Combination Of Hypothyroidism Research Articles

Thyroid Hormone Resistance Syndrome: From Molecular Mechanisms to Its Potential Contribution to Hypertension.

Thyroid hormone resistance (THR) is a rare inherited disorder that affects approximately one in every 40,000 live births. This condition arises from a mutation in the thyroid hormone receptor β, leading to reduced responsiveness of target tissues. It can result in a combination of hypothyroidism and hyperthyroidism symptoms in different tissues. The thyroid hormone is crucial for controlling blood pressure, and even small changes in its levels can have an effect on vascular resistance, cardiac performance, and heart rhythm. Both hypo- and hyperthyroidism have been associated with elevated blood pressure, underscoring the significant link between thyroid hormone sensitivity and vascular function. Considering thyroid hormone sensitivity is essential in clinical practice, particularly when managing patients with hypertension, to ensure personalized and effective treatment approaches. Monitoring thyroid function is essential during the diagnosis of hypertension, as thyroid dysfunction can often be corrected to normalize blood pressure. It's crucial to distinguish between essential hypertension and hypertension associated with a thyroid abnormality in THR. The mechanisms behind the development of hypertension in THR include reduced nitric oxide production, dysregulation of the renin-angiotensin-aldosterone system, impaired endothelial function, and mutations in the deiodinases. Physicians shouldunderstand the underlying mechanisms of THR and identify new therapeutic targets for hypertension in THR.

Особливості ремоделювання міокарда лівого шлуночка при гіпотиреозі й ішемічній хворобі серця на тлі хронічного системного запалення

Актуальність. Дисфункція щитоподібної залози у сучасній медичній науці розглядається як один із факторів ризику серцево-судинних захворювань, на жаль, непередбачливо недооцінюваний. Вiдомо, що навіть незначнi порушення тиреоїдної функцiї можуть супроводжуватися зростанням кардiометаболiчного ризику. Гіпотиреоз вже на ранній (субклінічній) стадії серйозно впливає на формування і розвиток серцево-судинних захворювань. Результати масштабних досліджень демонструють, що субклінічний гіпотиреоз асоціюється з підвищенням ризику розвитку ішемічної хвороби серця (ІХС), інфаркту міокарда і смертності від серцево-судинних захворювань. Мета дослідження — вивчення структурно-функціонального стану міокарда лівого шлуночка при гіпотиреозі та ішемічній хворобі серця на тлі хронічного системного запалення. Матеріали та методи. Проаналізовано 140 історій хвороб та обстежено 55 хворих на гіпотиреоз, ІХС та за умов поєднаної патології. Пацієнти були розподілені на 3 групи: І група — хворі на гіпотиреоз — 81, ІІ група — хворі на ІХС — 67, ІІІ група — хворі на гіпотиреоз в поєднанні з ІХС — 67. Групу контролю становили 20 осіб віком від 20 до 25 років. Результати. Виявлено, що гіпертрофія міокарда розвивається у всіх групах хворих, зниження функції щитоподібної залози характеризується ремоделюванням міокарда лівого шлуночка з розвитком ексцентричної гіпертрофії, з прогресуванням систолічної дисфункції серця в умовах коморбідності. Виявлений прямий кореляційний зв’язок зниження фракції викиду з підвищенням рівня IЛ-8. Висновки. Активація хронічного системного запалення більш виражена в умовах коморбідності з негативним прогностичним впливом на стан серцево-судинної системи. Зниження функції щитоподібної залози призводить до розвитку гіпертрофії міокарда лівого шлуночка з подальшою зміною геометрії серця в бік розвитку ексцентричного ремоделювання. Гіпотиреоз характеризується порушенням центральної гемодинаміки, прояви систолічної дисфункції серця наростають за умов поєднання тиреоїдної патології та ІХС. Активація хронічного системного запалення більш виражена в умовах коморбідності з негативним прогностичним впливом на стан серцево-судинної системи.

The content of adipokines in women with hypothyroidism and type 2 diabetes mellitus

Introduction. Type 2 diabetes mellitus (DM) and hypothyroidism are the most common endocrine pathologies. These diseases are associated with atherogenic dyslipidemia, insulin resistance, and overweight.Aim. Тo assess the relationship between adipokines and hormone-metabolic parameters in women with hypothyroidism, type 2 diabetes mellitus and their combination.Materials and methods. We examined 119 women aged 45 to 74 years: 42 women with primary hypothyroidism, 38 women with type 2 diabetes and 39 women with a combination of type 2 diabetes and hypothyroidism. All patients underwent an anthropometric examination, studied the indicators of lipid and carbohydrate metabolism, the content of adiponectin, leptin and resistin.Results. In women with type 2 diabetes and its combination with hypothyroidism, hyperglycemia, hyperinsulinemia, and insulin resistance were revealed. In all groups, an increase in total cholesterol, triglycerides, atherogenic coefficient was found. The examined women with a combination of hypothyroidism and type 2 diabetes mellitus had a decreased level of adiponectin and an increased level of leptin. In patients with hypothyroidism and patients with type 2 diabetes, a decrease in adiponectin levels and an increase in leptin and resistin were revealed.Discussion. The most pronounced hyperinsulinemia and insulin resistance were found in the group of patients with a combination of hypothyroidism and type 2 diabetes. At the same time, the combination of type 2 diabetes and hypothyroidism in the examined women, according to our data, did not aggravate lipid metabolism disorders. Against the background of visceral obesity in women with a combination of diseases, hypoadiponectinemia and hyperleptinemia were most pronounced. In this group, the level of resistin was positively correlated with the level of insulin and the index of insulin resistance.Conclusion. In women with hypothyroidism, type 2 diabetes and their combination, atherogenic dyslipidemia, hyperleptinemia, and hypoadiponectinemia were established. Hypoadiponectinemia and hyperleptinemia are involved in the development of atherogenic dyslipidemia in women with primary hypothyroidism.

Hoffmann Syndrome, Manifestation of Hypothyroidism: Case Report

Hoffmann syndrome is defined since 1897 as the combination of hypothyroidism with myopathy, mioedema, rigidity, muscle cramps, and hypertrophy. The objective of this publication is to describe a typical case of thyroid disease with clinical, hormonal, and muscular characteristics of a Hoffmann syndrome, as an exceptional manifestation of hypothyroidism. The clinical challenge consisted in linking the apparent ambiguity of the clinical symptoms such as: generalized weakness, fatigue, muscle cramps in a young patient, without personal record of previous disease, apparently healthy and well-nourished with favorable muscle development. Additionally, manifestation of pituitary gland dysfunction was found, such as headache and galactorrhea, bibliography reviewed showed mainly, male patients patter and not any comment concerning hypophysis impairment. all clinical manifestations disappeared after replacement treatment with levothyroxine, including the goiter and pituitary macroadenoma. The management of the case involved a multidisciplinary team and involved internists, cardiologist, endocrinologists, radiologist, and neurosurgeons. This form of thyroid myopathy is rare and usually accompanies adult patients with severe and long-standing hypothyroidism, is different from those that begin in early childhood and are associated with cretinism and muscle hypertrophy.

Associative relations between hypofunction of the thyroid gland of various origins and iron deficiency anemia

Background. Anemia is one of the thyroid deficiency manifestations, more often iron deficiency. The combination of hypothyroidism and anemia is an additional factor complicating the life quality of patients and requiring of adequate preventive measures.Purpose of the study was to establish the peculiarities of iron deficiency anemia in women with hypothyroidism that arose against the background of autoimmune thyroiditis (AIT) or after surgical treatment of nodular nontoxic goiter (NNG).Materials and methods. Thyroid status was assessed in 40 women with anemia on the background of hypothyroidism due to AIT (n = 28) and after surgery for NNG (n = 12) by the level of thyroid stimulating hormone and bound tetraiodothyronine, antibodies to thyroperoxidase. Anemia and its severity were determined by the blood hemoglobin level, number of red blood cells and color indicator.Study results. Level of thyroid stimulating hormone was increased in women of both groups on the background of levothyroxine in an individually selected dose, and it was significantly higher in group with postoperative hypothyroidism. Level of antibodies to thyroid peroxidase testified to the pronounced activity of antithyroid immunity in the group with AIT. Hemoglobin level in both groups ranged from 92 to 116 g/l, which according to WHO criteria corresponded to mild anemia. It was significantly lower than with postoperative hypothyroidism against the background of AIT, despite the best compensation for hypothyroidism. Color index in both groups was reduced, that is typical for hypochromic anemia, which includes iron deficiency anemia.Conclusions. Effectiveness of levothyroxine treatment in individually selected doses in women with a combination of hypothyroidism and anemic syndrome is higher at autoimmune thyroid pathology than after surgery for NNG. Active autoimmune process in women with hypothyroidism on the background of AIT is associated with more manifest anemia than in women with postoperative hypothyroidism as a result of NNG.

2. Craniopharyngioma presenting as bilateral carpal tunnel syndrome

A 35 year-old Caucasian information technology professional developed bilateral hand paraesthesia, increasing in severity over two months. He reported recent onset photophobia. He was obese with a weight of 138 kg and body mass index of 47.5 kg/m 2 . Visual acuity was 6/6 on the right and 6/18 on the left. Visual fields were normal to confrontation. There was no relative afferent pupillary defect and optic discs were normal. There was mild weakness of abductor pollicis brevis and mild sensory disturbance affecting his fingers in the median distribution bilaterally. Phalen’s test was positive. The remaining neurological examination was normal. Nerve conduction studies showed bilaterally prolonged median distal motor latencies (6.5 ms on left, 6.9 ms on right), bilaterally absent sensory potentials at digit two, and prolonged median lumbrical motor latencies compared to the ulnar interosseus, consistent with severe carpal tunnel syndrome (CTS). Blood tests performed in view of the rapid onset of symptoms showed normal haemoglobin A1c and vitamin B12 levels. Thyroid function tests showed a low thyroxine of 3.4 pmol/L (normal range 10–21) and inappropriately normal thyroid stimulating hormone of 3.3 mIU/L (normal range 0.4–4.0), suggestive of secondary hypothyroidism. Further pituitary function tests confirmed panhypopituitarism. MRI brain showed a suprasellar cystic mass with an enhancing wall, suggestive of a craniopharyngioma. Visual field testing was consistent with compression of the optic chiasm. The patient was started on hydrocortisone and thyroxine and underwent transsphenoidal resection of the tumour. His hand paraesthesia and visual symptoms resolved within two weeks. Repeat nerve conduction studies after five months showed significant electrophysiological improvement. Craniopharyngiomas are cystic suprasellar tumours arising from remnants of the craniopharyngeal duct ( Levy, 2004 ). They commonly present with headache, visual field defects, panhypopituitarism and hypothalamic dysfunction resulting in obesity and somnolence. CTS has not previously been reported in this context. There is a modest association between hypothyroidism and CTS ( Shiri, 2014 ). A combination of hypothyroidism and obesity likely predisposed this patient to CTS. Routine screening for thyroid disease is not recommended in patients with CTS due to low yield.

Integral stiffness of arterial system in patients with arterial hypertension of different genesis

Aim. To study and comparatively analyze the integral stiffness of arterial system in healthy subjects and in patients with hypertensive heart disease, hypothyroidism associated with arterial hypertension and rheumatoid arthritis associated with arterial hypertension. Methods. The study included 32 healthy volunteers and 178 patients with arterial hypertension, including 63 patients with hypertensive heart disease of 1-3 degree, 82 patients with hypothyroidism associated with arterial hypertension, 33 patients with rheumatoid arthritis associated with arterial hypertension. All patients underwent echocardiography; modulus of volume elasticity (MVE), pulse pressure, mean arterial pressure (MAP), total peripheral vascular resistance (TPVR), and MVE/TPVR ratio were calculated. The stiffness of arterial system was considered the main component if MVE/TPVR ratio exceeded 1; if MVE/TPVR ≤1, TPVR was considered the leading component. Results. Patients with arterial hypertension had higher rates of stiffness of arterial system in comparison with control group by MVE and pulse pressure. In control group, 87.5% persons had prevalence of TPVR, and in 12.5% arterial stiffness prevailed. In 77.8% of patients with hypertensive heart disease prevalence of TPVR was found, and in 22.2% arterial stiffness prevailed. In patients with combination of rheumatoid arthritis and hypertension arterial stiffness prevailed, while patients with combination of hypothyroidism and hypertension had higher TPVR. Conclusion. All patients with combination of rheumatoid arthritis and hypertension had arterial stiffness prevailing over TPVR. In patients with hypothyroidism associated with arterial hypertension TPVR prevailed over arterial stiffness.

Combination of hypothyroidism and stress abolishes early LTP in the CA1 but not dentate gyrus of hippocampus of adult rats

Clinical experience suggests that both hypothyroidism and stress interfere with mental concentration and memory. This electrophysiological study examined the effect of hypothyroidism and stress, separately or combined, on long-term potentiation (LTP), a widely accepted cellular model for learning and memory. Measurements of early LTP (E-LTP) were carried out in the hippocampus of urethane-anesthetized adult Wistar rats. Hypothyroidism was achieved by thyroidectomy, and the ‘intruder’ stress was used as a model of chronic psychosocial stress. Stimulating electrodes were placed in the left CA3 region and right angular bundle and a recording electrode was placed in the right CA1 or the dentate gyrus (DG). The results showed that in the CA1 region of the hippocampus, hypothyroid or stress partially blocked E-LTP. However, when hypothyroidism and stress were combined, they eliminated E-LTP. In contrast, no significant change in E-LTP was seen in the DG of the three groups of rats. These results suggest that impaired memory because of hypothyroidism or stress may be related to impairment of the E-LTP in the Schaffer collateral synapses but not of that of the perforant path synapses.

Anemia: A Cause of Intolerance to Thyroxine Sodium

Anemia: A Cause of Intolerance to Thyroxine Sodium