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1.
Clin Lab ; 67(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34258982

RESUMO

BACKGROUND: The failure to order the correct diagnostic test at the right time is one of the major contributing factors of diagnostic error. Excessive testing can lead to added economic burden and addressing underutilization is precarious as clinicians often fail to order the tests that would improve diagnosis, prognosis, and management. METHODS: A retrospective analysis of errors in test orders of thyroid function testing (TFT) in 321 pregnant women suspected of clinical and subclinical thyroid disorders was performed. Test selection was evaluated, and determinations were made about the extent of overutilization and underutilization of TFTs in reviewing each individual patient case by a Doctorate in Clinical Laboratory Science (DCLS) scholar. RESULTS: About 77% (247 cases) of the cases were found to have errors associated with test ordering for TFT. Of the cases reviewed, 18% cases were associated with overutilization, 53% of the cases were associated with underutilization, and 7% were associated with both (overutilization and underutilization). The annual cost burden because of ordering unnecessary tests was estimated to be approximately $13,000. The cost burden from errors resulting from not ordering a test would be of much greater magnitude but was difficult to estimate because underutilization has a ripple effect and may cause prolonged hospital stays, unnecessary medical bills, and delayed/ missed diagnosis leading to poor outcomes for patients. CONCLUSIONS: This study evaluated whether proper utilization of TFT were made at maternal health clinic locations of a large academic medical center in pregnant women to diagnose thyroid disorder and reported the issue of wastage of resources in the clinical laboratory. The study findings show significant errors in ordering of TFT for pregnant women in more than 75% of the cases that was based on evidence-based review of patient cases.


Assuntos
Gestantes , Testes de Função Tireóidea , Erros de Diagnóstico , Testes Diagnósticos de Rotina , Feminino , Humanos , Gravidez , Estudos Retrospectivos
2.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253523

RESUMO

A 47-year-old man was commenced on levothyroxine following a diagnosis of subclinical hypothyroidism with nonspecific symptoms. Despite increasing doses of levothyroxine, his thyroid-stimulating hormone (TSH) remained elevated and he was referred for further assessment as he was unable to tolerate further titration. On assessment, his thyroid function demonstrated an elevated TSH and elevated free-T4. The initial impression was of iatrogenic thyrotoxicosis, with possible underlying thyroid hormone resistance, TSHoma or assay interference. After discontinuation of levothyroxine, free-T4 normalised but TSH remained elevated. There was a normal response to thyrotropin-releasing hormone (TRH) testing. T3 suppression testing demonstrated free-T4 reduction but persistently high TSH. THRß sequencing was normal. TSH measurement by alternative assays revealed discrepant results. Gel filtration chromatography revealed the presence of high-molecular weight TSH variant alongside normal TSH. Macro-TSH is a rare phenomenon with spuriously elevated TSH and which may mimic subclinical hypothyroidism. Recognition of macro-TSH avoids misdiagnosis and prevents inappropriate treatment.


Assuntos
Hipotireoidismo , Tireotropina , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Hormônio Liberador de Tireotropina , Tiroxina , Tri-Iodotironina
3.
Medicine (Baltimore) ; 100(23): e26273, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115025

RESUMO

ABSTRACT: The association of nephropathy with autoimmune thyroid disease (AITD) has been reported previously. However, there is limited information on the relationship between thyroid autoantibodies and nephropathy. A retrospective study was conducted using the medical records of 246 patients with nephropathy, 82 of whom had concurrent AITD. General characteristics, thyroid function, autoantibodies, and the pathological types of nephropathy were analyzed. Immunohistochemistry was used to detect the thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) in the kidneys. We found nephropathy patients with AITD exhibited higher serum levels of TPO-Ab, TG-Ab, thyroid-stimulating hormone receptor antibody (TR-Ab), and immunoglobulin G (IgG) (P < .05). Compared with the nephropathy without AITD group, the nephropathy with AITD group exhibited higher proportions of membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), and relatively lower proportions of mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephropathy (MCN) (P = .005). TPO-Ab and TG-Ab levels in the kidney were more prevalent in nephropathy patients with AITD than those without AITD (P = .015 and P = .026, respectively). Subgroup analysis demonstrated that serum levels of thyroid stimulating hormone (TSH), TG-Ab, TPO-Ab, immunoglobulin M (IgM), and IgG in the MN group were significantly higher, whereas the levels of free thyroxine (FT4) and estimated glomerular filtration rate (eGFR) were lower, as compared with MN with Hashimoto thyroiditis (HT) group (P < .05). TPO-Ab and TG-Ab expression levels in the kidneys were more prevalent in the MN group than in the MN with HT group (P = .034). The expression levels of FT4, TG-Ab, TPO-Ab, and thyroid-stimulating hormone receptor antibody (TSHR-Ab) in the serum were significantly higher in the MN group than in the MN with Graves disease (GD) group (P < .05). The expression of TPO-Ab in the kidneys was more prevalent in the MN group than in the MN with GD group (P = .011). In sum, the expressions of TPO-Ab and TG-Ab were more prevalent in the kidneys of patients with nephropathy and AITD. Our findings indicate that TPO-Ab and TG-Ab may play a role in the development of AITD-related nephropathy.


Assuntos
Autoanticorpos/análise , Glomerulonefrite Membranosa , Glomerulosclerose Segmentar e Focal , Doença de Hashimoto , Iodeto Peroxidase/imunologia , Receptores da Tireotropina/imunologia , Tireoglobulina/imunologia , Tireoidite Autoimune , Correlação de Dados , Feminino , Glomerulonefrite Membranosa/imunologia , Glomerulonefrite Membranosa/patologia , Glomerulosclerose Segmentar e Focal/imunologia , Glomerulosclerose Segmentar e Focal/patologia , Doença de Hashimoto/sangue , Doença de Hashimoto/diagnóstico , Humanos , Imuno-Histoquímica , Rim/imunologia , Rim/patologia , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Tireoidite Autoimune/sangue , Tireoidite Autoimune/diagnóstico , Tireoidite Autoimune/imunologia
4.
Endocrinol Metab (Seoul) ; 36(3): 582-589, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34107601

RESUMO

BACKGROUND: The occurrence of Graves' disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. METHODS: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. RESULTS: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. CONCLUSION: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.


Assuntos
COVID-19/epidemiologia , Sobreviventes/estatística & dados numéricos , Doenças da Glândula Tireoide/epidemiologia , Glândula Tireoide/imunologia , Glândula Tireoide/fisiologia , Adulto , Autoimunidade/fisiologia , COVID-19/complicações , COVID-19/imunologia , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , SARS-CoV-2/fisiologia , Doenças da Glândula Tireoide/etiologia , Testes de Função Tireóidea , Tireoidite Autoimune/epidemiologia , Tireoidite Autoimune/etiologia
5.
Eur J Endocrinol ; 185(2): 209-218, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34061765

RESUMO

Purpose: Thyroid hormones (THs) are important mediators of brown adipose tissue (BAT) differentiation. However, the association of TH concentrations with human BAT is unclear. The present work examines the associations between circulating thyroid-stimulating hormone (TSH) and THs concentrations (i.e. free triiodothyronine, FT3, and free thyroxine, FT4), under thermoneutral (22-23°C) and cold-induced conditions, and BAT volume, 18F-fluorodeoxyglucose (18F-FDG) uptake and mean radiodensity. Methods: A total of 106 young healthy, euthyroid adults (34 men/72 women; 22.0 ± 2.1 years old; 24.9 ± 4.6 kg/m2) participated in this cross-sectional study. BAT volume, 18F-FDG uptake and mean radiodensity were assessed after 2 h of personalized (i.e. contemplating each individual's shivering threshold) cold exposure via positron emission tomography/computed tomography (PET/CT) static scanning. TSH and THs levels were determined before (thermoneutral) and 1 h after the cold exposure. Results: Cold exposure increased circulating FT4 (P = 0.038) and reduced TSH levels (P ≤ 0.001). Conversely, the FT3 serum concentration was not modified by cold exposure (P = 0.435). No associations were found between the TSH and THs thermoneutral (all P > 0.111) or cold-induced levels (all P > 0.067) and BAT volume, 18F-FDG uptake and mean radiodensity. These findings were independent of sex and BMI. Conclusions: Thyroid function is modulated by cold exposure, yet it is not associated with BAT volume or glucose metabolism assessed after 2 h of cold exposure in young healthy, euthyroid adults.


Assuntos
Tecido Adiposo Marrom/metabolismo , Fluordesoxiglucose F18/farmacocinética , Glândula Tireoide/fisiologia , Tecido Adiposo Marrom/diagnóstico por imagem , Adulto , Composição Corporal/fisiologia , Temperatura Baixa , Estudos Transversais , Feminino , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Termogênese/fisiologia , Testes de Função Tireóidea , Glândula Tireoide/diagnóstico por imagem , Hormônios Tireóideos/metabolismo , Tireotropina/metabolismo , Adulto Jovem
6.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34117002

RESUMO

Hyperthyroidism represents a state of hypercoagulability and hypofibrinolysis, which predisposes an individual to the increased risk of thromboembolism. We present a case of a 25-year-old patient presenting with an acute myocardial infarction secondary to plaque rupture with thrombotic occlusion of proximal left anterior descending artery, in a patient known to have Graves' disease. She had a sudden ventricular fibrillation arrest and a precordial thump given and cardiopulmonary resuscitation started. She successfully underwent cardiac catheterisation. Subsequent thyroid function tests showed she was in active thyrotoxicosis.


Assuntos
Doença de Graves , Hipertireoidismo , Infarto do Miocárdio , Tireotoxicose , Adulto , Feminino , Doença de Graves/complicações , Humanos , Infarto do Miocárdio/etiologia , Testes de Função Tireóidea
7.
J Int Med Res ; 49(5): 3000605211018422, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038203

RESUMO

OBJECTIVE: This study evaluated the association of serum irisin level with thyroid autoantibody (TAA) positivity and subclinical hypothyroidism (SH). METHODS: In this cross-sectional study, 334 participants were assigned to one of the following four age- and sex-matched groups: TAA plus SH (84 patients), isolated TAA (83 patients), isolated SH (83 patients), or healthy controls (84 individuals). Irisin and creatine kinase (CK) were measured in serum samples. RESULTS: Patients with TAA plus SH, isolated TAA, and isolated SH had higher irisin levels compared with the controls. There was a significant increase in the irisin level in the TAA plus SH group compared with the control group. Among all participants, the irisin levels were positively associated with thyroglobulin and thyroid peroxidase antibody titers and high-density lipoprotein cholesterol levels, but negatively associated with waist circumference, glycated hemoglobin levels, and fasting plasma glucose levels. The irisin level was not associated with the thyroid-stimulating hormone, free thyroxine, or CK levels. Irisin levels were independently associated with TAA, with or without SH, but they were not associated with SH alone. CONCLUSIONS: Irisin level may help to predict the risk of developing TAA with or without SH.


Assuntos
Hipotireoidismo , Estudos Transversais , Humanos , Hipotireoidismo/diagnóstico , Testes de Função Tireóidea , Tireotropina , Tiroxina
8.
Chin Med J (Engl) ; 134(9): 1064-1069, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33942801

RESUMO

BACKGROUND: Thyroid dysfunction is associated with cardiovascular diseases. However, the role of thyroid function in lipid metabolism remains partly unknown. The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization (MR). METHODS: The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial. A two-sample MR was performed to assess the causal association, using summary statistics from the Atrial Fibrillation Genetics Consortium (n = 537,409) and the Global Lipids Genetics Consortium (n = 188,577). The clinical measures of thyroid function include thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, FT3:FT4 ratio and concentration of thyroid peroxidase antibodies (TPOAb). The serum lipid metabolism traits include total cholesterol (TC) and triglycerides, high-density lipoprotein, and low-density lipoprotein (LDL) levels. The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism. RESULTS: The results demonstrated that increased TSH levels were significantly associated with higher TC (ß = 0.052, P = 0.002) and LDL (ß = 0.041, P = 0.018) levels. In addition, the FT3:FT4 ratio was significantly associated with TC (ß = 0.240, P = 0.033) and LDL (ß = 0.025, P = 0.027) levels. However, no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids. CONCLUSION: Taken together, the results of the present study suggest an association between thyroid function and serum lipid metabolism, highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.


Assuntos
Análise da Randomização Mendeliana , Glândula Tireoide , Metabolismo dos Lipídeos/genética , Testes de Função Tireóidea , Tireotropina , Tiroxina , Tri-Iodotironina
9.
Klin Lab Diagn ; 66(5): 261-265, 2021 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-34047510

RESUMO

Hypothyroidism syndrome is one of the most common pathologies of the endocrine system. Assessment of euthyroid status can not always be carried out according to the TSH indicator. In a number of patients with normal TSH levels and a clinical picture of hypothyroidism, the serum T3 concentration is determined at the lower limit of the norm or below it with a high content of free T4 in the blood. In world practice, positive experience has been accumulated in the combined use of preparations of sodium levothyroxine and liothyronine, a synthetic form of exogenous triiodothyronine. A number of studies have noted the advantages of using combination therapy for hypothyroidism over levothyroxine monotherapy in certain groups of patients. Possible reasons for the ineffectiveness of standard treatment for hypothyroidism are described.


Assuntos
Hipotireoidismo , Tiroxina , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Testes de Função Tireóidea , Tireotropina , Tri-Iodotironina
10.
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
11.
Clin Chim Acta ; 519: 183-186, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33933427

RESUMO

Measurements of thyroid stimulating hormone (TSH) and free thyroxine (fT4) are critical for the early detection of thyroid diseases and for monitoring treatment. The IFCC Committee for Standardization of Thyroid Function Tests (C-STFT) established reference systems for TSH harmonization and FT4 standardization, and is now working national partners on implementing these reference systems. These implementation activities include the maintenance of the reference systems, their use to standardize and harmonize assays, and educational activities to inform stakeholders about anticipated changes in measurement values as a result of standardization and harmonization. The IFCC C-STFT formed a network of reference laboratories for FT4 and is creating a new harmonization panel for TSH. The U.S. Centers for Disease Control and Prevention is a member of the reference laboratory network and is launching a formal standardization program for FT4. In Japan, national organizations successfully implemented TSH harmonization and established harmonized reference intervals for TSH. The C-STFT made available on its website research findings about potential concerns, communication needs and benefits of FT4 standardization and is assisting local organizations with communicating changes related to these standardization and harmonization efforts. Implementation of fT4 standardization and TSH harmonization is a complex, continuous task that requires collaboration with IVD manufacturers, laboratories, physicians and health care providers. C-STFT is working successfully with national organizations and local groups on improving FT4 and TSH measurements.


Assuntos
Doenças da Glândula Tireoide , Testes de Função Tireóidea , Humanos , Japão , Valores de Referência , Tireotropina , Tiroxina
13.
J Clin Endocrinol Metab ; 106(8): 2208-2220, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34008009

RESUMO

CONTEXT: The COVID-19 pandemic continues to exert an immense burden on global health services. Moreover, up to 63% of patients experience persistent symptoms, including fatigue, after acute illness. Endocrine systems are vulnerable to the effects of COVID-19 as many glands express the ACE2 receptor, used by the SARS-CoV-2 virion for cellular access. However, the effects of COVID-19 on adrenal and thyroid gland function after acute COVID-19 remain unknown. OBJECTIVE: Our objectives were to evaluate adrenal and thyroid gland function in COVID-19 survivors. METHODS: A prospective, observational study was undertaken at the Clinical Research Facility, Imperial College NHS Healthcare Trust, including 70 patients ≥18 years of age, at least 3 months after diagnosis of COVID-19. Participants attended a research study visit (8:00-9:30 am), during which a short Synacthen test (250 µg IV bolus) and thyroid function assessments were performed. RESULTS: All patients had a peak cortisol ≥450 nmol/L after Synacthen, consistent with adequate adrenal reserve. Basal and peak serum cortisol did not differ according to disease severity or history of dexamethasone treatment during COVID-19. There was no difference in baseline or peak cortisol after Synacthen or in thyroid function tests, or thyroid status, in patients with fatigue (n = 44) compared to those without (n = 26). CONCLUSION: Adrenal and thyroid function ≥3 months after presentation with COVID-19 was preserved. While a significant proportion of patients experienced persistent fatigue, their symptoms were not accounted for by alterations in adrenal or thyroid function. These findings have important implications for the clinical care of patients after COVID-19.


Assuntos
Glândulas Suprarrenais/fisiologia , COVID-19/reabilitação , Glândula Tireoide/fisiologia , Adulto , Idoso , COVID-19/sangue , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Estudos de Coortes , Dexametasona/uso terapêutico , Feminino , Seguimentos , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Testes de Função Adreno-Hipofisária , Estudos Prospectivos , SARS-CoV-2/fisiologia , Sobreviventes/estatística & dados numéricos , Testes de Função Tireóidea , Hormônios Tireóideos/sangue , Tireotropina/sangue , Reino Unido/epidemiologia
14.
Int J Mol Sci ; 22(6)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33808529

RESUMO

The most known effects of endogenous Cushing's syndrome are the phenotypic changes and metabolic consequences. However, hypercortisolism can exert important effects on other endocrine axes. The hypothalamus-pituitary-thyroid axis activity can be impaired by the inappropriate cortisol secretion, which determinates the clinical and biochemical features of the "central hypothyroidism". These findings have been confirmed by several clinical studies, which also showed that the cure of hypercortisolism can determine the recovery of normal hypothalamus-pituitary-thyroid axis activity. During active Cushing's syndrome, the "immunological tolerance" guaranteed by the hypercortisolism can mask, in predisposed patients, the development of autoimmune thyroid diseases, which increases in prevalence after the resolution of hypercortisolism. However, the immunological mechanism is not the only factor that contributes to this phenomenon, which probably includes also deiodinase-impaired activity. Cushing's syndrome can also have an indirect impact on thyroid function, considering that some drugs used for the medical control of hypercortisolism are associated with alterations in the thyroid function test. These considerations suggest the utility to check the thyroid function in Cushing's syndrome patients, both during the active disease and after its remission.


Assuntos
Síndrome de Cushing/complicações , Síndrome de Cushing/metabolismo , Doenças da Glândula Tireoide/etiologia , Glândula Tireoide/metabolismo , Animais , Síndrome de Cushing/etiologia , Síndrome de Cushing/terapia , Gerenciamento Clínico , Suscetibilidade a Doenças , Glucocorticoides/metabolismo , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Transdução de Sinais , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/metabolismo , Doenças da Glândula Tireoide/terapia , Testes de Função Tireóidea
15.
Medicine (Baltimore) ; 100(17): e25738, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907168

RESUMO

BACKGROUND: Whether hypothyroidism is related to non-alcoholic fatty liver disease (NAFLD) is controversial. Our aim was to investigate the relationship between NAFLD and hypothyroidism that may predict the NAFLD potential of these lesions and new prevention strategies in hypothyroidism patients. METHODS: Totally 51,407 hypothyroidism patients with average 28.23% NAFLD were analyzed by Revman 5.3 and Stata 15.1 softwares in the present study. The PubMed and Embase databases were systematically searched for works published through May 9, 2020. RESULTS: The blow variables were associated with an increased risk of NAFLD in hypothyroidism patients as following: increased of thyroid stimulating hormone (TSH) levels (odds ratio [OR] = 1.23, 1.07-1.39, P = .0001); old age (mean difference [MD] = 3.18, 1.57-4.78, P = .0001); increased of body mass index (BMI) (MD = 3.39, 2.79-3.99, P < .000001); decreased of free thyroxine 4 (FT4) levels (MD = -0.28, -0.53 to -0.03, P = .03). In addition, FT3 (MD = 0.11, -0.09-0.3, P = .29) had no association with the risk of NAFLD in hypothyroidism patients. CONCLUSION: Our systematic review identified results are as following: hypothyroidism was positively associated with the risk of NAFLD. The increased concentration of TSH levels maybe a risk factor that increased incidence of NAFLD. The BMI of NAFLD patients was significantly higher than that of non-NAFLD patients. Old age was significantly associated with the incidence of NAFLD. FT4 was significantly associated with the risk of NAFLD due to its negatively effect while FT3 was not significantly related to the risk of NAFLD. Taken together, the present meta-analysis provides strong evidence that hypothyroidism may play a vital role in the progression and the development of NAFLD.


Assuntos
Hipotireoidismo , Hepatopatia Gordurosa não Alcoólica , Tireotropina/sangue , Progressão da Doença , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prognóstico , Fatores de Risco , Testes de Função Tireóidea
16.
Nutrients ; 13(3)2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33808030

RESUMO

Hashimoto's disease is listed among the most common endocrine causes of obesity. As treatment of obesity in women with Hashimoto's disease is frequently unsuccessful, the aim of this study was to evaluate the effectiveness of two different reducing diets and their influence on changes in thyroid parameters in female patients. A six-month observational/interventional study was performed on 100 women aged 18-65 years, previously diagnosed with Hashimoto's disease and obesity and receiving L-thyroxine. The women were randomly assigned to the test group (group A, n = 50) following elimination/reducing diets, and the control group (group B, n = 50) following reducing diets with the same caloric content (without elimination). Anthropometric and thyroid parameters were evaluated at the beginning, after 3 months and after 6 months of treatment. In both groups a significant decrease in BMI and body fat percentage was achieved, but in test group A the decrease in BMI and body fat percentage was significantly greater than in control group B (p < 0.002 and p = 0.026, respectively). Serum TSH (thyroid stimulating hormon) levels decreased significantly more in group A than in group B (p < 0.001). Group A exhibited significantly greater increases in fT4 and fT3 levels than the control group (p < 0.001) as well as significantly greater decreases in the levels anti-TPO (thyroid peroxidase) (p < 0.001) and anti-TG (thyreoglobulin) antibodies (p = 0.048). The application of reducing diets with product elimination was found to be a more beneficial tool for changing anthropometric and thyroid parameters in women suffering from obesity and Hashimoto's disease than classic reducing diets with the same energy values and macronutrient content.


Assuntos
Dieta Redutora/métodos , Doença de Hashimoto/dietoterapia , Obesidade/dietoterapia , Tecido Adiposo , Adolescente , Adulto , Idoso , Antropometria , Autoanticorpos/sangue , Autoantígenos/imunologia , Índice de Massa Corporal , Feminino , Doença de Hashimoto/sangue , Doença de Hashimoto/imunologia , Humanos , Iodeto Peroxidase/imunologia , Proteínas de Ligação ao Ferro/imunologia , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/imunologia , Tireoglobulina/imunologia , Testes de Função Tireóidea , Glândula Tireoide/imunologia , Tireotropina/sangue , Tiroxina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
17.
Int J Mol Sci ; 22(8)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33916948

RESUMO

In Hashimoto's thyroiditis (HT), oxidative stress (OS) is driven by Th1 cytokines' response interfering with the normal function of thyrocytes. OS results from an imbalance between an excessive production of reactive oxygen species (ROS) and a lowering of antioxidant production. Moreover, OS has been shown to inhibit Sirtuin 1 (SIRT1), which is able to prevent hypoxia-inducible factor (HIF)-1α stabilization. The aims of this study were to determine the involvement of NADPH-oxidases (NOX), SIRT1, and HIF-1α in HT pathophysiology as well as the status of antioxidant proteins such as peroxiredoxin 1 (PRDX1), catalase, and superoxide dismutase 1 (SOD1). The protein expressions of NOX2, NOX4, antioxidant enzymes, SIRT1, and HIF-1α, as well as glucose transporter-1 (GLUT-1) and vascular endothelial growth factor A (VEGF-A), were analyzed by Western blot in primary cultures of human thyrocytes that were or were not incubated with Th1 cytokines. The same proteins were also analyzed by immunohistochemistry in thyroid samples from control and HT patients. In human thyrocytes incubated with Th1 cytokines, NOX4 expression was increased whereas antioxidants, such as PRDX1, catalase, and SOD1, were reduced. Th1 cytokines also induced a significant decrease of SIRT1 protein expression associated with an upregulation of HIF-1α, GLUT-1, and VEGF-A proteins. With the exception of PRDX1 and SOD1, similar results were obtained in HT thyroids. OS due to an increase of ROS produced by NOX4 and a loss of antioxidant defenses (PRDX1, catalase, SOD1) correlates to a reduction of SIRT1 and an upregulation of HIF 1α, GLUT-1, and VEGF-A. Our study placed SIRT1 as a key regulator of OS and we, therefore, believe it could be considered as a potential therapeutic target in HT.


Assuntos
Doença de Hashimoto/etiologia , Doença de Hashimoto/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Estresse Oxidativo , Sirtuína 1/genética , Células Th1/imunologia , Células Th1/metabolismo , Fator A de Crescimento do Endotélio Vascular/genética , Adulto , Doenças Autoimunes/etiologia , Doenças Autoimunes/metabolismo , Autoimunidade/genética , Biomarcadores , Citocinas/genética , Citocinas/metabolismo , Feminino , Imunofluorescência , Regulação da Expressão Gênica , Doença de Hashimoto/diagnóstico , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , NADPH Oxidase 2/genética , NADPH Oxidase 2/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Sirtuína 1/metabolismo , Superóxido Dismutase-1/metabolismo , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Timócitos/imunologia , Timócitos/metabolismo , Testes de Função Tireóidea , Glândula Tireoide/imunologia , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-33924694

RESUMO

BACKGROUND: Diagnostics of thyroid disorders (TD) are frequently based on the measurements of thyroid stimulating hormone (TSH) concentration only. If TSH is outside the reference range, the diagnostic procedure used in patients with TD isintroduced. Observations indicate that in a considerable number of these patients, TD is not confirmed. The aim of the study was to assess the incidence of transient hyperthyrotropinemia in healthy children during acute infections of the respiratory system. PATIENTS AND METHODS: The study included consecutive children (49 boys and 45 girls), aged 2.2-17.3 years, who visited one General Practitioner (GP) due to respiratory tract infections. The tests: complete blood count (CBC), C-reactive protein (CRP), TSH and FT4 were run on the next day after the visit at the physician's (initial visit) and ≥2 weeks after recovery. RESULTS: Among these children, elevated TSH values were found in about 10% of patients, and they went back to normal values after recovery. A prospective analysis showed a reduction of TSH values in approx. 65% of all groups and TSH at the follow-up visit was significantly lower. CONCLUSIONS: Transient hyperthyrotropinemia was observed in about 10% of children with acute respiratory tract infection. This preliminary finding remains unexplained.


Assuntos
Pacientes Ambulatoriais , Doenças da Glândula Tireoide , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Sistema Respiratório , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/epidemiologia , Testes de Função Tireóidea , Tireotropina , Tiroxina
19.
Nutrients ; 13(3)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33804451

RESUMO

Background: non-autoimmune thyroid disorder is a common finding in celiac patients, more frequent than in the general population. An impairment of iodine absorption has been hypothesized, but it has never been investigated so far. We aimed to evaluate the iodine absorption in children and adolescents with newly diagnosed celiac disease. Methods: 36 consecutive celiac patients (age 7.4 years, range 2.4-14.5 years) before starting a gluten-free diet (GFD) were enrolled. We assayed the urinary iodine concentration (UIC) in a 24-h urine sample, at baseline (T0) after 3 (T1) and 12 months (T2) of GFD. Results: UIC at T0 was 64 µg/L (IQR 45-93.25 µg/L) with an iodine deficiency rate of 77.8%. UIC was not different according to histological damage, clinical presentation (typical vs atypical); we found no correlation with the thyroid function tests and auxological parameters. UIC was not statistically different at T1 (76 µg/L) and T2 (89 µg/L) vs T0. UIC at T2 was similar between patients with positive and negative anti-transglutaminase antibodies at T2. No patients presented overt hypothyroidism during the study. Conclusions: We found that iodine absorption in celiac children is impaired compared to the general population; it increases slightly, but not significantly, during the GFD. We should regularly reinforce the need for a proper iodine intake in celiac disease patients to reduce iodine deficiency risk.


Assuntos
Doença Celíaca/complicações , Doença Celíaca/fisiopatologia , Dieta Livre de Glúten , Absorção Gastrointestinal , Iodo/deficiência , Adolescente , Doença Celíaca/urina , Criança , Pré-Escolar , Feminino , Humanos , Iodo/urina , Estudos Longitudinais , Masculino , Estado Nutricional , Projetos Piloto , Testes de Função Tireóidea , Glândula Tireoide/fisiopatologia , Resultado do Tratamento
20.
Eur J Endocrinol ; 184(5): 699-709, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33683214

RESUMO

Objective: Alterations in thyroid function tests (TFTs) have been recorded during SARS-CoV-2 infection as associated to either a destructive thyroiditis or a non-thyroidal illness. Methods: We studied 144 consecutive COVID-19 patients admitted to a single center in intensive or subintensive care units. Those with previous thyroid dysfunctions or taking interfering drugs were excluded. Differently from previous reports, TSH, FT3, FT4, thyroglobulin (Tg), anti-Tg autoantibodies (TgAb) were measured at baseline and every 3-7 days. C-reacting protein (CRP), cortisol and IL-6 were also assayed. Results: The majority of patients had a normal TSH at admission, usually with normal FT4 and FT3. Low TSH levels were found either at admission or during hospitalization in 39% of patients, associated with low FT3 in half of the cases. FT4 and Tg levels were normal, and TgAb-negative. TSH and FT3 were invariably restored at the time of discharge in survivors, whereas were permanently low in most deceased cases, but only FT3 levels were predictors of mortality. Cortisol, CRP and IL-6 levels were higher in patients with low TSH and FT3 levels. Conclusions: Almost half of our COVID-19 patients without interfering drugs had normal TFTs both at admission and during follow-up. In this series, the transient finding of low TSH with normal FT4 and low FT3 levels, inversely correlated with CRP, cortisol and IL-6 and associated with normal Tg levels, is likely due to the cytokine storm induced by SARS-Cov-2 with a direct or mediated impact on TSH secretion and deiodinase activity, and likely not to a destructive thyroiditis.


Assuntos
COVID-19/sangue , Tireoglobulina/sangue , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/imunologia , Proteína C-Reativa/imunologia , COVID-19/imunologia , Feminino , Humanos , Hidrocortisona/sangue , Interleucina-6/imunologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Tireoglobulina/imunologia , Testes de Função Tireóidea
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