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Frontiers in Endocrinology 2020Pharmacological interference on L-thyroxine (L-T4) therapy can be exerted at several levels, namely from the hypothalamus/pituitary through the intestine, where the... (Review)
Review
Pharmacological interference on L-thyroxine (L-T4) therapy can be exerted at several levels, namely from the hypothalamus/pituitary through the intestine, where the absorption of exogenous L-T4 takes place. A number of medications interfere with L-T4 therapy, some of them also being the cause of hypothyroidism. The clinician should be aware that some medications simply affect thyroid function tests with no need of modifying the dose of L-T4 that the patient was taking prior to their prescription. Usually, the topic of pharmacological interference on L-T4 therapy addresses the patient with primary hypothyroidism, in whom periodic measurement of serum thyrotropin (TSH) is the biochemical target. However, this minireview also addresses the patient with central hypothyroidism, in whom the biochemical target is serum free thyroxine (FT4). This minireview also addresses two additional topics. One is the costs associated with frequent monitoring of the biochemical target when L-T4 is taken simultaneously with the interfering drug. The second topic is the issue of metabolic/cardiovascular complications associated with undertreated hypothyroidism.
Topics: Drug Interactions; Humans; Hypothyroidism; Thyroid Function Tests; Thyroid Hormones; Thyroxine
PubMed: 33414765
DOI: 10.3389/fendo.2020.607446 -
Nature Reviews. Endocrinology Nov 2015The coordinated expression and activity of the iodothyronine deiodinases regulate thyroid hormone levels in hypothyroidism. Once heralded as the pathway underpinning... (Review)
Review
The coordinated expression and activity of the iodothyronine deiodinases regulate thyroid hormone levels in hypothyroidism. Once heralded as the pathway underpinning adequate thyroid-hormone replacement therapy with levothyroxine, the role of these enzymes has come into question as they have been implicated in both an inability to normalize serum levels of tri-iodothyronine (T3) and the incomplete resolution of hypothyroid symptoms. These observations, some of which were validated in animal models of levothyroxine monotherapy, challenge the paradigm that tissue levels of T3 and thyroid-hormone signalling can be fully restored by administration of levothyroxine alone. The low serum levels of T3 observed among patients receiving levothyroxine monotherapy occur as a consequence of type 2 iodothyronine deiodinase (DIO2) in the hypothalamus being fairly insensitive to ubiquitination. In addition, residual symptoms of hypothyroidism have been linked to a prevalent polymorphism in the DIO2 gene that might be a risk factor for neurodegenerative disease. Here, we discuss how these novel findings underscore the clinical importance of iodothyronine deiodinases in hypothyroidism and how an improved understanding of these enzymes might translate to therapeutic advances in the care of millions of patients with this condition.
Topics: Animals; Brain Diseases; Humans; Hypothyroidism; Iodide Peroxidase; Thyroid Hormones; Iodothyronine Deiodinase Type II
PubMed: 26416219
DOI: 10.1038/nrendo.2015.155 -
PloS One 2023We hypothesize that synbiotic supplementation could modulate the intestinal microbiota and subsequently, improve the condition of hypothyroid patients. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
We hypothesize that synbiotic supplementation could modulate the intestinal microbiota and subsequently, improve the condition of hypothyroid patients.
METHODS
Fifty-six adult hypothyroid patients were recruited to this double-blind, placebo-controlled, randomized clinical trial. The intervention was 10 weeks of synbiotic (500 mg of 109 CFU/g probiotics plus fructo-oligosaccharide, n = 28) compared to placebo (lactose, magnesium stearate, talc, and silicon dioxide, n = 28). Randomization and allocation to trial groups were carried out using random number sequences drawn from https://sealedenvelope.com/. Primary outcomes were serum thyroid stimulating hormone (TSH) and free thyroxine (FT4), and secondary outcomes were depression, quality of life, and blood pressure (BP). P-values< 0.05 were considered statistically significant.
RESULTS
Analysis on 51 patients who completed the trial showed that TSH and depression (p> 0.05) did not change significantly, while serum FT4 significantly increased in both groups (p = 0.03 and p = 0.02 in symbiotic and placebo respectively). A significant decrease in systolic BP occurred only in the synbiotic group (p = 0.05). Significant improvements occurred regarding different domains and areas of quality of life in the crude and adjusted analysis, including perceived mental health (p = 0.02), bodily pain (p = 0.02), general health perception (p = 0.002), and wellbeing (p = 0.002), which were significantly higher in the synbiotic group.
CONCLUSIONS
Ten-week supplementation with synbiotic had no favorable effect on depression and TSH, but it improved blood pressure and quality of life in patients with hypothyroidism. More trials are needed to support or reject these findings.
TRIAL REGISTRATION
IRCT20210926052583N1, Iranian Registry of Clinical Trials (IRCT), registered October 1st, 2021.
Topics: Adult; Humans; Synbiotics; Iran; Quality of Life; Hypothyroidism; Thyrotropin; Double-Blind Method
PubMed: 36745650
DOI: 10.1371/journal.pone.0277213 -
Ethiopian Journal of Health Sciences Nov 2023Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia....
BACKGROUND
Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia.
METHODS
A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism.
RESULTS
The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively.
CONCLUSION
Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.
Topics: Humans; Anemia, Sickle Cell; Hypothyroidism; Child; Male; Cross-Sectional Studies; Female; Nigeria; Thyrotropin; Child, Preschool; Prevalence; Adolescent; Thyroxine; Triiodothyronine; Thyroid Hormones; Infant
PubMed: 38784480
DOI: 10.4314/ejhs.v33i6.6 -
Frontiers in Endocrinology 2023Primary cilia (PC) are non-motile and microtube-based organelles protruding from the surface of almost all thyroid follicle cells. They maintain homeostasis in... (Review)
Review
Primary cilia (PC) are non-motile and microtube-based organelles protruding from the surface of almost all thyroid follicle cells. They maintain homeostasis in thyrocytes and loss of PC can result in diverse thyroid diseases. The dysfunction of structure and function of PC are found in many patients with common thyroid diseases. The alterations are associated with the cause, development, and recovery of the diseases and are regulated by PC-mediated signals. Restoring normal PC structure and function in thyrocytes is a promising therapeutic strategy to treat thyroid diseases. This review explores the function of PC in normal thyroid glands. It summarizes the pathology caused by PC alterations in thyroid cancer (TC), autoimmune thyroid diseases (AITD), hypothyroidism, and thyroid nodules (TN) to provide comprehensive references for further study.
Topics: Humans; Cilia; Thyroid Neoplasms; Hypothyroidism; Thyroid Nodule; Hashimoto Disease
PubMed: 38260150
DOI: 10.3389/fendo.2023.1306550 -
Scandinavian Journal of Primary Health... Sep 2023The objective was to explore the management of newly diagnosed hypothyroidism in adults regarding laboratory diagnostics and treatment in Region Halland (RH). In... (Observational Study)
Observational Study
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.
Topics: Adult; Humans; Adolescent; Thyrotropin; Sweden; Hypothyroidism; Thyroxine
PubMed: 37224192
DOI: 10.1080/02813432.2023.2213748 -
Endocrine Regulations Oct 2022Cardiovascular diseases (CVD) and thyroid dysfunction are two of the most prevailing disorders in the world that are closely interlinked. Actions of thyroid hormones are... (Review)
Review
Cardiovascular diseases (CVD) and thyroid dysfunction are two of the most prevailing disorders in the world that are closely interlinked. Actions of thyroid hormones are mediated via thyroid receptors present in the myocardium and the vascular tissue. Primary mechanism that links thyroid dysfunction with CVD is the modification of cardiovascular risk factors (dyslipidemia, blood pressure, coagulation parameters, etc.) resulting in endothelial and left ventricular systolic and diastolic dysfunction. Both overt and subclinical hyperthyroidism and hypothyroidism may cause adverse alterations in cardiac function. Hyperthyroidism gives rise to palpitation, atrial fibrillation, systolic hypertension, and heart failure, whereas hypothyroidism increases diastolic hypertension, pericardial effusion, and the risk of ischemic heart disease via altering lipid and coagulation parameters. Early recognition and treatment of thyroid dysfunction may prevent adverse cardiovascular events in patients with or without pre-existing CVD. Certain cardiac conditions and medications can cause alterations in thyroid function that may predispose an individual to higher morbidity and mortality. In certain situations, thyroid dysfunction treatment may have cardiovascular benefits. This study deals with the interplay between cardiovascular and thyroid dysfunctions associated with clinical implications and management strategies.
Topics: Humans; Hyperthyroidism; Hypothyroidism; Thyroid Diseases; Thyroid Hormones; Cardiovascular Diseases; Hypertension; Lipids
PubMed: 36270343
DOI: 10.2478/enr-2022-0033 -
Pediatric Research Feb 2023A rise in the incidence of congenital hypothyroidism (CH) has been reported worldwide. This nationwide study aimed to describe the secular trends and current incidence...
BACKGROUND
A rise in the incidence of congenital hypothyroidism (CH) has been reported worldwide. This nationwide study aimed to describe the secular trends and current incidence of CH in Finland.
METHODS
Two independent study cohorts, a national and a regional, were collected from national registers and patient records. The national cohort represents all CH cases born in Finland between 1994 and 2017. Birth data, results of the screening test, and the incidence of CH were reviewed.
RESULTS
Between 1994 and 2017, 1,400,028 children were born in Finland. Of these children, 503 were diagnosed with primary CH (incidence 1:2783). Male-to-female sex ratio was 1:2.0. The nationwide incidence was 33 cases per 100,000 live births between 1994 and 1999, 38 cases per 100,000 live births between 2000 and 2005, 40 cases per 100,000 live births between 2006 and 2011, and 33 cases per 100,000 live births between 2012 and 2017. In the regional cohort (n = 139), the incidence of transient CH was 3.6%. The incidence of mild, moderate, and severe CH remained constant.
CONCLUSIONS
In Finland, the incidence of CH has not changed during the 24-year study period.
IMPACT
As opposed to recent reports worldwide, the incidence of congenital hypothyroidism has not changed between 1994 and 2017 in Finland. The proportions of mild, moderate, and severe congenital hypothyroidism did not change significantly over the study period. Lowering the TSH cut-off limit or increasing immigration did not affect the incidence rate of primary congenital hypothyroidism in Finland.
Topics: Child; Humans; Male; Female; Infant, Newborn; Congenital Hypothyroidism; Incidence; Finland; Thyrotropin; Neonatal Screening
PubMed: 35661828
DOI: 10.1038/s41390-022-02118-4 -
The Journal of Clinical Endocrinology... Nov 2023Clinical guidelines have recommended a trial of liothyronine (LT3) with levothyroxine (LT4) in select patients with hypothyroidism. However, little is known about the...
CONTEXT
Clinical guidelines have recommended a trial of liothyronine (LT3) with levothyroxine (LT4) in select patients with hypothyroidism. However, little is known about the real-world use of LT3 and desiccated thyroid extract (DTE) and the characteristics of patients treated with LT3 and DTE.
OBJECTIVES
(1) Determine national trends of new LT4, LT3, and DTE prescriptions in the United States; (2) determine whether sociodemographic, healthcare access, and dietary factors are associated with different thyroid hormone (TH) therapies.
METHODS
Parallel cross-sectional studies were conducted using 2 datasets: (1) a national patient claims dataset (2010-2020) and (2) the National Health and Nutrition Examination Study (NHANES) dataset (1999-2016). Included participants had a diagnosis of primary or subclinical hypothyroidism. Study outcomes included the impact of demographics and healthcare access on differences in the proportion of TH therapies consisting of LT4, LT3, and DTE (patient claims) and differences in dietary behaviors between DTE-treated participants and LT4-treated matched controls (NHANES).
RESULTS
On an average annual basis, 47 711 adults received at least 1 new TH prescription, with 88.3% receiving LT4 monotherapy, 2.0% receiving LT3 therapy, and 9.4% receiving DTE therapy. The proportion receiving DTE therapy increased from 5.4% in 2010 to 10.2% in 2020. In the analysis between states, high primary care and endocrinology physician densities were associated with increased use of LT4 monotherapy (odds ratio 2.51, P < .001 and odds ratio 2.71, P < .001). DTE-treated NHANES participants (n = 73) consumed more dietary supplements compared to LT4-treated participants (n = 146) (4.7 vs 2.1, P < .001).
CONCLUSIONS
The proportion of new TH therapies containing DTE for hypothyroidism doubled since 2010 while LT3 therapies remained stable. DTE treatment was associated with decreased physician density and increased dietary supplement use.
Topics: Adult; Humans; Nutrition Surveys; Cross-Sectional Studies; Hypothyroidism; Thyroxine; Triiodothyronine; Thyroid Hormones; Demography
PubMed: 37327351
DOI: 10.1210/clinem/dgad331 -
Canadian Family Physician Medecin de... Apr 2018To summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice. (Review)
Review
OBJECTIVE
To summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice.
QUALITY OF EVIDENCE
Study selection involved routine literature surveillance by a group of primary care health professionals. This included screening abstracts of important journals and Evidence Alerts, as well as searching the American College of Physicians Journal Club.
MAIN MESSAGE
Topics of the 2017 articles include whether treating subclinical hypothyroidism improves outcomes or symptoms; whether evolocumab reduces cardiovascular disease as well as low-density lipoprotein levels; whether lifestyle interventions reduce medication use in patients with diabetes; whether vitamin D prevents cardiovascular disease, cancer, or upper respiratory tract infections; whether canagliflozin reduces clinical events in patients with diabetes; how corticosteroid injections affect knee osteoarthritis; whether drained abscesses benefit from antibiotic treatment; whether patients with diabetes benefit from bariatric surgery; whether exenatide reduces clinical events in patients with diabetes; and whether tympanostomy tubes affect outcomes in recurrent acute otitis media or chronic otitis media. We provide brief summaries, context where needed, and final recommendations for 10 studies with potential effects on primary care. We also briefly review 5 "runner-up" studies.
CONCLUSION
Research from 2017 produced several high-quality studies in diabetes management. These have demonstrated benefit for alternative therapies and offered evidence not previously available. This year's selection of studies also provided information on a variety of conditions and therapies that are, or might become, more common in primary care settings.
Topics: Biomedical Research; Cardiovascular Diseases; Diabetes Mellitus; Humans; Hypothyroidism; Primary Health Care; Randomized Controlled Trials as Topic
PubMed: 29650603
DOI: No ID Found