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PubMed1990

Screening for thyroid disease.

PURPOSE: To evaluate the usefulness of screening for thyroid dysfunction in various clinical settings. DESIGN: Review and synthesis of the literature. MAIN RESULTS: Screening in the community detects new overt thyrotoxicosis or hypothyroidism in approximately 0.5% of the general population. The yield is best among women over 40 years of age (1%) and is lowest among young men (0%). Case-finding (testing clinic patients who are seeing a physician for unrelated reasons) has a better yield and is less expensive than screening in the community. Patients hospitalized with acute illnesses do not benefit from routine thyroid function testing. However, patients who are admitted to specialized geriatric units because of general disability, failure to thrive, and other indications may benefit. In various studies, from 2% to 5% of patients admitted to geriatric units have treatable thyroid disease. The serum total thyroxine, free thyroxine index, free thyroxine, and sensitive thyrotropin assay are all effective as initial tests for screening. The sensitive thyrotropin assay is less cost-effective than the other choices. RECOMMENDATIONS: Case-finding in some women over 40 years of age can be useful. Patients admitted to specialized geriatric units may also benefit from routine testing. Thyroid function tests are not indicated for community screening programs or for patients hospitalized with acute medical or psychiatric illnesses.

Adult↗
PubMed1989

[Study of thyroid function in patients with paroxysmal supraventricular tachycardia].

Twenty-nine patients with paroxysmal supraventricular tachycardias of different origins and clinical pattern were investigated to detect latent thyroid disorders; hyperthyroidism was diagnosed in 2 of those, and hypothyroidism, in 4. Functional thyroid disorders were more common in patients with mitral prolapse and supraventricular tachycardias due to additional conductive pathways (the Wolff-Parkinson-White syndrome) and paroxysmal nodal reciprocal tachycardia, particularly if they were resistant to antiarrhythmic treatment and/or had aggravated thyroid history. It is suggested that thyroid dysfunction is just a triggering factor of arrhythmia since thyrostatic and replacement therapy eliminate paroxysms of tachycardia, while organic pathology of the heart and its conductive network remains unaffected.

Adolescent↗
PubMed1989

Laboratory based study of undetectable thyroid stimulating hormone.

The clinical importance of an undetectable thyroid stimulating hormone (TSH) concentration (less than 0.2 mU/l) was studied in a consecutive series of 2573 requests for routine thyroid function tests. Two hundred and seventeen (8.4%) patients had an undetectable TSH concentration, and of these 39 (18%) had otherwise normal thyroid hormone concentrations and no history of thyroid disease. In a follow up study 71 patients (34 outpatients and 37 inpatients) with undetectable TSH concentration associated with otherwise normal thyroid hormone concentrations were randomly selected during routine reporting of thyroid function test results. None of these patients had a history of thyroid disease. Sex hormone binding globulin concentrations were increased in five out of 50 of these patients and antithyroid antibodies were detectable in four out of 49, suggesting that in most cases the isolated undetectable TSH concentration was not associated with thyroid dysfunction, particularly hyperthyroidism. Isolated undetectable TSH concentration was observed in both inpatients and outpatients and was not associated with any particular clinical condition. Repeat specimens were received in 54 of the 71 patients and TSH concentration remained persistently undetectable in 35 of these.

Autoantibodies↗
PubMed2005

Musculoskeletal manifestations of endocrine disorders.

PURPOSE OF REVIEW: Much of our education about endocrine disorders focuses on their diagnosis and treatment. Although the musculoskeletal manifestations of endocrine disorders are well documented, they are often overlooked. This review will discuss new developments regarding those rheumatic manifestations. RECENT FINDINGS: Diabetic research is investigating connective tissue alterations in hand syndromes. A recent review elucidated the natural history of diabetic muscle infarction. Research has identified factors that stimulate osteoblast activity in diffuse idiopathic skeletal hyperostosis and bone loss in diabetics. Accumulating evidence documents thyroid disease coexisting with connective tissue disorders. Reports document cases of vasculitis occurring after propylthiouracil treatment. Finally, data clarifies the effects of thyroid dysfunction, hyperparathyroidism, acromegaly and hypercortisolism on bone. SUMMARY: Current research mainly relates to the effects of endocrine disorders on bone. As we advance our understanding of mechanisms that lead to rheumatic disorders in endocrine disease, we will improve our ability to treat them.

Bone Diseases↗
PubMed2002

Insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels of children living in an iodine- and selenium-deficient endemic goiter area.

Serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were investigated in 31 children living in an endemic goiter area and 33 healthy subjects living in an nonendemic area. Serum IGF-I and IGFBP-3 levels of iodine- and selenium-deficient children were found to be lower than those of control subjects (p<0.001). There was a positive correlation between the IGF-I with chronological age and body mass index. There was also positive correlation between the IGF-I and IGFBP-3. No significant difference was found between the goitrous and nongoitrous children. These results suggest that IGF-I and IGFBP-3 levels are affected by thyroid dysfunction as a result of iodine and selenium deficiency. However, IGF-I and IGFBP-3 levels are not associated with goiter.

Child↗
PubMed1990

Thyroid function and treatment in premenstrual syndrome.

In 1986 it was reported that a high percentage of women with premenstrual syndrome (PMS) were found to have thyroid hypofunction (TH), mostly subclinical hypothyroidism, as defined by an augmented response of TSH to TRH, and that all affected women had complete relief of PMS symptoms with L-T4 therapy. We studied baseline thyroid function (T4, T3 uptake, T3, TSH, and TSH response to TRH) in 15 normal women (group 1) and 44 women with PMS and treated 22 of the PMS women with L-T4 (group 2; 1.6 micrograms L-T4/kg dose) and the other half with placebo (group 3) for 2 months in a double blinded protocol. We found no evidence of thyroid dysfunction in group 2 or 3, except for 1 subject with slightly elevated TSH (6.2 microIU/mL) and moderate augmented response to TRH (change in TSH, 65 microIU/mL). During the treatment phase we found a complete relief of symptoms in 6 (27%), a partial relief of symptoms in 6 (27%), and some relief of symptoms in 12 (54%) in group 2. Whereas in group 3, 10 (45%) had complete relief, 5 (23%) had partial relief, and 15 (68%) had some relief of symptoms. These results show that 1) there is no significant thyroid disease in PMS; and 2) L-T4 is no better than placebo in treatment of PMS. We conclude that the high incidence of thyroid hypofunction previously reported in PMS is due to an unusually low TSH level for the limit of the normal range for the TRH stimulation test.

Adult↗
PubMedDate not supplied

Short-term and subchronic repeated exposure studies with 5-ethylidene-2-norbornene vapor in the rat.

5-Ethylidene-2-norbornene (ENB) is an industrial chemical whose physical properties indicate a likelihood for vapor exposure to humans. The potential for target organ or cumulative toxicity was investigated in rats exposed for 6 h per day for 9 days over an 11-day period, or 66 or 67 days over 14 weeks; 4- week recovery animals were added to the 14-week study. Mean analytically measured ENB vapor concentrations (+/-SD) were 52 +/- 1.5, 148 +/- 2.3 and 359 +/- 4.2 ppm for the 9-day study and 4.9 +/- 0.14, 24.8 +/- 1.23 and 149 +/- 4.40 ppm for the subchronic study. There were no mortalities, and clinical signs were limited to periocular swelling and/or encrustation, and urogenital area wetness. Body weight gain was decreased in the 9-day 359 ppm females and in the subchronic 24.8 and 149 ppm males. A minimal macrocytic anemia was present in subchronically exposed males, which resolved during the recovery period. In the 9-day study increased liver weight was associated with minimal centrilobular hepatocytomegaly and cytoplasmic basophilia with no degenerative or serum biochemical liver function changes, suggesting an adaptive response. Only relative liver weights were increased in the subchronic 149 ppm males, and no histopathological findings were observed. Principal target organ effects were to the thyroid gland, which showed an exposure concentration-related, but not exposure time-related, depletion of follicular colloid that resolved during the recovery period, together with light microscopic evidence for a hypertrophic and hyperplastic response in the follicular epithelium that resolved more slowly. The thyroid colloid depletion was a graded effect without a clear no-effect concentration, but was not accompanied by any clinical or clear biochemical evidence for thyroid dysfunction. A no-effect concentration of 4.9 ppm was established for the follicular cytological effects.

Administration, Inhalation↗
PubMed2005

Are detection and treatment of thyroid insufficiency in pregnancy feasible?

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. The workshop was sponsored jointly by The National Center on Birth Defects and Developmental Disabilities of The Centers for Disease Control and Prevention (CDC) and The American Thyroid Association. This paper reports on the individual session that examined the ability to detect and treat thyroid dysfunction during pregnancy. For this session, presented papers included: "Laboratory Reference Values in Pregnancy" and "Criteria for Diagnosis and Treatment of Hypothyroidism in Pregnancy." These presentations were formally discussed by invited respondents and by others in attendance. Salient points from this session about which there was agreement include the following: thyrotropin (TSH) can be used as marker for hypothyroidism in pregnancy, except when there is iodine deficiency usually evidenced by elevated serum thyroglobulin (Tg). We need more longitudinal studies of TSH during pregnancy in iodine-sufficient populations without evidence of autoimmune thyroid disease to develop trimester-specific TSH reference ranges. Current free thyroxine (FT4) estimate methods are sensitive to abnormal binding-protein states such as pregnancy. There is no absolute FT4 value that will define hypothyroxinemia across methods. Total thyroxine (TT4) changes in pregnancy are predictable and not method-specific. TT4 below 100 nmol/L (7.8 microg/dL) is a reasonable indicator of hypothyroxinemia in pregnancy. Women with known hypothyroidism and receiving levothyroxine (LT4) before pregnancy should plan to increase their dosage by 30% to 60% early in pregnancy. Women with autoimmune thyroid disease prior to pregnancy are at increased risk for thyroid insufficiency during pregnancy and postpartum thyroiditis and should be monitored with TSH during pregnancy.

Autoimmune Diseases↗
PubMed1991

Thyroid and ovarian function in infertile women.

The aim of this study was to examine more closely the interaction between thyroid function and pituitary--ovarian axis in infertile women. In 185 infertile women without clinical signs of thyroid dysfunction, TRH-tests (TSH basal and 30 min after 200 micrograms TRH i.v.) were performed in the early follicular phase in addition to routine hormonal checks (gonadotrophins, oestradiol, DHEAS, testosterone, prolactin). The women were classified as euthyroid (n = 74; TSH stim 5-20 mU/l), latent hyperthyroid (n = 31; TSH stim less than 5 mU/l), and preclinical hypothyroid (n = 80; TSH stim greater than 20 mU/l). From frozen serum, the following determinations were performed: TSH IRMA, laevothyroxine (T4), thyroxine binding globulin (TBG), microsomal (Mab) and thyroglobulin (Tab) antibodies. Various correlations between the thyroid parameters and the pituitary--ovarian axis were demonstrated. With increasing TBG concentrations, the interval between menses decreased. Overall and spontaneous pregnancy rates were highest in women with normal (less than 75th perc.) basal and stimulated TSH, high (greater than 75th perc.) T4 and low (less than 25th perc.) Mab. Women with normal Tab or high TBG experienced the highest delivery rate (77 versus 30%), while in women with low Tab or high Mab abortion and tubal pregnancies were most frequent. As only 25 women exhibited elevated Mab (greater than 500 U/ml) or Tab (greater than 200 U/ml) which correlated with elevated TSH and normal T4, the routine determination of thyroid antibodies was not necessary. The TRH-test, however, should be included in infertility work-up.

Female↗
PubMed1977

Effect of hypo- and hyperthyroidism on regional monoamine metabolism in the adult rat brain.

The effects of hypo- and hyperthyroidism were investigated on brain levels and accumulation rates (after pargyline) of 5-hydroxytryptamine (5-HT), norepinephrine (NE) and dopamine (DA) in discrete brain regions of the adult rat. Whereas NE remained unchanged in all brain areas except in the cerebellum, alterations in brain 5-HT and DA suggest that the behavioral abnormalities associated with thyroid dysfunction in adulthood may be related to neurotransmission disturbances. In hypothyroidism, 5-HT content decreased in cerebral hemispheres and mesodiencephalon and DA content decreased in these regions and also in cerebellum and pons-medulla. Concomitantly, accumulation rate of 5-HT was lower in pons-medulla whereas that of DA was increased in cerebral hemispheres and mesodiencephalon. In hyperthyroidism, 5-HT levels increased in cerebral hemispheres alone. Accumulation rate of 5-HT increased in pons-medulla and that of DA increased in mesodiencephalon. These data indicate that the influence of thyroid hormones on monoamines (MAs) in the adult brain varies with the neurotransmitter and the brain area considered.

Animals↗
PubMed1985

Influence of the HLA-DR4 antigen and iodine status on the development of autoimmune postpartum thyroiditis.

HLA-A, -B, and -DR antigens were determined in all 50 women with a serum thyroid microsomal hemagglutination antibody (MsAb) titer equal to or greater than 1:100 in the first trimester of pregnancy in a population of 733 pregnant women. The DR4 antigen was found in 58.0% of the women compared to 33.7% in control subjects, which corresponds to a relative risk of 2.71 (P less than 0.01 by X2 test). The MsAb-positive women were examined regularly during the year after delivery for the development of thyroid dysfunction. The DR4 antigen frequency was found to be even higher, 69.0% (relative risk = 4.36; P less than 0.001), among the 29 women who developed hypothyroidism in the postpartum period. No other HLA antigen deviations were found among those 15 hypothyroid women in whom an initial thyrotoxic phase occurred before hypothyroidism. The B8, DR3 haplotype was found in 3 of 5 women who developed Graves' thyrotoxicosis alone. Urinary iodine excretion measured in some MsAb-positive women 3 (n = 19) or 6 months (n = 29) postpartum, respectively, was compatible with leakage of thyroid iodine during the initial destruction-induced thyrotoxic phase of postpartum thyroiditis, followed by low iodine excretion during the subsequent hypothyroid phase. We conclude that genes coding for the DR4 antigen may have a regulatory influence on MsAb production, which in turn affects the development of postpartum hypothyroidism. Thyroid iodine content and iodine intake also may have an impact on the severity of the thyrotoxic and the hypothyroid phases of autoimmune postpartum thyroiditis.

Adult↗
PubMed1995

Assessment of thyroid functions and its role in body growth in thalassemia major.

The present study was done to establish the role of thyroid gland in causing growth retardation in regularly transfused thalassemic children. Growth, skeletal maturation and thyroid functions were assessed in 25 patients of thalassemia major in the age range of 5-17 years (mean age 10.3 +/ 3.6 years). Thirteen patients were migrants from Pakistan and 12 were of Indian origin. Twenty-five age and sex matched children who were not anemic served as controls. Thalassemic children received multiple blood transfusions ranging from 36-350 units with a mean of 168.4 +/ 98.9 (+/ 1 SD). The mean pretransfusion hemoglobin was 8.7 +/ 1.6 g/dl. Twenty eight per cent patients were below the 5th percentile for height and another 24% between 5th and 10th percentiles. The height age retardation was more pronounced than bone age retardation. The mean serum total T3 and T4 levels were significantly lower (p < 0.001) and the mean serum TSH levels were significantly higher (p < 0.005) in patients with thalassemia major as compared to the controls. Eight patients had high TSH levels; of these 5 had compensated primary subclinical hypothyroidism (elevated TSH with normal T3 and T4) and 3 had uncompensated primary sub-clinical hypothyroidism (elevated TSH, low T4 and normal T3). Two patients had low T4 with normal T3 and TSH levels. Thyroid dysfunction was not related to age, sex, hemoglobin levels and country of origin but transfused iron load (units/kg, units/year) was significantly higher in patients with hypothyroid function compared to those with euthyroid function (p < 0.005). Height age, weight age and bone age retardations were more pronounced in patients with hypothyroid function; however, the difference was not statistically significant. It is concluded that hypothyroidism is unlikely to be the sole cause of growth retardation; however, it may have a potentiating or permissive role. The strong association of high transfused iron load and decreased thyroid function stresses the need for intensive chelation therapy.

Adolescent↗
PubMed2005

Muscle carnitine in hypo- and hyperthyroidism.

Weakness is common in both hyper- and hypothyroidism, and skeletal muscle L-carnitine may play a role in this regard, as suggested by studies indicating abnormal levels of carnitine in serum and urine of patients with thyroid dysfunction. Skeletal muscle samples were obtained for carnitine analysis from control subjects, and from hyperthyroid and hypothyroid patients before and after treatment. There was a significant reduction in carnitine, especially the esterified portion, in hyperthyroid individuals, with a return to normal as euthyroid status was regained. In hypothyroid patients, there was a trend for carnitine to be lower than normal and for improvement once euthyroid status was attained. Our data indicate that muscle carnitine levels are affected by both hypo- and hyperthyroidism. A decrease in muscle carnitine in both conditions may contribute to thyroid myopathy.

Adult↗
PubMed2005

Endocrine late effects from multi-modality treatment of neuroblastoma.

Thyroid dysfunction has been reported after 131I-MIBG-treatment for neuroblastoma. In this study, we have evaluated all endocrine functions from patients who were given multi-modality treatment including 131I-MIBG. Twenty-five neuroblastoma survivors who were off therapy for a median period of 6.0 years (range 1.3-11.1) were evaluated and their median age was 8.1 years (range 2.2-14.7). All patients had received 131I-MIBG, 16 chemotherapy, and 16 surgery. Fourteen patients (56%) had permanently elevated thyrotropin levels and 9 received thyroxine. Two patients had a small thyroid volume while 6 had thyroid nodules or cysts. Two boys showed hypergonadotropic hypogonadism. Growth was retarded in 39% of children. Mean Target Height Standard Deviation Score of patients with thyrotropin elevation was lower than those without (P=0.019). Children treated for neuroblastoma with 131I-MIBG, chemotherapy and surgery were seen to be at risk from developing irreversible thyroid function loss, thyroid nodules, hypergonadotropic hypogonadism, and growth retardation. We recommend that during follow-up of neuroblastoma children, special attention should be paid to their endocrine state.

3-Iodobenzylguanidine↗
PubMed1994

Association between dietary iodine intake and prevalence of subclinical hypothyroidism in the coastal regions of Japan.

The prevalence of thyroid dysfunction in relation to iodine intake was studied in adults (n = 1061) in five coastal areas of Japan that produce iodine-rich seaweed (kelp). The prevalence of hyperthyroidism (TSH < 0.15 mU/L) was similar in these areas, whereas that of hypothyroidism (TSH > 5.0 mU/L) varied from 0-9.7%. The relative frequency of above normal iodide concentration in the morning urine (> or = 75 mumol/L) [high urinary iodide (UI)] varied from 3.7%-30.3%. Together with previously reported results of a noncoastal city, the frequency of high UI correlated significantly with that of hypothyroidism with negative thyroid autoantibody (r = 0.829, n = 6, P < 0.05) but not with positive thyroid autoantibody (r = 0.278, NS) or with that of hyperthyroidism (r = 0.038, NS). Hypothyroidism was more prevalent in thyroid autoantibody-negative subjects with high UI (group II, 12.1%) than with normal UI (group I, 2.3%) (P < 0.001). The TSH [21.9(6.5-73.7)mU/L] (mean +/- SD) and thyroglobulin [288 (182-456) micrograms/L] levels in group II were significantly higher than the respective levels in group I [9.6(3.7-25.3)mU/L and 123 (38-399) micrograms/L] (P < 0.05). Free T4 of group II (9.9 +/- 3.9 pmol/L) was significantly lower than in group I (14.2 +/- 3.9 pmol/L) (P < 0.05). These results indicate that 1) the prevalence of hypothyroidism in iodine sufficient areas may be associated with the amount of iodine ingested; 2) hypothyroidism is more prevalent and marked in subjects consuming further excessive amounts of iodine; and 3) excessive intake of iodine should be considered an etiology of hypothyroidism in addition to chronic thyroiditis in these areas.

Adult↗
PubMed1994

Thyroid function in children after allogeneic bone marrow transplantation.

Thyroid function was investigated in 35 children after allogeneic BMT. The study was longitudinal and all patients were followed for at least 5 years. Once a year TSH, T4, T3 and the TRH test were performed. Patients with severe aplastic anemia (n = 6) were transplanted without total body irradiation (TBI) and they had no detectable alterations in thyroid function. Patients with leukemia (n = 27) were conditioned with 10 Gy TBI in one fraction. The accumulated frequencies of thyroid dysfunction were 3 of 27 (11%) with high TSH and low T3 or T4 levels, and 10 of 27 (37%) with high basal TSH and normal T3 and T4 levels. An additional 11 of 27 (41%) had an exaggerated TSH response in the TRH test and normal basal TSH and T3/T4 levels. Only 3 of 27 (11%) continued to have normal values. Treatment with levo-thyroxine (L-T4) was given to the patients with a high basal TSH level. As 24 of 27 (89%) children had signs of disturbance in the thyroid axis, prophylactic L-T4 treatment for a few years after BMT with TBI may be of value. The main cause of a change in thyroid function after BMT seems to be conditioning with TBI.

Adolescent↗
PubMed2006

Hormonal disturbances associated with obesity in dogs.

Obesity is associated with multiple endocrine alterations and changes in the concentration of circulating hormones. However, few studies have explored such alterations in dogs with naturally acquired excess weight. In the present study, we investigated the effect of naturally acquired obesity on cortisol, insulin-like growth factor (IGF)-1 and prolactin secretion in dogs. Thirty-one overweight dogs were enrolled in the trial. Blood samples were collected before and after adrenocorticotrophic hormone (ACTH) injection. Free thyroxine (fT4), cortisol, thyroid-stimulating hormone (TSH), IGF-1, prolactin and fructosamine were assayed. Body weight excess increased significantly with age and neutered dogs were more obese than entire ones. The ACTH stimulation test was within the normal range for 26 of 31 dogs. Prolactinaemia was increased in seven dogs and IGF-1 in six dogs. Twenty dogs had a fructosamine concentration >340 microm. Interestingly, 18 of 31 dogs showed disturbances of thyroid function based on high TSH and/or low fT4 baseline concentration, with 11 dogs showing both. According to these parameters only six of 31 dogs were free of hormonal disturbances. These results revealed the high incidence of such disturbances, especially thyroid dysfunction, in obese, but otherwise apparently healthy dogs. They demonstrate the importance of examining endocrine function during the initial evaluation of obese dogs to avoid failure of any nutritional treatment.

Adrenocorticotropic Hormone↗
PubMed1981

Increased prevalence of antithyroid antibodies and thyroid diseases in pustulosis palmoplantaris.

A statistically significant increased prevalence of antithyroid antibodies was found by an indirect immunofluorescence technique in 37 patients with pustulosis palmoplantaris, as compared with an approximatley age- and sex-matched group of healthy controls. A history of thyroid disease was also more frequent in patients with PPP than in the population at large. The increased risk of thyroid dysfunction should be kept in mind in the long-term care of PPP cases. The prevalence of non-cutaneous autoantibodies was not increased in psoriatic subjects. The results accord with the concept that PPP and psoriasis may be separate entities.

Adult↗