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PubMed1993

Tuberculosis of the thyroid gland--a review.

A review of the literature reveals that tuberculosis of the thyroid gland is a very rare condition. Only one case was notified in Singapore over the last ten years. It can occur either as part of a miliary spread or as a primary lesion in the thyroid. It is difficult to diagnose clinically and the thyroid enlargement is often mistaken for carcinoma, suppurative abscess or a haemorrhage into a thyroid cyst. Signs and symptoms are variable, and are mostly related to enlargement of the gland. Thyroid dysfunction is rare. Diagnosis is made by histological examination and demonstration of the tubercle bacilli from biopsy or aspiration specimen.

Antitubercular Agents↗

PubMed2002

Thyronin treatment in adult and pediatric heart surgery: clinical experience and review of the literature.

Thyroid hormone has multiple direct and indirect effects on the heart and the vasculature. Many signs and symptoms of thyroid dysfunction are manifest by the cardiovascular system. Furthermore, many cardiovascular diseases are adversely affected by the concomitant presence of either hyper- or hypothyroidism: it is still being debated whether these alterations are the consequence of increased cardiac workload alone or are due to the intrinsic properties of thyroid hormone. There are three potential mechanisms by which thyroid hormone might exert a cardiovascular action: (1) direct effects at the cellular level (inotropic and chronotropic effect); (2) interaction with the sympathetic nervous system; and (3) alteration of the peripheral circulation through changes in preload, afterload and energy metabolism. We treated 54 adult and seven pediatric patients suffering from severe low cardiac output in different clinical conditions with a mean bolus dosage of 2+/-1.5 microg h(-1) of T(3), followed by a continuous infusion of 0.4+/-0.3 microg h(-1) for a mean duration of 48+/-12 h. In 45 patients, stabilization of the hemodynamic situation with a decrease in inotropic support requirement was observed; however, in 11 patients no beneficial effects were observed. From this experience we suggest that T(3) treatment may improve hemodynamics in a substantial proportion of cardiac and cardiosurgical patients in whom more conventional treatment is unsuccessful.

Adolescent↗

PubMed1989

A new TSH assay. Just another technique or a useful test?

The immunoradiometric assay is a sensitive test for diagnosing thyroid dysfunction. It permits greater accuracy by measuring response of thyrotropin-producing cells of the pituitary to thyroxine (T4) as opposed to comparing circulating T4 to a range of values from healthy controls. The assay allows improved precision in establishing replacement and suppressive doses of hormone for thyroid disease.

Humans↗

PubMed2005

Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine.

OBJECTIVE: To investigate the long-term effects of continuous methimazole (MMI) therapy. DESIGN AND METHODS: Five hundred and four patients over 40 years of age with diffuse toxic goiter were treated with MMI for 18 months. Within one year after discontinuation of MMI, hyperthyroidism recurred in 104 patients. They were randomized into 2 groups for continuous antithyroid and radioiodine treatment. Numbers of occurrences of thyroid dysfunction and total costs of management were assessed during 10 years of follow-up. At the end of the study, 26 patients were still on continuous MMI (group 1), and of 41 radioiodine-treated patients (group 2), 16 were euthyroid and 25 became hypothyroid. Serum thyroid and lipid profiles, bone mineral density, and echocardiography data were obtained. RESULTS: There was no significant difference in age, sex, duration of symptoms and thyroid function between the two groups. No serious complications occurred in any of the patients. The cost of treatment was lower in group 1 than in group 2. At the end of 10 years, goiter rate was greater and antithyroperoxidase antibody concentration was higher in group 1 than in group 2. Serum cholesterol and low density lipoprotein-cholesterol concentrations were increased in group 2 as compared with group 1; relative risks were 1.8 (1.12-2.95, P<0.02) and 1.6 (1.09-2.34, P<0.02) respectively. Bone mineral density and echocardiographic measurements were not different between the two groups. CONCLUSION: Long-term continuous treatment of hyperthyroidism with MMI is safe. The complications and the expense of the treatment do not exceed those of radioactive iodine therapy.

Adult↗

PubMed2000

Management of hyperthyroidism due to Graves' and nodular diseases.

Endocrine surgeons have had an important role in the management of hyperthyroidism due to either Graves' disease or toxic nodule(s). Since alternative treatments such as antithyroid drugs or radioiodine are also available, the decision-making for management should be based on clear assessment of advantages and limitations of each of the treatment options. Surgery provides rapid resolution of these conditions, and cure rates are high, although it may be associated with perioperative complications and postoperative thyroid dysfunction. The authors' experience in the surgical treatment of hyperthyroidism and a review of the recent literature are outlined in this report.

Graves Disease↗

PubMed1995

Mechanistic considerations for the relevance of animal data on thyroid neoplasia to human risk assessment.

There are two basic mechanisms whereby chemicals produce thyroid gland neoplasia in rodents. The first involves chemicals that exert a direct carcinogenic effect in the thyroid gland and the other involves chemicals which, through a variety of mechanisms, disrupt thyroid function and produce thyroid gland neoplasia secondary to hormone imbalance. These secondary mechanisms predominantly involve effects on thyroid hormone synthesis or peripheral hormone disposition. There are important species differences in thyroid gland physiology between rodents and humans that may account for a marked species difference in the inherent susceptibility for neoplasia to hormone imbalance. Thyroid gland neoplasia, secondary to chemically induced hormone imbalance, is mediated by thyroid-stimulating hormone (TSH) in response to altered thyroid gland function. The effect of TSH on cell proliferation and other aspects of thyroid gland function is a receptor mediated process and the plasma membrane surface of the follicular cell has receptors for TSH and other growth factors. Small organic molecules are not known to be direct TSH receptor agonists or antagonists; however, various antibodies found in autoimmune disease such as Graves' disease can directly stimulate or inhibit the TSH receptor. Certain chemicals can modulate the TSH response for autoregulation of follicular cell function and thereby increase or decrease the response of the follicular cell to TSH. It is thus important to consider mechanisms for the evaluation of potential cancer risks. There would be little if any risk for non-genotoxic chemicals that act secondary to hormone imbalance at exposure levels that do not disrupt thyroid function. Furthermore, the degree of thyroid dysfunction produced by a chemical would present a significant toxicological problem before such exposure would increase the risk for neoplasia in humans.

Animals↗

PubMed2002

Goiter prevalence, urinary iodine excretion, thyroid function and anti-thyroid function and anti-thyroid antibodies after 12 years of salt iodization in Shahriar, Iran.

OBJECTIVE: In a previous study in 1983, goiter was found to be endemic in Shahriar, Iran. Iodized salt has been distributed in the region for the past 12 years, and the present study was performed to examine the effect of iodide supplementation on indicators of iodine deficiency (IDD) and thyroid antibodies. DESIGN & METHODS: A total of 3164 people, 58% women and 42% men, were selected by random sampling from the Shahriar area. Goiter was staged according to World Health Organization guidelines. Urinary iodine was measured by a digestion method, and thyroid hormone measurements were done by radioimmunoassay. The results were compared with those of 1983. RESULTS: Goiter prevalence before and after iodine supplementation was 50 and 40% in men, 70 and 51% in women, and 60 and 47% in the whole community, respectively (p < 0.001). A decrease in the prevalence of goiter was observed especially in younger individuals. The mean urinary iodine excretion was 7.6 and 18.5 micrograms/dL, before and after iodine supplementation. In 1983, the urinary iodine in 47.5% of the population studied was between 2 to 5 micrograms/dL, while in 1995, 65% of the population studied had urinary iodine between 10 to 25 micrograms/dL, 12 years after iodine supplementation. Mean serum T4, T3, and thyroid-stimulating hormone (TSH) were normal before and after intervention. There was no significant change in occurrence of positive antibodies, or of hypo- and hyperthyroidism, following iodine supplementation. CONCLUSION: The result of this study shows that the use of iodized salt causes an increase in excreted urinary iodine and a decrease in the prevalence of thyroid goiter, especially in younger age groups. Consumption of iodized salt with 40 parts per million (ppm) iodine has not caused increased prevalence of thyroid dysfunction in this area.

Adolescent↗

PubMed2003

Palmoplantar pustulosis: a clinicoepidemiological study. The relationship between tobacco use and thyroid function.

BACKGROUND: Palmoplantar pustulosis (PPP) is a skin disease characterized by chronically recurring sterile pustules on the palms and the soles. Although the aetiology of PPP is unknown, it is interesting to note the high prevalence of tobacco use in these patients. It would seem that there may be a relationship between PPP, autoimmune diseases and alterations of thyroid function. METHODS: We studied a total of 17 patients with ages ranging from 28 to 67 years, diagnosed with PPP. Patients were interviewed about: autoimmune diseases, psoriasis and thyroid disease, tobacco use (classified as: A, non-smoker; B, ex smoker; C, smoker of less than 20 cigarettes/day; D, smoker of more than 20 cigarettes/day). The patients were interviewed regarding the possible existence of a personal or family history of thyroid disease, determined using thyroid-stimulating hormone, thyroxine, antithyroid antibodies (antimicrosomal and antithyroglobulin antibodies). RESULTS: The majority of the patients smoked cigarettes (according to classification). Of the 12 patients for whom a thyroid study was performed three had been diagnosed with thyroid diseases, an increase in thyroid-stimulating hormone in one case and two showed an increase in antimicrosomial antibodies. CONCLUSIONS: We have been able to demonstrate a high prevalence of thyroid dysfunction and tobacco use in patients with PPP.

Adult↗

PubMed1999

Thyroid hormone and intellectual development: a clinician's view.

Cretinism, which is characterized by marked intellectual impairment and is associated with severe iodine deficiency, has been appreciated for many years. Advances in the knowledge of thyroid physiology and its changes in normal pregnancy have now led to the realization of the potential importance of minor changes in maternal thyroxine (T4) concentrations in relation to brain maturation and development. Mild and subclinical neuropsychomotor deficits have been observed in neonates both in mildly iodine-deficient areas and in iodine-sufficient areas where maternal T4 concentrations are in the low normal range. Recent data from Holland suggest that children born to mothers known to have circulating antithyroid peroxidase antibodies or from mothers with low normal free T4 concentrations measured at 12 weeks gestation have significant development impairment. There are important implications for possible screening for thyroid dysfunction during pregnancy arising from these studies.

Brain↗

PubMed1983

Rheumatic heart disease and thyroid status.

A retrospective analysis of 76 patients with rheumatic heart disease revealed nine with thyrotoxicosis, three with hypothyroidism and seven with normal thyroid function and circulating thyroid antibodies. This suggests that there may be an association between rheumatic heart disease and thyroid dysfunction. The findings emphasize the need to formally exclude hyperthyroidism in patients with atrial fibrillation whatever the apparent cause. They also imply a possible autoimmune factor in the pathogenesis of rheumatic heart disease and suggest that patients with rheumatic heart disease may develop clinical or sub-clinical thyroid disease.

Adult↗

PubMed1988

Effect of mouth rinsing with two polyvinylpyrrolidone-iodine mixtures on iodine absorption and thyroid function.

A prospective study was conducted to investigate the effect of long term therapy with two iodine-containing mouth rinses on thyroid function. Two groups of subjects were treated daily for 6 months with either a 5% polyvinylpyrrolidone (PVPI)-1.5% H2O2 mixture (Perimed) or a 5% PVPI-water mixture. Thyroid function studies, serum iodine concentrations, and urinary iodine excretion were measured before treatment, at 6-week intervals during the 6-month treatment period, and 3 weeks after the last treatment. There was evidence of significant iodine absorption (elevated serum total iodine and inorganic iodide concentrations and urinary iodine excretion) from daily use of both Perimed and the PVPI-water mixture. Serum T3 and T4 concentrations and the free T4 index did not change. There was a small significant rise in serum TSH concentrations during mouth rinse therapy, but all values remained within the normal range. This small increase in serum TSH is a normal adaptive response to the antithyroid effect of increased iodine intake and accounts for the maintenance of normal serum T4 and T3 concentrations. While daily use of these iodine-containing mouth rinses does result in significant iodine absorption, there is no evidence for the development of thyroid dysfunction during a 6-month course of therapy.

Absorption↗

PubMedDate not supplied

[Thyroid function and lipid metabolism in patients with anorexia nervosa].

AIM: There are clinical similarities between anorexia nervosa (AN) and hypothyroidism. Previous reports have shown decrease FT3, increase rT3, sporadically decrease FT4 and normal levels of serum TSH. METHOD: To assess thyroid function in 36 patients with AN (4 males, 32 females the subjects ages ranged from 12 to 18 yrs) serum levels of FT4, FT3, rT3, TSH were measured. Out of this group, 24 patients have been singled out to examine the lipid metabolism by measuring the level of cholesterol, HDL, LDL, triglycerides. RESULTS: 67% (24) of the examined group resulted in low level of FT4 (0.75-0.97 ng/dcl), but decrease FT3 (= 0.67 pg/ml) was only found with 1 patient. The level of rT3 (measured in 94% (34) patients) were normal. The level of TSH were low (0.87-0.97 muIU/ml) in 25% (9) of patients, but 6 of them also manifested decrease FT4 (0.87-0.97 ng/dcl). At the same time, we found higher level of cholesterol in 63% of patients, decrease HDL in 71%. It is interesting to notice that in 80% of cases with a lipid metabolism disorder we found decrease FT4. CONCLUSIONS: Thyroid dysfunctions may be one of the essential reasons for lipid metabolism disorder in AN.

Adolescent↗

PubMed2004

The hypothalamic-pituitary-thyroid axis in subjects with subclinical thyroid diseases: the impact of the negative feedback mechanism.

OBJECTIVE: To evaluate the hypothalamus-pituitary-thyroid (HPT) axis in patients with subclinical thyroid dysfunction recently reported to have either symptoms or organ involvements with potential morbidity, in order to better differentiate these patients with respect to controls. PATIENTS: Sixtythree patients with subclinical hyperthyroidism (HyperT), 178 normal subjects (EuT) and 106 patients with subclinical hypothyroidism (HypoT) were enrolled; the groups presented normal thyroid hormone (FT4, FT3) levels and, respectively, reduced (HyperT), normal (EuT) and increased (HypoT) TSH levels. The negative feedback was simultaneously evaluated by multiple linear regression. RESULTS: The mean TSH, FT4 and FT3 levels were significantly different in the three groups. The negative correlation between thyroid hormones (FT4 and FT3) and TSH secretion was significant (p<0.001 in HyperT; p<0.01 in EuT; p<0.000001 in HypoT group). FT4 mostly contributed to the negative correlation with TSH. The normal ranges of TSH values was accurately defined on the basis of the regression equation in the EuT group, due to the combining influence of both thyroid hormones (FT3 and FT4). No patient of the HyperT or HypoT group fell inside the range of estimated values of the normal group. CONCLUSIONS: The HPT axis in patients with subclinical hyper- and hypo-thyroidism is significantly modified with respect to normal subjects. The status of the axis, as evaluated by the relationship between the three hormones (FT4, FT3, TSH) together considered, is characteristic of the normal or pathologic condition. A reliable method based on the regression analysis is proposed to correctly evaluate the status of the HPT axis.

Adult↗

PubMed1991

Recurrent acute suppurative thyroiditis.

Recurrent acute left-sided suppurative thyroiditis was observed and treated in an eight-year-old girl. Barium swallow performed after the third episode revealed the presence of a pyriform sinus fistula extending to the upper pole of the left lobe. Despite resection of the fistula, she relapsed for a fourth time. The fistula was again seen on esophagogram. A probe was left inside the tract during subsequent surgery, thus facilitating its complete removal. AST occurs most commonly as a result of the persistence of a connection between the throat and the thyroid gland which is otherwise extremely resistant to infection. AST is usually left-sided and not associated with thyroid dysfunction. Recurrences are common unless the congenital fistula is identified and completely excised.

Acute Disease↗

PubMed2003

Interferon-alpha-induced transient severe hypothyroidism in a patient with Graves' disease.

Interferons (IFNs) are proteins with anti-viral activity and are widely used in the treatment of patients with chronic hepatitis C virus (HCV) infection. The use of IFNs has resulted in thyroid dysfunction in a variety of ways. We report a case of a woman with hyperthyroidism due to Graves' disease who developed significant hypothyroidism during treatment with IFN-alpha 2a for HCV infection. However, after discontinuation of IFN-alpha 2a, hyperthyroidism recurred. Potential mechanisms by which IFNs influence thyroid function are discussed.

Antiviral Agents↗

PubMed2005

High iodine intake is a risk factor of post-partum thyroiditis: result of a survey from Shenyang, China.

The aim of the present study is to obtain the epidemiological data on post-partum thyroiditis (PPT) firstly in Chinese women, and to tryto evaluate whether excessive intake of iodine in post-partum women imposes any danger of occurring PPT. Sixty hundred and ten pregnant women were involved in the cohort just before delivery. Four hundred and eighty-eight (80%) of them accepted taking part in follow-ups more than 6 months post-partum. A blood sample was taken from participants before delivery and every 3 months post-partum for testing of serum TSH, thyroid autoantibodies. Free T3 (FT3), free T4 (FT4) and TSH receptor antibody (TRAb) were detected if TSH was abnormal. The iodine nutrition was evaluated according to the mean level of the fasting urinary iodine excretions at different times during the studying period, and participants were subgrouped into 3 categories with low, adequate and high iodine intake. For those participants who had thyroid dysfunction within 6 months post-partum, the follow-up persisted for 1 yr. Of 488 pregnant women, PPT developed in 11.9% (58/488). Given overt and subclinical PPT, the prevalence was 7.17% (no.=35) and 4.71% (no.=23), respectively. There was a strong association between the presence of thyroid peroxidase antibody (TPOAb) at delivery and the risk of developing PPT [RR=6.76, 95% (CI) 4.42-10.34]. Overt cases had much higher titers of TPOAb than subclinical patients (all p<0.05). The median urinary iodine (MUI) of patients with PPT was significantly higher than that of healthy women (231.93 vs 199.88 microg/l p=0.00153). Both the prevalence of PPT and positive TPOAb rise with the increment of iodine intakes. Pregnant women with high iodine intake had more risk of developing PPT when compared with those with low iodine intake (RR=2.92, 95%CI 1.31-6.50). We concluded that positive TPOAb was of value for predicting the occurrence and severity of PPT, and a high iodine intake was a risk factor triggering PPT.

Adult↗

PubMed1999

Thyroid function, morphology and autoimmunity in young patients with insulin-dependent diabetes mellitus.

OBJECTIVE: An association between insulin-dependent diabetes mellitus (IDDM) and autoimmune thyroid disease is well recognized. We have studied the prevalence of thyroid dysfunction, autoimmunity and morphological abnormalities by ultrasonography in young diabetics. SUBJECTS AND METHODS: Among young IDDM patients less than 18 years old and living in the county of Funen, Denmark, 105 of 116 eligible patients participated. They were compared with 105 healthy children matched for sex and age. Routine thyroid function parameters (thyroxine (T4), tri-iodothyronine (T3), T3 resin uptake and TSH) and thyroid autoantibodies (anti-thyroid peroxidase, TPOab, and thyroglobulin antibodies, Tgab) were measured. Thyroid size and morphology were determined by ultrasonography. RESULTS: Two of the diabetics had previously diagnosed hypothyroidism and three new cases of subclinical hypothyroidism were found. There were no significant differences in thyroid function variables or thyroid volume between diabetics and controls. Thyroid volume correlated significantly with age and weight in both groups. Among diabetics, 17 had thyroid autoantibodies (13 with TPOab, 14 with Tgab and 10 with both) compared with 2 children in the control group (P<0.001). Forty-four with IDDM as opposed to 11 of the controls (P<0.001) had morphological abnormalities at ultrasonography. Most of them had various degrees of hypoechogenicity thought to be a marker of thyroid autoimmunity. Among the 17 diabetics with autoantibodies, 10 had morphological abnormalities at ultrasonography. CONCLUSIONS: A high proportion of young IDDM patients without any clinical signs of thyroid disease have markers of thyroid autoimmunity. Many have thyroid autoantibodies, but even more have abnormalities by thyroid ultrasonography.

Adolescent↗

PubMed1992

Thyroid gland neoplasia: non-genotoxic mechanisms.

Animals↗