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1.
Am Fam Physician ; 103(10): 605-613, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33983002

RESUMO

Clinical hypothyroidism affects one in 300 people in the United States, with a higher prevalence among female and older patients. Symptoms range from minimal to life-threatening (myxedema coma); more common symptoms include cold intolerance, fatigue, weight gain, dry skin, constipation, and voice changes. The signs and symptoms that suggest thyroid dysfunction are nonspecific and nondiagnostic, especially early in disease presentation; therefore, a diagnosis is based on blood levels of thyroid-stimulating hormone and free thyroxine. There is no evidence that population screening is beneficial. Symptom relief and normalized thyroid-stimulating hormone levels are achieved with levothyroxine replacement therapy, started at 1.5 to 1.8 mcg per kg per day. Adding triiodothyronine is not recommended, even in patients with persistent symptoms and normal levels of thyroid-stimulating hormone. Patients older than 60 years or with known or suspected ischemic heart disease should start at a lower dosage of levothyroxine (12.5 to 50 mcg per day). Women with hypothyroidism who become pregnant should increase their weekly dosage by 30% up to nine doses per week (i.e., take one extra dose twice per week), followed by monthly evaluation and management. Patients with persistent symptoms after adequate levothyroxine dosing should be reassessed for other causes or the need for referral. Early recognition of myxedema coma and appropriate treatment is essential. Most patients with subclinical hypothyroidism do not benefit from treatment unless the thyroid-stimulating hormone level is greater than 10 mIU per L or the thyroid peroxidase antibody is elevated.


Assuntos
Monitoramento de Medicamentos/métodos , Hipotireoidismo , Complicações na Gravidez , Avaliação de Sintomas/métodos , Testes de Função Tireóidea/métodos , Tiroxina , Adulto , Fatores Etários , Idoso , Relação Dose-Resposta a Droga , Feminino , Terapia de Reposição Hormonal/métodos , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Hipotireoidismo/fisiopatologia , Hipotireoidismo/terapia , Masculino , Gravidade do Paciente , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/terapia , Hormônios Tireóideos/sangue , Tireotropina/sangue , Tiroxina/administração & dosagem , Tiroxina/efeitos adversos
2.
Fertil Steril ; 116(1): 218-231, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33838869

RESUMO

OBJECTIVE: To investigate the impact of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) on thyroid function. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Infertile women undergoing conventional IVF or intracytoplasmic sperm injection. INTERVENTION(S): Systematic search of PubMed, MEDLINE, Embase, Scopus, and Web of Science from inception until November 2020. Studies could be included only if they met the following criteria: subjects were classified as euthyroid or hypothyroid; serum thyroid-stimulating hormone (TSH) and/or free thyroxine (FT4) levels were evaluated before COH; and the same thyroid function test was reassessed after COH (i.e., at the time of trigger for final follicle maturation and/or at pregnancy test). MAIN OUTCOME MEASURE(S): Mean difference (MD) between the serum TSH or FT4 levels assessed after COH and before COH. RESULT(S): In euthyroid women, the serum TSH levels assessed at the time of trigger and at the time of pregnancy test were significantly higher than those at baseline (MD: 0.69 mIU/L, 95% confidence interval [CI]: 0.30-1.08, I2 = 93% and MD: 0.67, 95% CI: 0.49-0.85, I2 = 72%, respectively). The serum FT4 levels did not undergo significant changes. Subanalysis confirmed an increase in the TSH level after restricting the analysis to women treated with gonadotropin-releasing hormone agonist protocols and to those who achieved pregnancy. A pronounced increase in the TSH level was observed in women treated for hypothyroidism (MD: 1.50 mIU/L, 95% CI: 1.10-1.89, I2 = 0%). CONCLUSION(S): Pooling of the results showed a significant increase in serum TSH level in women undergoing COH for IVF. This change was particularly pronounced in women treated for hypothyroidism. New thyroid function screening strategies for women undergoing COH are warranted.


Assuntos
Fertilização In Vitro , Hipotireoidismo/fisiopatologia , Infertilidade Feminina/tratamento farmacológico , Indução da Ovulação/efeitos adversos , Ovulação/efeitos dos fármacos , Glândula Tireoide/efeitos dos fármacos , Biomarcadores/sangue , Feminino , Fertilidade/efeitos dos fármacos , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/diagnóstico , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Masculino , Gravidez , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Glândula Tireoide/metabolismo , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Resultado do Tratamento
3.
J Clin Endocrinol Metab ; 106(7): e2639-e2646, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-33720320

RESUMO

CONTEXT: Prepregnancy overweight/obesity (OWO) and isolated maternal hypothyroxinemia (IMH) may increase the risk of macrosomia, but little is known about their potential combined effect on macrosomia. OBJECTIVE: The aim of this study was to assess whether prepregnancy OWO and first-trimester IMH have a synergistic effect on the risk of macrosomia. METHODS: A large prospective cohort study in a Chinese population from January 2016 to December 2018 in a tertiary care center. In total, 34 930 pregnant women were included. The main outcome measure was macrosomia. RESULTS: A total of 34 930 participants comprising IMH and euthyroid cases was included in this study. Prepregnancy OWO and first-trimester IMH were independently associated with an increased risk of macrosomia (adjusted odds ratio [OR] 2.48, 95% CI 2.22, 2.78, and adjusted OR 1.65, 95% CI 1.34, 2.01, respectively). The coexistence of prepregnancy OWO and IMH was associated with macrosomia, with an adjusted OR of 5.26 (95% CI 3.9, 7.0) compared with pregnant women without either condition. The additive interaction between prepregnancy OWO and IMH was found to be significant with regard to macrosomia. CONCLUSION: Prepregnancy OWO and IMH in the first trimester may synergistically increase the risk of macrosomia.


Assuntos
Macrossomia Fetal/epidemiologia , Hipotireoidismo/complicações , Obesidade Materna/complicações , Complicações na Gravidez/etiologia , Tiroxina/deficiência , Adulto , Peso Corporal , China/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Humanos , Hipotireoidismo/fisiopatologia , Recém-Nascido , Obesidade Materna/fisiopatologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Estudos Prospectivos , Fatores de Risco
4.
Sci Rep ; 11(1): 6526, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33753827

RESUMO

This exploratory retrospective study aims to investigate the thermal changes in the thyroid gland region of patients with hypothyroidism and fibromyalgia by analyzing the temperature of the brown adipose tissue (BAT). A total of 166 individuals from 1000 thermographic electronic medical records were classified into four groups: Group HP + FM-50 individuals with hypothyroidism and fibromyalgia; Group FM-56 individuals with fibromyalgia only; Group HP-30 individuals with hypothyroidism only, and Group Control-30 healthy individuals. The thermal images from the electronic medical records were acquired by a FLIR T650SC infrared camera (used for thermometry) and the temperature data for each group were statistically analyzed. Group HP + FM showed r = 0, meaning that the average temperatures of the thyroid and BAT are independent of each other. Groups FM, HP and Control showed r = 1, meaning that the average temperatures of the thyroid and BAT were directly related. Our findings showed that the average temperatures of the thyroid and BAT regions are similar. Also, there was no correlation between thyroid gland temperature and the presence of hypothyroidism or fibromyalgia using thermometry.


Assuntos
Tecido Adiposo Marrom/fisiologia , Fibromialgia/fisiopatologia , Hipotireoidismo/fisiopatologia , Glândula Tireoide/fisiopatologia , Tecido Adiposo Marrom/diagnóstico por imagem , Adolescente , Adulto , Registros Eletrônicos de Saúde , Feminino , Fibromialgia/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Hipotireoidismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Temperatura , Termografia/métodos , Glândula Tireoide/diagnóstico por imagem , Adulto Jovem
5.
J Med Case Rep ; 15(1): 108, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33653380

RESUMO

BACKGROUND: Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. CASE PRESENTATION: We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient's insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. CONCLUSION: There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.


Assuntos
Hipotireoidismo/diagnóstico , Tireoidite Autoimune/diagnóstico , Alopecia/fisiopatologia , Apetite , Autoanticorpos/imunologia , Constipação Intestinal/fisiopatologia , Depressão/fisiopatologia , Fadiga/fisiopatologia , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Achados Incidentais , Iodeto Peroxidase/imunologia , Menorragia/fisiopatologia , Índice de Gravidade de Doença , Glândula Tireoide/diagnóstico por imagem , Tireoidite Autoimune/sangue , Tireoidite Autoimune/imunologia , Tireoidite Autoimune/fisiopatologia , Tireotropina/sangue , Tiroxina/sangue , Tiroxina/uso terapêutico , Ultrassonografia , Ganho de Peso , Adulto Jovem
6.
Int J Mol Sci ; 22(4)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33562494

RESUMO

The role that thyroid hormone deficiency plays in depression and synaptic plasticity in adults has only begun to be elucidated. This paper analyzes the possible link between depression and hypothyroidism in cognitive function alterations, using Wistar-Kyoto (WKY-an animal model of depression) rats and control Wistar rats under standard and thyroid hormone deficiency conditions (propylthiouracil administration-PTU). A weakening of memory processes in the WKY rats is shown behaviorally, and in the reduction of long-term potentiation (LTP) in the dentate gyrus (DG) and CA1 hippocampal regions. PTU administration decreased LTP and increased basal excitatory transmission in the DG in Wistar rats. A decrease in short-term synaptic plasticity is shown by the paired-pulse ratio measurement, occurring during hypothyroidism in DG and CA1 in WKY rats. Differences between the strains may result from decreases in the p-CaMKII, p-AKT, and the level of acetylcholine, while in the case of the co-occurrence of depression and hypothyroidism, an increase in the p-ERK1-MAP seemed to be important. Obtained results show that thyroid hormones are less involved in the inhibition of glutamate release and/or excitability of the postsynaptic neurons in WKY rats, which may indicate a lower sensitivity of the hippocampus to the action of thyroid hormones in depression.


Assuntos
Disfunção Cognitiva/etiologia , Depressão/etiologia , Hipocampo/fisiopatologia , Hipotireoidismo/complicações , Animais , Região CA1 Hipocampal/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Giro Denteado/fisiopatologia , Depressão/fisiopatologia , Depressão/psicologia , Modelos Animais de Doenças , Expressão Gênica/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Humanos , Hipotireoidismo/fisiopatologia , Hipotireoidismo/psicologia , Potenciação de Longa Duração/fisiologia , Masculino , Memória/fisiologia , Plasticidade Neuronal/fisiologia , Propiltiouracila/toxicidade , Ratos , Ratos Endogâmicos WKY , Ratos Wistar , Hormônios Tireóideos/deficiência , Hormônios Tireóideos/fisiologia
7.
Mol Cell Endocrinol ; 525: 111173, 2021 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-33549603

RESUMO

The hypothalamus-pituitary-thyroid axis is one of several hormone regulatory systems from the hypothalamus to the pituitary and ultimately to the peripheral target organs. The hypothalamus and the pituitary gland are in close anatomical proximity at the base of the brain and extended through the pituitary stalk to the sella turcica. The pituitary stalk allows passage of stimulatory and inhibitory hormones and other signal molecules. The target organs are placed in the periphery and function through stimulation/inhibition by the circulating pituitary hormones. The several hypothalamus-pituitary-target organ axis systems interact in very sophisticated and complicated ways and for many of them the interactive and integrated mechanisms are still not quite clear. The diagnosis of central hypothyroidism is complicated by itself but challenged further by concomitant affection of other hypothalamus-pituitary-hormone axes, the dysfunction of which influences the diagnosis of central hypothyroidism. Treatment of both the central hypothyroidism and the other hypothalamus-pituitary axes also influence the function of the others by complex mechanisms involving both central and peripheral mechanisms. Clinicians managing patients with neuroendocrine disorders should become aware of the strong integrative influence from each hypothalamus-pituitary-hormone axis on the physiology and pathophysiology of central hypothyroidism. As an aid in this direction the present review summarizes and highlights the importance of the hypothalamus-pituitary-thyroid axis, pitfalls in diagnosing central hypothyroidism, diagnosing/testing central hypothyroidism in relation to panhypopituitarism, pointing at interactions of the thyroid function with other pituitary hormones, as well as local hypothalamic neurotransmitters and gut-brain hormones. Furthermore, the treatment effect of each axis on the regulation of the others is described. Finally, these complicating aspects require stringent diagnostic testing, particularly in clinical settings with lower or at least altered à priori likelihood of hypopituitarism than in former obvious clinical patient presentations.


Assuntos
Sistema Hipotálamo-Hipofisário/fisiopatologia , Glândula Tireoide/fisiopatologia , Animais , Hormônios/sangue , Hormônios/metabolismo , Humanos , Hipopituitarismo/sangue , Hipopituitarismo/patologia , Hipopituitarismo/fisiopatologia , Sistema Hipotálamo-Hipofisário/patologia , Hipotireoidismo/sangue , Hipotireoidismo/patologia , Hipotireoidismo/fisiopatologia , Modelos Biológicos , Glândula Tireoide/patologia
8.
Medicine (Baltimore) ; 100(3): e23947, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545971

RESUMO

BACKGROUND: Subclinical hypothyroidism (SCH) can increase the risk of heart failure (HF) clinically. However, thyroxine therapy for patients with HF and SCH has the risk of developing tachyarrhythmias. At present, there is no sufficient evidence-based medical evidence for levothyroxine in the therapy of this situation, and the treatment issue is still controversial. Therefore, our meta-analysis aims to assess the effectiveness and safety of thyroxine therapy for patients with HF and SCH. METHODS: We searched the related randomized controlled trials that have been published in the following 7 electronic databases: PubMed, Cochrane Library, EMBASE, Chongqing VIP, China National Knowledge Infrastructure, Chinese biomedical literature database, and Wan Fang database. The treatment group was treated with routine HF therapy plus thyroxine, while the control group was treated with HF routine therapy. Main outcome measures effective rate and New York Heart Association classification; Secondary outcome measures included: left ventricular ejection fraction, quality of life score, brain natriuretic peptide / N-terminal pro brain natriuretic peptide, 6-minute walk test, and adverse events. After screening studies and extracting data, we will use Cochrane collaborative tools to evaluate the risk of bias to assess the methodological quality of the included randomized controlled trials. We will use STATA 14.0 software for data synthesis and statistical analysis. Both subgroup analysis and sensitivity analysis will be used to detect potential sources of heterogeneity. In addition, we will use sensitivity analysis to test the stability of the outcomes. If possible, we will perform a funnel chart and Eggers test evaluate publication bias. The quality of the evidence will be evaluated through the grades of recommendations assessment, development, and evaluation system. RESULTS: Our findings will be published in peer-reviewed journals. CONCLUSION: This research will provide evidence about the efficacy and safety of thyroxine in the treatment of patients with HF and SCH. Objective to provide evidence-based medicine basis for thyroxine treatment of patients with SCH and HF. REGISTRATION NUMBER: INPLASY2020100062.


Assuntos
Protocolos Clínicos , Insuficiência Cardíaca/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipotireoidismo/fisiopatologia , Metanálise como Assunto , Revisões Sistemáticas como Assunto
10.
Eur J Endocrinol ; 184(4): R123-R135, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33460394

RESUMO

Severe thyroid dysfunction may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary-ovarian axis and the reproductive organs. However, the exact prevalence of infertility in women with thyroid disorders remains unknown. Fertility problems may persist even after restoring normal thyroid function, and then surgery and/or an assisted reproductive technology (ART) may be necessary to obtain a pregnancy. The initial step in an ART treatment is the ovarian stimulation, putting strain on the thyroid gland, potentially leading to (permanent) hypothyroidism in women with thyroid autoimmunity (TAI) or when already treated with thyroid hormones (LT4). Moreover, women with ovarian and unexplained causes of infertility have a higher prevalence of TAI. In women treated with LT4, a serum TSH level <2.5 mIU/L should be targeted before ART. In women with TSH levels >4.0 mIU/L, fertilisation rates, embryo quality and live birth rates may be impaired but also improved with LT4 therapy. In euthyroid women with TAI, LT4 should not be given systematically, but on a case-by-case basis if serum TSH is >2.5 mIU/L. For all of the above reasons, women of infertile couples should be screened routinely for the presence of thyroid disorders. In this review, we will focus on the gaps in the current knowledge, the remaining questions on the associations between thyroid (disorders) and (assisted) reproduction and make proposals for future investigations that may lead to a better understanding and contribute to novel treatment options in the long term.


Assuntos
Infertilidade Feminina/etiologia , Doenças da Glândula Tireoide/complicações , Adulto , Feminino , Humanos , Hipertireoidismo/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Infertilidade Feminina/terapia , Pessoa de Meia-Idade , Ovário/fisiopatologia , Indução da Ovulação/efeitos adversos , Gravidez , Técnicas de Reprodução Assistida , Doenças da Glândula Tireoide/fisiopatologia , Glândula Tireoide/fisiopatologia , Tireoidite Autoimune/tratamento farmacológico
11.
Endocr J ; 68(2): 129-136, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33473054

RESUMO

We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.


Assuntos
COVID-19/fisiopatologia , Doença de Graves/fisiopatologia , Hipotireoidismo/fisiopatologia , Síndrome do Desconforto Respiratório/fisiopatologia , Tireoidite/fisiopatologia , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/complicações , COVID-19/metabolismo , Doença de Graves/etiologia , Doença de Graves/metabolismo , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/metabolismo , Mortalidade , Prognóstico , Receptores de Coronavírus/metabolismo , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/metabolismo , SARS-CoV-2/metabolismo , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/metabolismo , Síndrome Respiratória Aguda Grave/fisiopatologia , Glândula Tireoide/metabolismo , Tireoidite/etiologia , Tireoidite/metabolismo , Tireoidite Autoimune/etiologia , Tireoidite Autoimune/metabolismo , Tireoidite Autoimune/fisiopatologia , Tireoidite Subaguda/etiologia , Tireoidite Subaguda/metabolismo , Tireoidite Subaguda/fisiopatologia , Tireotropina/metabolismo , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo
12.
J Cancer Res Clin Oncol ; 147(1): 183-194, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32995956

RESUMO

PURPOSE: BRAFV600E, a major driver of thyroid cancer, evaluated in the context of thyroid hormones and human relaxin. METHODS: Immunohistochemical expressions of BRAFV600E, TSH, TSH receptor (TSHR), T4, T3 receptor (T3R), RLNH2, and its receptor, RXFP1, were evaluated in thyroid tumors from a retrospective U.S. population of 481 cancer cases diagnosed in 1983-2004. RESULTS: BRAFV600E was expressed in 52% of all thyroid tumors; expression of other markers ranged from 25% for T4 to 98% for RLNH2. Tumors predominantly exhibited hypothyroid-like conditions characterized by elevated TSH and TSHR and reduced T4. BRAFV600E prevalence was significantly higher in tumors expressing TSH, TSHR, T3R, and RXFP1 and lower in tumors expressing T4. The proportion of BRAFV600E mutation in classic papillary tumors significantly increased from 56 to 72% over the 21-year period of diagnoses, while expression of RXFP1, TSH, TSHR, and T3R decreased in non-tumor. Racial/ethnic differences were observed in thyroid hormone marker expression. Non-tumor expression of TSH, TSHR, and T3R were each associated with shorter overall survival, but did not remain significant after adjustment for demographic and clinical factors. CONCLUSIONS: Our study provides the first evidence of the potential interaction of BRAFV600E mutation, relaxin, and thyroid hormones in thyroid carcinogenesis. Moreover, our results suggest that hypothyroidism, influenced by RLNH2 activity, may underlie the development of the majority of thyroid cancers and mediate the role of BRAFV600E in thyroid carcinogenesis. BRAFV600E mutation is increasing in papillary thyroid cancers and may be contributing to the rising incidence of this malignancy.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Papilar/patologia , Hipotireoidismo/fisiopatologia , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Relaxina/metabolismo , Neoplasias da Glândula Tireoide/patologia , Idoso , Biomarcadores Tumorais/genética , Carcinoma Papilar/genética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Relaxina/genética , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/genética
13.
Am J Cardiol ; 139: 57-63, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33115640

RESUMO

Thyroid dysfunction is common in patients with chronic heart failure (CHF), but there is conflicting evidence regarding its prognostic significance. We investigated the relation between thyroid function and prognosis in a large, well characterized cohort of ambulatory patients with CHF. Heart failure was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) mild or worse (heart failure with reduced ejection fraction [HFrEF]), or no LVSD and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L; heart failure with normal ejection fraction [HFnEF]). Euthyroid state was defined as a thyroid-stimulating hormone (TSH) level between 0.35 and 4.70 mIU/l, hypothyroidism as TSH >4.70 mIU/l, and hyperthyroidism as TSH <0.35 mIU/l. 2997 patients had HFrEF and 1995 patients had HFnEF. 4491 (90%) patients were euthyroid, 312 (6%) were hypothyroid, and 189 (4%) were hyperthyroid. In univariable analysis, both hypothyroid patients (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.08 to 1.45) and hyperthyroid patients (HR 1.21, 95% CI 1.01 to 1.46) had a greater risk of death compared with euthyroid patients. There was a U-shaped relation between TSH and outcome. Increasing TSH was a predictor of mortality in univariable analysis (HR 1.02, 95% CI 1.01 to 1.03), but the association disappeared in multivariable analysis. The three strongest predictors of adverse outcome were increasing age, increasing NT-proBNP, and higher NYHA class. In conclusion, although thyroid dysfunction is associated with worse survival in patients with CHF, it is not an independent predictor of mortality.


Assuntos
Insuficiência Cardíaca/mortalidade , Hipotireoidismo/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Sistema de Registros , Volume Sistólico/fisiologia , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Idoso , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Masculino , Prognóstico , Precursores de Proteínas , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Glândula Tireoide/metabolismo , Reino Unido/epidemiologia
14.
Am J Emerg Med ; 39: 207-212, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33039222

RESUMO

BACKGROUND: Decompensated hypothyroidism, formerly known as myxedema coma, is an endocrine emergency that commonly presents with altered mental status, as well as hypothermia and depressed vital signs. The condition is often caused by an inciting event, which may lead to significant delays in the diagnosis and management of this disease. Although the incidence is low, this disease is associated with significant morbidity and mortality. Therefore, it is important for emergency clinicians to be aware of this condition. OBJECTIVE: This narrative review evaluates the emergency medicine diagnosis and management of adult patients with decompensated hypothyroidism. DISCUSSION: Decompensated hypothyroidism is a severe hypothyroid state associated with multiple organ failure. The diagnosis can be challenging due to similarities with more common diseases and lack of consideration of the diagnosis. Many patients may present with altered sensorium or depressed vital signs. Clinicians should obtain a thyroid stimulating hormone and free thyroxine level when considering the diagnosis. Management involves resuscitation, early steroid supplementation, thyroid hormone replacement, and treatment of the inciting event. CONCLUSIONS: Decompensated hypothyroidism should be considered in the evaluation of patients with altered sensorium and depressed vital signs so as to not miss this critical diagnosis.


Assuntos
Coma/etiologia , Medicina de Emergência/métodos , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Insuficiência de Múltiplos Órgãos/etiologia , Coma/diagnóstico , Coma/terapia , Terapia Combinada , Diagnóstico Diferencial , Emergências , Humanos , Hipotireoidismo/fisiopatologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/terapia , Índice de Gravidade de Doença
15.
World Neurosurg ; 147: 172-180.e1, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33346052

RESUMO

BACKGROUND: Data on neuroendocrine dysfunction (NED) in the acute setting of penetrating brain injury (PBI) are scarce, and the clinical approach to diagnosis and treatment remains extrapolated from the literature on blunt head trauma. METHODS: Three databases were searched (PubMed, Scopus, and Cochrane). Risk of bias was computed using the Newcastle-Ottawa Scale, or the methodological quality of case series and case reports, as indicated. This systematic review was registered in PROSPERO (42020172163). RESULTS: Six relevant studies involving 58 patients with PBI were included. Two studies were prospective cohort analyses, whereas 4 were case reports. The onset of NED was acute in all studies, by the first postinjury day. Risk factors for NED included worse injury severity and the presence of cerebral edema on imaging. Dysfunction of the anterior hypophysis involved the hypothalamic-pituitary-thyroid axis, treated with hormonal replacement, and hypocortisolism, treated with hydrocortisone. The prevalence of central diabetes insipidus was up to 41%. Most patients showed persistent NED months after injury. In separate reports, diabetes insipidus and hypocortisolism showed an association with higher mortality. The available literature for this review is poor, and the studies included had overall low quality with high risk of bias. CONCLUSIONS: NED seems to be prevalent in the acute phase of PBI, equally involving both anterior and posterior hypophysis. Despite a potential association between NED and mortality, data on the optimal management of NED are limited. This situation defines the need for prospective studies to better characterize the clinical features and optimal therapeutic interventions for NED in PBI.


Assuntos
Insuficiência Adrenal/epidemiologia , Lesões Encefálicas/epidemiologia , Diabetes Insípido Neurogênico/epidemiologia , Traumatismos Cranianos Penetrantes/epidemiologia , Hipopituitarismo/epidemiologia , Hipotireoidismo/epidemiologia , Doença Aguda , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/fisiopatologia , Edema Encefálico , Lesões Encefálicas/fisiopatologia , Diabetes Insípido Neurogênico/tratamento farmacológico , Diabetes Insípido Neurogênico/fisiopatologia , Traumatismos Cranianos Fechados/epidemiologia , Traumatismos Cranianos Fechados/fisiopatologia , Traumatismos Cranianos Penetrantes/fisiopatologia , Humanos , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/fisiopatologia , Sistema Hipotálamo-Hipofisário , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Escala de Gravidade do Ferimento , Mortalidade , Sistema Hipófise-Suprarrenal , Prevalência , Prognóstico , Glândula Tireoide
16.
Biomed Res Int ; 2020: 2182735, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33195690

RESUMO

Both thyroid hormones and irisin have profound influences on the metabolism of the human body. Based on their similarities, several studies have been conducted to explore changes in irisin levels in patients with hypothyroidism and hyperthyroidism. This study was conducted in accordance with the PRISMA statement and the MOOSE reporting guideline. Based on a preregistered protocol (PROSPERO-CRD42019138430), a comprehensive search of eight databases was performed from inception to April 2020. Studies with original data collected from patients with thyroid dysfunction were included. Subgroup analysis was performed based on the different types of clinical manifestations and patient characteristics. The quality of each study and the presence of publication bias were assessed by the Newcastle-Ottawa score (NOS) and funnel plot with Egger's test, respectively. A total of 11 studies with 1210 participants were included. Ten studies were identified as high-quality studies. Pooled analysis indicated decreased irisin levels in patients with hypothyroidism (MD -10.37, 95% CI -17.81 to -2.93). Subgroup analysis revealed an even lower level of irisin in patients with clinical-type hypothyroidism (MD -17.03, 95% CI -30.58 to -3.49) and hypothyroidism caused by autoimmune disease (MD -19.38, 95% CI -36.50 to -2.26). No differences were found after achieving euthyroid status from levothyroxine treatment in patients with hypothyroidism compared with controls. No differences were found between patients with hyperthyroidism and controls. Correlation analyses revealed a possible negative correlation between irisin and TSH and positive correlations between irisin and both fT3 and fT4. Irisin was correlated with TSH receptor antibodies.


Assuntos
Fibronectinas/sangue , Glândula Tireoide/fisiopatologia , Anticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/fisiopatologia , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/fisiopatologia , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Masculino , Viés de Publicação , Glândula Tireoide/efeitos dos fármacos , Tiroxina/farmacologia , Tiroxina/uso terapêutico
17.
Artigo em Inglês | MEDLINE | ID: mdl-32982959

RESUMO

Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous. Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study ("The German Health Interview and Examination Survey for Children and Adolescents") were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors. Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism. Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.


Assuntos
Autoimunidade/imunologia , Hipertireoidismo/fisiopatologia , Hipotireoidismo/fisiopatologia , Saúde Mental , Qualidade de Vida , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Função Tireóidea
18.
Ann Endocrinol (Paris) ; 81(5): 507-510, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950466

RESUMO

The World Health Organization (WHO) declared the COVID-19 epidemic to be a global pandemic in March 2020. COVID-19 is an infection caused by SARS-CoV-2, a coronavirus that utilizes the angiotensin-2 converting enzyme to penetrate thyroid and pituitary cells, and may result in a "cytokine storm". Based on the pathophysiological involvement of the pituitary-thyroid axis, the current review discusses the diagnosis of abnormal thyroid function test, and the management of patients presenting with thyrotoxicosis, thyroid-associated orbitopathy and hypothyroidism in the context of SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Doenças da Glândula Tireoide/etiologia , Enzima de Conversão de Angiotensina 2 , Apoptose , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/fisiopatologia , Suscetibilidade a Doenças , Oftalmopatia de Graves/complicações , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Hipotireoidismo/fisiopatologia , Interleucina-6/fisiologia , Peptidil Dipeptidase A/análise , Hipófise/fisiopatologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/fisiopatologia , Receptores Virais/análise , SARS-CoV-2 , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/fisiopatologia , Glândula Tireoide/química , Glândula Tireoide/patologia , Glândula Tireoide/fisiopatologia , Hormônios Tireóideos/sangue , Tireotoxicose/sangue , Tireotoxicose/etiologia , Tireotoxicose/fisiopatologia , Tireotropina/sangue
19.
J Coll Physicians Surg Pak ; 30(7): 726-729, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32811603

RESUMO

OBJECTIVE: To determine the effects of subclinical hypothyroidism on oxidative stress in children. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Paediatric Endocrinology, and General Outpatient Clinics, Kirikkale University, School of Medicine, from May 2017 to October 2018. METHODOLOGY: This study included 92 subjects aged between 2 and 18 years. The subjects were divided into two groups. Forty-seven children with subclinical hypothyroidism and 45 healthy controls were evaluated. In order to evaluate oxidative damage, native thiol, total thiol, disulfides, their ratios, and ischemia-modified albumin (IMA) levels were compared between the two groups. The relationship between TSH and IMA levels was assessed. RESULTS: Age and gender were not significantly different in the two groups. Native thiol, total thiol, disulfides and their ratios were similar in the two groups. Ischemia-modified albumin levels were significantly higher in the patient group than the controls (p<0.001). There was no correlation between TSH and IMA levels in the patient group (r=0.069 p=0.645). CONCLUSION: Subclinical hypothyroidism may be related to the impairment of IMA, and have a neutral effect on thiol/disulfide balance. Further research is needed to explain the effects of oxidative stress in subclinical hypothyroidism. Key Words: Subclinical hypothyroidism, Childhood, Oxidative stress.


Assuntos
Dissulfetos , Hipotireoidismo , Albumina Sérica Humana , Adolescente , Biomarcadores , Criança , Pré-Escolar , Estudos Transversais , Homeostase , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/metabolismo , Hipotireoidismo/fisiopatologia , Estresse Oxidativo , Albumina Sérica , Compostos de Sulfidrila
20.
BMC Cardiovasc Disord ; 20(1): 369, 2020 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795258

RESUMO

BACKGROUND: It is unclear whether the offspring of subclinical hypothyroidism (SCH) pregnant rats still have abnormal cardiac development, and whether early intervention with L-T4 can improve the abnormality of these offspring. Therefore, the aim of this study was to investigate the effect of early L-T4 intervention on the heart development of offspring of SCH pregnant rats and its possible molecular mechanism. METHODS: Eighty female Wistar rats were randomly divided into Sham group (placebo control), SCH group, LT4-E10 group (L-T4 treatment started on the 10th day of gestation), and LT4-E13 group (L-T4 treatment started on the 13th day of gestation). Each group was further divided into E16 (16th day of gestation), E18 (18th day of gestation), P5 (5th day postnatal day), and P10 (10th day postnatal day) subgroups. The levels of serum TT4 and TSH, the ratio of heart weight to body weight of offspring rats, the expression of metabolic enzymes, and the histopathology of cardiomyocytes were determined. To elucidate the effects of L-T4 on cardiac development of offspring of SCH pregnant rats, the expression levels of GATA4, Nkx2-5 and proteins involved in BMP4/Smad4 signaling pathway were detected by immunohistochemistry, real time quantitative polymerase chain reaction and Western blotting to elucidate the molecular mechanism of L-T4 regulating the heart development of the offspring of SCH pregnant rats. RESULTS: Compared with Sham group, serum TSH was significantly increased in SCH pregnant rats. Moreover, early L-T4 intervention significantly reduced the levels of serum TSH. Compared with the offspring in the SCH group, early L-T4 intervention significantly increased the heart weight, heart weight to body weight ratio, the activities of succinate dehydrogenase (SDH), Na+/K+-ATPase and Ca2+-ATPase, but reduced myocardial cell shrinkage and nuclear staining, hyperemia/congestion and vacuolar degeneration. In addition, early L-T4 intervention not only significantly increased the mRNA and protein expression of Gata4 and Nkx2-5, but also increased the protein expression involved in BMP4/Smad4 signal pathway in myocardium of the offspring of SCH pregnant rats. CONCLUSIONS: Early L-T4 intervention can regulate the cardiac development of the offspring of SCH pregnant rats by activating BMP4/Smad4 signaling pathway and increasing the expression of Gata4 and Nkx2-5 proteins.


Assuntos
Proteína Morfogenética Óssea 4/metabolismo , Coração Fetal/efeitos dos fármacos , Hipotireoidismo/tratamento farmacológico , Miócitos Cardíacos/efeitos dos fármacos , Proteína Smad4/metabolismo , Tiroxina/farmacologia , Animais , Doenças Assintomáticas , Modelos Animais de Doenças , Feminino , Coração Fetal/crescimento & desenvolvimento , Coração Fetal/metabolismo , Fator de Transcrição GATA4/metabolismo , Idade Gestacional , Proteína Homeobox Nkx-2.5/metabolismo , Hipotireoidismo/metabolismo , Hipotireoidismo/fisiopatologia , Miócitos Cardíacos/metabolismo , Gravidez , Ratos Wistar , Transdução de Sinais
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