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Ugeskrift For Laeger May 2023Acquired hypothyroidism is the most common thyroid disease in paediatric patients and in iodine-replete areas mainly due to autoimmune thyroiditis (AIT). Symptoms of... (Review)
Review
Acquired hypothyroidism is the most common thyroid disease in paediatric patients and in iodine-replete areas mainly due to autoimmune thyroiditis (AIT). Symptoms of hypothyroidism are unspecific and insidious for which reason thyroid function tests are often part of a general paediatric assessment. Consequently, only few patients present with pronounced symptoms which include a stunted growth pattern and multiorgan involvement when most extreme. This review provides an overview of the current knowledge on this common endocrinopathy in childhood.
Topics: Humans; Child; Adolescent; Hypothyroidism; Thyroid Diseases; Thyroiditis, Autoimmune; Iodine
PubMed: 37264859
DOI: No ID Found -
Thyroid : Official Journal of the... Dec 2023Increased height has been associated with increased risk of hypothyroidism or thyroid cancer in epidemiological studies. However, the potential causal association... (Meta-Analysis)
Meta-Analysis
Increased height has been associated with increased risk of hypothyroidism or thyroid cancer in epidemiological studies. However, the potential causal association between height and hypothyroidism or thyroid cancer has not been thoroughly explored. Autoimmune thyroid disease (AITD) mainly presents as hypothyroidism, thus we aim to evaluate the causal relationship between height as exposure and its association with AITD or thyroid cancer. Mendelian randomization (MR) analyses were performed by using genetic instruments associated with height, which were selected from the largest genome-wide association meta-analysis for height in up to 5.4 million individuals. Summary-level data for AITD and thyroid cancer (including 30,234 and 3001 cases, respectively) were collected from the large number of available genome-wide association studies. Bidirectional MR was performed to test for reverse causal association between AITD and adult height. MR analyses showed that increased genetically predicted height was associated with a 4% increased risk of AITD ([CI 1.02 to 1.07], -value = 1.99E-03) per 1-standard deviation (SD) increase in genetically predicted height. The bidirectional MR did not show any causal association between AITD and adult height. Additionally, increased genetically predicted height was associated with 15% increased risk of thyroid cancer ([CI 1.07 to 1.23], -value = 2.32E-04) per 1-SD increase in height. Sensitivity analysis confirmed the main results. This MR study showed that 1-SD increase in genetically predicted height was associated with increased risk of AITD and thyroid cancer. In contrast, there was no evidence of a causal association of genetically predicted AITD with height. These results could further aid in investigation of height-related pathways as a means of gaining new mechanistic insights into AITD and thyroid cancer.
Topics: Adult; Humans; Mendelian Randomization Analysis; Genome-Wide Association Study; Hashimoto Disease; Hypothyroidism; Thyroid Neoplasms; Polymorphism, Single Nucleotide
PubMed: 37772697
DOI: 10.1089/thy.2023.0272 -
The New England Journal of Medicine Jun 2017The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition.
METHODS
We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was <50 kg or the patient had coronary heart disease), with dose adjustment according to the thyrotropin level; 369 patients were assigned to receive placebo with mock dose adjustment. The two primary outcomes were the change in the Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points).
RESULTS
The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (P<0.001), at a median dose of 50 μg. We found no differences in the mean change at 1 year in the Hypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], -2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, -2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest.
CONCLUSIONS
Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126 .).
Topics: Aged; Aged, 80 and over; Double-Blind Method; Fatigue; Female; Humans; Hypothyroidism; Intention to Treat Analysis; Male; Quality of Life; Thyrotropin; Thyroxine; Treatment Failure
PubMed: 28402245
DOI: 10.1056/NEJMoa1603825 -
International Journal of Cancer Oct 2020Whether thyroid dysfunction plays a causal role in the development of cancer remains inconclusive. We conducted a two-sample Mendelian randomization study to investigate... (Meta-Analysis)
Meta-Analysis
Whether thyroid dysfunction plays a causal role in the development of cancer remains inconclusive. We conducted a two-sample Mendelian randomization study to investigate the associations between genetic predisposition to thyroid dysfunction and 22 site-specific cancers. Single-nucleotide polymorphisms associated with four traits of thyroid function were selected from a genome-wide association meta-analysis with up to 72,167 European-descent individuals. Summary-level data for breast cancer and 21 other cancers were extracted from the Breast Cancer Association Consortium (122,977 breast cancer cases and 105,974 controls) and UK Biobank (367,643 individuals). For breast cancer, a meta-analysis was performed using data from both sources. Genetically predicted thyroid dysfunction was associated with breast cancer, with similar patterns of associations in the Breast Cancer Association Consortium and UK Biobank. The combined odds ratios of breast cancer were 0.94 (0.91-0.98; p = 0.007) per genetically predicted one standard deviation increase in TSH levels, 0.96 (0.91-1.00; p = 0.053) for genetic predisposition to hypothyroidism, 1.04 (1.01-1.07; p = 0.005) for genetic predisposition to hyperthyroidism and 1.07 (1.02-1.12; p = 0.003) per genetically predicted one standard deviation increase in free thyroxine levels. Genetically predicted TSH levels and hypothyroidism were inversely with thyroid cancer; the odds ratios were 0.47 (0.30-0.73; p = 0.001) and 0.70 (0.51-0.98; p = 0.038), respectively. Our study provides evidence of a causal association between thyroid dysfunction and breast cancer (mainly ER-positive tumors) risk. The role of TSH and hypothyroidism for thyroid cancer and the associations between thyroid dysfunction and other cancers need further exploration.
Topics: Biological Specimen Banks; Breast Neoplasms; Female; Humans; Hyperthyroidism; Hypothyroidism; Male; Mendelian Randomization Analysis; Polymorphism, Single Nucleotide; Thyroid Function Tests; Thyroid Gland; Thyroid Neoplasms; Thyrotropin
PubMed: 32215913
DOI: 10.1002/ijc.32988 -
BMC Research Notes Feb 2022Abnormal thyroid function may disrupt sleep architecture. We aimed to determine the frequency of various chronotypes in women with hypothyroidism. We performed a...
OBJECTIVE
Abnormal thyroid function may disrupt sleep architecture. We aimed to determine the frequency of various chronotypes in women with hypothyroidism. We performed a single-center retrospective study at an ambulatory clinic from January 2013-December 2015. Participants were women with hypothyroidism. Chronotype was determined from the Munich ChronoType Questionnaire. The χ test was used to compare differences in clinical characteristics and sleep patterns in early and intermediate/late chronotypes. The t test was used to compare differences between means.
RESULTS
We evaluated 99 patients (mean [SD], 56 [7] years): calculated chronotype revealed: 56% early, 38% intermediate and 6% late. Analysis with the χ test showed significant differences between early and intermediate/late calculated chronotypes for sleep latency (P = 0.01), light exposure (P = 0.009), and no alcohol intake (P = 0.001). t test showed the following differences in mean (SD) between chronotypes: sleep duration, 7.30 (1.39) hours (early chronotype) and 7.04 (2.06) hours (intermediate/late); body mass index (BMI), 29.4 (7.3) (early) and 31.1 (6.8) (intermediate/late); and TSH level, 2.89 (3.69) mIU/L (early) and 1.69 (1.41) mIU/L (intermediate/late). Early chronotypes were frequent in women with hypothyroidism. Light exposure and BMI may influence chronotypes in patients with hypothyroidism; findings are consistent with healthier behaviors in patients who tend toward morningness.
Topics: Adult; Circadian Rhythm; Female; Humans; Hypothyroidism; Retrospective Studies; Sleep; Sleep Wake Disorders; Surveys and Questionnaires
PubMed: 35164850
DOI: 10.1186/s13104-022-05934-3 -
Hormone Research in Paediatrics 2022The history of the thyroid dates from 2697 BCE when the "Yellow Emperor" Hung Ti described the use of seaweed to treat goiter. The English name "thyroid" was coined by... (Review)
Review
The history of the thyroid dates from 2697 BCE when the "Yellow Emperor" Hung Ti described the use of seaweed to treat goiter. The English name "thyroid" was coined by Thomas Wharton in 1656 from the Greek word for a shield. Bernard Courtois discovered iodine in 1811 when he noted a residual purplish ash while burning seaweed. Robert Graves is known for his classic 1835 report of "palpitations, goiter, and exophthalmos" in three women, but Caleb Parry observed the same clinical features in 1786. The clinical syndrome we now recognize as hypothyroidism was characterized as "myxoedema" in 1878 by William Ord at St. Thomas Hospital. In 1891, George Murray reported that injection of thyroid extract from sheep led to improvement in symptoms in a woman with myxedema. Thomas Kocher, who reported that patients with goiter who underwent complete thyroidectomy developed cachexia strumipriva, was awarded the Nobel Prize in Physiology and Medicine in 1909. Edward Kendall discovered "thyroxin" on Christmas day in 1914. Studies by David Marine that iodine treatment prevented endemic goiter led to salt iodination, which has largely eradicated endemic cretinism. In 1973, Jean Dussault reported detection of congenital hypothyroidism by screening newborn populations.
Topics: Female; Male; Animals; Humans; Sheep; Goiter; Thyroidectomy; Hypothyroidism; Myxedema; Iodine
PubMed: 36446327
DOI: 10.1159/000526621 -
Cellular and Molecular Neurobiology Oct 2023Hypothyroidism (HPT) HPT could be a risk factor for the development and progression of Alzheimer's disease (AD). In addition, progressive neurodegeneration in AD may... (Review)
Review
Hypothyroidism (HPT) HPT could be a risk factor for the development and progression of Alzheimer's disease (AD). In addition, progressive neurodegeneration in AD may affect the metabolism of thyroid hormones (THs) in the brain causing local brain HPT. Hence, the present review aimed to clarify the potential association between HPT and AD. HPT promotes the progression of AD by inducing the production of amyloid beta (Aβ) and tau protein phosphorylation with the development of synaptic plasticity and memory dysfunction. Besides, the metabolism of THs is dysregulated in AD due to the accumulation of Aβ and tau protein phosphorylation leading to local brain HPT. Additionally, HPT can affect AD neuropathology through various mechanistic pathways including dysregulation of transthyretin, oxidative stress, ER stress, autophagy dysfunction mitochondrial dysfunction, and inhibition of brain-derived neurotrophic factor. Taken together there is a potential link between HPT and AD, as HPT adversely impacts AD neuropathology and the reverse is also true.
Topics: Humans; Alzheimer Disease; tau Proteins; Amyloid beta-Peptides; Brain; Hypothyroidism
PubMed: 37540395
DOI: 10.1007/s10571-023-01392-y -
Current Opinion in Nephrology and... Nov 2019Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed. (Review)
Review
PURPOSE OF REVIEW
Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed.
RECENT FINDINGS
Epidemiologic data show that there is a nearly five-fold higher prevalence of hypothyroidism in advanced chronic kidney disease (CKD) patients vs. those without CKD. Given that the metabolism, degradation, and excretion of thyroid hormone and its metabolites, as well as the regulation of the hypothalamic-pituitary-thyroid axis may be altered in ESRD, certain considerations should be made when interpreting thyroid functional tests in these patients. Growing evidence shows that hypothyroidism and other thyroid functional test derangements are associated with higher risk of cardiovascular disease, worse patient-centered outcomes, and survival in the advanced CKD population, including those with ESRD. Although limited data examining treatment of hypothyroidism suggests benefit, further studies of the efficacy and safety of thyroid hormone supplementation, including clinical trials and rigorous longitudinal observational studies are needed to inform the management of thyroid dysfunction in CKD.
SUMMARY
Given the high burden of hypothyroidism in ESRD patients, and potential ill effects on their cardiovascular health, patient-centered outcomes, and survival, further research is needed to inform the optimal management of thyroid dysfunction in this population.
Topics: Cardiovascular Diseases; Humans; Hypothyroidism; Kidney Failure, Chronic; Prevalence
PubMed: 31483325
DOI: 10.1097/MNH.0000000000000542 -
Medical Archives (Sarajevo, Bosnia and... Feb 2022Hypothyroidism occurs as a consequence of chronic autoimmune inflammation of the thyroid gland, which occurs due to the reduced function in the secretion of hormones FT3...
BACKGROUND
Hypothyroidism occurs as a consequence of chronic autoimmune inflammation of the thyroid gland, which occurs due to the reduced function in the secretion of hormones FT3 and FT4 and requires replacement therapy for life. CoV-19 infection has shown many complications in all organic systems, during the acute phase of infection and in the post COVID period.
OBJECTIVES
The aim of the study was a) to compare the frequency of patient visits for hypothyroidism and the average dose of levothyroxine in the SANASA polyclinic in the year before COVID pandemic, in the early 2019, with the frequency of patient visits during COVID infection in 2020 and 2021; b) to determine the incidence of hypothyroidism after the COVID 19 infection, the time of onset of hypothyroidism after acute phase of the disease, and the average dose of levothyroxine; and c) to monitor the incidence of subclinical hypothyroidism, which did not require substitution, before and after COVID 19 infection.
METHODS
In the SANASA polyclinic from the 2019 database we found 58 patients, at the age between 18-70 years, 53 women and 2 men with hypothyroidism and 2 female and 1 male patients with subclinical hypothyroidism. In 2020 there were a total of 89 patients, 73 women and 4 men with hypothyroidism, and 9 women and 3 men with subclinical hypothyroidism. In the 2021 there were 101 patients, 86 women and 7 men with hypothyroidism and 7 female and 1 male patients with subclinical hypothyroidism.
RESULTS
There was a significant difference in the number of patients with hypothyroidism and subclinical hypothyroidism during 2020 and 2021 in relation to 2019. The average dose of levothyroxine per patient did not differ statistically, comparing all three years, as well as comparing those who were ill, compared to patients who did not have COVID-19. There were diagnoses of post COVID subclinical hypothyroidism in 2020, as in 2021, with an average time of diagnosis of 2 months after infection for clinical hypothyroidism and 8 weeks for subclinical hypothyroidism.
CONCLUSION
CoV-19 infection adversely affects thyroid tissue causing clinical hypothyroidism, requiring levothyroxine substitution as well as subclinical hypothyroidism which should be monitored.
Topics: Adolescent; Adult; Aged; COVID-19; Female; Hormone Replacement Therapy; Humans; Hypothyroidism; Male; Middle Aged; Thyrotropin; Thyroxine; Young Adult
PubMed: 35422565
DOI: 10.5455/medarh.2022.76.12-16 -
Ugeskrift For Laeger Apr 2023Autoimmune thyroiditis (AIT) is the most common form of acquired hypothyroidism in paediatric patients in iodine-replete populations. AIT is characterised by a gradual...
Autoimmune thyroiditis (AIT) is the most common form of acquired hypothyroidism in paediatric patients in iodine-replete populations. AIT is characterised by a gradual autoimmune destruction of the thyroid gland. The diagnosis is verified by the presence of thyroid autoantibodies. Symptoms are rarely overt and the biochemical picture at presentation varies. This case report describes two paediatric patients that display heterogeneous clinical pictures to illustrate the variety of symptoms of AIT at presentation.
Topics: Humans; Child; Hypothyroidism; Thyroiditis, Autoimmune; Iodine
PubMed: 37114570
DOI: No ID Found