Thyroid disease—more research needed

Abstract

The world faces a burden of thyroid disease that has reached epidemic proportions. An estimated 200 million individuals worldwide have a thyroid disorder. Are existing treatments for thyroid disease working? Are symptomatic and asymptomatic thyroid conditions clinically meaningful enough to warrant treatment? In today's Lancet, two Seminars seek to provide answers to these and other important questions in a state-of-the-art update of two different thyroid pathologies.David Cooper and Bernadette Biondi discuss asymptomatic thyroid disease, which includes subclinical hyperthyroidism and subclinical hypothyroidism. The authors emphasise that the clinical significance of this mild degree of thyroid dysfunction is unknown. They point out existing disagreement among professional societies and experts about screening for subclinical thyroid disease. It is perhaps unsurprising that the benefits of treatment in subclinical thyroid disease are poorly characterised. Cooper and Biondi conclude that large-scale randomised trials are urgently needed to inform future care for individuals with subclinical thyroid disease.In the second Seminar, Jayne Franklyn and Kristien Boelaert write about thyrotoxicosis. There are three main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis. The authors point out that the available treatments for thyrotoxicosis have been unchanged for 60 years and vary in effectiveness and their burden of adverse events. They argue that there is a need to find novel and safe ways to change the underlying disease processes, rather than simply stop excess thyroid hormone production.Thyroid disease affects seven times more women than men, making it an important and understudied topic in women's health. There is a need for greater attention to research on thyroid disease to be conveyed clearly on May 25—World Thyroid Day—and thereafter by care givers, professional societies, and patient advocates. The world faces a burden of thyroid disease that has reached epidemic proportions. An estimated 200 million individuals worldwide have a thyroid disorder. Are existing treatments for thyroid disease working? Are symptomatic and asymptomatic thyroid conditions clinically meaningful enough to warrant treatment? In today's Lancet, two Seminars seek to provide answers to these and other important questions in a state-of-the-art update of two different thyroid pathologies. David Cooper and Bernadette Biondi discuss asymptomatic thyroid disease, which includes subclinical hyperthyroidism and subclinical hypothyroidism. The authors emphasise that the clinical significance of this mild degree of thyroid dysfunction is unknown. They point out existing disagreement among professional societies and experts about screening for subclinical thyroid disease. It is perhaps unsurprising that the benefits of treatment in subclinical thyroid disease are poorly characterised. Cooper and Biondi conclude that large-scale randomised trials are urgently needed to inform future care for individuals with subclinical thyroid disease. In the second Seminar, Jayne Franklyn and Kristien Boelaert write about thyrotoxicosis. There are three main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis. The authors point out that the available treatments for thyrotoxicosis have been unchanged for 60 years and vary in effectiveness and their burden of adverse events. They argue that there is a need to find novel and safe ways to change the underlying disease processes, rather than simply stop excess thyroid hormone production. Thyroid disease affects seven times more women than men, making it an important and understudied topic in women's health. There is a need for greater attention to research on thyroid disease to be conveyed clearly on May 25—World Thyroid Day—and thereafter by care givers, professional societies, and patient advocates. Subclinical thyroid diseaseSubclinical thyroid diseases—subclinical hyperthyroidism and subclinical hypothyroidism—are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Full-Text PDF ThyrotoxicosisThyrotoxicosis is a common disorder, especially in women. The most frequent cause is Graves' disease (autoimmune hyperthyroidism). Other important causes include toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules, and thyroiditis caused by inflammation, which results in release of stored hormones. Antithyroid drugs are the usual initial treatment (thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice). Full-Text PDF