Thyroid dysfunction is not more common in people with giant cell ateritis
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[Thyroid disease and reproduction dysfunction].
Thyroid disorders have been implicated in a broad spectrum of reproductive disorders ranging from abnormal sexual development to menstrual irregularities and infertility. Hyperthyroidism in the male is thought to cause gynecomastia. In the female hypo and hyperthyroidism results in changes in cycles length and amount of bleeding. The hypothyroidism in the male has less clear-cut effect on the reproductive system. Long-standing, untreated hypothyroidism is associated with galactorrhea. These abnormalities are reversible with adequate thyroid supplementation or collection of hyperthyroidism. Thus during the investigation of hirsurism, menstrual irregularity, infertility, galactorrhea, and gynecomastia, the possibility of thyroid dysfunction must always be considered.
Adult↗
Increased incidence of hypothyroidism in primary biliary cirrhosis.
We examined the thyroid status of 58 patients with primary biliary cirrhosis (PBC) using total serum thyroxin, thyroid hormone binding ratio, free thyroxin index, serum TSH, antithyroglobulin, and antimicrosomal antibodies. Seven patients were known to be hypothyroid prior to the diagnosis of PBC. Six additional patients were found to have biochemical evidence of hypothyroidism. The prevalence of hypothyroidism was 12% if we include only those six PBC patients with newly diagnosed hypothyroidism or 22% if we include all 13 patients. Five of the 58 patients had evidence for an elevation of thyroid hormone binding capacity. Three hypothyroid patients had normal total thyroxins with low thyroid hormone binding ratios. Two euthyroid patients had elevated total T4s with low thyroid hormone binding ratio and normal FTI. The prevalence of positive antimicrosomal antibodies was 34%, including 11 euthyroid PBC patients. The prevalence of positive antithyroglobulin antibodies was 20% including five euthyroid patients. There was no association between HLA DR3 or DR5 and the patients with hypothyroidism and/or antithyroid antibodies. Because fatigue, lethargy, and anorexia as well as hypercholesterolemia are common features of both hypothyroidism and PBC, patients with PBC should be screened for evidence of thyroid dysfunction. Thyroid disease may precede the diagnosis of PBC by several years. Therefore, the development of cholestatic liver disease in a patient with known autoimmune thyroiditis should arouse suspicion of PBC.
Autoantibodies↗
Thyroid abnormalities after therapeutic external radiation.
The thyroid gland is the largest pure endocrine gland in the body and one of the organs most likely to produce clinically significant abnormalities after therapeutic external radiation. Radiation doses to the thyroid that exceed approximately 26 Gy frequently produce hypothyroidism, which may be clinically overt or subclinical, as manifested by increased serum thyrotropin and normal serum-free thyroxine concentrations. Pituitary or hypothalamic hypothyroidism may arise when the pituitary region receives doses exceeding 50 Gy with conventional, 1.8-2 Gy fractionation. Direct irradiation of the thyroid may increase the risk of Graves' disease or euthyroid Graves' ophthalmopathy. Silent thyroiditis, cystic degeneration, benign adenoma, and thyroid cancer have been observed after therapeutically relevant doses of external radiation. Direct or incidental thyroid irradiation increases the risk for well-differentiated, papillary, and follicular thyroid cancer from 15- to 53-fold. Thyroid cancer risk is highest following radiation at a young age, decreases with increasing age at treatment, and increases with follow-up duration. The potentially prolonged latent period between radiation exposure and the development of thyroid dysfunction, thyroid nodularity, and thyroid cancer means that individuals who have received neck or pituitary irradiation require careful, periodic clinical and laboratory evaluation to avoid excess morbidity.
Humans↗
Plasma lipoprotein (a) concentrations in hypothyroid, euthyroid and hyperthyroid subjects.
OBJECTIVE: Alterations of the lipid profile are a well known phenomenon in thyroid dysfunction. Thyroid hormones regulate lipid metabolism through various mechanisms, but a key role is played by the LDL receptor pathway. Thyroid hormone influence on lipoprotein (a) [Lp(a)] metabolism is known. METHODS AND RESULTS: Therefore we studied Lp(a) concentrations in a group of 16 hypothyroid patients and in a group of 22 hyperthyroid patients. Twenty-six euthyroid subjects were used as a control group. Plasma Lp(a) concentrations in hyperthyroid patients (23.2 +/- 28.1 mg/dl) were significantly lower than those of the hypothyroid patients (27.1 +/- 19.2, p < 0.05). There were negative correlations between plasma Lp(a) concentrations and total T4 levels in patients with hyperthyroidism and hypothyroidism (r: -0.49, p < 0.05; r: -0.40, p < 0.05, respectively). Also, decreased HDL-C levels, increased LDL-C, total cholesterol and apo B levels in the hypothyroid patients according to euthyroid subjects were observed (p < 0.05). Decreased LDL-C levels, increased HDL-C and apo Al levels in the hyperthyroid patients according to euthyroid subjects were determined (p < 0.05). CONCLUSIONS: It was concluded that plasma Lp(a) concentrations increase in hypothyroid patients and the observed relationships between thyroid status and Lp(a) levels can be explained by impaired catabolism of apo B and Lp(a) in hypothyroidism.
Adult↗
[Administration of high dose levothyroxine in treatment of rapid cycling bipolar disorders. Review of the literature and initial therapeutic application apropos of 6 cases].
INTRODUCTION: Rapid cycling among bipolar disorders was characterized in 1974 by Dunner and Fieve by at least 4 episodes per year, lithium resistance, female predominance. The idea of using thyroid hormones is based on frequent coexisting thyroid dysfunction. Thyroid hormones where first used in the forties, and more recently (table I) in open label and blind trials (Stancer et Persad, 1982; Bauer et Whybrow, 1990). OBJECTIVE: Open label study of levothyroxine in rapid cycling bipolar disorder. MATERIAL AND METHODS: Six subjects (4 females and 2 males, mean age 45.5 years at onset of bipolar disorder) meeting DMS III-R criteria for rapid cycling bipolar disorder were consecutively included in an open label study of levothyroxine. Subject characteristics are presented in table II. RESULTS: After almost two years follow-up results appear positive in 67% of cases (2 complete remissions, 2 partial remissions and 2 failures). CONCLUSION: Our cases, with data reported in the literature, support the potential efficacy of levothyroxine for treatment of rapid cycling bipolar disorder patients. We suggest a protocol for the good application of this potential new treatment (table III).
Adult↗
The Thyroid-Brain Network: Exploring Inflammation, Immune Mechanisms and Common Triggers in Thyroid-Related Neurological Dysfunction.
Autoimmune thyroid diseases (AITD), including Hashimoto's thyroiditis and Graves' disease, represent the most prevalent endocrine disorders worldwide, affecting hundreds of millions with profound but often under recognized neurological consequences. There are emerging lines of evidence establishing inflammation and immunity as the critical missing link connecting peripheral thyroid dysfunction to central nervous system manifestations. Thyroid hormones function as essential neuromodulators governing neurodevelopment, synaptic plasticity, and cognitive processing through integrated genomic and non-genomic mechanisms, with region-specific cerebral metabolic disturbances correlating with distinct neuropsychiatric symptoms. The immunological perspective reveals that AITD propagates neuroinflammation through convergent pathways: molecular mimicry enabling cross-reactivity between thyroid and neural antigens, cytokine-mediated disruption of neurotransmitter metabolism, HMGB1-driven glial activation, and blood-brain barrier compromise facilitating immune cell infiltration. The thyroid-gut-microbiota axis emerges as a critical mediator wherein dysbiosis perpetuates both thyroid autoimmunity and neuroinflammation through impaired serotonin precursor availability and increased intestinal permeability. Mitochondrial dysfunction represents an energetic common denominator, as thyroid hormone dysregulation directly impairs oxidative phosphorylation, producing region-specific cerebral metabolic disturbances. Simultaneous compromise of monoamine systems, cholinergic signaling abnormalities, and glutamate excitotoxicity creates a particularly toxic neurochemical state in untreated thyroid dysfunction. Common triggers such as psychological stress, gut dysbiosis, and mitochondrial impairment may activate interconnected pathways that simultaneously compromise thyroid and brain function, revealing that these disorders share fundamental mechanistic origins. These insights have been discussed in the current review to enhance the understanding of thyroid-brain function, the core mechanisms and consequences of functional deficits.
Journal Article↗
[Puerperal thyroid gland dysfunction in healthy patients].
Elevated thyroid antibodies (AB) have been described in clinically healthy women indicating a postpartum thyroid dysfunction. We evaluated the incidence of the postpartum thyroid dysfunction in Hannover, FRG. 121 women were examined 1-5 days pp and 2-4 months later; 76 were restudied 5-7 months pp. Every time T3, T4, TSH, TBG, microsomal AB and thyroglobulin AB were determined. Six patients showed increased TAB and 10 increased MAB titers. Severe clinical symptoms were not complained. In some patients these elevated titers turned to normal subsequently. Further studies must evaluate the prognosis of this disease.
Adolescent↗
[Anti-thyroglobulin antibodies].
Measurement of anti-thyroglobulin antibody(TgAb) is used for diagnosis of autoimmune thyroid disease(AITD). Approximately 82-100% of patients with Hashimoto's thyroiditis and 60-70% of patients with Graves' disease are TgAb positive using high sensitive radioimmunoassay. In patients with subacute thyroiditis(SAT), TgAb is usually negative. Therefore, measurement of TgAb is useful to diagnose painless thyroiditis or acute worsening of Hashimoto's thyroiditis from SAT. To predict the post-partum thyroid dysfunction and thyroid dysfunction after interferon treatment, TgAb measurement is important, since patients with positive TgAb are apt to progress thyroid dysfunction.
Autoantibodies↗
[Thyroid clinical dysfunction in patients chronically treated with amiodarone].
This is a prospective study of 132 patients, without previous thyroid dysfunction, chronically treated with amiodarone for cardiac arrhythmias, to determine the incidence of thyroid dysfunction. Age was 62 +/- 11 years (mean +/- SD); 54 were female and 78 male. The arrhythmia was supraventricular in 66%, ventricular in 26.5%, and both in 7.5%. Amiodarone dose was 2,390 +/- 65 mg/week, and follow-up 20 +/- 9 months (minimum 9 months). Thyroid status was evaluated at the onset and at regular intervals during follow-up by means of clinical indexes defined by Crooks et al and Billewicz et al. During follow-up 4 patients developed diagnostic indexes (two hyperthyroid and two hypothyroid) and seven more developed suggestive symptoms without reaching a diagnostic index. Biochemical serum determinations of thyroid function proved dysfunction in the four with diagnostic indexes, and were normal in the other seven. The prevalence of new thyroid dysfunction in patients chronically treated with amiodarone in our population is 3%, with equal incidence of hyper and hypofunction. This is the expected incidence for an area with adequate dietary iodine intake. The use of clinical indexes of thyroid dysfunction appear as a useful and economical means of following thyroid function in these patients, saving a large number of biochemical tests.
Adult↗
Thyroid disease and breast cancer, benign breast neoplasm: a two-sample Mendelian randomization study.
BACKGROUND: Breast cancer (BC) is a prevalent and significant health issue and a major contributor to global cancer incidence, accounting for 31% of all reported cases in women. Benign breast neoplasm, as a benign tumor with a high incidence in women, may play an important role in the development of BC. Previous studies have shown that thyroid dysfunction and thyroid cancer (TC) can lead to the occurrence of many cancers. Therefore, we conduct Mendelian randomization (MR) analysis to explore the causality of thyroid dysfunctions, TC, and breast neoplasm. METHODS: The data of the analysis from the genome-wide association study (GWAS) dataset. The exposure includes FT4, TSH, hypothyroidism, hyperthyroidism, and TC. Meanwhile, the outcome consists of BC, HER2-enriched BC, HER2-negative BC, and benign breast neoplasm. We used five methods (inverse variance weighted (IVW) random effects model, IVW fixed effects model, MR-Egger method, median weighted method, and the weighted mode method). We used the MR-PRESSO test and MR-Egger intercept test to detect horizontal pleiotropy and Cochran's Q test to detect heterogeneity. RESULTS: The IVW method showed a positive relationship between high FT4 levels and BC (OR = 1.210 p = 0.008) and an inverse association between TSH levels (OR IVW = 0.908 p = 0.007), hypothyroidism (OR IVW = 0.959, p = 0.014) and BC. For HER2-positive BC, an elevated FT4 level was associated with an increased risk (OR IVW = 1.314, p = 0.001). Genetically predicted high TSH levels (OR IVW = 0.899, p = 0.02) and hypothyroidism (OR IVW = 0.944, p = 0.003) were associated with a decreased risk of HER2-positive BC. Meanwhile, individuals with TC (OR = 1.003, p = 0.048), and hyperthyroidism (OR IVW = 1.127, p = 0.006) were associated with an increasing risk of development of benign breast neoplasm. Hyperthyroidism was associated with an elevated risk of benign breast neoplasm. CONCLUSIONS: The present MR study explains the association between thyroid diseases and BC (mainly in HER2-positive BC). Furthermore, it demonstrates that hyperthyroidism, low levels of TSH, and TC may contribute to the development of benign breast neoplasm.
Humans↗
Thyroid autoantibodies in Thai type 1 diabetic patients: clinical significance and their relationship with glutamic acid decarboxylase antibodies.
OBJECTIVE: To study the clinical significance of thyroid autoantibodies in Thai patients with type 1 diabetes and their relationship with glutamic acid decarboxylase antibodies (GAD(65)Ab). METHODS: Thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab) were measured in 50 Thai type 1 diabetic patients. Forty-four patients also had GAD(65)Ab measured. Serum thyrotropin (TSH) was measured in all patients who had no history of thyroid disease regardless of thyroid antibody status. Clinical data including sex, age at onset and duration of diabetes, family history of diabetes, fasting c-peptide levels as well as frequencies of GAD(65)Ab were compared between patients with and without thyroid antibodies. GAD(65)Ab was also measured in 29 non-diabetic patients with hyperthyroid Graves' disease or Hashimoto thyroiditis as a control group. RESULTS: TG-Ab and TPO-Ab were positive in nine (18%) and 15 (30%) patients, respectively. Eight patients (16%) were positive for both antibodies. Two of 16 patients who were positive for TG-Ab or TPO-Ab had a previous history of hyperthyroidism prior to diabetes onset. Of the remainder, two were newly diagnosed with hyperthyroidism and one was found to have clinical hypothyroidism at the time of the study. None of 34 patients without thyroid antibodies had thyroid dysfunction. Eight patients with positive thyroid antibodies but without clinical thyroid dysfunction and 21 patients without thyroid antibodies were followed for up to 3 years, two patients of the first group developed hypothyroidism, whereas none of the latter developed thyroid dysfunction. The frequency of thyroid dysfunction at the time of initial study was significantly higher in patients with positive thyroid antibodies (3/14 vs. 0/34; P=0.021) and these patients who were initially euthyroid tended to have a higher risk of developing thyroid dysfunction (2/8 vs. 0/21; P=0.069). The frequency of thyroid antibodies was significantly increased in females and in those who had positive GAD(65)Ab. GAD(65)Ab was negative in all of the non-diabetic patients with autoimmune thyroid disease. CONCLUSIONS: About one-fourth of Thai patients with type 1 diabetes without thyroid disease had thyroid antibodies. The frequency of thyroid antibodies was increased in female and in GAD(65)Ab positive patients. The presence of thyroid antibodies is associated with a higher frequency of and may predict a higher risk for thyroid dysfunction in Thai type 1 diabetic patients.
Adult↗
Is systematic screening for thyroid disorders indicated in subfertile men?
CONTEXT: Data on the prevalence of thyroid disorders in male subfertility remain scarce. OBJECTIVE: To investigate the prevalence of thyroid dysfunction and thyroid autoimmunity in men with normal and abnormal semen characteristics. SETTING: Tertiary referral center for reproductive medicine of the University Hospital AZ-VUB, Brussels, Belgium. PATIENTS AND DESIGN: Two hundred and ninety-two men were stratified according to the presence of normal (group 1; n = 39) or abnormal (group 2; n = 253) semen characteristics. Thyroid function was assessed by serum thyrotropin (TSH) and free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) for thyroid autoimmunity (TAI or TPO-Ab > 34 kU/l); both were correlated with semen characteristics. MAIN OUTCOME MEASURES: Semen characteristics were determined by World Health Organisation criteria (rapid + slow motility > or = 50% and concentration > or = 20 x 10(6)) and Kruger criteria (morphology > or = 14% normal cells). RESULTS: In group 1, the mean (+/- s.d.) age was 33 +/- 4 years; serum TSH was 1.6 (0.3-29.6) mU/l (median (range)) and FT4 was 12.2 (8.8-15.6) ng/l. In group 2, the mean age was 33 +/- 5 years, serum TSH was 1.3 (0.3-5.2) mU/l and FT4 was 12.5 (8.4-17.5) ng/l; (compared with group 1 P = 0.008 for TSH and P = 0.037 for FT4). In both groups, one patient had increased TSH (2.6% and 0.4%; P = not significant (ns)). In group 1, one patient had TAI and in group 2 twelve patients had TAI (2.6% compared with 4.7%; P = ns). FT4 was an independent determinant for semen characteristics. CONCLUSIONS: The prevalence of thyroid dysfunction and autoimmunity is comparable between men with normal and abnormal semen characteristics. On the basis of these data, we do not advise systematic screening for thyroid disorders in subfertile men consulting a tertiary referral center for reproductive medicine.
Adult↗
Thyroid function after treatment of brain tumors in children.
In 134 children who had been treated for a brain tumor not involving the hypothalamic-pituitary axis, thyroid function was assessed up to 24 years after treatment with cranial or craniospinal irradiation. In addition, 78 children received up to 2 years of cytotoxic chemotherapy. Of 85 children who received craniospinal irradiation, 30 (35%) had abnormalities of thyroid function, and 10 (20%) of 49 who received cranial irradiation had such abnormalities. Frank hypothyroidism developed in three children and thyrotoxicosis in one. Thirty-six children had an elevated thyroid-stimulating hormone level in the presence of a normal thyroxine level; in 16 of them the thyroid-stimulating hormone level subsequently returned to normal. Twenty-eight children who were treated between 1960 and 1970 were excluded from the analysis. Of 34 children who received cranial irradiation, five had thyroid dysfunction and 24 of 72 who received craniospinal irradiation had such dysfunction (p = 0.013). Thyroid dysfunction was present in 4 of 35 children who received no chemotherapy and in 25 of 71 who received chemotherapy (p = 0.014). Direct irradiation plus chemotherapy was more damaging than irradiation alone. These data confirm the high incidence of thyroid dysfunction when the thyroid gland is included in the radiation field. However, in a high proportion, the thyroid abnormalities are minor and revert to normal with time; life-long replacement therapy with thyroxine may be unnecessary.
Adolescent↗
[Late potentials in high resolution ECG in thyroid gland dysfunction].
In this study we examined 278 patients as to the effect of thyroidal dysfunctions upon late-potential parameters in high-resolution ECG (HR-ECG). It could be demonstrated that both hyper- and hypothyroidism tend to produce late potentials. It is remarkable that even "subclinical" dysfunctions reveal significant alterations in HR-ECG. As late potentials represent a risk factor for ventricular arrhythmias these results are an additional indication that already "subclinical" dysfunctions of thyroid gland call for an appropriate therapy. In hyperthyroidism late potentials may be eliminated rapidly by propranolol even in low dosages.
Anti-Arrhythmia Agents↗
[Diagnosis and therapy of fetal thyroid gland dysfunction in primary maternal disease].
Fetal and maternal thyroid function are working independently under physiologic conditions. In case of maternal autoimmune hyperthyroidism during pregnancy there is an up to 12% chance for the fetus to develop thyroid dysfunction, mediated by the transplacental passage of maternal immunoglobulins directed against TSH receptors in the fetal thyroid gland. This may lead to intrauterine growth retardation, craniosynostosis, preterm delivery, perinatal death, etc. Sonography and fetal blood sampling provide important information to detect fetuses at risk and allow intrauterine therapy. Furthermore prenatal diagnosis is important in case of maternal antithyroid drug ingestion possibly leading to fetal hypothyroidism and goitre. The cooperation of specialists for internal and fetal medicine is required for the management of maternal thyroid disease in pregnancy.
Congenital Abnormalities↗
[Prevalence of thyroid gland dysfunctions in 50- to 80-year-old patients. An epidemiologic cross-sectional study in a southwestern community].
BACKGROUND: Thyroid dysfunctions in the elderly are common in iodine deficient Germany. However, the exact prevalence of hypo- and hyperthyroidism is unknown and differs according to the composition of the screened population. In this study we examined the prevalence of thyroid disorders in a population based sample of non-hospitalized elderly people living in a community in southwestern Germany. PATIENTS AND METHODS: In the context of an epidemiological study on the prevalence of osteoporosis and associated factors, 288 men and 271 women between the age of 50 and 80 years were screened for plasma levels of thyreotropin, free T3 and free T4. Participants received an interview on medical conditions including a history on thyroid disorders. RESULTS: 6.7% of the women and 1.7% of the men had a history of thyroid surgery. Manifest or treated hyperthyroidism was observed in 3.5% of the women (n = 10) and 0.7% of the men (n = 2). In 2 of 12 patients with manifest hyperthyroidism the condition was previously unknown. 70- to 80-year old women tended to have a higher prevalence of hyperthyroidism (6.3%) than 50- to 59-year old women (2.9%), or 60- to 69-year old women (3.4%). Subclinical hyperthyroidism was observed in 7.3% of the men (n = 21) and 5.9% of the women (n = 16). We observed no cases of over hypothyroidism in men but in 1.8% of the women (n = 5). Four of 5 manifest states of hypothyroidism were previously unknown. CONCLUSION: The prevalence of thyroid dysfunction in older women and men living in southwestern Germany is high. In view of the often nonspecific clinical symptoms of hypo- and hyperthyroidism in elderly individuals, thyroid disorders should be early included to the list of the differential diagnosis of clinical complaints in this age group.
Aged↗
Thyroid gland dysfunctions during antiviral therapy of chronic hepatitis C.
BACKGROUND: The aim of this study was assessment of the frequency of thyroid dysfunctions (TD) during antiviral treatment of chronic hepatitis C (CHC). MATERIAL AND METHODS: Data obtained from 120 not treated before patients with CHC, confirmed by the liver biopsy, and with the correct initial thyroid function, was analyzed. 63 patients were treated with IFN-alpha, and 57 with IFN + ribavirin combined therapy. HCV genotype was determined in 80 patients, and alleles HLA DRB1 in 74. Both tests were carried out by the use of commercial assay InnoLipa (Innogenetics, Belgium). All the patients had TSH level regularly monitored every 4 weeks. If any abnormalities were observed, the whole set of tests was applied for diagnosis. Frequency of TD was analyzed according to patients' sex, therapy scheme, HCV genotype and HLA DBR1 alleles. Both groups, with TD and without TD were compared by the initial data, such as: patients' sex, age, ALT activity, and liver biopsy results. RESULTS: TD occurred in 40 patients (33.3%): in 7 (5.8%) signs of hypothyroidism, and in 33 (27.5%) hyperthyroidism. In 14 patients (11.7%) autoimmunological thyroiditis was diagnosed, in 2 (1.7%) subacute thyroiditis, and in the rest of patients only temporary changes in TSH concentration, without any clinical manifestations, were observed. In 4 women, the antiviral treatment was withdrawn, because of thyreotoxicosis, and in 6 patients thyroid hormones supplementation was needed after termination of interferon application. Thyroid complications occurred significantly more often in women than in men. No significant differences according to the age, therapy scheme, ALT activity, fibrosis stage, nor HCV genotype were find in the TD frequency. Among 13 genotyped DRB1 alleles, differences were observed only in DRB*11 allele frequency: in 37.7% of patients with TD, and in 9.1% of patients without TD (p = 0.0093; Pc = 0.12). CONCLUSIONS: Antiviral treatment induces more often latent and transient thyroid dysfunctions as well as autoimmunological, and subacute thyroidis. The last mentioned complication may be the indication for withdrawal of the treatment, or may cause persistent hypothyroidism. Regular monitoring of TSH concentration, in 4-weeks intervals, seems to be essential for early diagnosis of thyroid complications.
Adult↗