Prevalence Of Hypothyroidism In Patients Research Articles

Evaluation of thyroid profile in biliary tract stones

Background: In the course of clinical practice it has been observed that a no. of patients with biliary tract stones have hypothyroidism in their medical history. The prevalence of hypothyroidism is increased in patients of choledocholithiasis than in cholelithiasis patients. Aims and objectives: To find the prevalence of hypothyroidism in patients of cholelithiasis and choledocholithiasis. Methods: This study was conducted in post graduate dept. of surgery, SMHS over a period of 2 years on a total of 100 patients, 50 diagnosed as having cholelithiasis and 50 having choledocholithiasis. A complete history, detailed clinical examination followed by evaluation as per protocol was done. Results: There was an increased prevalence of choledocholithiasis with increasing age (max. pts. in age group 51-60) with female predominance in patients diagnosed as choledocholithiasis, thereby implying increasing age and female gender as risk factors for choledocholithiasis. There was a prevalence of 16% of hypothyroidism in patients of choledocholithiasis in comparison to 8% in cholelithiasis group with subclinical hypothyroidism present in maximum no. of patients (75%). Conclusions: Hypothyroidism is more common in the choledocholithiasis patients as compared to cholelithiasis group, with female predominance and with subclinical variant in maximum No. of patients which support the hypothesis that hypothyroidism might play a role in the formation of CBD stones.

Prevalence of hypothyroidism in patients with dyslipidemia: Tehran Thyroid Study (TTS).

Hypothyroidism is a relatively common endocrine disorder usually accompanied with changes in serum lipid profiles. The purpose of this study was to assess the association between dyslipidemia and hypothyroidism in a population-based study. In this cross-sectional study, 2,315 dyslipidemic patients, aged 20-90 years (mean age: 38.1 ± 13.2 years), were selected from among 5,760 participants of Tehran Thyroid Study and divided into 3 groups, the subclinical hypothyroid, overt hypothyroid, and euthyroid subjects, based on national reference ranges. Serum lipid profiles, free thyroxine (FT4), thyroid stimulating hormone (TSH), and thyroid peroxidase antibody (TPOAb) were measured in all subjects. In subjects with dyslipidemia and nondyslipidemia, the prevalence of subclinical was 7% and 4.1%, respectively, and for clinical hypothyroidism 3% and 1.2%, respectively. In dyslipidemic subjects, the mean low density lipoprotein-cholesterol (LDL-C) levels differed significantly (p = 0.03) among the overt hypothyroid (144.3 ± 36.1), subclinical hypothyroid (129.3 ± 39.2), and euthyroid (132.7 ± 39.0) groups. In the overt hypothyroid group, mean total cholesterol level was higher than in the normal group, but not significant. There were no differences in median triglycerides (TG) and mean high density lipoprotein-cholesterol (HDL-C) levels among the 3 groups mentioned. After adjusting for age and sex, hypothyroidism was not related to elevated serum lipid profiles in patient with dyslipidemia. In conclusion, there is significant difference in the prevalence of subclinical and clinical hypothyroidism between nondyslipidemic and dyslipidemic subjects; after adjustment for age and sex the presence of dyslipidemia did not predict the presence of hypothyroidism.

Hypothyroidism and bipolar affective disorder: is there a connection?

Context:Hypothalamic-pituitary-thyroid axis dysfunction in the pathophysiology of bipolar disorder has received less attention as compared with that in depressive disorder.Aims:To study the prevalence of hypothyroidism in patients diagnosed with bipolar disorder and compare it with a population norm.Settings and Design:The setting was the psychiatry inpatient unit of a tertiary care hospital. The design was retrospective and observational.Subjects and Methods:A retrospective observational study was performed, referring to the case records of 84 cases of bipolar disorder admitted to the Department of Psychiatry in a Tertiary Referral Center during the year 2010-2012. The prevalence of hypothyroidism both subclinical as demonstrated by elevated thyroid stimulating hormone (TSH) levels (cut-off value 4.2 μU/ml) and overt hypothyroidism (fasting T4 <0.92 ng/dl and TSH >4.2 μU/ml) was calculated. This was compared with the population prevalence of hypothyroidism as determined by an epidemiological study carried out in the year 2009, in the same region. The correlation between hypothyroidism, gender, lithium prophylaxis and family history of mood disorder was computed.Statistical Analysis:Percentage prevalence of hypothyroidism in the sample was calculated and compared to a population norm. The correlation between hypothyroidism, gender, lithium prophylaxis and family history of mood disorder was computed using the odds ratio (OR).Results:The total prevalence of hypothyroidism in both males and females in the bipolar group was comparable with that in the general population. There is a significant association between family history of mood disorder in first degree relatives and patients having hypothyroidism (OR 5.504 and P = 0.012). There were no statistically significant associations between thyroid abnormalities and age, duration of illness and lithium prophylaxis.Conclusions:There is no significant association between hypothyroidism and bipolar disorder. Family history of mood disorder and hypothyroidism show significant association. (OR -5.504 AND P = 0.012).

Hipotiroidismo induzido pelos inibidores da tirosina-cinase

Thyroid dysfunction is an important adverse effect of tyrosine kinase inhibitors (TKI). To assess the prevalence of hypothyroidism in patients treated with TKI at our institution between 2003 and 2012, we reviewed their clinical records. One hundred and seven patients were evaluated, 56% male. Erlotinib was used in 27 patients, imatinib in 30, sunitinib in 17, lapatinib in 15, sorafenib in 7, gefitinib in 1 and more than one TKI in 10 patient (8 imatinib+sunitinib, 1 sunitinib+sorafenib, 1 imatinib+dasatinib). Of 107 patients, 59 (55%) performed thyroid function evaluation, in which hypothyroidism was documented in 35.6% (21 patients). Hypothyroidism was detected after a mean (±SD) time of 9.3±5.8 months of therapy. Levothyroxine was initiated in 11 patients. Hypothyroidism occurred in 57%, 46% e 17% of the patients treated with sunitinib, lapatinib and sorafenib, respectively. Seventy five percent of the patients treated with more than one TKI presented hypothyroidism and in all cases one of TKI was sunitinib. Of the patients receiving erlotinib, imatinib or gefitinib monotherapy that underwent thyroid function evaluation, none had hypothyroidism. The main limitation of the study is the low number of patients in each subgroup, however hypothyroidism seems to be more prevalent in patients on sunitinib or lapatinib. With the high prevalence of hypothyroidism in patients under TKI it is recommended to perform thyroid function assessment before and periodically during the treatment.

Increased risk of hypothyroidism and hyperthyroidism in patients with major depressive disorder: A population-based study

ObjectiveTo determine the prevalence and incidence of hypothyroidism, hyperthyroidism, and risk factors in patients with major depressive disorder (MDD). MethodsThe National Health Research Institute provided a database of 1,000,000 random subjects for health service studies. We identified subjects aged ≥18years who had at least 1 service claim during 2005 with a primary diagnosis of MDD or with a primary or secondary diagnosis of hypothyroidism or hyperthyroidism. We also compared the incidence of hypothyroidism and hyperthyroidism among patients with MDD and the general population from 2006 through 2010. ResultsThe prevalence of hypothyroidism in patients with MDD was higher than that in the general population (1.20% vs. 0.30%; odds ratio, 3.08; 95% confidence interval, 2.35–4.03) in 2005. The prevalence of hyperthyroidism was also higher in patients with MDD than in the general population (2.46% vs. 0.79%; odds ratio, 2.77; 95% confidence interval, 2.29–3.35) in 2005. The annual incidence of hypothyroidism was higher in patients with MDD than that in the general population (0.40% vs. 0.13%; risk ratio, 2.47; 95% confidence interval, 2.00–3.06). The annual incidence of hyperthyroidism was also higher in patients with MDD than that in the general population (0.72% vs. 0.32%; risk ratio, 2.06; 95% confidence interval, 1.75–2.43). ConclusionsPatients with MDD had a higher prevalence and a higher incidence of hypothyroidism or hyperthyroidism than the general population. Female sex was a risk factor for hypothyroidism and hyperthyroidism in MDD.

Prevalence of hypothyroidism in patients with metabolic syndrome

Aim: Hypothyroidism and metabolic syndrome are well-associated risk factors for atherogenic cardiovascular disease. Insulin resistance, being a common pathogenic mechanism in both, can cause a considerable overlap between hypothyroid and metabolic syndrome population. This cross-sectional study was intended to assess the 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 as per National Cholesterol Education Program-Adult Treatment Panel (NCEP ATP) III criteria and 50 controls (0 out of 5 criteria) attending the internal medicine outpatient clinic were included in the study. Patients were subjected to anthropometry, evaluation of vital parameters, and lipid and thyroid profile, along with other routine laboratory parameters. Students' t test, Chi-square test, linear regression, and multiple logistic regression models were used for statistical analysis. P value <0.05 was considered significant. Results: Body mass index, waist circumference, mean systolic pressure, diastolic pressure, fasting blood sugar, total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and thyroid stimulating hormone (TSH) were significantly higher, and free triiodothyronine (FT3), free thyroxine (FT4), and high density lipoprotein (HDL) cholesterol were significantly lower in the study group compared to the control group. In the metabolic syndrome group, 22 had subclinical hypothyroidism (22%), 4 were overtly hypothyroid (4%), and 74 were euthyroid (74%). Subclinical hypothyroidism was significantly associated with metabolic syndrome group (P = 0.032). There was significant linear association between TSH levels and total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol across the metabolic syndrome group in the linear regression model. Multiple logistic regression analysis recognized the association between body mass index with subclinical hypothyroidism (P = 0.006) in the metabolic syndrome group. Conclusion: It is concluded from this study that there is significant association between subclinical hypothyroidism and metabolic syndrome, and it highlights the importance of thyroid function tests in patients with metabolic syndrome.

Coexistence of hypothyroidism with inflammatory arthritis is associated with cardiovascular disease in women

ObjectivesHypothyroidism and inflammatory arthritis tend to coexist, but data on this association are sparse. In terms of cardiovascular risk, this association may have clinical relevance as this coexistence may carry...

Incidence and Prevalence of Hypothyroidism in Patients Affected by Chronic Heart Failure: Role of Amiodarone

It has been demonstrated that hypothyroidism can lead to significant hemodynamic alterations favoring the onset of chronic heart failure (CHF) as well as its progression. Furthermore, amiodarone, an iodine-containing antiarhythmic drug frequently used in CHF patients, is often the cause of primary hypothyroidism. To define the prevalence and incidence of hypothyroidism in a group of CHF outpatients in stable clinical conditions, with particular reference to the role of amiodarone therapy. Among the 422 enrolled patients (326 males, aged 65±12 years), 51 (12%) had a previous diagnosis of hypothyroidism while 21 (5%) were newly diagnosed at the enrolment. Then, the overall prevalence of hypothyroidism at the first evaluation was 17%and, as expected, it was significantly higher in females than males (33% vs 13%; p < 0.001). During follow-up (median 28 months) hypothyroidism occurred in further 19 patients (incidence rate: 26/1000/year) and it was mainly attributable to amiodarone therapy. Considering all together the hypothyroid patients, either those affected by thyroid failure at the enrolment than those developing hypothyroidism during the follow-up, levothyroxine therapy was continued or started in 69% of them; however, normal serum TSH values were obtained only in 76% of treated cases (mean levothyroxine dose: 69±44 mcg/day). In any case, in the group of patients affected by hypothyroidism a significantly greater occurrence of heart failure progression was observed. Hypothyroidism, especially the subclinical form, frequently occurs in patients affected by CHF receiving amiodarone therapy. Given the unfavorable impact of hypothyroidism on the progression and prognosis of CHF, and the opportunity to adequately manage thyroid failure by means of levothyroxine replacement therapy without the need to withdraw amiodarone, we recommend regular testing of thyroid function in CHF patients, in particular in those submitted to amiodarone therapy, in order to early diagnose a condition of hypothyroidism and titrate substitutive treatment.

Racial and Sex Differences in Prevalence of Hypothyroidism in Patients With Cardiomyopathies Enrolled into a Heart Failure Disease Management Program

The authors evaluated the prevalence of hypothyroidism in patients with heart failure (HF) to determine whether there are racial and sex differences and to determine the number of new cases of hypothyroidism. The study included 194 patients in an HF disease management program (HFDMP) in South Florida. Patients were interviewed for a history of hypothyroidism and referred for measurement of thyrotropin. The prevalence of hypothyroidism was calculated by race and sex. The prevalence of hypothyroidism was 18% for all patients with HF and 23% among Hispanics; however, this trend was not statistically significant (P = .06). More men than women had hypothyroidism (P = .04). Patients with hypothyroidism had higher mean lipid profiles (P < .01) and lower mean heart rates (P = .03) than healthy patients. Hypothyroidism is prevalent among HF patients, especially men. Hispanics with HF may have a higher prevalence of hypothyroidism. The standardized protocol of the HFDMP helped identify new cases of hypothyroidism.

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

Hypercholesterolemia is one of the most representative disorders of the common diseases. To evaluate the prevalence of hypothyroidism in the population of adult hypercholesterolemia, we prospectively examined the thyroid function in patients with untreated or treated hypercholesterolemia as a multi-center survey. Subjects were the patients who were treated with some antilipemic agents or the untreated patients whose total cholesterol (TC) was over 220 mg/dL and/or LDL-cholesterol (LDL-C) over 140 mg/dL. Among 737 cases recruited, 725 cases (300 males and 425 females) participated in the survey including the thyroid function test. The patient's backgrounds include hypertension (51%), diabetes mellitus (49%), fatty liver (17%), smoking (15%), and habitual drinking (10%). The 72% of the patients were treated with some antilipemic agents and the mean values of TC, LDL-C, triglyceride (TG), HDL-cholesterol (HDL-C), and LDL-C/HDL-C ratio (L/H) were 204.5 mg/dL, 119.6 mg/dL, 144.4 mg/dL, 60.7 mg/dL and 2.25, respectively. The primary hypothyroidism was seen in 27 cases (3.7%) (11 males, 16 females) with subclinical hypothyroidism in 17 cases (2.4%) and overt hypothyroidism in 10 cases (1.4%). The central hypothyroidism was seen in 4 cases (0.6%). The prevalence of hypothyroidism was 4.3% in patients with hypercholesterolemia. Taking account of the large number of patients with dyslipidemia and importance of avoiding unnecessary administration and associated adverse effects, evaluation of the thyroid function could be warranted in patients with dyslipidemia although cost-benefit issues waits further investigation.

Hypothyroidism and the risk of lower extremity arterial disease

BackgroundAlthough an independent association between hypothyroidism and coronary artery disease has been demonstrated, few studies have examined the association between hypothyroidism and peripheral arterial disease. In the current study, we test the hypothesis that there is an independent association between hypothyroidism and lower extremity arterial disease.MethodsWe retrospectively compared the prevalence of hypothyroidism in patients who had infra-inguinal arterial bypass surgery over a 6-year period with that of a control group of surgical patients who had pure cardiac valve surgery during the same time period. Both unadjusted and adjusted odds ratios were calculated to estimate the association between hypothyroidism and lower extremity arterial disease.ResultsA total of 614 cases and 529 control subjects had surgery during the study period. When comparing all subjects, there was no association between hypothyroidism and lower extremity arterial disease (unadjusted odds ratio 0.88; 95% confidence intervals [CI]: 0.61–1.28). However, gender was found to be a significant effect modifier (P < 0.001), and gender-stratified analyses were subsequently performed. In men, there was a positive independent association between hypothyroidism and lower extremity arterial disease (adjusted odds ratio 2.65; 95% CI: 1.19–5.89), whereas in women there was a negative independent association (adjusted odds ratio 0.22; 95% CI: 0.11–0.46).ConclusionsGender is a significant effect modifier for the association between hypothyroidism and lower extremity arterial disease. The association is positive in men and negative in women. Future prospective studies that evaluate hypothyroidism as a risk factor for peripheral arterial disease should consider gender stratification in order to corroborate this finding.

Prevalence of Hypothyroidism in Benign Breast Disorders and Effect of Thyroxine Replacement on the Clinical Outcome

The aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD. This prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared. The mean age of the patients was 34 +/- 8 years, and the mean length of follow-up was 13.0 +/- 4.2 months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P = 0.001) or a lump (P = 0.01). In all, 39% of hypothyroid women had TSH concentrations >10 mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P = 0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P = 0.144). All women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.

Thyroid Disease in Patients with Idiopathic Thrombocytopenia: A Cohort Study

To estimate the prevalence of the association between thyroid disease and idiopathic thrombocytopenia (ITP), and to examine the effect of treatment of the thyroid condition on platelet count. Retrospective cohort study performed in a tertiary care center setting. All patients who were diagnosed with ITP by a single provider at the Cleveland Clinic Hematology/Oncology Department between 1988 and 2005 were included. Among the 98 patients, thyroid function tests were available in 80 patients. Of these, 16 (20%) had abnormal thyroid function: 6 had hyperthyroidism and 10 had hypothyroidism. The median interval from the onset of the thyroid or hematological condition (whichever came first) was 84 months (range: 25-612). The autoimmune nature of the thyroid disease was proven in 12 cases (75%). Three patients showed a transient increase in the platelet count after restoring the euthyroid state; however, durable improvement of thrombocytopenia was not encountered. The prevalence of hypothyroidism in patients with ITP is higher than in the general population. Based on this observation, routine assessment of thyroid function should be done in patients with ITP. The long-term course of ITP was not influenced by the treatment of the thyroid condition.

Hypothyroidism in coronary heart disease and its relation to selected risk factors

Hypothyroidism (HT) has been found a predictor of cardiovascular diseases. We aimed to ascertain the prevalence of HT in patients with manifest coronary heart disease (CHD), and to establish its association with conventional risk factors. 410 patients, 6-24 months after hospitalization for acute coronary syndrome, and/or revascularization, were included into the cross-sectional study. The prevalence of thyroid dysfunction was found in males and females as follows: overt HT, ie, thyroid stimulating hormone (TSH) > 3.65 mIU/L and free thyroxine (fT4) < 9 pmol/L and/or L-thyroxine substitution, in 2.6% and 8.4%, respectively; subclinical HT (TSH > 3.65, fT4 9-23 and no substitution) in 4.3% and 15.0%, respectively. Higher prevalence of HT was found in females with hypercholesterolemia, and in males and females with concomitant positive thyroid peroxidase antibodies. Hypothyroid subjects had higher total homocysteine in both genders and von Willebrand factor in males only. Hypothyroid females had higher total and LDL cholesterol, and were more often treated for diabetes. HT was found highly prevalent in patient with clinical coronary heart disease, mainly in females, and was associated with several cardiovascular risk factors.

High Prevalence of Hypothyroidism in Patients with Autoimmune Pancreatitis

Autoimmune pancreatitis is a unique form of chronic pancreatitis and has been correlated with various extrapancreatic lesions. To search for a correlation between autoimmune pancreatitis and thyroid lesions, we measured thyroid functions in 41 patients with autoimmune pancreatitis and in 41 patients with chronic calcifying pancreatitis and investigated the correlation between HLA antigens and hypothyroidism. We found a significant difference in the prevalence of antithyroglobulin antibody and hypothyroidism between patients with autoimmune pancreatitis and those with chronic pancreatitis (34.1 vs. 7.3%, P = 0.005, and 26.8 vs. 0%, P = 0.0005, respectively). Patients with hypothyroidism had a significantly higher frequency of antithyroglobulin antibody (63.6%) than those without hypothyroidism but showed no differences in other findings, including serum IgG4 concentration. We could find no significant association between any HLA antigens and the hypothyroid state of autoimmune pancreatitis. One quarter of the patients with autoimmune pancreatitis have hypothyroidism that may be independent of the active state of the pancreatic lesion or systemic fibrosing disorder, and thus patients suspected of having autoimmune pancreatitis should be evaluated for possible hypothyroidism.

Is hypothyroidism a risk factor for non-alcoholic steatohepatitis?

Thyroid hormones play an important role in the regulation of lipid and carbohydrate metabolism, both of which are affected in patients with non-alcoholic steatohepatitis (NASH). Anecdotally, we have observed that a number of patients with NASH carried a diagnosis of hypothyroidism. However, it is unknown if thyroid dysfunction plays any role in the pathogenesis of NASH. To further investigate this observation, we conducted a case-control study to determine the association between hypothyroidism and NASH. Cases were defined as patients with well-documented NASH attending hepatology clinics at Indiana University Hospital from January 1, 1995 to December 31, 2000. Age, gender, race, and body-weight matched individuals seen during the same period in the general medical clinics served as controls. Patients with a previous diagnosis of hypothyroidism who are currently on synthetic T4 replacement were considered to be "hypothyroid". The strength of association was assessed by logistic regression analysis after controlling for the frequency of diabetes mellitus, hyperlipidemia, and hypertension. One hundred seventy-four patients with NASH (cases) and 442 controls were included. The mean age of cohort was 49 +/- 13 years, 59% were female, and 98% were white. The prevalence of hypothyroidism in patients with NASH was 15% was significantly higher than in the controls (7.2%, P < 0.001). By multivariate analysis, the prevalence of hypothyroidism in the NASH group was significantly higher than in control group (OR: 2.3, 95% CI: 1.2-4.2, P = 0.008). These data suggest that hypothyroidism is associated with human NASH. Further research is needed to confirm this finding and to understand its implications.

Hypothyroidism in patients treated with total laryngectomy. A multivariate study.

One of the complications of the treatment of head and neck carcinoma patients is hypothyroidism. The objective of our study was to quantify the prevalence of hypothyroidism in patients with laryngeal or hypopharyngeal cancer treated with a total laryngectomy and to evaluate the importance of different variables in the appearance of hypothyroidism in this group of patients. A transversal study in 182 patients treated with total laryngectomy between 1986 and 1998 was carried out. TSH and FT4 were determined in all patients. Hypothyroidism was classified as subclinical (increased TSH and normal T4 levels) and clinical (increased TSH and decreased T4 levels). Univariate and multivariate analysis was carried out to examine the relationship between hypothyroidism and different variables. Our results showed that the prevalence of hypothyroidism in our group of patients was 52% (27% subclinical and 25% clinical). Sex, initial extension of the tumour, hemithyroidectomy, use of chemotherapy and radiotherapy were variables associated with the appearance of hypothyroidism in the univariate analysis (P < 0.05). When all these variables were included in a multivariate study, only hemithyroidectomy (RR 3,6; CI 95% 1,7-7,2) and combined treatment with radiotherapy (RR 3,4; CI 95% 1,2-9,6) appeared as prognostic factors. In conclusion, hypothyroidism is a frequent complication in patients treated with a total laryngectomy (52%), especially when this treatment includes hemithyroidectomy and/or radiotherapy. We consider that it is important to check the thyroid function periodically in these patients to obtain early diagnosis and appropriate treatment.

Pretreatment prevalence of hypothyroidism in patients with head and neck carcinoma.

Hypothyroidism in the normal population age > 60 years is encountered in the range of 0.5-5% clinically, and 5-20% have subclinical hypofunction. Hypothyroidism is recognized as a common complication of treatment in patients with head and neck carcinoma (HNC) and is reported in up to 75% of patients who receive combined treatment. Surprisingly, base-line pretreatment measurements of thyroid function in large series of patients have not been reported. Serum thyroid-stimulating hormone, free T4, and total T3 levels were recorded in 110 patients with nonthyroid HNC prior to treatment in a prospective, controlled study. The mean patient age (+/- standard deviation) was 65 years +/- 13.8 years, and 82% of patients had squamous cell carcinoma. A diagnosis of hypothyroidism already was established in 4.5% of patients, and subclinical hypothyroidism was discovered in an additional 6.4% of patients. Sixteen patients had other equivocal anomalies in thyroid function and were referred for further endocrine evaluation. No patients with formerly unrecognized clinical hypothyroidism were found. Hypothyroidism in patients with head and neck carcinoma in Israel corresponds with the reported incidence in the general population. Hypothyroidism after treatment for head and neck carcinoma stems from the effects of treatment. The need for pretreatment evaluation of thyroid function should be considered.

High Prevalence of Hypothyroidism in Patients with Primary Pulmonary Hypertension

To characterize the prevalence of hypothyroidism in a population with primary pulmonary hypertension (PPH). Retrospective record review of 41 patients with PPH seen between 1991 and 1997 at a tertiary care center. Data abstracted included: history of previous thyroid disease, intake of thyroid supplement, and thyroid function tests. Hypothyroidism was defined as a serum thyroid stimulating hormone (TSH) level higher than 5.5 U/L, intake of thyroid supplement, or low serum thyroxine level. Of the 40 patients with PPH included in the study (11 men and 29 women), ages ranged from 11 to 76 years (mean 43.5 years). The mean pulmonary artery pressure was 58.7 mm Hg. Thirty-three patients had normal serum TSH levels (3 of whom were on levothyroxine supplement); 1 had low TSH; 5 had high TSH (range, 6.8-9.9 U/L, mean 8.4 U/L), and 1 had low thyroxine (T4 < 1.0 microg/dL). Nine of 40 patients (22.5%) had evidence of hypothyroidism, which is much more than expected in the general population of similar age range (2.8% in men, 7.5% in women) (p = 0.002). The prevalence of hypothyroidism in patients with PPH is high (22.5%). Patients with PPH should be investigated for the possibility of coexisting hypothyroidism.

High Prevalence of Hypothyroidism in Patients with Primary Pulmonary Hypertension

ABSTRACT Purpose: To characterize the prevalence of hypothyroidism in a population with primary pulmonary hypertension (PPH). Methods: Retrospective record review of 41 patients with PPH seen between 1991 and 1997 at a tertiary care center. Data abstracted included: history of previous thyroid disease, intake of thyroid supplement, and thyroid function tests. Hypothyroidism was defined as a serum thyroid stimulating hormone (TSH) level higher than 5.5 U/L, intake of thyroid supplement, or low serum thyroxine level. Results: Of the 40 patients with PPH included in the study (11 men and 29 women), ages ranged from 11 to 76 years (mean 43.5 years). The mean pulmonary artery pressure was 58.7 mm Hg. Thirty-three patients had normal serum TSH levels (3 of whom were on levothyroxine supplement); 1 had low TSH; 5 had high TSH (range, 6.8-9.9 U/L, mean 8.4 U/L), and 1 had low thyroxine (T4