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Biological Research For Nursing Apr 2020The postpartum period can be a vulnerable time during which many women are prone to mood disturbances. Since telomere length (TL) is known to be associated with... (Comparative Study)
Comparative Study
BACKGROUND
The postpartum period can be a vulnerable time during which many women are prone to mood disturbances. Since telomere length (TL) is known to be associated with dysphoric moods, inflammation, and stress in many populations, this study's objective was to assess the relationships among TL, dysphoric moods, stress, and inflammation during the postpartum period.
METHOD
This cross-sectional pilot study is a secondary analysis of data collected in a larger parent study of anti-thyroid peroxidase (TPO) enzyme antibody positive versus negative women. The parent study followed selected mothers every month for 6 postpartum months. From this parent study, a random sample of preserved peripheral blood mononuclear cells from 97 participants collected at 2-4 months postpartum were measured for TL. Data were available on the production of interleukin-6 (IL-6), an inflammatory cytokine, in stimulated ex vivo cultures for 59 of these women. Dysphoric moods and stress were measured. Pearson correlations and linear regressions were performed, controlling for postpartum thyroiditis status and age.
RESULTS
There were no statistically significant relationships between TL and demographic factors, stress, depression, or TPO status. There were significant negative correlations between TL and anxiety and a trend for a relationship between TL and IL-6 levels. IL-6 levels were significantly, positively associated with negative moods.
CONCLUSIONS
Higher anxiety scores and inflammation were associated with shorter TL. Inflammation was related to anxiety and other dysphoric moods and was marginally associated with shorter TLs.
Topics: Adult; Anxiety Disorders; Cross-Sectional Studies; Cytokines; Depressive Disorder, Major; Female; Humans; Inflammation; Iodide Peroxidase; Leukocytes, Mononuclear; Middle Aged; Pilot Projects; Postpartum Period; Telomere; Young Adult
PubMed: 31858822
DOI: 10.1177/1099800419890424 -
Cureus Oct 2022Due to the characteristics of the thyroid gland that prevent infiltration of pathogens, suppurative thyroid gland infections causing thyroid gland abscess are rarely...
Due to the characteristics of the thyroid gland that prevent infiltration of pathogens, suppurative thyroid gland infections causing thyroid gland abscess are rarely encountered. Herein, we report a young female who presented to our hospital with pulmonary tuberculosis and pneumonia complicated with empyema. During her admission, she developed a rapidly enlarging and tender thyroid gland that produced respiratory obstructive symptoms. Upon clinical examination and radiological imaging, the diagnosis of thyroid abscess was confirmed. Surgical incision and drainage of the abscess was performed along with proper coverage of antibiotics. Thereafter, the patient's clinical status improved dramatically. Although thyroid gland abscesses are rare in clinical practice, a rapidly enlarging thyroid gland in a patient with overt bacterial infection should raise the suspicion of thyroid abscess. Timely diagnosis and proper management can be life-saving in such cases.
PubMed: 36381905
DOI: 10.7759/cureus.30082 -
Thyroid Research 2017Pregnancy and delivery markedly influence thyroid function. However, the comparative prevalence of gestational thyrotoxicosis (GT), new onset of Graves' disease during...
BACKGROUND
Pregnancy and delivery markedly influence thyroid function. However, the comparative prevalence of gestational thyrotoxicosis (GT), new onset of Graves' disease during pregnancy (GD during pregnancy), postpartum destructive thyrotoxicosis (PPT), and postpartum Graves' thyrotoxicosis (PPGD) has not yet been determined.
METHODS
We prospectively registered and performed a review of 4127 consecutive non treated female patients with thyrotoxicosis, seen between August 2008 and December 2013 in our outpatient clinic of Kuma Hospital. 187 out of the 4127 women had new diagnosis of thyrotoxicosis during pregnancy or in the postpartum period. We investigated the prevalence of new diagnosis of GT, GD during pregnancy, PPT and PPGD and compared the characteristics of these types of thyrotoxicosis. The postpartum period is defined as twelve months after delivery.
RESULTS
Out of 187 pregnant or postpartum women, we identified 30 (16.0%) with GT, 13 (7.0%) with GD during pregnancy, 42 (22.5%) with PPT, and 102 (54.5%) with PPGD. The onset time of thyrotoxicosis during pregnancy, i.e., both GT and GD during pregnancy, was delayed by a couple of weeks when hCG peaked at 10 gestational weeks. Seventy-six percent of patients with PPT developed thyrotoxicosis between delivery and 4 months postpartum; on the other hand, 83.3% of patients with PPGD developed thyrotoxicosis at 6 months postpartum or later.
CONCLUSIONS
We named gestational thyrotoxicosis, new onset of Graves' disease during pregnancy, postpartum destructive thyrotoxicosis, and postpartum Graves' thyrotoxicosis as pregnancy-associated thyrotoxicosis. A clinically significant number of women developed Graves' disease in the postpartum period in a single thyroid centre.
PubMed: 28804518
DOI: 10.1186/s13044-017-0039-0 -
European Journal of Pediatrics Nov 2018Although thyroid medications are frequently prescribed during pregnancy, paediatricians treating the respective neonates often have no information about the underlying...
Although thyroid medications are frequently prescribed during pregnancy, paediatricians treating the respective neonates often have no information about the underlying maternal thyroid disease, and inconsistencies in postnatal diagnostics may result. We analysed a cohort of 1819 mothers admitted for delivery in 1 year to one hospital. We analysed the pre- and postpartum diagnostics in the mothers, the postnatal diagnostics in the neonates and their postnatal auxological development. Two hundred thirteen mothers (11.7%) had "thyroid disease"; 37 (2.0%) had Hashimoto thyroiditis, seven (0.4%) Graves' disease and 169 (9.3%) "thyroid disease of other origins". One hundred eighty-eight out of 213 (88%, 10.3% of the entire cohort) took levothyroxine. Pre- and postpartum diagnostics of the mothers and postnatal diagnostics of the neonates revealed striking inconsistencies. For example, 39 % of the gynaecologists routinely determined TSH, while only 59% carried out a dosage adjustment for known hypothyroidism. Second specialists were consulted in 86%. Unnecessary postpartum diagnostics were initiated in 19/213 neonates (9%). TRAb was analysed, however, in only one neonate born from the mothers with Graves' disease-a condition in which further diagnostic efforts are mandatory.Conclusion: Although many pregnant women have thyroid dysfunction, we observed a lack of uniformity in the diagnostic approach of the women and their neonates. What is Known: • Disturbed maternal thyroid function in pregnancy often has an adverse impact on both the mother and the foetus. • Although detailed guidelines for managing impaired maternal thyroid function during pregnancy have been published, their application in clinical practice varies widely. What is New: • Recommendations for managing the newborn of a mother presenting with thyroid disease of unknown entity are remarkably inconsistent. • This leads to a possible over-diagnosis in general and a potentially life-threatening failure to note neonatal hyperthyroidism requiring rapid treatment.
Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Mothers; Practice Patterns, Physicians'; Pregnancy; Pregnancy Complications; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroxine
PubMed: 30187120
DOI: 10.1007/s00431-018-3232-9 -
Endokrynologia Polska 2021Selenium (Se) supplements are commonly prescribed to autoimmune thyroiditis (AIT) patients by European endocrinologists, despite the lack of official guidelines. The... (Review)
Review
Selenium (Se) supplements are commonly prescribed to autoimmune thyroiditis (AIT) patients by European endocrinologists, despite the lack of official guidelines. The majority of Europe is depleted of natural Se sources, and the daily population intake does not comply with recommended values. Optimal individual plasma Se concentration is reached when the selenoproteins (selenoprotein P, glutathione peroxidase) are fully saturated. However, Se intake has to be regulated because both Se shortage and overdose negatively impact health. In the case of AIT, Se may alleviate symptoms or prevent progression to hypothyroidism and postpartum hypothyroidism. Se supplementation in euthyroid, subclinical, or overt hypothyroid AIT patients decreased thyroid autoantibodies, lowered or maintained the TSH level, decreased the fT4/fT3 ratio, reduced the body's oxidative stress and inflammatory status, and amended quality of life and thyroid ultrasound structure and volume. In pregnant females, adequate Se intake protected them against miscarriages, preeclampsia/hypertension, preterm birth, small-for-gestational-age infants' birth, and improved child's neuropsychological development. In the elderly population, adequate Se supplementation decreased cardiovascular diseases and hypertension risk, but prolonged intake of excessive doses increased the all-cause mortality rate. Routine Se supplementation implementation requires from researchers and clinicians consideration of specific populational differences in natural Se and iodine supply, the patient's clinical situation (supplementation simultaneously or before levothyroxine treatment, AIT/non-AIT hypothyroidism), individual response to supplementation (Se and selenoprotein P assessment), predisposition (genetic testing), the status of other trace elements, and the interplay between those micronutrients. Moreover, the safety of commercially available Se formulations, doses, and duration of treatment should be determined. Proper guidelines are warranted to standardise the medical approach to Se supplementation. This article presents a comprehensive review of recent randomised-controlled trials, meta-analyses, and clinical trials concerning the risks and benefits of Se supplementation in different clinical settings and specific populations with particular emphasis on AIT in a practical manner.
Topics: Aged; Child; Dietary Supplements; Female; Hashimoto Disease; Humans; Hypertension; Hypothyroidism; Infant, Newborn; Pregnancy; Premature Birth; Quality of Life; Selenium; Selenoprotein P; Thyroiditis, Autoimmune
PubMed: 33970480
DOI: 10.5603/EP.a2021.0017 -
Endocrinology and Metabolism (Seoul,... Jun 2016Genetic factors contribute for about 70% to 80% and environmental factors for about 20% to 30% to the pathogenesis of autoimmune thyroid disease (AITD). Relatives of... (Review)
Review
Genetic factors contribute for about 70% to 80% and environmental factors for about 20% to 30% to the pathogenesis of autoimmune thyroid disease (AITD). Relatives of AITD patients carry a risk to contract AITD themselves. The 5-year risk can be quantified by the so-called Thyroid Events Amsterdam-score, based on serum thyroid-stimulating hormone, thyroid peroxidase (TPO)-antibodies and family history. Subjects at risk may ask what they can do to prevent development of AITD. This review summarizes what is known about modulation of exposure to environmental factors in terms of AITD prevention. To stop smoking decreases the risk on Graves disease but increases the risk on Hashimoto disease. Moderate alcohol intake provides some protection against both Graves and Hashimoto disease. Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive. Low serum vitamin D levels are associated with a higher prevalence of TPO antibodies, but intervention studies with extra vitamin D have not been done yet. Stress may provoke Graves hyperthyroidism but not Hashimoto thyroiditis. Estrogen use have been linked to a lower prevalence of Graves disease. The postpartum period is associated with an increased risk of AITD. Taking together, preventive interventions to diminish the risk of AITD are few, not always feasible, and probably of limited efficacy.
PubMed: 27184015
DOI: 10.3803/EnM.2016.31.2.213 -
Journal of Endocrinological... Aug 2020Bartolomeo Vivarini (Venezia 1432c.-Venezia 1499c.) was an Italian painter during the Renaissance. The artist was widely influenced by Andrea Mantegna, whose opera was...
INTRODUCTION
Bartolomeo Vivarini (Venezia 1432c.-Venezia 1499c.) was an Italian painter during the Renaissance. The artist was widely influenced by Andrea Mantegna, whose opera was characterized by personages with anatomical details meticulously described.
MATERIALS AND METHODS
Some of the most valued paintings of Bartolomeo Vivarini were analyzed. Purpose of the present article is to describe these artworks focusing on female personages represented with thyroid swelling.
RESULTS
A recurring female model in Vivarini's artworks is portrayed with a goitrous neck. This might display a real prevalence of thyroid diseases among young women in the Renaissance age (e.g. postpartum thyroiditis).
CONCLUSIONS
Representation of goiter in the artworks of Vivarini and Mantegna reflects the increased anatomic accuracy and knowledge developed in art since Renaissance and Baroque.
Topics: Female; Goiter; History, 15th Century; Humans; Italy; Male; Medicine in the Arts; Models, Biological; Paintings
PubMed: 32157663
DOI: 10.1007/s40618-020-01217-5 -
Journal of the European Academy of... May 2019
Topics: Famous Persons; Female; History, 16th Century; Humans; Italy; Medicine in the Arts; Paintings; Postpartum Thyroiditis
PubMed: 30821015
DOI: 10.1111/jdv.15412 -
Lakartidningen Oct 2022In Europe thyroid ultrasound has been used at outpatient endocrine clinics since many years, and in southern Sweden only during the last years. Ultrasound has a role in...
In Europe thyroid ultrasound has been used at outpatient endocrine clinics since many years, and in southern Sweden only during the last years. Ultrasound has a role in the investigation of Graves' disease, subacute thyroiditis, gestational thyrotoxicosis, postpartum thyroiditis, amiodarone thyrotoxicosis and goiter with or without adenoma, but adenomas are usually investigated by endocrine surgeons in Sweden. If widely used the risk for detection of incidentaloma increases. Indications have to be strictly used to avoid further investigations. If an adenoma is localized, the risk for malignancy and requirement of aspiration is estimated by use of the EU-TIRADS classification based on morphology and size. The aspirate is judged by the Bethesda classification, which determines if further investigation is needed. The use of ultrasound at the outpatient clinic has improved the diagnostic quality and follow-up of thyroid patients.
Topics: Female; Humans; Thyroid Diseases; Thyrotoxicosis; Graves Disease; Amiodarone
PubMed: 36285373
DOI: No ID Found -
Therapeutic Drug Monitoring Apr 2020From the very beginning of pregnancy, the maternal thyroid has to adapt to increased thyroid hormone secretion of up to 50%. This is paralleled by changes in...
PURPOSE
From the very beginning of pregnancy, the maternal thyroid has to adapt to increased thyroid hormone secretion of up to 50%. This is paralleled by changes in thyroid-stimulating hormone secretion and by the thyroid-topic action of human chorionic gonadotropin. Thus, hypothyroidism and hyperthyroidism may occur. Many women exhibit preexisting thyroid diseases. This review tries to add the most recently published approaches to diagnosing thyroid malfunction in pregnancy to existing guidelines.
METHODS
Different literature-based approaches to diagnosing thyroid malfunction during pregnancy and the postpartum period were applied. To diagnose thyroid malfunction in pregnancy, trimester-specific reference ranges for thyroid-stimulating hormone and T4 are used.
RESULTS
Definitions of thyroid malfunction are given. Treatment schedules for various thyroid diseases were reviewed and, on the basis of recent findings, were revised where necessary. For a daily clinical workup, this outline not only suggests diagnostic and therapeutic steps but also refers to frequent pitfalls and misinterpretations of laboratory data.
CONCLUSIONS
Although the body of knowledge is increasing rapidly, the authors believe that this review is able to present new ideas concerning diagnostic and therapeutic tools for thyroid malfunction in pregnancy and the postpartum period. Nevertheless, there seems to remain room for individual approaches based on the personal experience of physicians who deal with these issues regularly.
Topics: Antithyroid Agents; Female; Humans; Hyperthyroidism; Hypothyroidism; Iodine; Postpartum Period; Pregnancy; Pregnancy Complications; Reference Values; Selenium; Thyroid Function Tests; Thyroid Hormones; Thyroiditis
PubMed: 31425445
DOI: 10.1097/FTD.0000000000000691