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Sample records for subclinical hypothyroidism defined

  1. Subclinical Hypothyroid

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Kalantar Hormozi

    2011-04-01

    Full Text Available Background: subclnical hypothyroid (SCH, defined by a normal total or free T4 level and a midly Elevated TSH, is common in adults. Subclinical hypothyroid is a risk factor for developing hypothyroidism complication . the goal of screening is to identify and treatment patients with sublinical hypothyroid before they develop these complication. Methods: The sample size of this study was the articles indexed in pubmed,ovid, tripdatabase, new spring link black coehrane, Elsevirer, Embase and contained the terms subclinical hypothyroid, Anti-tpo, Thyrotropin, levothyroxine trapy. Results: 831 articles were found that 75 articles were investigated for this issue. The results are discussed under. The subtile such as subclinical hypothyroid, screening for subclinical hypothyroid, Indication of treatment of Subclinical hypothyroid. Conclusion: In this summary, we tried to review the current literature about definition, Indection of screening and treatment of subclinical hypothyroid and reach a comprehensive guidline for practical significance of this subject in routines practice.

  2. Subclinical hypothyroidism

    DEFF Research Database (Denmark)

    Bak, Peter; Hjortshøj, Cristel S; Gaede, Peter

    2018-01-01

    OBJECTIVE: Cyanotic congenital heart disease is a systemic disease, with effects on multiple organ systems. A high prevalence of subclinical hypothyroidism (SCH) has been reported in a small cohort of cyanotic congenital heart disease patients. Subclinical hypothyroidism has been associated...... with various adverse cardiovascular effects, as well as an increased risk of progression to overt hypothyroidism. The aim of this study was to examine the prevalence of SCH in cyanotic congenital heart disease patients, consider possible etiologies, and evaluate thyroid function over time. METHODS: First, 90...... follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03...

  3. Dyslipidemia in subclinical hypothyroidism

    OpenAIRE

    Čaparević Zorica; Bojković Gradimir; Stojanović Dragoš Lj.; Ilić Vesna

    2003-01-01

    Introduction Subclinical hypothyroidism is defined as an increased serum TSH and normal serum FT4 concentration. In subclinical hypothyroidism, thyroid peroxidase and thyroglobulin antibodies are frequently present. Subclinical hypothyroidism may have endogenous or exogenous causes. The prevalence of subclinical hypothyroidism is rather high. The number of patients progressing to overt hypothyroidism may be higher. These patients may be asymptomatic, or have only mild symptoms or a single sym...

  4. Subclinical hypothyroidism

    DEFF Research Database (Denmark)

    Bak, Peter; Hjortshøj, Cristel S; Gaede, Peter

    2018-01-01

    follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03...... clinically stable cyanotic congenital heart disease patients were examined with blood samples (thyroid-stimulating hormone, C-reactive protein, hemoglobin, hematocrit, and N-terminal pro-brain-natriuretic peptide) in a cross-sectional descriptive study. Second, a longitudinal follow-up study of 43 patients...... originating from the first study part, was carried out. These patients had thyroid function parameters (thyroid-stimulating hormone, thyroid hormones, and thyroid peroxidase antibodies) evaluated biannually. RESULTS: Elevated thyroid-stimulating hormone was present in 24% of the 90 screened patients. During...

  5. Subclinical hypothyroidism in childhood.

    LENUS (Irish Health Repository)

    O'Grady, M J

    2012-02-01

    Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) in association with a normal total or free thyroxine (T4) or triiodothyronine (T3). It is frequently encountered in both neonatology and general paediatric practice; however, its clinical significance is widely debated. Currently there is no broad consensus on the investigation and treatment of these patients; specifically who to treat and what cut-off level of TSH should be used. This paper reviews the available evidence regarding investigation, treatments and outcomes reported for childhood SH.

  6. Subclinical hypothyroidism: Should we treat?

    Science.gov (United States)

    Redford, Christopher; Vaidya, Bijay

    2017-06-01

    Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.

  7. Subclinical hypothyroidism in obese children

    Directory of Open Access Journals (Sweden)

    Aleksandra Januszek-Trzciąkowska

    2013-08-01

    Full Text Available Subclinical hypothyroidism (SH is defined as an elevated thyroid stimulating hormone (TSH associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.

  8. [Subclinical hypothyroidism in obese children].

    Science.gov (United States)

    Januszek-Trzciąkowska, Aleksandra; Małecka-Tendera, Ewa

    2013-08-05

    Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.

  9. Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism

    DEFF Research Database (Denmark)

    Faber, J; Petersen, L; Wiinberg, N

    2002-01-01

    by LT(4) (p treatment in SH results in changes in hemodynamic parameters of potentially beneficial character. SH and overt hypothyroidism should......In hypothyroidism, lack of thyroid hormones results in reduced cardiac function (cardiac output [CO]), and an increase of systemic vascular resistance (SVR). We speculated whether hemodynamic regulation in subjects with subclinical hypothyroidism (SH) (defined as mildly elevated thyrotropin [TSH......) and T(3) estimates) LT(4) treatment resulted in 6% reduction in supine MAP (p treatment (p

  10. Subclinical hypothyroidism after vascular complicated pregnancy

    NARCIS (Netherlands)

    Zanden, M. van der; Hop-de Groot, R.J.; Sweep, F.C.; Ross, H.A.; Heijer, M. den; Spaanderman, M.E.A.

    2013-01-01

    OBJECTIVE: Women with a history of vascular complicated pregnancy are at risk for developing remote cardiovascular disease. It is associated with underlying cardiovascular risk factors both jeopardizing trophoblast and vascular function. Subclinical hypothyroidism may relate to both conditions.

  11. SUBCLINICAL HYPOTHYROIDISM CURRENT CONCEPTS & M ANAGEMENT STRATEGEIES

    OpenAIRE

    Radha Krishnan; Soumini; Adithya

    2015-01-01

    Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone ( TSH ) and normal free T3 & T4 , without clinical features of hypothyroidism . Clinical significance of SCH remains uncertain and controversial . Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms . There are still controversies surrounding SCH and associated risk of ...

  12. Subclinical hypothyroidism in childhood - current knowledge and open issues.

    Science.gov (United States)

    Salerno, Mariacarolina; Capalbo, Donatella; Cerbone, Manuela; De Luca, Filippo

    2016-12-01

    Subclinical hypothyroidism is defined as serum levels of TSH above the upper limit of the reference range, in the presence of normal concentrations of total T 4 or free T 4 . This biochemical profile might be an indication of mild hypothyroidism, with a potential increased risk of metabolic abnormalities and cardiovascular disease recorded among adults. Whether subclinical hypothyroidism results in adverse health outcomes among children is a matter of debate and so management of this condition remains challenging. Mild forms of untreated subclinical hypothyroidism do not seem to be associated with impairments in growth, bone health or neurocognitive outcome. However, ongoing scientific investigations have highlighted the presence of subtle proatherogenic abnormalities among children with modest elevations in their TSH levels. Although current findings are insufficient to recommend levothyroxine treatment for all children with mild asymptomatic forms of subclinical hypothyroidism, they highlight the potential need for assessment of cardiovascular risk among children with this condition. Increased understanding of the early metabolic risk factors associated with subclinical hypothyroidism in childhood will help to improve the management of affected individuals.

  13. Spontaneous Bacterial Peritonitis in Subclinical Hypothyroidism

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    Dalip Gupta

    2013-11-01

    Full Text Available Hypothyroidism is an uncommon cause of ascites. Here we describe a case of a 75 year-old female patient with spontaneous bacterial peritonitis and subclinical hypothyroidism that resolved with thyroid replacement and antibiotic therapy respectively. Ascitic fluid analysis revealed a gram-positive bacterium on gram staining. A review of the literature revealed just one other reported case of myxoedema ascites with concomitant spontaneous bacterial peritonitis and no case has till been reported of spontaneous bacterial peritonitis in subclinical hypothyroidism.

  14. Pulmonary functions in patients with subclinical hypothyroidism.

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    Cakmak, Gulfidan; Saler, Tayyibe; Saglam, Zuhal Aydan; Yenigun, Mustafa; Ataoglu, Esra; Demir, Tuncalp; Temiz, Levent Umit

    2011-10-01

    To determine whether alterations in pulmonary function takes place in subclinical hypothyroidism by examining the diffusion lung capacity and muscle strength of such patients. This is a descriptive study conducted in 2009 at Haseki Training and Research Hospital, Istanbul, Turkey. Hundred and twenty-six patients with subclinical hypothyroidism and 58 age and sex matched individuals were recruited. Simple spirometry tests were performed, and pulmonary diffusion capacity (DLco) and muscle strength were measured. ScH patients showed a significant reduciton of the following pulmonary function tests (% predicted value) as compared with control subjects: FVC, FEV1, FEV1%, FEF25-75, FEF25-75%, DLco, DLco/VA, Pimax, Pimax% and Pemax%. These data indicate that pulmonary functions are effected in subclinical hypothyrodism. Therefore patients with or who are at high risk of having subclinical hypothyroidism, should be subjected to evaluation of pulmonary functions with simple spirometry.

  15. Electromyographic Findings in Overt Hypothyroidism and Subclinical Hypothyroidism

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    Emel Oğuz Akarsu

    2013-12-01

    Full Text Available OBJECTIVE: Hypothyroidism may cause neurologic signs and symptoms as its effects neuromuscular system like many other systems. Subclinical hypothyroidism is the most common thyroid dysfuntion, it may cause neuromuscular signs and symptoms. In this retrospective study, it is aimed to compare neuromuscular symptoms and electromyographic (EMG manifestations between hypothyroid patients and control group with normal thyroid function and without a disease causing polyneuropathy. METHODS: 31 overt hypothyroidic, 139 subclinic hypothyroidic patients and 50 individuals with normal thyroid function, without a disease causing polyneuropathy, as control group whom made EMG for another reason were included to the study. Neuromuscular symptoms, neurological examination and electrophysiological findings was obtained from the patient records. RESULTS: In our study, we observed frequent neuromuscular complaints such as fatigue, morning stiffness, cramp, general pain and paresthesia in favor of both for overt and subclinic hypothyroidism. Carpal Tunnel Syndrom(CTS, was statistically higher in overt hypothyroidism group than control group. CTS was also observed higher in subclinic hypothyroidism group when compared with control group but it didn't reach to statistical significance. We did not detect polyneuropathy in any group. Motor nerve velocity and compound muscle action potential amplitudes were found to be statistically significant difference between hypothyroid ve control group. CONCLUSION: Since motor fibres' and neuromuscular area's being affected in hypothyroidism, which we interpret to happen due to basal metabolism's slowing down, can show a significant recovery after thyroid replacement therapy. We consider that, in further studies, comparison of electrophysiological findings after treatment with the findings of pre -treatment is necessary

  16. Subclinical Hypothyroidism: A Prospective Observational Study from Southern India.

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    Sridhar, Mathrubootham; Mahadevan, Shriraam; Vishwanathan, Latha; Subbarayan, Anbezhil

    2018-03-15

    To assess the natural history and progression of subclinical hypothyroidism and to study factors which help predict evolution of subclinical hypothyroidism into overt hypothyroidism. Longitudinal study in 40 children (2-16 yrs) presenting with subclinical hypothyroidism in a tertiary care unit in Chennai, India. Patients showing evidence of overt hypothyroidism or thyroid stimulating hormone ≥15 mIU/mL during follow-up were started on thyroxine. Others were followed up with 3-monthly thyroid function tests up to one year. At the end of our study period 3 (7.5%) were overtly hypothyroid, 16 (40%) remained as subclinical hypothyroid, and 21 (52.5%) became euthyroid. Evidence of auto- immunity at baseline was a significant (Phypothyroidism. Subclinical hypothyroidism in children, with thyroid stimulating hormone upto 15 mIU/L and irrespective of thyroid autoimmunity, needs only periodic clinical and biochemical follow up. Thyroid autoimmunity may point to an increased probability of progression to overt hypothyroidism.

  17. SUBCLINICAL HYPOTHYROIDISM CURRENT CONCEPTS & M ANAGEMENT STRATEGEIES

    Directory of Open Access Journals (Sweden)

    Radha Krishnan

    2015-05-01

    Full Text Available Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone ( TSH and normal free T3 & T4 , without clinical features of hypothyroidism . Clinical significance of SCH remains uncertain and controversial . Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms . There are still controversies surrounding SCH and associated risk of various cardiovascular diseases ( CVDs , pregnancy outcomes , neuropsychiatric issues , metabolic syndrome , and dyslipidemia . This review will summarize the current data related to the effects of SCH on cardiovascular risk , SCH in pregnancy , in dyslipedemia and clinical guidelines on management of this condition . The evidence has been updated by a Pub med search on the risks and treatment of subclinical hypothyroidism of most recent articles published until March 2015

  18. The debate on treating subclinical hypothyroidism

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    Tng, Eng Loon

    2016-01-01

    Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH. PMID:27779276

  19. The debate on treating subclinical hypothyroidism.

    Science.gov (United States)

    Tng, Eng Loon

    2016-10-01

    Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH. Copyright: © Singapore Medical Association.

  20. Subclinical hypothyroidism: Controversies to consensus

    Directory of Open Access Journals (Sweden)

    Syed Abbas Raza

    2013-01-01

    Full Text Available Diagnoses of subclinicaal hypothyroidism (SCH is biochemically made, when serum thyroid stimulating hormone (TSH levels is elevated while free thyroid hormone levels are within normal reference range. SCH is diagnosed after excluding all other causes of elevated TSH levels. Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms. The risk of progression to overt hypothyroidism is related to number of factors including initial serum TSH concentration, presence of auto antibodies, family history and presence goiter. Various screening recommendations for thyroid function assessment are in practice. There are still controversies surrounding SCH and associated risk of various cardiovascular diseases (CVDs, pregnancy outcomes, neuropsychiatric issues, metabolic syndrome, and dyslipidemia. Consensus will require more large randomized clinical studies involving various age groups and medical condition, especially in developing countries. All these efforts will definitely improve our understanding of disease and ultimately patient outcomes.

  1. Subclinical hypothyroidism in children with Down syndrome: To treat ...

    African Journals Online (AJOL)

    Mohamed El Kholy

    2014-12-01

    Dec 1, 2014 ... In children with subclinical hypothyroidism, The American. Thyroid Association ... reflects mild hypothyroidism that could harm brain growth and development in the ... results in a normal cognitive development [9]. In conclusion ...

  2. [Should subclinical hypothyroidism in older persons be treated?

    NARCIS (Netherlands)

    Elzen, W.P. den; Smit, J.W.A.; Mooijaart, S.P.; Gussekloo, J.

    2012-01-01

    Subclinical hypothyroidism is a common finding in older persons. Clinical guidelines are inconsistent in providing recommendations for the treatment of subclinical hypothyroidism, especially in older persons. To date, there is no high-quality evidence from randomized controlled trials about the

  3. Sub-clinical hypothyroidism in infertile Nigerian women with ...

    African Journals Online (AJOL)

    Studies on the impact of subclinical hypothyroidism in infertility are scarce and this seeks to determine the proportion of infertile Nigerian women with hyperprolactinaemia that had subclinical hypothyroidism. Serum prolactin and thyroid stimulating hormone were determined using ELECSYS 1010 auto analyzer.

  4. Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke

    DEFF Research Database (Denmark)

    Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J

    2015-01-01

    OBJECTIVE: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished...... studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels....... DATA EXTRACTION AND SYNTHESIS: We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared...

  5. The Clinical Study on 39 Cases of Subclinical Hypothyroidism

    International Nuclear Information System (INIS)

    Yu, Cheol Jae; Ahn, Weon Jeon; Lee, Houn Young; Ro, Heung Kyu

    1986-01-01

    Subclinical hypothyroidism can be defined as an asymptomatic state in which a reduction in thyroid activity has been compensated by an increased TSH output to maintain an euthyroid state. We analysed clinical features, laboratory data, and pathologic findings in 39 cases of subclinical hypothyroidism who were diagnosed at the Dept. of Internal Medicine, Chungnam National University Hospital from Aug. 1984 to June, 1985. 1) The age distribution was from sixteen to sixty-nine and mean age was 34.8. Peak incidence was in the 4th decade and 3rd, 5th, 6th decade in order. 2) The sex distribution showed female preponderance with a ratio of 18.5 to 1. 3) The major presenting manifestations were nonspecific ones such as fatigue, indigestion, and anorexia. 4) Physical examination revealed diffuse goiter in 47.6%. Major abnormalities were no gross abnormality (30.9%), nodular goiter and facial edema. 5) There was no significant difference of the basal serum T3 and T4 concentrations between subclinical hypothyroidism and normal controls (p>0.05). 6) The basal serum TSH concentration of subclinical hypothyroidism (32.61±14.95 μU/ml) was significantly higher than that of normal controls (3.92±1.05 μU/ml) (p<0.005). 7) Microsomal antibody was detected in 80.6% and thyroglobulin antibody was detected in 30%. 8) The pathologic findings in 26 cases revealed Hashimoto's thyroiditis in 76.9% (lymphocytic type, 34.6%; oxyphilic type, 26.9%; fibrotic type, 15.4%). The others were adenomatous goiter (15.4%), adenomatous carcinoma (3.8%) and subacute thyroiditis (3.8%).

  6. The Clinical Study on 39 Cases of Subclinical Hypothyroidism

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    Yu, Cheol Jae; Ahn, Weon Jeon; Lee, Houn Young; Ro, Heung Kyu [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1986-03-15

    Subclinical hypothyroidism can be defined as an asymptomatic state in which a reduction in thyroid activity has been compensated by an increased TSH output to maintain an euthyroid state. We analysed clinical features, laboratory data, and pathologic findings in 39 cases of subclinical hypothyroidism who were diagnosed at the Dept. of Internal Medicine, Chungnam National University Hospital from Aug. 1984 to June, 1985. 1) The age distribution was from sixteen to sixty-nine and mean age was 34.8. Peak incidence was in the 4th decade and 3rd, 5th, 6th decade in order. 2) The sex distribution showed female preponderance with a ratio of 18.5 to 1. 3) The major presenting manifestations were nonspecific ones such as fatigue, indigestion, and anorexia. 4) Physical examination revealed diffuse goiter in 47.6%. Major abnormalities were no gross abnormality (30.9%), nodular goiter and facial edema. 5) There was no significant difference of the basal serum T3 and T4 concentrations between subclinical hypothyroidism and normal controls (p>0.05). 6) The basal serum TSH concentration of subclinical hypothyroidism (32.61+-14.95 muU/ml) was significantly higher than that of normal controls (3.92+-1.05 muU/ml) (p<0.005). 7) Microsomal antibody was detected in 80.6% and thyroglobulin antibody was detected in 30%. 8) The pathologic findings in 26 cases revealed Hashimoto's thyroiditis in 76.9% (lymphocytic type, 34.6%; oxyphilic type, 26.9%; fibrotic type, 15.4%). The others were adenomatous goiter (15.4%), adenomatous carcinoma (3.8%) and subacute thyroiditis (3.8%).

  7. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy.

    Science.gov (United States)

    Casey, Brian M; Thom, Elizabeth A; Peaceman, Alan M; Varner, Michael W; Sorokin, Yoram; Hirtz, Deborah G; Reddy, Uma M; Wapner, Ronald J; Thorp, John M; Saade, George; Tita, Alan T N; Rouse, Dwight J; Sibai, Baha; Iams, Jay D; Mercer, Brian M; Tolosa, Jorge; Caritis, Steve N; VanDorsten, J Peter

    2017-03-02

    Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4.00 mU or more per liter and a normal free thyroxine (T 4 ) level (0.86 to 1.90 ng per deciliter [11 to 24 pmol per liter]), and for hypothyroxinemia, defined as a normal thyrotropin level (0.08 to 3.99 mU per liter) and a low free T 4 level (hypothyroidism underwent randomization at a mean of 16.7 weeks of gestation, and 526 with hypothyroxinemia at a mean of 17.8 weeks of gestation. In the subclinical hypothyroidism trial, the median IQ score of the children was 97 (95% confidence interval [CI], 94 to 99) in the levothyroxine group and 94 (95% CI, 92 to 96) in the placebo group (P=0.71). In the hypothyroxinemia trial, the median IQ score was 94 (95% CI, 91 to 95) in the levothyroxine group and 91 (95% CI, 89 to 93) in the placebo group (P=0.30). In each trial, IQ scores were missing for 4% of the children. There were no significant between-group differences in either trial in any other neurocognitive or pregnancy outcomes or in the incidence of adverse events, which was low in both groups. Treatment for subclinical hypothyroidism or hypothyroxinemia beginning between 8 and 20 weeks of gestation did not result in significantly better cognitive outcomes in children through 5 years of age than no treatment for those conditions. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00388297 .).

  8. Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy.

    Science.gov (United States)

    Akram, Frida Hosseini; Johansson, Bengt; Möllerström, Gunnar; Landgren, Britt-Marie; Stavreus-Evers, Anneli; Skjöldebrand-Sparre, Lottie

    2017-11-01

    Untreated and subclinical hypothyroidism (SCH) has been associated with adverse pregnancy complications such as increased risk of miscarriage, hypertension, preeclampsia, and preterm delivery. However, in Sweden, screening for thyroid dysfunction during pregnancy is only recommended for women with a high risk of thyroid disease. Therefore, the aim of this study was to determine the incidence of clinical and SCH in women in the first trimester of pregnancy. In this prospective study, 1298 pregnant women were divided into three groups: one unselected general screening group (n = 611), one low-risk group comprising women without risk factors for thyroid disorder (n = 511), and one high-risk group comprising women with an inheritance or suspicion of thyroid disease or undergoing treatment for thyroid disease (n = 88). Serum was obtained up to gestational week 13, and thyrotropin (TSH) was analyzed. The incidences of thyroid dysfunction in the three screening groups were 9.8% in the general screening group, 9.6% in the low-risk group, and 10.2%, p = 0.948, in the high-risk group. In the women with known hypothyroidism on levothyroxine treatment, 50.6% had serum TSH levels above 2.0 mIU/L. High-risk screening is not useful in predicting which women are at risk of thyroid disease in early pregnancy since ∼10% of women with SCH or hypothyroidism could not be diagnosed in this way.

  9. Subclinical hypothyroidism and cognitive function in people over 60 years

    DEFF Research Database (Denmark)

    Akintola, Abimbola A; Jansen, Steffy W; van Bodegom, David

    2015-01-01

    from the 15 studies was pooled, and meta-analyzed cross-sectionally for global cognition [assessed by Mini-Mental State Examination (MMSE)], executive function, and memory, using random effects models. Pooled effect size (ES) for MMSE was -0.01 (95% CI -0.09, 0.08), with heterogeneity (I (2)) of 55......Subclinical hypothyroidism (SCH), defined as elevated thyroid stimulating hormone (TSH) and normal thyroid hormone levels, and cognitive impairment are both common in older people. While the relation between overt hypothyroidism and cognitive impairment is well established, data on the association...... between SCH and cognitive impairment are conflicting. This systematic review and meta-analysis was performed to assess available evidence on the association of SCH with cognition in community dwelling, relatively healthy older adults. PubMed, EMBASE, Web of Science, COCHRANE, CINAHL, Psyc...

  10. Hyperprolactinemia in Children with Subclinical Hypothyroidism.

    Science.gov (United States)

    Sharma, Neera; Dutta, Deep; Sharma, Lokesh Kumar

    2017-12-15

    Prevalence of hyperprolactinemia in children with subclinical hypothyroidism (ScH) is not known. This study aimed to determine the occurrence and predictors of hyperprolactinemia in euthyroid children and in children with ScH and overt primary hypothyroidism (OPH). Serum prolactin levels were estimated in consecutive children hypothyroidism, multiple pituitary hormone deficiency, comorbid states, and drug-induced hyperprolactinemia were excluded. From the initially screened 791 children, hormonal data from 602 children who fulfilled all criteria were analyzed. Seventy-one (11.79%) of these had ScH, and 33 (5.48%) had OPH. Occurrence of hyperprolactinemia was highest in the OPH group (51.51%), followed by ScH (30.98%) and euthyroid children (4.41%) (p<0.001). Median (25 th -75 th percentiles) levels for prolactin in euthyroid, ScH, and OPH children were 13.3 (9.4-17.95), 19.15 (15.97-30.12), and 28.86 (17.05-51.9) ng/mL, respectively (p<0.001). In children, prolactin levels were comparable in males and females. An age-related increase in serum prolactin was noted in euthyroid children, which was statistically significant in post-pubertal (16-18 years) children. Area under the curve for thyroid stimulating hormone (TSH) in predicting hyperprolactinemia in children was 0.758 (95% confidence interval: 0.673-0.829; p<0.001). TSH ≥4.00 mIU/L had a sensitivity of 69.4% and specificity of 77.6% in detecting hyperprolactinemia. Hyperprolactinemia is common in children with ScH and OPH. TSH ≥4.00 mIU/L has a good sensitivity and specificity in predicting hyperprolactinemia in children. More studies are needed to establish if hyperprolactinemia should be an indication for treating ScH in children.

  11. Is subclinical hypothyroidism increasing exogen obesity in children?

    Directory of Open Access Journals (Sweden)

    Ceyda Tuna Kirsaclioglu

    2015-03-01

    Conclusion:.Thyrotropin releasing hormone stimulation test may be helpful to determine subclinical hypothyroidism in exogen obese children, if basal TSH levels were elevated. [J Contemp Med 2015; 5(1.000: 1-7

  12. Cardiovascular risk factors in patients with subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Pešić Milica

    2007-01-01

    Full Text Available Background/Aims. Overt hypothyroidism is disease associated with accelerated arteriosclerosis and coronary heart disease. Whether subclinical hypothyroidism (SH is associated with increased cardiovascular risk is contraversial. As SH is a high prevalence thyroid dysfunction, specially in older women, it is important to evaluate cardiovascular risk factors in these patients and that was the aim of this study. Methods. We examined 30 patients with SH and 20 healthy controls. Subclinical hypothireoidism was defined as an elevated thyrotropin (TSH (> 4.5 mU/L and normal free thyroxine (FT4 level. In all the participants we determined body mass index (BMI, blood pressure, TSH, FT4, antibodies to thyroid peroxidase, antibodies to thyroglobulin, total cholesterol, high density lipoprotein (HDL cholesterol, low density lipoprotein (LDL cholesterol, triglicerides, total cholesterol/HDL cholesterol ratio and LDL/HDL cholesterol ratio. Results. Mean BMI in patients with SH was significantly higher (p < 0.05, as well as diastolic blood pressure (p < 0.01 compared with the controls. Average levels of total cholesterol (5.40±0.62 vs 5.06±0.19 mmol/l, p < 0.01 and triglycerides (2.16±0.56 vs 1.89±0.24 mmol/l, p < 0.05 were also significantly higher in the group with SH. Individual analysis revealed that the percentage of patients with SH having borderline elevated total cholesterol (63.33%, hypertrigliceridemia (43.33% and elevated total cholesterol/HDL cholesterol ratio (26.67% were significantly higher than the percentage in the controls. No significant correlation between TSH and lipid parameters was detected. Conclusion. Subclinical hypothyroidism was associated with higher BMI, diastolic hypertension, higher total cholesterol and triglicerides levels and higher total cholesterol/HDL cholesterols ratio. This might increase the risk of accelerated arteriosclerosis in patients with SH.

  13. Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance

    NARCIS (Netherlands)

    Wiersinga, W. M.

    1995-01-01

    Subclinical hypothyroidism has a prevalence of approx. 6% in the general population; it is more common in females and in the elderly. The incidence of progression to overt hypothyroidism is 5-15% per year; women with positive thyroid antibodies are especially at risk. The biological significance

  14. Subclinical hypothyroidism ups the risk of vascular complications in ...

    African Journals Online (AJOL)

    Subclinical hypothyroidism ups the risk of vascular complications in type 2 diabetes. ... hypothyroidism (SCH) and vascular complications of type 2 diabetes. ... However, gender (p = 0.076), BMI (p = 0.092), and smoking (P = 0.715) were not ...

  15. Altered fructosamine and lipid fractions in subclinical hypothyroidism.

    Science.gov (United States)

    Udupa, Sridevi V; Manjrekar, Poornima A; Udupa, Vinit A; Vivian, D'Souza

    2013-01-01

    Thyroid function disorders lead to changes in the lipoprotein metabolism. To study the lipid and the glycaemic abnormalities in the subclinical hypothyroidism cases and to compare the same with the euthyroid, overt hypothyroid and the hyperthyroid subjects. Four groups, euthyroid (Group-I), hypothyroid (Group-II), subclinical hypothyroid (Group-III) and hyperthyroid (Group-IV), which consisted of 30 subjects each, of either sex, who were aged 25-55 years, underwent Fasting Plasma Glucose (FPG), fructosamine, lipid profile and total T3, T4 and TSH estimations. The subjects who were on lipid lowering or thyroid disorder drugs and known diabetics were excluded from the study. In Group-III, all the lipid fractions were comparable to those of Group-II and they were significantly deranged, as compared to those of Group-I. The fructosamine levels were significantly higher in Group-II and Group-III (phypothyrodism, the subclinical hypothyroid cases also need to be treated similarly. The fructosamine values which are largely in excess of the FPG values, indicate a higher propensity to glycation and a decreased turnover of the proteins in the hypothyroid and the subclinical hypothyroid pools. Vice versa is true of the hyperthyroid pool. Fructosamine can be included in the thyroid work up of the patients to assess the metabolic function and the subsequent response after the initiation of the therapy.

  16. Subclinical Hypothyroidism in Children and Adolescents: Is It Clinically Relevant?

    Directory of Open Access Journals (Sweden)

    Aneta Gawlik

    2015-01-01

    Full Text Available Although subclinical hypothyroidism (SH is a common clinical problem, its diagnosis tends to be incidental. According to the definition, it should be asymptomatic, only detectable by screening. The presence or coincidence of any symptoms leads to L-thyroxine treatment. The clinical presentation, especially in younger patients with subclinical hypothyroidism, is still under dispute. Accordingly, the aim of this paper was to review the literature from the past seven years. The literature search identified 1,594 potentially relevant articles, of which 24 met the inclusion criteria. Few studies focus on the symptomatology of subclinical hypothyroidism, and most of them analyzed a small number of subjects. A significant correlation was found by some authors between subclinical hypothyroidism and a higher risk of hypertension, dyslipidemia, and migraine. No evidence of the impact of subclinical hypothyroidism on weight, growth velocity, and puberty was revealed. As the quality of most studies is poor and no definite conclusions can be drawn, randomized, large-scale studies in children and adolescents are warranted to determine the best care for patients with SH.

  17. Myxedema coma in a patient with subclinical hypothyroidism.

    Science.gov (United States)

    Mallipedhi, Akhila; Vali, Hamza; Okosieme, Onyebuchi

    2011-01-01

    Myxedema coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of myxedema coma. A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3-24.5), FT3 2.7 pmol/L (reference range 2.67-7.03), and thyrotropin 6.09 mU/L (reference range 0.4-4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and coma. Biochemical profile showed hyponatremia, elevated creatinine phosphokinase, metabolic acidosis, and renal failure. An echocardiogram revealed a moderate-sized pericardial effusion. We diagnosed myxedema coma and started treatment with intravenous T3. She responded dramatically with improvement in level of consciousness and normalization of metabolic parameters. We found no explanation other than hypothyroidism to account for the presentation. Adrenocorticotrophic hormone (ACTH) stimulation tests excluded adrenal insufficiency, and serum gonadotrophins were within the normal reference range. FT4 estimation by equilibrium dialysis excluded analytical interference, and molecular analysis for the thyroid hormone receptor β gene associated with thyroid hormone resistance was negative. To the best of our knowledge this is the first report of myxedema coma in a patient with subclinical hypothyroidism. The reason for normal thyroid hormone levels is unclear but may reflect deviation from a higher pre-morbid set-point. The case

  18. The Biochemical Prognostic Factors of Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Myung Won Lee

    2014-06-01

    Full Text Available BackgroundPatients with subclinical hypothyroidism (SHT are common in clinical practice. However, the clinical significance of SHT, including prognosis, has not been established. Further clarifying SHT will be critical in devising a management plan and treatment guidelines for SHT patients. Thus, the aim of this study was to investigate the prognostic factors of SHT.MethodsWe reviewed the medical records of Korean patients who visited the endocrinology outpatient clinic of Severance Hospital from January 2008 to September 2012. Newly-diagnosed patients with SHT were selected and reviewed retrospectively. We compared two groups: the SHT maintenance group and the spontaneous improvement group.ResultsThe SHT maintenance group and the spontaneous improvement group had initial thyroid-stimulating hormone (TSH levels that were significantly different (P=0.035. In subanalysis for subjects with TSH levels between 5 to 10 µIU/mL, the spontaneous improvement group showed significantly lower antithyroid peroxidase antibody (anti-TPO-Ab titer than the SHT maintenance group (P=0.039. Regarding lipid profiles, only triglyceride level, unlike total cholesterol and low density lipoprotein cholesterol, was related to TSH level, which is correlated with the severity of SHT. Diffuse thyroiditis on ultrasonography only contributed to the severity of SHT, not to the prognosis. High sensitivity C-reactive protein and urine iodine excretion, generally regarded as possible prognostic factors, did not show any significant relation with the prognosis and severity of SHT.ConclusionOnly initial TSH level was a definite prognostic factor of SHT. TPO-Ab titer was also a helpful prognostic factor for SHT in cases with mildly elevated TSH. Other than TSH and TPO-Ab, we were unable to validate biochemical prognostic factors in this retrospective study for Korean SHT patients.

  19. BENEFICIAL EFFECTS OF LEVOTHYROXINE IN THE TREATMENT OF SUBCLINICAL HYPOTHYROIDISM

    Directory of Open Access Journals (Sweden)

    Mulic Mersudin

    2016-12-01

    Full Text Available Introduction:Increased cardiovascular risk in thyroid dysfunction is associated with disorders of lipid and lipoproteins, endothelial dysfunction, metabolic, hormonal, hemodynamic changes and coagulation disorders. Subclinical hypothyroidism is characterized by a suprarnormal level of TSH with normal levels of thyroid hormones. The correlation between subclinical hypothyroidism of the lipid profile and cardiovascular outcomes remains unclear. Several intervention studies assessed the effect of levothyroxine therapy on the lipid profile of patients with subclinical hypothyroidism and obtained conflicting results. The aim of the research is to determine whether subclinical hypothyroidism is associated with the atherogenic lipid profile and whether these changes are reversible after the introduction of the L-thyroxine replacement therapy. Method: The study included 51 patients over 50 years of age with subclinical hypothyroidism. All the participants were subjected to an examination programme which included a detailed anamnesis and physical examination, laboratory tests (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, T3, T4, TSH. After eight weeks of levothyroxine therapy, the same laboratory parameters were determined in the patients. Results: Subjects with subclinical hypothyroidism had high average values: TSH (12.77 + 2.78 mIU / ml, total cholesterol (7.55 ± 0.79 mmol / l, LDL cholesterol (5.03 ± 0.61 mmol / l, triglycerides (2.48 ± 1.01 mmol / l; and the average value of HDL cholesterol was within reference values (1.12 ± 0.21 mmol / l. After eight weeks of levothyroxine replacement therapy, there was a statistically significant reduction of average values (p <0.0001: TSH (3.83 ± 1.33 mIU / ml, total cholesterol (6.28 ± 0.96 mmol / l, LDL cholesterol ( 4.03 ± 0.70 mmol / mmol / l l, triglycerides (1.98 ± 0.87 mmol / l; and the average value of HDL cholesterol increased significantly (p <0.0001 (1.32 ± 0.22 mmol

  20. Comparison of QT dispersion between subclinical hypothyroid and euthyroid patients

    Directory of Open Access Journals (Sweden)

    Muharrem Kıskaç

    2010-06-01

    Full Text Available Objectives: The aim of this study was to investigate the relationship between subclinical hypothyroid and QTc dispersionindicating local heterogeneity in repolarization of myocardium, which is well known as independent cardiac risk factor for sudden death and ventricular arrhythmia.Materials and Methods: We compared QTc dispersion of subclinical hypothyroid patients, after treatment and healthy control group. We included a total of 50 patients with 41 women and 9 men in the study group. Electrocardiographywith 12 derivations, thyroid hormones, serum electrolytes and basic biochemical parameters were measured.The control group consisted of 25 healthy individuals.QT distances were calculated by using Bazet formula. The difference between the longest QTc and the shortest QTc distance was accepted as QTc dispersion (QTcd.Results: Comparison of subclinical hypothyroid patients, their euthyroidic period after treatment and healthy controlgroup, gave no significant differences in age, body weight, body mass index and free thyroxin values. However,significant difference was found in durations of QTd and QTcd between the subclinical hypothyroid, the control and the euthyroidic groups (p0.05.Conclusion: Our results suggested that subclinical hypothyroidpatients had longer QTc dispersion compared to euthyroidic period and healthy subjects. However there was no QTcd difference between the euthyroidic period and healthy control group.

  1. Subclinical hypothyroidism has little influences on muscle mass or strength in elderly people.

    Science.gov (United States)

    Moon, Min Kyong; Lee, You Jin; Choi, Sung Hee; Lim, Soo; Yang, Eun Joo; Lim, Jae-Young; Paik, Nam-Jong; Kim, Ki Woong; Park, Kyong Soo; Jang, Hak C; Cho, Bo Youn; Park, Young Joo

    2010-08-01

    Sarcopenia, the age-related decline in muscle mass, affects the muscle strength and muscle quality, and these changes decrease functional capacity. The prevalence of thyroid dysfunction increases with age, and changes in thyroid hormone level lead to neuromuscular deficits. We investigated the effects of subclinical hypothyroidism on the muscle mass, strength or quality in elderly people. One thousand one hundred eighteen subjects aged > or = 65 yr were randomly selected from a local population and classified into a euthyroid (280 men and 358 women), subclinically hypothyroid (61 men and 75 women), or overtly hypothyroid (7 men and 16 women) group. Although women with subclinical hypothyroidism had a higher prevalence of sarcopenia, defined according to the ratio of appendicular skeletal muscle mass to the square of height, muscle mass, strength or quality did not differ in relation to thyroid status in men or in women. Multivariate analysis including age, diabetes, hypertension, acute coronary event, alcohol, smoking, presence of pain, physical activity score, and lipid profile, showed that thyroid-stimulating hormone level was not associated with muscle mass, strength or quality. In conclusion, subclinical hypothyroidism has little influences on muscle mass, strength or quality, and may not be associated with sarcopenia.

  2. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

    NARCIS (Netherlands)

    Stott, D.J.; Rodondi, N.; Kearney, P.M.; Ford, I.; Westendorp, R.G.; Mooijaart, S.P.; Sattar, N.; Aubert, C.E.; Aujesky, D.; Bauer, D.C.; Baumgartner, C.; Blum, M.R.; Browne, J.P.; Byrne, S.; Collet, T.H.; Dekkers, O.M.; Elzen, W.P. den; Puy, R.S. Du; Ellis, G.; Feller, M.; Floriani, C.; Hendry, K.; Hurley, C.; Jukema, J.W.; Kean, S.; Kelly, M.; Krebs, D.; Langhorne, P.; McCarthy, G.; McCarthy, V.; McConnachie, A.; McDade, M.; Messow, M.; O'Flynn, A.; O'Riordan, D.; Poortvliet, R.K.; Quinn, T.J.; Russell, A.; Sinnott, C.; Smit, J.W.A.; Dorland, H.A. Van; Walsh, K.A.; Walsh, E.K.; Watt, T.; Wilson, R.; Gussekloo, J.

    2017-01-01

    BACKGROUND: The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. METHODS: We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving

  3. The prevalence of subclinical hypothyroidism among patients with ...

    African Journals Online (AJOL)

    2012-10-03

    Oct 3, 2012 ... Original Research: The prevalence of subclinical hypothyroidism among patients with diabetes mellitus. 106. 2013 Volume 18 No 2. JEMDSA. Introduction. Diabetes mellitus and its associated complications is a major challenge for both the private and state health sector in South Africa. The number of ...

  4. Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke: An Individual Participant Data Analysis.

    Science.gov (United States)

    Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J; Ikram, M Arfan; Blum, Manuel R; Collet, Tinh-Hai; Bakker, Stephan J L; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N; Hofman, Albert; Portegies, Marileen L P; Medici, Marco; Iervasi, Giorgio; Stott, David J; Ford, Ian; Bremner, Alexandra; Wanner, Christoph; Ferrucci, Luigi; Newman, Anne B; Dullaart, Robin P; Sgarbi, José A; Ceresini, Graziano; Maciel, Rui M B; Westendorp, Rudi G; Jukema, J Wouter; Imaizumi, Misa; Franklyn, Jayne A; Bauer, Douglas C; Walsh, John P; Razvi, Salman; Khaw, Kay-Tee; Cappola, Anne R; Völzke, Henry; Franco, Oscar H; Gussekloo, Jacobijn; Rodondi, Nicolas; Peeters, Robin P

    2015-06-01

    The objective was to determine the risk of stroke associated with subclinical hypothyroidism. Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished studies were identified through the Thyroid Studies Collaboration. We collected individual participant data on thyroid function and stroke outcome. Euthyroidism was defined as TSH levels of 0.45-4.49 mIU/L, and subclinical hypothyroidism was defined as TSH levels of 4.5-19.9 mIU/L with normal T4 levels. We collected individual participant data on 47 573 adults (3451 subclinical hypothyroidism) from 17 cohorts and followed up from 1972-2014 (489 192 person-years). Age- and sex-adjusted pooled hazard ratios (HRs) for participants with subclinical hypothyroidism compared to euthyroidism were 1.05 (95% confidence interval [CI], 0.91-1.21) for stroke events (combined fatal and nonfatal stroke) and 1.07 (95% CI, 0.80-1.42) for fatal stroke. Stratified by age, the HR for stroke events was 3.32 (95% CI, 1.25-8.80) for individuals aged 18-49 years. There was an increased risk of fatal stroke in the age groups 18-49 and 50-64 years, with a HR of 4.22 (95% CI, 1.08-16.55) and 2.86 (95% CI, 1.31-6.26), respectively (p trend 0.04). We found no increased risk for those 65-79 years old (HR, 1.00; 95% CI, 0.86-1.18) or ≥ 80 years old (HR, 1.31; 95% CI, 0.79-2.18). There was a pattern of increased risk of fatal stroke with higher TSH concentrations. Although no overall effect of subclinical hypothyroidism on stroke could be demonstrated, an increased risk in subjects younger than 65 years and those with higher TSH concentrations was observed.

  5. Unresolved Subclinical Hypothyroidism is Independently Associated with Progression of Chronic Kidney Disease

    Science.gov (United States)

    Kim, Eun Oh; Lee, Ihn Suk; Choi, Yoo A; Lee, Sang Ju; Chang, Yoon Kyung; Yoon, Hye Eun; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok

    2014-01-01

    Background and Aim: Patients with chronic kidney disease (CKD) often have subclinical hypothyroidism. However, few reports have investigated changes in the status of subclinical hypothyroidism in CKD patients and its clinical significance in CKD progression. Methods: We included 168 patients with nondialysis-dependent CKD stages 2-4. The normalization of subclinical hypothyroidism during follow-up was assessed, and the association between transitions in subclinical hypothyroid status and the rate of decline of the estimated glomerular filtration rate (eGFR) was investigated. Results: At baseline, 127 patients were euthyroid and 41 (24.4%) patients were diagnosed with subclinical hypothyroidism. Of these 41 patients, 21 (51.2%) spontaneously resolved to euthyroid during follow-up. The rate of eGFR decline of patients with resolved subclinical hypothyroidism was similar to that of euthyroid patients. The patients with unresolved subclinical hypothyroidism showed a steeper renal function decline than patients with euthyroidism or resolved subclinical hypothyroidism (all p hypothyroidism than in those who were euthyroid (p = 0.006). In multivariate linear regression for rate of eGFR decrease, unresolved subclinical hypothyroidism (β = -5.77, p = 0.001), baseline renal function (β = -0.12, p hypothyroidism did not resolve to euthyroidism, and this lack of resolution was independently associated with rapid renal function decline. PMID:24396286

  6. Long-Term Outcome in Levothyroxine Treated Patients With Subclinical Hypothyroidism and Concomitant Heart Disease.

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Kristensen, Søren Lund; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar H; Selmer, Christian

    2016-11-01

    Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function. This study sought to examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease. This was a register-based historical cohort study. The study was composed of Danish primary care patients and hospital outpatients age 18 years and older with established heart disease who were diagnosed with subclinical hypothyroidism in 1997-2011. Patients were stratified according to whether they claimed a subsequent prescription of levothyroxine. Event rates and incidence rate ratios (IRR) were calculated by use of time-dependent multivariable Poisson regression models. Measures included all-cause mortality and major adverse cardiac events (MACEs), defined as cardiovascular death, fatal or nonfatal myocardial infaction and stroke, and all-cause hospital admissions. Of 61 611 patients with a diagnosis of cardiac disease having their first time thyroid function testing, 1192 patients with subclinical hypothyroidism (mean age 73.6 [SD ± 13.3] y, 63.8% female) were included, of whom 136 (11.4%) were treated with levothyroxine. During a median follow-up time of 5.6 y (interquartile range, 6.5 y), 694 (58.2%) patients died. Patients treated with levothyroxine displayed no significantly increased risk of all-cause mortality (adjusted IRR, 1.17; 95% confidence interval [CI], 0.90-1.52), MACE (adjusted IRR, 1.08; 95% CI, 0.80-1.45), or hospital admission (adjusted IRR, 0.94; 95% CI, 0.71-1.24), when compared with patients not treated with levothyroxine. Levothyroxine treatment in patients with subclinical hypothyroidism and heart disease was not associated with a significant benefit nor risk of all-cause mortality, MACE, or hospital admission in this large real-world cohort study.

  7. Subclinical hypothyroidism, mood, and cognition in older adults: a review.

    Science.gov (United States)

    Joffe, Russell T; Pearce, Elizabeth N; Hennessey, James V; Ryan, Joseph J; Stern, Robert A

    2013-02-01

    To perform a critical review of the literature on the mood and cognitive changes associated with subclinical hypothyroidism (SCH), with an emphasis on older adults. To evaluate these data against the Consensus Statement on the management of SCH from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. A comprehensive literature review. Subclinical hypothyroidism may be associated with an increased risk of mood and cognitive dysfunction, although the strength of this association and the efficacy of replacement hormone therapy require further investigation. It remains unclear whether SCH leads to significant mood and cognitive impairments in most older patients. More research is required to determine the nature and extent of this association and whether thyroid hormone replacement therapy is appropriate and effective in treating SCH-associated neurobehavioral impairments. Copyright © 2012 John Wiley & Sons, Ltd.

  8. Prevalence and predictors of hyperprolactinemia in subclinical hypothyroidism.

    Science.gov (United States)

    Sharma, Lokesh Kumar; Sharma, Neera; Gadpayle, Adesh Kisanji; Dutta, Deep

    2016-11-01

    Hyperprolactinemia has been reported in 0-57% of primary hypothyroidism. Data on hyperprolactinemia in subclinical hypothyroidism (ScH) is scant and inconsistent. This study aimed to determine the prevalence and predictors of hyperprolactinemia in ScH. Consecutive patients diagnosed to have normal thyroid function, ScH or overt primary hypothyroidism underwent serum prolactin, gonadotropins, testosterone and estradiol estimation. Patients with pregnancy, pituitary adenomas, secondary hypothyroidism, hyperthyroidism, comorbid states and drug-induced hyperprolactinemia were excluded. From initially screened 4950 patients, hormonal data from 2848 individuals who fulfilled all criteria were analyzed. The occurrence of hyperprolactinemia (females:males) was highest in primary hypothyroidism (42.95%:39.53%) (n=192), followed by ScH (35.65%:31.61%) (n=770) and euthyroid individuals (2.32%:2.02%) (n=1886) (P10mIU/L (females: males) was 25.56%:20.73%, 49.07%:50% and 61.43%:35.71% respectively (Phypothyroidism. In females, testosterone was lowest in patients with primary hypothyroidism. In males, serum estradiol was significantly higher, and testosterone significantly lower in men with ScH and primary hypothyroidism. Regression analysis revealed serum TSH followed by free T 4 , to be best predictors of serum prolactin in both sexes. Hyperprolactinemia is common in ScH, especially in those with TSH>7.5mIU/L. ROC analysis confirmed that TSH≥7.51mIU/L in females and ≥8.33mIU/L in males had a sensitivity of ≈50% with a very high specificity of >90% in detecting hyperprolactinemia. Prolactin screening may be warranted in ScH with TSH>7.5mIU/L, and may form an indication for treating ScH. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  9. Long-term outcome in levothyroxine treated patients with subclinical hypothyroidism and concomitant heart disease

    DEFF Research Database (Denmark)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager

    2016-01-01

    Context: Subclinical hypothyroidism is a common condition that may lead to impaired cardiac function. Objective: This study sought to examine the effects of levothyroxine treatment in patients with subclinical hypothyroidism and heart disease. Design: This was a register-based historical cohort s...

  10. Functional capacity and muscular abnormalities in subclinical hypothyroidism.

    Science.gov (United States)

    Reuters, Vaneska S; Teixeira, Patrícia de Fátima S; Vigário, Patrícia S; Almeida, Cloyra P; Buescu, Alexandre; Ferreira, Márcia M; de Castro, Carmen L N; Gold, Jaime; Vaisman, Mario

    2009-10-01

    Neuromuscular abnormalities and low exercise tolerance are frequently observed in overt hypothyroidism, but it remains controversial if they can also occur in subclinical hypothyroidism (sHT). The aim of this study is to evaluate neuromuscular symptoms, muscle strength, and exercise capacity in sHT, compared with healthy euthyroid individuals. A cross-sectional study was performed with 44 sHT and 24 euthyroid outpatients from a university hospital. Neuromuscular symptoms were questioned. Muscle strength was tested for neck, shoulder, arm, and hip muscle groups, using manual muscle testing (MMT). Quadriceps muscle strength was tested with a chair dynamometer and inspiratory muscle strength (IS) by a manuvacuometer. Functional capacity was estimated based on the peak of oxygen uptake (mL/kg/min), using the Bruce treadmill protocol. Cramps (54.8% versus 25.0%; P muscle strength by MMT and the coexistence of neuromuscular complaints in patients with sHT may indicate neuromuscular dysfunction.

  11. [Clinical and muscular evaluation in patients with subclinical hypothyroidism].

    Science.gov (United States)

    Reuters, Vaneska Spinelli; Buescu, Alexandru; Reis, Fabiola A Aarão; Almeida, Cloyra Paiva; Teixeira, Patrícia F dos S; Costa, Antônio J Leal; Wagman, Márcia Branco; Ferreira, Márcia Martins; de Castro, Carmen Lucia N; Vaisman, Mario

    2006-06-01

    Some symptoms and signs of hypothyroidism, as well as some laboratory abnormalities, may be present in subclinical hypothyroidism (SH). This study evaluates the prevalence of signs and symptoms of hypothyroidism and skeletal muscle dysfunction in 57 patients with SH compared to 37 euthyroid controls. The participants received a clinical score based on signs and symptoms of hypothyroidism. The muscle strength was estimated by manual testing and chair dynamometer and inspiratory force by manuvacuometer. Thyroid hormones and muscle enzymes were measured. The SH group presented with higher score (p< 0.01), complained about myalgia and weakness more frequently (p< 0.05), and showed strength disability in scapular and pelvic girdles (p< 0.05). The median free T4 serum levels were lower in SH (p< 0.001). These findings suggest that signs and symptoms of thyroid dysfunction may be related to lower levels of FT4 in SH and should be taken into account in the decision of beginning LT4 therapy.

  12. Insulin resistance and glucose levels in subjects with subclinical hypothyroidism

    International Nuclear Information System (INIS)

    Kahn, S.H.; Fazal, N.; Yasir, M.; Asif, N.; Rafi, T.

    2017-01-01

    To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, from December 2015 to September 2016. Methodology: Subjects referred for executive screening of apparently healthy population (without any known history of diabetes, hypertension, heart disease or other chronic ailments), were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism. Results: Median (IQR) insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 (n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mIU/L) and group-2 (n=26, 13%, Thyroid Stimulating Hormone: 3.51 - 15 mIU/L) were 7.6 (6.70) vs. 11.4 (13.72, p=0.040) and 1.77 (1.79) vs. 2.8 (3.07, p=0.071). The median differences for fasting plasma glucose were 5.0 (1.0) in group-1 vs. 5.0 (1.47) for Group-2 [p=0.618], and glycated hemoglobin was 5.60 (1.1) vs. 5.60 (1.7, p=0.824). Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median (IQR) 86.67 (92.94)] than group-1 [111.6 (189.64, p= 0.040)]. Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism. (author)

  13. Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment.

    Science.gov (United States)

    Maraka, Spyridoula; Mwangi, Raphael; McCoy, Rozalina G; Yao, Xiaoxi; Sangaralingham, Lindsey R; Singh Ospina, Naykky M; O'Keeffe, Derek T; De Ycaza, Ana E Espinosa; Rodriguez-Gutierrez, Rene; Coddington, Charles C; Stan, Marius N; Brito, Juan P; Montori, Victor M

    2017-01-25

     To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.  Retrospective cohort study.  Large US administrative database between 1 January 2010 and 31 December 2014.  5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L.  Thyroid hormone therapy.  Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes.  Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (Ptreatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (Ptreatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Subclinical hypothyroidism and mortality in a large Austrian cohort: a possible impact on treatment?

    Science.gov (United States)

    Kovar, Florian Maria; Fang, I-Fei; Perkmann, Thomas; Haslacher, Helmuth; Slavka, Georg; Födinger, Manuela; Endler, Georg; Wagner, Oswald F

    2015-12-01

    Clinical implications of subclinical hypothyroidism (SCH) are still matter of intense debate, resulting in the controversial discussion whether subclinical hypothyroidism should be treated. We performed a cohort study to evaluate the impact of subclinical hypothyroidism on vascular and overall mortality. Between 02/1993 and 03/2004, a total of 103,135 persons attending the General Hospital Vienna with baseline serum thyrotropin (TSH, thyroid-stimulating hormone) and free thyroxin (fT4) measurements could be enrolled in a retrospective cohort study. Subclinical hypothyroidism was defined by elevated TSH ranging from 4.5 to 20.0 mIU/L and normal fT4 concentration (0.7-1.7 ng/dL). Overall and vascular mortality as primary endpoints were assessed via record linkage with the Austrian Death Registry. A total of 80,490 subjects fulfilled inclusion criteria of whom 3934 participants (3.7%) were classified as SCH (868 males and 3066 females, median age 48 years). The mean follow-up among the 80,490 subjects was 4.1 years yielding an observation period of 373,301 person-years at risk. In a multivariate Cox regression model adjusted for age and gender TSH levels showed a dose-dependent association with all-cause mortality. The association between SCH and overall or vascular mortality was stronger in men below 60 years compared to older males or females. Our data support the hypothesis that SCH might represent an independent risk factor for overall and vascular mortality, especially in men below 60 years. Whether this group would benefit from replacement therapy should be evaluated in interventional studies.

  15. A review on cardiovascular diseases originated from subclinical hypothyroidism.

    Science.gov (United States)

    Mansourian, Azad Reza

    2012-01-15

    Thyroid hormones play an important role on the cardiovascular systems and thyroid disorder ultimately have a profound adverse effects on myocardium and vascular functions. There are extensive reports on the role of overt thyroid dysfunction which adversely can modify the cardiovascular metabolism but even at the present of some controversial reports, the subclinical thyroid disorders are able also to manipulate cardiovascular system to some extent. The aim of this study is to review the cardiovascular disorders accompanied with subclinical hypothyroidism. It is concluded that adverse effect of thyroid malfunction on myocardium and vascular organs are through the direct role of thyroid hormone and dyslipidemia on heart muscle cells at nuclear level and vascular system, respectively. It seems many cardiovascular disorders initially would not have been occurred in the first place if the thyroid of affected person had functioned properly, therefore thyroid function tests should be one of a prior laboratory examinations in cardiovascular disorders.

  16. Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity

    DEFF Research Database (Denmark)

    Feldthusen, Anne-Dorthe; Pedersen, Palle L; Larsen, Jacob

    2015-01-01

    INTRODUCTION: The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb), and mild (subclinical) hypothyroidism in women from The Danish General Suburban Population Study (GESUS) on the number of children born, the number of pregnancies, and the number...... TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated...

  17. Effects of maternal subclinical hypothyroidism on amniotic fluid cells oxidative status.

    Science.gov (United States)

    Novakovic, Tanja R; Dolicanin, Zana C; Djordjevic, Natasa Z

    2018-06-01

    In this study, we researched the effects of maternal subclinical hypothyroidism on the amniotic fluid cells oxidative metabolism during the first trimester of pregnancy. Oxidative stress and damage biomarkers were assayed in the amniotic fluid cells of healthy and pregnant women with subclinical hypothyroidism. Obtained results show that amniotic fluid cells of pregnant women with subclinical hypothyroidism have significantly higher concentrations of oxidative stress biomarkers (superoxide anion, nitric oxide, peroxynitrite) and oxidative damage (lipid peroxide and micronuclei frequency), but lower concentrations of hydrogen peroxide and oxidized glutathione in comparison to healthy pregnant women. We also showed that oxidative stress biomarkers were positively correlated with micronuclei frequency and lipid peroxide concentration in amniotic fluid cells of pregnant women with subclinical hypothyroidism. The present study provides the first evidence for prooxidative effects of maternal subclinical hypothyroidism on the fetus obtained by the estimating oxidative metabolism in the amniotic fluid cells. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Sex differences in risk factors for subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Jeonghoon Ha

    2018-04-01

    Full Text Available Objective: To investigate the prevalence of subclinical hypothyroidism (SCH in Korean adults and identify the risk factors for the occurrence of SCH by sex. Design and methods: This study used data from the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI, a cross-sectional, nationally representative survey, which comprises a health interview survey, a health examination survey and a nutrition survey. To examine SCH, the reference range of thyroid-stimulating hormone (TSH was defined using both the range provided by the test kit manufacturer (SCH-M and a population-based range (SCH-P. We investigated the prevalence of SCH and its risk factors by sex using both reference ranges. Results: The prevalence of SCH in Koreans according to SCH-M (0.35–5.5 μIU/mL was 5.6%, and 3.3% with SCH-P (0.62–6.68 μIU/mL. For men, smoking significantly reduced the incidence of SCH, positive anti-thyroid peroxidase antibody (TPOAb significantly increased the risk of SCH, and in an adjusted model, the risk of SCH in all quartiles increased as the urine iodine creatinine ratio (UICR quartile increased. For women, positive TPOAb was confirmed as a risk factor for SCH, as was the highest UICR quartile. Furthermore, the odds ratio for SCH in urban vs rural residence was 1.78. Conclusions: The prevalence rates of SCH were similar to those reported in the literature and previously known risk factors were confirmed using both TSH reference ranges. The notable findings from this study are that the increased risk of SCH with increased iodine intake was more marked in men than in women and that residential area may be a risk factor for SCH in women.

  19. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.

    Science.gov (United States)

    Baumgartner, Christine; da Costa, Bruno R; Collet, Tinh-Hai; Feller, Martin; Floriani, Carmen; Bauer, Douglas C; Cappola, Anne R; Heckbert, Susan R; Ceresini, Graziano; Gussekloo, Jacobijn; den Elzen, Wendy P J; Peeters, Robin P; Luben, Robert; Völzke, Henry; Dörr, Marcus; Walsh, John P; Bremner, Alexandra; Iacoviello, Massimo; Macfarlane, Peter; Heeringa, Jan; Stott, David J; Westendorp, Rudi G J; Khaw, Kay-Tee; Magnani, Jared W; Aujesky, Drahomir; Rodondi, Nicolas

    2017-11-28

    Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF. © 2017 American Heart Association, Inc.

  20. Study protocol; Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism - a randomised placebo controlled Trial (TRUST)

    NARCIS (Netherlands)

    Stott, D.J.; Gussekloo, J.; Kearney, P.M.; Rodondi, N.; Westendorp, R.G.; Mooijaart, S.; Kean, S.; Quinn, T.J.; Sattar, N.; Hendry, K.; Puy, R. Du; Elzen, W.P. den; Poortvliet, R.K.; Smit, J.W.A.; Jukema, J.W.; Dekkers, O.M.; Blum, M.; Collet, T.H.; McCarthy, V.; Hurley, C.; Byrne, S.; Browne, J.; Watt, T.; Bauer, D.; Ford, I.

    2017-01-01

    BACKGROUND: Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large

  1. Outcome of in vitro fertilization in women with subclinical hypothyroidism.

    Science.gov (United States)

    Cai, YunYing; Zhong, LanPing; Guan, Jie; Guo, RuiJin; Niu, Ben; Ma, YanPing; Su, Heng

    2017-05-25

    Previous studies examining associations between subclinical hypothyroidism (SCH) with in vitro fertilization (IVF) outcome indicate some benefits of levothyroxine (LT4) treatment. But IVF outcomes in treated SCH women whose serum Thyroid Stimulating Hormone (TSH) concentration did and did not exceed 2.5 mIU/L before the IVF cycle has not been studied thoroughly. In this study, we performed a prospective cohort study with 270 treated subclinical hypothyroidism patients undergoing their first IVF retrieval cycle at a single cite. SCH in women receiving LT4 replacement with a basal TSH level between 0.2-2.5mIU/L displayed a similar rate of clinical pregnancy (47.4% vs 38.7%, P = .436), miscarriage (7.4% vs 16.7%, P = .379) and live birth (43.9% vs 32.3%, P = .288) compared to women with a basal TSH level between 2.5-4.2 mIU/L. Strictly controlled TSH (less than 2.5 mIU/L) before IVF may have no effect on the pregnancy rate in LT4 treated SCH women.

  2. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism.

    Science.gov (United States)

    Stott, David J; Rodondi, Nicolas; Kearney, Patricia M; Ford, Ian; Westendorp, Rudi G J; Mooijaart, Simon P; Sattar, Naveed; Aubert, Carole E; Aujesky, Drahomir; Bauer, Douglas C; Baumgartner, Christine; Blum, Manuel R; Browne, John P; Byrne, Stephen; Collet, Tinh-Hai; Dekkers, Olaf M; den Elzen, Wendy P J; Du Puy, Robert S; Ellis, Graham; Feller, Martin; Floriani, Carmen; Hendry, Kirsty; Hurley, Caroline; Jukema, J Wouter; Kean, Sharon; Kelly, Maria; Krebs, Danielle; Langhorne, Peter; McCarthy, Gemma; McCarthy, Vera; McConnachie, Alex; McDade, Mairi; Messow, Martina; O'Flynn, Annemarie; O'Riordan, David; Poortvliet, Rosalinde K E; Quinn, Terence J; Russell, Audrey; Sinnott, Carol; Smit, Jan W A; Van Dorland, H Anette; Walsh, Kieran A; Walsh, Elaine K; Watt, Torquil; Wilson, Robbie; Gussekloo, Jacobijn

    2017-06-29

    The use of levothyroxine to treat subclinical hypothyroidism is controversial. We aimed to determine whether levothyroxine provided clinical benefits in older persons with this condition. We conducted a double-blind, randomized, placebo-controlled, parallel-group trial involving 737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg if the body weight was Hypothyroid Symptoms score and Tiredness score on a thyroid-related quality-of-life questionnaire at 1 year (range of each scale is 0 to 100, with higher scores indicating more symptoms or tiredness, respectively; minimum clinically important difference, 9 points). The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (PHypothyroid Symptoms score (0.2±15.3 in the placebo group and 0.2±14.4 in the levothyroxine group; between-group difference, 0.0; 95% confidence interval [CI], -2.0 to 2.1) or the Tiredness score (3.2±17.7 and 3.8±18.4, respectively; between-group difference, 0.4; 95% CI, -2.1 to 2.9). No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest. Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126 .).

  3. Subclinical hypothyroidism and cognitive function in people over 60 years: A systematic review and meta- analysis.

    Directory of Open Access Journals (Sweden)

    Abimbola A. Akintola

    2015-08-01

    Full Text Available Subclinical hypothyroidism (SCH, defined as elevated thyroid stimulating hormone and normal thyroid hormone levels, and cognitive impairment are both common in older people. While the relation between overt hypothyroidism and cognitive impairment is well established, data on the association between SCH and cognitive impairment are conflicting. This systematic review and meta- analysis was performed to assess available evidence on the association of SCH with cognition in community dwelling, relatively healthy older adults.PubMed, EMBASE, Web of Science, COCHRANE, CINAHL, PsycINFO and Academic Search Premier (January 1966 to April 1, 2015 were searched without language restrictions, as were references of key articles, for studies on the association between SCH and cognition in older adults (>60 years. These studies were reviewed by two independent reviewers according to predefined criteria for eligibility and methodological quality, and data extracted using standardized forms.Of the 844 reports initially identified, 270 remained after exclusion of duplicates. Of the 270, fifteen studies comprising 19, 944 subjects, of whom 1, 199 had subclinical hypothyroidism were included. Data from the 15 studies was pooled, and meta- analyzed cross-sectionally for global cognition (MMSE, executive function, and memory, using random effects models. Pooled effect size (ES for MMSE was -0.01 (95% CI -0.09, 0.08, with heterogeneity (I2 of 55.1%. Pooled ES was <0.001 (95% CI -0.10, 0.09 for executive function (I2 = 13.5%, and 0.01 (95% CI -0.12, 0.14 for memory (I2 = 46.9%. In addition, prospective analysis including four studies showed pooled ES of 0.033 (95% CI -0.001-0.067 for MMSE (I2 <0.001%, indicating that subclinical hypothyroidism was not significantly associated with accelerated cognitive decline.This systematic review and meta-analysis provides no evidence that supports an association between SCH and cognitive impairment in relatively healthy older

  4. Subclinical Hypothyroidism and Survival: The Effects of Heart Failure and Race

    Science.gov (United States)

    Curhan, Gary C.; Alexander, Erik K.; Bhan, Ishir; Brunelli, Steven M.

    2013-01-01

    Context: Studies examining the association between subclinical hypothyroidism and mortality have yielded conflicting results. Emerging data suggest these associations may depend upon underlying congestive heart failure (CHF) and/or race, but this has not been empirically determined. Objective: Our objective was to examine the association between subclinical hypothyroidism and hypothyroidism overall with mortality according to pre-existing CHF and race. Design and Participants: We examined the associations of subclinical hypothyroidism (TSH higher than assay upper limit of normal; total T4 within reference) and hypothyroidism overall (TSH higher than assay upper limit of normal; total T4 below lower limit of normal or within reference) with all-cause mortality among Third National Health and Nutrition Examination Survey participants stratified by CHF and race using multivariable Cox models. To confirm whether differences between strata were statistically significant, we tested for interaction on the basis of CHF (separately) and race by likelihood ratio testing. Results: There were 14 130 (95.0%) euthyroid controls and 749 (5.0%) participants with hypothyroidism, 691 (4.6%) of whom had subclinical disease. Subclinical hypothyroidism vs euthyroidism was associated with greater mortality in those with CHF but not in those without: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) = 1.44 (1.01–2.06) and 0.97 (0.85–1.11), respectively (P interaction = .03). Similar findings were observed for hypothyroidism overall. Hypothyroidism overall vs euthyroidism was associated with greater mortality in Black participants (HR = 1.44 [95% CI = 1.03–2.03]) but not in non-Blacks (HR = 0.95 [95% CI = 0.83–1.08]) (P interaction = .03). Conclusion: Among participants with CHF, subclinical hypothyroidism and hypothyroidism overall are associated with greater death risk. Additional studies are needed to confirm findings and explore possible mechanisms for the

  5. Non-Autoimmune Subclinical and Overt Hypothyroidism in Idiopathic Steroid-resistant Nephrotic Syndrome in Children.

    Science.gov (United States)

    Marimuthu, Vidhya; Krishnamurthy, Sriram; Rajappa, Medha

    2017-11-15

    To evaluate the frequency of non-autoimmune subclinical and overt hypothyroidism in children with idiopathic steroid-resistant nephrotic syndrome (SRNS). This cross-sectional study recruited 30 children (age 1-18 y) with idiopathic SRNS; and 30 healthy controls. Serum T3, T4 and TSH were performed in cases as well as controls. Anti-thyroid peroxidase and anti-thyroglobulin antibody tests were performed in all cases. Non-autoimmune subclinical or overt hypothyroidism was detected in 10 out of 30 children with idiopathic SRNS; 2 had overt hypothyroidism, while 8 patients had subclinical hypothyroidism. Children with SRNS had a mean (SD) TSH value 4.55 (4.64) mIU/L that was higher as compared to controls (1.88 (1.04) mIU/L) (Phypothyroidism (2 cases) and grade III subclinical hypothyroidism (1 case) were subsequently started on levothyroxine therapy. The prevalence of subclinical and overt hypothyroidism seems to be high in idiopathic SRNS, with almost one-third of children having overt or subclinical non-autoimmune hypothyroidism.

  6. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

    DEFF Research Database (Denmark)

    Stott, David J.; Rodondi, Nicolas; Kearney, Patricia M.

    2017-01-01

    737 adults who were at least 65 years of age and who had persisting subclinical hypothyroidism (thyrotropin level, 4.60 to 19.99 mIU per liter; free thyroxine level within the reference range). A total of 368 patients were assigned to receive levothyroxine (at a starting dose of 50 μg daily, or 25 μg......) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year,this level had decreased to 5.48 mIU per liter in the placebo group, as compared with3.63 mIU per liter in the levothyroxine group (P

  7. Subclinical hypothyroidism in danish lean and obese children and adolescents

    DEFF Research Database (Denmark)

    Dahl, Maria; Ohrt, Johanne Dam; Fonvig, Cilius Esmann

    2017-01-01

    : The prevalence of SH was higher among overweight/obese compared to lean study participants (10.4% vs. 6.4%, p=0.0001). In the overweight/obese group, fasting serum TSH concentrations were associated positively with BMI SDS (p... developmental stage, whereas fasting serum fT4 concentrations were associated positively only with WHtR. The odds ratio of exhibiting SH was 1.8 when being overweight/obese compared with lean (p=0.0007) and 1.8 when presenting with a WHtR >0.5 (p=0.0003). Conclusion: The prevalence of SH was higher among......Objective: Thyroid abnormalities are common in obese children. The aim of the present study was to examine the prevalence of subclinical hypothyroidism (SH) and to determine how circulating thyroid hormone concentrations correlate with anthropometrics in Danish lean and obese children...

  8. The Natural History of Subclinical Hypothyroidism in the Elderly: The Cardiovascular Health Study

    Science.gov (United States)

    Somwaru, Lily L.; Rariy, Chevon M.; Arnold, Alice M.

    2012-01-01

    Context: Studies of long-term outcomes of subclinical hypothyroidism have assessed only baseline thyroid function, despite natural transitions to euthyroidism and overt hypothyroidism over time. Objective: We provide estimates of persistence, resolution, and progression of subclinical hypothyroidism over 4 yr, stratified by baseline TSH, anti-thyroid peroxidase antibody (TPOAb) status, age, and sex. Design, Setting, and Participants: Participants were 3996 U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study. Subclinical hypothyroidism was detected at baseline in 459 individuals not taking thyroid medication. Main Outcome Measure: Thyroid function was evaluated at 2 and 4 yr and initiation of thyroid medication annually. Results were stratified by baseline TSH, TPOAb status, age, and sex. Results: Persistence of subclinical hypothyroidism was 56% at 2 and 4 yr. At 2 yr, resolution was more common with a TSH of 4.5–6.9 mU/liter (46 vs. 10% with TSH 7–9.9 mU/liter and 7% with TSH ≥10 mU/liter; P hypothyroidism (P hypothyroidism were common between 2 and 4 yr. Age and sex did not affect transitions. Conclusions: Subclinical hypothyroidism persists for 4 yr in just over half of older individuals, with high rates of reversion to euthyroidism in individuals with lower TSH concentrations and TPOAb negativity. Future studies should examine the impact of transitions in thyroid status on clinical outcomes. PMID:22438233

  9. Subclinical hypothyroidism: A common finding in adult patients with cyanotic congenital heart disease.

    Science.gov (United States)

    Bak, Peter; Hjortshøj, Cristel S; Gaede, Peter; Idorn, Lars; Søndergaard, Lars; Jensen, Annette S

    2018-03-01

    Cyanotic congenital heart disease is a systemic disease, with effects on multiple organ systems. A high prevalence of subclinical hypothyroidism (SCH) has been reported in a small cohort of cyanotic congenital heart disease patients. Subclinical hypothyroidism has been associated with various adverse cardiovascular effects, as well as an increased risk of progression to overt hypothyroidism. The aim of this study was to examine the prevalence of SCH in cyanotic congenital heart disease patients, consider possible etiologies, and evaluate thyroid function over time. First, 90 clinically stable cyanotic congenital heart disease patients were examined with blood samples (thyroid-stimulating hormone, C-reactive protein, hemoglobin, hematocrit, and N-terminal pro-brain-natriuretic peptide) in a cross-sectional descriptive study. Second, a longitudinal follow-up study of 43 patients originating from the first study part, was carried out. These patients had thyroid function parameters (thyroid-stimulating hormone, thyroid hormones, and thyroid peroxidase antibodies) evaluated biannually. Elevated thyroid-stimulating hormone was present in 24% of the 90 screened patients. During follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03). Subclinical hypothyroidism is a very common finding in cyanotic congenital heart disease. This is not associated with increased levels of C-reactive protein, heart failure, or autoimmunity but appears to be associated with cyanosis and age. Since the clinical impact of SCH is uncertain, further studies are needed to determine this. Regular thyroid evaluation is recommended in cyanotic congenital heart disease patients since SCH can develop to overt hypothyroidism. © 2017

  10. Subclinical Hypothyroidism and the Risk of Stroke Events and Fatal Stroke : An Individual Participant Data Analysis

    NARCIS (Netherlands)

    Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P. J.; Ikram, M. Arfan; Blum, Manuel R.; Collet, Tinh-Hai; Bakker, Stephan J. L.; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N.; Hofman, Albert; Portegies, Marileen L. P.; Medici, Marco; Iervasi, Giorgio; Stott, David J.; Ford, Ian; Bremner, Alexandra; Wanner, Christoph; Ferrucci, Luigi; Newman, Anne B.; Dullaart, Robin P.; Sgarbi, Jose A.; Ceresini, Graziano; Maciel, Rui M. B.; Westendorp, Rudi G.; Jukema, J. Wouter; Imaizumi, Misa; Franklyn, Jayne A.; Bauer, Douglas C.; Walsh, John P.; Razvi, Salman; Khaw, Kay-Tee; Cappola, Anne R.; Voelzke, Henry; Franco, Oscar H.; Gussekloo, Jacobijn; Rodondi, Nicolas; Peeters, Robin P.

    Objective: The objective was to determine the risk of stroke associated with subclinical hypothyroidism. Data Sources and Study Selection: Published prospective cohort studies were identified through a systematic search through November 2013 without restrictions in several databases. Unpublished

  11. A Genomic Analysis of Subclinical Hypothyroidism in Hippocampus and Neocortex of the Developing Brain -- JN

    Science.gov (United States)

    Hypothyroidism during pregnancy and the early postnatal period has severe neurological consequences for the developing offspring. The impact of milder degrees of perturbation of the thyroid axis, typically considered subclinical, however, has not been established. Thyroid hormo...

  12. [POSSIBLE CAUSES OF INEFFICIENT MONOTHERAPY OF SUBCLINICAL HYPOTHYROIDISM WITH L-THYROXIN].

    Science.gov (United States)

    Budnevsky, A V; Kravchenko, A Ya; Drobysheva, E S; Fes'kova, A A

    2015-01-01

    Substitution therapy with L-thyroxin was recognized in 2012 to be the method of choice for the treatment of subclinical hypothyroidism. However it does not always allow to achieve normalization of all metabolic parameters. The aim of our work was to search for and analyze data on the possible mechanisms responsible for the failure of replacement hormonal therapy with L-thyroxin with a view to changing the therapeutic strategy for patients with subclinical hypothyroidism.

  13. Subclinical hypothyroidism and diabetic nephropathy in Iranian patients with type 2 diabetes.

    Science.gov (United States)

    Mansournia, N; Riyahi, S; Tofangchiha, S; Mansournia, M A; Riahi, M; Heidari, Z; Hazrati, E

    2017-03-01

    Association of subclinical hypothyroidism with type 2 diabetes and its complications has been previously documented. These reports were, however, inconclusive and mainly gathered from Chinese and East Asian populations. In this study, we aimed to determine the prevalence of subclinical hypothyroidism and its relationship with diabetic nephropathy in Iranian individuals with type 2 diabetes, drawn from a white Middle Eastern population with an increasing prevalence of diabetes. In this cross-sectional study, 255 Iranian participants with type 2 diabetes and without history of thyroid disorders were included. Patients with TSH > 4.2 mIU/L and normal T4 were classified as having subclinical hypothyroidism. Diabetic nephropathy was diagnosed based on abnormal 24-h urinary albumin or protein measurements (24-h urinary albumin ≥30 mg/day or 24-h urinary protein ≥150 mg/day). Multivariate logistic regression was employed to obtain the OR for the relationship between subclinical hypothyroidism and diabetic nephropathy. We found that subclinical hypothyroidism and diabetic nephropathy were as prevalent as 18.1 and 41.2 %, respectively, among the participants. We also found that subclinical hypothyroidism was independently associated with higher rates of diabetic nephropathy, after multivariable adjustment (OR [95 % CI] 3.23 [1.42-7.37], p = 0.005). We found that the prevalence of subclinical hypothyroidism in Iranian diabetic population was among the highest rates reported to date. Our data supported the independent association of subclinical hypothyroidism with diabetic nephropathy, calling for further investigations to evaluate their longitudinal associations.

  14. Changes of subtests of Wechsler Memory Scale and cognitive function in subjects with subclinical hypothyroidism following treatment with levothyroxine.

    Science.gov (United States)

    Aghili, Rokhsareh; Khamseh, Mohammad E; Malek, Mojtaba; Hadian, Ali; Baradaran, Hamid R; Najafi, Laily; Emami, Zahra

    2012-12-20

    Subclinical hypothyroidism has been reported to be associated with disturbed cognitive function. In this study, changes of subtests of the Wechsler Memory Scale and memory quotient were investigated in subjects with subclinical hypothyroidism following treatment with levothyroxine. The aim of the study was a randomized double blind placebo-controlled clinical trial. Sixty subjects (51 females and 9 males) with subclinical hypothyroidism were enrolled. Memory quotient was evaluated at the beginning of the study and three months after enrollment, using Wechsler's memory test. Subclinical hypothyroidism was defined as serum TSH level between 4.5 mU/l and 10 mU/l in the presence of normal free-T4 (0.8-2 ng/dl) and positive anti-TPO-Ab. The intervention and control groups received levothyroxine and placebo respectively for 3 months. Re-evaluation was done using the Wechsler Memory Scale at the end of the study. The mean age was 34 ±10 years, mean TSH level was 8.25 ±3.64 muIU/l. Memory quotient was similar in both groups at the beginning of the study: 105.70 ±2.1 in intervention group vs. 105.87 ±2.1 in control group (p = 0.89). At the end of the study, the memory quotient rose by 9.3 points in the intervention group and by 3.23 in the controls (p = 0.002). Analysis of the scores of Wechsler Memory subtests in the intervention group indicated significant improvement of mental control (p = 0.002), logical memory (p < 0.001), associate learning (p = 0.014), age corrected score (p = 0.002), and memory quotient (p < 0.001). This study showed the efficacy of levothyroxine for cognitive function of subjects with subclinical hypothyroidism.

  15. Subclinical Hypothyroidism in Children and Adolescents: a single-center retrospective study

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    Ana Margarida Monteiro

    2018-04-01

    Conclusion: The mild form of subclinical hypothyroidism was the most common typepf disease and, among patients managed conservatively, the majority presented normal thyroid function after one year of follow-up and none progressed to overt hypothyroidism. Our results reinforce the idea that, in most patients, subclinical hypothyroidism is a benign condition with a low risk of progression to overt thyroid dysfunction. However, further studies are needed to evaluate the potential long-term effects of the condition in untreated patients and to clarify the best clinical approach and follow-up strategy.

  16. Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study

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    Anne-Dorthe Feldthusen

    2015-01-01

    Full Text Available Introduction. The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb, and mild (subclinical hypothyroidism in women from The Danish General Suburban Population Study (GESUS on the number of children born, the number of pregnancies, and the number of spontaneous abortions. Methods. Retrospective cross sectional study of 11254 women participating in GESUS. Data included biochemical measurements and a self-administrated questionnaire. Results. 6.7% had mild (subclinical hypothyroidism and 9.4% prevalent hypothyroidism. In women with mild hypothyroidism TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated with spontaneous abortions. Mild (subclinical hypothyroidism was associated with a risk of not having children and a risk of not getting pregnant in age-adjusted and multiadjusted models. Prevalent hypothyroidism was not associated with the number of children born, the number of pregnancies, or spontaneous abortions. Conclusion. Impaired fertility is associated with TSH, TPOAb, and mild (subclinical hypothyroidism in a Danish population of women.

  17. Changes of serum bone metabolic biochemical markers in elderly subjects with subclinical hypothyroidism

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    Dai Yaozong; Li Liren

    2005-01-01

    Objective: To explore the clinical significance of changes of serum bone metabolic biochemical markers levels in elderly subjects with subclinical hypothyroidism. Methods: Serum S-BGP (with RIA), TSH, FT 4 (with ECLIA), total cholesterol (TC), triglyceride (TG), HDL, LDL, ApoA 1 , ApoB and Ca 2+ (with biochemical methods) were measured in 30 elderly subjects with subclinical hypothyroidism and 30 controls. Results: The serum levels of S-BGP and calcium in elderly subjects with subclinical hypothyroidism (2.78 ± 0.96 μg/L and 2.16 ± 0.17 mmol/L respectively) were significantly lower than those in controls (3.9 ± 1.48 μg/L and 2.31 ± 0.21 mmol/L respectively, both P<0.01). TC and LDL levels in the subclinical hypothyroid subjects (5.58 ± 0.41 mmol/L and 3.67 ± 0.36 mmol/L) were significantly higher than those in controls (P<0.01). Conclusion: The lowering of calcium levels in subjects with subclinical hypothyroidism would lead to loss of bone mass. Decreased S-BGP contents might be the chief cause of osteoporosis in these subjects. (authors)

  18. Association of metabolic risks with subclinical hypothyroidism: A cross-sectional analysis.

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    Khan, Sikandar Hayat; Manzoor, Syed Mohsin; Niazi, Najumusaquib Khan; Asif, Naveed; Ijaz, Aamir; Fazal, Nadeem

    2018-01-01

    To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism. This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:≥ 10.0 mIU/L, n=9). LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant. LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.

  19. Cardiovascular Risk Factors in Children and Adolescents with Subclinical Hypothyroidism.

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    Yadav, Yogesh; Saikia, Uma Kaimal; Sarma, Dipti; Hazarika, Manoj

    2017-01-01

    Subclinical hypothyroidism (SCH) is a commonly encountered entity in day-to-day clinical practice and has been associated with adverse cardiovascular risk profile in adults and children. Data on children and adolescents with SCH, from India, are limited. This study was a cross-sectional case-control study, conducted at a tertiary care center in Northeast India. Twenty-seven children and adolescents aged 11 ± 2.4 years with SCH and thyroid-stimulating hormone >7.5 mIU/L were included in the study along with 20 age-, gender-, and height-matched controls. Multiple clinical, biochemical, and radiological cardiovascular risk factors were assessed and compared between the two groups. Body mass index (BMI) ( P = 0.048), waist circumference ( P = 0.008), waist to height ratio ( P = 0.007), low-density lipoprotein cholesterol ( P = 0.04), triglycerides (TGs) ( P = 0.038), TGs to high-density lipoprotein (HDL) cholesterol ratio ( P = 0.005), non-HDL cholesterol ( P = 0.019), fasting insulin ( P = 0.006), and homeostasis model assessment of insulin resistance ( P = 0.007) were found to be significantly higher while free T4 ( P = 0.002) and HDL cholesterol ( P = 0.019) were found to be significantly lower in SCH subjects compared to controls. On multiple regression analysis, BMI was found to have significant association with multiple cardiovascular risk factors. Children and adolescents with SCH were found to have adverse cardiovascular risk profile. Long-term follow-up studies are required to assess the clinical significance of these findings and requirement for therapy.

  20. Cardiovascular risk factors in children and adolescents with subclinical hypothyroidism

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    Yogesh Yadav

    2017-01-01

    Full Text Available Background: Subclinical hypothyroidism (SCH is a commonly encountered entity in day-to-day clinical practice and has been associated with adverse cardiovascular risk profile in adults and children. Data on children and adolescents with SCH, from India, are limited. Materials and Methods: This study was a cross-sectional case–control study, conducted at a tertiary care center in Northeast India. Twenty-seven children and adolescents aged 11 ± 2.4 years with SCH and thyroid-stimulating hormone >7.5 mIU/L were included in the study along with 20 age-, gender-, and height-matched controls. Multiple clinical, biochemical, and radiological cardiovascular risk factors were assessed and compared between the two groups. Results: Body mass index (BMI (P = 0.048, waist circumference (P = 0.008, waist to height ratio (P = 0.007, low-density lipoprotein cholesterol (P = 0.04, triglycerides (TGs (P = 0.038, TGs to high-density lipoprotein (HDL cholesterol ratio (P = 0.005, non-HDL cholesterol (P = 0.019, fasting insulin (P = 0.006, and homeostasis model assessment of insulin resistance (P = 0.007 were found to be significantly higher while free T4 (P = 0.002 and HDL cholesterol (P = 0.019 were found to be significantly lower in SCH subjects compared to controls. On multiple regression analysis, BMI was found to have significant association with multiple cardiovascular risk factors. Conclusion: Children and adolescents with SCH were found to have adverse cardiovascular risk profile. Long-term follow-up studies are required to assess the clinical significance of these findings and requirement for therapy.

  1. Subclinical hypothyroidism in the first trimester of pregnancy in North India

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    Jubbin Jagan Jacob

    2013-01-01

    Full Text Available Subclinical hypothyroidism based on population and trimester specific cut-offs is reported to complicate 1-2% of all pregnancies. Using the recent Endocrine Society guidelines of 2.5 mIU/L of Thyroid Stimulating Hormone as the upper level of normal in the first trimester the reported prevalence of subclinical hypothyroidism is much higher. Recent publications have also emphasized that there is considerable racial variation in the prevalence of thyroid disorders in pregnancy. Among published literature North Indian women appear to have the highest rates of subclinical hypothyroidism in the first trimester of pregnancy. More widespread use of universal screening and trimester specific ranges in pregnancy for thyroid hormonal assays will lead to a large number of North Indian women requiring treatment for thyroid disorders in pregnancy.

  2. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR 2) in Mild Subclinical Hypothyroid Subjects.

    Science.gov (United States)

    Sengupta, Shreejita; Jaseem, T; Ambalavanan, Jayachidambaram; Hegde, Anupama

    2018-04-01

    Despite various studies with conflicting results, the effect of thyroid hormones on lipids and insulin levels in dysthyroidism is of great interest. This case control study was aimed to perceive the existence of IR and dyslipidemia in mild subclinical hypothyroid subjects (TSH ≤ 9.9 µIU/ml) as compared to their age and gender matched euthyroid controls. Basic demographic information like height, weight was recorded. Serum samples of all the subjects were assayed for thyroid profile, lipid profile, blood glucose, HbA1C and insulin. BMI and insulin resistance was calculated. Compared to controls patients with mild subclinical hypothyroidism demonstrated hyperinsulinemia and dyslipidemia observed by the higher LDL cholesterol. A significantly positive correlation was observed for HOMA-IR with TSH and LDL cholesterol. Hence, even in the mild subclinical hypothyroid state assessment of thyroid function should be combined with estimation of plasma glucose, insulin and serum lipids to monitor and prevent its associated effects.

  3. [Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism].

    Science.gov (United States)

    Curotto Grasiosi, Jorge; Peressotti, Bruno; Machado, Rogelio A; Filipini, Eduardo C; Angel, Adriana; Delgado, Jorge; Cortez Quiroga, Gustavo A; Rus Mansilla, Carmen; Martínez Quesada, María del Mar; Degregorio, Alejandro; Cordero, Diego J; Dak, Marcelo; Izurieta, Carlos; Esper, Ricardo J

    2013-10-01

    To assess whether levothyroxine treatment improves functional capacity in patients with chronic heart failure (New York Heart Association class i-iii) and subclinical hypothyroidism. One hundred and sixty-three outpatients with stable chronic heart failure followed up for at least 6 months were enrolled. A physical examination was performed, and laboratory tests including thyroid hormone levels, Doppler echocardiogram, radionuclide ventriculography, and Holter monitoring were requested. Functional capacity was assessed by of the 6-min walk test. Patients with subclinical hypothyroidism were detected and, after undergoing the s6-min walk test, were given replacement therapy. When they reached normal thyrotropin (TSH) levels, the 6-min walk test was performed again. The distance walked in both tests was recorded, and the difference in meters covered by each patient was analyzed. Prevalence of subclinical hypothyroidism in patients with heart failure was 13%. These patients walked 292±63m while they were hypothyroid and 350±76m when TSH levels returned to normal, a difference of 58±11m (P<.011). Patients with normal baseline TSH levels showed no significant difference between the 2 6-min walk tests. Patients with chronic heart failure and subclinical hypothyroidism significantly improved their physical performance when normal TSH levels were reached. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  4. Improvement in subclinical cognitive dysfunction with thyroxine therapy in hypothyroidism: A study from tertiary care center

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    Sridevi Paladugu

    2015-01-01

    Full Text Available Aim: To evaluate the effect of hypothyroidism (both overt and subclinical on cognitive function using latencies of P300 auditory evoked potentials (AEPs. P300 latency suggests that shorter latency times are related to better cognitive performance. P300 latencies were also done after thyroxine replacement to see the effect of treatment on cognitive function. Materials and Methods: Biochemically proven new onset cases with hypothyroidism (overt and subclinical were enrolled into the study, AEPs of these two groups when compared with matched controls. After detailed history and physical examination, P300 potentials were recorded at two points Cz and Pz (Cz: On the midline of the head at the vertex, Pz: On the midline of the head between the vertex and occipital protuberance using a Nicolet Viking Select neuro diagnostic system version 10.0. The study was done in electrophysiology lab in Osmania Medical College. Results: A patient characteristics of both cases and controls were comparable. The cases consisted of two groups, overt hypothyroid cases 24, mean thyroid stimulating hormone (TSH values in them was 94, subclinical cases 21 in whom mean TSH value was 12.3. Mean P300 latencies of all cases at Cz was 342.42 ± 29.5 ms, and at Pz was 345.4 ± 30 ms. Mean P300 latencies of controls at Cz was 296.4 ± 34 ms and at Pz was 297.9 ± 33 ms (difference in P < 0.001. Mean P300 values in overt cases were 362.6 ± 32.9 ms at Cz, and at Pz it was 362.5 ± 33.9 ms. Mean P300 values in subclinical cases were 319.3 ± 30.9 ms at Cz, and at Pz it was 316.4 ± 27.9 ms. P300 values in overt cases were highly significant as compared to controls, and P300 values in the subclinical cases versus controls were also significant (P < 0.001. Conclusion: P300 latency prolongation in both clinical and subclinical hypothyroid cases shows that cognitive function is affected adversely in hypothyroidism including the subclinical hypothyroid cases. Larger studies evaluating

  5. SUBCLINICAL HYPOTHYROIDISM IN METABOLIC SYNDROME AND ROLE OF CRP IN 50 ADULT PATIENTS

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    Pratik Shah

    2017-04-01

    Full Text Available BACKGROUND Metabolic Syndrome (MetS is generally characterised as a clustering of the abnormal levels of blood lipids (low HDL and high triglycerides, impaired fasting glucose, elevated blood pressure, and excess abdominal obesity. The objectives of the study areTo evaluate presence of Subclinical Hypothyroidism in the study population of the patients with metabolic syndrome. To find out relation between Subclinical Hypothyroidism and different parameters of metabolic syndrome. To evaluate whether patients of metabolic syndrome with raised hs-CRP have an increased risk of having hypothyroidism. MATERIALS AND METHODS A total of 50 adult patients who met with inclusion criteria were selected. Patients with metabolic syndrome (MetS who fulfilled the NCEP-ATP III criteria: 3 out of 5 criteria positive. Patients with liver disorders, renal disorders, congestive cardiac failure, pregnant women, patients on oral contraceptive pills, statins and other medications that alter thyroid functions (e.g. lithium, amiodarone or γ-interferon were excluded from the study. RESULTS A total of 50 patients of metabolic syndrome were enrolled. Out of which 36 were euthyroid, 3 were overt hypothyroid and 11 were subclinical hypothyroid. Out of 11 patients of subclinical hypothyroidism, 9 were female and 2 were male patients. Out of 28 females, 9 (32% were SCH while out of 22 males, 2 (9% were SCH. Out of 50 patients, 3 were overt hypothyroid. All 3 patients had BP >130/85, waist circumference was >88 cm and HDL of 130/85, HDL 150 mg/dL and fasting blood glucose of >100 mg/dL were more associated with male patients. CONCLUSION Subclinical Hypothyroidism was present in 22% of study population and more so in females having metabolic syndrome (32%. Hence, it will be worthwhile to screen female metabolic syndrome patients for thyroid function abnormality. Abnormal blood pressure, triglycerides and HDL cholesterol levels were more associated with subclinical hypothyroidism

  6. Subclinical Hypothyroidism in Children: Normal Variation or Sign of a Failing Thyroid Gland?

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    Kaplowitz PaulB

    2010-05-01

    Full Text Available Subclinical hypothyroidism (SCH, defined by a normal total or free T4 level and a mildly elevated TSH (typically 5–10 mU/L, is common in children, but there is currently no consensus on management. Several recent pediatric studies indicate that progression of SCH to overt hypothyroidism (OH is uncommon and that over a period of several years, elevated TSH usually either normalizes or persists but does not increase. The etiology appears to be multifactorial, with some cases representing minor developmental abnormalities, some related to obesity, some to mild autoimmune thyroiditis, and some associated with mutations in the gene for the TSH-receptor. There are no pediatric studies showing clinical benefit of treating these children with thyroid hormone, but additional studies in this area are needed. Since few cases of pediatric SCH progress to OH, treatment can be deferred, and periodic follow-up testing may be the preferred strategy, with elevated thyroid antibodies or a goiter being considered risk factors for eventual OH.

  7. Levothyroxine substitution in patients with subclinical hypothyroidism and the risk of myocardial infarction and mortality

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    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager

    2015-01-01

    BACKGROUND: Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of ...

  8. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

    2015-01-01

    Background Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Methods and Results Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI’s and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Conclusion Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI. PMID:26069971

  9. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

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    Mette Nygaard Andersen

    Full Text Available Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI, cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism.Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9% had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female. Within the first six months 2,483 (20.3% patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2 years, 358 MI's and 1,566 (12.8% deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44], cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25] or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19], except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99].Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  10. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality.

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

    2015-01-01

    Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI's and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  11. Cardiovascular Risk Factors in Subclinical Hypothyroidism: A Case Control Study in Nepalese Population

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    Rajendra KC

    2015-01-01

    Full Text Available Objectives. To assess cardiovascular risk factors in Nepalese population with subclinical hypothyroidism as compared to age and sex matched controls. Materials and Methods. A case control study was conducted among 200 subjects (100 subclinical hypothyroid and 100 euthyroid at B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Demographic and anthropometric variables including systolic and diastolic blood pressure (BP were taken. Blood samples were assayed for serum free triiodothyronine (fT3, free thyroxine (fT4, thyroid stimulating hormone (TSH, total cholesterol (TC, high density lipoprotein cholesterol (HDL-C, low density lipoprotein cholesterol (LDL-C, and high sensitivity C reactive protein (hs-CRP. Results. Subclinical hypothyroid patients had significantly higher diastolic BP, total cholesterol, LDL cholesterol, and hs-CRP than controls. The odds ratio of having hypercholesterolemia (>200 mg/dL, low HDL cholesterol (100 mg/dL, high hs-CRP (>1 mg/L, and high diastolic BP (>80 mmHg and being overweight (BMI ≥ 23 Kg/m2 in subclinical hypothyroidism was 2.29 (95% CI; 1.2–4.38, p=0.011, 1.73 (95% CI; 0.82–3.62, p=0.141, 3.04 (95% CI; 1.66–5.56, p<0.001, 2.02 (95% CI; 1.12–3.64, p=0.018, 3.35 (95% CI; 1.72–6.55, p<0.001, and 0.9 (95% CI; 0.48–1.67, p=0.753, respectively, as compared to controls. Conclusion. Subclinical hypothyroid patients are associated with higher risk for cardiovascular disease than euthyroid subjects.

  12. Prevalence of subclinical hypothyroidism in adults visiting primary health-care setting in Riyadh.

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    Al Eidan, Eidan; Ur Rahman, Saeed; Al Qahtani, Saeed; Al Farhan, Ali I; Abdulmajeed, Imad

    2018-01-01

    Background and objectives : Subclinical hypothyroidism is an asymptomatic condition with normal thyroxin and raised thyroid stimulating hormone (TSH) level. The objective of the study was to determine the prevalence of subclinical hypothyroidism in primary health care (PHC) settings in Riyadh and explore the relationship of TSH level with age, gender, family history, body mass index, and co-morbid conditions. Subjects and methods : A cross-sectional study of adult visitors to nine satellites PHC clinics in military housing in Riyadh was carried out. TSH concentration and free T4 levels were measured. Data were collected by nurses and physicians during routine clinical practice in primary care. Descriptive analysis was performed on all variables in study, and relationships were explored using chi-square, t -test, analysis of variance, and linear regression. Results : A total of 340 out of 394 participants in the study gave blood samples. Subclinical hyperthyroidism was identified in 2.1% ( p  = .001) and subclinical hypothyroidism in 10.3% ( p  = .001) of the PHC visitors. TSH levels were found to be significantly higher ( p  = .047) in elderly population of ≥60 years and those with family history of thyroid disease. Non-significant upward trends were noted in TSH levels with hyperlipidemia and increasing blood pressure. No overt hyperthyroidism or hypothyroidism was found in our study sample. Conclusion : Subclinical hypothyroidism has a prevalence of 10% of adults visiting PHC's. TSH levels are higher in the elderly, which warrants screening of those aged 60 years and above.

  13. Lipids in newly discovered subclinical and clinical hypothyroidism

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    Marinković Snežana

    2016-01-01

    Full Text Available There is a positive correlation between the levels of TSH and cholesterol levels, while levels between TSH levels triglicrerida negative correlation with the clinical and subclinical form of reduced thyroid function.

  14. The effect of L-thyroxine treatment on hypothyroid symptom scores and lipid profile in children with subclinical hypothyroidism.

    Science.gov (United States)

    Çatlı, Gönül; Anık, Ahmet; Ünver Tuhan, Hale; Böber, Ece; Abacı, Ayhan

    2014-12-01

    To evaluate i) the frequency of typical hypothyroidism symptoms in children with subclinical hypothyroidism (SH), ii) to evaluate the association of SH with lipoproteins and iii) to investigate possible improving effects of L-thyroxine (LT4) treatment on these findings. Twenty-seven children with SH who had elevated thyroid-stimulating hormone (TSH: >4.94 µIU/L) but normal free T4 levels and healthy euthyroid children of similar age and sex were enrolled in the study. Anthropometric and laboratory (lipid profile and thyroid function tests) measurements were performed at diagnosis and six months after euthyroidism was achieved. All children were also subjected to a questionnaire on hypothyroid symptoms at diagnosis. The SH patients were subjected to the questionnaire also following treatment. Pre-treatment data were compared with those of controls and post-treatment measurements. Anthropometric and laboratory parameters of the groups were not statistically different except for higher TSH levels in the SH group. Serum lipoprotein levels and dyslipidemia frequency were similar between the groups. Compared to the controls, hypothyroidism symptom score was significantly higher in the SH group. Six months after euthyroidism was achieved, a significant reduction in the hypothyroid symptom score was obtained in the SH group. Except for significantly higher serum TSH values, no significant differences regarding demographic characteristics, symptom scores and lipid parameters were present between patients with Hashimoto's thyroiditis and the remaining SH patients. The results of this study showed that in children with SH i) the hypothyroidism symptom score was significantly higher than in euthyroid children, ii) LT4 treatment improved the hypothyroidism symptom score and iii) SH does not seem to be associated with dyslipidemia.

  15. Comparison of Pre and Post-Treatment Orexin A Levels in Patients with Subclinical Hypothyroidism

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    Muhammed Erdal

    2010-01-01

    Full Text Available Aim: Subclinical hypothyroidism is a clinical condition mostly observed in women, the prevalence of which increases by age. Sleepiness and appetite problems are observed in subclinical hypothyroidism. Orexins play a role in the physiological regulations like the stabilization of cardiovascular functions and the sleep-alert cycle. Similarities in the physiological regulation areas of orexins and the clinical findings of hypothyroidism were influential in the planning of this research. Additionally, homosisteine, which is influential on the cardiovascular system and the plasma level of which changes by eating (as is the case with orexins, was also analyzed. Besides, the change in the lipid profiles of the patients was also observed. Material and Methods: Nineteen pre-menopausal female patients (mean age=39.58±12.58, mean BMI= 26.7±4.9 included in this study. Following 12 hours fasting blood samples were taken from brachial vein. All patients were given 50µg/day L-T4 TSH levels were examined in every 4-6 weeks to adjust the L-T4 doses. When euthyroidism was ensured, a re-evaluation was made 4 months later. Results:  Pre-treatment plasma orexin A levels of 19 patients with pre-menopausal subclinical hypothyroidism increased significantly following a treatment of l-tiroxin for 4 months (pre-treatment orexin level median=1.20 mg/dl (mean: 1.33±0.28 post-treatment median=1.82 mg/dl (mean: 1.70±0.42 p=0.007. A significant change in the level of plasma total homosisteine and lipid profile was not detected. Conclusions: Advanced studies are needed to study the physiological effects of orexin levels in cases with subclinical hypothyroidism and the possible benefits in treatment.

  16. Both exogenous subclinical hyperthyroidism and short-term overt hypothyroidism affect myocardial strain in patients with differentiated thyroid carcinoma

    NARCIS (Netherlands)

    Abdulrahman, Randa M.; Delgado, Victoria; Hoftijzer, Hendrieke C.; Ng, Arnold C. T.; Ewe, See Hooi; Marsan, Nina Ajmone; Holman, Eduard R.; Hovens, Guido C.; Corssmit, Eleonora P.; Romijn, Johannes A.; Bax, Jeroen J.; Smit, Johannes W. A.

    2011-01-01

    Background: The cardiovascular effects of transitions from exogenous subclinical hyperthyroidism to short-term overt hypothyroidism in patients treated for differentiated thyroid carcinoma remain unclear. The present study aims at evaluating the changes in multidirectional myocardial strain using

  17. [Subclinical and manifested hypothyroidism as a consequence of thyroid autoimmune disease].

    Science.gov (United States)

    Milosević, Dragoslav P; Djurica, Snezana; Davidović, Mladen; Stević, Radmila; Rajić, Miodrag; Marković, Natasa

    2005-10-01

    Chronic thyroiditis (Hashimoto's disease) is a slowly developing persistent inflamation of the thyroid gland, which frequently leads to hypothyroidism. Some of the up-to-date knowledge about hypothyroidism, both subclinical and manifested, caused by autoimmune disease, was presented. Autoimmune thyroid gland disease can occur at any age, but predominantly affects women after periods of high emotional and physical stress or accidents, as well as during periods of hormonal changes. It can also develop in families, and having an autoimmune disease slightly increases the risk of developing another. This paper showed an increasing incidence of subclinical hypothyroidism (4.17%) in elderly, and, at the same time, the incidence of primary hypothyroidism accounting for 1%. It is very usefull to estimate the stimulated thyrotropin (TSH) response, as well as the value of fast, short time thyroid gland reserves, analyzed by T3 and T4 serum level at 60th minute after TRH stimulation. Treatment of choice for HT (hypothyroidism of any cause) is thyroid hormone replacement. Drug of choice is orally administered levothyroxine sodium, usually for life-time. The standard dose is 1.6-1.8 mcg/kg body weight per day, but is in most cases patient dependent. Elderly patients usually require smaller replacement dose of levothyroxine, sometimes less than 1 mcg/kg body weight per day with coronary dilatator at the same time.

  18. Regression of the increased common carotid artery-intima media thickness in subclinical hypothyroidism after thyroid hormone replacement.

    Science.gov (United States)

    Kim, Soo-Kyung; Kim, Se-Hwa; Park, Kyung-Sun; Park, Seok-Won; Cho, Yong-Wook

    2009-01-01

    The association between subclinical hypothyroidism and cardiovascular disease and the beneficial effect of levothyroxine replacement in subclinical hypothyroidism are still under debate. The present study was designed to determine whether subclinical hypothyroidism is associated with an increase in the intima-media thickness of the common carotid artery (C-IMT) and whether thyroid hormone replacement can reverse this change in the C-IMT. Patients with newly-diagnosed subclinical (n=36) and overt (n=40) hypothyroidism and healthy euthyroid individuals (n=32) participated in this study. All the patients were examined for clinical characteristics, and the serum lipid levels and the C-IMT were measured. Patients with subclinical hypothyroidism had a C-IMT measurement after 18 months of levothyroxine replacement. There were meaningful differences in total cholesterol and LDL-cholesterol levels between patients with subclinical hypothyroidism and euthyroidism. The subjects with subclinical and overt hypothyroidism had a greater C-IMT compared with euthyroid controls (0.66+/- 0.10 and 0.70+/- 0.11 vs. 0.57+/- 0.08 mm, respectively; P replacement significantly decreased the C-IMT (0.67+/- 0.11 to 0.60+/- 0.10 mm; P = 0.021) and improved the lipid profile. Based on multiple regression analysis, the decrement in LDL-cholesterol was independently associated with the regression of the C-IMT. Subclinical hypothyroidism was closely related to an increased C-IMT. Thyroid hormone replacement resulted in regression of the increased C-IMT, which was attributed to the improvement in the lipid profile.

  19. Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study.

    Science.gov (United States)

    Andrade, Gustavo R G; Gorgulho, Bartira; Lotufo, Paulo A; Bensenor, Isabela M; Marchioni, Dirce M

    2018-05-30

    Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years. Dietary data was collected using a previously validated food frequency questionnaire. Subclinical hypothyroidism was categorized as thyroid-stimulating hormone levels of >4.0 IU/mL and free prohormone thyroxine levels within normal limits, without administering drugs for thyroid disease. A multiple logistic regression model was used to assess the relationship between the presence of subclinical hypothyroidism and tertiles of Se consumption. The prevalence of subclinical hypothyroidism in the study sample was 5.4% (95% confidence interval [CI], 3.8⁻7.0%). Compared with the first tertile of Se intake, the second (odds ratio [OR], 0.79; 95% CI, 0.65⁻0.96%) and third (OR, 0.72; 95% CI, 0.58⁻0.90%) tertiles were inversely associated with subclinical hypothyroidism, however further research is needed to confirm the involvement of Se in subclinical hypothyroidism using more accurate methodologies of dietary assessment and nutritional status to evaluate this relationship.

  20. Massive pericardial effusion without cardiac tamponade due to subclinical hypothyroidism (Hashimoto's disease).

    Science.gov (United States)

    Papakonstantinou, Panteleimon E; Gourniezakis, Nikolaos; Skiadas, Christos; Patrianakos, Alexandros; Gikas, Achilleas

    2018-05-01

    Hypothyroidism is a significant cause of pericardial effusion. However, large pericardial effusions due to hypothyroidism are extremely rare. Hormone replacement therapy is the cornerstone of treatment for hypothyroidism and regular follow-up of patients after initiation of the therapy is indicated. Herein, the case of a 70-year-old woman with a massive pericardial effusion due to Hashimoto's disease is presented. A 70-year-old female from a rural village on the island of Crete, Greece, was admitted to our hospital due to a urinary tract infection. She was under hormone replacement therapy with levothyroxine 100 µg once a day for Hashimoto's disease. Two years previously, the patient had had an episode of pericarditis due to hypothyroidism and had undergone a computed tomography-guided pericardiocentesis. The patient did not have regular follow-up and did not take the hormone replacement therapy properly. On admission, the patient's chest X-ray incidentally showed a possible pericardial effusion. The patient was referred for echocardiography, which revealed a massive pericardial effusion. Beck's triad was absent. Thyroid hormones were consistent with subclinical hypothyroidism: thyroid-stimulating hormone (TSH) 30.25 mIU/mL (normal limits: 0.25-3.43); free thyroxin 4 0.81 ng/dL (normal limits: 0.7-1.94). The patient had a score of 5 on the scale outlined by the European Society of Cardiology (ESC) position statement on triage strategy for cardiac tamponade and, despite the absence of cardiac tamponade, a pericardiocentesis was performed after 48 hours. The patient was treated with 125 µg levothyroxine orally once daily. This was a rare case of an elderly female patient from a rural village with chronic massive pericardial effusion due to subclinical hypothyroidism without cardiac tamponade. Hypothyroidism should be included in the differential diagnosis of pericardial effusion, especially in a case of unexplained pericardial fluid. Initiation of hormone

  1. Study protocol; Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism - a randomised placebo controlled Trial (TRUST).

    Science.gov (United States)

    Stott, David J; Gussekloo, Jacobijn; Kearney, Patricia M; Rodondi, Nicolas; Westendorp, Rudi G J; Mooijaart, Simon; Kean, Sharon; Quinn, Terence J; Sattar, Naveed; Hendry, Kirsty; Du Puy, Robert; Den Elzen, Wendy P J; Poortvliet, Rosalinde K E; Smit, Jan W A; Jukema, J Wouter; Dekkers, Olaf M; Blum, Manuel; Collet, Tinh-Hai; McCarthy, Vera; Hurley, Caroline; Byrne, Stephen; Browne, John; Watt, Torquil; Bauer, Douglas; Ford, Ian

    2017-02-03

    Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large randomised controlled trial (RCT) of Levothyroxine treatment for SCH. Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range. The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects hypothyroid symptoms and fatigue / vitality) on the thyroid-related quality of life questionnaire (ThyPRO) at one year. The study has 80% power (at p = 0.025, 2-tailed) to detect a change with levothyroxine treatment of 3.0% on the hypothyroid scale and 4.1% on the fatigue / vitality scale with a total target sample size of 750 patients. Secondary outcomes include general health-related quality of life (EuroQol), fatal and non-fatal cardiovascular events, handgrip strength, executive cognitive function (Letter Digit Coding Test), basic and instrumental activities of daily living, haemoglobin, blood pressure, weight, body mass index and waist circumference. Patients are monitored for specific adverse events of interest including incident atrial fibrillation, heart failure and bone fracture. This large multicentre RCT of levothyroxine treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition. Clinicaltrials.gov NCT01660126 ; registered 8th June 2012.

  2. Pattern Of Altered Lipid Profile In Patients With Subclinical And Clinical Hypothyroidism And Its Correlation With Body Mass Index

    International Nuclear Information System (INIS)

    Humerah, S.; Siddiqui, A.; Khan, H. F.

    2016-01-01

    Objective: To compare the lipid profile of the subclinical and clinical hypothyroid patients and to evaluate the correlation between body mass index (BMI) and lipid profile in hypothyroidism. Study Design: Cross-sectional study. Place and Duration of Study: Islamic International Medical College, Riphah International University, Islamabad, and Citi Laboratory, Rawalpindi, from January to December 2013. Methodology: The subjects were selected through non-probability, purposive sampling. On the basis of thyroid profile, the subjects were divided into 3 groups: euthyroids (n=20), subclinical hypothyroids (n=50), and clinical hypothyroids (n=30). The blood of these subjects was then analyzed for lipid profile. Data was analyzed using SPSS version 18 statistical software. Result: Both hypothyroid groups showed altered lipid profile which was observed to be significantly raised when compared with the euthyroid subjects. Comparison of lipid profile in euthyroid, subclinical, and clinical hypothyroid groups showed significant differences by non-parametric tests (p < 0.05). An assessment of correlation of lipid profile with the BMI was found to be significant (p < 0.01). Conclusion: Hypothyroidism causes alteration of lipid profile. Clinical and subclinical hypothyroid patients have altered lipid profile as compared to euthyroids. Thyroid status monitoring is very important, since it can induce changes in lipid profile. Such dyslipidemic status is significant not only for the management of thyroid disorders but also for common diseases like obesity and coronary atherosclerosis in the population. (author)

  3. Data on the impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Yonggu Lee

    2018-02-01

    Full Text Available This article contains the data showing the different influence of subclinical hypothyroidism (SCH on the risk of cardiovascular events after percutaneous coronary intervention (PCI in various subgroups regarding myocardial infarction, previous PCI, the stent generation, total stent length, the extent of coronary artery disease, diabetes mellitus, obesity, a lipid reduction level and a C-reactive protein level. This article also contains the data showing the association between SCH and the risk of receiving repeat PCI for in-stent restenosis or de novo coronary stenosis. The data are supplemental to our original research article titled “Impact of Subclinical Hypothyroidism on Clinical Outcomes Following Percutaneous Coronary Intervention” (Lee et al., 2017 [1].

  4. Effect of Subclinical Hypothyroidism on the Mean Platelet Volume of Pregnant Women

    OpenAIRE

    Sari, Oktay; Tanoglu, Alpaslan; Mahmutoglu, Onur; Aydogan, Umit; Beyazit, Fatma; Akpak, Yasam Kemal; Keskin, Ugur

    2016-01-01

    Subclinical hypothyroidism (SH) is a frequently seen clinical disorder, which needs to be managed strictly in the pregnant population. SH is closely related with newborn complications and also suggested to be risk factor for cardiovascular events. Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk marker for cardiovascular events. The aim of this study was to evaluate how MPV values and other hematological parameters are influenced in pregnants with subcl...

  5. Serum cholesterol and triglyceride concentrations in diabetic patients with subclinical hypothyroidism.

    Science.gov (United States)

    Díez, Juan J; Iglesias, Pedro

    2014-10-01

    To assess whether subclinical hypothyroidism is associated to elevations in serum cholesterol and triglyceride levels in patients with type 2 diabetes. From a total population of 1,112 patients with type 2 diabetes screened for thyroid dysfunction (thyrotropin measurement), a group of 325 patients with normal thyroid function and another group of 29 patients with subclinical hypothyroidism were selected. No patient had known dyslipidemia or was taking lipid lowering medication. Patients with subclinical hypothyroidism had serum levels of total cholesterol (4.88 ± 0.74 mmol/L), HDL cholesterol (1.37 ± 0.34 mmol/L), LDL cholesterol (2.94 ± 0.58 mmol/L), and triglycerides (1.05 [0.88-1.41] mmol/L) that did not significantly differ from those found in euthyroid patients (4.79 ± 0.83, 1.33 ± 0.36, 2.87 ± 0.76, and 1.11 [0.81-1.43] mmol/L, respectively). Multiple regression analysis showed no association between TSH and serum lipid levels. These results suggest that, in our population, there are no significant differences in serum cholesterol and triglyceride levels between diabetic patients with normal and reduced thyroid function. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  6. Phosphorous magnetic resonance spectroscopy-based skeletal muscle bioenergetic studies in subclinical hypothyroidism.

    Science.gov (United States)

    Rana, P; Sripathy, G; Varshney, A; Kumar, P; Devi, M Memita; Marwaha, R K; Tripathi, R P; Khushu, S

    2012-02-01

    Subclinical hypothyroidism (sHT) is considered to be a milder form of thyroid dysfunction. Few earlier studies have reported neuromuscular symptoms as well as impaired muscle metabolism in sHT patients. In this study we report our findings on muscle bioenergetics in sHT patients using phosphorous magnetic resonance spectroscopy (31P MRS) and look upon the possibility to use 31P MRS technique as a clinical marker for monitoring muscle function in subclinical thyroid dysfunction. Seventeen normal subjects, 15 patients with sHT, and 9 patients with hypothyroidism performed plantar flexion exercise while lying supine in 1.5 T magnetic resonance scanner using custom built exercise device. MR Spectroscopy measurements of inorganic phosphate (Pi), phosphocreatine (PCr), and ATP of the calf muscle were taken during rest, at the end of exercise and in the recovery phase. PCr recovery rate constant (kPCr) and oxidative capacity were calculated by monoexponential fit of PCr vs time (t) at the beginning of recovery. We observed that changes in some of the phosphometabolites (increased phosphodiester levels and Pi concentration) in sHT patients which were similar to those detected in patients with hypothyroidism. However, our results do not demonstrate impaired muscle oxidative metabolism in sHT patients based upon PCr dynamics as observed in hypothyroid patients. 31P MRS-based PCr recovery rate could be used as a marker for monitoring muscle oxidative metabolism in sub clinical thyroid dysfunction.

  7. Evidence for a specific defect in hippocampal memory in overt and subclinical hypothyroidism.

    LENUS (Irish Health Repository)

    Correia, Neuman

    2012-02-01

    CONTEXT: Declarative memory largely depends upon normal functioning temporal lobes (hippocampal complex) and prefrontal cortex. Animal studies suggest abnormal hippocampal function in hypothyroidism. OBJECTIVE: The aim of the study was to assess declarative memory in overt and subclinical (SCH) hypothyroid patients before and after l-T(4) (LT4) replacement and in matched normal subjects. DESIGN AND SETTING: A prospective, open-labeled interventional study was conducted at a teaching hospital. PARTICIPANTS AND INTERVENTION: Hypothyroid (n = 21) and SCH (n = 17) patients underwent neuropsychological tests at baseline and 3 and 6 months after LT4 replacement. Normal subjects were studied at the same time-points. MAIN OUTCOME: Tests of spatial, verbal, associative, and working memory; attention; and response inhibition and the Hospital Anxiety and Depression Scale were administered. RESULTS: Baseline deficits in spatial, associative, and verbal memory, which rely upon the integrity of the hippocampal and frontal areas, were identified in patients with overt hypothyroidism. Spatial and verbal memory were impaired in SCH patients (P < 0.05). TSH levels correlated negatively (P < 0.05) with these deficits. After LT4 replacement, verbal memory normalized. Spatial memory normalized in the SCH group but remained impaired in the hypothyroid group. Associative memory deficits persisted in the overt hypothyroid group. Hospital Anxiety and Depression Scale scores did not correlate with cognitive function. Measures of attention and response inhibition did not differ from control subjects. CONCLUSION: Cognitive impairment occurs in SCH and more markedly in overt hypothyroidism. These impairments appear predominantly mnemonic in nature, suggesting that the etiology is not indicative of general cognitive slowing. We propose that these deficits may reflect an underlying disruption of normal hippocampal function and\\/or connectivity.

  8. Relationship between subclinical hypothyroidism and serum homocysteine concentration in premenopausal women

    Directory of Open Access Journals (Sweden)

    Ayfer Aydoğdu Çolak

    2013-09-01

    Full Text Available Objective: In our study we aimed to examine serum homocysteinelevels of patients without thyroid dysfunctionswho have high serum anti thyroid peroxidase (anti-TPOlevels and patients with subclinical hypothyroidism whohave high serum thyroid stimulating hormone (TSH andanti-TPO levels.Methods: One hundred and seven premenopause femaleoutpatients who referred to endocrine clinic of our hospitalwere included in our study. We generated 3 groups. Firstgroup (Control consists of 53 (50% patients between theages of 30-40 years. Second group (Euthyroid consistsof 31 (29% patients between the ages of 26-49. Thirdgroup (Subclinical Hypothyroidism consists of 23 (21%patients between the ages of 33-53 years. Serum totalcholesterol, triglycerides, high density lipoprotein (HDLlevels were measured by Olympus 2700 autoanalyzer.Serum TSH, free T4, anti-TPO and homocysteine levelswere measured by Siemens Immulite 2000 autoanalyzer.Results: In our study, total cholesterol, triglycerides, lowdensity lipoprotein (LDL and very low density lipoprotein(VLDL levels were not statistically significantly differentamong the groups. Although serum homocysteine levelsof the third group were higher than the other groups it wasnot statistically significantly different among the groups.Conclusion: Serum homocysteine and lipid levels of patientswith euthyroidism and subclinical hypothyroidismwho have positive anti-TPO levels may be inadequate inassessing the risk of cardiovascular diseases. J Clin ExpInvest 2013; 4 (3: 293-297Key words: Hypothyroidsm, homocysteine, premenopause

  9. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults.

    Science.gov (United States)

    Tseng, Fen-Yu; Lin, Wen-Yuan; Lin, Cheng-Chieh; Lee, Long-Teng; Li, Tsai-Chung; Sung, Pei-Kun; Huang, Kuo-Chin

    2012-08-21

    This study sought to evaluate the relationship between subclinical hypothyroidism (SCH) and all-cause and cardiovascular disease (CVD) mortality. SCH may increase the risks of hypercholesterolemia and atherosclerosis. The associations between SCH and all-cause or CVD mortality are uncertain, on the basis of the results of previous studies. A baseline cohort of 115,746 participants without a history of thyroid disease, ≥20 years of age, was recruited in Taiwan. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.0 to 19.96 mIU/l with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47 to 4.9 mIU/l. Cox proportional hazards regression analysis was used to estimate the relative risks (RRs) of death from all-cause and CVD for adults with SCH during a 10-year follow-up period. There were 3,669 deaths during the follow-up period; 680 deaths were due to CVD. Compared with subjects with euthyroidism, after adjustment for age, sex, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol consumption, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval) of deaths from all-cause and CVD among subjects with SCH were 1.30 (1.02 to 1.66), and 1.68 (1.02 to 2.76), respectively. Adult Taiwanese with SCH had an increased risk for all-cause mortality and CVD death. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Vitiligo and alopecia areata associated with subclinical/clinical hypothyroidism.

    Science.gov (United States)

    Sehgal, Virendra N

    2011-01-01

    The parents of an 18-year-old woman had noticed white hair while combing their daughter's hair 12 years ago. They found tiny white spots on her scalp, but she was asymptomatic. The spots have since progressed. Examination of the affected skin on the scalp was marked by the presence of a chalky/ivory white macule, 8 to 10 cm in diameter, conforming to that of segmental (zosteriformis) vitiligo (Figure 1). The lesions were located on the temporoparietal region of the scalp. The hair over the macules was white (leukotrichia) and dry, coarse, and brittle. The patient's nails were thin and dull. Her thyroid profile revealed the following: triiodothyronine, 1.12 nmol/L (0.95-2.5 nmol/L); thyroxine, 69.21 nmol/L (60.0-120.0 nmol/L); and thyroid-stimulating hormone, 6.26 microIU/mL (0.25-5.00 microIU/mL), indicative of primary hypothyroidism. Liver and renal function tests were within normal limits. A lipid profile revealed the following: total lipids, 503.8 mg% (400-700 mg %); triglycerides, 123.0 mg % (160 mg %); cholesterol, 212.0 mg % (150-250 mg %); high-density lipoprotein, 43.1 mg % (30-63 mg %); and low-density lipoprotein, 144.3 mg % (50 mg %). Electrocardiographic findings were normal. History of tiredness, constipation, depression, sensitivity to cold, weight gain, muscle weakness, cramps, and increased menstrual flow supported the diagnosis. The patient was administered 100 microg of thyroxine once a day along with methoxsalen, the dose of which was calculated at 0.6 mg/kg to 0.7 mg/kg body weight per day given on alternate days, followed 2 hours later by exposure to UV-A (1 J/cm2) irradiation (psoralen-UV-A [PUVA]), supplemented by 1 mg of beta-methasone, 150 mg of levamisole on 2 consecutive days per week, and an antioxidant. During the course of 7 weeks, the macules (13 exposures) had become erythematous, with an appearance of perifollicular/ marginal pigmentation. Repeat examination showed a thyroid profile of total triiodothyronine (T3), 127.3 microg

  11. Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

    Science.gov (United States)

    Baumgartner, Christine; den Elzen, Wendy P J; Blum, Manuel R; Coslovsky, Michael; Streit, Sven; Frey, Peter; Herzig, Lilli; Haller, Dagmar M; Mooijaart, Simon P; Bischoff, Thomas; Rosemann, Thomas; Gussekloo, Jacobijn; Rodondi, Nicolas

    2015-01-01

    As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

  12. [Impairment of muscle vasodilation during mental stress in women with subclinical hypothyroidism].

    Science.gov (United States)

    Ghetti, Fabiana de Faria; Lacerda, Rafaela Pinheiro; Wernek, Francisco Zacaron; Coelho, Emerson Filipino; Vaisman, Mário; Lima, Jorge Roberto Perrout de; Martinez, Daniel Godoy; Laterza, Mateus Camaroti

    2014-10-01

    To test the hypothesis that women with subclinical hypothyroidism (SH) have forearm vascular conductance (FVC) impaired during mental stress. We evaluated 20 women with SH and 21 euthyroid (Control group), matched for age (p = 0.699) and body mass index (p = 0.462). Muscle blood flow (MBF) was assessed by venous occlusion plethysmography and blood pressure by Dixtal2023. Both variables were recorded simultaneously for 3 minutes of baseline followed by 3 minutes of mental stress. The FVC was calculated by dividing MBF by mean arterial pressure. Significant differences were assumed at p muscle vasodilatatory response during mental stress.

  13. Thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus: a case report

    Directory of Open Access Journals (Sweden)

    Kunii Yasuto

    2011-09-01

    Full Text Available Abstract Introduction Non-convulsive status epilepticus is a form of epileptic seizure that occurs without convulsions. Recent reviews suggest that the diagnosis of non-convulsive status epilepticus remains difficult. Here, we report the case of a patient with thyroid-stimulating hormone elevation misdiagnosed as subclinical hypothyroidism following non-convulsive status epilepticus. Case presentation Our patient was a 68-year-old Japanese woman. The results of endocrine testing after her first episode of non-convulsive status epilepticus suggested latent subclinical hypothyroidism: she had elevated thyroid-stimulating hormone with normal levels of free tri-iodothyronine and free thyroxine. On examination, a diagnosis of thyroid disorder was not supported by other test results and our patient remained untreated. A follow-up examination revealed that her thyroid-stimulating hormone levels had spontaneously normalized. When she consulted another doctor for confusion, the transient increase in thyroid-stimulating hormone levels following non-convulsive status epilepticus was mistaken for subclinical hypothyroidism, and unfortunately treated with levothyroxine. Our patient then experienced levothyroxine-induced non-convulsive status epilepticus. Conclusions In this report, we suggested possible mechanisms for latent hypothyroid-like hormone abnormality following epileptic seizures and the possibility of provoking epileptic seizures by administering levothyroxine for misdiagnosed subclinical hypothyroidism.

  14. The Effects of Altered Membrane Cholesterol Levels on Sodium Pump Activity in Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Suparna Roy

    2017-02-01

    Full Text Available BackgroundMetabolic dysfunctions characteristic of overt hypothyroidism (OH start at the early stage of subclinical hypothyroidism (SCH. Na+/K+-ATPase (the sodium pump is a transmembrane enzyme that plays a vital role in cellular activities in combination with membrane lipids. We evaluated the effects of early changes in thyroid hormone and membrane cholesterol on sodium pump activity in SCH and OH patients.MethodsIn 32 SCH patients, 35 OH patients, and 34 euthyroid patients, sodium pump activity and cholesterol levels in red blood cell membranes were measured. Serum thyroxine (T4 and thyroid stimulating hormone (TSH levels were measured using enzyme-linked immunosorbent assays. Differences in their mean values were analysed using post hoc analysis of variance. We assessed the dependence of the sodium pump on other metabolites by multiple regression analysis.ResultsSodium pump activity and membrane cholesterol were lower in both hypothyroid groups than in control group, OH group exhibiting lower values than SCH group. In SCH group, sodium pump activity showed a significant direct dependence on membrane cholesterol with an inverse relationship with serum TSH levels. In OH group, sodium pump activity depended directly on membrane cholesterol and serum T4 levels. No dependence on serum cholesterol was observed in either case.ConclusionDespite the presence of elevated serum cholesterol in hypothyroidism, membrane cholesterol contributed significantly to maintain sodium pump activity in the cells. A critical reduction in membrane cholesterol levels heralds compromised enzyme activity, even in the early stage of hypothyroidism, and this can be predicted by elevated TSH levels alone, without any evident clinical manifestations.

  15. Postpartum follow-up in women diagnosed with subclinical hypothyroidism during pregnancy

    Directory of Open Access Journals (Sweden)

    K Neelaveni

    2017-01-01

    Full Text Available Background: Management guidelines about the thyroid disease in pregnancy are silent about the postpartum course of new onset subclinical hypothyroidism (SCH. Hence, we analyzed the 2 years outcome of SCH diagnosed during pregnancy. Materials and Methods: We conducted this retrospective study using the medical records of patients with new onset SCH during pregnancy between 2010 and 2013 (n = 718. Patients who stopped their levothyroxine after delivery with a 2-year follow-up record were included. We excluded patients with known thyroid disorders and continuous use of drugs that affect the thyroid results. The patients were divided into two groups (Group 1 – euthyroid and Group 2 – hypothyroid based on the final outcome after 2 years. The data were analyzed using appropriate statistical methods and a P < 0.05 was considered statically significant. Results: A total of 559 (77.8% women stopped levothyroxine after delivery, and the final follow-up data were available for 467 patients only. At the end of 2 years, 384 (82.2% remained euthyroid, and the remaining 83 (17.8% developed hypothyroidism. SCH and overt hypothyroidism were seen in 22 and 61 patients, respectively. Group 2 patients had higher mean age (25.5 vs. 23.6 years, goiter (51 vs. 2%, initial thyroid stimulating hormone (7.9 vs. 5.1 μIU/mL, and thyroid antibody positivity (76 vs. 13% (P < 0.001. Conclusion: The majority of patients with SCH during pregnancy remain euthyroid after delivery. Advanced age, goiter, positive family history, and thyroid autoimmunity increase the future risk of hypothyroidism in patients with SCH diagnosed during pregnancy.

  16. Subclinical Hypothyroidism in PCOS: Impact on Presentation, Insulin Resistance, and Cardiovascular Risk

    Directory of Open Access Journals (Sweden)

    Qun Yu

    2016-01-01

    Full Text Available Aim of Study. To assess status of thyroid function and thyroid disorders particularly subclinical hypothyroidism (SCH in subjects with polycystic ovarian syndrome (PCOS and impact of SCH on various clinical and biochemical parameters and cardiovascular risk in PCOS. Methods. Hundred females diagnosed with PCOS as per Rotterdam criteria and 100 normal controls were recruited and were subjected to elaborate anthropometric, clinical, and biochemical assessment. Results. Notable findings included significantly higher frequency of subjects with subclinical hypothyroidism (p=0.0002, autoimmune thyroiditis (p<0.001, and goitre (p=0.02 in polycystic ovarian syndrome subjects compared to control subjects. Further SCH PCOS subjects were found to harbor significantly higher HOMA-IR (p<0.05 and frequency of subjects with dyslipidemia (p<0.05 compared to both euthyroid PCOS and euthyroid control subjects. Though frequency of subjects with cardiovascular risk factors was higher in SCH PCOS group than euthyroid PCOS group, it failed to reach statistical significance. Conclusion. We concluded that PCOS is associated with high incidence of SCH and AIT compared to normal population and SCH poses increased risk of cardiovascular disorder in PCOS.

  17. Iodine deficiency and subclinical hypothyroidism are common in cystic fibrosis patients.

    Science.gov (United States)

    Naehrlich, Lutz; Dörr, Helmuth-Günther; Bagheri-Behrouzi, Azadeh; Rauh, Manfred

    2013-04-01

    Disorders of thyroid function have been inconsistently described in cystic fibrosis (CF) patients and in CF transmembrane regulator protein knockout animals. The literature lacks reports on iodine status of CF individuals. We hypothesize, that iodine deficiency is common in CF and account for abnormal thyroid function in CF patients. We investigated 129 children, adolescents, and adults with CF, who were living in the northern part of Bavaria/Germany. Malnutrition and lung function were analyzed. Urinary iodine excretion, TSH (thyroid-stimulating hormone), and ft4 (free thyroxine) were measured and set in relation to population-based, age-adjusted reference ranges. Subclinical hypothyroidism (normal fT4, elevated TSH) was found in 11.6% of subjects, and iodine deficiency in 83.7%. No correlations were found with age, BMI, status of malnutrition, or lung function. Dramatic iodine deficiency was found in our cohort of CF patients. This condition can cause subclinical hypothyroidism; therefore, an individual iodine supplementation program is necessary and should be started immediately. Crown Copyright © 2012. Published by Elsevier GmbH. All rights reserved.

  18. Replacement therapy with levothyroxine modulates platelet activation in recent-onset post-thyroidectomy subclinical hypothyroidism.

    Science.gov (United States)

    Desideri, G; Bocale, R; D'Amore, A; Necozione, S; Boscherini, M; Carnassale, G; Barini, A; Barini, A; Bellantone, R; Lombardi, C P

    2017-10-01

    Subclinical hypothyroidism has been linked to increased risk of atherosclerotic disease. Soluble CD40 ligand (sCD40L), mainly derived from activated platelets, and the lipid peroxidation product 8-iso-prostaglandin F 2α (8-iso-PGF 2α ) are known to play a relevant pathophysiological role in atherogenesis. In this study, we analyzed the relationship between thyroid hormones and circulating levels of sCD40L and 8-iso-PGF 2α in patient with recent-onset post-thyroidectomy subclinical hypothyroidism under replacement therapy. Circulating levels of thyroid hormones, sCD40L, and 8-iso-PGF 2α were assessed in 40 recently thyroidectomized patients (33 females, mean age 52.0 ± 11.7 years) at baseline (5-7 day after surgery) and after 2 months under replacement therapy with levothyroxine (LT-4). At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 7.7 ± 3.9 μU/mL, FT3 1.8 ± 0.6 pg/mL, and FT3 8.9 ± 3.0 pg/mL). Circulating levels of sCD40L and 8-iso-PGF 2α were directly correlated with each other (r = 0.360, p = 0.023) and with TSH levels (r = 0.322, p = 0.043 and r = 0.329 p = 0.038, respectively). After 2 months under the replacement therapy with LT-4 circulating levels of TSH (from 7.7 ± 3.9 to 2.7 ± 2.8 μU/mL, p hypothyroidism to develop atherosclerotic disease. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  19. Thyroid antibody status, subclinical hypothyroidism, and the risk of coronary heart disease: an individual participant data analysis.

    Science.gov (United States)

    Collet, Tinh-Hai; Bauer, Douglas C; Cappola, Anne R; Asvold, Bjørn O; Weiler, Stefan; Vittinghoff, Eric; Gussekloo, Jacobijn; Bremner, Alexandra; den Elzen, Wendy P J; Maciel, Rui M B; Vanderpump, Mark P J; Cornuz, Jacques; Dörr, Marcus; Wallaschofski, Henri; Newman, Anne B; Sgarbi, José A; Razvi, Salman; Völzke, Henry; Walsh, John P; Aujesky, Drahomir; Rodondi, Nicolas

    2014-09-01

    Subclinical hypothyroidism has been associated with increased risk of coronary heart disease (CHD), particularly with thyrotropin levels of 10.0 mIU/L or greater. The measurement of thyroid antibodies helps predict the progression to overt hypothyroidism, but it is unclear whether thyroid autoimmunity independently affects CHD risk. The objective of the study was to compare the CHD risk of subclinical hypothyroidism with and without thyroid peroxidase antibodies (TPOAbs). A MEDLINE and EMBASE search from 1950 to 2011 was conducted for prospective cohorts, reporting baseline thyroid function, antibodies, and CHD outcomes. Individual data of 38 274 participants from six cohorts for CHD mortality followed up for 460 333 person-years and 33 394 participants from four cohorts for CHD events. Among 38 274 adults (median age 55 y, 63% women), 1691 (4.4%) had subclinical hypothyroidism, of whom 775 (45.8%) had positive TPOAbs. During follow-up, 1436 participants died of CHD and 3285 had CHD events. Compared with euthyroid individuals, age- and gender-adjusted risks of CHD mortality in subclinical hypothyroidism were similar among individuals with and without TPOAbs [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.87-1.53 vs HR 1.26, CI 1.01-1.58, P for interaction = .62], as were risks of CHD events (HR 1.16, CI 0.87-1.56 vs HR 1.26, CI 1.02-1.56, P for interaction = .65). Risks of CHD mortality and events increased with higher thyrotropin, but within each stratum, risks did not differ by TPOAb status. CHD risk associated with subclinical hypothyroidism did not differ by TPOAb status, suggesting that biomarkers of thyroid autoimmunity do not add independent prognostic information for CHD outcomes.

  20. Subclinical hypothyroidism neither so asymptomatic nor so harmless

    OpenAIRE

    Quesada, Marelys Yanes; Rodríguez Fernández, Lisbet; Cruz Hernández, Jeddú; Turcios Tristá, Silvia; Yanes Quesada, Miguel Ángel

    2009-01-01

    El hipotiroidismo subclínico es la condición definida por la elevación de la hormona estimulante del tiroides, en presencia de secreción de hormonas tiroideas (T3 y T4) normales para el rango de referencia. Sus manifestaciones clínicas no son tan nulas como lo define el término subclínico. Si se hace un correcto interrogatorio y examen clínico se pueden encontrar alteraciones en diversos sistemas y órganos que perjudican la calidad de vida de los pacientes afectos e incrementan su morbimortal...

  1. Overview of Hypothyroidism in Pregnancy.

    Science.gov (United States)

    Kroopnick, Jeffrey M; Kim, Caroline S

    2016-11-01

    Overt hypothyroidism in pregnancy, defined as an elevated serum thyroid-stimulating hormone (TSH) and reduced serum free thyroxine or a TSH >10 mIU/L, is known to have adverse effects on pregnancy. Subclinical hypothyroidism is typically defined as an elevated TSH and normal FT4 levels. There remains much controversy on the benefit of starting levothyroxine for mothers diagnosed with subclinical hypothyroidism. Recent studies are redefining the normal range for TSH in pregnancy, and the data on whether treatment of subclinical hypothyroidism improves outcomes for the mother and fetus are unclear. One confounding variable is the presence of thyroid peroxidase antibodies, as it may be a surrogate marker for other autoimmune disorders detrimental to pregnancy. If levothyroxine treatment is initiated, the dosing and monitoring strategy is different from nonpregnant individuals. Randomized clinical trials are underway that may better elucidate whether treatment of subclinical hypothyroidism is warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Subclinical hypothyroidism in children and adolescents after hematopoietic stem cells transplantation without irradiation

    Directory of Open Access Journals (Sweden)

    Milenković Tatjana

    2014-01-01

    Full Text Available Background/Aim. Although total body irradiation (TBI was considered to be the primary cause of thyroid dysfunction following hematopoietic stem cells transplantation (HSCT, a significant prevalence of subclinical hypothyroidism after HSCT with chemotherapy-only conditioning regimens has been observed in several studies. The aim of this study was to assess changes in thyroid stimulating hormone (TSH levels in children after HSCT, without the use of irradiation at any time in the course of the treatment. Methods. Our cohort consisted of 41 children and adolescents who underwent autologous or allogeneic HSCT and were available for follow-up for at least one year after transplantation. Irradiation was not performed in any of the subjects, neither during pretransplatation therapy, nor during conditioning. The median duration of follow-up was 2.9 years. The indications for HSCT were hematologic malignancy (41.5%, solid malignant tumor (34.1%, and other disorders (24.4%. The thyroid status of all the subjects was assessed prior to HSCT and after follow-up period. Results. Thyroid dysfunction after HSCT was present in 27 (65.8% subjects. Subclinical hypothyroidism was the most common abnormality, presenting in 23 (56.1% patients, primary hypothyroidism was present in one (2.4% patient, while 3 (7.3% subjects had low free T4 with normal TSH values. Significantly (p < 0.01 higher elevations in TSH levels were present in the patients who received chemotherapy for the underlying disease prior to HSCT. Conclusion. Our findings emphasize the need for long-term monitoring of thyroid function following HSCT, regardless of whether or not irradiation was used.

  3. Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Norman J. Blumenthal

    2017-01-01

    Full Text Available Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH (serum TSH > 2.5 mIU/L and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH, anti-thyroglobulin antibodies (TGAb, and thyroid peroxidase antibodies (TPOAb. Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. Results. There were a total of 1025 patients of whom 382 (37.5% were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy

  4. Evaluation of Selected Atherosclerosis Risk Factors in Women with Subclinical Hypothyroidism Treated with L-Thyroxine.

    Science.gov (United States)

    Adamarczuk-Janczyszyn, Maria; Zdrojowy-Wełna, Aleksandra; Rogala, Natalia; Zatońska, Katarzyna; Bednarek-Tupikowska, Grażyna

    2016-01-01

    Subclinical hypothyroidism (SCH) is a common endocrine disorder, probably increasing cardiovascular (CV) risk. However, the relation between SCH and atherosclerosis risk factors remains unclear. The aim of the study was to evaluate selected atherosclerosis risk factors in women with SCH in comparison to a group of healthy women and women with overt hypothyroidism, as well as to investigate the influence of L-thyroxine replacement on those risk factors. The study group consisted of 187 obese women aged between 50 and 70 years: 100 women with SCH, 45 women with overt hypothyroidism and 42 women with TSH level in reference ranges. Anthropometric parameters were evaluated. Laboratory tests included thyroid hormones concentrations, lipid profile with apolipoproteins, CRP, homocysteine. Atherosclerotic indexes were calculated: LDL C/HDL C ratio, apoA1/apoB ratio and Castelli risk index. Women with hypothyroidism were given L-thyroxine treatment and after 6 months in euthyroidism the evaluation was repeated. Total cholesterol, LDL-cholesterol and triglycerides concentrations as well as LDL-C/HDL-C ratio and Castelli index were higher in SCH than in controls and decreased after L-thyroxin substitution. All of the calculated atherosclerosis indexes showed significant positive correlations with TSH concentration in SCH group. Also in this group the systolic and diastolic blood pressure decreased significantly after treatment. Dyslipidemia in obese SCH women is not severe, but if untreated for many years, it may lead to atherosclerosis. Substitution therapy improves the lipid profile, changing the relations between protective and proatherogenic fractions of serum lipids, and optimises blood pressure.

  5. Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

    Science.gov (United States)

    Irdem, Ahmet; Aydın Sahin, Derya; Kervancioglu, Mehmet; Baspinar, Osman; Sucu, Murat; Keskin, Mehmet; Kilinc, Metin

    2016-09-01

    This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P wave dispersion was significantly different in the pediatric patients with hypothyroidism (P wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism. © 2016, Wiley Periodicals, Inc.

  6. Study protocol; Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism

    DEFF Research Database (Denmark)

    Stott, David J.; Gussekloo, Jacobijn; Kearney, Patricia M.

    2017-01-01

    randomised controlled trial (RCT) of Levothyroxine treatment for SCH. METHODS: Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range...... treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition. TRIAL REGISTRATION: Clinicaltrials.gov NCT01660126 ; registered 8th June 2012........ The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects

  7. Lymphocutaneous Sporotrichosis Treated with Potassium Iodide with Development of Subclinical Hypothyroidism: Wolff-Chaikoff Effect?

    Science.gov (United States)

    Arora, Pooja; Raihan, M; Kubba, Asha; Gautam, Ram K

    2017-01-01

    Sporotrichosis is a subcutaneous mycotic infection caused by Sporothrix schenckii that is acquired by traumatic implantation. The diagnosis is established by demonstration of fungal elements on histopathology and culture. Potassium iodide, azole antifungals, and terbinafine are the treatment options available. In this article, we report a 60-year-old female with lymphocutaneous sporotrichosis that responded well to potassium iodide. However, subclinical hypothyroidism (Wolff-Chaikoff effect) was encountered as a side effect of therapy which was managed with thyroxine replacement. Knowledge about the Wolff-Chaikoff effect (WCE) is important for the dermatologist and reinforces the need for screening and monitoring of thyroid stimulating hormone (TSH) in patients where long duration therapy is being planned.

  8. The Association Between Maternal Subclinical Hypothyroidism and Growth, Development, and Childhood Intelligence: A Meta-analysis

    Science.gov (United States)

    Liu, Yahong; Chen, Hui; Jing, Chen; Li, FuPin

    2018-06-01

    To explore the association between maternal subclinical hypothyroidism (SCH) in pregnancy and the somatic and intellectual development of their offspring. Using RevMan 5.3 software, a meta-analysis of cohort studies published from inception to May 2017, focusing on the association between maternal SCH in pregnancy and childhood growth, development and intelligence, was performed. Sources included the Cochrane Library, Pub-Med, Web of Science, China National Knowledge Infrastructure and Wan Fang Data. Analysis of a total of 15 cohort studies involving 1.896 pregnant women with SCH revealed that SCH in pregnancy was significantly associated with the intelligence (p=0.0007) and motor development (pdevelopment, low birth weight, premature delivery, fetal distress and fetal growth restriction.

  9. Changes of serum lipid for patients with subclinical hypothyroidism induced by post-radiotherapy nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Shao Qian; Zhao Baohua; Liang Chaoqian; Li Jianbing; Tian Shiyu; Fan Tingyong

    2007-01-01

    Objective: To study the changes of serum lipid of pre-and post-treatment by Levothyroxine(LT 4 ) for patients with subclinical hypothyroidism (SHT) induced by post-radiotherapy nasopharyngeal carcinoma(NPC). Methods: From Nov. 1998 to Nov. 2002, 76 NPC pathologically confirmed patients were treated by radiotherapy. The total dose of thy- ;old was 45Gy-60Gy and the median dose was 50Gy. There were 40 patients with normal thyroid function(NC group) and 36 patients with subclinical hypothyroidism(SHT group). The SHT patients received LT 4 treatment from 25 μg/day with the does gyadually increased till thyrotropin(TSH) was normal. The serum levels of TSH, free thyroxine (FT 4 ), free triiodothyronine (FT 3 ), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) in NC group and SHT group was measured and compared before and after LT4 treatment. Results: The serum levels of TSH, FT 3 , FT 4 , TC, TG, HDL-C, LDL-C in pre-and post-treatment SHT group and NC group were significantly different between those in the pre-and post-treatment SHT group was measured aha compared, and pre-treatment SHT group and NC group except HDL-C (P<0.001 or 0.05). Conclusions: Radiotherapy on NPC patients can induce SHT, and LT4 treatment for SHT patients can ameliorates the function of thyroid and metabolism of serum lipid. (authors)

  10. Subclinical Hypothyroidism after 131I-Treatment of Graves' Disease: A Risk Factor for Depression?

    Science.gov (United States)

    Yu, Jing; Tian, Ai-Juan; Yuan, Xin; Cheng, Xiao-Xin

    2016-01-01

    Although it is well accepted that there is a close relationship between hypothyroidism and depression, previous studies provided inconsistent or even opposite results in whether subclinical hypothyroidism (SCH) increased the risk of depression. One possible reason is that the etiology of SCH in these studies was not clearly distinguished. We therefore investigated the relationship between SCH resulting from 131I treatment of Graves' disease and depression. The incidence of depression among 95 patients with SCH and 121 euthyroid patients following 131I treatment of Graves' disease was studied. The risk factors of depression were determined with multivariate logistic regression analysis. Thyroid hormone replacement therapy was performed in patients with thyroid-stimulating hormone (TSH) levels exceeding 10 mIU/L. Patients with SCH had significantly higher Hamilton Depression Scale scores, serum TSH and thyroid peroxidase antibody (TPOAb) levels compared with euthyroid patients. Multivariate logistic regression analysis revealed SCH, Graves' eye syndrome and high serum TPO antibody level as risk factors for depression. L-thyroxine treatment is beneficial for SCH patients with serum TSH levels exceeding 10 mIU/L. The results of the present study demonstrated that SCH is prevalent among 131I treated Graves' patients. SCH might increase the risk of developing depression. L-thyroxine replacement therapy helps to resolve depressive disorders in SCH patients with TSH > 10mIU/L. These data provide insight into the relationship between SCH and depression.

  11. Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism.

    Science.gov (United States)

    López-Tinoco, Cristina; Rodríguez-Mengual, Amparo; Lara-Barea, Almudena; Barcala, Julia; Larrán, Laura; Saez-Benito, Ana; Aguilar-Diosdado, Manuel

    2018-03-01

    The impact of subclinical hypothyroidism (SH) and thyroid autoimmunity on obstetric and perinatal complications continues to be a matter of interest and highly controversial. To assess the impact of SH and autoimmunity in early pregnancy on the obstetric and perinatal complications in our population. A retrospective cohort study in 435 women with SH (TSH ranging from 3.86 and 10 μIU/mL and normal FT4 values) in the first trimester of pregnancy. Epidemiological and clinical parameters were analyzed and were related to obstetric and perinatal complications based on the presence of autoimmunity (thyroid peroxidase antibodies [TPO] > 34 IU/mL). Mean age was 31.3 years (SD 5.2). Seventeen percent of patients had positive TPO antibodies. Presence of positive autoimmunity was associated to a family history of hypothyroidism (P=.04) and a higher chance of miscarriage (P=.009). In the multivariate analysis, positive TPO antibodies were associated to a 10.25-fold higher risk of miscarriage. No statistically significant associations were found with all other obstetric and perinatal complications. In our region, pregnant women with SH and thyroid autoimmunity had a higher risk of miscarriage but not of other obstetric and perinatal complications. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Hipotiroidismo subclínico: Actualización Updating on subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Julieta García Sáez

    2005-12-01

    Full Text Available La utilización de técnicas ultrasensibles para la determinación de tirotropina (TSH han posibilitado un incremento notable del diagnóstico de hipotiroidismo subclínico (HSC, trastorno que se presenta en cualquier etapa de la vida (con mayor frecuencia en la tercera edad con predominio del sexo femenino y relacionado frecuentemente con la presencia de anticuerpos antitiroperoxidasa (antiTPO. Aunque por definición el HSC es asintomático, la mayoría de los pacientes refieren, al menos, un síntoma que podría ser expresión del HSC. El tratamiento medicamentoso o el expectante son las terapéuticas recomendadas, aunque no existe consenso internacional respecto a decidir una u otra. Los diferentes aspectos que giran alrededor de este trastorno, la controversia sobre la conducta terapéutica, así como lo disperso de las publicaciones sobre el tema y la utilización en la práctica clínica en Cuba de métodos ultrasensibles para precisar los niveles de TSH, motivaron la realización de esta revisión.The use of ultrasensitive techniques for determination of thyrotropine (TSH has made it possible to substantially raise the possibilities of diagnosis of subclinical hypothyroidism (SCH. This is a disorder that may occur in any life stage (more frequently in the older age mainly in females and mostly related to the presence of anti-thyroid peroxidase antibodies (antiTPO. By definition, subclinical hypothyroidism is asymptomatic but the majority of patients report at least a symptom that might be expression of hypothyroidism. Drug and expectant therapies are the most recommended types of treatment, although there is no international consensus on deciding the use of one or the other. The different aspects of this disorder, the controversy about the therapeutic behavior to be adopted as well as the scattered publications about this topic and the use of ultrasensitive methods in Cuban clinical practice to establish the levels of TSH motivated this

  13. International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey.

    Science.gov (United States)

    den Elzen, Wendy P J; Lefèbre-van de Fliert, Anne A; Virgini, Vanessa; Mooijaart, Simon P; Frey, Peter; Kearney, Patricia M; Kerse, Ngaire; Mallen, Christian D; McCarthy, Vera J C; Muth, Christiane; Rosemann, Thomas; Russell, Audrey; Schers, Henk; Stott, David J; de Waal, Margot W M; Warner, Alex; Westendorp, Rudi G J; Rodondi, Nicolas; Gussekloo, Jacobijn

    2015-02-01

    There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people. To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics. Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand. The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L). A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]). GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care. © British Journal of General Practice 2015.

  14. Hypothyroidism

    Science.gov (United States)

    ... to meet your body's needs. This condition is hypothyroidism. Hypothyroidism is more common in women, people with other ... cause. Other causes include thyroid nodules, thyroiditis, congenital hypothyroidism, surgical removal of part or all of the ...

  15. Treatment of subclinical hypothyroidism in pregnancy using fixed thyroxine daily doses of 75 μg.

    Science.gov (United States)

    Penin, Manuel; Trigo, Cristina; López, Yolanda; Barragáns, María

    2014-01-01

    Treatment of hypothyroid pregnant women is usually calculated based on weight (1 μg/kg/day) and TSH levels. This study assessed the usefulness of treating these women with a fixed dose of 75 μg/day. All women with pregnancy diagnosed from January to August 2012 in the Vigo Health Area (Spain) without previous diagnosis of thyroid disease or thyroxine treatment and with TSH levels over 4,5 mUI/ml were enrolled by consecutive sampling. All 116 women in the sample were treated with a fixed daily dose of thyroxine 75 μg-thyroxine levels were measured at two, four, and six months, and thyroxine dose was modified if TSH level was lower than 0.3 or higher than 4.5 mUI/ml. A woman had a TSH level less than 0.3 mUI/ml in a test; reduction of thyroxine dose to 50 μg/day allowed for maintaining TSH level within the desired range until delivery. Six women had TSH levels over 4.5 mUI/ml in one test; in all of them, increase in thyroxine dose to 100 μg/day allowed for maintaining the level within the desired range until delivery. Fixed daily doses of thyroxine 75 μg allowed for achieving goal TSH levels in most of our pregnant women with subclinical hypothyroidism, irrespective of their weight and baseline TSH level. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  16. Diagnosis and Management of Subclinical Hypothyroidism in Elderly Adults: A Review of the Literature.

    Science.gov (United States)

    Hennessey, James V; Espaillat, Ramon

    2015-08-01

    The estimated prevalence of subclinical hypothyroidism (SCH) in the general population is 3% to 8%. As the average age of the population in the United States and other countries continues to increase, the overall prevalence of SCH may also be expected to increase. Although age-related changes in thyroid function are well described, normal thyroid-stimulating hormone (TSH) reference limits, derived for age-specific populations, are not routinely used to identify thyroid dysfunction in elderly adults. Therefore, currently accepted values for the upper limit of normal of TSH may be inappropriate for diagnosing SCH in individuals aged 65 and older, resulting in potential overestimation of the prevalence of SCH in this population. This review discusses the current evidence of the effects of SCH on cardiovascular health and neuropsychiatric function in older adults. Although the results of some studies are conflicting, the overall evidence suggests that the consequences of SCH may be different for elderly adults than for younger populations. Treatment of SCH in older individuals requires special consideration with regard to thyroid hormone replacement therapy and expected clinical outcomes. Although careful identification of individuals with persistent SCH who could benefit from levothyroxine treatment is necessary, current evidence suggests that individuals with TSH levels greater than 10 mIU/L who test positive for antithyroid antibodies or are symptomatic may benefit from levothyroxine treatment to reduce the risk of progression to overt hypothyroidism, decrease the risk of adverse cardiovascular events, and improve their quality of life. After treatment is initiated, careful monitoring is essential. © 2015, The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  17. Hypothyroidism

    Science.gov (United States)

    ... weight gain, cold intolerance, constipation, impaired fertility, and depression. • Women are much more likely than men to develop hypothyroidism. • Women with hypothyroidism should discuss ...

  18. Thyroxine treatment may be useful for subclinical hypothyroidism in patients with female infertility.

    Science.gov (United States)

    Yoshioka, Waka; Amino, Nobuyuki; Ide, Akane; Kang, Shino; Kudo, Takumi; Nishihara, Eijun; Ito, Mitsuru; Nakamura, Hirotoshi; Miyauchi, Akira

    2015-01-01

    Infertile women sometimes associated with subclinical hypothyroidism (SCH). The guidelines of the American Endocrine Society, and American Association of Clinical Endocrinologists and American Thyroid Association recommend treatment with thyroxine (T4) for patients with SCH who want to have children. We examined 69 female infertile patients with SCH and the effects of levothyroxine (l-T4) therapy on pregnancy rates and pregnancy outcomes were observed. Fifty-eight (84.1%) patients successfully conceived during the T4 treatment period (Group A), although 17 patients (29.3%) had miscarriage afterward. The remaining 11 patients continued to be infertile (Group B). The median TSH value in Group A before the T4 treatment was 5.46 μIU/mL (range 3.1-13.3) and this significantly decreased to 1.25 μIU/mL (range 0.02-3.75) during the treatment (ptreatment was 2.8±1.7 years and the duration until pregnancy after the treatment was significantly shorter at 0.9±0.9 years (ptreatment strongly suggest that T4 enhanced fertility in infertile patients with SCH.

  19. Subclinical hypothyroidism does not influence the metabolic and hormonal profile of women with PCOS.

    Science.gov (United States)

    Trakakis, Eftihios; Pergialiotis, Vasilios; Hatziagelaki, Erifili; Panagopoulos, Periklis; Salloum, Ioannis; Papantoniou, Nikolaos

    2017-06-23

    Background Subclinical hypothyroidism (SCH) is present in 5%-10% of polycystic ovary syndrome (PCOS) patients. To date, its impact on the metabolic and hormonal profile of those women remains controversial. The purpose of our study is to evaluate the impact of SCH on the glycemic, lipid and hormonal profile of PCOS patients. Materials and methods We conducted a prospective case control study of patients that attended the Department of Gynecological Endocrinology of our hospital. Results Overall, 280 women with PCOS were enrolled during a time period of 7 years (2009-2015). Twenty-one patients (7.5%) suffered from SCH. The anthropometric characteristics were comparable among women with PCOS and those with SCH + PCOS. The prevalence of acne, hirsutism and anovulation did not differ. Significant differences were observed in the 2-h oral glucose tolerance test (OGTT) (p = 0.003 for glucose and p = 0.046 for insulin). The QUICKI, Matsuda and homeostatic model assessment-insulin resistance (HOMA-IR) indices where, however, similar. No difference in serum lipids was observed. Slightly elevated levels of follicle stimulating hormone (FSH) and testosterone were noted. The remaining hormonal parameters remained similar among groups. Similarly, the ovarian volume and the endometrial thickness did not differ. Conclusions The impact of SCH on the metabolic and hormonal profile of PCOS patients seems to be negligible. Future studies are needed in the field and their conduct in a multi-institutional basis seems to be required, given the small prevalence of SCH among women with PCOS.

  20. Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life.

    Science.gov (United States)

    Reuters, Vaneska Spinelli; Almeida, Cloyra de Paiva; Teixeira, Patrícia de Fátima dos Santos; Vigário, Patrícia dos Santos; Ferreira, Márcia Martins; Castro, Carmen Lucia Natividade de; Brasil, Marco Antônio; Costa, Antônio José Leal da; Buescu, Alexandru; Vaisman, Mário

    2012-03-01

    To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health-related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.

  1. Effect of subclinical hypothyroidism on the skeletal system and improvement with short-term thyroxine therapy.

    Science.gov (United States)

    Gao, Cuixia; Wang, Yu; Li, Tingting; Huang, Jing; Tian, Limin

    2017-10-27

    The purpose of the study was to observe changes in the skeletal system of rats with subclinical hypothyroidism (SCH) and to determine whether L-thyroxine (L-T4) administration suppresses those changes. Sixty male Wistar rats were randomly divided into control, SCH, and SCH+T4 groups. SCH was induced in rats by administration of methimazole (MMI), and rats in the SCH+T4 group were treated with L-T4 after 45 days of MMI administration. The SCH group had higher thyroid-stimulating hormone (TSH) level than the control and SCH+T4 groups. There were no differences in serum thyroid hormone (FT4 and FT3) levels among the three groups. Bone mineral density; serum levels of BALP and TRACP-5b, two bone metabolic markers; and the biomechanical properties of the femurs were lower in the SCH group than in the control group. After L-T4 treatment, serum BALP and TRACP-5b levels and the femur biomechanical properties were higher in the SCH+T4 than the SCH group. Histopathological examination revealed damage to the structure of the femur trabecular bone network in rats with SCH, and L-T4 treatment improved this condition to some extent. These findings demonstrate that L-T4 treatment ameliorates the destructive effects of SCH on the skeletal system in rats.

  2. Hyperirisinemia is independently associated with subclinical hypothyroidism: correlations with cardiometabolic biomarkers and risk factors.

    Science.gov (United States)

    Stratigou, Theodora; Dalamaga, Maria; Antonakos, Georgios; Marinou, Ioanna; Vogiatzakis, Evaggelos; Christodoulatos, Gerasimos Socrates; Karampela, Irene; Papavassiliou, Athanasios G

    2018-02-17

    Irisin, a newly discovered adipo-myokine, is implicated in the modulation of the adipose phenotype, increasing energy expenditure and ameliorating systemic metabolism. Our aim was to investigate circulating irisin in subclinical hypothyroidism (SH) and study its associations with cardiometabolic risk factors. In a large case-control study, serum irisin, insulin resistance and lipid parameters, classic adipokines, inflammatory and hepatic biomarkers, and cardiovascular risk factors were determined in 120 consecutive patients with SH and 120 healthy controls matched on age, gender, and date of blood draw. Sixteen patients with SH received L-T4 treatment and, after 6 months, serum irisin and other biomarkers were assessed. SH cases exhibited significantly higher circulating irisin than controls (p counterbalancing a potential, gradual deterioration of lipid metabolism and insulin sensitivity in SH as well as reflecting a protective compensatory mechanism against oxidative muscle and thyroid cell stress. More mechanistic and prospective studies shedding light on the pathogenetic role of irisin in SH are needed to confirm and extend these data.

  3. [Impact of subclinical hypothyroidism in cardiopulmonary response during effort and its recovery].

    Science.gov (United States)

    Mainenti, Míriam R M; Teixeira, Patrícia F S; Oliveira, Fátima P; Vaisman, Mário

    2007-12-01

    In order to identify the characteristics of subclinical hypothyroidism (SH) during physical stress and its recovery, 15 SH patients and 16 healthy women were compared by a treadmill cardiopulmonary test. Means of variables were analyzed by the Mann-Whitney U test. Patients obtained lower values for peak expired fraction of O2 (14.90+/-1.05 x 16+/-1.14%; p = 0.014); systolic blood pressure variation (34.33+/-17.92 x 52.50+/-17.22; p = 0.009); exercise duration (8.83+/-2.91 x 14.5+/-5.63 min; p = 0.0005), maximal test load (11.6+/-4.22 x 18.94+/-5.45%; p = 0.0004), as well as tendencies in gas exchange ratio and peak heart rate. Between the first and the third recovery minutes, there was a reduction of only 0.71 mmHg in the diastolic blood pressure, whereas there was a 5.33-mmHg reduction to control group (p = 0.0009) (slower recovery of patients). It is presumable that SH may cause cardiopulmonary dysfunctions, with higher sensibility to the parameters previously cited.

  4. Prevalence of hypertension and other cardiovascular risk factors in subjects with subclinical hypothyroidism.

    Science.gov (United States)

    Gonzalez Gil, Lidia; de la Sierra, Alejandro

    2017-04-21

    To assess the prevalence of hypertension, diabetes, and dyslipidaemia in subjects with subclinical hypothyroidism (SH) in comparison with an age- and sex-matched control group. Case-control study with 240 subjects with SH and 480 controls carried out on patients aged 35-75 years admitted to a Primary Care Centre. The prevalence of hypertension, diabetes and dyslipidaemia, as well as blood pressure, plasma glucose, and lipid profilses, were evaluated in both groups. No differences were observed neither in the prevalence of hypertension (34.2% vs. 29.6%) or diabetes (12.1% vs. 10%) nor in mean values of blood pressure or plasma fasting glucose. Subjects with SH had an increased prevalence of lipid abnormalities (72.1% vs. 57.7%; P<.001), and increased mean values of total cholesterol (205±34 vs. 193±35mg/dL; P<.001), compared to the control group. Patients with SH have an increased prevalence of lipid abnormalities. This can be responsible for an increased cardiovascular risk in such patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. Alteration in intrinsic and extrinsic functional connectivity of resting state networks associated with subclinical hypothyroid.

    Science.gov (United States)

    Kumar, Mukesh; Modi, Shilpi; Rana, Poonam; Kumar, Pawan; Kanwar, Ratnesh; Sekhri, Tarun; D'souza, Maria; Khushu, Subash

    2018-03-05

    Subclinical hypothyroidism (SCH) is characterized by mild elevation of thyroid stimulating hormone (TSH) (range 5-10 μIU/ml) and normal free triiodothyronine (FT3) and free thyroxine (FT4). The cognitive function impairment is well known in thyroid disorders such as hypothyroidism and hyperthyroidism, but little is known about deficits in brain functions in SCH subjects. Also, whether hormone-replacement treatment is necessary or not in SCH subjects is still debatable. In order to have an insight into the cognition of SCH subjects, intrinsic and extrinsic functional connectivity (FC) of the resting state networks (RSNs) was studied. For resting state data analysis we used an unbiased, data-driven approach based on Independent Component Analysis (ICA) and dual-regression that can emphasize widespread changes in FC without restricting to a set of predefined seeds. 28 SCH subjects and 28 matched healthy controls (HC) participated in the study. RSN analysis showed significantly decreased intrinsic FC in somato-motor network (SMN) and right fronto-parietal attention network (RAN) and increased intrinsic FC in default mode network (DMN) in SCH subjects as compared to control subjects. The reduced intrinsic FC in the SMN and RAN suggests neuro-cognitive alterations in SCH subjects in the corresponding functions which were also evident from the deficit in the neuropsychological performance of the SCH subjects on behavioural tests such as digit span, delayed recall, visual retention, recognition, Bender Gestalt and Mini-Mental State Examination (MMSE). We also found a significant reduction in extrinsic network FC between DMN and RAN; SMN and posterior default mode network (PDMN); and increased extrinsic FC between SMN and anterior default mode network (ADMN) in SCH subjects as compared to controls. An altered extrinsic FC in SCH suggests functional reorganization in response to neurological disruption. The partial correlation analysis between intrinsic and extrinsic RSNs

  6. Effects of 18 months of L-T4 replacement in women with subclinical hypothyroidism.

    LENUS (Irish Health Repository)

    Adrees, M

    2012-02-01

    CONTEXT: Some of the cardiovascular and renal abnormalities seen in overt hypothyroidism have also been reported in subclinical hypothyroidism (SCH). Short-term L-T4 replacement in SCH improves cardiovascular risk markers and reduces carotid intima-media thickness (CIMT), a surrogate marker of atherosclerosis. The haemodynamic and renal effects of L-T4 replacement in SCH are poorly understood. OBJECTIVES: To compare cardiovascular risk factors and renal variables in women with SCH and normal women. To study the effects of L-T4 replacement in SCH subjects on these variables and on structural and functional changes in common carotid and brachial arteries. DESIGN: Fifty-six women with SCH before and after L-T4 replacement for 18 months and 56 normal women of similar age distribution were studied. Blood Pressure (BP), plasma lipids and homocysteine were measured and renal function evaluated [estimation of glomerular filtration rate (eGFR) using standard equations and measurement of serum Cystatin-C] in women with SCH before and after 18 months of l-T4, and in healthy women. CIMT and endothelial function (using brachial artery ultrasound) were studied before and after L-T4 in a subgroup of women with SCH. RESULTS: Systolic and diastolic BP, total cholesterol, triglyceride, LDL-cholesterol, lipoprotein(a) and homocysteine were greater in SCH (P < 0.05), and following L-T4 replacement decreased (P < 0.05) to levels that no longer differed from normal subjects. Estimated GFR was reduced and serum Cystatin-C increased (P < 0.05) in SCH. These variables also normalized following L-T4. Following L-T4 replacement the carotid artery baseline diameter increased by 7.1% and CIMT decreased by a mean value of 13%, while brachial artery diameter increased basally by 12.5% and following endothelium-dependent vasodilatation by 17.5% (P < 0.05). However, the increment following reactive hyperaemia did not differ before or following L-T4 replacement. CONCLUSION: Normalization of

  7. Endothelial Functioning and Hemodynamic Parameters in Rats with Subclinical Hypothyroid and the Effects of Thyroxine Replacement.

    Directory of Open Access Journals (Sweden)

    Cuixia Gao

    Full Text Available Subclinical hypothyroidism (SCH and its associations with atherosclerosis (AS and cardiovascular disease remain controversial. The purpose of our study was to observe changes in endothelial functioning and hemodynamics in rats with SCH and to determine whether L-thyroxine (L-T4 administration affects these changes.In total, sixty male Wistar rats were randomly divided into the following three groups with 20 rats each: control euthyroid rats, SCH rats and SCH rats that had been treated with thyroxine (SCH+T4. The SCH rats were induced by administration of 10 mg x kg(-1 x d(-1 methimazole (MMI once daily by gavage for 3 months. The SCH+T4 rats were administered the same dose of MMI for three months in addition to 2 μg x kg(-1 x d(-1 L-T4 once daily by gavage after 45 days of MMI administration. The control rats received physiological saline via gavage.The SCH group had significantly higher thyroid-stimulating hormone (TSH, total cholesterol (TC, low-density lipoprotein cholesterol (LDL-C, and endothelin (ET levels and a lower nitric oxide (NO level than the control and SCH+T4 groups. The tail and carotid artery blood pressures, left ventricular systolic pressure, heart rate and aorta ventralis blood flow were significantly lower in the SCH group than in the control and SCH+T4 groups. ACH treatment caused concentration-dependent relaxation, which was reduced in the SCH arteries compared with the control and SCH+T4 arteries. Histopathological examination revealed the absence of pathological changes in the SCH rat arteries.These findings demonstrate that L-T4 treatment ameliorates endothelial dysfunction and hemodynamic changes in SCH rats.

  8. Effect of hormone replacement on exercise cardiopulmonary reserve and recovery performance in subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    M.R.M. Mainenti

    2010-11-01

    Full Text Available Subclinical hypothyroidism (SH patients present cardiopulmonary, vascular and muscle dysfunction, but there is no consensus about the benefits of levothyroxine (L-T4 intervention on cardiopulmonary performance during exercise. The aim of the present study was to investigate the effects of L-T4 on cardiopulmonary exercise reserve and recovery in SH patients. Twenty-three SH women, 44 (40-50 years old, were submitted to two ergospirometry tests, with an interval of 6 months of normalization of thyroid-stimulating hormone (TSH levels (L-T4 replacement group or simple observation (TSH = 6.90 μIU/mL; L-T4 = 1.02 ng/dL. Patients with TSH >10 μIU/mL were excluded from the study to assure that they would receive treatment in this later stage of SH. Twenty 30- to 57-year-old women with no thyroid dysfunction (TSH = 1.38 μIU/mL; L-T4 = 1.18 ng/dL were also evaluated. At baseline, lower values of gas exchange ratio reserve (0.24 vs 0.30; P < 0.05 were found for SH patients. The treated group presented greater variation than the untreated group for pulmonary ventilation reserve (20.45 to 21.60 L/min; median variation = 5.2 vs 25.09 to 22.45 L/min; median variation = -4.75, respectively and for gas exchange ratio reserve (0.19 to 0.27; median variation = 0.06 vs 0.28 to 0.18; median variation = -0.08, respectively. There were no relevant differences in cardiopulmonary recovery for either group at baseline or after follow-up. In the sample studied, L-T4 replacement improved exercise cardiopulmonary reserve, but no modification was found in recovery performance after exercise during this period of analysis.

  9. Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

    Science.gov (United States)

    Donnay, S; Balsa, J A; Álvarez, Julia; Crespo, C; Pérez-Alcántara, F; Polanco, C

    2013-11-01

    Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  10. Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults

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    Mervat M. El-Eshmawy

    2013-12-01

    Full Text Available BackgroundRecent evidence has suggested an association between subclinical hypothyroidism (SCH and microalbuminuria in patients with type 2 diabetes. However, whether SCH is related to microalbuminuria among subjects with prediabetes has not been studied. Thus, we evaluated the association between SCH and microalbuminuria in a cohort of prediabetic Egyptian adults.MethodsA total of 147 prediabetic subjects and 150 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR, thyroid stimulating hormone (TSH, free thyroxine, triiodothyronine levels, and urinary albumin-creatinine ratio (UACR were assessed.ResultsThe prevalence of SCH and microalbuminuria in the prediabetic subjects was higher than that in the healthy controls (16.3% vs. 4%, P<0.001; and 12.9% vs. 5.3%, P=0.02, respectively. Prediabetic subjects with SCH were characterized by significantly higher HOMA-IR, TSH levels, UACR, and prevalence of microalbuminuria than those with euthyroidism. TSH level was associated with total cholesterol (P=0.05, fasting insulin (P=0.01, HOMA-IR (P=0.01, and UACR (P=0.005. UACR was associated with waist circumference (P=0.01, fasting insulin (P=0.05, and HOMA-IR (P=0.02. With multiple logistic regression analysis, SCH was associated with microalbuminuria independent of confounding variables (β=2.59; P=0.01.ConclusionOur findings suggest that prediabetic subjects with SCH demonstrate higher prevalence of microalbuminuria than their non-SCH counterparts. SCH is also independently associated with microalbuminuria in prediabetic subjects. Screening and treatment for SCH may be warranted in those patients.

  11. Hypothyroidism

    Science.gov (United States)

    Myxedema coma, the most severe form of hypothyroidism, is rare. It occurs when thyroid hormone levels get very ... or certain medicines in people with untreated hypothyroidism. Myxedema coma is a medical emergency that must be treated ...

  12. Inability of recombinant human thyrotropin to predict the evolution from subclinical hypothyroidism to overt disease. A pilot study.

    Science.gov (United States)

    Zafon, C; Rodríguez, B; Montoro, J B; Cabo, D; Mesa, J

    2012-01-01

    The use of recombinant human TSH (rhTSH) is indicated to evaluate thyroid carcinoma patients. In recent years, some authors have reported that rhTSH could serve as a dynamic test of thyroid reserve. The aim of the present study was to determine whether or not rhTSH can predict the evolution from subclinical hypothyroidism (SH) to overt hypothyroidism. Twenty-one women who met the diagnostic criteria of SH were enrolled. All patients received a single dose of rhTSH (0.1 mg). Basal blood samples for TSH, free T4 (fT4), thyroglobulin (Tg), and anti-thyoperoxidase and anti-Tg antibodies were obtained before and 1 day after rhTSH administration. All patients were followed for 2 yr, and blood samples were obtained every 6 months. Twenty-four hours after rhTSH administration, the TSH level increased to >20 mU/l in 14 patients; the serum peak TSH levels remained 10 mlU/l. None of the parameters analyzed differed significantly between patients who developed overt hypothyroidism from those who had persistent SH. The response of thyroid function tests to a single low dose of rhTSH is not useful in identifying those patients with SH who will develop overt hypothyroidism over a 2-yr period.

  13. Bone health in children with long–term idiopathic subclinical hypothyroidism

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    Di Mase Raffaella

    2012-10-01

    Full Text Available Abstract Background Subclinical hypothyroidism (SH is a relatively common condition characterized by a mild persistent thyroid failure. The management of children with SH is still a controversial issue and the decision to treat with L-thyroxine represents a clinical dilemma. Thyroid hormone and TSH play an important role in skeletal growth and bone mineral homeostasis. Aim To evaluate whether untreated idiopathic SH may affect bone health in childhood and to compare two different diagnostic tools such as dual-energy X-ray densitometry (DXA and quantitative ultrasound (QUS. Patients and Methods Twenty-five children and adolescents (11 males aged 9.8 ± 3.5 years (range 4.2-18.7 with untreated idiopathic SH were enrolled in the study. SH was diagnosed on the basis of normal FT4 levels with TSH concentrations between 4.2 and 10 mU/l. Children have been followed for 3.3 ± 0.3 years from the time of SH diagnosis. Twenty-five healthy children, age- and sex-matched, were enrolled as controls. Patients and controls underwent DXA to evaluate lumbar spine bone mineral density (BMD and QUS at proximal phalanges of the non-dominant hand to assess bone quality, measured as amplitude-dependent speed of sound (Ad-SoS and bone transmission time (BTT. Results Mean BMD Z-score was −0.4 ± 1.36 in patients and −0.2 ± 1.2 in controls. Mean Ad-SoS Z-score was 0.01 ± 1.0 in patients and 0.1 ± 1.2 in controls and mean BTT Z-score was −0.03 ± 0.8 and 0.04 ± 1.1 respectively. All values were within the normal range, both in patients and in controls. There were no statistically significant differences between the two groups. Conclusion Bone health, evaluated by lumbar spine DXA and phalangeal QUS, is not impaired in our children, despite long-term duration of idiopathic SH. Data about bone status provided by QUS are comparable to those provided by DXA. Therefore, QUS may represent a good, cheaper and safe screening test for bone evaluation in children with SH.

  14. [Subclinical thyroid diseases].

    Science.gov (United States)

    Zamrazil, V

    2007-01-01

    Subclinical thyroids disease (STD) is recently defined term in clinical thyroidology, which includes mainly functional disorders. Basic diagnostic signs are: normal values of thyroid hormones (fT4, fT3) and elevated TSH level (subclinical hypothyroidism) or suppresed TSH level (subclinical hyperthyroidism). In a category of STD may be included subclinical autoimunne thyroiditis (elevated level of thyroid antigens antibodies and/or hypoechogenity in sonographic screen, increased volume of the thyroid without clinical symptoms and/or autoimminity) and microscopic lesions of papillary thyroid carcinoma. Subclinical hypothyroidism may be dangerous for tendency to development of manifest hypothyroidism and for risk of disorders of lipid profile and development of atherosclerosis and its organ complication (esp. myocardial infarction). Subclinical hyperthyroidism is a risk factor of cardiac arythmias and probably can increase a risk of cardiovascular mortality) as well for osteoporosis (esp. in peri- and post-climacteric women), and last but not least for degenerative diseases of brain (?). Indication of treatment of STD is a matter of controversies. Recomendations of experts, varied from "no therapy, monitoring only" to "treat always". Treatment of risk groups (esp. pregnant women) is probably nowadays a most rationale recommendations since results of sofisticated prospective studies will be available.

  15. [Prevalence and clinical characteristics of subclinical hypothyroidism in an opportunistic sample in the population of Castile-León (Spain)].

    Science.gov (United States)

    Mariscal Hidalgo, Ana Isabel; Lozano Alonso, José E; Vega Alonso, Tomás

    2015-01-01

    To describe the distribution of thyroid-stimulating hormone (TSH) values and to estimate the prevalence of subclinical hypothyroidism in the adult population of Castile and León (Spain). An observational study was conducted in an opportunistic sample of 45 primary care centers in Castile and León. TSH was determined in people aged ≥35 years that attended a primary care physician and had a blood test for any reason. Confirmatory analysis included free thyroxine and anti-thyroid peroxidase antibody determination. A total of 3957 analyses were carried out, 63% in women. The mean age was 61.5 years. The median TSH value was 2.3 μIU/mL (2.5 μIU/mL in women and 2.1 μIU/mL in men), with a rising trend with age. TSH values were higher in undiagnosed or untreated subclinical hypothyroidism than in patients under treatment. The lowest levels were found in euthyroidism. The prevalence of subclinical hypothyroidism was 9.2% (95%CI: 8.3-10.2), and hypothyroidism was three times higher in women than in men (12.4% versus 3.7%). Hypothyroidism increased with age, reaching a peak of 16.9% in women aged 45 to 64 years. The prevalence of subclinical hypothyroidism in our sample was high and in the upper limits of values found in previous studies. Proper diagnosis and treatment are important because of the risk of progression to hypothyroidism and the association with multiple diseases and other risk factors. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Impact of Overt and Subclinical Hypothyroidism on Exercise Tolerance: A Systematic Review

    Science.gov (United States)

    Lankhaar, Jeannette A. C.; de Vries, Wouter R.; Jansen, Jaap A. C. G.; Zelissen, Pierre M. J.; Backx, Frank J. G.

    2014-01-01

    Purpose: This systematic review describes the state of the art of the impact of hypothyroidism on exercise tolerance and physical performance capacity in untreated and treated patients with hypothyroidism. Method: A systematic computer-aided search was conducted using biomedical databases. Relevant studies in English, German, and Dutch, published…

  17. Hipotiroidismo subclínico, ni tan asintomático, ni tan inofensivo Subclinical hypothyroidism neither so asymptomatic nor so harmless

    Directory of Open Access Journals (Sweden)

    Marelys Yanes Quesada

    2009-04-01

    Full Text Available El hipotiroidismo subclínico es la condición definida por la elevación de la hormona estimulante del tiroides, en presencia de secreción de hormonas tiroideas (T3 y T4 normales para el rango de referencia. Sus manifestaciones clínicas no son tan nulas como lo define el término subclínico. Si se hace un correcto interrogatorio y examen clínico se pueden encontrar alteraciones en diversos sistemas y órganos que perjudican la calidad de vida de los pacientes afectos e incrementan su morbimortalidad. Durante el embarazo, la entidad cobra especial atención debido a la repercusión en el feto de la alteración de su desarrollo. En los pacientes ancianos es de vital importancia su diagnóstico, debido al incremento de la prevalencia de la entidad en este grupo y la repercusión sobre la calidad de vida. El presente trabajo tiene como objetivo revisar las alteraciones clínicas que se puedan presentar en el hipotiroidismo subclínico, así como en situaciones especiales de la vida (embarazo y senectud.Subclinical hypothyroidism is the condition defined by the raise of thyroid-stimulating hormone in presence of normal thyroid hormone secretion (T3 and T4 for reference rank. Its clinical manifestations are not so nulls as defines the subclinical term. If an appropriate questioning and clinical examination is made it is possible to find alterations in many systems and organs harming the quality of life of patients affected and to increase its morbidity and mortality. During pregnancy this entity acquires a special attention due to repercussion on fetal development alteration. In elderly patients is essential its diagnosis due to entity prevalence increase on this group and the repercussion on quality of life. Aim of present paper is to review the clinical alterations that may be present in subclinical hypothyroidism, as well as in special situations of life (pregnancy and senescence.

  18. Subclinical hypothyroidism in pregnant rats impaired learning and memory of their offspring by promoting the p75NTR signal pathway

    Directory of Open Access Journals (Sweden)

    Fan Zhang

    2018-05-01

    Full Text Available Objective: Maternal hypothyroidism during pregnancy can affect the neurodevelopment of their offspring. This study aimed to investigate the effects of maternal subclinical hypothyroidism (SCH on spatial learning and memory, and its relationship with the apoptotic factors in cerebral cortex of the offspring. Methods: Female adult Wistar rats were randomly divided into three groups (n = 15 per group: control (CON group, SCH group and overt hypothyroidism (OH group. Spatial learning and memory in the offspring were evaluated by long-term potentiation (LTP and Morris water-maze (MWM test. The protein expression of the p75 neurotrophin receptor (p75NTR, phospho-c-Jun N-terminal kinase (p-JNK, the pro-apoptotic protein p53 and Bax were detected by Western blotting. Results: The Pups in the SCH and OH groups showed longer escape latencies in the MWM and decreased field-excitatory post synaptic potentials in LTP tests compared with those in the CON group. p75NTR, p-JNK, p53 and Bax expression levels in the cerebral cortex increased in pups in the SCH and OH groups compared with those in the CON group. Conclusions: Maternal SCH during pregnancy may impair spatial learning and memory in the offspring and may be associated with the increased apoptosis in the cerebral cortex.

  19. The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women : a need for case-finding?

    NARCIS (Netherlands)

    Bindels, A.J.; Westendorp, R.G.; Frölich, M.; Seidell, J C; Blokstra, A.; Smelt, A.H.M.

    OBJECTIVE: In order to determine whether screening of thyroid function is justified in patients with hypercholesterolaemia, we determined the prevalence of subclinical hypothyroidism at different levels of total plasma cholesterol in middle-aged men and women. DESIGN AND METHODS: 1200 participants

  20. Subclinical Thyroid Dysfunction and Fracture Risk

    DEFF Research Database (Denmark)

    Blum, Manuel R; Bauer, Douglas C; Collet, Tinh-Hai

    2015-01-01

    . Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES: The primary outcome was hip...... fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS: Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975...... hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS...

  1. Clinical aspects of endogenous hypothyroidism and subclinical hyperthyroidism in patients with differentiated thyroid carcinoma

    NARCIS (Netherlands)

    Heemstra, Karen Anne

    2009-01-01

    Patients with DTC are initially treated with a total thyroidectomy and radioiodine therapy. Hereafter, all patients are treated with high doses of thyroxin aiming at significantly suppressing thyrotropin (TSH) levels, resulting in a subclinical hyperthyroid state. The rationale of this approach is

  2. Depressive symptoms in patients with subclinical hypothyroidism--the effect of treatment with levothyroxine: a double-blind randomized clinical trial.

    Science.gov (United States)

    Najafi, Laily; Malek, Mojtaba; Hadian, Ali; Ebrahim Valojerdi, Ameneh; Khamseh, Mohammad E; Aghili, Rokhsareh

    2015-01-01

    Despite the increasing evidence for relationships between thyroid dysfunction and neuropsychiatric alterations, the effect of treatment of thyroid disease on various clinical psychiatric outcomes is controversial. The purpose of this study was to investigate the effect of levothyroxine treatment on depressive symptoms in subjects with subclinical hypothyroidism. A randomized double-blind placebo-controlled clinical trial was performed. Sixty subjects (51 females and 9 males) with subclinical hypothyroidism were enrolled. Beck Depression Inventory was completed for all participants at the beginning of the study and 12 weeks after enrollment. The intervention and control groups received levothyroxine and placebo, respectively, for 12 weeks. There were no statistical differences in the total depression score and its subscales between the two groups at the beginning of the study. The Beck Depression Inventory score decreased from 16.79 ± 13.25 to 12.37 ± 10.01 (p value = 0.04) in the intervention group. The change in score was not significant for the control group (13.77 ± 11.71 to 11.86 ± 10.71; p value= 0.16). The affective subscale of Beck Depression Inventory did not change after 12 weeks of treatment with levothyroxine, while somatic subscale remarkably improved in the intervention group (p value = 0.02). This study showed the efficacy of treatment of subclinical hypothyroidism in people with levothyroxine in relation to depressive symptoms.

  3. Comparison of pre- and post-levothyroxine high-sensitivity c-reactive protein and fetuin-a levels in subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Oktay Bilgir

    2015-02-01

    Full Text Available OBJECTIVE: The objective of this trial was to determine the levels of inflammatory markers, high-sensitivity C-reactive protein and fetuin-A pre- and post-levothyroxine treatment in cases of subclinical hypothyroidism. MATERIALS AND METHODS: A total of 32 patients with a diagnosis of subclinical hypothyroidism and a control group of 30 healthy individuals were tested for high-sensitivity C-reactive protein and fetuin-A, followed by the administration of 50 µg of levothyroxine in the patient group for 3 months. During the post-treatment stage, high-sensitivity C-reactive protein and fetuin-A levels in the patient group were re-assessed and compared with pre-treatment values. RESULTS: Pre-treatment levels of both high-sensitivity C-reactive protein and fetuin-A were observed to be higher in the patient group than in the control group. The decrease in high-sensitivity C-reactive protein levels during the post-treatment stage was not statistically significant. However, the decrease observed in post-treatment fetuin-A levels was found to be statistically significant. CONCLUSION: The decrease in fetuin-A levels in subclinical hypothyroidism cases indicates that levothyroxine treatment exerts anti-inflammatory and anti-apoptotic effects. Although the decrease in high-sensitivity C-reactive protein levels was statistically non-significant, it is predicted to reach significance with sustained treatment.

  4. Clinical aspects of endogenous hypothyroidism and subclinical hyperthyroidism in patients with differentiated thyroid carcinoma

    OpenAIRE

    Heemstra, Karen Anne

    2009-01-01

    Patients with DTC are initially treated with a total thyroidectomy and radioiodine therapy. Hereafter, all patients are treated with high doses of thyroxin aiming at significantly suppressing thyrotropin (TSH) levels, resulting in a subclinical hyperthyroid state. The rationale of this approach is based on the potential harmful effects of TSH on tumor recurrence. Furthermore, thyroxin replacement therapy can be transiently stopped in these patients to detect residual or recurrent disease by T...

  5. Evolution of subclinical hypothyroidism and its relation with glucose and triglycerides levels in morbidly obese patients after undergoing sleeve gastrectomy as bariatric procedure.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Boix, Evangelina; Galindo, Isabel; Zubiaga, Lorea; Diez, María; Arroyo, Antonio; Calpena, Rafael

    2014-05-01

    There is an increased prevalence of subclinical hypothyroidism (SCH) in patients with obesity. It is unclear if this biochemical abnormality may be a secondary phenomenon of obesity or a real hypothyroid state. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and November 2012 was performed. Weight loss, body mass index (BMI) and excess weight loss, baseline glucose, lipid profiles, and TSH levels were obtained before operation and postoperative determinations at 3, 6, and 12 months after surgery. Sixty patients were included. Prevalence of subclinical hypothyroidism was 16.7% preoperatively, 10% at 3 months, 3.3% at 6 months, and 1.7% at 12 months. A significant correlation could be established between TSH decrease and weight loss at 12 months (Pearson 0.603; p = 0.007). TSH decrease showed a significant correlation with glucose and glycated hemoglobin decrease from 6th month onwards. Referring to lipid profile, an association of TSH decrease with total cholesterol, LDL cholesterol, or HDL cholesterol could not be determined. A significant association between TSH decrease and triglycerides and cardiovascular risk index triglycerides/HDL cholesterol reductions could also be established 12 months after surgery. SCH is usually corrected after bariatric surgery, while there are no significant changes in total or LDL cholesterol. This suggests that, in morbidly obese subjects, SCH is, in most patients, just a consequence of the abnormal fat accumulation and not a real hypothyroid state.

  6. Evaluation of thyroid nodule characteristics in subclinical hypothyroid patients under a myo-inositol plus selenium treatment.

    Science.gov (United States)

    Nordio, M; Basciani, S

    2018-04-01

    The anticancer effect of myo-inositol (MI) is catching researchers' attention worldwide. Thyroid nodules (TNs) have been detected by ultrasound (US) in up to 76% of the general population and, although most of them are benign, thyroid cancer is the most common malignancy of the endocrine system. A retrospective, observational study was conducted in 642 patients with suspected hypothyroidism undergoing US. The analysis was addressed exclusively to patients with subclinical hypothyroidism (SCH) or thyroid-stimulating hormone (TSH) levels borderline associated to TNs classified as class I and II; 1 group (control, no. 16) no treatment was prescribed; the other group (treated, no. 18) underwent treatment with 1 tablet containing MI plus selenium (Se) every day, for six months. Clinical data were collected to evaluate the nodular size, number, and elasticity, as well as TSH levels. Final data were analyzed from 34 patients: in 76% of mixed TNs was observed a significant reduction of their size and 56% of them significantly regressed nodule stiffness following oral supplementation with MI plus Se. The mean number of mixed nodules for patient shifted from 1.39 ± 0.16 to 1.05 ± 0.15 (p ≤ 0.05). TSH levels dropped from 4.2 ± 0.21 mIU/L at baseline to 2.1 ± 0.20 mIU/L post-treatment (p treatment with MI plus Se, a reduction of the size, number and elasticity score of TNs as well as TSH levels was observed. Further studies are required, either in vitro and in vivo, to investigate the use of MI plus Se for the management of TNs.

  7. Marked improvement of thyroid function and autoimmunity by Aloe barbadensis miller juice in patients with subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    Daniela Metro

    2018-03-01

    Full Text Available Some natural compounds decrease serum levels of thyroid autoantibodies, but results are inconsistent and thyroid function has been evaluated infrequently; moreover, the effects of Aloe on thyroid autoimmunity and function have been examined in very few studies. This study stems from the observation of one co-author, who has Hashimoto’s thyroiditis (HT-related subclinical hypothyroidism (SCH. Upon checking her biochemical thyroid panel when taking daily Aloe barbardensis Miller juice (ABMJ for thyroid-unrelated reasons, she noticed a decrease in serum thyroperoxidase autoantibodies (TPOAb and thyrotropin (TSH and an increase in serum free thyroxine (FT4. Based on this observation, we enrolled 30 consecutive HT women with levothyroxine-untreated SCH and high TPOAb levels. All of them took ABMJ (50 ml daily for nine months and were tested for serum TSH, FT4, free triiodothyronine (FT3 and TPOAb. Measurements were performed at baseline and at months 3 and 9. TSH, FT4 and TPOAb improved significantly already at month 3 and further (−61%, +23% and −56% at month 9. However, FT3 decreased significantly at month 3 (−16% with no further decrease at month 9, so that the FT4:FT3 ratio increased significantly (+33% and + 49%. At baseline, 100% of women had TSH > 4.0 mU/L and TPOAb > 400 U/ml, but frequencies fell to 0% and 37%, respectively, at month 9. In contrast, a control group (namely, 15 untreated SCH women of comparable age and baseline levels of TSH, FT4, FT3 and TPOAb had no significant changes in any index. We conclude that the daily intake of 100 ml ABMJ for 9 months in women with HT-related SCH decreases the burden of thyroid autoimmune inflammation. In addition, ABMJ rescues thyrocyte function, with decreased need for conversion of the prohormone T4 into the more active T3 through ABMJ-induced inhibition of T4 deiodination. Keywords: Aloe vera, Subclinical hypothyroidism, Thyroid autoimmunity, Thyroid function

  8. Subclinical Hypothyroidism and the Effect of Autoimmunity on the Echocardiography Indices of Left Ventricular Function, Lipid Profile, and Inflammatory Markers

    Directory of Open Access Journals (Sweden)

    Zohreh Moossavi

    2015-03-01

    Full Text Available Background: Subclinical hypothyroidism (Sch is the most frequent thyroid disease. The relationship between overt hypothyroidism and cardiovascular diseases has been well documented, but conflicting data have remained regarding Sch. Objectives: The present study aimed to assess the effect of Sch on increasing the risk of cardiovascular involvement considering the autoimmune subset. Patients and Methods: This case-control study was conducted on thirty patients with Sch and 30 healthy controls. Serum levels of thyroperoxidase antibody (TPOab, lipids, hsCRP, homocysteine, and ferritin were measured. Besides, conventional echocardiographic study and tissue Doppler imaging (including strain rate indices was done to evaluate Left Ventricular (LV systolic function. Results: The results showed a significant difference between the Sch patients and the controls regarding the serum level of triglyceride (117.43 ± 63.51 mg/dL vs. 86.86 ± 41.57, P = 0.031, echocardiographic parameters (longitudinal systolic strain rate [SRs: -1.006 ± 0.4 vs. -1.26 ± 0.16, P = 0.002; SRl: -1.43 ± 0.27 vs. -1.68 ± 0.29, P = 0.001], and Sm of septal mitral annulus (6.90 ± 0.6 vs. 7.43 ± 0.8, P = 0.006]. However, no significant difference was observed between the two groups regarding the serum levels of the inflammatory markers. Moreover, a significant correlation was found between TSH and Sm (r = -0.36, P = 0.005 and longitudinal systolic strain rate (SRs: r = 0.42, P < 0.001; SRl: r = 0.40, P = 0.001. Systolic strain rate was significantly lower in the TPOab positive patients (-0.99 ± 0.18 vs. -1.15 ± 0.25, P = 0.047. Conclusions: The clear association between Sch and subclinical LV systolic dysfunction which was more evident in the subgroup of patients with circulating anti-thyroid antibodies would remind a greater emphasis for considering the subgroup of TPOab positive patients for directing toward hormone replacement.

  9. Hypothyroidism and the Heart

    Science.gov (United States)

    Udovcic, Maja; Pena, Raul Herrera; Patham, Bhargavi; Tabatabai, Laila; Kansara, Abhishek

    2017-01-01

    Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters. PMID:28740582

  10. Hypothyroidism in clinical practice

    Directory of Open Access Journals (Sweden)

    Faiza Qari

    2014-01-01

    Full Text Available Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points.

  11. Hypothyroidism and the Heart.

    Science.gov (United States)

    Udovcic, Maja; Pena, Raul Herrera; Patham, Bhargavi; Tabatabai, Laila; Kansara, Abhishek

    2017-01-01

    Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters.

  12. The Brazilian consensus for the clinical approach and treatment of subclinical hypothyroidism in adults: recommendations of the thyroid Department of the Brazilian Society of Endocrinology and Metabolism.

    Science.gov (United States)

    Sgarbi, Jose A; Teixeira, Patrícia F S; Maciel, Lea M Z; Mazeto, Glaucia M F S; Vaisman, Mario; Montenegro Junior, Renan M; Ward, Laura S

    2013-04-01

    Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO - Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values > 10 mU/L and for certain patient subgroups.

  13. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism.

    Science.gov (United States)

    Wasniewska, Malgorzata; Corrias, Andrea; Aversa, Tommaso; Valenzise, Mariella; Mussa, Alessandro; De Martino, Lucia; Lombardo, Fortunato; De Luca, Filippo; Salerno, Mariacarolina

    2012-01-01

    The question of whether children with subclinical hypothyroidism (SH) should be treated or not is controversial due to the lack of studies on outcomes of SH children treated with L-thyroxine (L-T(4)) versus those receiving no therapy. (a) To evaluate thyroid tests under L-T(4) and after therapy withdrawal in 69 SH children (group A) and (b) to compare our results with those recorded in 92 untreated children (group B). Group A children were treated for 24 months and TSH and FT(4) levels 3 months after therapy withdrawal were compared with those measured in group B at the end of follow-up in order to investigate treatment effects. The prevalence of children who had normalized TSH at the end of follow-up was higher in group A, but the prevalence of those who had normalized or maintained unchanged TSH was similar in the two groups, as was the prevalence of children who exhibited a TSH increase >10 mU/l. In group A, TSH values at 27 months were associated with baseline values. (a) Two-year treatment in SH children is unable to modify posttherapy outcome of hyperthyrotropinemia; (b) therapy is unable to prevent the risk of further TSH increase after treatment withdrawal, and (c) posttherapy TSH outcome is conditioned by baseline TSH. Copyright © 2012 S. Karger AG, Basel.

  14. Alteration of Hemostatic Parameters in Patients with Different Levels of Subclinical Hypothyroidism and the Effect of L-thyroxine Treatment.

    Science.gov (United States)

    Gao, Fang; Wang, Guangya; Xu, Jinxiu

    2017-01-01

    Subclinical hypothyroidism (SH) is associated with hypercoagulability and hypofibrinolysis. The objective of this study was to assess the effect of L-thyroxine (L-T4) treatment and to evaluate changes in the hemostatic abnormalities of patients with varying severities of SH. We measured tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), D-dimer (DDI), fibrinogen (FIB), platelet counts (PLT), mean platelet volume (MPV), platelet distribution width (PDW), activated partial thromboplastin time (APTT), and prothrombin time (PT) in 149 female subjects. The prospective study included 54 patients in the control group, 53 patients with 4.2 μIU/mLtreatment, a significant decrease in FIB, PAI-1 and t-PA levels and an increase in APTT and DDI were observed in the severe SH group. In conclusion, SH patients displayed a distinct pattern of alteration of hemostatic parameters that was dependent on the severity of the disease. Patients with TSH levels ≥10 μIU/mL displayed hypercoagulability, which was reversed by 6 months of L-T4 treatment. © 2017 by the Association of Clinical Scientists, Inc.

  15. Thickening of the epicardial adipose tissue can be alleviated by thyroid hormone replacement therapy in patients with subclinical hypothyroidism.

    Science.gov (United States)

    Sayin, Irmak; Erkan, Aycan Fahri; Ekici, Berkay; Kutuk, Utku; Corakci, Ahmet; Tore, Hasan Fehmi

    2016-01-01

    Subclinical hypothyroidism (SCH) is a common disorder which has adverse cardiovascular effects. Epicardial adipose tissue (EAT), a novel marker of cardiovascular risk, is increased in SCH. We aimed to investigate whether L-thyroxine treatment can reverse the thickening of EAT in SCH. Forty-four patients with SCH and 42 euthyroid control subjects were included. EAT thickness was measured using transthoracic echocardiography at baseline and after restoration of the euthyroid status with 3 months of L-thyroxine treatment. At baseline, mean EAT thickness was significantly greater in the SCH group when compared to the control group (6.3 ± 1.7 mm vs. 4.1 ± 0.9 mm, respectively, p treatment (6.3 ± 1.7 mm vs. 5.1 ± 1.4 mm, p treatment when compared to baseline (DEAT) significantly correlated to the difference in TSH levels before and after treatment (DTSH; r = 0.323; p = 0.032). Epicardial adipose tissue thickness is increased in patients with SCH. This thickening was alleviated with restoration of the euthyroid status with L-thyroxine treatment in our study population of predominantly male, relatively old subjects with greater baseline EAT thickness.

  16. Epicardial Adipose Tissue Thickness in Patients With Subclinical Hypothyroidism and the Relationship Thereof With Visceral Adipose Tissue Thickness.

    Science.gov (United States)

    Arpaci, Dilek; Gurkan Tocoglu, Aysel; Yilmaz, Sabiye; Korkmaz, Sumeyye; Ergenc, Hasan; Gunduz, Huseyin; Keser, Nurgul; Tamer, Ali

    2016-03-01

    Subclinical hypothyroidism (SH) is associated with cardiovascular metabolic syndromes, especially dislipidemia and abdominal obesity. Visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) have the same ontogenic origin and produce many proinflammatory and proatherogenic cytokines. We evaluated EAT and VAAT thickness in patients with SH. Forty-one patients with SH and 35 controls were included in the study. Demographical and anthropometric features of both patients and controls were recorded. Thyroid and metabolic parameters were measured. EAT was measured using 2D-transthoracic echocardiography. The age and gender distributions were similar in the two groups (P = 0.998 and P = 0.121, respectively). Body mass index (BMI), fat mass, waist circumference (WC), hip circumference (HC), the WC/HC ratio, and the thicknesses of VAAT and abdominal subcutaneous adipose tissue were higher in the case group than the control group (all P values 0.05). We found no difference between the two groups in fasting plasma glucose (FPG) level (P = 0.780), but the levels of LDL-C and TG differed significantly (P = 0.002 and P = 0.026, respectively). The serum TSH level was higher and the FT4 level was lower in the case than the control group (both P values <0.01). Increased abdominal adipose tissue thickness in patients with SH is associated with atherosclerosis. To detemine the risk of atherosclerosis in such patients, EAT measurements are valuable; such assessment is simple to perform.

  17. Subclinical thyroid disorders and cognitive performance among adolescents in the United States

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    Wilson Jim L

    2006-04-01

    Full Text Available Abstract Background Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States. Methods Study sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III. Serum thyroxine (T4 and thyroid stimulating hormone (TSH were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R and the Wechsler Intelligence Scale for Children-Revised (WISC-R. The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments. Results Subclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level. Conclusion Subclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.

  18. Subclinical thyroid disorders and cognitive performance among adolescents in the United States.

    Science.gov (United States)

    Wu, Tiejian; Flowers, Joanne W; Tudiver, Fred; Wilson, Jim L; Punyasavatsut, Natavut

    2006-04-19

    Thyroid hormone plays a crucial role in the growth and function of the central nervous system. The purpose of the study was to examine the relationships between the status of subclinical thyroid conditions and cognition among adolescents in the United States. Study sample included 1,327 adolescents 13 to 16 years old who participated in the Third National Health and Nutrition Examination Survey (NHANES III). Serum thyroxine (T4) and thyroid stimulating hormone (TSH) were measured and subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroid groups were defined. Cognitive performance was assessed using the subscales of the Wide Range Achievement Test-Revised (WRAT-R) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The age-corrected scaled scores for arithmetic, reading, block design, and digit span were derived from the cognitive assessments. Subclinical hypothyroidism was found in 1.7% and subclinical hyperthyroidism was found in 2.3% of the adolescents. Cognitive assessment scores on average tended to be lower in adolescents with subclinical hyperthyroidism and higher in those with subclinical hypothyroidism than the score for the euthyroid group. Adolescents with subclinical hypothyroidism had significantly better scores in block design and reading than the euthyroid subjects even after adjustment for a number of variables including sex, age, and family income level. Subclinical hypothyroidism was associated with better performance in some areas of cognitive functions while subclinical hyperthyroidism could be a potential risk factor.

  19. Subclinical hypothyroidism is associated with increased risk for cancer mortality in adult Taiwanese-a 10 years population-based cohort.

    Directory of Open Access Journals (Sweden)

    Fen-Yu Tseng

    Full Text Available The association between subclinical hypothyroidism (SCH and cancer mortality is seldom discussed.A total of 115,746 participants without thyroid disease history, aged 20 and above, were recruited from four nationwide health screening centers in Taiwan from 1998 to 1999. SCH was defined as a serum thyroid-stimulating hormone (TSH level of 5.0-19.96 mIU/L with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47-4.9 mIU/L. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs of death from cancer for adults with SCH during a 10-year follow-up period.Among 115,746 adults, 1,841 had SCH (1.6% and 113,905 (98.4% had euthyroidism. There were 1,532 cancer deaths during the 1,034,082 person-years follow-up period. Adjusted for age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol drinking, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval of cancer deaths among subjects with SCH versus euthyroid subjects were 1.51 (1.06 to 2.15. Cancer site analysis revealed a significant increased risk of bone, skin and breast cancer among SCH subjects (RR 2.79, (1.01, 7.70. The risks of total cancer deaths were more prominent in the aged (RR 1.71, (1.02 to 2.87, in females (RR 1.69 (1.08 to 2.65, and in heavy smokers (RR 2.24, (1.19 to 4.21.Subjects with SCH had a significantly increased risk for cancer mortality among adult Taiwanese. This is the first report to demonstrate the association between SCH and cancer mortality.

  20. Subclinical hypothyroidism is associated with increased risk for cancer mortality in adult Taiwanese-a 10 years population-based cohort.

    Science.gov (United States)

    Tseng, Fen-Yu; Lin, Wen-Yuan; Li, Chia-Ing; Li, Tsai-Chung; Lin, Cheng-Chieh; Huang, Kuo-Chin

    2015-01-01

    The association between subclinical hypothyroidism (SCH) and cancer mortality is seldom discussed. A total of 115,746 participants without thyroid disease history, aged 20 and above, were recruited from four nationwide health screening centers in Taiwan from 1998 to 1999. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.0-19.96 mIU/L with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47-4.9 mIU/L. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of death from cancer for adults with SCH during a 10-year follow-up period. Among 115,746 adults, 1,841 had SCH (1.6%) and 113,905 (98.4%) had euthyroidism. There were 1,532 cancer deaths during the 1,034,082 person-years follow-up period. Adjusted for age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol drinking, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval) of cancer deaths among subjects with SCH versus euthyroid subjects were 1.51 (1.06 to 2.15). Cancer site analysis revealed a significant increased risk of bone, skin and breast cancer among SCH subjects (RR 2.79, (1.01, 7.70)). The risks of total cancer deaths were more prominent in the aged (RR 1.71, (1.02 to 2.87)), in females (RR 1.69 (1.08 to 2.65)), and in heavy smokers (RR 2.24, (1.19 to 4.21)). Subjects with SCH had a significantly increased risk for cancer mortality among adult Taiwanese. This is the first report to demonstrate the association between SCH and cancer mortality.

  1. Low mood and response to Levothyroxine treatment in Indian patients with subclinical hypothyroidism.

    Science.gov (United States)

    Vishnoi, Gaurav; Chakraborty, Baidarbhi; Garda, Hormaz; Gowda, Srinivas H; Goswami, Binita

    2014-04-01

    There is considerable controversy regarding the association of subclinical hypothyrodism (SCH) and depression. We studied the association of SCH with low mood and also investigated the effects of L-thyroxine (LT4) therapy on improvement of symptoms. Three hundred patients with SCH and 300 age and sex-matched healthy controls were studied. Serum levels of TSH, FT3, FT4 were measured by chemi-illuminescence. Hamilton Depression Rating Scale (HAM-D) was used to evaluate baseline depression in all participants and subsequently, in 133 patients who had undergone LT4 therapy for 2 months. The HAM-D scores were significantly higher for cases (10.0±4.7) as compared to controls (2.4±1.5). A positive correlation (r(2)=0.87, p=0.00) was found, between the Hamilton scores and serum TSH levels. No such association was seen between serum FT3, FT4 levels and HAM-D scores. Levothyroxine treatment resulted in a significant decrease in TSH levels and Hamilton scores. SCH is associated with low mood and there is a positive correlation between serum TSH levels and HAM-D scores. The administration of Levothyroxine therapy is associated with significant improvement in HAM-D scores. This underlines the importance of thyroid screening in cases of low mood and also asserts the role of Levothyroxine therapy. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. The Change of Left Ventricular Function in Rats with Subclinical Hypothyroid and the Effects of Thyroxine Replacement.

    Science.gov (United States)

    Chen, Xuedi; Gao, Cuixia; Gong, Ningning; Wang, Yu; Tian, Limin

    2018-01-01

    The main purpose of this study was to explore the relationships between serca2a, Ryr2, adipokines, and the left ventricular function in the subclinical hypothyroidism with different TSH levels and to determine the impact of L-T4 treatment on these indexes. Sixty-five male Wistar rats were randomly divided into five groups: control group; sHT A, B, and C group; and sHT + T4 group. The sHT rats were induced by methimazole (MMI), and the sHT + T4 rats were administered with L-T4 treatment after 8 weeks of MMI administration. Serum TT4, TSH, APN, chemerin, and TNF- α were detected by radioimmunoassay kits and ELISA kits; left ventricular function was measured by PowerLab system via subclavian artery catheter. The expression of Serca2a, Ryr2, APN, chemerin, and TNF- α were detected by RT-PCR, Western blot, and immunohistochemistry. The sHT groups had significantly higher TSH, chemerin, and TNF- α and lower Serca2a, Ryr2, and APN. The left ventricular pressure and heart rate in sHT groups were significantly lower in control and sHT + T4 group. Histopathological examination revealed the pathological changes in the sHT rats' heart. L-T4 administration reduced TSH level and improved left ventricular function. TSH can impair left ventricular function by regulating several factors, and L-T4 treatment ameliorates it in sHT rats.

  3. Intrauterine Zn Deficiency Favors Thyrotropin-Releasing Hormone-Increasing Effects on Thyrotropin Serum Levels and Induces Subclinical Hypothyroidism in Weaned Rats

    Directory of Open Access Journals (Sweden)

    Viridiana Alcántara-Alonso

    2017-10-01

    Full Text Available Individuals who consume a diet deficient in zinc (Zn-deficient develop alterations in hypothalamic-pituitary-thyroid axis function, i.e., a low metabolic rate and cold insensitivity. Although those disturbances are related to primary hypothyroidism, intrauterine or postnatal Zn-deficient adults have an increased thyrotropin (TSH concentration, but unchanged thyroid hormone (TH levels and decreased body weight. This does not support the view that the hypothyroidism develops due to a low Zn intake. In addition, intrauterine or postnatal Zn-deficiency in weaned and adult rats reduces the activity of pyroglutamyl aminopeptidase II (PPII in the medial-basal hypothalamus (MBH. PPII is an enzyme that degrades thyrotropin-releasing hormone (TRH. This hypothalamic peptide stimulates its receptor in adenohypophysis, thereby increasing TSH release. We analyzed whether earlier low TH is responsible for the high TSH levels reported in adults, or if TRH release is enhanced by Zn deficiency at weaning. Dams were fed a 2 ppm Zn-deficient diet in the period from one week prior to gestation and up to three weeks after delivery. We found a high release of hypothalamic TRH, which along with reduced MBH PPII activity, increased TSH levels in Zn-deficient pups independently of changes in TH concentration. We found that primary hypothyroidism did not develop in intrauterine Zn-deficient weaned rats and we confirmed that metal deficiency enhances TSH levels since early-life, favoring subclinical hypothyroidism development which remains into adulthood.

  4. Incidence of subclinical hypothyroidism in patients with Hodgkin lymphoma and non-Hodgkin requiring neck irradiation and/or mediastinum in the Hospital Mexico in the year 2009

    International Nuclear Information System (INIS)

    Monestel Umana, Rigoberto

    2010-01-01

    The treatment of lymphoma, both Hodgkin as non-Hodgkin, has had irradiation as part of management. The neck and/or mediastinum is irradiated and occurs, inevitably, partial or total irradiation of the thyroid gland. The evaluation that the effect may have on the function of the gland has been the purpose of this study. The risk of hypothyroidism in patients with Hodgkin lymphoma and non-Hodgkin should receive radiation therapy to the head, neck and/or mediastinum was studied. This has represented a first report of a follow-up study, of 2 years, analytical, longitudinal, observational, prospective. This is a first report of a follow-up study, of 2 years, analytical, longitudinal, observational, prospective. Design of cases, controls and a sample of 32 patients were studied; of these 31.25% have developed subclinical hypothyroidism. The subgroup with hypothyroidism was studied and an association was found between thyroid failure and dose, including the possibility of reversion of disorders. Association with the type of lymphoma and received chemotherapy was found, while with age, sex, lymphoma staging and dose received by the lymphoma is found without association. The onset of subclinical hypothyroidism generated by irradiation of the neck and/or mediastinum is associated with the radiation dose received by the thyroid. A relationship, unclear, has existed between the type of lymphoma and chemotherapy indicated as a treatment and should be explored further, a routine basis indicating the evaluation of the thyroid function in all these patients to avoid the development of unmonitored disorders. (author) [es

  5. Hypothyroidism: etiology, diagnosis, and management.

    Science.gov (United States)

    Almandoz, Jaime P; Gharib, Hossein

    2012-03-01

    Hypothyroidism is the result of inadequate production of thyroid hormone or inadequate action of thyroid hormone in target tissues. Primary hypothyroidism is the principal manifestation of hypothyroidism, but other causes include central deficiency of thyrotropin-releasing hormone or thyroid-stimulating hormone (TSH), or consumptive hypothyroidism from excessive inactivation of thyroid hormone. Subclinical hypothyroidism is present when there is elevated TSH but a normal free thyroxine level. Treatment involves oral administration of exogenous synthetic thyroid hormone. This review presents an update on the etiology and types of hypothyroidism, including subclinical disease; drugs and thyroid function; and diagnosis and treatment of hypothyroidism. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Hypothyroidism (primary)

    DEFF Research Database (Denmark)

    Nygaard, Birte

    2014-01-01

    INTRODUCTION: Hypothyroidism is six times more common in women, affecting up to 40 in 10,000 each year (compared with 6/10,000 men). METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for clinical (overt......) hypothyroidism? What are the effects of treatments for subclinical hypothyroidism? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We...

  7. Subclinical Thyroid Dysfunction and Depressive Symptoms among Elderly

    DEFF Research Database (Denmark)

    Blum, Manuel R; Wijsman, Liselotte W; Virgini, Vanessa S

    2016-01-01

    adults aged 70-82 years with pre-existing cardiovascular disease or known cardiovascular risk factors, TSH and free T4 levels were measured at baseline and repeated after 6 months to define persistent thyroid function status. Main outcome measures were depressive symptoms, assessed with the Geriatric...... on the association of persistent subclinical thyroid dysfunction and depression, subclinical hypothyroidism was not associated with increased depressive symptoms among older adults at high cardiovascular risk. Persistent subclinical hyperthyroidism might be associated with increased depressive symptoms, which......BACKGROUND: Subclinical hypothyroidism has been associated with depressive symptoms in cross-sectional studies, but prospective data and data on subclinical hyperthyroidism are scarce. METHODS: In the Leiden sub-study of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) among...

  8. Atherogenic Lipoproteins in Subclinical Hypothyroidism and Their Relationship with Hepatic Lipase Activity: Response to Replacement Treatment with Levothyroxine.

    Science.gov (United States)

    Brenta, Gabriela; Berg, Gabriela; Miksztowicz, Veronica; Lopez, Graciela; Lucero, Diego; Faingold, Cristina; Murakami, Masami; Machima, Tetsudo; Nakajima, Katsuyuki; Schreier, Laura

    2016-03-01

    Qualitative lipoprotein changes, such as an increase in fasting remnants, are reported in subclinical hypothyroidism (SCH). It was hypothesized that such changes are due to reduced hepatic lipase (HL) activity in SCH: HL is an enzyme regulated by thyroid hormones, and is involved in the degradation of triglyceride (TG)-rich remnants. This study aimed to quantify remnant-like lipoproteins (RLP), small dense LDL (sdLDL), and HL activity in women with SCH, and to assess these parameters after levothyroxine replacement therapy. This was an observational cross-sectional study with a subsequent longitudinal follow-up. Findings in women with thyrotropin levels >4.5 mIU/L (SH group) were compared with age- and body mass index (BMI)-matched euthyroid women (control group). In addition, a subgroup analysis was undertaken in SCH women who chose to receive levothyroxine treatment (0.9 μg/kg/day) for 6 months. RLP was quantified by measuring cholesterol (RLP-C) and triglycerides (RLP-TG) after immunoaffinity chromatography, and sdLDL by automated standardized methods; HL activity was measured in post-heparin plasma. The SCH group included 37 women; 29 women were included in the control group. In addition, 22 women with SCH were included in the subgroup analysis (levothyroxine treatment). Significantly higher RLP values were observed in the SCH group than in the control group: RLP-C (median [range], mg/dL): 20.3 (5.8-66.8) versus 10.2 (2.7-36.3), p = 0.005; RLP-TG (mg/dL): 26.3 (3.2-123.3) versus 12.1 (2.5-61.6), p = 0.033. HL activity (mean ± standard deviation [SD], μmol free fatty acid/mL post-heparin plasma.h)-9.83 ± 4.25 versus 9.92 ± 5.20, p = 0.707-and sdLDL levels (mg/dL)-23.1 ± 10.7 versus 22.6 ± 8.4, p = 0.83-were similar. After levothyroxine, RLP-C decreased-21.5 (5.8-66.8) versus 17.2 (4.1-45.6), p = 0.023-and HL increased-9.75 ± 4.04 versus 11.86 ± 4.58, p = 0.012-in the subgroup of SCH women. No changes

  9. Subclinical hypothyroidism as a risk factor for placental abruption: evidence from a low-risk primigravid population.

    LENUS (Irish Health Repository)

    Breathnach, Fionnuala M

    2013-12-01

    Subclinical thyroid hypofunction in pregnancy has been shown to have an association with neurodevelopmental delay in the offspring. It is unclear whether obstetric factors may account for this observation.

  10. Low incidence rate of overt hypothyroidism compared with hyperthyroidism in an area with moderately low iodine intake

    DEFF Research Database (Denmark)

    Laurberg, P; Bülow Pedersen, I; Pedersen, K M

    1999-01-01

    In areas with relatively high iodine intake, the incidence rate of hypothyroidism is several-fold higher than that of hyperthyroidism. Recently, we found a similarly high prevalence rate of subclinical hypothyroidism compared with hyperthyroidism in a high iodine intake area, while a relatively low...... prevalence of subclinical hypothyroidism was observed in a low iodine intake area. In the present study we compared the incidence rate (newly diagnosed in primary care and at hospital) of overt hypothyroidism with that of hyperthyroidism in a well-defined geographical area in Jutland, Denmark, with an iodine...... intake around 60 microg/day. The number of personsxyears studied was 569,108. Data on hyperthyroidism have been published previously. The overall incidence of hypothyroidism was 13.5/100,000 per year (F/M 22.9/3.6), hyperthyroidism 38.7/100.000 per year (F/M 63.0/13.0). The incidence of hypothyroidism...

  11. Lipid profiles in the untreated patients with Hashimoto thyroiditis and the effects of thyroxine treatment on subclinical hypothyroidism with Hashimoto thyroiditis.

    Science.gov (United States)

    Tagami, Tetsuya; Tamanaha, Tamiko; Shimazu, Satoko; Honda, Kyoko; Nanba, Kazutaka; Nomura, Hidenari; Yoriko, Sakane Ueda; Usui, Takeshi; Shimatsu, Akira; Naruse, Mitsuhide

    2010-01-01

    To evaluate the prevalence of dyslipidemia in the population of Hashimoto thyroiditis, we reviewed medical records on the consecutive 1181 cases with adult Hashimoto thyroiditis and 830 cases were adopted for the study. First, the serum TSH level increased and serum free T4 level decreased, slightly but significantly, with increasing age. There were significant positive correlations between serum TSH levels and lipid parameters such as total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), non-HDL-C and LDL-C/HDL-C ratio (L/H). In contrast, there were significant negative correlations between serum free T4 levels and all of these lipid parameters. According to the thyroid function, the cases were classified into 4 groups such as thyrotoxicosis (TT), euthyroidism (EU), subclinical hypothyroidism (SH) and overt hypothyroidism (OH). TC, HDL-C, non-HDL-C and LDL-C of TT were significantly lower than those in EU. In contrast, TC, TG, non-HDL-C, LDL-C, L/H and age of OH were significantly higher than those in EU. Interestingly, LDL-C and L/H of SH were significantly higher compared with EU. Thirty-two of SH patients were treated with small doses of levothyroxine and the effects on the lipid profile were examined. The TC, non-HDL-C, LDL-C and L/H were significantly decreased after treatment. In conclusion, the prevalence of dyslipidemia increases along with hypofunction of the thyroid and T4 replacement therapy may improve lipid profile in the cases of SH with Hashimoto thyroiditis.

  12. Focus on BMI and subclinical hypothyroidism in adolescent girls first examined for amenorrhea or oligomenorrhea. The emerging role of polycystic ovary syndrome.

    Science.gov (United States)

    Nezi, Markella; Christopoulos, Panagiotis; Paltoglou, George; Gryparis, Alexandros; Bakoulas, Vassilios; Deligeoroglou, Efthimios; Creatsas, George; Mastorakos, George

    2016-06-01

    TSH concentrations 4.5 μIU/mL (subclinical hypothyroidism), respectively. Following the definition of polycystic ovary syndrome (PCOS) according to either the National Institutes of Health (NIH) criteria or those proposed in the literature by Carmina and his team, patients presented mainly with oligomenorrhea or secondary amenorrhea. There was good agreement between patients with amenorrhea or oligomenorrhea fulfilling both of the PCOS definition criteria employed. Among adolescent patients presenting with amenorrhea or oligomenorrhea for the first time those with low and high BMI present more often with primary and secondary amenorrhea, respectively. Obesity is involved in the development of hyperandrogenemia and hyperinsulinemia, particularly in PCOS patients. In these patients, subclinical hypothyroidism may be concealed and it should be investigated. These patients should be treated for abnormally increased or decreased BMI and be investigated for autoimmune thyroiditis.

  13. Effect of Thyroxin Treatment on Carotid Intima-Media Thickness (CIMT) Reduction in Patients with Subclinical Hypothyroidism (SCH): a Meta-Analysis of Clinical Trials.

    Science.gov (United States)

    Aziz, Muhammad; Kandimalla, Yugandhar; Machavarapu, Archana; Saxena, Anshul; Das, Sankalp; Younus, Adnan; Nguyen, Michelle; Malik, Rehan; Anugula, Dixitha; Latif, Muhammad A; Humayun, Choudhry; Khan, Idrees M; Adus, Ali; Rasool, Aisha; Veledar, Emir; Nasir, Khurram

    2017-07-01

    Research shows that subclinical hypothyroidism (SCH) is related to an increased carotid intima-media thickness (CIMT), a surrogate marker of subclinical cardiovascular disease (CVD). It is controversial whether or not SCH should be treated to reduce CVD morbidity and mortality. This meta-analysis aimed to determine whether SCH is associated with an increase in CIMT as compared to Euthyroidism (EU) and whether thyroxin (T4) treatment in SCH can reverse the change in CIMT. Two independent reviewers conducted an extensive database research up to December 2016. A total of 12 clinical trials discussed the effect of Thyroxin on CIMT values at pre- and post-treatment in subjects with SCH. CIMT was significantly higher among SCH (n=280) as compared to EU controls (n=263) at baseline; the pooled weighted mean difference (WMD) of CIMT was 0.44 mm [95% confidence interval (CI) 0.14, 0.74], p=0.004; I 2 =65%. After treatment with thyroxin in subjects with SCH (n=314), there was a statistically significant decrease in CIMT from pre- to post-treatment; the pooled WMD of CIMT decrease was [WMD -0.32; 95% CI (-0.47, -0.16), p=<0.0001; I 2 =2%], and it was no longer different from EU controls [WMD 0.13 mm; 95% CI (-0.04, 0.30); p=0.14; I 2 =27%]. The total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) were higher in SCH as compared to EU controls and decreased significantly after treatment with thyroxin. This meta-analysis shows that thyroxin therapy in subjects with SCH significantly decreases CIMT and improves lipid profile, modifiable CVD risk factors. Thyroid hormone replacement in subjects with SCH may play a role in slowing down or preventing the progression of atherosclerosis.

  14. At the end of a two-year follow-up elevated TSH levels normalize or remain unchanged in most the children with subclinical hypothyroidism

    Directory of Open Access Journals (Sweden)

    De Luca Filippo

    2010-01-01

    Full Text Available Abstract Data about the natural evolution of subclinical hypothyroidism (SH in pediatric age are very scanty. Moreover all the available reports in both aged and young patients were based on unselected study populations including also patients with either thyroid disorders or other pathological causes that are well known to be able to affect SH development and evolution. Aim of the study by Wasniewska et al was to prospectively evaluate for the first time the natural course of SH in children and adolescents with no underlying diseases and no risk factors that might interfere with the progression of SH. On the basis of the 2-year follow-up results, the Authors concluded that: a the natural course of TSH values in a pediatric population with idiopathic SH is characterized by a progressive decrease over time; b the majority of patients (88% normalized or maintained unchanged their TSH; and c TSH changes were not associated with changes of either FT4 values or clinical status or auxological parameters. Study design of this study is very accurate and the results are robust, thus supporting the Authors' conclusions.

  15. Clinical and subclinical deficits at 8 years in a geographically defined cohort of low birthweight infants.

    OpenAIRE

    Pharoah, P O; Stevenson, C J; Cooke, R W; Stevenson, R C

    1994-01-01

    OBJECTIVE--To determine the prevalence of subclinical deficits in cognitive and motor function in low birthweight infants. DESIGN--Children of birth weight < or = 2000 g born to mothers resident in Merseyside in 1980-1 assessed using the Wechsler Intelligence Scale for Children (WISC), the Neale analysis of reading ability, and the Stott-Moyes-Henderson test of motor impairment (TOMI). Children attending normal schools assessed with controls matched for age, sex, and class in school. Children...

  16. Subclinical hypothyroidism is associated with higher carotid intima-media thickness in cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

    Science.gov (United States)

    Peixoto de Miranda, É J F; Bittencourt, M S; Pereira, A C; Goulart, A C; Santos, I S; Lotufo, P A; Bensenor, I M

    2016-10-01

    Although subclinical hypothyroidism (SCH) is associated with cardiovascular risk, there is scarce data about subclinical atherosclerosis in subjects with SCH. We aimed to analyze the association between SCH and carotid intima-media thickness (IMT) using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (TSH: 0.4-4.0 mIU/l, and normal free thyroxine (FT4): 0.8-1.9 ng/dl) and SCH (TSH ≥ 4.0 mIU/l and normal FT4) evaluated for IMT in a cross-sectional analysis. We excluded individuals using medications that affect thyroid function and those with a history of cardiovascular disease. We performed logistic and linear regression models to evaluate the association with IMT (mean values and categorized at the 75th percentile) as a dependent variable and SCH as an independent variable, adjusted for other cardiovascular risk factors. From 8623 subjects (median age of 50 years; interquartile range: 44-57), 4624 (53.6%) were women, 8095 (93.9%) were euthyroid, and 528 (6.1%) had SCH. Groups varied in age, body mass index, Framingham risk score, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), C-reactive protein, as well as, IMT, that were all higher in SCH compared to euthyroid participants. SCH is associated with IMT as a continuous variable (β = 0.010, P = 0.036) and IMT >75th percentile: OR = 1.30 (95% CI = 1.06-1.59) in logistic models. Individuals with SCH presented higher IMT compared with euthyroid subjects, even after adjustment for potential confounders. IMT was independently associated with SCH in the baseline of the ELSA-Brasil study. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  17. Epifisiólise proximal do fêmur e hipotireoidismo subclínico: relato de caso Proximal femoral epiphysiolysis and subclinical hypothyroidism: case report

    Directory of Open Access Journals (Sweden)

    Grasiele Correa de Mello

    2012-10-01

    Full Text Available A epifisiólise proximal do fêmur (EPF é uma doença ortopédica prevalente na adolescência, porquanto esta coincide com o momento de maior crescimento das estruturas osteomusculares. Curiosamente, alguns pacientes apresentam esta patologia precocemente e esse desfecho converte para a possível explicação etiológica de que o escorregamento ocorreria pelo estirão de crescimento. Para esses pacientes, a gênese do escorregamento ainda não foi elucidada; todavia, as afecções endocrinológicas vêm sendo assinaladas como possíveis causas. Na tentativa de reforçar a teoria da etiologia endocrinológica e apresentar os resultados do tratamento cirúrgico para essa patologia, os autores relatam neste artigo o caso de um paciente do sexo masculino, de nove anos e três meses de idade com EPF e hipotireoidismo subclínico, diagnosticado e tratado no Hospital Universitário de nossa instituição.Proximal femoral epiphysiolysis is an orthopedic disease that is prevalent during adolescence, because this coincides with the time of greatest growth of osteomuscular structures. Curiously, some patients present this disease early, and this outcome converts to the possible etiological explanation that the slippage might occur through a growth spurt. For these patients, the genesis of the slippage has not yet been elucidated, but endocrine disorders have been noted as possible causes. In an attempt to strengthen the theory of endocrinological etiology and present the results from surgical treatment for this pathological condition, the case of a male patient aged 9 years and 3 months with proximal femoral epiphysiolysis and subclinical hypothyroidism who was diagnosed and treated at our university's teaching hospital is reported here.

  18. [Treatment of primary hypothyroidism in adult patients].

    Science.gov (United States)

    Salmela, Pasi; Metso, Saara; Moilanen, Leena; Niskanen, Leo; Nuutila, Pirjo; Schalin-Jäntti, Camilla

    2016-01-01

    The diagnosis of hypothyroidism is based on the findings of an increased serum TSH (above the reference range) and decreased serum free T4 (below the reference range) concentration. Treatment of subclinical hypothyroidism is indicated if serum THS is above 10 mU/l. For less severe forms of subclinical hypothyroidism, the treatment should be individually tailored. The treatment of choice is synthetic human levothyroxine. The goals for treatment are amelioration of symptoms and normalization of TSH and free T4 concentrations.

  19. Hypothyroidism and obesity: An intriguing link

    Directory of Open Access Journals (Sweden)

    Debmalya Sanyal

    2016-01-01

    Full Text Available According to common perception, hypothyroidism is held responsible for obesity. However, linking them causally is controversial. Overt hypothyroidism is associated with modest weight gain, but there is a lack of clarity regarding subclinical hypothyroidism. Novel view indicates that changes in thyroid-stimulating hormone (TSH could well be secondary to obesity. The increasing prevalence of obesity further confounds definition of normal TSH range in population studies. Thyroid autoantibody status may help in establishing the diagnosis of subclinical hypothyroidism in obesity. High leptin levels may play a role in the hyperthyrotropinemia of obesity and also increase susceptibility to thyroid autoimmunity and subsequent hypothyroidism. There is at most a modest effect of L-T4 treatment in overt hypothyroidism in inducing weight loss; benefit in subclinical hypothyroidism is not established with no data supporting thyroid hormone use in euthyroid obese patients.

  20. Central hypothyroidism

    Directory of Open Access Journals (Sweden)

    Vishal Gupta

    2011-01-01

    Full Text Available Central hypothyroidism is defined as hypothyroidism due to insufficient stimulation by thyroid stimulating hormone (TSH of an otherwise normal thyroid gland. It has an estimated prevalence of approximately 1 in 80,000 to 1 in 120,000. It can be secondary hypothyroidism (pituitary or tertiary hypothyroidism (hypothalamus in origin. In children, it is usually caused by craniopharyngiomas or previous cranial irradiation for brain tumors or hematological malignancies. In adults, it is usually due to pituitary macroadenomas, pituitary surgeries or post-irradiation. Fatigue and peripheral edema are the most specific clinical features. Diagnosis is established by the presence of normal to low-normal TSH on the background of low-normal thyroid hormones, confirmed by the thyrotropin releasing hormone stimulation test. Therapy includes use of levothyroxine titrated to improvement in symptomology and keeping free T4 in the upper limit of normal reference range.

  1. Resveratrol ameliorates the anxiety- and depression-like behavior of subclinical hypothyroidism rat: possible involvement of the HPT axis, HPA axis, and Wnt/β-catenin pathway

    Directory of Open Access Journals (Sweden)

    Jinfang eGe

    2016-05-01

    Full Text Available Metabolic disease subclinical hypothyroidism (SCH is closely associated with depression-like behavior both in human and animal studies, and our previous studies have identified the antidepressant effect of resveratrol (RES in stressed rat model. The aim of this study was to investigate whether RES would manifest an antidepressant effect in SCH rat model and explore the possible mechanism. A SCH rat model was induced by hemi-thyroid electrocauterization, after which the model rats in the RES and LT4 groups received a daily intragastric injection of RES at the dose of 15 mg/kg or LT4 at the dose of 60 μg/kg for 16 days, respectively. The rats’ plasma concentrations of thyroid hormones were measured. Behavioral performance and hypothalamic-pituitary-adrenal (HPA activity were evaluated. The protein expression levels of the Wnt/β-catenin in the hippocampus were detected by western blot. The results showed that RES treatment down-regulated the elevated plasma thyroid stimulating hormone (TSH concentration and the hypothalamic mRNA expression of thyrotropin releasing hormone (TRH in the SCH rats. RES-treated rats showed increased rearing frequency and distance in the OFT, increased sucrose preference in the SPT, and decreased immobility in the FST compared with SCH rats. The ratio of the adrenal gland weight to body weight, the plasma corticosterone levels and the hypothalamic CRH mRNA expression were reduced in the RES-treated rats. Moreover, RES treatment up-regulated the relative ratio of phosphorylated-GSK3β (p-GSK3β/GSK3β and protein levels of p-GSK3β, cyclinD1 and c-myc, while down-regulating the relative ratio of phosphorylated-β-catenin (p-β-catenin/β-catenin and expression of GSK3β in the hippocampus. These findings suggest that RES exerts anxiolytic- and antidepressant-like effect in SCH rats by down-regulating hyperactivity of the HPA axis and regulating both the HPT axis and the Wnt/β-catenin pathway.

  2. Pediatric Hypothyroidism: Diagnosis and Treatment.

    Science.gov (United States)

    Wassner, Ari J

    2017-08-01

    Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.

  3. Hypothyroidism and obesity: Cause or Effect

    International Nuclear Information System (INIS)

    Verma, A.; Jayaraman, M.; Kumar, Hari K.V.S.; Modi, Kirtikumar D.

    2008-01-01

    Objective was to establish relationship between obesity and hypothyroidism and to analyze the frequency of primary hypothyroidism in obese patients and frequency of obesity in primary hypothyroidism patients. We conducted this retrospective, observational study in Department of Endocrinology and Obesity Clinic, Medwin Hospital, Hyderabad, India in March 2008. In the last 18 months (between September 2006 to February 2008), data on 625 consecutive primary hypothyroidism patients (Group I) and 450 patients from obesity clinic (Group II) were analyzed. Frequency difference between the 2 groups was assessed by Chi-square test. In Group I, 278/625 (44%) had body mass index (BMI) >25 kg/m2. Obesity was higher (46% versus 34%) in overt hypothyroidism than in subclinical hypothyroidism (p=0.21). More patients were overweight in overt hypothyroidism group than in subclinical hypothyroidism group (p=0.02). In obesity patients, overt hypothyroidism was present in 33% and subclinical hypothyroidism in 11% patients. Overall thyroid dysfunction was found more in obese individuals with varying degree of significance. Detailed studies are required to assess the cause and effect relation between obesity and hypothyroidism. (author)

  4. Hypothyroidism in the elderly: diagnosis and management

    Science.gov (United States)

    Bensenor, Isabela M; Olmos, Rodrigo D; Lotufo, Paulo A

    2012-01-01

    Thyroid disorders are highly prevalent, occurring most frequently in aging women. Thyroid-associated symptoms are very similar to symptoms of the aging process; thus, improved methods for diagnosing overt and subclinical hypothyroidism in elderly people are crucial. Thyrotropin measurement is considered to be the main test for detecting hypothyroidism. Combined evaluations of thyroid stimulating hormone (TSH) and free-thyroxine can detect overt hypothyroidism (high TSH with low free-thyroxine levels) and subclinical hypothyroidism (high TSH with normal free-thyroxine levels). It is difficult to confirm the diagnosis of thyroid diseases based only on symptoms, but presence of symptoms could be an indicator of who should be evaluated for thyroid function. The most important reasons to treat overt hypothyroidism are to relieve symptoms and avoid progression to myxedema. Overt hypothyroidism is classically treated using L-thyroxine; elderly patients require a low initial dose that is increased every 4 to 6 weeks until normalization of TSH levels. After stabilization, TSH levels are monitored yearly. There is no doubt about the indication for treatment of overt hypothyroidism, but indications for treatment of subclinical disease are controversial. Although treatment of subclinical hypothyroidism may result in lipid profile improvement, there is no evidence that this improvement is associated with decreased cardiovascular or all-cause mortality in elderly patients. In patients with a high risk of progression from subclinical to overt disease, close monitoring of thyroid function could be the best option. PMID:22573936

  5. Subclinical Thyroid Dysfunction and Frailty Among Older Men

    Science.gov (United States)

    Virgini, Vanessa S.; Rodondi, Nicolas; Cawthon, Peggy M.; Harrison, Stephanie Litwack; Hoffman, Andrew R.; Orwoll, Eric S.; Ensrud, Kristine E.

    2015-01-01

    Context: Both subclinical thyroid dysfunction and frailty are common among older individuals, but data on the relationship between these 2 conditions are conflicting. Objective: The purpose of this study was to assess the cross-sectional and prospective associations between subclinical thyroid dysfunction and frailty and the 5 frailty subdomains (sarcopenia, weakness, slowness, exhaustion, and low activity). Setting and Design: The Osteoporotic Fractures in Men Study is a prospective cohort study. Participants: Men older than 65 years (n = 1455) were classified into 3 groups of thyroid status: subclinical hyperthyroidism (n = 26, 1.8%), subclinical hypothyroidism (n = 102, 7.0%), and euthyroidism (n = 1327, 91.2%). Main Outcome Measures: Frailty was defined using a slightly modified Cardiovascular Health Study Index: men with 3 or more criteria were considered frail, men with 1 to 2 criteria were considered intermediately frail, and men with no criteria were considered robust. We assessed the cross-sectional relationship between baseline thyroid function and the 3 categories of frailty status (robust/intermediate/frail) as well as the prospective association between baseline thyroid function and subsequent frailty status and mortality after a 5-year follow-up. Results: At baseline, compared with euthyroid participants, men with subclinical hyperthyroidism had an increased likelihood of greater frailty status (adjusted odds ratio, 2.48; 95% confidence interval, 1.15–5.34), particularly among men aged hyperthyroidism were not consistently associated with overall frailty status or frailty components. Conclusion: Among community-dwelling older men, subclinical hyperthyroidism, but not subclinical hypothyroidism, is associated with increased odds of prevalent but not incident frailty. PMID:26495751

  6. Hypothyroidism in children

    Directory of Open Access Journals (Sweden)

    Renata Karwowska

    2017-12-01

    Full Text Available Thyroid hormones are crucial for normal development of a child from early foetal life. They have an impact on the development of the central nervous system, both prenatally and up to the age of 3 years, and regulate growth and most metabolic processes. Their importance has led to the introduction of screening for congenital hypothyroidism, which has been conducted in Poland for over 40 years. The diagnosis of congenital hypothyroidism necessitates immediate levothyroxine implementation and strict treatment monitoring. Thanks to iodine prophylaxis, children in Poland do not require additional iodine administration. An isolated increase in thyroid-stimulating hormone concentration without clinical signs of hypothyroidism and with negative antithyroid antibodies does not require treatment, but only monitoring of thyroidstimulating hormone levels. Children with positive antithyroid antibodies, genetic syndromes that predispose to hypothyroidism and history of thyroid irradiation require more frequent controls. The recommendations for suspected hypothyroidism presented in this article are based on the European Thyroid Association guidelines from 2014 on the management of subclinical hypothyroidism in children and pregnant women.

  7. Short-term overt hypothyroidism induces sympathovagal imbalance in thyroidectomized differentiated thyroid carcinoma patients

    NARCIS (Netherlands)

    Heemstra, Karen A.; Burggraaf, Jacobus; van der Klaauw, Agatha A.; Romijn, Johannes A.; Smit, Johannes W. A.; Corssmit, Eleonora P. M.

    2010-01-01

    Thyroid hormone impacts on the cardiovascular system. (Subclinical) hyperthyroidism results in sympathovagal imbalance due to decreased vagal tone. However, conflicting data have been reported on the effects of hypothyroidism on the activity of the autonomic nervous system (ANS). In hypothyroidism,

  8. Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders.

    Science.gov (United States)

    Ordookhani, Arash; Burman, Kenneth D

    2017-04-01

    There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. A comprehensive literature search was conducted employing MEDLINE database. The following words were used for the search: Hypothyroidism; thyroiditis, autoimmune; blood coagulation factors; blood coagulation tests; hemostasis, blood coagulation disorders; thyroid hormones; myxedema; venous thromboembolism; fibrinolysis, receptors thyroid hormone. The papers that were related to hypothyroidism and autoimmune thyroid disorder and hemostasis are used in this review. Overt hypothyroidism is more associated with a hypocoagulable state. Decreased platelet count, aggregation and agglutination, von Willebrand factor antigen and activity, several coagulation factors such as factor VIII, IX, XI, VII, and plasminogen activator-1 are detected in overt hypothyrodism. Increased fibrinogen has been detected in subclinical hypothyroidism and autoimmune thyroid disease rendering a tendency towards a hypercoagulability state. Increased factor VII and its activity, and plasminogen activator inhibitor-1 are among several findings contributing to a prothrombotic state in subclinical hypothyroidism. Overt hypothyroidism is associated with a hypocoagulable state and subclinical hypothyroidism and autoimmune thyroid disorders may induce a prothrombotic state. However, there are contradictory findings for the abovementioned thyroid disorders. Prospective studies on the risk of VTE in various levels of hypofunctioning of the thyroid and autoimmune thyroid disorders are warranted.

  9. Frequency of other endocrine disorders in hypothyroidism

    Directory of Open Access Journals (Sweden)

    Bjekić-Macut Jelica

    2012-01-01

    Full Text Available Hypothyroidism is a condition of reduced production, distribution, or absence of action of thyroid hormones. Clinical diagnosis of hypothyroidism is not easily established due to the nonspecific clinical manifestations. Determination of serum TSH is the first-line test for the diagnosis of hypothyroidism. The aim of the study was to determine the presence of other endocrine disorders in patients with subclinical (TSH levels between 5 and 10 mIU/l, or clinical (TSH above 10 mIU/l hypothyrodism. We analyzed 50 patients (35 with clinical hypothyroidism and 15 with subclinical form. In all patients anthropometric data (age, sex, weight, height, body mass index, blood pressure and heart rate, and clinical signs of hypothyroidism (skin changes, menstrual disorders were determined. Blood was drawn in fasting state for measurement of FT4, sTSH, glucose, lipids, ionized calcium, PTH, cortisol, ACTH, prolactin, gonadotropins, estradiol in women of reproductive age, and testosterone in men. Skin lesions were rarely present. Oligomenorrhea was more frequent in subclinical hypothyroidism, and menopause in clinical hypothyroidism. Blood pressure was normal in all subjects. Patients with clinical hypothyroidism compared to those with subclinical form had higher TSH values (19.5 ± 5.7 vs. 5.9 ± 0.3 mIU/l, and higher doses of L-thyroxine (81.2 ± 4.6 vs. 21.4 ± 3.5 μg/day. Disturbance of glycemic control was present in 18% of patients. Total cholesterol and LDL were insignificantly higher in patients with hypothyroidism than in subclinical form of the disease. FT4, calcium, PTH, cortisol, ACTH, gonadotropins, estradiol and testosterone did not differ between groups. The proatherogenic relation of estradiol with triglycerides was established in women with clinical form of hypothyroidism.

  10. Subclinical hypothyroidism diagnosed by thyrotropin-releasing hormone stimulation test in infertile women with basal thyroid-stimulating hormone levels of 2.5 to 5.0 mIU/L.

    Science.gov (United States)

    Lee, You-Jeong; Kim, Chung-Hoon; Kwack, Jae-Young; Ahn, Jun-Woo; Kim, Sung-Hoon; Chae, Hee-Dong; Kang, Byung-Moon

    2014-11-01

    To investigate the prevalence of subclinical hypothyroidism (SH) diagnosed by thyrotropin-releasing hormone (TRH) stimulating test in infertile women with basal thyroid-stimulating hormone (TSH) levels of 2.5 to 5.0 mIU/L. This study was performed in 39 infertile women with ovulatory disorders (group 1) and 27 infertile women with male infertility only (group 2, controls) who had basal serum TSH levels of 2.5 to 5.0 mIU/L and a TRH stimulating test. Serum TSH levels were measured before TRH injection (TSH0) and also measured at 20 minutes (TSH1) and 40 minutes (TSH2) following intravenous injection of 400 µg TRH. Exaggerated TSH response above 30 mIU/L following TRH injection was diagnosed as SH. Group 1 was composed of poor responders (subgroup A), patients with polycystic ovary syndrome (subgroup B) and patients with WHO group II anovulation except poor responder or polycystic ovary syndrome (subgroup C). The prevalence of SH was significantly higher in group 1 of 46.2% (18/39) compared with 7.4% (2/27) in group 2 (P=0.001). TSH0, TSH1, and TSH2 levels were significantly higher in group 1 than the corresponding values in group 2 (Pstimulation test had better be performed in infertile women with ovulatory disorders who have TSH levels between 2.5 and 5.0 mIU/L for early detection and appropriate treatment of SH.

  11. Psychiatric and cognitive manifestations of hypothyroidism

    Science.gov (United States)

    Samuels, Mary H

    2014-01-01

    Purpose of review Overt hypothyroidism has major effects on neuropsychiatric function, but patients with mild hypothyroidism may attribute unrelated neuropsychiatric symptoms to their thyroid condition. This review will summarize data on neuropsychiatric effects of hypothyroidism, and provide guidelines regarding the relationship between hypothyroidism and neuropsychiatric issues, and treatment indications. Recent findings Clinical investigations and functional imaging studies confirm that overt hypothyroidism is associated with affective and cognitive decrements, largely reversible with treatment. In contrast, subclinical hypothyroidism is not associated with major neuropsychiatric deficits, although studies utilizing sensitive measures show small deficits in memory and executive function. Neuropsychiatric complaints are more common when patients are aware of their thyroid disease, regardless of their thyroid function at the time of testing. Summary Neuropsychiatric dysfunction is common in overt hypothyroidism, and will improve (although perhaps not completely resolve) with therapy. On the other hand, deficits related to thyroid dysfunction are usually mild in subclinical hypothyroidism, and realistic expectations need to be set regarding symptom reversibility with treatment. Patients with mild hypothyroidism and significant distress related to neuropsychiatric symptoms most likely have independent diagnoses that should be evaluated separately. PMID:25122491

  12. Subclinical and overt thyroid dysfunction and risk of all-cause mortality and cardiovascular events

    DEFF Research Database (Denmark)

    Selmer, Christian; Olesen, Jonas Bjerring; Hansen, Morten Lock

    2014-01-01

    hypothyroidism with TSH of 5-10 mIU/L [IRR 0.92 (95% CI 0.86-0.98)]. CONCLUSIONS: Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5-10 mIU/L might be associated with a lower risk of all-cause mortality....

  13. [Hypothyroidism in patients with heart disease].

    Science.gov (United States)

    Jiskra, Jan

    Hypothyroidism is frequently found in patients with heart disease. It is a risk factor for atherosclerosis and ischemic heart disease and has a direct negative effect on both the left and right ventricular functions (hypothyroidism-induced cardiomyopathy). The confirmed manifest hypothyroidism is always a reason for replacement therapy with levothyroxine; regarding patients with heart disease, we always begin treatment with a small dose and increase it gradually. The treatment of subclinical hypothyroidism in patients with heart disease is disputable and its benefits probably depend on age. At a higher age, the therapy-related risks often outweigh its benefits, so we make do with the target levels of the thyroid stimulating hormone being within the upper band of the normal range, or even slightly above it, rather than overdosing the patient. To summarize in a simplified way, the treatment of subclinical hypothyroidism in patients with heart disease is the most effective in younger individuals, mainly those aged below 65, while at a higher age > 80 years the risk usually outweighs the benefit.Key words: cardiovascular risk - hypothyroidism - ischemic heart disease - left ventricular dysfunction - right ventricular dysfunction - subclinical hypothyroidism - thyroid peroxidase antibodies.

  14. Hypothyroidism (image)

    Science.gov (United States)

    Hypothyroidism is a decreased activity of the thyroid gland which may affect all body functions. The rate ... and physical sluggishness. The most severe form of hypothyroidism is myxedema, which is a medical emergency.

  15. Congenital Hypothyroidism

    Science.gov (United States)

    ... Disease Featured Resource Find an Endocrinologist Search Congenital Hypothyroidism March 2012 Download PDFs English Espanol Editors Rosalind S. ... Resources MedlinePlus (NIH) Mayo Clinic What is congenital hypothyroidism? Newborn babies who are unable to make enough ...

  16. Can levothyroxine treatment reduce urinary albumin excretion rate in patients with early type 2 diabetic nephropathy and subclinical hypothyroidism? A randomized double-blind and placebo-controlled study.

    Science.gov (United States)

    Liu, Peng; Liu, Ruidong; Chen, Xia; Chen, Yingying; Wang, Debao; Zhang, Fengmei; Wang, Yangang

    2015-12-01

    To investigate the effect of levothyroxine (LT4) therapy on urinary albumin excretion rate (UAER) in early type 2 diabetic nephropathy (DN) and subclinical hypothyroidism (SCH) patients with mildly increased thyroid stimulating hormone (TSH) levels and serum thyroid peroxidase antibody (TPO-Ab) positivity. Application of randomized double-blind and placebo-controlled methods. A total of 136 normotensive patients with early type 2 DN and SCH (TSH 4.0-7.0 mIU/L and TPO-Ab positive) were selected, and were randomly divided into two groups for LT4 or placebo treatments, respectively. Changes in UAER, serum creatinine, glomerular filtration rate (GFR), blood pressure, serum uric acid and lipids in patients before and after 48 weeks of treatment were examined and compared between groups. There were no statistically significant differences in the baseline characteristics of study participants between two treatment groups (p > 0.05 for all). After 48 weeks of treatment, compared to the placebo treatment, the LT4 treatment was more effective in reducing total cholesterol (p treatment was better in reducing UAER, low-density lipoprotein cholesterol and uric acid than the placebo group (p treatment may decrease UAER and exert kidney protection effects in early type 2 DN and SCH patients with mildly increased TSH levels and serum TPO-Ab positivity. However, due to the short duration of follow-up and small number of cases, the results of this study need future trials with larger numbers of patients and longer follow-up periods to verify whether such a strategy can provide durable benefits.

  17. Management of Subclinical Hypothyroidism in Pregnancy: A Comment from the Italian Society of Endocrinology and the Italian Thyroid Association to the 2017 American Thyroid Association Guidelines-"The Italian Way".

    Science.gov (United States)

    Rotondi, Mario; Chiovato, Luca; Pacini, Furio; Bartalena, Luigi; Vitti, Paolo

    2018-05-01

    The 2017 American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum were published six years after the previous ones. They provide comprehensive clinical recommendations for the whole spectrum of thyroid diseases, as well as for optimal iodine intake during pregnancy, postpartum, and lactation. The present position statement mainly regards the recommended flow chart for therapeutic decision making in pregnant women being diagnosed with subclinical hypothyroidism. Here, we comment on the major biochemical and clinical situations and the corresponding therapeutic recommendations. In particular, we welcome the critical revision of the thyrotropin (TSH) reference range in pregnancy, and we agree that there is no need to treat thyroid peroxidase antibody-negative women with a serum TSH ranging from 2.5 μIU/mL to the upper limit of the reference range. This recommendation will hopefully reduce the huge proportion of healthy pregnant women in whom, according to the previous guidelines, levothyroxine therapy had to be initiated. On the other hand, we are concerned with the recommendation to only "consider treatment" in thyroid peroxidase antibody-negative pregnant women with a serum TSH ranging from the upper limit of the reference range to 10.0 μIU/mL. This is because thyroid antibodies may be falsely negative during gestation, and serum negative chronic autoimmune thyroiditis is a well-known clinical entity even outside pregnancy. Based on these and other arguments, we recommend treatment with levothyroxine in pregnant women with TSH levels ranging between the upper limit of the reference range and 10.0 μIU/mL independently from their thyroid antibody status.

  18. Prevalence of Hypothyroidism in a Cohort of Saudi Women with Heart Failure and Effect on Systolic and Diastolic Function

    International Nuclear Information System (INIS)

    AlGhalayini, K.

    2015-01-01

    Objectives: To determine the prevalence of hypothyroidism in a cohort of Saudi women with heart failure; to define the demographic variables associated with heart failure; and the impact of hypothyroidism on systolic function in relation to non-hypothyroidism group. Methods: The cross-sectional cohort study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised all women diagnosed with heart failure who were seen in the Cardiology outpatients clinic between February 2010 and March 2013. All of them were subjected to complete medical history and clinical examination, including complete cardiac clinical examination, electrocardiogram, echocardiography, blood pressure reading as well as thyroid examination. Laboratory tests were performed for thyroid stimulating hormone, total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein. Results: Of the 111 patients, 37 (33.3 percent) had hypothyroidism (p<0.001), and 16(14.4 percent) of them showed subclinical hypothyroidism. The mean value for thyroid stimulating hormone was 4.79+/-4.98U/L. There was a significant negative correlation between thyroid stimulating hormone and ejection fraction. Conclusion: There was close relation between hypothyroidism and heart failure. Further large-scale studies are recommended for early detection of hypothyroidism. (author)

  19. Respiratory manifestations of hypothyroidism

    DEFF Research Database (Denmark)

    Sorensen, Jesper Roed; Winther, Kristian Hillert; Bonnema, Steen Joop

    2016-01-01

    BACKGROUND: Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. We conducted a systematic review to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. METHODS: PubMed and EMBASE databases were...... searched for relevant literature from January 1950 through January 2015 with study eligibility criteria: English-language publications; Adult subclinical or overt hypothyroid patients; Intervention, observational or retrospective studies; and respiratory manifestations. We followed the PRISMA statement...... and used the Cochrane's risk of bias tool. RESULTS: A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full text analyses, of which 22 were included in the review. We identified possible mechanisms explaining respiratory...

  20. Prepregnancy hypothyroidism versus gestational hypothyroidism: A comparative study

    Directory of Open Access Journals (Sweden)

    Prashant Ulhas Kaduskar

    2017-01-01

    Full Text Available Introduction: Hypothyroidism managed inadequately in pregnancy may have grave outcomes for both mother and baby. Understanding pregnancy outcomes in our country with low awareness about thyroid diseases is important. Objectives: The objectives of the study were to evaluate demographic features and biochemical parameters in patients with prepregnancy hypothyroidism versus patients diagnosed to have primary hypothyroidism during pregnancy and to assess pregnancy outcomes. Study Design: Prospective design Materials and Methods: The study was conducted in a tertiary care center in Bengaluru for 2 years. The patients were divided into two groups - Group I: Prepregnancy hypothyroidism and Group II: Hypothyroid during pregnancy. They were further staged according to ESI guidelines as subclinical or overt hypothyroidism. Statistical Analysis: Chi-square and Mann–Whitney test. Results: A total of 452 pregnant women with hypothyroidism were analyzed. The data of 371 delivered pregnancies were available. Group I and II had 196 (43.36% and 256 (56.64% patients, respectively. Age at presentation (years was 27.09 ± 4.19 in Group I versus 25.74 ± 4.29 in Group II (P = 0.003; gestational age (weeks was 9.04 ± 5.41 in Group I versus 13.81 ± 9.12 in Group II (P = 0.000. There was one case of congenital hypothyroidism in baby in each group. Mean birth weight was 2.90 ± 0.39 kg in Group I versus 2.88 ± 0.36 kg in Group II; P = 0.608. There were four abortions in Group I versus ten in Group II (P = 0.231, 104 cesarean sections in Group I compared to 133 in Group II; (P = 0.382. There was no difference in number of cesarean sections, abortions and low birth weight babies between overt and subclinical hypothyroidism subgroups. Conclusions: Group I patients presented earlier for testing suggesting awareness was good in this group. There was no difference in pregnancy outcome between the two groups. Overt versus subclinical status did not have any different

  1. [Subclinical hyperthyroidism].

    Science.gov (United States)

    Feldkamp, J

    2013-10-01

    Subclinical hyperthyroidism is defined as abnormal low TSH level with thyroid hormones within their reference range. This laboratory condition may be symptomatic in a relevant number of patients leading to tachycardia, sweating, nervousness, anxiety and insomnia. The risk for cardiovascular disease is increased with more frequent atrial fibrillation and increased left ventricular mass including diastolic dysfunction. Cardiovascular mortality and overall mortality surmounts the average of the normal population. Longterm TSH suppression leads to decreased bone mineral density and an increased fracture rate in the hip and in the spine. After evaluation of underlying causes, therapy should be considered, especially if TSH levels are below 0.1 mIU/l. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Effect of levothyroxine therapy on dyslipidemia in hypothyroid patients

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    hypothyroidism (both subclinical and overt hypothyroidism), its association with ... with dyslipidemia, replacement therapy with levothyroxine resulted in reversal to .... aseptically after 12 hours overnight fasting for lipid ..... Workers in the field also observed that restoration ... between SCH and metabolic syndrome (MetS) and.

  3. Association between different degrees of hypothyroidism and serum ...

    African Journals Online (AJOL)

    The association between overt hypothyroidism (OH) and altered lipid profile is well known, however the significance of dyslipidemia in subclinical hypothyroidism (SCH) remain controversial. Therefore, this study was conducted to determine any association between lipid profile and different degrees of thyroid dysfunction.

  4. Longitudinal study on thyroid function in patients with thalassemia major: High incidence of central hypothyroidism by 18 years

    Directory of Open Access Journals (Sweden)

    Ashraf T Soliman

    2013-01-01

    Full Text Available Introduction: Primary hypothyroidism is one of the most frequent complications observed in-patients suffering from thalassemia. We investigated and reviewed the thyroid function in all thalassemic patients attending the Pediatric Endocrine Clinic of Hamad Medical Center, Doha, Qatar during the last 10 years of follow-up. Patients and Methods: A total of 48 patients with ί-thalassemia major between 5 years and 18 years of age. Thyroid dysfunction was defined as follows: Overt hypothyroidism (low Free thyroxine [FT4] and increased thyroid-stimulating hormone [TSH] levels >5 μIU/ml; subclinical hypothyroidism (normal FT4, TSH between 5 μIU/ml and 10 μIU/ml and central (secondary hypothyroidism (low FT4 and normal or decreased TSH. Results: A total of 48 patients (22 males and 26 females completed a 12 year-period of follow-up. During this period, hypothyroidism was diagnosed in 17/48 (35% of patients. There was no significant difference in the prevalence in males 7/22 (32% versus females 10/26 (38%. Sixteen of the patients had hypothyroidism after the age of 10 years (94%. The prevalence of overt hypothyroidism had risen from 0% at the age of 7 years to 35% at the age of 18 years. None of the patients had high anti-thyroperoxidase antibody titers. Out of 17 patients, 13 patients with hypothyroidism had normal or low TSH level (not appropriately elevated indicative of defective hypothalamic pituitary response to low FT4 (central hypothyroidism. Three patients (6.3% had subclinical hypothyroidism (TSH between 5 uIU/ml and 10 uIU/ml and normal FT4. The general trend of FT4 level showed progressive decrease over the 12 years, whereas, TSH levels did not show a corresponding increase. These data suggested defective hypothalamic pituitary thyroid axis involving both TSH and FT4 sretion in patients with thalassemia major over time. There was a significant negative correlation between serum ferritin and FT4 (r = −0.39, P = 0.007, but no correlation

  5. Prevalência do hipotiroidismo subclínico e repercussões sobre o perfil lipídico e massa óssea em mulheres na pós-menopausa Prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Eliana Aguiar Petri Nahas

    2005-08-01

    Full Text Available OBJETIVO: avaliar a prevalência do hipotiroidismo subclínico e suas repercussões sobre o perfil lipídico e a densidade mineral óssea (DMO em mulheres na pós-menopausa. Métodos: trata-se de estudo transversal com recuperação de dados de prontuários de pacientes acompanhadas em ambulatório de climatério. Critérios de inclusão: mulheres na pós-menopausa com dosagem do hormônio estimulador da tiróide (TSH e de tiroxina livre (T4-L. Critérios de exclusão: hipertiroidismo e carcinoma de tiróide. Considerou-se hipotiroidismo subclínico valores de TSH superiores a 5,0 mUI/mL e T4-L normal. Foram selecionadas 320 pacientes (idade 55,2±6,4 anos divididas em 3 grupos: função tiroideana normal (n=208, hipotiroidismo subclínico (n=53 e hipotiroidismo clínico sob tratamento (n=59. Foram analisados dados clínicos, uso de terapia hormonal, índice de massa corpórea (IMC=kg/m², perfil lipídico (colesterol total, HDL, LDL, triglicerídeos e DMO da coluna lombar e fêmur. Na análise estatística, as diferenças entre as médias dos grupos foram comparadas utilizando-se a análise de variância (ANOVA. Para múltipla comparação, assumindo que a variância era diferente entre os grupos, utilizou-se o método de Tukey. RESULTADOS: o hipotiroidismo subclínico foi diagnosticado em 16,1% dos casos. Os grupos foram homogêneos quanto às características clínicas, IMC e perfil lipídico e uso de terapêutica hormonal. Nas pacientes com hipotiroidismo subclínico ou clínico encontrou-se menor freqüência de osteopenia na coluna lombar e fêmur quando comparadas às eutiroidianas (pPURPOSE: to evaluate the prevalence of subclinical hypothyroidism and its effects on lipidic profile and bone mineral density (BMD in postmenopausal women. METHODS: a cross-sectional study with survey of data from medical records of patients attended at a climacteric outpatient clinic. Inclusion criteria: postmenopausal women with measured thyroid

  6. Neonatal hypothyroidism

    Science.gov (United States)

    ... the first month or so usually have normal intelligence. Untreated mild hypothyroidism can lead to severe intellectual ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

  7. A review of the evidence for and against increased mortality in hypothyroidism

    DEFF Research Database (Denmark)

    Thvilum, Marianne; Brandt, Frans; Brix, Thomas H

    2012-01-01

    The lifetime risk of overt hypothyroidism is around 5%, and this disease is usually preceded by subclinical hypothyroidism, which has an even higher prevalence (estimated to be up to 9%). Hypothyroidism has been linked with cardiac dysfunction, atherosclerosis, hypertension and coagulopathy....... Intuitively, this increased morbidity is expected to shorten patients' lifespan, but definitive data are lacking on whether either of these hypothyroid states (particularly overt hypothyroidism) increase mortality. Study findings are inconsistent and, overall, the pooled data do not demonstrate increased...... mortality in patients with either subclinical or overt hypothyroidism. However, none of the available studies was adequately designed to answer this question. This Review discusses major shortcomings in those studies, such as population dissimilarities, hypothyroid state classification and misclassification...

  8. Subclinical thyroid dysfunction and risk of carotid atherosclerosis.

    Directory of Open Access Journals (Sweden)

    Hosu Kim

    Full Text Available The effect of subclinical thyroid dysfunction on vascular atherosclerosis remains uncertain. The objective of this study was to elucidate the association between sustained subclinical thyroid dysfunction and carotid plaques, which are an early surrogate marker of systemic atherosclerosis.The study included 21,342 adults with consistent thyroid hormonal status on serial thyroid function tests (TFTs and carotid artery duplex ultrasonography at a health screening center between 2007 and 2014. The effect of subclinical thyroid dysfunction on baseline carotid plaques and newly developed carotid plaques during 5-year follow-up was determined by logistic regression analyses and GEE (Generalized Estimating Equations, respectively.Carotid plaques were more common in the subclinical hypothyroidism (55.6% than the euthyroidism (47.8% at baseline. However, in multivariable analysis, thyroid status was not a significant risk for the carotid plaques at baseline. Instead, traditional cardiovascular risk factors, such as age (P <0.001, systolic blood pressure (P = 0.023, fasting blood glucose (P = 0.030, and creatinine (P = 0.012 were associated with baseline carotid plaques in subclinical hypothyroidism. In longitudinal analyses of subjects who were followed up for more than 5 years, there was no significant difference in the cumulative incidence of new carotid plaques according to time between subjects with subclinical hypothyroidism and those with euthyroidism (P = 0.392.Sustained subclinical thyroid dysfunction did not affect the baseline or development of carotid plaques in healthy individuals.

  9. Hypothyroidism and Mortality among Dialysis Patients

    Science.gov (United States)

    Rhee, Connie M.; Alexander, Erik K.; Bhan, Ishir

    2013-01-01

    Summary Background and objectives Hypothyroidism is highly prevalent among ESRD patients, but its clinical significance and the benefits of thyroid hormone replacement in this context remain unclear. Design, setting, participants, & measurements This study examined the association between hypothyroidism and all-cause mortality among 2715 adult dialysis patients with baseline thyrotropin levels measured between April of 2005 and April of 2011. Mortality was ascertained from Social Security Death Master Index and local registration systems. The association between hypothyroidism (thyrotropin greater than assay upper limit normal) and mortality was estimated using Cox proportional hazards models. To reduce the risk of observing reverse-causal associations, models included a 30-day lag between thyrotropin measurement and at-risk time. Results Among 350 (12.9%) hypothyroid and 2365 (87.1%) euthyroid (assay within referent range) patients, 917 deaths were observed during 5352 patient-years of at-risk time. Hypothyroidism was associated with higher mortality. Compared with thyrotropin in the low-normal range (0.4–2.9 mIU/L), subclinical hypothyroidism (thyrotropin >upper limit normal and ≤10.0 mIU/L) was associated with higher mortality; high-normal thyrotropin (≥3.0 mIU/L and ≤upper limit normal) and overt hypothyroidism (thyrotropin >10.0 mIU/L) were associated with numerically greater risk, but estimates were not statistically significant. Compared with spontaneously euthyroid controls, patients who were euthyroid while on exogenous thyroid replacement were not at higher mortality risk, whereas patients who were hypothyroid were at higher mortality risk. Sensitivity analyses indicated that effects on cardiovascular risk factors may mediate the observed association between hypothyroidism and death. Conclusions These data suggest that hypothyroidism is associated with higher mortality in dialysis patients, which may be ameliorated by thyroid hormone replacement

  10. Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison's disease with primary hypothyroidism.

    Science.gov (United States)

    Sahoo, Jaya Prakash; Selviambigapathy, Jayakumar; Kamalanathan, Sadishkumar; Nagarajan, K; Vivekanandan, Muthupillai

    2016-01-01

    Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.

  11. Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison's disease with primary hypothyroidism

    Science.gov (United States)

    Sahoo, Jaya Prakash; Selviambigapathy, Jayakumar; Kamalanathan, Sadishkumar; Nagarajan, K.; Vivekanandan, Muthupillai

    2016-01-01

    Background: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. Materials and Methods: This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Results: Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. Conclusions: The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations. PMID:27042409

  12. Inherited hypothyroidism.

    Science.gov (United States)

    Jackson, I M

    1976-03-01

    Familial hypothyroidism results from both thyroidal and extrathyroidal dysfunction. Specific intrathyroidal abnormalities in thyroid hormone synthesis causing goitrous hypothyroidism are iodide trap defect, organification defect, "coupling" defect, iodoprotein defect, and dehalogenase defect. The diagnostic studies for each are outlined utilizing radioiodine(131I) studies. Other causes of cretinism include failure of the thyroid gland to respond to TSH and lack of pituitary TSH (or hypothalamic TRH). The syndrome of peripheral resistance to thyroid hormone is discussed. The diagnosis of inherited hypothyrodism rests on an adequate family history and measurement of both T4 and TSH levels which can be determined in cord blood or peripheral blood from the infant. The importance of early treatment of hypothyroidism in the neonatal period to prevent brain damage is emphasized. The rec:nt discovery of the importance of reverse T3 (RT3) in fetal thyroid metabolism is described, and the possibility of amniocentesis as an aid in prenatal diagnosis is considered. The place of intrauterine administration of thyroid hormone to the fetus at risk from hypothyroidism is uncertain at this time and requires carefully controlled studies and long-term follow-up.

  13. The issue of neuropsychiatric disorders in patients with hypothyroidism

    Directory of Open Access Journals (Sweden)

    Kutashov V.A.

    2016-09-01

    Full Text Available The aim of the study was assessment of thyroid function in patients with psychiatric and psychological assistance; to study the structure of AR in patients with hypothyroidism, to reveal alexithymical identifying of personality characteristics of patients with hypothyroidism and AP Materials and Methods. 406 patients with AR at the age of 51.3±4.7 years. To verify the useofTSH hypothyroidism rate and to assess depressive disorder — Hamilton Scale and the Montgomery— Asberg; with clinical and psychopathological study: 1 the scale of self-BH alarm Spielberger (Y. L. Hanin, 2 questionnaire G. Shmisheka 3 Toronto alexithymia scale. Results. Hypothyroidism is set at 116 (28.6% of 406 patients suffering from RA. Among the 374 patients with depressive disorders hypothyroidism was observed in 116: subclinical — in 76 patients (65.5%, symptomatic — in 40 (34.5%. The first group consisted of 258 patients with the presence of depressive disorders and without hypothyroidism; second — 116 patients with the presence of depression and hypothyroidism. TSH in patients suffering AR, without thyroid dysfunction was 5.2 times lower than in patients with the presence of hypothyroidism. Among AP comorbid with hypothyroidism, are predominant depressive with a predominance of mild and moderate forms. Dominating are anxious-depressive, dysphoric, adynamic, sad, depressive disorders. Conclusion. In patients with AR and hypothyroidism predominant types of personality accentuation are dysthymic, anxious, demonstrative and meticulous.

  14. Update on subclinical hyperthyroidism.

    Science.gov (United States)

    Donangelo, Ines; Braunstein, Glenn D

    2011-04-15

    Subclinical hyperthyroidism is defined by low or undetectable serum thyroid-stimulating hormone levels, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (as in Graves disease or toxic nodular goiter), administration of thyroid hormone for treatment of malignant thyroid disease, or unintentional excessive thyroid hormone therapy. The rate of progression to overt hyperthyroidism is higher in persons who have suppressed thyroid-stimulating hormone levels compared with those who have low but detectable levels. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation in older adults, and with decreased bone mineral density in postmenopausal women; however, the effectiveness of treatment in preventing these conditions is unknown. There is lesser-quality evidence suggesting an association between subclinical hyperthyroidism and other cardiovascular effects, including increased heart rate and left ventricular mass, and increased bone turnover markers. Possible associations between subclinical hyperthyroidism and quality of life parameters, cognition, and increased mortality rates are controversial. Prospective randomized controlled trials are needed to address the effects of early treatment on potential morbidities to help determine whether screening should be recommended in the asymptomatic general population.

  15. Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine.

    Science.gov (United States)

    Lima Carvalho, Marise de Farias; de Medeiros, Josian Silva; Valença, Marcelo Moraes

    2017-09-01

    Objective The objective of this article is to analyze the features of headache attributed to hypothyroidism (HAH), evaluate the differences between groups with and without HAH, between "overt" and "subclinical" hypothyroidism groups, and evaluate outcomes after levothyroxine treatment. Methods Patients with hypothyroidism were selected in a cross-sectional study, followed prospectively for 12 months, and classified as subclinical or overt hypothyroidism. The patients were divided into two groups: with and without HAH. Results HAH was reported by 73/213 (34%) patients, involving the following areas: fronto-orbital (49%), temporal (37%), and posterior part of the head (15%). The HAH features were as follows: pulsatile (63%), four to 72 hours' duration (78%), unilateral (47%), nausea/vomiting (60%), and moderate-severe intensity (72%). Hypothyroidism symptomatology was similar in both groups, except for a greater frequency of hoarseness in the group with HAH. Migraine history was more frequent in the patients with HAH (53% vs 38%, p hypothyroidism. After levothyroxine treatment 78% reported a decrease in HAH frequency. Subclinical and overt hypothyroid patients reported a similar alleviation of their headaches. Conclusion Patients with HAH may present with unilateral, pulsatile, episodic pattern, and nausea/vomiting, which is at odds with the criteria for HAH established by ICHD 3 beta. Not all individuals responded to levothyroxine, and patients with the subclinical form of hypothyroidism benefit from this treatment.

  16. The diagnostic effects of s-TSH and TRH stimulating test on subclinical thyroid function

    International Nuclear Information System (INIS)

    Lu Shujun; Wang Wenliang; Lu Shuyan; Zheng Linong; Hu Changjun; Fang Xiaozheng; Zheng Huian; Ma Meizhen

    2002-01-01

    The study was carried out to investigate the diagnostic effects of supersensitive TSH on diagnosing subclinical thyroid function with only once s-TSH detection and with TRH stimulating tests. TRH stimulating tests have been undertaken for 90 patients with different thyroid disease and 58 normal subjects. Diagnostic basal levels of s-TSH test in control group, subclinical hyperthyroidism group and subclinical hypothyroidism group were 2.20 +- 1.85 mIU/L, 0.54 +- 0.3 mIU/L and 9.08 +- 6.3 mIU/L, respectively, the levels of subclinical hyperthyroidism and subclinical hypothyroidism group were significantly higher than that of normal subjects group (P s -TSH>30 mIU/L. Dynamic observing of TRH stimulating tests have more effect than that of only once s-TSH detection in diagnosing subclinical thyroid function

  17. Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality.

    Science.gov (United States)

    Wolf, Peter; Beiglböck, Hannes; Smaijs, Sabina; Wrba, Thomas; Rasoul-Rockenschaub, Susanne; Marculescu, Rodrig; Gessl, Alois; Luger, Anton; Winhofer, Yvonne; Krebs, Michael

    2017-05-01

    Hypothyroidism is referred to be a rare but possible cause of hyponatremia. However, there is only poor evidence supporting this association. Since hyponatremia and hypothyroidism are both common conditions themselves, co-occurrence does not have to be causal. To address a potential relationship, a retrospective analysis of data from the Division of Endocrinology of the Medical University of Vienna from April 2004 to February 2016 was performed. A total of 8053 hypothyroid patients (48 ± 18 years of age; 71% female) with thyrotropin >4.0 μIU/mL and available blood tests for free thyroxine and sodium (Na + ) within maximal ± seven days were included and screened for hyponatremia. Patients' records were searched for concomitant disease and medication when Na + concentration was causes of hyponatremia in 442/448 (98.88%) patients (i.e., side effects of medication, concomitant underlying disease, or other endocrine disorders). This distribution did not differ between patients suffering from clinical or subclinical hypothyroidism. No case of clinically relevant hyponatremia (Na + hypothyroidism. There was a very weak but statistically significant trend toward a positive association between thyroid function and serum Na + levels (Na + /thyrotropin: R = 0.022, p = 0.046; Na + /free thyroxine: R = -0.047, p hypothyroid patients with moderate to severe hyponatremia often have other potential explanations for their low serum Na + concentrations in routine care.

  18. Hypothyroid symptoms and the likelihood of overt thyroid failure

    DEFF Research Database (Denmark)

    Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils

    2014-01-01

    in hypothyroidism. Hypothyroid patients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70-9.60)), hair loss (4.58 (2.80-7.51)), and dry skin (4.09 (2.73-6.16)). A hypothyroidism-component-score was defined as the number...

  19. [Changes in muscle tissue in hypothyroidism].

    Science.gov (United States)

    Jiskra, J

    2001-09-01

    This article offers a synopsis of detailed analysis of the functional and structural changes in muscle tissue in manifest and subclinical hypothyroidism. There is a brief overview of the division between mypathy and myositis, with emphasis on endocrinological and metabolic disorders. The necessity of endocrinological examination in each case of myopathy the etiology of which is indefinite is stressed, and this especially before the instigation of non-specific immunosuppressive treatment (e.g., corticosteroids) as this treatment has the risk of undesirable side-effects. In conclusion, it emphasises the negative influence of the nexus of hypothyroidism and the administering of a hypolipidemic in tandem on muscle tissue, as in rare cases this can lead to the disintegration of muscle tissue, i.e., rhabdomyolysis. The administering of hypolipidemic drugs to patients with hypothyroidism is indicated only in those cases where persists hyperlipoproteinemia after the normalisation of the thyroid function by substitutional treatment.

  20. pattern of subclinical thyroid disease

    International Nuclear Information System (INIS)

    Ijaz, A.; Marri, M.H.; Qureshi, A.H.; Qamar, M.A.; Ali, N.

    2002-01-01

    Objective: To evaluate the prevalence of subclinical thyroid disease (SCTD) in local population visiting a hospital laboratory for thyroid function tests. Design: It was a hospital - based study carried in consecutive patients who reported for thyroid function tests in the hospital laboratory. Place and duration of study: The study was conducted in combined military Hospital, Quetta during June 1999 to September 2000. Subject and methods: Serum samples of 917 patients living in Quetta and its surrounding were analysed for thyroid stimulating hormone (TSH) free thyroxin (FT4), and total tri-iodothyronine (T3) concentration using chemiluminescence technique on hormone auto analyser (LIA-Mat - Sangtech Germany). Results: Out of 917 patients, 287 (23%) were found to be having SCTD while overt thyroid disease was found in 288 (31%) patients. Prevalence of sub-clinical hypothyroidism (SCO) and sub-clinical hyperthyroidism (sce) was found to be almost equal with a profound female preponderance in both the groups. SCO was more common in children (<12 years of age). Conclusion: Almost every fourth patient reporting for thyroid function tests was diagnosed as having SCTD - a disease entity that is still not well known and that poses diagnostic and management problems for the pathologists and clinicians. (author)

  1. Hypothyroidism in diabetes mellitus patients in Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Robin Maskey

    2015-01-01

    Full Text Available Context: The coexistence of diabetes mellitus (DM with hypothyroidism is a known clinical observation. Aims: To estimate prevalence and co-relate that of hypothyroidism in patients with DM in relation to the age and sex, the lipid profile, body mass index visiting diabetes clinic and inpatients in B. P. Koirala Institute of Health Sciences. Settings and Design: The hospital-based descriptive study. Materials and Methods: Two hundred and seventy-one known or newly detected cases of DM aged more than 15 years were selected randomly from September 2012 to September 2013 and subjected to evaluation for thyroid function - clinically and biochemically and other relevant investigations were done. Statistical Analysis Used: For descriptive statistics mean, standard deviation, percentage, proportion were calculated. For inferential statistics following test were carried out at the level of significant 0.05 where confidence interval is 95%. The statistical operations were done through Statistical Package for the Social Sciences version 10. Results: Of 271 subjects, the prevalence of hypothyroidism (clinical and subclinical in diabetics was, 4.05% (11/271 with females preponderance, of which 7 (30.4% were clinically hypothyroid and 4 (17.4% were subclinical hypothyroid. One (4.3% patient had subclinical hyperthyroidism. The mean age at diagnosis of type 2 DM was 51-60 years. 8.69% of diabetics with primary hypothyroids were having morbid obesity. High-density lipoprotein among different thyroid status were statistically significant (P = 0.042. Conclusions: Hypothyroidism is not uncommon in diabetes, and we found body mass index, mean triglyceride and cholesterol levels were more in those diabetic patients having coexisting hypothyroidism.

  2. [Subclinical hyperthyroidism: from diagnosis to treatment].

    Science.gov (United States)

    Corvilain, B

    2012-09-01

    Subclinical hyperthyroidism is a common clinical entity. Subclinical hyperthyroidism is defined as a serum TSH below the reference range but a normal T4 and T3 level in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional studies and longitudinal population-based studies demonstrate association between subclinical hyperthyroidism and risk of atrial fibrillation, osteoporosis and cardiovascular and global mortality. However, there are no randomized clinical trials answering the question whether long term-health outcomes are improved by the treatment of subclinical hyperthyroidism. Therefore in the absence of evidence for or against treatment of subclinical hyperthyroidism, it seems appropriate to follow algorithms that consider the level of TSH and the presence of risks factors (age > 65 years, osteoporosis, post menopause and cardiac disease).

  3. Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison′ s disease with primary hypothyroidism

    Directory of Open Access Journals (Sweden)

    Jaya Prakash Sahoo

    2016-01-01

    Full Text Available Background: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab titer in Addison's disease with primary hypothyroidism. Materials and Methods: This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (22 pmol/L and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical was defined as high thyroid stimulating hormone (TSH with/without low free thyroxine (fT4. TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Results: Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. Conclusions: The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.

  4. Investigation of the choroidal thickness in patients with hypothyroidism

    Directory of Open Access Journals (Sweden)

    Fatih Ulas

    2015-01-01

    Full Text Available Purpose: The effect of hypothyroidism on the choroidal thickness (CT was investigated in patients with subclinical hypothyroidism and overt hypothyroidism, and biochemically and clinically euthyroid patients receiving levothyroxine treatment. The patients were compared with healthy subjects. Materials and Methods: One eye of 71 hypothyroid and 22 healthy subjects between 20 and 40 years of age were included in this study. CT measurements were taken at the fovea and at 2 points that were 1500 μm nasal and temporal to the fovea using spectral-domain optical coherence tomography. Independent sample t-test′s and was used for statistical analysis of the data. Results: The CT was significantly thicker in hypothyroid patients compared to healthy subjects (P values were 0.013 for subfoveal, 0.015 for temporal and 0.020 for nasal segments. The intraocular pressure (IOP and body mass index (BMI were also significantly higher in hypothyroid patients (P values were 0.021 and 0.003, respectively. There was not a statistically significant difference in the BMI and IOP measurements between healthy subjects and euthyroid patients (P > 0.05. However, there was a statistically significant difference in the subfoveal, temporal and nasal CT measurements between healthy subjects and euthyroid patients (P values were 0.006, 0.031 and 0.013, respectively. Conclusions: All subgroups of hypothyroid patients had thicker CT compared to healthy subjects. Euthyroid patients receiving levothyroxine treatment had lower IOP, BMI levels, and serum lipid levels than patients with subclinical hypothyroidism and overt hypothyroidism.

  5. Newborn screening for congenital hypothyroidism in a public sector hospital

    International Nuclear Information System (INIS)

    Ghafoor, F.; Mohsin, S.N.; Mukhtar, S.; Hussain, W.

    2013-01-01

    Background: Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. Objectives: To screen new borns for congenital hypothyroidism in two public sector hospitals of Lahore. Study type, settings and duration:Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Subjects and Methods: Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. Results: A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal ( =20mIU/L). These 27 neonates were further tested using confirmatory tests For serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. Conclusion: The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates

  6. Subclinical hyperthyroidism: clinical features and treatment options.

    Science.gov (United States)

    Biondi, Bernadette; Palmieri, Emiliano Antonio; Klain, Michele; Schlumberger, Martin; Filetti, Sebastiano; Lombardi, Gaetano

    2005-01-01

    Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.

  7. Asymmetric Dimethyl Arginine in Hypothyroid Patients

    International Nuclear Information System (INIS)

    Abdel-Messeih, P.L.

    2012-01-01

    Thyroid diseases may lead to endothelial dysfunction, however, the mechanism underlying the endothelial dysfunction in thyroid disease is still not clear. Asymmetric dimethyl arginine (ADMA), a novel inhibitor of endothelial nitric oxide synthetase (eNOS), was reported to inhibit nitric oxide (NO) synthesis from L-arginine. The present study was carried out to investigate ADMA levels together with effects of dislipidemia in sub-clinical and overt hypothyroid females. There were significant increase in the levels of total cholesterol, low density lipoprotein-cholesterol (LDL-c), high density lipoprotein-cholesterol (HDL-c), thyroid stimulating hormone (TSH) and ADMA in hypothyroid females as compared to controls while the levels of NO and free T 4 were significantly decreased than controls. Sub-clinical hypothyroid females had significant high TSH, LDL-c and non-significantly high ADMA levels and total cholesterol as compared to controls while they had significant decrease in NO, HDL-c and non-significant decrease in free T 4 as compared to controls. There were significant negative correlations between NO and both ADMA (r 2 = 0.84) and free T 4 (r 2 = 0.95) in overt hypothyroid group while significant positive correlation (r 2 = 0.85) was detected between TSH and HDL-c in the same group. These results are highly suggestive that the decrease of nitric oxide secondary to accumulation of ADMA represent an important pathogenic factor together with dyslipidemia in endothelial dysfunction and increased cardiovascular risk especially in hypothyroid females

  8. Asymmetric Dimethyl Arginine in Hypothyroid Patients

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Messeih, P. L. [Health Radiation Research Department, National Centre for Radiation Research and Technology, Cairo (Egypt)

    2012-07-01

    Thyroid diseases may lead to endothelial dysfunction, however, the mechanism underlying the endothelial dysfunction in thyroid disease is still not clear. Asymmetric dimethyl arginine (ADMA), a novel inhibitor of endothelial nitric oxide synthetase (eNOS), was reported to inhibit nitric oxide (NO) synthesis from L-arginine. The present study was carried out to investigate ADMA levels together with effects of dislipidemia in sub-clinical and overt hypothyroid females. There were significant increase in the levels of total cholesterol, low density lipoprotein-cholesterol (LDL-c), high density lipoprotein-cholesterol (HDL-c), thyroid stimulating hormone (TSH) and ADMA in hypothyroid females as compared to controls while the levels of NO and free T{sub 4} were significantly decreased than controls. Sub-clinical hypothyroid females had significant high TSH, LDL-c and non-significantly high ADMA levels and total cholesterol as compared to controls while they had significant decrease in NO, HDL-c and non-significant decrease in free T{sub 4} as compared to controls. There were significant negative correlations between NO and both ADMA (r{sup 2} = 0.84) and free T{sub 4} (r{sup 2} = 0.95) in overt hypothyroid group while significant positive correlation (r{sup 2} = 0.85) was detected between TSH and HDL-c in the same group. These results are highly suggestive that the decrease of nitric oxide secondary to accumulation of ADMA represent an important pathogenic factor together with dyslipidemia in endothelial dysfunction and increased cardiovascular risk especially in hypothyroid females.

  9. Levothyroxine treatment restored the decreased circulating fibroblast growth factor 21 levels in patients with hypothyroidism.

    Science.gov (United States)

    Wang, Guang; Liu, Jia; Yang, Ning; Hu, Yanjin; Zhang, Heng; Miao, Li; Yao, Zhi; Xu, Yuan

    2016-06-01

    Fibroblast growth factor 21 (FGF21) is an important endogenous regulator of energy metabolism. Thyroid hormone has been shown to regulate hepatic FGF21 expression in rodents. The goal of this study was to evaluate the plasma FGF21 levels in participants with normal thyroid function, subclinical hypothyroidism, or overt hypothyroidism and to investigate the change of plasma FGF21 levels in patients with overt hypothyroidism after levothyroxine treatment. A total of 473 drug-naive participants were recruited, including 250 healthy control subjects, 116 patients with subclinical hypothyroidism, and 107 patients with overt hypothyroidism. Thirty-eight patients with overt hypothyroidism were assigned to receive levothyroxine treatment. The overt hypothyroidism group had decreased FGF21 levels compared with the control and subclinical hypothyroidism groups (Ptreatment markedly attenuated the increased circulating levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high-sensitivity C-reactive protein (hsCRP), and homeostasis model assessment index of insulin resistance (HOMA-IR) in patients with overt hypothyroidism. A significant increase in plasma FGF21 levels was observed after levothyroxine treatment (Ptreatment (FT3: r=0.44; FT4: r=0.53; all Ptreatment ameliorated metabolic disorders and restored the decreased circulating FGF21 levels in patients with overt hypothyroidism. The increase in FGF21 levels after levothyroxine treatment might be partly associated with the amelioration of metabolic disorders in patients with hypothyroidism. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  10. [Management of hypothyroidism and hyperthyroidism].

    Science.gov (United States)

    Jiskra, Jan

    2015-10-01

    Functional thyropathies present significant health risks for patients. Advanced functional thyropathies are always treated while indications for therapy of subclinical thyropathies are individual and often controversial. It is widely agreed that these disorders should be diagnosed and individuals should be followed. The drug of choice in substitution therapy of hypothyroidism is levothyroxine, in the treatment of hyperthyroidism it is methimazole. Administration of propylthiouracil should be limited to the first trimester of pregnancy, because its serious hepatotoxicity has been described. Hyperthyroidism based on thyroid nodules and immunogenic hyperthyroidism not reaching long-term remission, need to be treated radically: by surgery or radioiodine treatment. When radiation protection requirements are met, radioiodine can also be administered on an outpatient basis. Exceptionally, small doses of methimazole can be administered over an extended period of time in individual cases.

  11. [Hypothyroidism in adults in a basic health area].

    Science.gov (United States)

    López-Macías, I; Hidalgo-Requena, A; Pérez-Membrive, E; González-Rodríguez, M E; Bellido-Moyano, C; Pérula-de Torres, L A

    2018-04-01

    The objective of the present study is to study the prevalence, as well as the clinical and epidemiological characteristics of hypothyroid disease in adults using the computerised clinical records. Observational, descriptive and cross-sectional study. The target population was the patients of the health centres of Lucena I and II (Córdoba). Patients 14 years or older, diagnosed with hypothyroidism, born and resident in Lucena. Two hundred and fourteen patients were recruited by random sampling, who then underwent a clinical interview using a questionnaire. The mean age of the patients was 49.71 years (SD 17.03; 95% CI 47.34-51.98), with 85.5% women. A diagnosis of sub-clinical hypothyroidism was found in 74.8%, compared to 18.7% of primary hypothyroidism, and 6.5% of secondary hypothyroidism. The 53.7% (95% CI 46.81-60.59) of patients diagnosed with hypothyroidism did not have thyroid antibodies results. However, 75.2% (95% CI 68.89-80.86) were being treated with levothyroxine. The prevalence of hypothyroidism was 5.7% (95% CI 5.46-5.96). Sub-clinical hypothyroidism is very common in Primary Care clinics. Many patients are not correctly diagnosed and many are over-medicated, suggesting a need to review the diagnosis. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  12. [Congenital hypothyroidism].

    Science.gov (United States)

    Castilla Peón, María Fernanda

    Congenital hypothyroidism (CH) is a cause of preventable mental retardation; therefore, timely diagnosis and treatment by the primary care physician is very important. CH screening must be performed between the second and fifth days of life with capillary blood done with a heel prick and must be confirmed by measurement of thyroid hormones in venous blood. The most common cause of CH is thyroid dysgenesis, which may be identified by a thyroid scan carried out before initiating treatment. Treatment should be with levothyroxine (10-15μg/kg/day) and should not be delayed or suspended during the first 3 years of life due to the deleterious effect on neurodevelopment in case of low thyroid hormones during this time. Preterm or sick infants or those with Down syndrome require special consideration. This article provides diagnostic and therapeutic algorithms for CH. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  13. Subclinical ketosis in post-partum dairy cows fed a predominantly pasture-based diet: defining cut-points for diagnosis using concentrations of beta-hydroxybutyrate in blood and determining prevalence.

    Science.gov (United States)

    Compton, C W R; Young, L; McDougall, S

    2015-09-01

    Firstly, to define, in dairy cows in the first 5 weeks post-calving fed a predominantly pasture-based diet, cut-points of concentrations of beta-hydroxybutyrate (BHBA) in blood, above which there were associations with purulent vaginal discharge (PVD), reduced pregnancy rates (PR) and decreased milk production, in order to better define subclinical ketosis (SCK) in such cattle; and secondly, to determine the prevalence, incidence and risk factors for SCK. An observational field study was conducted in 565 cows from 15 spring-calving and predominantly pasture-fed dairy herds in two regions of New Zealand during the 2010- 2011 dairy season. Within each herd, a cohort of randomly selected cows (approximately 40 per herd) was blood sampled to determine concentrations of BHBA on six occasions at weekly intervals starting within 5 days of calving. The key outcome variables were the presence/absence of PVD at 5 weeks post-calving, PR after 6 weeks (6-week PR) and after the completion of the breeding season (final PR), and mean daily milk solids production. Two cut-points for defining SCK were identified: firstly concentration of BHBA in blood≥1.2 mmol/L within 5 days post-calving, which was associated with an increased diagnosis of PVD (24 vs. 8%); and secondly concentration of BHBA in blood≥1.2 mmol/L at any stage within 5 weeks post-calving, which was associated with decreased 6-week PR (78 vs. 85%). The mean herd-level incidence of SCK within 5 weeks post-calving was 68 (min 12; max 100)% and large variations existed between herds in peak prevalence of SCK and the interval post-calving at which such peaks occurred. Cows>8 years of age and cows losing body condition were at increased risk of SCK within 5 weeks of calving. Cows with concentration of BHBA in blood≥1.2 mmol/L in early lactation had a higher risk of PVD and lower 6-week PR. Cow and herd-level prevalence of SCK varied widely in early lactation. Subclinical ketosis is common and is significantly

  14. Medicines for Hypothyroidism

    Science.gov (United States)

    ... T4 made by your body. What is the treatment for hypothyroidism? People who have hypothyroidism must take a pill ... Questions to ask your doctor • Do I have hypothyroidism? • What treatment do I need for it? • What are the ...

  15. Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism.

    Science.gov (United States)

    Khan, Shoukat H; P, Madhu Vijay; Rather, Tanveer A; Laway, Bashir A

    2017-01-30

    Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15-20 MBq of Technetium-99m sulfur colloid diluted in 10-15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls ( P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation ( r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels.

  16. The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Song, Fei; Bao, Cuiping; Deng, Meiyu; Xu, Hui; Fan, Meijuan; Paillard-Borg, Stéphanie; Xu, Weili; Qi, Xiuying

    2017-01-01

    The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.

  17. Longitudinal study of the effects of chronic hypothyroidism on skeletal muscle in dogs.

    Science.gov (United States)

    Rossmeisl, John H; Duncan, Robert B; Inzana, Karen D; Panciera, David L; Shelton, G Diane

    2009-07-01

    To study the effects of experimentally induced hypothyroidism on skeletal muscle and characterize any observed myopathic abnormalities in dogs. 9 female, adult mixed-breed dogs; 6 with hypothyroidism induced with irradiation with 131 iodine and 3 untreated control dogs. Clinical examinations were performed monthly. Electromyographic examinations; measurement of plasma creatine kinase, alanine aminotransferase, aspartate aminotransferase, lactate, and lactate dehydrogenase isoenzyme activities; and skeletal muscle morphologic-morphometric examinations were performed prior to and every 6 months for 18 months after induction of hypothyroidism. Baseline, 6-month, and 18-month assessments of plasma, urine, and skeletal muscle carnitine concentrations were also performed. Hypothyroid dogs developed electromyographic and morphologic evidence of myopathy by 6 months after treatment, which persisted throughout the study, although these changes were subclinical at all times. Hypothyroid myopathy was associated with significant increases in plasma creatine kinase, aspartate aminotransferase, and lactate dehydrogenase 5 isoenzyme activities and was characterized by nemaline rod inclusions, substantial and progressive predominance of type I myofibers, decrease in mean type II fiber area, subsarcolemmal accumulations of abnormal mitochondria, and myofiber degeneration. Chronic hypothyroidism was associated with substantial depletion in skeletal muscle free carnitine. Chronic, experimentally induced hypothyroidism resulted in substantial but subclinical phenotypic myopathic changes indicative of altered muscle energy metabolism and depletion of skeletal muscle carnitine. These abnormalities may contribute to nonspecific clinical signs, such as lethargy and exercise intolerance, often reported in hypothyroid dogs.

  18. Screening for Hypothyroidism-Results of a Study Conducted at District Headquarter Hospital, Abbottabad

    International Nuclear Information System (INIS)

    Gul, N.; Farid, J.; Idris, M.; Sarwar, J.

    2016-01-01

    Background: Sub-clinically hypo-functioning thyroid is a condition in which there is biochemical evidence of hypothyroidism but patient is clinically asymptomatic. This concept is not new. The typical picture of this condition is increased thyroid stimulating hormone and normal thyroxine levels. Subclinical hypothyroidism has been found to have variable prevalence ranging from 4-10 percent to 10-26 percent. Methods: This cross sectional study was conducted on 378 adult patients coming to outpatient department of District Headquarter Hospital Abbottabad over a period of two years from February 2013 to February 2015. Results: Out of the 378 individuals studied, 37 (9.78 percent) had subclinical hypothyroidism. Mean age of the patients was 43.5±10.5 years. Females outnumbered males, i.e., 24 out of 37 (65 percent). It was noted that there was no correlation between mean TSH level and gender or age of the patients. Conclusion: Subclinical hypothyroidism is not an uncommon condition and its diagnosis is established easily by doing thyroid hormone levels in fasting condition. Early diagnosis and therapeutic intervention may not only prevent the progression to clinical hypothyroidism but also help in preventing the wastage of resources on doing unnecessary investigations. (author)

  19. Screening For Hypothyroidism-Results Of A Study Conducted At District Headquarter Hospital, Abbottabad.

    Science.gov (United States)

    Gul, Nasreen; Farid, Jamila; Idris, Muhammad; Sarwar, Javed

    2016-01-01

    Sub-clinically hypo-functioning thyroid is a condition in which there is biochemical evidence of hypothyroidism but patient is clinically asymptomatic. This concept is not new. The typical picture of this condition is increased thyroid stimulating hormone and normal thyroxine levels. Subclinical hypothyroidism has been found to have variable prevalence ranging from 4-10% to 10- 26%. This cross sectional study was conducted on 378 adult patients coming to outpatient department of District Headquarter Hospital Abbottabad over a period of two years from February 2013 to February 2015. Out of the 378 individuals studied, 37 (9.78%) had subclinical hypothyroidism. Mean age of the patients was 43.5±10.5 years. Females outnumbered males, i.e., 24 out of 37 (65%). It was noted that there was no correlation between mean TSH level and gender or age of the patients. Subclinical hypothyroidism is not an uncommon condition and its diagnosis is established easily by doing thyroid hormone levels in fasting condition. Early diagnosis and therapeutic intervention may not only prevent the progression to clinical hypothyroidism but also help in preventing the wastage of resources on doing unnecessary investigations.

  20. Prevalence of Hypothyroidism and Its Association with Diabetes Mellitus in Patients of an Ambulatory Clinic.

    Science.gov (United States)

    Bernal, Mariela; Escobar, Eddy; Rodríguez González, Carmen E

    2016-01-01

    Hypothyroidism is the most common thyroid disorder in the adult population. Studies have found a higher prevalence of overt hypothyroidism in type 2 diabetic population than in the general population, but the relationship between subclinical hypothyroidism and diabetes mellitus 2 is still controversial. The aim of this study is to estimate the prevalence rate of hypothyroidism in the adult population receiving services in an ambulatory clinic and to determine if there is an association between hypothyroidism and diabetes mellitus. From the database of all adult patients who attended the outpatient clinic at Family Medicine Center Policlínica Bella Vista in Mayagüez, P.R. during 2014, a random sample of 200 subjects was obtained and the medical records were reviewed. The prevalence rate of diabetes mellitus in this group was 22% and the prevalence rate of hypothyroidism was 17%. The prevalence rate of hypothyroidism in diabetic patients was 10/44 (22.7%). The prevalence rate of hypothyroidism in non-diabetic patients was 24/156 (15.4%). The prevalence ratio was 1.48 (95% CI: 0.77, 2.85; X2 = 1.31, p = 0.25). The results of this cross-sectional study showed a non-statistically significant tendency for a higher prevalence of hypothyroidism in diabetic patients, which suggest that screening for hypothyroidism among patients with diabetes should be considered. More studies with more patients are necessary to investigate the association between thyroid dysfunction and diabetic patients.

  1. The Progression and Early detection of Subclinical Atherosclerosis (PESA) study

    DEFF Research Database (Denmark)

    Fernández-Ortiz, Antonio; Jiménez-Borreguero, L Jesús; Peñalvo, José L

    2013-01-01

    The presence of subclinical atherosclerosis is a likely predictor of cardiovascular events; however, factors associated with the early stages and progression of atherosclerosis are poorly defined.......The presence of subclinical atherosclerosis is a likely predictor of cardiovascular events; however, factors associated with the early stages and progression of atherosclerosis are poorly defined....

  2. Etiological evaluation of primary congenital hypothyroidism cases.

    Science.gov (United States)

    Bezen, Diğdem; Dilek, Emine; Torun, Neşe; Tütüncüler, Filiz

    2017-06-01

    Primary congenital hypothyroidism is frequently seen endocrine disorder and one of the preventable cause of mental retardation. Aim of study was to evaluate the frequency of permanent/transient hypothyrodism, and to detect underlying reason to identfy any marker which carries potential to discriminate permanent/transient form. Forty eight cases older than 3 years of age, diagnosed as primary congenital hypothyroidism and started thyroxin therapy in newborn-period, and followed up between January 2007-June 2013 were included in the study. Thyroid hormon levels were evaluated and thyroid ultrasonography was performed in cases who are at the end of their 3 years of age, after 6 weeks of thyroxine free period. Thyroid sintigraphy was performed if serum thyroid-stimulating hormone was high (≥ 5 mIU/mL) and perchlorate discharge test was performed if uptake was normal or increased on sintigraphy. Cases with thyroid-stimulating hormone levels ≥ 5 mIU/mL were defined as permanent primary congenital hypothyroidism group and as transient primary congenital hypothyroidism group with normal thyroid hormones during 6 months. The mean age was 3.8±0.7 years. Mean diagnosis age was 16.6±6.5 days and 14 cases (29.2%) were diagnosed by screening program of Ministry of Health. There were 23 cases (14F, 9M) in permanent primary congenital hypothyroidism group and 12 (52.2%) of them were dysgenesis (8 hypoplasia, 4 ectopia), and 11 (47.8%) dyshormonogenesis. In transient primary congenital hypothyroidism group, there were 25 cases (17M, 8F). The mean thyroid-stimulating hormone levels at diagnosis were similar in two groups. The mean thyroxin dose in permanent primary congenital hypothyroidism group was significantly higher than transient group at the time of thyroxin cessation (2.1±0.7, 1.5±0.5 mg/kg/d, respectively, p=0.004). Thyroxin dose ≥1.6 mcg/kg/d was 72% sensitive and 69.6% specific for predicting permenant primary congenital hypothyroidism. Transient primary

  3. Central Hypothyroidism in Miniature Schnauzers

    NARCIS (Netherlands)

    Voorbij, Annemarie M W Y; Leegwater, Peter A J; Buijtels, Jenny J C W M; Daminet, Sylvie; Kooistra, Hans S

    2016-01-01

    BACKGROUND: Primary hypothyroidism is a common endocrinopathy in dogs. In contrast, central hypothyroidism is rare in this species. OBJECTIVES: The objective of this article is to describe the occurrence and clinical presentation of central hypothyroidism in Miniature Schnauzers. Additionally, the

  4. Primary and secondary hypothyroidism (image)

    Science.gov (United States)

    Hypothyroidism is a decreased activity of the thyroid gland which may affect all body functions. The rate ... and physical sluggishness. The most severe form of hypothyroidism is myxedema, a medical emergency. Hypothyroidism can be ...

  5. Genetics Home Reference: congenital hypothyroidism

    Science.gov (United States)

    ... Facebook Twitter Home Health Conditions Congenital hypothyroidism Congenital hypothyroidism Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Congenital hypothyroidism is a partial or complete loss of function ...

  6. Myopathy in acute hypothyroidism

    OpenAIRE

    Ma, JTC; Yu, YL; Kung, AWC

    1987-01-01

    Hypothyroid myopathy has so far been reported in long standing cases of hypothyroidism. We describe two adult patients with myopathy associated with acute transient hypothyroidism. Both presented with severe muscle aches and cramps, stiffness and spasms. Muscle enzymes were markedly elevated and electromyography in one patient showed myopathic features. Histological changes were absent in muscle biopsy, probably because of the short duration of metabolic disturbance. The myopathy subsided pro...

  7. Myopathy in acute hypothyroidism.

    OpenAIRE

    Kung, A. W.; Ma, J. T.; Yu, Y. L.; Wang, C. C.; Woo, E. K.; Lam, K. S.; Huang, C. Y.; Yeung, R. T.

    1987-01-01

    Hypothyroid myopathy has so far been reported in long standing cases of hypothyroidism. We describe two adult patients with myopathy associated with acute transient hypothyroidism. Both presented with severe muscle aches and cramps, stiffness and spasms. Muscle enzymes were markedly elevated and electromyography in one patient showed myopathic features. Histological changes were absent in muscle biopsy, probably because of the short duration of metabolic disturbance. The myopathy subsided pro...

  8. MENSTRUAL IRREGULARITIES IN HYPOTHYROIDISM

    OpenAIRE

    Kalyani

    2015-01-01

    AIM OF THE STUDY: To study the effect of hypothyroidism, on the menstrual cycle of women in the reproductive age group. MATERIAL & METHODS: A total number of 50 cases of hypothyroidism patients recruited over a period of one year from the department of Nuclear Medicine K.G.H Visakhapatnam. All these subjects were evaluated clinically and the data recorded as per the proforma. RESULTS: In my study out of 50 hypothyroid women, 22% had normal menstrual cycle &...

  9. Hypothyroidism and myxedema coma.

    Science.gov (United States)

    Finora, Kevin; Greco, Deborah

    2007-01-01

    Hypothyroidism is a common endocrinopathy in dogs but is rare in cats. Lymphocytic thyroiditis and idiopathic thyroid atrophy are common causes of this condition. Specific thyroid function tests, in conjunction with clinical signs and physical examination findings, are used to help confirm a diagnosis of hypothyroidism. This disease can be managed with synthetic hormone supplementation and has an excellent prognosis. Myxedema coma is a rare and potentially fatal manifestation of severe hypothyroidism that can be successfully treated using intravenous levothyroxine.

  10. [Hypothyroidism incidence after multimodal treatment for laryngeal cancer].

    Science.gov (United States)

    Ortega-Gutiérrez, César; Luna-Ortiz, Kuauhyama; Villavicencio-Valencia, Verónica; Herrera Gómez, Angel; Téllez-Palacios, Daniela; Contreras-Buendía, Marlen

    2012-01-01

    Hypothyroidism following total laryngectomy or radiotherapy treatment for laryngeal cancer is not a rare event, especially in advanced stages. There are no reports on the incidence of hypothyroidism in patients who received chemotherapy and radiotherapy. The objective of this study is to determine the incidence of thyroid dysfunction in a group of patients with laryngeal cancer who underwent surgery as sole treatment, total laryngectomy or radiotherapy alone, and patients with combined treatment: surgery plus radiotherapy, concomitant chemoradiation therapy and chemoradiation therapy plus salvage surgery. A prospective study of patients diagnosed with laryngeal cancer whose serum TSH and T4 levels were evaluated in a serial fashion. 70 patients with laryngeal cancer were studied; the average age at diagnosis was 70.2 years. Male patients were more affected, with a men-women ratio of 3.6:1. Glottic localization was the most frequent (44%). 64% of tumors were locally advanced carcinomas and 51% received multimodal treatment. 45 patients (63%) were diagnosed with hypothyroidism; 49% of the patients with subclinical hypothyroidism, and 51% with clinical hypothyroidism. Hypothyroidism is a complication following treatment for laryngeal cancer. It is recommended to evaluate the thyroid function periodically for timely detection.

  11. Incidence of hypothyroidism after irradiation of the neck with special reference to lymphoma patients

    International Nuclear Information System (INIS)

    Feyerabend, T.; Kapp, B.; Richter, E.; Becker, W.; Reiners, C.; Wuerzburg Univ.

    1990-01-01

    Twenty-eight patients were studied prospectively in order to determine the incidence of hypothyroidism after mantle irradiation for malignant lymphoma. This group was compared with a historical group of 65 patients, among them 36 patients with malignant lymphoma. The mean follow-up was 30 months for the prospective group and 46 months for the retrospective group. The mean thyroid dose for irradiated malignant lymphomas in the prospective and the retrospective group was 45 Gy and 43 Gy respectively. For other tumors with neck irradiation (retrospective group) the mean thyroid dose was 53 Gy. There were no cases of clinical hypothyroidism in our study. As for subclinical hypothyroidism which is characterised by elevated TSH, the incidence was 22% in the prospective group and 3% in the retrospective group, i.e. 8/93 patients showed a hypothyroid dysfunction. Three of the 8 patients with subclinical hypothyroidism had undergone lymphangiography before radiotherapy. Due to the elevated iodine pool a lymphangiogram is considered as a risk factor for hypothyroidism as well as for hyperthyroidism, which we observed twice in the prospective group. Evaluation of the thyroid function before lymphangiography and irradiation as well as regular thyroid function studies during the follow-up are recommended in order to detect hypothyroidism in time. (orig.)

  12. Hypothyroidism Among Military Infants Born in Countries of Varied Iodine Nutrition Status

    Science.gov (United States)

    2010-02-01

    while permanent congenital hypothyroidism causes include thyroid dysgenesis, dys- hormonogenesis, and central hypothyroidism and is relatively rare, with... causes have found a gender influence only among permanent cases of congenital hypothyroidism [15,20]. Given our use of ICD-9-CM codes to define cases...Naval Health Research Center Hypothyroidism among Military Infants Born in Countries of Varied Iodine Nutrition Status . M. M. Cranston

  13. A PROSPECTIVE STUDY OF HYPOTHYROIDISM IN DIAGNOSED CASE OF GALLSTONE DISEASE

    Directory of Open Access Journals (Sweden)

    P. Sundareswar

    2016-11-01

    Full Text Available BACKGROUND Disturbances in lipid metabolism, which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with gallstones. The aim of this study was to investigate the association between hypothyroidism and gallstone disease. MATERIALS AND METHODS 200 patients admitted as inpatients for management of gallstone disease in Department of General Surgery, GRH, Madurai, between September 2014 to August 2015 were evaluated with details of cases, full history, clinical examination, symptoms and signs of hypothyroidism (loss of appetite, gaining weight, tiredness, constipation, cold intolerance, menstrual disturbances, bradycardia, presence or absence of goiter, etc. and investigations (USG abdomen, USG neck, thyroid function test (T3, T4, TSH. Patients are divided according to history, clinical examination, USG neck and lab estimation of T3, T4 and TSH. 1. Subclinical Hypothyroidism: Symptom free patient with TSH concentration above upper limit of normal range and T3/T4 or both decrease below normal limit. 2. Clinical Hypothyroidism: In which, there are symptoms of hypothyroidism with TSH level above the upper limit and T3/T4 or both decrease below normal limit. 3. Euthyroid Group: Where clinical and lab tests are within normal range (all these groups may present with or without goiter. RESULTS This study included 200 gallstone patients who were studied prospectively over a period of 1 year from September 2014 to August 2015. Among them, 18 patients had subclinical hypothyroidism and 6 patients had clinical hypothyroidism. A total of 12% of gallstone patients were diagnosed to have hypothyroidism showing that there is association of hypothyroidism with gallstone disease. CONCLUSION Thyroid dysfunction is more common among patients with gallstones and it maybe a risk factor for biliary stone formation. This may be attributed to the absence of the pro-relaxing effects of

  14. Palpebral redundancy from hypothyroidism.

    Science.gov (United States)

    Wortsman, J; Wavak, P

    1980-01-01

    A patient is described with disabling palpebral edema. Primary hypothyroidism had been previously diagnosed and treated. Testing of thyroid function revealed persistence of the hypothyroidism. Treatment with L-thyroxine produced normalization of the biochemical parameters and resolution of palpebral edema. The search for hypothyrodism in patients with palpebral redundancy is emphasized.

  15. Hypothyroidism in Women.

    Science.gov (United States)

    Dunn, Donna; Turner, Carla

    2016-01-01

    Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the second most common endocrine disorder among women. Symptoms of hypothyroidism include fatigue, weight gain, alteration in cognition, infertility, and menstrual abnormalities. The most common cause of hypothyroidism in the United States is Hashimoto's thyroiditis. The American Thyroid Association recommends an initial screening for thyroid disease at age 35years and every 5years thereafter. Thyroid-stimulating hormone is highly sensitive to thyroid dysfunction and is used to evaluate thyroid disorders. Monotherapy with levothyroxine is the standard for treating hypothyroidism. Diagnosing hypothyroidism requires appropriate diagnostic tests to facilitate prompt diagnosis and treatment. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  16. Frequency of hypothyroidism in patients of beta-thalassaemia

    International Nuclear Information System (INIS)

    Malik, S.A.; Syed, S.; Ahmed, N.

    2010-01-01

    To determine the frequency of hypothyroidism in patients suffering from homozygous-thalassaemia. This descriptive study included 70 diagnosed thalassaemia major patients aged 5-14 years. Demographic data as well as history of blood transfusion and chelation therapy was collected. Random blood samples were drawn and thyroid profile (serum thyroxine [T4], triiodothyronine [T3] and thyroid stimulating hormone concentrations [TSH]) was done by enzyme-linked immunosorbent assay (ELISA). Primary hypothyroidism was defined by a TSH level >4 macro IU/ml. Results were analysed by descriptive statistical methods. Primary hypothyroidism was seen in 18 (25.7%) patients. Of these, 17 had normal T4 levels with elevated TSH levels consistent with a diagnosis of compensated primary hypothyroidism whereas only one patient showed a decreased T4 level with elevated TSH (uncompensated primary hypothyroidism). Mean age of hypothyroid patients was 9.2 +- 2.6 years. Frequency of hypothyroidism was associated with increased serum ferritin levels. Primary hypothyroidism occurs in a significant proportion of thalassaemia major patients in the absence of obvious clinical signs of hypothyroidism. Regular follow-up for early detection and timely treatment of such complications could improve the quality of life of these patients (JPMA 60:17; 2010). (author)

  17. Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace.

    Science.gov (United States)

    Diaz-Olmos, Rodrigo; Nogueira, Antônio-Carlos; Penalva, Daniele Queirós Fucciolo; Lotufo, Paulo Andrade; Benseñor, Isabela Martins

    2010-01-01

    Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP). All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH), free thyroxine (free-T4) and anti-thyroperoxidase antibodies (anti-TPO). The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01). There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l) did not change the results. In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

  18. Frequency of subclinical thyroid dysfunction and risk factors for cardiovascular disease among women at a workplace

    Directory of Open Access Journals (Sweden)

    Rodrigo Diaz-Olmos

    Full Text Available CONTEXT AND OBJECTIVE: Subclinical thyroid dysfunction is very common in clinical practice and there is some evidence that it may be associated with cardiovascular disease. The aim here was to evaluate the frequencies of subclinical thyroid disease and risk factors for cardiovascular disease among women at a workplace, and to evaluate the association between subclinical thyroid disease and cardiovascular risk factors among them. DESIGN AND SETTING: Cross-sectional study on 314 women aged 40 years or over who were working at Universidade de São Paulo (USP. METHODS: All the women answered a questionnaire on sociodemographic characteristics and risk factors for cardiovascular disease and the Rose angina questionnaire. Anthropometric variables were measured and blood samples were analyzed for blood glucose, total cholesterol and fractions, high-sensitivity C-reactive protein, thyroid-stimulating hormone (TSH, free thyroxine (free-T4 and anti-thyroperoxidase antibodies (anti-TPO. RESULTS: The frequencies of subclinical hypothyroidism and hyperthyroidism were, respectively, 7.3% and 5.1%. Women with subclinical thyroid disease presented higher levels of anti-TPO than did women with normal thyroid function (P = 0.01. There were no differences in sociodemographic factors and cardiovascular risk factors according to thyroid function status, except for greater sedentarism among the women with subclinical hypothyroidism. Restricting the comparison to women with subclinical hypothyroidism (TSH > 10 mIU/l did not change the results. CONCLUSION: In this sample of women, there was no association between poor profile of cardiovascular risk factors and presence of subclinical thyroid disease that would justify screening at the workplace.

  19. Analysis of Subclinical Hyperthyroidism Influence on Parameters of Bone Metabolism

    Directory of Open Access Journals (Sweden)

    I.V. Pankiv

    2016-03-01

    Full Text Available State of subclinical hypothyroidism can be considered as the optimal model for assessing the significance of thyroid stimulating hormone (TSH for bone tissue in clinical practice. Objective: to make a comparative analysis of the impact of subclinical hyperthyroidism of various origins on the performance of bone mineral density (BMD and bone metabolism parameters. Materials and methods. The study in an outpatient setting included 112 women with a diagnosis of subclinical hyperthyroidism and duration of menopause for at least 5 years. Among the examinees, endogenous subclinical hyperthyroidism has been detected in 78 women (group I, exogenous subclinical hyperthyroidism on the background of suppressive levothyroxine therapy (group II — in 34. The control group (group III included 20 women without thyroid dysfunction. Results. The study first conducted a comparative analysis of bone metabolism, BMD indicators, as well as parameters of phosphorus and calcium, blood lipids in women with subclinical hyperthyroidism of various origins. A positive correlation between markers of bone metabolism and free triiodothyronine (fT3 as hormones necessary for the development of the skeleton and to maintain its homeostasis indicates a physiological effect of parathyroid hormone and fT3 on bone tissue. It is shown that the bone metabolism and BMD depend not only on the content of TSH, but also on the causes of subclinical hyperthyroidism.Conclusions. In postmenopausal women with endogenous subclinical hyperthyroidism, there is a significant decline in BMD indices, more pronounced in the bones with the cortical structure. A negative correlation between markers of bone metabolism and TSH has been observed among all patients included in the study.

  20. Subclinical hyperthyroidism: to treat or not to treat?

    NARCIS (Netherlands)

    Hoogendoorn, E.H.; Heijer, M. den; Dijk, A.P.J. van; Hermus, A.R.M.M.

    2004-01-01

    Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical

  1. Hypothyroidism and Risk of Mild Cognitive Impairment in Elderly Persons - A Population Based Study

    Science.gov (United States)

    Parsaik, Ajay K; Singh, Balwinder; Roberts, Rosebud O; Pankratz, Shane; Edwards, Kelly K.; Geda, Yonas E; Gharib, H; Boeve, Bradley F; Knopman, David S; Petersen, Ronald C

    2014-01-01

    IMPORTANCE Association of clinical and subclinical hypothyroidism with mild cognitive impairment (MCI) is not established. OBJECTIVE To evaluate the association of clinical and subclinical hypothyroidism with MCI in a large population based cohort. DESIGN A cross-sectional, population-based study. SETTING Olmsted County, Minnesota. PARTICIPANTS Randomly selected participants were aged 70 to 89 years on October 1, 2004, and were without documented prevalent dementia. A total of 2,050 participants were evaluated and underwent in-person interview, neurological evaluation and neuropsychological testing to assess performance in memory, attention/executive function, visuospatial, and language domains. Subjects were diagnosed by consensus as cognitively normal, MCI or dementia according to published criteria. Clinical and subclinical hypothyroidism was ascertained from a medical records-linkage system. MAIN OUTCOME MEASURES Association of clinical and subclinical hypothyroidism with MCI. Results Among 1904 eligible participants, the frequency of MCI was 16% in 1450 subjects with normal thyroid function, 17% in 313 subjects with clinical hypothyroidism, and 18% in 141 subjects with subclinical hypothyroidism. After adjusting for covariates (age, gender, education, education years, sex, ApoE ε 4, depression, diabetes, hypertension, stroke, BMI and coronary artery disease) we found no significant association between clinical or subclinial hypothyroidism and MCI [OR 0.99 (95% CI 0.66–1.48) and OR 0.88 (95% CI 0.38–2.03) respectively]. No effect of gender interaction was seen on these effects. In stratified analysis, the odds of MCI with clinical and subclinical hypothyroidisn among males was 1.02 (95%CI, 0.57–1.82) and 1.29 (95%CI 0.68–2.44), among females was 1.04 (95% 0.66–1.66) and 0.86 (95% CI 0.37–2.02) respectively. Conclusion In this population based cohort of eldery, neither clinical nor subclinical hypothyrpodism was associated with MCI. Our findings

  2. Hypothyroidism Potentially Linked to Cutaneous Squamous Cell Carcinoma: Retrospective Study at a Single Tertiary Academic Medical Center.

    Science.gov (United States)

    Ahadiat, Omeed; Higgins, Shauna; Trodello, Cameron; Talmor, Guy; Kokot, Niels; Wysong, Ashley

    2018-01-01

    There are multiple known risk factors for the development of cutaneous squamous cell carcinoma (SCC). To determine whether patients with cutaneous SCC have a higher prevalence of hypothyroidism than the general US population. A retrospective review was performed for patients seen at the University of Southern California with cutaneous SCC. Chart review was performed for the presence of hypothyroidism and thyroid replacement therapy before the diagnosis of SCC for each patient. Multiple prevalence studies were gathered from the literature for comparison, reporting the prevalence of overt and subclinical hypothyroidism in the general US population and/or elderly US population. Of the 265 patients diagnosed with SCC of the skin, 61 (23%) of patients were found to have a preceding diagnosis of hypothyroidism. The prevalence of hypothyroidism among the population of SCC patients was significantly greater than the prevalence of hypothyroidism (overt and subclinical) in any general and/or elderly US population reported. Patients with SCC of skin are more likely to have a history of hypothyroidism than the general population. The authors conclude that hypothyroidism may be linked to the development of cutaneous SCC.

  3. Rhabdomyolysis case based on hypothyroidism

    OpenAIRE

    Bilal Katipoglu; Ihsan Ates; Fatih Acehan; Ayşenur Meteris; Nisbet Yılmaz

    2016-01-01

    Summary Hypothyroidism is a wide clinical spectrum disorder and only a few cases in literature show this. Rhabdomyolysis and acute renal impairment can be seen concurrently in a hypothyroid state. We report a case of severe hypothyroidism with poor drug compliance leading to rhabdomyolysis and acute kidney injury. Learning points: Hypothyroidism is a rare cause of acute kidney injury. In this case report, we studied a rare occurrence of acute renal impairment due to hypothyroidism with poor d...

  4. Respiratory Manifestations of Hypothyroidism: A Systematic Review.

    Science.gov (United States)

    Sorensen, Jesper Roed; Winther, Kristian Hillert; Bonnema, Steen Joop; Godballe, Christian; Hegedüs, Laszlo

    2016-11-01

    Hypothyroidism has been associated with increased pulmonary morbidity and overall mortality. A systematic review was conducted to identify the prevalence and underlying mechanisms of respiratory problems among patients with thyroid insufficiency. PubMed and EMBASE databases were searched for relevant literature from January 1950 through January 2015 with the following study eligibility criteria: English-language publications; adult subclinical or overt hypothyroid patients; intervention, observational, or retrospective studies; and respiratory manifestations. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was followed, and Cochrane's risk of bias tool was used. A total of 1699 papers were screened by two independent authors for relevant titles. Of 109 relevant abstracts, 28 papers underwent full-text analyses, of which 22 were included in the review. Possible mechanisms explaining respiratory problems at multiple physiological levels were identified, such as the ventilator control system, diaphragmatic muscle function, pulmonary gas exchange, goiter caused upper airway obstruction, decreased capacity for energy transduction, and reduced glycolytic activity. Obstructive sleep apnea syndrome was found among 30% of newly diagnosed patients with overt hypothyroidism, and demonstrated reversibility following treatment. The evidence for or against a direct effect on pulmonary function was ambiguous. However, each of the above-mentioned areas was only dealt with in a limited number of studies. Therefore, it is not possible to draw any strong conclusions on any of these themes. Moreover, most studies were hampered by considerable risk of bias due for example to small numbers of patients, lack of control groups, randomization and blinding, and differences in body mass index, sex, and age between subjects and controls. Mechanistic data linking hypothyroidism and respiratory function are at best limited. This area of research is therefore

  5. Subclinical hypothyroidism ups the risk of vascular complications in ...

    African Journals Online (AJOL)

    Ghada A. Mohamed

    a Department of Internal Medicine, Assiut Faculty of Medicine, Assiut University, Egypt ... Undiagnosed thyroid dysfunction may affect the metabolic control and ..... thyroid dysfunction: a joint statement on management from the American.

  6. Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism

    DEFF Research Database (Denmark)

    Faber, J; Petersen, L; Wiinberg, N

    2002-01-01

    ] despite free thyroxine [T(4)] and triiodothyronine [T(3)] estimates within reference range) would benefit from levothyroxine (LT(4)) substitution. CO was measured by impedance cardiography, which is an observer independent method with high precision, and mean arterial pressure (MAP) by oscillometry. SVR...

  7. Subclinical hypothyroidism in children with Down syndrome: To treat ...

    African Journals Online (AJOL)

    Solaf M. Elsayed

    2014-09-16

    Sep 16, 2014 ... delay in the maturation of the hypothalamic-pituitary-thyroid axis [8]. Others ... release of TSH related to a central disorder, the production of a less active form of TSH, or some form of TSH insensitivity in the thyroid gland [11].

  8. Hypothyroidism simulating as polymyositis.

    Science.gov (United States)

    Aslam, Hina; Sayeed, Mohammad Ahsan; Qadeer, Rashid; Afsar, Salahuddin

    2015-05-01

    Polymyositis-like syndrome in hypothyroidism is a rare condition characterised by proximal muscle weakness and elevated muscle enzymes. Patients with this condition can initially be misdiagnosed as having polymyositis due to similar characteristics of both diseases; however a response to thyroxine is the main differentiating feature. This report highlights the case of a 30-year-old male who had severe myalgia and proximal muscle weakness. In addition to raised creatinine phosphokinase (CPK) levels, his biochemical profile showed hypothyroidism. Initially thought to be suffering from polymyositis, improvement in both clinical and biochemical profile with thyroxine led to the diagnosis of polymyositis-like syndrome associated with hypothyroidism.

  9. Normal tissue complication probability modeling of radiation-induced hypothyroidism after head-and-neck radiation therapy.

    Science.gov (United States)

    Bakhshandeh, Mohsen; Hashemi, Bijan; Mahdavi, Seied Rabi Mehdi; Nikoofar, Alireza; Vasheghani, Maryam; Kazemnejad, Anoshirvan

    2013-02-01

    To determine the dose-response relationship of the thyroid for radiation-induced hypothyroidism in head-and-neck radiation therapy, according to 6 normal tissue complication probability models, and to find the best-fit parameters of the models. Sixty-five patients treated with primary or postoperative radiation therapy for various cancers in the head-and-neck region were prospectively evaluated. Patient serum samples (tri-iodothyronine, thyroxine, thyroid-stimulating hormone [TSH], free tri-iodothyronine, and free thyroxine) were measured before and at regular time intervals until 1 year after the completion of radiation therapy. Dose-volume histograms (DVHs) of the patients' thyroid gland were derived from their computed tomography (CT)-based treatment planning data. Hypothyroidism was defined as increased TSH (subclinical hypothyroidism) or increased TSH in combination with decreased free thyroxine and thyroxine (clinical hypothyroidism). Thyroid DVHs were converted to 2 Gy/fraction equivalent doses using the linear-quadratic formula with α/β = 3 Gy. The evaluated models included the following: Lyman with the DVH reduced to the equivalent uniform dose (EUD), known as LEUD; Logit-EUD; mean dose; relative seriality; individual critical volume; and population critical volume models. The parameters of the models were obtained by fitting the patients' data using a maximum likelihood analysis method. The goodness of fit of the models was determined by the 2-sample Kolmogorov-Smirnov test. Ranking of the models was made according to Akaike's information criterion. Twenty-nine patients (44.6%) experienced hypothyroidism. None of the models was rejected according to the evaluation of the goodness of fit. The mean dose model was ranked as the best model on the basis of its Akaike's information criterion value. The D(50) estimated from the models was approximately 44 Gy. The implemented normal tissue complication probability models showed a parallel architecture for the

  10. Normal Tissue Complication Probability Modeling of Radiation-Induced Hypothyroidism After Head-and-Neck Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Bakhshandeh, Mohsen [Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran (Iran, Islamic Republic of); Hashemi, Bijan, E-mail: bhashemi@modares.ac.ir [Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran (Iran, Islamic Republic of); Mahdavi, Seied Rabi Mehdi [Department of Medical Physics, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Nikoofar, Alireza; Vasheghani, Maryam [Department of Radiation Oncology, Hafte-Tir Hospital, Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of); Kazemnejad, Anoshirvan [Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran (Iran, Islamic Republic of)

    2013-02-01

    Purpose: To determine the dose-response relationship of the thyroid for radiation-induced hypothyroidism in head-and-neck radiation therapy, according to 6 normal tissue complication probability models, and to find the best-fit parameters of the models. Methods and Materials: Sixty-five patients treated with primary or postoperative radiation therapy for various cancers in the head-and-neck region were prospectively evaluated. Patient serum samples (tri-iodothyronine, thyroxine, thyroid-stimulating hormone [TSH], free tri-iodothyronine, and free thyroxine) were measured before and at regular time intervals until 1 year after the completion of radiation therapy. Dose-volume histograms (DVHs) of the patients' thyroid gland were derived from their computed tomography (CT)-based treatment planning data. Hypothyroidism was defined as increased TSH (subclinical hypothyroidism) or increased TSH in combination with decreased free thyroxine and thyroxine (clinical hypothyroidism). Thyroid DVHs were converted to 2 Gy/fraction equivalent doses using the linear-quadratic formula with {alpha}/{beta} = 3 Gy. The evaluated models included the following: Lyman with the DVH reduced to the equivalent uniform dose (EUD), known as LEUD; Logit-EUD; mean dose; relative seriality; individual critical volume; and population critical volume models. The parameters of the models were obtained by fitting the patients' data using a maximum likelihood analysis method. The goodness of fit of the models was determined by the 2-sample Kolmogorov-Smirnov test. Ranking of the models was made according to Akaike's information criterion. Results: Twenty-nine patients (44.6%) experienced hypothyroidism. None of the models was rejected according to the evaluation of the goodness of fit. The mean dose model was ranked as the best model on the basis of its Akaike's information criterion value. The D{sub 50} estimated from the models was approximately 44 Gy. Conclusions: The implemented

  11. Obstructive sleep apnea syndrome and hypothyroidism - merely concurrence or causal association?

    Science.gov (United States)

    Kuczyński, Wojciech; Gabryelska, Agata; Mokros, Łukasz; Białasiewicz, Piotr

    2016-01-01

    The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients.

  12. Features of the nervous system lesion in primary hypothyroidism (literature review

    Directory of Open Access Journals (Sweden)

    I.I. Bilous

    2018-03-01

    Full Text Available The review presents the pathogenetic mechanisms of central and peripheral nervous system pathology in primary hypothyroidism. Lack of thyroid hormones leads to changes in the organization of the central nervous system, decrease in the energy supply of neurons, changes in the synthesis of some specific proteins of the nervous system that cause the development of cretinism in children. The role of hypothyroidism in the development of cognitive impairment in adults, such as decreased cognitive function, memory and attention, has been proved. The impairment of logical thinking is found already in patients with subclinical hypothyroidism. Disorders in mediation exchange lead to the development of depression. Neuromuscular disorders (hypothyroid myopathy and myotonic phenomenon and affection to the peripheral nerves are best studied in hypothyroidism. Primary hypothyroidism may be masked by tunnel neuropathy, polyneuropathy and atactic syndrome. Despite the existing papers on the problem of hypothyroidism and its neurological complications, some issues of pathogenesis, diagnosis, course and treatment of neurological pathology in primary hypothyroidism require further research.

  13. The heart and hypothyroidism

    African Journals Online (AJOL)

    1983-04-09

    Apr 9, 1983 ... influenced by the thyroid disorder and vice versa. We recenrly ... hypothyroidism is a rare cause of heart failure other causes of heart failure must be excluded ... signs of cardiac tamponade and echocardiographic features of a.

  14. Macular amyloidosis and hypothyroidism

    Directory of Open Access Journals (Sweden)

    Chopra Adarsh

    1999-01-01

    Full Text Available A 53 year old woman presented with extensive pruritic hyperpigmented macules in interscapular area and extremities of four years duration.She was an established case of hypothyroidism on treatment for last four years.

  15. Hypothyroidism following surgery and radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    Park, I. K.; Kim, J. C.

    1997-01-01

    Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer. We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy. The follow-up duration was 3 to 80 months. The overall incidence of hypothyroidism was 56.3% (40/71); 7 out of 71 patients (9.9%) developed clinical hypothyroidism and 33 patients (46.4%) developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000). Four of 26 patients (15.4%) with neck dissection alone developed hypothyroidism while 36 of 45 patients (80%) with laryngectomy and neck dissection developed hypothyroidism. The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced the incidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is

  16. Hypothyroidism following surgery and radiation therapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, I. K.; Kim, J. C. [Kyungpook National Univ., Taegu (Korea, Republic of). Coll. of Medicine

    1997-09-01

    Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer. We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients` age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy. The follow-up duration was 3 to 80 months. The overall incidence of hypothyroidism was 56.3% (40/71); 7 out of 71 patients (9.9%) developed clinical hypothyroidism and 33 patients (46.4%) developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000). Four of 26 patients (15.4%) with neck dissection alone developed hypothyroidism while 36 of 45 patients (80%) with laryngectomy and neck dissection developed hypothyroidism. The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced the incidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is

  17. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India

    Directory of Open Access Journals (Sweden)

    Ambika Gopalakrishnan Unnikrishnan

    2013-01-01

    Full Text Available Background: Hypothyroidism is believed to be a common health issue in India, as it is worldwide. However, there is a paucity of data on the prevalence of hypothyroidism in adult population of India. Materials and Methods: A cross-sectional, multi-centre, epidemiological study was conducted in eight major cities (Bangalore, Chennai, Delhi, Goa, Mumbai, Hyderabad, Ahmedabad and Kolkata of India to study the prevalence of hypothyroidism among adult population. Thyroid abnormalities were diagnosed on the basis of laboratory results (serum FT3, FT4 and Thyroid Stimulating Hormone [TSH]. Patients with history of hypothyroidism and receiving levothyroxine therapy or those with serum free T4 5.50 μU/ml, were categorized as hypothyroid. The prevalence of self reported and undetected hypothyroidism, and anti-thyroid peroxidase (anti-TPO antibody positivity was assessed. Results: A total of 5376 adult male or non-pregnant female participants ³18 years of age were enrolled, of which 5360 (mean age: 46 ± 14.68 years; 53.70% females were evaluated. The overall prevalence of hypothyroidism was 10.95% (n = 587, 95% CI, 10.11-11.78 of which 7.48% (n = 401 patients self reported the condition, whereas 3.47% (n = 186 were previously undetected. Inland cities showed a higher prevalence of hypothyroidism as compared to coastal cities. A significantly higher ( P 5.50 μIU/ml. Anti - TPO antibodies suggesting autoimmunity were detected in 21.85% (n = 1171 patients. Conclusion: The prevalence of hypothyroidism was high, affecting approximately one in 10 adults in the study population. Female gender and older age were found to have significant association with hypothyroidism. Subclinical hypothyroidism and anti-TPO antibody positivity were the other common observations.

  18. Clinical, behavioural and pharmacogenomic factors influencing the response to levothyroxine therapy in patients with primary hypothyroidism-protocol for a systematic review.

    Science.gov (United States)

    Dew, Rosie; Okosieme, Onyebuchi; Dayan, Colin; Eligar, Vinay; Khan, Ishrat; Razvi, Salman; Pearce, Simon; Wilkes, Scott

    2017-03-21

    Suboptimal thyroid hormone therapy including under-replacement and over-replacement is common amongst patients with hypothyroidism. This is a significant health concern as affected patients are at risk of adverse cardiovascular or metabolic consequences. Despite a growing body of evidence on the effects of various factors on thyroid hormone replacement, a systematic appraisal of the evidence is lacking. This review aims to appraise and quantify the extent to which clinical, behavioural and pharmacogenomic factors affect levothyroxine therapy in patients with primary hypothyroidism. The databases Web of Science, Cochrane Library, EMBASE and PubMed will be searched. Patients must be adults over the age of 18 years, suffering from primary hypothyroidism including overt and subclinical hypothyroidism and receiving levothyroxine treatment. Studies in children, pregnant women and patients with secondary or tertiary hypothyroidism will not be included. We will also exclude studies focused on forms of thyroid hormone replacement therapy other than levothyroxine. The primary outcome is to quantify the effect of clinical, behavioural and pharmacogenomic factors on thyroid stimulating hormone (TSH) levels. Secondary outcomes are the effect these factors have on thyroxine (T4) and triiodothyronine (T3) levels, mortality, morbidity, quality of life, treatment complications, adverse effects, physical and social functioning. Studies will be screened through reading the title, abstract and then full text. Two reviewers will independently extract the data and select articles, and a third reviewer will be consulted if there is any disagreement. We will undertake a meta-analysis of studies in which there is a defined intervention or exposure, patients are receiving levothyroxine for hypothyroidism, there is an appropriate control group of levothyroxine treated patients that are not exposed to the intervention, and the primary outcome is determined by serum TSH levels. Studies will

  19. Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy

    Directory of Open Access Journals (Sweden)

    Pyoung Ahn

    2013-12-01

    Full Text Available Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

  20. Statin-induced bilateral foot drop in a case of hypothyroidism

    Directory of Open Access Journals (Sweden)

    Neera Chaudhary

    2015-01-01

    Full Text Available Muscle involvement is a common manifestation of both clinical and subclinical hypothyroidism, with serum creatine kinase (CK elevation being probably the most common manifestation, and is seen in up to 90% of patients, but is usually mild (less than 10 times the upper limit of normal. Rhabdomyolysis is a distinctively uncommon presentation of hypothyroidism described usually in the setting of precipitating events such as strenuous exercise, alcohol, or statin use. Rarely rhabdomyolysis and myoedema seen in hypothyroidism can be complicated by the development of anterior compartment syndrome leading to neurovascular compression. We describe a case of a patient with hypothyroidism who developed acute onset bilateral foot drop on initiation of statins. This case highlights the need for cautious use of statins in patients at risk for rhabdomyolysis.

  1. Subclinical form of the American visceral leishmaniasis

    Directory of Open Access Journals (Sweden)

    Mônica Elinor Alves Gama

    2004-12-01

    Full Text Available The subclinical form of visceral leishmaniasis (VL shows nonspecific clinical manifestations, with difficulties being frequently met in its clinical characterization and diagnostic confirmation. Thus, the objective of the present study was to define the clinical-laboratory profile of this clinical form. A cohort study was conducted in the state of Maranhão, Brazil, from January/1998 to December/2000, with monthly follow-up of 784 children aged 0-5 years. Based on the clinical-laboratory parameters reported in the literature, four categories were established, with the children being classified (according to their clinical-evolutive behavior as asymptomatic (N = 144, as having the subclinical form (N = 33 or the acute form (N = 12 or as subjects "without VL" (N = 595. Multiple discriminant analysis demonstrated that the combination of fever, hepatomegaly, hyperglobulinemia, and increased blood sedimentation rate (BSR can predict the subclinical form of VL as long as it is not associated with splenomegaly or leukopenia. Subjects with the subclinical form did not show prolonged or intermittent evolution or progression to the acute form of VL. Subclinical cases have a profile differing from the remaining clinical forms of VL, being best characterized by the combination of fever, hepatomegaly, hyperglobulinemia, and increased BSR.

  2. Subclinical hyperthyroidism: current concepts and scintigraphic imaging.

    Science.gov (United States)

    Intenzo, Charles; Jabbour, Serge; Miller, Jeffrey L; Ahmed, Intekhab; Furlong, Kevin; Kushen, Medina; Kim, Sung M; Capuzzi, David M

    2011-09-01

    Subclinical hyperthyroidism is defined as normal serum free thyroxine and a free triiodothyronine level, with a thyroid-stimulating hormone level suppressed below the normal range and is usually undetectable. Although patients with this diagnosis have no or few signs and symptoms of overt thyrotoxicosis, there is sufficient evidence that it is associated with a relatively higher risk of supraventricular arrhythmias as well as the acceleration or the development of osteoporosis. Consequently, the approach to the patient with subclinical hyperthyroidism is controversial, that is, therapeutic intervention versus watchful waiting. Regardless, it is imperative for the referring physician to identify the causative thyroid disorder. This is optimally accomplished by a functional study, namely scintigraphy. Recognition of the scan findings of the various causes of subclinical hyperthyroidism enables the imaging specialist to help in diagnosing the underlying condition causing thyroid-stimulating hormone suppression thereby facilitating the workup and management of this thyroid disorder.

  3. Incidence of hypothyroidism after irradiation of the neck with special reference to lymphoma patients; A retrospective and prospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Feyerabend, T; Kapp, B; Richter, E; Becker, W; Reiners, C [Wuerzburg Univ. (Germany, F.R.). Klinik fuer Radioonkologie Wuerzburg Univ. (Germany, F.R.). Klinik fuer Nuklearmedizin

    1990-01-01

    Twenty-eight patients were studied prospectively in order to determine the incidence of hypothyroidism after mantle irradiation for malignant lymphoma. This group was compared with a historical group of 65 patients, among them 36 patients with malignant lymphoma. The mean follow-up was 30 months for the prospective group and 46 months for the retrospective group. The mean thyroid dose for irradiated malignant lymphomas in the prospective and the retrospective group was 45 Gy and 43 Gy respectively. For other tumors with neck irradiation (retrospective group) the mean thyroid dose was 53 Gy. There were no cases of clinical hypothyroidism in our study. As for subclinical hypothyroidism which is characterised by elevated TSH, the incidence was 22% in the prospective group and 3% in the retrospective group, i.e. 8/93 patients showed a hypothyroid dysfunction. Three of the 8 patients with subclinical hypothyroidism had undergone lymphangiography before radiotherapy. Due to the elevated iodine pool a lymphangiogram is considered as a risk factor for hypothyroidism as well as for hyperthyroidism, which we observed twice in the prospective group. Evaluation of the thyroid function before lymphangiography and irradiation as well as regular thyroid function studies during the follow-up are recommended in order to detect hypothyroidism in time. (orig.).

  4. Thyroid peroxidase and thyroglobulin auto-antibodies in patients with newly diagnosed overt hypothyroidism

    DEFF Research Database (Denmark)

    Carle, A.; Laurberg, P.; Knudsen, N.

    2006-01-01

    Objectives: Thyroid autoimmunity is a major cause for hypothyroidism. We describe thyroid auto-antibodies in patients with various nosological subtypes of hypothyroidism identified in a population study. Design: Population-based follow-up study identifying all new cases of hypothyroidism in an open...... cohort. Methods: We established a monitoring system, and identified all new cases with primary overt hypothyroidism (n = 685) in a 4 year period in a well-defined population cohort (2,027,208 person-years of observation). Patients were sub-classified into: spontaneous hypothyroidism, presumably...... of autoimmune origin ( n 578); non-spontaneous hypothyroidism ( associated with medication, delivery, neck-irradiation or subacute thyroiditis, n 97); and congenital hypothyroidism ( n 10). A total of 186 adult patients (61% of those invited) underwent thyroid ultrasonography and measurements of antibodies...

  5. Endogenous subclinical hyperthyroidism and cardiovascular system: time to reconsider?

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

    2011-05-19

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. Exogenous sublinical hyperthyroidism is a thyroid metabolic state caused by L-thyroxine administration. Endogenous subclinical hyperthyroidism is a thyroid metabolic state in patients with autonomously functioning thyroid nodule or multinodular goiter, various forms of thyroiditis, in areas with endemic goiter and particularly in elderly subjects. Endogenous subclinical hyperthyroidism is currently the subject of numerous studies and it yet remains controversial particularly as it relates to its treatment and to cardiovascular impact nevertheless established effects have been demonstrated. Recently, acute myocardial infarction without significant coronary stenoses and recurrent acute pulmonary embolism have been reported associated with subclinical hyperthyroidism without L-thyroxine administration. So, it is very important to recognize and to treat promptly also endogenous subclinical hyperthyroidism. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  6. Hypothyroidism during pregnancy and its association to perinatal and obstetric morbidity: a review.

    Science.gov (United States)

    Martínez, María; Soldevila, Berta; Lucas, Anna; Velasco, Inés; Vila, Lluis; Puig-Domingo, Manel

    2018-02-01

    There is currently no consensus among the different scientific societies on screening for thyroid dysfunction in the first trimester of pregnancy. Indeed, diagnosis and treatment of subclinical hypothyroidism during pregnancy are controversial, as no cut-off value for thyrotropin (TSH) is universally accepted. TSH measurement may be influenced by different factors throughout pregnancy, but especially during the first trimester. The association between overt hypothyroidism during pregnancy and obstetric and perinatal complications is well established. It is also accepted that thyroid hormones are important for neurodevelopment of the offspring. However, there is no scientific evidence available about the impact of subclinical hypothyroidism and its treatment during the first trimester of pregnancy on children's neurodevelopment. In recent years, studies conducted in the offspring of mothers with subclinical hypothyroidism have reported new biochemical parameters which may eventually serve as biomarkers of offspring neurodevelopment and which are more reproducible and are measured at an earlier time than the conventional clinical tests. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Subclinical thyroid dysfunction and psychiatric disorders: cross-sectional results from the Brazilian Study of Adult Health (ELSA-Brasil).

    Science.gov (United States)

    Benseñor, Isabela M; Nunes, Maria Angélica; Sander Diniz, Maria de Fátima; Santos, Itamar S; Brunoni, André R; Lotufo, Paulo A

    2015-01-12

    To evaluate the association between subclinical thyroid dysfunction and psychiatric disorders using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Cross-sectional study. The study included 12 437 participants from the ELSA-Brasil with normal thyroid function (92·8%), 193 (1·4%) with subclinical hyperthyroidism and 784 (5·8%) with subclinical hypothyroidism, totalling 13 414 participants (50·6% of women). The mental health diagnoses of participants were assessed by trained raters using the Clinical Interview Schedule - Revised (CIS-R) and grouped according to the International Classification of Diseases 10 (ICD-10). Thyroid dysfunction was assessed using TSH and FT4 as well as routine use of thyroid hormones or antithyroid medications. Logistic models were presented using psychiatric disorders as the dependent variable and subclinical thyroid disorders as the independent variable. All logistic models were corrected for multiple comparisons using Bonferroni correction. After multivariate adjustment for possible confounders, we found a direct association between subclinical hyperthyroidism and panic disorder odds ratio [OR], 2·55; 95% confidence Interval (95% CI), 1·09-5·94; and an inverse association between subclinical hypothyroidism and generalized anxiety disorder (OR, 0·75; 95% CI, 0·59-0·96). However, both lost significance after correction for multiple comparisons. Subclinical hyperthyroidism was positively associated with panic disorder and negatively associated with anxiety disorder, although not significant after adjustment for multiple comparisons. © 2015 John Wiley & Sons Ltd.

  8. Renal Function in Hypothyroidism

    International Nuclear Information System (INIS)

    Khalid, S.; Khalid, M; Elfaki, M.; Hassan, N.; Suliman, S.M.

    2007-01-01

    Background Hypothyroidism induces significant changes in the function of organ systems such as the heart, muscles and brain. Renal function is also influenced by thyroid status. Physiological effects include changes in water and electrolyte metabolism, notably hyponatremia, and reliable alterations of renal hemodynamics, including decrements in renal blood flow, renal plasma flow, glomerular filtration rate (GFR). Objective Renal function is profoundly influenced by thyroid status; the purpose of the present study was to determine the relationship between renal function and thyroid status of patients with hypothyroidism. Design and Patients In 5 patients with primary hypothyroidism and control group renal functions are measured by serum creatinine and glomerular filtration rate (GFR) using modified in diet renal disease (MDRD) formula. Result In hypothyroidism, mean serum creatinine increased and mean estimated GFR decreased, compared to the control group mean serum creatinine decreased and mean estimated GFR Increased. The hypothyroid patients showed elevated serum creatinine levels (> 1.1mg/dl) compared to control group (p value .000). In patients mean estimated GFR decreased, compared to mean estimated GFR increased in the control group (p value= .002).

  9. Renal Function in Hypothyroidism

    International Nuclear Information System (INIS)

    Khalid, A. S; Ahmed, M.I; Elfaki, H.M; Hassan, N.; Suliman, S. M.

    2006-12-01

    Background hypothyroidism induces significant changes in the function of organ systems such as the heart, muscles and brain. Renal function is also influenced by thyroid status. Physiological effects include changes in water and electrolyte metabolism, notably hyponatraemia, and reliable alterations of renal hemodynamics, including decrements in renal blood flow, renal plasma flow, glomerular filtration rate (GFR). Objective renal function is profoundly influenced by thyroid status, the purpose of the present study was to determine the relationship between renal function and thyroid status of patients with hypothyroidism. Design and patients in 5 patients with primary hypothyroidism and control group renal functions are measured by serum creatinine and glomerular filtration rate(GFR) using modified in diet renal disease (MDRD) formula. Result in hypothyroidism, mean serum creatinine increased and mean estimated GFR decreased, compared to the control group mean serum creatinine decreased and mean estimated GFR increased. The hypothyroid patients showed elevated serum creatinine levels(>1.1 mg/d1) compared to control group (p value= 000). In patients mean estimated GFR increased in the control group (p value=.002).Conclusion thus the kidney, in addition to the brain, heart and muscle, is an important target of the action of thyroid hormones.(Author)

  10. Vegan diets and hypothyroidism.

    Science.gov (United States)

    Tonstad, Serena; Nathan, Edward; Oda, Keiji; Fraser, Gary

    2013-11-20

    Diets eliminating animal products have rarely been associated with hypothyroidism but may protect against autoimmune disease. Thus, we investigated whether risk of hypothyroidism was associated with vegetarian compared to omnivorous dietary patterns. The Adventist Health Study-2 was conducted among church members in North America who provided data in a self-administered questionnaire. Hypothyroidism was queried at baseline in 2002 and at follow-up to 2008. Diet was examined as a determinant of prevalent (n = 4237 of 65,981 [6.4%]) and incident cases (1184 of 41,212 [2.9%]) in multivariate logistic regression models, controlled for demographics and salt use. In the prevalence study, in addition to demographic characterstics, overweight and obesity increased the odds (OR 1.32, 95% CI: 1.22-1.42 and 1.78, 95% CI: 1.64-1.93, respectively). Vegan versus omnivorous diets tended to be associated with reduced risk (OR 0.89, 95% CI: 0.78-1.01, not statistically significant) while a lacto-ovo diet was associated with increased risk (OR 1.09, 95% CI: 1.01-1.18). In the incidence study, female gender, white ethnicity, higher education and BMI were predictors of hypothyroidism. Following a vegan diet tended to be protective (OR 0.78, 95% CI: 0.59-1.03, not statistically significant). In conclusion, a vegan diet tended to be associated with lower, not higher, risk of hypothyroid disease.

  11. Is suppressed thyroid-stimulating hormone (TSH) associated with subclinical depression in the Danish General Suburban Population Study?

    DEFF Research Database (Denmark)

    Kvetny, Jan; Ellervik, Christina; Bech, Per

    2015-01-01

    BACKGROUND: The first phase of the Danish General Suburban Population Study (GESUS) including 8214 individuals was an attempt to evaluate the association between subclinical hypothyroidism without or with elevated peroxidase antibodies and depression. No such association was found. In the second...

  12. Subclinical hyperthyroidism (Sh) in atomic-bomb survivors in Japan

    International Nuclear Information System (INIS)

    Ashizawa, K.; Imaizumi, M.; Usa, T.; Tominaga, T.; Hida, A.; Ejima, E.; Neriishi, K.; Soda, M.; Fujiwara, S.; Maeda, R.; Akahoshi, M.; Nagataki, S.; Eguchi, K.

    2005-01-01

    Full text: Purpose/Background Subclinical hyperthyroidism (Sh) is defined as a biochemical abnormality characterized by a subnormal level of TSH with otherwise normal thyroid tests (F T 3 , F T 4 ) and no clinical symptoms. There are only a small number of cross-sectional studies on the prevalence of Sh. With the improvement of the sensitivity of TSH assay, it has become possible to survey the clinical significance of Sh. With regard to both Sh and subclinical hypothyroidism, discussions are being focused on such as the necessity of treatment. In order to elucidate the clinical significance of Sh, examination data of A-bomb survivors in Hiroshima and Nagasaki were analyzed. Subjects and Method Between 2000 and 2003, of 4,090 A-bomb survivors (1,352 males and 2,738 females with average age of 70.7), 75 individuals (1.83%) with Sh were found who had normal Free T 4 (0.71∼1.51 ng/dL) and TSH<0.45 m U/L. Analysis was limited to those who had not taken antithyroid drugs or thyroxin, and the Sh group (n=35; 9 males and 26 females) was compared with a control group with TSH:0.45∼4.5 m U/L (Group C; N=3,243; 1,109 males and 2,134 females). Result: Nine individuals had TSH<0.1 m U/L. In the Sh group, six individuals were TPO antibody-positive (17%) and 14 were TG antibody-positive (40%); hence, TG antibody-positive was significantly greater in number (p=0.0096). Hematological biochemical tests showed no significant difference between the two groups. Electrocardiograms indicated that more individuals had atrial fibrillation [p=0.028; Odds ratio (OR)=3.98; 95% Confidential interval (CI)=1.2-13.7] or ventricular premature contraction [p=0.016; OR=3.29; 95% CI=1.3-8.6] in the Sh group. In terms of the presence or absence of diabetes, dyslipidemia, hypertension, and hyperuricemia, there was no difference between the two groups. One individual from the Sh group was confirmed to have Graves' disease two years later. Conclusion: Since more individuals in the Sh group were

  13. Subclinical hyperthyroidism (Sh) in atomic-bomb survivors in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Ashizawa, K; Imaizumi, M; Usa, T; Tominaga, T; Hida, A; Ejima, E; Neriishi, K; Soda, M; Fujiwara, S; Maeda, R; Akahoshi, M; Nagataki, S; Eguchi, K [Radiation Effects Research Foundation, Nagasaki (Japan). Nagasaki Branch

    2005-07-01

    Full text: Purpose/Background Subclinical hyperthyroidism (Sh) is defined as a biochemical abnormality characterized by a subnormal level of TSH with otherwise normal thyroid tests (F T{sub 3}, F T{sub 4}) and no clinical symptoms. There are only a small number of cross-sectional studies on the prevalence of Sh. With the improvement of the sensitivity of TSH assay, it has become possible to survey the clinical significance of Sh. With regard to both Sh and subclinical hypothyroidism, discussions are being focused on such as the necessity of treatment. In order to elucidate the clinical significance of Sh, examination data of A-bomb survivors in Hiroshima and Nagasaki were analyzed. Subjects and Method Between 2000 and 2003, of 4,090 A-bomb survivors (1,352 males and 2,738 females with average age of 70.7), 75 individuals (1.83%) with Sh were found who had normal Free T{sub 4} (0.71{approx}1.51 ng/dL) and TSH<0.45 m U/L. Analysis was limited to those who had not taken antithyroid drugs or thyroxin, and the Sh group (n=35; 9 males and 26 females) was compared with a control group with TSH:0.45{approx}4.5 m U/L (Group C; N=3,243; 1,109 males and 2,134 females). Result: Nine individuals had TSH<0.1 m U/L. In the Sh group, six individuals were TPO antibody-positive (17%) and 14 were TG antibody-positive (40%); hence, TG antibody-positive was significantly greater in number (p=0.0096). Hematological biochemical tests showed no significant difference between the two groups. Electrocardiograms indicated that more individuals had atrial fibrillation [p=0.028; Odds ratio (OR)=3.98; 95% Confidential interval (CI)=1.2-13.7] or ventricular premature contraction [p=0.016; OR=3.29; 95% CI=1.3-8.6] in the Sh group. In terms of the presence or absence of diabetes, dyslipidemia, hypertension, and hyperuricemia, there was no difference between the two groups. One individual from the Sh group was confirmed to have Graves' disease two years later. Conclusion: Since more individuals in

  14. Resistance of the peripheral nervous system to the effects of chronic canine hypothyroidism.

    Science.gov (United States)

    Rossmeisl, J H

    2010-01-01

    Hypothyroidism has been implicated in the development of multiple peripheral mono- and polyneuropathies in dogs. The objectives of this study were to evaluate the clinical and electrophysiologic effects of experimentally induced hypothyroidism on the peripheral nervous system of dogs. Chronic hypothyroidism will induce peripheral nerve sensorimotor dysfunction. Eighteen purpose-bred, female dogs. Prospective, longitudinal study: Hypothyroidism was induced by radioactive iodine administration in 9 dogs, and the remaining 9 served as untreated controls. Neurological examinations were performed monthly. Electrophysiologic testing consisting of electromyography (EMG); motor nerve conduction studies of the sciatic-tibial, radial, ulnar, and recurrent laryngeal nerves; sciatic-tibial and ulnar F-wave studies; sensory nerve conduction studies of the tibial, ulnar, and radial nerves; and evaluation of blink reflex and facial responses were performed before and 6, 12, and 18 months after induction of hypothyroidism and compared with controls. Clinical evidence of peripheral nervous dysfunction did not occur in any dog. At 6 month and subsequent evaluations, all hypothyroid dogs had EMG and histologic evidence of hypothyroid myopathy. Hypothyroid dogs had significant (Pmuscle action potentials over time, which were attributed to the concurrent myopathy. No significant differences between control and hypothyroid dogs were detected in electrophysiologic tests of motor (P>or=.1) or sensory nerve conduction velocity (P>or=.24) or nerve roots (P>or=.16) throughout the study period, with values remaining within reference ranges in all dogs. Chronic hypothyroidism induced by thyroid irradiation does not result in clinical or electrophysiologic evidence of peripheral neuropathy, but does cause subclinical myopathy.

  15. Lipid profile in hypothyroidism

    International Nuclear Information System (INIS)

    Ramalho, A.; Medeiros, F.; Campos, C.; Medeiros, N.; Kuklinsky-Sobral, J.; Araujo, E.

    1995-01-01

    The elevated levels of cholesterol (T-C), more specifically, the increase of carried cholesterol by low density protein (LDL-C), is the principal responsible to atheroma's plaque. This elevated levels had been associated with chronic renal disease, bile pathway obstruction and hypothyroidism; this pathology is an important and frequent cause of reversible hyperlipidaemia by hormonal treatment. In 50 hypothyroidism cases diagnosed by radioimmunoassay method, principally primary form, have been met elevated levels of TC (68%), triglyceride (14%), LDL-C (78%), HDL-C (66%) and coronary heart disease (CHD) risk, LDL-C/HDL-C (82%). These percentages showed that the low concentration of thyroid hormones conduct to high concentration of LDL-C, which represents the risk factor to CHD, despite the increase of HDL-C. Thereby, the hypothyroidism must be always searched in hyperlipemic patients without apparent cause. (author). 17 refs., 3 tabs

  16. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India

    Directory of Open Access Journals (Sweden)

    Dinesh Kumar Dhanwal

    2016-01-01

    Full Text Available Background: A previous hospital based study from Delhi revealed a high prevalence of hypothyroidism in pregnant women. Several other studies with small sample size also indicate a rising trend of prevalence of hypothyroidism during pregnancy in India. Objective: To assess prevalence of hypothyroidism in pregnant women from various states/cities across India. Materials and Methods: This was a cross-sectional multicenter study conducted at Allahabad (Uttar Pradesh, Bengaluru (Karnataka, Chennai (Tamil Nadu, Kolkata (West Bengal, Hyderabad (Telangana, Nasik (Maharashtra, Rohtak (Haryana, Pune (Maharashtra, New Delhi (Delhi, Srinagar (Kashmir, and Vizag (Andhra Pradesh enrolling 2599 pregnant women. Estimation of thyroid stimulating hormone (TSH, free T4, and antithyroid peroxidase (TPO antibodies was carried out using Roche modular kit using ECLIA technology in a central laboratory. Results: We found in our study population that 13.13% of pregnant women have hypothyroidism (n = 388, using a cutoff TSH level of 4.5 μIU/ml. This prevalence was much higher using the American Thyroid Association criteria. Anti-TPO antibodies were positive in 20.74% of all pregnant women (n = 613, whereas 40% (n = 155 of hypothyroid pregnant women were positive for anti-TPO antibodies. Conclusion: This study concludes that there is a high prevalence of hypothyroidism (13.13%, majority being subclinical in pregnant women during the first trimester from India and universal screening of hypothyroidism may be desirable in our country.

  17. Hypothyroidism Is Associated With Coronary Endothelial Dysfunction in Women

    Science.gov (United States)

    Sara, Jaskanwal D; Zhang, Ming; Gharib, Hossein; Lerman, Lilach O; Lerman, Amir

    2015-01-01

    Background Hypothyroidism is associated with an increased risk of coronary artery disease, beyond that which can be explained by its association with conventional cardiovascular risk factors. Coronary endothelial dysfunction precedes atherosclerosis, has been linked to adverse cardiovascular events, and may account for some of the increased risk in patients with hypothyroidism. The aim of this study was to determine whether there is an association between epicardial and microvascular coronary endothelial dysfunction and hypothyroidism. Methods and Results In 1388 patients (mean age 50.5 [12.3] years, 34% male) presenting with stable chest pain to Mayo Clinic, Rochester, MN for diagnostic coronary angiography, and who were found to have nonobstructive coronary artery disease (hypothyroidism, defined as a documented history of hypothyroidism or a thyroid-stimulating hormone (TSH) >10.0 mU/mL, n=188, and euthyroidism, defined as an absence of a history of hypothyroidism in the clinical record and/or 0.3hypothyroidism had a significantly lower % Δ CBF Ach (48.26 [80.66] versus 64.58 [128.30]) compared to patients with euthyroidism, while the % Δ CAD Ach did not vary significantly between groups. After adjusting for covariates, females with hypothyroidism still had a significantly lower % Δ CBF Ach (estimated difference in % Δ CBF Ach [SE]: −16.79 [8.18]). Conclusions Hypothyroidism in women is associated with microvascular endothelial dysfunction, even after adjusting for confounders, and may explain some of the increased risk of cardiovascular disease in these patients. PMID:26224049

  18. Guidelines for Mass Screening of Congenital Hypothyroidism (2014 revision)

    Science.gov (United States)

    Nagasaki, Keisuke; Minamitani, Kanshi; Anzo, Makoto; Adachi, Masanori; Ishii, Tomohiro; Onigata, Kazumichi; Kusuda, Satoshi; Harada, Shohei; Horikawa, Reiko; Minagawa, Masanori; Mizuno, Haruo; Yamakami, Yuji; Fukushi, Masaru; Tajima, Toshihiro

    2015-01-01

    Purpose of developing the guidelines: Mass screening for congenital hypothyroidism started in 1979 in Japan, and the prognosis for intelligence has been improved by early diagnosis and treatment. The incidence was about 1/4000 of the birth population, but it has increased due to diagnosis of subclinical congenital hypothyroidism. The disease requires continuous treatment, and specialized medical facilities should make a differential diagnosis and treat subjects who are positive in mass screening to avoid unnecessary treatment. The Guidelines for Mass Screening of Congenital Hypothyroidism (1998 version) were developed by the Mass Screening Committee of the Japanese Society for Pediatric Endocrinology in 1998. Subsequently, new findings on prognosis and problems in the adult phase have emerged. Based on these new findings, the 1998 guidelines were revised in the current document (hereinafter referred to as the Guidelines). Target disease/conditions: Primary congenital hypothyroidism. Users of the Guidelines: Physician specialists in pediatric endocrinology, pediatric specialists, physicians referring patients to pediatric practitioners, general physicians, laboratory technicians in charge of mass screening, and patients. PMID:26594093

  19. Hypothyroidism in women above 35 years in an endemic area recently under iodine supplementation: preliminary report

    International Nuclear Information System (INIS)

    Mahmood, Saiyeeda; Islam, S.M. Moinul; Hossain, Gazi Abul; Chakraborty, Ratan Kumar; Akhter, Nasima; Meah, Tito

    2004-01-01

    The region of greater Mymensingh is known of iodine endemicity. Association of IDD with hypothyroidism is well established phenomenon. Both iodine deficiency and iodine excess can lead to thyroid dysfunction. 150 consecutive female patients of 35 plus years, who attended the Resident Physician of Mymensingh Medical College were invited to assay free T3, free T4 and TSH in CNMU, Mymensingh. Residencies of these patients were in the various districts of greater Mymensingh. 150 volunteers were offered to give their blood for the study. 134 attended CNMU, Mymensingh. Mean age was 45.03 + 6.65 y (mean + STD). Age ranged from 35 to 60 years. 24 (17.91%) had overt or sub-clinical hypothyroidism. Full blown hypothyroidism with low FT3, FT4 and high TSH were seen in 6 (4.48%) cases. 18 (13.43%) showed elevated TSH level with normal FT4 and T3, suggesting sub-clinical hypothyroidism. Overt hypothyroidism is high in this area. (author) 1 fig., 23 refs

  20. Optimal levothyroxine replacement adequately improves symptoms of hypothyroidism; Residual symptoms need further evaluation for other than hypothyroidism causation

    Directory of Open Access Journals (Sweden)

    Rekha Singh

    2017-01-01

    Full Text Available Objectives: Many patients with hypothyroidism complain of persistent residual symptoms, despite optimal treatment, although the similar prevalence is seen in patients with documented absence of thyroid disorder in primary health-care setup. We aimed to investigate symptomatic relief in new cases of primary hypothyroidism and compare with controls with other chronic conditions. Methods: This prospective case–control follow-up study enrolled patients from July 2014 to May 2015 in an endocrine outpatient clinic of a tertiary hospital. Controls were age- and gender-matched ambulatory individuals with well-controlled other chronic diseases and no major comorbidity. Thyroid symptom questionnaire (TSQ was administered at pretreatment to all the cases and then they were started on levothyroxine (LT. At euthyroidism, TSQ was readministered. For controls, TSQ was administered only once. TSQ was measured on Likert scale 1-4 for lack of energy, dry skin, constipation, aches and pains, cold intolerance, poor memory, depression, weight gain, tiredness after walking, and difficulty in getting up (DGU. P < 0.05 was considered statistically significant. Results: A total of 194 cases (147 females and 47 males and 259 controls (187 females and 72 males were analyzed. A significant difference in the symptoms prevalence was seen between controls and pretreatment cases, except for DGU, and between subclinical and overt hypothyroidism. Pretreatment serum thyroid-stimulating hormone in cases correlated significantly with all their pretreatment symptoms score. All symptoms prevalence decreased significantly posttreatment. At euthyroidism, the mean symptoms score in posttreatment cases was similar or lower than the controls. Conclusion: LT effectively improves the symptoms of hypothyroidism in newly diagnosed cases of primary hypothyroidism. The residual symptoms need an alternation explanation other than hypothyroidism.

  1. Optimal Levothyroxine Replacement Adequately Improves Symptoms of Hypothyroidism; Residual Symptoms Need Further Evaluation for Other than Hypothyroidism Causation.

    Science.gov (United States)

    Singh, Rekha; Tandon, Ashwani; Gupta, Sushil Kumar; Saroja, K

    2017-01-01

    Many patients with hypothyroidism complain of persistent residual symptoms, despite optimal treatment, although the similar prevalence is seen in patients with documented absence of thyroid disorder in primary health-care setup. We aimed to investigate symptomatic relief in new cases of primary hypothyroidism and compare with controls with other chronic conditions. This prospective case-control follow-up study enrolled patients from July 2014 to May 2015 in an endocrine outpatient clinic of a tertiary hospital. Controls were age- and gender-matched ambulatory individuals with well-controlled other chronic diseases and no major comorbidity. Thyroid symptom questionnaire (TSQ) was administered at pretreatment to all the cases and then they were started on levothyroxine (LT). At euthyroidism, TSQ was readministered. For controls, TSQ was administered only once. TSQ was measured on Likert scale 1-4 for lack of energy, dry skin, constipation, aches and pains, cold intolerance, poor memory, depression, weight gain, tiredness after walking, and difficulty in getting up (DGU). P < 0.05 was considered statistically significant. A total of 194 cases (147 females and 47 males) and 259 controls (187 females and 72 males) were analyzed. A significant difference in the symptoms prevalence was seen between controls and pretreatment cases, except for DGU, and between subclinical and overt hypothyroidism. Pretreatment serum thyroid-stimulating hormone in cases correlated significantly with all their pretreatment symptoms score. All symptoms prevalence decreased significantly posttreatment. At euthyroidism, the mean symptoms score in posttreatment cases was similar or lower than the controls. LT effectively improves the symptoms of hypothyroidism in newly diagnosed cases of primary hypothyroidism. The residual symptoms need an alternation explanation other than hypothyroidism.

  2. Subclinical Cushing's syndrome: current concepts and trends.

    Science.gov (United States)

    Zografos, George N; Perysinakis, Iraklis; Vassilatou, Evangeline

    2014-01-01

    Clinically inapparent adrenal masses which are incidentally detected have become a common problem in everyday practice. Approximately 5-20% of adrenal incidentalomas present subclinical cortisol hypersecretion which is characterized by subtle alterations of the hypothalamic-pituitary-adrenal axis due to adrenal autonomy. This disorder has been described as subclinical Cushing's syndrome, since there is no typical clinical phenotype. The diagnosis of subclinical Cushing's syndrome is based on biochemical evaluation; however, there is still no consensus for the biochemical diagnostic criteria. An abnormal 1mg dexamethasone suppression test (DST) as initial screening test in combination with at least one other abnormal test of the hypothalamic-pituitary-adrenal axis has been advocated by most experts for the diagnosis of subclinical Cushing's syndrome. DST is the main method of establishing the diagnosis, while there is inhomogeneity of the information that other tests provide. Arterial hypertension, diabetes mellitus type 2 or impaired glucose tolerance, central obesity, osteoporosis/vertebral fractures and dyslipidemia are considered as detrimental effects of chronic subtle cortisol excess, although there is no proven causal relationship between subclinical cortisol hypersecretion and these morbidities. Therapeutic strategies include careful observation along with medical treatment of morbidities potentially related to subtle cortisol hypersecretion versus laparoscopic adrenalectomy. The optimal management of patients with subclinical Cushing's syndrome is not yet defined. The conservative approach is appropriate for the majority of these patients; however, the duration of follow-up and the frequency of periodical evaluation still remain open issues. Surgical resection may be beneficial for patients with hypertension, diabetes mellitus type 2 or abnormal glucose tolerance and obesity.

  3. Treatment of subclinical hyperthyroidism

    DEFF Research Database (Denmark)

    Mark, Peter D; Andreassen, Mikkel; Petersen, Claus L

    2015-01-01

    PURPOSE: The aim of this study was to investigate structure and function of the heart in subclinical hyperthyroidism (SH) before and after obtaining euthyroidism by radioactive iodine treatment, using high precision and observer-independent magnetic resonance imaging (MRI) technology. METHODS...

  4. Hypothyroidism masquerading as polymyositis

    OpenAIRE

    Cabili, Shaltiel; Kaplinsky, Naomi; Pines, Amos; Frankl, Otto

    1982-01-01

    A group of patients is described who presented with proximal muscle weakness and elevated muscle enzymes. They were initially believed to have polymyositis and one of them was even treated as such over a long period of time. The patients were subsequently found to have hypothyroidism and responded well to thyroid hormone replacement.

  5. Vegan Diets and Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Serena Tonstad

    2013-11-01

    Full Text Available Diets eliminating animal products have rarely been associated with hypothyroidism but may protect against autoimmune disease. Thus, we investigated whether risk of hypothyroidism was associated with vegetarian compared to omnivorous dietary patterns. The Adventist Health Study-2 was conducted among church members in North America who provided data in a self-administered questionnaire. Hypothyroidism was queried at baseline in 2002 and at follow-up to 2008. Diet was examined as a determinant of prevalent (n = 4237 of 65,981 [6.4%] and incident cases (1184 of 41,212 [2.9%] in multivariate logistic regression models, controlled for demographics and salt use. In the prevalence study, in addition to demographic characterstics, overweight and obesity increased the odds (OR 1.32, 95% CI: 1.22–1.42 and 1.78, 95% CI: 1.64–1.93, respectively. Vegan versus omnivorous diets tended to be associated with reduced risk (OR 0.89, 95% CI: 0.78–1.01, not statistically significant while a lacto-ovo diet was associated with increased risk (OR 1.09, 95% CI: 1.01–1.18. In the incidence study, female gender, white ethnicity, higher education and BMI were predictors of hypothyroidism. Following a vegan diet tended to be protective (OR 0.78, 95% CI: 0.59–1.03, not statistically significant. In conclusion, a vegan diet tended to be associated with lower, not higher, risk of hypothyroid disease.

  6. Subclinical hyperthyroidism: to treat or not to treat?

    OpenAIRE

    Hoogendoorn, E; den Heijer, M; van Dijk, A P J; Hermus, A

    2004-01-01

    Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical hyperthyroidism, for example, effects on heart and bone mass, are discussed. Guidelines for treatment are given, based on expert opinion.

  7. Very early onset of autoimmune thyroiditis in a toddler with severe hypothyroidism presentation: a case report.

    Science.gov (United States)

    Marzuillo, Pierluigi; Grandone, Anna; Perrotta, Silverio; Ruggiero, Laura; Capristo, Carlo; Luongo, Caterina; Miraglia Del Giudice, Emanuele; Perrone, Laura

    2016-06-18

    In infants under 3 years of age acquired primary hypothyroidism caused by autoimmune thyroiditis is very rare. Hypothyroidism can manifest with different signs and symptoms and has a wide range of presentations from subclinical hypothyroidism to overt form. We describe a child with acquired autoimmune thyroiditis during a very early period of life and with a severe hypothyroidism presentation. A 22-month-old white male patient with normal neonatal screening presented with a six-month history of asthenia and cutaneous pallor. At general clinical and biochemical exams he showed weight gain, statural growth deceleration, poor movements, sleepy expression, instability while walking, myxoedema, bradycardia, open anterior fontanelle, changes in the face habitus, macrocytic anaemia, ascites, and high CPK, creatinine and cholesterol levels. Acquired autoimmune thyroiditis was the final diagnosis. The thyroxine replacement therapy normalized all the clinical and biochemical abnormalities but at the age of 30 months his mental age showed a delay of 6 months. Our case could give useful learning points: i) although the screening for congenital hypothyroidism is routinely performed, a severe hypothyroidism (for example due to autoimmune thyroiditis) can anyway occur early in life and the clinicians should consider this possibility; ii) hypothyroidism can have a misleading and multi-face clinical presentation; iii) anemia, rhabdomyolysis and high creatinine levels should always include the hypothyroidism in the differential diagnosis; iv) thyroxine replacement therapy is able to revert all the clinical manifestations related to the hypothyroidism; v) evaluating the patient's previous pictures could play an important role in resolving a diagnostic conundrum.

  8. Hypothyroidism in adults. Levothyroxine if warranted by clinical and laboratory findings, not for simple TSH elevation.

    Science.gov (United States)

    2015-10-01

    Hypothyroidism is a common disorder due to inadequate thyroid hormone secretion. When a patient has signs and symptoms suggestive of hypothyroidism, how is it determined whether thyroid hormone replacement therapy will have a favourable harm-benefit balance? How should treatment be managed? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. The symptoms of hypothyroidism are due to slow metabolism (constipation, fatigue, sensitivity to cold, weight gain, etc.) and to polysaccharide accumulation in certain tissues, leading to hoarseness, eyelid swelling, etc. A blood TSH concentration of less than 4 or 5 mlU/L rules out peripheral hypothyroidism. TSH levels increase with age. Between 30% and 60% of high TSH levels are not confirmed on a second blood test. In overt hypothyroidism, the TSH level is high and the free T4 (thyroxine) level is low. Most of these patients are symptomatic. So-called subclinical hypothyroidism, which is rarely symptomatic, is characterised by high blood TSH levels and normal free T4 levels. The natural history of hypothyroidism depends on its cause. In chronic autoimmune thyroiditis, the most common form seen in rich countries, hypothyroidism generally worsens over time. However, other situations can lead to transient hypothyroidism that may last several weeks or months. Subclinical hypothyroidism, as the name implies, is usually asymptomatic. The risk of progression to overt hypothyroidism is about 3% to 4% per year overall but increases with the initial TSH level. Treatment guidelines are mainly based on physiological and pharmacological considerations and generally recommend levothyroxine therapy. The adverse effects of levothyroxine are signs of thyrotoxicosis in case of overdose (tachycardia, tremor, sweating, etc.). Even a slight overdose carries a risk of osteoporotic fractures and atrial fibrillation, especially in the elderly. In young adults, levothyroxine is usually started

  9. Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

    Science.gov (United States)

    Zhang, Ming; Sara, Jaskanwal D.S.; Matsuzawa, Yasushi; Gharib, Hossein; Bell, Malcolm R.; Gulati, Rajiv; Lerman, Lilach O.

    2016-01-01

    Abstract Aims The aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Methods and results Two thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism ( n = 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism ( n = 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH hypothyroidism were further categorized as untreated ( n = 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P = 0.0001; myocardial infarction (MI): HR: 1.25, P = 0.037; heart failure: HR: 1.46, P = 0.004; revascularization: HR: 1.26, P = 0.0008; stroke: HR: 1.62, P = 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P = 0.005; HR: 0.78, P = 0.045), cardiac death (HR: 0.43, P = 0.008), MI (HR: 0.50, P = 0.0004; HR: 0.60, P = 0.02), and heart failure (HR: 0.50, P = 0.02; HR: 0.52, P = 0.017). Conclusion Hypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE. PMID:26757789

  10. Effect of Thyroid Remnant Volume on the Risk of Hypothyroidism After Hemithyroidectomy: A Prospective Study.

    Science.gov (United States)

    Lang, Brian Hung-Hin; Wong, Carlos K H; Wong, Kai Pun; Chu, Kelvin Ka-Wan; Shek, Tony W H

    2017-06-01

    Hypothyroidism is a common sequel after a hemithyroidectomy. Although various risk factors leading to hypothyroidism have been reported, the effect of the contralateral lobe's volume has been understudied. This study aimed to examine the association between the preoperative contralateral lobe's volume and the risk of postoperative hypothyroidism. During a 2-year period, 150 eligible patients undergoing a hemithyroidectomy were evaluated. The volume of the contralateral nonexcised lobe was estimated preoperatively by independent assessors on ultrasonography using the following formula: width (in cm) × depth (in cm) × length (in cm) × (π/6), adjusted for the body surface area (BSA). Postoperative hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) exceeding 4.78 mIU/L. Any significant characteristics in the univariate analysis were entered into the multivariate analysis to determine independent factors. After a mean follow-up period of 53.5 ± 9.4 months, 44 patients (29.3 %) experienced postoperative hypothyroidism, and 10 of these patients required thyroxine replacement. Hypothyroidism was associated with a higher preoperative TSH level (p hypothyroidism. Patients with a BSA-adjusted volume smaller than 3.2 ml had a threefold greater hypothyroidism risk than those with a BSA-adjusted volume of 3.2 ml or more (p hypothyroidism risk was observed after hemithyroidectomy. Together with a higher preoperative TSH level and fewer ipsilateral nodules, a smaller BSA-adjusted volume measured by preoperative ultrasonography independently predicted hypothyroidism.

  11. The Early Diagnosis of Hypothyroidism as a Factor in the Progression of Osteoarthritis and Comorbid Processes, the Features of Phytocorrection

    Directory of Open Access Journals (Sweden)

    L.O. Voloshynа

    2016-10-01

    Full Text Available Objective: to study the prevalence and forms of hypothyroidism in patients with osteoarthritis (OA and to investigate the effect of phytomedication zobofit on the functional and morphological status of the thyroid gland, the manifestations of comorbid diseases, oxidative status, fibrinolytic and proteolytic activity of the blood. Materials and methods. In 312 patients with OA, we have studied the manifestations of comorbid processes, and among them — hypothyroidism phenomena. We have used clinical, biochemical, radioimmunological, ultrasound methods. Results. All patients with OA after 50 years had the increasing number and severity of comorbid processes. Among them, 4.48 % of patients has symptomatic and 13.78 % — subclinical hypothyroidism. Symptoms of hypothyroidism were marked in people over 55, especially — over 60 years. Subclinical hypothyroidism slightly worsened clinical symptoms of OA and comorbid processes, but enhanced the effects of oxidative stress, reduction of fibrinolytic and increase of proteolytic activity of the blood, impaired glomerular filtration rate of the kidneys. The above is considered as non-specific pathophysiological basis for the progression of identified ailments. Three-month application of the herbal medication zobofit in most patients has normalized thyroid homeostasis, improved overall outcomes of the treatment for underlying and comorbid illnesses, reduced the severity of metabolic disorders. Conclusions. In OA patients aged over 50 years with a high level of comorbidity, it is necessary to carry out screening for hypothyroidism. If you noticed the signs of subclinical hypothyroidism in this population of patients, it is appropriate to use multicomponental phytomedications with diverse thyroid-stimulating action.

  12. Hypothyroidism: Can It Cause Peripheral Neuropathy?

    Science.gov (United States)

    Hypothyroidism: Can it cause peripheral neuropathy? Can hypothyroidism cause peripheral neuropathy and, if so, how is it treated? Answers from Todd B. Nippoldt, M.D. Hypothyroidism — a condition in which your ...

  13. Management of Subclinical Hyperthyroidism

    Science.gov (United States)

    Santos Palacios, Silvia; Pascual-Corrales, Eider; Galofre, Juan Carlos

    2012-01-01

    The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient’s medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves’ disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation). PMID:23843809

  14. Congenital hypothyroidism in neonates

    Directory of Open Access Journals (Sweden)

    Aneela Anjum

    2014-01-01

    Full Text Available Context: Congenital hypothyroidism (CH is one of the most common preventable causes of mental retardation in children and it occurs in approximately 1:2,000-1:4,000 newborns. Aims and Objectives: The aim of this study is to determine the frequency of CH in neonates. Settings and Design: This cross-sectional study was conducted in neonatal units of the Department of Pediatrics Unit-I, King Edward Medical University/Mayo Hospital, Lahore and Lady Willington Hospital Lahore in 6 months (January-June 2011. Materials and Methods: Sample was collected by non-probability purposive sampling. After consent, 550 newborn were registered for the study. Demographic data and relevant history was recorded. After aseptic measures, 2-3 ml venous blood analyzed for thyroid-stimulating hormone (TSH level by immunoradiometric assay. Treatment was started according to the individual merit as per protocol. Statistical Analysis Used: Data was analyzed by SPSS 17 and Chi-square test was applied to find out the association of CH with different variables. Results: The study population consisted of 550 newborns. Among 550 newborns, 4 (0.8% newborns had elevated TSH level. CH had statistically significant association with mother′s hypothyroidism (P value 0.000 and mother′s drug intake during the pregnancy period (P value 0.013. Conclusion: CH is 0.8% in neonates. It has statistically significant association with mother′s hypothyroidism and mother′s drug intake during pregnancy.

  15. Study on the incidence and etiology of subclinical thyroid function disorders

    International Nuclear Information System (INIS)

    Gu Jingxin; Xie Xiuhai; Huang Chenyang; Fu Junyan; Lu Weiguo; Chen Kejing

    2006-01-01

    Objective: To study the incidence and etiology of subclinical thyroid function disorders in 12592 subjects tested. Methods: The etiology of 874 patients with abnormal serum TSH (with IRMA) found in the tested 12592 patients, whose serum T 3 , T 4 , FT 3 , FT 4 , TSH, TGA and TMA were also detected with RIA was analyzed. Results: 874 of 12592 patients had abnormal TSH levels (6.94%). Among them, TSH was elevated in 397 patients (3.15%) and decreased in 477 patients (3.79%). Most of them were associated with obvious related thyroid or other thronic diseases such as hyperthyroidism after therapy, thyroxine replacement treatment of hypothyroidism and other thyroid diseases (thyroiditis, diffuse nontoxic goiter). In the remaining apparently disease-free 143 subjects, there were with subclinical hypothyroidism and 34 (3.89% of 874) with subclinical hyperthyroidism. Also among the 874 patients, 30.78% (n=269) patients had elevated TGA and TMA[16.82% (n=147) had elevated TSH and TGA, TMA simultaneously, 13.96% (n=122) had decreased TSH and elevated TGA and TMA simultaneously]. In the 874 patients, 256 (29.29%) were older than 60. Conclusion: Elderly people has higher incidence of subclinical thyroid function disorders. We should pay more attention to the detection of this condition, especially in elderly patients. (authors)

  16. Hypertrichosis due to primary hypothyroidism.

    OpenAIRE

    Stern, S R; Kelnar, C J

    1985-01-01

    A 10 year old girl with hypertrichosis associated with primary hypothyroidism that resolved after 6 months' replacement treatment with thyroxine is reported. It is important to consider the diagnosis of hypothyroidism in children with abnormal hairiness or distribution of body hair.

  17. The frequency of hypothyroidism and its relationship with HCV positivity in patients with thalassemia major in southern Iran.

    Science.gov (United States)

    Haghpanah, Sezaneh; Jelodari, Shohreh; Karamifar, Hammdollah; Saki, Forough; Rahimi, Rahil; De Sanctis, Vincenzo; Dehbozorgian, Javad; Karimi, Mehran

    2018-03-27

    Hypothyroidism is one the most complication due to iron overload in patients with β-thalassemia major (TM). On the other hand these patients are prone to Hepatitis C virus (HCV) infection that can cause  thyroid dysfunction by itself or as the side effect of treatment with interferon (INF) or IFN plus ribavirin. The aim of this study is to evaluate the association of hypothyroidism with HCV positivity and serum ferritin levels in patients with TM. In this cross-sectional study, 201 randomly selected patients with TM who were registered at the Thalassemia Clinic of a tertiary hospital in Shiraz, southern Iran were investigated. Thyroid function tests and serologic screening assays for HCV seropositivity (HCV Ab and HCV-RNA) were conducted for all patients. Frequency of hypothyroidism was 22.9% including 19.9% subclinical hypothyroidism, 2% primary overt hypothyroidism and 1% central hypothyroidism. Eighty six patients (42.8%) were HCV Ab positive and 60 patients (29.9%) were HCV RNA positive. No significant relationship was found between hypothyroidism and HCV positivity or receiving IFN-α (P>0.05). Hypothyroidism showed a borderline significant association with high serum ferritin levels in TM patients (P=0.055). Our results showed no significant association between hypothyroidism and HCV infection in TM patients. It seems that the main mechanism of hypothyroidism in our patients is iron overload; however, for better evaluation a larger multicenter study is recommended.  Also due to the importance of consequences of HCV infection, more careful pre-transfusional screening of blood should be considered in TM patients.

  18. Diural TSH variations in hypothyroidism.

    Science.gov (United States)

    Weeke, J; Laurberg, P

    1976-07-01

    There is a circadian variation in serum TSH in euthyroid subjects. A similar diurnal variation has been demonstrated in patients with hypothyroidism. In the present study the 24-hour pattern of serum TSH was investigated in eight patients with hypothyroidism of varying severity and in five hypothyroid patients treated with thyroxine (T4). There was a circadian variation in serum TSH in patients with hypothyroidism of moderate degree, and in patients treated for severe hypothyrodism with thyroxine. The pattern was similar to that found in normal subjects, i.e., low TSH levels in the daytime and higher levels at night. In severely hypothyroid patients, no diurnal variation in serum TSH was observed. A practical consequence is that blood samples for TSH measurements in patients with moderately elevated TSH levels are best taken after 1100 h, when the low day levels are reached.

  19. Screening of subclinical hepatic encephalopathy

    NARCIS (Netherlands)

    Groeneweg, M; Moerland, W; Quero, J C; Hop, W C; Krabbe, P F; Schalm, S W

    BACKGROUND/AIMS: Subclinical hepatic encephalopathy adversely affects daily functioning. The aim of this study was to determine which elements of daily life have predictive value for subclinical hepatic encephalopathy. METHODS: The study was performed in 179 outpatients with liver cirrhosis.

  20. Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system

    Directory of Open Access Journals (Sweden)

    Manish Gutch

    2013-01-01

    Full Text Available Thyroid hormone mediates growth and development of the skeleton through its direct effects and through its permissive effects on growth hormone. The effect of hypothyroidism on bone is well described in congenital hypothyroidism, but the impact of thyroid hormone deficiency on a growing skeleton, as it happens with juvenile hypothyroidism, is less defined. In addition, the extent to which the skeletal defects of juvenile hypothyroidism revert on the replacement of thyroid hormone is not known. A study was undertaken in 29 juvenile autoimmune hypothyroid patients to study the skeletal manifestations of juvenile hypothyroidism and the impact of treatment of hypothyroidism on the skeletal system of juvenile patients. Hypothyroidism has a profound impact on the skeletal system and delayed bone age, dwarfism, and thickened bands at the metaphyseal ends being the most common findings. Post treatment, skeletal findings like delayed bone age and dwarfism improved significantly, but there were no significant changes in enlargement of sella, presence of wormian bones, epihyseal dysgenesis, vertebral changes and thickened band at the metaphyseal ends. With the treatment of hypothyroidism, there is an exuberant advancement of bone age, the catch up of bone age being approximately double of the chronological age advancement.

  1. Skeletal manifestations of juvenile hypothyroidism and the impact of treatment on skeletal system.

    Science.gov (United States)

    Gutch, Manish; Philip, Rajeev; Philip, Renjit; Toms, Ajit; Saran, Sanjay; Gupta, K K

    2013-10-01

    Thyroid hormone mediates growth and development of the skeleton through its direct effects and through its permissive effects on growth hormone. The effect of hypothyroidism on bone is well described in congenital hypothyroidism, but the impact of thyroid hormone deficiency on a growing skeleton, as it happens with juvenile hypothyroidism, is less defined. In addition, the extent to which the skeletal defects of juvenile hypothyroidism revert on the replacement of thyroid hormone is not known. A study was undertaken in 29 juvenile autoimmune hypothyroid patients to study the skeletal manifestations of juvenile hypothyroidism and the impact of treatment of hypothyroidism on the skeletal system of juvenile patients. Hypothyroidism has a profound impact on the skeletal system and delayed bone age, dwarfism, and thickened bands at the metaphyseal ends being the most common findings. Post treatment, skeletal findings like delayed bone age and dwarfism improved significantly, but there were no significant changes in enlargement of sella, presence of wormian bones, epihyseal dysgenesis, vertebral changes and thickened band at the metaphyseal ends. With the treatment of hypothyroidism, there is an exuberant advancement of bone age, the catch up of bone age being approximately double of the chronological age advancement.

  2. The effect of substitution therapy on symptoms in patients with hypothyroidism following treatment for laryngeal and hypopharyngeal carcinomas.

    Science.gov (United States)

    Lo Galbo, A M; Verdonck-De Leeuw, I M; Lips, P; Kuik, D J; Leemans, C R; De Bree, R

    2013-08-01

    Hypothyroidism is a well-known complication following treatment of laryngeal or hypopharyngeal carcinomas, and may cause various psychological and physical problems that negatively affect quality of life. The aim of this study was to evaluate the effect of substitution therapy on symptoms in patients with hypothyroidism. A study-specific questionnaire on physical and psychological problems (before and after substitution therapy) was sent to 70 patients who had been treated between 1977 and 2008 with clinical or subclinical hypothyroidism. Ninety-four percent returned the questionnaire. Symptoms on energy levels were reported most often (67% always tired and 70% lack of energy). Moodiness and emotional and physical symptoms were reported more often in substituted (sub)clinical hypothyroidism. Substitution therapy resulted in an improvement of energy (P = 0.013), sense of general interest and enjoyment (P = 0.022) and a reduction of puffy face (P = 0.041). Most symptoms in patients with thyroid dysfunction do not improve after substitution therapy. Nevertheless, due to its impact on health-related quality of life and the low burden of substitution therapy, screening for hypothyroidism and subsequent substitution therapy remains important.

  3. Changes in arterial stiffness, carotid intima-media thickness, and epicardial fat after L-thyroxine replacement therapy in hypothyroidism.

    Science.gov (United States)

    del Busto-Mesa, Abdel; Cabrera-Rego, Julio Oscar; Carrero-Fernández, Lisván; Hernández-Roca, Cristina Victoria; González-Valdés, Jorge Luis; de la Rosa-Pazos, José Eduardo

    2015-01-01

    To assess the relationship between primary hypothyroidism and subclinical atherosclerosis and its potential changes with L-thyroxine replacement therapy. A prospective cohort study including 101 patients with primary hypothyroidism and 101 euthyroid patients as controls was conducted from July 2011 to December 2013. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of L-thyroxine replacement therapy. At baseline, hypothyroid patients had significantly greater values of blood pressure, total cholesterol, VLDL cholesterol, left ventricular mass, epicardial fat, and carotid intima-media thickness as compared to controls. Total cholesterol, VLDL cholesterol, ventricular diastolic function, epicardial fat, carotid intima-media thickness, carotid local pulse wave velocity, pressure strain elastic modulus, and β arterial stiffness index showed a significant and positive correlation with TSH levels. After one year of replacement therapy, patients with hypothyroidism showed changes in total cholesterol, VLDL cholesterol, TSH, carotid intima-media thickness, and arterial stiffness parameters. Primary hypothyroidism is characterized by an increased cardiovascular risk. In these patients, L-thyroxine replacement therapy for one year is related to decreased dyslipidemia and improvement in markers of subclinical carotid atherosclerosis. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  4. Subclinical Hyperthyroidism: When to Consider Treatment.

    Science.gov (United States)

    Donangelo, Ines; Suh, Se Young

    2017-06-01

    Subclinical hyperthyroidism is defined by a low or undetectable serum thyroid-stimulating hormone level, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (e.g., in Graves disease, toxic nodular goiter, or transient thyroiditis), by administration of thyroid hormone to treat malignant thyroid disease, or by unintentional excessive replacement therapy. The prevalence of subclinical hyperthyroidism in the general population is about 1% to 2%; however, it may be higher in iodinedeficient areas. The rate of progression to overt hyperthyroidism is higher in persons with thyroid-stimulating hormone levels less than 0.1 mIU per L than in persons with low but detectable thyroid-stimulating hormone levels. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation and heart failure in older adults, increased cardiovascular and all-cause mortality, and decreased bone mineral density and increased bone fracture risk in postmenopausal women. However, the effectiveness of treatment in preventing these conditions is unclear. A possible association between subclinical hyperthyroidism and quality-of-life parameters and cognition is controversial. The U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for thyroid dysfunction in asymptomatic persons. The American Thyroid Association and the American Association of Clinical Endocrinologists recommend treating patients with thyroid-stimulating hormone levels less than 0.1 mIU per L if they are older than 65 years or have comorbidities such as heart disease or osteoporosis.

  5. Correlation of Hypothyroidism and Obesity

    Directory of Open Access Journals (Sweden)

    Т.Y. Yuzvenko

    2016-11-01

    Full Text Available Obesity and hypothyroidism are common diseases, and consequently clinicians should be particularly alert for the possible thyroid dysfunction in obese patients. The relationship between thyroid function and obesity is likely to be bidirectional, with hypothyroidism affecting weight, but obesity also influencing thyroid function. Both serum thyroid-stimulating hormone and fT3 are typically increased in obese individuals, likely mediated by leptin. Following LT4 treatment for overt hypothyroidism, weight loss appears due to water weight rather than fat. Selected thyroid analogs might be a means to improve weight loss by increasing energy expenditure in obese patients during lasting hypocaloric diet.

  6. Subclinical laminitis in dairy heifers.

    Science.gov (United States)

    Bradley, H K; Shannon, D; Neilson, D R

    1989-08-19

    By causing poorer horn quality, subclinical laminitis is considered to be a major predisposing cause of other hoof problems, particularly sole ulcers in newly calved heifers. In this study the hind hooves of 136 female Friesian/Holstein cattle aged between four months and two years were examined to discover at what age the signs of subclinical laminitis appeared. Sole haemorrhages were found in the hoof horn of calves as young as five months. The consistent finding of these lesions in heifers of all ages indicated that subclinical laminitis of varying degree was a common condition during the early growing period of young dairy heifers.

  7. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.

    Science.gov (United States)

    Garber, Jeffrey R; Cobin, Rhoda H; Gharib, Hossein; Hennessey, James V; Klein, Irwin; Mechanick, Jeffrey I; Pessah-Pollack, Rachel; Singer, Peter A; Woeber, Kenneth A

    2012-12-01

    Hypothyroidism has multiple etiologies and manifestations. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. This paper describes evidence-based clinical guidelines for the clinical management of hypothyroidism in ambulatory patients. The development of these guidelines was commissioned by the American Association of Clinical Endocrinologists (AACE) in association with American Thyroid Association (ATA). AACE and the ATA assembled a task force of expert clinicians who authored this article. The authors examined relevant literature and took an evidence-based medicine approach that incorporated their knowledge and experience to develop a series of specific recommendations and the rationale for these recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach outlined in the American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Guidelines-2010 update. Topics addressed include the etiology, epidemiology, clinical and laboratory evaluation, management, and consequences of hypothyroidism. Screening, treatment of subclinical hypothyroidism, pregnancy, and areas for future research are also covered. Fifty-two evidence-based recommendations and subrecommendations were developed to aid in the care of patients with hypothyroidism and to share what the authors believe is current, rational, and optimal medical practice for the diagnosis and care of hypothyroidism. A serum thyrotropin is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations. The standard treatment is replacement with L-thyroxine. The decision to treat subclinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient.

  8. Primary and Central Hypothyroidism After Radiotherapy for Head-and-Neck Tumors

    International Nuclear Information System (INIS)

    Bhandare, Niranjan; Kennedy, Laurence; Malyapa, Robert S.; Morris, Christopher G.; Mendenhall, William M.

    2007-01-01

    Purpose: To investigate the incidence of radiotherapy (RT)-induced central and primary hypothyroidism regarding total dose, fractionation, and adjuvant chemotherapy. Methods and Materials: We retrospectively reviewed the data from 312 patients treated with RT for extracranial head-and-neck tumors between 1964 and 2000. The cervical lymph nodes were irradiated in 197 patients. The radiation doses to the thyroid gland and hypothalamic-pituitary axis were estimated by reconstructing the treatment plans. Results: Clinical central hypothyroidism (CH) was observed in 17 patients (5.4%); the median clinical latency was 4.8 years. Clinical primary hypothyroidism (PH) was observed in 40 patients (20.3%); the median clinical latency was 3.1 years. Multivariate analysis of clinical CH revealed that fractionation, adjuvant chemotherapy, and total dose to the pituitary were not significant. Multivariate analysis of clinical PH revealed that the total dose to the thyroid (p = 0.043) was significant, but adjuvant chemotherapy, age, and gender were not. Of the patients tested for hypopituitarism, 14 (20.3%) of 69 demonstrated subclinical CH and 17 (27.4%) of 62 demonstrated subclinical PH. The 5-year and 10-year rates of freedom from clinical CH and PH were 97% and 87% and 68% and 67%, respectively. Of the patients tested, the 5-year and 10-year rates of freedom from subclinical CH and PH were 91% and 78% and 71% and 71%, respectively. Conclusion: Clinical and subclinical manifestations of late radiation toxicity were observed in the thyroid and hypothalamic-pituitary axis. Although CH did not indicate a dependence on fractionation, adjuvant chemotherapy, or total dose to the pituitary, PH showed a dependence on the total dose to the thyroid gland

  9. Hypothyroidism in metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Kota

    2012-01-01

    Full Text Available Aim: Metabolic syndrome (MetS and hypothyroidism are well established forerunners of atherogenic cardiovascular disease. Considerable overlap occurs in the pathogenic mechanisms of atherosclerotic cardiovascular disease by metabolic syndrome and hypothyroidism. Insulin resistance has been studied as the basic pathogenic mechanism in metabolic syndrome. [1] This cross sectional study intended to assess thyroid function in patients with metabolic syndrome and to investigate the association between hypothyroidism and metabolic syndrome. Materials and Methods: One hundred patients with metabolic syndrome who fulfilled the National Cholesterol Education Program- Adult Treatment Panel (NCEP-ATP III criteria [ 3 out of 5 criteria positive namely blood pressure ≥ 130/85 mm hg or on antihypertensive medications, fasting plasma glucose > 100 mg/dl or on anti-diabetic medications, fasting triglycerides > 150 mg/dl, high density lipoprotein cholesterol (HDL-C 102 cms in men and 88 cms in women] were included in the study group. [2] Fifty patients who had no features of metabolic syndrome (0 out of 5 criteria for metabolic syndrome were included in the control group. Patients with liver disorders, renal disorders, congestive cardiac failure, pregnant women, patients on oral contraceptive pills, statins and other medications that alter thyroid functions and lipid levels and those who are under treatment for any thyroid related disorder were excluded from the study. Acutely ill patients were excluded taking into account sick euthyroid syndrome. Patients were subjected to anthropometry, evaluation of vital parameters, lipid and thyroid profile along with other routine laboratory parameters. Students t-test, Chi square test and linear regression, multiple logistic regression models were used for statistical analysis. P value < 0.05 was considered significant. Results: Of the 100 patients in study group, 55 were females (55% and 45 were males (45%. Of the 50

  10. Subclinical Thyroid Dysfunction and the Risk for Fractures

    Science.gov (United States)

    Wirth, Christina D.; Blum, Manuel R.; da Costa, Bruno R.; Baumgartner, Christine; Collet, Tinh-Hai; Medici, Marco; Peeters, Robin P.; Aujesky, Drahomir; Bauer, Douglas C.; Rodondi, Nicolas

    2015-01-01

    Background Data on the association between subclinical thyroid dysfunction and fractures conflict. Purpose To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. Data Sources Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. Study Selection Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. Data Extraction One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. Data Synthesis The 7 population-based cohorts of heterogeneous quality included 50 245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2 = 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). Limitations Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. Conclusion Subclinical hyperthyroidism might be associated with

  11. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants.

    Science.gov (United States)

    Ning, Yu; Cheng, Yun J; Liu, Li J; Sara, Jaskanwal D S; Cao, Zhi Y; Zheng, Wei P; Zhang, Tian S; Han, Hui J; Yang, Zhen Y; Zhang, Yi; Wang, Fei L; Pan, Rui Y; Huang, Jie L; Wu, Ling L; Zhang, Ming; Wei, Yong X

    2017-02-02

    Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality. We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality. Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01-1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05-1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38-2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13-1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28-3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26-1.81). Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.

  12. Subclinical hyperthyroidism is a risk factor for poor functional outcome after ischemic stroke.

    Science.gov (United States)

    Wollenweber, Frank Arne; Zietemann, Vera; Gschwendtner, Andreas; Opherk, Christian; Dichgans, Martin

    2013-05-01

    Subclinical hyperthyroidism is associated with adverse cardiovascular events, including stroke and atrial fibrillation. However, its impact on functional outcome after stroke remains unexplored. A total of 165 consecutively recruited patients admitted for ischemic stroke were included in this observational prospective study. Blood samples were taken in the morning within 3 days after symptom onset, and patients were divided into the following 3 groups: subclinical hyperthyroidism (0.1hyperthyroidism, and 23 patients (13.9%) had subclinical hypothyroidism. Patients with subclinical hyperthyroidism had a substantially increased risk of functional disability 3 months after stroke compared with subjects with euthyroid state (odds ratio, 2.63; 95% confidence interval, 1.02-6.82, adjusted for age, sex, smoking status, and time of blood sampling). The association remained significant, when including the baseline NIHSS, TIA, serum CRP, atrial fibrillation, body mass index, and total cholesterol as additional variables (odds ratio, 3.95; 95% confidence interval, 1.25-12.47), and was confirmed by the secondary outcome (Barthel Index: odds ratio, 9.12; 95% confidence interval, 2.08-39.89). Subclinical hyperthyroidism is a risk factor for poor outcome 3 months after ischemic stroke.

  13. Maternal hypothyroidism in the perinatal period and childhood asthma in the offspring

    DEFF Research Database (Denmark)

    Liu, Xiaoqin; Andersen, Stine Linding; Olsen, Jørn

    2017-01-01

    BACKGROUND: There is increasing interest in the possible link between maternal hypothyroidism in the perinatal period and childhood asthma risk. We explored this in the present study while accounting for the timing of hypothyroidism diagnosis. Further, we evaluated whether the risk was moderated...... that maternal hypothyroidism, especially when it is untreated, increases childhood asthma risk. Early detection and appropriate treatment of hypothyroidism in pregnant women may be an area for possible prevention of childhood asthma. This article is protected by copyright. All rights reserved....... by thyroid hormone treatment during pregnancy. METHODS: We conducted a population-based cohort study using Danish national registers. All liveborn singletons in Denmark from 1998 to 2007 were identified. Maternal hypothyroidism and asthma in the children were defined by data from the Patient Register...

  14. Hypothyroidism in Filipino neonates

    International Nuclear Information System (INIS)

    Guevarra, R.; Torres, J.F.; Estrada, F.A.; San Luis, T.O.L.

    1988-01-01

    Thyroid hormone determination (T4, T3, rT3, TSH) in cord blood of 3,897 newborns was carried out in Metro Manila (non-endemic) and central, Northern and Southern Luzon (endemic for goiter). The objective is to detect congenital hypothyroidism and establish its incidence in new born Filipinos. This was done by radioimmunoassay, using commercial kits from Abbott Laboratories. The results obtained as mean values for non-endemic regions are: T4: 10.96 +- 2.25 ug/dl; T3: 60-64 +- 13.82 ng/dl; rT3: 250.4 +- 64.9 ng/dl; and TSH 5.89 +- 2.58 uU/ml, n=200. Mean values in endemic regions (n = 205) are T4: 9.46 +- 2.18 ug/dl; T3: 67.8 +- 12.05 ng/dl; rT3: 184.3 +- 32.7 ng/dl and TSH: 6.65 +- 3.13 uU/ml. From the above data, nomograms were drawn where the values obtained from each case were plotted. From non-endemic regions 28 positive cases were recalled and in the endemic regions 16 positive cases were also recalled for re-examination but most of them turned out to be false positive. As of now, four positive cases were found in Metro Manila, i.e. 4/2, 441 births and five in endemic regions out of 1,456 births so the incidence of neonatal hypothyroidism is 9/3,897 births. This is 9 times higher than most reports abroad which is about 1/4000 births. (Auth.). 36 refs; 10 tabs; 10 figs

  15. A Clinical Study on Hypothyroidism

    International Nuclear Information System (INIS)

    Park, Keun Jo; Park, Sun Yang; Park, Jung Sik; Lee, Myung Chul; Koh, Chang Soon; Lee, Mun Ho

    1976-01-01

    A clinical study was made on 263 patients of hypothyroidism among the 5,970 patients of Various thyroid diseases diagnosed and treated at the Radioisotope Clinic and Laboratory, Seoul National University Hospital from May, 1960 to Aug, 1975. The results obtained with this study are as follows: 1) The etiological classification of hypothyroidism revealed 244 cases (93%) of primary hypothyroidism and 19 cases (7%) of secondary hypothyroidism. 2) The most frequent cause of the thyroprivic primary hypothyroidism was post radioiodine therapy with 109 cases (41.4%). 3) There were 37 cases (14%) of male and 226 cases (86%) of female, showing a ratio of 1 : 6. 4) The majority of patients were between the ages of 30 and 60 with the peak incidence (87 cases, 33%) in their fourth decades of lives. 5) The major symptoms and signs were weakness (97%), edema of face and extremities (92%); Decreased Achilles tendon reflex (87%), cold intolerance (82%), gain in weight (76%), constipation (58%) and cold skin (51%). 6) The cumulative incidence of hypothyroidism in patient treated with 131 I (3-8 mci) was 7.2% at first year, 33.3% at tenth year and the 50% at fourteenth year and the annual increment was 2.9%. 7) The incidence of hypothyroidism related to the numbers of 131 I therapy was not linear. 8) The diagnostic compatibilities of the various tests to hypothyroidism were TSH (100%), T 4 (93.8%), 24-hour-RNIU (91.5%), ATR (86.7%), T 3 RU (66.1%) and BMR (64.9%).

  16. Primary hypothyroidism masquerading pituitary macroadenoma

    Directory of Open Access Journals (Sweden)

    Agrawal Amit

    2014-03-01

    Full Text Available Diffuse and reactive pituitary gland enlargement secondary to primary hypothyroidism is an uncommon occurrence and that can masquerade many pituitary disorders. In present article, we report a case of 19 year female severe hypothyroidism presenting with diffuse enlargement of pituitary gland and hyperprolactinemia and review the clinical importance of this entity. Knowledge of this entity is very important to avoid unnecessary surgery and irreversible complications in this sub-group of patients.

  17. Primary hypothyroidism masquerading pituitary macroadenoma

    OpenAIRE

    Agrawal Amit; Reddy Amareesh P.; Malleswara Rao G.; Reddy V. Umamaheswara

    2014-01-01

    Diffuse and reactive pituitary gland enlargement secondary to primary hypothyroidism is an uncommon occurrence and that can masquerade many pituitary disorders. In present article, we report a case of 19 year female severe hypothyroidism presenting with diffuse enlargement of pituitary gland and hyperprolactinemia and review the clinical importance of this entity. Knowledge of this entity is very important to avoid unnecessary surgery and irreversible complications in this sub-group of patients.

  18. A Clinical Study on Hypothyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Park, Keun Jo; Park, Sun Yang; Park, Jung Sik; Lee, Myung Chul; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1976-03-15

    A clinical study was made on 263 patients of hypothyroidism among the 5,970 patients of Various thyroid diseases diagnosed and treated at the Radioisotope Clinic and Laboratory, Seoul National University Hospital from May, 1960 to Aug, 1975. The results obtained with this study are as follows: 1) The etiological classification of hypothyroidism revealed 244 cases (93%) of primary hypothyroidism and 19 cases (7%) of secondary hypothyroidism. 2) The most frequent cause of the thyroprivic primary hypothyroidism was post radioiodine therapy with 109 cases (41.4%). 3) There were 37 cases (14%) of male and 226 cases (86%) of female, showing a ratio of 1 : 6. 4) The majority of patients were between the ages of 30 and 60 with the peak incidence (87 cases, 33%) in their fourth decades of lives. 5) The major symptoms and signs were weakness (97%), edema of face and extremities (92%); Decreased Achilles tendon reflex (87%), cold intolerance (82%), gain in weight (76%), constipation (58%) and cold skin (51%). 6) The cumulative incidence of hypothyroidism in patient treated with {sup 131}I (3-8 mci) was 7.2% at first year, 33.3% at tenth year and the 50% at fourteenth year and the annual increment was 2.9%. 7) The incidence of hypothyroidism related to the numbers of {sup 131}I therapy was not linear. 8) The diagnostic compatibilities of the various tests to hypothyroidism were TSH (100%), T{sub 4} (93.8%), 24-hour-RNIU (91.5%), ATR (86.7%), T{sub 3}RU (66.1%) and BMR (64.9%).

  19. Cardiac function in acute hypothyroidism

    International Nuclear Information System (INIS)

    Donaghue, K.; Hales, I.; Allwright, S.; Cooper, R.; Edwards, A.; Grant, S.; Morrow, A.; Wilmshurst, E.; Royal North Shore Hospital, Sydney

    1985-01-01

    It has been established that chronic hypothyroidism may affect cardiac function by several mechanisms. It is not known how long the patient has to be hypothyroid for cardiac involvement to develop. This study was undertaken to assess the effect of a short period of hypothyroidism (10 days) on cardiac function. Nine patients who had had total tyroidectomy, had received ablative radioiodine for thyroid cancer and were euthyroid on replacement therapy were studied while both euthyroid and hypothyroid. Cardiac assessment was performed by X-ray, ECG, echocardiography and gated blood-pool scans. After 10 days of hypothyroidisms, the left-ventricular ejection fraction failed to rise after exercise in 4 of the 9 patients studied, which was significant (P<0.002). No significant changes in cardiac size or function at rest were detected. This functional abnormality in the absence of any demonstrable change in cardiac size and the absence of pericardial effussion with normal basal function suggest that short periods of hypothyroidism may reduce cardiac reserve, mostly because of alterations in metabolic function. (orig.)

  20. CARDIOVASCULAR DISORDERS WITH HYPOTHYROIDISM AND ADIPOKINES

    Directory of Open Access Journals (Sweden)

    S. Ye. Myasoyedova

    2015-01-01

    Full Text Available The article describes the mechanisms of development of cardiovascular disorders and dyslipidemia with hypothyroidism. Reference data are presented that are devoted to the study of adipokines content with hypothyroidism and their effect on echocardiographic indicators.

  1. Influence of Hypothyroidism on Separate Links of Metabolism, Structure and Function of the Heart in Insulin Resistance

    Directory of Open Access Journals (Sweden)

    T.Yu. Yuzvenko

    2014-05-01

    Full Text Available The article presents research findings of reduced thyroid function impact on the background of insulin resistance on the specific links of metabolism, structure and function of the heart. It is found that in thyroid dysfunction, the main nosological form of myocardial lesion in female patients without concomitant cardiovascular disease is the development of metabolic endocrine cardiomyopathy. Feature of cardiac lesion is the absence of cardiosclerotic, myocardial and ischemic processes in hypothyroidism. Obscure clinical symptoms of the heart both in apparent and subclinical hypothyroidism are detected. Features of clinical, instrumental and laboratory changes in female patients with impaired thyroid function are a trend to systolic blood pressure increase, the absence of significant dyslipidemia, dysglycemia, and cardiocytolysis and hepatocytolysis. Thyroid hormone deficiency is associated with increased myocardial repolarization heterogeneity: subclinical hypothyroidism is accompanied by violation of repolarization processes and the development of electrical heterogeneity of ventricular myocardium, and in the apparent hypothyroidism changes are more linked with the violation of the homogeneity of the electrical impulse to the atria.

  2. Concomitância de fibromialgia em pacientes portadores de hipotireoidismo e de alterações tireoideanas em pacientes com fibromialgia Fibromyalgia concomitance in patients with hypothyroidism and thyroid disorders in patients with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Marlene Freire

    2006-02-01

    Full Text Available INTRODUÇÃO: a fibromialgia (FM pode ser definida como uma síndrome dolorosa musculoesquelética não-inflamatória de caráter crônico, tendo como sintomas mais comuns a fadiga e o sono não-reparador. Tais manifestações podem não resultar da FM, mas de outras doenças associadas, como o hipotireoidismo. OBJETIVO: descrever a ocorrência de FM em pacientes com hipotireoidismo, e os casos de hipotireoidismo em pacientes com FM, além de determinar os sintomas associados a essas condições clínicas. MÉTODOS: foram avaliados 166 pacientes portadores de FM e 56 com hipotireoidismo. Os voluntários responderam a um questionário para detecção dos principais sinais e sintomas dessas doenças em estudo e foram submetidos às dosagens séricas de hormônio estimulador da tireóide (TSH, tiroxina livre (T4 livre e anticorpo antitireoperoxidase (a-TPO. RESULTADOS: nos 166 pacientes com FM, foram diagnosticados hipotireoidismo clínico ou subclínico em 35 (21,1%. Dos 56 pacientes portadores de hipotireoidismo, em 36 (64,3% foi confirmado o diagnóstico de FM pelos critérios do American College of Rheumatology (ACR. Nos pacientes com hipotireoidismo previamente diagnosticado, a fadiga, o sono não-restaurador e a cefaléia crônica foram estatisticamente mais freqüentes naqueles que apresentavam diagnóstico de FM. A rigidez matinal foi mais prevalente nos pacientes com hipotireoidismo sem FM. CONCLUSÃO: há que se considerar a presença de manifestações clínicas ou laboratoriais de disfunção tireoideana nos pacientes portadores de FM e de FM em pacientes portadores de hipotireoidismo, para uma melhor abordagem diagnóstica e posterior tratamento dos mesmos.INTRODUCTION: Fibromyalgia can be defined as a non-inflammatory musculoskeletal pain syndrome. It is a chronic condition, commonly associated with fatigue and non-restorative sleep. However, such symptoms may result from coexisting diseases, for instance hypothyroidism. OBJECTIVE

  3. Thyroidectomy for Graves' disease: is hypothyroidism inevitable?

    OpenAIRE

    Davenport, M.; Talbot, C. H.

    1989-01-01

    The outcome of 234 patients with Graves' disease treated by subtotal thyroidectomy over a 12-year period is analysed with specific reference to hypothyroidism. Of definite hypothyroid cases, 98% occurred within 2 years. Failure to develop hypothyroidism was statistically related to large remnant size and a large goitre preoperatively. Histological review showed that any degree of lymphocytic infiltration was associated with the development of hypothyroidism (50% vs 22%). Late onset hypothyroi...

  4. Does Hypothyroidism Affect Gastrointestinal Motility?

    Directory of Open Access Journals (Sweden)

    Olga Yaylali

    2009-01-01

    Full Text Available Background. Gastrointestinal motility and serum thyroid hormone levels are closely related. Our aim was to analyze whether there is a disorder in esophagogastric motor functions as a result of hypothyroidism. Materials and Methods. The study group included 30 females (mean age ± SE 45.17 ± 2.07 years with primary hypothyroidism and 10 healthy females (mean age ± SE 39.40 ± 3.95 years. All cases underwent esophagogastric endoscopy and scintigraphy. For esophageal scintigraphy, dynamic imaging of esophagus motility protocol, and for gastric emptying scintigraphy, anterior static gastric images were acquired. Results. The mean esophageal transit time (52.56 ± 4.07 sec for patients; 24.30 ± 5.88 sec for controls; P=.02 and gastric emptying time (49.06 ± 4.29 min for the hypothyroid group; 30.4 ± 4.74 min for the control group; P=.01 were markedly increased in cases of hypothyroidism. Conclusion. Hypothyroidism prominently reduces esophageal and gastric motor activity and can cause gastrointestinal dysfunction.

  5. Hypothyroidism associated with parathyroid disorders.

    Science.gov (United States)

    Mantovani, Giovanna; Elli, Francesca Marta; Corbetta, Sabrina

    2017-03-01

    Hypothyroidism may occur in association with congenital parathyroid disorders determining parathyroid hormone insufficiency, which is characterized by hypocalcemia and concomitant inappropriately low secretion of parathormone (PTH). The association is often due to loss of function of genes common to thyroid and parathyroid glands embryonic development. Hypothyroidism associated with hypoparathyroidism is generally mild and not associated with goiter; moreover, it is usually part of a multisystemic involvement not restricted to endocrine function as occurs in patients with 22q11 microdeletion/DiGeorge syndrome, the most frequent disorders. Hypothyroidism and hypoparathyroidism may also follow endocrine glands' damages due to autoimmunity or chronic iron overload in thalassemic disorders, both genetically determined conditions. Finally, besides PTH deficiency, hypocalcemia can be due to PTH resistance in pseudohypoparathyroidism; when hormone resistance is generalized, patients can suffer from hypothyroidism due to TSH resistance. In evaluating patients with hypothyroidism and hypocalcemia, physical examination and clinical history are essential to drive the diagnostic process, while routine genetic screening is not recommended. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Hypothyroidism During Tyrosine Kinase Inhibitor Therapy Is Associated with Longer Survival in Patients with Advanced Nonthyroidal Cancers.

    Science.gov (United States)

    Lechner, Melissa G; Vyas, Chirag M; Hamnvik, Ole-Petter R; Alexander, Erik K; Larsen, P Reed; Choueiri, Toni K; Angell, Trevor E

    2018-04-01

    Tyrosine kinase inhibitor (TKI)-induced thyroid dysfunction is recognized as a common adverse effect of treatment, but the importance of incident hypothyroidism during TKI therapy remains unclear. This study analyzed the prognostic significance of hypothyroidism during TKI therapy in cancer patients. This was a retrospective cohort study of adult patients with advanced nonthyroidal cancer treated with TKI and available thyroid function testing at three affiliated academic hospitals from 2000 to 2017. Patients with preexisting thyroid disease were excluded. Demographic, clinical, and cancer treatment data were collected. Thyroid status with TKI treatment was determined from thyroid function testing and initiation of thyroid medication, and classified as euthyroid (thyrotropin [TSH] normal), subclinical hypothyroidism (SCH; TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (OH; TSH >10 mIU/L, low free thyroxine, or requiring replacement). Multivariate models were used to evaluate the effect of TKI-related hypothyroidism on overall survival (OS). Of 1120 initial patients, 538 remained after exclusion criteria. SCH occurred in 72 (13%) and OH in 144 (27%) patients with TKI therapy. Patients with hypothyroidism had significantly longer OS, with median OS in euthyroid patients of 685 days [confidence interval (CI) 523-851] compared to 1005 days [CI 634-1528] in SCH and 1643 days [CI 1215-1991] in OH patients (p hypothyroid patients (SCH and OH) with TSH >5 and hypothyroidism in cancer patients treated with TKI is associated with significantly improved OS, should not necessitate TKI dose reduction or discontinuation, and may provide independent prognostic information.

  7. Congenital hypothyroidism: insights into pathogenesis and treatment

    OpenAIRE

    Cherella, Christine E.; Wassner, Ari J.

    2017-01-01

    Congenital hypothyroidism occurs in approximately 1 in 2000 newborns and can have devastating neurodevelopmental consequences if not detected and treated promptly. While newborn screening has virtually eradicated intellectual disability due to severe congenital hypothyroidism in the developed world, more stringent screening strategies have resulted in increased detection of mild congenital hypothyroidism. Recent studies provide conflicting evidence about the potential neurodevelopmental risks...

  8. Risk Factors for New Hypothyroidism During Tyrosine Kinase Inhibitor Therapy in Advanced Nonthyroidal Cancer Patients.

    Science.gov (United States)

    Lechner, Melissa G; Vyas, Chirag M; Hamnvik, Ole-Petter R; Alexander, Erik K; Larsen, P Reed; Choueiri, Toni K; Angell, Trevor E

    2018-04-01

    Thyroid dysfunction during tyrosine kinase inhibitor (TKI) cancer treatment is common, but predisposing risk factors have not been determined. Recommendations for monitoring patients treated with one or multiple TKI and in conjunction with other relevant cancer therapies could be improved. The study objective was to assess the risk factors for new thyroid dysfunction in TKI-treated previously euthyroid cancer patients. A retrospective cohort study of patients with advanced nonthyroidal cancer treated with TKI from 2000 to 2017, having available thyroid function tests showing initial euthyroid status, excluding patients with preexisting thyroid disease or lack of follow-up thyroid function tests. During TKI treatment, patients were classified as euthyroid (thyrotropin [TSH] normal), subclinical hypothyroidism (TSH 5-10 mIU/L, or higher TSH if free thyroxine normal), or overt hypothyroidism (TSH >10 mIU/L, low free thyroxine, or requiring thyroid hormone replacement). The timing of thyroid dysfunction and TKI used were assessed. Risk factors for incident hypothyroidism were evaluated using multivariate models. In 538 adult patients included, subclinical hypothyroidism occurred in 71 (13.2%) and overt hypothyroidism occurred in 144 (26.8%) patients with TKI therapy, following a median cumulative TKI exposure of 196 days (interquartile range [IQR] 63.5-518.5 days). The odds of hypothyroidism were greatest during the first six months on a TKI. Median exposure time on the TKI concurrent with thyroid dysfunction in patients treated with only one TKI was 85 days (IQR 38-293.5 days) and was similar to the 74 days (IQR 38-133.3 days) in patients treated previously with other TKI (p = 0.41). Patients who developed hypothyroidism compared to those who remained euthyroid had greater odds of being female (odds ratio = 1.99 [confidence interval 1.35-2.93], p < 0.01), but greater cumulative TKI exposure and greater number of TKI received were not associated with

  9. Subclinical pertussis in incompletely vaccinated and unvaccinated ...

    African Journals Online (AJOL)

    subclinical whooping cough) does in fact occur. Recent studies have shown subclinical disease in vaccinated infants ... through home visits by a community health nurse with ..... The current study extends the knowledge of contagious spread of ...

  10. Hypothyroidism following allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia.

    Science.gov (United States)

    Medinger, Michael; Zeiter, Deborah; Heim, Dominik; Halter, Jörg; Gerull, Sabine; Tichelli, André; Passweg, Jakob; Nigro, Nicole

    2017-07-01

    Hypothyroidism may complicate allogeneic hematopoietic stem cell transplantation (allo-HSCT); we therefore analyzed risk factors in this study. We studied 229 patients with acute myeloid leukemia (AML) who underwent an allo-HSCT between 2003 and 2013 with different conditioning regimens (myeloablative, reduced-intensity, chemotherapy-based, or total body irradiation-based). Thyroid-stimulating hormone (TSH) and free thyroxine levels (fT4) were available in 104 patients before and after allo-HSCT. The median age at transplantation (n=104) was 47 (IQR 40-59)], 37 (35.6%) patients were female, and the overall mortality was 34.6% (n=36). After a median follow-up period of 47 (IQR 25-84) months, overt hypothyroidism (basal TSH>4.49mIU/l, FT4hypothyroidism (basal TSH>4.49mIU/l, normal fT4) was observed in 20 patients (19.2%). Positive thyroperoxidase (TPO) antibodies were found in 5 (4.8%) patients. A total of 13 patients (12.5%) were treated with thyroid hormone replacement. Acute graft-versus-host disease (aGvHD) ≥grade 2 occurred in 55 (52.9%) and chronic GvHD (cGvHD) in 74 (71.2%) of the patients. The risk of developing hypothyroidism was higher in the patients with repeated allo-HSCTs (P=0.024) and with positive TPO antibodies (P=0.045). Furthermore, the development of overt hypothyroidism was inversely proportional to age (P=0.043). No correlation was found with GvHD, HLA-mismatch, total body irradiation, and gender. After allo-HSCT, a significant number of patients experience thyroid dysfunction, including subclinical and overt hypothyroidism. Long-term and continuous follow-up for thyroid function after HSCT is important to provide timely and appropriate treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. HYPOTHYROIDISM - A SPECIAL COMORBIDITY FACTOR IN PATIENTS WITH OSTEOARTHROSIS: CLINICAL, PATHOPHYSIOLOGICAL AND PROGNOSTIC ASPECTS.

    Science.gov (United States)

    Voloshyna, L; Doholich, О; Sithinska, I

    2017-11-01

    Objective - to study the features of the functional and morphological condition of the thyroid gland (TG) in patients with osteoarthrosis (OA), the incidence and forms of hypothyroidism and their effects on clinical manifestations, metabolic disorders and the results of the treatment of OA and comorbid processes. A complex examination involved 312 patients with OA aged 37-76 years. Methods used: anthropometric, clinical, ultrasonographic, biochemical, radioimmunological (levels of TSH, free thyroxine, antibodies to thyroid peroxidase). It has been established that with increasing age in patients OA phenomena are progressing, there is an increase in comorbid diseases, especially of the cardiovascular system with atherosclerotic genesis, they become more severe. Against this background, clinical hypothyroidism was found in 4.44% and subclinical one in 13.78%. Stratification of the clinical form of hypothyroidism contributed to the deterioration of the course and outcome of the treatment of OA and comorbid diseases. Both forms of hypothyroidism intensified the degrees of metabolic disorders in the blood, reduced the glomerular filtration rate, especially the clinical form. Manifestations of hypothyroidism were observed in patients with OA with its significant systemic manifestations, high comorbidity rate, in individuals aged over 50, especially 60 years, mainly in women (83,72%). In patients with OA aged over 50 years with a high comorbidity rate, it is advisable to conduct an ultrasound examination of the thyroid gland, to measure the levels of TSH, free thyroxine in order to diagnose hypothyroidism early and to treat it timely as one of the ways to improve the overall outcomes of the treatment of such patients.

  12. Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland

    Directory of Open Access Journals (Sweden)

    B A Laway

    2012-01-01

    Full Text Available Introduction: Hypothyroidism is a known consequence of external-beam radiotherapy to the neck encompassing a part or whole of the thyroid gland. In this non-randomized prospective study, we have tried to evaluate the response of the thyroid gland to radiation by assessing thyroid function before irradiation and at regular intervals after irradiation. Aims and Objectives: The aim of this study were to assess in the cancer patients, who were exposed to the therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland: the incidence of primary hypothyroidism, the time required to become hypothyroid, any relation between the total dose for the development of hypothyroidism, and whether there are any patient or treatment-related factors that are predictive for the development of hypothyroidism, including the use of concurrent chemotherapy. Materials and Methods: This non-randomized, prospective study was conducted for a period of 2 years in which thyroid function was assessed in 59 patients (cases of head and neck cancer, breast cancer, lymphoma patients and other malignancies, who had received radiotherapy to the neck region. 59 euthyroid healthy patients (controls were also taken, who had not received the neck irradiation. These patients/controls were assessed periodically for 2 years. Results: The incidence of hypothyroidism after external beam radiation therapy (EBRT to neck where radiation portals include part or whole of the thyroid gland was 16.94%, seven cases had subclinical hypothyroidism (11.86% and three cases had clinical hypothyroidism (5.08%. Mean time for development of hypothyroidism was 4.5 months. There was no effect of age, gender, primary tumor site, radiation dose and chemotherapy, whether neoadjuvant or concurrent with the development of hypothyroidism. Conclusion: In summary, we found that thyroid dysfunction is a prevalent, yet easily treatable source of morbidity in patients

  13. Primary hypothyroidism in breast cancer patients with irradiated supraclavicular lymph nodes

    International Nuclear Information System (INIS)

    Bruning, P.; Bonfrer, J.; Jong-Bakker, M. de; Nooyen, W.; Burgers, M.

    1985-01-01

    Since the treatment of postmenopausal breast cancer patients with aminoglutethimide caused hypothyroidism with an unexpectedly high frequency previous treatment was suspected to contribute to hypofunction of the thyroid. Serum thyrotropin, triiodothyronine and free thyroxine index were compared between breast cancer patients who had undergone irradiation of regional lymph nodes and non-irradiated breast cancer patients, as well as patients having endometrial or colorectal carcinoma. Subclinical and clinical primary hypothyroidism was significantly more frequent in breast cancer patients who had previously received irradiation on supraclavicular lymph nodes comprising a minor part of the thyroid. Testing for the presence of autoantibodies against thyroid tissue components gave no evidence for radiation-induced autoimmune thyroiditis. Drugs suppressing thyroid hormone synthesis like aminoglutethimide may frequently cause myxedema in such irradiated women, especially at postmenopausal age. (author)

  14. A Japanese Family with Central Hypothyroidism Caused by a Novel IGSF1 Mutation.

    Science.gov (United States)

    Nishigaki, Satsuki; Hamazaki, Takashi; Fujita, Keinosuke; Morikawa, Shuntaro; Tajima, Toshihiro; Shintaku, Haruo

    2016-12-01

    Hemizygous mutations in the immunoglobulin superfamily member 1 (IGSF1) gene have been demonstrated to cause congenital central hypothyroidism in males. This study reports a family with a novel mutation in the IGSF1 gene located on the long arm of the X chromosome. A two-month-old boy was diagnosed with central hypothyroidism because of prolonged jaundice. A thyrotropin-releasing hormone (TRH) stimulation test indicated dysfunction in both the hypothalamus and the pituitary gland, and prompted the IGSF1 gene to be analyzed. The patient had a novel nonsense variant, c.2713C>T (p.Q905X), in exon 14 of the IGSF1 gene. Studies of the family revealed that the patient's sister and mother were heterozygous carriers of the IGSF1 mutation. The patient's maternal uncle carried the same mutation as the proband but had no overt symptoms. The mother and uncle started levothyroxine supplementation because of subclinical hypothyroidism. A novel mutation (c.2713C>T, p.Q905X) of the IGSF1 gene was identified that causes congenital central hypothyroidism in a Japanese family. The findings further expand the clinical heterogeneity of this entity.

  15. Canine hypothyroidism. A diagnostic challenge?

    International Nuclear Information System (INIS)

    Boretti, Felicitos; Reusch, C.E.

    2010-01-01

    Hypothyroidism is one of the most common endocrinopathies in dogs. Clinical symptoms and hematological and biochemical parameters lead to a first suspicion. To confirm diagnosis can be challenging, however. Determination of total serum T4 concentration is accepted as the primary screening test for the disease, and low serum T4 concentrations are intuitively suggestive of hypothyroidism. However it is well known that low T4 concentrations are frequently encountered in euthyroid dogs with various nonthyroidal diseases and in dogs receiving certain pharmacologic agents. Since assessment of endogenous TSH (canine TSH) using current canine TSH assays shows normal values in a high percentage of hypothyroid dogs (up to 40%), its diagnostic value is only limited. The TSH-stimulation test can still be recognized as the gold standard for the diagnosis of hypothyroidism in dogs. Determination of circulating T4 concentration before and 6 hours after the administration of exogenous TSH (recombinant human TSH, Thyrogen registered ) provides an assessment of the functional reserve capacity of the thyroid gland with minimal change in post-TSH T4 concentration, compared with the basal concentration, expected in dogs with hypothyroidism. Also this test can be influenced by nonthyroidal illness and by medications known to affect thyroid function. This suppressing influence seems to be less pronounced using a higher dose of TSH. Therefore, to improve the discriminatory power of the TSH stimulation test to differentiate between euthyroid-sick and primary hypothyroidism, the higher dose should be used in cases in which testing cannot be delayed. More recently, ultrasonography and scintigraphy have been used for the diagnosis of primary hypothyroidism. Using ultrasonography, a sensitivity of 98% was reported if size and echogenicity of the gland were combined. However, specificity was as low as 77%. and care must be taken when measuring the gland because of a relatively high

  16. Congenital hypothyroidism presenting with postpartum bradycardia

    International Nuclear Information System (INIS)

    Kara, S.; Tayman, C.; Tonbul, A.; Tatli, M.; Andiran, N.; Turkay, S.

    2013-01-01

    Congenital hypothyroidism is a clinical condition characterized by lack of thyroid hormone because of thyroid gland developmental and thyroid hormone biosynthesis disorders. The most common cause of permanent hypothyroidism is congenital factors. Prompt diagnosis is critical. However, overt signs of hypothyroidism are rarely present at birth, and 95% of affected babies are asymptomatic. Hypoxemia, apnea, acidosis, increased intracranial pressure, vagal stimulus and central nerve system abnormalities represent the most common causes of bradycardia in the neonate. Bradycardia associated with congenital hypothyroidism is very rare. In this paper, a case of severe congenital hypothyroidism, induced by maternal blocker antibodies, who presented with bradycardia, is reported. (author)

  17. A Prospective Cohort Study on Radiation-induced Hypothyroidism: Development of an NTCP Model

    International Nuclear Information System (INIS)

    Boomsma, Marjolein J.; Bijl, Hendrik P.; Christianen, Miranda E.M.C.; Beetz, Ivo; Chouvalova, Olga; Steenbakkers, Roel J.H.M.; Laan, Bernard F.A.M. van der; Wolffenbuttel, Bruce H.R.; Oosting, Sjoukje F.; Schilstra, Cornelis; Langendijk, Johannes A.

    2012-01-01

    Purpose: To establish a multivariate normal tissue complication probability (NTCP) model for radiation-induced hypothyroidism. Methods and Materials: The thyroid-stimulating hormone (TSH) level of 105 patients treated with (chemo-) radiation therapy for head-and-neck cancer was prospectively measured during a median follow-up of 2.5 years. Hypothyroidism was defined as elevated serum TSH with decreased or normal free thyroxin (T4). A multivariate logistic regression model with bootstrapping was used to determine the most important prognostic variables for radiation-induced hypothyroidism. Results: Thirty-five patients (33%) developed primary hypothyroidism within 2 years after radiation therapy. An NTCP model based on 2 variables, including the mean thyroid gland dose and the thyroid gland volume, was most predictive for radiation-induced hypothyroidism. NTCP values increased with higher mean thyroid gland dose (odds ratio [OR]: 1.064/Gy) and decreased with higher thyroid gland volume (OR: 0.826/cm 3 ). Model performance was good with an area under the curve (AUC) of 0.85. Conclusions: This is the first prospective study resulting in an NTCP model for radiation-induced hypothyroidism. The probability of hypothyroidism rises with increasing dose to the thyroid gland, whereas it reduces with increasing thyroid gland volume.

  18. A Prospective Cohort Study on Radiation-induced Hypothyroidism: Development of an NTCP Model

    Energy Technology Data Exchange (ETDEWEB)

    Boomsma, Marjolein J.; Bijl, Hendrik P.; Christianen, Miranda E.M.C.; Beetz, Ivo; Chouvalova, Olga; Steenbakkers, Roel J.H.M. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Laan, Bernard F.A.M. van der [Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Wolffenbuttel, Bruce H.R. [Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Oosting, Sjoukje F. [Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Schilstra, Cornelis [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Langendijk, Johannes A., E-mail: j.a.langendijk@umcg.nl [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

    2012-11-01

    Purpose: To establish a multivariate normal tissue complication probability (NTCP) model for radiation-induced hypothyroidism. Methods and Materials: The thyroid-stimulating hormone (TSH) level of 105 patients treated with (chemo-) radiation therapy for head-and-neck cancer was prospectively measured during a median follow-up of 2.5 years. Hypothyroidism was defined as elevated serum TSH with decreased or normal free thyroxin (T4). A multivariate logistic regression model with bootstrapping was used to determine the most important prognostic variables for radiation-induced hypothyroidism. Results: Thirty-five patients (33%) developed primary hypothyroidism within 2 years after radiation therapy. An NTCP model based on 2 variables, including the mean thyroid gland dose and the thyroid gland volume, was most predictive for radiation-induced hypothyroidism. NTCP values increased with higher mean thyroid gland dose (odds ratio [OR]: 1.064/Gy) and decreased with higher thyroid gland volume (OR: 0.826/cm{sup 3}). Model performance was good with an area under the curve (AUC) of 0.85. Conclusions: This is the first prospective study resulting in an NTCP model for radiation-induced hypothyroidism. The probability of hypothyroidism rises with increasing dose to the thyroid gland, whereas it reduces with increasing thyroid gland volume.

  19. "Subclinical" laminitis in dairy cattle.

    Science.gov (United States)

    Vermunt, J J

    1992-12-01

    In dairying countries worldwide, the economic importance of lameness in cattle is now recognised. Laminitis is regarded as a major predisposing factor in lameness caused by claw disorders such as white zone lesions, sole ulcer, and heel horn erosion. The existence of subclinical laminitis was first suggested in the late 1970s by Dutch workers describing the symptoms of sole haemorrhages and yellowish-coloured, soft sole horn. In an attempt to clarify some of the confusing and often conflicting terminology, the literature on laminitis is reviewed. Disturbed haemodynamics, in particular repeated or prolonged dilation of arteriovenous anastomoses, have been implicated in the pathogenesis of both equine and bovine laminitis. Some characteristics of the vascular system of the bovine claw which may be of importance in the pathophysiology of the subclinical laminitis syndrome are therefore discussed. Clinical observations suggest that subclinical laminitis is a multifactorial disease. The different factors that are or may be involved in its aetiology vary in complexity and severity according to the management protocol of the animals. The possible involvement of subclinical laminitis in claw lesions is assessed.

  20. Genetics of Primary Congenital Hypothyroidism

    NARCIS (Netherlands)

    Zwaveling-Soonawala, Nitash; van Trotsenburg, Paul

    2018-01-01

    Congenital hypothyroidism (CH) is one of the most common preventable forms of mental retardation and since the implementation of neonatal screening programs in the mid-1970s, early detection and treatment have proven to be very successful in preventing brain damage. CH may be of thyroidal (=

  1. Depression and anxiety in hypothyroidism.

    Science.gov (United States)

    Demet, M M; Ozmen, B; Deveci, A; Boyvada, S; Adiguzel, H; Aydemir, O

    2003-09-01

    The aim of the study was to determine the prevalence and severity of depression and anxiety in patients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used. There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyrodism. However, depression was more significant in the hypothyroid than euthyroid group.

  2. Test-day records as a tool for subclinical ketosis detection

    OpenAIRE

    Gantner Vesna; Potočnik K.; Jovanovac Sonja

    2009-01-01

    The prevalence, as well as the effect of subclinical ketosis on daily milk yield, was observed using 1.299,630 test-day records collected from January 2000 to December 2005 on 73,255 Slovenian Holstein cows. Subclinical ketosis was indicated by the fat to protein ratio (F/P ratio) higher than 1.5 in cows that yielded between 33 to 50 kg of milk per day (Eicher, 2004). The ketosis index was defined in relation to the timing of subclinical ketosis detection to the subsequent measures of test-da...

  3. Association between the clinical classification of hypothyroidism and reduced TSH in LT4 supplemental replacement treatment for pregnancy in China.

    Science.gov (United States)

    Zhang, Lyu; Zhang, Zhaoyun; Ye, Hongying; Zhu, Xiaoming; Li, Yiming

    2016-01-01

    The study was aimed to evaluate the effects of levothyroxine (LT4) supplemental replacement treatment for pregnancy and analyze the associations between the clinical classification of hypothyroidism and reduced thyroid-stimulating hormone (TSH) in LT4 therapy. Totally, 195 pregnant women with hypothyroidism receiving routine prenatal care were enrolled. They were categorized into three groups: overt hypothyroidism (OH), subclinical hypothyroidism (SCH) with negative thyroperoxidase antibody (TPOAb), and SCH with positive TPOAb. The association between the clinical classification and reduced TSH in LT4 supplemental replacement treatment was assessed. The results indicated that reduced TSH was significantly different among the groups according to the clinical classifications (p = 0.043). The result was also significantly different between patients with OH and patients with SCH and negative TPOAb (p = 0.036). Similar result was reported for the comparison between patients with OH and patients with SCH and positive TPOAb (p = 0.016). Multiple variable analyses showed that LT4 supplementation, gestational age and the variable of clinical classifications were associated with reduced TSH independently. Our data suggested that the therapeutic effect of substitutive treatment with LT4 was significantly associated with different clinical classifications of hypothyroidism in pregnancy and the treatment should begin as soon as possible after diagnosis.

  4. ISOLATED HYDROPERICARDIUM – THE IMPLICATION OF LATE DIAGNOSIS OF PRIMARY HYPOTHYROIDISM

    Directory of Open Access Journals (Sweden)

    Snitko V. N.

    2018-02-01

    Full Text Available Background. In therapeutic practice the diagnostics of hypothyroidism can be difficult due to its non-specific nature and symptoms diversity. Goal. To present the result of successful diagnostics and treatment of primary hypothyroidism, where hydropericardium was defined as the main symptom of the disease. Material and methods. A case of late diagnosis of primary hypothyroidism in a female aged 50 with hydropericardium is described. The tactics of examination of the patient according to the recommendations of the European Society of Cardiology (2015 with the purpose of excluding metabolic causes of pericardial effusion is presented. Results. The ignoring of the most frequent symptoms of hypothyroidism was found to be the reason for late diagnostics of the disease, hydropericardium being considered the primary disease. Conclusions. In order to exclude metabolic causes of pericardial effusion during the examination of patients with the diseases of pericardium, evaluation of the thyroid function is warranted.

  5. Subclinical pulmonary involvement in collagen vascular diseases

    International Nuclear Information System (INIS)

    Dansin, E.; Wallaert, B.; Jardin, M.R.; Remy, J.; Hatron, P.Y.; Tonnel, A.B.

    1990-01-01

    A recruitment of immune and inflammatory cells into alveolar spaces has been reported in patients with collagen vascular diseases (CVD) and a normal chest radiograph. These findings defined the concept of subclinical alveolitis (SCA). To determine whether SCA may be associated with CT signs of interstitial lung disease (ILD), the authors of this paper compared bronchoalveolar lavage (BAL) findings and high-resolution (HRCT) scans in 36 patients with CVD and normal chest radiographs (systemic sclerosis [SS, n = 21], rheumatoid arthritis [RA, n = 9], primary Sjogren's syndrome [PS, n = 6]). HRCT scans were obtained in supine and prone positions. Results of BAL revealed SCA in 17/36 patients (47%); lymphocyte SCA in 4/36 (24%); neutrophil SCA in 7/36 (41%); and mixed SCA in 6/36 (35%)

  6. Dosimetric predictors of hypothyroidism in oropharyngeal cancer patients treated with intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Chyan, Arthur; Chen, Josephine; Shugard, Erin; Lambert, Louise; Quivey, Jeanne M; Yom, Sue S

    2014-01-01

    Radiation to the neck has long been associated with an elevated risk of hypothyroidism development. The goal of the present work is to define dosimetric predictors of hypothyroidism in oropharyngeal cancer (OPC) patients treated with intensity-modulated radiation therapy. Data for 123 patients, with a median follow up of 4.6 years, were retrospectively analyzed. Patients with elevated thyroid-stimulating hormone levels or with a clinical diagnosis were categorized as hypothyroid. Patient demographic parameters, thyroid volume, mean thyroid dose, the percent of thyroid volume receiving minimum specified dose levels (VxxGy), and the absolute thyroid volume spared from specified dose levels (VSxxGy) were analyzed. Normal-tissue complication probability (NTCP) was also calculated using several recently published models. Thyroid volume and many radiation dosimetric parameters were statistically different in the hypothyroid group. For the patients with initial thyroid volumes of 8 cc or greater, several dosimetric parameters were found to define subgroups at statistically significant lower risk of developing hypothyroidism. Patients with VS45 Gy of at least 3 cc, VS50 Gy at least 5 cc, VS50 Gy at least 6 cc, V50 Gy below 45%, V50 Gy below 55%, or mean thyroid dose below 49 Gy had a 28-38% estimated risk of hypothyroidism at 3 years compared to a 55% risk for the entire study group. Patients with a NTCP of less than 0.75 or 0.8, calculated using recently published models, were also observed to have a lower risk of developing hypothyroidism. Based on long-term follow up data for OPC patients treated with IMRT, we recommend plan optimization objectives to reduce the volume of thyroid receiving over 45 Gy to significantly decrease the risk of developing hypothyroidism. The online version of this article (doi:10.1186/s13014-014-0269-4) contains supplementary material, which is available to authorized users

  7. Hypothyroidism: The Thyroid and You | NIH Medlineplus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Hypothyroidism The Thyroid and You: Coping with a Common ... is made by the pituitary gland. What is hypothyroidism? Hypothyroidism is a condition in which the thyroid ...

  8. Hypothyroidism:Symptoms,Diagnosis and Treatment | NIH Medlineplus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Hypothyroidism Hypothyroidism: Symptoms, Diagnosis & Treatment Past Issues / Spring 2012 Table ... of its symptoms are seen in other diseases, hypothyroidism usually cannot be diagnosed based on symptoms alone. ...

  9. Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis.

    Directory of Open Access Journals (Sweden)

    Itxaso González-Ortega

    Full Text Available Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use.64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a patients with subclinical depressive symptoms at least once during follow-up (DPG, and (b patients without subclinical depressive symptoms during follow-up (NDPG. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS, depressive symptoms using the Hamilton Depression Rating Scale (HDRS-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF. A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome.Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001 and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009.Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.

  10. An observational study of the initial management of hypothyroidism in France: the ORCHIDÉE study

    Science.gov (United States)

    Delemer, Brigitte; Aubert, Jean-Pierre; Nys, Pierre; Landron, Frédéric; Bouée, Stéphane

    2012-01-01

    Objective To document the initial management of hypothyroidism in France with respect to diagnostic setting, investigations, and therapeutic approach. Design Observational study of the management by primary care practitioners (PCPs) and endocrinologists of patients diagnosed with, and treated for, hypothyroidism during the enrollment period or the previous 6 months. Methods A representative sample of PCPs and endocrinologists enrolled up to five consecutive patients and reported sociodemographic, clinical, therapeutic, and laboratory data. Data were submitted at baseline and at the first measurement of TSH after starting the treatment. Results The analysis population comprised 1255 patients (mean (s.d.) age 52.8 (16.3) years; 84% female). Hypothyroidism was suspected on clinical grounds in 77% of patients, with goiter in 16%. Autoimmune thyroiditis, supported by positive anti-thyroid antibodies, was the most frequent diagnosis (59%), followed by iatrogenic causes (28%), of which thyroidectomy was the most common. The median baseline TSH was 8.6 mIU/l, suggesting a high incidence of subclinical hypothyroidism. Imaging studies were requested in over 75% of patients, with ultrasound performed in 98% and scintigraphy performed in 19% of these patients. Both groups of physicians treated their patients almost exclusively with levothyroxine. Endocrinologists were more likely than PCPs to provide counseling on how to take medication correctly. Conclusions This observational study of a large cohort of patients with newly diagnosed hypothyroidism in France illustrates current practice and indicates some areas where physician education may be required to optimize adherence to guidelines and cost-effectiveness. PMID:23034782

  11. Platysmal myoclonus in subclinical hyperthyroidism.

    Science.gov (United States)

    Teoh, Hock-Luen; Lim, Erle Chuen-Hian

    2005-08-01

    Hyperthyroidism is associated with various movement disorders, such as chorea and tremors. We report on a young Chinese woman with an unusual presentation of myoclonus, involving both platysmal muscles, in association with subclinical hyperthyroidism. The myoclonus was preceded by symptoms of hyperthyroidism, namely weight loss, menstrual disturbances, and heat intolerance. The movements abated with clonazepam and hyperthyroidism was treated with carbimazole. The myoclonus recurred briefly when she stopped taking clonazepam, but she has since remained well and euthyroid. Copyright 2005 Movement Disorder Society

  12. Conversion of autoimmune hypothyroidism to hyperthyroidism

    OpenAIRE

    Furqan, Saira; Haque, Naeem-ul; Islam, Najmul

    2014-01-01

    Background Graves’ disease and Hashimoto’s thyroiditis are the two autoimmune spectrum of thyroid disease. Cases of conversion from hyperthyroidism to hypothyroidism have been reported but conversion from hypothyroidism to hyperthyroidism is very rare. Although such cases have been reported rarely in the past we are now seeing such conversions from hypothyroidism to hyperthyroidism more frequently in clinical practice. Case presentation We are reporting three cases of middle aged Asian female...

  13. Hypothyroidism - new aspects of an old disease

    OpenAIRE

    Kostoglou-Athanassiou, I; Ntalles, K

    2010-01-01

    Hypothyroidism is divided in primary, caused by failure of thyroid function and secondary (central) due to the failure of adequate thyroid-stimulating hormone (TSH) secretion from the pituitary gland or thyrotrophin-releasing hormone (TRH) from the hypothalamus. Secondary hypothyroidism can be differentiated in pituitary and hypothalamic by the use of TRH test. In some cases, failure of hormone action in peripheral tissues can be recognized. Primary hypothyroidism may be clinical, where free ...

  14. The Treatment of Hypothyroidism in Pregnancy

    OpenAIRE

    Miulescu Rucsandra Dănciulescu; Mihai Andrada Doina

    2017-01-01

    Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Gu...

  15. A Prospective Study of Routine Screening of Hypothyroidism in Antenatal Patients and their Outcome with Levothyroxine Treatment

    Directory of Open Access Journals (Sweden)

    Manisha Sahu

    2017-10-01

    Full Text Available Introduction: Pregnancy with hypothyroidism is associated with significant maternal, fetal and neonatal complications. Early diagnosis and treatment can effectively reduce such complications. Aim: To find out the complications that can be prevented or reduced in severity in adequately treated hypothyroid pregnant women. Materials and Methods: Pregnant women attending obstetrics’ OPD upto 20 weeks were screened with serum Thyroid Stimulating Hormone (TSH and free Thyroxine FT4. Those having Subclinical Hypothyroidism (SCH, Overt Hypothyroidism (OH and pre pregnant women with hypothyroid were treated with levothyroxine as per consulting with endocrine unit. They were followed up till delivery and any adverse outcomes were documented such as Pregnancy Induced Hypertension (PIH, Pre Eclamptic Toxemia (PET, Abruption, Preterm Premature Rupture Of Membranes (PPROM, Low Birth Weight (LBW, oligohydramnios, Gestational Diabetes Mellitus (GDM, abortion, Intra Uterine Death (IUD, mode of delivery and Neonatal Intensive Care Unit (NICU admission were compared with similar complications documented among normal pregnant women excluding the treated hypothyroid during a period of one year study. Untreated or late trimester diagnosed hypothyroidism were excluded from study group. Results: Incidence of PIH, GDM, Oligohydramnios, PPROM, NICU admissions and caesarean section were higher among hypothyroid pregnant women though adequately treated than the control pregnant women. But incidence of LBW baby is less and no one had developed PET, Eclampsia or abruption among treated group. Comparing between SCH and OH incidence of PIH is almost equal in both while association of GDM is more in OH. A p-value for PIH, GDM, Oligohydramnios, PPROM developed in hypothyroid pregnant ladies which were calculated by Yates corrected Chi-Square and Fisher’s-exact test from open epic version 3.03a. A p-value is significant (<0.001 for PIH, GDM, PPROM and oligohydramnios but

  16. Improved endothelial function and lipid profile compensate for impaired hemostatic and inflammatory status in iatrogenic chronic subclinical hyperthyroidism of thyroid cancer patients on L-t4 therapy.

    Science.gov (United States)

    Gazdag, A; Nagy, E V; Burman, K D; Paragh, G; Jenei, Z

    2010-06-01

    We aimed to compare the changes of endothelial function and haemostatic, inflammatory and metabolic parameters of short-term iatrogenic hypothyroidism to the characteristics of subclinical hyperthyroidism in patients with differentiated thyroid cancer. Twenty four women (mean age 42.4+/-8.1 years) had undergone total thyroidectomy and radioiodine ablation in treatment for differentiated thyroid cancer. We measured serum thyroglobulin, thyroid function, plasma levels of lipid parameters, homocystine, C-reactive protein, fibrinogen, von Willebrandt factor activity (vWF), nitric oxide, as well as flow-mediated vasodilatation (FMD) and nitroglycerin-mediated vasodilatation of the brachial artery during iatrogenic hypothyroidism (TSH 89.82+/-29.36 mU/L) and again in the same patients during subclinical hyperthyroidism secondary to exogenous levothyroxine administration (TSH 0.24+/-0.11 mU/L). In hypothyroidism, FMD was markedly lower than in subclinical hyperthyroidism (6.79+/-4.44 vs. 14.37+/-8.33%, phyperthyroidism was associated with improved endothelial function and lipid profile, while haemostatic and inflammatory parameters were impaired. The two opposite mechanisms may well compensate for each other at the level of the vessel wall. (c) J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart, New York.

  17. Clinical presentation of primary hypothyroidism

    International Nuclear Information System (INIS)

    Ahmed, B.; Hussain, T.; Memon, A. R.; Solangi, G. A.

    2001-01-01

    Objective: To determine the clinical preparation of primary hypothyroidism at the time of diagnosis. Design: It was an observational and prospective study. Place and Duration of Study: Civil Hospital, Karachi from 1st January 1997 to 31st December 1997. Subjects and Methods: Forty-eight consecutive cases of primary hypothyroidism were included. A detailed history with special emphasis on symptoms and signs was conducted and the findings observed were noted in previously made proforma. Results: Primary hypothyroidism was found to be 5 times more common in female patients, with male to female ratio 1:5, majority of cases (33.33%) were between 41 to 50 years of age. The common symptoms at the time of presentation were tiredness (95.8%), weakness (91.6%), weight gain (85.4%), hoarseness of voice (83.3%), cold intolerance (77.0%) and constipation (75.0%) in patients. Physical signs observed were delayed relaxation of ankle jerk (93.7%), periorbital edema (83.3%), thick tongue (62.5%), goiter (50.0%), dry and coarse skin (47.9%) in patients. Serum, TSH, T4 and T3 were performed in all cases through immunoradiometric technique. Serum TSH was markedly elevated, with normal to reduced T4 and T3 levels in all cases. Conclusion: Primary hypothyroidism was found more common in female than male of the age group 41-50 years. Weakness, tiredness, hoarseness of voice and constipation were the common symptoms noted. The diagnosis is almost certain on clinical grounds if the patient happens to have delayed relaxation of ankle jerks and periorbital puffiness. (author)

  18. A stepwise approach to the evaluation and treatment of subclinical hyperthyroidism.

    Science.gov (United States)

    Mai, Vinh Q; Burch, Henry B

    2012-01-01

    To review a stepwise approach to the evaluation and treatment of subclinical hyperthyroidism. English-language articles regarding clinical management of subclinical hyperthyroidism published between 2007 and 2012 were reviewed. Subclinical hyperthyroidism is encountered on a daily basis in clinical practice. When evaluating patients with a suppressed serum thyrotropin value, it is important to exclude other potential etiologies such as overt triiodothyronine toxicosis, drug effect, nonthyroidal illness, and central hypothyroidism. In younger patients with mild thyrotropin suppression, it is acceptable to perform testing again in 3 to 6 months to assess for persistence before performing further diagnostic testing. In older patients or patients with thyrotropin values less than 0.1 mIU/L, diagnostic testing should proceed without delay. Persistence of thyrotropin suppression is more typical of nodular thyroid autonomy, whereas thyroiditis and mild Graves disease frequently resolve spontaneously. The clinical consequences of subclinical hyperthyroidism, such as atrial dysrhythmia, accelerated bone loss, increased fracture rate, and higher rates of cardiovascular mortality, are dependent on age and severity. The decision to treat subclinical hyperthyroidism is directly tied to an assessment of the potential for clinical consequences in untreated disease. Definitive therapy is generally selected for patients with nodular autonomous function, whereas antithyroid drug therapy is more appropriate for mild, persistent Graves disease. The presented stepwise approach to the care of patients presenting with an isolated suppression of serum thyrotropin focuses on the differential diagnosis, a prediction of the likelihood of persistence, an assessment of potential risks posed to the patient, and, finally, a personalized choice of therapy.

  19. Central hypothyroidism - a neglected thyroid disorder.

    Science.gov (United States)

    Beck-Peccoz, Paolo; Rodari, Giulia; Giavoli, Claudia; Lania, Andrea

    2017-10-01

    Central hypothyroidism is a rare and heterogeneous disorder that is characterized by a defect in thyroid hormone secretion in an otherwise normal thyroid gland due to insufficient stimulation by TSH. The disease results from the abnormal function of the pituitary gland, the hypothalamus, or both. Moreover, central hypothyroidism can be isolated or combined with other pituitary hormone deficiencies, which are mostly acquired and are rarely congenital. The clinical manifestations of central hypothyroidism are usually milder than those observed in primary hypothyroidism. Obtaining a positive diagnosis for central hypothyroidism can be difficult from both a clinical and a biochemical perspective. The diagnosis of central hypothyroidism is based on low circulating levels of free T 4 in the presence of low to normal TSH concentrations. The correct diagnosis of both acquired (also termed sporadic) and congenital (also termed genetic) central hypothyroidism can be hindered by methodological interference in free T 4 or TSH measurements; routine utilization of total T 4 or T 3 measurements; concurrent systemic illness that is characterized by low levels of free T 4 and normal TSH concentrations; the use of the sole TSH-reflex strategy, which is the measurement of the sole level of TSH, without free T 4 , if levels of TSH are in the normal range; and the diagnosis of congenital hypothyroidism based on TSH analysis without the concomitant measurement of serum levels of T 4 . In this Review, we discuss current knowledge of the causes of central hypothyroidism, emphasizing possible pitfalls in the diagnosis and treatment of this disorder.

  20. Recurrent thyrotoxicosis after I-131 induced hypothyroidism

    International Nuclear Information System (INIS)

    Liu, L.; Borowski, G.D.; Shtasel, P.; Rose, L.I.

    1984-01-01

    The first clinically and biochemically documented case of recurrent thyrotoxicosis after I-131 induced hypothyroidism in a patient with Graves' disease is reported. Two months after the administration of 9.2 mCi of I-131, the subject developed hypothyroidism. One month later, the patient became euthyroid. Then, nine months following ablation, the patient again developed thyrotoxicosis. A second dose of I-131 of 12.5 mCi was required to finally produce permanent hypothyroidism. This case illustrates the recurrence of hypothyroidism after what had seemed to have been adequate I-131 radiation

  1. Experimental models of developmental hypothyroidism.

    Science.gov (United States)

    Argumedo, G S; Sanz, C R; Olguín, H J

    2012-02-01

    Hypothyroidism is a systemic disease resulting from either thyroid gland's anatomical and functional absence or lack of hypophyseal stimulation, both of which can lead to deficiency in thyroid hormone (TH) production. TH is essential for human and animal development, growth, and function of multiple organs. Children with deficient TH can develop alterations in central nervous system (CNS), striated muscle, bone tissue, liver, bone marrow, and cardiorespiratory system. Among the clinical outlook are signs like breathing difficulty, cardiac insufficiency, dysphagia, and repeated bronchial aspiration, constipation, muscle weakness, cognitive alterations, cochlear dysfunction, reduced height, defects in temperature regulation, anaemia, jaundice, susceptibility to infection, and others. Experimental and clinical studies have shown that TH is very essential for normal brain development. Other research work based on mice pointed out that a reduced level of TH in pregnant mother leads to congenital hypothyroidism in animal models and it is associated with mental retardation, deep neurologic deficiency that impacts on cognitive, learning, and memory functions. The principal experimental model studies that have focused on hypothyroidism are reviewed in this study. This is important on considering the fact that almost all animal species require thyroid hormones for their metabolism. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Reversible hypothyroidism and Whipple's disease

    Directory of Open Access Journals (Sweden)

    Tran Huy A

    2006-05-01

    Full Text Available Abstract Background The major cause of primary hypothyroidism is autoimmune mediated with progressive and permanent destruction of the thyroid gland resulting in life-long replacement therapy. Treatable and reversible hypothyroidism is unusual and here forth is such a case due to infection of the thyroid gland with Tropheryma whippleii, Whipple disease. Case presentation A 45 year-old female presented with symptoms and signs consistent with primary hypothyroidism, which was also confirmed biochemically. Her response to thyroxine replacement therapy was poor however, requiring a significantly elevated amount. Further investigation revealed the presence of Whipple's disease involving the gastrointestinal trace and possibly the thyroid gland. Her thyroxine requirement decreased drastically following appropriate antimicrobial therapy for Whipple's disease to the extent that it was ceased. Thyrotropin releasing hormone testing in the steady state suggested there was diminished thyroid reserve due to Whipple's disease. Conclusion This is the first ante-mortem case report studying the possible involvement of the thyroid gland by Whipple's disease. Despite the normalization of her thyroid function test biochemically after antibiotic therapy, there is diminished thyroid reserve thus requiring close and regular monitoring.

  3. Six controversial issues on subclinical Cushing's syndrome.

    Science.gov (United States)

    Chiodini, Iacopo; Albani, Adriana; Ambrogio, Alberto Giacinto; Campo, Michela; De Martino, Maria Cristina; Marcelli, Giorgia; Morelli, Valentina; Zampetti, Benedetta; Colao, Annamaria; Pivonello, Rosario

    2017-05-01

    Subclinical Cushing's syndrome is a condition of hypercortisolism in the absence of signs specific of overt cortisol excess, and it is associated with an increased risk of diabetes, hypertension, fragility fractures, cardiovascular events and mortality. The subclinical Cushing's syndrome is not rare, being estimated to be between 0.2-2 % in the adult population. Despite the huge number of studies that have been published in the recent years, several issues remain controversial for the subclinical Cushing's syndrome screening, diagnosis and treatment. The Altogether to Beat Cushing's syndrome Group was founded in 2012 for bringing together the leading Italian experts in the hypercortisolism-related diseases. This document represents the Altogether to Beat Cushing's syndrome viewpoint regarding the following controversial issues on Subclinical Cushing's syndrome (SCS): (1) Who has to be screened for subclinical Cushing's syndrome? (2) How to screen the populations at risk? (3) How to diagnose subclinical Cushing's syndrome in patients with an adrenal incidentaloma? (4) Which consequence of subclinical Cushing's syndrome has to be searched for? (5) How to address the therapy of choice in AI patients with subclinical Cushing's syndrome? (6) How to follow-up adrenal incidentaloma patients with subclinical Cushing's syndrome surgically or conservatively treated? Notwithstanding the fact that most studies that faced these points may have several biases (e.g., retrospective design, small sample size, different criteria for the subclinical Cushing's syndrome diagnosis), we believe that the literature evidence is sufficient to affirm that the subclinical Cushing's syndrome condition is not harmless and that the currently available diagnostic tools are reliable for identifying the majority of individuals with subclinical Cushing's syndrome.

  4. Subclinical organ damage and cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Olsen, Michael H

    2010-01-01

    Traditional cardiovascular risk factors have poor prognostic value for individuals and screening for subclinical organ damage has been recommended in hypertension in recent guidelines. The aim of this review was to investigate the clinical impact of the additive prognostic information provided...... by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii...

  5. Acute myocardial infarction without significant coronary stenoses associated with endogenous subclinical hyperthyroidism.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

    2012-04-05

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. Nowadays, there is growing interest regarding endogenous sublinical hyperthyroidism and the cardiovascular system. We present a case of acute myocardial infarction without significant coronary stenoses in a 75-year-old Italian woman with endogenous subclinical hyperthyroidism. Also this case focuses attention on the importance of a correct evaluation of endogenous subclinical hyperthyroidism. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  6. Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review

    International Nuclear Information System (INIS)

    Boomsma, Marjolein J.; Bijl, Hendrik P.; Langendijk, Johannes A.

    2011-01-01

    Purpose: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults. Material and Methods: Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review. Results: The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70 Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies. Conclusions: Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.

  7. Predictors of Hypothyroidism in Hodgkin Lymphoma Survivors After Intensity Modulated Versus 3-Dimensional Radiation Therapy.

    Science.gov (United States)

    Pinnix, Chelsea C; Cella, Laura; Andraos, Therese Y; Ayoub, Zeina; Milgrom, Sarah A; Gunther, Jillian; Thosani, Sonali; Wogan, Christine; Conson, Manuel; D'Avino, Vittoria; Oki, Yasuhiro; Fanale, Michelle; Lee, Hun J; Neelapu, Sattva; Fayad, Luis; Hagemeister, Frederick; Rodriguez, M Alma; Nastoupil, Loretta J; Nieto, Yago; Qiao, Wei; Pacelli, Roberto; Dabaja, Bouthaina

    2018-03-14

    To identify predictors of hypothyroidism after chemoradiation therapy for Hodgkin lymphoma (HL) and to compare outcomes after intensity modulated radiation therapy (IMRT) with those after 3-dimensional (3D) conformal radiation therapy (CRT). Ninety patients who underwent involved-site IMRT in 2009 through 2014 were evaluated for treatment-induced hypothyroidism, defined as elevated thyroid-stimulating hormone or decreased free thyroxine levels (or both). Receiver operating characteristic curve analysis identified individuals at low versus high risk based on dosimetric variables. Dosimetric cutoff points were verified with an external data set of 50 patients who underwent 3D-CRT. In the IMRT group, most patients (75 [83%]) had stage II HL, and the median prescribed dose was 30.6 Gy; in the 3D-CRT group, 32 patients (64%) had stage II HL, and the median prescribed dose was 32.0 Gy. No differences were found in the proportions of patients with bilateral (P = .982) or unilateral (P = .074) neck involvement between the 2 groups. Hypothyroidism rates were marginally higher in the IMRT group, with estimated 3-year rates of freedom from hypothyroidism of 56.1% in the 3D-CRT group and 40% in the IMRT group (P = .057). Univariate analysis showed that smaller thyroid volume and higher thyroid dose were associated with hypothyroidism in both groups (P hypothyroidism (P = .001 and P hypothyroidism (P hypothyroidism after either IMRT or 3D-CRT for HL. IMRT may confer a higher risk than 3D-CRT unless a treatment avoidance structure is used during planning. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Post-external radiotherapy hypothyroidism: 15 cases

    International Nuclear Information System (INIS)

    Kaffel, N.; Mnif, M.; Abid, M.; Daoud, J.

    2001-01-01

    Post-external radiotherapy hypothyroidism: 15 cases. Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infra-clinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck. (authors)

  9. Rhabdomyolysis in a Patient with Severe Hypothyroidism

    OpenAIRE

    Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J.

    2017-01-01

    Patient: Female, 52 Final Diagnosis: Hypothyroidism induced rhabdomyolysis Symptoms: Bilateral leg pain ? fatigue Medication: Levothyroxine ? Calcitriol ? Calcium Gluconate Clinical Procedure: ? Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare...

  10. Hypothyroidism in late-onset Pompe disease

    Directory of Open Access Journals (Sweden)

    Joseph Schneider

    2016-09-01

    Conclusions: Hypothyroidism was found at a higher prevalence in patients with late-onset Pompe disease compared to the general adult population at UMMC. Studies in larger populations of patients with Pompe disease would be needed to confirm an association of Pompe disease and hypothyroidism. Challenges include finding an adequate sample size, due the rarity of Pompe disease.

  11. Rhabdomyolysis in a Patient with Severe Hypothyroidism

    Science.gov (United States)

    Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J.

    2017-01-01

    Patient: Female, 52 Final Diagnosis: Hypothyroidism induced rhabdomyolysis Symptoms: Bilateral leg pain • fatigue Medication: Levothyroxine • Calcitriol • Calcium Gluconate Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients with hypothyroidism who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. Case Report: We report a case of a 52-year-old Hispanic woman with a history of hypothyroidism, hypertension, and type 2 diabetes mellitus who presented with fatigue, severe generalized weakness, bilateral leg pain, and recurrent falls. She reported poor medication compliance for the preceding month. Initial laboratory testing showed elevated thyroid stimulating hormone (TSH) and creatine kinase (CK) levels, indicating uncontrolled hypothyroidism with associated rhabdomyolysis. Supportive treatment with intravenous fluids and intravenous levothyroxine were initiated and resulted in dramatic clinical improvement. Conclusions: We report a case of rhabdomyolysis, which is a rare but potentially serious complication of hypothyroidism. Screening for hypothyroidism in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment of hypothyroidism is essential to prevent rhabdomyolysis and its consequences. PMID:28827517

  12. Prognostic Role of Hypothyroidism in Heart Failure

    Science.gov (United States)

    Ning, Ning; Gao, Dengfeng; Triggiani, Vincenzo; Iacoviello, Massimo; Mitchell, Judith E.; Ma, Rui; Zhang, Yan; Kou, Huijuan

    2015-01-01

    Abstract Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive. We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. We searched MEDLINE via PubMed, EMBASE, and Scopus databases for studies of hypothyroidism and clinical outcomes in patients with HF published up to the end of January 2015. Random-effects models were used to estimate summary relative risk (RR) statistics. We included 13 articles that reported RR estimates and 95% confidence intervals (95% CIs) for hypothyroidism with outcomes in patients with HF. For the association of hypothyroidism with all-cause mortality and with cardiac death and/or hospitalization, the pooled RR was 1.44 (95% CI: 1.29–1.61) and 1.37 (95% CI: 1.22–1.55), respectively. However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90–1.52) and in studies of patients with mean age hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF. PMID:26222845

  13. Transient hypothyroidism following radioiodine therapy for thyrotoxicosis

    International Nuclear Information System (INIS)

    Connell, J.M.C.; McCruden, D.C.; Alexander, W.D.; Hilditch, T.E.

    1983-01-01

    A prospective study of thyroid function including serial tracer radioisotope uptake measurements in 55 patients treated with 131 I therapy is described. Five patients had an episode of transient hypothyroidism within eight months of treatment: in three of these patients this was due to impaired organification of iodide, with normal iodide trapping by the thyroid (as measured by a twenty minute 123 I uptake) being preserved. In contrast, in all patients who developed permanent hypothyroidism, iodide trapping was markedly diminished and did not recover. It is suggested that hypothyroidism due to organification failure following 131 I therapy is potentially short-lived; where hypothyroidism is associated with gross impairment of iodide trapping, recovery is unlikely. Early iodine uptake measurements may be of value in selecting those patients whose hypothyroidism is transient and who do not require permanent thyroid hormone replacement. (author)

  14. Radioimmunoassay of luteinizing hormone in hypothyroidism

    International Nuclear Information System (INIS)

    Sobieszczyk, S.

    1975-01-01

    Radioimmunoassay of luteinizing hormone was performed in 18 women with primary hypothyroidism and 15 women with secondary hypothyroidism. The results of determinations were compared with LH values found in healthy women at reproductive age and after menopause. It was observed that in primary hypothyroidism the level of LH is normal, in young women it was from 6 to 25 m IU/ml, while in the postmenopausal period it increased to 70 to 200 m IU/ml. In secondary hypothyroidism due to pituitary hypofunction the LH level is undetectable or lies in the range of lowest values observed in healthy subjects, not exceeding 8 m IU/ml. Determinations of serum LH may be useful for differential diagnosis of primary and secondary hypothyroidism. (author)

  15. Verbal episodic memory in young hypothyroid patients

    Directory of Open Access Journals (Sweden)

    Vatsal Priyadarshi Pandey

    2017-01-01

    Full Text Available Context: Hypothyroidism affects cognitive functions especially memory. However, most of the previous studies have generally evaluated older hypothyroid patients and sample size of these studies varied in terms of age range. Aims: To see whether hypothyroidism affects memory in young patients. Settings and Design: The sample consisted of 11 hypothyroid patients with an age of 18–49 and 8 healthy controls matched on age and education. Subjects and Methods: Verbal episodic memory was assessed using Hindi adaptation of Rey-Auditory Verbal Learning Test. Statistical Analysis Used: An independent t-test was used to see the difference between mean performance of the patient group and healthy control on memory measures. Results: Results indicated nonsignificant difference between verbal episodic memory of patient group and healthy controls. Conclusions: On the basis of these findings, it was concluded that hypothyroidism may not affect younger patients in terms of episodic verbal memory the same way as it does in the older patients.

  16. Excess mortality in patients diagnosed with hypothyroidism

    DEFF Research Database (Denmark)

    Thvilum, Marianne; Brandt, Frans; Pedersen, Dorthe Almind

    2013-01-01

    Background: Although hypothyroidism is associated with increased morbidity, an association with increased mortality is still debated. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism influences mortality. Methods: In an observational cohort study from...... January 1, 1978 until December 31, 2008 using record-linkage data from nationwide Danish health registers, 3587 singletons and 682 twins diagnosed with hypothyroidism were identified. Hypothyroid individuals were matched 1:4 with nonhypothyroid controls with respect to age and gender and followed over...... a mean period of 5.6 years (range 0-30 years). The hazard ratio (HR) for mortality was calculated using Cox regression analyses. Comorbidity was evaluated using the Charlson score (CS). Results: In singletons with hypothyroidism, the mortality risk was increased (HR 1.52; 95% confidence interval [CI]: 1...

  17. Thyroid stimulating hormone and subclinical thyroid dysfunction

    International Nuclear Information System (INIS)

    Guo Yongtie

    2008-01-01

    Subclinical thyroid dysfunction has mild clinical symptoms. It is nonspecific and not so noticeable. It performs only for thyroid stimulating hormone rise and decline. The value of early diagnosis and treatment of thyroid stimulating hormone in subclinical thyroid dysfunction were reviewed. (authors)

  18. Subclinical Hypercorticism: the Necessity of Diagnostic Search

    Directory of Open Access Journals (Sweden)

    А.N. Kvacheniuk

    2016-02-01

    Full Text Available Considering certain difficulties in subclinical hypercorticism diagnosis, the object of this work is to focus attention of doctors in different areas on the necessity of thorough examination of patients with pathological conditions that may be the manifestation of Cushing’s syndrome (arterial hypertension, obesity, impaired carbohydrate metabolism and osteoporosis. The laboratory diagnosis is the instrument for early subclinical hypercorticism detection.

  19. The secondary hypothyroidism after radioiodine therapy and the replacement treatment

    International Nuclear Information System (INIS)

    Xu Ying; Xu Xiaohui

    2004-01-01

    The secondary hypothyroidism is the most important intercurrent disease after radioiodine therapy. The early hypothyroidism and the late hypothyroidism are incompletely different in pathogenesis. It needs researching further. there has not yet been an affirmable answer to choose the distillates from animal hypothyroid extract or complex preparation of levo-thyroxine in replacement treatment. (authors)

  20. The heart and hypothyroidism | Bennett | South African Medical ...

    African Journals Online (AJOL)

    The association of hypothyroidism with heart disease is reviewed. The. relative rarity of cardiac failure due to hypothyroidism is stressed, and structural abnormalities of the heart due to hypothyroidism are discussed. The clinical management of hypothyroid patients with heart disease is described.

  1. Hipertiroidismo subclínico Subclinical hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Lisbet Rodríguez Fernández

    2009-04-01

    Full Text Available El hipertiroidismo subclínico se define por la presencia de niveles disminuidos o no detectables de tirotropina, asociados a concentración de tetrayodotironina y triyodotironina libres dentro de parámetros normales. Su prevalencia en la población varía entre un 0,5 y un 16 % aproximadamente, y es el tratamiento con levotiroxina sódica la causa más frecuente. No siempre resulta tan asintomático, y las afectaciones principales ocurren sobre el sistema cardiovascular y óseo. Esta condición médica puede ser reversible espontáneamente. Por lo controversial del tema, el presente trabajo trata los aspectos clínicos más relevantes y la conducta a seguir.Subclinical hyperthyroidism is defined by presence of decreased o non-detected levels of thyrotropin, associated with free concentrations of tetraiodothyronine and triiodothyromime within normal parameters. Its prevalence in population differs between 0,5 % and 16 % approximately, and the sodium Levothyroxine treatment is the more frequent cause. Not always it is so asymptomatic, and main affections occur on cardiovascular and osseous system. This medical condition may be spontaneously reversible. Due to controversial of this topic, present paper approaching the more significant clinical features and the strategy to go on.

  2. Reversible primary hypothyroidism in Japanese patients undergoing maintenance hemodialysis.

    Science.gov (United States)

    Sanai, T; Inoue, T; Okamura, K; Sato, K; Yamamoto, K; Abe, T; Node, K; Tsuruya, K; Iida, M

    2008-02-01

    The presence or absence of hypothyroidism was assessed in 152 consecutive Japanese patients with end-stage renal disease on hemodialysis. Eight patients who had undergone treatment for thyroid disease before starting hemodialysis therapy, and 3 patients with amyloidosis due to rheumatoid arthritis were excluded. Of the remaining 141 hemodialysis patients, 14 (9.9%) (9 males and 5 females, aged 69.1 A+/- 8.8 years with a mean duration of hemodialysis of 69 A+/- 51 months) were in a hypothyroid state, defined as a thyroid-stimulating hormone (TSH) level > 5 mU/l. Antithyroid peroxidase antibodies were positive in only 1 of the 14 patients, while antithyroglobulin antibodies were negative in all of these patients. After iodide restriction, the serum TSH level decreased in all the patients from a mean of 16.49 A+/- 22.80 to 4.44 A+/- 3.35 mU/l after 1 month, 4.25 A+/- 2.24 mU/l after 2 months and 3.97 A+/- 2.22 mU/l after 3 months. The 3 months of iodide restriction were also associated with decreases in systolic blood pressure (142 A+/- 19 to 125 A+/- 16 mmHg, p patients on hemodialysis. Retention of excess iodide may be the mechanism responsible for reversible hypothyroidism rather than immunological perturbations. It is, therefore, recommended to attempt iodide restriction before starting l-thyroxine replacement therapy.

  3. Epidemic juvenile hypothyroidism among a population of Hanford 'downwinders'

    International Nuclear Information System (INIS)

    Grossman, C.M.; Nussbaum, R.H.; Nussbaum, F.D.; Kordysh, E.; Goldsmith, J.R.

    2001-01-01

    Self-defined 'downwinders' responded to questionnaires as to their health and their potential exposures to emissions from the Hanford Nuclear Facility in the U.S. The area considered was between the Cascades and the Rocky Mountains, primarily to the East and Northeast of the facility. Of 801 questionnaires, returned, 518 were from women. Of these, 210 reported that they had been diagnosed by their physicians as having hypothyroidism. 31 of the 283 men had reported being diagnosed as hypothyroid. The condition is generally found to be frequent among adult women, but is uncommon in children. 54 of the 210 cases among females were diagnosed among those less than 20 years of age, and 5 out of 31 males were found in this age range. Peak years for diagnosis among females were from 1945 to 1965, with only three juvenile cases occurring after 1970 among 80 female hypothyroid cases overall. Among males there were five juvenile cases in 1955-1960 out of 7 overall, but no juvenile cases among 24 cases at other times. The timing of the onset of this epidemic follows closely after the massive release of I 131 from the facility in 1945, so that a causal relationship is strongly suggested. The counties of residence of cases corresponds to the counties with high cumulative dose estimates in children's thyroid glands. Validation of the diagnostic criteria was checked in a sample of cases. Other types of thyroid abnormalities were also increased. One case of juvenile thyroid cancer was reported. While thyroid cancer in adults was unusually frequent, the first cases occurred in 1955 and the highest number (8) in 1985. Our findings are consistent with the clinical finding that hypothyroidism in children frequently follows radiation of the head and neck. Similarities with the Marshall Islanders exposed to the nuclear test, 'Bravo' and to those exposed near Chernobyl are discussed. (orig.)

  4. Atrial fibrillation and acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism and erythrocytosis.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo

    2010-11-05

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that sub-clinical hyperthyroidism is not associated with CHD or mortality from cardiovascular causes but is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. Moreover increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. It has been also reported an acute myocardial infarction with normal coronary arteries associated with iatrogenic hyperthyroidism and with a myocardial bridge too. It has been also reported an acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism. Furthermore it has been reported that at highly increased hematocrit levels patients may experience hyperviscosity symptoms. We present a case of atrial fibrillation and acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism and erythrocytosis. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

  5. Ocular changes in primary hypothyroidism.

    Science.gov (United States)

    Ozturk, Banu T; Kerimoglu, Hurkan; Dikbas, Oguz; Pekel, Hamiyet; Gonen, Mustafa S

    2009-12-29

    To determine the ocular changes related to hypothyrodism in newly diagnosed patients without orbitopathy. Thirty-three patients diagnosed to have primary overt hypothyroidism were enrolled in the study. All subjects were assigned to underwent central corneal thickness (CCT), anterior chamber volume, depth and angle measurements with the Scheimpflug camera (Pentacam, Oculus) and cup to disc ratio (C/D), mean retinal thickness and mean retinal nerve fiber layer (RNFL) thickness measurements with optical coherence tomography (OCT) in addition to ophthalmological examination preceeding the replacement therapy and at the 1(st), 3(rd )and 6(th )months of treatment. The mean age of the patients included in the study were 40.58 +/- 1.32 years. The thyroid hormone levels return to normal levels in all patients during the follow-up period, however the mean intraocular pressure (IOP) revealed no significant change. The mean CCT was 538.05 +/- 3.85 mu initially and demonstrated no statistically significant change as the anterior chamber volume, depth and angle measurements did. The mean C/D ratio was 0.29 +/- 0.03 and the mean retinal thickness was 255.83 +/- 19.49 mu initially and the treatment did not give rise to any significant change. The mean RNFL thickness was also stable during the control visits, so no statistically significant change was encountered. Neither hypothyroidism, nor its replacement therapy gave rise to any change of IOP, CCT, anterior chamber parameters, RNFL, retinal thickness and C/D ratio.

  6. Rhabdomyolysis in a Patient with Severe Hypothyroidism.

    Science.gov (United States)

    Salehi, Nooshin; Agoston, Endre; Munir, Iqbal; Thompson, Gary J

    2017-08-22

    BACKGROUND Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with symptomatic hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients with hypothyroidism who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. CASE REPORT We report a case of a 52-year-old Hispanic woman with a history of hypothyroidism, hypertension, and type 2 diabetes mellitus who presented with fatigue, severe generalized weakness, bilateral leg pain, and recurrent falls. She reported poor medication compliance for the preceding month. Initial laboratory testing showed elevated thyroid stimulating hormone (TSH) and creatine kinase (CK) levels, indicating uncontrolled hypothyroidism with associated rhabdomyolysis. Supportive treatment with intravenous fluids and intravenous levothyroxine were initiated and resulted in dramatic clinical improvement. CONCLUSIONS We report a case of rhabdomyolysis, which is a rare but potentially serious complication of hypothyroidism. Screening for hypothyroidism in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment of hypothyroidism is essential to prevent rhabdomyolysis and its consequences.

  7. Hypothyroidism after radiotherapy to the neck

    International Nuclear Information System (INIS)

    Yoden, Eisaku; Soejima, Toshinori; Maruta, Tsutomu; Demizu, Yusuke; Nishimura, Hideki; Ejima, Yasuo; Sasaki, Ryohei; Yamada, Kazunari; Sugimura, Kazuro

    2004-01-01

    The purpose of this study was to investigate the incidence and possible predictors of hypothyroidism after radiotherapy to the neck, focusing on radiation dose-volume factors. Thyroid function was measured in 169 patients treated with radiation ports including the thyroid, between 1989 and 2000. Hypothyroidism was determined with an endpoint of elevated serum thyroid stimulating hormone (TSH) levels >10.0 μU/ml. In 60 patients, radiation dose-volume factors were calculated; e.g., total volume of the thyroid, mean radiation dose to the thyroid, and %-volume of the thyroid which received radiation doses of no less than 10-70 Gy (V 10 -V 70 ). The evaluated risk factors for hypothyroidism included these dose-volume factors, sex, age, primary disease, combined chemotherapy, and follow-up period. Hypothyroidism was detected in 33 (19.5%) of the 169 patients. None of them had clinical symptoms of hypothyroidism. V 10 , V 20 , and V 30 seemed to be possible predictors of hypothyroidism and had a significant impact on the peak level of serum TSH. Radiation dose-volume factors of the thyroid seemed to correlate with the incidence of hypothyroidism, and V 10 , V 20 , and V 30 had a significant impact on the peak level of serum TSH. (author)

  8. Conversion of autoimmune hypothyroidism to hyperthyroidism.

    Science.gov (United States)

    Furqan, Saira; Haque, Naeem-ul; Islam, Najmul

    2014-08-03

    Graves' disease and Hashimoto's thyroiditis are the two autoimmune spectrum of thyroid disease. Cases of conversion from hyperthyroidism to hypothyroidism have been reported but conversion from hypothyroidism to hyperthyroidism is very rare. Although such cases have been reported rarely in the past we are now seeing such conversions from hypothyroidism to hyperthyroidism more frequently in clinical practice. We are reporting three cases of middle aged Asian females who presented with classical symptoms of hypothyroidism and the investigations showed elevated thyroid stimulating hormone with positive thyroid antibodies. Diagnosis of autoimmune hypothyroidism was made and thyroxine replacement therapy was initiated. Patients became asymptomatic with normalization of thyroid stimulating hormone level. After few years they developed symptoms of hyperthyroidism with suppressed thyroid stimulating hormone level. Over replacement of thyroxine was considered and the dose of thyroxine was decreased, but they remain symptomatic. After gradual decrease in the dose of thyroxine it was stopped finally. Even after few months of stopping thyroxine, the symptoms of hyperthyroidism did not improve and the biochemical and imaging modalities confirmed that the patients have developed hyperthyroidism. Anti-thyroid treatment was then started and the patients became symptom free. High index of suspicion should be there for possible conversion of hypothyroidism to hyperthyroidism if a patient with primary hypothyroidism develops persistent symptoms of hyperthyroidism. Otherwise it can be missed easily considering it as an over replacement with thyroid hormone.

  9. Prediabetes is not a risk factor for subclinical coronary atherosclerosis.

    Science.gov (United States)

    Park, Gyung-Min; Cho, Young-Rak; Lee, Seung-Whan; Yun, Sung-Cheol; Won, Ki-Bum; Ann, Soe Hee; Kim, Yong-Giun; Kim, Shin-Jae; Roh, Jae-Hyung; Kim, Young-Hak; Yang, Dong Hyun; Kang, Joon-Won; Lim, Tae-Hwan; Jung, Chang Hee; Koh, Eun Hee; Lee, Woo Je; Kim, Min-Seon; Lee, Ki-Up; Park, Joong-Yeol; Kim, Hong-Kyu; Choe, Jaewon; Lee, Sang-Gon

    2017-09-15

    There are limited data regarding the influence of glycemic status on the risk of subclinical coronary atherosclerosis on coronary computed tomographic angiography (CCTA) in asymptomatic individuals. We analyzed 6434 asymptomatic individuals who underwent CCTA. The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. Of study participants, 2197 (34.1%), 3122 (48.5%), and 1115 (17.3%) were categorized as normal, prediabetic and diabetic individuals, respectively. Compared with normal individuals, there were no statistically differences in the adjusted odds ratios of prediabetic individuals for significant coronary artery stenosis (0.98, 95% confidence interval [CI] 0.80-1.22, p=0.888), any plaque (0.96, 95% CI 0.86-1.07, p=0.483), calcified plaque (0.90, 95% CI 0.79-1.01, p=0.080), non-calcified plaque (1.02, 95% CI 0.88-1.17, p=0.803), and mixed plaque (1.00, 95% CI 0.82-1.22, p=0.983). However, adjusted odds ratios for significant coronary artery stenosis (1.71, 95% CI 1.34-2.19, pprediabetic individuals were not associated with an increased risk of subclinical coronary atherosclerosis. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. [Cardiac myopathy due to overt hypothyroidism].

    Science.gov (United States)

    Harbeck, B; Berndt, M J; Lehnert, H

    2014-03-01

    A 51-year-old man presented with progressive tiredness, proximal muscle weakness, hair loss and weight gain for months. The patient showed mild pretibial myxedema and dry skin. Laboratory findings revealed strongly elevated cardiac enzymes as well as marked hypothyroidism. The electrocardiogram, echocardiography, abdominal sonography and chest X-ray were unremarkable. Thyroid ultrasound demonstrated features of Hashimoto thyroiditis. The findings supported the diagnosis of an overt hypothyroidism with myxedema and rhabdomyolysis. After starting levothyroxine and volume substitution laboratory parameters and clinical condition slowly normalized. Severe overt hypothyroidism may rarely present primarily as myopathy with myositis and cardiac involvement. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Hypothyroidism after radiotherapy for early glottic cancer

    International Nuclear Information System (INIS)

    Katayama, Motoyuki; Nishimura, Tetsuo; Nozue, Masashi; Kawai, Hiroaki; Takai, Michikatsu; Kaneko, Masao; Nishi, Shigeo

    1993-01-01

    Reported is the case of a 46-year-old male with hypothyroidism after radiotherapy for early glottic cancer, T1N0M0, Stage I. Six months after 60 Co irradiation 66 Gy with the radiation field size of 5 x 5 cm was given, the clinical signs of acute hypothyroidism was presented. Retrospective CT examinations proved that over 80% of the total dose was irradiated to about 10% of whole thyroid volume. Since laboratory examinations revealed high serum level of thyrogobrin antibody, we postulated immunological mechanism was associated with the onset of hypothyroidism. (author)

  12. Epidemiology of subtypes of hypothyroidism in Denmark

    DEFF Research Database (Denmark)

    Carlé, Allan; Laurberg, Peter; Pedersen, Inge B.

    2006-01-01

    in the cohort; the incidence rate was 32.8 per 100 000 person-years (standardised to the Danish population). Nosological types of hypothyroidism were: spontaneous (presumably autoimmune) 84.4%, post-partum 4.71%, amiodarone-associated 4.0%. subacute thyroiditis 1.8%. previous radiation or surgery 1.......8%. congenital 1.6% and lithium-associated 1.6%. Crude incidence rates were 29.0 around Aalborg and 40.6 in an area of Copenhagen. The higher incidence rate of hypothyroidism in the area with higher iodine intake was caused solely by more cases of spontaneous (presumably autoimmune) hypothyroidism, whereas...

  13. Gender differences in symptoms of hypothyroidism

    DEFF Research Database (Denmark)

    Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils

    2015-01-01

    of questionnaires. The gender-specific distribution of 13 hypothyroidism-associated symptoms and a simple combined score (0-13) was explored in conditional uni- and multivariate models taking into account a broad spectrum of possible confounders. Diagnostic odds ratios (DORs) were calculated as measures......OBJECTIVES: We examined the gender-specific symptom prevalences in hypothyroidism and in healthy controls and explored the extent to which symptoms indicative of thyroid status may be different in women and men. DESIGN AND METHODS: Patients newly diagnosed with overt autoimmune hypothyroidism (n...

  14. Hypothyroidism among military infants born in countries of varied iodine nutrition status

    Directory of Open Access Journals (Sweden)

    Smith Tyler C

    2010-02-01

    Full Text Available Abstract Background Iodine deficiency is a global problem representing the most common preventable cause of mental retardation. Recently, the impact of subtle deficiencies in iodine intake on children and pregnant women has been questioned. This study was designed to compare hypothyroidism among infants born to US military families in countries of varied iodine nutrition status. Methods A cohort design was used to analyze data from the Department of Defense Birth and Infant Health Registry for infants born in 2000-04 (n = 447,691. Hypothyroidism was defined using ICD-9-CM codes from the first year of life (n = 698. The impact of birth location on hypothyroidism was assessed by comparing rates in Germany, Japan, and US territories with the United States, while controlling for infant gender, plurality, gestational age, maternal age, maternal military status, and military parent's race/ethnicity. Results Hypothyroidism did not vary by birth location with adjusted odds ratios (OR as follows: Germany (OR 0.82, [95% CI 0.50, 1.35], Japan (OR 0.67, [95% CI 0.37, 1.22], and US territories (OR 1.29, [95% CI 0.57, 2.89]. Hypothyroidism was strongly associated with preterm birth (OR 5.44, [95% CI 4.60, 6.42]. Hypothyroidism was also increased among infants with civilian mothers (OR 1.24, [95% CI 1.00, 1.54], and older mothers, especially ages 40 years and older (OR 2.09, [95% CI 1.33, 3.30]. Conclusions In this study, hypothyroidism in military-dependent infants did not vary by birth location, but was associated with other risk factors, including preterm birth, civilian maternal status, and advanced maternal age.

  15. Headache Disorders May Be a Risk Factor for the Development of New Onset Hypothyroidism.

    Science.gov (United States)

    Martin, Andrew T; Pinney, Susan M; Xie, Changchun; Herrick, Robert L; Bai, Yun; Buckholz, Jeanette; Martin, Vincent T

    2017-01-01

    To determine whether headache disorders are a risk factor for the development of new onset hypothyroidism. Past studies have reported associations between headache disorders and hypothyroidism, but the directionality of the association is unknown. This was a longitudinal retrospective cohort study using data from the Fernald Medical Monitoring Program (FMMP). Residents received physical examinations and thyroid function testing every 3 years during the 20 year program. Residents were excluded from the cohort if there was evidence of past thyroid disease or abnormal thyroid function tests at the first office visit. A diagnosis of a headache disorder was established by self-report of "frequent headaches," use of any headache-specific medication, or a physician diagnosis of a headache disorder. The primary outcome measure was new onset hypothyroidism defined as the initiation of thyroid replacement therapy or TSH ≥ 10 without thyroid medication. A Cox survival analysis with time dependent variables were used for the model. Headache disorders, age, sex, body mass index, income, smoking, narcotic use, and hypothyroidism-producing medications were independent variables in the model. Data from 8412 residents enrolled in the FMMP were used in the current study. Headache disorders were present in about 26% of the residents and new onset hypothyroidism developed in ∼7%. The hazard ratio for the development of new onset hypothyroidism was 1.21 (95% CI = 1.001, 1.462) for those with headache disorders. Headache disorders may be associated with an increased risk for the development of new onset hypothyroidism. © 2016 American Headache Society.

  16. Over- and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality: A Register-Based Cohort Study.

    Science.gov (United States)

    Lillevang-Johansen, Mads; Abrahamsen, Bo; Jørgensen, Henrik Løvendahl; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2018-05-01

    This study investigated the association between hypothyroidism and mortality in both treated and untreated hypothyroid patients, and the consequences of over- and under-treatment with respect to mortality. This was a register-based cohort study of 235,168 individuals who had at least one serum thyrotropin (TSH) during 1995-2011 (median follow-up 7.2 years). Hypothyroidism was defined as at least two measurements of TSH >4.0 mIU/L within a half year spaced by at least 14 days, or one measurement of TSH >4.0 mIU/L and two filled prescriptions of levothyroxine the following year. All-cause mortality rates were calculated using multivariable Cox regression analysis adjusted for age, sex, and comorbidities using the Charlson Comorbidity Index. Mortality was increased in untreated hypothyroid individuals (n = 673; hazard ratio [HR] = 1.46 [confidence interval (CI) 1.26-1.69]; p 4.0 mIU/L and ≤10 mIU/L; p hypothyroidism (TSH >10 mIU/L; p = 0.002). Mortality was increased in both treated and untreated hypothyroid individuals for each six months a patient had increased TSH (HR = 1.05 [CI 1.02-1.07], p hypothyroidism) and age (older and younger than 65 years). Mortality was increased in untreated but not in treated hypothyroid individuals, independently of age and severity of hypothyroidism. Duration of decreased TSH in treated individuals had a greater impact on mortality than did duration of elevated TSH. These results stress the need for close monitoring of treatment in individuals receiving thyroid hormone replacement therapy.

  17. Well-being and depression in individuals with subclinical hypothyroidism and thyroid autoimmunity

    DEFF Research Database (Denmark)

    Fjaellegaard, Katrine; Kvetny, Jan; Allerup, Peter N.

    2014-01-01

    triiodothyronine (tT3), free thyroxine (fT4) and anti-TPO was measured. Prevalence of poor well-being and depression was measured using the WHO-5 Well-being questionnaire and WHO MDI [Major (ICD-10) Depression Inventory] questionnaire. RESULTS: Raw score for well-being or depression overall and stratified for sex...

  18. Relationship between subclinical hypothyroidism and serum osteoprotegerin level in type 2 diabetic patients

    Directory of Open Access Journals (Sweden)

    Eman H El-Adawy

    2017-01-01

    Conclusion T2DM patients with SCH demonstrate higher level and independent association with serum OPG than those with euthyroid. This result might add new information about the causal relationship between SCH and cardiovascular disorders in such a population.

  19. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism and the Risk of Atrial Fibrillation

    DEFF Research Database (Denmark)

    Baumgartner, Christine; da Costa, Bruno R.; Collet, Tinh-Hai

    2017-01-01

    were associated with increased AF risk in ageand sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment...

  20. Over-and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality

    DEFF Research Database (Denmark)

    Lillevang-Johansen, Mads; Abrahamsen, Bo; Jørgensen, Henrik Løvendahl

    2018-01-01

    who had at least one serum thyrotropin (TSH) during 1995-2011 (median follow-up 7.2 years). Hypothyroidism was defined as at least two measurements of TSH >4.0 mIU/L within a half year spaced by at least 14 days, or one measurement of TSH >4.0 mIU/L and two filled prescriptions of levothyroxine...... (CI) 1.26-1.69]; p 4.0 mIU/L and ≤10 mIU/L; p 10 mIU/L; p = 0.002). Mortality was increased in both treated and untreated hypothyroid individuals...

  1. Hypothyroidism

    Science.gov (United States)

    ... you may notice that you feel colder, you tire more easily, your skin is getting drier, you’ ... to the thyroid. Keeping thyroid hormone production in balance requires the right amount of iodine. Taking in ...

  2. Hypothyroidism

    Science.gov (United States)

    ... the front of your neck, below your Adam’s apple. The thyroid makes hormones that control how your ... Travel Occupational Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition ...

  3. Thyroid function in neonatal hypothyroidism.

    Science.gov (United States)

    Dussault, J H; Letarte, J; Guyda, H; Laberge, C

    1976-10-01

    Various aspects of the thyroid function have been measured in 28 cases of neonatal hypothyroidism detected by means of the Quebec Screening Program for Metabolic Diseases. In all instances the T4 value in the blood of filter paper spot was below 2 SD of the mean of the day, averaging 0.39 +/- 0.04 ng/40 mul (mean +/- SEM) of eluted blood. The T4 value of a second similar sample averaged 0.22 +/- 0.04 ng/mul of eluted blood; this value was significantly lower than the first one. The serum T4 concentration was decreased in all the infants, whereas three of them had a normal serum TSH concentration. At least three groups of patients could be identified: (1) patients with primary thyroid failure, (2) those with secondary or tertiary hypothyrodism, and (3) those with abnormal synthesis of thyroid hormone.

  4. Hypothyroidism: Does It Cause Joint Pain?

    Science.gov (United States)

    ... help, adequate thyroid hormone replacement is the primary treatment and often helps dramatically. When to see your doctor Keep in mind that people with the most common form of hypothyroidism have an increased risk of developing other autoimmune ...

  5. Acute compartment syndrome caused by uncontrolled hypothyroidism.

    Science.gov (United States)

    Modi, Anar; Amin, Hari; Salzman, Matthew; Morgan, Farah

    2017-06-01

    Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. Physical examination was concerning for acute compartment syndrome of right leg which was confirmed by demonstration of elevated compartmental pressures. No precipitating causes were readily identified. Further laboratory testing revealed uncontrolled hypothyroidism. Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Antithyroid drug-induced fetal goitrous hypothyroidism

    DEFF Research Database (Denmark)

    Bliddal, Sofie; Rasmussen, Ase Krogh; Sundberg, Karin

    2011-01-01

    Maternal overtreatment with antithyroid drugs can induce fetal goitrous hypothyroidism. This condition can have a critical effect on pregnancy outcome, as well as on fetal growth and neurological development. The purpose of this Review is to clarify if and how fetal goitrous hypothyroidism can...... be prevented, and how to react when prevention has failed. Understanding the importance of pregnancy-related changes in maternal thyroid status when treating a pregnant woman is crucial to preventing fetal goitrous hypothyroidism. Maternal levels of free T(4) are the most consistent indication of maternal...... and fetal thyroid status. In patients with fetal goitrous hypothyroidism, intra-amniotic levothyroxine injections improve fetal outcome. The best way to avoid maternal overtreatment with antithyroid drugs is to monitor closely the maternal thyroid status, especially estimates of free T(4) levels....

  7. Primary congenital hypothyroidism complicated by persistent severe ...

    African Journals Online (AJOL)

    2013-12-24

    Dec 24, 2013 ... hypothyroidism, there is a general paucity of studies on anaemia in infants ... a physiological adaptation to the decreased tissue ..... patients with Sheehan's syndrome: response to replacement of glucocorticoids and thyroxine ...

  8. [Economic evaluation od the value of early diagnosis and management of hypothyroidism in hypercholesterolemia].

    Science.gov (United States)

    Lenne, X; Allenet, B; Laurent, P; Lebrun, T; Wemeau, J L

    1999-11-01

    The aim of the study was to assess the economic consequences of the early screening and management for overt hypothyrodism in elderly women suffering from hypercholesterolaemia. A cost analysis was performed using screening decision tree followed by a Markov model, targeted on an hypothetical cohort of elderly women (i.e. > or = 55 years of age) suffering from hypercholesterolaemia. Two arms were compared, "no diagnosis", patients being treated by lipid lowering drugs in the long run, "diagnosis", patients being screened for thyroid disturbance and proposed adequate correction by hormone treatment. Relevant clinical data introduced into the model were obtained from published data and from experts. At the end of the initial diagnostic, patients could enter three different health states: euthyroidism, subclinical hypothyroidism or overt hypothyroidism. During 30 years, patients were assumed to be seen each year by a general practitioner for clinical examination and cholesterol dosage, plus, according to the health state evolution, TSH and T4 screening. In the baseline analysis, euthyroidian patients who had a inexplicable degradation of hypercholesterolaemia control were tested for TSH and, if abnormal, T4 serum; for subclinical hypothyroidian patients, TSH and T4 were measured every year. The direct costs taken into account were concerning medical supervision, drug treatment and biologic exams. Costs were analysed from the societal perspective and were expressed in 1998 French Francs (FF) with an accounting rate of 5% by year. A sensitivity analysis was also performed. The total cost at 30-year was equal to 25,006 F for "diagnosis" strategy, to 24,390 F for "no diagnosis" strategy. The incremental cost of the first strategy decreased according to the time horizon. It was 6.8% at 5-year and 2.5% at 30-year. Results were sensitive to variation in response rate of hypercholesterolaemic patients to hormone treatment of hypothyroidism (0.25 in base-case). The investment

  9. Ocular changes in primary hypothyroidism

    Directory of Open Access Journals (Sweden)

    Pekel Hamiyet

    2009-12-01

    Full Text Available Abstract Background To determine the ocular changes related to hypothyrodism in newly diagnosed patients without orbitopathy. Findings Thirty-three patients diagnosed to have primary overt hypothyroidism were enrolled in the study. All subjects were assigned to underwent central corneal thickness (CCT, anterior chamber volume, depth and angle measurements with the Scheimpflug camera (Pentacam, Oculus and cup to disc ratio (C/D, mean retinal thickness and mean retinal nerve fiber layer (RNFL thickness measurements with optical coherence tomography (OCT in addition to ophthalmological examination preceeding the replacement therapy and at the 1st, 3rd and 6th months of treatment. The mean age of the patients included in the study were 40.58 ± 1.32 years. The thyroid hormone levels return to normal levels in all patients during the follow-up period, however the mean intraocular pressure (IOP revealed no significant change. The mean CCT was 538.05 ± 3.85 μ initially and demonstrated no statistically significant change as the anterior chamber volume, depth and angle measurements did. The mean C/D ratio was 0.29 ± 0.03 and the mean retinal thickness was 255.83 ± 19.49 μ initially and the treatment did not give rise to any significant change. The mean RNFL thickness was also stable during the control visits, so no statistically significant change was encountered. Conclusions Neither hypothyroidism, nor its replacement therapy gave rise to any change of IOP, CCT, anterior chamber parameters, RNFL, retinal thickness and C/D ratio.

  10. Biological half-time of tritiated water: comparison of hyperthyroid and hypothyroid patients

    Energy Technology Data Exchange (ETDEWEB)

    Eberstadt, P; Fernandez, M V.G.; Gonzalez, O

    1986-01-01

    The half-time values of tritiated water were explored in eleven hyperthyroid patients and in two hypothyroid ones. For reasons of comparability the numbers are expressed in days per square meter (d/m/sup 2/) of body surface. Against the estimated 5.4d/m/sup 2/ in normal subjects, the hyperthyroids reflected 3.9+-0.66 and the two determinations of hypothyroids were 6.42 and 7.13, respectively. During the study neither diagnostic nor therapeutic procedures were ever postponed. The half-time values are not representative of extreme conditions in hyper- or hypothyroids, but are sufficiently clear to indicate well-defined differences from normal people. The total exposure to radiation for the exploratory procedure was minimal, estimated at less than 12 mrem for the normal standard man.

  11. Hypothyroidism in late-onset Pompe disease.

    Science.gov (United States)

    Schneider, Joseph; Burmeister, Lynn A; Rudser, Kyle; Whitley, Chester B; Jarnes Utz, Jeanine

    2016-09-01

    In Pompe disease, a deficiency of acid α-glucosidase enzyme activity leads to pathologic accumulation of glycogen in tissues. Phenotype heterogeneity in Pompe includes an infantile form and late-onset forms (juvenile- and adult-onset forms). Symptoms common to all phenotypes include progressive muscle weakness and worsening respiratory function. Patients with late-onset forms of Pompe disease commonly complain of chronic fatigue and generalized muscle weakness prior to being diagnosed with Pompe disease, and this may lead to consideration of hypothyroidism in the differential diagnosis. This study aimed to evaluate the prevalence of hypothyroidism in the adult-onset form of Pompe disease. Electronic chart review was performed at the Advanced Therapies Clinic at the University of Minnesota Medical Center (UMMC) to identify patients with late-onset Pompe disease. The identified charts were reviewed for a co-diagnosis of hypothyroidism. A query was made to the clinical data repository at UMMC searching diagnosis ICD9 code 244.9 (hypothyroidism not otherwise specified) and/or presence of levothyroxine from 2011 to 2014 in patients 18 years of age and older. The clinical data repository found a prevalence of hypothyroidism of 3.15% (56,072 of 1,782,720 patients) in the adult patient population at UMMC. Ten adult patients with Pompe disease were identified, five with the diagnosis of hypothyroidism (50%, 95% CI: 23.7, 76.3, p Hypothyroidism was found at a higher prevalence in patients with late-onset Pompe disease compared to the general adult population at UMMC. Studies in larger populations of patients with Pompe disease would be needed to confirm an association of Pompe disease and hypothyroidism. Challenges include finding an adequate sample size, due the rarity of Pompe disease.

  12. High androgen levels protect against hypothyroidism.

    Science.gov (United States)

    Schmidt, Johanna; Dahlgren, Eva; Bryman, Inger; Berntorp, Kerstin; Trimpou, Penelope; Wilhelmsen, Lars; Landin-Wilhelmsen, Kerstin

    2017-01-01

    Hypothyroidism is a common disorder, appearing mainly in women although less frequently found in women with polycystic ovary syndrome (PCOS). The objective was to test the hypothesis that hyperandrogenism might protect against hypothyroidism. The data from three prospective follow-up studies (up to 21 years) and one register study were compared: women with PCOS (Rotterdam criteria), n = 25, women with Turner syndrome, n = 217, a random population sample of women, n = 315, and men, n = 95 (the WHO MONICA study). Findings were to be verified or rejected in all females, n = 553 716, from the same region. The proportion of hypothyroidism was calculated and thyroid peroxidase antibodies (TPO) in serum were measured. Hypothyroidism at >50 years of age was found in 8% of women with PCOS, 4% in men (PCOS vs. men; ns), 43% of women with Turner syndrome, irrespective of karyotype (p Hypothyroidism increased with age in all groups except PCOS women and men. In the register study, hypothyroidism was less common in women with PCOS >25 years (5.5%) than in women without PCOS (6.8%) from the same region (p Hypothyroidism was less frequently seen in women with PCOS and in men compared with women in the general population and among women with Turner syndrome. This was not explained by altered autoimmunity or the Y-chromosome. Androgens seem to protect against hypothyroidism. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Hemostasis in Hypothyroidism and Autoimmune Thyroid Disorders

    OpenAIRE

    Ordookhani, Arash; Burman, Kenneth D.

    2017-01-01

    Context There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate population-based studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism and autoimmune thyroid disorders. Evidence Acquisition A comprehensive literature search was conducted employing MEDLINE database. T...

  14. Evaluation and Management of the Child with Hypothyroidism.

    Science.gov (United States)

    Leung, Alexander K C; Leung, Alexander A C

    2018-05-08

    Thyroid hormones are critical for early neurocognitive development as well as growth and development throughout childhood. Prompt recognition and treatment of hypothyroidism is therefore of utmost importance to optimize physical and neurodevelopmental outcomes. To review in depth the evaluation, diagnosis, and treatment of hypothyroidism in children. A PubMed search was completed in Clinical Queries using the key term "hypothyroidism". Patents were searched using the key term "hypothyroidism" from www.freepatentsonline.com. Hypothyroidism may be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Thyroid dysgenesis and dyshormonogenesis account for approximately 85% and 15% of permanent cases of congenital primary hypothyroidism, respectively. More than 95% of infants with congenital hypothyroidism have few, if any, clinical manifestations of hypothyroidism. Newborn screening programs allow early detection of congenital hypothyroidism. In developed countries, Hashimoto thyroiditis is the most common cause of goiter and acquired hypothyroidism in children and adolescents. Globally, iodine deficiency associated with goiter is the most common cause of hypothyroidism. Central hypothyroidism is uncommon and may be associated with other congenital syndromes and deficiencies of other pituitary hormones. Familiarity of the clinical features would allow prompt diagnosis and institution of treatment. Recent patents related to the management of childhood hypothyroidism are discussed. To optimize neurocognitive outcome in infants with congenital hypothyroidism, treatment with levothyroxine should be started as soon as possible, preferably within the first two weeks of life. Children with acquired hypothyroidism should also be treated early to ensure normal growth and development as well as cognitive outcome. The target is to keep serum TSH hypothyroidism. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Massive pericardial effusion associated with hypothyroidism.

    Science.gov (United States)

    Ionescu, Simona Daniela; Tănase, Daniela Maria; Ouatu, Anca; Ambăruş, V; Dosa, Anca; Arsenescu-Georgescu, Cătălina

    2014-01-01

    The diagnosis of hypothyroidism is difficult because hypothyroidism in adults and especially the elderly, classic, has an insidious onset with a range of nonspecific symptoms which may delay diagnosis for months or even years. Old age seems to represent trigger factor for autoimmune diseases, including hypothyroidism. Clinical features in hypothyroidism, such as weight gain, fatigue, cold intolerance, constipation, dry skin, edema and muscle weakness, and decreased osteo-tendinous reflexes are usually subtle and can be overlooked. Thyroid dysfunction may be associated with a negative impact on the cardiovascular system. Pericardial, pleural and peritoneal effusions are common findings in hypothyroidism. This case report represents a typical primary hypothyroidism (autoimmune) and shows the clinical features of this disease. Basically we talked about a severe myxedema with the involvement of internal organs in an elderly woman and the euthyroidism restoration, under thyroid replacement therapy, was correlated with the clinical improvement and cardiovascular and neurological status, with radiographic remission and regression to extinction of pericardial effusion at repeated echocardiographic evaluations.

  16. Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort

    DEFF Research Database (Denmark)

    Fernández-Friera, Leticia; Peñalvo, José L; Fernández-Ortiz, Antonio

    2015-01-01

    age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque...

  17. Association between diabetic retinopathy and subclinical atherosclerosis in China: Results from a community-based study.

    Science.gov (United States)

    Liu, Yu; Teng, Xiangyu; Zhang, Wei; Zhang, Ruifeng; Liu, Wei

    2015-09-01

    To evaluate the association of diabetic retinopathy with subclinical atherosclerosis in middle-aged and elderly Chinese with type 2 diabetes. A cross-sectional community-based study was performed among 1607 patients aged 40 years or older in Shanghai. Non-mydriatic digital fundus photography examination was used in diabetic retinopathy detection. Presence of elevated carotid intima-media thickness or carotid plaque was defined as subclinical atherosclerosis. The prevalence of diabetic retinopathy was 15.1% in total patients. Patients with diabetic retinopathy were more likely to have elevated carotid intima-media thickness, carotid plaque and subclinical atherosclerosis than those without diabetic retinopathy (37.9% vs 30.7%, 57.6% vs 49.6% and 64.6% vs 57.1%, respectively). The presence of diabetic retinopathy was significantly associated with increased odds of subclinical atherosclerosis (odds ratio = 1.93, 95% confidence interval = 1.03-3.60) after full adjustments. The presence of diabetic retinopathy was significantly associated with subclinical atherosclerosis in middle-aged and elderly patients with type 2 diabetics in China. © The Author(s) 2015.

  18. Synthetic prevention and treatment for hypothyroidism after radioiodine therapy hyperthyroidism

    International Nuclear Information System (INIS)

    Li Shiyun

    2004-01-01

    Hypothyroidism is main complication after 131 I therapy for hyperthyroidism in Graves' disease. The hypothyroidism restricts its popular application that 131 I treatment for Graves' disease. In clinic practice, different factors of every patient, involved case selection, sensitivity estimation, unite using medicine before 131 I therapy are analysed, and synthetic measures for posttreatment examination, transient hypothyroidism and permanent hypothyroidism after 131 I therapy are discussed

  19. Dose-volume analysis of hypothyroidism in patients irradiated to the neck

    International Nuclear Information System (INIS)

    Te, Vuong; Liu, Mitchell C.C.; Parker, William; Curtin-Savard, Arthur J.; Clark, Brenda

    1997-01-01

    Purpose: To determine if the incidence of hypothyroidism in patients who have received radiation therapy to the neck region has any relationship with the total dose to the thyroid and volume of thyroid irradiation. Methods and Materials: From 1988 to 1996, TSH levels were measured at regular intervals of every 3 to 6 months in 528 patients with head and neck cancers or lymphomas (Hodgkin and non-Hodgkin) who had received radiation therapy to the neck region. Hypothyroidism was defined by TSH of ≥ 5 (normal range: 0.5 - 4mU/L). Medical charts, radiotherapy charts, treatment planning films, dosimetry and CT scans/MRI were reviewed. Thyroid volume was determined utilizing treatment planning films and CT scans/MRI. Four hundred and six patients had normal TSH prior to radiation and sufficient information to be eligible for analysis. There were 264 (65%) male and 142 (35%) female, median age was 59 yr (range: 12 - 85). Median follow-up was 39.5 months (range: 1 - 289 months). Results: Out of the 406 eligible patients, 152 (37%) had developed hypothyroidism. The actuarial incidence of hypothyroidism at 1 yr, 3 yr and 5 yr are 9.1%, 29% and 38.5%, respectively. Analysis of volume effect and dose effect are as follows: When the radiation dose to the thyroid and the volume of thyroid irradiated are analyzed together, the group of patients who received ≥ 60Gy to half of thyroid or received ≥ 30Gy to the whole thyroid has increased risk of developing hypothyroidism as compared to those receiving <60Gy to half the thyroid or <30Gy to the whole thyroid (p=.0001). Conclusions: The actuarial incidence of hypothyroidism at 5 year in patients who had received radiation to the neck is 38.5%. Patients who received ≥ 60Gy to half the thyroid or received ≥ 30Gy to the whole thyroid are at higher risk of developing hyperthyroidism

  20. Polymyositis associated with hypothyroidism or hyperthyroidism: two cases and review of the literature.

    Science.gov (United States)

    Wang, Han; Li, Hong; Kai, Cui; Deng, Juelin

    2011-04-01

    Studies confirming a possible relationship of polymyositis within thyroid dysfunction, either hypothyroidism or hyperthyroidism, are hardly available. To define the association, identify clinical, laboratory, electromyographic, and pathologic features in polymyositis (PM) patients with hypothyroidism or hyperthyroidism, we conducted a MEDLINE and Chinese biomedicine database search to identify relevant literature published in the past 25 years. Seventeen cases were included. All patients were female (10 hypothyroidism patients, seven hyperthyroidism patients). The mean (SD) age of PM, hypothyroidism, and hyperthyroidism at diagnosis was 54.8 (16.7), 55.5 (16.5), and 32.7 years (10.2), respectively. PM diagnosis can precede or parallel hypothyroidism while PM may occur following the diagnosis of hyperthyroidism. The most common comorbidities were malignant tumors in these disorders, including thymoma, colon cancer, and thyroid cancer. Muscle weakness was described in 100% of patients. Other common manifestations included muscles' atrophy and pain, deep tendon reflexes, polyarthralgia, and dysphagia. Most patients had markedly elevated creatine kinase and the presence of anti-Sjogren's syndrome A (SSA) antibodies was also found in two cases. Malignancy associated with PM may more frequently occur in hypothyroidism than in hyperthyroidism. The abnormalities on electromyography and biopsy did not differ from those findings of PM. Therapy consisting of corticosteroids, thyroid hormone, or anti-thyroid drugs was administrated; however, poor prognosis seemed to be associated with malignant tumors as well as older age and the presence of anti-SSA antibodies. It is reasonable to suggest that those patients should be routinely evaluated for thyroid function, especially in older female and patients suffering from cancers.

  1. The Effect of Hypothyroidism on a Composite of Mortality, Cardiovascular and Wound Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Komatsu, Ryu; You, Jing; Mascha, Edward J; Sessler, Daniel I; Kasuya, Yusuke; Turan, Alparslan

    2015-09-01

    We tested the hypothesis that hypothyroidism, as defined by thyroid-stimulating hormone (TSH) concentration, is associated with a severity-weighted composite of mortality and major cardiovascular and infectious complications after noncardiac surgery. In this retrospective cohort study, we evaluated adults at the Cleveland Clinic Main Campus between 2005 and 2012, who had had available TSH concentrations within the 6 months before noncardiac surgery. Patients were categorized as (1) hypothyroid (patients who had diagnosis of hypothyroidism any time prior to surgery and increased TSH value (> 5.5 mIU/L) within 6 months prior to surgery); (2) treated (hypothyroid diagnosis and normal TSH concentrations [0.4-5.5 mIU/L]); and (3) euthyroid (no hypothyroid diagnosis and normal TSH concentrations). We conducted pairwise comparisons among the 3 groups using inverse propensity score weighting to control for observed confounding variables. Average relative effect generalized estimating equation model was used for the primary outcome composite of in-hospital cardiovascular morbidity, surgical wound complication or infection, and mortality. Logistic regression and Cox proportional hazards regression were used for secondary outcomes of intraoperative vasopressor use and duration of hospitalization, respectively. We identified 800 hypothyroid patients (median TSH: 8.6 mIU/L [Q1, Q3: 6.5, 13.0]), 1805 treated patients (2.0 mIU/L [1.1, 3.2]), and 5612 euthyroid patients (1.7 mIU/L [1.1, 2.6]). There were no significant differences among the hypothyroid, treated, and euthyroid patients on the primary composite outcome (all P values ≥0.30). Hypothyroid patients were slightly more likely to receive vasopressor during surgery than either treated (odds ratio, 1.17; 99.2% confidence interval [CI], 1.01-1.36) or euthyroid (odds ratio, 1.12; 99.2% CI, 1.02-1.24) patients. Furthermore, hypothyroid patients were slightly but significantly less likely to be discharged at any given

  2. Juvenile-onset hypothyroidism in a dog

    International Nuclear Information System (INIS)

    Greco, D.S.; Peterson, M.E.; Cho, D.Y.; Markovits, J.E.

    1985-01-01

    Juvenile-onset hypothyroidism was diagnosed in an adult mixed-breed dog examined because of quadraparesis. Unusual clinical signs attributable to juvenile-onset or congenital hypothyroidism included disproportionate dwarfism; enlarged, protruding tongue; mental dullness; and retention of a 'puppy' coat, which was soft and fluffy, without guard hairs. Radiography of the vertebral column and long bones revealed multiple areas of delayed epiphyseal closure and epiphyseal dysgenesis. Myelography demonstrated several intervertebral disk protrusions in the cervical and lumbar regions. Hypothyroidism was confirmed on the basis of a low basal serum thyroxine concentration that failed to increase after the administration of thyroid stimulating hormone. Other laboratory abnormalities included nonregenerative, normocytic, normochromic anemia; mild hypercalcemia; and an impaired growth hormone (GH) secretory response after xylazine administration. At necropsy, the thyroid gland was small and weighed only 0.2g. Microscopic examination of the thyroid gland revealed a loss of glandular tissue, which was replaced by adipose tissue along its periphery. Gross or microscopic abnormalities were not noted in the pituitary gland, and immunohistochemical staining of the pituitary gland revealed a normal number of GH-containing acidophils. This suggests that primary hypothyroidism may result in an impaired secretion of growth hormone, and that pituitary dwarfism or GH deficiency may be difficult to differentiate from hypothyroid dwarfism on the basis of provocative GH testing alone

  3. Update on the treatment of hypothyroidism.

    Science.gov (United States)

    Jonklaas, Jacqueline

    2016-01-01

    Differentiated thyroid cancer is a malignancy that is rapidly increasing in frequency. As thyroidectomy plays a central role in the treatment of thyroid cancer, it is incumbent on physicians treating this patient group to be well versed in the intricacies of treating hypothyroidism. Treatment of hypothyroidism may be refined by careful attention to dose selection, monitoring of therapy and achievement of thyrotropin goals that are specific to the individual patient's overall clinical situation. These goals are common not only to patients with a sole diagnosis of hypothyroidism, as discussed in the recent American Thyroid Association Guidelines, but also to patients with hypothyroidism in the setting of thyroid cancer. Several recent studies have illuminated our understanding of the benefits and risks of thyrotropin suppression therapy in patients with differentiated thyroid cancer. Multiple studies of combination therapy with levothyroxine and liothyronine for treating hypothyroidism have not led to a clear conclusion about its benefits over levothyroxine monotherapy. Animal studies have advanced our understanding of the altered serum and tissue milieu that characterizes levothyroxine monotherapy. Crossing the bridge from this translational research into clinical research using sustained release triiodothyronine preparations may ultimately enhance the health of our patients. Continued refinement of our understanding of thyroid status and our ability to flawlessly implement thyroid hormone replacement is an active area of research.

  4. Adolescent with Rhabdomyolysis due to Undiagnosed Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Raquel Farias Moeller

    2011-01-01

    Full Text Available Exercise-induced rhabdomyolysis has been described in military recruits, trained athletes and daily runners. Statin use, quail ingestion, infection by Epstein-Barr virus (EBV, and hypothyroidism, though rare, are risk factors for the development of rhabdomyolysis. We describe the case of a 15-year-old female who presented with myalgias, weakness, and pigmenturia following marching band practice. Laboratory tests confirmed an elevated creatine kinase (CK level as well as a profound hypothyroid state. Muscle biopsy revealed severe muscle necrosis and myositis. Treatment with levothyroxine resulted in obtaining an euthyroid state and regain of muscle strength as well as decrease in CK levels. Although rare, hypothyroidism should be considered as a potential cause of rhabdomyolysis in pediatric patients undergoing a myopathy workup.

  5. Primary Hypothyroidism With Markedly High Prolactin

    Directory of Open Access Journals (Sweden)

    MOHD SALEEM ANSARI

    2016-04-01

    Full Text Available Secondary Pituitary enlargement due to primary hypothyroidism is not a common manifestation. The loss of thyroxin feedback inhibition in primary hypothyroidism causes overproduction of thyroid-releasing hormone (TRH, which results in secondary pituitary enlargement.TRH has a weak stimulatory effect on lactotroph cells of pituitary, so mild to moderate rise in prolactin (PRL level is expected. We report a 67 years old female who presented with a large pituitary mass and very high level of TSH with a significant rise in PRL level. In this case the diagnosis of seller mass was challenging, it was difficult to distinguish between pituitary prolactinoma and primary hypothyroidism with secondary pituitary hyperplasia. The thyroid hormone replacement proved that hyperprolactinemia was due to hyperplasia of the pituitary gland.Hence, the correct diagnosis and thyroid hormone therapy can prevent unnecessary treatment with dopamine agonist.

  6. The interrelation between hypothyroidism and glaucoma

    DEFF Research Database (Denmark)

    Thvilum, Marianne; Hjelm Brandt Kristensen, Frans; Brix, Thomas Heiberg

    2017-01-01

    Data on the association between hypothyroidism and glaucoma are conflicting. We sought to shed light on this by conducting a critical review and meta-analyses. The meta-analyses were conducted in adherence with the widely accepted MOOSE guidelines. Using the Medical Subject Heading (MeSH) terms......: hypothyroidism, myxoedema and glaucoma or intraocular pressure, case-control studies, cohort studies and cross-sectional studies were identified (PubMed) and reviewed. Using meta-analysis, the relative risk (RR) of coexistence of glaucoma and hypothyroidism was calculated. Based on the literature search......, thirteen studies fulfilled the inclusion criteria and could be categorized into two groups based on the exposure. The designs of the studies varied considerably, and there was heterogeneity related to lack of power, weak phenotype classifications and length of follow-up. Eight studies had glaucoma (5757...

  7. Neonatal screening for hypothyroidism in Southern Thailand

    International Nuclear Information System (INIS)

    Sukthomya, V.

    1985-08-01

    Thyroid stimulating hormone (TSH) determination by a radioimmunoassay on dried blood spots was selected as the screening method for congenital hypothyroidism in Southern Thailand. Blood from the infant's heel was obtained in 7814 newborns on the fifth day of life. Infants with TSH values greater than 25 mU/L were recalled for a more careful clinical examination and to have their T4 (thyroxine) and TSH re-estimated. Fifty-four infants with TSH values between 25 and 50 mU/L were found to be normal at re-evaluation. These are still being followed longitudinally for full confirmation. Two with values above 50 mU/L, although clinically euthyroid, were found to be hypothyroid by T3, T4, thyroid scintigraphy and bone age on roentgenography. Replacement therapy has been started. We have shown that a screening program for neonatal hypothyroidism can be done, and is probably worthwhile and perhaps even cost-effective

  8. Hypothyroidism: challenges when treating older adults.

    Science.gov (United States)

    Pearson, Tamera

    2013-01-01

    Hypothyroidism frequently affects older adults' general sense of health, their cognitive abilities, and quality of life. Management decisions regarding when to start treatment and at what dosage to begin medication are influenced by both laboratory values and patient symptoms. Although specific guidelines regarding management of hypothyroidism in older adults do not exist, general recommendations include initiating hormone replacement with levothyroxine (Levoxyl(®), Synthroid(®), and others) at 12.5 mcg to 25 mcg and titrating the dose slowly based on response at 6-week intervals. Multiple medications and certain foods can interact with levothyroxine; therefore, the best dosage time is when a person is fasting or 4 hours postprandial. Using a consistent brand-name drug for hormone replacement with levothyroxine is important due to variations in the active ingredient in generic formulations. Providers need to be aware of the prevalence of hypothyroidism and management issues when caring for older adults. Copyright 2013, SLACK Incorporated.

  9. Influence of subclinical hyperthyroidism on the cardiovascular system

    Directory of Open Access Journals (Sweden)

    T Y Demidova

    2015-06-01

    Full Text Available Subclinical hyperthyroidism occurs when the serum TSH is below the lower limit of the reference range and the free T4 and T3 concentrations are normal. Тhe clinical significance of subclinical hyperthyroidism is much debated. Subclinical hyperthyroidism has been associated with several biological effects on cardiovascular system, such as increased heart rate, left ventricular mass. Observational studies have reported an association between subclinical hyperthyroidism and coronary heart disease, incident atrial fibrillation, and cardiac dysfunction.

  10. Influence of subclinical hyperthyroidism on the cardiovascular system

    OpenAIRE

    T Y Demidova; I N Drozdova

    2015-01-01

    Subclinical hyperthyroidism occurs when the serum TSH is below the lower limit of the reference range and the free T4 and T3 concentrations are normal. Тhe clinical significance of subclinical hyperthyroidism is much debated. Subclinical hyperthyroidism has been associated with several biological effects on cardiovascular system, such as increased heart rate, left ventricular mass. Observational studies have reported an association between subclinical hyperthyroidism and coronary heart diseas...

  11. Diagnostic value of blood lipids testing in patients with high-normal and subclinical levels of TSH in prevention and treatment of dislipoproteinemia

    Directory of Open Access Journals (Sweden)

    O D Rymar

    2010-12-01

    Full Text Available The purpose of the study is to evaluate character of lipid profile changes in Novosibirsk populational sample of men and women (45–69 years with subclinical and high-normal TSH levels. Current study was performed within the HAPIEE project “Determinants of cardiovascular diseases in Eastern Europe” of the Welcome Trust fond. Populational subsample of 280 subjects (125 men (44.6% and 155 women (55.4% was analyzed. Received data showed that high-normal TSH levels within 1.71–4.05 mIU/l have been associated with higher levels of triglycerides, total cholesterol and LDL cholesterol, compared with low-normal TSH levels 0.17–0.47 mIU/l (р<0.05. Women with subclinical hypothyroidism had significantly higher average levels of total cholesterol and LDL cholesterol compared with women without thyroid disorders.

  12. Hypophysiary hyperplasia secondary to primary hypothyroidism

    International Nuclear Information System (INIS)

    Garcia, Jorge; Polania, Diana Ligia; Builes, Carlos Alfonso

    2005-01-01

    This is a 43 years old woman, complaining of galactorhea, headache and hyperprolactinaemia. A large macro adenoma of the pituitary with extensive suprasellar extension and displacement of the optic chiasm was detected on MRI and primary hypothyroidism was found. After treatment with levothyroxine for four months, her TSH and prolactin levels returned to normal, her symptoms improved and a marked shrinkage of the selar lesion was observed. The visual fields returned to normal. This is a case of pituitary hyperplasia due to primary hypothyroidism

  13. Neonatal hypothyroidism detection with locally produced reactives

    International Nuclear Information System (INIS)

    Balter, H.; Robles, A.; Nappa, A.

    1993-01-01

    The Congenital hypothyroidism is the endocrinopathy of frequency lives in the childhood together with the Diabetes Mellitus. It has estimated in other countries that approximately a boy for each 4500 has probability of being born with this pathology.It is detected by radioinmuno essay RIA.In 1990 it forms to multidisciplinary group for the hypothyroidism congenital studies, integrate for the Nuclear Investigations Center of (CIN), Nuclear Medicine Center (CMN), the Neonatology Department of the Medicine College and the Cathedra of Radioquimica of the Chemistry College with the aim for implement the programme [es

  14. Serum lipids in hypothyroidism: Our experience

    OpenAIRE

    Prakash, Archana; Lal, Ashok Kumar

    2006-01-01

    In order to determine whether the screening of lipid profile is justified in patients with hypothyroidism we estimated serum lipids in cases having different levels of serum TSH. 60 patients of hypothyroidism in the age group of 20 to 60 yrs were studied for thyroid profile over a period of one year. On the basis of serum TSH level the cases were divided into three groups: In the first group TSH concentration was 8.8±2.99 μlU/ml, 95% confidence interval (Cl) 8.8±1.07, whereas serum total chol...

  15. Treatment for primary hypothyroidism: current approaches and future possibilities

    Science.gov (United States)

    Chakera, Ali J; Pearce, Simon HS; Vaidya, Bijay

    2012-01-01

    Primary hypothyroidism is the most common endocrine disease. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism. PMID:22291465

  16. Impact of bovine subclinical mastitis and effect of lactational treatment

    NARCIS (Netherlands)

    van den Borne, B.H.P.|info:eu-repo/dai/nl/304836826

    2010-01-01

    This thesis aimed to quantify the impact of subclinical mastitis in dairy cattle in the Netherlands and to explore the epidemiologic and economic effects of antimicrobial treatment of recently acquired subclinical mastitis during lactation. First, the occurrence of (sub)clinical mastitis was

  17. Gentamicin Nephrotoxicity in Subclinical Renal Disease.

    Science.gov (United States)

    Frazier, Donita L.

    The purpose of the present study was to examine the pharmacokinetic disposition of gentamicin and to define the mechanisms which predispose to nephrotoxicity in subclinical renal disease. Subtotally nephrectomized beagle dogs were used as a model for human beings with compromised renal function secondary to a reduced number of functional nephrons. Using ultrastructural morphometry, light microscopy and clinical chemistry data, the model was defined and the nephrotoxic responses of intact dogs administered recommended doses of drug were compared to the response of subtotally nephrectomized dogs administered reduced doses based on each animal's clearance of drug. Lysosomal and mitochondrial morphometric changes suggested mechanisms for increased sensitivity. To determine if increased sensitivity in this model was dependent on altered serum concentrations, variable rate infusions based on individual pharmacokinetic disposition of drug were administered using computer-driven infusion pumps. Identical serum concentration-time profiles were achieved in normal dogs and subtotally nephrectomized dogs, however, toxicity was significantly greater in nephrectomized dogs. The difference in the nephrotoxic response was characterized by administering supratherapeutic doses of drug to dogs. Nephrectomized dogs given a recommended dose of gentamicin became oliguric during the second week of treatment and increasingly uremic after withdrawal of drug. In contrast, intact dogs administered 2 times the recommended dose of gentamicin become only slightly polyuric during week 4 of treatment. The need to individualize dosage regimens based on drug clearance and not serum creatinine nor creatinine clearance alone was substantiated by describing the pharmacokinetic disposition of gentamicin in spontaneously occurring disease states. Four individualized dosage regimens with differing predicted efficacy were then administered to nephrectomized dogs to determine their relative nephrotoxic

  18. Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region

    International Nuclear Information System (INIS)

    Dragano, Nico; Hoffmann, Barbara; Stang, Andreas; Moebus, Susanne; Verde, Pablo E.; Weyers, Simone; Moehlenkamp, Stefan; Schmermund, Axel; Mann, Klaus; Joeckel, Karl-Heinz; Erbel, Raimund; Siegrist, Johannes

    2009-01-01

    Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45-75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease

  19. Asymptomatic myotonia congenita unmasked by severe hypothyroidism.

    Science.gov (United States)

    Passeri, Elena; Sansone, Valeria A; Verdelli, Chiara; Mendola, Marco; Corbetta, Sabrina

    2014-04-01

    Myotonia congenita is an inherited muscle disorder sustained by mutations in the skeletal muscle chloride channel gene CLCN1. Symptoms vary from mild to severe and generalized myotonia and worsen with cold, stressful events and hormonal fluctuations. Here we report the case of a young woman who sought medical attention because of subacute onset of diffuse and severe limb myotonia. CLCN1 gene sequencing showed a heterozygous transversion (T550M), two polymorphisms and one silent mutation. Thyroid function screening revealed severe hypothyroidism. She was placed on l-thyroxine replacement therapy which dramatically improved myotonia. We conclude that hypothyroidism unmasked a genetically determined, clinically asymptomatic chloride channelopathy. Diagnostic work-up in patients with clinically isolated myotonia should not be limited to genetic screening of non-dystrophic or dystrophic myotonias. Considering the high prevalence of hypothyroidism in females, systematic thyroid function screening by looking for additional hypothyroid symptoms and serum TSH levels measurement is mandatory in these patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Central Diabetes Insipidus, Central Hypothyroidism, Renal Tubular ...

    African Journals Online (AJOL)

    readmitted to the hospital because of jaundice and failure to thrive, for which he was investigated and diagnosed to have central congenital hypothyroidism. Shortly thereafter, he was admitted to our institute with a history of vomiting, decreased oral intake, polyuria, and dehydration having lasted 5 days. He was investigated ...

  1. Recurrent Pericardial Effusion Associated with Hypothyroidism in ...

    African Journals Online (AJOL)

    Background: The complex of Down Syndromehypothyroidism-pericardial effusion is largely unreported in sub-Sahara. Objective: To present and highlight an unusual manifestation of hypothyroidism. Methods: A 16-year-old girl with confirmed Down Syndrome presented with complaints of generalised body swelling of eight ...

  2. Effects of Hypothyroidism and Exogenous Thyroxine on ...

    African Journals Online (AJOL)

    Summary: Thyroxine (T4) is important in gut development and maturation, and its use in treating hypothyroidism is becoming more popular. This study was conducted to evaluate the effect of thyroidectomy and thyroxine replacement on some gastrointestinal organs. Ten out of 20 thyroidectomised rats received 100pg/kgbw ...

  3. Severe hypothyroidism masquerading as renal impairment

    DEFF Research Database (Denmark)

    Bistrup, C; Jensen, Dorte Møller; Kvetny, J

    1996-01-01

    A case of severe hypothyroidism in a 51-year old male is presented. The patient was especially complaining of weakness, stiffness and moderate pain in the proximal muscle groups together with rhinorrhea and nasal stenosis. Because of severely elevated S-creatine-kinase combined with reduced...

  4. NEOCORTICAL HYPERTROPHY FOLLOWING DEVELOPMENTAL HYPOTHYROIDISM IN RATS

    Science.gov (United States)

    Thyroid hormones (TH) are essential to the normal development of the brain. Although severe congenital hypothyroidism has long been associated with mental retardation and motor defects, it has only recently been established that even subtle decreases in maternal TH alter fetal br...

  5. Hypothyroidism and depression: Are cytokines the link?

    Directory of Open Access Journals (Sweden)

    Parimal S Tayde

    2017-01-01

    Full Text Available Context: Primary hypothyroidism has been thought of as an inflammatory condition characterized by raised levels of cytokines such as C-reactive protein (CRP, interleukin-6 (IL-6, and tumor necrosis factor-alpha (TNF-α. Depression is also well known to occur in hypothyroidism. Depression is also characterized by elevated inflammatory cytokines. We planned to study whether cytokines play an important part in linking these two conditions. Objectives: (1 To know the prevalence of depression in overt hypothyroidism due to autoimmune thyroid disease. (2 To correlate the levels of inflammatory markers with the occurrence of depression. (3 To study the effect of levothyroxine on inflammatory markers and depression. Materials and Methods: In this longitudinal, case–controlled study, 33 patients with autoimmune hypothyroidism (thyroid-stimulating hormone >10 uIU/ml were included with 33 age-, sex-, and body max index-matched healthy controls. Individuals were tested for Serum TNF-α, IL-6, high-sensitivity-CRP (hs-CRP. They were assessed for depression using Montgomery Asberg Depression Rating Scale (MADRS and World Health Organization Quality of Life (QOL Scale. Patients received L Thyroxine titrated to achieve euthyroidism and were reassessed for inflammatory markers and cognitive dysfunction. Results: Nineteen patients (57% had mild to moderate depression (MADRS >11. After 6 months of treatment, eight patients (42% had remission of depression with significant improvement in QOL scores (P < 0.05. TNF-α, IL-6, and hs-CRP were significantly elevated in patients compared with controls and reduced with therapy but did not reach baseline as controls. The change in inflammatory markers correlated with improvement in QOL scores in social and environmental domains (P < 0.01. Conclusions: Primary autoimmune hypothyroidism is an inflammatory state characterized by elevated cytokines which decline with LT4 therapy. It is associated with depression and poor

  6. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism.

    Science.gov (United States)

    Burch, Henry B; Burman, Kenneth D; Cooper, David S; Hennessey, James V

    2014-06-01

    In 2012, comprehensive clinical practice guidelines (CPGs) were published regarding the management of hypothyroidism. We sought to document current practices in the management of primary hypothyroidism and compare these results with recommendations made in the 2012 American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) hypothyroidism CPGs. In addition, we sought to examine differences in management among international members of U.S.-based endocrine societies and to compare survey results with those obtained from a survey of ATA members performed 12 years earlier. Clinical members of The Endocrine Society (TES), the ATA, and the AACE were asked to take a web-based survey consisting of 30 questions dealing with testing, treatment, and modulating factors in the management of primary hypothyroidism. In total, 880 respondents completed the survey, including 618 members of TES, 582 AACE members, and 208 ATA members. North American respondents accounted for 67.6%, Latin American 9.7%, European 9.2%, Asia and Oceania 8.1%, and Africa and Middle East 5.5%. Overt hypothyroidism would be treated using l-T4 alone by 99.2% of respondents; 0.8% would use combination l-T4 and liothyronine (l-T3) therapy. Generic l-T4 would be used by 49.3% and a brand name by 49.9%. The rate of replacement would be gradual (38.5%); an empiric dose, adjusted to achieve target (33.6%); or a calculated full replacement dose (27.8%). A target TSH of 1.0 to 1.9 mU/L was favored in the index case, but 3.0 to 3.9 mU/L was the most commonly selected TSH target for an octogenarian. Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 84.3% of respondents, a referral to primary care by 11.3%, and a change to l-T4 plus l-T3 therapy by 3.6%. Evaluation of persistent symptoms would include measurement of T3 levels by 21.9% of respondents. Subclinical disease with a TSH 5.0 to 10.0 mU/L would be treated without further

  7. Thermogenic Effect of Glucose in Hypothyroid Subjects

    Directory of Open Access Journals (Sweden)

    Agnieszka Kozacz

    2014-01-01

    Full Text Available The importance of thyroid hormone, catecholamines, and insulin in modification of the thermogenic effect of glucose (TEG was examined in 34 healthy and 32 hypothyroid subjects. We calculated the energy expenditure at rest and during oral glucose tolerance test. Blood samples for determinations of glucose, plasma insulin, adrenaline (A, and noradrenaline (NA were collected. It was found that TEG was lower in hypothyroid than in control group (19.68±3.90 versus 55.40±7.32 kJ, resp., P<0.0004. Mean values of glucose and insulin areas under the curve were higher in women with hypothyroidism than in control group (286.79±23.65 versus 188.41±15.84 mmol/L·min, P<0.003 and 7563.27±863.65 versus 4987.72±583.88 mU/L·min, P<0.03 resp.. Maximal levels of catecholamines after glucose ingestion were higher in hypothyroid patients than in control subjects (Amax—0.69±0.08 versus 0.30±0.07 nmol/L, P<0.0001, and NAmax—6.42±0.86 versus 2.54±0.30 nmol/L, P<0.0002. It can be concluded that in hypothyroidism TEG and glucose tolerance are decreased while the adrenergic response to glucose administration is enhanced. Presumably, these changes are related to decreased insulin sensitivity and responsiveness to catecholamine action.

  8. Sonographic evaluation of children with congenital hypothyroidism

    Directory of Open Access Journals (Sweden)

    Anelise de Almeida Sedassari

    2015-08-01

    Full Text Available AbstractObjective:To establish benchmarks and study some sonographic characteristics of the thyroid gland in a group of euthyroid children aged up to 5 years as compared with age-matched children with congenital hypothyroidism.Materials and Methods:Thirty-six children (17 female and 19 male aged between 2 months and 5 years were divided into two groups – 23 euthyroid children and 13 children with congenital hypothyroidism – and were called to undergo ultrasonography.Results:In the group of euthyroid children (n = 23, mean total volume of the thyroid gland was 1.12 mL (minimum, 0.39 mL; maximum, 2.72 mL; a homogeneous gland was found in 17 children (73.91% and 6 children (26.08% had a heterogeneous gland. In the group of children with congenital hypothyroidism (n = 13, mean total volume of the thyroid gland was 2.73 mL (minimum, 0.20 mL; maximum, 11.00 mL. As regards thyroid location, 3 patients (23.07% had ectopic thyroid, and 10 (69.23% had topic thyroid, and out of the latter, 5 had a homogeneous gland (50% and 5, a heterogeneous gland (50%. In the group with congenital hypothyroidism, 6 (46.15% children had etiological diagnosis of dyshormoniogenesis, 3 (23.07%, of ectopic thyroid, and 4 (30.76%, of thyroid hypoplasia.Conclusion:Thyroid ultrasonography is a noninvasive imaging method, widely available, easy to perform and for these reasons could, and should, be performed at any time, including at birth, with no preparation or treatment discontinuation, to aid in the early etiological definition of congenital hypothyroidism.

  9. Hypothyroidism and Glaucoma in The United States

    Science.gov (United States)

    Kakigi, Caitlin; Kasuga, Toshimitsu; Wang, Sophia Y.; Singh, Kuldev; Hiratsuka, Yoshimune; Murakami, Akira; Lin, Shan C.

    2015-01-01

    Purpose To investigate the association between hypothyroidism and glaucomatous disease. Methods This cross-sectional study included all subjects above the age of 40 years from two nationwide surveys: the 2008 National Health Interview Survey (NHIS) as well as the 2007 and 2008 National Health and Nutrition Examination Survey (NHANES). The presence or absence of glaucoma, thyroid disease and other demographic and health-related information including comorbidities was ascertained via interview. Blood samples were collected from NHANES subjects and analyzed for thyrotropin (TSH). Results A total of 13,599 and 3,839 NHIS and NHANES participants respectively were analyzed to assess for a possible relationship between self-reported glaucoma, and self-reported hypothyroidism as well as self-reported thyroid disease. The unadjusted odds ratio (OR) for NHIS showed a significant association between self-reported glaucoma and self-reported hypothyroidism (OR 1.46, 95% confidence interval [CI] 1.07-1.99). Multivariate logistic regression analysis adjusted for age, gender, race, comorbidities, and health-related behavior, however, showed no association between self-reported glaucoma and hypothyroidism or thyroid disease in both surveys (OR 1.60, 95%CI 0.87-2.95 for NHIS; OR 1.05, 95%CI 0.59-1.88 for NHANES). Conclusion A previously reported association between hypothyroidism and glaucomatous disease was not confirmed in two large U.S. health survey populations. While such an association was noted in the univariate analysis for the NHIS survey, such a relationship was not found in the mult