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PubMed1990

Relationship of thyroid disease to renal cell carcinoma. An epidemiologic study.

Thyroid hormone participates in numerous cellular functions besides thermogenesis and metabolism. Several studies, including the recent identification of the product of an oncogene, c-erb-A, as a thyroid-hormone receptor, have shown possible involvement of thyroid hormone in the process of carcinogenesis. A recent anecdotal observation of an unusually high incidence of thyroid dysfunction in women with renal cell carcinoma led to a retrospective review of the incidence and distribution of thyroid disorders in women with renal cell carcinoma compared with a control group of women with transitional cell carcinoma of the renal pelvis, ureter, bladder, or urethra. Women with renal cell carcinoma had a statistically significantly higher percentage of hypothyroidism, thyroid disease in general, and the use of thyroid-hormone supplements as compared with the control group (P = 0.033, P = 0.005, P = 0.041, respectively). The nature of the relationship, however, could not be determined. These findings add a new dimension to renal cell carcinoma, and prospective studies are encouraged to define the contribution of thyroid hormone to renal cell carcinogenesis.

Adult↗
PubMed1998

[Means for the safe surgical treatment of patients with thyroid diseases].

An analysis of a 35-years experience with organ-saving surgical treatment of 13,751 patients with diseases of the thyroid gland has been made. The basic principles of prevention of recurrent diseases and specific postoperative complications are formulated. An original technique of operations resulting in less frequent injuries of the recurrent nerves, hypoparathyrosis and postoperative lethality after surgical treatment of patients with benign diseases and carcinoma of the thyroid gland has been developed.

Humans↗
PubMed2003

Autoimmune thyroid diseases in patients with chronic fasciolosis.

BACKGROUND: The prevalence of autoimmune thyroid diseases and autoantibodies in patients with chronic fasciolosis (CF) was investigated. METHODS: Thyroid function of 32 patients with CF and 72 patients without fasciolosis infection was evaluated biochemically. Thyroid hormones, antithyroglobulin antibodies (TgAb) and antithyroid peroxidase antibodies (TPOAb) were measured. RESULTS: In patients with CF, the prevalences of autoantibodies against thyroid peroxidase and thyroglobulin were 21.9% (7/32) and 15.6% (5/32) respectively. However, thyroid function disorder was identified in only 3 (9.4%) cases. In the control group, TPOAb and TgAb were determined in 2 (2.7%) cases, but no one had thyroid function disorder. The prevalences of thyroid autoantibodies (chi 2: 7.948, p < 0.01) and autoimmune thyroid diseases (chi 2: 4.007, p < 0.05) were significantly higher in the CF group. CONCLUSIONS: The high prevalence of TPOAb and TgAb in CF suggests that patients with CF should be evaluated for autoimmune thyroid disorders at the time of diagnosis and during the follow-up period.

Adult↗
PubMed1993

Levothyroxine therapy in patients with thyroid disease.

PURPOSE: To review the indications for and the proper monitoring of levothyroxine therapy in patients with thyroid disease. DATA SOURCES: Relevant English language articles published from 1966 to 1992 were identified through a MEDLINE search and manual searches of both identified articles and selected endocrinology texts. STUDY SELECTION: Studies, case reports, and review articles that contained data on the pathophysiologic aspects of relevant thyroid disorders and on the pharmacologic aspects of, indications for, and administration of levothyroxine therapy. DATA EXTRACTION: Data on the epidemiology, clinical manifestations, complications, and treatment of thyroid disorders were analyzed with respect to patient selection, methods, diagnostic criteria, and conclusions. These data were used to develop a rational approach to the management of such patients. RESULTS OF DATA SYNTHESIS: Levothyroxine is a reliable and commonly prescribed drug to treat thyroid disease, but excessive dosage may have adverse effects. In patients with hypothyroidism, levothyroxine is used as replacement therapy. For most patients, therapy can be initiated with a full replacement dosage (1.6 micrograms/kg body weight), which is usually 75 to 100 micrograms/day for women and 100 to 150 micrograms/d for men. The goal is to normalize the serum thyroid-stimulating hormone concentration. Levothyroxine is also used to suppress the serum thyroid-stimulating hormone concentration. A trial of thyroid-stimulating hormone suppressive therapy is indicated for most patients with benign solitary nonfunctioning thyroid nodules and for those with a history of thyroid cancer. Levothyroxine in non-thyroid-stimulating hormone-suppressive doses may also be indicated for patients with nontoxic multinodular goiter and for certain patients after lobectomy for benign thyroid nodules. CONCLUSIONS: With proper patient monitoring, levothyroxine replacement therapy should be effective, inexpensive, and free of complications. Recommendations for thyroid-stimulating hormone suppression with levothyroxine are based on risk-benefit considerations of the biologic characteristics of the thyroid disorder and the individual patient.

Female↗
PubMed1980

Contribution of unexpected serum thyroxine (T4) abnormality to detection of thyroid disease.

The screening serum thyroxine (T4) was compared to the history and physical examination as a means of detecting new cases of thyroid disease in a university hospital outpatient population. Of 13 new cases of hyperthyroidism diagnosed during the study period, 10 were suspected on the basis of history and physical examination, and 3 as a result of an elevated screening T4. Of 32 new cases of hypothyroidism, 23 were discovered on the basis of history and physical examination, and 9 as a result of a low screening T4. Thus approximately one quarter of new diagnoses of thyroid disease were made not by history and physical examination but by the unexpected appearance of a deviant T4 on the screening laboratory panel. Since approximately 40 percent of the deviant T4 values were not followed up by physicians, it is possible that an even higher yield of new cases would have resulted by laboratory detection alone. These results suggest that a significant number of new cases of thyroid disease are missed by the clinician and are uncovered only as a result of screening laboratory procedures.

Humans↗
PubMed2004

[Guideline for radioiodine therapy for benign thyroid diseases (version 3)].

The version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves' disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves' disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient's preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients' preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

Combined Modality Therapy↗
PubMed2000

Autoantibodies to the flavoprotein subunit of succinate dehydrogenase: analysis of specificity in autoimmune thyroid disease.

OBJECTIVE: Thyroid-associated ophthalmopathy is a progressive eye disorder affecting the extraocular muscle and orbital connective tissue and is considered to have an autoimmune aetiology. A recent study reported a close relationship between serum antibodies against the flavoprotein subunit of succinate dehyhdrogenase (SDHFp) and active thyroid-associated ophthalmopathy involving eye muscle damage. The aim of the present study was to develop a sensitive and quantitative radiobinding assay for the detection of antibodies to the flavoprotein subunit of succinate dehydrogenase and to use this to determine the distribution of antibodies in different patient groups. DESIGN AND PATIENTS: Serum samples from the following patient groups were analysed: 20 systemic lupus erythematosus; 20 Addison's disease; 26 autoimmune hypothyroidism; 28 Graves' hyperthyroidism; 12 pretibial myxoedema; 25 thyroid-associated ophthalmopathy. Sera from 20 healthy subjects were used as controls. [35S]-labelled succinate dehydrogenase flavoprotein was produced in an in vitro transcription-translation system and subsequently used in immunoprecipitation experiments with sera from patient and control groups to test for the presence of antibodies to the flavoprotein. RESULTS: Succinate dehydrogenase flavoprotein antibodies were detected in five of the 20 (25%) patients with Addison's disease, six of the 20 (30%) with systemic lupus erythematosus, five of the 26 (19%) with autoimmune hypothyroidsm, six of the 28 (21%) with Graves' hyperthyroidism, two of the 12 (17%) with pretibial myxoedema and three of the 25 (12%) with thyroid-associated ophthalmopathy. The frequencies of flavoprotein antibodies were significantly greater than controls (P-value < 0.05) for patients with systemic lupus erythematosus (P = 0.02), but not for patients with either Addison's disease (P = 0.05), pretibial myxoedema (P = 0.13), Graves' hyperthyroidism (P = 0.07), autoimmune hypothyroidism (P = 0.06) or thyroid-associated ophthalmopathy (P = 0.24). For the patients with thyroid-associated ophthalmopathy, the frequency of SDHFp antibodies did not appear to be related to the length of time from diagnosis: the group containing samples taken less than one year from diagnosis showed no increased frequency of SDHFp antibodies when compared to controls (P = 0.10), with three of the 18 (17%) patients being positive. With respect to seven patients with thyroid-associated ophthalmopathy diagnosed for more than a year, SDHFp antibodies were not detected in any of their serum samples. In addition, the clinical severity of the disease, as recorded by the NOSPECS classification, did not correlate with the frequency of SDHFp antibodies: P = 0.13, 0.33 and 0.38, respectively, for patients with Grade II, III and IV ophthalmopathy. Similar results were also found in the case of patients with pretibial myxoedema and eye disease: P = 0.06 for patients with Grade III ophthalmopathy and, SDHFp antibodies were not detected in any of the sera taken from patients with Grade IV ophthalmopathy. In addition, no association was found between disease duration and the frequency of antibodies to the flavoprotein in this patient group. CONCLUSIONS: Our results indicate that succinate dehydrogenase flavoprotein antibodies are not a suitable marker for thyroid-associated ophthalmopathy, at least with the assay system used, as they can be found in patients who do not have eye disease and therefore lack the disease specificity required of a diagnostic tool.

Addison Disease↗
PubMed2001

Diagnostic accuracy of fine-needle aspiration and frozen section in nodular thyroid disease.

OBJECTIVE: To assess the diagnostic accuracy of fine-needle aspiration (FNA) and frozen section (FS) in nodular thyroid disease. SETTING: Tertiary care academic medical center. STUDY DESIGN: Retrospective review of 139 consecutive patients undergoing surgery for nodular thyroid disease. FNA and FS sensitivity, specificity, and accuracy were calculated with respect to permanent section histology. RESULTS: Among 63 patients with an FNA interpreted as either benign (n = 38) or malignant (n = 25), FNA was accurate (sensitivity 89%, specificity 97%, accuracy 94%). FS identified only one case of carcinoma missed by FNA. Among 76 patients with a "suspicious" FNA, FS was reasonably accurate (sensitivity 67%, specificity 100%, accuracy 89%), but was deferred in 50% of cases. CONCLUSION: Given high FNA accuracy, more selective use of FS is suggested. SIGNIFICANCE: The study results will assist with intra-institutional patient counseling and intraoperative decision-making with respect to FNA and FS results in patients with nodular thyroid disease.

Adenoma↗
PubMedDate not supplied

[Discordance of total plasma l-triiodothyronine and l-thyroxine in thyroid diseases].

Radioimmunoassay (RIA) for plasma T3 has been proposed in the diagnosis of thyroid disease. 1 171 simultaneous determination (RIA) of plasma Thyrotropin-Stimulating Hormone (TSH), triiodothyronine (T3) and thyroxine (T4) have been performed in unselected patients under suspicion of a thyroid disease. 81.8% of the cases showed a good agreement between T3 and T4 levels. The remaining 18.2% can be divided into 6 groups: 1. High T3-normal T4 : 51% of the discrepancies: Graves disease untreated (16%) or treated (4%); sporadic goiter (13%); growth failure (8%); hypothyroidism under treatment (6%); thyroiditis, Graves ophtalmopathy, toxic adenoma (4%); 2. High T3-low T4 : 6.5%; sporadic goiter (3%); hypothyroidism (3%); 3. Normal T3-low T4 : 22%: Graves disease under treatment (6%); sporadic goiter (4.5%); subacute thyroiditis (3%); hypothyroidism (3%); miscellaneous (5.5%); 4. Normal T3-High T4 : 9.5%; thyroidectomized patients for cancer well-substituted with T4 (6%); miscellaneous (3.5%) including 1 case of Graves disease; 5. Low T3-normal T4 : 8% 8%: sporadic goiter (4%); hypothyroidism (2%); treated hyperthyroidism (2%); 6. Low T3-high T4 : 3% : including 1 case of hyperthyroidism and 2 cases of thyroidectomized patients well-substituted with T4. In conclusion discrepancies between T3 and T4 levels have been observed mainly in untreated or treated Graves disease (high T3-normal or low T4) and in hypothyroidism (normal or high T3-low T4). The basal TSH and TSH peak after I.V. injection of TRH (65 cases) are in better agreement with T4 level than with T3 level. Indeed, both TRS values are high when T4 is low while T3 is normal of high.

Humans↗
PubMed1987

Existence and immunological significance of circulating Ia+T cells in autoimmune thyroid diseases.

We investigated the percentage of circulating HLA-DR antigen positive (Ia antigen positive: Ia+) T cells and the additive proliferation by non-specific mitogens and thyroid-specific antigens by means of a cytotoxicity test in autoimmune thyroid diseases. Furthermore, we studied the stimulative function of circulating Ia+T cells in autologous mixed lymphocyte reactions. %Ia+T cells were significantly increased in patients with autoimmune thyroid diseases compared with those in normal controls. They were additionally increased by the stimulation of TSH-receptor or thyroid-microsome in patients with Graves' disease, and by the stimulation of thyroglobulin and thyroid-microsome in patients with Hashimoto's thyroiditis. As to the cellular immune function, circulating Ia+T cells stimulated Ia-T cells in autologous MLR in patients with autoimmune thyroid diseases. These data suggest that some of the T cells are already activated in vivo, that the activation of T cells may be by thyroid-specific antigens, and that these activated (Ia+) T cells may be able sequentially to induce the activation of inactivated (Ia-) T cells in autoimmune thyroid diseases.

Cytotoxicity Tests, Immunologic↗
PubMed2004

Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease.

STUDY OBJECTIVES: Surgery is the treatment of choice for symptomatic tracheal obstruction due to benign or malignant thyroid disease. In case of inoperability, or when surgery is refused, few therapeutic alternatives are available. Interventional bronchoscopic procedures have only been reported anecdotally. The objective of this study is to evaluate the results of interventional bronchoscopic procedures in the treatment of severe tracheal obstruction due to thyroid disease. STUDY DESIGN: Retrospective cohort analysis. SETTING: University hospital, tertiary referral center. PATIENTS: Thirty consecutive patients referred for bronchoscopic treatment of benign (n = 17) or malignant (n = 13) thyroid-related upper airway obstruction due to tracheomalacia, extrinsic compression, and/or tracheal ingrowth. Indications for bronchoscopic treatment were medical or surgical inoperability, prevention or treatment of tracheomalacia, and refusal of surgery. There were no procedure-related complications. INTERVENTIONS: Rigid bronchoscopy with dilatation, stenting and/or Nd-YAG laser treatment, and clinical follow-up. MEASUREMENTS AND RESULTS: Subjective improvement, pulmonary function tests, early and late complications, and survival. In the benign group, immediate (100% relief of dyspnea) and long-term (88% relief of dyspnea) results were excellent after airway stenting (21 stents used in 17 patients). There was one unrelated death 1 week after stenting in a 98-year-old patient. There were 6% and 30% short-term and long-term complications, respectively, that could be managed endoscopically. In the malignant group, Nd-YAG laser treatment (n = 3) and stenting (n = 13) yielded immediate and long-term success in 92% of patients. There were 15% short-term and 8% long-term complications. Median survival time was 540 days. CONCLUSIONS: Interventional bronchoscopic procedures including Nd-YAG laser treatment and stenting are valuable alternatives to surgery in inoperable thyroid-induced tracheal obstruction, or when surgery is refused.

Aged↗
PubMed1978

[Thyroid diseases. Impulses for the ORL-physician].

Diseases of the thyroid gland are not uncommon. Understanding the basics of physiology, pathophysiology, endocrinology and nuclear medicine, the otolaryngologist very often will uncover pathologic findings which he previously might have overlooked. A systematic evaluation of thyroid disorders will result in a worthwhile and fascinating collaboration among specialists in internal and nuclear medicine as well as specialists in surgery.

Diagnosis, Differential↗
PubMed2004

No association of IL-1beta C + 3954 T polymorphism and thyroid disease.

Interleukin-1 is a potent pro inflammatory agent, has a direct influence on human thyroid cell function, and modulates cell growth in differentiated thyroid carcinoma cell lines. To evaluate whether a polymorphism on the IL-1beta gene has an influence on the incidence of thyroid disorders, we analyzed the C + 3954 T polymorphism in DNA samples of 673 individuals. 414 venous blood samples were collected from patients suffering from thyroid diseases (Graves' disease n = 53, euthyroid or hyperthyroid non-immunogenic benign thyroid disorders n = 240, thyroid carcinoma n = 121). 259 persons without thyroid disease served as a control. There was no statistically significant association between either of the thyroid alterations or functional conditions on the one hand and the examined genetic polymorphism on the other. Because of the large number of samples tested we can conclude with a high degree of confidence that there is no association between the genotype and the surveyed diseases.

Adolescent↗
PubMed1982

Simultaneous primary hyperparathyroidism and nodular thyroid disease.

Of 351 patients treated for primary hyperparathyroidism from 1966 to 1981, 70 (20%) had grossly evident nodular thyroid disease at the time of subtotal parathyroidectomy. These patients have been reviewed to determine if prior radiation exposure may play a role in their coexistence and if combined subtotal parathyroidectomy and thyroidectomy are safe and efficacious. Thirty-three of the 70 patients (47%) had received prior radiation therapy for benign conditions of the head and neck. Nine of 15 patients with nonmedullary thyroid carcinoma had received previous irradiation. In addition to subtotal parathyroidectomy, 28 patients underwent total thyroidectomy, 14 underwent bilateral subtotal thyroidectomy, and 28 underwent unilateral lobectomy. There were no deaths and no permanent recurrent laryngeal nerve injury from combined subtotal parathyroidectomy and thyroidectomy. Two patients in whom parathyroid tissue was not autotransplanted required calcium and vitamin D supplementation. This study shows that (1) primary hyperparathyroidism and nodular thyroid disease occur simultaneously with sufficient frequency to warrant careful preoperative and intraoperative evaluation of both glands, (2) radiation probably does play a role in the pathogenesis of coexistent primary hyperparathyroidism and nodular thyroid disease, and (3) in experienced hands combined subtotal parathyroidectomy and thyroidectomy can be safely performed.

Adenoma↗
PubMed2003

[Prevention, screening and therapy of thyroid diseases and their cost-effectiveness].

Cost-effectiveness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves' disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal, older persons, hospitalisation due to acute diseases) and in persons with previously elevated TPO-antibodies or TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves' disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%.

Cost-Benefit Analysis↗
PubMed2000

Maternal thyroid disease: a risk factor for newborn encephalopathy in term infants.

Two previously published studies of term newborn encephalopathy showed that maternal thyroid disease to be a risk factor. From these studies we identified 13 case and three control mothers with thyroid disease and investigated them further. The majority of affected case mothers had idiopathic or autoimmune hypothyroidism. Compared with control mothers, case mothers had fewer thyroid function tests in pregnancy, were more likely to remain on the same dose of medication throughout pregnancy and to have experienced other pregnancy complications. The association between maternal thyroid disease and encephalopathy may be the result of a series of different causal pathways, some of which are suggested by our data.

Brain Diseases↗