Thyroid Dysfunction In Adults Research Articles

Thyroid-function reference ranges in the diagnosis of thyroid dysfunction in adults.

Thyroid-function reference ranges in the diagnosis of thyroid dysfunction in adults.

Thyroid Function Status in Patient with Iron Deficiency Anaemia in A Tertiary Care Hospital of Lalitpur, Nepal

Introduction: Studies have found that iron deficiency anaemia (IDA) impairs thyroid hormone metabolism. The prevalence of thyroid dysfunction in adults in the general population ranges from 1 to 10 percent, and is even higher in selected groups. Thus, in this study we would like to see thyroid function status in people with IDA. Materials and Methods: It was Laboratory based cross sectional study conducted in the Department of Biochemistry of a tertiary care hospital of KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Secondary data of 162 patients available in laboratory database of 3 years’ duration from August 2018 to August 2021 were taken. All Patients diagnosed with IDA whose thyroid profile was also done were included in the study. Data were entered in Microsoft Excel. Statistical analysis was performed using version 29 of the Statistical Package for Social Sciences (SPSS Inc, Chicago IL, USA). Results: Among 162 IDA patients, 86.4% (n=140) were females and 13.62% (n=22) were males. Age ranged widely from 19 to 88 years and median age was 38 years. Out of 162 patients most of the patients 68.5% were euthyroid, 8.7% had euthyroid hypothyroxinemia, 7.4% had primary hypothyroidism,3.7% had subclinical hypothyroidism, 3.1% had secondary hypothyroidism, 1.2% had primary hyperthyroidism, 1.2% had T3 toxicosis, 0.6% had euthyroid hyperthyroxinemia. Based on multiple independent KW test, relationship between category of thyroid disorders and iron profile as well as thyroid disorder and Hb level were found not to be statistically significant. No category of thyroid dysfunction was associated with value of haemoglobin level or severity of anaemia. Irrespective of category of thyroid profile including euthyroid, hypothyroid and hyperthyroid, no category is particularly associated with IDA. Conclusion: In patients with IDA, there is no significant association between Hb level or severity of iron deficiency irrespective of patient being euthyroid, hypothyroid or hyperthyroid.

Thyroid Dysfunction in Adults with Newly Detected Type 2 Diabetes Mellitus: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Thyroid disorders and diabetes mellitus are common endocrine disorders that often coexist and can significantly impact each other’s management. The American Diabetes Association recommends that people with diabetes be periodically screened for thyroid dysfunction due to the strong link between the two conditions. It is important for individuals to be aware of the risk factors for both conditions and to seek appropriate medical care if necessary, and for healthcare providers to consider testing for thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. The aim of the study was to find out thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. Material Methods: This cross-sectional, descriptive study was conducted at the Departments of Medicine and Endocrinology at Sir Salimullah Medical College and Mitford Hospital in Dhaka. The study period lasted six months, from May to October 2019. A total of 102 adult patients (above 20 years old) with newly diagnosed type 2 diabetes mellitus who were attending the Endocrinology and Medicine Outpatient Department participated in the study. Results: Out of 102 adults with newly detected type 2 diabetes mellitus, the majority (86.3%) had normal thyroid function (euthyroid), while a smaller number (13.7%) had thyroid dysfunction. The most common subgroup of thyroid dysfunction was subclinical hypothyroidism (7.8%), followed by hypothyroidism (3.9%), subclinical thyrotoxicosis (1.0%), and hyperthyroidism (1.0%). The majority of the study population was male (66%) and from urban areas (88%), with a mean age of 45.1 years, a mean BMI of 25.0 kg/m2, and a mean waist circumference of 98.4 cm. About 45% had a family history of diabetes mellitus and 37% were smokers. The blood pressure of the study population was within normal limits. A minority (30%) had co-morbidities such as hypertension, dyslipidemia, and ischemic heart disease. The predictors of thyroid dysfunction were observed Age (OR=0.785), F/H of thyroid disorder (OR=0.495) BMI (OR=1.059), Anti-TPO Ab(OR= 0.021). Conclusion: Thyroid dysfunction and diabetes are commonly associated with each other and can impact clinical presentation and laboratory results. It is important to routinely screen for thyroid function in all patients with type 2 diabetes mellitus to detect, treat, and prevent complications of both these conditions.

Association between bisphenol A exposure and thyroid dysfunction in adults: a systematic review and meta-analysis.

The occurrence of thyroid dysfunction is affected by environmental factors, and BPA is a ubiquitous environmental pollutant with the potential to cause thyroid dysfunction. However, the limited epidemiological evidence shows an inconsistent association between BPA exposure and thyroid dysfunction. Therefore, the literature on the impact of BPA on thyroid was sorted and analyzed to study the relationship between BPA and adult thyroid function. The studies published on or before 23rd May 2022 from PubMed, Web of Science, and Scopus were collected analyzing the association between BPA exposure and the levels of thyroid hormones. The methodological quality of each study was assessed, the sensitivity analysis and subgroup analysis based on study population and gender were also performed, and publication bias was evaluated. A total of 2969 literature studies were retrieved. Based on inclusion and exclusion criteria, eleven studies were included. Our results showed that BPA concentration was negatively correlated with FT4 and TSH in males. Pooled correlation coefficients between BPA and FT4/TSH were -0.027 (95%CI = -0.030∼-0.024) and -0.058 (95%CI = -0.111∼-0.004). BPA concentration was positively correlated with FT4 in females, and the pooled correlation coefficient was 0.006 (95%CI = 0.003-0.008). The effects of BPA on thyroid hormone levels were significantly different between males and females. BPA may significantly decrease the levels of FT4 and TSH in males but increase the levels of FT4 in females. Considering the high heterogeneity among studies and the limited investigations into subgroups, the relationship between BPA exposure and thyroid dysfunction needs to be further investigated.

The effect of COVID-19 on the presentation of thyroid disease in children.

Although studies suggest a potential link between COVID-19 and thyroid dysfunction in adults, there are insufficient data to confirm that association in children, and whether there is any effect on presentation to healthcare services. To identify whether presentations of thyroid dysfunction in children to a tertiary paediatric hospital changed as a result of the COVID-19 pandemic. A retrospective case note review was conducted of all children with abnormal thyroid function tests between 1st January 2016 and 31st December 2021 at a tertiary paediatric endocrine centre in the United Kingdom. Overall, 244 children whose first presentation was within the timeframe of interest were included in this study, with a median age (range) of 11.5 (6.1, 16.8) years. Of these, 43 (18%) were hyperthyroid and 201 (82%) were hypothyroid. The greatest number of thyroid presentations occurred in 2021 (n=60, 25% of total over time period) and the fewest in 2020 (n=10, 4% of total over time period). Prior to this, the median (range) number of presentations per year was 34 (28, 39). There were no statistically significant differences in biochemistry, antibody status or other clinical characteristics between those who presented with hyperthyroidism prior to the pandemic or after. In those with hypothyroidism, baseline biochemistry was similar between the 2 groups, but the presence of other autoimmune conditions was greater pre-pandemic (17.2% vs 15.0%, p=0.03). In addition, patients were more likely to have transient thyroid dysfunction, which did not require treatment post-pandemic (70.0% vs 49.6%, p=0.0086). Although overall rates of presentation with thyroid dysfunction have not altered since the first wave of the COVID-19 pandemic, presentations with transient thyroid dysfunction, not requiring ongoing treatment have increased. Further research regarding the relationship between COVID-19 and thyroid function in children and young people, is needed.

Pediatric thyroid abscess: an unusual late complication of COVID-19 infection

<p class="abstract">Coronavirus disease 2019 (COVID-19) infection in children usually presents as mild infection. There have been several reported papers of thyroid dysfunction in adults suffering from SARS-CoV-2 infection but there hasn’t been any reported case in pediatric population. We report first pediatric case of post COVID-19 thyroid abscess that developed 6 weeks post infection.</p>

Pathophysiology and Clinical Features of Neuropsychiatric Manifestations of Thyroid Disease.

Thyroid hormones (TH) have a cardinal role in the development of the central nervous system during embryogenesis and early infancy. However, the TH-responsive genes in the developing brain cease to respond to TH in adulthood. Nevertheless, thyroid dysfunction in adults is commonly associated with a host of cognitive and psychiatric problems. Cognitive decline, dysphoria, and depression are common manifestations of overt hypothyroidism while hyperthyroidism can cause agitation, acute psychosis, and apathy, especially in older people. Whereas levothyroxine treatment can reverse dementia in the setting of hypothyroidism, the effect of levothyroxine on depressive symptoms in subjects with subclinical hypothyroidism is controversial. The use of supraphysiologic doses of TH to treat depression refractory to antidepressant remains a viable therapeutic tool with the caveat that excessive doses of thyroid hormone to treat depression may have potentially damaging effects on other organ systems. The present communication describes the pathophysiology of neuropsychiatric manifestations of thyroid disease, including changes in neurotransmission, alterations in neuronal or glial cell gene expression, blood-brain barrier dysfunction, increased risk of cerebrovascular disease, and occasionally cerebral inflammatory disease in the context of autoimmune thyroid disease. Elucidating the molecular mechanisms of TH effect on cerebral tissue will help identify novel therapeutic targets for managing people with neuropsychiatric disorders.

Prevalence of Hypothyroidism in Patients With Erdheim-Chester Disease

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis affecting multiple organs and commonly caused by somatic pathogenic variants in BRAF V600E and mitogen-activated protein kinase genes. Clinical features of ECD result from histiocytic involvement of various tissues; while endocrine involvement in ECD occurs frequently, the prevalence of central or primary hypothyroidism has not been thoroughly investigated. To assess hypothalamus-pituitary-thyroid (HPT) dysfunction in patients with ECD. This cross-sectional study included 61 patients with ECD who were enrolled in a natural history study at a tertiary care center between January 2011 and December 2018. ECD was diagnosed on the basis of clinical, genetic, and histopathological features. Data were analyzed in March 2020. Diagnosis of ECD. Main outcome was the prevalence of thyroid dysfunction in adults with ECD compared with community estimates. Patients underwent baseline evaluation with a thyroid function test, including thyrotropin, free thyroxine (fT4), and total thyroxine (T4), and sellar imaging with magnetic resonance imaging or computed tomography scan. The association of HPT dysfunction was assessed for differences in age, sex, body mass index, BRAF V600E status, high sensitivity C-reactive protein level, sellar imaging, and pituitary hormonal dysfunction. A total of 61 patients with ECD (46 [75%] men; mean [SD] age, 54.3 [10.9] years) were evaluated. Seventeen patients (28%) had hypothyroidism requiring levothyroxine therapy. The prevalence of both central and primary hypothyroidism were higher than community estimates (central hypothyroidism: 9.8% vs 0.1%; odds ratio, 109.0; 95% CI, 37.4-260.6; P < .001; primary hypothyroidism: 18.0% vs 4.7%; OR, 4.4; 95% CI, 2.1-8.7; P < .001). Patients with hypothyroidism (both primary and central), compared with patients with euthyroidism, had higher body mass index (median [interquartile range] 31.4 [28.3-38.3] vs 26.7 [24.4-31.9]; P = .004) and a higher prevalence of panhypopituitarism (7 [47%] vs 3 [7%]; P < .001). Among patients with hypothyroidism, those with central hypothyroidism, compared with patients with primary hypothyroidism, had a lower mean (SD) body mass index (28.3 [2.6] vs 36.3 [5.9]; P = .007) and higher frequencies of abnormal sellar imaging (5 [83%] vs 3 [27%]; P = .050) and panhypopituitarism (5 [83%] vs 3 [27%]; P = .050). In this cohort study, a higher prevalence of central and primary hypothyroidism was identified in patients with ECD compared with the community. There should be a low threshold for testing for hypothyroidism in patients with ECD, and treatment should follow standard guidelines.

Prevalence of Components of Metabolic Syndrome Among Adults with the Presence of Autoimmune Thyroid Condition in an Iodine-Sufficient Region.

The presence of autoimmune thyroid condition could lead to thyroid dysfunction in adults. In addition, thyroid antibody positivity has been suggested to be associated with hyperuricemia, diabetes and obesity in individuals with thyroid autoimmune diseases. Currently, there are limited studies that assessed the relationship of thyroid antibody with the components of metabolic syndrome in adults, especially from iodine-sufficient regions. Therefore, the aim of this study was to determine the prevalence of components of metabolic syndrome in Chinese adults with autoimmune thyroid condition. Medical records of adult inpatients in the Suzhou Ninth People's Hospital, Suzhou, Jiangsu, China, from January 2016 to September 2019 were reviewed and included after screening for eligibility. A total of 1105 participants were included in our final analysis, and of these, 77.5% (n = 856) were females. There was a higher prevalence of thyroid antibodies in females than males (30.6% vs. 23.7%) (p = 0.034). Although there were significant differences in mean TSH, FT3 and FT4 values between participants positive and negative for thyroid antibodies, these values were still within the normal reference range. No differences in the mean BMI, prevalence of diabetes, hyperuricemia, hypertriglyceridemia and hypercholesterolemia between participants positive and negative for thyroid antibodies were reported (p > 0.05). In conclusion, our study reported that participants positive for thyroid antibodies did not appear to be accompanied by abnormal thyroid function, lipid profile, uric acid and glucose concentrations.

No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study.

Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous.Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study (“The German Health Interview and Examination Survey for Children and Adolescents”) were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors.Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism.Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.

Assessment of Thyroid Function in Patients With Alkaptonuria

Alkaptonuria is an autosomal recessive disorder caused by pathogenic variants in the HGD gene. Deficiency of the HGD enzyme leads to tissue deposition of homogentisic acid (HGA), causing severe osteoarthropathies and cardiac valve degeneration. Although HGD is vital for the catabolism of tyrosine, which provides the basis for thyroid hormone synthesis, the prevalence of thyroid dysfunction in alkaptonuria is unknown. To assess thyroid structure and function in patients with alkaptonuria. A single-center cohort study was conducted in a tertiary referral center including patients with alkaptonuria followed up for a median of 93 (interquartile range, 48-150) months between February 1, 2000, and December 31, 2018. The alkaptonuria diagnosis was based on clinical presentation and elevated urine HGA levels. A total of 130 patients were considered for participation. Prevalence of thyroid dysfunction in adults with alkaptonuria compared with the general population. Thyrotropin and free thyroxine levels were measured by immunoassay and repeated in each patient a median of 3 (interquartile range, 2-22) times. Neck ultrasonographic scans were analyzed in a subset of participants. Logistic regression was used to test the association of thyroid dysfunction with age, sex, thyroid peroxidase (TPO) antibodies, serum tyrosine levels, and urine HGA levels. Of the 130 patients, 5 were excluded owing to thyroidectomy as the cause of hypothyroidism. The study cohort consisted of 125 patients; the median age was 45 (interquartile range, 35-51) years. Most of the patients were men (72 [57.6%]). The prevalence of primary hyperthyroidism was 0.8% (1 of 125 patients), similar to 0.5% observed in the general population (difference, 0.003; 95% CI, -0.001 to 0.04; P = .88). The prevalence of primary hypothyroidism was 16.0% (20 of 125 patients), which is significantly higher than 3.7% reported in the general population (difference, 0.12; 95% CI, 0.10-0.24; P < .001). Women were more likely to have primary hypothyroidism than men (odds ratio, 10.99; 95% CI, 3.13-38.66; P < .001). Patients with TPO antibodies had a higher likelihood of primary hypothyroidism than those without TPO antibodies (odds ratio, 7.36; 95% CI, 1.89-28.62; P = .004). There was no significant difference in the prevalence of thyroid nodules between patients in this study (29 of 49 [59.2%]) vs the general population (68%) (difference, 0.088; 95% CI, -0.44 to 0.73; P = .20) or of cancer (7% vs 5%; difference, 0.01; 95% CI, -0.01 to 0.17; P = .86). The high prevalence of primary hypothyroidism noted in patients with alkaptonuria in this study suggests that serial screening in this population should be considered and prioritized.

Evaluation of cardiovascular autonomic reactivity by cold pressor test in thyroid dysfunction in adults: A prospective case-control study

Background: Changes, in thyroid status, have pronounced effects on cardiovascular system reflecting autonomic dysfunction and increased morbidity. Exact interaction between autonomic nervous activity and thyroid hormones is controversial. Aims and Objective: The cold pressor test (CPT) was used to evaluate cardiac autonomic function in thyroid patients and compared with age and sex-matched healthy controls (18-45 years). Materials and Methods: This was a prospective case–control study. By clinical examination and serum levels of (T3, T4 and TSH) three groups hypothyroid, hyperthyroid and control group were categorized and blood pressure (BP) responses to CPT were evaluated in these groups. Statistical analysis was performed using student’s t-test. Results: In hyperthyroid group, rise in systolic BP after CPT is not as that of control group. However, the difference in mean rise is statistically highly significant. While in hypothyroid group rise in diastolic BP is statistically highly significant as compared to that of control group. Conclusion: In hypothyroidism, lack of direct action of thyroid hormones is compensated by increased basal sympathetic tone which exhibits blunted sympatho - excitatory responses leading to aortic stiffness and resistance. This prevents fall in systolic pressure and further reduces vagal tone. Hence, rise in systolic BP after CPT declined but insignificant (P > 0.05). In hyperthyroidism, significant decrease (P 0.05) in diastolic BP after CPT suggests direct action of thyroid hormone on vascular smooth muscles causing vasodilatation and reduced vagal tone decreasing sympathetic activity. Thus, the study revealed thyroid dysfunction leads to sympathovagal imbalance affecting cardiac autonomic function.

Long-Term Exposure to Excessive Iodine from Water Is Associated with Thyroid Dysfunction in Children

Previous studies have indicated an association between iodine excess and increased incidence of thyroid dysfunction in adults. However, there have been few studies on how the intake of excessive iodine affects thyroid function in children. The objective of this study was to assess the effects of a long-term exposure to excessive iodine on thyroid dysfunction in children. Urinary iodine concentration (UIC) and thyroid function in 371 children from a high iodine (HI) area (water iodine: 150–963 μg/L) and 150 children from an adequate iodine (AI) area (water iodine: 12.8–50.9 μg/L) were measured. The water iodine concentration in the HI area was higher than that in the AI area (P < 0.001) and the median urinary iodine concentration of children in the HI area was 1030 μg/L, which was 8.6 times that of children in the AI area (123 μg/L) (P < 0.001). Children in the HI area had a higher concentration of sensitive thyroid stimulating hormone and higher positivity of both thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). The prevalence of thyroid diseases was higher in HI area children than that in AI area children (P = 0.000), especially subclinical hypothyroidism (SCH; P = 0.004). A body mass index (BMI) of ≥22.3 kg/m2 was associated with the incidence of SCH (OR: 5.51; 95% CI: 1.52, 19.9; P = 0.009). UIC ≥600 μg/L (OR: 3.62; 95% CI: 1.22, 10.8; P = 0.024) and TPOAb or TGAb-positivity (Ab+ OR: 6.48; 95% CI: 1.78, 23.6; P = 0.005) in children were significantly and independently associated with SCH. Interactions between UIC ≥800 μg/L and Ab+ (P-interaction = 0.004) were found. Furthermore, increased thyroid volume was correlated with higher UIC (β = 0.22; P = 0.002). Excessive iodine intake in children in HI areas is associated with impaired thyroid function; UIC ≥600 μg/L and Ab+ are the risk factors for SCH. Effective measures need to be taken for reducing excessive iodine intake.

Iodine toxicity from soy milk and seaweed ingestion is associated with serious thyroid dysfunction

We report a series of cases of thyroid dysfunction in adults associated with ingestion of a brand of soy milk manufactured with kombu (seaweed), and a case of hypothyroidism in a neonate whose mother had been drinking this milk. We also report two cases of neonatal hypothyroidism linked to maternal ingestion of seaweed made into soup. These products were found to contain high levels of iodine. Despite increasing awareness of iodine deficiency, the potential for iodine toxicity, particularly from sources such as seaweed, is less well recognised.

Prevalence of thyroid dysfunction in adults over age 60 years from an urban community.

Thyroid dysfunction affects a considerable portion of the elder population. The aim of the present study has been to assess the prevalence of thyroid dysfunction in adult healthy subjects over age 60 years from our population. We performed a descriptive, cross-sectional study in the setting of a sanitary area in an urban community in Madrid (Spain). Serum concentrations of thyrotropin (TSH) and free thyroxine (FT4) were determined by an electrochemiluminescency assay in all participants after antecubital venous sampling. A second examination, including the measurement of triiodothyronine and thyroid autoantibodies, was performed in subjects with abnormal results. A total of 127 women and 167 men, aged 60 to 84 years, were studied. We identified 6 subjects (all women) with hypothyroidism (2.04 %) and 19 (6 women, 13 men) with hyperthyroidism (6.46 %, 95 %CI 3.65 - 9.27 %). There were 3 cases (1.02 %) of subclinical and 3 cases (1.02 %) of overt hypothyroidism. In the hyperthyroid group only one patient (0.34 %) showed overt hyperthyroidism. TSH test did not detect erroneously any case of hypothyroidism or hyperthyroidism, although one patient with hyperthyroidism was not diagnosed by this test. FT4 test detected erroneously two cases of hypothyroidism; however, it was the only way to detect the patient with overt hyperthyroidism. In conclusion, in our population over age 60 years the prevalence of hypothyroidism was 2.04 % and that of hyperthyroidism 6.46 % (95 %CI 3.65 - 9.27 %). The total prevalence of thyroid dysfunction was, therefore, 8.50 % (95 %CI 5.31 - 11.69). Our data suggest that TSH test is probably enough to screen for thyroid dysfunction in adults over age 60 years.

Amiodarone-associated thyroid dysfunction: risk factors in adults with congenital heart disease.

Amiodarone is widely used in adults with congenital heart disease, but no systematic study has been published on its effects on thyroid function in these patients. A retrospective study was performed to examine the frequency of amiodarone-associated thyroid dysfunction in adults with congenital heart disease and to identify any contributing factors. All adults (16 to 60 years old) with congenital heart disease were identified from a database if they had no preexisting thyroid disease, had taken amiodarone for >/=6 months, and were currently followed up by 1 consultant (J.S.). Ninety-two patients were found and evaluated for thyroid status and cardiac complications. A case-control analysis was performed, with patients matched for duration of amiodarone therapy. Of the 92 patients (age, 34.9+/-10.2 years; range, 18 to 60 years), 36% developed thyroid dysfunction: 19 became hyperthyroid and 14 hypothyroid. Female sex and complex cyanotic heart disease were significant risk factors for developing thyroid dysfunction (odds ratios, 3.0 and 7.00; P=0.04 and 0.01, respectively). Previous Fontan-type surgery also appeared to be a risk factor for developing thyrotoxicosis (odds ratio, 4.0; P=0.17), and amiodarone >200 mg/d a risk factor for thyroid dysfunction (odds ratio, 4.0; P=0.60). Amiodarone-associated thyroid dysfunction is common in adults with congenital heart disease. Women and those with complex cyanotic lesions are at particular risk, as patients may be who have had Fontan-type surgery or are taking >200 mg/d of amiodarone. Amiodarone should be used only when other antiarrhythmics are ineffective or contraindicated. Vigilance is required to detect and treat thyroid dysfunction.

Longitudinal screening of thyroid dysfunction in adults with Down's syndrome

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Thyroid dysfunction in adults with Down's syndrome

Thyroid treatment was used at the beginning of the 20th century for people with Down's syndrome, and an improvement in the physical and mental response was noted (Smith &amp; Berg, 1976). Later studies reported conflicting findings about the prevalence and type of thyroid dysfunction (Sare et al, 1978; Lobo et al, 1980) but there now seems little doubt about the existence of a high prevalence of hypothyroidism (Mani, 1988; Dinani &amp; Carpenter, 1990).

Thyroid dysfunction in adults over age 55 years: A study in an urban U.S. community: Bagchi M, Brown TR, Parish RF. Arch Intern Med. 1990:150:785-7

Thyroid dysfunction in adults over age 55 years: A study in an urban U.S. community: Bagchi M, Brown TR, Parish RF. Arch Intern Med. 1990:150:785-7

Thyroid dysfunction in adults over age 55 years. A study in an urban US community

Thyroid dysfunction in adults over age 55 years. A study in an urban US community