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2.
J Clin Endocrinol Metab ; 105(12)2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929476

RESUMO

CONTEXT: Invited update on the management of systemic autoimmune Graves disease (GD) and associated Graves orbitopathy (GO). EVIDENCE ACQUISITION: Guidelines, pertinent original articles, systemic reviews, and meta-analyses. EVIDENCE SYNTHESIS: Thyrotropin receptor antibodies (TSH-R-Abs), foremost the stimulatory TSH-R-Abs, are a specific biomarker for GD. Their measurement assists in the differential diagnosis of hyperthyroidism and offers accurate and rapid diagnosis of GD. Thyroid ultrasound is a sensitive imaging tool for GD. Worldwide, thionamides are the favored treatment (12-18 months) of newly diagnosed GD, with methimazole (MMI) as the preferred drug. Patients with persistently high TSH-R-Abs and/or persistent hyperthyroidism at 18 months, or with a relapse after completing a course of MMI, can opt for a definitive therapy with radioactive iodine (RAI) or total thyroidectomy (TX). Continued long-term, low-dose MMI administration is a valuable and safe alternative. Patient choice, both at initial presentation of GD and at recurrence, should be emphasized. Propylthiouracil is preferred to MMI during the first trimester of pregnancy. TX is best performed by a high-volume thyroid surgeon. RAI should be avoided in GD patients with active GO, especially in smokers. Recently, a promising therapy with an anti-insulin-like growth factor-1 monoclonal antibody for patients with active/severe GO was approved by the Food and Drug Administration. COVID-19 infection is a risk factor for poorly controlled hyperthyroidism, which contributes to the infection-related mortality risk. If GO is not severe, systemic steroid treatment should be postponed during COVID-19 while local treatment and preventive measures are offered. CONCLUSIONS: A clear trend towards serological diagnosis and medical treatment of GD has emerged.


Assuntos
Gerenciamento Clínico , Doença de Graves/diagnóstico , Oftalmopatia de Graves/diagnóstico , Hipertireoidismo/diagnóstico , Imunoglobulinas Glândula Tireoide-Estimulantes/sangue , Antitireóideos/uso terapêutico , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/terapia , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/terapia , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Imunoglobulinas Glândula Tireoide-Estimulantes/imunologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Metimazol/uso terapêutico , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Receptores da Tireotropina/imunologia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/imunologia , Tireoidectomia/métodos , Ultrassonografia
3.
Cir. Esp. (Ed. impr.) ; 98(7): 395-402, ago.-sept. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-198665

RESUMO

INTRODUCCIÓN: La principal causa de hiperparatiroidismo primario en nuestro medio es el adenoma paratiroideo único. La paratiroidectomía se considera el único tratamiento potencialmente curativo y requiere de estudios de imagen de localización preoperatorios para un abordaje quirúrgico dirigido. En pacientes con negatividad en pruebas convencionales, la PET-TC colina ha demostrado tasas de sensibilidad superiores respecto al gold-standard. MÉTODOS: Se diseñó un estudio de cohortes prospectivo que incluyó a 34 pacientes con diagnóstico de hiperparatiroidismo primario entre 2017 y 2019, candidatos a cirugía con pruebas de imagen con gammagrafía y SPECT-TC MIBI negativas. A todos se les realizó una PET-TC con 18F-fluorocolina. Los resultados se compararon con un grupo control de 30 pacientes con pruebas convencionales positivas intervenidos en el mismo período. RESULTADOS: La PET-TC colina detectó tejido paratiroideo hiperfuncionante en el 85% de los pacientes con gammagrafía previa negativa. Se realizó resección selectiva del adenoma identificado en estos pacientes, con criterio de curación en el 87% de los casos, sin precisar de exploración cervical bilateral. Los niveles de PTH, calcemia y el peso glandular fueron significativamente menores en este grupo con respecto al control. No se identificaron diferencias respecto al criterio de curación ni a la vía de abordaje en ambos grupos. CONCLUSIÓN: En nuestro estudio, la PET-TC colina demostró tasas superiores de detección que permitieron aumentar el número de pacientes candidatos a cirugía dirigida con disminución de la morbilidad quirúrgica, especialmente en grupos con adenomas de menor tamaño asociados a niveles más bajos de calcemia y PTH preoperatorias y en pacientes con cirugías cervicales previas


INTRODUCTION: Single parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHP) in our population. Parathyroidectomy is still the only potentially curative treatment and requires preoperative localization imaging studies to perform selective surgery. In patients with negative results on conventional tests, PET/CT has demonstrated higher sensitivity rates. METHODS: A prospective cohort study was designed, including 34 patients diagnosed with PHP between 2017 and 2019, candidates for surgery with negative preoperative localization tests with scintigraphy and MIBI SPECT/CT. All patients underwent PET/CT with 18F-Fluorocholine. The clinical, biochemical and postoperative outcome results were compared with a control group of 30 patients with positive standard tests. RESULTS: Hyperfunctional parathyroid tissue was detected in 85% of the patients that had undergone choline PET/CT. The selective resection of the adenoma identified in these patients achieved curative criteria in 87% of the cases without undergoing bilateral cervical surgical exploration. The preoperative levels of PTH, calcemia and gland weight were significantly lower in this group compared to the control group. No differences were identified in cure criteria or approach between the 2 groups. CONCLUSION: In our study, choline PET/CT showed higher detection rates compared to the gold standard. The increase provides the opportunity to perform unilateral selected adenoma resection, especially in patients with smaller adenomas associated with lower calcemia and PTH levels and patients with previous cervical surgery


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hipertireoidismo/diagnóstico por imagem , Hipertireoidismo/complicações , Adenoma/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Sensibilidade e Especificidade , Estudos de Casos e Controles , Estudos Prospectivos , Estudos de Coortes , Paratireoidectomia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32560169

RESUMO

Thyroid diseases are characterized by a wide range of physical and mental symptoms that can affect biological function, emotional and social life of patients. However, their impact on work functioning is not yet fully understood. Therefore, this review aims to address the way in which thyroid diseases can affect occupational outcomes, i.e., the employment rate, sick leave, working capacity and work income of patients. A systematic review of Pubmed, Scopus and ISI Web of Knowledge databases has been performed. Although it is not possible to extrapolate precise data for benign pathologies, about a third of the survivors of thyroid cancer could be unemployed. Hyperthyroid and hypothyroid patients presented a greater risk of long-term sick leave than controls, depending on the severity of the disease. Hyperthyroidism impaired working ability in about a third of affected patients, particularly in cases complicated by orbitopathy with diplopia. A possible influence of thyroid diseases on various occupational outcomes emerged from our review, however further research seems necessary to understand the relationship between work problems, specific pathological characteristics over time and risk factors in the workplace. This may support a comprehensive, interdisciplinary management of thyroid disorders, with benefits for patients' personal, social and professional life.


Assuntos
Hipertireoidismo , Hipotireoidismo , Ocupações , Doenças da Glândula Tireoide , Adulto , Feminino , Humanos , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Masculino , Pessoa de Meia-Idade , Licença Médica , Doenças da Glândula Tireoide/complicações , Carga de Trabalho , Adulto Jovem
6.
Rev. méd. Chile ; 148(5): 697-701, mayo 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1139355

RESUMO

ABSTRACT Hyperthyroidism can induce elevation in several liver function tests including aminotransferases, alkaline phosphatases and, less frequently, serum bilirubin. These alterations are usually mild and asymptomatic. We report a 26 year-old male presenting with palpitations, progressive jaundice, choluria and generalized itching. Laboratory tests were compatible with hyperthyroidism and a mild elevation of bilirubin, alkaline phosphatases and gamma glutamyl transpeptidase. A liver biopsy showed portal hepatitis with canalicular cholestasis. The patient was treated temporarily with glucocorticoids, cholestyramine and betablockade. Thereafter, he was treated with radioactive iodine, after which serum bilirubin decreased steadily until normalization in ten weeks.


El hipertiroidismo puede producir elevación de aminotransferasas, fosfatasas alcalinas y, menos frecuentemente, de bilirrubina sérica. Habitualmente, estas alteraciones son leves y asintomáticas. Reportamos un hombre de 26 años con hipertiroidismo secundario a enfermedad de Basedow-Graves, que debutó con un cuadro colestásico, inicialmente estudiado por sospecha de patología hepática autoinmune que incluyó biopsia hepática. Posteriormente, se diagnosticó hipertiroidismo que fue tratado con glucocorticoides, colestiramina y beta bloqueo como puente a terapia definitiva con radioyodo. La evolución mostró disminución progresiva hasta la normalización de bilirrubina sérica.


Assuntos
Humanos , Masculino , Adulto , Doença de Graves/complicações , Colestase/diagnóstico , Colestase/etiologia , Hipertireoidismo/complicações
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(1): 132-135, 2020 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-32131953

RESUMO

Based on our experience in treating one patients with non-small cell lung cancer complicated with hyperthyroidism,the following considerations in immunotherapy and pharmaceutical care are proposed:role of iodine contrast and contrast agent selection in patients with hyperthyroidism;selection of hemostatic agents and assessment of thrombosis risk in patients with hemoptysis caused by tumor invasion of bronchus;influence of glucocorticoid use on the treatment with programmed cell death-1(PD-1)inhibitor and the role of PD-1 inhibitors in patients with a history of hyperthyroidism;education methods for patients refuse to receive opioids.The participation of clinical pharmacists in the Multiple Disciplinary Team and the multi-dimensional pharmaceutical monitoring for patients can improve the safety and rationality of medications.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Hipertireoidismo/complicações , Imunoterapia , Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/complicações , Glucocorticoides/uso terapêutico , Humanos , Neoplasias Pulmonares/complicações , Receptor de Morte Celular Programada 1/antagonistas & inibidores
8.
Life Sci ; 245: 117385, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32014425

RESUMO

AIM: The influence of thyroid hormones on exocrine pancreas function is poorly understood, and limited to the postnatal development period. Here, we evaluated the effects of hypo- and hyperthyroidism on the morphology and enzyme content of this tissue. MAIN METHODS: To induce hypothyroidism male Wistar rats were subjected to a thyroidectomy (Tx) or sham operated (SO). After 40 days, some of the Tx and SO rats were treated with T3 for 7 days. Following euthanization, the pancreas was removed and evaluated for morphology, as well as amylase, lipase and trypsin content, using histological and immunoreactive techniques analyses, respectively. Serum amylase levels were also evaluated. KEY FINDINGS: The pancreatic acinar cells of Tx rats were smaller, exhibited reduced Haematoxyllin stained areas, and contained lower amylase and lipase levels, indicative of low cell activity. Tx rats also presented higher collagen levels, and high trypsin content in pancreatic extracts. Interestingly, T3 administration reversed the observed acinar cell alterations and restored pancreatic enzyme content, by augmenting amylase and lipase and attenuating trypsin levels, but failed to change collagen content. Increased levels of lipase and decreased trypsin were also observed in T3-treated SO rats. SIGNIFICANCE: Thyroid hormones play an important role in acinar cell morphology and function. In the hypothyroid state there is a decrease in pancreatic enzyme levels that is restored with T3 treatment. In addition to participating in insulin sensitivity and glycemic control, THs also modulate enzyme expression and activity in the exocrine pancreas, consequently, delivering metabolic substrates to specific organs and tissues.


Assuntos
Pâncreas Exócrino/patologia , Hormônios Tireóideos/fisiologia , Amilases/sangue , Animais , Western Blotting , Hipertireoidismo/complicações , Hipertireoidismo/patologia , Hipotireoidismo/complicações , Hipotireoidismo/patologia , Masculino , Pâncreas Exócrino/efeitos dos fármacos , Pâncreas Exócrino/fisiopatologia , Ratos , Ratos Wistar , Tireoidectomia , Tireotropina/sangue , Tri-Iodotironina/farmacologia
10.
Vnitr Lek ; 65(12): 802-808, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32013524

RESUMO

Thyroid gland function is mediated by thyreoideal hormones, in which iodine is very important structural part. High iodine intake, can initiate thyroid dysfunction. Amiodarone induced hypothyroidism is treated with levothyroxine and amiodarone taking is not interrupted. Amiodarone induced hyperthyroidism is divided into two subtypes, which differ by mechanism of origin and treatment strategy. In patients with cardiovascular disease is higher possibility of getting substances, with high content of iodine in diagnostic-therapeutic examination with contrast or treatment with amiodarone. In this group of patients is necessary to control thyroid function regularly and to hold preventive actions.


Assuntos
Doenças Cardiovasculares , Hipertireoidismo , Hipotireoidismo , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Doenças Cardiovasculares/complicações , Humanos , Hipertireoidismo/complicações , Hipotireoidismo/etiologia , Iodo , Tiroxina
11.
J Ethnopharmacol ; 252: 112602, 2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-32004632

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Hyperthyroidism is closely associated with liver injury. The preliminary clinical observation suggests that Yinning Tablet, a hospitalized preparation of traditional Chinese formula for hyperthyroidism, improves not only hyperthyroidism, but also hyperthyroidism-associated liver injury. AIM: To evaluate the effect and underlying mechanisms of Yinning Tablet on thyroid hormone-induced liver injury. MATERIALS AND METHODS: Female rats were orally administered L-thyroxine (1 mg/kg) once daily for 60 days, and co-treated with the carefully identified Yinning Tablet extract (0.6-2.4 g/kg) during the last 30 days. Blood and liver variables were determined enzymatically, histologically, by ELISA, radioimmunoassay, Real-Time PCR or Western blot, respectively. RESULTS: Co-treatment with the extract attenuated L-thyroxine-induced increases in serum alanine transaminase and aspartate transaminase activities, the ratio of liver weight to body weight, cytoplasmic vacuolization in hepatocytes, infiltrated inflammatory cells and confused structures in liver tissue, accompanied by attenuation of increased serum triiodo-l-thyronine concentration and hepatic deiodinase type I overexpression in rats. Importantly, Yinning Tablet suppressed L-thyroxine-triggered hepatic Bax, cleaved caspases-3, -8 and -9 protein overexpression, and Bcl-2 protein downregulation. Furthermore, the increases in cytochrome c protein expression, Ca2+-ATPase activity and malondialdehyde content, and decreases in activities of Na+/K+-ATPase, catalase, superoxide dismutase and glutathione peroxidase, and total antioxidant capacity in liver tissue were attenuated. CONCLUSION: The present results suggest that Yinning Tablet ameliorates thyroid hormone-induced liver injury in rats by regulating mitochondria-mediated apoptotic signals. Our findings go insight into the pharmacological basis of the hospitalized preparation for treatment of hyperthyroidism-associated liver injury.


Assuntos
Hipertireoidismo/tratamento farmacológico , Hepatopatias/tratamento farmacológico , Mitocôndrias/efeitos dos fármacos , Substâncias Protetoras/uso terapêutico , Tiroxina , Alanina Transaminase/sangue , Animais , Apoptose/efeitos dos fármacos , Aspartato Aminotransferases/sangue , Medicamentos de Ervas Chinesas , Feminino , Formulários de Hospitais como Assunto , Hipertireoidismo/complicações , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Hepatopatias/etiologia , Hepatopatias/genética , Hepatopatias/patologia , Estresse Oxidativo/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Ratos Sprague-Dawley , Tiroxina/sangue , Transcriptoma/efeitos dos fármacos , Tri-Iodotironina/sangue
12.
Artigo em Inglês | MEDLINE | ID: mdl-32013113

RESUMO

Background: Little evidence is available about the risk of sudden sensorineural hearing loss (SSNHL) in patients with thyroid diseases. We assessed whether a diagnosis of thyroid disease, particularly hyperthyroidism or hypothyroidism, is associated with SSNHL risk in an Asian population. Material and Methods: This case-control study was conducted with population-based data from Taiwan's National Health Insurance Research Database from January 2000 to December 2013. The case group comprised 3331 adult patients with newly diagnosed SSNHL, and four controls without SSNHL for each case matched by sex, age, monthly income, and urbanization level of residence. Underlying Thyroid diseases were retrospectively evaluated in the case and control groups. Multivariate logistic regression analyses were used to explore relations between thyroid diseases and SSNHL. Results: Of the 3331 cases, 5.7% had preexisting thyroid diseases, whereas only 4.0% of the 13,324 controls had the same condition. After adjustment for sex, age, monthly income, urbanization level of residence, history of hypertension, diabetes mellitus, chronic otitis media, and hyperlipidemia, associations were identified between a history of either hypothyroidism (adjusted odds ratio [AOR], 1.54; 95% CI, 1.02-2.32; p = 0.042) or hyperthyroidism (AOR, 1.41; 95% CI, 1.07-1.85; p = 0.015) and an elevated risk of SSNHL. In subgroup analysis, the correlation between hypothyroidism and increased SSNHL risk remained significant only for patients aged over 50 years (AOR, 1.61; 95% CI, 1.01-2.57; p = 0.045), and that between hyperthyroidism and SSNHL was significant only for female patients (AOR, 1.48; 95% CI, 1.09-2.01; p = 0.012). Treatment for hypothyroidism and hyperthyroidism did not alter the association in subgroup analyses. Conclusion: Preexisting hypothyroidism and hyperthyroidism appear associated with SSNHL susceptibility in Taiwan. Physicians should be wary of this elevated risk of SSNHL among patients with previously diagnosed thyroid dysfunction, especially women and patients aged more than 50 years.


Assuntos
Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Súbita/etiologia , Hipertireoidismo/complicações , Hipotireoidismo/complicações , Otite Média/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Feminino , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Súbita/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Cobertura de Condição Pré-Existente , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
14.
J Cardiothorac Surg ; 15(1): 22, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948453

RESUMO

BACKGROUND: Thyroid storm is a rare, life-threatening disease triggered by an acute event or trauma, such as surgery of the thyroid or another area, and infection. However, recent studies have shown that irregular use or discontinuation of antithyroid drugs is the most common cause of thyroid storm. A cardiovascular event caused by thyroid storm following coronary artery bypass graft (CABG) is high output heart failure with extreme tachycardia, which can be fatal. Thyroid storm after nonthyroidal surgery, especially CABG, has been rarely reported, with only one reported case until now. Herein, we present a case of thyroid storm onset in a patient who underwent CABG. CASE PRESENTATION: A 74-year-old woman with a history of antithyroid medication discontinuation against medical advice underwent urgent CABG. The patient exhibited extreme tachycardia postoperatively, which is highly suggestive of thyroid storm. Although a higher infection risk is an important consideration, a high-dose steroid was used to control the intractable tachycardia that did not respond to beta-blocker administration. Despite appropriate antibiotic treatment, the patient's condition was exacerbated, and she developed multiple organ failure resulting from adult respiratory distress syndrome progression, and she died on day 8 after surgery. CONCLUSIONS: Risk factors for thyroid storm after CABG and its treatment outcomes are rarely reported. Patients with a history of inappropriate antithyroid medication prescription should be in a euthyroid state before surgery. If surgery is imminent, anticipating thyroid storm and its treatment as well as a euthyroid state can improve recovery outcomes postoperatively.


Assuntos
Antitireóideos/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/cirurgia , Hipertireoidismo/tratamento farmacológico , Adesão à Medicação , Crise Tireóidea/etiologia , Idoso , Antitireóideos/efeitos adversos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Doença das Coronárias/complicações , Evolução Fatal , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Hipertireoidismo/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , /terapia , Fatores de Risco , Crise Tireóidea/terapia , Resultado do Tratamento
16.
Curr Opin Endocrinol Diabetes Obes ; 27(1): 70-76, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31789723

RESUMO

PURPOSE OF REVIEW: This review is intended to highlight recent studies which provide new data on the epidemiology and management of children with hyperthyroidism, including neonates. RECENT FINDINGS: A French study demonstrates differences in age-related trends in incidence of hyperthyroidism in males versus females and suggests the overall incidence may be increasing. New studies confirm the effectiveness and safety of long-term medical therapy (up to 10 years), including from the first randomized trial of short-term versus long-term therapy. Radioiodine ablation (RAI) is the main alternative therapy, though surgery may have some advantages if done in a high-volume center; using higher weight-based doses of I-131 (250 µCI/g thyroid tissue) could increase proportion of patients achieving hypothyroidism and decrease repeat ablations. Maternal or neonatal thyroid-stimulating hormone (TSH) receptor antibodies in children of mothers with Graves' disease, and TSH at 3-7 days of age are good predictors of which neonates will have problems. SUMMARY: More research is needed on the epidemiology of Graves' disease. Long-term medical therapy well past two years should be considered an option in compliant patients to decrease the number who need definitive therapy. For those receiving RAI, a dose of about 250 µCI/g thyroid tissue should result in fewer cases of persistent hyperthyroidism than lower doses.


Assuntos
Hipertireoidismo/epidemiologia , Hipertireoidismo/terapia , Idade de Início , Antitireóideos/uso terapêutico , Criança , Feminino , Doença de Graves/tratamento farmacológico , Doença de Graves/epidemiologia , Humanos , Hipertireoidismo/complicações , Incidência , Recém-Nascido , Radioisótopos do Iodo/uso terapêutico , Masculino
19.
Am J Cardiol ; 125(1): 48-54, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711634

RESUMO

A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrial fibrillation (AF), with good discrimination and internal calibration. To define high-risk patients at particular age strata for incident AF in a nationwide population cohort, who could potentially be targeted for AF screening, we used a nationwide cohort study of all Danish citizen aged ≥65 years to evaluate the performance of the C2HEST score. "High risk" subjects at age 65, 70, and 75 had 5-year risks of new onset AF of 11.8%, 14.2% and 13.6%, respectively, and the corresponding event rates were 2.99, 3.67, and 3.38 per 100 person years, respectively. Associated hazard ratios (HR) were 4.08 (95% confidence interval [CI] 3.84 to 4.34), 3.80 (95% CI: 3.68 to 3.92) and 2.17 (95% CI: 2.13 to 2.22), respectively compared with the lowest risk strata within age category. At all age cohorts, the greatest risk component of the C2HEST score on multivariable analysis was by having 2 points for C (C2), that is both CAD and COPD followed by systolic heart failure (S) both with HRs up to 2.0. CAD or COPD alone (C1) or hypertension (H) were associated with increased risk of new onset AF corresponding to HR between 1.44 and 1.64. In conclusion, this nationwide population cohort addresses the question on clinical risk prediction for new onset AF in a population at different age strata, whereby the C2HEST score may help in identifying those at 'high risk' of new onset AF at 3 distinct age cohorts (65, 70, and 75 years). A high risk C2HEST score stratum was associated with a greater risk of new onset AF. These patients could be considered for more intensive efforts for screening and detection of incident AF.


Assuntos
Fibrilação Atrial/epidemiologia , Insuficiência Cardíaca Sistólica/complicações , Hipertensão/complicações , Hipertireoidismo/complicações , Programas de Rastreamento/métodos , Vigilância da População , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca Sistólica/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertireoidismo/epidemiologia , Incidência , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
20.
Ann Pharmacother ; 54(5): 486-495, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31744311

RESUMO

Objective: To describe the various pharmacotherapeutic strategies in managing thyroid disease-induced pericarditis (TDIP). Considerations for both hypothyroid-induced and hyperthyroid-induced pericarditis will be discussed. Data Sources: A literature search of MEDLINE, including PubMed, was performed inclusive of all years, using the following search terms: thyroid disease, pericardial diseases, pericarditis, acute pericarditis, cholesterol pericarditis, hypothyroidism, hyperthyroidism, colchicine, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, methimazole, propylthiouracil, and P-glycoprotein. Product monographs were reviewed as well. Study Selection and Data Extraction: Relevant English-language studies and data as well as the most current guidelines for diagnosis and management of thyroid and pericardial diseases were considered. Because of limited data regarding the subject matter, no date range limits were established during literature search. Data Synthesis: It is well documented that thyroid dysfunction can adversely affect cardiovascular function. Additionally, there are published guidelines on the diagnosis and management of pericarditis and, separately, thyroid disease. There are limited data, however, on managing TDIP. The sequela of untreated TDIP can be detrimental. Relevance to Patient Care and Clinical Practice: Strategies on managing TDIP are scarcely reported in the literature. This review provides clinicians with a single reference source for treatment strategies toward managing hypothyroidism-induced and hyperthyroidism-induced pericarditis as well as significant drug interactions that can potentially confound the management of hypothyroidism- and hyperthyroidism-induced pericarditis. Conclusions: Treatment of TDIP involves addressing both the thyroid disease as well as the pericarditis. Along with treatment strategies, clinicians should also consider potential drug-drug and drug-disease interactions that can potentially worsen clinical outcomes.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Colchicina/uso terapêutico , Pericardite/tratamento farmacológico , Doenças da Glândula Tireoide/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Colchicina/administração & dosagem , Interações Medicamentosas , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/tratamento farmacológico , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Pericardite/diagnóstico , Pericardite/etiologia , Doenças da Glândula Tireoide/complicações
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