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1.
Orv Hetil ; 161(27): 1131-1136, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32564004

RESUMO

INTRODUCTION: Benign thyroid nodules are frequent findings in imaging studies, most of the time not requiring any intervention. Treatment is usually started when nodules increase in size, the patient becomes symptomatic or clinically relevant hyperthyroidism develops. Thermoablation is an effective alternative modality. In Hungary, our team has pioneered these interventions using radiofrequency ablation for decreasing the size of the nodules. AIM: We are presenting our results showing the effectiveness of this treatment after introducing the role, importance and technique of thermoablation in benign thyroid nodules. METHOD: Between June of 2016 and September of 2019, 186 nodules of 140 patients were treated with radiofrequency ablation and had at least 6 months of follow up. The volume and diameter of all the ablated nodules were measured and calculated, then the decreases of these parameters were followed using ultrasonography. The mean follow-up time was 12.5 ± 5.9 months. RESULTS: The size measurements at the follow-up ultrasonography examinations showed a decrease in size and vascularity. The mean volume reduction was 44.7 ± 17.6% at one-month post-treatment and 72.9 ± 17.9% at 6 months. There were 3 minor complications. CONCLUSIONS: Radiofrequency ablation represents a feasible, effective, well tolerated method for outpatient treatment of benign thyroid nodules. This method is a valuable alternative to surgical treatments in selected cases. Orv Hetil. 2020; 161(27): 1131-1136.


Assuntos
Ablação por Cateter , Hipertireoidismo/terapia , Nódulo da Glândula Tireoide/cirurgia , Ultrassonografia/métodos , Seguimentos , Humanos , Hungria , Hipertireoidismo/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento
2.
Eur J Endocrinol ; 183(1): G33-G39, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32438340

RESUMO

This manuscript provides guidance on the management of thyroid dysfunction during the COVID-19 pandemic. Autoimmune thyroid diseases are not linked to increased risks of COVID-19. Uncontrolled thyrotoxicosis may result in more severe complications from SARS-CoV-2 infection, including thyroid storm. The management of patients with a new diagnosis of hyperthyroidism is best undertaken with a block-and-replace regimen due to limited biochemical testing availability. Antithyroid drug (ATD)-induced neutropenia may favour the progression of COVID-19 and symptoms of infection may be confused with SARS-CoV-2 infection. The withdrawal of ATDs and urgent measurement of neutrophils should be considered in case of flu-like manifestations occurring in the initial months of treatment. Urgent surgery or 131-I may be undertaken in selected cases of uncontrolled thyrotoxicosis. Patients with COVID-19 infection may present with conjunctivitis, which could cause diagnostic difficulties in patients with new or existing Graves' ophthalmopathy. Patients who are on replacement treatment with thyroid hormones should ensure they have sufficient supply of medication. The usual advice to increase dosage of levothyroxine during pregnancy should be adhered to. Many newly presenting and previously diagnosed patients with thyroid dysfunction can be managed through virtual telephone or video clinics supported by a dedicated nurse-led service, depending on available facilities.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Hipertireoidismo/terapia , Hipotireoidismo/terapia , Pneumonia Viral/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/epidemiologia , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Fatores de Risco
3.
J Surg Res ; 246: 435-441, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31630881

RESUMO

BACKGROUND: Thyroidectomy is a definitive treatment for hyperthyroidism. The purpose of this study is to examine how often patients with hyperthyroidism are referred for thyroidectomy and what are the common reasons for referral. MATERIALS AND METHODS: We identified 864 patients with hyperthyroidism diagnosis. A total of 237 patients underwent thyroidectomy from January 2011 to December 2016. Patients were divided into six groups according to the year of thyroidectomy, group 1 to group 6, from 2011 to 2016, respectively. Primary and secondary outcomes: reasons why patient was referred for thyroidectomy, time from diagnosis, and/or start of antithyroid drugs (ATDs) to thyroidectomy as well as the trend and total number of thyroidectomies each surgeon did during the study period. RESULTS: The mean age was 44 ± 15 y, 73% were women, and 54% were African American. A significant increase in the rate of thyroidectomy over the study period was observed where 31 patients underwent thyroidectomy in 2011 compared with 61 patients in 2016. The most common reasons patients were referred for thyroidectomy were resistance or intolerance to ATDs followed by patient's preference, and presentation with obstructive symptoms with no statistically significant difference between groups. The median time from diagnosis to surgery was 8 mo (0 to 204 mo) and 7 mo from initiation of ATDs to thyroidectomy with no significant difference between groups. CONCLUSIONS: An increase of thyroidectomy rate was observed at our institution over the last 6 y. Patients were mostly referred due to resistance or intolerance to antithyroid medications, patients' preference of surgery, and presentation with obstructive symptoms.


Assuntos
Antitireóideos/farmacologia , Hipertireoidismo/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Tireoidectomia/tendências , Adulto , Antitireóideos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Tireoidectomia/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos
5.
Medicine (Baltimore) ; 98(52): e18537, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876751

RESUMO

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09-1.46; COCI: HR = 1.22, 95% CI = 1.06-1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.


Assuntos
Continuidade da Assistência ao Paciente , Diabetes Mellitus Tipo 2/etiologia , Doenças da Glândula Tireoide/complicações , Adulto , Fatores Etários , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Hipotireoidismo/complicações , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Doenças da Glândula Tireoide/terapia , Adulto Jovem
6.
Ann Endocrinol (Paris) ; 80(4): 240-249, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31427038

RESUMO

Subclinical hyperthyroidism is a common clinical entity, defined by serum TSH below the reference range, with normal FT4 and FT3 levels in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional and longitudinal population-based studies demonstrate association of subclinical hyperthyroidism with risk of atrial fibrillation and osteoporosis, and with cardiovascular and all-cause mortality. However, there are no randomized clinical trials addressing whether long-term health outcomes are improved by treating subclinical hyperthyroidism; in the absence of evidence one way or the other, it seems appropriate to use decision trees taking account of TSH concentration and presence of risk factors (age>65 years or post-menopause, osteoporosis and cardiac disease).


Assuntos
Bócio Nodular , Doença de Graves , Hipertireoidismo , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Bócio Nodular/complicações , Bócio Nodular/epidemiologia , Bócio Nodular/terapia , Doença de Graves/complicações , Doença de Graves/epidemiologia , Doença de Graves/terapia , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/epidemiologia , Hipertireoidismo/terapia , Fatores de Risco
7.
Ann Endocrinol (Paris) ; 80(4): 216-224, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400861

RESUMO

TSH (thyroid-stimulating hormone)-secreting tumors are the rarest type of pituitary tumor. The objective of this study was to describe initial presentation and follow-up in patients presenting TSH-secreting tumors and to characterize the pathological features, based on a cohort of 20 patients treated in our referral center, between 1981 and 2014. Most of the patients (75%) were female, aged around 50 years (mean: 50±13 years). Initial symptoms were hyperthyroidism (8/20) and/or tumor mass-related symptoms. Median time to diagnosis was 18 months. Biochemical hyperthyroidism was found in 15 patients. Most of the tumors were macroadenomas (75%) and 30% were invasive. Seventeen patients underwent transsphenoidal surgery. All tumors expressed TSH, with>50% positive cells. Eleven were monohormonal and 6 plurihormonal, expressing ßTSH plus growth hormone (GH) and/or prolactin (PRL). Both subtypes showed high expression of Pit-1 and SSTR2A somatostatin receptors. SSTR5 was slightly expressed in the plurihormonal subtype. Ki-67 index was elevated (≥3%) in only one tumor. Signs of hyperthyroidism were more frequent in the plurihormonal than in the monohormonal subtype. At final follow-up (median: 34.79±66.7 months), 75% of the patients were in complete remission after surgery; persistent hyperthyroidism was controlled by somatostatin analogs, alone (n=3) or associated to radiotherapy (n=1). The multidisciplinary approach promoted early diagnosis and control of hyperthyroidism by neurosurgical treatment, associated to somatostatin analogs or not. Clinical/pathological correlations highlighted the variations in immune profiles and in clinical and biological symptoms.


Assuntos
Adenoma , Neoplasias Hipofisárias , Tireotropina/metabolismo , Adenoma/diagnóstico , Adenoma/metabolismo , Adenoma/patologia , Adenoma/terapia , Adulto , Idoso , Feminino , França , História do Século XX , História do Século XXI , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/patologia , Hipertireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/terapia , Estudos Retrospectivos , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico
9.
Endocrinol Metab Clin North Am ; 48(3): 533-545, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31345521

RESUMO

Clinical hyperthyroidism affects 0.1% to 0.4% of pregnancies. Gestational thyrotoxicosis is due to homology of the structure of TSH and HCG, which weakly stimulates the TSH receptor. Graves' disease (GD) most commonly causes clinically significant hyperthyroidism. Given concerns for teratogenicity from antithyroid drugs, these may be discontinued in low-risk GD patients. High-risk patients are treated with propylthiouracil in the first trimester then may transition to methimazole. Surgery is reserved for special circumstances; radioactive iodine is contraindicated. In late pregnancy, GD may remit; postpartum relapse is common. Measurement of serum thyrotropin receptor antibodies identifies pregnancies at-risk for fetal and neonatal hyperthyroidism.


Assuntos
Hipertireoidismo/complicações , Complicações na Gravidez , Antitireóideos/uso terapêutico , Contraindicações , Feminino , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/epidemiologia , Hipertireoidismo/terapia , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/prevenção & controle , Radioisótopos do Iodo/uso terapêutico , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Fatores de Risco
10.
Clin Obes ; 9(5): e12328, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267667

RESUMO

Hyperthyroidism causes weight loss in the majority, but its effect is variable and 10% of patients gain weight. Its treatment usually leads to weight gain and some studies have reported an excess weight regain. However, there is considerable inter-individual variability and a differential effect on body weight by different treatments, with some studies reporting more weight increase with radioiodine, and perhaps surgery, compared with anti-thyroid drugs. The excess weight regain may relate to treatment-induced hypothyroidism. Furthermore, the transition from hyperthyroidism to euthyroidism may unmask, or exacerbate, the predisposition that some patients have towards obesity. Other risk factors commonly implicated for such weight increase include the severity of thyrotoxicosis at presentation and underlying Graves' disease. Conflicting data exist whether lean body mass or fat mass or both are increased post-therapy and whether such increments occur concurrently or in a sequential manner; this merits clarification. In any case, clinicians need to counsel their patients regarding this issue at presentation. Limited data on the effect of dietary interventions on weight changes with treatment of hyperthyroidism are encouraging in that they cause significantly lesser weight gain compared to standard care. More research is indicated on the impact of the treatment of hyperthyroidism on various anthropometric indices and the predisposing factors for any excessive weight gain. Regarding the impact of dietary management or other weight loss interventions, there is a need for well-designed and, ideally, controlled intervention studies.


Assuntos
Hipertireoidismo/terapia , Ganho de Peso , Antitireóideos/uso terapêutico , Composição Corporal , Dietoterapia , Feminino , Doença de Graves/terapia , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Obesidade/epidemiologia , Obesidade/etiologia , Fatores de Risco , Tireoidectomia , Tireotoxicose/terapia
11.
Zhongguo Zhen Jiu ; 39(6): 667-72, 2019 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-31190507

RESUMO

To explore the clinical acupoint selection rules for hyperthyroidism and related exophthalmos treated with acupuncture. By taking "hyperthyroidism" "acupuncture and moxibustion" as keywords,literature regarding acupuncture for hyperthyroidism and related exophthalmos published was collected in the Chinese Journal Full-text Database (CNKI), VIP Database (VIP) and WANFANG database. The literature was organized, the database of acupuncture prescription was established and the characteristics and rules of acupoint selection were analyzed. A total of 46 papers were included, involving 89 acupoints, the frequency of acupoint application was 449 times. The most commonly used 6 acupoints for hyperthyroidism treated with acupuncture were Sanyinjiao (SP 6), Neiguan (PC 6), Zusanli (ST 36), Shuitu (ST 10), Hegu (LI 4), Taichong (LR 3). And the most meridians of acupoints were the stomach meridian and the pericardium meridian. The most commonly used 6 acupoints for hyperthyroidism related exophthalmos treated with acupuncture were Fengchi (GB 20), Shangtianzhu (Extra), Hegu (LI 4), Sanyinjiao (SP 6), Cuanzhu (BL 2), Yangbai (GB 14). And the most meridian of acupoints was the gallbladder meridian. The most commonly used specific acupoints for hyperthyroidism treated with acupuncture were crossing points, yuan-source points and five-shu points. The most commonly used specific acupoints for hyperthyroidism related exophthalmos treated with acupuncture were crossing points, yuan-source points and five-shu points. Acupuncture masters in modern times have achieved significant therapeutic effect in the treatment of hyperthyroidism,which has showed the principles of searching for the primary cause of disease in treatment and giving consideration to both the root cause and symptoms. But there is a lack of simple and effective treatment methods that can be rapidly promoted in clinical practice.


Assuntos
Terapia por Acupuntura , Exoftalmia , Hipertireoidismo , Meridianos , Pontos de Acupuntura , Exoftalmia/terapia , Humanos , Hipertireoidismo/terapia
12.
BMJ Case Rep ; 12(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954956

RESUMO

We report two women who were diagnosed with hypothyroidism due to what was thought to be Hashimoto's thyroiditis 18 and 16 years ago, respectively. They had been euthyroid on stable doses of levothyroxine for many years, and they presented to our clinic with clinically and biochemically overt hyperthyroidism that persisted even after stopping levothyroxine. Immunological and imaging workups were consistent with Graves' disease. Both patients were treated medically and then received definitive treatment. To our knowledge, the intervals for these two conversions are among the longest conversion intervals reported in the medical literature.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antitireóideos/uso terapêutico , Doença de Graves/fisiopatologia , Doença de Hashimoto/fisiopatologia , Hipertireoidismo/imunologia , Hipotireoidismo/imunologia , Feminino , Doença de Graves/complicações , Doença de Graves/imunologia , Doença de Graves/terapia , Doença de Hashimoto/complicações , Doença de Hashimoto/imunologia , Doença de Hashimoto/terapia , Humanos , Hipertireoidismo/etiologia , Hipertireoidismo/fisiopatologia , Hipertireoidismo/terapia , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Hipotireoidismo/terapia , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Propranolol/uso terapêutico , Tireoidectomia , Tiroxina/efeitos adversos , Tiroxina/uso terapêutico , Resultado do Tratamento
13.
Clin Obstet Gynecol ; 62(2): 320-329, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31026230

RESUMO

Hyperthyroidism is relatively uncommon during pregnancy. However, those caring for pregnant patients should be versed in the evaluation and management of hyperthyroidism, as there are potential maternal and fetal implications that are related to the disease and to treatment. The differential diagnosis of hyperthyroidism includes clinical and subclinical entities, as well as transient laboratory findings that are related to the pregnancy itself. The clinical management, including the indications for the use of thioamide or antithyroid medications, will be discussed in the context of pregnancy. Finally, considerations for the management of the postpartum and/or breastfeeding patient with hyperthyroidism will be reviewed.


Assuntos
Hipertireoidismo/diagnóstico , Complicações na Gravidez/diagnóstico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Antitireóideos/uso terapêutico , Autoanticorpos/sangue , Feminino , Humanos , Hiperêmese Gravídica/complicações , Hipertireoidismo/terapia , Troca Materno-Fetal , Tireoidite Pós-Parto/terapia , Cuidado Pré-Concepcional , Gravidez , Complicações na Gravidez/terapia , Testes de Função Tireóidea
14.
BMC Cardiovasc Disord ; 19(1): 83, 2019 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947691

RESUMO

BACKGROUND: Subclinical thyroid dysfunction whose typical patterns include subclinical hypothyroidism and subclinical hyperthyroidism, has been indicated to be associated with an increased risk of heart failure (HF). However, the relationship between subclinical thyroid dysfunction and the clinical outcomes of HF patients is uncertain. This meta-analysis was conducted to assess the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. METHODS: Pubmed, Embase, Web of Science and Cochrane Central Register of Clinical Trials were searched for eligible studies published up to August 1, 2018 which reported the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. The pooled hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used to assess the association. RESULTS: Fourteen studies met the eligibility criteria and a total of 21,221 patients with heart failure were included in the meta-analysis. Compared with HF patients with euthyroidism, the pooled HR of subclinical hypothyroidism for all-cause mortality was 1.45 (95% CI 1.26-1.67) in a randomized effects model with mild heterogeneity (I2 = 40.1, P = 0.073). The pooled HR of subclinical hypothyroidism for cardiac death and/or hospitalization was 1.33 (1.17-1.50) in a randomized effects model with moderate heterogeneity (I2 = 69.4, P < 0.001). Subclinical hyperthyroid can increase the risk of all-cause mortality without heterogeneity (HR 1.31, 95% CI 1.10-1.55, I2 = 25.5%, P = 0.225) but have no influence on the risk of cardiac death and/or hospitalization (HR 1.03, 95% CI 0.87-1.23, I2 = 0.0%, P = 0.958). These significant adverse associations were also retained in subgroup analysis. Sensitivity analysis demonstrated the stability of the results of our meta-analysis. CONCLUSIONS: Both subclinical hypothyroidism and subclinical hyperthyroidism are associated with adverse prognosis in patients with HF. Subclinical thyroid dysfunction may be a useful and promising predictor for the long-term prognosis in HF patients.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Hipertireoidismo/fisiopatologia , Hipotireoidismo/fisiopatologia , Volume Sistólico , Glândula Tireoide/fisiopatologia , Função Ventricular Esquerda , Idoso , Doenças Assintomáticas , Causas de Morte , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/mortalidade , Hipertireoidismo/terapia , Hipotireoidismo/diagnóstico , Hipotireoidismo/mortalidade , Hipotireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
15.
J Pharm Pract ; 32(3): 314-326, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852927

RESUMO

Endocrine emergencies are frequent in critically ill patients and may be the cause of admission or can be secondary to other critical illness. The ability to anticipate endocrine abnormalities such as adrenal excess or , hypothyroidism, can mitigate their duration and severity. Hyperglycemic crisis may trigger hospital and intensive care unit (ICU) admission and may be life threatening. Recognition and safe treatment of severe conditions such as acute adrenal insufficiency, thyroid crisis, and hypoglycemia and hyperglycemic crisis may be lifesaving. Electrolyte abnormalities such as hypercalcemia and hypocalcemia may have underlying endocrine causes, and may be treated differently with recognition of those disorders- electrolyte replacement alone may not be adequate for efficient resolution. Sodium disorders are common in the ICU and are generally related to altered water balance however may be related to pituitary abnormalities in selected patients, and recognition may improve treatment effectiveness and safety.


Assuntos
Doenças do Sistema Endócrino/terapia , Unidades de Terapia Intensiva/normas , Insuficiência Adrenal/terapia , Síndrome de Cushing/terapia , Humanos , Hipercalcemia/terapia , Hiperglicemia/terapia , Hipernatremia/terapia , Hipertireoidismo/terapia , Hipocalcemia/terapia , Hipoglicemia/terapia , Hipotireoidismo/terapia
16.
Thyroid ; 29(3): 332-340, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30648498

RESUMO

BACKGROUND: Cardiovascular disease remains the most prevalent cause of death in hyperthyroidism. However, the impact on cardiovascular events of varying thyroid status and of treatment remains unclarified. The aims of this study were to investigate the association between hyperthyroidism and cardiovascular events in treated and untreated hyperthyroid individuals, as well as exploring the impact of cumulative periods of hyperthyroidism as a proxy for undertreatment on cardiovascular events. METHOD: This was a case-control study nested within a population-based cohort of individuals attending health services in Funen County, Denmark, in the period from 1995 to 2011. Data on comorbidities and mortality were collected from The Danish National Patient Register and The Danish Register of Causes of Death. Participants were 275,467 individuals with at least one serum thyrotropin (TSH) measurement in the study period. Hyperthyroidism was defined as at least two measurements of decreased serum TSH within six months, separated by at least 14 days. Incident cases of cardiovascular disease (myocardial infarction, atrial fibrillation, heart failure, stroke, and cardiovascular death) were matched with controls. Conditional logistic regression analyses were performed to calculate odds ratios (OR) for exposure to hyperthyroidism, adjusting for preexisting comorbidities. RESULTS: A total of 20,651 individuals experienced a cardiovascular event (9.5% incidence rate 13.2/1000 person-years [confidence interval (CI) 13.0-13.4]) compared to euthyroid individuals, conditional logistic regression showed increased cardiovascular risk in untreated hyperthyroid patients (OR = 1.25 [CI 1.06-1.48], p = 0.007) but not in treated hyperthyroid patients (OR = 1.04 [CI 0.90-1.22], p = 0.57)]. The OR for cardiovascular events per six months of decreased TSH was 1.09 ([CI 1.05-1.14], p < 0.001) in treated hyperthyroid individuals, and 1.10 ([CI 1.05-1.15], p < 0.001) in untreated hyperthyroid individuals. CONCLUSIONS: The risk of cardiovascular disease was found to be increased in untreated hyperthyroid patients, and the duration of decreased TSH associated with increasing risk of cardiovascular outcomes in both treated and untreated hyperthyroid individuals. This suggests that increased cardiovascular risk is driven not only by lack of treatment but also by insufficient therapy. The results support timely treatment and careful monitoring of hyperthyroid patients in order to reduce cardiovascular risk.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/terapia , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Análise de Regressão , Fatores de Risco , Tireotropina/sangue , Resultado do Tratamento
17.
J Gynecol Obstet Hum Reprod ; 48(4): 231-233, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30634005

RESUMO

Fetal thyroid disorders while uncommon in general, have significant morbidity and profound effects in the neonate. Pregnancy provides the opportunity not only for the diagnosis of these conditions but also for therapeutic interventions. In careful balance, these disorders range from hypothyroidism to hyperthyroidism, both may manifest with fetal thyroid goiters as well. The intrauterine therapeutic approach of these must also weight the balance in this range as well as the maternal well being which may also express thyroid dysfunction. In this review we explore the different fetal manifestations of thyroid disease, describe the pathophysiology and therapeutic approaches both in practice and in development.


Assuntos
Doenças Fetais/diagnóstico , Doenças da Glândula Tireoide/embriologia , Antitireóideos/administração & dosagem , Feminino , Doenças Fetais/fisiopatologia , Doenças Fetais/terapia , Idade Gestacional , Bócio/diagnóstico por imagem , Bócio/embriologia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/embriologia , Hipertireoidismo/terapia , Hipotireoidismo/diagnóstico , Hipotireoidismo/embriologia , Hipotireoidismo/terapia , Recém-Nascido , Triagem Neonatal , Gravidez , Complicações na Gravidez , Diagnóstico Pré-Natal , Propiltiouracila/administração & dosagem , Doenças da Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/terapia , Tiroxina/administração & dosagem , Ultrassonografia Pré-Natal
18.
J Pediatr Endocrinol Metab ; 32(2): 151-157, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30685744

RESUMO

Background The objective of the study was to evaluate the long-term outcome of paediatric-onset hyperthyroidism with follow-up into adulthood and to identify any early predictors of a need for definitive therapy (DT). Methods In a retrospective analysis of patients diagnosed with hyperthyroidism under the age of 18 years and at follow-up, a comparison was made by categorising them into those who underwent definitive therapy (DT group), i.e. thyroidectomy/radioactive iodine (RAI), those who remained on antithyroid drugs (ATD) (CBZ group) and those who had complete remission (RE group). Results Sixty-one (49 females, 12 males) patients with a median age of 15.1 years (range: 3.6-18) at diagnosis were studied. The duration of the first course of ATD varied from <1 year (7%), 1-2 years (26%), >2 years (46%) and ATD never discontinued (21%). Disease relapsed in 69% of patients with <1 year of ATD vs. 79% with >2 years of ATD. At follow-up, the median duration since diagnosis was 8.75 years (range 2.0-20.7 years) and the median age at follow-up was 23.2 years (8-36 years). Thirty-three percent (20/61) had undergone DT (DT group) - with 16.5% (n=10) on RAI and 16.5% (n=10) on surgery, 36% (22/61) were on ATD (CBZ group), whilst 32% (19/61) had undergone full remission (RE group). The comparison did not identify any statistically significant difference for predictor factors at diagnosis including age, T4 and free T4 levels, thyroid peroxidise antibody levels (TPO) and the duration of the first course of carbimazole (CBZ) treatment. Conclusion Long-term complete remission of paediatric-onset hyperthyroidism in our study was 31%. There were no predictors identified that could help predict the long-term outcome, especially into adulthood.


Assuntos
Antitireóideos/uso terapêutico , Hipertireoidismo/terapia , Radioisótopos do Iodo/uso terapêutico , Tireoidectomia/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Hipertireoidismo/patologia , Masculino , Indução de Remissão , Estudos Retrospectivos , Testes de Função Tireóidea , Resultado do Tratamento
19.
Surgery ; 165(1): 80-84, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30415871

RESUMO

BACKGROUND: Although hyperthyroidism is associated with high turnover osteopenia and its recovery after treatment, the extent of recovery with different forms of therapy remains controversial. This prospective study evaluated the bone mineral density in thyrotoxic subjects undergoing total thyroidectomy and 131I radioactive iodine therapy. METHODS: Newly diagnosed subjects with hyperthyroidism undergoing total thyroidectomy (group 1; n = 127) and 131I radioactive iodine therapy (group 2; n = 30) were evaluated for bone mineral density by dual energy x-ray absorptiometry at the time of diagnosis (point A), on achieving euthyroidism with antithyroid drugs (point B), and 6 months after definitive treatment (point C). RESULTS: In group 1, bone mineral density (expressed as g/sq cm; mean ± standard deviation) in the hip (0.842 ± 0.157) and spine (0.97 ± 0.155) at point A, improved at point B (hip, 0.853 ± 0.157 and spine, 0.982 ± 0.155), and further improved at point C (hip, 0.91 ± 0.158 and spine, 1.053 ± 0.161, each P < .001). In group 2, at point C, bone mineral density in the hip (0.761 ± 0.168 versus point A, 0.741 ± 0.146) and spine (0.831 ± 0.159 versus point A, 0.823 ± 0.158) were less than group 1 (each P < .01). CONCLUSION: Bone mineral density improved significantly after all forms of treatment of hyperthyroidism and was greatest in lumbar vertebrae (8.6%) as early as 6 months after total thyroidectomy. The delayed recovery of bone mineral density after 131I radioactive iodine therapy needs long-term evaluation.


Assuntos
Densidade Óssea/fisiologia , Fêmur/diagnóstico por imagem , Hipertireoidismo/terapia , Vértebras Lombares/diagnóstico por imagem , Tireoidectomia , Absorciometria de Fóton , Adulto , Antitireóideos , Carbimazol/uso terapêutico , Feminino , Fêmur/fisiopatologia , Humanos , Hipertireoidismo/fisiopatologia , Radioisótopos do Iodo/uso terapêutico , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
20.
Praxis (Bern 1994) ; 107(22): 1187-1192, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-30376773

RESUMO

Hyperthyroidism is caused by an increased synthesis of thyroid hormones or release of preformed thyroid hormones due to destruction of thyroid tissue, or there is an exogenous extrathyroidal source. The term thyroiditis describes a heterogeneous group of disorders, which result in destruction of thyroid tissue and release of preformed thyroid hormones. Although a less common condition, a thyroiditis remains an important differential diagnosis for thyrotoxicosis, and a symptomatic therapy is the cornerstone of treatment. Because of the classical triphasic clinical course a 'wait and see strategy' is reasonable, especially during the first and self-limited hyperthyroid phase. Usually a transient hypothyroid phase follows, before the euthyroid function is restored within a year. However, as permanent hypothyroidism may result, regular follow-up and in that case treatment with levothyroxine is mandatory.


Assuntos
Hipertireoidismo/diagnóstico , Tireoidite/diagnóstico , Tireotoxicose/diagnóstico , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Diagnóstico Diferencial , Feminino , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/etiologia , Doença de Hashimoto/terapia , Humanos , Hipertireoidismo/etiologia , Hipertireoidismo/terapia , Prednisolona/uso terapêutico , Prognóstico , Tireoidite/etiologia , Tireoidite/terapia , Tireotoxicose/etiologia , Tireotoxicose/terapia , Conduta Expectante
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