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PubMed1990

[Thyroid diseases in the elderly].

Thyroid dysfunction in the elderly differs from that in the young, because most symptoms at presentation are absent, or non specific or atypical. Hypothyroid patients generally present with cardiovascular or central nervous system symptoms. A serious complication, occurring more easily in elderly is hypothyroid coma. The diagnosis of hypothyroidism is confirmed by a high serum TSH and low values of FT4 and T4. Elderly patients should be started on low doses of thyroid-hormone replacement that are increased slowly. Particular caution must be used in patients with underlying cardiovascular disease. Hyperthyroid patients are more likely to show cardiovascular symptoms, central nervous system symptoms or gastrointestinal symptoms. The diagnosis is confirmed by a low serum TSH value and elevated values for the serum FT4 and/or T3. Radioiodine (131I) therapy is the most efficient treatment in this age group. A diffusely enlarged thyroid gland in the elderly is most often caused by a multinodular goiter. Solitary thyroid nodules which appear cold on isotope scan may represent a carcinoma. The diagnosis of malignancy can be made after fine needle-aspiration of the nodule.

Aged↗
PubMed1985

Amiodarone-induced hypothyroidism. A common complication of prolonged therapy: a report of eight cases.

Amiodarone is a widely used antiarrhythmic drug, which contains 75 mg of iodide per 200 mg of active substance. Eight of our patients receiving long-term amiodarone therapy became hypothyroid. Seven of these patients had no previous history of thyroid dysfunction or goiter. Antithyroid antibodies were absent, and standard perchlorate discharge tests were positive in seven patients when hypothyroidism was diagnosed. In one patient, amiodarone therapy was withdrawn; over the next nine months, the hypothyroidism resolved, and results of the perchlorate discharge test reverted to normal. We conclude that amiodarone-induced hypothyroidism is similar to previously described iodide-induced hypothyroidism. It may develop in the absence of a previous history of thyroid disease, and all patients receiving long-term amiodarone therapy should therefore be regularly monitored for hypothyroidism.

Aged↗
PubMed2002

Postpartum thyroiditis.

Post partum thyroiditis occurs in 50% of TPO AB+ve women and is characterised by transient hyperthyroidism followed by transient hypothyroidism during the first six months, post partum. A third of the latter group develop permanent hypothyroidism. The syndrome is seen in 5-9% of women and post partum thyroid dysfunction (PPTD) reoccurs in 75% of women in a subsequent pregnancy. An increase in depressive symptomatology is seen in women with PPTD as well as in ante TPO Ab+ve women without PPTD. The immunology of PPT is associated with the presence of TPO antiboides with those IgG subclasses best able to activate the complement cascade. The HLA-DR frequencies seen in PPT suggest that PPT may be related to Hashimoto's thyroiditis. TPO Ab driven complement fixation is seen in PPT and complement activation relates to the extent and progression of thyroid damage. Recent studies have shown an increase in both Th2 and Th1 cytokine release from lymphocytes in ante partum women destined to develop PPTD. More data are required on the cellular immune changes both ante partum and post partum in PPT.

Antibody Affinity↗
PubMed1988

Growth studies in infants and children with Down's syndrome and elevated levels of thyrotropin.

A retrospective survey of 147 patients with Down's syndrome (age range, 4 months to 27 years) showed that 60% had a thyrotropin (TSH) level higher than 5.7 mU/L in the presence of high or normal thyroxine levels. The remaining 40% of the group had low to normal TSH values. High TSH levels were predominant in patients under 4 years of age (94 children), ie, during the phase of active growth, and showed a declining trend with increasing age. All 94 infants had delayed growth of all parameters including head circumference, height, and weight, as compared with normal infants, and growth was particularly retarded in patients with TSH levels greater than 5.7 mU/L. Thyroid dysfunction, expressed as a high TSH concentration, is associated with growth retardation in children with Down's syndrome who are younger than 4 years.

Adolescent↗
PubMed1988

Hypothyroidism and the influence on human blood rheology.

Viscoelastic properties of human whole blood were measured in 338 subjects: 110 persons (75 F, 35 M) following total thyroidectomy but without substitution therapy over three weeks as well as 228 healthy control subjects (124 F, 104 M) were investigated in this study. Subjects with other variable factors were excluded. The viscous and the elastic portion of apparent whole blood viscosity -the latter subdivided into red cell aggregation and red cell rigidity were determined by using a newly developed oscillating capillary rheometer and densitymeter at the real hematocrit value and at a computed hematocrit of 40%. Serum viscosity, hematocrit (Hct), hemoglobin (Hb), mean corpuscular volume of red blood cells (MCV), free triiodothyronine (fT3), free thyroxine (fT4) and serum-thyrotropin (bTSH) were evaluated as well. In a further subgroup of 80 subjects (40 patients with hypothyroidism, 40 healthy control persons) additional plasma viscosity and sedimentation rate were determined. Red cell aggregation and blood viscosity especially at shear-rates below 10/sec increased significantly in hypothyroid patients. There was no significant difference of red cell rigidity, serum viscosity, plasma viscosity and sedimentation rate as against euthyroids. So new aspects of thyroid dysfunction could be described probably with consequences for therapy and for considerations about the development of atherosclerosis and ischemic disorders.

Adult↗
PubMed1991

Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom.

Increasing use of assays for TSH with improved sensitivity as a first-line test of thyroid function has raised questions regarding prevalence and clinical significance of abnormal results, especially values below normal. We have assessed the thyroid status of 1210 patients aged over 60 registered with a single general practice by measurement of serum TSH using a sensitive assay. High TSH values were more common in females (11.6%) than males (2.9%). TSH values below normal were present in 6.3% of females and 5.5% of males, with values below the limit of detection of the assay present in 1.5% of females and 1.4% of males. Anti-thyroid antibodies were found in 60% of those with high TSH but only 5.6% of those with subnormal TSH. Eighteen patients were hypothyroid (high TSH, low free thyroxine) and one thyrotoxic (low TSH, raised free thyroxine) at initial testing. Seventy-three patients with elevated TSH but normal free T4 were followed for 12 months; 13 (17.8%) developed low free T4 levels and commenced thyroxine, TSH returned to normal in four (5.5%) and 56 (76.7%) continued to have high TSH values. Sixty-six patients with TSH results below normal were followed. Of the 50 subjects with low but detectable TSH at initial testing, 38 (76%) returned to normal at 12 months; of those 16 with undetectable TSH followed, 14 (87.5%) remained low at 12 months. Only one subject (who had an undetectable TSH) developed thyrotoxicosis. In view of the marked prevalence of thyroid dysfunction in the elderly, we suggest that screening of all patients over 60 should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Transcutaneous iodine absorption in adult patients with thyroid cancer disinfected with povidone-iodine at operation.

Povidone-iodine is used as disinfection in patients undergoing many kinds of operations. Several cases of thyroid dysfunction induced by transcutaneous absorption of povidone-iodine have been reported in small infants. However, transcutaneous absorption was not clearly reported in adults. The aim of this study was to assess transcutaneous absorption of iodine in patients who received single topical application with povidoneiodine and serial changes of urinary iodine excretion under the condition with a simple iodine-restricted diet in Japan, an iodine-sufficient area. Sixty-eight patients with thyroid carcinoma undergoing total thyroidectomy received single skin disinfection with either povidone-iodine (group A; n = 47) or chlohexidine gluconate, a noniodine containing biguanide (group B; n = 21). In group A, urinary iodine excretion on the first day after operation increased up to 7 times that of the preoperative value. The amounts of urinary iodine correlated positively with operating time. Increased urinary iodine, however, returned to preoperative values on the third or fifth day after operation. In group B, there was no increase in urinary iodine excretion and urinary iodine excretion was ranged from 54 to 193 microg/g of creatinine on the third day of operation. In conclusion, a large amount of povidone-iodine was absorbed through healthy skin even in adults. This may possibly interfere with scintigraphy or radioactive iodine treatment, or cause thyroid disinfection in susceptible patients.

Administration, Cutaneous↗
PubMed1999

Aspects of fetal thyroid dose following iodine-131 administration during early stages of pregnancy in patients suffering from benign thyroid disorders.

Detrimental effects on the thyroid of the developing fetus as a result of iodine-131 treatment for thyrotoxicosis of the mother in the first trimester of pregnancy are discussed. Dose estimations under typical clinical circumstances yield a fetal thyroid dose of 100- 450 Sv. This dose may increase considerably if the blood concentration of (131)I in the mother remains high. Under such circumstances there may be fetal thyroid dysfunction, which can lead to severe abnormalities.

Abnormalities, Radiation-Induced↗
PubMed1992

Use of amiodarone during pregnancy.

UNLABELLED: Five cases are studied in which amiodarone (AM) was given during pregnancy, in two of them also during the breast feeding period, to estimate the risks for adverse effects. We measured the concentrations of AM and its major metabolite desethylamiodarone (DEA) in maternal plasma, cord plasma, infant plasma, placental tissue and breast milk and the thyroid hormones were measured in maternal and neonatal serum. Also, the neonates were examined for AM-associated adverse effects over a period varying from 8 months up to 5 years. We observed a limited maternal-fetal transfer of AM and DEA, while the concentration of DEA in placental tissue is relatively high. Considerable amounts of AM and DEA were present in breast milk. One infant appeared to be hypothyroid, detected by the neonatal thyroid screening. He was treated with triiodothyronine for weeks, until it was clear that the thyroid dysfunction was resolved. The other infants had normal screening results. No effect of the AM medication was observed on growth, liver function or cornea and skin. IN CONCLUSION: although pregnancy and lactation are no absolute contraindications for use of AM, special precautions are necessary. It is unavoidable that in some cases the pregnant mother, and especially her infant, becomes hypothyroid. AM has to be administered in the lowest possible dose, and the maternal and neonatal thyroid function must be controlled as long as the exposure to AM lasts.

Amiodarone↗
PubMed2005

Methods and criteria used in evidence-based decisions in public health.

A workshop entitled, "The Impact of Maternal Thyroid Diseases on the Developing Fetus: Implications for Diagnosis, Treatment, and Screening," was held in Atlanta, Georgia, January 12-13, 2004. This paper reports on the session that examined methods and criteria used for decisions in public health. For this session the following papers were presented: "Methods to Evaluate Scientific Evidence," "Criteria for Screening," and "Public Health Considerations." Development of evidence-based guidelines, strengthened by rigorous systematic reviews, will improve the quality, efficiency, and cost effectiveness of management of thyroid dysfunction among reproductive-age women. Maternal and fetal benefits that have been hypothesized to result from screening pregnant and pre-pregnant women for hypothyroidism include reduced incidences of peripartum maternal complications and fetal loss and optimization of fetal and neonatal neuropsychological development. Screening should be considered as the initial step in a comprehensive program that includes appropriate diagnostic and therapeutic interventions. The actual benefits and potential risks (i.e., iatrogenic thyrotoxicosis) of implementing a thyroid function screening program have not been demonstrated in a prospective randomized clinical trial or prospective cohort study. Consequently, it is difficult to develop consensus and secure resources for a comprehensive thyroid function screening and therapeutic intervention program in women who are or anticipate becoming pregnant. Marshalling support for performance of both a clinical trial and high-quality observational studies should be a high priority.

Decision Trees↗
PubMedDate not supplied

Thyroid autoimmunity and hypothyroidism before and during pregnancy.

In the present review, an attempt was made to describe current knowledge and concepts concerning the complex relationships that link thyroid autoimmunity (TAI) and hypothyroidism with female and male infertility, as well as abnormalities occurring during pregnancy, such as pregnancy loss and maternal and fetal repercussions associated with hypothyroidism. In the case of infertility, although the clinical relevance of TAI is somewhat controversial, when all available information is considered the results strongly suggest that when infertility is due to well-defined female causes, autoimmunity is involved and TAI constitutes a useful marker of the underlying immune abnormality, independently of thyroid function disorders. In the case of pregnancy loss, the vast majority of available studies clearly establish that TAI (even with no overt thyroid dysfunction) is associated with a significant increase in miscarriage risk. To find an association, however, does not imply a causal relationship, and the aetiology of increased pregnancy loss associated with TAI remains presently not completely understood. With regard to maternal repercussions during gestation, the main risk associated with TAI is the occurrence of hypothyroidism and obstetric complications (premature birth, pre-eclampsia, etc.). Thus, systematic screening of TAI and hypothyroidism during early pregnancy, monitoring of thyroid function with/without L-thyroxine treatment and follow-up during post-partum have proved helpful and important in order to manage these patients adequately. Finally, with regard to potential repercussions affecting the offspring, recent evidence suggests that thyroid maternal underfunction, even when considered mild (or subclinical), may be associated with an impairment of fetal brain development. When present only during the first half of gestation, maternal hypothyroxinaemia is a risk factor for impaired fetal brain development, due to insufficient transfer of maternal thyroid hormones to the feto-placental unit. When hypothyroidism is not restricted to the first trimester and worsens as gestation progresses (as in untreated hypothyroidism), the fetus may also be deprived of adequate amounts of thyroid hormones during later neurological maturation and development, leading to poorer school performance and lower IQ.

Abortion, Spontaneous↗
PubMed1990

In vivo regulation of hepatic insulin-like growth factor-1 messenger ribonucleic acids with thyroid hormone.

Insulin-like growth factor-1 (IGF-1) is synthesized primarily by the liver in response to growth hormone (GH). Thyroid hormone plays a major role in mediating pituitary GH secretion. In order to clarify the effect of thyroid hormone on IGF-1 gene expression, we measured hepatic IGF-1 mRNA levels in rats with thyroid dysfunction. Female Wistar rats were rendered hypothyroid by surgical thyroidectomy or hyperthyroid by daily injections of thyroxine (12 micrograms/day) for 2 weeks. Northern gel analysis of hepatic poly (A) RNA revealed the multiple sizes of the RNA transcripts ranging from 1.6 to 9.0 kb. After 4 weeks, hepatic IGF-1 mRNA levels were suppressed in hypothyroid rats, to less than 20% of control euthyroid animals. These suppressed mRNA levels were restored to euthyroid levels by thyroid hormone replacement for 2 weeks. Hyperthyroid rats, however, did not contain altered levels of hepatic IGF-1 mRNA as compared to euthyroid rats. The gamma-actin mRNA hybridization signal was not altered in hypothyroid or hyperthyroid rats. These results suggest that thyroid hormone regulates the in vivo expression of hepatic IGF-1 mRNA, probably through the mechanism of GH regulation.

Animals↗
PubMed1991

Endemic goitre in Guinea-Bissau.

A survey was performed of endemic goitre in the Oio, Gabu, and Cacheu regions of Guinea-Bissau. Among adult women, the following prevalences of goitre were observed: 53% (Oio), 48% (Gabu), and 27% (Cacheu). For goitres of grades 2 and 3 only, the prevalences were 20% (Oio), 13% (Gabu), and 2% (Cacheu). No cretinism or cases of thyroid dysfunction were found. The mean urinary iodine excretions in Oio, Gabu, and Cacheu were 17 micrograms/g, 24 micrograms/g and 33 micrograms/g creatinine, respectively.

Adult↗
PubMed1980

Incidence of malignant thyroid tumors in humans after exposure to diagnostic doses of iodine-131. I. Retrospective cohort study.

Between 1952 and 1965, 10,133 patients received an average of 60 mu Cl of 131I for diagnostic examinations of the thyroid gland. The examinations were mainly done on adults, and only 5% of the patients were younger than 20 years at the time of examination. Of the patients, 9 appeared in the Swedish Cancer Registry between 1958 and 1977 with a diagnosis of malignant tumor of the thyroid gland more than 5 years after the administration of 131I. Inasmuch as the expected number of malignant thyroid tumors computed from Swedish cancer incidence figures was 8.3, there was no elevation of the incidence of malignant thyroid tumors in these patients receiving diagnostic doses of 131I. The patients were examined because of a suspected thyroid dysfunction and therefore represented a selected group. The investigation is being continued to analyze further parameters that could have a bearing on these results.

Adult↗
PubMed1998

Effect of thyroid hormones on Lp(a) and lipid metabolism.

The effect of thyroid hormones on lipoprotein(a) plasma concentrations and the other parameters of lipoprotein metabolism was studied in 158 patients with thyroid dysfunction and in 37 euthyroid controls (cross-sectional study). Multiple regression analysis revealed that 65.5% of the variability in lipoprotein(a) levels were predicted by changes in lipoprotein(a) phenotypes (60.5%), thyrotropin (3.5%), and age (0.8%). The lipid parameters, however, showed no significant effect on lipoprotein(a). A subgroup analysis on samples from patients with large lipoprotein(a) isoforms showed that 28% of the variability in lipoprotein(a) concentrations could be explained by changes in thyroid function (19.1%), age (6.5%) and triglycerides (3.5%). Much stronger correlations were found between thyrotropin and total cholesterol, low density lipoprotein cholesterol or apolipoprotein B respectively (R2=0.951 for low density lipoprotein cholesterol, R2=0.801 for apolipoprotein B). Our data suggest that thyroid hormone is a significant modulator of lipoprotein(a) metabolism. However, different mechanisms are responsible for the change in lipoprotein(a) levels and for the decrease in total- and low density lipoprotein cholesterol levels.

Adult↗
PubMed2003

Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study.

Subacute thyroiditis (SAT), or granulomatous thyroiditis, is an inflammatory thyroid condition associated with pain and systemic symptoms. Few community studies are available. We studied the 160 patients with SAT in Olmsted County, Minnesota, seen between January 1, 1960, and December 30, 1997. Subjects were identified through the medical diagnostic index of the Rochester Epidemiology Project. The overall age- and sex-adjusted incidence from 1960 through 1997 was 4.9 cases per 100,000/yr. In the most recent 28-yr period (1970-1997), 94 patients were identified. In this group, pain was the presenting symptom in 96%. SAT recurred in 4% of the patients 6-21 yr after the initial episode. Corticosteroid therapy was given to 36%. Early-onset hypothyroidism occurred both in patients receiving corticosteroid therapy (29%) and in those not receiving corticosteroid therapy (37%). At latest follow-up, significantly more patients who had received corticosteroid therapy had a diagnosis of hypothyroidism than the group without corticosteroid therapy (25% vs. 10%, P < 0.05; overall rate of hypothyroidism, 15%). Early transient hypothyroidism is common in SAT. Permanent hypothyroidism is less common, and only 15% of the patients are receiving T(4) therapy after 28 yr of follow-up. Symptomatic relief is achieved with corticosteroid therapy, but such therapy does not prevent early- and late-onset thyroid dysfunction.

Adolescent↗
PubMed2005

N-Terminal-proBNP (NT-proBNP) as an indicator of cardiac dysfunction. A study in patients presenting with suspected cardiac disorders.

BACKGROUND: Natriuretic peptides represent a novel diagnostic tool in the assessment of cardiac dysfunction. METHODS: A total of 473 consecutive referred patients presenting to 18 cardiologists for the assessment of their cardiac state were recruited for the study. Patients received a medical history, a physical examination an electrocardiogram and an echocardiogram where left ventricular ejection fraction was recorded. RESULTS: NT-proBNP was found to correlate with left ventricular ejection fraction (LVEF), level of symptoms (NYHA classification), history of angina pectoris (AP) and myocardial infarction (AMI). Atrial fibrillation (AF) and thyroid dysfunction as well as renal impairment were shown to influence NT-proBNP levels. CONCLUSION: The study supports the hypothesis that NT-proBNP determination contributes to the assessment of patients presenting to cardiologists.

Adult↗