RESUMEN
PURPOSE: Osteoporosis has been a widespread concern for older women, especially postmenopausal women. Thyroid function is crucial for bone metabolism. However, the relationship between thyroid function variation within thyroxine reference range and bone mineral density (BMD) remains ambiguous. The objective of this study was to evaluate the effect of subclinical hypothyroidism or hyperthyroidism on total spinal BMD in postmenopausal women. METHODS: Based on data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010, multivariable weighted logistic regression was used to evaluate the relationships between total spine BMD and TSH among postmenopausal women aged ≥50. RESULTS: After accounting for a number of variables, this study discovered that the middle TSH tertile was associated with a decreased probability of osteoporosis. Additionally, the subgroup analysis revealed that postmenopausal women over the age of 65 or people with an overweight BMI had a clearer relationship between total spine BMD and TSH. CONCLUSION: The total spinal BMD had a positive relationship with thyroid stimulating hormone in postmenopausal women, and that appropriate TSH level (1.38-2.32 mIU/L) was accompanied by higher total spinal BMD.
Asunto(s)
Densidad Ósea , Hipertiroidismo , Posmenopausia , Tirotropina , Humanos , Femenino , Densidad Ósea/fisiología , Persona de Mediana Edad , Anciano , Posmenopausia/fisiología , Tirotropina/sangre , Hipertiroidismo/sangre , Hipertiroidismo/fisiopatología , Encuestas Nutricionales , Osteoporosis Posmenopáusica/epidemiología , Osteoporosis Posmenopáusica/sangre , Columna Vertebral , Hipotiroidismo/sangre , Hipotiroidismo/fisiopatología , Hipotiroidismo/epidemiología , Glándula Tiroides/fisiología , Glándula Tiroides/fisiopatología , Pruebas de Función de la TiroidesRESUMEN
Subclinical hyperthyroidism (SHyper) is defined as normal levels of free thyroxine (fT4) and free triiodothyronine (fT3) with suppressed levels of TSH. Previous studies have reported the individual pathophysiology of endogenous SHyper patients and athyreotic patients receiving TSH suppression therapy with levothyroxine; however, apparently no studies have compared the two conditions. Five-hundred-forty untreated endogenous SHyper patients and 1,024 patients receiving TSH suppression therapy who underwent total thyroidectomy for papillary thyroid carcinoma were sampled. Thyroid hormone profiles and peripheral indices related to thyrotoxicosis were investigated in endogenous SHyper patients, athyreotic patients receiving TSH suppression therapy, and healthy participants. Endogenous SHyper patients showed significantly higher thyroid hormone levels (fT4 [p < 0.001] and fT3 [p < 0.001]), and peripheral indices showed a significant tendency towards thyrotoxicosis (strong TSH suppression: alkaline phosphatase [ALP, p < 0.001], creatinine [Cre, p < 0.001], pulse rate [p < 0.05]; and mild TSH suppression: Cre [p < 0.05]) than healthy participants. In contrast, athyreotic patients receiving TSH suppression therapy showed a significant tendency towards thyrotoxicosis than healthy participants only when TSH was strongly suppressed (fT3 [p < 0.001] and Cre [p < 0.001]). Endogenous SHyper patients showed significantly higher fT3 levels (p < 0.001) than athyreotic patients receiving TSH suppression therapy; however, there was a significant tendency towards thyrotoxicosis only when TSH was strongly suppressed (ALP [p < 0.05] and pulse rate [p < 0.05]). The effects of endogenous SHyper and TSH suppression therapy on target organ function are different. Although the serum thyroid hormone profile is similar to that of the thyrotoxic state, athyreotic patients receiving TSH suppression therapy with mildly suppressed serum TSH levels are not thyrotoxic.
Asunto(s)
Hipertiroidismo , Tiroidectomía , Tirotropina , Tiroxina , Triyodotironina , Humanos , Hipertiroidismo/sangre , Hipertiroidismo/fisiopatología , Hipertiroidismo/complicaciones , Femenino , Masculino , Adulto , Persona de Mediana Edad , Tiroxina/uso terapéutico , Tiroxina/sangre , Triyodotironina/sangre , Tirotropina/sangre , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/fisiopatología , Neoplasias de la Tiroides/complicaciones , Tirotoxicosis/sangre , Tirotoxicosis/fisiopatología , Tirotoxicosis/complicaciones , Pruebas de Función de la Tiroides , Anciano , Cáncer Papilar Tiroideo/sangre , Cáncer Papilar Tiroideo/fisiopatología , Cáncer Papilar Tiroideo/complicacionesRESUMEN
Thyroid disease is known to affect brain metabolism and cognitive function, although the recovery of thyroid-induced brain functional changes after treatment remains unclear. We aimed to investigate the alteration in brain functional connectivity and its correlation with neuropsychological variables in hyperthyroid patients before and after anti-thyroid treatment using a resting-state functional magnetic resonance imaging (rsfMRI) technique. This is a follow-up rsfMRI study of previous work that showed impaired brain functional connectivity in hyperthyroid patients compared to healthy controls. We included rsfMRI and neuropsychological data from 21 hyperthyroid patients out of an original cohort of 28 patients, before and after anti-thyroid treatment for 30 weeks. Functional connectivity analysis and neuropsychological scores were compared using paired t tests in patients at baseline and at follow-up. Patients showed an improvement in some of the memory (p < .05) and executive, visuospatial and motor (p < .001) functions after treatment, and also showed increased functional connectivity in the regions of the right fronto-parietal network, left fronto-parietal network, and default mode network (DMN) (p < .05). At follow-up, the functional connectivity of the right fronto-parietal network showed a significantly positive correlation with the recognition of objects memory score. The overall findings suggest that anti-thyroid treatment with carbimazole improves the functional connectivity within some of the resting state networks in the hyperthyroid patients, whereas the remaining networks still show impairment.
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Antitiroideos/uso terapéutico , Encéfalo/efectos de los fármacos , Hipertiroidismo/tratamiento farmacológico , Vías Nerviosas/efectos de los fármacos , Adulto , Encéfalo/citología , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Carbimazol/uso terapéutico , Cognición/efectos de los fármacos , Estudios de Cohortes , Función Ejecutiva/efectos de los fármacos , Femenino , Humanos , Hipertiroidismo/diagnóstico , Hipertiroidismo/fisiopatología , Hipertiroidismo/psicología , India , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Vías Nerviosas/diagnóstico por imagen , Pruebas NeuropsicológicasAsunto(s)
Ascitis , Insuficiencia Cardíaca , Hipertiroidismo , Metimazol/administración & dosificación , Metoprolol/administración & dosificación , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Antitiroideos/administración & dosificación , Ascitis/diagnóstico por imagen , Ascitis/etiología , Ascitis/terapia , Fibrilación Atrial/diagnóstico , Diagnóstico Diferencial , Ecocardiografía Transesofágica/métodos , Electrocardiografía/métodos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Hipertiroidismo/sangre , Hipertiroidismo/complicaciones , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/fisiopatología , Imagen por Resonancia Cinemagnética/métodos , Cumplimiento de la Medicación , Persona de Mediana Edad , Paracentesis/métodos , Pruebas de Función de la Tiroides/métodosRESUMEN
Atrial fibrillation is exceedingly rare in children with structurally and functionally normal hearts. We present a novel case of a 15-year-old female with known hyperthyroidism who subsequently developed atrial fibrillation. She had been suffering from fatigue, heat intolerance and myalgias for 6 months. Her initial TSH was 0.01mU/L, and free T4 was 75.4 pmol/L, with a free T3 of >30.8 pmol/L. An electrocardiogram showed atrial fibrillation with a ventricular rate of 141 beats per minute. An echocardiogram demonstrated an enlarged left atrium and ventricle, with mild mitral regurgitation. She was treated with methimazole and underwent synchronized cardioversion. She subsequently returned to a euthyroid state and remained in normal sinus rhythm. In this case, we discuss the physiologic and arrhythmogenic properties of thyroid hormone, with a summary of the existing literature on atrial fibrillation in hyperthyroidism in children. Current guidelines for treatment of atrial fibrillation are also outlined.
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Antitiroideos/uso terapéutico , Fibrilación Atrial/etiología , Hipertiroidismo/complicaciones , Metimazol/uso terapéutico , Adolescente , Fibrilación Atrial/fisiopatología , Electrocardiografía , Femenino , Humanos , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/fisiopatología , Pruebas de Función de la Tiroides , Resultado del TratamientoRESUMEN
In differentiated thyroid cancer (DTC), the standard treatment includes total thyroidectomy and lifetime levothyroxine (LT4) replacement. However, long-term exogenous LT4 has become controversial due to the adverse effects of oversuppression. The study included 191 patients (aged 18-76 years) with a prospective diagnosis of non-metastatic DTC and 79 healthy individuals. The patients with DTC were stratified into three groups according to their TSH levels: suppressed thyrotropin if TSH was below 0.1 µIU/ml, mildly suppressed thyrotropin if TSH was between 0.11 and 0.49 µIU/ml, and low-normal thyrotropin if THS was between 0.5 and 2 µIU/ml. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Short Symptom Inventory (SSI), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants. It was found that the BDI, BAI, SSI and PSQI scores were worse in patients with DTC (p=0.024, p=0.014, p=0.012, and p=0.001, respectively). According to theTSH levels, the mean ASI was found to be higher in the suppressed and mildly suppressed thyrotropin groups (19±14.4 vs. 10.6±11.1; 16.4±14.9 vs. 10.6±11.1, p=0.024, respectively), the mean SSI was found higher in the suppressed group (61.0±55.5 vs. 35.1±37.0, p=0.046), and the mean PSQI was higher in all three groups (7.94±3.97 vs. 5.35±4.13; 7.21±4.59 vs. 5.35±4.13; 7.13±4.62 vs. 5.35±4.13, p=0.006) when compared with the controls. No significant difference was found between the groups. A positive correlation was detected in the duration of LT4 use and BDI and SSI, and a weak, negative correlation was detected between TSH levels and ASI and PSQI. Based on our study, it was found that depression, anxiety disorders, and sleep problems were more prevalent in patients with DTC, being more prominent in the suppressed TSH group. These results were inversely correlated with TSH values and positively correlated with the duration of LT4 use. Unnecessary LT4 oversuppression should be avoided in patients with DTC.
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Adenocarcinoma Folicular , Trastornos Mentales , Calidad del Sueño , Neoplasias de la Tiroides , Tirotropina/sangre , Tiroxina/efectos adversos , Adenocarcinoma Folicular/sangre , Adenocarcinoma Folicular/tratamiento farmacológico , Adenocarcinoma Folicular/psicología , Adenocarcinoma Folicular/cirugía , Adolescente , Adulto , Anciano , Enfermedades Asintomáticas , Estudios de Casos y Controles , Enfermedad Crónica , Estudios Transversales , Regulación hacia Abajo/efectos de los fármacos , Femenino , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Hipertiroidismo/sangre , Hipertiroidismo/inducido químicamente , Hipertiroidismo/fisiopatología , Hipertiroidismo/psicología , Hipotiroidismo/sangre , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/epidemiología , Hipotiroidismo/etiología , Masculino , Trastornos Mentales/sangre , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Persona de Mediana Edad , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/tratamiento farmacológico , Neoplasias de la Tiroides/psicología , Neoplasias de la Tiroides/cirugía , Tiroidectomía/rehabilitación , Tirotropina/efectos de los fármacos , Tiroxina/uso terapéutico , Turquía/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: We aimed at demonstrating the effect of thyroid function status on proprotein convertase subtilisin kexin type 9 (PCSK9) and determining the effect of thyroid hormones on lipid metabolism by comparing the PCSK9 levels of patients with subclinical hypothyroidism, overt hypothyroidism, and hyperthyroidism. PATIENTS AND METHODS: 124 patients with thyroid disorders, aged between 18 and 65 years, were included in this study. The participants were divided into 3 groups. Group 1 comprised 52 patients with subclinical hypothyroidism, Group 2 comprised 40 patients with overt hypothyroidism, and Group 3 comprised 32 patients with hyperthyroidism. In all of these groups, the thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, total cholesterol, fasting serum glucose, antithyroid peroxidase antibody, antithyroglobulin antibody, and PCSK9 levels were measured. RESULTS: No significant difference was found between the 3 groups in terms of age, gender, and body mass indices. Median PCSK9 measurements were 14.55 ng/mL in Group 1, 14.895 ng/mL in Group 2, and 9.775 ng/mL in Group 3. There was a significant difference in the PCSK9 levels between Group 1-Group 3 and Group 2-Group 3 (p <0.0001 and p <0.0001, respectively). A positive correlation between PCSK9 and the TSH levels (r = 0.211, p= 0.019), and a negative correlation (r = -0,239, p = 0.009 and r = -, 0.218, p = 0.015) between the fT3 and fT4 levels were found. CONCLUSIONS: The serum PCSK9 levels were shown to be associated with thyroid dysfunction. However, no relationship was observed between the serum PCSK9 level and thyroid autoantibody positivity, and obesity in this study.
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Hipertiroidismo/fisiopatología , Hipotiroidismo/fisiopatología , Proproteína Convertasa 9/sangre , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Estudios Transversales , Femenino , Humanos , Hipertiroidismo/sangre , Hipotiroidismo/sangre , Metabolismo de los Lípidos , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/epidemiología , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangre , Adulto JovenRESUMEN
BACKGROUND: Thyroid storm is a feared complication in patients with hyperthyroidism undergoing surgery. We assessed the risk of thyroid storm for different preoperative treatment options for patients with primary hyperthyroidism undergoing surgery. METHODS: Pubmed, EMBASE, and The Cochrane Library were searched systematically for all studies reporting on adult hyperthyroid patients undergoing elective surgery under general anaesthesia. Selected studies were categorised based on preoperative treatment: no treatment, antithyroid medication (thionamides), iodine, ß-blocking medication, or a combination thereof. Treatment effect, that is restoring euthyroidism, was extracted from the publications if available. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) or the Cochrane Risk of Bias tool for randomised studies. RESULTS: The search yielded 7009 articles, of which 26 studies published between 1975 and 2020 were selected for critical appraisal. All studies had moderate to critical risk of bias, mainly attributable to risk of confounding, classification of intervention status, and definition of the outcome. All studies reported on thyroidectomy patients. We found no randomised studies comparing the risk of thyroid storm between treated and untreated patients. Cases of thyroid storm were reported in all treatment groups with incidences described ranging from 0% to 14%. CONCLUSION: Evidence assessing the risk of perioperative thyroid storm is of insufficient quality. Given the seriousness of this complication and the impossibility of identifying patients at increased risk, preoperative treatment of these patients remains warranted.
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Hipertiroidismo/complicaciones , Hipertiroidismo/fisiopatología , Periodo Perioperatorio , Cuidados Preoperatorios/métodos , Crisis Tiroidea/complicaciones , Crisis Tiroidea/fisiopatología , Humanos , Medición de Riesgo , Procedimientos Quirúrgicos OperativosRESUMEN
BACKGROUND AND AIMS: Thyrotropin-secreting pituitary adenomas (TSHomas) are a rare entity, occurring in one per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discussed the current guidelines for diagnosis and treatment. METHODS: A structured research was conducted using Pubmed and Web of Science with the following MeSH terms: 'thyrotropin secreting pituitary adenoma' OR 'TSHoma' OR 'thyrotropinoma.' RESULTS: Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. The mean age at diagnosis was 46 years. At presentation, 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. The median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean FT4 of 41.5 ± 15.3 pmol/L. The majority (76.9%) of the TSHomas were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% of patients of which 33.5% had residual pituitary adenoma. Post-operative treatment with a somatostatin analogue (SSA) led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r = 0.490, P < 0.001). However, in patients preoperatively treated with an SSA, this correlation was absent. CONCLUSION: TSHomas are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHomas are macroadenoma being diagnosed in the fifth to sixth decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one-third of TSHomas. Treatment consists of neurosurgical resection and SSA in case of surgical failure.
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Adenoma/metabolismo , Hipertiroidismo/metabolismo , Neoplasias Hipofisarias/metabolismo , Tirotropina/metabolismo , Tiroxina/metabolismo , Adenoma/patología , Adenoma/fisiopatología , Adenoma/terapia , Fibrilación Atrial/fisiopatología , Quimioterapia Adyuvante , Bocio/fisiopatología , Gonadotropinas Hipofisarias/metabolismo , Adenoma Hipofisario Secretor de Hormona del Crecimiento/metabolismo , Insuficiencia Cardíaca/fisiopatología , Hormonas/uso terapéutico , Humanos , Hipertiroidismo/fisiopatología , Neoplasia Residual , Procedimientos Neuroquirúrgicos , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/fisiopatología , Neoplasias Hipofisarias/terapia , Prolactinoma/metabolismo , Radioterapia Adyuvante , Somatostatina/análogos & derivados , Somatostatina/uso terapéutico , Carga Tumoral , Trastornos de la Visión/fisiopatologíaRESUMEN
This study was conducted to clarify the relationship between thyroid function and gastrointestinal motility. We established an experimental configuration in which the feedback of thyroid function was completely removed using conscious dogs. With hypothyroidism, time of phase I of interdigestive migrating contractions (IMC) was longer, time of phase II and phase III was significantly shortened, and both the continuous time of strong tetanic contraction at antrum and 10-h frequency of phase III counted from the first IMC after meal significantly decreased. Whereas, hyperthyroidism caused the opposite events to those with hypothyroidism. Furthermore, We found giant migrating contractions (GMC) occurred from the upper gastrointestinal tract when we administrated high dose of thyroid hormone. One GMC occurred from anal sides propagated to cardiac, and this propagation was similar to the emesis-like interdigestive motor activity, the other GMC occurred from oral sides propagated to anal sides and this was similar to the diarrhea-like interdigestive motor activity. We examined the relationship between thyroid function and gastrointestinal hormones including of ghrelin, GLP-1, and cholecystokinin (CCK). However, we could not find significant differences under different thyroid hormone status. This is the first report that thyroid hormone activated upper gastrointestinal motility without mediating gastrointestinal hormones.
Asunto(s)
Hormonas Gastrointestinales/fisiología , Motilidad Gastrointestinal , Hipertiroidismo/fisiopatología , Hipotiroidismo/fisiopatología , Hormonas Tiroideas/fisiología , Animales , Perros , Femenino , Ghrelina/sangreRESUMEN
OBJECTIVE: Subclinical hyperthyroidism (SHyper), defined as reduced thyrotropin with free hormones within the reference range, is a common medical finding, in particular in elderly people. In the last years has gained attention due to its health-related conditions, in particular at the cardiovascular level. MATERIALS AND METHODS: We searched electronic database (PubMed) and search engines (Google Scholar) of articles and reviews using the terms "subclinical hyperthyroidism", "Atrial fibrillation", Ischemic stroke", "Hypertension", Heart failure", and "Mortality". RESULTS: Subclinical hyperthyroidism was clearly associated with the onset of atrial fibrillation and, consequently, with ischemic stroke. However, the latter association is less clear. The effect on hypertension is doubtful and fair. Subclinical hyperthyroidism could increase the risk of acute heart failure, possibly by increasing heart rhythm. Data on mortality are scanty but seem to suggest a possible association, probably linked to the detrimental effect on the cardiovascular system. CONCLUSIONS: Current findings mainly described possible associations with rhythm alterations, heart failure, and stroke but the effective beneficial effects of the treatment of subclinical hyperthyroidism are still lacking.
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Sistema Cardiovascular/fisiopatología , Hipertiroidismo/fisiopatología , HumanosRESUMEN
Hyperthyroid heart disease (HHD) is one of the most severe complications of overt hyperthyroidism and increases the risk of mortality in affected patients. Early identification of patients at a higher risk of developing HHD can improve clinical outcomes through active surveillance and management. Connective tissue growth factor (CTGF), a secreted extracellular protein, plays a significant role in cardiac remodeling and dysfunction. We aimed to investigate the association between plasma CTGF level and the risk of HHD in this study. A total of 142 overt hyperthyroid patients without HHD and 99 patients with HHD were included. The plasma CTGF levels were measured using ELISA kits. Routine clinical medical data and echocardiography parameters were recorded for analysis. The plasma CTGF level was significantly higher in patients with HHD than in those without HHD (P=0.002). The plasma CTGF level was positively correlated with free triiodothyronin, tryrotropin receptor antibody, troponin I and lactate dehydrogenase levels and the left atrium diameters, right atrium diameters, and right ventricular end-diastolic diameters (all P<0.05). Logistic regression analysis showed that quartiles 3 and 4 of plasma CTGF levels were significantly associated with the increased risk of HHD (crude OR: 2.529; 95% CI: 1.188-5.387). However, after adjustment for the potentially confounding variables, quartile 4 alone was significantly associated with the higher risk of HHD relative to quartile 1. Hyperthyroid patients with HHD display higher plasma CTGF levels. Furthermore, CTGF is an independent risk factor for HHD. Therefore, the plasma CTGF level may be a potential biomarker for the risk of HHD.
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Cardiopatías/sangre , Cardiopatías/complicaciones , Hipertiroidismo/sangre , Hipertiroidismo/complicaciones , Adulto , Factor de Crecimiento del Tejido Conjuntivo/sangre , Electrocardiografía , Femenino , Cardiopatías/diagnóstico por imagen , Cardiopatías/fisiopatología , Pruebas de Función Cardíaca , Humanos , Hipertiroidismo/diagnóstico por imagen , Hipertiroidismo/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
Erythroderma (exfoliative dermatitis) is associated with important metabolic changes that include an enhancement in energy expenditure. The key components to total energy expenditure (TEE) include basal metabolic rate (~68% of TEE), physical activity (~22% of TEE) and thermic effect of food (~10% of TEE). In the erythrodermic state, there are likely multiple contributors to the increase in basal metabolic rate, such as 'caloric drain' resulting from increased evaporation of water from enhanced transepidermal water loss, increased activity of the cardiovascular system (including high-output cardiac failure), increased nonshivering thermogenesis and hormonal changes such as hypercortisolaemia. A change in the patient's level of physical activity and appetite as a result of ill health status may further impact on their TEE and energy consumption. In Part 2 of this two-part concise review, we explore the key constituents of energy homeostasis and the potential mechanisms influencing energy homeostasis in erythroderma, and suggest much-needed dietetic management strategies for this important condition.
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Dermatitis Exfoliativa/dietoterapia , Dermatitis Exfoliativa/metabolismo , Apetito , Metabolismo Basal , Gasto Cardíaco , Síndrome de Cushing/fisiopatología , Dermatitis Exfoliativa/fisiopatología , Metabolismo Energético , Ejercicio Físico , Homeostasis , Humanos , Hipertiroidismo/fisiopatología , Hipotiroidismo/fisiopatología , Proteínas/metabolismo , Termogénesis , Pérdida Insensible de AguaRESUMEN
Background: Population studies on the prevalence of thyroid dysfunctions are costly. The pharmacy dispensing (PDR) and diagnosis (DR) registers allow us to study the epidemiology of these pathologies in a simpler way. Our aims: 1/Estimate the prevalence of thyroid dysfunction in Catalonia based on data from the PDR and the DR, 2/to evaluate the concordance of the results obtained by both strategies. Methods: The population studied was the one registered with the public health system in Catalonia(Catsalut). In the PDR analysis, the information obtained through the Pharmaceutical Provision file (during 2012, 2013, 2014) was used regarding the number of patients under treatment (NPT) (levothyroxine and antithyroid medication). The DR analysis (2014) was performed by ICD-9 codes (hyperthyroidism 242 and hypothyroidism 243, 244). Results: According to the NPT in the PDR analysis, the prevalence of treated hypothyroidism increased over 3 years: 2.81%(2012), 2.92%(2013) and 3.07%(2014) (P < .00001). The prevalence of hyperthyroidism in treatment was 0.14%(2012), 0.13%(2013) and 0.14%(2014). According to the DR analysis in 2014, the prevalence of hypothyroidism was 2.54% and 0.35% for hyperthyroidism. The PDR analysis estimated a higher hypothyroidism prevalence compared to that estimated by the DR (P < .0001) and vice versa in the case of hyperthyroidism. Conclusion: Both PDR and DR prevalence estimations of thyroid dysfunction show some degree of discordance probably due to undercoding bias in the case of DR and the absence of subclinical pathology in the case of PDR. However, both approaches are valid and complementary for estimating the prevalence of thyroid dysfunction.
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Prescripciones de Medicamentos/estadística & datos numéricos , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/epidemiología , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/epidemiología , Sistema de Registros , Adolescente , Adulto , Anciano , Antitiroideos/administración & dosificación , Femenino , Humanos , Hipertiroidismo/fisiopatología , Hipotiroidismo/fisiopatología , Masculino , Persona de Mediana Edad , Farmacoepidemiología , Prevalencia , España/epidemiología , Glándula Tiroides/fisiopatología , Tiroxina/administración & dosificación , Adulto JovenRESUMEN
Severe thyroid dysfunction may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary-ovarian axis and the reproductive organs. However, the exact prevalence of infertility in women with thyroid disorders remains unknown. Fertility problems may persist even after restoring normal thyroid function, and then surgery and/or an assisted reproductive technology (ART) may be necessary to obtain a pregnancy. The initial step in an ART treatment is the ovarian stimulation, putting strain on the thyroid gland, potentially leading to (permanent) hypothyroidism in women with thyroid autoimmunity (TAI) or when already treated with thyroid hormones (LT4). Moreover, women with ovarian and unexplained causes of infertility have a higher prevalence of TAI. In women treated with LT4, a serum TSH level <2.5 mIU/L should be targeted before ART. In women with TSH levels >4.0 mIU/L, fertilisation rates, embryo quality and live birth rates may be impaired but also improved with LT4 therapy. In euthyroid women with TAI, LT4 should not be given systematically, but on a case-by-case basis if serum TSH is >2.5 mIU/L. For all of the above reasons, women of infertile couples should be screened routinely for the presence of thyroid disorders. In this review, we will focus on the gaps in the current knowledge, the remaining questions on the associations between thyroid (disorders) and (assisted) reproduction and make proposals for future investigations that may lead to a better understanding and contribute to novel treatment options in the long term.
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Infertilidad Femenina/etiología , Enfermedades de la Tiroides/complicaciones , Adulto , Femenino , Humanos , Hipertiroidismo/fisiopatología , Sistema Hipotálamo-Hipofisario/fisiopatología , Hipotiroidismo/etiología , Hipotiroidismo/fisiopatología , Infertilidad Femenina/terapia , Persona de Mediana Edad , Ovario/fisiopatología , Inducción de la Ovulación/efectos adversos , Embarazo , Técnicas Reproductivas Asistidas , Enfermedades de la Tiroides/fisiopatología , Glándula Tiroides/fisiopatología , Tiroiditis Autoinmune/tratamiento farmacológicoRESUMEN
Hyperthyroidism is a set of disorders that involve excess synthesis and secretion of thyroid hormones by the thyroid gland, which leads to thyrotoxicosis. The most common forms of hyperthyroidism include diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer disease), and a solitary toxic adenoma. The most reliable screening measure of thyroid function is the thyroid-stimulating hormone (TSH) level. Options for treatment of hyperthyroidism include: antithyroid drugs, radioactive iodine therapy (the preferred treatment of hyperthyroidism among US thyroid specialists), or thyroidectomy. Massive thyroid enlargement with compressive symptoms, a suspicious nodule, Graves' orbitopathy, and patient preference are indications for surgical treatment of thyrotoxicosis. This paper reviews the current literature and controversies on the surgical approach to the management of hyperthyroidism.
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Antitiroideos/farmacología , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/cirugía , Radioisótopos de Yodo/farmacología , Amiodarona/metabolismo , Terapia Combinada , Enfermedad de Graves/fisiopatología , Humanos , Hipertiroidismo/inducido químicamente , Hipertiroidismo/fisiopatología , Factores de Riesgo , Glándula Tiroides , Hormonas Tiroideas , TiroidectomíaRESUMEN
BACKGROUND: The present study compared behavioral and molecular indicators of hippocampal function in L-thyroxine treated rats to determine whether thyroid hormone excessiveness produces relatively stable lifelong changes. METHODS: Hyperthyroidism was induced in rats by daily injections of L-thyroxine (0.2 mg/kg) to their dams for lactation period (MOH: maternal-onset hyperthyroidism) or to the rats itself during the young adult period (AOH: adult-onset hyperthyroidism; between the day 39-60). Spatial learning was assessed in the Morris Water Maze (MWM). Levels of type 2 and type 3 deiodinases, Erk1/2, JNK and P38MAPK were assessed via western blotting in the hippocampus of trained rats. Measurements were all done in rats aged 60-66 days. RESULTS: In MWM, maternally treated rats with L-thyroxine swam more away from the hidden platform, with showing more anxiety-like behavior, as compared to the rats treated or no treated with L-thyroxine in young adulthood. In spite of impaired acquisition, MOH group was not significantly different from the other groups in probe trial. In Western blot of the hippocampus, a decreased the expression of P38MAPK was found in rats treated with L-thyroxine in young adulthood period. However, maternal treatment with L-thyroxine resulted in an increased expression of Type 2 deiodinase and a tendency toward decreased expression of total and phosphorylated ERK1/2. No detectable band for type 3 deiodinase, p-JNK and p-P38MAPK was observed in all three groups. CONCLUSION: These results suggest that perinatal excessiveness of thyroid hormone has longstanding effects on hippocampal function and may account for memory problems experienced by adolescents with lactational hyperthyroidism.
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Ansiedad/etiología , Hipertiroidismo/complicaciones , Trastornos de la Memoria/etiología , Tiroxina/metabolismo , Animales , Ansiedad/fisiopatología , Conducta Animal/fisiología , Modelos Animales de Enfermedad , Femenino , Hipocampo/fisiopatología , Hipertiroidismo/fisiopatología , Lactancia , Masculino , Aprendizaje por Laberinto/fisiología , Ratas , Memoria Espacial/fisiología , Tiroxina/administración & dosificaciónRESUMEN
Subclinical thyroid disorders have a high prevalence among older individuals and women. Subclinical hypothyroidism is diagnosed by elevated serum levels of thyroid-stimulating hormone (TSH) with thyroxine levels within the reference range, and subclinical hyperthyroidism is diagnosed by low TSH in conjunction with thyroxine and triiodothyronine levels within reference ranges. Atrial fibrillation is the most commonly diagnosed cardiac arrhythmia and has been associated with an increased risk of mortality, heart failure, stroke, and depression. Mechanistic data from animal and human physiology studies as well as observational data in humans support an association of subclinical hyperthyroidism with atrial fibrillation. Guidelines recommend the measurement of TSH in the evaluation of new-onset atrial fibrillation. All patients with overt hyperthyroidism should be treated, and treatment of subclinical hyperthyroidism should be considered in patients older than 65 years with TSH < 0.4 mlU/L, or in younger patients with TSH < 0.1 mlU/L. Guidelines also recommend screening for AF in patients with known hyperthyroidism. Wearable devices that measure the heart electrical activity continuously may be a novel strategy to detect atrial fibrillation in patients at risk. In this review, we explore the interplay between thyroid hormones and atrial fibrillation, management controversies in subclinical hyperthyroidism, and potential strategies to improve the management of atrial fibrillation in patients with subclinical hyperthyroidism.
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Fibrilación Atrial/terapia , Hipertiroidismo/terapia , Tirotropina/metabolismo , Tiroxina/metabolismo , Triyodotironina/metabolismo , Factores de Edad , Fibrilación Atrial/complicaciones , Fibrilación Atrial/metabolismo , Fibrilación Atrial/fisiopatología , Manejo de la Enfermedad , Humanos , Hipertiroidismo/complicaciones , Hipertiroidismo/metabolismo , Hipertiroidismo/fisiopatología , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVE: All three isoforms of nitric oxide (NO) synthase (NOS) are targets for thyroid hormones in the cardiovascular system. The aim of this study was to assess the effects of hypo- and hyperthyroidism on inducible (iNOS), endothelial (eNOS), and neural (nNOS) NOS levels in aorta and heart tissues of male rats. METHODS: Rats were divided into control, hypothyroid, and hyperthyroid groups; hypo- and hyperthyroidism were induced by adding propylthiouracil (500 mg/L) and L-thyroxine (12 mg/L) to drinking water for a period of 21 days. On day 21, systolic blood pressure, heart rate, left ventricular developed pressure (LVDP), peak rate of positive and negative (±dp/dt) changes in left ventricular pressure as well as NO metabolites (NOx) and iNOS, eNOS, and nNOS protein levels in aorta and heart, were all measured. RESULTS: Compared to controls, LVDP and ±dp/dt were lower in both hypo- and hyperthyroid rats. Compared to controls, heart rate and systolic blood pressure were lower in hypothyroid and higher in hyperthyroid rats. NOx levels in the heart of hypothyroid rats were lower (53%), whereas that in hyperthyroid rats were higher (56% and 40%) than controls. Compared to controls, hypothyroid rats had lower levels of eNOS, iNOS, and nNOS in the aorta (16%, 34%, and 15%, respectively) and lower iNOS and higher nNOS in heart tissue (27% and 46%). In hyperthyroid rats, eNOS levels were lower (54% and 30%) and iNOS were higher (63%, and 35%) in the aorta and heart while nNOS was lower in the aorta (18%). CONCLUSION: Hypothyroidism increased while hyperthyroidism decreased the ratio of eNOS/iNOS in aorta and heart; these changes of NOS levels were associated with impaired cardiovascular function.
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Sistema Cardiovascular/enzimología , Hipertiroidismo/enzimología , Hipotiroidismo/enzimología , Óxido Nítrico Sintasa/metabolismo , Animales , Sistema Cardiovascular/fisiopatología , Modelos Animales de Enfermedad , Hemodinámica , Hipertiroidismo/sangre , Hipertiroidismo/fisiopatología , Hipotiroidismo/sangre , Hipotiroidismo/fisiopatología , Masculino , Óxido Nítrico Sintasa de Tipo I/metabolismo , Óxido Nítrico Sintasa de Tipo II/metabolismo , Óxido Nítrico Sintasa de Tipo III/metabolismo , Ratas Wistar , Hormonas Tiroideas/sangre , Función Ventricular IzquierdaRESUMEN
Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disability in daily living, cognitive function, depressive symptoms, physical function, and mortality in people aged 80 years and older. Methods: Four prospective cohorts participating in the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included. We performed a two-step individual participant data meta-analysis on source data from community-dwelling participants aged 80 years and older from the Netherlands, New Zealand, United Kingdom, and Japan. Outcome measures included disability in daily living (disability in activities of daily living [ADL] questionnaires), cognitive function (Mini-Mental State Examination [MMSE]), depressive symptoms (Geriatric Depression Scale [GDS]), physical function (grip strength) at baseline and after 5 years of follow-up, and all-cause five-year mortality. Results: Of the total 2116 participants at baseline (mean age 87 years, range 80-109 years), 105 participants (5.0%) were overtly hypothyroid, 136 (6.4%) subclinically hypothyroid, 1811 (85.6%) euthyroid, 60 (2.8%) subclinically hyperthyroid, and 4 (0.2%) overtly hyperthyroid. Participants with thyroid dysfunction at baseline had nonsignificantly different ADL scores compared with euthyroid participants at baseline and had similar MMSE scores, GDS scores, and grip strength. There was no difference in the change of any of these functional measures in participants with thyroid dysfunction during five years of follow-up. Compared with the euthyroid participants, no 5-year survival differences were identified in participants with overt hypothyroidism (hazard ratio [HR] 1.0, 95% confidence interval [CI 0.6-1.6]), subclinical hypothyroidism (HR 0.9 [CI 0.7-1.2]), subclinical hyperthyroidism (HR 1.1 [CI 0.8-1.7]), and overt hyperthyroidism (HR 1.5 [CI 0.4-5.9]). Results did not differ after excluding participants using thyroid-influencing medication. Conclusions: In community-dwelling people aged 80 years and older, (sub-)clinical thyroid dysfunction was not associated with functional outcomes or mortality and may therefore be of limited clinical significance.