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1.
J Pediatr Endocrinol Metab ; 37(6): 536-542, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38662611

RESUMO

OBJECTIVES: Transient hyperthyrotropinemia/transient hypothyroxinaemia and congenital hypothyroidism (CH) have completely different treatment and clinical outcomes. However, a powerful, highly sensitive and cost-effective marker for the differentiation of these clinical entities in the early postnatal period is not available. Therefore, we aimed to test the potential, early predictive, diagnostic power of the thyroid-stimulating hormone (TSH)/free thyroxine (fT4) ratio for differentiation of the two clinical entities in the early period of life. METHODS: TSH and fT4 levels were recorded on the postnatal day 7 of premature infants<32 weeks of gestational age. TSH/fT4 ratio was calculated. The significance degree of TSH/fT4 ratio was analyzed for the differentiation of transient hyperthyrotropinemia or transient hypothyroxinaemia and CH. RESULTS: The study included 1,204 preterm infants<32 weeks of gestational age. Of the 1,204 infants, 978 (81.2 %) had normal thyroid function. Eighty-eight infants (7.3 %) were diagnosed with CH and 138 (11.5 %) with transient hyperthyrotropinemia or transient hypothyroxinemia. Initial TSH/fT4 ratio>4.8 was found to be an early diagnostic warning sign with high power in favor of transient hyperthyrotropinemia or transient hypothyroxinemia (AUC value: 0.947) and TSH/fT4 ratio>12.5 (AUC value: 0.999) was found to be an early diagnostic warning sign with high power in favor of CH (p=0.0001). CONCLUSIONS: We found for the first time that the TSH/fT4 ratio can be used for the early differentiation of transient hyperthyrotropinemia/transient hypothyroxinaemia and CH in preterm infants without additional cost and with high power.


Assuntos
Biomarcadores , Hipotireoidismo Congênito , Hipertireoxinemia , Recém-Nascido Prematuro , Tireotropina , Tiroxina , Humanos , Recém-Nascido , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/sangue , Tiroxina/sangue , Tireotropina/sangue , Masculino , Feminino , Biomarcadores/sangue , Hipertireoxinemia/diagnóstico , Hipertireoxinemia/sangue , Idade Gestacional , Testes de Função Tireóidea , Prognóstico , Diagnóstico Diferencial , Seguimentos , Doenças do Prematuro/sangue , Doenças do Prematuro/diagnóstico
3.
Front Endocrinol (Lausanne) ; 12: 643307, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484109

RESUMO

The purpose of this paper was to systematically summarize the published literature on neonatal isolated hyperthyrotropinemia (HTT), with a focus on prevalence, L-T4 management, re-evaluation of thyroid function during infancy or childhood, etiology including genetic variation, thyroid imaging tests, and developmental outcome. Electronic and manual searches were conducted for relevant publications, and a total of 46 articles were included in this systematic review. The overall prevalence of neonatal HTT was estimated at 0.06%. The occurrence of abnormal imaging tests was found to be higher in the persistent than in the transient condition. A continuous spectrum of thyroid impairment severity can occur because of genetic factors, environmental factors, or a combination of the two. Excessive or insufficient iodine levels were found in 46% and 16% of infants, respectively. Thirty-five different genetic variants have been found in three genes in 37 patients with neonatal HTT of different ethnic backgrounds extracted from studies with variable design. In general, genetic variants reported in the TSHR gene, the most auspicious candidate gene for HTT, may explain the phenotype of the patients. Many practitioners elect to treat infants with HTT to prevent any possible adverse developmental effects. Most patients with thyroid abnormalities and/or carrying monoallelic or biallelic genetic variants have received L-T4 treatment. For all those neonates on treatment with L-T4, it is essential to ensure follow-up until 2 or 3 years of age and to conduct medically supervised trial-off therapy when warranted. TSH levels were found to be elevated following cessation of therapy in 44% of children. Withdrawal of treatment was judged as unsuccessful, and medication was restarted, in 78% of cases. Finally, data extracted from nine studies showed that none of the 94 included patients proved to have a poor developmental outcome (0/94). Among subjects presenting with normal cognitive performance, 82% of cases have received L-T4 therapy. Until now, the precise neurodevelopmental risks posed by mild disease remain uncertain.


Assuntos
Hipertireoxinemia/patologia , Doenças do Recém-Nascido/patologia , Mutação , Receptores da Tireotropina/genética , Humanos , Hipertireoxinemia/genética , Recém-Nascido , Doenças do Recém-Nascido/genética , Prognóstico
4.
J Clin Res Pediatr Endocrinol ; 13(3): 269-275, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-33374096

RESUMO

Objective: Initial high-dose sodium levothyroxine (Na-LT4) (10-15 µg/kg/day) replacement for primary congenital hypothyroidism (CH) is recommended in guidelines. However, high-dose Na-LT4 risks iatrogenic hyperthyroidism. The aim of this study was to investigate the normalizing effect of varying initial doses of Na-LT4 on serum thyroid hormone levels. Methods: Fifty-two patients were analyzed retrospectively. The patients were classified into mild (27/51.9%), moderate (11/21.1%) and severe (14/26.9%) CH, based on initial free thyroxine (fT4) levels. Time taken to achieve target hormone levels was compared within groups. Results: Initial mean Na-LT4 doses for mild, moderate and severe disease were 6.9±3.3, 9.4±2.2 and 10.2±2 µg/kg/day. Serum fT4 levels reached the upper half of normal range (>1.32 ng/dL) in a median of 16, 13 and 16 days in patients with mild, moderate and severe CH with the mean time from initial treatment to first control visit of 14.8±6 days (range 1-36). There was no significant difference in terms of time to achieve target fT4 hormone levels according to disease severity (p=0.478). Seven (25.9%), eight (72.7%) and eight (57.1%) patients experienced hyperthyroxinemia (serum fT4 >1.94 ng/dL) in the mild, moderate, and severe CH groups at the first visit, respectively (p=0.016). Conclusion: Not all patients diagnosed with CH require high-dose Na-LT4. Initial dose of Na-LT4 may be selected on the basis of pre-treatment thyroid hormone levels. Some patients with moderate and severe CH, experienced iatrogenic hyperthyroxinemia even though the dose was close to the lower limit of the recommended range in guidelines. We suggest that lower initial doses may be appropriate with closer follow-up within the first week.


Assuntos
Hipotireoidismo Congênito/tratamento farmacológico , Terapia de Reposição Hormonal , Tiroxina/administração & dosagem , Tiroxina/sangue , Biomarcadores/sangue , Tomada de Decisão Clínica , Hipotireoidismo Congênito/sangue , Hipotireoidismo Congênito/diagnóstico , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipertireoxinemia/sangue , Hipertireoxinemia/induzido quimicamente , Doença Iatrogênica , Recém-Nascido , Masculino , Triagem Neonatal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tiroxina/efeitos adversos , Resultado do Tratamento
5.
Endocr J ; 68(3): 317-328, 2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115985

RESUMO

The purpose of this study was to explore the impact of maternal thyroid hormone dysfunction in late pregnancy on birth outcomes in a Chinese population. We retrospectively examined hospitalisation records and laboratory data between April 2016 and March 2017 and obtained results from 11,564 consecutive pregnant women with singleton births in which serum thyroid hormone had been examined together with birth outcomes. We assessed the association between maternal thyroid level and dysfunction with adverse birth outcomes based on regression analysis. Hyperthyroidism was associated with an increased risk of preterm birth (PTB, adjusted OR: 2.41, 95% CI: 1.83-3.17) and hypothyroidism was associated with an increased risk of small for gestational age (SGA, adjusted OR: 1.56, 95% CI: 1.10-2.22), while hyperthyroxinaemia was associated with a decreased risk of large for gestational age (LGA, adjusted OR: 0.64, 95% CI: 0.45-0.90). In addition, compared to women with normal FT3 and TSH (≥the 5th and ≤the 95th percentiles), women with high free triiodothyronine (FT3 >the 95th percentile) and low thyroid-stimulating hormone (TSH

Assuntos
Macrossomia Fetal/epidemiologia , Hipertireoidismo/epidemiologia , Hipertireoxinemia/epidemiologia , Hipotireoidismo/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , China , Estudos de Coortes , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoxinemia/sangue , Hipotireoidismo/sangue , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações na Gravidez/sangue , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
6.
Thyroid ; 30(11): 1681-1684, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32669045

RESUMO

A 23-year-old man and his grandmother with hyperthyroxinemia and hypercortisolemia were heterozygous for an ALB mutation (p. Arg218Pro), known to cause familial dysalbuminemic hyperthyroxinemia (FDH). However, serum-free cortisol levels in these individuals were normal and total cortisol concentrations fell markedly after depletion of albumin from their serum. We conclude that binding of steroid as well as iodothyronines to mutant albumin causes raised circulating cortisol as well as thyroid hormones in euthyroid euadrenal individuals with R218P FDH, with potential for misdiagnosis, unnecessary investigation, and inappropriate treatment.


Assuntos
Hidrocortisona/sangue , Hipertireoxinemia Disalbuminêmica Familiar/complicações , Hipertireoxinemia/complicações , Mutação , Albumina Sérica Humana/genética , Albuminas/química , Genótipo , Heterozigoto , Humanos , Imunoensaio , Masculino , Militares , Ligação Proteica , Albumina Sérica/genética , Esteroides/química , Tironinas/sangue , Tiroxina/sangue , Adulto Jovem
7.
Hormones (Athens) ; 19(3): 311-315, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32128699

RESUMO

Disorders of thyroid function are among the commonest referrals to endocrinology. While interpretation of thyroid function testing is usually straightforward, accurate interpretation becomes significantly more challenging when the parameters do not behave as would be expected in normal negative feedback. In such cases, uncertainty regarding further investigation and management arises. An important abnormal pattern encountered in clinical practice is that of high normal or raised free thyroxine (fT4) with inappropriately non-suppressed or elevated thyroid-stimulating hormone (TSH). In this short review using two clinical vignettes, we examine the diagnostic approach in such cases. A diagnostic algorithm is proposed to ensure that a definitive diagnosis is reached in these challenging cases.


Assuntos
Hipertireoxinemia/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Testes de Função Tireóidea/normas , Tireotoxicose/diagnóstico , Tireotropina/sangue , Tiroxina/sangue , Adulto , Feminino , Humanos , Hipertireoxinemia/sangue , Neoplasias Hipofisárias/sangue , Síndrome da Resistência aos Hormônios Tireóideos/sangue , Síndrome da Resistência aos Hormônios Tireóideos/diagnóstico , Tireotoxicose/sangue , Tireotoxicose/fisiopatologia
8.
Clin Endocrinol (Oxf) ; 91(6): 824-833, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31614008

RESUMO

OBJECTIVE: To assess a possible relationship between maternal cognitive dysfunction during pregnancy and hypothyroxinemia, adjusted for major confounders. BACKGROUND: Thyroid dysfunction in general is associated with cognitive dysfunction. Cognitive dysfunction is common during pregnancy. DESIGN: Prospective follow-up study from 12 to 32 weeks of pregnancy. PARTICIPANTS: 2082 healthy pregnant women. MEASUREMENTS: Cognitive function, depression and sleeping problems were assessed by self-report questionnaires at 12, 22 and 32 weeks of gestation, higher scores reflecting more symptoms. FT4, TSH and TPO-Ab were assessed at 12 weeks of gestation. DEFINITIONS: healthy (euthyroxinemia) control group: FT4 within 10-90th percentiles, without elevated TPO-Ab titres and TSH within first trimester-specific reference range (0.23-4.0 mU/L). Hypothyroxinemia: FT4 <2.5th percentile with TSH within first trimester-specific reference range. Poor cognitive function: a score >1 SD > mean on the cognitive function scale. RESULTS: A total of 54 women showed hypothyroxinemia and 1476 women had euthyroxinemia. At 12 weeks, multiple logistic regression showed that poor cognitive function was independently related to hypothyroxinemia: OR: 2.9 (95% CI: 1.6-5.4), adjusted for depression (OR: 3.1; 95% CI: 2.7-4.6) and sleeping problems (OR: 2.8, 95% CI: 1.9-3.9). TPO-Ab + women with hypothyroxinemia had the highest levels of cognitive dysfunction. Other cut-offs of hypothyroxinemia (<5th or <10th percentile with normal TSH) showed similar results. GLM-ANOVA showed that throughout pregnancy women with hypothyroxinemia at 12 weeks had significantly higher cognitive dysfunction scores compared with the healthy controls: F = 12.1, P = .001. CONCLUSIONS: Women with hypothyroxinemia during early gestation are at risk for poor cognitive function throughout gestation, adjusted for depression and sleeping problems.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Hipertireoxinemia/fisiopatologia , Adulto , Depressão/fisiopatologia , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Sono , Inquéritos e Questionários , Testes de Função Tireóidea , Glândula Tireoide/patologia , Glândula Tireoide/fisiopatologia
9.
PLoS One ; 14(7): e0220040, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31318940

RESUMO

BACKGROUND: Maternal iodine deficiency is related to high neonatal thyroid-stimulating hormone (TSH) values, with the threshold of 5 mIU/L recommended as an indicator of iodine nutrition status. The objective of this study was to analyse possible risk factors for increased TSH that could distort its validity as a marker of iodine status. The clinical relevance of this research question is that if the factors associated with iodine deficiency are known, iodine supplementation can be introduced in risk groups, both during pregnancy and in newborns. METHODS: A case-control study was carried out in a sample of 46,622 newborns in 2002-2015 in Spain. Of these, 45,326 had a neonatal TSH value ≥5 mIU/L. The main variable was having TSH ≥5 mIU/L and the secondary variables were: sex, gestational age, day of sample extraction and maternal origin. Associated factors were analysed through a logistic regression model, calculating the odds ratio (OR). RESULTS: The factors associated with this outcome were: male sex (OR = 1.34, 95% CI: 1.20-1.50, p<0.001), originating from an Asian/Oceanic country (OR = 0.80, 95% CI: 0.54-1.20, p = 0.536) or Europe (OR = 0.80, 95% CI: 0.66-0.96, p = 0.285) (including Spain, OR = 1) [p<0.001 for America (OR = 0.54, 95% CI: 0.44-0.68) and p = 0.025 for Africa (OR = 0.78, 95% CI: 0.62-0.97)] and fewer days from birth to sampling (OR = 0.80, 95% CI: 0.77-0.82, p<0.001). CONCLUSIONS: The risk of high neonatal TSH without congenital hypothyroidism is higher in males, decreases with a greater number of days from birth to extraction, and is dependent on maternal ethnicity but not on gestational age.


Assuntos
Hipertireoxinemia/diagnóstico , Hipertireoxinemia/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertireoxinemia/metabolismo , Recém-Nascido , Doenças do Recém-Nascido , Masculino , Triagem Neonatal , Razão de Chances , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Tireotropina/metabolismo
10.
J Surg Res ; 244: 102-106, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279993

RESUMO

BACKGROUND: After thyroidectomy, patients require Levothyroxine (LT4). It may take years of dose adjustments to achieve euthyroidism. During this time, patients encounter undesirable symptoms associated with hypo- or hyper-thyroidism. Currently, providers adjust LT4 dose by clinical estimation, and no algorithm exists. The objective of this study was to build a decision tree that could estimate LT4 dose adjustments and reduce the time to euthyroidism. METHODS: We performed a retrospective cohort analysis on 320 patients who underwent total or completion thyroidectomy at our institution. All patients required one or more LT4 dose adjustments from their initial postoperative dose before attaining euthyroidism. Using the Classification and Regression Tree algorithm, we built various decision trees from patient characteristics, estimating the dose adjustment to reach euthyroidism. RESULTS: The most accurate decision tree used thyroid-stimulating hormone values at first dose adjustment (mean absolute error = 13.0 µg). In comparison, the expert provider and naïve system had a mean absolute error of 11.7 µg and 17.2 µg, respectively. In the evaluation dataset, the decision tree correctly predicted the dose adjustment within the smallest LT4 dose increment (12.5 µg) 79 of 106 times (75%, confidence interval = 65%-82%). In comparison, expert provider estimation correctly predicted the dose adjustment 76 of 106 times (72%, confidence interval = 62%-80%). CONCLUSIONS: A decision tree predicts the correct LT4 dose adjustment with an accuracy exceeding that of a completely naïve system and comparable to that of an expert provider. It can assist providers inexperienced with LT4 dose adjustment.


Assuntos
Árvores de Decisões , Cálculos da Dosagem de Medicamento , Terapia de Reposição Hormonal/métodos , Tireoidectomia/efeitos adversos , Tiroxina/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Hipertireoxinemia/sangue , Hipertireoxinemia/etiologia , Hipertireoxinemia/prevenção & controle , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tireotropina/sangue , Tiroxina/efeitos adversos
11.
J Pediatr Endocrinol Metab ; 32(6): 561-568, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31129653

RESUMO

Background Severe obesity is associated with a number of cardiometabolic risk factors. Thyroid-stimulating hormone (TSH) levels are often slightly increased in children with obesity. The clinical significance of the mild elevation in TSH in children with obesity is unclear. Objective To examine the association between TSH and lipids in children with severe obesity. Methods We performed a retrospective analysis of records of children with severe obesity with simultaneous measurements of TSH and lipids. Children with TSH <0.3 mIU/L and ≥10 mIU/L were excluded. The relationship between TSH and lipids was evaluated using univariate/multiple variable linear and logistic regression. Results The study included 834 children (age 13.8 ± 4.1 years, males 46%, body mass index [BMI]: 36.9 ± 7.6 kg/m2; BMI z-score 2.6 ± 0.4). Seventy-four (8.9%) children had TSH between 5 and <10 mIU/L (high TSH [HTSH]). TSH was positively associated with non-high-density lipoprotein (HDL) cholesterol (ß: 1.74; 95% confidence interval [CI] 0.29-3.20, p = 0.02). Total cholesterol and non-HDL cholesterol were higher in males with HTSH compared to those with normal TSH (175.5 vs. 163.5 mg/dL, p = 0.02 and 133.7 vs. 121.4 mg/dL, p = 0.02, respectively). The odds of elevated non-HDL cholesterol (≥145 mg/dL) was higher in males with HTSH relative to those with normal TSH (odds ratio [OR]: 2.78; 95% CI 1.35-5.69, p = 0.005). Conclusions TSH levels were positively associated with non-HDL cholesterol in children with severe obesity. Males with mildly elevated TSH had higher total cholesterol and non-HDL cholesterol compared to males with normal TSH. Further studies are warranted to determine if levothyroxine therapy would result in improvement in total cholesterol or non-HDL cholesterol in children with severe obesity with mildly elevated TSH.


Assuntos
Biomarcadores/sangue , Hipercolesterolemia/etiologia , Hipertireoxinemia/etiologia , Lipídeos/sangue , Obesidade Mórbida/complicações , Tireotropina/sangue , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipertireoxinemia/sangue , Hipertireoxinemia/diagnóstico , Masculino , Prognóstico , Estudos Retrospectivos
12.
World J Pediatr ; 14(3): 247-253, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29721843

RESUMO

BACKGROUND: Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable causes. We searched for an association between abnormal thyroid levels after birth and INHB. METHODS: Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40-48 hours of age and measured in the National Newborn Screening Program. RESULTS: Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association with INHB: TT4 ≥ 13 µg/dL and birth at 38-38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence interval (CI) 1.23-24.4] and birth at 38-38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19-9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13-3.83) and 1-min Apgar score < 9 (P < 0.001, OR 3.8, 95% CI 1.83-7.9), but not TT4, showed such an association. CONCLUSIONS: INHB was significantly associated with birth on 38-38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.


Assuntos
Hiperbilirrubinemia Neonatal/etiologia , Hiperbilirrubinemia Neonatal/terapia , Hipertireoxinemia/complicações , Fototerapia/métodos , Análise de Variância , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hiperbilirrubinemia Neonatal/fisiopatologia , Hipertireoxinemia/diagnóstico , Recém-Nascido , Israel , Modelos Logísticos , Masculino , Análise Multivariada , Triagem Neonatal/métodos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
13.
Nutr Metab Cardiovasc Dis ; 28(2): 173-179, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29239740

RESUMO

BACKGROUND AND AIMS: A potential causal relationship between thyroid function and type 2 diabetes mellitus is currently under debate, but the current state of research is limited. Our aim was to investigate the association of thyroid hormone levels with prevalent and incident type 2 diabetes mellitus (T2DM) in two representative studies. METHODS AND RESULTS: Analyses are based on data from the Study of Health in Pomerania (SHIP), a German population based cohort with 4308 individuals at baseline and 3300 individuals at a five-year follow-up, and from INTER99, a Danish population-based randomized controlled trial with 6784 individuals at baseline and 4516 individuals at the five-year-follow-up. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) concentrations were measured in both studies, while free triiodothyronine was measured in SHIP only. T2DM was defined by self report or intake of anti-diabetic medication. Neither in SHIP nor in INTER99 we detected significant associations of serum TSH levels with prevalent or incident T2DM. Serum fT4 levels were significantly positively associated with prevalent T2DM in SHIP and INTER99. In longitudinal analyses baseline levels of fT4 were significantly positively associated with incident T2DM in SHIP (RR per pmol/L = 1.07; 95%-CI = 1.05-1.10), while this association barely missed statistical significance in INTER99 (RR per pmol/L = 1.03; 95%-CI = 0.99-1.06). In SHIP baseline fT3 levels were significantly associated with incident T2DM (RR per pmol/L = 1.21; 95%-CI = 1.16-1.27). CONCLUSION: We demonstrated positive associations of thyroid hormones with prevalent and incident type 2 diabetes mellitus suggesting that hyperthyroxinemia may contribute to the pathogenesis of this condition.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertireoxinemia/epidemiologia , Tiroxina/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos Transversais , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Alemanha/epidemiologia , Humanos , Hipertireoxinemia/sangue , Hipertireoxinemia/diagnóstico , Hipoglicemiantes/uso terapêutico , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Tireotropina/sangue , Fatores de Tempo , Tri-Iodotironina/sangue , Adulto Jovem
14.
Pediatrics ; 140(2)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28701428

RESUMO

Mercury (Hg) poisoning is considered a rare disease by the National Institutes of Health and the diagnosis can present great challenges to clinicians. Children who are exposed to Hg can present with a wide variety of symptoms, including acrodynia, tremor, excessive salivation, and psychiatric symptoms, including insomnia. However, endocrinologic manifestations from Hg exposure are less well known. This is a case report of a 12-year-old boy who presented with body rash, irritability, insomnia, and profuse sweating after returning from a summer camp. The child was initially managed in the outpatient setting, and the investigation was mainly targeted toward infectious etiology, including Rocky Mountain spotted fever and Lyme disease. He was eventually admitted to the hospital with altered mental status and was noted to have hyponatremia with serum sodium of 121 mEq/L. Thyroid studies also revealed elevated free thyroxine levels in the presence of normal triiodothyronine and thyrotropin. The patient developed hypertension and tachycardia, and was found to have elevated 24-hour vanillylmandelic acid and metanephrines. Finally, heavy metal measurements revealed a blood Hg level that was greater than the reference values of 0 to 9 ng/mL. Chelation treatment with 2,3-dimercaptopropane-1-sulfonate was subsequently initiated and over a period of 8 months his symptoms resolved and his thyroid function test returned to normal. This case highlights some of the challenges commonly encountered in identifying Hg exposure. More importantly, it illustrates that exposure to Hg should be considered in children who present with the symptoms and abnormal endocrinologic test results described in this report.


Assuntos
Hipertireoxinemia/diagnóstico , Hiponatremia/diagnóstico , Intoxicação por Mercúrio/diagnóstico , Metanefrina/sangue , Doenças Raras , Ácido Vanilmandélico/sangue , Terapia por Quelação , Criança , Diagnóstico Diferencial , Humanos , Hipertireoxinemia/etiologia , Hiponatremia/etiologia , Masculino , Intoxicação por Mercúrio/tratamento farmacológico , Admissão do Paciente , Unitiol/uso terapêutico
15.
J Endocrinol Invest ; 40(12): 1311-1319, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28585021

RESUMO

PURPOSE: Mild TSH elevations are frequently observed in obese patients, in the absence of any detectable thyroid disease. Our objective is to evaluate the relationship between the raised TSH levels and the biochemical and clinical consequences of obesity. METHODS: This is a retrospective cross-sectional study of a large population of obese children and adolescents. We evaluated 833 subjects (340 m, 493 f), aged 14.4 ± 2.5 (range 5.2-18.5) years, height SDS 0.27 ± 1.04 (-3.49-4.35), and BMI SDS 2.94 ± 0.59 (1.60-4.68). Body composition, free T4, TSH, anti-TPO antibodies, anti-TG antibodies, inflammation markers (total WBC and the subtypes, ultrasensitive C-reactive protein), and metabolic parameters [AST, ALT, γGT, ALP, glycaemia, insulin, total cholesterol (TC), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C), triglycerides (TG)] were measured, and oral disposition index (ODI) and cardiovascular risk factors (TC/HDL-C and TG/HDL-C) were calculated. After exclusion of the subjects showing anti-thyroid antibodies, the remaining 779 (325 m, 454 f) were then subdivided into two subgroups according to a TSH value below (group A) or above (group B) 4.5 mU/L. RESULTS: Clinical characteristics and hematological markers of patients with and without positive anti-thyroid antibodies were similar, with the exception of higher TSH levels in the latter group. Using analysis of covariance, the subjects of group B had significantly higher values of TC (170.3 ± 28.7 vs 163.3 ± 32.9 mg/dL; p < 0.05), systolic (125.8 ± 13.5 vs 124.5 ± 13.1 mm/Hg), and diastolic blood pressure (79.2 ± 8.0 vs 77.9 ± 8.2 mm/Hg) than subjects of group A. No difference was observed in body composition, ODI, and the cardiovascular risk factors between these two groups. CONCLUSION: TSH elevation in overweight and obese children and adolescents, being associated with a higher TC and blood pressure, might negatively influence the cardiac status. Longitudinal studies are requested, however, to confirm this hypothesis and, therefore, to conclude whether a substitutive treatment with l-thyroxine is really needed in these patients.


Assuntos
Doenças Cardiovasculares/etiologia , Hipertireoxinemia/etiologia , Doenças Metabólicas/etiologia , Obesidade/complicações , Sobrepeso/complicações , Adolescente , Doenças Cardiovasculares/patologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Hipertireoxinemia/patologia , Masculino , Doenças Metabólicas/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
16.
J Korean Med Sci ; 32(1): 124-129, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27914141

RESUMO

Subclinical hypothyroidism (SCH) is a common problem in pediatric population, and the natural history of SCH varies depending on its etiology. Whether Hashimoto's thyroiditis (HT) negatively affects the natural course of SCH was investigated in pediatric patients without concomitant diseases. Predictors for levothyroxine medication were also evaluated. Medical records of 109 children with SCH (91 girls, 5?18 years) diagnosed between 2005 and 2014 were retrospectively reviewed. Patients were classified into HT (n = 37) and isolated non-autoimmune hyperthyrotropinemia (iso-NAHT, n = 72). During median 2 years of follow-up, only 10.1% of SCH patients eventually initiated levothyroxine, and HT patients showed a higher probability of requiring levothyroxine medication than iso-NAHT patients (21.6% vs. 4.2%). Underlying HT independently predicted deterioration of thyroid function, leading to levothyroxine medication (hazard ratios [HRs], 4.6 vs. iso-NAHT, P = 0.025). High titers of anti-thyroglobulin antibodies (TGAbs) predicted later medication in the HT group (HRs, 28.2 vs. normal TGAbs, P = 0.013). Most pediatric SCH showed benign and self-remitting courses. Underlying HT significantly increases the risk for levothyroxine medication, especially with high titers of TGAbs.


Assuntos
Doença de Hashimoto/diagnóstico , Hipertireoxinemia/diagnóstico , Hipotireoidismo/diagnóstico , Adolescente , Autoanticorpos/sangue , Criança , Pré-Escolar , Feminino , Seguimentos , Bócio/etiologia , Doença de Hashimoto/complicações , Doença de Hashimoto/patologia , Humanos , Hipertireoxinemia/complicações , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Tireotropina/sangue , Tiroxina/uso terapêutico
17.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-149594

RESUMO

BACKGROUND: Owing to its large molecular size, polyethylene glycol (PEG)-precipitable thyrotropin (TSH) can accumulate in the circulation, elevating TSH levels. PEG-precipitable TSH can be used to detect macro-TSH (mTSH) in serum. Our aim was to evaluate the prevalence of mTSH in patients who had undergone thyroidectomy for thyroid cancer. METHODS: Seventy-three thyroid cancer patients and 24 control subjects on levothyroxine (LT4) TSH-suppressive or replacement therapy were evaluated. Screening for mTSH was performed by adding PEG to serum in order to precipitate γ-globulin. A percentage of PEG-precipitable TSH ≥80% was considered suggestive of mTSH. RESULTS: No correlation between free-T4 (fT4) and TSH levels was found. PEG-precipitable TSH was 39.3%±1.9% in thyroid cancer patients and 44.1%±3.9% in controls. Macro-TSH was deemed to be present in one thyroid cancer patient and in two control subjects. Only in the thyroid cancer group was PEG-precipitable TSH found to be negatively correlated with fT4 concentration. No correlation was found between PEG-precipitable TSH and other clinical conditions in any patients. CONCLUSION: The presence of mTSH seems to be a rare phenomenon in thyroid cancer. In some patients with low PEG-precipitable TSH, a reduction in LT4 dosage could be suggested. LT4 dosage adjusted to body weight is the main factor in maintaining TSH in a semi-suppressed or normal range. Evaluation of mTSH could be necessary in patients in whom a balance is required between adequate TSH suppression and the avoidance of unnecessary exogenous hyperthyroxinemia.


Assuntos
Humanos , Peso Corporal , Hipertireoxinemia , Programas de Rastreamento , Polietilenoglicóis , Polietileno , Prevalência , Valores de Referência , Glândula Tireoide , Neoplasias da Glândula Tireoide , Tireoidectomia , Tireotropina , Tiroxina
18.
Georgian Med News ; (255): 40-5, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27441534

RESUMO

Several medical - biological and social - hygienic factors have been found to account for the definite increase in the incidence of thyroid gland disorders in reproductive age and pregnant women. Aim of our study was to identify the risk factors for development of thyroid gland pathology in outpatient pregnant women. Observational study - "case - control" study has been conducted at the base of David Gagua Hospital Ltd. Main (study) group involved 292 pregnant patients with established thyroid pathology. Control group included 58 conditionally healthy pregnant participants without any demonstrated thyroid pathology. Study of risk factors was performed by initial interviewing and specialized questionnaire recording process (so-called two-stage model of interviewing). Characteristics of diet, sleep, physical activity, including harmful habits, socio-economic and hereditary factors were studied; quantitative indices of risk for each component were calculated: odds ratio (OR) and attributable risk (AR), taking into account 95% confidence interval (CI). The Pearson's criterion χ2 with respective P value and the calculator developed by International Society of Evidence-based Medicine were used to obtain the final results. Statistically significant risk factors for development of thyroid pathology were identified, which included: Thyroid gland diseases and hereditary history of diabetes mellitus; low economic income, unfavorable living conditions, unhealthy dietary habits. Despite of the difficulty of assessment of causative relationship between above mentioned components, their strong correlation should be taken into account when defining the strategy of preventive measures, moreover the most part of identified risk factors are manageable.


Assuntos
Complicações na Gravidez/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Adolescente , Adulto , Assistência Ambulatorial , Feminino , Bócio/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Hipertireoidismo/epidemiologia , Hipertireoxinemia/epidemiologia , Hipotireoidismo/epidemiologia , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/psicologia , Primeiro Trimestre da Gravidez , Fatores de Risco , Fatores Socioeconômicos , Doenças da Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/psicologia , Adulto Jovem
19.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-145137

RESUMO

Inherited thyroxine binding globulin (TBG) disorder can be identified incidentally or through neonatal screening test. TBG excess is characterized by high levels of thyroxine (T4) but normal level of free T4 (fT4), while TBG deficiency presents with low T4 levels and normal fT4 levels. A 27-day-old newborn was brought to the hospital because of hyperthyroxinemia detected by neonatal screening. His T4 level was 18.83 µg/dL (normal range, 5.9-16.0 µg/dL). His mother had no history of any thyroid disease. His fT4 and thyroid stimulating hormone (TSH) levels were 1.99 ng/dL (normal range, 0.8-2.1 ng/dL) and 4.54 mIU/L (normal range, 0.5-6.5 mIU/L), respectively. His serum total triiodothyronine (T3) level was 322.5 ng/dL (normal range, 105.0-245.0 ng/dL). His TBG level was 68.27 mg/L (normal range, 16.0-36.0 mg/L) at the age of 3 months. At 6 months and 12 months of age, his TBG levels were 48.77 mg/L (normal range, 16.0-36.0 mg/L) and 50.20 mg/L (normal range, 14.0-28.0 mg/L), respectively, which were 2 to 3 times higher than normal values. Hormonal studies showed consistently elevated T3 and T4 levels and upper normal levels of fT4 and free T3 with normal TSH levels. His growth and development were normal. TBG excess should be considered as a potential differential diagnosis for hyperthyroxinemia and especially high T3 levels with normal TSH concentration.


Assuntos
Humanos , Recém-Nascido , Diagnóstico Diferencial , Crescimento e Desenvolvimento , Hipertireoxinemia , Mães , Triagem Neonatal , Valores de Referência , Doenças da Glândula Tireoide , Tireotropina , Tiroxina , Globulina de Ligação a Tiroxina , Tri-Iodotironina
20.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-145149

RESUMO

Inherited thyroxine binding globulin (TBG) disorder can be identified incidentally or through neonatal screening test. TBG excess is characterized by high levels of thyroxine (T4) but normal level of free T4 (fT4), while TBG deficiency presents with low T4 levels and normal fT4 levels. A 27-day-old newborn was brought to the hospital because of hyperthyroxinemia detected by neonatal screening. His T4 level was 18.83 µg/dL (normal range, 5.9-16.0 µg/dL). His mother had no history of any thyroid disease. His fT4 and thyroid stimulating hormone (TSH) levels were 1.99 ng/dL (normal range, 0.8-2.1 ng/dL) and 4.54 mIU/L (normal range, 0.5-6.5 mIU/L), respectively. His serum total triiodothyronine (T3) level was 322.5 ng/dL (normal range, 105.0-245.0 ng/dL). His TBG level was 68.27 mg/L (normal range, 16.0-36.0 mg/L) at the age of 3 months. At 6 months and 12 months of age, his TBG levels were 48.77 mg/L (normal range, 16.0-36.0 mg/L) and 50.20 mg/L (normal range, 14.0-28.0 mg/L), respectively, which were 2 to 3 times higher than normal values. Hormonal studies showed consistently elevated T3 and T4 levels and upper normal levels of fT4 and free T3 with normal TSH levels. His growth and development were normal. TBG excess should be considered as a potential differential diagnosis for hyperthyroxinemia and especially high T3 levels with normal TSH concentration.


Assuntos
Humanos , Recém-Nascido , Diagnóstico Diferencial , Crescimento e Desenvolvimento , Hipertireoxinemia , Mães , Triagem Neonatal , Valores de Referência , Doenças da Glândula Tireoide , Tireotropina , Tiroxina , Globulina de Ligação a Tiroxina , Tri-Iodotironina
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