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PubMed2005

[Thyroid diseases in oncological patients].

The authors review the most common situation concerning oncological patients with concomitant thyroid disease. In case of unknown origin of metastasis and nodular goitre the ultrasound examination with fine needle aspiration biopsy confirms or excludes the thyroid origin. The euthyroid sick syndrome is often diagnosed in oncological patient as a consequence of oncological disease and it doesn't mean hypothyroidism. If oncological patients prove to have a thyroid functional failure the endocrinologist must correct the function as fast as possible to enable oncological treatment. There is no evidence that chemotherapy can influence the thyroid function, but radiotherapy can cause thyroiditis with later hypofunction. The interferon therapy causes thyroid dysfunction in 10% of patients and the recommendation to examine not only TSH and FT4 but also thyroid antibodies is warranted. Lymphoma of the thyroid gland occurs most often on the basis of lymphocytic thyroiditis and lymphocytic thyroiditis may be a risk factor for papillary carcinoma of the thyroid as well. Women with breast carcinoma were proved to have lymphocytic thyroiditis with minor thyroid hypofunction more often than the corresponding group of women with colon cancer or control group of healthy women. In case of renal tumor (Grawitz), breast or lung carcinoma the thyroid can be attacked with metastasis, and ultrasound with fine needle biopsy can reliably differentiate between primary or secondary thyroid involvements. The thyroid can be involved in some diseases: multiple endocrine neoplasia, Carney, Cowden and Gardner's syndromes.

Humans↗
PubMed1990

[Thyroid disease in progressive systemic sclerosis].

There is no agreement wither thyroid disease is a common feature of progressive systemic sclerosis (PSS). We evaluated 28 patients with proven PSS with determinations of T3, T4, TSH and Tg as well as antimicrosomal autoantibodies. Radioactive I uptake, thyroid scintigraphy, TRH test and fine needle biopsy were performed in selected patients. Twelve (43%) patients had clinical or laboratory evidence of thyroid dysfunction. Four patients had euthyroid goiter, 3 had evidence of autoimmune disease, 2 had chronic Hashimoto's thyroiditis, 1 was hypothyroid, 1 hyperthyroid and one has subacute thyroiditis. The CREST variant of PSS was most commonly associated with thyroid pathology. Our results indicated that thyroid disease is frequently associated to PSS. A complete clinical and laboratory evaluation is needed to confirm its presence.

Adult↗
PubMed1985

The influence of lithium chloride on experimental autoimmune thyroid disease.

Lithium administration is known to be associated with the development of thyroid dysfunction; it also exerts an effect on the immune system. The effect of lithium on experimental autoimmune thyroid disease was studied in female August rats. Following immunization with rat thyroglobulin in Freund's complete adjuvant, lithium chloride was administered i.p. for 30 days to four groups at varying stages of the disease. Control animals received i.p. saline. Anti-thyroglobulin antibody levels (measured by ELISA) were significantly increased in rats given lithium immediately post-immunization (group B) compared to control animals (661 +/- 42 OD vs 448 +/- 68; mean +/- s.e., P less than 0.02). In contrast, animals which received lithium during the spontaneous resolution of the disease (group D) showed a significant fall in anti-TG antibody compared to controls (99 +/- 15 vs 27 +/- 15; P less than 0.001). Anti-TG antibody levels remained undetectable in animals which received lithium but were not immunized. The splenic T cell blastogenic response (as measured following phytohaemagglutinin stimulation) was significantly increased in rats receiving lithium prior to and during immunization (group A) (stimulation index 63.4 +/- 6.9 vs 10.2 +/- 2.4; P less than 0.001). Spontaneous cell proliferation of splenic lymphocytes was decreased in two lithium treated groups (group A P less than 0.005, group C P less than 0.05). There was no alteration in splenic weight or the degree of thyroid lymphocytic infiltration in any of the treated group. Lithium exerted both positive and negative influences on the immune system in rats immunized with thyroglobulin in adjuvant but did not induce autoantibody production in normal rats.

Animals↗
PubMed1986

Antithyroid antibodies in Hispanic patients with type I diabetes mellitus. Prevalence and significance.

Antithyroglobulin antibodies (ATA) and antithyroid microsomal antibodies (AMA) were sought and thyroid function was determined in 90 Hispanic patients with type I diabetes mellitus followed up for up to seven years. We detected ATA in 7.5% of our patients and AMA in 34.8%. All serum samples positive for ATA also contained AMA. There was no sex difference in the prevalence of thyroid autoimmunity. A small, firm goiter was present in eight patients, one of whom developed Graves' disease. Our results suggest that a relatively high prevalence of AMA and no sex difference in thyroid autoimmunity may be unique features of Hispanic children and adolescents with type I diabetes mellitus. Such patients should be clinically evaluated for thyroid dysfunction and should be screened annually for the presence of AMA. When antibodies are present, laboratory evaluation of thyroid function should be performed frequently.

Adolescent↗
PubMed1992

The development of thyroid storm in a child with McCune-Albright syndrome after orthopedic surgery.

OBJECTIVE: To report a case of thyroid storm that developed in a child with McCune-Albright syndrome after orthopedic surgery. The development of thyroid storm has not previously been described after surgery in a child. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit. PARTICIPANT: Patient with McCune-Albright syndrome who developed thyroid storm. SELECTION PROCEDURES AND INTERVENTIONS: Clinical features and treatment of thyroid storm are described. A highly sensitive immunochemiluminometric thyroid-stimulating hormone assay to help diagnose hyperthyroid states is also described. CONCLUSIONS: Before all operative procedures, children at high risk for thyroid dysfunction, including patients with McCune-Albright syndrome, should be screened and observed closely for the development of thyroid storm.

Child↗
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↗
PubMed1989

Cythion-induced histophysiological changes in thyroid and thyrotrophs of the teleost fish, Channa punctatus (Bloch).

The chronic effects of continuous exposure for 6 months, from January to June, to safe (2.0 ppm) and sublethal (4.0 ppm) concentrations of a commonly used organophosphorus pesticide, cythion, on the histophysiology of the thyroid and thyrotrophs in Channa punctatus are described in this investigation. The pharyngeal thyroid of fish of both treated groups exhibited hypertrophy and hyperplasia of the follicular epithelium and reduction of colloid content. Apart from this, in the fish exposed to 4.0 ppm, some of the follicles were exhausted and transformed into degenerated cystic masses. The presence of free blood cells at these sites suggests rupture of blood vessels and possible phagocytosis. These histopathological changes could be correlated with a significant and dose-dependent reduction of thyroidal radioiodine uptake and conversion ratio (serum protein-bound iodine:total serum iodine) values. After cythion exposure, the thyrotrophs in the pituitary were activated. These results suggest that the thyroid dysfunction caused by cythion may be responsible for the stimulation of the thyrotrophs which in turn stimulated the thyroid follicles through the pituitary-thyroid axis in this species.

Animals↗
PubMed1990

The influence of blood chemistry on T4 and FT4I in major depression.

The pathophysiology underlying thyroid dysfunction in some depressed patients has not yet been determined. In order to clarify possible biochemical influences on thyroid regulation in these patients, we retrospectively examined several thyroid indices in charts from 81 depressed inpatients and 82 psychiatric controls. The depressed group had significantly higher T4 levels and free T4 index (FT4I), as well as lower chloride (CL) levels than controls. Albumin (ALB) also tended to be higher in the depressives. After adjustment for previously reported effects of ALB and CL on thyroid hormone binding in plasma, the initial differences in thyroid indices became non-significant. We suggest from these findings that plasma biochemical factors contribute significantly to the transient changes in thyroid function observed in some acutely depressed patients. Potential explanations for these biochemical alterations are discussed.

Chlorides↗
PubMed2003

Chronic urticaria and autoimmune thyroid disease: is there a link?

Chronic idiopathic urticaria (CIU) is a common and frustrating disorder. A subset of patients with CIU has been classified as autoimmune on the basis of two main findings: association with thyroid autoimmunity and anti-IgE and/or anti-IgE receptor antibodies. There is growing evidence that some cases of CIU are associated with thyroid autoimmunity. Patients with CIU have an increased frequency of Hashimoto thyroiditis with the presence of antibodies to thyroglobulin or a microsomal-derived antigen (peroxidase), even in euthyroid patients. No broad non-specific autoimmunity is present. Antibodies reactive with Fc(epsilon)RI, the high-affinity IgE receptor are found in sera of 10-40% of patients with CIU. A smaller subset of patients with CIU lack anti-Fc(epsilon)RI antibodies and have anti-IgE antibodies that cross-link Fc(epsilon)RIs occupied by IgE. There are a minority of CIU patients that lack such antibodies, but can degranulate basophils by a serum factor that has not yet been determined. Most patients with anti-IgE antibodies have an IgG antibody directed against the 34 kd alpha subunit of the IgE receptor. There are no data to suggest that any of the anti thyroid antibodies is pathogenic in terms of CIU, and most likely these are associated, parallel, autoimmune events. Screening for thyroid autoimmunity and function is advisable in all patients with CIU for the early identification of patients requiring either treatment of underlying thyroid dysfunction or follow-up.

Animals↗
PubMed1998

A study of the association between a polymorphism in the CTLA-4 gene and postpartum thyroiditis.

OBJECTIVE: Postpartum thyroiditis (PPT) is an autoimmune thyroid disease which shares immunological and clinical features with autoimmune hypothyroidism and Graves' disease, and is believed to be caused by a combination of genetic and environmental factors. Recently, an association has been described between Graves' disease or autoimmune hypothyroidism and a polymorphism in the CTLA-4 gene, which encodes a T cell receptor for the B7 family of ligands, and we wished to test whether a similar association exists with PPT. DESIGN: A population-based case-control study of a CTLA-4 gene microsatellite polymorphism was performed, to look for an association with PPT. PATIENTS: Caucasoid women (n = 122) were studied; 58 had thyroid antibodies (against thyroglobulin or thyroid peroxidase) alone during the postpartum period (PPT-) and 64 had thyroid antibodies and some form of postpartum thyroid dysfunction (PPT+). RESULTS: There was no significant difference between this whole group of women and 161 local Caucasoid thyroid antibody-negative women for the CTLA-4106 base pair (AT)n microsatellite polymorphism (relative risk = 1.3; P = 0.3), nor did the PPT+ group differ from controls when analysed separately (P = 0.2). When the postpartum women were subdivided in groups according to clinical pattern of PPT and the type of thyroid antibodies, there were no associations within the subgroups. CONCLUSIONS: No significant association exists between postpartum thyroiditis and a polymorphism in the CTLA-4 gene. Furthermore, a natural variation in the prevalence of the polymorphism in healthy UK populations underscores the need to select appropriately matched normal subjects in future case-control studies.

Abatacept↗
PubMed2001

Thyroid status and leptin in Basedow-Graves and multinodular goiter patients.

In this study it was of interest to investigate the relationship between plasma leptin levels and thyroid function in recently diagnosed 27 Basedow-Graves patients and 22 multinodular goiter patients brought to euthyroid state with 1 mo of propylthiouracil (PTU) treatment. A group of 15 control subjects matched for age, gender, and body mass index were also studied. In Basedow-Graves patients there were significantly higher T4 and T3 levels accompanied by a marked fall in plasma thyroid-stimulating hormone (TSH). In multinodular goiter patients with PTU, the plasma T3 and T4 levels were significantly lower than in Basedow-Graves and TSH was markedly higher. However, TSH values in multinodular goiter patients were signifcantly lower than the control Plasma leptin levels were unchanged in all groups. These data suggest that leptin levels are not affected by thyroid dysfunction.

Adult↗
PubMed1993

Urinary cortisol metabolites in the assessment of peripheral thyroid hormone action: application for diagnosis of resistance to thyroid hormone.

Urinary cortisol metabolites are altered both quantitatively and qualitatively in thyroid dysfunction. This study was conducted to elucidate the usefulness of urinary cortisol metabolites in the assessment of peripheral thyroid hormone action, particularly in the patients with inappropriate thyrotropin secretion. Twenty-four hour urinary 17-hydroxycorticosteroid (17-OHCS) level and gas chromatographical steroid profile were studied in 25 hyperthyroid, 18 hypothyroid, and 24 euthyroid control subjects. Five patients with generalized thyroid hormone resistance and two patients with thyrotropin secreting pituitary tumor were also studied. The ratio of urinary tetrahydrocortisone to tetrahydrocortisol (THE/THF) was significantly elevated in hyperthyroidism (4.58 +/- 1.49) and depressed in hypothyroidism (1.31 +/- 0.55) compared to control (1.93 +/- 0.35). There were good correlations between THE/THF and serum thyroid hormone levels, especially in hypothyroidism. THE/THF can be a good biochemical indicator for deficiency of peripheral thyroid hormone action. Two patients with thyrotropin-secreting tumor showed high THE/THF, which reflected thyroid hormone excess. In contrast, THE/THF in the patients with generalized thyroid hormone resistance was low as compared to high serum thyroid hormone levels. Similar findings were demonstrated with 17-OHCS but discrimination of thyroid hormone resistance was insufficient. Thus, the ratio of the urinary concentrations of cortisol metabolites, THE/THF, appears to be a good marker for peripheral thyroid hormone resistance.

17-Hydroxycorticosteroids↗
PubMed1993

A five-year longitudinal study of thyroid function in children with Down syndrome.

The thyroid function and health status of 101 children with Down syndrome were assessed annually for five years. One child had congenital hypothyroidism at entry to the study. During the study period, eight more developed compensated hypothyroidism. Five of 10 children with compensated hypothyroidism still had the condition at the end of the study, it resolved spontaneously in four and one child developed uncompensated hypothyroidism. There were no significant differences in growth and development between those with compensated hypothyroidism and those with normal thyroid function. Two children developed transient rises in thyroxine, associated with elevations in thyroid-stimulating hormone (TSH). A large proportion of thyroid dysfunction in children with Down syndrome is transient and may be related to inappropriate secretion of TSH or thyroid insensitivity to TSH, rather than to auto-immune thyroiditis.

Child↗
PubMed1987

Prevalence of thyroid disorders in psychogeriatric inpatients. A possible relationship of hypothyroidism with neurotic depression but not with dementia.

Thyroid disorders are known to manifest occasionally as isolated psychiatric disorders. In order to determine whether thyroid dysfunctions could play a significant role in the pathogenesis of psychiatric disorders in the elderly, the prevalence of thyroid disorders was compared in a group of psychogeriatric patients and in a group of nonpsychiatric elderly patients. Thyroid function screening was performed in 157 patients consecutively admitted to a psychogeriatric unit, and the prevalence of hypothyroidism was determined in the different groups of psychiatric disorders (senile and multi-infarct dementia, organic brain syndrome of other etiologies, psychotic depression, neurotic depression, chronic delusional state, acute confusional state, and personality disorder). Thyroid function screening was performed similarly in 104 unselected elderly patients admitted to the medico-surgical admission unit of the University hospital to assess the prevalence of hypothyroidism in a general, nonpsychiatric, elderly population. Eight patients were diagnosed as hypothyroid based on an elevated basal thyrotropin (TSH) and on thyrotropin-releasing hormone (TRH) test in the total number of patients, two in the nonpsychiatric and six in the psychiatric group. Three had clinical hypothyroidism, with decreased total and free T4 and T3 plasma levels in addition to increased basal TSH, five had biochemical hypothyroidism, with normal T4 and T3 levels and an excess TSH response to oral TRH. The prevalence of hypothyroidism in the two groups did not differ significantly (1.9% in the nonpsychiatric versus 3.8% in the psychiatric group). The prevalence of hypothyroidism in a subgroup of 88 patients with senile and multi-infarct dementia was 2.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Thyroid function in clinical subtypes of major depression: an exploratory study.

BACKGROUND: Unipolar depression might be characterized by a 'low-thyroid function syndrome'. To our knowledge, this is the first study which explores the possible relationship of DSM-IV depressive subtypes and the medium term outcome, with thyroid function. METHODS MATERIAL: Thirty major depressive patients (DSM-IV) aged 21-60 years and 60 control subjects were included. Clinical Diagnosis: The SCAN v 2.0 and the IPDE were used. The psychometric Assessment included HDRS the HAS and the GAF scales. Free-T3, Free-T4, TSH, Thyroid Binding Inhibitory Immunoglobulins (TBII), Thyroglobulin antibodies (TA) and Thyroid Microsomal Antibodies (TMA) were measured in the serum. The Statistical analysis included 1 and 2-way MANCOVA, discriminant function analysis and Pearson Product Moment Correlation Coefficient. RESULTS: All depressive subtypes had significantly higher TBII levels in comparison to controls. Atypical patients had significantly higher TMA in comparison to controls. No significant correlation was observed between the HDRS, HAS and GAF scales and thyroid indices. Discriminant function analysis produced functions based on thyroid indices, which could moderately discriminate between diagnostic groups, but could predict good response to treatment with 89.47% chance of success. CONCLUSION: Although overt thyroid dysfunction is not common in depression, there is evidence suggesting the presence of an autoimmune process affecting the thyroid gland in depressive patients

Adult↗
PubMed2003

[Smoking and the thyroid].

The effects of smoking on the thyroid gland have been studied for years. The consequences of smoking on thyroid function and size are however still controversial. It is accepted that an increase in serum thyiocyanate, a potent inhibitor of iodine transport, may contribute to the development of thyroid dysfunction, particularly in geographical areas with borderline iodine deficiency. In the general population, smoking is associated with normal thyroid hormone levels, with a tendency to lower TSH levels and enlargement of thyroid size. There is an increased risk of developing over thyroid disease. The relationship between smoking and relapse of Graves' disease and the incidence and severity of Graves' ophthalmopathy are constantly reported. Smoking also has a potent nodular goitrigenic effect in low iodine areas. Despite the fact that smoking decrease both thyroid secretion and thyroid hormone action, hypothyroidism does not appear to be more frequent. Smoking does however increase the metabolic effects of hypothyroidism. Active and passive smoking have proven deleterious effects on the fetal thyroid. Paradoxically, there is evidence of reduced risk for thyroid cancer in smokers.

Goiter, Nodular↗
PubMed2004

Interrelations between fibromyalgia, thyroid autoantibodies, and depression.

OBJECTIVE: To detect and quantify the association between fibromyalgia (FM) and thyroid autoimmunity. METHODS: This cross-sectional study comprised 146 women with FM and 74 case-controls, all 18 years of age or older. FM was diagnosed according to the American College of Rheumatology 1990 classification criteria. The Mini-International Neuropsychiatric Interview (MINI) was applied for the diagnosis of depression, previously considered as an important confounding factor. Thyroid autoimmunity was defined as the occurrence of detectable antithyroid peroxidase antibodies and/or antithyroglobulin antibodies by the immunometric assay. Cases of diffuse connective tissue diseases and thyroid dysfunctions (hypo or hyperthyroidism) were excluded in both groups. RESULTS: Univariate analysis detected an association between FM and thyroid autoimmunity (odds ratio, OR = 3.87, 95% confidence interval, CI = 1.54-10.13), depression (OR = 3.94, 95% CI = 1.97-7.93), and age (OR = 1.04, 95% CI = 1.01-1.07). In the final logistic regression model, after adjustment for depression and age, the association between FM and thyroid autoimmunity was strengthened (OR = 4.52, 95% CI = 1.86-11.0). CONCLUSION: Our results suggest an association between FM and thyroid autoimmunity.

Adolescent↗
PubMed2005

[Prolonged ventricular repolarization measured by QTc interval in hyperthyroidism].

UNLABELLED: Thyroid dysfunction exerts an effect on cardiac function and on an electrocardiographic curve. Few studies analyzed the influence of thyroid hormones on heart repolarization. Heart repolarization is assessed in every-day-practice with corrected QT interval in ECG. Prolonged QTc is associated with increased risk for heart rythm disturbances and mortality. The aim of this study was to assess the effect of hyperthyroidism on heart repolarization, measured with QT corrected by Bazett's formula. MATERIAL AND METHODS: The study group included 68 hyperthyroid patients (30 males, 38 females, mean age 39+/-10 yrs) and the controls were 39 in age and sex matched healthy subjects. TSH and free thyroxine were assessed. The QTc was measured in a standard 12 lead ECG. RESULTS: In the study group the heart rhythm was faster when compared to controls (91.8 vs.73.7, SD+/-16.11, p<0.0001). The mean corrected QT (QTc) was 0.430, SD+/-0.0273 sec., in controls respectively: 0.414, SD+/-0.0208 sec., p<0.01. QTc did not correlate with free thyroxine concentrations (p=0.2785). CONCLUSIONS: Corrected QT intervals were significantly prolonged in hyperthyroid patients, although they did not reach high values.

Action Potentials↗