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Interferon-associated thyroid dysfunction in anti-D-related chronic hepatitis C.

To assess the frequency and nature of thyroid abnormality in association with interferon (IFN) therapy alone and in combination with ribavirin, 19 patients receiving IFN therapy for hepatitis C virus (HCV)-induced liver disease had thyroid function tests assessed on a monthly basis. Group I (n = 9) patients received 5 million U of IFN s.c. daily for 2 weeks, followed by 3 million U three times per week for 6 months. Group II (n = 10) patients received 3 million U IFN s.c. three times per week together with ribavirin 400 mg twice daily orally for 6 months. Five of 19 patients (26.3%) developed thyroid abnormalities, 3 (33.3%) in group I and 2 (20%) in group II. Three patients developed thyroid function tests consistent with hyperactivity, and 2 of these normalized on cessation of IFN therapy. One patient continued on IFN but remained clinically euthyroid with antithyroid treatment. Two patients developed thyroiditis and required thyroid supplementation. (One of the 2 had pretreatment antimicrosomal thyroid antibodies and a positive family history of thyroid disease.) Of the 3 patients with HCV type 1b, 1 had pretreatment thyroid antibodies, and all 3 had antibodies during IFN therapy. Neither of the 2 patients with genotype 3 had pre-IFN or post-IFN thyroid antibodies. Patients on IFN therapy need regular thyroid function testing. The frequency of abnormal thyroid tests may be dose related. HCV genotype may influence the development of thyroid antibodies.

Antiviral Agents↗

[Preliminary results of thyroid function assessment in children and adolescents with Hodgkin's disease (HD) treated according to PGP-HD-97 protocol].

The intensive treatment of HD (multidrug chemotherapy combined with radiotherapy) carries the risk of early and late complications. One of the late effects is thyroid dysfunction which may occur after radiotherapy of the cervical region. In this report preliminary results of thyroid function assessment in children with HD in correlation with time after cessation of therapy are presented. Between January 1, 1997 and December 31, 2002, 58 children with HD (age: 2.6-18.3 years, median, 14.9 years) were treated in Department of Pediatric Oncology and Hematology PAIP CMUJ in Kraków, according to PGP-HD-97 protocol and these patients were included in the study. Multidrug chemotherapy combined with low-dose involved-field radiotherapy (15-25 Gy) was used in treatment of these children. Therapy was completed in all of analysed patients and in 38 of them (65.5%) at least 24 months before the end of observation. Physical and ultrasound examination of thyroid gland, and plasma levels of T3, T4, fT3, fT4, and TSH were measured before treatment of HD, before the treatment cessation, and every 6-12 months after the completion of therapy. The observation was completed on December 31, 2003. Six hundred and twelve measurements were performed in all of patients. At least one abnormal result of thyroid hormones or TSH levels was found in 50% of children. The most frequent abnormality was the increased level of TSH which occurred in 27.6% of patients. The rates of abnormal results of TSH concentration before HD treatment, and 1 year, 2 years, and later than 2 years after the cessation of therapy were: 8.3%, 8.8%, 21,4%, and 10.2%, respectively. These differences were not statistically significant. Seven patients (12%) require endocrinological treatment due to thyroid dysfunction. These patients as well as other analysed children are clinically euthyreotic. Initial results of thyroid function assessment presented in this report indicate that longer follow up and further thyroid function tests, physical and ultrasound examination of thyroid gland in patients after HD therapy cessation are needed. These studies are essential to early detection and adequate treatment of early and late complications of HD therapy.

Adolescent↗

[Effects of venous compression for blood sampling on the results of in vitro tests of thyroid function (author's transl)].

In a group of subjects with a normal as well as pathological thyroid function there was a significant increase in RT3U, serum-thyroxine-concentrations and TSH-levels but there were no significant changes in the T4-RT3U-indices and ETR-tests after 5 min of venous compression. The discordant results were obtained in 21 cases (26.9%) with the RT3U-test and in 4 cases (5,1%) with the T4-serum-level-determination, which may cause diagnostic errors. The non-standardized venous compression time causes a widening of the euthyroid zone which reduces the discrimination capabilities of these function tests. With TSH-determinations these deviations may be of diagnostic importance in the evaluation of TRH-TSH-test results. A standardized and minimum compression time when drawing blood samples is recommended in order to eliminate this potential source of diagnostic error.

Arm↗

Hypothyroidism in head and neck cancer patients: experimental and clinical observations.

Damage to the thyroid gland may occur in patients undergoing treatment for head and neck neoplasms. This injury may result from damage incurred during surgery, from radiation therapy, or a combination of the two. Development of hypothyroidism is often insidious with potential harmful effects. An experimental study was performed to study the effects of hypothyroidism in pigs whose skin closely approximates that of the human. Wound tensile strength and flap necrosis were studied in the hypothyroid animal treated by surgery, radiation, and a combination of the two. The results of this study indicate that hypothyroidism alone has no significant unfavorable impact on wound tensile strengths or flap survival. When combined with preoperative radiation, however, there are statistically significant deleterious effects on both wound tensile strengths and flap survival. Histologically, collagen fibers within the wound appear shorter and thinner, which probably accounts for decreased wound tensile strengths. A clinical review of 62 head and neck cancer patients was also conducted. Within the study group, 10% of patients developed abnormally low thyroxine measurements, whereas 15% developed high thyroid-stimulating hormone levels as the only evidence of early primary hypothyroidism. Hypothyroidism was not statistically related to tumor size, nodal status, clinical staging, or treatment group (surgery alone, radiation alone, or combination surgery and radiation). A previously unreported finding is that patients who develop a second primary tumor are significantly at risk for developing hypothyroidism. All patients diagnosed with a head and neck cancer should undergo baseline thyroid function testing, including measurement of TSH, and have serial repeat testing after treatment. Thyroid function determination should be mandatory in patients undergoing oncologic salvage procedures or treatment of a second primary tumor.

Adult↗

Thyroid stimulating hormone measurement by an ultrasensitive assay during thyroxine replacement: comparison with other tests of thyroid function.

Serum thyroid stimulating hormone (TSH) was measured using a highly sensitive enzyme-amplified immunoassay in 37 clinically euthyroid patients receiving thyroxine replacement therapy and compared with other biochemical tests of thyroid function. A highly significant correlation (P less than 0.001) was found between the basal serum TSH and the increase in serum TSH concentration 20 min after the administration of thyrotropin releasing hormone (TRH). The basal serum TSH was negatively correlated with the serum total thyroxine (P = 0.05). When patients results were classified as abnormal or normal many discrepancies were noted between the various thyroid tests. A suppressed serum TSH was found in 65% of patients with a normal serum total thyroxine. However, in patients on thyroxine replacement therapy a basal TSH measured by enzyme-amplified immunoassay provides the same information as a TRH test.

Female↗

Human immunodeficiency virus infection and the thyroid.

Abnormalities of thyroid function are associated with a number of systemic conditions, including patients infected with human immunodeficiency virus (HIV). Most patients with early HIV infection and a stable body weight have normal thyroid function. Subtle abnormalities of a number of thyroid function tests have been reported during the early asymptomatic phase of HIV disease. These include an inappropriately normal triiodothyronine (T(3)) and reduced reverse triiodothyronine (rT(3)), and increased thyroxine-binding globulin (TBG) levels. Opportunistic infections involving the thyroid gland, neoplasms such as lymphoma and Kaposi's sarcoma, and medications can alter the thyroid function in individuals with more advanced HIV infection. If thyroid dysfunction is diagnosed in an HIV-infected patient, it should be treated in the usual manner. However, high index of suspicion and caution in the interpretation of thyroid function tests in patients with HIV disease are needed for optimal diagnosis and treatment.

Anti-HIV Agents↗

[Acute recurrent suppurative thyroiditis in childhood].

Acute suppurative thyroiditis in children is very rare and has been reported in only six cases. We describe a 4 1/2 year old girl who presented with acute suppurative thyroiditis of the left lobe. All thyroid function tests were normal but the radioisotope scan showed decreased activity over the upper pole of the left lobe. The child was treated with massive doses of antibiotics and gradually recovered. Three years later she presented with exactly the same findings in the left lobe of the thyroid. Thyroid function tests were again normal but repeated radioisotopic scan showed decreased activity over the left upper pole. Again she recovered gradually under massive antibiotic treatment. A follow up scan showed great improvement with almost complete recovery of activity in the left lobe.

Acute Disease↗

[Thyroid malfunction in women].

The prevalence of thyroid dysfunctions is high in women, this female preponderance has been related with a bigger susceptibility to autoimmune abnormalities. Clinical features of thyroid disease have poor specificity and insidious onset. It is recommended to suspect thyroid pathology in the event of postpartum depression, menstrual abnormalities, amenorrhea, galactorrhea, precocious or delayed sexual development, inexplicable sterility or habitual abortus. The difficult in the clinical diagnosis is compensated by the accessibility and relative easiness of the biological diagnosis by means of the thyroid function tests, mainly the measurements of TSH and FT4 levels; thus, gynecological evaluations should be completed by obtaining thyroid function test. An opportune diagnosis of thyroid illness will solve under the best conditions the gynecological dysfunctions.

Adolescent↗

Elevations of thyroid-stimulating hormone during acute nonthyroidal illness.

To determine whether the incidence of unrecognized thyroid disorders is high enough to warrant screening, we studied a group of 95 elderly hospitalized women with the use of clinical examinations, along with thyroid function tests. We found that 13 (13.7%) of the 95 women had elevated serum thyroid-stimulating hormone (TSH) levels and mean serum thyroxine (T4) levels, and their free T4 indexes and triiodothyronine levels (measured by radioimmunoassay) were lower than the levels in the normal control group. In four (4.2%) of the 95 patients, the elevation of TSH levels was transient. In two patients (2.1%), the elevation of TSH levels was caused by underlying hypothyroidism. The results of thyroid function tests, including serum TSH, obtained during acute nonthyroidal illness should be interpreted cautiously, and screening for thyroid disorders among elderly patients with acute illnesses is not warranted. While primary hypothyroidism may be regularly associated with an elevated TSH level, an elevated TSH level may be the result of an acute illness and not associated with clinical hypothyroidism.

Acute Disease↗