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Biomedical subjects

D Glinoer

Publications and source records attributed to D Glinoer.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Evolution of diagnostic and therapeutic criteria in Graves' disease in Spain. Comparison of the results of 2 surveys in 1987 and 1995].

BACKGROUND: To assess the new diagnostic and therapeutic trends for hyperthyroidism due to Graves' disease in Spain and the differences with respect to a previous study performed in 1987. METHODS: A questionnaire about a typical clinical case of hyperthyroidism due to Graves' disease and 10 variations to it, in which different diagnostic and therapeutic options are exposed. These questionnaires were mailed to 70 Spanish units of endocrinology during 1995, and 51 participated finally in the study. The results are compared with those obtained in Spain with a similar study in 1987. RESULTS: Thyrotropin (98%) and free thyroxine (88%) were the most used tests for diagnosis of Graves' disease, with a significant decrease (p < 0.001) in the use of total T4 and total T3 in comparison with the results of the questionnaire performed in 1987. The measurement of antibodies against thyrotropin receptor (TSH-R-Ab) was the most frequently used immune marker for the diagnosis (78%), with significant differences (p < 0.001) with respect to questionnaire in 1987. The use of anti-thyroperoxidase antibodies (anti-TPO-Ab) (36%) in diagnosis of this disease, significantly increased (p < 0.05) with respect to 1987. Antithyroid drugs were the most frequent initial treatment (98%) with significant differences (p < 0.001) in use of radioiodine (24%) as treatment of choice in elderly patients respect to 1987. Surgery was mainly used for large-size goiters (33%) and radioiodine for recurrences after medical (61%) or surgical (80%) treatment. Antithyroid drugs were the most frequent treatment for children and for recurrences during gestation. CONCLUSIONS: In Spain, the measurements of TSH, FT4 and TSH-R-Ab are the main diagnostic test of hyperthyroidism. Antithyroid drugs are still the treatment of choice in typical case of hyperthyroidism due to Graves' disease, in recurrences during gestation and children. Surgery is only used for large goiters and radioiodine is the treatment of choice in recurrences after medical or surgical treatment.

Adult↗
PubMed1998

Thyroid hyperfunction during pregnancy.

The present report focuses on the two main causes of hyperthyroidism observed in the pregnant state: Graves' disease (GD) and gestational transient thyrotoxicosis. Together, the prevalence of hyperthyroidism may represent 3% to 4% of all pregnancies, and therefore constitutes an important clinical issue. Concerning GD, the variable presentations of the disease (women under treatment, in remission, or considered cured) and specific alterations occurring in pregnancy are discussed: changes in thyrotropin (TSH) receptor antibody titers, the risk of fetal and neonatal thyrotoxicosis, the outcome of pregnancy in relation to the control of hyperthyroidism, and the treatment of active GD during and after pregnancy with antithyroid drugs. Gestational transient thyrotoxicosis is associated with a direct stimulation of the maternal thyroid gland by human chorionic gonadotropin (hCG), and has been shown to be directly related to both the amplitude and duration of peak hCG values. The syndrome is usually transient, observed at the end of the first trimester, and is frequently associated with emesis. Finally, we propose a global strategy for the systematic screening of hyperthyroidism during pregnancy, based on an algorithm that allows for the diagnosis of both autoimmune and nonautoimmune forms of hyperthyroidism in the pregnant state.

Female↗
PubMed1997

The thyrotrophic role of human chorionic gonadotrophin (hCG) in the early stages of twin (versus single) pregnancies.

OBJECTIVE: Human chorionic gonadotrophin (hCG) is known to possess thyroid-stimulating activity. The aim of the present study was to assess the role of hCG in stimulating the maternal thyroid gland in the early stages of normal gestation. STUDY DESIGN: Thirty euthyroid healthy women were investigated prospectively. In each, conception had been assisted by in vitro fertilization techniques, which allowed for the precise determination of gestational age. Women were subdivided into single (n = 17) and twin (n = 13) pregnancies. Serum intact hCG and its free alpha and beta subunits, TSH and free T4 concentrations were measured at 6, 8, 9, 10, 11, 15, 19, 22 and 32 weeks. RESULTS: In twin pregnancies compared with single pregnancies, peak hCG concentrations (9-11 weeks) were significantly higher (mean +/- SE 171,000 +/- 12,500 vs 65,500 +/- 7600 U/l; P < 0.001), and also much more prolonged. Human CG concentrations above 75,000 U/l lasted for less than 1 week in single, compared with up to 6 weeks in twin pregnancies. Free beta-hCG subunit concentrations paralleled those of intact hCG in both groups. The ratios of free beta-hCG subunit/total hCG were similar in single and twin pregnancies, and did not vary with gestation time. Concerning thyroid function, twin pregnancy was more frequently associated with a lowering of TSH, which was also more profound than in single pregnancies. Furthermore, while free T4 levels remained normal in single pregnancies, they were transiently supranormal (up to 52 pmol/l) in four twin pregnancies. CONCLUSION: In twin pregnancies the placenta produces larger amounts of hCG for a prolonged period of time than in single pregnancies. Both the amplitude and duration of hCG production (i.e. the global exposure of the thyroid gland to hCG) are responsible for increased thyroidal stimulation, leading more frequently to increased free T4 and suppressed TSH levels. The results emphasize the role of hCG in stimulating maternal thyroid function in the first trimester of pregnancy. Even though the production of a variant hCG molecule with potent thyrotrophic activity cannot be excluded, this hypothesis is not required to explain the data. Clinicians should be aware of the frequent occurrence of significant but transient biochemical hyperthyroidism associated with hCG stimulation in the early stages of gestation, particularly in twin pregnancies.

Chorionic Gonadotropin↗
PubMed1997

[Thyroid nodule and cancer in pregnant women].

Most thyroid nodules discovered during pregnancy are benign. In this article, we propose a pragmatic attitude for the diagnosis and treatment of such nodules, insisting particularly on the importance of thyroid echography and fine needle aspiration. For women who have successfully been treated for thyroid cancer before pregnancy, we discuss the adaptation of thyroxine substitution when they become pregnant, the obstetrical and fetal risks (spontaneous miscarriage, fetal abnormalities of the thyroid gland and others), and also potential later risks for the child, in relation with previous radioactive iodine administration to the mother. Finally, we evoke more difficult questions, such as the rare instances in which thyroid cancer is discovered during pregnancy, pregnancy occurring during the months immediately following radioiodine treatment, and exceptional cases where therapeutic radioiodine was inadvertently given during pregnancy.

Biopsy, Needle↗
PubMed1996

[Thyroid changes in the pregnant woman].

In Belgium the iodine intake is restricted and even marginally insufficient. During pregnancy, the insufficient iodine supply is associated with chronic stimulation of the thyroid gland, leading to the development of gestational goiters and to an increased risk of foetal goitrogenicity. Also, approximately one third of pregnant women exhibit relative hypothyroxinemia. Moreover, women who present chronic autoimmune thyroiditis and in whom thyroid function is normal at the onset of pregnancy carry a significant risk of developing thyroid insufficiency during gestation. In conclusion, healthy pregnant women should be given the benefit of iodine supplementation, both during pregnancy and breastfeeding. This will allow them to maintain a well adapted thyroid function, prevent goitrogenicity, and ensure adequate foetal hormone production. For women with autoimmune thyroiditis, thyroid function should be closely monitored during pregnancy and the slightest indication of thyroid insufficiency should prompt the administration of thyroid hormone substitution.

Adult↗
PubMed1996

[Use of 131 iodine for the treatment of hyperthyroidism in adults].

The authors report on their experience with the treatment of hyperthyroidism using radioiodine (RI) over a period of 15 years in 516 patients. RI dosimetry was calculated from thyroid 24 hr uptake and weight, using linearly increasing RI doses (from 40 to 100 microCi/g) with increasing thyroid weight (between 10 and 100 g) for both diffuse (D) and multinodular (MN) toxic goiters. For solitary toxic (ST) nodules, a fixed dose of 250 microCi/g was used. In severe hyperthyroidism, antithyroid drugs (ATD) and KI (15 mg/d) were added 24 hours after RI and given during 1-4 months and 21 days, respectively. Combining RI + ATD/KI therapy allowed for a reduction of RI recirculation and release from the gland and also for more rapid return to a euthyroid status. The results showed that 88% of patients with ST, 68% with D, and 55% with MN were cured with a single dose of RI. Furthermore, the incidence of late hypothyroidism was relatively low, reaching 7% in ST, 36% in D, and 28% in MN after a follow-up period of fifteen years. Annual follow-up, however, showed that an additional 2.7% of patients (3.5% of D; 1.6% of MN; 2.4% of ST) exhibited--per year--an exaggerated TSH response to TRH even though these patients remained clinically and biochemically euthyroid (normal circulating basal hormones and TSH levels). In conclusion, 1) low doses RI combined with ATD/KI yielded a high success rate: less than 30% of patients required more than 1 dose and only 30% became hypothyroid after prolonged follow-up; 2) abnormalities of TRH test were not infrequent in patients with D and MN goiters, as well as ST nodules, thereby fully justifying the need for careful and prolonged follow-up of all hyperthyroid patients receiving RI therapy.

Adult↗
PubMed1995

[Reevaluation of antithyroid drug therapy in Graves disease].

Though antithyroid medical therapy has been used for several decades in the medical treatment of hyperthyroidism, only recently has attention been drawn towards prospective controlled trials concerning the effect in relation to dosage as well as the dosage related to side effects. A review is given in relation to recent investigations on treatment strategies in various parts of the world as well as the most frequently used strategies in Europe. Special attention is given to treatment principles in relation to pregnancy, children and adolescents as well as patients with eye symptoms. Antithyroid drug therapy of hyperthyroidism is a frequent and successful treatment strategy in Europe. Globally, there are still large discrepancies in the treatment strategies, related rather to conventions than to a rational attitude.

Antithyroid Agents↗
PubMed1995

A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects.

One hundred and eighty euthyroid pregnant women were selected at the end of the first trimester of gestation on the basis of biochemical criteria of excessive thyroid stimulation, defined as supranormal serum thyroglobulin (TG > 20 micrograms/L) associated with a low normal free T4 index (< 1.23) and/or an increased T3/T4 ratio (> 25 x 10(-3)). Women were randomized in a double blind protocol into three groups and treated until term with a placebo, 100 micrograms potassium iodide (KI)/day, or 100 micrograms iodide plus 100 micrograms L-T4/day. Parameters of thyroid function, urinary iodine excretion, and thyroid volume were monitored sequentially. Neonatal thyroid parameters, including thyroid volume by echography, were also assessed in the newborns from mothers of the three groups. In women receiving a placebo, the indices of excessive thyroid stimulation worsened as gestation progressed, with low free T4 levels, markedly increased serum TG and T3/T4 ratio. Serum TSH doubled, on the average, and was supranormal in 20% of the cases at term. Urinary iodine excretion levels were low, around 30 micrograms/L at term. The thyroid volume increased, on the average, by 30%, and 16% of the women developed a goiter, confirming the goitrogenic stimulus associated with pregnancy. Moreover, the newborns of these mothers had significantly larger thyroid volumes at birth as well as elevated serum TG levels. In both groups of women receiving an active treatment, the alterations in thyroid function associated with pregnancy were markedly improved. The increase in serum TSH was almost suppressed, serum TG decreased significantly, and changes in thyroid volume were minimized (group receiving KI) or almost suppressed (group receiving KI combined with L-T4). Moreover, in the newborns of the mothers in the two groups receiving an active treatment, serum TG was significantly lower, and thyroid volume at birth was normal. The effects of therapy were clearly more rapid and more marked in the group receiving a combination of T4 and KI than in the women receiving KI alone. The differences could be partly attributed to the slightly higher amount of iodine received by women in the combined treatment. However, the main benefits of the combined treatment were almost certainly attributable to the hormonal effects of the addition of L-T4. Furthermore, the study demonstrated that the administration of T4 did not hamper the beneficial effect of iodine supplementation. In conclusion, the present work emphasizes the potential risk of goitrogenic stimulation in both mother and newborn in the presence of mild iodine deficiency.(ABSTRACT TRUNCATED AT 400 WORDS)

Double-Blind Method↗
PubMed1994

Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders.

A prospective study was undertaken in 87 healthy pregnant women with thyroid antibodies and normal thyroid function at initial presentation [asymptomatic autoimmune thyroid disorders (AITD)]. The aims of the study were to assess whether women with AITD constitute a group at risk of developing subclinical hypothyroidism during pregnancy, and whether a mild thyroid function impairment may be associated with obstetrical repercussions. The women investigated were selected among a cohort of 1660 consecutive pregnancies on the basis of 1) no previous history of thyroid disease, 2) euthyroidism at initial presentation, and 3) positive thyroglobulin antibodies and/or thyroid peroxidase antibodies (TPO-Ab). Women with AITD had a basal TSH value significantly higher, albeit still normal, in the first trimester (1.6 vs. 0.9 mU/L; P < 0.001) than that in women with healthy pregnancies used as controls. Despite a 60% average reduction in TPO-Ab titers during gestation, serum TSH remained higher in women with AITD than in controls throughout gestation: at delivery, 40% of the cases had serum TSH levels above 3 mU/L, and 16% had serum TSH levels above 4 mU/L. A TRH test carried out in the days after parturition showed an exaggerated response in 50% of the cases. Furthermore, free T4 concentrations were in the range of hypothyroid values in 42% of the women. Obstetrical repercussions were observed, namely increased rates of spontaneous miscarriage and premature deliveries. In conclusion, women with asymptomatic AITD who are euthyroid in early pregnancy carry a significant risk of developing hypothyroidism progressively during gestation, despite a marked reduction in antibody titers. Hypothyroidism results from the reduced ability of the gland to adjust to the changes in thyroidal economy associated with pregnancy. At the individual level, progression to subclinical hypothyroidism was broadly predictable on the basis of serum TSH levels and TPO-Ab titers in the first trimester. Hence, these parameters provide useful markers to identify women who carry a higher risk, allowing for a close monitoring of thyroid function during pregnancy and the administration of L-T4 in specific cases. Taken together with the known incidences of postpartum thyroiditis and hypothyroidism in women with AITD, the present observations in our opinion justify systematic screening of thyroid autoimmunity during pregnancy.

Adolescent↗
PubMed1994

Total amounts of circulating human chorionic gonadotrophin alpha and beta subunits can be assessed throughout human pregnancy using immunoradiometric assays calibrated with the unaltered and thermally dissociated heterodimer.

The aim of the present study was to determine the variations in the balance between total (free plus combined) circulating alpha and beta subunits of human chorionic gonadotrophin (hCG) throughout human pregnancy. The equivalence between the International Units (IU) of hCG (IRP 75/537) and those assigned to the alpha (IRP 75/569) and beta (IRP 75/551) free subunits was experimentally determined by using intact and thermally dissociated hCG. Heat exposure (2 min at 100 degrees C) of hCG preparations resulted in a complete dissociation of hCG into free, soluble and intact alpha and beta subunits. The hCG and alpha and beta subunit contents of unaltered and heated hCG preparations were assessed by specific immunoradiometric assays. The amount of immunoreactive subunits dissociated by heat from hCG could then be evaluated on a molar basis. Circulating hCG and its free alpha and beta subunits were immunoassayed in 836 blood samples collected from healthy pregnant women at different gestational ages. After conversion of hCG and its subunits into a common IU system, the gestational profiles of the total amounts (free plus combined) of alpha- and beta hCG subunits increased together and peaked at 9-10 weeks of gestation. Thereafter, total alpha and beta subunits decreased and subsequently remained stable until term. The decline in total alpha hCG subunit was less marked than that of total beta hCG subunit. The alpha- to beta hCG ratio was equimolar until 10 weeks of gestation when it increased almost fourfold until term (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1993

Maternal thyroid function in pregnancy.

In healthy pregnant women, the regulation of thyroid function depends upon several factors. Three factors act independently to increase thyroid hormone requirements: 1) the marked increase in the binding capacity of serum due to high TBG levels; 2) the direct stimulation of the thyroid by human chorionic gonadotropin, acting as a thyrotropic hormone; and 3) the increase in placental deiodinating activity, which may contribute to modify thyroid hormone metabolism. These stimulatory events result in a physiological adaptation of the maternal thyroid gland to pregnancy, as long as the availability of iodine for the thyroidal "machinery" remains sufficient. Our studies were performed in an area where the iodine intake is precisely at the lower limit of the needs for healthy non pregnant adult subjects (less than 100 micrograms/day). In these conditions, decreased iodine availability during gestation leads to relative iodine deficiency and hence, pregnancy constitutes a "challenge" for the thyroid gland. It was shown that excessive thyroidal stimulation occurred in as much as one third of pregnancies in Brussels, accompanied by relative hypothyroxinemia, marked elevation in serum TG levels and goitrogenesis. About 10% of women had developed a goiter at parturition, which was only partially reversible during the postpartum period. A randomized prospective trial was then undertaken in euthyroid pregnant women who were below 16 weeks of gestation at initial presentation and who fulfilled biochemical criteria of excessive thyroidal stimulation (high molar T3/T4 ratio, low normal free T4 index, elevated serum TG). Thyroid function and volume were monitored sequentially during gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Use of eye muscle antibody measurements to monitor response to plasmapheresis in patients with thyroid-associated ophthalmopathy.

We have measured eye muscle antibodies, in immunoblotting, in the serum from five patients with severe ophthalmopathy associated with Graves' hyperthyroidism who underwent plasmapheresis, correlating their levels with clinical features of the eye disorder and response to treatment. Blood taken before each plasma exchange was tested in SDS-polyacrylamide gel electrophoresis and Western blotting for antibodies reactive with pig eye muscle membrane (PEMM) antigens and in a 51Cr release assay for antibodies which are cytotoxic to human eye muscle cells in antibody-dependent cell-mediated cytotoxicity (ADCC). Antibodies reactive with a 64 kDa PEMM antigen were detected in three patients who had eye disease of less than six months duration, but not in the two with more chronic disease. Antibodies against a 95 kDa PEMM antigen were detected in one patient in whom anti-64 kDa antibodies were also demonstrated. All five patients showed significant improvement in their eye disease following plasmapheresis exchange and titres of the anti-64 kDa protein antibody decreased in the three patients with detectable levels before treatment. TSH receptor stimulating antibodies were detected in all five patients before treatment, falling during plasmapheresis in four and becoming undetectable in three by the end of treatment. There was no close correlation between levels of TSH receptor antibodies and titres of anti-64 kDa protein antibodies although both tended to fall during and following plasmapheresis. ADCC tests were negative in all five patients before plasmapheresis but, surprisingly, transiently positive in three following treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗