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2.
Eur J Endocrinol ; 183(4): 419-426, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688338

RESUMO

Objective: The need for personalization of the reference values of thyroid function tests has been previously suggested. We aimed at determining TSH reference values in a large cohort of children according to age, sex, BMI, and ethnicity. Design: A population-based cohort study. Methods: The study cohort included 75 549 healthy children aged 5-18 years. Data analyzed included age, gender, TSH, FT4 levels, BMI and ethnicity. Multivariate logistic regression analysis examined the associations between the study parameters. Results: TSH in the Jewish population is lower than in the non-Jewish population (median: 2.1 IU/L (IQR: 1.5) vs 2.2 IU/L (IQR: 1.5), P < 0.0001). TSH is significantly affected by BMI for children defined as underweight, normal weight, overweight or obese, levels increased as weight diverged from the normal range (median levels: 2.1 IU/L (IQR: 1.4), 2.0 IU/L (IQR: 1.3), 2.1 IU/L (IQR: 1.4), 2.4 (IQR: 1.5), respectively, P < 0.001). The 2.5 percentile is affected by gender and BMI (P < 0.02 and P < 0.001, respectively), while the 97.5 percentile is affected by ethnic origin and BMI (P < 0.001 for both). New TSH reference intervals (RI) adjusted according to BMI and ethnicity are suggested. Comparison of the old and new RI demonstrate the significance of RI personalization: 25.1% of the children with TSH levels above the old RI are within the new RI, while 2.3% of the children who were in the old RI are below the new RI. Conclusions: TSH reference values in children are affected by BMI and ethnicity. Reference values should be individualized accordingly to improve future clinical decision-making and treatment.


Assuntos
Índice de Massa Corporal , Grupos Étnicos , Medicina de Precisão/métodos , Testes de Função Tireóidea/normas , Tireotropina/sangue , Adolescente , Análise Química do Sangue/normas , Criança , Pré-Escolar , Técnicas de Diagnóstico Endócrino/normas , Feminino , Humanos , Judeus , Masculino , Pediatria/métodos , Pediatria/normas , Medicina de Precisão/normas , Valores de Referência , Estudos Retrospectivos , Tireotropina/normas , Tiroxina/sangue
3.
Eur J Endocrinol ; 183(4): 381-387, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698147

RESUMO

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


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tireotoxicose/virologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/imunologia , Citocinas/sangue , Citocinas/imunologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Hipotireoidismo/virologia , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , Estudos Retrospectivos , Fatores de Risco , Testes de Função Tireóidea , Glândula Tireoide/imunologia , Glândula Tireoide/virologia , Tireotoxicose/epidemiologia , Tireotoxicose/imunologia , Tireotropina/sangue , Tireotropina/imunologia
6.
Eur J Endocrinol ; 183(3): 265-273, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32580148

RESUMO

Objective: Congenital hypothyroidism (CH) is defined as thyroid hormone deficiency at birth due to disorders of the thyroid gland (thyroidal CH, CH-T), or the hypothalamus or pituitary (central CH, CH-C). The Dutch Newborn Screening (NBS) strategy is primarily based on determination of thyroxine (T4) concentrations in dried blood spots followed, if necessary, by thyroid-stimulating hormone (TSH) and thyroxine-binding globulin (TBG) measurement enabling detection of both CH-T and CH-C. A calculated T4/TBG ratio serves as an indirect measure for free T4. A T4/TBG ratio ≤ 17 in a second heel puncture is suggestive of CH-C. Design and methods: In the present study, we evaluated 11 years of Dutch CH NBS using a database of referred cases by assessing the contribution of each criterion in the unique stepwise T4-TSH-TBG NBS algorithm. Results: Between 2007 and the end of 2017, 1 963 465 newborns were screened in the Netherlands. Use of the stepwise algorithm led to 3044 referrals and the identification of 612 CH cases, consisting of 496 CH-T, 86 CH-C, and 30 CH of unknown origin diagnoses. We detected 62.8% of CH-C cases by the T4/TBG ratio in the second heel puncture. The positive predictive value (PPV) of the stepwise T4-TSH-TBG NBS algorithm was 21.0%. Conclusion: This evaluation shows that the Dutch stepwise T4-TSH-TBG NBS algorithm with a calculated T4/TBG ratio is of great value for the detection of both CH-T and CH-C in the Netherlands, at the cost of a lower PPV compared to TSH-based NBS strategies.


Assuntos
Hipotireoidismo Congênito/diagnóstico , Triagem Neonatal/métodos , Algoritmos , Bases de Dados Factuais , Feminino , Humanos , Hipotálamo/patologia , Recém-Nascido , Masculino , Países Baixos , Hipófise/patologia , Testes de Função Tireóidea , Glândula Tireoide/patologia
7.
Arch Endocrinol Metab ; 64(3): 269-275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555993

RESUMO

OBJECTIVE: Acromegaly is characterized by high neoplastic morbidity as a side effect of growth hormone (GH) hypersecretion. Increased incidence of goiter, thyroid carcinoma, and thyroid dysfunction is also reported. The aim of the present study was to find the prevalence of thyroid dysfunction and goiter in patients with acromegaly and determine its relationship to disease activity, disease duration, and the presence of secondary hypothyroidism. SUBJECTS AND METHODS: In a cross-sectional study of the period 2008-2012 were included 146 patients with acromegaly (56 men, 90 women) of mean age 50.3 ± 12.4 years. Acromegaly disease activity and thyroid function were evaluated in all patients. Thyroid ultrasonography was performed to calculate thyroid volume and detect the presence of nodular goiter. RESULTS: Ninety-one patients were determined to have an active disease, and 55, a controlled disease. The mean thyroid volume in patients without previous thyroid surgery was 37.6 ± 38.8 mL. According to disease activity, thyroid volume was significantly higher in patients with active disease (38.5 ± 45.4 mL vs. 27.2 ± 18.4 mL, p = 0.036). A weak positive correlation was found between thyroid volume and insulin-like growth factor 1 (IGF-1) in the whole group and in females (R = 0.218; p = 0.013, and R = 0.238; p = 0.037, respectively). There was no significant correlation of thyroid volume with disease duration and GH level in the whole group and in both sexes. The patients with secondary hypothyroidism had twofold smaller thyroid volume, relative to the rest of the group. The prevalence of thyroid dysfunction was 39%, with a female to male percentage ratio of 1.73. Goiter was diagnosed in 87% of patients, including diffuse goiter (17.1%) and nodular (69.9%), with no significant difference between patients with active and controlled disease or the presence of secondary hypothyroidism. CONCLUSIONS: Thyroid volume in patients with acromegaly depends on disease activity and the presence of secondary hypothyroidism as a complication. The increased prevalence of nodular goiter determines the need of regular ultrasound thyroid evaluation in the follow-up of patients with acromegaly. Arch Endocrinol Metab. 2020;64(3):269-75.


Assuntos
Acromegalia/complicações , Bócio Nodular/fisiopatologia , Hipotireoidismo/fisiopatologia , Glândula Tireoide/fisiopatologia , Acromegalia/fisiopatologia , Adulto , Estudos Transversais , Feminino , Bócio Nodular/diagnóstico , Humanos , Hipotireoidismo/diagnóstico por imagem , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Testes de Função Tireóidea , Glândula Tireoide/diagnóstico por imagem , Hormônios Tireóideos/sangue , Ultrassonografia
8.
Ann Afr Med ; 19(2): 89-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499464

RESUMO

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


Assuntos
Bócio/epidemiologia , Saúde da População Rural , Doenças da Glândula Tireoide/epidemiologia , Testes de Função Tireóidea/métodos , Adulto , Feminino , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/epidemiologia , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Retrospectivos , Doenças da Glândula Tireoide/complicações , Glândula Tireoide
9.
Lancet Diabetes Endocrinol ; 8(6): 501-510, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445737

RESUMO

BACKGROUND: Adequate transplacental passage of maternal thyroid hormone is important for normal fetal growth and development. Maternal overt hypothyroidism and hyperthyroidism are associated with low birthweight, but important knowledge gaps remain regarding the effect of subclinical thyroid function test abnormalities on birthweight-both in general and during the late second and third trimester of pregnancy. The aim of this study was to examine associations of maternal thyroid function with birthweight. METHODS: In this systematic review and individual-participant data meta-analysis, we searched MEDLINE (Ovid), Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception to Oct 15, 2019, for prospective cohort studies with data on maternal thyroid function during pregnancy and birthweight, and we issued open invitations to identify study authors to join the Consortium on Thyroid and Pregnancy. We excluded participants with multiple pregnancies, in-vitro fertilisation, pre-existing thyroid disease or thyroid medication usage, miscarriages, and stillbirths. The main outcomes assessed were small for gestational age (SGA) neonates, large for gestational age neonates, and newborn birthweight. We analysed individual-participant data using mixed-effects regression models adjusting for maternal age, BMI, ethnicity, smoking, parity, gestational age at blood sampling, fetal sex, and gestational age at birth. The study protocol was pre-registered at the International Prospective Register of Systematic Reviews, CRD42016043496. FINDINGS: We identified 2526 published reports, from which 36 cohorts met the inclusion criteria. The study authors for 15 of these cohorts agreed to participate, and five more unpublished datasets were added, giving a study population of 48 145 mother-child pairs after exclusions, of whom 1275 (3·1%) had subclinical hypothyroidism (increased thyroid stimulating hormone [TSH] with normal free thyroxine [FT4]) and 929 (2·2%) had isolated hypothyroxinaemia (decreased FT4 with normal TSH). Maternal subclinical hypothyroidism was associated with a higher risk of SGA than was euthyroidism (11·8% vs 10·0%; adjusted risk difference 2·43%, 95% CI 0·43 to 4·81; odds ratio [OR] 1·24, 1·04 to 1·48; p=0·015) and lower mean birthweight (mean difference -38 g, -61 to -15; p=0·0015), with a higher effect estimate for measurement in the third trimester than in the first or second. Isolated hypothyroxinaemia was associated with a lower risk of SGA than was euthyroidism (7·3% vs 10·0%, adjusted risk difference -2·91, -4·49 to -0·88; OR 0·70, 0·55 to 0·91; p=0·0073) and higher mean birthweight (mean difference 45 g, 18 to 73; p=0·0012). Each 1 SD increase in maternal TSH concentration was associated with a 6 g lower birthweight (-10 to -2; p=0·0030), with higher effect estimates in women who were thyroid peroxidase antibody positive than for women who were negative (pinteraction=0·10). Each 1 SD increase in FT4 concentration was associated with a 21 g lower birthweight (-25 to -17; p<0·0001), with a higher effect estimate for measurement in the third trimester than the first or second. INTERPRETATION: Maternal subclinical hypothyroidism in pregnancy is associated with a higher risk of SGA and lower birthweight, whereas isolated hypothyroxinaemia is associated with lower risk of SGA and higher birthweight. There was an inverse, dose-response association of maternal TSH and FT4 (even within the normal range) with birthweight. These results advance our understanding of the complex relationships between maternal thyroid function and fetal outcomes, and they should prompt careful consideration of potential risks and benefits of levothyroxine therapy during pregnancy. FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).


Assuntos
Peso ao Nascer/fisiologia , Hipotireoidismo/fisiopatologia , Complicações na Gravidez/fisiopatologia , Glândula Tireoide/fisiologia , Glândula Tireoide/fisiopatologia , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Gravidez , Testes de Função Tireóidea/tendências
11.
Arch Endocrinol Metab ; 64(2): 159-164, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32236307

RESUMO

Objective Maternal hypothyroidism during pregnancy may lead to adverse outcomes. Recently published guidelines by the American Thyroid Association (ATA) do not advocate for universal screening but recommend a case-finding approach in high-risk pregnant women. The present study aims to evaluate the accuracy of this approach in identifying women with thyroid dysfunction during early pregnancy. Subjects and methods This is a multiple-center, cross-sectional study. Three hundred and one pregnant women were enrolled. Anamnesis and a physical examination were performed to detect which women fulfilled the criteria to undergo laboratory screening of thyroid dysfunction, according to the ATA's 2017 guidelines. The Zulewski's validated clinical score was applied to assess signs and symptoms of hypothyroidism. Serum levels of thyrotropin (TSH), free thyroxine (FT4), anti-thyroperoxidase (TPO-Ab), and anti-thyroglobulin (Tg-Ab) antibodies were determined. Results Two hundred and thirty one women (78%) were classified as high risk, and 65 (22%) were classified as low risk for thyroid dysfunction. Regarding the clinical score, 75 patients (31.2%) presented mild symptoms that were compatible with SCH, of which 22 (7.4%) had symptoms as the only risk factor for thyroid disease. 17 patients (5.7%) had SCH, of which 10 (58.8%) belonged to the high-risk group, and 7 (41.2%) belonged to the low-risk group. OH was found in 4 patients (1.4%): 3 (75%) in the high-risk group and 1 (25%) in the low-risk group. Conclusions The ATA's proposed screening criteria were not accurate in the diagnosis of thyroid dysfunction in pregnancy. Testing only the high-risk pregnant women would miss approximately 40% of all hypothyroid patients.


Assuntos
Hipotireoidismo/diagnóstico , Programas de Rastreamento/métodos , Complicações na Gravidez/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Medição de Risco , Fatores de Risco , Testes de Função Tireóidea
12.
Am J Clin Nutr ; 112(2): 389-412, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32320029

RESUMO

BACKGROUND: Mild-to-moderate iodine deficiency, particularly in pregnancy, is prevalent; this is of concern because observational studies have shown negative associations with child neurodevelopment. Although neither the benefits nor the safety of iodine supplementation in pregnancy in areas of mild-to-moderate deficiency are well researched, such supplementation is increasingly being recommended by health authorities in a number of countries. OBJECTIVES: By reviewing the most recent published data on the effects of iodine supplementation in mildly-to-moderately deficient pregnant women on maternal and infant thyroid function and child cognition, we aimed to determine whether the evidence was sufficient to support recommendations in these areas. METHODS: A systematic review of randomized controlled trials (RCTs), non-RCT interventions, and observational studies was conducted. To identify relevant articles, we searched the PubMed and Embase databases. We defined mild-to-moderate iodine deficiency as a baseline median urinary iodine concentration (UIC) of 50-149 µg/L. Eligible studies were included in meta-analyses. RESULTS: In total, 37 publications were included-10 RCTs, 4 non-RCT interventions, and 23 observational studies. Most studies showed no effect of iodine supplementation on maternal or infant thyroid-stimulating hormone and free thyroxine. Most RCTs found that supplementation reduced maternal thyroglobulin and in 3 RCTs, it prevented or diminished the increase in maternal thyroid volume during pregnancy. Three RCTs addressed child neurodevelopment; only 1 was adequately powered. Meta-analyses of 2 RCTs showed no effect on child cognitive [mean difference (MD): -0.18; 95% CI: -1.22, 0.87], language (MD: 1.28; 95% CI: -0.28, 2.83), or motor scores (MD: 0.28; 95% CI: -1.10, 1.66). CONCLUSIONS: There is insufficient good-quality evidence to support current recommendations for iodine supplementation in pregnancy in areas of mild-to-moderate deficiency. Well-designed RCTs, with child cognitive outcomes, are needed in pregnant women who are moderately deficient (median UIC < 100 µg/L). Maternal intrathyroidal iodine stores should be considered in future trials by including appropriate measures of preconceptional iodine intake.This review was registered at www.crd.york.ac.uk/prospero as CRD42018100277.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Iodo/administração & dosagem , Transtornos do Neurodesenvolvimento/prevenção & controle , Complicações na Gravidez/tratamento farmacológico , Adulto , Criança , Suplementos Nutricionais , Feminino , Humanos , Lactente , Iodo/deficiência , Transtornos do Neurodesenvolvimento/metabolismo , Gravidez , Testes de Função Tireóidea , Hormônios Tireóideos/metabolismo
13.
Eur J Endocrinol ; 182(6): 533-538, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32213658

RESUMO

Objective: Familial dysalbuminaemic hyperthyroxinaemia (FDH), most commonly due to an Arginine to Histidine mutation at residue 218 (R218H) in the albumin gene, causes artefactual elevation of free thyroid hormones in euthyroid individuals. We have evaluated the susceptibility of most current free thyroid hormone immunoassay methods used in the United Kingdom, Europe and Far East to interference by R218H FDH. Methods: Different, one- and two-step immunoassay methods were tested, measuring free T4 (FT4) and free T3 (FT3) in 37 individuals with genetically proven R218H FDH. Results: With the exception of Ortho VITROS, FT4 measurements were raised in all assays, with greatest to lowest susceptibility to interference being Beckman ACCESS > Roche ELECSYS > FUJIREBIO Lumipulse > Siemens CENTAUR > Abbott ARCHITECT > Perkin-Elmer DELFIA. Five different assays recorded high FT3 levels, with the Siemens CENTAUR method measuring high FT3 values in up to 30% of cases. However, depending on the assay method, FT4 measurements were unexpectedly normal in some, genetically confirmed, affected relatives of index FDH cases. Conclusions: All FT4 immunoassays evaluated are prone to interference by R218H FDH, with their varying susceptibility not being related to assay architecture but likely due to differing assay conditions or buffer composition. Added susceptibility of many FT3 assays to measurement interference, resulting in high FT4 and FT3 with non-suppressed TSH levels, raises the possibility of R218H FDH being misdiagnosed as resistance to thyroid hormone beta or TSH-secreting pituitary tumour, potentially leading to unnecessary investigation and inappropriate treatment.


Assuntos
Hipertireoxinemia Disalbuminêmica Familiar/sangue , Testes de Função Tireóidea/métodos , Hormônios Tireóideos/sangue , Humanos , Imunoensaio , Tiroxina/sangue , Tri-Iodotironina/sangue
14.
Orv Hetil ; 161(12): 474-478, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32172585

RESUMO

Thyrotropin-secreting pituitary tumors are rare causes of hyperthyroidism and account for less than 1% of all pituitary adenomas. The number of reported cases increased over the last few years as a consequence of the routine use of ultrasensitive immunometric assays for measuring thyrotropin levels. In the clinical practice, thyrotropin secreting adenomas must be considered in case of inappropriately normal to elevated thyrotropin in the presence of elevated free serum thyroid hormone levels. The authors present the case history of a middle aged female patient, who suffered from hyperthyreodism caused by a thyrotropin-secreting pituitary macroadenoma. After transient thyreostatic treatment, radical neurosurgical removal of the tumor was performed. The pituitary surgery was effective in restoring the patient's euthyreodism. The postoperative pituitary function remained intact. During follow-up, the recurrence of the disease was not detected. In our case report, the difficulties in the differential diagnoses are also discussed. Orv Hetil. 2020; 161(12): 474-478.


Assuntos
Adenoma/metabolismo , Adenoma/cirurgia , Hipertireoidismo/etiologia , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/cirurgia , Tireotropina/metabolismo , Adenoma/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/patologia , Testes de Função Tireóidea , Tireotropina/sangue , Resultado do Tratamento
15.
Fertil Steril ; 113(3): 587-600.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192591

RESUMO

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


Assuntos
Aborto Habitual/epidemiologia , Aborto Habitual/etiologia , Hipotireoidismo/epidemiologia , Tireoidite Autoimune/epidemiologia , Aborto Habitual/imunologia , Doenças Assintomáticas , Feminino , Humanos , Hipotireoidismo/complicações , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Fatores de Risco , Testes de Função Tireóidea , Tireoidite Autoimune/complicações
16.
JAMA Netw Open ; 3(3): e201357, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32202644

RESUMO

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


Assuntos
Alcaptonúria/metabolismo , Hipotireoidismo/epidemiologia , Adulto , Alcaptonúria/complicações , Alcaptonúria/genética , Autoanticorpos/sangue , Autoantígenos/imunologia , Estudos de Coortes , Feminino , Ácido Homogentísico/urina , Humanos , Hipertireoidismo/epidemiologia , Hipertireoidismo/genética , Hipotireoidismo/genética , Iodeto Peroxidase/imunologia , Proteínas de Ligação ao Ferro/imunologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Testes de Função Tireóidea , Glândula Tireoide/enzimologia , Tireotropina/sangue , Tiroxina/sangue , Tirosina/sangue
17.
Medicine (Baltimore) ; 99(9): e19232, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118725

RESUMO

The aim of the study was to systematically characterize the interference of biotin on thyroid function tests and biotin washout periods.Ten healthy adults were recruited with administration of 5 and 10 mg/d biotin for 7 days. Analyte concentrations of thyroid function tests were measured at baseline prior to starting biotin and from 2 hours to 2 days after withdrawal of 5 and 10 mg/d biotin. The outcomes were compared the baseline with the several points after taking biotin at Roche cobas e602, Beckman UniCel DxI 800, and Abbott Architect 2000 immunoassay platforms, respectively.Ingesting 5 or 10 mg/d of biotin for 7 days could produce positive or negative interference among the thyroid function tests at Roche cobas e602 and Beckman UniCel DxI 800 systems, but no interference on Abbott Architect 2000. Interference duration of 5 mg/d biotin for Roche cobas e602 and Beckman UniCel DxI 800 of thyroid function tests lasted for 8 hours, while 10 mg/d biotin interfered with Roche cobas e602 or Beckman UniCel DxI 800 for 1 day or 2 days.This study provides valuable guidance on biotin washout periods at doses common in over-the-counter supplements necessary to avoid false assay results.Trial registration: ChiCTR1800020472.


Assuntos
Biotina/farmacologia , Testes de Função Tireóidea/normas , Complexo Vitamínico B/farmacologia , Administração Oral , Adulto , Biotina/administração & dosagem , Feminino , Voluntários Saudáveis , Humanos , Masculino , Tiroxina/sangue , Tiroxina/efeitos dos fármacos , Tri-Iodotironina/sangue , Tri-Iodotironina/efeitos dos fármacos , Complexo Vitamínico B/administração & dosagem , Adulto Jovem
18.
Medicine (Baltimore) ; 99(11): e19492, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176089

RESUMO

Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development.Five hundred seventy-seven patients with cirrhosis who applied to Demiroglu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system.In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference (P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group (P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group (P < .05).Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.


Assuntos
Carcinoma Hepatocelular/complicações , Hipotireoidismo/complicações , Cirrose Hepática , Neoplasias Hepáticas/complicações , Hormônios Tireóideos/sangue , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Carcinoma Hepatocelular/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Hipotireoidismo/sangue , Neoplasias Hepáticas/sangue , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Testes de Função Tireóidea
19.
Clin Chim Acta ; 505: 125-129, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32070724

RESUMO

BACKGROUND-AIM: Measurement of serum thyrotropin is currently the recommended test for the screening of thyroid dysfunction, while serum free thyroxine is kept as a reflex test. In our laboratory, the strategy followed in adult individuals from Primary Care includes a 'safety margin' for requests with a thyrotropin ≤1.0 or ≥4.0 mIU/L (normal: 0.35-4.95 mIU/L). Our aim was to optimize the thyrotropin cut-off values for the addition of free thyroxine and, based on these cut-offs, to retrospectively analyze avoidable free thyroxine measurements and possible adverse clinical consequences. METHODS: Retrospective observational study performed in a tertiary care hospital between 2013 and 2018. We considered all laboratory requests for screening of thyroid dysfunction (TD) in adult patients from Primary Care. Requests from patients with a previous diagnosis of thyroid disease or pregnant women were excluded. Different receiver operating characteristic (ROC) curves were performed and the obtained thyrotropin cut-off values were compared. Economic savings were assessed considering the current cost of free thyroxin assays in our laboratory. RESULTS: From a total of 554,529 TD protocols included, 119,504 requests had free thyroxine added. From the ROC curve that enables ≥95% of abnormal free thyroxine results to be detected, the thyrotropin values obtained were ≥4.58 mIU/L and ≤0.94 mIU/L. These thyrotropin cut-off values would lead to a saving of 22.7% of annual free thyroxine measurements without adverse clinical consequences. DISCUSSION: Setting optimized thyrotropin cutoffs for reflex testing of free thyroxine would reduce the need for this test. Clinical laboratories need to offer not only true results, but also become the cornerstone in the optimization of resources.


Assuntos
Doenças da Glândula Tireoide/sangue , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/normas , Tireotropina/sangue , Tiroxina/sangue , Adulto , Idoso , Algoritmos , Feminino , Testes Hematológicos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/tratamento farmacológico , Resultado do Tratamento
20.
Isr Med Assoc J ; 22(2): 100-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043327

RESUMO

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


Assuntos
Hepatite Autoimune , Hipotireoidismo , Glândula Tireoide/imunologia , Adulto , Autoanticorpos/análise , Autoimunidade/imunologia , Estudos de Casos e Controles , Feminino , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/imunologia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/imunologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Testes de Função Tireóidea/métodos , Testes de Função Tireóidea/estatística & dados numéricos
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