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PubMed1999

[Assessment of sub-clinical thyroid disfunction in aged hospitalized patients in Limousin].

UNLABELLED: The aims of the study were to assess the prevalence of sub-clinical thyroid dysfunction in older patients and to analyze morphological and immunological thyroid abnormalities. SUBJECTS AND METHODS: The effect of aging on thyroid function morphology and immunology was studied in 102 french patients (70 women and 32 men) with a mean age of 81.7 +/- 7.3 years (65-101 years). All patients were hospitalized with different pathological conditions but without any thyroid disease. Patients with treatment or iodine substance which could modify thyroid function were excluded. Serum Free thyroxine (FT4) and TSH levels were detected by RIA. Morphological thyroid study was performed by clinical evaluation and ultrasonography. Two sub-groups of patients were distinguished according to immunological detection tests: In group A (n = 64) immunological parameter was performed by antithyroid microsomal antibodies and in group B (N = 38) by thyroid peroxidase antibodies. RESULTS: We found 4 hypothyroidisms (3.9%), 3 hyperthyroidisms (3%) and 4 marginal isolated high FT4 levels. Elevated levels of FT4 was observed in 3 patients and 1 care of low T4 was described. All patients with abnormal hormonal levels were female. Other patient had normal thyroid function: mean level FT4 was 11.2 +/- 2.2 pg/ml (N: 7-17) and mean level TSH was 1.6 +/- 0.8 mU/l (N: 0.2-4). These values are comparable to those observed in adult populations. Incidence of thyroid autoimmunity was very low (3.9%) in this series compared with previous data. From the morphological analysis, we found 32 morphological abnormalities (31.4%), without strong relation with thyroid dysfunction. Nodule prevalence was near 15% and goiter near 10%.

Aged↗
PubMed2004

[Adult-onset latent autoimmune diabetes and autoimmune thyroid disease].

OBJECTIVE: To investigate the relationship between latent autoimmune diabetes in adults (LADA) and thyroid autoimmunity. METHODS: The frequency of thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab) was determined with radioimmunoassay in 394 subjects, including 90 LADA, 104 classic type 1 diabetics (T1DM), 100 type 2 diabetics (T2DM) and 100 controls. Glutamic acid decarboxylase antibody (GAD-Ab) was measured with radioligand immunoassay. RESULTS: (1) TPO-Ab existed more frequently in LADA (16.7%, 15/90) than in T2DM patients (7.0%, 7/100; P < 0.05). The frequency of thyroid antibody (TPO-Ab or TG-Ab positivity) in LADA and T1DM was 18.9% (17/90) and 25.0% (26/104) respectively, being higher than that in the control group (8/100, 8.0%; P < 0.05). (2) Thyroid antibodies occurred more frequently in LADA patients with higher titer of GAD-Ab (GAD-Ab > or = 0.5) than those with lower ones (50.0% vs 12.5%, P < 0.05). (3) 47.1% (8/17) of LADA patients with thyroid autoimmunity had thyroid dysfunction as compared with 17.6% (6/34) in the group without thyroid antibodies (P < 0.05). CONCLUSIONS: (1) LADA patients, especially those with high titer of GAD-Ab, have high risk for thyroid autoimmunity. (2) The presence of thyroid antibody may predict high risk for thyroid dysfunction in LADA patients. (3) LADA may be one of the components in autoimmune polyendocrine syndrome.

Adolescent↗
PubMedDate not supplied

Plasma and erythrocyte magnesium concentrations in thyroid disease: relation to thyroid function and the duration of illness.

To clarify magnesium metabolism in thyroid dysfunction, plasma and erythrocyte magnesium concentrations (P-Mg, E-Mg) were determined in patients with untreated thyroid diseases and their relations to thyroid hormone levels and the duration of illness were examined. P-Mg was significantly lower in hyperthyroid patients than in euthyroid or hypothyroid individuals. E-Mg was significantly higher in hypothyroid patients than in hyperthyroid or euthyroid individuals. In the entire series of 84 subjects, both P-Mg and E-Mg showed significant negative correlations with thyroid hormone levels, but the correlations were greater in P-Mg than E-Mg. In hyperthyroid patients, both P-Mg and E-Mg were negatively correlated with the duration of illness, but this correlation was greater in E-Mg than P-Mg. Also, both P-Mg and E-Mg were significantly higher in patients with destructive thyroiditis with a short duration (0.5 months) such as subacute or painless thyroiditis than in patients with Graves' disease (4.9 months). These results suggest that magnesium metabolism in thyroid dysfunction is affected not only by thyroid hormone levels but also by the duration of illness.

Acute Disease↗
PubMed1995

[Anti-thyroid autoantibodies in hepatitis C. Thyroid function after interferon therapy in 4 patients].

Four female patients had chronic hepatitis C associated with antithyroid autoantibodies. Hepatitis C virus infection was evidenced by liver biopsy and a positive-four-antigen recombinant immunoblot assay. All four patients were euthyroid before interferon therapy. Recombinant interferon alpha was given at a dose of 3 millions units three times a week for 6 months. At the end of the treatment, serum aminotransferase levels were within the normal range. Two patients progressed to hypothyroidism and 2 patients remained euthyroid. One year after the end of the treatment, only one patient had hypothyroidism and another had normal serum aminotransferase levels. These case-reports suggest that interferon administration may induce thyroid dysfunction in patients with antithyroid autoantibodies at the beginning of treatment. Thyroid dysfunction may be reversed when cytokine is withdrawn.

Adult↗
PubMed2003

[Thyroid peroxidase antibodies and thyroid diseases in children and adolescents with type 1 diabetes mellitus from Southeast Poland].

The authors evaluated the prevalence of TPO Ab and thyroid disorders in 219 children and adolescents (119/54% girls) with type 1 diabetes from southeast Poland aged 3.2-22.3 years (mean age-13.7 +/- 3.9 years). Their age upon diagnosis ranged from 1.6 to 17.2 years (mean age--8.1 +/- 3.6 years), while diabetes duration was between 1 and 18.7 years (mean, 6.4 +/- 3.7 years). In addition to clinical assessment of all patients, determinations were made of serum TPO Ab, FT4 and TSH; thyroid ultrasound was performed in each patient with abnormal thyroid morphology and/or positive TPO Ab titer. Positive TPO Ab titer was demonstrated in 76 (34.7%) patients with type 1 diabetes; in this group 49 showed no other overt thyroid pathological symptoms. Hashimoto's disease was detected in 26 children, Graves's disease in 1 girl. Twenty children (9.1%) with negative TPO Ab titter were shown to have euthyrotic goiter. Thus, thyroid abnormalities were demonstrated in 43.8% of the patients and were seen twice as often in girls than in boys (+ n = 69 > n = 27). Thyroid dysfunction was detected in 11 (5.05%) patients. These 11 patients with thyroid dysfunction constituted 14.5% of the entire group of children with both type 1 diabetes and positive TPO Ab titer (n = 76). Ten patients were hypothyroid (including 8 with previously undiagnosed disease) and 1 girls had hyperthyroidism. The present results indicate that in each child with type 1 diabetes--apart from diabetes control--thyreologic assessment should be done, and the frequency and type of examinations should depend on the comprehensive preliminary evaluation.

Adolescent↗
PubMed2004

Thyroid autoimmunity and dysfunction associated with type I interferon therapy.

Type I interferons are currently used for the treatment of chronic viral hepatitis, multiple sclerosis and several hematological and solid tumors. Side effects are not uncommon, and include multiple alterations in thyroid function, some of which are unrelated to autoimmunity. Review of the literature revealed an overall mean prevalence of incident thyroid dysfunction of 6.2%, hypothyroidism occurring more frequently (3.9%) than hyperthyroidism (2.3%). Destructive thyroiditis characterized by early transient thyrotoxicosis followed by hypothyroidism has also been described. Thyroid dysfunction was mainly subclinical, and spontaneous resolution occurred in almost 60% of patients with or without withdrawal of interferon. Risk factors for developing thyroid abnormalities were female sex and the presence of pre-existing autoimmune thyroiditis. Whether prolonged interferon therapy will increase the likelihood of experiencing thyroid dysfunction, as well as the relationship between incident thyroid autoimmunity and the efficacy of interferon therapy, are still open questions. Although the most-likely explanation for thyroid disease occurring with type I interferon therapy remains an autoimmune reaction or immune system dysregulation, a direct inhibitory effect on thyrocytes may be presumed in patients who developed hypothyroidism without autoimmunity. However, the mechanisms of thyroid damage induced by type I interferons have not yet been clarified in detail. We recommend routine evaluation of serum thyroid-stimulating hormone during interferon therapy. A systematic thyroid assessment is useful only for those patients with pre-existing thyroiditis or incident dysfunction. Although discontinuation of interferon therapy is seldom required, it may be necessary in patients who develop Graves' disease and overt hyperthyroidism.

Autoimmune Diseases↗
PubMed2006

[Thyroid gland and the aging process of the men].

Changes in the anatomy of thyroid and age-related modifications in the regulation of the hypothalamic-pituitary-thyroid axis in aging men were described and reciprocal dependences with the cytokine network were also discussed. Pathophysiological role of the inflammatory cytokines in the promotion of thyroid dysfunctions, autoimmunological including were demonstrated. The modulating impact of environmental factors (micronutrient deficiencies, condiments) on thyroid metabolism was reported. The differences in symptomatology and therapy in thyroid dysfunction in elderly men were depicted. Furthermore the associations between thyroid status and gonadal as well as adrenal function were illustrated.

Aged↗
PubMedDate not supplied

Serum thyroid hormone balance and lipid profile in patients with epilepsy.

PURPOSE: Patients with epilepsy may exhibit changes in thyroid hormone balance, lipids and lipoproteins concentrations. The suggestion that lipid abnormalities are associated with subclinical thyroid dysfunction remains controversial. The aim of this study was to analyze whether thyroid dysfunction encountered in patients with epilepsy would also be associated with abnormal lipid profile. METHODS: Eighty-eight patients with epilepsy and 30 control subjects were included in the study. A fasting blood sample for thyroid hormones, lipid profile and GGT determination was obtained. RESULTS: The serum levels of FT3 was elevated in 10.2% of patients, FT4 was low in 28.4%, TSH was high in 4.6% and low in 2.3%. 13.6% of patients had high TC, 17.1% had high LDL-c, 60.2% had marked reduction of HDL-c levels (P<0.0001) and only 2.3% had high TG levels. Abnormalities were predominated in CBZ-treated patients. 27.3% patients with abnormal hormones had abnormal lipid profile. Significant association was identified between the serum TC, LDL-c, TG, GGT and EIAEDs and between the duration of illness and TG (r=-0.411; P=0.017), and FT4 (r=-0.412; P=0.018). HDL was higher in women than men (r=0.416; P<0.002). However, changes in HDL-c levels associated neither with duration of illness, type or serum levels of AEDs nor with age or degree of control on AEDs. CONCLUSIONS: Our results support that (1) altered lipid metabolism might be associated but not solely influenced by thyroid hormones and (2) enzyme induction is not the main or only reason for altered thyroid function or HDL-c among patients with epilepsy. Hypothalamic/pituitary dysregulation by precisely mechanism caused by epilepsy itself or AEDs seems possible and (3) it is important to recognize that patients with epilepsy are at great risk for atherosclerosis, hence monitoring and correction of the culprit risks are mandatory.

Adult↗
PubMed1993

Thyroid hormone profiles in experimental acute renal failure.

Thyroid hormone profiles were determined in two groups of dogs made uremic, either by i.v. uranyl nitrate 10 mg/kg BW injection or by bilateral ureteral ligation, and in one group of sham-operated animals. Each group consisted of 6 dogs and served as its own control. From blood samples taken in 12-h intervals up to 144 h for uranyl nitrate-injected dogs and 96 h for operated dogs, serum levels of T4, T3, fT4, fT3, rT3, and cortisol were measured by radioimmunoassays. The results obtained in both groups of uremic dogs showed an initial sharp fall of T4, T3, fT4, and fT3 followed by a plateau or retarded decrease. In sham-operated dogs the fall of these hormones was slight and of short duration. Reverse T3 had a tendency to increase in all groups examined, but a significant elevation was recorded only after bilateral ureteral ligation. In this group cortisol serum levels were found the highest, being also significantly increased in the other two groups. The temporal coincidence of the most marked alterations in T3, rT3, and cortisol serum concentrations indicates a significant role of stress in thyroid dysfunction. Although serum creatinine rise and weight loss were not parallel with thyroid hormone alterations, the involvement of uremic compounds and malnutrition in this process is also quite clear. Thus, the data presented suggest simultaneous influences of uremic toxins, stress, and malnutrition on the induction of thyroid dysfunction in dogs made uremic by uranyl nitrate injection or bilateral ureteral ligation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1995

Thyroid disorders of pregnancy.

Practical aspects in the management of thyroid diseases in pregnancy are reviewed. Information on the hypothalamic-pituitary thyroid axis function in pregnancy and transplacental passages of thyroid hormones is discussed. Diagnosis and management of thyroid dysfunction in pregnancy are updated together with the management of women on thyroid replacement therapy at the time of conception. A practical evaluation of thyroid nodules in pregnancy is suggested. Finally, the syndrome of postpartum thyroid dysfunction is reviewed, stressing the importance of proper diagnosis and the need for long-term follow-up evaluation of these patients.

Female↗
PubMedDate not supplied

Extrapulmonary tuberculosis with paravertebral abscess formation and thyroid involvement.

Extrapulmonary tuberculosis has a broad spectrum of clinical manifestations. Involvement of the thyroid gland has rarely been reported. We report a case in a patient with a non-tender swelling of the thyroid, whose symptoms, sonographic and scintigraphic features mimicked carcinoma. Initially the patient presented with back pain due to a paravertebral mass. Fine needle aspiration and culture of the aspirate both from the paravertebral mass and the thyroid ensured the diagnosis. Although seldom observed, tuberculosis should be kept in mind in the differential diagnosis of nodular lesions of the thyroid. The preponderant absence of thyroid dysfunction in mycobacterial thyroiditis is confirmed by this case.

Abscess↗
PubMed1988

An autoimmune aetiology for hypothyroidism following interferon therapy for breast cancer.

Alpha-interferon has been administered as an adjuvant treatment for women with loco-regional relapse of breast cancer. During the course of treatment 5/10 (50%) of women receiving interferon developed de novo thyroid autoantibodies. Three patients became clinically myxoedematous, with biochemical evidence of hypothyroidism which responded to thyroxine replacement therapy. The leucocyte alpha-interferon preparations used in the trial enhanced Class I but not Class II MHC antigens on thyrocytes in vitro. These data strongly suggest that patients receiving alpha-interferon therapy should be closely monitored for the possible development of thyroid dysfunction and that thyroid antibody determination can greatly help to predict overt thyroid clinical abnormalities.

Autoantibodies↗
PubMed2005

Increased prevalence of chronic autoimmune (Hashimoto's) thyroiditis in children and adolescents with vitiligo.

BACKGROUND: An increased prevalence of autoimmune (Hashimoto's) thyroiditis in adult patients with vitiligo has been described. This association has scarcely been studied in children. OBJECTIVE: We sought to assess children and adolescents with vitiligo for autoimmune thyroid disorder and to identify any predisposing factors of this association. METHODS: In all, 54 children and adolescents (23 boys, 31 girls; mean age 11.4 years) with known vitiligo were studied by physical examination and laboratory studies. RESULTS: Four patients with vitiligo were already known to have Hashimoto's thyroiditis. In 9 of the remaining 50 patients, autoimmune thyroiditis was revealed at the time of the investigation. Of the 54 patients with vitiligo, 13 (24.1%) had autoimmune thyroiditis as compared with 9.6% of school-aged children from an iodine-replete area of Greece ( P = .002). There was no association between thyroiditis and clinical type of vitiligo, age at onset, mean duration of vitiligo, or sex. CONCLUSIONS: Hashimoto's thyroiditis is 2.5 times more frequent among children and adolescents with vitiligo than in a healthy age- and sex-matched population. It usually follows the onset of vitiligo. We propose that children and adolescents with vitiligo should be screened annually for thyroid dysfunction, particularly autoimmune thyroiditis.

Adolescent↗
PubMed1999

Autoimmunity and extrahepatic manifestations in hepatitis C virus infection.

Hepatitis C virus (HCV) infection is associated with various extrahepatic manifestations: mixed cryoglobulinaemia, membranoproliferative glomerulonephritis and, in southern Europe, to some extent with porphyria cutanea tarda. The association of haplotype HLA B-8 and DR-3 mixed cryoglobulinaemia and HCV infection has recently been demonstrated. Interferon alpha therapy decreases hepatitis C viraemia and improves the clinical signs and biochemical abnormalities of cryoglobulinaemia. There seems to be a south-north gradient in the prevalence of HCV-associated cryoglobulinaemia. The rare combination of hepatitis C and panarteritis nodosa has still not been confirmed. The sicca syndrome also seems to be associated with hepatitis C virus, but this is not the typical Sjögren syndrome. Existing studies have not answered the question of whether HCV plays a pathogenic role in the development of thyroid dysfunction and autoimmune thyroiditis. There seems to be a genetic predisposition for the manifestations of thyroid disease in the case of hepatitis C infection and interferon therapy. This predominantly affects women with haplotype HLA DR-3. Before beginning interferon therapy, these patients often show thyroid autoantibodies against the thyroid peroxidase and/or thyroglobulin. It is still unclear whether the rare combination of hepatitis C with aplastic anaemia and lymphoma has pathogenic aspects. These haematological manifestations are thought to be induced by the infection of haematopoietic cells with the hepatitis C virus. In rare cases, a stimulated HCV-induced interferon gamma synthesis by haematopoietic stem cells has been shown. Although an epidemiological association of hepatitis C with lichen planus, neuropathies and other diseases has been observed, the aetiological role and the pathogenic involvement of the hepatitis C infection remains unclear. Furthermore, the question of whether these extrahepatic diseases are autoimmune has not been clarified. On the other hand, a number of autoantibodies may be observed during the course of hepatitis C. Of particular interest are liver/kidney microsomal antibodies (LKM). Their occurrence in viral hepatitis may indicate an increased risk for treatment with interferons. In the clinical setting, the presence of these diseases should suggest hepatitis C infection and hepatitis C antibodies should be tested and, if positive, hepatitis C-RNA is indicated. If there is any evidence of an aetiological association of replicative hepatitis C infection and the above-mentioned extrahepatic diseases, antiviral treatment should be considered.

Autoimmune Diseases↗
PubMed2001

Serum thyroid-stimulating hormone measurement for assessment of thyroid function and disease.

Third generation thyroid stimulating hormone (TSH) assays have emerged as the single most useful test of thyroid function, and are used widely and appropriately as a screening test. TSH measurement alone may be misleading in complicated patients and those undergoing treatment for thyroid dysfunction. Before obtaining thyroid function tests, clinicians need to consider whether the patient might have pituitary or hypothalamic disease or severe nonthyroidal illness, and whether assessment of the pituitary-thyroid axis reflects steady-state conditions. Subclinical hyperthyroidism is associated with adverse effects on the skeleton and the heart, and is best assessed by measurement of serum TsH with a third-generation assay.

Humans↗
PubMed1997

Primary open angle glaucoma and hypothyroidism: chance or true association?

The prevalence of hypothyroidism in British patients with primary open angle glaucoma (POAG) was examined. A recently reported study from Montreal had shown a significant increase (p < 0.004) in biochemical hypothyroidism (23.4%) in a population of 64 POAG patients compared with controls (4.7%). Mechanisms for a possible causal association between the two diseases are discussed, including mucopolysaccharide deposition in the trabecular meshwork and vasculopathy altering ocular bloodflow. Reports of improved glaucoma control following treatment of hypothyroidism are discussed. This study examined 100 consecutive patients with POAG in a specialist glaucoma clinic. All patients were questioned regarding symptoms of thyroid dysfunction and previous thyroid disease. All patients not already taking thyroxine underwent an assay of thyroid stimulating hormone. The 4% (95% CI 1.1-9.4%) prevalence of overt hypothyroidism in our study shows no clinically significant increase either over controls in the Montreal study or over our local population. We conclude that in our local population there is no evidence for a clinically important association of hypothyroidism with glaucoma.

Aged↗