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Cells Mar 2023The most common cause of acquired thyroid dysfunction is autoimmune thyroid disease, which is an organ-specific autoimmune disease with two presentation phenotypes:... (Review)
Review
The most common cause of acquired thyroid dysfunction is autoimmune thyroid disease, which is an organ-specific autoimmune disease with two presentation phenotypes: hyperthyroidism (Graves-Basedow disease) and hypothyroidism (Hashimoto's thyroiditis). Hashimoto's thyroiditis is distinguished by the presence of autoantibodies against thyroid peroxidase and thyroglobulin. Meanwhile, autoantibodies against the TSH receptor have been found in Graves-Basedow disease. Numerous susceptibility genes, as well as epigenetic and environmental factors, contribute to the pathogenesis of both diseases. This review summarizes the most common genetic, epigenetic, and environmental mechanisms involved in autoimmune thyroid disease.
Topics: Humans; Hashimoto Disease; Graves Disease; Autoimmune Diseases; Thyroid Diseases; Autoantibodies
PubMed: 36980259
DOI: 10.3390/cells12060918 -
Thyroid : Official Journal of the... Mar 2017Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were...
BACKGROUND
Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.
METHODS
The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.
RESULTS
The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.
CONCLUSIONS
We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
Topics: Autoantibodies; Breast Feeding; Clinical Decision-Making; Disease Management; Evidence-Based Medicine; Female; Humans; Hypothyroidism; Infertility, Female; Lactation; Postpartum Period; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Societies, Medical; Thyroid Diseases; Thyroid Function Tests; Thyroid Neoplasms; Thyroid Nodule; Thyrotoxicosis; United States
PubMed: 28056690
DOI: 10.1089/thy.2016.0457 -
Obstetrics and Gynecology Jun 2020Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal...
Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes. This Practice Bulletin has been updated with information on the diagnosis and the management of thyroid disease in pregnant women and includes a new clinical algorithm on management of thyroid disease in pregnancy.
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Prenatal Care; Puerperal Disorders; Societies, Medical; Thyroid Diseases; Thyroid Function Tests; United States
PubMed: 32443080
DOI: 10.1097/AOG.0000000000003893 -
Radiologic Clinics of North America Nov 2020Thyroid ultrasound with gray-scale and color Doppler is the most helpful imaging modality to differentiate normal thyroid parenchyma from diffuse or nodular thyroid... (Review)
Review
Thyroid ultrasound with gray-scale and color Doppler is the most helpful imaging modality to differentiate normal thyroid parenchyma from diffuse or nodular thyroid disease by evaluating glandular size, echogenicity, echotexture, margins, and vascularity. The various causes of diffuse thyroid disease often have overlapping sonographic imaging features. Thyroid nodules may be hyperplastic or neoplastic, with most due to benign hyperplastic changes in architecture and benign follicular adenomas; only a small percentage are malignant. A systematic approach to nodule morphology that includes evaluation of composition, echogenicity, margin, shape, and any echogenic foci can guide decision to biopsy or follow nodules.
Topics: Biopsy, Fine-Needle; Diagnosis, Differential; Female; Humans; Male; Risk Assessment; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography, Doppler; Ultrasonography, Doppler, Color
PubMed: 33040847
DOI: 10.1016/j.rcl.2020.07.003 -
Clinical Medicine (London, England) Mar 2023Pregnancy is accompanied by metabolic changes associated with the thyroid gland. It is therefore important to understand the underlying physiological alterations and the... (Review)
Review
Pregnancy is accompanied by metabolic changes associated with the thyroid gland. It is therefore important to understand the underlying physiological alterations and the management of patients with thyroid disorders in pregnancy. This review focuses on the physiology and the management of hyperthyroidism, hypothyroidism and thyroid nodules in the context of pregnancy.
Topics: Pregnancy; Female; Humans; Pregnancy Complications; Thyroid Diseases; Hyperthyroidism; Hypothyroidism
PubMed: 36958843
DOI: 10.7861/clinmed.2023-0018 -
Reviews in Endocrine & Metabolic... Mar 2017Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect... (Review)
Review
Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.
Topics: Humans; Kidney Diseases; Thyroid Diseases
PubMed: 27864708
DOI: 10.1007/s11154-016-9395-7 -
The Medical Clinics of North America Jan 1998Thyroid diseases occur more commonly in women than men, in part because of the autoimmune nature of many thyroid disorders. Hypothyroidism, and thyroid nodules occur... (Review)
Review
Thyroid diseases occur more commonly in women than men, in part because of the autoimmune nature of many thyroid disorders. Hypothyroidism, and thyroid nodules occur frequently in both pre- and postmenopausal women. Pregnancy is also associated with changes in thyroid function. The goal of this article is to review the current information on the pathophysiology and treatment of thyroid disorders which are common in women.
Topics: Chorionic Gonadotropin; Female; Humans; Hyperthyroidism; Placenta; Pregnancy; Pregnancy Complications; Thyroid Diseases; Thyroid Nodule; Thyroiditis; Ultrasonography
PubMed: 9457153
DOI: 10.1016/s0025-7125(05)70596-4 -
British Medical Bulletin 2011Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability.
INTRODUCTION
Thyroid disorders are prevalent and their manifestations are determined by the dietary iodine availability.
SOURCES OF DATA
Data from screening large population samples from USA and Europe.
AREAS OF AGREEMENT
The most common cause of thyroid disorders worldwide is iodine deficiency, leading to goitre formation and hypothyroidism. In iodine-replete areas, most persons with thyroid disorders have autoimmune disease.
AREAS OF CONTROVERSY
Definition of thyroid disorders, selection criteria used, influence of age and sex, environmental factors and the different techniques used for assessment of thyroid function.
GROWING POINTS
Increasing incidence of well-differentiated thyroid cancer. Environmental iodine influences the epidemiology of non-malignant thyroid disease.
AREAS TIMELY FOR DEVELOPING RESEARCH
Iodine supplementation of populations with mild-to-moderate iodine deficiency. An evidence-based strategy for the risk stratification, treatment and follow-up of benign nodular thyroid disease. Is there any benefit in screening adults for thyroid dysfunction?
Topics: Adult; Age Factors; Dietary Supplements; Effect Modifier, Epidemiologic; Europe; Female; Health Surveys; Humans; Incidence; Iodine; Male; Mass Screening; Prevalence; Risk Factors; Sex Factors; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Trace Elements; United States
PubMed: 21893493
DOI: 10.1093/bmb/ldr030 -
Nature Reviews. Endocrinology Oct 2017Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a... (Comparative Study)
Comparative Study Review
Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.
Topics: Adult; Female; Gestational Age; Humans; Hyperthyroidism; Hypothyroidism; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Diagnosis; Randomized Controlled Trials as Topic; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones; Treatment Outcome
PubMed: 28776582
DOI: 10.1038/nrendo.2017.93 -
Advances in Experimental Medicine and... 2020Autophagy is a dynamic process, regulated by a variety of factors, and may play different roles in different thyroid diseases or in different stages of the same thyroid... (Review)
Review
Autophagy is a dynamic process, regulated by a variety of factors, and may play different roles in different thyroid diseases or in different stages of the same thyroid disease. Autophagy can mediate inflammatory response and immunity, which is closely related to the pathogenesis of thyroid autoimmune diseases. Therefore, it is still necessary to further understand the relationship between autophagy and autoimmune thyroid disease and hypothyroidism. With more and more studies on the relationship between autophagy and thyroid cancer, the relationship between the two is becoming more and more complicated. From the perspective of current studies, it is still worth pondering whether inhibition or activation of autophagy can be a valuable targeted therapy for thyroid cancer, and further research and efforts are still needed.
Topics: Autophagy; Humans; Hypothyroidism; Thyroid Diseases; Thyroid Neoplasms
PubMed: 32671766
DOI: 10.1007/978-981-15-4272-5_31