anik Y, Icli AD, Cabuk B, Anik I, Ceylan S. The Endoscopic Endonasal Transsphenoidal Approach for Thyrotropin-Secreting Pituitary Adenomas: Single-Center Experience and Clinical Outcomes of 49 Patients. World Neurosurg 2022; 167:e1275-e1283. [PMID: 36096394 DOI: 10.1016/j.wneu.2022.09.027] [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] [Received: 08/08/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To analyze surgical outcomes and tumor characteristics of 49 patients with thyrotropin-secreting pituitary adenoma, a rare functional pituitary adenoma subtype with challenging surgery, who underwent endoscopic endonasal transsphenoidal surgery. METHODS In this single-center study, clinical, radiological, surgical, and endocrinological data of 49 patients diagnosed with thyrotropin-secreting pituitary adenoma were retrospectively reviewed. RESULTS Mean tumor size was 21.12 mm (6 microadenomas, 41 macroadenomas, 2 giant adenomas). Cavernous sinus invasion was present in 12 (24.48%) patients. Tumor consistency was firm in 23 (46.93%) patients. Plurihormonal secretion characteristics were present in 9 patients (5 growth hormone + thyrotropin and 4 growth hormone + prolactin + thyrotropin). Mean follow-up duration was 51.73 months. Of the cases with firm tumors, 14 patients had a history of antithyroid drug use; there was no statistically significant correlation between the antithyroid medication and the firmness of the tumor. Gross total resection was achieved in 32 (65.30%) cases, near-total resection was achieved in 14 (28.57%) cases, and subtotal resection was achieved in 3 (6.12%) cases. The analysis showed that the negative effect of >2 cm tumor size and cavernous sinus invasion on resection rate was statistically significant (P < 0.001). Although early remission was achieved in 33 (67.34%) patients, 44 (89.79%) patients were in euthyroid state at >3 months' follow-up. Complications were 4 new-onset pituitary deficiencies, 3 cases of permanent diabetes insipidus, 1 thyrotoxic crisis, and 1 cerebrospinal fluid leak. CONCLUSIONS Endoscopic endonasal transsphenoidal surgery is the first-line treatment in thyrotropin-secreting pituitary adenoma and should be performed in a tertiary center. Gross total resection is the goal, and early diagnosis is essential for surgical success.
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Affiliation(s)
- Harun Emre Sen
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Ecem Cemre Ceylan
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Sazak Atayev
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Mehmet Sozen
- Department of Endocrinology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Busra Yaprak Bayrak
- Department of Pathology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Berrin Cetinarslan
- Department of Endocrinology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Yonca Anik
- Department of Radiology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Arife Dilek Icli
- Department of Anesthesiology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Burak Cabuk
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Ihsan Anik
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Savas Ceylan
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
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22
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Kim SM, Sultana F, Korkmaz F, Lizneva D, Yuen T, Zaidi M. Independent Skeletal Actions of Pituitary Hormones. Endocrinol Metab (Seoul) 2022; 37:719-731. [PMID: 36168775 PMCID: PMC9633224 DOI: 10.3803/enm.2022.1573] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 12/30/2022] Open
Abstract
Over the past years, pituitary hormones and their receptors have been shown to have non-traditional actions that allow them to bypass the hypothalamus-pituitary-effector glands axis. Bone cells-osteoblasts and osteoclasts-express receptors for growth hormone, follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), prolactin, oxytocin, and vasopressin. Independent skeletal actions of pituitary hormones on bone have been studied using genetically modified mice with haploinsufficiency and by activating or inactivating the receptors pharmacologically, without altering systemic effector hormone levels. On another front, the discovery of a TSH variant (TSH-βv) in immune cells in the bone marrow and skeletal action of FSHβ through tumor necrosis factor α provides new insights underscoring the integrated physiology of bone-immune-endocrine axis. Here we discuss the interaction of each pituitary hormone with bone and the potential it holds in understanding bone physiology and as a therapeutic target.
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Affiliation(s)
- Se-Min Kim
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corresponding authors: Se-Min Kim. The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, PO Box 1055, New York, NY 10029, USA Tel: +1-212-241-8797, Fax: +1-212-426-8312 E-mail:
| | - Farhath Sultana
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Funda Korkmaz
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daria Lizneva
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tony Yuen
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mone Zaidi
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mone Zaidi. The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, PO Box 1055, New York, NY 10029, USA Tel: +1-212-241-8797, Fax: +1-212-426-8312, E-mail:
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Sharma VK, Sonkhya N, Gupta S, Jat KS, Sehra R, Singhal P, Sharma MP, Agarwal S. Diagnostic Efficacy of Thyrotropin to Thyroglobulin Ratio in Correlation with Histopathology of Euthyroid Patient Having Solitary Thyroid Nodule. Indian J Otolaryngol Head Neck Surg 2022; 74:2281-2286. [PMID: 36452702 PMCID: PMC9702168 DOI: 10.1007/s12070-020-02120-4] [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] [Received: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022] Open
Abstract
In patients with solitary thyroid nodules, the first course of action is to determine whether the nodule is benign or malignant. Many investigations are used to differentiate between benign and malignant nodules so as to avoid surgery in those who don't need it. Among these, FNAC and USG are commonly used in association with clinical features but there are drawbacks of each technique. The present study was undertaken to assess the diagnostic effectivity of thyrotropin (also known as TSH) to thyroglobulin ratio in correlation with histopathology in euthyroid patients having solitary thyroid nodule. This is a prospective study carried out on 48 euthyroid cases of solitary thyroid nodule. All patients subjected to FNAC, USG, thyrotropin and thyroglobulin assay. Then, they underwent surgery and histopathological examination (HPE) of the specimens done. Finally, the histopathology reports were correlated with the thyrotropin to thyroglobulin ratio in order to evaluate their sensitivity and specificity by statistical methods. The sensitivity and specificity of thyrotropin to thyroglobulin ratio was 100% and 100% respectively. All malignant lesions according to thyrotropin to thyroglobulin ratio were confirmed by histopathology indicating its excellence. Therefore, TSH to thyroglobulin ratio helps in planning the correct management and avoids second surgery. It was found that serum TSH:Tg is a safe, reliable and effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignant nodules.
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Affiliation(s)
- Vijay Kumar Sharma
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Nishi Sonkhya
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Shubhangi Gupta
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Kailash Singh Jat
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Ritu Sehra
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Man Prakash Sharma
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
| | - Sunita Agarwal
- Department of Otorhinolaryngology, SMS Medical College, C168E, Street No. 2, Khadi Colony, Bajaj Nagar, Jaipur, Rajasthan 302015 India
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Hajifoghaha M, Teshnizi SH, Forouhari S, Dabbaghmanesh MH. Association of thyroid function test abnormalities with preeclampsia: a systematic review and meta-analysis. BMC Endocr Disord 2022; 22:240. [PMID: 36163002 PMCID: PMC9511725 DOI: 10.1186/s12902-022-01154-9] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preeclampsia is a life-threatening disorder during pregnancy and postpartum periods. Preeclampsia can affect the activity of many organs. It is very important because if this disorder is associated with changes in thyroid function, it can affect the results of maternal and fetal tests. Accordingly, the aim of this meta-analysis study was to assess the abnormalities in thyroid function tests in preeclampsia. METHODS Studies were selected through a systematic search of the MEDLINE/PubMed, Scopus, Web of Science Core Collection, and Google Scholar databases in 31st August 2021. Also, reference lists of review articles and relevant studies were manual-searched to identify other potentially eligible studies. English studies that compared TSH, T4 and T3 of normal pregnant with preeclamptic women (Known to be normotensive before pregnancy; gestational age 20 week or more; singleton pregnancy; no previous history of thyroid dysfunction) were screened. Data sets were screened for eligibility by two independent reviewers. Articles were assessed by the Newcastle-Ottawa Scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS After reviewing 886 published studies, 63 observational studies were selected and used for this meta-analysis. The study population included 21,528 pregnant women. The findings revealed that TSH (SMD = 1.70, 95%CI: 1.39 to 2.02; p < 0.001) was significantly higher in preeclamptic women. TT4 (SMD = -0.82, 95%CI: -1.16, -0.49; p < 0.001), TT3 (SMD = -0.88, 95%CI: -1.36 to -0.41; p < 0.001) and FT3 (SMD = -0.59, 95%CI: -0.91 to -0.27; p < 0.001) were less in preeclamptic women. There was no statistically significant difference in FT4 between two groups (SMD = 0.002, 95%CI: -0.27 to 0.27; p = .990). The results of publication bias and sensitivity analysis confirmed the reliability and stability of this meta-analysis. The quality of evidence was regarded as moderate, low, and very low for these risk factors according to the GRADE approach. CONCLUSIONS Findings of this meta-analysis indicated preeclamptic women were more at risk of changes in thyroid function tests. In order to prevent thyroid disorders, it is recommended that thyroid function tests be performed in women with pre-eclampsia.
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Affiliation(s)
- Mahboubeh Hajifoghaha
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Hosseini Teshnizi
- Department of Community Medicine, School of Medicine, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Sedighe Forouhari
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Jensen RC, Glintborg D, Timmermann CAG, Nielsen F, Boye H, Madsen JB, Bilenberg N, Grandjean P, Jensen TK, Andersen MS. Higher free thyroxine associated with PFAS exposure in first trimester. The Odense Child Cohort. Environ Res 2022; 212:113492. [PMID: 35597289 DOI: 10.1016/j.envres.2022.113492] [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] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFAS) are endocrine disrupting chemicals with elimination half-lives ranging from four to eight years. Experimental studies found PFAS able to interfere with thyroid hormone-binding proteins. During the first 20 weeks of gestation (GW), the fetus is reliant on placental transfer of maternal thyroid hormones, mainly free thyroxine (FT4). However, previous studies investigating associations between exposure to PFAS and thyroid hormone status mainly focused on blood samples from late pregnancy or umbilical cord with mixed findings. OBJECTIVES To investigate associations between serum-PFAS concentrations and thyroid hormone status in early pregnancy as reflected by FT4 and thyroid-stimulating hormone (TSH). METHODS In the Odense Child Cohort, a single-center study, we measured maternal pregnancy serum concentrations of five PFAS: perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA); and FT4 and TSH in 1048 pregnant women at median GW 12 (25th, 75th percentile: 10, 15). Multivariate linear regression models were performed to estimate associations between PFAS exposure and thyroid hormone status. RESULTS A doubling in PFOS, PFOA, and PFNA concentrations was associated with an increment in FT4 concentration by 1.85% (95% CI: 0.66%, 3.05%), 1.29% (95% CI: 0.21%, 2.39%), and 1.70% (95% CI: 0.48%, 2.94%), respectively, in adjusted analyses. A statistically significant dose-response relationship was observed across exposure quartiles for PFOS, PFOA, and PFNA in the association with FT4. No association was found between concentrations of PFAS and TSH in adjusted analyses. CONCLUSION Exposure to PFOS, PFOA, and PFNA was associated with higher FT4 concentrations in women during early pregnancy. The potential clinical implications of these findings remain to be clarified.
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Affiliation(s)
- Richard Christian Jensen
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark.
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark
| | - Clara Amalie Gade Timmermann
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, København K, Denmark
| | - Flemming Nielsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Jeppe Buur Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Kabbeltoft 25, University Hospital of Southern Denmark, 7100, Vejle, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark; Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, J. B. Winsløws Vej 16, 5000, Odense, Denmark
| | - Philippe Grandjean
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, 677 Huntington Avenue Boston, MA, 02115, USA
| | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 17A, 5000, Odense C, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark; OPEN, University of Southern Denmark, J. B. Winsløws Vej 9a, 5000, Odense C, Denmark
| | - Marianne S Andersen
- Department of Endocrinology, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000, Odense, Denmark
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Sheikhi V, Heidari Z. Increase in Thyrotropin Is Associated with an Increase in Serum Prolactin in Euthyroid Subjects and Patients with Subclinical Hypothyroidism. Med J Islam Repub Iran 2022; 35:167. [PMID: 35505831 PMCID: PMC9034874 DOI: 10.47176/mjiri.35.167] [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: 01/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Prevalence and clinical significance of hyperprolactinemia in subclinical hypothyroidism have been reported in few studies. The upper limit of the normal range for TSH used to diagnose subclinical hypothyroidism is a matter of controversy. Some experts believe that the upper limit of the normal TSH range should be reduced from 4.2 to 2.5 mIU/L. Some evidence suggests a positive relationship between TSH > 2.5 mIU/L and cortisol as an indicator of metabolic stress. With this view prolactin as a stress hormone can be elevated in TSH >2.5 in comparison to TSH< 2.5. Hence the aim of this study was to evaluate the relationship between TSH and prolactin levels in the TSH range <10.
Methods: This cross-sectional study was performed on apparently healthy subjects with TSH<10 mIU/L. Subjects with the age of 18 to 35 years were enrolled. The sera were analyzed for prolactin, FT3, FT4, TSH, TPO-Ab and Tg-Ab.
Results: From the total number of 519 participants, in 65 subjects (12.5%) TSH was < 2.5. Seventy-nine subjects (15.2%) had TSH: 2.5-4.2 and 375 (72.3%) of the participants had TSH> 4.2 mIU/L. The mean age, weight and BMI of subjects in the three TSH groups were not significantly different. In the three TSH groups, the prevalence of hyperprolactinemia was zero, 3.8 and 30.7%, respectively. There was a positive and significant correlation between prolactin and TSH levels (r=0.613).
Conclusion: Hyperprolactinemia is common in patients with subclinical hypothyroidism (30.7%) and there is a positive correlation between TSH and PRL in subjects with TSH<10 mIU/l.
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Affiliation(s)
- Vahid Sheikhi
- Department of Pediatric Nephrology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Heidari
- Department of Endocrinology and Metabolism, Zahedan University of Medical Sciences, Zahedan, Iran
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Abstract
Circulating concentrations of thyrotropin (TSH) and thyroxine (T4) are tightly regulated. Each individual has setpoints for TSH and free T4 which are genetically determined, and subject to environmental and epigenetic influence. Pituitary-thyroid axis setpoints are probably established in utero, with maturation of thyroid function continuing until late gestation. From neonatal life (characterized by a surge of TSH and T4 secretion) through childhood and adolescence (when free triiodothyronine levels are higher than in adults), thyroid function tests display complex, dynamic patterns which are sexually dimorphic. In later life, TSH increases with age in healthy older adults without an accompanying fall in free T4, indicating alteration in TSH setpoint. In view of this, and evidence that mild subclinical hypothyroidism in older people has no health impact, a strong case can be made for implementation of age-related TSH reference ranges in adults, as is routine in children.
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Affiliation(s)
- John P. Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
- Medical School, University of Western Australia, Crawley, Australia
- Corresponding author: John P. Walsh Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia 6009, Australia Tel: +61-864572466, Fax: +61-864573221, E-mail:
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Samimi H, Haghpanah V. Molecular evidence reveals thyrotropin intervention enhances the risk of developing radioiodine-refractory differentiated thyroid carcinoma. Cancer Cell Int 2022; 22:61. [PMID: 35114985 PMCID: PMC8812241 DOI: 10.1186/s12935-022-02484-3] [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: 09/23/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022] Open
Abstract
Radioiodine (RAI) is the mainstay of treatment for differentiated thyroid carcinoma (DTC) following total thyroidectomy. Nevertheless, about 5% of patients with DTC are RAI-refractory (RAI-R). Understanding the molecular mechanisms associated with DTC during progression towards RAI-R DTC, including thyroid-stimulating hormone levels, may help to explain the pathophysiology of challenging RAI-R DTC clinical cases.
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Affiliation(s)
- Hilda Samimi
- Endocrinology and Metabolism Research Center (EMRC), Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Haghpanah
- Endocrinology and Metabolism Research Center (EMRC), Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Helfinger L, Tate CG. Expression and Purification of the Human Thyroid-Stimulating Hormone Receptor. Methods Mol Biol 2022; 2507:313-325. [PMID: 35773589 DOI: 10.1007/978-1-0716-2368-8_16] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The thyroid-stimulating hormone receptor (TSHR) is a Class A G protein-coupled receptor (GPCR) that mediates signalling through the hypothalamic-pituitary-thyroid axis. Inappropriate activation of TSHR by autoantibodies or mutations, results in human disease such as Grave's disease and Hashimito's thyroiditis. Therefore, there is a need to develop novel therapeutics targeting the TSHR. Understanding the structure and mechanism of activation of this receptor would help elucidate the pathogenesis of disease and aid drug development. Here, we describe a method for the expression of the human TSHR in a mammalian cell line generated through a lentiviral expression system. The receptor is then purified by affinity chromatography in the ligand-free state and is suitable for structure determination by single-particle electron cryo-microscopy (cryo-EM).
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Rhee CM, Budoff M, Brent G, You AS, Stenvinkel P, Novoa A, Flores F, Hamal S, Dailing C, Kinninger A, Nakata T, Kovesdy CP, Nguyen DV, Kalantar-Zadeh K. Serum Thyrotropin Elevation and Coronary Artery Calcification in Hemodialysis Patients. Cardiorenal Med 2022; 12:106-116. [PMID: 35551382 PMCID: PMC9452456 DOI: 10.1159/000525037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/11/2021] [Accepted: 05/03/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients. METHODS In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression. RESULTS Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance. CONCLUSIONS In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Gregory Brent
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Fred Flores
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Sajad Hamal
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | | | - April Kinninger
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA,Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
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Siegel EL, Kezios KL, Houghton L, Pereira-Eshraghi C, Cirillo P, Cohn BA, Factor-Litvak P. Could maternal thyroid function during pregnancy affect daughters' age at menarche through child growth? A mediation analysis. Reprod Toxicol 2022; 107:33-39. [PMID: 34808459 PMCID: PMC8760156 DOI: 10.1016/j.reprotox.2021.11.004] [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] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023]
Abstract
Early menarche is associated with adverse health outcomes during adolescence as well as breast and other reproductive cancers later in adulthood. However, the causes of early menarche and the pathways through which they operate are not fully understood. Though maternal thyroid function during pregnancy affects child growth, and rapid childhood growth is associated with a decreased age at menarche, the relationship between prenatal maternal thyroid function and daughters' age at menarche has not been examined. We conducted a mediation analysis in a historical cohort of 260 mother-child pairs to estimate the total and indirect effects of maternal prenatal thyroid function on daughters' age at menarche. No association was observed between thyroid stimulating hormone (TSH) or anti-thyroid peroxidase antibodies (ATPO) and daughters' age at menarche. Using a sample-specific, a-priori cutoff at the 10th percentile, low levels of maternal free thyroxine (FT4) were associated with earlier daughter age at menarche, with a hazard ratio (95 % CI) of 1.70 (1.02, 2.84) comparing the bottom 10th percentile with the top 90th percentile of exposure levels. Higher maternal FT4 was associated with rapid child weight gain from ages 5-9, and rapid child weight gain from ages 5-9 was associated with earlier age at menarche; the estimated indirect effect of this pathway was null. While maternal FT4 is associated with earlier age at menarche in daughters, this is not mediated by rapid weight gain in our study population, suggesting that maternal FT4 is operating through a different pathway.
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Affiliation(s)
- Eva L Siegel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA, 10032,corresponding author: . 722 W 168th St. New York, NY, 10032
| | - Katrina L Kezios
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA, 10032
| | - Lauren Houghton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA, 10032
| | - Camila Pereira-Eshraghi
- Department of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, USA, 10032
| | - Piera Cirillo
- Child Health and Development Studies, Center for Research on Women’s and Children’s Health, Public Health Institute, 555 12th Street, Suite 290, Oakland, CA, USA, 94607
| | - Barbara A Cohn
- Child Health and Development Studies, Center for Research on Women’s and Children’s Health, Public Health Institute, 555 12th Street, Suite 290, Oakland, CA, USA, 94607
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA, 10032
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González IF, Maeso-Méndez S, Miranda AS, Del Hoyo Moracho M, Blázquez IL, López ID. Differences in thyroid function between small for gestational age and those with appropriate weight for gestational age. Is thyroid function normal in small for gestational age newborns? An Pediatr (Barc) 2021; 95:330-335. [PMID: 34716082 DOI: 10.1016/j.anpede.2020.10.008] [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] [Received: 06/16/2020] [Accepted: 10/09/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Several studies conclude that small for gestational age (SGA) children have a higher number of comorbidities, as well as a different hormonal profile compared to those with appropriate weight for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Thyroid function in SGA children is still not completely known. OBJECTIVES To compare the thyroid function of SGA children during the first 2 years of life with that in publications on thyroid function in other groups of infants, such as AGA and premature children, using the same methodology. METHODS A cohort of 38 SGA children was obtained, in which the thyrotropin (TSH) values in blood were measured at different points in the development of the SGA child. The results were compared with a population of AGA children from Zaragoza and a population of premature children from Barcelona by comparing the means using a 2-tailed test. RESULTS A statistically significant difference (P < 0.05) was observed between the SGA children in our study and the AGA children older than 6 months, but not between the SGA children of the study and the population of premature infants. CONCLUSIONS SGA children have higher TSH values compared to AGA children older than 6 months. Therefore, it seems reasonable to establish a screening and a follow-up protocol in those SGA with high risk to develop thyroid dysfunction.
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Affiliation(s)
| | - Sandra Maeso-Méndez
- Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Ainhoa Sarasua Miranda
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Marta Del Hoyo Moracho
- Sección de Neonatología, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Isabel Lorente Blázquez
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Ignacio Díez López
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Facultad de Medicina, Universidad del País Vasco (UPV/EHU), Vitoria-Gasteiz, Álava, Spain
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Ghazisaeidi B, Sarvghadi F, Ghasemi A, Tohidi M, Azizi F, Amouzegar A. Association Between Serum Nitric Oxide Level and Changes in Thyroid Function Test in a Population-based Study: Tehran Thyroid Study Participants (TTS). Int J Endocrinol Metab 2021; 19:e109214. [PMID: 34567136 PMCID: PMC8453649 DOI: 10.5812/ijem.109214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/20/2020] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) plays a key role in thyroid function regulation through the inhibition of iodide (I) uptake at the thyroidal sodium-iodide symporter (NIS) and impacts on the thyroid vascularity and blood flow. OBJECTIVES This study aimed to evaluate the association between serum NO metabolites (NOx) and thyroid-stimulating hormone (TSH), free thyroxin (FT4), and anti-thyroid peroxidase (TPOAb) changes. Also, it aimed at evaluating the correlation between serum NOx and the incidence of clinical hypothyroidism, characterized by elevated TSH level and decreased FT4 concentration, and subclinical hypothyroidism, characterized by mildly elevated TSH level despite FT4 concentration within the normal range, over three years of follow-up. METHODS This study included 1,137 participants of the Tehran Thyroid study (TTS), aged > 20 years old, for whom data on serum TSH, FT4, and TPOAb in the third and fourth phases, and serum NOx in the third phase were available. Changes in TSH (ΔTSH), FT4 (ΔFT4), and TPOAb (ΔTPO) between the third and fourth phases were calculated, and the associations between serum NOx and ΔTSH, ΔFT4, and ΔTPOAb were assessed after multivariable adjustment using linear regression analysis. RESULTS No significant association was found between serum NOx and ΔTSH, ΔFT4, and ΔTPOAb after the multivariable adjustment; neither was any observed in TPOAb split groups after multivariable adjustment. No significant association was found between serum NOx tertiles and clinical and subclinical hypothyroidism incidence in the fourth phase of TTS. CONCLUSIONS There was no association between serum NOx levels and changes in TSH, FT4, and TPOAb and clinical and subclinical hypothyroidism incidence.
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Affiliation(s)
- Behnaz Ghazisaeidi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Sarvghadi
- School of Medicine, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Endocrine Research Center, Research Institute for Endocrine Sciences, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Mehran L, Amouzegar A, Abdi H, Delbari N, Madreseh E, Tohidi M, Mansournia MA, Azizi F. Incidence of Thyroid Dysfunction Facing Metabolic Syndrome: A Prospective Comparative Study with 9 Years of Follow-Up. Eur Thyroid J 2021; 10:390-398. [PMID: 34540709 PMCID: PMC8406240 DOI: 10.1159/000512665] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies assessing thyroid hormones in metabolic syndrome (MetS) patients are contradictory. Also, the effect of MetS on thyroid function over time is not yet evaluated. This study investigated the prevalence and incidence of thyroid dysfunction (TD) as well as time trends of thyroid hormones in subjects with and without MetS, during a 10-year follow-up in Tehranian adult population. METHODS This is a prospective cohort study conducted in the framework of Tehran Thyroid Study on 5,786 subjects aged ≥20 years: 4,905 eligible participants entered the study after excluding those with corticosteroid or radioactive iodine use, pregnancy, thyrotropin (TSH) <0.1 and >10 mU/L, and missing data. Physical examinations were performed and serum concentrations of TSH, free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), fasting plasma glucose, insulin, and lipid profile were assessed at baseline and 3-year intervals during the follow-up. MetS was defined according to the Joint Interim Statement Definition. RESULTS At baseline, there were no difference in median serum concentrations of FT4 and TSH between MetS and non-MetS group after adjusting for age, sex, BMI, smoking, and TPOAb positivity. Although there was higher risk of overt (42%) and subclinical hypothyroidism (16%) in MetS compared with non-MetS subjects, no significant difference was observed in adjusted ORs for any TD between 2 groups. There were also no significant differences in time trends of TSH, FT4, TPOAb positivity, and incidence rates of TDs between MetS and non-MetS groups during 10 years, after adjustment for age, sex, BMI, smoking status, and TPOAb positivity. CONCLUSION MetS is not associated with thyroid hypofunction considering other important confounders such as age, sex, smoking, BMI, and TPOAb positivity. There is also no difference in the trend of thyroid hormones and incidence of TD between MetS and non-MetS subjects during a 10-year follow-up.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Delbari
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Madreseh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Fereidoun Azizi, Professor of Internal Medicine and Endocrinology, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395-4763 Tehran 1985717413 (Iran),
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Lee EK, Kang YE, Park YJ, Koo BS, Chung KW, Ku EJ, Won HR, Yoo WS, Jeon E, Paek SH, Lee YS, Lim DM, Suh YJ, Park HK, Kim HJ, Kim BH, Kim M, Kim SW, Yi KH, Park SK, Jung EJ, Choi JY, Bae JS, Hong JH, Nam KH, Lee YK, Yu HW, Go S, Kang YM. A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol. Endocrinol Metab (Seoul) 2021; 36:574-581. [PMID: 34034365 PMCID: PMC8258337 DOI: 10.3803/enm.2020.943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. METHODS This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. CONCLUSION The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.
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Affiliation(s)
- Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang,
Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon,
Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong,
Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan,
Korea
| | - Eonju Jeon
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu,
Korea
| | - Se Hyun Paek
- Department of Surgery, Ewha Womans University School of Medicine, Seoul,
Korea
| | - Yong Sang Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Dong Mee Lim
- Department of Internal Medicine, Konyang University Hospital, Daejeon,
Korea
| | - Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Ha Kyoung Park
- Department of Surgery, Inje University Busan Paik Hospital, Busan,
Korea
| | - Hyo-Jeong Kim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul,
Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Mijin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Convergence Graduate Program in Innovative Medical Science, Seoul,
Korea
| | - Eun-Jae Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ja Seong Bae
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Joon Hwa Hong
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon,
Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul,
Korea
| | - Young Ki Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang,
Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Sujeong Go
- Center for Thyroid Cancer, National Cancer Center, Goyang,
Korea
| | - Young Mi Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon,
Korea
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Lazcano I, Rodríguez Rodríguez A, Uribe RM, Orozco A, Joseph-Bravo P, Charli JL. Evolution of thyrotropin-releasing factor extracellular communication units. Gen Comp Endocrinol 2021; 305:113642. [PMID: 33039406 DOI: 10.1016/j.ygcen.2020.113642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 10/15/2019] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Thyroid hormones (THs) are ancient signaling molecules that contribute to the regulation of metabolism, energy homeostasis and growth. In vertebrates, the hypothalamus-pituitary-thyroid (HPT) axis links the corresponding organs through hormonal signals, including thyrotropin releasing factor (TRF), and thyroid stimulating hormone (TSH) that ultimately activates the synthesis and secretion of THs from the thyroid gland. Although this axis is conserved among most vertebrates, the identity of the hypothalamic TRF that positively regulates TSH synthesis and secretion varies. We review the evolution of the hypothalamic factors that induce TSH secretion, including thyrotropin-releasing hormone (TRH), corticotrophin-releasing hormone (CRH), urotensin-1-3, and sauvagine, and non-mammalian glucagon-like peptide in metazoans. Each of these peptides is part of an extracellular communication unit likely composed of at least 3 elements: the peptide, G-protein coupled receptor and bioavailability regulator, set up on the central neuroendocrine articulation. The bioavailability regulators include a TRH-specific ecto-peptidase, pyroglutamyl peptidase II, and a CRH-binding protein, that together with peptide secretion/transport rate and transduction coupling and efficiency at receptor level shape TRF signal intensity and duration. These vertebrate TRF communication units were coopted from bilaterian ancestors. The bona fide elements appeared early in chordates, and are either used alternatively, in parallel, or sequentially, in different vertebrate classes to control centrally the activity of the HPT axis. Available data also suggest coincidence between apparition of ligand and bioavailability regulator.
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Affiliation(s)
- Iván Lazcano
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Querétaro, Mexico
| | - Adair Rodríguez Rodríguez
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Mexico
| | - Rosa María Uribe
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Mexico
| | - Aurea Orozco
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Querétaro, Mexico
| | - Patricia Joseph-Bravo
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Mexico
| | - Jean-Louis Charli
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México (UNAM), Cuernavaca, Mexico.
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Takahashi S, Ito M, Masaki Y, Hada M, Minakata M, Kohsaka K, Nakamura T, Kasahara T, Kudo T, Nishihara E, Fukata S, Nishikawa M, Akamizu T, Miyauchi A. Association between serum thyroid hormone balance and thyroid volume in patients treated with levothyroxine monotherapy for hypothyroidism. Endocr J 2021; 68:353-360. [PMID: 33239477 DOI: 10.1507/endocrj.ej20-0542] [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: 11/23/2022] Open
Abstract
Many previous studies including ours have reported that athyreotic patients on levothyroxine (LT4) have relatively low serum free triiodothyronine (FT3) levels, whereas patients with large goitrous diseases often have high serum FT3 levels. Here we investigated Hashimoto thyroiditis (HT) patients on LT4 to study the relationship between thyroid volume (TV) and thyroid hormone status in hypothyroid patients on LT4. We retrospectively studied 408 euthyroid HT patients treated with LT4 for hypothyroidism; divided them as per TV and compared serum levels of free thyroxine (FT4) and FT3 and the FT3/FT4 ratio in each patient group with those in euthyroid matched control group. We also evaluated the association between serum FT3 level and FT3/FT4 ratio and TV among HT patients on LT4. In patients with TV <15 mL, serum FT3 levels were significantly lower than those in controls. In patients with TV 15-80 mL, serum FT3 levels were equivalent to those in controls. In patients with TV ≥80 mL, the serum FT3 levels were significantly higher than those in controls. The serum FT3 level (r = 0.35, p < 0.01) and FT3/FT4 ratio (r = 0.42, p < 0.01) showed a positive correlation with TV. TVs in HT patients on LT4 caused differences in serum thyroid hormone balance, as increasing volume increases the serum FT3 level and FT3/FT4 ratio. Serum thyroid hormone balance in HT patients with smaller thyroids was similar to that in athyreotic patients. Mild thyrotropin suppression with LT4 is needed to achieve normal FT3 levels in such patients.
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Affiliation(s)
- Sawako Takahashi
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Mitsuru Ito
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Yuzuki Masaki
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Mikiko Hada
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Mizuho Minakata
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Kazuyoshi Kohsaka
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Tomohiko Nakamura
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Toshihiko Kasahara
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Takumi Kudo
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Eijun Nishihara
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Shuji Fukata
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Takashi Akamizu
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan
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Gholami S, Namiranian N, Shukohifar M, Kalantari F, Azizi R. Maternal thyroid function test level during the first trimester of pregnancy at a center Yazd, Iran: A cross-sectional study. Int J Reprod Biomed 2021; 19:255-260. [PMID: 33842822 PMCID: PMC8023001 DOI: 10.18502/ijrm.v19i3.8573] [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: 03/14/2020] [Revised: 08/15/2020] [Accepted: 09/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background Thyroid dysfunction is associated with negative pregnancy outcomes. There is a lack of reliable information on thyroid hormones in Iranian pregnant women, especially in Yazd. Objective To determine the safe thyroid hormone levels in women of Yazd and also the first trimester-specific reference ranges for serum thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3). Materials and Methods In this cross-sectional study, the serum of 1,148 women in the first trimester of pregnancy was analyzed. Thyroid function tests (TSH, T4, T3) were measured through radioimmunoassay (RIA) [immunoradiometric (IRMA) for TSH]. The study was conducted in Yazd, from September 2018 to November 2019. Reference intervals were defined as the 5 th , 50 th , and 95 th percentiles. Results The mean age of the participants was 28.78 (± 5.86 yr) (range: 15-45 yr). The thyroid hormones reference intervals in the first trimester were TSH (0.2-3.8 mIU/l), T4 (7.45-12.75, μg/dl), and T3 (100-217 ng/dl). Conclusion The results of the present study determined a local thyroid function measurement in the first trimester of pregnancy at a center of Yazd, Iran. This could facilitate the decision-making of maternal TSH level during the first trimester of pregnancy.
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Affiliation(s)
- Somaye Gholami
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Marzieh Shukohifar
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Foroozandeh Kalantari
- Deputy for Health Affairs, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reyhaneh Azizi
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Kikuyama S, Hasunuma I, Okada R. Development of the hypothalamo-hypophyseal system in amphibians with special reference to metamorphosis. Mol Cell Endocrinol 2021; 524:111143. [PMID: 33385474 DOI: 10.1016/j.mce.2020.111143] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
In this review article, topics of the embryonic origin of the adenohypophysis and hypothalamus and the development of the hypothalamo-hypophyseal system for the completion of metamorphosis in amphibians are included. The primordium of the adenohypophysis as well as the primordium of the hypothalamus in amphibians is of neural origin as shown in other vertebrates, and both are closely associated with each other at the earliest stage of development. Metamorphosis progresses via the interaction of thyroid hormone and adrenal corticosteroids, of which secretion is enhanced by thyrotropin and corticotropin, respectively. However, unlike in mammals, the hypothalamic releasing factor for thyrotropin is not thyrotropin-releasing hormone (TRH), but corticotropin-releasing factor (CRF) and the major releasing factor for corticotropin is arginine vasotocin (AVT). Prolactin, the release of which is profoundly enhanced by TRH at the metamorphic climax, is another pituitary hormone involved in metamorphosis. Prolactin has a dual role: modulation of the metamorphic speed and the development of organs for adult life. The secretory activities of the pituitary cells containing the three above-mentioned pituitary hormones are elevated toward the metamorphic climax in parallel with the activities of the CRF, AVT, and TRH neurons.
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Affiliation(s)
- Sakae Kikuyama
- Department of Biology, Faculty of Education and Integrated Sciences, Center for Advanced Biomedical Sciences, Waseda University, Tokyo, 162-8480, Japan
| | - Itaru Hasunuma
- Department of Biology, Faculty of Science, Toho University, Chiba, 274-8510, Japan
| | - Reiko Okada
- Department of Biological Science, Faculty of Science, Shizuoka University, Shizuoka, 422-8529, Japan.
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Kang SY, Ahn HR, Youn HJ, Jung SH. Prognosis of papillary thyroid carcinoma in relation to preoperative subclinical hypothyroidism. Ann R Coll Surg Engl 2021; 103:367-373. [PMID: 33682437 DOI: 10.1308/rcsann.2020.7064] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been established that thyroid-stimulating hormone (TSH) stimulates the growth and development of thyroid malignancy, and a higher serum TSH level is associated with the incidence of thyroid cancer and an advanced tumour stage. This study aimed to evaluate the association of preoperative subclinical hypothyroidism with the prognosis of papillary thyroid cancer (PTC). METHODS A total of 466 patients who underwent surgery for PTC between December 2006 and June 2009 were enrolled. Among them, 44 patients had subclinical hypothyroidism, while 422 did not have subclinical hypothyroidism, as diagnosed using the preoperative thyroid function test. We compared the recurrence rate and association with clinicopathological features in the two groups. RESULTS The median patient age was 46.9 years (17-74 years). There were 420 female and 46 male patients. The median follow-up duration was 81.4 months. There were no statistical differences between the two groups with respect to age, sex, tumour size, extrathyroidal extension, multifocality, lymph node metastasis, TNM stages, recurrence and disease-free survival, despite a significant difference in the average TSH concentrations of the two groups. CONCLUSIONS Our results suggest that preoperative subclinical hypothyroidism was not associated with tumour aggressiveness and recurrence in PTC.
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Affiliation(s)
- S Y Kang
- Research Institute of Clinical Medicine, Jeonbuk National University and Biomedical Research Institute, Korea
| | - H R Ahn
- Research Institute of Clinical Medicine, Jeonbuk National University and Biomedical Research Institute, Korea
| | - H J Youn
- Research Institute of Clinical Medicine, Jeonbuk National University and Biomedical Research Institute, Korea
| | - S H Jung
- Research Institute of Clinical Medicine, Jeonbuk National University and Biomedical Research Institute, Korea
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Canovi S, Vezzani S, Polese A, Frasoldati A, Schiatti C, Preda C, Corradini Zini M, Vitiello A, Foracchia M, Comitini G, Aguzzoli L, Fasano T, Vecchia L. Pregnancy-related reference intervals for serum thyrotropin based on real-life clinical data. Gynecol Endocrinol 2021; 37:113-116. [PMID: 32321333 DOI: 10.1080/09513590.2020.1756251] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM During pregnancy, thyroid homeostasis is physiologically modified, leading to altered levels of thyrotropin (TSH): hence, the adoption of pregnancy-related, population- and method-specific reference ranges is recommended. This monocentric and retrospective study was conducted to establish local pregnancy-related reference intervals for serum TSH in singleton pregnant women using real-life clinical data. METHODS We included women who measured serum TSH during pregnancy at our Laboratory over six years, excluding pregnant women with current or past history of thyroid disease, pituitary or autoimmune diseases, use of medications known to influence thyroid function, multiple and/or pathological pregnancies, BMI >30 Kg/m2. RESULTS We retrieved a total of 3744 TSH results. Reference limits (90% confidence intervals) for TSH (in mIU/L) are: first trimester 0.09 (0.06-0.12) - 3.16 (3.05-3.29); second trimester 0.25 (0.11-0.30) - 3.55 (3.34-3.73); third trimester 0.42 (0.15-0.48) - 3.93 (3.80-4.08). CONCLUSION In conclusion, real-life clinical data could be used to establish or verify local reference intervals for TSH in pregnant women: this may reduce the risk of misclassification of pregnant women undergoing thyroid function testing.
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Affiliation(s)
- Simone Canovi
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Vezzani
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Polese
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Frasoldati
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Clara Schiatti
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Preda
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Corradini Zini
- Struttura complessa di Endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Vitiello
- Servizio tecnologie informatiche e telematiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Foracchia
- Servizio tecnologie informatiche e telematiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Ginecologia e Ostetricia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Ginecologia e Ostetricia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Tommaso Fasano
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Vecchia
- Laboratorio analisi chimico-cliniche e di endocrinologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Rani S, Maharana S, Metri KG, Bhargav H, Nagaratna R. Effect of yoga on depression in hypothyroidism: A pilot study. J Tradit Complement Med 2021; 11:375-380. [PMID: 34195032 PMCID: PMC8240110 DOI: 10.1016/j.jtcme.2021.01.001] [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] [Received: 10/06/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 10/25/2022] Open
Abstract
Background The prevalence of hypothyroidism among Indian women is 15.8%. Depression is frequently reported in hypothyroidism. Yoga is an effective intervention for depression. However, the influence of yoga on depression in patients with hypothyroidism has not been studied. Aim The present study investigated the effect of a 3-month integrated yoga intervention (3-IY) on depression, lipid indices, and serum thyroid-stimulating hormone (sTSH) levels among female patients having hypothyroidism, and mild-to-moderate depression. Method The present single-arm pre-post design study was conducted in thirty-eight women (average age 34.2 ± 4.7 years). Participants received a 3-IY comprising asanas, pranayama, and relaxation techniques for 60 min daily (5 days a week). Depression, sTSH, lipid profile indices, Body Mass Index (BMI), fatigue, anxiety, and stress were assessed at baseline and after 12 weeks. Thyroid medication was kept constant during the study period. Data were analysed using R Studio software. Result A significant (P < 0.05) reduction in depression (58%), sTSH (37%), BMI (6%), fatigue (64%), anxiety (57%), lipid profile indices (HLD increased significanty), and stress (55%) levels was observed after 3 months, compared with the corresponding baseline levels. Conclusion The 3-IY is useful for reducing depression, dyslipidemia, and sTSH in women with hypothyroidism and depression. Further studies with a larger sample size and a robust research design using objective variables must be conducted to strengthen the study findings.
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Affiliation(s)
- S Rani
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga AnusandhanaSamsthana (SVYASA University), Bengaluru, India
| | - Satyapriya Maharana
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga AnusandhanaSamsthana (SVYASA University), Bengaluru, India
| | - Kashinath G Metri
- Department of Yoga, Central University of Rajasthan, Bandar Sindri, Ajmer, Rajasthan, India
| | - Hemant Bhargav
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - R Nagaratna
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga AnusandhanaSamsthana (SVYASA University), Bengaluru, India
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Foster JR, Tinwell H, Melching-Kollmuss S. A review of species differences in the control of, and response to, chemical-induced thyroid hormone perturbations leading to thyroid cancer. Arch Toxicol 2021; 95:807-36. [PMID: 33398420 DOI: 10.1007/s00204-020-02961-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
This review summarises the current state of knowledge regarding the physiology and control of production of thyroid hormones, the effects of chemicals in perturbing their synthesis and release that result in thyroid cancer. It does not consider the potential neurodevelopmental consequences of low thyroid hormones. There are a number of known molecular initiating events (MIEs) that affect thyroid hormone synthesis in mammals and many chemicals are able to activate multiple MIEs simultaneously. AOP analysis of chemical-induced thyroid cancer in rodents has defined the key events that predispose to the development of rodent cancer and many of these will operate in humans under appropriate conditions, if they were exposed to high enough concentrations of the affecting chemicals. There are conditions however that, at the very least, would indicate significant quantitative differences in the sensitivity of humans to these effects, with rodents being considerably more sensitive to thyroid effects by virtue of differences in the biology, transport and control of thyroid hormones in these species as opposed to humans where turnover is appreciably lower and where serum transport of T4/T3 is different to that operating in rodents. There is heated debate around claimed qualitative differences between the rodent and human thyroid physiology, and significant reservations, both scientific and regulatory, still exist in terms of the potential neurodevelopmental consequences of low thyroid hormone levels at critical windows of time. In contrast, the situation for the chemical induction of thyroid cancer, through effects on thyroid hormone production and release, is less ambiguous with both theoretical, and actual data, showing clear dose-related thresholds for the key events predisposing to chemically induced thyroid cancer in rodents. In addition, qualitative differences in transport, and quantitative differences in half life, catabolism and turnover of thyroid hormones, exist that would not operate under normal situations in humans.
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Montaner-Ramón A, Hernández-Pérez S, Campos-Martorell A, Ballesta-Anguiano M, Clemente-León M, Castillo-Salinas F. [Thyroid function in < 32 weeks gestation preterm infants]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30485-9. [PMID: 33358353 DOI: 10.1016/j.anpedi.2020.10.023] [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] [Received: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Preterm newborns (PN) have a higher risk of thyroid dysfunction than term newborns (TN). This condition may go unnoticed in neonatal screening due to a late elevation of thyrotropin (TSH) in these patients. OBJECTIVE Evaluate thyroid function in the second week of life in PN of < 32 weeks gestation (WG), and to identify factors associated to its alteration. PATIENTS AND METHODS A retrospective study was performed in neonates of < 32 weeks gestation (WG), in whom thyroid function was determined. An analysis was performed on thyroxine (T4L) and TSH levels, as well as their association with perinatal and neonatal outcomes. RESULTS The study included a total of 358 patients with mean gestational age (GA) of 29.3 weeks, and mean birth weight (BW) 1127 grams. A linear correlation was found between T4L and BW (correlation coefficient (R) 0.356; p < 0.001) and GA (R = 0.442; p < 0.001). TSH values were associated with small for gestational age (SGA 5.3 mU/L [1.5-37]; non-SGA 2.89 mU/L [0.2-19.5]; p < 0.001), inotropic support (Yes 3.98 mU/L [0.6-22.9]; No 3.16 mU/L [0.2-37]; p = 0.019) and BW (R = -0.249; p < 0.001). Nine (2.5%) patients were treated with levothyroxine, of whom six were SGA. CONCLUSIONS Thyroid function analysis in the second week of life helps to identify asymptomatic newborns with risk of thyroid dysfunction. SGA newborns are at higher risk of thyroid function alterations.
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Affiliation(s)
- Alicia Montaner-Ramón
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España.
| | - Susana Hernández-Pérez
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Ariadna Campos-Martorell
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | | | - María Clemente-León
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Félix Castillo-Salinas
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
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Fernández González I, Maeso-Méndez S, Sarasua Miranda A, Del Hoyo Moracho M, Lorente Blázquez I, Díez López I. [Differences in thyroid function between small for gestational age and those with appropriate weight for gestational age. Is thyroid function normal in small for gestational age newborns?]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30451-3. [PMID: 33317977 DOI: 10.1016/j.anpedi.2020.10.009] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Several studies conclude that small for gestational age (SGA) children have a higher number of comorbidities, as well as a different hormonal profile compared to those with appropriate weight for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Thyroid function in SGA children is still not completely known. OBJECTIVES To compare the thyroid function of SGA children during the first 2 years of life with that in publications on thyroid function in other groups of infants, such as AGA and premature children, using the same methodology. METHODS A cohort of 38 SGA children was obtained, in which the TSH values in blood were measured at different points in the development of the SGA child. The results were compared with a population of AGA children from Zaragoza and a population of premature children from Barcelona by comparing the means using a 2-tailed test. RESULTS A statistically significant difference (P<.05) was observed between the SGA children in our study and the AGA children older than 6 months, but not between the SGA children of the study and the population of premature infants. CONCLUSIONS SGA children have higher TSH values compared to AGA children older than 6 months. Therefore, it seems reasonable to establish a screening and a follow-up protocol in those SGA with high risk to develop thyroid dysfunction.
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Affiliation(s)
| | - Sandra Maeso-Méndez
- Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Ainhoa Sarasua Miranda
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Marta Del Hoyo Moracho
- Sección de Neonatología, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Isabel Lorente Blázquez
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Ignacio Díez López
- Sección de Endocrinología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Facultad de Medicina, Universidad del País Vasco (UPV/EHU), Vitoria-Gasteiz, Álava, España
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Jang D, Marcus-Samuels B, Morgan SJ, Klubo-Gwiezdzinska J, Neumann S, Gershengorn MC. Thyrotropin regulation of differentiated gene transcription in adult human thyrocytes in primary culture. Mol Cell Endocrinol 2020; 518:111032. [PMID: 32941925 PMCID: PMC7606794 DOI: 10.1016/j.mce.2020.111032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 01/05/2023]
Abstract
Thyroid transcription factors (TTFs) - NKX2-1, FOXE1, PAX8 and HHEX - regulate multiple genes involved in thyroid development in mice but little is known about TTF regulation of thyroid-specific genes - thyroglobulin (TG), thyroid peroxidase (TPO), deiodinase type 2 (DIO2), sodium/iodide symporter (NIS) and TSH receptor (TSHR) - in adult, human thyrocytes. Thyrotropin (thyroid-stimulating hormone, TSH) regulation of thyroid-specific gene expression in primary cultures of human thyrocytes is biphasic yielding an inverted U-shaped dose-response curve (IUDRC) with upregulation at low doses and decreases at high doses. Herein we show that NKX2-1, FOXE1 and PAX8 are required for TSH-induced upregulation of the mRNA levels of TG, TPO, DIO2, NIS, and TSHR whereas HHEX has little effect on the levels of these thyroid-specific gene mRNAs. We show that TSH-induced upregulation is mediated by changes in their transcription and not by changes in the degradation of their mRNAs. In contrast to the IUDRC of thyroid-specific genes, TSH effects on the levels of the mRNAs for NKX2-1, FOXE1 and PAX8 exhibit monophasic decreases at high doses of TSH whereas TSH regulation of HHEX mRNA levels exhibits an IUDRC that overlaps the IUDRC of thyroid-specific genes. In contrast to findings during mouse development, TTFs do not have major effects on the levels of other TTF mRNAs in adult, human thyrocytes. Thus, we found similarities and important differences in the regulation of thyroid-specific genes in mouse development and TSH regulation of these genes in adult, human thyrocytes.
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Affiliation(s)
- Daesong Jang
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Bernice Marcus-Samuels
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Sarah J Morgan
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Joanna Klubo-Gwiezdzinska
- Metabolic Disease Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Susanne Neumann
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Marvin C Gershengorn
- Laboratory of Endocrinology and Receptor Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA.
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Choi JB, Kim DI, Paik HJ, Lee SJ, Jung CS, Kang SK, Jung YJ, Kim HY. Thyrotropin suppression therapy for papillary thyroid carcinoma with a huge recurred neck lymph node. Korean J Clin Oncol 2020; 16:145-147. [PMID: 36945712 PMCID: PMC9942732 DOI: 10.14216/kjco.20023] [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] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
Abstract
Differentiated thyroid cancer (DTC) originating from thyroid tissue is affected by thyrotropin (TSH). TSH suppression therapy is usually recommended after thyroidectomy in cases of DTC. A 57-year-old woman who harbored a very huge recurred lymph node underwent TSH suppression therapy because of the risk of surgical complications. After TSH suppression, the huge neck lymph node exhibited a response and decreased in size. She had been followed up for 144 months. TSH suppression therapy could be considered as an alternative treatment option in a recurred DTC patient with a high perioperative risk.
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Affiliation(s)
- Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Dong-il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-june Paik
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Joo Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Shin Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seok Kyung Kang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Yul Kim
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Delgado JA, Bauça JM, Pérez Esteban G, Caimari Jaume M, Robles Bauza J. Challenges in screening for congenital hypothyroidism: Optimization of thyrotropin cut-off values. Clin Chim Acta 2020; 512:20-25. [PMID: 33238181 DOI: 10.1016/j.cca.2020.11.009] [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: 06/24/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND-AIM Different protocols exist for newborn screening of congenital hypothyroidism (CH) worldwide, with different thyrotropin cut-off values for repetition and confirmation tests. This study aimed to assess local protocol in terms of specificity and improve our screening process by optimizing thyrotropin cut-off values. Subsequently, the cut-off values obtained were retrospectively applied to evaluate the number of tests avoided. METHODS Retrospective observational study between 2013 and 2019. All newborn children with a confirmation test for CH were considered for the study. ROC curve analysis was performed for thyrotropin cut-off value optimization in DBS which triggers a confirmatory test, and odds ratios were calculated. For individuals affected by the cut-off value modification, serum thyrotropin and free thyroxine in the confirmation test were analyzed for consideration of clinical outcomes. RESULTS A total of 72,133 newborn children were screened for CH, and 208 individuals were included in the study. Incidence in our population was 1:2,000 live births. The area under the ROC curve was 0.819 (CI 95%: 0.748-0.897). While the current cut-off value (thyrotropin ≥ 10mIU/L) had a specificity of 31.8% [ORs: 3.5 (CI 95%: 1.4-8.8)], the optimal cut-off value (thyrotropin ≥ 15mIU/L) yielded a specificity of 92.4% for the detection of CH and transient hypothyroidism [ORs: 15.9 (CI 95%: 7.1-35.8)], with no loss of sensitivity. DISCUSSION While keeping a maximum sensitivity, optimization of cut-off values may be of great use not only in management, but also in reducing family stress, which is of special relevance for the newborn.
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Affiliation(s)
- Jose Antonio Delgado
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Spain
| | | | - Maria Caimari Jaume
- Department of Pediatric Endocrinology, Hospital Universitari Son Espases, Palma, Spain
| | - Juan Robles Bauza
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
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Fontenelle LC, Feitosa MM, Freitas TEC, Severo JS, Morais JBS, Henriques GS, Oliveira FE, Moita Neto JM, Marreiro DDN. Selenium status and its relationship with thyroid hormones in obese women. Clin Nutr ESPEN 2020; 41:398-404. [PMID: 33487296 DOI: 10.1016/j.clnesp.2020.10.012] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/17/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Studies have been conducted with the purpose of elucidating thyroid gland dysfunction in obesity, however the contributing factors for such dysfunction are not yet fully understood. Selenium is notable for its role in thyrocyte protection against oxidative damage and control of thyroid hormone synthesis. In addition, subjects with obesity may exhibit alterations in the selenium homeostasis. Therefore, the present study aimed to examine the selenium status and its relationship with serum thyroid hormone levels in obese women. METHODS This cross-sectional study included 69 euthyroid women, aged between 18 and 50 years, who were divided in two groups: an obese group (n = 35) and a control group with women of normal weight (n = 34). Selenium intake was assessed by three-day diet records and analyzed using NutWin software version 1.5. Plasma, erythrocyte, and urinary selenium levels were determined using inductively coupled plasma optical emission spectrometry. Testing for thyroid hormones and thyroid autoantibodies was performed based on chemiluminescence. RESULTS The median dietary selenium content was adequate according to the recommendations, with no statistical difference between groups. Obese women had reduced plasma and erythrocyte selenium levels compared to the control group, although selenium concentration in erythrocytes was adequate within the normal range for both groups. There was no significant difference between the urinary selenium concentrations in the subjects; however, the mineral clearance was higher in the obese group. Free triiodothyronine (fT3) and free thyroxine (fT4) levels were higher in obese women with class II obesity when compared to the control group. There was a negative correlation between plasma selenium and serum fT4 levels. CONCLUSIONS Obese women showed impairment in selenium homeostasis, however, this fact did not seem to adversely affect thyroid metabolism.
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Affiliation(s)
- Larissa Cristina Fontenelle
- Department of Nutrition, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
| | - Mayara Monte Feitosa
- Department of Nutrition, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
| | | | - Juliana Soares Severo
- Department of Nutrition, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
| | - Jennifer Beatriz Silva Morais
- Department of Nutrition, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
| | - Gilberto Simeone Henriques
- School of Nursing, Department of Nutrition, Federal University of Minas Gerais, 6627 Av. Pres. Antônio Carlos, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Francisco Erasmo Oliveira
- Med Imagem Clinical Laboratory, Rua Paissandu 1862, Centro Sul, CEP, Teresina, Piauí, 64001-120, Brazil.
| | - José Machado Moita Neto
- Department of Chemistry, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
| | - Dilina do Nascimento Marreiro
- Department of Nutrition, Federal University of Piauí, Campus Ministro Petrônio Portella, Teresina, Piauí, 64049-550, Brazil.
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Sakamaki K, Tsunekawa K, Ishiyama N, Kudo M, Ando K, Akuzawa M, Nakajima K, Shimomura Y, Araki O, Kimura T, Murakami M. Association between high normal-range thyrotropin concentration and carotid intima-media thickness in euthyroid premenopausal, perimenopausal and postmenopausal women. Maturitas 2020; 144:29-36. [PMID: 33358205 DOI: 10.1016/j.maturitas.2020.10.022] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/30/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE There are currently no established cutoff levels for thyrotropin (TSH) within the reference intervals associated with carotid atherosclerosis to prevent the onset of cardiovascular diseases. The present study aimed to determine the TSH cutoff level associated with carotid maximum intima-media thickness (max IMT) in euthyroid premenopausal, perimenopausal and postmenopausal women. STUDY DESIGN We conducted a cross-sectional study of 468 euthyroid women who had not been treated for or diagnosed with cardiovascular diseases and/or metabolic disorders among 1221 Japanese women who participated in a comprehensive medical examination at the Hidaka Hospital, Japan. Participants' weight, blood pressure, plasma glucose, serum lipoprotein, free thyroxine and TSH were measured and an interview about menstruation was conducted. Carotid ultrasonography was performed to determine max IMT. RESULTS Max IMT significantly increased stepwise as menopausal status progressed (p < 0.001). Serum TSH levels were significantly higher in participants with carotid plaques, defined as max IMT ≥1.1 mm (p = 0.038), and were independently associated with the presence of carotid plaque using multivariate logistic regression analysis (β =1.218, p = 0.036). In postmenopausal women, significantly higher carotid max IMT values were observed in women with serum TSH ≥2.5 μIU/mL compared with women with concentrations <2.5 μIU/mL (p = 0.018) without elevated total cholesterol and low-density lipoprotein cholesterol concentrations. These differences were not observed in premenopausal women. CONCLUSIONS Laboratory finding of serum TSH concentration ≥2.5 μIU/mL may be useful to assess risk of atherosclerosis, especially in postmenopausal women.
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Affiliation(s)
- Koji Sakamaki
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan; Center for Health Control, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Katsuhiko Tsunekawa
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Nobuyoshi Ishiyama
- Diabetes and Metabolic Disease Research Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Mizuho Kudo
- Center for Health Control, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Kimiko Ando
- Center for Health Control, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Masako Akuzawa
- Center for Health Control, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Katsuyuki Nakajima
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan; Center for Health Control, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Yohnosuke Shimomura
- Diabetes and Metabolic Disease Research Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma, 370-0001, Japan
| | - Osamu Araki
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takao Kimura
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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