Treatment Of Thyroid Dysfunction Research Articles

P-756 Neurodevelopmental outcomes at school-age after conception with hysterosalpingography using iodinated contrast media - follow-up of the nationwide multicentre H2Oil trial

Abstract Study question How does conception <6 months after hysterosalpingography (HSG) with iodinated contrast media affect the neurodevelopment of the offspring compared to naturally-conceived peers at a school-age? Summary answer Children conceived <6 months after HSG with iodinated contrast media perform lower on intelligence tests and information processing and attention control compared to naturally-conceived peers. What is known already Tubal patency in subfertile women is commonly assessed using hysterosalpingography (HSG), but the potential risks of exposure to high iodine content in contrast media used remains unknown. Exposure to iodine excess can cause transient reduction in thyroid hormone synthesis due to the Wolff-Chaikoff effect. Thyroid hormone sufficiency in early pregnancy is vital for children’s neurodevelopment. When conception occurs shortly after HSG with iodinated contrast, a temporary reduction of maternal and/or foetal thyroid hormone supply could jeopardize children’s neurodevelopment. Study design, size, duration We evaluated neurodevelopmental outcomes of 6–9-year-old children conceived <6 months after HSG with oil-based (iodine content: 480mg/ml) or water-based contrast (iodine content: 240-300mg/ml) in a nationwide randomised controlled trial (H2Oil trial; Netherlands; 2012-2014; NCT05168228). Naturally-conceived children (n = 44) with similar age, sex and parental education were used as a comparison group (NTR9574). We also compared children conceived <4w, 4-12w, >12w after HSG with those conceived naturally. The study took place January 2022 until November 2023. Participants/materials, setting, methods We contacted 140 mothers from the H2Oil trial, 69 children conceived <6m after HSG participated, and parallelly we recruited 44 naturally-conceived children. Primary outcomes were intelligence (Wechsler’s Intelligence Scale for Children V), behavioural functioning (SDQ and SWAN, administered to parents and teachers), and academic performance. Secondary outcomes were neurocognitive function assessed by a battery of computerized tests. We used linear regression adjusted for age, sex, and parental education and applied FDR correction. Main results and the role of chance Compared to naturally conceived children, children conceived <6m after HSG had lower performance on intelligence tests (-6.81; 95%CI-10.97 to -2.65; p = 0.02) and the neurocognitive domain Processing & Control (-0.52; 95%CI-0.84 to -0.19; p = 0.02), with functions relating to information processing speed and consistency affected. No differences were found for other neurocognitive domains, behaviour or academic performance. Considering time between HSG and conception, intelligence scores were lower for children conceived <4w after HSG compared to naturally-conceived peers (-11.47; 95%CI-17.98 to -4.95; p = 0.03), while no significant differences were found for the groups of children conceived 4-12 weeks after HSG (-7.17; 95%CI -12.28 to -2.06; p = 0.10) or > 12 weeks after HSG (-4.20; 95%CI -9.33 to 0.94; p = 0.52). The findings of this study warrant replication in larger independent samples in order to evaluate the long-term neurodevelopment of children conceived after HSG with iodinated contrast media. Limitations, reasons for caution We aimed to recruit 64 children for each group, but our study was not sufficiently powered for small- and medium-sized differences. We did not collect information on the thyroid or iodine status of the mothers following HSG, and there is limited knowledge about pharmacokinetics of iodinated contrast media in humans. Wider implications of the findings Replication studies with are needed to further evaluate the safety of iodinated contrast media use periconception, including their effects on thyroid function and children’s neurodevelopment. Closer monitoring and treatment of thyroid dysfunction in the months following HSG may be warranted. Trial registration number NCT05168228

IMPACT OF THYROID DYSFUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, affecting approximately 2% of the general population and increasing the risk of stroke, heart failure and mortality. AF is often associated with several clinical conditions, including thyroid dysfunction, which can alter metabolism, function and cardiac structure. Thyroid dysfunction can be classified as hypothyroidism (low production of thyroid hormones) or hyperthyroidism (excess production of thyroid hormones), both of which can cause or worsen AF. The mechanism by which thyroid dysfunction affects AF is complex and involves electrophysiological, hemodynamic, inflammatory and structural changes in the atria. Appropriate diagnosis and treatment of thyroid dysfunction can improve AF control and reduce thromboembolic and hemorrhagic complications. However, the prevalence, incidence, risk factors, prognosis and management of AF in patients with thyroid dysfunction are still controversial topics in the literature. Objective: to evaluate the impact of thyroid dysfunction in patients with AF, addressing the following aspects: epidemiology, pathophysiology, diagnosis, treatment and clinical outcomes. Methodology: This review was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The PubMed, Scielo and Web of Science databases were searched, using the following descriptors: "atrial fibrillation", "thyroid dysfunction", "hypothyroidism", "hyperthyroidism" and "thyrotoxicosis". Articles published in the last 10 years, in Portuguese, English or Spanish, that addressed the proposed topic were included. Articles that were not original, did not have sufficient data or were not relevant to the research question were excluded. Results: 18 studies were selected. The diagnosis of AF in patients with thyroid dysfunction requires confirmation of the heart rhythm by electrocardiogram (ECG) and assessment of serum thyroid hormone levels (TSH, free T4 and free T3). Treatment of AF in patients with thyroid dysfunction aims to restore and maintain sinus rhythm, control ventricular rate, prevent thromboembolic events, and correct thyroid dysfunction. Therapeutic options include antiarrhythmic drugs, antithyroid drugs, anticoagulant drugs, electrical cardioversion, catheter ablation, and surgical thyroid treatment. The clinical outcomes of AF in patients with thyroid dysfunction are influenced by the type, severity and duration of thyroid dysfunction, as well as rhythm, frequency and anticoagulation control. AF in patients with thyroid dysfunction is associated with a higher risk of arrhythmia recurrence, heart failure, stroke and mortality. Conclusion: Thyroid dysfunction is a frequent and important clinical condition in patients with AF, as it can cause or worsen arrhythmia, as well as increase the risk of complications. Appropriate diagnosis and treatment of thyroid dysfunction can improve AF control and reduce adverse outcomes. However, there are still gaps in knowledge about the epidemiology, pathophysiology, prognosis and management of AF in patients with thyroid dysfunction, which require further studies of high quality and clinical relevance.

Large method differences for free thyroid hormone assays in the hyperthyroid range can affect assessment of hyperthyroid status: Comparison of Abbott Alinity to Roche Cobas, Siemens Centaur and equilibrium dialysis LC-MS/MS

BackgroundFree T4 (FT4) determination is one of the most commonly performed biochemical tests in endocrinology. Treatment of thyroid dysfunctions is adjusted based on the severity of symptoms and biochemical test results. For Graves’ hyperthyroidism, clinical guidelines recommend using FT4 as a (rough) guide to dose antithyroid drugs, together with other clinical information. It is well known that different platforms and methods give different FT4 results; however, large non-linear method differences at high FT4 concentrations are less well recognized. Current clinical guidelines do not make it clear that method differences in the hyperthyroid range can affect recommendations. MethodSerum samples from patients with very low (biochemically hypothyroid) to very high (hyperthyroid) concentrations of FT4 and/or free T3 (FT3) were analyzed using Abbott Alinity and compared to concentrations measured using Roche Cobas, Siemens ADVIA Centaur (FT4 only) and an in-house equilibrium dialysis liquid chromatography tandem mass spectrometry (LC-MS/MS) method. ResultsAlinity measured markedly lower FT4 and FT3 concentrations compared to the other methods, particularly at high FT4 concentrations. Regression analysis indicated that Alinity FT4 had a non-linear (curved) relationship to FT4 measured by the other methods. The method differences affected guideline-recommended treatments for hyperthyroidism. ConclusionMeasured free thyroid hormone concentrations are highly method-dependent, especially at high FT4 concentrations. Clinicians treating hyperthyroid patients should be aware that patients appear much less hyperthyroid from FT4-measurements performed using Alinity compared to Cobas or Centaur. Guideline-recommended antithyroid drug dosages based on FT4 (including multiples of the upper reference range) have to be adjusted to the FT4 method used. FT4 results from different methods should be clearly distinguished (e.g. separate lines) in medical records.

Thyroid and Pregnancy

Abstract Hormonal changes and metabolic needs during pregnancy result in profound changes in biochemical parameters of thyroid function, especially if there is preexsisting autoimmune thyroid disease (AITD). Normal thyroid function is important in order to ensure the best outcome. Many changes in the functioning of the thyroid gland occur during pregnancy, and some diseases of thyroid gland can affect both mother and fetus. Hypothyroidism is the most serious disorder that occurs during pregnancy and can go unnoticed as a „non-specific” problem. Hypothyroidism arises from the reduced ability of the gland to adapt to the increased needs during pregnancy. Mild thyroid dysfunction of mothers in the first trimester, which does not threaten during the pregnancy, can damage the psychomotor development of the child. Measurement of TSH is the most practical, simple and cost-effective screening test for thyroid dysfunction. It is necessary to apply the trimester-specific TSH reference values to correctly interpreted thyroid function during pregnancy. The presence of TPOAb is confirmation of existence of AITD, and predicts increased risk of developing subclinical hypothyroidism (SH). Preconceptional education and adequate diagnosis and treatment of thyroid dysfunction in early pregnancy are of great importance, in order to prevent complications during pregnancy and offspring. Current data indicate an increase in pregnancy loss, gestational diabetes, gestational hypertension, pre-eclampsia and preterm delivery in women with SH in pregnancy. The control of thyroid disease reduce complications of pregnancy.

Структурні зміни тa зміни гормонпродукуючої функції щитоподібної зaлози при перебігу вагітності в природньому циклі і при застосуванні додаткових репродуктивних технологій

Purpose - to evaluate changes in thyroid function that occur during normal pregnancy and in the use of assisted reproductive technologies, various disorders with their consequences for the mother and fetus, laboratory diagnosis and the best ways to treat these conditions. Common abnormalities of thyroid function, such as hypothyroidism, thyrotoxicosis and benign thyroid neoplasms, which disrupt menstrual cycles and female fertility, are considered, which, in turn, directly affect the course of pregnancy, and can lead to pregnancy termination, placental abruption, pre-eclampsia, preterm labor, neonatal morbidity, including reduced fetal neurological development. It has been suggested that the harmful effects of thyroid dysfunction may also extend not only to pregnancy and childbirth, but also affect the neuro-intellectual development of a child at an early age. Early diagnosis of thyroid dysfunction in pregnant women and treatment of thyroid dysfunction during pregnancy is an important and cost-effective aspect aimed at avoiding the occurrence of secondary complications in both the fetus and the mother caused by thyroid dysfunction. No conflict of interests was declared by the authors.

Weight Gain after Treatment of Thyroid Dysfunction and Thyroid Surgery.

Thyroid surgery is generally recommended for malignant conditions and for some benign thyroid disorders. Many patients report weight gain after thyroidectomy especially during the first months following surgery. Studies on patients with Graves' disease treated either with antithyroid drugs or radioiodine confirm that these patients frequently gain weight after restoration of thyroid function. Other studies have also shown that there is considerable weight gain after thyroidectomy for both nodular goiter and thyroid cancer. Transient hypothyroidism during the postoperative period is often thought to be associated with weight gain after thyroidectomy. The role of a number of adipocytokines and their interaction with the thyroid function has been investigated in the pathogenesis of weight changes. Levothyroxine replacement or suppressive therapy after thyroidectomy has a different impact on the metabolic parameters independent of TSH levels. The long-term effects of the impaired T3/T4 ratio are not fully understood as there are no sensitive markers to assess the biological response of target organs and tissues. Future studies are needed to identify such parameters, provide new considerations for the treatment of patients after total thyroidectomy, and help determine individual target hormone levels to ensure a sustained euthyroid state.

ASSESSMENT OF URINARY IODINE LEVEL AND ITS RELATION TO THYROID FUNCTION IN SAMPLE OF EGYPTIAN PREGNANT FEMALES IN 1ST TRIMESTER

Background: Thyroid disorders are considered the second most common endocrine disorders affecting women during their reproductive years and can impact up to 4% of all pregnancies. Of all thyroid disorders, hypothyroidism is the most prevalent, impacting approximately 2- 3% of all pregnancies. Hyperthyroidism is far less prevalent, impacting approximately 0.2% of all pregnancies.Aim of the Work: To assess the level of urinary iodine in 1st trimester of pregnancy and its relation with thyroid hormones level and autoimmunity status.Subjects and Methods: To elucidate this aim 100 healthy pregnant female in their 1st trimester of pregnancy were included in the study. They were collected from Obstetrics and Gynecology Department El Demerdash hospital and Dar El shefa Hospital in the period from September, 2020 to November, 2020.Results: Median urinary iodine was 55(41.0-76.0) μg/l and their was99 females had insufficient iodine intake less than 150μg /l, one had adequate intake (150-249) μg /l and none showed more than necessary intake (250-499) μg /l or excessive intake more than 500 μg /l. As regard thyroid ultrasound there was normal Thyroid volume in 94 subjects,(94.0%)., increased volume in 6 subjects (6%). There was a Significant negative correlation between each of the following the age and the gestational age; and urinary iodineConclusion: There was a significant iodine deficiency in pregnant women within the study area, indicating that some women may need to increase their iodine intake during pregnancy. Additionally, diagnosis and treatment of thyroid dysfunction during pregnancy should be based on pregnancy and method specific reference intervals, and more detailed staging is needed to assess pregnant women's thyroid function.

The role of vitamin D deficiency and thyroid dysfunction on blood glucose regulation in patients with type 2 diabetes mellitus: A retrospective cohort study

Background/Aim: In patients with diabetes mellitus (DM), complications due to hyperglycemia decrease the quality of life and increase mortality. Vitamin D deficiency and thyroid dysfunction negatively affect blood glucose regulation. We aimed to demonstrate effects of treatment of vitamin D deficiency and thyroid dysfunction on blood glucose regulation. This study aimed to reduce the complications that may develop due to hyperglycemia. Methods: In this retrospective cohort study, Type 2 DM patients admitted to our clinic between 2015-2018 were reviewed from hospital registry. Patients who did not attend to their control visits for DM at the 0th, 3rd and 6th months and those with the exclusion criteria were not included. Patients who regularly attended diabetes controls at the 0th, 3rd and 6th months were determined. Among them, those with 25-hydroxy (OH) vitamin D, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PPG), free T4, free T3, thyroid stimulating hormone (TSH) values in the hospital registry were sought. Patients with vitamin D deficiencies and thyroid disorders who began treatment at the 0th month were finally included in the study, and the effects of vitamin D replacement treatment and thyroid dysfunction treatment on blood glucose regulation parameters at the 3rd and 6th months were examined. Results: HbA1c levels significantly decreased in Type 2 DM patients whose vitamin D levels were within normal limits at the 3rd month after receiving vitamin D replacement therapy (P=0.023). Vitamin D and HbA1c levels at the 3rd month controls were negatively correlated (r=-0.23, P=0.016, respectively). There were no significant differences in FBG and PPG levels at the 3rd month (P=0.063, P=0.361, respectively). In type 2 DM patients with hypothyroidism at the 0th month who were euthyroid at the 3rd month, there were no statistically significant differences in HbA1c, FBG and PPG (P=0.202, P=0.14, P=0.40, respectively). Six type 2 DM patients became euthyroid at the 3rd and 6th months after beginning levothyroxine treatment at the 0th month, and six patients became euthyroid at the 3rd and 6th months after hyperthyroidism treatment. Two patients had their FBG, and PPG values measured. Due to the insufficient sample size, statistical significance of differences in HbA1c, FBG and PPG levels could not be determined. Conclusion: Vitamin D replacement treatment had positive effects on blood glucose regulation in DM patients with vitamin D deficiency. The effects of vitamin D on blood glucose regulation should be evaluated by HbA1c. Thyroid dysfunctions were not sufficiently questioned during the three-month follow-up of DM patients, so its effects on blood glucose regulation could not be evaluated. Thyroid dysfunction should be questioned in the 3-month follow-up of DM patients and thyroid function tests should be requested.

Prevalence and incidence of thyroid disorder during pregnancy in Bangladesh - a tertiary care hospital based study

Objectives: To establish the prevalence and incidence of thyroid dysfunction during pregnancy in a tertiary care center in Bangladesh. Methodology: 749 cases were randomly selected among the pregnant women who reported to antenatal clinic. Later 121 women were excluded as they were already diagnosed cases of thyroid disorder. The rest were investigated for thyroid stimulating hormone (TSH) and if required then they were also investigated for free triiodothyronine (FT3), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb). Thyroid status was classified according to TSH level – euthyroidism, subclinical hypothyroidism, overt hypothyroidism and hyperthyroidism (sub-clinical hyperthyroidism, Graves’ disease/toxic multinodular goiter, transient hyperthyroidism of pregnancy). And all patients were divided into 2 groups – normal/euthyroidism and abnormal/thyroid disorder, considering their thyroid status. Result: The prevalence of thyroid disorder during pregnancy was 34.98% and incidence was 22.45%. The mean TSH levels (μIU/mL) of 1st, 2nd and 3rd trimester were 2.67±3.59, 2.39±1.87 and 2.74±3.98, respectively. Significant number of overt hypothyroid cases were detected among rural people (P – 0.004). There were significant difference of incidence of euthyroid (P – 0.029) and SCHTh (P - 0.031) cases at different stages of gestation. There were also significant number of cases with goiter (P - ˂0.001) and TPOAb (P – ˂0.001) in different patient groups. Conclusion: Thyroid disorders are common in pregnancy. Early detection and proper treatment of thyroid dysfunction can help for better outcome. Hence, thyroid function test must be advised to all pregnant women.

Endocrine Challenges in Patients with Continuous-Flow Left Ventricular Assist Devices

Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement. In this review, data on endocrine challenges in patients carrying an LVAD are gathered to highlight pathophysiological states relevant to this setting of patients, and to summarize the current therapeutic suggestions in the treatment of thyroid dysfunction, and vitamin D, erythropoietin and testosterone administration.

PREVALENCE OF THYROID DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Background: Patients with type 2 diabetes mellitus are more prone to thyroid disorders. Hypothyroidism in them leads to an aggravation of microvascular complications. Diabetic patients with hypothyroidism also are at an increased risk of cardiovascular disease. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism.
 Methods: All patients were evaluated for thyroid status; assessment of T3, T4 and TSH levels and Blood glucose levels and HbA1c.
 Results: 22.00% patients were present with subclinical hypothyroidism, 18.00% patients were present with hypothyroidism and 4.00% patients present with hyperthyroidism
 Conclusion: Screening for thyroid disease disease among patients with diabetes mellitus should be routinely performed for early detection and treatment of thyroid dysfunction to delay the complications of diabetes
 Keywords: Thyroid, Type-2DM, Complication

Effects of a new thyrotropic drug isolated from Potentilla alba on the male reproductive system of rats and offspring development

BackgroundThe dysfunction of the thyroid gland is a common medical condition. Nowadays, patients frequently use medicinal herbs as complementary or alternative options to conventional drug treatments. These patients may benefit from treatment of thyroid dysfunctions with Potentilla alba L. preparations. While it has been reported that Potentilla alba preparations have low toxicity, nothing is known about their ability to affect reproductive functions in patients of childbearing age.MethodsMale Wistar rats were orally treated with a thyrotrophic botanical drug, standardized Potentilla alba Dry Extract (PADE), at doses 8 and 40 times higher than the median therapeutic dose recommended for the clinical trials, for 60 consecutive days. Male Wistar rats receiving water (H2O) were used as controls. After completing treatment, half of the PADE-treated and control males were used to determine PADE gonadotoxicity, and the remaining half of PADE-treated and control males were mated with intact females. Two female rats were housed with one male for two estrus cycles. PADE effects on fertility and fetal/offspring development were evaluated.ResultsHerein, we report that oral treatment of male Wistar rats with PADE before mating with intact females instigated marked effects on male reproductive organs. Treatment significantly decreased the motility of the sperm and increased the number of pathological forms of spermatozoa. Additionally, a dose-dependent effect on Leydig cells was observed. However, these PADE effects did not significantly affect male fertility nor fetal and offspring development when PADE-treated males were mated with intact females.ConclusionsPADE treatment of male rates negatively affected sperm and testicular Leydig cell morphology. However, these changes did not affect male fertility and offspring development. It is currently not known whether PADE treatment may affect human male fertility and offspring development. Therefore, these results from an animal study need to be confirmed in humans. Results from this animal study can be used to model the exposure-response relationship and adverse outcomes in humans.

Treatment of Thyroid Dysfunction and Serum Lipids: A Systematic Review and Meta-analysis.

Hyperthyroidism is associated with low levels of cholesterol and triglycerides, and hypothyroidism is associated with hypercholesterolemia and hypertriglyceridemia. The aim of this systematic review was to investigate the impact of therapy for overt and subclinical hyper- and hypothyroidism on serum lipids. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus from 1970 through April 5, 2018. Pairs of independent reviewers selected randomized and observational studies evaluating lipid parameters in patients undergoing treatment for hyper- or hypothyroidism. Pairs of independent reviewers extracted data and appraised studies. Treatment of overt hyperthyroidism showed a significant increase in total cholesterol (TC) by 44.50 mg/dL (95% confidence interval [CI]: 37.99, 51.02), low-density lipoprotein cholesterol (LDL-C) by 31.13 mg/dL (95% CI: 24.33, 37.93), high-density lipoprotein cholesterol (HDL-C) by 5.52 mg/dL (95% CI: 1.48, 9.56), apolipoprotein A (Apo A) by 15.6 mg/dL (95% CI: 10.38, 20.81), apolipoprotein B (apo B) by 26.12 mg/dL (95% CI: 22.67, 29.57), and lipoprotein (Lp[a]) by 4.18 mg/dL (95% CI: 1.65, 6.71). There was no significant change in triglyceride (TG) levels. Treatment of subclinical hyperthyroidism did not change any lipid parameters significantly. Levothyroxine therapy in overt hypothyroidism showed a statistically significant decrease in TC by -58.4 mg/dL (95% CI: -64.70, -52.09), LDL-C by -41.11 mg/dL (95% CI: -46.53, -35.69), HDL-C by -4.14 mg/dL (95% CI: -5.67, -2.61), TGs by -7.25 mg/dL (95% CI: -36.63, 17.87), apo A by -12.59 mg/dL (95% CI: -17.98, -7.19), apo B by -33.96 mg/dL (95% CI: 41.14, -26.77), and Lp(a) by -5.6 mg/dL (95% CI: -9.06, -2.14). Levothyroxine therapy in subclinical hypothyroidism showed similar changes but with a smaller magnitude. The studies contained varied population characteristics, severity of thyroid dysfunction, and follow-up duration. Treatment of overt but not subclinical hyperthyroidism is associated with worsening of the lipid profile. Levothyroxine therapy in both overt and subclinical hypothyroidism leads to improvement in the lipid profile, with a smaller magnitude of improvement in subclinical hypothyroidism.

Prevalence, predictors and outcomes of thyroid dysfunction in patients with acute myocardial infarction: the ThyrAMI-1 study

PurposeThyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors and outcomes of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI).MethodsA prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and 2016. Thyroid profile, standard biochemistry measurements and demographic information were obtained within 12 h of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019.ResultsOf the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper) and 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels and early morning sampling time (between 00:01–06:00 h). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01 and 18:00 h). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03–3.95), p = 0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74–1.49), p = 0.79 and 0.27 (0.04–1.95), p = 0.19, respectively.ConclusionsThyroid dysfunction is common in AMI patients on admission to hospital and our data provide an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.

Diagnosis, treatment, and management of gestational hypothyroidism. The TIROGEST study

IntroductionThere is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. Study designThis was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. ResultsFourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). ConclusionsOur results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.

Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review

BackgroundThis systematic review was conducted to inform the Canadian Task Force on Preventive Health Care recommendations on screening for thyroid dysfunction (TD). The review sought to answer key questions on the benefits and harms of screening for TD, patients’ values and preferences for screening, and the benefits and harms of treating screen-detected TD.MethodsThis review followed Canadian Task Force on Preventive Health Care methods, which include the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The search strategy used for benefits and harms of screening and treatment was an update to the 2014 review by the US Preventive Services Task Force and searched MEDLINE and the Cochrane Library. MEDLINE, Embase, ProQuest Public Health, and SCOPUS were searched for patients’ values and preferences for screening. Outcomes of interest included all-cause mortality, deaths due to cardiovascular diseases, fatal and non-fatal cardiovascular events, atrial fibrillation, fractures, quality of life, cognitive function, and harms due to TD treatment. Two reviewers independently screened abstracts and full texts according to pre-determined inclusion criteria and assessed the risk of bias for each study included. Strength and quality of the evidence was assessed for each outcome. A narrative synthesis was conducted due to heterogeneity of the included studies.ResultsNo studies were found on screening for TD, treatment of subclinical hyperthyroidism, or patients’ values and preferences for screening for TD. Twenty-two studies (from 24 publications) on the treatment of TD in patients with screen-detected subclinical hypothyroidism were included. Results from the included randomized controlled trials suggested no benefit of treatment for subclinical hypothyroidism for the large majority of outcomes. We found very low-quality evidence (from two cohort studies) for a small reduction in all-cause mortality among adults < 65 or 40–70 years who were treated for TD compared to those who were not.ConclusionsThis review found moderate to very low-quality evidence on the benefits and harms of treatment for subclinical hypothyroidism, with most of the evidence showing no benefit of treatment.

Congenital Heart Disease and Thyroid Dysfunction: Combination, Association, and Implication.

Patients with congenital heart disease have higher prevalence of thyroid dysfunction due to embryonic and genetic coexistence. Marked changes in cardiac function occur secondary to alternations in thyroid hormone levels. Cardiac catheterizations or cardiac surgeries with cardiopulmonary bypass can cause abnormalities in the circulating hormones, in the absence of primary thyroid disease. Therefore, monitoring of thyroid function should be routinely performed in children with congenital heart disease. Thyroid hormone supplementation has been postulated as a possible therapeutic option; however, the therapeutic decisions should be made based on individual circumstances, symptoms, and the severity of the thyroid dysfunction. To describe the correlation between congenital heart disease in children and thyroid dysfunction and the debate on monitoring, intervention, and treatment. PubMed, Clinical Key, and the Cochrane Library were searched using keywords relevant to congenital heart disease/surgery, cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and cardiac catheterization. Studies were limited to the English language and to children 0 to 18 years old. Studies in adults with important findings were reviewed as well. All clinical studies believed to have relevance were considered. All relevant studies were reviewed, and the most pertinent data were incorporated in this review. There is lack of significant evidence concerning treatment for thyroid dysfunction in children with a congenital cardiac diagnosis. Adequately powered studies are needed before a uniform recommendation about treatment can be made.

Diagnosis, treatment, and management of gestational hypothyroidism. The TIROGEST study

IntroductionThere is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. Study designThis was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. ResultsFourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5μIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). ConclusionsOur results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.

Screening for thyroid dysfunction in pregnancy

The most controversial issue in the field of thyroid and pregnancy is whether clinicians should screen all pregnant women for thyroid disease, and the screening should be performed before pregnancy or at the first prenatal visit. This review aimed to discuss updates on the important issue of thyroid screening before conception and during pregnancy and to highlight the gap in evidence that has led to remarkable controversies on this topic. The terms “screening” AND “thyroid” AND “pregnancy” were used to search Medline for English-language papers published from 1990 to the end of January 2018. After reviewing of titles of 482 articles, we focused on high quality and important studies. With respect to the Wilson and Jungner criteria for disease screening, thyroid dysfunction screening before and during pregnancy is still a conflicting issue. Available data suggests that compared to the universal screening, the case finding screening would result in missing cases of thyroid dysfunction. The primary debate is regarding maternal, fetal and offspring benefits of treatment of mothers with subclinical hypothyroidism and/or thyroid autoimmunity. Results of few high-quality studies in this field are in favor of some benefit considering pregnancy outcomes but no significant beneficial impact on fetal and offspring outcomes. Likewise, cost-effectiveness studies support the concept of universal screening. More evidence is required to assess the advantages and disadvantages of two different screening strategies for thyroid dysfunction in pregnancy, focusing on maternal, neonatal and offspring health outcomes following diagnosis and treatment of thyroid dysfunction, especially subclinical hypothyroidism in pregnancy. Moreover, screening strategies need to be individualized for each country according to disease burden, case finding costs and available health services.

Expert opinion on thyroid complications of new anti-cancer therapies: Tyrosine kinase inhibitors

Thyroid pathology is the most frequent form of endocrinopathy during tyrosine kinase inhibitor (TKI) treatment. Dysthyroidism occurs in 10% to 80% of cases, depending on diagnostic criteria. In patients with intact thyroid gland prior to TKI treatment, incidence of dysthyroidism is 30–40%, with subclinical presentation in half of cases. It mainly involves hypothyroidism, preceded in 20–40% of cases by transient thyrotoxicosis that may go overlooked. The pathophysiological mechanism is “vascular” thyroiditis induced by the anti-angiogenic action of TKIs. Between 20% and 60% of patients receiving levothyroxine ahead of TKI treatment show increased levothyroxine requirements. TKIs should not be discontinued because of onset of thyroid dysfunction. Treatment is symptomatic in case of thyrotoxicosis, and levothyroxine replacement therapy is initiated in case of symptomatic hypothyroidism or TSH>10mIU/L. During TKI treatment, TSH should be assayed monthly, or at end of off-period (i.e., day 1 of new cycle after interruption), for the first 6 months, then every 2–3 months or in case of clinical signs of dysthyroidism. In patients already treated for hypothyroidism, TSH should be assayed monthly for 3 months, then every 3 months throughout treatment. At TKI termination, remission of hypothyroidism is possible but unpredictable, and progressive discontinuation of levothyroxine may be considered under monitoring. Teamwork between oncologists and endocrinologists improves screening and treatment of thyroid dysfunction, enabling the patient to be better accompanied during treatment.