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PubMed1989

[Thyroid function and cancer].

Despite extensive epidemiological and biochemical studies, the effects of a thyroid dysfunction on the incidence and progress of human cancer have been, for many years, a controversial subject. Endocrine manipulations on laboratory animals clearly demonstrate the influence of thyroid hormones on the induction and growth of several types of experimental tumors: lymphomas, mammary tumors, primary or transplanted hepatomas. In vitro, triiodothyronine also plays an early and critical role in the neoplastic transformation of cultured cells by X-rays, chemical carcinogens and RNA- and DNA-viruses. At the molecular level, the effects of thyroid hormones on the alterations of gene expression accompanying neoplasms remain unknown. Yet, the presence of nuclear triiodothyronine receptors in experimental and human tumors and the recent discovery, by several authors, that the cellular counterpart of a viral oncogene (v-erb A) encodes a thyroid hormone receptor, suggest: either a direct influence of the hormone on the initiation and/or the progress of these tumors; or an indirect effect, via the modulation of another metabolic regulator, for example a polypeptide growth factor (Epidermal Growth Factor, Transforming Growth Factor).

Animals↗
PubMed1984

[Indices of thyroid activity in patients with breast cancer].

An all-round study established thyroid dysfunction in 51 reproductive, climacteric and menopausal patients with primary T2-3 NO-1 MO cancer of the breast. Hypothyroidism is attributed to functional derangement of the thyroid and disorder development in peripheral metabolism.

Adult↗
PubMed1982

Cost-effectiveness of thyroid function tests.

The cost-effectiveness of thyroid function tests (serum thyroxine concentration, triiodothyronine [T3]-resin uptake, free thyroxine index, serum T3, and serum thyrotropin concentration) was assessed in 135 ambulatory patients suspected of hypothyroidism or hyperthyroidism who did not have a history of thyroid disease requiring medication or thyroid surgery within the preceding two years. Of patients with five or more signs and symptoms compatible with thyroid dysfunction, 50.0% had biochemical abnormalities substantiating hypothyroidism or hyperthyroidism, while only 1.5% of patients with fewer than two signs and symptoms had either disease. The cost of thyroid function tests was twice as much per patient evaluated by residents as for those evaluated by faculty physicians. These results suggest that interventions to reduce the number and type of tests in patients without multiple signs and symptoms of thyroid disease could improve the cost-effective use of these tests.

Cost-Benefit Analysis↗
PubMed1978

Lithium and hypothyroidism.

There is general agreement that hypothyroidism is a possible consequence of lithium treatment but there is little agreement as to what the incidence of lithium related hypothyroidism is, or what clinical and laboratory tests could best be used to evaluate thyroid function. This study involved a survey of 70 clinicians, a chart review of 2,590 patients and a review of the pathophysiology of lithium-induced hypothyroidism. The major finding of this investigation is that lithium related thyroid dysfunction is not a common problem. Goiter during lithium therapy is 0.3%, clinical hypothyroidism is 1-2%, and TSH is the most specific laboratory test for evaluating thyroid function.

Goiter↗
PubMed1994

Etiological aspects of congenital diaphragmatic hernia: results of a case comparison study.

We report the results of a parental questionnaire concerning possible etiological and teratological factors, such as exposure to herbicides, in the development of congenital diaphragmatic hernia (CDH). The herbicide Nitrofen interferes with lung development in rats, can induce diaphragmatic hernia and greatly resembles thyroid hormone. No association with the studied teratogens nor with maternal thyroid dysfunction was found. The questionnaire was completed by 33 parents whose baby had CDH, and by 43 couples whose baby had oesophageal atresia. The resemblance of Nitrofen to thyroid hormone, a well-known growth factor for the developing lung, is of particular interest from a pathogenetic point of view in the development of CDH.

Case-Control Studies↗
PubMed1983

Serum concentrations of amiodarone during long term therapy. Relation to dose, efficacy and toxicity.

In 17 patients on long term therapy with amiodarone, serum drug levels measured by HPLC were related to pharmacological effects. At steady state, serum levels were directly proportional to the dose, 5 mg/kg per day leading to an average serum level of approximately 2.5 mumol/l. The non-amiodarone level of iodine averaged 4-times higher than the level of amiodarone iodine. The elimination half-life of amiodarone ranged from 21 to 78 days, and of non-amiodarone iodine from 24 to 160 days. Control of arrhythmias was satisfactory in all 12 evaluable patients, when the serum amiodarone level exceeded 1.5 mumol/l. Deterioration of vision and polyserositis occurred only at amiodarone levels above 4 mumol/l. Tentatively, a therapeutic range of 1.5 to 4 mumol/l is proposed. In contrast, thyroid dysfunction was observed at any amiodarone level. In view of the narrow therapeutic window, therapy with amiodarone may be optimized by monitoring its serum level and in addition, thyroid function should be regularly checked.

Adult↗
PubMed2002

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↗
PubMed2002

Discordant effect of IFN-beta1a therapy on anti-IFN antibodies and thyroid disease development in patients with multiple sclerosis.

Interferon-beta1b (IFN-beta1b) therapy is associated with a relatively high risk of developing thyroid disease. IFN-beta1a is regarded as less immunogenic than IFN-beta1b because of its structural homology to natural IFN-beta. We assessed the effect of 1 year of IFN-beta1a treatment on thyroid function and autoimmunity in 14 multiple sclerosis (MS) patients. The results were compared with those obtained in a series of 31 MS patients treated with IFN-beta1b. The prevalence of positive binding antibody (BAb) titer and neutralizing (NAb) anti-IFN antibody titer in the two groups was also assessed. The BAb and NAb positivity rate in IFN-beta1a-treated patients was significantly lower than in the group submitted to IFN-beta1b therapy (7% vs. 84% and 0% vs. 30%, respectively). Although the incidence of thyroid dysfunction was slightly higher in IFN-beta1b-treated patients than in those undergoing IFN-beta1a treatment (33% vs. 23%, respectively), it did not reach statistical significance. Thyroid disease was unrelated to the presence of positive serum BAb or NAb titer in both the group undergoing IFN-beta1a therapy and in that treated with IFN-beta1b. In both groups, thyroid disease developed mostly in women (71%) against a background of preexisting thyroiditis and a diffuse hypoechoic ultrasound thyroid pattern (80%). IFN-beta1a treatment was associated with a significantly lower prevalence of both BAb and NAb-positive titers than was IFN-beta1b. Conversely, thyroid disease was similar and unrelated to the presence of positive anti-IFN-beta antibody titer. Therefore, routine thyroid assessment may be advised during IFN-beta1a treatment, especially in patients with preexisting thyroiditis.

Adult↗
PubMed1993

Hypothyroidism and anti-endothelial cell antibodies.

Because of our previous demonstration of anti-endothelial cell antibodies (AECA) in patients with insulin-dependent diabetes mellitus and their association, in this condition, with thyroid disease, we sought these antibodies in patients with suspected thyroid dysfunction using an enzyme immunoassay with human umbilical vein endothelial cells as the substrate. AECA were found in 5/120 (4.2%) patients with normal and 15/97 (15.4%) with abnormal thyroid function. The increased prevalence in the latter group was due to a highly significant association between the presence of AECA and raised levels of TSH. We conclude that a highly significant correlation exists between the levels of AECA and TSH, but not between those of AECA and fT4. Patients with hypothyroidism as defined by high levels of TSH have AECA significantly more often than patients with low or normal TSH (22.2% versus 2.8% and 5.8%).

Aged↗
PubMed1992

Thyroid functions in patients treated with interleukin-2 and lymphokine-activated killer cells.

Treatment of malignant disease with interleukin-2 and lymphokine-activated killer cells activates autoreactive T lymphocytes, stimulates release of cytokines and induces expression of HLA-class II antigens by tumour cells. We studied eight patients with hepatocellular carcinoma treated with a total of 16 courses of recombinant human interleukin-2 and lymphokine-activated killer cells and observed them for features of autoimmune thyroid disease. During the course of treatment there were significant decreases in total serum T4 and T3 and free thyroxine levels, but no change in TSH levels when all patients were analysed as a group. This was due to a number of factors including suppression of thyroid hormone release, haemodilution during interleukin-2 infusion and actual removal of thyroid hormones from the circulation during leukapheresis. Thyroid hormones returned to normal levels during resting period. One patient subsequently developed compensated hypothyroidism (normal total T4, total T3 and free T4 but elevated TSH) and four patients had features of 'sick euthyroid syndrome' (low total T4, total T3 or free T4 but normal TSH). None of the patients studied developed antibodies to thyroglobulin or microsomes. In contrast, no abnormality of thyroid function was seen in any of the nine subjects who received no active treatment. In conclusion, thyroid dysfunction was associated with immunotherapy of malignant disease with interleukin-2 and lymphokine-activated killer cells. This may arise from direct hormonal effects of the cytokines on thyroid hormone production.

Adult↗
PubMed1990

American Thyroid Association guidelines for use of laboratory tests in thyroid disorders.

Selection of appropriate laboratory determinations will enable the clinician to diagnose thyroid dysfunction readily in the majority of patients. At the present time, estimation of free thyroxine and a "sensitive" thyrotropin assay are recommended as the principal laboratory tests for thyroid disease. A decrease in serum free thyroxine estimate and a raised level of serum thyrotropin confirm the diagnosis of hypothyroidism caused by thyroid gland failure. An increase in free thyroxine estimate combined with a serum sensitive thyrotropin level suppressed to less than 0.1 mU/L establishes the diagnosis of thyrotoxicosis. In sick patients, a normal or raised serum free thyroxine estimate together with a normal level of serum thyrotropin suggests that the patient has neither hypothyroidism nor thyrotoxicosis. Patients with severe illnesses, generally in the intensive care unit, and those treated with certain drugs, as well as individuals with unusual thyroid disorders, may present with confusing laboratory findings. An understanding of the regulation of the thyroid hormone system and/or judicious consultation with an endocrinologist should enable the clinician to diagnose thyroid disease, if present, in such patients.

Female↗
PubMed1997

[Relevance of the thyroid function assessment in psychiatric patients].

BACKGROUND: Thyroid dysfunction is frequent in psychiatric outpatients and the correction of their endocrine abnormalities seems to improve the response to psychopharmacologic treatment. AIM: To retrospectively explore the frequency of thyroid abnormalities in psychiatric outpatients. MATERIAL AND METHODS: Clinical charts and thyroid assessment of 102 psychiatric patients aged 40.8 +/- 15 years old (28 male) seen between April 1995 and September 1996 were reviewed. Endocrine diagnosis was made according to international criteria and psychiatric diagnosis was made by a single psychiatrist following DSM IV criteria. RESULTS: Forty patients (39.2%) had thyroid abnormalities. Thirteen (12.7%) had a diagnosis of thyroid problems and were in treatment before they came to the psychiatric clinic. Sixteen patients had hypothyroidism (40%), seven had subclinical hypothyroidism (17.5%), 12 were euthyroid but had goiter or positive thyroid antibodies (30%) and 5 individuals had hyperthyroidism (12.5%). The most frequent thyroid abnormality was the presence of positive thyroid antibodies in 16 cases (15.7%). No specific association was found between psychiatric and endocrine diagnoses. CONCLUSIONS: The design of this study prevents to draw conclusions about prevalence of thyroid alterations in psychiatric patients. Nevertheless results support the need for routine thyroid assessment in this specific population.

Bipolar Disorder↗
PubMed1986

Juvenile autoimmune thyroiditis. Hormonal status at presentation and after long-term follow-up.

Thirty children and adolescents with the clinical diagnosis of juvenile autoimmune thyroiditis (JAT) were studied. Twenty-six patients were female and four were male. The median age at diagnosis was 12.9 years (range, 7.5 to 17.3 years). At the initial evaluation, endocrine studies revealed that 40% of the patients were euthyroid, while 33% had compensated hypothyroidism and 27% had overt hypothyroidism. Seventeen patients, 16 of whom received thyroid hormone replacement therapy for a median period of 26 months, were followed up on a long-term basis after discontinuation of therapy. Seven (87%) of eight patients who were initially euthyroid have remained so for a median period of 28 months after treatment and a median period of 50 months since diagnosis. Four (44%) of nine patients who initially had hypothyroidism (either compensated or overt) have reverted to a euthyroid state and have remained so for a median period of 33 months after discontinuation of therapy. Neither the size of the thyroid gland nor the pattern or absolute titer of thyroid autoantibodies correlated with functional status. These results indicate that individuals with euthyroid JAT may remain euthyroid for many years and that a substantial percentage of patients with hypothyroid JAT will experience resolution of thyroid dysfunction.

Adolescent↗
PubMed1999

Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment.

BACKGROUND: This review addresses the definition, prevalence, etiology, and clinical significance of lithium-associated subclinical hypothyroidism and offers guidelines for evaluation and treatment of this condition. DATA SOURCES: MEDLINE was used to search all articles written in English from 1964-present that included the words lithium and thyroid; lithium and subclinical hypothyroidism; mood and thyroid function; and bipolar illness and thyroid function. STUDY FINDINGS: Lithium interferes with thyroid metabolism and increases the incidence of overt and subclinical hypothyroidism. Subclinical hypothyroidism may be associated with the presence of somatic and neuropsychiatric symptoms and interfere with treatment responsiveness. CONCLUSION: A careful assessment of thyroid function is recommended prior to initiating lithium treatment and during maintenance treatment. Recommendations regarding the threshold for initiation of thyroxine supplementation in patients with lithium-associated subclinical hypothyroidism are discussed in relationship to the degree of detrimental effects potentially associated with thyroid dysfunction.

Bipolar Disorder↗
PubMed1999

Abnormal TSH: a rational approach to the older patient.

The clinician whose older patient exhibits an abnormal TSH value must first determine if the result is caused by nonthyroidal illness or a medication whose effect is reversible. Patients without a nonthyroidal cause for the TSH abnormality and corresponding abnormalities in levels of circulating thyroid hormones and/or significant reproducible TSH elevation are usually in need of therapy. Those with normal circulating concentrations of thyroid hormone and potentially reversible signs and symptoms may be considered for a monitored therapeutic trial of treatment. All others need to be followed biochemically regardless of treatment choices. Patients with subclinical thyroid dysfunction require follow-up.

Aged↗
PubMedDate not supplied

[Availability and clinical informative value of thyroid function tests].

The use of quantitative analysis (point system) suggests that informativeness of a complex of tests of radioactive iodine absorption by the thyroid and radioimmunoassay of hormones is conclusive. It is recommended that a staged approach (primary application of the available tests) be used in the diagnosis of thyroid dysfunction.

Evaluation Studies as Topic↗
PubMedDate not supplied

Thyroid storm induced by aspirin intoxication and the effect of hemodialysis: a case report.

Thyroid dysfunction is one of the serious consequences of an overdose of acetaminophen, aspirin, or nonsteroidal antiinflammatory drugs. The management of such consequences remains a medical challenge. A variety of thyroid abnormalities are common in clinical practice and can, in many cases, be accurately diagnosed and managed by the primary care physician. This case study covers an aspirin overdose causing thyroid storm that was treated successfully with hemodialysis.

Adult↗
PubMed1997

Iodine insufficiency and neonatal hyperthyrotropinaemia in Hong Kong.

OBJECTIVES: 23% of the neonatal hypothyroidism in Hong Kong is transient. The present study aims to evaluate iodine excretion in healthy pregnant women in Hong Kong and to determine whether iodine insufficiency may occur in the local population to account for the type of neonatal thyroid dysfunction seen in our screening programme. SUBJECTS: Pilot screening of urinary iodine excretion was determined in 253 healthy pregnant women between 32 and 36 weeks gestation. Fetal and maternal thyroid function in relation to urinary iodine excretion was evaluated in another 55 pregnant women who had given birth to infants with cord blood TSH > or = 16 mIU/I (95th percentile of the cord blood TSH screening programme) and the results were compared to a control group of 160 healthy women whose infants had cord blood TSH < 16 mIU/I. RESULTS: Using a cut-off value of 0.79 mumol/l, a level as defined by WHO as iodine deficiency, we found that 35.8% of the pregnant women had urinary iodine concentrations below this cut off value. We demonstrated that the existence of borderline iodine supply affected the maternal and fetal thyroid function as evidenced by (i) a negative correlation between maternal TSH and urinary iodine concentration, (ii) higher cord blood TSH in those infants whose mothers had a low urinary iodine concentration as compared to those in whose mothers it was normal, (iii) women who had given birth to infants with cord blood TSH > or = 16 mIU/I had lower urinary iodine concentrations and serum fT4 levels as compared to mothers who had given birth to infants with normal cord TSH levels, and their offspring also had higher cord blood thyroglobulin levels. CONCLUSION: Although Hong Kong is not a goitrous area, borderline iodine deficiency exists. Iodization of salt in our community could obviate the necessity for iodine supplements in pregnant women and other at-risk groups.

Congenital Hypothyroidism↗