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JCEM Case Reports Jul 2023Lithium is not commonly used to treat thyrotoxicosis, and there are few reports in the literature of its use as initial therapy in thyrotoxicosis. We describe the case...
Lithium is not commonly used to treat thyrotoxicosis, and there are few reports in the literature of its use as initial therapy in thyrotoxicosis. We describe the case of a patient with Graves thyrotoxicosis and ophthalmopathy, on a background of autoimmune neutropenia, treated successfully with relatively long-term lithium monotherapy. Lithium was used at a lower dose and longer duration than previously reported on, to good effect. We demonstrate that lithium is an important and useful option for those who are unable to tolerate thionamide therapy.
PubMed: 37908984
DOI: 10.1210/jcemcr/luad094 -
Frontiers in Endocrinology 2023Moyamoya disease (MMD), also known as abnormal cerebral vascular network disease, is characterized by progressive occlusion or stenosis of the internal carotid and... (Review)
Review
Moyamoya disease (MMD), also known as abnormal cerebral vascular network disease, is characterized by progressive occlusion or stenosis of the internal carotid and cerebral arteries, as well as the formation of an abnormal cerebral vascular network. It can occur anywhere in the world but is most common in China, Japan, and the Republic of Korea. In recent years, there have been increasing reports on the coexistence of thyroid diseases and MMD, but the mechanism of their coexistence is still unclear. For this article, we used keywords such as "moyamoya disease", "thyroid", "Grave disease", "thyrotoxicosis", and "thyroid autoimmune antibodies" to search for 52 articles that met the requirements in medical databases such as PubMed and Web of Science. This article also reviews the research on the role of thyroid hormone, the mechanism of immune antibodies, the possible correlation between thyroid diseases and MMD disease genes, and the treatment methods, and discusses the possible relationship between MMD and thyroid diseases to provide a reference for the pathogenesis and treatment of MMD with thyroid diseases.
Topics: Humans; Moyamoya Disease; Thyroid Diseases; Thyrotoxicosis; Japan
PubMed: 37900127
DOI: 10.3389/fendo.2023.1233567 -
Problemy Endokrinologii Jun 2023Multiple sclerosis (MS) is a severe chronic autoimmune demyelinating disease of the central nervous system, mediated by Th1/Th17 lymphocytes as well as B lymphocytes,...
Multiple sclerosis (MS) is a severe chronic autoimmune demyelinating disease of the central nervous system, mediated by Th1/Th17 lymphocytes as well as B lymphocytes, macrophages and other immune cells. Some patients with MS are treated with alemtuzumab, a monoclonal antibody against CD52+ cells, which belongs to the disease-modifying therapies (DMTs). The main effect of alemtuzumab is related to changes in immune recruitment. Alemtuzumab therapy can induce secondary autoimmunity against the background of immune rebalancing. The thyroid gland is generally involved in the autoimmune process. Graves' disease (GD) develops most often, followed by autoimmune thyroiditis.We present a clinical case of a patient with GD developed after alemtuzumab therapy for MS. The patient was referred to a radiologist at the Department of Radionuclide Therapy of Endocrinology Research Centre for radioiodine therapy (RAIT) due to relapse of thyrotoxicosis after anti-thyroid drug therapy for GD. The goal of treatment was achieved in 2 months, thyroid hormone therapy was initiated, against the background of this, there was compensation of thyroid function.
Topics: Humans; Alemtuzumab; Iodine Radioisotopes; Neoplasm Recurrence, Local; Graves Disease; Multiple Sclerosis
PubMed: 37448247
DOI: 10.14341/probl13238 -
Endocrine Feb 2024Immune checkpoint inhibitors (ICIs) are a revolutionary class of drugs that powerfully contribute to cancer therapy by harnessing the immune system to fight... (Review)
Review
Immune checkpoint inhibitors (ICIs) are a revolutionary class of drugs that powerfully contribute to cancer therapy by harnessing the immune system to fight malignancies. However, their successful use as anti-cancer drugs is accompanied by a wide spectrum of immune-related adverse effects (irAEs), including endocrinopathies. Among them, thyroid dysfunction stands out as one of the most common endocrinopathies induced by ICI therapy and surfaces as a prominent concern. Destructive thyroiditis is the pathophysiological basis shared by the most common patterns of thyrotoxicosis followed by hypothyroidism and isolated hypothyroidism. Diagnostic approach is guided by clinical manifestation, laboratory evaluation and imaging modalities. Treatment approaches range from the substitution of levothyroxine to the utilization of beta blockers, depending on the extent of thyroid dysfunction's severity. While the medical community is dealing with the evolution and complexities of immunotherapy, recognizing and effectively managing ICI-induced thyroid dysfunction emerged as crucial for enhancing patient safety and achieving improved outcomes. The aim of this review is to navigate the significance of ICI-induced thyroid dysfunction unraveling the various patterns, underlying mechanisms, diagnostic approaches, and treatment strategies. It, also, highlights the impact of various factors such as cancer subtype, ICI dosage, age, and genetic susceptibility on the risk of experiencing dysfunction.
PubMed: 38345684
DOI: 10.1007/s12020-024-03718-2 -
Thyroid : Official Journal of the... Jun 2024Introduction Thyroid hormone transporters are essential for thyroid hormones to enter target cells. Monocarboxylate transporter MCT8 is a key transporter and expressed...
Introduction Thyroid hormone transporters are essential for thyroid hormones to enter target cells. Monocarboxylate transporter MCT8 is a key transporter and expressed at the blood-brain barrier, in neural cells and many other tissues. Patients with MCT8 deficiency have severe neurodevelopmental delays due to cerebral hypothyroidism and chronic sequelae of peripheral thyrotoxicosis. The T3 analog 3,3,5-triiodothyroacetic acid (TRIAC) rescued neurodevelopmental features in animal models mimicking MCT8 deficiency and improved key metabolic features in patients with MCT8 deficiency. However, the identity of the transporter(s) that facilitate TRIAC transport are unknown. Here, we screened candidate transporters that are expressed at the human blood-brain barrier and/or brain-cerebrospinal fluid barrier and known thyroid hormone transporters for TRIAC transport. Materials and methods Plasma membrane expression was determined by cell surface biotinylation assays. Intracellular accumulation of 1 nM TRIAC was assessed in COS-1 cells expressing candidate transporters in Dulbecco's phosphate buffered saline (DPBS)/0.1% glucose or Dulbecco's modified Eagle's medium (DMEM) with or without 0.1% bovine serum albumin (BSA). Expression of Slc22a8 was determined by fluorescent in situ hybridization (FISH) in brain sections from wild-type and Mct8/Oatp1c1 knock-out mice at postnatal day 12, 21 and 120. Results Fifty-nine plasma membrane transporters were selected for screening of TRIAC accumulation (n=40 based on expression at the human blood-brain barrier and/or brain-cerebrospinal fluid barrier and having small organic molecules as substrates; n=19 known thyroid hormone transporters). Screening of the selected transporter panel showed that 18 transporters facilitated significant intracellular accumulation of TRIAC in DPBS/0.1% glucose or DMEM in the absence of BSA. In the presence of BSA, substantial transport was noted for SLCO1B1 and SLC22A8 (in DPBS/0.1% glucose and DMEM) and SLC10A1, SLC22A6 and SLC22A24 (in DMEM). The zebrafish and mouse orthologues of these transporters similarly facilitated intracellular accumulation of TRIAC. Highest Slc22a8 mRNA expression was detected in mouse brain capillary endothelial cells and choroid plexus epithelial cells at early postnatal time points, but wasreduced at P120. Conclusions Human SLC10A1, SLCO1B1, SLC22A6, SLC22A8 and SLC22A24 as well as their mouse and zebrafish orthologues are efficient TRIAC transporters. These findings contribute to the understanding of TRIAC treatment in patients with MCT8 deficiency and animal models thereof.
PubMed: 38836423
DOI: 10.1089/thy.2023.0467 -
Danish Medical Journal Oct 2023The diagnosis and management of subacute thyroiditis (SAT) may be challenging, and more evidence on patient and disease characteristics is warranted.
INTRODUCTION
The diagnosis and management of subacute thyroiditis (SAT) may be challenging, and more evidence on patient and disease characteristics is warranted.
METHODS
This was a retrospective cohort study of all patients in the North Denmark Region with a SAT diagnosis in the Danish National Patient Registry, 2016-2018. The medical records and biochemical results prior to the diagnosis and during a two-year follow-up period were reviewed.
RESULTS
A total of 71 patients with a SAT diagnosis were identified, and the diagnosis was verified in 44 (62.0%) cases with an incidence rate of 2.4/100,000/year. Patients with verified SAT were predominantly females (72.7%) with a median age of 50.7 years. Biochemical results showed thyrotoxicosis at the initial examination in 69.8% and elevated C-reactive protein in 86.5% of patients. Longitudinal biochemical assessment showed a biphasic response (median thyroid-stimulating hormone, initially: 0.02 mIU/l, at three months: 4.7 mIU/l and 2.4 mIU/l after two years). Treatment with non-steroidal anti-inflammatory drugs, beta-blockers and/or prednisolone was initiated in 23 of the 38 patients (60.5%) evaluated, and ten of 33 patients (30.3%) with follow-up data received thyroid hormone replacement therapy.
CONCLUSION
In the North Denmark Region, a hospital diagnosis of SAT was verified in less than two thirds of cases. Further large studies are warranted to extend the findings concerning the treatment and outcome of SAT.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Female; Humans; Middle Aged; Male; Thyroiditis, Subacute; Retrospective Studies; Prednisolone; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 37897374
DOI: No ID Found -
European Journal of Nuclear Medicine... May 2024
Topics: Humans; Thyroid Neoplasms; Thyrotoxicosis
PubMed: 38172355
DOI: 10.1007/s00259-023-06580-y -
BMJ Nutrition, Prevention & Health 2023An outbreak of exogenous thyrotoxicosis is an uncommon cause of thyrotoxicosis. This study aimed to investigate the characteristics and outcomes of exogenous...
INTRODUCTION
An outbreak of exogenous thyrotoxicosis is an uncommon cause of thyrotoxicosis. This study aimed to investigate the characteristics and outcomes of exogenous thyrotoxicosis and electrolyte imbalance in a prison during an outbreak of exogenous thyrotoxicosis in the Phitsanulok, Thailand prison.
METHODS
This study collected cross-sectional data during an outbreak of thyrotoxicosis among inmates at Phitsanulok prison between 29 December 2019 and 17 January 2020. In the first phase, a total of 2815 prisoners were screened for thyroid-stimulating hormone (TSH), potassium levels and pulse rate. In the second phase, samples from 490 male prisoners were collected for test on thyroid function, serum electrolytes and urine electrolytes. Thyroglobulin levels were also measured in patients with thyrotoxicosis. A questionnaire was used to obtain patient information about signs and symptoms of thyrotoxicosis.
RESULTS
The prevalence of subclinical thyrotoxicosis was 78.1%. The pulse rate was significantly higher in the subclinical thyrotoxicosis group. Weight loss, palpitation, muscle weakness and fatigue were found predominantly in the subclinical thyrotoxicosis group. The prevalence of hypokalaemia was 38.4%; however, there was no difference between subclinical thyrotoxicosis and normal TSH. The mean magnesium levels were significantly lower in the subclinical thyrotoxicosis group. Patients with hypokalaemia mainly showed potassium loss through the kidneys. Almost all patients with suppressed TSH levels had low to normal thyroglobulin levels. In addition, the mean of calculated total step-up deiodinase activity in patients with subclinical thyrotoxicosis was lower than 30 nmol/s, which was an additional clue to confirm exogenous thyrotoxicosis. The frozen meat during the outbreak had higher levels of thyroid hormone compared with the control group.
CONCLUSIONS
With an outbreak of thyrotoxicosis, most likely due to exposure to exogenous thyroid hormone in frozen meat, our findings have raised awareness of nutritional problems in prison. The development of surveillance systems to prevent outbreaks is urgently needed.
PubMed: 38618547
DOI: 10.1136/bmjnph-2023-000789 -
The Journal of Clinical Endocrinology... Dec 2023Hyperthyroidism in pregnancy is a clinical concern, and surveillance of any change in the occurrence of hyperthyroidism in pregnancy is important, especially when a...
CONTEXT
Hyperthyroidism in pregnancy is a clinical concern, and surveillance of any change in the occurrence of hyperthyroidism in pregnancy is important, especially when a mandatory iodine fortification (IF) program is implemented such as in Denmark in the year 2000.
OBJECTIVE
To investigate any change in the occurrence of hyperthyroidism and the use of antithyroid drugs (ATDs) in Danish pregnant women during a 20-year period before and after the implementation of IF.
METHODS
A nationwide register-based cohort (1997-2016) and 2 birth cohorts with biochemical data (the Danish National Birth Cohort, 1997-2003, and the North Denmark Region Pregnancy Cohort, 2011-2015) were used to study maternal use of ATDs in pregnancy and frequency of early pregnancy biochemical hyperthyroidism during a 20-year period prior to and after the implementation of mandatory IF.
RESULTS
In the nationwide cohort, the adjusted odds ratio (aOR) for treatment with ATDs was 1.51 (95% CI, 1.30-1.74) after mandatory IF (2001-2004) compared with baseline (1997-1999). The increase was more pronounced in the previously moderately iodine-deficient West Denmark (aOR 1.67; 95% CI, 1.36-2.04) than the mildly deficient East Denmark (aOR 1.30; 95% CI, 1.06-1.60) and returned to baseline levels at the end of follow-up in both regions. No time-related difference in early pregnancy biochemical hyperthyroidism was observed.
CONCLUSION
The use of ATDs in Danish pregnant women increased following the implementation of IF and then leveled out. Results comply with observations in the general Danish population and suggest that IF influences the occurrence of autoimmune hyperthyroidism in younger individuals.
Topics: Female; Humans; Pregnancy; Pregnant Women; Cohort Studies; Hyperthyroidism; Antithyroid Agents; Iodine; Pregnancy Complications; Denmark
PubMed: 37437100
DOI: 10.1210/clinem/dgad410