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PubMed1975

Primary hypothyroidism. Differentiation from primary hypopituitarism.

Five patients with growth failure but few other abnormal clinical signs are presented. Two were shown to have primary hypopituitarism, three had primary hypothyroidism. All received levothyroxine sodium and grew 7.0 to 12.5 cm during the first year and 6.2 to 8.7 cm during the second year of treatment. Three of the adolescent patients developed signs of signs of puberty within six to nine months of initiation of levothyroxine therapy. One hypopituitary patient had femoral epiphysial dysgenesis, hypopglycemia, and undescended testes. One hypothyroid patient had been treated for diabetes mellitus for 8.5 years and may be the youngest patient reported with such a disease combination. We conclude that in a few patients with growth failure without specific clinical signs, diagnosis and differentiation between primary hypothyroidism and primary hypopituitarism can only be made by specific endocrinologic testing.

Adolescent↗
PubMed1997

Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors.

We prospectively used ultrasonography to detect thyroid abnormalities in 96 long-term survivors of childhood cancer, who received head and neck radiation therapy at a median age of 8.9 years. The median time interval since irradiation was 10.8 years (range 5.6-22.8 years). Most survivors of leukemia received 24 Gy cranial irradiation for central nervous system prophylaxis; patients with solid tumors received between 20 and 66 Gy (median 37.5 Gy). The total evaluation included clinical history, physical examination, thyroid function tests, and thyroid ultrasonography; radionuclide scans were performed in patients whose abnormalities persisted on subsequent ultrasound exams. Clinical history and physical examination revealed thyroid abnormalities in 14 patients (15%), but ultrasound detected abnormalities in 42 patients (44%). These findings included inhomogeneity (n = 29), cysts (n = 15), and nodules (n = 22) and occurred in nearly half of patients treated with 15 Gy or more directly to the thyroid gland. Radionuclide scans confirmed the presence of thyroid nodules in 13 of 15 patients with ultrasonographic evidence of nodules. Six patients had thyroid neoplasia, including one case of papillary carcinoma. All patients with neoplasia had nodules demonstrated on ultrasonography. Our experience suggests that in childhood cancer survivors, ultrasonography is a sensitive, affordable, and noninvasive means of detecting subtle parenchymal abnormalities. We recommend thyroid ultrasonography for childhood cancer survivors who received head and neck irradiation. A baseline study should be obtained within 1 year of completion of therapy. The frequency of subsequent examinations should be based on the radiation dose and the patient's age at the time of irradiation.

Adolescent↗
PubMed1990

Autoimmune thyroiditis associated with mild "subclinical" hypothyroidism in adults with Down syndrome: a comparison of patients with and without manifestations of Alzheimer disease.

Serum tests of thyroid function were compared in Down syndrome (DS) patients with and without manifestations of Alzheimer disease (AD). Relative to control individuals, DS patients had, overall, lower mean total T4 (P = 0.070) and T3f (P = 0.015), higher T3U (P = 0.013) and TSH (P = 0.020), no difference in free T4, and higher thyroid antithyroglobulin (ATA) (P = 0.033) and antimicrosomal autoantibody (AMA) titres (P = 0.0097). Similar trends were apparent in DS males and females, and in DS patients off all drugs. In an analysis of case/control pairs with corrections for age and sex, DS patients with AD manifestations (n = 9) had significantly lower T3 (P = 0.029) and higher AMA (P = 0.043) than paired control individuals, whereas DS patients without AD manifestations (n = 20) had significantly lower T3 (P = 0.013) but higher ATA (P = 0.0065). T3 was significantly lower in the DS patients with AD manifestations than in the unaffected (P = 0.0013). These data suggest that autoimmune thyroiditis associated with a mild "subclinical" form of hypothyroidism is common in adult DS patients and more pronounced in patients with AD manifestations than in those without. This "subclinical" hypothyroidism may contribute to cognitive deficits in ageing DS patients.

Adult↗
PubMed2003

Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy.

OBJECTIVE: Treatment of maternal hyperthyroidism during pregnancy is complicated by the lack of readily available measures of the thyroid status of the fetus. The aim of this study is to describe the use of serial in utero ultrasound measurements of fetal thyroid in patients being treated for Graves' disease in pregnancy. METHODS: Over a 24-month period, all pregnant women with Graves' disease attending our special Fetal Thyroid Unit were followed. Maternal thyroid status was assessed by thyroid function tests. Fetal thyroid size was measured serially by transvaginal ultrasonography between 14 and 17 weeks of gestation and by abdominal ultrasonography between 18 and 37 weeks of gestation in 20 women with Grave's disease. RESULTS: In 15 fetuses, thyroid width and circumference were within the 95% confidence interval of the normal population. In five fetuses, thyroid size was above the 95th percentile for gestational age. In three of them, thyroid size decreased concurrently with a decrease in maternal thionamide dosage, reaching normal range. These three fetuses were born euthyroid. In two fetuses, thyroid size was unaffected by a decrement in maternal drug dosage. Both had neonatal thyrotoxicosis at birth. CONCLUSIONS: Serial in utero ultrasonography measuring fetal thyroid size in mothers with Graves' disease can serve as an effective noninvasive tool for the early detection of enlarged fetal thyroid. These findings can be used to monitor the maternal antithyroid drug dosage, thereby preventing intrauterine hypothyroidism in some cases. When a dosage reduction does not cause a decrease in fetal thyroid size, transplacental passage of thyroid-stimulating antibodies causing fetal thyrotoxicosis should be suspected.

Adult↗
PubMed2003

Mental retardation.

Mental retardation (MR) occurs in 2-3% of the general population. Prevalence of milder MR is seven to ten times more than severe MR. Cause of severe MR can be determined in 60-70% of cases, as compared to mild MR where 35-55% remain idiopathic. The diagnostic process is aided considerably if the timing of a developmental insult can be determined: prenatal, periatal, postnatal (not mutually exclusive). History plays a pivotal role in approaching a diagnosis. After clinical evaluation one should be able to assess whether the disorder is static or progressive; approximate developmental quotient; possible timing of insult and possible underlying genetic etiology. Investigations should be based on history and physical examination. The important category of tests include: thyroid function tests, cytogenetic studies, metabolic work-up, fragile-X screening, radiological investigations, electrophysiological studies and specific tests according to the suspected diagnosis. Having an etiological explanation aids in the development of a specific treatment plan; helps families understand prognosis and recurrence risk and on the community level assists in the development of preventive strategies.

Child↗
PubMedDate not supplied

Thyroid function in haemochromatosis.

BACKGROUND: In hereditary haemochromatosis (HH), the thyroid gland is the site of substantial iron deposition. However, there have been relatively few reported cases of thyroid dysfunction in HH. AIM: To evaluate the prevalence of thyroid disorders in a large group of patients with HH. METHODS: A variety of endocrine investigations were undertaken including thyroid function tests and thyroid antibody studies. RESULTS: A total of 154 consecutive patients (123 male, 31 female) were studied. One case of primary hypothyroidism was identified, giving a prevalence of 0.6%. Subclinical hypothyroidism was identified in two females, giving a prevalence of 1.3%. Iatrogenic hypothyroidism was identified in two other cases. No case of hyperthyroidism was identified. CONCLUSION: Thyroid dysfunction is an uncommon occurrence in patients with HH.

Adult↗
PubMed1991

Covert hypothyroidism presenting as a cardiovascular event.

Hypothyroidism presenting with classic signs and symptoms is generally easily recognized. Less often, patients with hypothyroidism may present with symptoms and laboratory abnormalities suggestive of cardiovascular disease. In this article, we describe six such patients. Hypothyroidism was suspected when creatine phosphokinase (CPK) levels were persistently elevated. The diagnosis was confirmed by thyroid function tests, and thyroid hormone therapy resulted in resolution of symptoms and CPK elevations. Persistently elevated CPK levels associated with cardiovascular symptoms but without demonstrable myocardial damage should prompt consideration of covert hypothyroidism.

Adult↗
PubMed1992

Long-term thyroxine treatment and bone mineral density.

Studies of the effect of thyroxine replacement therapy on bone mineral density have given conflicting results; the reductions in bone mass reported by some have prompted recommendations that prescribed doses of thyroxine should be reduced. We have examined the effect of long-term thyroxine treatment in a large homogeneous group of patients; all had undergone thyroidectomy for differentiated thyroid cancer but had no history of other thyroid disorders. The 49 patients were matched with controls for age, sex, menopausal status, body mass index, smoking history, and calcium intake score; in all subjects bone mineral density at several femoral and vertebral sites was measured by dual-energy X-ray absorptiometry. Despite long-term thyroxine therapy (mean duration 7.9 [range 1-19] years) at doses (mean 191 [SD 50] micrograms/day) that resulted in higher serum thyroxine and lower serum thyrotropin concentrations than in the controls, the patients showed no evidence of lower bone mineral density than the controls at any site. Nor was bone mineral density correlated with dose, duration of therapy, or cumulative intake, or with tests of thyroid function. There was a decrease in bone density with age in both groups. We suggest that thyroxine alone does not have a significant effect on bone mineral density and hence on risk of osteoporotic fractures.

Absorptiometry, Photon↗
PubMed1993

Thyroid function and other clinical chemistry parameters in subjects eating iodine-enriched eggs.

Iodine-enriched (IE) eggs are produced by chickens fed a diet containing kelp. These eggs, which contain an average of 711 micrograms iodine/egg, have been reported to reduce plasma cholesterol in humans and laboratory animals. A modified form of these eggs is under consideration for marketing in the United States. 104 hyperlipidaemic subjects were placed on a low-fat diet for 12 wk. Between wk 4 and 12, approximately half of the subjects were randomized to a dietary control group (n = 53) or a group who ingested one IE egg/day in addition to this diet (n = 51). Some subjects in both groups continued in the study for an additional 4-8 wk. No significant adverse clinical effects were observed or reported, with the exception of one subject who reported an allergic-like reaction soon after beginning egg ingestion. All clinical chemistry values remained within normal limits, and comparisons between the egg group and controls were not significant. Three subjects (two in the egg group and one in the control group) had elevated thyroid stimulating hormone levels during the experimental period. All thyroid function tests remained within normal limits in the remaining subjects. Thus, ingestion of one IE egg of the type used in our study appears to be relatively safe and devoid of clinically significant, short-term adverse effects in healthy individuals.

Animals↗
PubMed1983

Endocrine aspects of lithium therapy in Tourette's syndrome.

The use of Lithium Carbonate (Li2CO3) therapy in Gilles de la Tourette syndrome is reported in one patient. The patient, a 22-year-old male, was treated with a daily dose of 900 mg of Li2CO3 to attain therapeutic blood serum lithium concentration between 0.76 and 0.87 mEq/L. Renal function tests, urine analysis and thyroid function tests were monitored in addition to determinations of serum gonadotropins and testosterone concentrations throughout the 8 months of the study. The neuroendocrine measurements indicate blunting of Thyrotropin Stimulating Hormone (TSH) response, to Thyrotropin Releasing Hormone (TRH) stimulation test, which may be due to lithium therapy. The patient's growth and development were normal. This case represents the first report of blunting of TSH response to TRH in Tourette's disease. The fact that this disease has an onset during childhood suggests the importance of monitoring various endocrine functions during lithium therapy.

Adult↗
PubMed1981

Triiodothyronine--binding immunoglobulin in a euthyroid patient.

We describe a clinically euthyroid 60-year old woman with a past history of 1311 therapy for treatment of possible toxic nodular goitre. She had an elevated thyroxine level of 188 microgram/L (normal range 50-125 microgram/L) following her therapy, and her TSH was within normal limits at 4.7 mU/L. However her T3 level, as determined by an RIA technique employing charcoal to separate bound and free T3, was not measurable. T3 added to the patient's serum could not be recovered, therefore the presence of an unusual protein capable of binding T3 was suspected. To avoid this interference, T3 analysis was performed on an ethanol extract of the patient's serum and was found to be 17 microgram/L (normal range 0.8-1.8 microgram/L). At this time her thyroid microsomal antibody titre was 1:100,000. A protein, capable of binding more than 70% of the patient's T3, was demonstrated in the gamma globulin fraction by agarose gel electrophoresis. This protein did not bind T4. Scatchard analysis for T3 binding revealed a protein, presumably IGG, with a binding affinity of 2 x 109 L/mole and binding capacity of 50 microgram/L. This case exemplifies the caution that must be taken in interpreting thyroid function tests. When thyroid hormone levels are inappropriate to the clinical status of the patient the presence of circulating antibodies which can bind the thyroid hormones should be considered.

Alpha-Globulins↗
PubMed2003

Color Doppler sonography in hypothyroidism.

BACKGROUND: The value of color Doppler sonography in thyroid disease continues to be a matter of debate. Over the past few years, several studies have proved unable to yield unequivocal results. Only a few studies concerning color Doppler sonography in patients with hypothyroidism have been published. METHODS: 89 patients with hypothyroidism have been evaluated. They were examined clinically; laboratory tests on thyroid function and color Doppler sonography have been performed. The color flow distribution and intensity were estimated and the fastest flow velocity (PSV) detectable with a pw-doppler was registered. The color pattern was graded from 0 to III as has been described by others and the color Doppler findings were then correlated to both the clinical picture and the laboratory results. RESULTS: 56 of the 89 hypothyroid patients showed pattern 0 with a PSV of 22 cm/s. In 33 patients different degrees of increased parenchymal color could be found with a concordant PSV: 16 patients showed pattern I with a PSV of 39 cm/s; 11 showed pattern II with PSV 58 cm/s, and 6 showed pattern III with PSV 63 cm/s. Regarding the corresponding clinical and laboratory variables, there was a very close correlation between color intensity and anti-Tg/anti-TPO antibody levels: pattern 0: anti-Tg 474 IU/ml, anti-TPO-Ab 810 IU/ml; pattern I: 1053/1733; pattern II: 1774/2432; pattern III: 1951/2633. Some correlation could also be found for the TSH values and the calculated volume of the thyroid gland, whereas the duration of hypothyroidism showed an inverse correlation to color intensity. (Pattern 0: TSH 3.1 mE/ml, volume 9.2 ml, duration 43 months; pattern I: 4.2 mE/l, 15.7 ml, 24 mos.; pattern II: 11.5 mE/l, 22.3 ml, 16 mos.; pattern III: 38.2 mE/l, 34.3 ml, 10 mos, respectively). CONCLUSIONS: The color Doppler pattern of intense hypervascularization of the thyroid gland formerly attributed only to the hyperthyroid state of active Graves' Disease can also be seen in hypothyroidism. Our data support the concept that the color flow appearance is not the result of stimulated thyroid hormone production, but a measure of the activity of an autoimmune process.

Blood Flow Velocity↗