Status of the thyroid gland in pregnancy and its relation to postpartum depression

OBJECTIVES: Adequate adjustments by the hypothalamic-pituitary-thyroid axis during pregnancy allow women to remain euthyroid with only slight changes in thyroid volume and other thyroid functions. In approximately 10 percent of women, the challenge of thyroid economy results in sub-clinical hypothyroidism. This study is to elucidate the association between such hypothyroidism and postpartum depression, if any. METHOD: Blood samples were collected from 73 healthy subjects attending the antenatal clinc of the University Hospital of the West Indies, at booking, 28 weeks, 36 weeks of gestation, and 1 day and 6 weeks postpartum. Serum level of total thyroxine, free tri-iodothyronine, and thyroid stimulating hormone (TSH) were determined by radioimmunoassays. The thyroid volume was estimated by ultrasonography in some subjects. A self-rating depression scale was administered at 28 weeks of gestation and at 6 weeks postpartum for quantitative measurement of depression. The preliminary results revealed that 22 subjects (30 percent) had postpartum depression, 12 (16 percent) had mild depressin and 10 (14 percent) had moderated to marked depression. Of these, only 2 subjects had total thyroxine values less than 5.5g/100 ml and TSH values greater than 2.5 IU/ml. There were no significant changes between postpartum and antepartum thyroid volumes. CONCLUSION: Although a significant number of women in this study had postpartum depression, no significant relationship between depression and the serum levels of thyroid hormones was established.(Au)

Limited usefulness of antithyroperoxidase and antithyroglobulin assays in Jamaicans with Graves' disease

The clinical usefulness of commercially prepared haemagglutination kits for thryro peroxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43 percent) of the patients were newly diagnosed, 12 (8 percent) were in remission and 71 (49 percent) had relapsed. Sera from 65 (45 percent) patients were positive for thyroid antibodies. The TPO antibodies were found in 43 percent (63/145), thyroglobulin antibodies in 12 percent (17/145) fifteen (10 percent) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44 percent v. 41 percent) but the prevalence in the patients in remission was significantly higher (75 percent; X2 = 4.8, P <0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56 percent v. 32 percent; X2 = 8.09, P <0.005). The presence of both TPO antibody (64 percent v. 31 percent; X2 = 13.1, P <0.001) and TG antibody (22 percent v. 6 percent; X2 = 8.8, P <0.005) correlated positively with Graves' opthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans. (AU)

Thyroid papillary carcinoma arising in a branchial cleft cyst

We describe the clinico-pathological features and discuss the possible pathogenetic mechanism of thyroid papillary carcinoma arising in a branchial cleft cyst. This has been described only once previously in the literature. (AU)

Thyroid-Gonad relationship in systemic lupus erythematosus

Thirty women with systemic lupus erythematosus (SLE) were examined to assess the thyroid-gonad relationship. Significant decreases in mean serum tri-iodo-thyronine and testerone levels and increases in mean serum estradiol and luteinizing hormone levels were observed in SLE patients as compared to control subjects. The serum levels of thyroxine, thyrotropin, tri-iodo-thyronine uptake, free thyroxine index and prolactin were, however, not significantly different in both groups. The interpretation of these findings is unclear but SLE could be regarded as one of the nonthyroidal systematic illness since low serum tri-iodo-thyrotropin levels were observed in our patients. Furthermore, high levels of estradiol and low levels of testosterone in our female patients may indicate involvement of sex steroids in the pathogenesis of SLE. (AU)

Thyroid-gonad relationship in chronic schizophrenia

The effects of the severity of psychiatric illnesses on thyroid function and their relationship to serum testosterone levels were studied in 38 men of African origin, suffering from chronic schizophrenia. Significantly lower levels of serum T4, T3, FT4I and testosterone in acutely psychotic patients indicated decreased thyroid-gonadal activity. Higher serum T4 and FT4I and lower serum TSH, testosterone and cortisol levels were observed in patients whose illnesses were in remission. Levels of both FT4I and testosterone in clinically stable patients, however, were not significantly different in comparison to controls, suggesting recovery from the illness. No significant differences either in thyroid or gonadal hormones were observed between patients exhibiting depression or elated affects; among disorganized, catatonic, paranoid and undifferentiated types; and among patients treated with different psychotropic drugs. The possible mechanisms involved in such thyroid-gonad relationship are discussed. (AU)

Abnormal thyroid hormone and thyrotropin levels in homozygous sickle cell disease

Male patients with SS disease had significantly lower T3 and higher TSH levels than a comparison group. Stimulation with TRH in 10 male sibling pairs showed highly significant increases in T3 and TSH in both patients and sibling controls although the increase in TSH was significantly greater in SS disease. The interpretation of these findings unclear although the thyroid indices indicate an abnormal pituitary-thyroid axis most consistent with a modest primary thyroid failure

The thyroid gland

The thyroid gland secretes two hormones, T4 and T3, which help to maintain tissue metabolism, growth and mental development. The biosynthesis of these hormones involves an active transport of absorbed iodide, from blood to the thyroid gland. Immediately after the synthesis, the hormones are released into the blood and the major portion is bound to the binding plasma proteins. Only a small fraction which remains unbound exhibits biochemical effects in the body. The secretion of these hormones is closely regulated by (1) hypothalamic hormones - TRH and SRIF; (2) pituitary TSH and (3) directly by factors like immunoglobulins, antithyroid drugs, diet, physiological agents such as estrogens, glucocorticoids, catecholamines, prostaglandin E and HCG. The action of thyroid hormones on calorigenesis is direct and is mainly through increased synthesis of Na+/K+ ATPase. Many of the consequences of either a deficiency (hypothyroidism) or an excess (hyperthyroidism) of T4 and T3 have been fully compared. The clinical assessment of various thyroid disorders includes a proper history from the patient, inspection and auscultation of the gland, physical examination and ancillary investigations. Various laboratory tests like total and free serum T4, T3, TSH, T3 uptake, FTI/ETR, and radioactive iodine uptake, have been detailed. Certain specific tests like TRH test and immunoglobulin detection in serum have also been discussed for the differential diagnosis of thyroid disorders of various origins. (Summary)

Thyroid-gonad relationship in chronic renal failure

Thirty-four men of African origin suffering from chronic renal failure, (CRF) were studied to assess thyroid functions and their relationships to serum testosterone. Significantly lower mean values of T4, T3, testosterone, FT4I and FT3I were observed in CRF patients as compared to those in 23 healthy control subjects. Serum TSH, LH and TBG did not differ significantly whereas T3U and PRL were higher in CRF patients. Mean serum T4, T3U and FT4I values were further reduced in haemodialysed than in nonhaemodialysed patients. Significant positive coefficients of correlation between thyroid hormones and testosterone were observed in CRF patients. Simultaneous decreases in both serum and testosterone in the presence of normal serum TSH, LH and TBG levels suggest dysfunction of the pituitary-thyroid-gonad axis (AU)

Thyroid function in dengue fever, meningitis, encephalitis, poliomyelitis and other febrile conditions

Thyroid function was studied by estimating serum thyroxine (T4), triodothyronine (T3) and thyrotropin (TSH) in 52 patients suffering from dengue fever, bacterial meningitis, viral encephalitis, paralytic poliomyelitis and other febrile illnesses. Mean serum concentrations of total T4 and T3 were significantly lower in all patients except those suffering from poliomyelitis. Serum TSH was significantly low in dengue fever and pyrexia of unknown origin (PUO). Though the TSH levels were also low in patients with bacterial meningitis and encephalitis, the differences were not statistically significant. Decreases in serum T4, T3 and FT1 in severe illnesses as compared to normal subjects may signify a state of secondary hypothyroidism of a functional type. It will be erroneous to say that decreases in T4 and T3 in systemic illnesses is entirely an adaptive or protective process to maintain metabolic rate. The possible value of thyroid hormone replacement therapy in these illnesses needs further investigations. (AU)

Thyroid-gonad relationship in bronchial asthma

Serum concentrations of thyroxine (T4), triodothyronine (T3), thyrotropin (TSH), T3 uptake (T3U), free thyroxine (FT4I) and free triodothyronine (FT3I) indices and testosterone (T) were studied by radioimmunoassays to elucidiate thyroid-gonad relationships in 30 men of African origin with bronchial asthma. In asthmatic subjects, (i) there were decreases (p<0.001) in both serum T3, FT3I and T levels;(ii) significant increases (p<0.001) in T3U were not associated with changes in serum T4 and FT4I, indicating an abnormality in thyroid-binding globulins (TBG); and is concluded that the hypophyseal-thyroid-gonadal axis may be set at a lower level in asthmatic patients (AU)

Thyroid-gonad relationship in marijuana smokers: a field study in Jamaica

Serum concentrations of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), T3 uptake (T3U), free thyroxine index (FTI) and testosterone were studied by radioimmunoassays to elucidate thyroid-gonad relationship in 26 male marijuana smokers in Jamaica. Serum T3 levels were significantly lower (p<0.05) in smokers compared with non-smokers, whereas serum T4, TSH, T3U, FTI and testosterone levels were found to be within normal limits. Decrease in serum T3 levels has been attributed to ingestion of tetrahydrocannabinol in addition to other factors associated with marijuana smoking. Such a profile of thyroid hormones, with no change in TSH, is suggestive of euthyroidism in smokers. The study also did not indicate any alteration in the pituitary-thyroid-gonad axis in chronic marijuana smokers (AU)

Chronic effects of marihuana extract on thyroid-gonad relationship in rats

Studies were carried out to elucidate the effects of Crude Aqueous Marihauna Extract free of tetrahydrocannabinol and other cannabinoids (CAME) on thyroid-gonad relationship in male rats. Oral indigestion of CAME for 52 days increased (p<0.01) the plasma levels of total circulating thyroxine and triiodothyronine, increased the weight of the adrenal gland (p<0.05), slightly decreased the plasma thyrotrophin level and the weight of the thyroid gland. These changes suggest the presence of hyperthyroidism in rats receiving CAME. Increased plasma thyroxine levels in CAME-treated rats correlated with the total plasma testosterone (r=0.526), indicating a possibility of thyroid-gonad relationship in such rats (AU)

Surigical pathology of the thyroid in Suriname in 1976

A small series of surgical diagnosis of the thyroid gland in surinam is presented. The most common diagnosis were diffuse hyperplasia, multinodular goiter, adenoma, and hashimoto's disease. A significant radical predeliction is not observed......(AU)

Thyroid function in euthyroid Jamaicans

Thyroid function has been investigated in 32 hospitalized euthyroid Jamaicans. The in vivo investigations performed were measurement of 2«, 4 and 24 hr thyroidal uptake of 131I, thyroidal and renal clearances of radioiodide, absolute iodide uptakes and, in 6 subjects, radiothyroxine turnover studies. Thyroxine binding globulin and prealbumin capacities were measured in a small number of cases. Results obtained in all these investigations agreed well with those found in temperate climates and are at variance with previous finding of low 24 hr thyroidal uptakes of 131I in euthyroid Jamaicans, associated with a normal serum protein-bound iodine.(AU)