Improvement Of Thyroid Function Research Articles

The efficacy and complications of radiofrequency ablation of thyroid nodules

The use of radiofrequency ablation has increased rapidly in recent years and is receiving increased attention as a minimally invasive method to treat benign and malignant thyroid nodules. Radiofrequency ablation has been shown to be an alternative to surgery in the treatment of benign thyroid nodules. Radiofrequency ablation of benign cold nodules showed volume reductions of 32.7-58.2% at 1 month and 50.7-84.8% at 6 months, while reducing symptoms and cosmetic problems. Radiofrequency ablation of autonomously functioning thyroid nodules effectively improves thyroid function and reduces nodule volume. Recently, radiofrequency ablation of recurrent thyroid cancers showed good short-term results for locoregional control of well differentiated thyroid carcinoma in patients at high risk for surgery. Various complications of radiofrequency ablation have been reported, including pain, voice change, hematoma, skin burn at the puncture site, thyrotoxicosis, hypothyroidism, edema, and fever, but most patients recovered spontaneously without sequelae. Radiofrequency ablation is an effective and well tolerated treatment option for benign thyroid nodules. Radiofrequency ablation of recurrent thyroid cancers may be an alternative to surgery in patients at high surgical risk.

Coexistence of primary aldosteronism and Hashimoto’s thyroiditis

In light of research carried out in recent years, it seems that aldosterone may produce a complex proinflammatory effect. Theoretically, excessive aldosterone release may stimulate the development and/or progression of autoimmune disorders. In this article, we report a case of a female in whom primary aldosteronism coexisted with Hashimoto’s thyroiditis. Surgical removal of an aldosterone-producing tumor improved thyroid function and decreased thyroid autoimmunity. We describe in details diagnostic and treatment strategies applied in our patient and their impact on the course and outcome of thyroiditis. We also present monocyte and lymphocyte cytokine release in the index subjects before and after surgical treatment. We conclude that primary aldosteronism may exacerbate the clinical course of autoimmune thyroiditis and probably also of other autoimmune disorders.

Improvement of Thyroid Function in Hypothyroid Patients with Rheumatoid Arthritis After 6 Months of Adalimumab Treatment: A Pilot Study

Rheumatoid arthritis (RA) is characterized by high levels of cytokines such as tumor necrosis factor (TNF). TNF appears to have an etiologic role in thyroid dysfunction, and thyroid dysfunction is a common comorbidity in RA. Anti-TNF treatment might limit thyroid dysfunction. Thus, changes in thyroid hormones were studied during TNF-blocking therapy in patients with RA. At baseline and after 6 months' treatment with adalimumab, thyroid function [thyroid-stimulating hormone (TSH), free thyroxine (fT4), and antibodies against thyroid peroxidase (TPOabs)] were assessed in 138 consecutive adalimumab-treated patients with RA who were naive for TNF-blocking agents. Patients were categorized as hypothyroid, hyperthyroid, or euthyroid. In these groups, changes in thyroid function were determined. Prevalences of hypothyroidism, hyperthyroidism, and TPOabs were 13%, 5%, and 15%, respectively. After 6 months, TPOabs decreased from 267 to 201 IU/ml (p = 0.048). In hypothyroid patients without concomitant L-thyroxine, a trend for declining levels of TSH was observed. Subgroup analysis revealed that in patients who were hypothyroid and TPOabs-positive and L-thyroxine-naive, TSH levels decreased significantly, from 12.5 (interquartile range 6.7-18.4) to 7.1 (interquartile range 4.9-13.8) mU/l (p = 0.043). Anti-TNF treatment improves thyroid function in hypothyroid patients with RA (especially in those who are L-thyroxine-naive and TPOabs-positive), providing further evidence that inflammatory cytokines such as TNF have a pathogenic role in thyroid dysfunction.

Oral Sodium Bicarbonate Improves Thyroid Function in Predialysis Chronic Kidney Disease

Background/Aims: Metabolic acidosis (MA) in chronic kidney disease (CKD) associates with protein energy malnutrition, osteoporosis, abnormal endocrine function and increased mortality. Oral sodium bicarbonate has been shown to improve nutritional status and preserve renal function in CKD. Depressed thyroid function has been described in CKD and was believed to be related to MA. This is a prospective randomized study that examined the effect of oral sodium bicarbonate on thyroid function in predialysis CKD with MA. Methods: Predialysis CKD patients with serum total CO₂ ≤22 mM were randomized into two groups. The treatment group received increasing dose of oral sodium bicarbonate until serum total CO₂ was ≧24 mM. Control patients were kept on the same medications. Thyroid function tests were measured at baseline and again after 8–12 weeks. Results: All patients had a glomerular filtration rate <35 ml/min/1.73 m². Serum total CO₂ increased significantly in the treatment group and was unchanged in the control group. At baseline, over half of the patients had T3 below the lower limit of normal. At study completion, free T3 declined further in the control group, whereas free T3, total T3, free T4 and TSH rose significantly in the treatment group. Percentage changes of total CO₂ from baseline were strongly associated with the changes of T3 parameters. Glomerular filtration rate was maintained in the treatment group but declined significantly in the control group. Conclusion: Oral sodium bicarbonate, through correction of MA, improved thyroid function in predialysis CKD.

Selenium Supplementation in the Treatment of Hashimoto's Thyroiditis: A Systematic Review and a Meta-analysis

Evidence suggests that selenium (Se) supplementation could be useful as an adjunctive therapy to levothyroxine (LT₄) in the treatment of Hashimoto's thyroiditis (HT). To summarize evidence regarding its effect on thyroid autoantibodies' titers, demands in LT₄ replacement therapy, ultrasonographic thyroid morphology, and mood in patients with HT under LT₄ treatment, a systematic review and meta-analysis of relevant literature were performed. Systematic review of prospective studies involving patients with HT under LT₄ treatment and meta-analysis of studies on randomized, placebo-controlled, blinded trials were performed. Patients with HT assigned to Se supplementation for 3 months demonstrated significantly lower thyroid peroxidase autoantibodies (TPOab) titers (four studies, random effects weighted mean difference: −271.09, 95% confidence interval: −421.98 to −120.19, p< 10⁻⁴) and a significantly higher chance of reporting an improvement in well-being and/or mood (three studies, random effects risk ratio: 2.79, 95% confidence interval: 1.21-6.47, p= 0.016) when compared with controls. Demands in LT₄ replacement therapy and ultrasonographic thyroid morphology were found either unaltered or underreported. On the basis of the best available evidence, Se supplementation is associated with a significant decrease in TPOab titers at 3 months and with improvement in mood and/or general well-being. Evidence suggests a different pattern of response to Se supplementation in HT relative to baseline TPOab titers, and this, if confirmed, could be used to identify which patients would benefit most from treatment. An improvement in thyroid function and morphology should be demonstrated before Se routine supplementation can be recommended in the treatment of HT.

Iodine: It's Important in Patients that Require Parenteral Nutrition

Iodine deficiency has multiple adverse effects on growth and development because of inadequate thyroid hormone production. Four methods are generally recommended for assessment of iodine nutrition: urinary iodine concentration, thyroid size, and blood concentrations of thyroid-stimulating hormone and thyroglobulin. Iodine intakes < or = 1 mg/d are well tolerated by most adults, because the thyroid is able to adjust to a wide range of intakes. A daily dose of 1 microg iodine/kg body weight is recommended for infants and children receiving parenteral nutrition (PN), but this is far below their requirement. Daily iodine requirements in adults receiving enteral nutrition or PN are estimated to be 70-150 microg, but most PN formulations do not contain iodine. Despite this, deficiency is unlikely because absorption from iodine-containing skin disinfectants and other adventitious sources can provide sufficient iodine. However, if chlorhexidine replaces iodine-containing disinfectants for catheter care, iodine deficiency may occur during long-term PN, and periodic testing of thyroid functions may be prudent. Infants may be particularly vulnerable because of their small thyroidal iodine store, but available data do not yet support routine supplementation of preterm infants with iodine. Adults may be less vulnerable because thyroidal iodine stores may be able to support thyroid hormone production for several months. More studies to clarify this issue would be valuable.

Acute renal failure due to amiodarone-induced hypothyroidism

Renal alterations in hypothyroidism include decreased glomerular filtration rate and renal plasma flow. We herein report a case of amiodarone -induced hypothyroidism associated with a rapid decrease of renal function, reversible upon amiodarone withdrawal. A 72-year-old man presented to our clinic in August 2007 reporting a recent deterioration of renal function. Ten weeks before he was admitted to another hospital for a supraventricular tachyarrhythmia treated with carvedilol 12.5 mg/day and amiodarone 400 mg/day. On admission, laboratory tests revealed altered renal function (serum creatinine 6 mg/dl, blood urea nitrogen 78 mg/dl) and severe hypothyroidism (free T4 0.27 pg/ml, free T3 1.49 pg/ml, TSH 183.36 mU/l). Amiodarone and carvedilol were stopped, while levothyroxine 75 mcg/die was started. After three months renal function had completely recovered to 1.9 mg/dl, BUN 28 mg/dl, with concurrent improvement of thyroid function free T4 14.2 pg/ml, free T3 6.4 pg/ml, TSH 15.5 mU/l.

Radioiodine Studies, Low Serum Thyrotropin, and the Influence of Statin Drugs

A low serum thyrotropin (TSH) concentration is an excellent predictor of hyperthyroidism, either overt or subclinical. Whether statin use influences the ability of a low serum TSH measurement to detect hyperthyroidism has not been evaluated. In a cohort of 307 patients with low or undetectable serum TSH concentrations suggestive of hyperthyroidism, we determined whether concurrent statin use influenced the results of radioiodine uptakes and scans. Participants included 29 patients taking a statin medication and 278 who were not taking a statin. Radioiodine uptakes and scans were interpreted by board-certified nuclear medicine physicians. Sixteen of the 29 patients who were taking a statin (55%) had normal radioiodine uptakes and scans despite their low serum TSH. The remaining 13 low-TSH patients who were taking a statin (45%) had abnormal uptakes and scans, most commonly showing diffuse thyroid hyperplasia with increased radioiodine uptake. In contrast, the vast majority of the 278 patients not taking a statin had abnormal uptakes and scans (84%), while only 16% of them had normal uptakes and scans (p < 0.001 vs. those on statins). The age- and sex-adjusted odds ratio of a statin user with a low serum TSH having normal radioiodine studies (as opposed to abnormal studies) was 3.6 (95% CI, 1.6-8.4). In patients with a low serum TSH concentration, normal thyroid function and morphology, as assessed by radioiodine studies, were much more common if the patient was taking a statin. Statins may falsely lower the serum TSH without altering thyroid function ("pseudohyperthyroidism") or, alternatively, statins may improve thyroid function in patients with hyperthyroidism.

Statins Decrease the Aberrant HLA-DR Expression on Thyrocytes from Patients with Hashimoto's Thyroiditis

Statins have been found to exert anti-inflammatory and immune modulatory effects. It seems likely that these drugs may improve thyroid function in patients with Hashimoto's thyroiditis (HT). The objective of our study was to investigate the effect of statins on HLA-DR (human leukocyte antigen D-related) expression of thyrocytes from patients with HT hypothyroidism. Thyroid tissues were obtained from surgical specimens. Thyrocytes were cultured in the presence or absence of IFN-gamma (50 ng/ml) with or without statins (simvastatin 10 microM or atorvastatin 10 microM) for 72 hours. HLA-DR expression was detected by flow cytometry. Normal thyrocytes were used for controls. HLA-DR expression of HT thyrocytes was much higher than that of normal thyrocytes (41.2+/-4.5% vs. 2.7+/-2.1%, p<0.01), which could be further increased by IFN-gamma stimulation in both groups (p<0.01). However, simvastatin and atorvastatin could significantly inhibit the "aberrant" HLA-DR expression on HT thyrocytes and decrease IFN-gamma- induced HLA-DR expression in both HT and normal thyroid cells (p<0.01). Statins can repress HLA-DR expression of HT thyrocytes, which might inhibit the subsequent lymphocyte activation and ameliorate the immune disturbance of HT.

Serum TSH and serum thyroid peroxidase antibody fluctuate in parallel and high urinary iodine excretion predicts subsequent thyroid failure in a 1-year study of patients with untreated subclinical hypothyroidism

To explore the possibility of predicting decline or improvement in thyroid function over 1 year, and to investigate the correlations of serum TSH (s-TSH) with hypothyroidism-related symptoms and signs, serum thyroid peroxidase antibody (s-TPO-Ab) and urinary iodine excretion in individual patients with untreated subclinical hypothyroidism (SH). Monthly repeated measurement study without intervention. Twenty-one patients without former thyroid disease who had been identified with s-TSH between 5 and 12 mU/l and normal serum thyroxine (s-T4) at two occasions were enrolled. Subsequently, 13 monthly measurements of s-TSH, hypothyroidism-related symptoms and signs, serum free T4, s-TPO-Ab and urinary iodine excretion were performed. Over the study year, s-TSH increased significantly in 5 patients, 16 had unchanged s-TSH, whereas none improved. From clinical and biochemical inclusion data, it was not possible to predict who would later increase in s-TSH. In individual patients, a highly significant correlation between s-TSH and s-TPO-Ab was found (r=0.37, P<0.0001) and also between s-TSH and urinary iodine excretion (r=0.14, P=0.034). No correlation between s-TSH and clinical symptoms and signs was observed. Time shift showed best correlation between s-TSH and s-TPO-Ab measured at the same time point, whereas urinary iodine excretion correlated best to s-TSH and s-TPO-Ab obtained 1 month later. At the time of inclusion, it was not possible to identify the 24% of SH patients who would show deterioration in thyroid function over the following year. Impairment in thyroid function varied in parallel with thyroid autoimmunity, whereas high urinary iodine excretion predicted high s-TSH and s-TPO-Ab 1 month later.

Current Approaches for the Treatment with Thyroid Hormone Analogs

Thyroid hormones affect the function of nearly every organ of the body, including lipid homeostasis, regulation of body weight and cardiovascular effects. Application of thyroid hormones for the treatment of metabolic and cardiovascular disorders is not possible due to their side effects, but the discovery of drugs specifically affecting some of these functions may overcome this limitation. In the current review, we outline the physiology of thyroid receptors and summarize patterns of new drugs that bind to different receptors, thereby providing the base for a treatment of patients with metabolic and cardiovascular disorders. More recently, thyrotropin releasing hormone (TRH) has been shown to improve thyroid function in patients with nonthyroidal illness syndrome (NTIS), and may provide a future therapeutic option for critically ill patients. In addition, there is evidence that TRH is involved in central nervous regulation of blood glucose and repair of brain damage. However, therapeutical application of TRH is hampered by its rapid metabolization. Specific long acting analogues may therefore allow better treatment of these conditions. Recent patents on design and therapeutical use of these drugs are summarized in this manuscript. Keywords: Thyroid hormone, analogs, metabolic syndrome, TRH, NTIS

Effect of Iron Repletion and Correction of Iron Deficiency on Thyroid Function in Iron-deficient Iranian Adolescent Girls

The aim of this study was to determine whether iron supplementation in iron-deficient adolescent girls would improve thyroid function. A double-blind clinical trial was performed in a region in southern I.R. Iran. A total of 103 iron deficient participants were chosen. In all, 94 participants successfully completed this study. Participants were randomly assigned to one of two groups and treated with a 300 mg ferrous sulfate 5 times/week (n = 47) and placebo 5 times/week (n = 47) for 12 weeks. Blood samples were collected and assayed for hemoglobin, hematocrit, serum ferritin, iron, total iron binding capacity (TIBC), Thyroid stimulating hormone (TSH), total thyroxine (TT4), total triiodothyronine (TT3), free thyroid hormones (FT4 and FT3), triiodothyronine resin uptake (T3RU), reverse triiodothyronine (rT3), selenium and albumin concentrations. Statistical analysis was performed with parametric and non-parametric methods as appropriate. Data analysis revealed a significant increase in TT4, TT3, T3RU and a significant decrease in rT3 concentration in comparison to initial values in iron treated group (12%, p<0.001; 3.5%, p<0.001; 16%, p<0.05 and 47%, p<0.001, respectively). At 12 week there were significant differences between control and placebo in TT4, TT3, T3RU and rT3 concentrations (9.9 vs 8.4 microg dL(-1), 145.2 vs 130.4 microg dL(-1), 32.5 vs 28.4% and 23 vs 41 microg dL(-1), respectively, all p<0.001). Alterations in FT3 and TSH concentration were not significant, but concentration of FT4 revealed a significant difference between the beginning and the end of the study in iron treated group (10.3 vs 11.4, p<0.001). Iron supplementation improves some indices of thyroid function in iron-deficient adolescent girls.

Thyroid Function in Thalassemic Patients Treated with Combined Chelation Therapy.

Recently introduced chelation regimens that combine deferoxamine (DFO) and deferiprone (DFP) have been shown to have greater efficacy in promoting iron excretion than either chelator alone and have been associated with rapid reduction of the iron load in the heart and liver, and with reversal of cardiac dysfunction. It is unclear whether this combined therapy could be associated with a decline in the severity of iron-induced endocrinopathies. The primary endpoint of the present study was to investigate the effects of this therapy on the thyroid function in thalassemic patients with subclinical hypothyroidism (SH) or normal thyroid function. Starting in January 2001, 42 patients with b-tlalassaemia major, previously maintained on subcutaneous DFO only, were switched to combined treatment with DFO and DFP. Before the initiation of combined therapy 14 patients had overt hypothyroidism and were treated with thyroxin substitution. The thyroid function of the remaining patients with normal fasting levels of both FT4 and FT3 was further assessed with TRH test. TSH was measured at 0, 30, 60 and 90 minutes after IV injection of 200 mcg of TRH. 15 patients with normal TSH responses (7 males, 8 females, age 28.86 ± 2.20 years, mean ± SEM), and 13 patients (6 males, 7 females, age 31.15 ± 1.85 years), who were considered suffering from SH were finally enrolled. Criteria for the diagnosis of SH was an elevated basal TSH concentration (>5 TSH μIU/ml) or an increment of the TSH levels during the test more than 20 μIU/ml from the basal value. Combination therapy markedly decreased ferritin levels (585 ± 457 vs. 2124 ± 456 μg/l, P < 0.001 in SH group and 868 ± 339 vs. 2877 ± 552 μg/l, P < 0.001 in eythyroidal group). At the time of reassessment (June 2006), the levels of TSH were decreased at all times during the second TRH test in patients with SH: Basal TSH: 4.12 ± 0.63 vs. 6.27 ± 1.08, P=0.01. TSH At 30′ mins: 22.13 ± 2.18 vs. 34.06 ± 4.75, P=0.005. TSH At 60′ mins: 15.89 ± 1.13 vs. 25.69 ± 3.72, P=0.002. TSH At 90′ mins: 11.83±1.26 vs. 19.44±3.27, P=0.001. TSH quantitative secretion, calculated as the area under the curve, was also significantly decreased with combined therapy (1380±118) compared with the initial assessment (2178±312, P=0.004), while no change occurred in basal FT4 (1.06 ± 0.04 vs. 1.15 ± 0.08 in 2001, normal range 0.71–1.85 ng/ml) and FT3 levels (1.55± 0.07 vs. 1.59± 0.08 in 2001, normal range 1.45–3.48 pg/ml). Nevertheless, 7 patients with previous SH exhibited normal results in the reassessment. In patients with previous normal thyroid function TSH response to TRH stimulus was significantly improved only at 60′ mins (9.78±0.73 vs. 11.49±1.28, P=0.03). This study showed that the combination of DFO and DFP followed by an intensive iron chelation might be associated with an improvement in thyroid function in the early stages of hypothyroidism.

Assessment of Iodine Status Using Dried Blood Spot Thyroglobulin: Development of Reference Material and Establishment of an International Reference Range in Iodine-Sufficient Children

Thyroglobulin (Tg) may be a valuable indicator of improving thyroid function in children after salt iodization. A recently developed Tg assay for use on dried whole blood spots (DBS) makes sampling practical, even in remote areas. The study aim was to develop a reference standard for DBS-Tg, establish an international reference range for DBS-Tg in iodine-sufficient children, and test the standardized DBS-Tg assay in an intervention trial. Serum Tg reference material of the European Community Bureau of Reference (CRM-457) was adapted for DBS and its stability tested over 1 yr. DBS-Tg was determined in an international sample of 5- to 14-yr-old children (n = 700) who were euthyroid, anti-Tg antibody negative, and residing in areas of long-term iodine sufficiency. In a 10-month trial in iodine-deficient children, DBS-Tg and other indicators of iodine status were measured before and after introduction of iodized salt. Stability of the CRM-457 Tg reference standard on DBS over 1 yr of storage at -20 and -50 C was acceptable. In the international sample of children, the third and 97th percentiles of DBS-Tg were 4 and 40 microg/liter, respectively. In the intervention, before introduction of iodized salt, median DBS-Tg was 49 microg/liter, and more than two thirds of children had DBS-Tg values greater than 40 microg/liter. After 5 and 10 months of iodized salt use, median DBS-Tg decreased to 13 and 8 microg/liter, respectively, and only 7 and 3% of children, respectively, had values greater than 40 microg/liter. DBS-Tg correlated well at baseline and 5 months with urinary iodine and thyroid volume. The availability of reference material and an international reference range facilitates the use of DBS-Tg for monitoring of iodine nutrition in school-age children.

In vivo and in vitro effects of statins on lymphocytes in patients with Hashimoto’s thyroiditis

Statins have apoptotic effects on many cell types. Hashimoto's thyroiditis (HT) is an autoimmune disease in which cell-mediated autoimmune mechanisms are pathogenetically involved. The aim of this study was to evaluate the in vivo effects of Simvastatin on thyroid function, lymphocyte subtypes and also to investigate the apoptotic effects of Simvastatin, Mevastatin, Pravastatin and Cerivastatin on lymphocytes from patients with HT. In the first part of the study, 11 patients with HT and subclinical hypothyroidism (SH) were given Simvastatin (20 mg/day) for 8 weeks. Ten patients with SH and HT served as the control group. No treatment was given to controls. Thyroid function, C-reactive protein (CRP) levels and lymphocyte subtypes of both groups were determined before the study and after 8 weeks. In the second part of the study, the apoptotic effects of statins on lymphocytes were evaluated in patients with HT (n = 10) and normal subjects (n = 10) in vitro. Apoptosis was investigated by using Annexin-V and propidium iodide. Lymphocytes from patients and controls were incubated with different concentrations of Simvastatin, Cerivastatin, Mevastatin and Pravastatin. An increase in serum free tri-iodothyronine and free thyroxine levels and a decrease in TSH levels were observed (P < 0.05) with Simvastatin treatment. CD4+ cells and B lymphocytes increased whilst CD8+ cells, natural killer cells and activated T lymphocytes decreased significantly in the treatment group (P < 0.05). The CRP level of the group also decreased with Simvastatin but it did not reach significance (P = 0.057). None of parameters was found to be different from the baseline in the control group. In in vitro experiments, apoptosis was observed in CD3 + (both in CD8+ and CD4+ cells) with all statins in both patient and control samples. Mevalonate, which was used in experiments, reversed apoptosis in some but not all samples. The results of this study suggested that Simvastatin is an immune modulatory agent and improves thyroid function in patients with HT. This effect is probably mediated via lymphocyte apoptosis as demonstrated with in vitro experiments and is not confined to Simvastatin since Mevastatin, Pravastatin and Cerivastatin also induced apoptosis in lymphocytes.

Improvement of idiopathic thrombocytopenic purpura by antithyroid therapy

Here we report a case of idiopathic thrombocytopenic purpura accompanied by Graves' disease. Improvement in thyroid function with methimazole led to the spontaneous recovery of the platelet count from 8 x 10(9)/L to 84 x 10(9)/L. Furthermore, the second fall and recovery of the platelet count well coincided with the recurrence of hyperthyroidism after the discontinuation of methimazole and its normalization by resumption of the drug, respectively. These parallel fluctuations of platelet and thyrotropin because of the cessation and resumption of antithyroid therapy suggests that correction of hyperthyroidism may be beneficial to the control of an imbalance in the immune system which impairs not only thyroid but also the platelet.

Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been very effective in managing a broad range of morbid obesity-related co-morbidities. We report a beneficial effect of LRYGBP that has not been previously observed. Between December 1999 and September 2002, 224 patients underwent LRYGBP. Preoperative assessment for hypothyroidism and follow-up data were prospectively collected in our database. Improved thyroid function (ITF) or unchanged thyroid function (UTF) was determined by comparison of preoperative and postoperative thyroxine requirements. 23 of 224 patients (10.3%) were treated preoperatively for hypothyroidism. During a median follow-up of 17 months, hypothyroidism was improved in 10/23 patients (43.5%). 2 patients had complete resolution, and the remaining 8 had reduction (14%-50%) of their thyroxine requirements. ITF occurred at a mean follow-up of 8.9 months and at a mean excess weight loss (EWL) of 57%. 6 of the 8 patients (75%) with ITF >or= 25% had EWL >90% at last follow-up, compared to 1 out of 15 patients (6.6%) with UTF or <25% improvement (P =0.001). Comparison of patients with ITF and UTF over time during a 20-month follow-up, showed no significant difference in mean body mass index (BMI) and mean percentage of EWL. Improvement of hypothyroidism may be an additional benefit of bariatric surgery that has not been previously reported. Reduction of thyroxine requirements is most likely the result of the decrease in the BMI.

Development of a dried whole-blood spot thyroglobulin assay and its evaluation as an indicator of thyroid status in goitrous children receiving iodized salt

Serum thyroglobulin appears to be a sensitive marker of thyroid dysfunction in endemic goiter. However, its value as an indicator of thyroid status in children after the introduction of iodized salt has not been tested. The objective was to optimize and validate a thyroglobulin assay on dried whole blood spots and to evaluate thyroglobulin as an indicator of thyroid response to iodized salt. A standardized, commercially available, sandwich fluoroimmunometric serum thyroglobulin assay was adapted for use on blood spots and validated in Swiss children. In a 1-y prospective study in 377 goitrous Moroccan children aged 6-15 y, the assay was used to measure thyroglobulin before and after the introduction of iodized salt. Urinary iodine, thyroid volume, thyrotropin, and thyroxine were measured, and regression was done with thyroglobulin as the dependent variable. Correlation between the blood spot and serum assays was excellent (r = 0.98). The SD of the difference between the blood spot and serum assays was 3.8 micro g/L; the median CVs for the blood spot assay in controls and samples were 6.3% and 14.4%, respectively. Median thyroglobulin was 24.5 (range: 0-328.8) micro g/L at baseline and fell significantly after the introduction of iodized salt to 6.2 (0-83.1) and 4.4 (0-47.1) micro g/L at 5 and 12 mo, respectively (P < 0.0001). Regression of urinary iodine and thyroid volume on thyroglobulin was highly significant at baseline and at 5 mo (P < 0.001). Thyroglobulin, measured in dried whole blood spots, may be a valuable indicator of improving thyroid function in children after supplementation with iodized salt.

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 20

A 26‐year‐old woman acutely developed bilateral sensory symptoms of carpal tunnel syndrome (CTS). Neurophysiological investigations confirmed the diagnosis of CTS (severe at right and moderate at left hand). Because of the severity of the CTS in young patients without evident causes, we asked some further investigations in order to find a primary disease that might cause CTS. Endocrinological studies revealed a Hashimoto's thyroiditis with hyperthyroidism. She was treated for the thyroiditis with improvement of thyroid function and entrapment syndrome. Neurophysiological controls confirmed the progressive improvement of CTS. The current case suggests to look for subclinical endocrinological disease when severe CTS is found in young patients without mechanical stress condition (work or hobby).

Iron status influences the efficacy of iodine prophylaxis in goitrous children in Côte d'Ivoire.

In the developing countries of Africa, many children are at high risk for both goiter and iron-deficiency anemia (IDA). Because iron (Fe) deficiency can have adverse effects on thyroid metabolism, Fe deficiency may influence response to supplemental iodine in areas of endemic goiter. Therefore, our aims were to determine: 1) if goitrous children also suffering from IDA could respond to oral iodine supplementation; and 2) if Fe supplementation in goitrous children with IDA would improve their response to oral iodized oil and iodized salt. First, we compared the efficacy of oral iodized oil in two groups of goitrous children: a nonanaemic group vs. an IDA group. The therapeutic response to iodized oil was impaired in the goitrous children with IDA. Second, an open trial of Fe treatment in goitrous children with IDA improved their response to oral iodized oil. Finally, in a randomized double-blind trial, goitrous, Fe-deficient children consuming iodized salt were given Fe supplementation or placebo. Fe supplementation improved the efficacy of the iodized salt. In these studies, both anatomic (thyroid size) and biochemical (TSH, T4) measures indicated that iodine significantly improved thyroid function in the nonanaemic children compared to the Fe deficient children. Iodine was less efficacious in children with lower Hb at baseline and in those with a poorer response to Fe. The data suggest that a high prevalence of IDA among children in areas of endemic goiter may reduce the effectiveness of iodine prophylaxis.