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1.
Kardiologiia ; 60(9): 76-83, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131478

RESUMO

Aim To study features of coronary damage and incidence of different types of acute coronary syndrome (ACS) in history associated with primary symptomatic hypothyroidism in patients with ischemic heart disease (IHD) and possible associations of replacement hormonal therapy with lipidogram indexes.Material and methods This retrospective study included 344 patients with IHD and functional class I-III stable angina (ССS, 1976). Of them 100 patients had primary symptomatic hypothyroidism and 244 had no hypothyroidism. Coronary angiography was performed for all patients included into this study. Routine laboratory, instrumental and clinical indexes were analyzed. Hypothyroidism was confirmed by levels of thyrotropic hormone, free triiodothyronine, and thyroxine. Comparative analysis was performed for the incidence of ACS types in history, types of coronary injury, and laboratory, instrumental and clinical indexes with assessment of potential interrelations. Statistically significant results were reported. Type of data distribution was evaluated with the Kolmogorov-Smirnov test. Quantitative data with normal (Gaussian) distribution were presented as mean (M) and standard deviation (SD). Data with attributes of non-normal distribution were presented as median (Me) with maximum and minimum values (min; max). Statistical significance of differences between means was assessed with the Mann-Whitney test. Logistic regression analysis was used in parallel for evaluating dependence of a quantitative variable on values of two or more quantitative or qualitative variables (factors). Significance level for testing of statistical hypotheses was р<0.05.Results Incidence of ST segment elevation ACS (STEACS) was significantly higher in IHD patients with hypothyroidism than in the group without hypothyroidism (61.6 and 35.6 %, р=0.03) and also with three-vessel coronary artery disease (60.6 and 30.6 %, р=0.001). In the IHD group with hypothyroidism, levels of total cholesterol, triglycerides, and low- and very low-density lipoproteins were significantly increased compared to the respective values in patients without hypothyroidism (р<0.0001). An inverse correlation was found between lipidogram indexes and L-thyroxine (р<0.0001).Conclusion The incidence of STEACS associated with primary symptomatic hypothyroidism in history was significantly higher in the patient group with IHD on the background of primary symptomatic hypothyroidism compared to the comparison group. Also, the incidence of three-vessel coronary disease was significantly greater than in the IHD patient group without hypothyroidism. A significant association was found between the replacement hormonal therapy and the best lipidogram indexes. The authors suggested that the key factor for prevention of adverse cardiovascular events in IHD with hypothyroidism is achieving control of clinical manifestations of hypothyroidism with replacement hormonal therapy.


Assuntos
Doença da Artéria Coronariana , Hipotireoidismo , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/epidemiologia , Estudos Retrospectivos
2.
Artigo em Inglês | MEDLINE | ID: mdl-33166098

RESUMO

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Psicóticos/reabilitação , Centros de Reabilitação , Esquizofrenia/reabilitação , Adulto , Afro-Americanos , Americanos Asiáticos , Betacoronavirus , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , California/epidemiologia , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Refluxo Gastroesofágico/epidemiologia , Hispano-Americanos , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Controle de Infecções , Assistência de Longa Duração , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Reabilitação Psiquiátrica , Psicoterapia de Grupo , Transtornos Psicóticos/epidemiologia , Recreação , Reabilitação Vocacional , Esquizofrenia/epidemiologia , Fumar/epidemiologia , Visitas a Pacientes
3.
Mymensingh Med J ; 29(4): 764-770, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116075

RESUMO

Among general population sub-clinical primary hypothyroidism is common. The cross sectional descriptive type of observational study was conducted in medicine and allied wards in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2010 to December 2010; among 230 purposively selected hospitalized pre-dialysis patients with chronic kidney disease. The purpose of the study was to find out the prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease. Data were collected from the patients using a case record form by face to face interview, clinical examination and laboratory investigations. The collected data were entered into SPSS version 20.0 and analyzed accordingly. Mean age of the patients was 47.2 years with a SD of ±2.05 years. Maximum patients were male with a male female ratio of 5:1. A significant number of patients were smoker- 11.8% of sub-clinical hypothyroidism group and 13.6% of euthyroid group. Among the patients 40 (17.40%) had sub-clinical hypothyroidism while the majority 190 (82.60%) did not have it. Estimated prevalence of sub-clinical hypothyroidism in hospitalized pre-dialysis patients with chronic kidney disease was 17.40%. Co-morbidities found in the patients were hypertension, diabetes mellitus, chronic glomerulonephritis and obstructive uropathy. All the patients (40, 100.0%) with sub-clinical hypothyroidism were hypertensive. On the other hand, 184 (97.1%) patients without sub-clinical hypothyroidism were hypertensive. Presence of co-morbidities in patients with sub-clinical hypothyroidism did not differ significantly (p>0.05) from patients without sub-clinical hypothyroidism. Patients in group with sub-clinical hypothyroidism were more over weight in comparison to patients without sub-clinical hypothyroidism (p<0.05). Biochemical parameters of patients with sub-clinical hypothyroidism differed significantly (p<0.05) from those of patients without sub-clinical hypothyroidism. There was no significant difference between urinary albumin of two groups of patients (p>0.05). Stage 4 CKD patients were more in sub-clinical hypothyroidism group in comparison to euthyroid group. As this study may not reflect the actual picture, further large scale multi-centric study is recommended to explore the real situation of sub-clinical hypothyroidism in patients with chronic kidney disease.


Assuntos
Hipotireoidismo , Insuficiência Renal Crônica , Bangladesh/epidemiologia , Estudos Transversais , Diálise , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
5.
Eur J Endocrinol ; 183(4): 381-387, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698147

RESUMO

Objective: This study assessed thyroid function in patients affected by the coronavirus disease-19 (COVID-19), based on the hypothesis that the cytokine storm associated with COVID-19 may influence thyroid function and/or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly act on thyroid cells, such as previously demonstrated for SARS-CoV-1 infection. Design and methods: This single-center study was retrospective and consisted in evaluating thyroid function tests and serum interleukin-6 (IL-6) values in 287 consecutive patients (193 males, median age: 66 years, range: 27-92) hospitalized for COVID-19 in non-intensive care units. Results: Fifty-eight patients (20.2%) were found with thyrotoxicosis (overt in 31 cases), 15 (5.2%) with hypothyroidism (overt in only 2 cases), and 214 (74.6%) with normal thyroid function. Serum thyrotropin (TSH) values were inversely correlated with age of patients (rho -0.27; P < 0.001) and IL-6 (rho -0.41; P < 0.001). In the multivariate analysis, thyrotoxicosis resulted to be significantly associated with higher IL-6 (odds ratio: 3.25, 95% confidence interval: 1.97-5.36; P < 0.001), whereas the association with age of patients was lost (P = 0.09). Conclusions: This study provides first evidence that COVID-19 may be associated with high risk of thyrotoxicosis in relationship with systemic immune activation induced by the SARS-CoV-2 infection.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tireotoxicose/virologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/imunologia , Citocinas/sangue , Citocinas/imunologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Hipotireoidismo/virologia , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , Estudos Retrospectivos , Fatores de Risco , Testes de Função Tireóidea , Glândula Tireoide/imunologia , Glândula Tireoide/virologia , Tireotoxicose/epidemiologia , Tireotoxicose/imunologia , Tireotropina/sangue , Tireotropina/imunologia
6.
Eur J Endocrinol ; 183(4): E7-E9, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688333

RESUMO

The validity of clinical research is potentially threatened by missing data. Any variable measured in a study can have missing values, including the exposure, the outcome, and confounders. When missing values are ignored in the analysis, only those subjects with complete records will be included in the analysis. This may lead to biased results and loss of power. We explain why missing data may lead to bias and discuss a commonly used classification of missing data.


Assuntos
Viés , Reprodutibilidade dos Testes , Projetos de Pesquisa/normas , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/epidemiologia , Modelos Logísticos , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Placebos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tamanho da Amostra , Tiroxina/uso terapêutico
7.
Saudi Med J ; 41(7): 703-708, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601637

RESUMO

OBJECTIVES: To determine the incidence of newborn screening (NBS) disorders and to study the key performance indicators of the program. METHODS: This retrospective single-center study enrolled all infants who underwent NBS from January 2012 to December 2017 at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. We screened 17 NBS disorders. Blood samples were collected 24 hours after birth. If the initial result was positive, a second sample was collected. True positive cases were immediately referred for medical management. Data were extracted from laboratory computerized and non-computerized records using case report forms. RESULTS: During the study period, 56632 infants underwent NBS with a coverage rate of 100%. Thirty-eight cases were confirmed. The incidence of congenital hypothyroidism was 1:3775. The positive predictive value for the detection of congenital hypothyroidism was 11.8%. Propionic aciduria was the most common metabolic disorder, with an incidence of 1:14158. Very long-chain acyl CoA dehydrogenase deficiency and glutaric aciduria type 1 had an incidence of 1:18877 each. Phenylketonuria, biotinidase deficiency, maple syrup urine disease, and citrullinemia had an incidence of 1:28316 each. However, galactosemia and 3-methyl crotonyl carboxylase deficiency had the lowest incidence of 1:56632. CONCLUSION: The NBS coverage rate at our facility was 100%. Congenital hypothyroidism was the most frequently detected disorder with an incidence that matches worldwide figures. The incidence of other inherited disorders was consistent with regional figures.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Triagem Neonatal , Acil-CoA Desidrogenase de Cadeia Longa/deficiência , Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Erros Inatos do Metabolismo dos Aminoácidos/epidemiologia , Biomarcadores/sangue , Encefalopatias Metabólicas/diagnóstico , Encefalopatias Metabólicas/epidemiologia , Síndrome Congênita de Insuficiência da Medula Óssea/diagnóstico , Síndrome Congênita de Insuficiência da Medula Óssea/epidemiologia , Glutaril-CoA Desidrogenase/deficiência , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Incidência , Recém-Nascido , Erros Inatos do Metabolismo Lipídico/diagnóstico , Erros Inatos do Metabolismo Lipídico/epidemiologia , Doenças Mitocondriais/diagnóstico , Doenças Mitocondriais/epidemiologia , Doenças Musculares/diagnóstico , Doenças Musculares/epidemiologia , Valor Preditivo dos Testes , Acidemia Propiônica/diagnóstico , Acidemia Propiônica/epidemiologia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Fatores de Tempo
8.
Arch Osteoporos ; 15(1): 88, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32542548

RESUMO

Disorders of vitamin D concentration (deficiency or insufficiency) are a global health problem, which are associated with various chronic diseases. In Latin America, alterations in vitamin D prevalence are different from those shown in previous studies and may be due to differences in geographic location, skin color, and diet type. PURPOSE: To know the prevalence of vitamin D insufficiency (21-29 ng/mL) and deficiency (< 20 ng/mL) in Mexican patients; although it is a risk factor for developing multiple complex diseases, its prevalence in the population is still unknown. METHODS: Cross-sectional study carried out at the endocrinology service of the highly specialized national center November 20. Data on cardiovascular risk factors were obtained and 25-hydroxy vitamin D was measured by chemiluminescence. Prevalence was calculated, and the results were analyzed to categorize the patients according to 25-hydroxy vitamin D deficient or insufficient levels. RESULTS: The mean value of the serum vitamin D concentration was 18.37 ng/mL. Of the 117 patients, 93.2% (n = 109) have decreased vitamin D values; 62.4% (n = 73) of the patients had vitamin D deficiency and 30.8% (n = 36) vitamin D insufficiency. The prevalence of vitamin D deficiency was 62.4% and 30.8% for vitamin D insufficiency. The total prevalence of alterations in vitamin D levels in this population was 93.2%. CONCLUSIONS: This study reports a prevalence of vitamin D deficiency and insufficiency much higher than those described by previous studies, which is of utmost importance for the population due to the morbidities associated with these alterations.


Assuntos
Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Adulto , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/etnologia
9.
J Comput Assist Tomogr ; 44(4): 619-626, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32558769

RESUMO

OBJECTIVE: The aim of the study was to study clinical, imaging findings, response patterns, and immune-related adverse events in classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphoma (NHL) patients treated with immune checkpoint inhibitors (ICIs). METHODS: A retrospective search was performed to identify patients with relapsed/refractory cHL and NHL treated with ICIs from 2015 to 2019. Clinical and laboratory data were collected. Imaging studies were reviewed for treatment response and immune-related adverse events. RESULTS: Ten patients with relapsed/refractory cHL (median age, 41 years) and 14 patients with relapsed/refractory NHL (median age, 61 years) were identified. Overall response rate was 70% for cHL patients. None of the NHL patients demonstrated complete or partial response. One case of hyperprogression and one case with atypical response were radiologically detected in cHL patients. Hypothyroidism requiring treatment occurred in 2 (20%) of 10 cHL patients, one of which had imaging correlate. Of 14 NHL patients, 1 (7%) had radiologic evidence of pneumonitis and 1 (7%) had colitis. CONCLUSIONS: This single-institution observational study demonstrated that overall response rate was higher in patients with cHL undergoing ICI. Immune checkpoint inhibitor therapy has unique response patterns and toxicities in both cHL and NHL patients that radiologists should keep in mind.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Colite/epidemiologia , Doença de Hodgkin/tratamento farmacológico , Hipotireoidismo/epidemiologia , Linfoma não Hodgkin/tratamento farmacológico , Pneumonia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Colite/induzido quimicamente , Feminino , Doença de Hodgkin/diagnóstico por imagem , Humanos , Hipotireoidismo/induzido quimicamente , Linfoma não Hodgkin/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Pneumonia/induzido quimicamente , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
10.
Ann Afr Med ; 19(2): 89-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499464

RESUMO

Background: Thyroid disorders are one of the most common endocrine disorders seen globally. Diagnostic challenge may arise both clinically and biochemically because of the multiple function of thyroid hormones (THs). Request for thyroid function test (TFT s) may be based on clinical impression that may suggest thyroid dysfunction or obvious symptoms and signs that are diagnostic of hyperthyroidism or hypothyroidism. Materials and Methods: This retrospective study looks at the biochemical patterns of TFTs and the clinical impression of thyroid disorders in a rural tertiary institution. Information extracted from the laboratory register includes indication for the test, the hospital number, the gender, the age, and the THs assayed. The corresponding biochemical pattern of the TFT result was established. Results: A total of 297 requests were submitted for TH assay; 34 were excluded from the present study because there were no clinical information. There were 239 females and 24 males giving a female-to-male ratio of 9.9:1. Majority of the requests (36.5%) were for goiters, followed by gynecological disorders (20.9%) and clinical thyroid disorders (17.9%). About 46% (45.8%) of the goiter cases were biochemically euthyroid, whereas 13.5% were biochemically primary hyperthyroid. Among the 47 cases of thyroid disorders by the physician's clinical impression, 27.7% were euthyroid, 17% were biochemically hyperthyroid, and 10.6% were hypothyroid. Of the 55 gynecological disorders assessed, only 7.3% show biochemical evidence of TH alteration with 56.4% being euthyroid. About 47% (46.6%) of those that did routine medical examination had altered TH level that includes hyperthyroidism and hypothyroidism. Conclusion: Goiter is the most prevalent thyroid disorder in this environment. Biochemical pattern of thyroid function test in our environment was mostly euthyroid despites clinical features suggestive of thyroid disorders.


Assuntos
Bócio/epidemiologia , Saúde da População Rural , Doenças da Glândula Tireoide/epidemiologia , Testes de Função Tireóidea/métodos , Adulto , Feminino , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/epidemiologia , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Retrospectivos , Doenças da Glândula Tireoide/complicações , Glândula Tireoide
11.
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
12.
Acta Orthop ; 91(4): 457-463, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32285743

RESUMO

Background and purpose - Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE.Patients and methods - 2,564 patients diagnosed with SCFE at age 5-16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals.Results - The risk of obesity (HR 9, 95% CI 7-11) and hypothyroidism (HR 3, CI 2-4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1-1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1-2). The incidence of SCFE did not increase over the past decades.Interpretation - Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates.


Assuntos
Depressão/etiologia , Hipotireoidismo/etiologia , Obesidade/etiologia , Escorregamento das Epífises Proximais do Fêmur/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Depressão/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Escorregamento das Epífises Proximais do Fêmur/epidemiologia , Escorregamento das Epífises Proximais do Fêmur/mortalidade , Suécia/epidemiologia , Adulto Jovem
13.
Medicine (Baltimore) ; 99(16): e19840, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312007

RESUMO

To determine the levels of parathyroid hormone (PTH) in the fluids of various tissues for identification of parathyroid glands during thyroidectomy.Our study comprised 31 patients with thyroid cancer who underwent lobectomy with central compartment dissection at our hospital from October 2014 to February 2015. A total of 186 tissue samples, including 28 from parathyroid glands and 158 from non-parathyroid tissues, were obtained during the operations. Tissue fluids were collected via fine-needle aspiration to measure PTH levels; the tissue was punctured 3 times with a 26-gauge syringe needle and washed with 0.5 mL normal saline. Tissues were also prepared for pathological examination.PTH concentrations were significantly higher in parathyroid tissues than non-parathyroid tissues. None of the patients had irremediable parathyroid dysfunction after surgical resection.Use of fine-needle aspiration for quantification of PTH levels in tissue fluids rapidly, safely, and effectively identifies the parathyroid glands during thyroidectomy.


Assuntos
Biópsia por Agulha Fina/métodos , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/análise , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/prevenção & controle , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/normas , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/fisiopatologia , Glândulas Paratireoides/patologia , Período Pós-Operatório , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos
14.
Medicine (Baltimore) ; 99(17): e19569, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332605

RESUMO

Hypothyroidism and chronic kidney disease (CKD) are highly prevalent conditions with a potential mechanistic link. We sought to determine whether hypothyroidism is associated with CKD among a large diverse community-based cohort.A cross-sectional study was performed (January 1, 1990-December 31, 2017) within a large integrated health system. Individuals age ≥55 years of age with outpatient measurements of thyroid stimulating hormone (TSH) and ≥2 serum creatinine values were included. Hypothyroidism was defined as TSH >4 mIU/L and/or receipt of thyroid hormone replacement and further categorized as hypothyroid status: TSH >4 mcIU/mL and attenuated-hypothyroid status: TSH <4 mcIU/mL with receipt of thyroid hormone replacement. Euthyroidism was defined as TSH <4 mIU/L and no thyroid hormone replacement. Our primary measure was CKD defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m. Multivariable logistic regression adjusting for age, sex, race, and comorbidities was used to estimate odds ratios (OR) for CKD by thyroid status.Among 378,101 individuals, 114,872 (30.4%) had hypothyroidism among whom 31,242 and 83,630 had hypothyroid and attenuated-hypothyroid statuses, respectively. Individuals with hypothyroidism had a CKD OR (95%CI) of 1.25 (1.21-1.29) compared with those with euthyroidism. Granular examination of thyroid statuses showed that hypothyroid and attenuated-hypothyroid statuses had CKD ORs (95% CI) of 1.59 (1.52-1.66) and 1.12 (1.08-1.16), respectively. A similar relationship was observed in analyses that defined CKD as an eGFR <60 L/min/1.73 m.Among individuals 55 years and older, we observed that those with hypothyroidism were more likely to have CKD. A stronger association was found among patients of hypothyroid status compared with attenuated-hypothyroid status suggesting a dose dependent relationship.


Assuntos
Hipotireoidismo/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Idoso , California/epidemiologia , Comorbidade , Estudos Transversais , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Tireotropina/sangue
15.
Georgian Med News ; (298): 105-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141860

RESUMO

The long-term androgen deficiency (AD) in men with hypothyroidism is an important problem due to the fact that it leads to concomitant cardiac pathology, which remains the leading cause of mortality in the world. The presence of different points of view on the problem of AD and its effect on the risk factors for cardiovascular disease in patients with hypothyroidismattracts attention. The aim of the study is to assess the clinical signs of age-related androgen deficiency and their association with cardiovascular risk factors in men with hypothyroidism. 84 patients were examined, 38 of them - with hypothyroidism and age-related androgen deficiency, 46 patients with hypothyroidism and normal testosterone levels. The control group was formed of 20 men without hypothyroidism. The lipid and carbohydrate metabolism status, the presence and type of obesity, the level of depression, daily blood pressure monitoring were determined. AD was verified by decrease the total testosterone concentration in serum (<12 nmol/L). The level of total testosterone and sex hormone binding globulin in serum were determined by radioimmunoassay analysis. The decrease of testosterone level in men with hypothyroidism is accompanied by an increase in the frequency of abdominal obesity, triglycerides and glucoseescape, and is associated with subclinical depression. In men with hypothyroidism and AD, the average blood pressure in the daytime significantly exceeds the similar rates in patients with hypothyroidism and normal levels of testosterone. The presence of androgen deficiency negatively affects the risk factors of cardiovascular disease in men with hypothyroidism.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hipotireoidismo/sangue , Globulina de Ligação a Hormônio Sexual/análise , Testosterona/deficiência , Fatores Etários , Idoso , Estudos de Casos e Controles , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Testosterona/sangue
16.
JAMA Netw Open ; 3(3): e201357, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32202644

RESUMO

Importance: Alkaptonuria is an autosomal recessive disorder caused by pathogenic variants in the HGD gene. Deficiency of the HGD enzyme leads to tissue deposition of homogentisic acid (HGA), causing severe osteoarthropathies and cardiac valve degeneration. Although HGD is vital for the catabolism of tyrosine, which provides the basis for thyroid hormone synthesis, the prevalence of thyroid dysfunction in alkaptonuria is unknown. Objective: To assess thyroid structure and function in patients with alkaptonuria. Design, Setting, and Participants: A single-center cohort study was conducted in a tertiary referral center including patients with alkaptonuria followed up for a median of 93 (interquartile range, 48-150) months between February 1, 2000, and December 31, 2018. The alkaptonuria diagnosis was based on clinical presentation and elevated urine HGA levels. A total of 130 patients were considered for participation. Main Outcomes and Measures: Prevalence of thyroid dysfunction in adults with alkaptonuria compared with the general population. Thyrotropin and free thyroxine levels were measured by immunoassay and repeated in each patient a median of 3 (interquartile range, 2-22) times. Neck ultrasonographic scans were analyzed in a subset of participants. Logistic regression was used to test the association of thyroid dysfunction with age, sex, thyroid peroxidase (TPO) antibodies, serum tyrosine levels, and urine HGA levels. Results: Of the 130 patients, 5 were excluded owing to thyroidectomy as the cause of hypothyroidism. The study cohort consisted of 125 patients; the median age was 45 (interquartile range, 35-51) years. Most of the patients were men (72 [57.6%]). The prevalence of primary hyperthyroidism was 0.8% (1 of 125 patients), similar to 0.5% observed in the general population (difference, 0.003; 95% CI, -0.001 to 0.04; P = .88). The prevalence of primary hypothyroidism was 16.0% (20 of 125 patients), which is significantly higher than 3.7% reported in the general population (difference, 0.12; 95% CI, 0.10-0.24; P < .001). Women were more likely to have primary hypothyroidism than men (odds ratio, 10.99; 95% CI, 3.13-38.66; P < .001). Patients with TPO antibodies had a higher likelihood of primary hypothyroidism than those without TPO antibodies (odds ratio, 7.36; 95% CI, 1.89-28.62; P = .004). There was no significant difference in the prevalence of thyroid nodules between patients in this study (29 of 49 [59.2%]) vs the general population (68%) (difference, 0.088; 95% CI, -0.44 to 0.73; P = .20) or of cancer (7% vs 5%; difference, 0.01; 95% CI, -0.01 to 0.17; P = .86). Conclusions and Relevance: The high prevalence of primary hypothyroidism noted in patients with alkaptonuria in this study suggests that serial screening in this population should be considered and prioritized.


Assuntos
Alcaptonúria/metabolismo , Hipotireoidismo/epidemiologia , Adulto , Alcaptonúria/complicações , Alcaptonúria/genética , Autoanticorpos/sangue , Autoantígenos/imunologia , Estudos de Coortes , Feminino , Ácido Homogentísico/urina , Humanos , Hipertireoidismo/epidemiologia , Hipertireoidismo/genética , Hipotireoidismo/genética , Iodeto Peroxidase/imunologia , Proteínas de Ligação ao Ferro/imunologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Testes de Função Tireóidea , Glândula Tireoide/enzimologia , Tireotropina/sangue , Tiroxina/sangue , Tirosina/sangue
17.
Fertil Steril ; 113(3): 587-600.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192591

RESUMO

OBJECTIVE: To determine whether overt/subclinical hypothyroidism and/or thyroid autoimmunity is associated with recurrent pregnancy loss (RPL) and whether treatment improves outcomes. DESIGN: Systematic review and meta-analysis. SETTING: University obstetrics and gynecology departments. PATIENT(S): Women with RPL and overt/subclinical hypothyroidism, and/or thyroid autoimmunity. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Associations between RPL and overt/subclinical hypothyroidism and/or thyroid autoimmunity and any effects of treatment. RESULT(S): After our review of articles from PubMed, EMBASE, Web of Science, and CENTRAL, we found two interventional studies in which levothyroxine did not improve the subsequent live-birth rate in women with subclinical hypothyroidism with or without thyroid antibodies. A meta-analysis of five studies revealed the prevalence of subclinical hypothyroidism in RPL to be 12.9% (95% confidence interval [CI], 0%-35.2%). A meta-analysis of 17 studies revealed a statistically significant association between RPL and thyroid autoimmunity (odds ratio 1.94; 95% CI, 1.43-2.64). However, a randomized study suggested that levothyroxine does not benefit euthyroid women with thyroid autoimmunity. CONCLUSION(S): Based on the limited observational studies available, no association exists between RPL and subclinical hypothyroidism, nor does levothyroxine improve subsequent pregnancy outcomes. An association exists between RPL and thyroid autoimmunity, but levothyroxine does not improve subsequent pregnancy outcomes. Women with RPL should be screened/treated for overt thyroid disease but not thyroid autoimmunity. Thyroid antibody screening is not supported by the published studies, and further randomized studies are needed. No recommendation regarding the treatment of subclinical hypothyroidism can be made at this time; prospective and randomized studies are urgently needed.


Assuntos
Aborto Habitual/epidemiologia , Aborto Habitual/etiologia , Hipotireoidismo/epidemiologia , Tireoidite Autoimune/epidemiologia , Aborto Habitual/imunologia , Doenças Assintomáticas , Feminino , Humanos , Hipotireoidismo/complicações , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Fatores de Risco , Testes de Função Tireóidea , Tireoidite Autoimune/complicações
18.
Sci Rep ; 10(1): 2261, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041973

RESUMO

The prevalence of Metabolic syndrome (MetS) in Sichuan of China has not yet been estimated. Meanwhile the association among anxiety, subclinical hypothyroidism (SCH) and MetS was less well-studied. The data was retrieved retrospectively from Health Promotion Center of West China Hospital database between 2014 and 2017. Internal validation by randomizing into training and testing panel by 9:1 and external validation with National Health and Nutrition Examination Survey (NHNES) were conducted. 19006 subjects were included into analysis, and 3530 (18.6%) of them were diagnosed with MetS. In training panel, age, sex (male), SCH (presence), SAS score, alcohol (Sometimes & Usual) and smoking (Active) were identified as independent risk factors for MetS, which was confirmed in testing panel internally. NHNES data validated externally the association between free thyroxine (fT4) and MetS components. The C-indices of predicting MetS nomogram were 0.705 (95% CI: 0.696-0.714) and 0.728 (95% CI: 0.701-0.754) in training and testing panel respectively. In conclusion, MetS prevalence was 18.6% in Sichuan. SCH and anxiety may be associated with MetS independently. A risk scale-based nomogram with accurate and objective prediction ability was provided for check-up practice, but more cohort validation was needed.


Assuntos
Ansiedade/epidemiologia , Hipotireoidismo/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
19.
Isr Med Assoc J ; 22(2): 100-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043327

RESUMO

BACKGROUND: Autoimmune hepatitis (AIH) may be associated with other autoimmune diseases. Autoantibodies are common in AIH suggesting their potential role in the pathogenesis of the disease. Among these autoantibodies, thyroid autoantibodies have been reported in patients with chronic hepatitis, with greater prevalence in patients with chronic hepatitis C infection. OBJECTIVES: To assess the prevalence of thyroid dysfunction among patients with AIH. METHODS: In this case-control, retrospective study, we examined patients diagnosed with AIH according to both the original and revised international AIH group scoring systems. Patients with other hepatic pathologies were excluded AIH was evaluated as an independent risk factor for thyroid disease by a logistic regression model. Univariate and multivariate regression analyses were conducted using hypothyroidism and hyperthyroidism as the dependent variables. RESULTS: Our cohort comprised 163 patients diagnosed with AIH and 1104 healthy age- and gender-matched controls. Hypothyroidism was more prevalent among those with AIH compared to controls (17.7% vs. 5%, respectively, 95% confidence interval [95%CI] 1.68-2.48, P < 0.001). Hyperthyroidism was more prevalent in AIH patients compared to controls (odds ratio 3.2% and 1.2%, respectively, 95%CI 1.68-2.47, P < 0.001). Using a multivariate logistic analysis, we found an independent association between AIH and hypothyroidism but not with hyperthyroidism. CONCLUSIONS: Thyroid dysfunction is more prevalent in patients with AIH. Whether thyroid dysfunction is the cause or a risk factor for AIH, or vice versa, is still unclear. Screening for thyroid dysfunction is warranted after AIH is diagnosed.


Assuntos
Hepatite Autoimune , Hipotireoidismo , Glândula Tireoide/imunologia , Adulto , Autoanticorpos/análise , Autoimunidade/imunologia , Estudos de Casos e Controles , Feminino , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/imunologia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/imunologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/estatística & dados numéricos
20.
Med. clín (Ed. impr.) ; 154(1): 1-6, ene. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188676

RESUMO

Introducción: El hígado graso no alcohólico (HGNA) es la enfermedad hepática más prevalente en los países desarrollados y se considera el componente hepático del síndrome metabólico (SM). Últimamente el hipotiroidismo se ha asociado al HGNA, pero nunca se ha estudiado en nuestro entorno. Objetivos: Analizar la relación entre hipotiroidismo (clínico y subclínico) y HGNA. Conocer la asociación de SM con HGNA e hipotiroidismo. Metodología: Estudio transversal, retrospectivo, poblacional en sujetos ≥45 años procedentes de centros de atención primaria de Cataluña e incluidos en la base de datos SIDIAP. Los datos fueron recogidos entre 2009 y 2013. Variables: datos sociodemográficos, comorbilidades, hábitos tóxicos, exploración física, analítica y diagnóstico de SM. Se llevó a cabo un análisis descriptivo y la aplicación de pruebas estadísticas para la comparación de variables. Resultados: Muestra de 10.116 individuos con edad media de 61 (10) años y predominio del sexo femenino (63,6%). La prevalencia de hipotiroidismo fue del 9,1%, sin encontrar diferencias significativas según la presencia de HGNA (p=0,631). El hipotiroidismo se asoció a niveles más elevados de triglicéridos y mayor prevalencia de obesidad (p=0,003). Se detectó mayor alteración de la AST en los individuos con valores incrementados de TSH (p=0,012) y disminuidos de T4L (p=0,037). Las alteraciones en los niveles de hormonas tiroideas no se vincularon con mayor prevalencia de HGNA (TSH p=0,072 y T4L p=0,447). El hipotiroidismo no se asoció como factor de riesgo para el desarrollo de HGNA (OR 0,75; IC 95%: 0,39-1,44; p=0,38). Conclusiones: No se ha demostrado asociación entre el hipotiroidismo y el HGNA. Se necesitan estudios prospectivos para esclarecer la relación entre ambas enfermedades


Background: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in developed countries and is considered the hepatic component of metabolic syndrome (MetS). Recently hypothyroidism has been associated with NAFLD but has never been studied in Spain. Objectives: To analyze the relationship between hypothyroidism (clinical and subclinical) and NAFLD. To determine the association between MetS with NAFLD and hypothyroidism. Methods: Cross-sectional, retrospective, population study in subjects ≥45 years from primary care centres in Catalonia included in the SIDIAP database. The data was collected between 2009 and 2013. Variables: socio-demographic data, comorbidities, toxic habits, physical examination, analytical tests and diagnosis of MetS. Descriptive analysis and application of statistical tests for the comparison of variables. Results: Sample of 10,116 individuals with a mean age of 61(10) and a predominance of females (63.6%). The prevalence of hypothyroidism was 9.1%, with no significant differences according to the presence of NAFLD (p=.631). Hypothyroidism was associated with higher triglyceride levels and a greater prevalence of obesity (p=.003). Greater alteration of AST was detected in individuals with elevated TSH (p=.012) and decreased levels of T4L (p=.037). Alterations in thyroid hormone levels were not associated with a higher prevalence of NAFLD (TSH p=.072 and T4L p=.447). Hypothyroidism was not considered a risk factor for the development of NAFLD (OR .75; 95% CI: .39-1.44; p=.38). Conclusions: No association was found between hypothyroidism and NAFLD. Prospective studies are needed to clarify a possible relationship between these two diseases


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hipotireoidismo/epidemiologia , Hipotireoidismo/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Síndrome Metabólica/complicações , Hipotireoidismo/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Espanha/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Obesidade/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia
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