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PubMed2002

[Prevalence of hypothyroidism and hyperthyroidism in Nord-Trondelag].

BACKGROUND: The objective of this survey was to examine the prevalence of thyroid disease including autoimmunity in Norway. MATERIALS AND METHODS: All 94,009 inhabitants aged 20 and above in Nord-Trøndelag county, Norway were invited to participate in a health survey. RESULTS: The prevalence of formerly diagnosed hyperthyroidism was 2.5% in women and 0.6% in men, hypothyroidism 4.8% and 0.9% respectively, increasing with age. In individuals without a history of thyroid disease the median, 2.5 and 97.5 percentiles for TSH (mU/l) were 1.8 and 0.49-5.7 for women and 1.5 and 0.56-4.6 for men. When excluding individuals with positive thyroid peroxidase antibodies (TPOAb), the 97.5 percentiles were 3.6 mU/l for women and 3.4 mU/l for men. The prevalence of pathological TSH values in women and men were TSH > or = 10 mu/l 0.9% and 0.4%; TSH 4.1-9.9 mU/l 5.1% and 3.7%; TSH < or = 0.05 mU/l 0.5% and 0.2%. The prevalence of positive TPOAb was 13.9% in women and 2.8% in men, the lowest percentage was seen with TSH 0.2-2.0 mU/l and increased both with higher and lower TSH values and was higher in women except for those with TSH > or = 10 mU/l (85% TPOAb positive). CONCLUSION: In spite of a high prevalence of recognised thyroid disease in the population a considerable number have undiagnosed thyroid dysfunction and positive TPOAb.

Adult↗

PubMed1985

Sensory thresholds and motor responsiveness in thyroid disease: their responses to treatment and warming.

It has been our clinical observation that patients with hypothyroidism are relatively insensitive to the discomfort of venepuncture, whereas thyrotoxic patients seem to have a heightened sensitivity. In an initial study we have measured the sensory thresholds of perception along with motor responsiveness in hypothyroid, thyrotoxic and euthyroid subjects, employing a simple and readily reproducible technique. Sensory thresholds were elevated and motor responsiveness impaired in hypothyroid subjects as compared to euthyroid controls. In thyrotoxic subjects, motor responsiveness was significantly enhanced, but sensory thresholds did not differ from control values. In a subsequent study the threshold abnormalities of thyroid dysfunction were corrected by rendering the patients euthyroid with appropriate therapy. Warming a further group of untreated hypothyroid patients produced a similar improvement in motor responsiveness to that seen in the L-thyroxine-treated group, thus implying that this parameter is at least, in part, temperature dependent. Sensory thresholds would seem to be reliable reflectors of tissue thyroid status in hypothyroidism, whereas motor responsiveness seems the better guide to thyroid status across the whole spectrum of thyroid function.

Carbimazole↗

PubMedDate not supplied

Thyroid autoimmunity in chronic urticaria.

A subset of patients with idiopathic chronic urticaria (CU) has been recently classified as autoimmune on the basis of two main findings: association with thyroid autoimmunity and with anti-IgE and/or anti-IgE receptor antibodies. The association of CU with thyroid autoimmunity has been known since 1983, but its frequency varies in different reports. The objective of the present study was to verify the prevalence of thyroid antibodies (anti-thyroid peroxidase, TPO; thyroglobulin, TG; TSH-receptor, TSH-R) in two distinct series of CU: of known cause (70 cases, group A) and idiopathic (52 cases, group B). Twenty-three patients (M/F:7/16) of group A (33%) and 12 (M/F:4/8) of group B (23%) tested positive for at least one type of thyroid antibody. The difference was not statistically significant. Thyroid disease or altered serum TSH levels (requiring treatment) were present in 39% of group A and 42% of group B seropositive patients. In conclusion, the present study shows that CU, either of known cause or idiopathic, is more common in females than in males and is significantly associated with thyroid autoimmunity. These results were not expected on the assumption that autoimmune phenomena are a specific pattern of idiopathic CU. Thus, screening for thyroid autoimmunity and function is advisable in all patients with CU for the early identification of patients requiring either treatment of underlying thyroid dysfunction or follow-up.

Adolescent↗

PubMed2005

[Large mediastinal mass of heterotopic thyroid tissue: a case report and review of literature].

Incidental detection of a mediastinal mass in a asymptomatic patient poses a not easy diagnostic problem. For solid masses or cysts, histology or cytology is often necessary. Although substernal extension of a cervical goiter is common, totally intrathoracic primary thyroidal mass is unusual. We describe a rare case of heterotopic accessory mediastinal thyroid in a patient completely asymptomatic both for signs of thyroid dysfunction and mechanical compression. Radiological and hormonal 6 and 12 months follow-up is reported.

Adult↗

PubMedDate not supplied

[Effects of chronic administration of high doses of potassium iodide on iodine metabolism in the rat thyroid gland].

The effect of various doses of KI on iodine methabolism in rat thyroid gland was investigated. Treatment with 1, 3, 10, 100 and 500 physiological daily doses of KI for 14 days had no influence on blood level of thyroid hormones. However, increased administration of KI was accompanied by the increase of iodine in the thyroid gland tissue by 60-121% due to 35-108% and 94-128% increases of protein-bound and free fractions respectively. Chronic treatment with both low and high doses of KI was accompanied by oxidative stress. It is suggested that reactive oxygen species and highly iodinated proteins (particularly thyroglobulin) induced by chronic ingestion of high doses of KI can play the important role in the development of thyroid dysfunctions and autoimmune diseases.

Animals↗

PubMed2006

The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives.

OBJECTIVE: Denmark was an area of iodine deficiency, and mandatory iodine fortification of table salt and salt in bread (13 p.p.m. iodine) was initiated in 2000/2001. The Danish investigation on iodine intake and thyroid disease (DanThyr) is the monitoring of the iodine fortification program. DESIGN AND METHODS: DanThyr consists of three main parts: a study of population cohorts initialized before (n=4649) and after (n=3570) iodization of salt, a prospective identification of incident cases of overt hyper- and hypothyroidism in a population of around 550,000 people since 1997, and compilation of data from the national registers on the use of thyroid medication, thyroid surgery, and radioiodine therapy. Studies were carried-out in parallel in subcohorts living in areas with differences in iodine content of ground water. RESULTS: The study showed profound effects of even small differences in iodine intake level on the prevalence of goiter, nodules, and thyroid dysfunction. Mild and moderate iodine deficiency was associated with a decrease in serum TSH with age. Other environmental factors were also important for goiter development (increase in risk, smoking and pregnancy; decrease in risk, oral contraception and alcohol consumption), and the individual risk depended on the genetic background. Environmental factors had only a minor influence on the prevalence of thyroid autoantibodies in the population. There were more cases of overt hypothyroidism in mild than in moderate iodine deficiency caused by a 53% higher incidence of spontaneous (presumably autoimmune) hypothyroidism. On the other hand, there were 49% more cases of overt hyperthyroidism in the area with moderate iodine deficiency. The cautious iodine fortification program, aiming at an average increase in iodine intake of 50 mug/day has been associated with a 50% increase in incidence of hyperthyroidism in the area with the most severe iodine deficiency. The incidence is expected to decrease in the future, but there may be more cases of Graves' hyperthyroidism in young people. CONCLUSION: A number of environmental factors influence the epidemiology of thyroid disorders, and even relatively small abnormalities and differences in the level of iodine intake of a population have profound effects on the occurrence of thyroid abnormalities. Monitoring and adjustment of iodine intake in the population is an important part of preventive medicine.

Adult↗

PubMed1994

[Effect of low-dose amiodarone on thyroid function].

Thyroid function was examined periodically in a group of 85 patients treated with low-dose amiodarone, and followed for 1-13 years (mean 3.6). Biochemical hypothyroidism (elevated thyroid stimulating hormone (TSH) only) developed in 8 patients and clinical hypothyroidism in 3, while hypothyroidism developed in 5. In the first 11 cases amiodarone was continued but 1-thyroxine was added. In the 5 that became hyperthyroid, amiodarone was stopped and thyroid function became normal within a few months. In the 69 patients without thyroid dysfunction, elevated thyroxine (T4) and free thyroxine index (FTI) were found in 20% and 17%, respectively, and elevated free T4 (FT4) in 28%; all had normal total tri-iodothyronine (TT3) and TSH. In practically all patients, reverse T3 (rT3) rose more than 30% above initial levels. It is concluded that in patients treated with low dose amiodarone: 1) thyroid function should be followed closely; 2) elevated levels of TT4, FTI and FT4 do not necessarily imply hyperthyroidism; 3) hypothyroidism may be biochemical only, without progression to overt hypothyroidism, despite continued treatment; 4) both the hypo- and the hyperthyroidism induced are usually reversible; 5) amiodarone may be continued despite onset of hypothyroidism, provided replacement therapy is given.

Amiodarone↗

PubMed2006

Myxedema coma in a patient with Down's syndrome.

INTRODUCTION: hyroid dysfunction is common in Down's syndrome, most common being hypothyroidism. Longstanding, untreated hypothyroidism can lead to myxedema coma. METHODS: Here we report a patient with Down's syndrome who presented with myxedema coma. DISCUSSION: The three essential elements for the diagnosis of myxedema coma include altered mental status, defective thermoregulation and a precipitating event or illness; all of these were present in our patient. Also, very high TSH, low T3 and T4, and the rapid response to the treatment with levothyroxine confirmed the diagnosis. CONCLUSION: Patients with Down's syndrome should have regular screening for thyroid dysfunction.

Adult↗

PubMed1980

Ultrasound in early thyroid orbitopathy.

Fourteen patients with unilateral exophthalmos were found on A-scan ultrasound examination to have enlarged extraocular muscles. Thyroid dysfunction later was documented in 12 patients (86%) by laboratory tests and subsequent clinical examination. The suspicion of endocrine orbitopathy was based on the presence of enlarged extraocular muscles in both orbits and on the difference in thickness between corresponding muscles. A-scan orbital examination including specific muscle measurements is a simple and apparently reliable method of diagnosing early thyroid orbitopathy.

Adult↗

PubMed2005

[Schilddrüse und polyendokrinopathien].

The thyroid gland can be affected in the course of several polyendocrinopathy syndromes either by impairment of physiological function or thyroid carcinoma. The various syndromes -- polyglandular autoimmune syndrome, autoimmune hypophysitis, multiple pituitary hormone deficiency, multiple endocrine neoplasia, and Carney complex -- are discussed. Therapy of thyroid dysfunction is identical whether it is part of a specific syndrome or not. Genetic testing for mutations, however, has had an enormous impact on screening procedures and therapeutic consequences.

Chromosome Aberrations↗

PubMed1986

An improved approach to thyroid function testing in patients with non-thyroidal illness.

We have compared the results of serum thyrotrophin (TSH) measurements using a sensitive immunoradiometric assay (IRMA) with those of conventional thyroid function tests in 299 hospital inpatients with a range of non-thyroidal illnesses. Levels of total thyroxine (T4), free T4, total tri-iodothyronine (T3) and free T3 in the hypothyroid range were recorded in 8%, 15%, 19% and 49% of patients, respectively, whereas TSH (IRMA) was abnormally low in 1%. Furthermore, basal TSH (IRMA) accurately predicted the result of the thyrotrophin-releasing hormone test in 72 of the 74 patients in whom this test was performed and, unlike thyroid hormone measurement, identified patients with subclinical thyroid disease. It would appear that a single basal TSH (IRMA) measurement is the most appropriate screening test for thyroid dysfunction in patients with concomitant acute or chronic illness.

Adolescent↗

PubMed2004

Thyroid hormone regulates excitability in central neurons from postnatal rats.

A lack of thyroid hormone in the postnatal period causes an irreversible mental retardation, characterized by a slowing of thoughts and movements accompanied by prolonged latencies of several evoked potentials and slowed electroencephalographic rhythms. Here we show that in cultured hippocampal and cortical neurons from postnatal rats treatment with thyroid hormone not only up-regulates Na(+)-current densities but also increases rates of rise, amplitudes and firing frequencies of action potentials. Furthermore, we show that the regulation of the Na(+)-current density by thyroid hormones also occurs in vivo: recordings from acutely isolated cortical neurons obtained from hypothyroid, euthyroid and hyperthyroid postnatal rats showed that hypothyroidism decreases the ratio of Na(+) inward- to K(+) outward-currents while hyperthyroidism upregulates Na(+)-currents with respect to K(+)-currents. Our observation of a regulation of neuronal excitability by thyroid hormone offers a direct explanation for the origin of various neurological symptoms related to thyroid dysfunction.

Action Potentials↗

PubMed2005

Thyroid function and ioduria in infants after cardiac surgery: comparison of patients with primary and delayed sternal closure.

OBJECTIVES: Thyroid hormone alterations after cardiac surgery may be aggravated by the use of iodine antiseptics. We evaluated thyroid function and ioduria in infants with delayed sternal closure (DSC) who are exposed to povidone-iodine for sternal wound protection and compared them with findings in infants after primary sternal closure. DESIGN: Prospective clinical study. SETTING: Pediatric cardiac intensive care unit. PATIENTS: Ninety-three infants after cardiac surgery using cardiopulmonary bypass, 60 of them with primary sternal closure and 33 of them with delayed sternal closure. MEASUREMENTS AND MAIN RESULTS: Thyroid hormones were studied in patients with primary sternal closure immediately after surgery, 5 days and 19 days after surgery, in patients with DSC immediately after surgery, immediately after sternal closure, and 2 wks after sternal closure. Ioduria was evaluated on the first, third, and fifth postoperative days after cardiac surgery with primary sternal closure and immediately after DSC. In both groups of patients, low total triiodothyronine, total thyroxine, thyroxine-binding globulin levels, high reverse triiodothyronine levels, and normal free triiodothyronine, free thyroxine, and thyroid-stimulating hormone levels were recorded immediately after surgery. Concentrations of total triiodothyronine and thyroid-stimulating hormone were lower in the patients with DSC. Five days after primary sternal closure and 2 wks after DSC, all thyroid hormone levels were normal for age. Ioduria after DSC was higher than ioduria after primary sternal closure. CONCLUSIONS: Patients with DSC compared with patients with primary sternal closure display more profound thyroid suppression in the immediate postoperative period. The use of povidone-iodine adhesive drapes with single povidone-iodine mediastinal irrigation in patients with DSC is associated with significant iodine absorption but no significant thyroid dysfunction.

Anti-Infective Agents, Local↗

PubMed1993

Quantitation of thyroid hormone effect on skin perfusion by laser Doppler flowmetry.

Clinical observations have long suggested that skin perfusion (SP), among other factors, depends on thyroid status. However, quantitative data concerning this relationship are rather sparse. This study characterizes SP by means of laser Doppler flowmetry (LDF) in various thyroid dysfunctional states. The data reveal that mean capillary flow velocity, capillary pulse wave amplitude, and capillary flow oscillation amplitude, but not capillary flow oscillation frequency, are increased in hyperthyroid patients and decreased in hypothyroid patients. Regaining the euthyroid state is accompanied by normalization of LDF parameters only in hyperthyroid patients. It is concluded that LDF is useful in monitoring the thyroid effect on SP. However, it may not be used as a biological marker for the thyroid status of a given individual.

Adult↗

PubMed1997

Recombinant thyroid peroxidase-specific Fab converted to immunoglobulin G (IgG) molecules: evidence for thyroid cell damage by IgG1, but not IgG4, autoantibodies.

A recombinant autoantibody Fab (SP1.4) to thyroid peroxidase (TPO), cloned from intrathyroidal B cell immunoglobulin genes, interacts with an epitope on TPO recognized by all patients with autoimmune thyroid disease. To compare the biological properties of IgG1 and IgG4 TPO autoantibodies, we converted Fab SP1.4 to full-length immunoglobulins. The SP1.4 heavy and kappa light chain variable region genes, spliced by overlap PCR to a mammalian signal peptide, were transferred to expression vectors for human IgG1, IgG4, and kappa L chains. Plasmids containing the IgG1 (or IgG4) heavy chain and the kappa L chain were cotransfected into SP2/0 mouse myeloma cells. Cells secreting TPO autoantibodies were cloned, and IgG1-SP and IgG4-SP were affinity purified from medium using protein G. Their subclass specificities were confirmed by enzyme-linked immunosorbent assay and fluorometry after binding to Chinese hamster ovary cells expressing cell surface TPO. Further confirmation of SP1.4 Fab conversion to full-length molecules was the ability of protein A to precipitate IgG1-SP and IgG4-SP complexed to [125I]TPO. IgG1-SP1.4, IgG4-SP1.4, and Fab SP1.4 had similar high affinities for TPO (Kd = approximately 2 x 10(-10) mol/L). Complexes of [125I]TPO and IgG1-SP (but not IgG4-SP) bound to peripheral blood mononuclear cells (PBMC), but not to a B cell line. Flow cytometry demonstrated Fc receptors Fc gamma RI, Fc gamma RII, and Fc gamma RIII on PBMC, but only Fc gamma RII on the B cell line. Together, these data indicate that IgG1-SP/TPO complexes bind to either Fc gamma RI on monocytes or RIII on natural killer cells. In assays for antibody-dependent cytotoxicity using PBMC, 51Cr release was higher for thyroid cells preincubated with IgG1-SP (13.4%) than with IgG4-SP (2.5%) or with culture medium alone (-0.7%). No specific 51Cr release was observed when either fibroblasts or Chinese hamster ovary cells expressing cell surface TPO were used as target cells. In conclusion, a human TPO-specific Fab converted to IgG1, but not IgG-4, can mediate cytotoxic effects on human thyroid cells in vitro. These observations support the clinical relevance of TPO autoantibody subclass distribution and emphasize the likelihood that, as opposed to being simple markers of thyroid damage, TPO autoantibodies may play a role in the induction of thyroid dysfunction in vivo.

Animals↗

PubMed1999

Autoimmune thyroiditis and myelosuppression following treatment with interferon-alpha for hepatitis C.

CASE: We describe the case of a 48-year-old woman from Thailand diagnosed with chronic hepatitis C, who experienced a suppression of all blood cell counts accompanied by a newly developed clinically manifested autoimmune thyroid disorder after treatment with interferon alpha-2b (INF-alpha) 46 days after beginning of therapy a decrease of platelet, red and white blood cell counts became obvious. Concomitantly we observed an increase of FT4 and FT3 with a totally depressed TSH level 80 days after starting INF-alpha administration. Antibody assessment resulted in detection of high numbers of antithyroid-microsomal antibodies and antithyroglobulin antibodies. Thyroid hormone levels normalized under treatment with methimazole/propylthiouracil within 4.5 months. However, two months after cessation of antithyroid therapy increasing TSH levels and decreasing FT4 levels indicated a new tendency towards a hypothyroid state. CONCLUSION: We classify this case as an interferon-alpha-induced disorder of thyroid function accompanied by myelosuppression. A close monitoring for thyroid dysfunction, e.g. evaluation of TSH-levels before and after administration of INF-alpha is mandatory.

Autoimmune Diseases↗

PubMed2000

[Thyroid function in children with diagnosed chronic hepatitis B treated with interferon alpha].

The aim of the study is to estimate thyroid function during interferon alpha therapy in children with chronic hepatitis B. 31 children aged 4-16 years were included in the study. Thyroid function was monitored by estimation of thyroid hormones (FT3, FT4, TSH) and antithyroid antibodies (TPO, ATG) concentration before and after therapy completion. In all children normal thyroid hormones and ATG concentration were found before and after therapy completion. Presence of TPO before IFN treatment in blood serum of 2 girls (6.45%) and in 4 children (12.9%) after IFN therapy were found. Clinical features of thyroid dysfunction were not observed in this group of children during IFN therapy.

Adolescent↗

PubMed1998

Thyroid volume is progressively reduced as a sequela of neck irradiation for childhood Hodgkin's disease.

Thyroid volume reduction was observed, among 25 subjects off-therapy after Hodgkin's disease. The volume reduction was related to dose (p = 0.014) and time from radiotherapy (p = 0.01). The correlation was very specific since all patients with reduced volume had hypothyroidism, but not very sensitive since 25% of subjects with thyroid dysfunction had normal gland volume.

Adolescent↗