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1.
BMC Endocr Disord ; 24(1): 80, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38840128

RESUMO

PURPOSE: Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing's syndrome (CS) potentially complicates its metabolic sequelae. We investigated thyroid function in CS patients to determine this relationship. METHODS: In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS. RESULTS: Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies. CONCLUSION: Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.


Assuntos
Síndrome de Cushing , Testes de Função Tireóidea , Humanos , Síndrome de Cushing/sangue , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/complicações , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Glândula Tireoide/fisiopatologia , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/complicações , Tireotropina/sangue , Hidrocortisona/sangue , Hormônios Tireóideos/sangue , Tiroxina/sangue , Prognóstico
2.
Sci Rep ; 14(1): 13047, 2024 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844538

RESUMO

Neonicotinoids, a relatively new widely used class of insecticide is used in agriculture to control insect populations. We examined the capacity of ancestral exposure to the neonicotinoid thiacloprid (thia) to induce transgenerational effects on thyroid tissue. Pregnant outbred Swiss female mice were exposed to thia at embryonic days E6.5 to E15.5 using 0, 0.6, and 6 mg/kg/day doses. Thyroid paraffin sections were prepared for morphology analysis. We apply ELISA method to measure T4 and TSH levels, RT-qPCR for gene expression analysis, ChIP-qPCR techniques for sperm histone H3K4me3 analysis, and immunofluorescence microscopy and western blots for protein detection. We observed an alteration in the morphology of thyroids in both males and females in the F3 generation. We observed an increase in T4 hormone in F1 females and a significant T4 level decrease in F3 males. T4 changes in F1 females were associated with a TSH increase. We found that the amount of Iodothyronine Deiodinase 1 (DIO1) (an enzyme converting T4 to T3) was decreased in both F1 and F3 generations in female thyroids. GNAS protein which is important for thyroid function has increased in female thyroids. Gene expression analysis showed that the expression of genes encoding thyroid gland development, chromatin, biosynthesis and transport factors were affected in the thyroid gland in both sexes in F1 and F3. The analysis of sperm histone H3K4me3 showed that H3K4me3 occupancy at the Dio1 locus has decreased while Thyroglobulin (Tg) and Matrix Metallopeptidase 2 (Mmp2) genes have increased H3K4me3 occupancy in the sperm of F3 mice. Besides, DNA methylation analysis of our previously published datasets showed that, in the sperm of F1 and F3 thia-derived mice, several genes related to thyroid function show consistent alterations. Our data suggest that ancestral exposure to thiacloprid affects thyroid function not only in exposed but also in indirectly exposed F3 generation.


Assuntos
Neonicotinoides , Glândula Tireoide , Animais , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Feminino , Neonicotinoides/toxicidade , Camundongos , Masculino , Tiazinas/toxicidade , Gravidez , Histonas/metabolismo , Tiroxina/metabolismo , Iodeto Peroxidase/metabolismo , Iodeto Peroxidase/genética , Espermatozoides/efeitos dos fármacos , Espermatozoides/metabolismo , Inseticidas/toxicidade , Tireotropina/sangue , Tireotropina/metabolismo , Fatores Sexuais
3.
J ASEAN Fed Endocr Soc ; 39(1): 120-124, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38863905

RESUMO

Infants of mothers with Graves' disease (GD) may develop central hypothyroidism (CH) due to exposure of the foetal hypothalamic-pituitary-thyroid axis to higher-than-normal thyroid hormone concentrations, primary hypothyroidism (PH) due to transplacental passage of maternal thyroid stimulating hormone receptor antibody (TRAb), antithyroid drugs (ATD) or thyroid dysgenesis secondary to maternal uncontrolled hyperthyroidism. We describe two infants with PH and four infants with CH born to mothers with poorly controlled Graves' disease. All infants required levothyroxine and had normal developmental milestones. While national guideline consensus for high thyroid stimulating hormone (TSH) on neonatal screening is well-established, thyroid function tests (TFTs) should be serially monitored in infants with low TSH on screening, as not all mothers with Graves' disease are diagnosed antenatally.


Assuntos
Doença de Graves , Hipotireoidismo , Complicações na Gravidez , Humanos , Feminino , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Doença de Graves/complicações , Doença de Graves/imunologia , Gravidez , Recém-Nascido , Masculino , Adulto , Lactente , Tiroxina/uso terapêutico , Tiroxina/sangue , Testes de Função Tireóidea , Tireotropina/sangue
4.
J Diabetes Res ; 2024: 8462987, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38712310

RESUMO

Background and Aims: This study is aimed at investigating the potential correlation of thyroid hormone sensitivity with visceral fat area (VFA), subcutaneous fat area (SFA), and body mass index (BMI) among euthyroid type 2 diabetes mellitus (T2DM) subjects. Methods: Thyroid hormone sensitivity indices were calculated by thyroid feedback quantile-based index (TFQI), TSH index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free thyroxine (fT4)/free triiodothyronine (fT3) ratio. These indices were then categorized into quartiles for analysis. The outcomes were the change rates in VFA, SFA, and BMI among the participants. Result: The present study included 921 patients, with a median follow-up of 2.2 years. In multivariate linear regression, when compared to the first quartile, SFA demonstrated a notable decline in the fourth quartile of TFQI, TSHI, and TT4RI (ß coefficient = -5.78, -7.83, and - 6.84 cm2 per year), while it significantly increased in the fourth quartile of fT4/fT3 ratio (ß coefficient = 6.13 cm2 per year). Similarly, in the fourth quartile of TFQI, TSHI, and TT4RI, VFA decreased significantly, evidenced by ß coefficients of -5.14, -4.80, and -4.08 cm2 per year. Yet, among the quartiles of the fT4/fT3 ratio, no discernible trend in VFA was observed. There was no significant association between indices of thyroid hormone sensitivity and change in BMI. Conclusion: Impaired central sensitivity to thyroid hormones was significantly associated with the reduction of VFA and SFA, while impaired peripheral sensitivity was associated with an increase of SFA in euthyroid individuals with T2DM.


Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2 , Hormônios Tireóideos , Humanos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Pessoa de Meia-Idade , Masculino , Feminino , Estudos Retrospectivos , Hormônios Tireóideos/sangue , Idoso , Tiroxina/sangue , Gordura Intra-Abdominal/metabolismo , Tireotropina/sangue , Gordura Abdominal/metabolismo , Adulto , Tri-Iodotironina/sangue , Testes de Função Tireóidea
5.
Syst Rev ; 13(1): 123, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720372

RESUMO

BACKGROUND: Thyroid dysfunction is common in older people, with females at higher risk. Evidence suggests that thyroid-stimulating hormone (TSH) levels naturally increase with age. However, as uniform serum TSH reference ranges are applied across the adult lifespan, subclinical hypothyroidism (SCH) diagnosis is more likely in older people, with some individuals also being commenced treatment with levothyroxine (LT4). It is unclear whether LT4 treatment in older people with SCH is associated with adverse cardiovascular or bone health outcomes. METHODS: A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected. RESULTS: Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible. CONCLUSIONS: This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022308006.


Assuntos
Doenças Cardiovasculares , Hipotireoidismo , Tiroxina , Humanos , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Idoso , Feminino , Densidade Óssea/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade
6.
Lakartidningen ; 1212024 May 21.
Artigo em Sueco | MEDLINE | ID: mdl-38773921

RESUMO

This is the first national guideline in hyperthyroidism to harmonise and update clinical practice according to what is evidence based and direct care from patients' needs. We present 4 articles in Läkartidningen of different views of the guideline, including family care perspectives, patient care perspectives and perspectives on ophthalmology. This article concerns treatment of Graves' disease and includes endocrinological, surgical and oncological perspectives on what is established practice, but also news in the national guideline that remain to be fully implemented in Sweden in the years to come. News are precision medicine using the GREAT score, preoperative calcium/D vitamin treatment, individualized levothyroxine treatment after thyroid surgery, uniformed levothyroxine replacement strategy, access to national patient information and national guidelines on radiation protection and treatment schemes for radioactive iodine. A national guideline is the creation of many persons' views, including patient representatives, and the recommendations have undergone a thorough national review process from stakeholders. It is a guideline with future perspectives for an improved care.


Assuntos
Doença de Graves , Guias de Prática Clínica como Assunto , Medicina de Precisão , Humanos , Doença de Graves/terapia , Suécia , Tiroxina/uso terapêutico , Tiroxina/administração & dosagem , Vitamina D/uso terapêutico , Vitamina D/administração & dosagem , Radioisótopos do Iodo/uso terapêutico , Tireoidectomia
7.
Front Endocrinol (Lausanne) ; 15: 1381180, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38752179

RESUMO

Background: The prevalence of autism spectrum disorder (ASD) has significantly risen in the past three decades, prompting researchers to explore the potential contributions of environmental factors during pregnancy to ASD development. One such factor of interest is gestational hypothyroxinemia (HTX), a frequent condition in pregnancy associated with cognitive impairments in the offspring. While retrospective human studies have linked gestational HTX to autistic traits, the cellular and molecular mechanisms underlying the development of ASD-like phenotypes remain poorly understood. This study used a mouse model of gestational HTX to evaluate ASD-like phenotypes in the offspring. Methods: To induce gestational HTX, pregnant mice were treated with 2-mercapto-1-methylimidazole (MMI), a thyroid hormones synthesis inhibitor, in the tap-drinking water from embryonic days (E) 10 to E14. A separate group received MMI along with a daily subcutaneous injection of T4, while the control group received regular tap water during the entire pregnancy. Female and male offspring underwent assessments for repetitive, anxious, and social behaviors from postnatal day (P) 55 to P64. On P65, mice were euthanized for the evaluation of ASD-related inflammatory markers in blood, spleen, and specific brain regions. Additionally, the expression of glutamatergic proteins (NLGN3 and HOMER1) was analyzed in the prefrontal cortex and hippocampus. Results: The HTX-offspring exhibited anxious-like behavior, a subordinate state, and impaired social interactions. Subsequently, both female and male HTX-offspring displayed elevated proinflammatory cytokines in blood, including IL-1ß, IL-6, IL-17A, and TNF-α, while only males showed reduced levels of IL-10. The spleen of HTX-offspring of both sexes showed increased Th17/Treg ratio and M1-like macrophages. In the prefrontal cortex and hippocampus of male HTX-offspring, elevated levels of IL-17A and reduced IL-10 were observed, accompanied by increased expression of hippocampal NLGN3 and HOMER1. All these observations were compared to those observed in the Control-offspring. Notably, the supplementation with T4 during the MMI treatment prevents the development of the observed phenotypes. Correlation analysis revealed an association between maternal T4 levels and specific ASD-like outcomes. Discussion: This study validates human observations, demonstrating for the first time that gestational HTX induces ASD-like phenotypes in the offspring, highlighting the need of monitoring thyroid function during pregnancy.


Assuntos
Transtorno do Espectro Autista , Efeitos Tardios da Exposição Pré-Natal , Animais , Feminino , Gravidez , Transtorno do Espectro Autista/etiologia , Transtorno do Espectro Autista/metabolismo , Camundongos , Masculino , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Fenótipo , Comportamento Animal , Hipotireoidismo/metabolismo , Tiroxina/sangue , Biomarcadores/metabolismo , Camundongos Endogâmicos C57BL , Complicações na Gravidez/metabolismo , Modelos Animais de Doenças , Inflamação/metabolismo , Comportamento Social
9.
Medicina (Kaunas) ; 60(5)2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38792984

RESUMO

Background and Objectives: Pregnancy introduces various interfering factors that, alongside individual variations, impact the assessment of thyroid function tests. This underscores the necessity of defining trimester-specific reference intervals for thyroid-stimulating hormone (TSH) levels. Differences in population characteristics, including ethnicity, socio-economic factors, iodine prophylaxis, and obesity, emphasize the need to establish trimester-specific TSH ranges for women of reproductive age in the respective region or center. The aim of the present study was to establish first- and second-trimester-specific reference intervals for TSH and free thyroxine (FT4) in a relevant pregnant population. Materials and Methods: A retrospective monocenter analysis utilized the electronic database of Ob/Gyn Hospital "Dr. Shterev", Sofia, Bulgaria. The analysis involved data from 497 pregnant and 250 non-pregnant women, all without evidence of thyroid dysfunction or a family history thereof, no indication of taking medication interfering with thyroid function, no evidence of levothyroxine treatment, and no history of sterility treatment. To establish the limits of the TSH reference range, the percentile method was applied using a bootstrapping procedure following the recommendations of the International Federation of Clinical Chemistry (IFCC). Results: Trimester-specific reference intervals for TSH and FT4 in our center were established as follows: first trimester-0.38-2.91 mU/L, FT4-12.18-19.48 pmol/L; second trimester-0.72-4.22 mIU/L and 9.64-17.39 pmol/L, respectively. We also established the normal reference range for the non-pregnant control group, which is similar to that applicable in our laboratory. Conclusions: Our results differ from the fixed limits recommended by the American Thyroid Association, European Thyroid Association, and Endocrine Society Guidelines. Following the relevant established intervals would significantly impact timely diagnosis and therapy requirements for a substantial proportion of pregnant women.


Assuntos
Hormônios Tireóideos , Tireotropina , Tiroxina , Humanos , Feminino , Gravidez , Bulgária , Valores de Referência , Adulto , Estudos Retrospectivos , Tireotropina/sangue , Tiroxina/sangue , Hormônios Tireóideos/sangue , Testes de Função Tireóidea/normas , Testes de Função Tireóidea/métodos , Trimestres da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue
10.
Medicine (Baltimore) ; 103(21): e38290, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38788029

RESUMO

The management of low-risk differentiated thyroid cancer (DTC) has evolved over time toward treatment de-escalation. However, overtreatment with supraphysiological dose of levothyroxine (LT4) continues to be observed despite current clinical guideline. This study aimed to assess the actual thyrotropin suppressive therapy for low-risk DTC patients at an endocrine center in Bangkok. This retrospective study included patients with low-risk DTC who were regularly follow-up for at least 18 months at Theptarin Hospital between 2016 and 2022. The serum thyroid stimulating hormone (TSH) levels were stratified as TSH < 0.1 mIU/L; TSH 0.1 to 0.5 mIU/L; TSH 0.5 to 2.0 mIU/L; and TSH > 2.0 mIU/L. The initial risk stratification (IRS) and dynamic risk stratification were determined at 12 months of follow-up after completing the initial treatment and at the last visit. The clinical factors associated with overtreatment with LT4 were analyzed. A total of 102 patients (83.3% female, age at diagnosis 41.8 ±â€…13.6 years, mean tumor size 1.6 ±â€…1.0 cm) were evaluated with a mean follow-up of 5.9 years. The IRS classified 92.2% of patients after the initial treatment and 93.1% of patients at the last follow-up visit into the excellent response category. The mean LT4 daily dosage at the last follow-up was 121.3 ±â€…44.8 µg/day. Serum TSH levels were in an appropriate target range according to IRS in only 8.8% (9/102) of the patients and then improved to 19.6% (20/102) at the last follow-up visit. Further analysis showed that treating physicians with ≥10 years of practice was associated with severe TSH suppression therapy (TSH < 0.1 mIU/L). Despite the current clinical guideline recommendations and scientific evidences, less than one-fifth of low-risk DTC patients achieved the appropriate serum TSH target. While the proportion of an optimum LT4 suppressive had improved during the study period, further efforts are needed to overcome this clinical inertia.


Assuntos
Neoplasias da Glândula Tireoide , Tireotropina , Tiroxina , Humanos , Feminino , Masculino , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia , Estudos Retrospectivos , Adulto , Tireotropina/sangue , Pessoa de Meia-Idade , Tiroxina/uso terapêutico , Tiroxina/administração & dosagem , Tailândia , Medição de Risco , Sobretratamento
11.
Front Endocrinol (Lausanne) ; 15: 1301213, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38742199

RESUMO

Purpose: To investigate the relationship between bone turnover markers (BTMs) and thyroid indicators in Graves' disease (GD) and to further assess predictive value of changes in early stage retrospectively. Methods: We studied 435 patients with GD and 113 healthy physical examiners retrospectively and followed up these two groups of patients after 6 months. We investigated the correlations between BTMs and other 15 observed factors, and analyzed the predictive value of FT3 and FT4 before and after treatment (FT3-P/FT3-A, FT4-P/FT4-A) on whether BTMs recovered. Results: The levels of thyroid hormones and BTMs in GD group were significantly higher than those in control group (P < 0.05) and decreased after 6 months of treatment. FT3, W, Ca and ALP were independent factors in predicting the elevation of OST. Duration of disease, FT3, TSH and ALP were independent factors in predicting the elevation of P1NP. Age, duration of disease, TRAb and ALP were independent factors in predicting the elevation of CTX-1. The AUC of FT3-P/FT3-A and FT4-P/FT4-A for predicting OST recovery were 0.748 and 0.705 (P < 0.05), respectively, and the cut-off values were 0.51 and 0.595. There was no predictive value for P1NP and CTX-1 recovery (P > 0.05). Conclusion: BTMs were abnormally elevated in GD and were significantly correlated with serum levels of FT3, FT4, TRAb, Ca, and ALP. FT3 decreased more than 51% and FT4 dropped more than 59.5% after 6 months of treatment were independent predictors for the recovery of BTMs in GD.


Assuntos
Biomarcadores , Remodelação Óssea , Doença de Graves , Valor Preditivo dos Testes , Humanos , Masculino , Feminino , Doença de Graves/sangue , Doença de Graves/tratamento farmacológico , Doença de Graves/metabolismo , Adulto , Biomarcadores/sangue , Estudos Retrospectivos , Pessoa de Meia-Idade , Glândula Tireoide/metabolismo , Osso e Ossos/metabolismo , Hormônios Tireóideos/sangue , Estudos de Casos e Controles , Prognóstico , Antitireóideos/uso terapêutico , Tiroxina/sangue , Tri-Iodotironina/sangue , Seguimentos
12.
Arq Bras Cardiol ; 121(4): e20230544, 2024.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38695471

RESUMO

BACKGROUND: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. OBJECTIVES: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. METHODS: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. RESULTS: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 µUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). CONCLUSIONS: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.


FUNDAMENTO: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. OBJETIVOS: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. MÉTODOS: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. RESULTADOS: Um total de 593 pacientes foram incluídos ­ 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 µUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). CONCLUSÕES: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.


Assuntos
Fibrilação Atrial , Biomarcadores , Ablação por Cateter , Recidiva , Tireotropina , Humanos , Fibrilação Atrial/cirurgia , Fibrilação Atrial/sangue , Biomarcadores/sangue , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Ablação por Cateter/métodos , Idoso , Tireotropina/sangue , Peptídeo Natriurético Encefálico/sangue , Valor Preditivo dos Testes , Proteína C-Reativa/análise , Resultado do Tratamento , Tiroxina/sangue , Fatores de Risco , Troponina I/sangue
13.
PLoS One ; 19(5): e0303169, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38771770

RESUMO

BACKGROUND: Although small studies have shown that flavonoids can affect thyroid disease, few epidemiological studies have explored the relationship between dietary total flavonoids (TFs) intake and serum thyroid function. The aim of this research was to evaluate the relationship between TFs and serum thyroid function. METHODS: Our study included 4,949 adults from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. Multivariable linear regression, subgroup analyses, and interaction terms were used to explore the relationships between TFs and thyroid function. And we also used restricted cubic splines (RCS) to investigate possible nonlinear relationships. RESULTS: After adjusting for covariates, we found that log10-transformated dietary total flavonoids intake (LgTFs) was negatively associated with total thyroxine (TT4) (ß = -0.153, 95% CI = -0.222 to -0.084, P<0.001). Subgroup analyses revealed a stronger and statistically supported association in subjects with high annual family income (ß = -0.367, P<0.001, P for interaction = 0.026) and subjects with high poverty to income ratio (PIR) (ß = -0.622, P<0.001, P for interaction = 0.042). And we found a U-shaped curve association between LgTFs and free triiodothyronine (FT3) (inflection point for LgTFs: 2.063). CONCLUSION: The results of our study demonstrated that a higher intake of total flavonoids in the diet was negatively associated with a lower TT4. Furthermore, the associations were more pronounced in high annual family income and high PIR adults. And we found a U-shaped relationship between LgTFs and FT3. These findings provided guidance for future thyroid dysfunction diet guidelines.


Assuntos
Dieta , Flavonoides , Inquéritos Nutricionais , Glândula Tireoide , Humanos , Flavonoides/administração & dosagem , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Glândula Tireoide/metabolismo , Glândula Tireoide/fisiologia , Estados Unidos , Tiroxina/sangue , Testes de Função Tireóidea
14.
PLoS One ; 19(5): e0298871, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38771782

RESUMO

BACKGROUND: Subclinical hypothyroidism (SCH) is a biochemical thyroid disorder characterised by elevated levels of Thyroid Stimulating Hormone (TSH) together with normal levels of thyroid hormones. Evidence on the benefits of treatment is limited, resulting in persistent controversies relating to its clinical management. AIM: This study describes the demographic and clinical characteristics of patients identified as having subclinical hypothyroidism in Wales between 2000 and 2021, the annual cumulative incidence during this period and the testing and treatment patterns associated with this disorder. METHODS: We used linked electronic health records from SAIL Databank. Eligible patients were identified using a combination of diagnostic codes and Thyroid Function Test results. Descriptive analyses were then performed. RESULTS: 199,520 individuals (63.8% female) were identified as having SCH, 23.6% (n = 47,104) of whom received levothyroxine for treatment over the study period. The median study follow-up time was 5.75 person-years (IQR 2.65-9.65). Annual cumulative incidence was highest in 2012 at 502 cases per 100,000 people. 92.5% (n = 184,484) of the study population had TSH levels between the upper limit of normal and 10mIU/L on their first test. 61.9% (n = 5,071) of patients identified using Read v2 codes were in the treated group. 41.9% (n = 19,716) of treated patients had a history of a single abnormal test result before their first prescription. CONCLUSION: In Wales, the number of incident cases of SCH has risen unevenly between 2000 and 2021. Most of the study population had mild SCH on their index test, but more than a third of the identified patients received levothyroxine after a single abnormal test result. Patients with clinically recorded diagnoses were more likely to be treated. Given the expectation of steadily increasing patient numbers, more evidence is required to support the clinical management of subclinical hypothyroidism.


Assuntos
Registros Eletrônicos de Saúde , Hipotireoidismo , Tiroxina , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/tratamento farmacológico , Feminino , Masculino , País de Gales/epidemiologia , Pessoa de Meia-Idade , Adulto , Idoso , Tiroxina/uso terapêutico , Tiroxina/sangue , Tireotropina/sangue , Incidência , Estudos de Coortes , Adolescente , Adulto Jovem , Testes de Função Tireóidea
15.
Clin Nutr ESPEN ; 61: 71-78, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38777475

RESUMO

BACKGROUND: It is unclear whether variation in thyroid stimulating hormone (TSH) levels within the reference range affect energy expenditure and clinical symptoms and even within the normal range of TSH levels, resting energy expenditure may alter. The aim of the present study was to determine whether treated hypothyroid subjects and healthy subjects with a low-normal TSH range (0.3-2.3 mIU/L) have better clinical outcomes and increased energy expenditure than those with a high-normal TSH range (2.3-4.3 mIU/L). METHODS: This was a case-control study of 160 overweight/obese women with TSH levels across the reference range of 0.3-4.3 mU/l. Subjects were paired in four groups: healthy subjects with low-normal target TSH (n = 40), healthy subjects with high-normal target TSH (n = 40), subjects with treated hypothyroidism with low-normal target TSH (n = 40), and subjects with treated hypothyroidism with high-normal target TSH (n = 40). Resting energy expenditure (RMR), dietary intake, body composition, physical activity, and biochemical markers were assessed. RESULTS: Subjects with low-normal (≤2.3 mU/L) and high-normal (>2.3 mU/L) TSH levels did not differ in terms of RMR, serum T3 levels, and clinical symptoms except fatigue (P = 0.013). However, serum fT4 levels were found to be significantly different between the study groups (P = 0.002). Serum fT4 concentration was the highest in subjects with treated hypothyroidism with low-normal target TSH. CONCLUSION: Variation in serum TSH levels within the reference range did not significantly affect REE and clinical symptoms except fatigue in healthy and women with hypothyroidism.


Assuntos
Metabolismo Basal , Hipotireoidismo , Tireotropina , Humanos , Feminino , Hipotireoidismo/sangue , Estudos de Casos e Controles , Tireotropina/sangue , Adulto , Pessoa de Meia-Idade , Metabolismo Energético , Composição Corporal , Tiroxina/sangue , Obesidade/sangue , Valores de Referência , Biomarcadores/sangue , Exercício Físico/fisiologia
16.
BMC Endocr Disord ; 24(1): 76, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38816692

RESUMO

OBJECTIVE: There has been some confusion in earlier research on the connection between thyroid function and polycystic ovary syndrome (PCOS). This research is aimed to probe into the correlation between thyroid condition and the risk of PCOS from a new standpoint of thyroid hormone sensitivity. METHODS: This research comprised 415 females with PCOS from Drum Tower Hospital Affiliated with the Medical School of Nanjing University, and 137 non-PCOS individuals were selected as the normal control. Based on free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH), we calculated the thyroid hormone sensitivity indices, which consist of Thyroid Feedback Quantile-based Index (TFQI), Thyroid-stimulating Hormone Index (TSHI), Thyrotroph Thyroxine Resistance Index (TT4RI) and Free Triiodothyronine /Free thyroxine (FT3/FT4). The binary logistic regression model was adopted to investigate the correlation between thyroid hormone sensitivity indices with the risk of PCOS. Pearson or Spearman correlation analysis was employed to explore the association among thyroid-related measures with metabolic parameters in PCOS. RESULTS: Results of this research showed that females with PCOS had rising TFQI, TSHI, TT4RI, and FT3/FT4 levels compared with the control group. After adjustment for the impact of various covariates, there was no significant correlation between FT3/FT4 and the risk of PCOS; However, the odds ratio of the third and fourth vs. the first quartile of TFQI were 3.57(95% confidence interval [CI]:1.08,11.87) and 4.90(95% CI:1.38,17.38) respectively; The odds ratio of the fourth vs. the first quartile of TSHI was 5.35(95% CI:1.48,19.37); The odds ratio of the second vs. the first quartile of TT4RI was 0.27(95%CI 0.09,0.82). In addition, no significant correlation was observed between thyroid-related measures and metabolic measures in females with PCOS. CONCLUSIONS: A reduction in the sensitivity of central thyroid hormone is closely correlated with a higher risk of PCOS. Further research is necessary to corroborate our findings and the supporting mechanisms.


Assuntos
Síndrome do Ovário Policístico , Hormônios Tireóideos , Humanos , Síndrome do Ovário Policístico/sangue , Feminino , Adulto , Hormônios Tireóideos/sangue , Estudos de Casos e Controles , Testes de Função Tireóidea , Fatores de Risco , Adulto Jovem , Tireotropina/sangue , Tri-Iodotironina/sangue , Tiroxina/sangue , Biomarcadores/sangue , Prognóstico
17.
BMJ Case Rep ; 17(5)2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38806398

RESUMO

Hashimoto encephalopathy presents with a myriad of neuropsychiatric features in the background of elevated antithyroid antibodies and it may or may not be associated with Hashimoto thyroiditis. It is a diagnosis of exclusion. Here, we present the case of a hypothyroid woman in her 30s, with a 5-year history of chronic progressive gait ataxia along with hand and head tremor, inattention and electroencephalogram (EEG) suggestive of interictal epileptiform discharges without any clinical seizures. The patient had very high titres of anti-thyroid peroxidase antibodies >2000 IU/mL and was on very high-dose levothyroxine replacement therapy. She responded to intravenous pulse corticosteroids. Improvement was noted both clinically and on subsequent EEGs. Pure cerebellar syndrome without frank encephalopathy can also be a rare presentation of Hashimoto encephalopathy. This highlights the importance of antithyroid antibodies testing even in cases of pure cerebellar syndrome to rule out Hashimoto encephalopathy associated ataxia.


Assuntos
Doenças Cerebelares , Encefalite , Doença de Hashimoto , Humanos , Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/tratamento farmacológico , Feminino , Encefalite/diagnóstico , Encefalite/complicações , Adulto , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/tratamento farmacológico , Doenças Cerebelares/etiologia , Eletroencefalografia , Tiroxina/uso terapêutico , Tiroxina/administração & dosagem , Diagnóstico Diferencial
18.
Front Endocrinol (Lausanne) ; 15: 1372824, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38808109

RESUMO

Background: IgA nephropathy (IgAN), the most common type of glomerulonephritis, has great individual differences in prognosis. Many studies showed the relationship between thyroid hormones and chronic kidney disease. However, the relationship between free thyroxine (FT4), as a thyroid hormone, and IgAN is still unclear. This study aimed to evaluate the impact of FT4 on IgAN prognosis. Methods: This retrospective study involved 223 patients with biopsy-proven IgAN. The renal composite outcomes were defined as: (1) ESRD, defined as eGFR < 15 ml/(min·1.73 m2) or initiation of renal replacement therapy (hemodialysis, peritoneal dialysis, renal transplantation); (2) serum creatinine doubled from baseline; (3) eGFR decreased by more than 50% from baseline. The predictive value was determined by the area under the curve (AUC). Kaplan-Meier and Cox proportional hazards analyses assessed renal progression and prognosis. Results: After 38 (26-54) months of follow-up, 23 patients (10.3%) experienced renal composite outcomes. Kaplan-Meier survival curve analysis showed that the renal survival rate of the IgAN patients with FT4<15.18pmol/L was lower than that with FT4≥15.18pmol/L (P < 0. 001). Multivariate Cox regression model analysis showed that FT4 was a protective factor for poor prognosis of IgAN patients, whether as a continuous variable or a categorical variable (HR 0.68, 95%CI 0.51-0.90, P =0.007; HR 0.04, 95%CI 0.01-0.20, P <0.001). ROC curve analysis showed that FT4 combined with t score had a high predictive value for poor prognosis of IgAN patients (AUC=0.881, P<0.001). Conclusion: FT4 was a protective factor for IgAN. In addition, FT4 combined with tubular atrophy/interstitial fibrosis had a high predictive value for poor prognosis of IgAN.


Assuntos
Atrofia , Fibrose , Glomerulonefrite por IGA , Tiroxina , Humanos , Glomerulonefrite por IGA/sangue , Glomerulonefrite por IGA/patologia , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/mortalidade , Masculino , Feminino , Tiroxina/sangue , Prognóstico , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Fibrose/sangue , Atrofia/sangue , Valor Preditivo dos Testes , Túbulos Renais/patologia , Taxa de Filtração Glomerular , Seguimentos
19.
BMJ Case Rep ; 17(5)2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38772867

RESUMO

A woman in her 70s with metastatic melanoma presenting with refractory hypokalaemia on combined immune checkpoint inhibitors, nivolumab-ipilimumab, was diagnosed with adrenocorticotropic hormone (ACTH)-dependent hypercortisolism 11 weeks following the initiation of her immunotherapy. Investigations also demonstrated central hypothyroidism and hypogonadotropic hypogonadism. She underwent imaging studies of her abdomen and brain which revealed normal adrenal glands and pituitary, respectively. She was started on levothyroxine replacement and had close pituitary function monitoring. Two weeks later, her cortisol and ACTH levels started to trend down. She finally developed secondary adrenal insufficiency and was started on hydrocortisone replacement 4 weeks thereafter.This report highlights a case of immunotherapy-related hypophysitis with well-documented transient central hypercortisolism followed, within weeks, by profound secondary adrenal insufficiency. Healthcare professionals should remain vigilant in monitoring laboratory progression in these patients. Early recognition of the phase of hypercortisolism and its likely rapid transformation into secondary adrenal insufficiency can facilitate timely hormonal replacement and prevent complications.


Assuntos
Síndrome de Cushing , Hipofisite , Inibidores de Checkpoint Imunológico , Melanoma , Humanos , Feminino , Hipofisite/induzido quimicamente , Inibidores de Checkpoint Imunológico/efeitos adversos , Síndrome de Cushing/induzido quimicamente , Melanoma/tratamento farmacológico , Idoso , Nivolumabe/efeitos adversos , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/tratamento farmacológico , Hormônio Adrenocorticotrópico/sangue , Ipilimumab/efeitos adversos , Hidrocortisona/uso terapêutico , Tiroxina/uso terapêutico
20.
BMC Cancer ; 24(1): 629, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783224

RESUMO

PURPOSE: Observational studies and clinical validation have suggested a link between thyroid dysfunction and an elevated ovarian cancer (OC) risk. However, whether this association indicates a cause-and-effect relationship remains uncertain. We aimed to investigate the plausible causal impact of thyroid dysfunction on OC through a Mendelian randomization (MR) study. METHODS: Genome-wide association study (GWAS) data for thyrotropin (TSH), free thyroxine (FT4), hypothyroidism, and hyperthyroidism were obtained as exposures and those for OC (N = 199,741) were selected as outcomes. Inverse variance-weighted method was used as the main estimation method. A series of sensitivity analyses, including Cochran's Q test, MR-Egger intercept analysis, forest plot scatter plot, and leave-one-out test, was conducted to assess the robustness of the estimates. RESULTS: Genetic prediction of hyperthyroidism was associated with a potential increase in OC risk (odds ratio = 1.094, 95% confidence interval: 1.029-1.164, p = 0.004). However, no evidence of causal effects of hypothyroidism, TSH, and FT4 on OC or reverse causality was detected. Sensitivity analyses demonstrated consistent and reliable results, with no significant estimates of heterogeneity or pleiotropy. CONCLUSIONS: This study employed MR to establish a correlation between hyperthyroidism and OC risk. By genetically predicting OC risk in patients with hyperthyroidism, our research suggests new insights for early prevention and intervention of OC.


Assuntos
Estudo de Associação Genômica Ampla , Hipertireoidismo , Análise da Randomização Mendeliana , Neoplasias Ovarianas , Humanos , Feminino , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/sangue , Hipertireoidismo/genética , Hipertireoidismo/complicações , Tireotropina/sangue , Hipotireoidismo/genética , Polimorfismo de Nucleotídeo Único , Tiroxina/sangue , Fatores de Risco , Predisposição Genética para Doença
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