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2.
Rev Med Suisse ; 16(684): 455-458, 2020 Mar 04.
Artigo em Francês | MEDLINE | ID: mdl-32134225

RESUMO

Subclinical hypothyroidism is frequent and its treatment by thyroid hormones is debated. Current guidelines tend to recommend a treatment for symptomatic adults or for thyrotropin (TSH) levels > 10 mIU/l. Nevertheless, new evidence from systematic review, -including 21 trials and 2192 participants, demonstrated that thyroid hormone replacement has no clinically relevant benefit on patients' symptoms or prognosis. An international and independent panel -including physicians, methodologists and patients issues a strong recommendation (BMJ Rapid Recommendation) against thyroid hormones therapy for adults with subclinical hypothyroidism. This recommendation does not apply to women who are pregnant or trying to conceive or to patients with TSH > 20 mIU/l.


Assuntos
Hipotireoidismo/tratamento farmacológico , Hormônios Tireóideos/uso terapêutico , Humanos , Hipotireoidismo/sangue , Prognóstico , Tireotropina/sangue
4.
Int J Vitam Nutr Res ; 90(1-2): 156-168, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31017555

RESUMO

Protective effects of vitamin E (Vit E) on long term potentiation (LTP) impairment, neuronal apoptosis and increase of nitric oxide (NO) metabolites in the hippocampus of juvenile rats were examined. The rats were grouped (n=13) as: (1) control; (2) hypothyroid (Hypo) and (3) Hypo-Vit E. Propylthiouracil (PTU) was given in drinking water (0.05%) during 6 weeks. Vit E (20 mg/ kg) was daily injected (IP). To evaluate synaptic plasticity, LTP from the CA1 area of the hippocampus followed by high frequency stimulation to the ipsilateral Schafer collateral pathway was carried out. The cortical and hippocampal tissues were then removed to measure NO metabolites. The brains of 5 animals in each group were removed for apoptosis study. The hypothyroidism status decreased the slope, 10-90% slope and amplitude of field excitatory post synaptic potential (fEPSP) compared to the control group (P<0.01-P<0.001). Injection of Vit E increased the slope, 10-90% slope and amplitude of the fEPSP in the Hypo-Vit E group in comparison to the Hypo group (P<0.05-P<0.01). TUNEL positive neurons and NO metabolites were higher in the hippocampus of the Hypo rats, as compared to those in the hippocampus of the control ones (P<0.001). Treatment of the Hypo rats by Vit E decreased apoptotic neurons (P<0.01-P<0.001) and NO metabolites (P<0.001) in the hippocampus compared to the Hypo rats. The results of the present study showed that Vit E prevented the LTP impairment and neuronal apoptosis in the hippocampus of juvenile hypothyroid rats.


Assuntos
Hipocampo/efeitos dos fármacos , Hipotireoidismo , Potenciação de Longa Duração , Vitamina E/farmacologia , Animais , Hipotireoidismo/tratamento farmacológico , Ratos , Ratos Wistar , Vitamina E/química
6.
Curr Sports Med Rep ; 18(12): 474-476, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31834179

RESUMO

Recent media have highlighted the controversy surrounding treatment of elite athletes for hypothyroidism. The World Anti-Doping Agency denied a request by the United States Anti-Doping Agency to ban the use of thyroid medication. At present, there is no scientific evidence that thyroid medication has the potential to enhance performance. Clinical practice guidelines are not definitive in regard to what classifies a patient as having hypothyroidism. Thyroid-stimulating hormone and free T4 are recommended to screen for thyroid disease; however, the thyrotropin-releasing hormone stimulation test is still advocated by some for detecting the earliest stages of hypothyroidism. Hypothyroidism has been demonstrated to reduce cardiopulmonary function and result in musculoskeletal symptoms, such as fatigue and muscle stiffness. Symptoms of hypothyroidism, including depression, fatigue, and impaired sleep, are similar to those reported in overtraining. These patients may have hypothalamic-pituitary dysfunction that may complicate interpretation of basal thyroid-stimulating hormone and free T4. To date, no association has been identified between training state and hypothyroidism. Research to more clearly define hypothyroidism using provocative testing, evaluate the potential for thyroid medication to enhance performance, and examine whether training may induce hypothyroidism in athletes is desirable.


Assuntos
Hipotireoidismo/diagnóstico , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Atletas , Exercício Físico , Humanos , Hipotireoidismo/tratamento farmacológico , Guias de Prática Clínica como Assunto , Tireotropina/sangue , Tiroxina/uso terapêutico
7.
Artigo em Inglês | MEDLINE | ID: mdl-31795239

RESUMO

Background: Hypothyroidism has several symptoms (weight gain, arrhythmias, mood changes, etc.). The aims of this study were (1) to assess the prevalence of anxiety and depression in levothyroxine-treated hypothyroid women and in women without hypothyroidism; (2) to identify variables associated with anxiety and depression. Methods: A case-control study was performed with 393 women. Case-group: 153 levothyroxine-treated hypothyroid women. Control-group: 240 women without hypothyroidism. Convenience sampling. Instrument: The Hamilton Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire. Results: The prevalence of anxiety in levothyroxine-treated hypothyroid women was higher than in women without hypothyroidism (29.4% vs. 16.7%, χ2 p < 0.001). The prevalence of depression in the case group was higher than in the control group (13.1% vs. 4.6%, χ2 p < 0.001). Levothyroxine-treated hypothyroid women were more likely to have anxiety (OR = 2.08, CI: 1.28-3.38) and depression (OR = 3.13, IC = 1.45-6.45). Conclusion: In spite of receiving treatment with levothyroxine, women with hypothyroidism are more likely to have depression and anxiety. Health professionals need to assess the mood of women with hypothyroidism. Although levothyroxine is a good treatment for the symptoms of hypothyroidism, it may not be enough to prevent development or persistence of depression and anxiety by itself.


Assuntos
Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Transtornos do Humor/complicações , Tiroxina/uso terapêutico , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipotireoidismo/psicologia , Prevalência , Inquéritos e Questionários
10.
BMJ Case Rep ; 12(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31619400

RESUMO

We report a preterm breastfed infant who developed a transient hypothyroidism after his lactating mother had a CT scan with iodinated contrast medium, despite the advised 24 hours' pause in breast feeding. The aetiological assessment did not show any other cause for this hypothyroidism. Transient neonatal hypothyroidism after the use of topical iodine is well known, but it has not been described as a complication of intravenous contrast medium administration to a lactating mother. This case highlights the possibility of transient neonatal hypothyroidism secondary to contrast medium exposure to a lactating mother. When imaging is needed in the lactating mother, a longer break in breast feeding might be needed to prevent transient hypothyroidism in the preterm infant.


Assuntos
Aleitamento Materno , Meios de Contraste/efeitos adversos , Hipotireoidismo/induzido quimicamente , Doenças do Recém-Nascido/induzido quimicamente , Iodo/efeitos adversos , Exposição Materna , Diagnóstico Diferencial , Feminino , Humanos , Hipotireoidismo/tratamento farmacológico , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Masculino , Tiroxina/uso terapêutico
11.
J Med Case Rep ; 13(1): 311, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31623668

RESUMO

BACKGROUND: Levothyroxine is a synthetic thyroxine and is the treatment of choice for hypothyroidism. It is a prohormone with minimal intrinsic activity. The drug is de-iodinated in peripheral tissue to form triiodothyronine, which is the active thyroid hormone. On initiation of treatment, levothyroxine is titrated, and usually it is extremely well tolerated in the vast majority of patients. We report a case of a patient with self-limiting levothyroxine-induced liver injury, a rare adverse effect of this drug. CASE PRESENTATION: We report a case of a 34-year-old Mediterranean woman diagnosed with post-thyroidectomy hypothyroidism. She was commenced on levothyroxine and developed liver injury confirmed by noninvasive liver investigations. Complete recovery of the patient's liver tests occurred upon cessation of the drug. Triiodothyronine was an appropriate treatment alternative. CONCLUSION: Levothyroxine-induced liver injury is a rare, and in the present case report, a self-limiting, adverse effect. The diagnosis of our patient was confirmed via noninvasive diagnostic methods. Knowledge of this rare adverse effect is important in the differential diagnosis of patients who have commenced on levothyroxine and have deranged liver enzymes in the context of hypothyroidism.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Terapia de Reposição Hormonal/efeitos adversos , Hipotireoidismo/tratamento farmacológico , Tiroxina/efeitos adversos , Adulto , Feminino , Humanos , Hipotireoidismo/etiologia , Tireoidectomia , Tri-Iodotironina/uso terapêutico
13.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586959

RESUMO

Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.


Assuntos
Hipotireoidismo/diagnóstico , Transtornos Psicóticos/etiologia , Rabdomiólise/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Masculino , Rabdomiólise/sangue , Rabdomiólise/complicações , Rabdomiólise/tratamento farmacológico , Tiroxina/administração & dosagem , Tiroxina/uso terapêutico
15.
Endocrine ; 66(1): 27-34, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31617163

RESUMO

Subclinical Hypothyroidism (SCH) is defined as a raised level of serum TSH level in the presence of normal circulating free thyroid hormones. SCH is a highly prevalent condition displaying some peculiarities, both in terms of the diagnostic and therapeutic approach, when specific population and/or concomitant diseases are taken into account. The debate upon whether LT4 therapy should be initiated or not in patients with SCH is a long lasting one and still it remains controversial. Current evidence supports the concept that the clinical consequences of SCH may be profoundly different in relation to several patient-specific characteristics. Aim of the present review is to provide updated indications for SCH treatment in specific clinical settings. These will include the management of SCH in obese and diabetic patients, in pregnant women, and in specific age groups. Treatment modalities, including LT4 doses and recommended follow-up strategy will also be discussed. In the era of "precision medicine" the decision to-treat-not-to-treat SCH should be individualized taking into account risks and beneficial outcomes of LT4 therapy. With this in mind, we reviewed the most relevant studies in the recent literature in order to provide evidence for or against LT4 replacement therapy for SCH in specific clinical settings.


Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Tireotropina/sangue , Tiroxina/uso terapêutico , Humanos , Hipotireoidismo/sangue
16.
Endocrine ; 66(1): 35-42, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31617164

RESUMO

Hypothyroidism is the most frequent pregnancy-related thyroid dysfunction, including overt and subclinical hypothyroidism. Studies show that even mild hypothyroidism may eventuate in adverse gestational outcomes and intellectual impairment of offspring. Women with overt hypothyroidism (OH) must be treated by levothyroxine (LT4) pre- and during pregnancy, however, it is controversial that when and how to initiate LT4 therapy and further optimize dosing so that pregnant women and their offspring may truly benefit. In the review we will analyze the changes in thyroid hormone requirements in pregnant women, the timing of LT4 treatment and adjustment of LT4 dose according to etiology in patients with hypothyroidism during pregnancy, and adjustment of LT4 after delivery.


Assuntos
Hipotireoidismo/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Tiroxina/administração & dosagem , Animais , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia
17.
Endocrine ; 66(1): 70-78, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31617166

RESUMO

Guidelines on T4 + T3 combination therapy were published in 2012. This review investigates whether the issue is better understood 7 years later. Dissatisfaction with the outcome of T4 monotherapy remains high. Persistent symptoms consist mostly of fatigue, weight gain, problems with memory and thinking and mood disturbances. T4 monotherapy is associated with low serum T3 levels, which often require TSH-suppressive doses of L-T4 for normalization. Peripheral tissue thyroid function tests during T4 treatment indicate mild hyperthyroidism at TSH < 0.03 mU/L and mild hypothyroidism at TSH 0.3-5.0 mU/L; tissues are closest to euthyroidism at TSH 0.03-0.3 mU/L. This is explained by the finding that whereas T4 is usually ubiquinated and targeted for proteasomal degradation, hypothalamic T4 is rather stable and less sensitive to ubiquination. A normal serum TSH consequently does not necessarily indicate a euthyroid state. Persistent symptoms in L-T4 treated patients despite a normal serum TSH remain incompletely understood. One hypothesis is that a SNP (Thr92Ala) in DIO2 (required for local production of T3 out of T4) interferes with its kinetics and/or action, resulting in a local hypothyroid state in the brain. Effective treatment of persistent symptoms has not yet realized. One may try T4 + T3 combination treatment in selected patients as an experimental n = 1 study. The 2012 ETA guidelines are still valid for this purpose. More well-designed randomized clinical trials in selected patients are key in order to make progress. In the meantime the whole issue has become rather complicated by commercial and political overtones, as evident from skyrocketing prices of T3 tablets, aggressive pressure groups and motions in the House of Lords.


Assuntos
Hipotireoidismo/tratamento farmacológico , Tiroxina/administração & dosagem , Tri-Iodotironina/administração & dosagem , Quimioterapia Combinada , Terapia de Reposição Hormonal , Humanos
18.
Rom J Morphol Embryol ; 60(2): 479-486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658321

RESUMO

OBJECTIVES: To assess the efficacy of thymoquinone (TQ), the most active constituent in Nigella sativa, which is a medicinal plant from the Ranunculaceae family, in restoring the normal liver structure after 6-propyl-2-thiouracil (PTU)-induced hypothyroidism and explore the mechanism behind this. MATERIALS AND METHODS: Hypothyroidism was induced in rats by injection of PTU [6 mg∕kg body weight (b.w.)] for six weeks. Twenty-four adult male Wistar rats were divided into four groups; the control, TQ-treated at the dose 400 mg∕kg b.w., untreated hypothyroidism and TQ-treated hypothyroid groups. Serum levels of thyroid hormones and antioxidant profile were measured. Real-time polymerase chain reaction was used to assess gene expression of catalase (CAT). Liver was histopathologically examined using routine and immunohistochemical techniques. RESULTS: Livers of rats with hypothyroidism displayed nonalcoholic fatty liver disease (NAFLD) in the form of steatosis as well as nonalcoholic steatohepatitis (NASH). Moreover, there was an intralobular inflammatory reaction associated with significant (p<0.05) increases in the density of resident hepatic macrophages [cluster of differentiation 68 (CD68)+ cells], as well as in activated hepatic stellate cells, alpha-smooth muscle actin (α-SMA) index in livers with hypothyroidism. Resolution of hypothyroid NAFLD was observed in livers after treatment with TQ. The significantly increased (p<0.05) steatosis, lobular inflammation, NAFLD activity scores, α-SMA index as well as CD68+ cells induced by hypothyroidism were corrected after TQ administration. Up-regulation of the CAT gene in livers with hypothyroidism after treatment with TQ supported our hypothesis of its antioxidant mechanistic hepatoprotective action. CONCLUSIONS: TQ efficiently restores the normal liver histology in hypothyroid rats with up-regulation of the antioxidant CAT gene.


Assuntos
Benzoquinonas/uso terapêutico , Hipotireoidismo/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Animais , Benzoquinonas/farmacologia , Modelos Animais de Doenças , Masculino , Hepatopatia Gordurosa não Alcoólica/patologia , Ratos , Ratos Wistar
19.
BMJ ; 366: l4892, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481394

RESUMO

OBJECTIVE: To explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures. DESIGN: Retrospective cohort study. SETTING: The Health Improvement Network (THIN), a database of electronic patient records from UK primary care. PARTICIPANTS: Adult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017. EXPOSURE: TSH concentration in patients with hypothyroidism. MAIN OUTCOME MEASURES: Ischaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome. RESULTS: 162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)). CONCLUSIONS: In patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Hipotireoidismo/tratamento farmacológico , Tireotropina/sangue , Tiroxina/administração & dosagem , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Tireotropina/normas
20.
Ann Surg Oncol ; 26(13): 4405-4413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489555

RESUMO

BACKGROUND: The goal of the present study was to determine the actual incidence, predictive risk factors, and clinical characteristics of levothyroxine supplementation (LT4S) used for the management of hypothyroidism after hemithyroidectomy. METHODS: From 2008 to 2015, we included 535 patients who underwent hemithyroidectomy. LT4S was initiated based on three major criteria: the development of overt hypothyroidism, subclinical hypothyroidism with thyroid-stimulating hormone (TSH) levels > 10 mIU/L, or subclinical hypothyroidism with TSH levels of 4.5-10 mIU/L with associated signs/symptoms. RESULTS: During the 69-month follow-up period, 321 patients (60%) developed overall hypothyroidism following hemithyroidectomy, and 141 ultimately required LT4S, with an overall LT4S incidence of 26.4%. The most common cause of LT4S initiation was subclinical hypothyroidism with TSH levels > 10 mIU/L. In 141 patients with LT4S, the mean maintenance dose of levothyroxine was 1.34 µg/kg, and only 6 patients (4.3%) discontinued LT4S during the follow-up. The 1-, 3-, 5-, and 7-year LT4S-free survival rates of 535 patients were 88.6%, 80.2%, 73.8%, and 69.1%, respectively. Preoperative TSH levels > 2.12 mIU/L and coexistence of Hashimoto's thyroiditis were significantly associated with LT4S following hemithyroidectomy. The risk of LT4S increased by 1.401 times, as preoperative TSH levels increased by 1 mIU/L. DISCUSSION: A quarter of patients required LT4S after hemithyroidectomy for the management of hypothyroidism, with a mean maintenance levothyroxine dose of 1.34 µg/kg. The preoperative TSH level and coexistence of Hashimoto's thyroiditis were significant predictive factors of LT4S following hemithyroidectomy.


Assuntos
Hipotireoidismo/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Tireoidectomia/métodos , Tiroxina/uso terapêutico , Adolescente , Adulto , Idoso , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
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