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Clinical Endocrinology Dec 2021Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace... (Observational Study)
Observational Study
OBJECTIVE
Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status.
DESIGN
This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported.
SUBJECTS
Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78).
MEASUREMENTS
Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile).
RESULTS
Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001).
CONCLUSIONS
There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
Topics: Cross-Sectional Studies; Female; Humans; Iodine; Iron; Nutritional Status; Postpartum Period; Prevalence; Selenium; Thyroid Gland; Thyrotropin; Thyroxine
PubMed: 34008190
DOI: 10.1111/cen.14502 -
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 -
Endocrine May 2021The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis... (Review)
Review
The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis form part of the spectrum of visceral involvement linked to SARS-CoV-2. In this review, we will describe the various documented clinical forms of thyroiditis (inflammatory thyroiditis, subacute or de Quervain's thyroiditis, chronic lymphocytic thyroiditis or Hashimoto's disease, painless (silent) postpartum thyroiditis) to facilitate their diagnosis in more or less symptomatic Covid-19 patients and to provide guidance for patient treatment.
Topics: COVID-19; Female; Humans; Pandemics; SARS-CoV-2; Thyroiditis; Thyroiditis, Subacute
PubMed: 33774779
DOI: 10.1007/s12020-021-02689-y -
BMJ (Clinical Research Ed.) Mar 2021
Topics: Adult; Female; Humans; Postpartum Thyroiditis
PubMed: 33658175
DOI: 10.1136/bmj.n495 -
The Quarterly Journal of Nuclear... Jun 2021Hyperthyroidism is a clinical condition characterized by inappropriately high synthesis and secretion of thyroid hormones by the thyroid gland. It has multiple... (Review)
Review
Hyperthyroidism is a clinical condition characterized by inappropriately high synthesis and secretion of thyroid hormones by the thyroid gland. It has multiple aetiologies, manifestations and potential therapies. Graves' disease is the most common form of hyperthyroidism, due to the production of autoantibodies against thyrotropin receptor, capable of over-stimulating thyroid function. A reliable diagnosis of hyperthyroidism can be established on clinical grounds, followed by the evaluation of serum thyroid function tests (thyrotropin first and then free thyroxine, adding the measurement of free triiodothyronine in selected specific situations). The recent guidelines of both the American and European Thyroid Associations have strongly recommended the measurement of thyrotropin receptor autoantibodies for the accurate diagnosis and management of Graves' disease. If autoantibody test is negative, a radioiodine uptake should be performed. Considering the most recent laboratory improvements, binding assays can be considered the best first solution for the measurement of thyrotropin receptor autoantibodies in diagnosis and management of overt cases of Graves' disease. In fact, they have a satisfactory clinical sensitivity and specificity (97.4% and 99.2%, respectively) being performed in clinical laboratories on automated platforms together with the other thyroid function tests. In this setting, the bioassays should be reserved for fine and complex diagnoses and for particular clinical conditions where it is essential to document the transition from stimulating to blocking activity or vice versa (e.g. pregnancy and post-partum, related thyroid eye disease, Hashimoto's thyroiditis with extrathyroidal manifestations, unusual cases after LT4 therapy for hypothyroidism or after antithyroid drug treatment for Graves' disease). Undoubtedly, technological advances will help improve laboratory diagnostics of hyperthyroidism. Nevertheless, despite future progress, the dialogue between clinicians and laboratory will continue to be crucial for an adequate knowledge and interpretation of the laboratory tests and, therefore, for an accurate diagnosis and correct management of the patient.
Topics: Animals; Antithyroid Agents; Autoantibodies; Biosensing Techniques; Cell Line; Humans; Hyperthyroidism; Iodine Radioisotopes; Protein Binding; Receptors, Thyrotropin; Sensitivity and Specificity; Thyroid Gland
PubMed: 33565846
DOI: 10.23736/S1824-4785.21.03344-6 -
International Journal of Clinical... May 2021Thyroid ultrasound, thyroid scintigraphy and radioactive iodine uptake (RAIU) tests are helpful in the differential diagnosis of thyrotoxicosis and hyperthyroidism. In...
BACKGROUND
Thyroid ultrasound, thyroid scintigraphy and radioactive iodine uptake (RAIU) tests are helpful in the differential diagnosis of thyrotoxicosis and hyperthyroidism. In the setting where these techniques are unavailable or unusable more accessible, and cheaper techniques would be helpful.
AIMS
We evaluated the capability of free triiodothyronine to free thyroxine ratio (FT3/FT4) to differentiate Graves' Disease (GD) and destructive thyroiditis (DT).
METHODS
In total, 318 patients with GD and 140 patients with DT were included in the study. Patients were assigned to two groups: GD and DT (subacute thyroiditis, painless thyroiditis, postpartum thyroiditis). Serum thyroid-stimulating hormone (TSH), FT4, FT3 levels and FT3/FT4 ratio were evaluated in each group. To obtain the optimal diagnostic cut-off value of FT3, FT4 and FT3/FT4 ratio, ROC curve analysis was performed of all untreated thyrotoxicosis patients.
RESULTS
The optimal FT3/FT4 ratio cut-off value was 2.96, with a sensitivity of 71.7%, the specificity of 88.6%. The area under the ROC curve of the FT3/FT4 ratio regarding the diagnosis of GD was 0.864 (95% CI: 0.830-0.894). The cut-off level of FT3 for GD was determined as 6.6 pg/mL which had a sensitivity of 72.3% and specificity of 68.6% (AUC = 0.771 P < .001). The cut-off level of FT4 for GD was determined as 3.65 ng/dl with a sensitivity of 35.5% and specificity of 83.6% (AUC = 0.615 P < .001). When a high specificity is needed, FT3/FT4 cut-off value increases to 3.63 with 99.3% specificity and 36.5% sensitivity.
CONCLUSIONS
FT3/FT4 ratio helps distinguish GD and DT. In cases of situations where RAIU/scintigraphy and TRAb cannot be studied, the FT3/FT4 ratio is a viable diagnostic tool. Cut-off values with higher specificity can be more helpful in differential diagnosis of GD.
Topics: Diagnosis, Differential; Female; Humans; Hyperthyroidism; Iodine Radioisotopes; Retrospective Studies; Thyroid Neoplasms; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 33403716
DOI: 10.1111/ijcp.14003 -
Endocrine Journal Mar 2021Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having...
Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.
Topics: Adult; Autoantibodies; COVID-19; Female; Humans; Postpartum Thyroiditis; Recovery of Function; Remission, Spontaneous; SARS-CoV-2; Thyroglobulin
PubMed: 33177251
DOI: 10.1507/endocrj.EJ20-0553 -
Nutrients Sep 2020Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved... (Review)
Review
Vitamin D is a steroid hormone traditionally connected to phosphocalcium metabolism. The discovery of pleiotropic expression of its receptor and of the enzymes involved in its metabolism has led to the exploration of the other roles of this vitamin. The influence of vitamin D on autoimmune disease-namely, on autoimmune thyroid disease-has been widely studied. Most of the existing data support a relationship between vitamin D deficiency and a greater tendency for development and/or higher titers of antibodies linked to Hashimoto's thyroiditis, Graves' disease, and/or postpartum thyroiditis. However, there have also been some reports contradicting such relationships, thus making it difficult to establish a unanimous conclusion. Even if the existence of an association between vitamin D and autoimmune thyroid disease is assumed, it is still unclear whether it reflects a pathological mechanism, a causal relationship, or a consequence of the autoimmune process. The relationship between vitamin D's polymorphisms and this group of diseases has also been the subject of study, often with divergent results. This text presents a review of the recent literature on the relationship between vitamin D and autoimmune thyroid disease, providing an analysis of the likely involved mechanisms. Our thesis is that, due to its immunoregulatory role, vitamin D plays a minor role in conjunction with myriad other factors. In some cases, a vicious cycle is generated, thus contributing to the deficiency and aggravating the autoimmune process.
Topics: Graves Disease; Humans; Thyroiditis, Autoimmune; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 32933065
DOI: 10.3390/nu12092791 -
JPMA. the Journal of the Pakistan... Jun 2020To investigate the effects of haemodynamic indices on colour Doppler ultrasound in differential diagnosis in patients with postpartum thyroiditis and with Graves'...
OBJECTIVE
To investigate the effects of haemodynamic indices on colour Doppler ultrasound in differential diagnosis in patients with postpartum thyroiditis and with Graves' disease.
METHODS
The cross-sectional study was conducted at the Endocrinology Polyclinic of Medical Park Hospital, Ordu, Turkey, from March 2017 to May 2018 and comprised patients referred from the Gynaecology Department for routine check-up after parturition within the first 6 months. The patients were divided into two groups. Group 1 had postpartum thyroiditis patients and Group 2 had those of Graves' disease. In both groups, parameters measured were peak systolic velocity, end-diastolic velocity and resistive index of the inferior thyroid artery with proper angle (45-60⁰) on colour Doppler ultrasound. Data was analysed using SPSS 20.
RESULTS
Of the 42 subjects,18(42.85%) were in Group 1 and 24(57.14%) were in Group 2. Peak systolic velocity and end-diastolic velocity values of the inferior thyroid artery were higher in Group 2 compared to Group 1 (p<005). (p<0.05), while the resistive index value was significantly higher in Group 1 compared to Group 2.
CONCLUSIONS
Due to its wide availability, the use of colour Doppler ultrasound parameters indicating parenchymal perfusion were found to be broadly useful in distinguishing between postpartum thyroiditis and Graves' disease.
Topics: Cross-Sectional Studies; Diagnosis, Differential; Female; Graves Disease; Humans; Postpartum Thyroiditis; Turkey
PubMed: 32810095
DOI: 10.5455/JPMA.13040