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Lancet (London, England) Aug 2003Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormone. The most common cause of this syndrome is... (Review)
Review
Hyperthyroidism is a pathological syndrome in which tissue is exposed to excessive amounts of circulating thyroid hormone. The most common cause of this syndrome is Graves' disease, followed by toxic multinodular goitre, and solitary hyperfunctioning nodules. Autoimmune postpartum and subacute thyroiditis, tumours that secrete thyrotropin, and drug-induced thyroid dysfunction, are also important causes. The diagnosis of hyperthyroidism is generally straightforward, with raised serum thyroid hormones and suppressed serum thyrotropin in almost all cases. Appropriate treatment of hyperthyroidism relies on identification of the underlying cause. Antithyroid drugs, radioactive iodine, and surgery are the traditional treatments for the three common forms of hyperthyroidism. Beta-adrenergic blocking agents are used in most patients for symptomatic relief, and might be the only treatment needed for thyroiditis, which is transient. The more unusual causes of hyperthyroidism, including struma ovarii, thyrotropin-secreting tumours, choriocarcinoma, and amiodarone-induced thyrotoxicosis are, more often than not, a challenge to diagnose and treat.
Topics: Antithyroid Agents; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Pregnancy; Thyroidectomy
PubMed: 12927435
DOI: 10.1016/S0140-6736(03)14073-1 -
European Journal of Endocrinology Jul 1998
Review
Topics: Autoantibodies; Female; Forecasting; Humans; Iodide Peroxidase; Mass Screening; Pregnancy; Puerperal Disorders; Risk Factors; Thyroiditis
PubMed: 9703370
DOI: 10.1530/eje.0.1390012 -
Acta Medica Portuguesa 2009In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear,... (Review)
Review
In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear, and is observed a return to a normal state - after an exacerbation period - of autoimmune reactivity, during which a great increase in T cells and autoantibodies is observed. In this period - 3 to 9 months after birth - the thyroid autoimmune disease relapses or reappears. The reactivation of the immune system in the post-partum period unchains an acute phase of celular destruction which characterizes the post-partum thyroiditis.
Topics: Female; Humans; Puerperal Disorders; Thyroiditis
PubMed: 19944044
DOI: No ID Found -
Radiographics : a Review Publication of... 2001The term autoimmune thyroiditis encompasses multiple inflammatory conditions of the thyroid gland, each with variable clinical manifestations. The more acute forms,... (Review)
Review
The term autoimmune thyroiditis encompasses multiple inflammatory conditions of the thyroid gland, each with variable clinical manifestations. The more acute forms, silent (painless) thyroiditis and postpartum thyroiditis, are associated with transient hyperthyroidism and are sometimes mistaken for Graves disease. The chronic form, Hashimoto thyroiditis (chronic autoimmune thyroiditis), results in goiter and eventual hypothyroidism unless it is recognized and treated promptly. Thyroid uptake measurements and scintigraphic findings (usually obtained with technetium-99m or iodine-123) play a complementary role along with thyroid function testing in differentiating autoimmune thyroiditis from other thyroid diseases, thereby influencing treatment. In some cases, histologic evaluation of biopsy specimens is required to yield the definitive diagnosis. Knowledge of the entire spectrum of these disorders is essential for appropriate case management.
Topics: Diagnosis, Differential; Humans; Radionuclide Imaging; Thyroiditis, Autoimmune
PubMed: 11452070
DOI: 10.1148/radiographics.21.4.g01jl17957 -
Romanian Journal of Internal Medicine =... 2009Autoimmune thyroid diseases (Hashimoto thyroiditis, Graves' disease, postpartum thyroiditis, atrophic thyroiditis and drug induced thyroiditis) are prevalent disorders... (Review)
Review
Autoimmune thyroid diseases (Hashimoto thyroiditis, Graves' disease, postpartum thyroiditis, atrophic thyroiditis and drug induced thyroiditis) are prevalent disorders worldwide, especially in women (related to the millieu of sex steroids and X chromosome effects on the thyroid and the immune system). Disruption of thyroid self tolerance, usually induced by an infection, generates abnormal thyroid--immune interactions, implicating an array of cytokines and their receptors. Thyrocytes achieve antigen presenting cell properties which stimulate effector immune cells (Th1, Th2, Th17), in the context of defective immunomodulatory T regulatory cells, resulting in thyroid lymphocytic infiltration and activation of B cells, with production of antibodies against thyroid antigens, thyroid destruction or stimulation, depending on the Th1-Th2 balance. During pregnancy there is a Th2 predominance sustained by the increased glucocorticoid, estrogen and progesteron levels, which allows tolerance versus the histoincompatible fetoplacental unit. In the postpartum period, the return shift Th2 to Th1 favors the occurrence of postpartum thyroiditis. Altered thyroid hormone levels can influence the immune system, and, on the other side, some immune cells secrete TSH, which exerts endocrine and paracrine, cytokine-like effects. Understanding the complex pathogenesis of autoimmune thyroid disorders is crucial for prevention and management.
Topics: Autoimmune Diseases; Autoimmunity; B-Lymphocytes; Female; Humans; Pregnancy; Pregnancy Complications; T-Lymphocytes; Thyroid Diseases; Thyroid Gland; Thyroiditis, Autoimmune
PubMed: 20446435
DOI: No ID Found -
Nutrients May 2022Selenium (Se) is an essential trace element with antioxidant and anti-inflammatory properties and a pivotal role in thyroid metabolism. Ensuring a sufficient Se supply... (Review)
Review
Selenium (Se) is an essential trace element with antioxidant and anti-inflammatory properties and a pivotal role in thyroid metabolism. Ensuring a sufficient Se supply is possible via a balanced, wholesome diet; however, Se content in foods may be different throughout geographical areas. Se supplementation is expected to improve inflammatory status in patients with autoimmune thyroiditis, especially in those with high activity, and has been demonstrated as effective in reducing the thyroid peroxidase antibodies titer. Se status seems to affect thyroid function in pregnancy, which prompts the potential role of Se supplementation in such patients. Few clinical trials have investigated the effectiveness of Se supplementation in pregnant women with thyroiditis, and their results suggest the safety and effectiveness of this element in reducing autoantibody levels and preventing postpartum thyroiditis development, although limited. Hence, more robust evidence is needed to confirm these data. The current study aims to summarize published data on the relationship between Se and thyroid status in pregnant women with thyroiditis and the potential use of Se. Moreover, an algorithm for Se supplementation is proposed for pregnant women with thyroiditis to help endocrinologists in daily clinical practice to consider Se status.
Topics: Dietary Supplements; Female; Hashimoto Disease; Humans; Pregnancy; Pregnant Women; Selenium; Thyroiditis, Autoimmune
PubMed: 35684035
DOI: 10.3390/nu14112234 -
Der Internist Jul 2018During pregnancy thyroid hormones have profound effects on embryonal/fetal development and maternal health. Therefore, thyroid gland disorders should be immediately... (Review)
Review
During pregnancy thyroid hormones have profound effects on embryonal/fetal development and maternal health. Therefore, thyroid gland disorders should be immediately diagnosed and adequately treated. Pregnancy-specific physiological alterations during pregnancy cause changes in the reference interval for thyroid-stimulating hormone levels and trimester-specific thresholds must be taken into account. This article summarizes the most important diagnostic and therapeutic aspects before, during and after pregnancy. With reference to the period prior to pregnancy, the article discusses iodide supplementation, preconceptional examination of thyroid gland metabolism and the importance of thyroid gland functional disorders for fertility and fulfilling the desire to have children. With a view to the period during pregnancy, the effect of hypothyroxinemia, hypothyroidism, and hyperthyroidism as well as the effects of their treatment on the development of the child are explained. Finally, a description is given of what must be paid attention to in the breast-feeding period and in postpartum thyroiditis.
Topics: Female; Humans; Hyperthyroidism; Hypothyroidism; Pregnancy; Pregnancy Complications; Thyroid Diseases
PubMed: 29774380
DOI: 10.1007/s00108-018-0435-0 -
Journal of Thyroid Research 2014Background. Postpartum thyroiditis (PPT) is a common triphasic autoimmune disease in women with thyroid peroxidase (TPO) autoantibodies. This study evaluated women's...
Background. Postpartum thyroiditis (PPT) is a common triphasic autoimmune disease in women with thyroid peroxidase (TPO) autoantibodies. This study evaluated women's thyroid disease symptoms, physical findings, stress levels, and thyroid stimulating hormone (TSH) levels across six postpartum months in three groups, TPO negative, TPO positive, and PPT positive women. Methods. Women were recruited in midpregnancy (n = 631) and TPO status was determined which then was used to form the three postpartum groups. The three groups were compared on TSH levels, thyroid symptoms, weight, blood pressure, heart rate, a thyroid exam, and stress scores. Results. Fifty-six percent of the TPO positive women developed PPT. Hypothyroid group (F (2, 742) = 5.8, P = .003) and hyperthyroid group (F (2, 747) = 6.6, P = .001) subscale scores differed by group. Several symptoms and stress scores were highest in the PPT group. Conclusions. The normal postpartum is associated with many symptoms that mimic thyroid disease symptoms, but severity is greater in women with either TPO or PPT positivity. While the most severe symptoms were generally seen in PPT positive women, even TPO positive women seem to have higher risk for these signs and symptoms.
PubMed: 25405057
DOI: 10.1155/2014/531969 -
Progress in Clinical and Biological... 1981The term "subacute thyroiditis" has come to be applied to two rather distinct forms of inflammation of the thyroid gland, both of which run courses lasting several weeks... (Review)
Review
The term "subacute thyroiditis" has come to be applied to two rather distinct forms of inflammation of the thyroid gland, both of which run courses lasting several weeks to several months. While it is clear that the term "subacute thyroiditis" connotes a temporal quality only, and could conceivably apply to any inflammatory process of intermediate severity and duration, by current usage it excludes several forms of infective (ie, bacterial fungal) thyroiditis. On the other hand, it specifically includes a painful form of thyroiditis of probable viral origin (de Quervain or pseudogranulomatous thyroiditis), and a painless form of thyroiditis, which may be called "subacute lymphocytic thyroiditis." The latter term does not necessarily imply that there is any relationship to chronic lymphocytic thyroiditis, as will be discussed carefully below.
Topics: Autoimmune Diseases; Female; Humans; Postpartum Period; Pregnancy; Thyroiditis; Thyroiditis, Autoimmune
PubMed: 7033979
DOI: No ID Found -
Current Opinion in Obstetrics &... Dec 2015Recognition and management of thyroid disease during pregnancy is challenging with conflicting recommendations from various professional organizations. (Review)
Review
PURPOSE OF REVIEW
Recognition and management of thyroid disease during pregnancy is challenging with conflicting recommendations from various professional organizations.
RECENT FINDINGS
We review the literature related to the diagnosis and management of gestational hypothyroidism and hyperthyroidism. We also discuss postpartum thyroiditis, thyroid nodules and thyroid cancer. The evidence clearly demonstrates that both overt hypothyroidism and hyperthyroidism should be treated, but controversy exists regarding the treatment of subclinical hypothyroidism and thyroid antibody positive euthyroidism, and whether pregnant women should be screened for thyroid disease.
SUMMARY
Appropriate management of thyroid disease during pregnancy is important for maternal and fetal health, particularly the recognition and management of hypothyroidism and thyrotoxicosis.
Topics: Adult; Early Diagnosis; Female; Humans; Hyperthyroidism; Hypothyroidism; Mass Screening; Postpartum Period; Pregnancy; Pregnancy Complications; Thyroid Gland; Thyroid Hormones; Thyroid Neoplasms; Thyroiditis
PubMed: 26485458
DOI: 10.1097/GCO.0000000000000226