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At least 19 recordsLinked to original sources
PubMed1992

Acute thyroid dysfunction (thyroiditis) after therapy with interleukin-2.

Interleukin-2 (IL-2) is frequently incorporated in antineoplastic therapy: While the effect of interferon on the thyroid has been extensively studied the impact of other cytokines on thyroid function is less well understood. We monitored the thyroid function in six patients who received IL-2 in combination with tumor necrosis factor-alpha (TNF) or alpha-Interferon (alpha IFN). Hyperthyroxinemia with suppressed TSH developed within the first four weeks of IL-2 administration; during this phase, there was no technetium or iodine uptake by the thyroid gland. During the following few weeks, serum thyroxine decreased and serum TSH rose, consistent with the development of primary hypothyroidism; during this phase, thyroidal isotope incorporation was normal. All hypothyroid patients received thyroxine replacement therapy upon documentation of hypothyroidism; in several cases thyroxine was successfully discontinued after 2-3 months. None of the patients had detectable antithyroidal antibodies and none experienced thyroid-related pain, although two patients developed thyroid enlargement. We conclude that IL-2 administration is associated with the development of transient, subacute, painless thyroiditis. The frequency and severity of this complication requires further elucidation through systematic, prospective study.

Adult↗
PubMed1989

[Thyroid dysfunction and thyroid antibodies in a population group over the age of 70. A prevalence study from Oslo and Naeröy].

The prevalence of thyroid dysfunction and thyroid antibodies was investigated in a small rural community (Naerøy) and in Oslo. Attendance rates in Naerøy and Oslo were 99 and 71%, respectively. The prevalence of undiagnosed latent hypothyroidism and primary hypothyroidism was 4.0 and 5.3% in women in Oslo and Naerøy respectively and 0 and 3.5% in men. Undiagnosed hyperthyroidism was detected in 1.2% of men in Naerøy and in 1% of women in Oslo. Antibody to the thyroid microsomal antigen in titre greater than or equal to 400 was detected in 10.2 and 17.5% of women and 7.3 and 7.2% of men in Oslo and Naerøy, respectively. Among women with antibody to the thyroid microsomal antigen in both Oslo and Naerøy, and among men in Naerøy, the prevalence of past or present thyroid dysfunction was increased.

Age Factors↗
PubMed1992

Association between postpartum thyroid dysfunction and thyroid antibodies and depression.

OBJECTIVE: To define the relation between mood and autoimmune thyroid dysfunction during the eight months after delivery. DESIGN: Double blind comparison of the psychiatric status of women positive and negative for thyroid antibodies. Clinical examination and blood sampling for free triiodothyronine and thyroxine, thyroid stimulating hormone, and thyroid antibody concentrations at four weekly intervals. Psychiatric assessment at six, eight, 12, 20, and 28 weeks post partum. SETTING: Outpatient department of district hospital. PATIENTS: 145 antibody positive women and 229 antibody negative women delivering between August 1987 and December 1989. MAIN OUTCOME MEASURES: Thyroid status. Number of cases of mental ill health by the general health questionnaire, research diagnostic criteria, Hamilton 17 item depression scale, hospital anxiety and depression scale, and Edinburgh postnatal depression scale. RESULTS: Six weeks after delivery the general health questionnaire showed 62 (43%) antibody positive women and 65 (28%) antibody negative women had mental ill health (chi 2 = 8.18, p less than 0.005). Follow up of 110 antibody positive and 132 antibody negative women showed significantly greater depression by research diagnostic criteria in antibody positive women (47%) than antibody negative women (32%) regardless of thyroid dysfunction. Antibody positive women showed higher mean scores for depression on the Hamilton (6.01 v 3.89, p = 0.0002), Edinburgh (7.45 v 5.92, p = 0.031), and hospital depression scales (4.95 v 3.79, p = 0.003). CONCLUSION: Depressive symptoms are associated with positive thyroid antibody status in the postpartum period.

Autoantibodies↗
PubMed1992

Post-miscarriage thyroid dysfunction.

BACKGROUND: Thyroid dysfunction is a common postpartum event affecting as many as 16.7% of women. The purpose of this paper was to report the first known case of post-miscarriage thyroid dysfunction. CASE: A 32-year-old woman with a 9-year history of infertility underwent in vitro fertilization. After two spontaneous miscarriages, she delivered a full-term healthy child. Spontaneous menses did not return following delivery, and hormonal evaluation revealed severe postpartum thyroid disease associated with hyperprolactinemia. Retrospective analysis of frozen sera revealed thyroid dysfunction and hyperprolactinemia after the first miscarriage, even though the gestation lasted only 47 days. CONCLUSION: The present case of thyroid dysfunction following a first-trimester miscarriage raises issues concerning the immunology of pregnancy and thyroid dysfunction after pregnancy. The incidence of post-miscarriage thyroid dysfunction and severe postpartum thyroid disease resulting in amenorrhea requires further study.

Abortion, Spontaneous↗
PubMed1992

Postpartum thyroid dysfunction.

Postpartum thyroid dysfunction (PPTD) refers to the syndromes of transient hyperthyroidism, transient hypothyroidism, or both, occurring sequentially in the first 12 months postpartum. Approximately 5 to 9% of women develop the disorder in this period. PPTD is most often subclinical but some women will experience symptoms such as lack of energy and depression in the hypothyroid phase. The thyroid gland, which normally enlarges during pregnancy, will remain enlarged or enlarge further in the postpartum period in a significant number of affected women, instead of returning to the prepregnancy size as in unaffected women. The gland is painless and histologically demonstrates lymphocytic infiltration. PPTD is strongly associated with the presence of antimicrosomal and/or antithyroglobulin antibodies, which occur in up to 76% of cases. Antibody activity tends to increase in the postpartum period and to peak at the time of onset of the disorder. TSH receptor antibodies are not seen and the gland has low radioiodine uptake, distinguishing PPTD from Graves' disease. The HLA associations are controversial, as is the role of dietary iodine. The etiology of PPTD is almost certainly immunological, reflecting the phenomenon of rebound from the relative immune tolerance of pregnancy. Detection of the disorder is important in order to reassure or treat those who are symptomatic and because PPTD may recur in subsequent pregnancies. In addition, up to one third of affected women will go on to develop permanent hypothyroidism 2 to 4 years later. The role of screening for PPTD remains to be clarified.

Autoantibodies↗
PubMed1988

Thyroid dysfunction.

This article reviews currently available thyroid function tests and considers the utility of these tests in the investigation of suspected thyroid dysfunction. Potential thyroid screening tests as well as those secondary tests useful in establishing or excluding thyroid dysfunction are evaluated. Current controversies regarding free thyroid hormone and sensitive TSH assays are considered, and algorithms are provided for diagnosing both hypothyroidism and thyrotoxicosis.

Humans↗
PubMed1986

[Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction].

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia. The diagnostic performance of an ultrasensitive method of measuring TSH (TSH-U), capable of distinguishing hyper and euthyroidism were compared with standard thyroid function tests and TSH stimulation with TRH in 50 patients treated with amiodarone. Only 6 of the 14 patients with hyperthyroxinaemia had TSH-U values in the hyperthyroid range: only one of these patients had an increased triiodothyronine. In 2 cases the THS-U was low but the T4L was normal. In 4 patients, increased TSH-U allowed diagnosis of latent or patent hypothyroidism. There was a close correlation between results of the TRH stimulation test and those of the TSH-U in all cases. This test may therefore be used as an initial screening test for thyroid dysfunction in patients on amiodarone and is simple, reliable and relatively cheap to perform. It makes it unnecessary to measure all thyroid hormonal parameters and the TRH test simultaneously.

Amiodarone↗
PubMed1988

Postpartum thyroid dysfunction in Mid Glamorgan.

A high prevalence of postpartum thyroid dysfunction has been reported in several countries, but there have been no systematic studies of its prevalence in Britain. Among a group of 901 consecutive, unselected pregnant women thyroid autoantibodies were detected in 117 (13%) at booking. The clinical course of postpartum thyroid dysfunction, factors associated with its development, and its likely prevalence were defined in 100 of these women with thyroid antibodies and 120 women with no such antibodies who were matched for age. None of the women had a history of autoimmune thyroid disease. Normal reference ranges for thyroid function during pregnancy and post partum were established in the 120 women negative for thyroid antibodies. On the basis of these observations postpartum thyroid dysfunction was observed in 49 (22%) of the 220 women studied, and the prevalence in the total group of 901 women was estimated to be 16.7%. Thyroid dysfunction, mainly occurring in the first six months post partum, was usually transient and included both destruction induced hyperthyroidism and hypothyroidism. The development of the syndrome was significantly related to smoking more than 20 cigarettes a day and the presence of thyroid microsomal autoantibodies at booking. Of the 16 women with a family history of thyroid disease in whom thyroid microsomal autoantibody activity was detectable at booking, 11 developed thyroid dysfunction. Age, parity, presence of goitre at presentation, duration of breast feeding, and the sex and birth weight of the infant were not associated with the development of postpartum thyroid dysfunction. The mood changes experienced by women post partum may in part be associated with altered thyroid function during this time.

Adult↗
PubMed1990

Postpartum thyroid dysfunction in Bangkok: a geographical variation in the prevalence.

To determine the prevalence of thyroid dysfunction in Thai postpartum women, we evaluated thyroid function and thyroid autoantibodies in 812 consecutive unselected women at 1.5 months post partum. At 3.5 months post partum 570 women without previous thyroid abnormality returned for a second set of thyroid function test. The prevalence of thyroid dysfunction was 1.1%, which was less than that reported from other countries. Various types of postpartum thyroid dysfunction, namely, transient thyrotoxicosis followed by transient hypothyroidism, transient thyrotoxicosis or hypothyroidism occurring alone or permanent hypothyroidism were encountered. Eight out of 9 patients with thyroid dysfunction had thyroid autoantibodies. Fine needle aspiration biopsy of the thyroid was done in 4 patients and all showed lymphocytic thyroiditis. Even though Bangkok is an iodine surfeit area, iodine intake is relatively lower than in other areas where the prevalence of postpartum thyroid dysfunction is much higher. The discrepancy in geographic prevalence of postpartum thyroid dysfunction may result from the interaction of immunogenetic heterogeneity of different ethnic background, environmental iodine intake, and other unidentified environmental factors.

Adult↗
PubMed1990

Relationship of autoimmunity to thyroid dysfunction in children and adults with Down syndrome.

The extent to which autoimmunity contributes to thyroid dysfunction in Down Syndrome (DS) individuals has not been clarified. We studied 61 persons (34 males and 27 females) with DS (age 5 months to 48 years) for the presence of thyroid autoantibodies (thyroid microsomal antibodies and thyroglobulin antibodies), pancreatic islet cell autoantibodies, gastric parietal cell autoantibodies, and adrenocortical autoantibodies. Thyroid function was determined by measurement of TSH. HLA-A, B and -DR typing was performed on 52 subjects. Forty of 61 subjects (66%) had thyroid dysfunction: elevated TSH values (greater than 5 mcIU/ml) were found in 35 of 61 individuals; 3 subjects had previously documented Hashimoto thyroiditis and were on therapy for hyperthyroidism; and 2 persons had Graves disease. No age or sex variation was detected. Seventeen (28%) subjects had thyroid autoantibodies. Fifteen of the 17 had thyroid dysfunction. Twelve of 25 subjects (48%) over 10 years with thyroid dysfunction had thyroid autoantibodies compared to only 3 of 15 (20%) under the age of 10 years. However, children less than of 10 years tended to have higher TSH values. Only 1 individual who had thyroid antibodies had gastric parietal cell autoantibodies present. Islet cell and adrenocortical autoantibodies were not found in any individuals. Neither thyroid dysfunction nor thyroid autoantibodies correlated with any HLA allele. These findings suggest that thyroid dysfunction in individuals with DS of all ages is a common heterogeneous disorder which cannot be solely explained on the basis of autoimmunity. We recommend that thyroid function be followed closely whether or not thyroid autoantibodies are present.

Adolescent↗
PubMed1989

The immunofluorometric TSH assay as first-line test for suspected thyroid dysfunction.

In this study of 103 patients with suspected thyroid dysfunction, the diagnostic value of a single basal immunofluorometric (IFMA) TSH measurement was evaluated and compared with the classical TRH test with RIA-TSH measurements, plasma TT4 concentrations and FT4I. A single basal TSH determination accurately predicted the TRH-stimulated TSH response, making the TRH test redundant in most patients. Because undetectable basal TSH did not always exclude a small rise in TSH, the TRH test could still be indicated in patients receiving thyroxine suppression therapy for thyroid cancer. Basal TSH differentiated accurately between euthyroidism and thyroid dysfunction, especially at the decision values of 0.20 and 4.0 mU/l, as proposed in this study. For diagnosis of clinical and subclinical hypo- and hyperthyroidism, additional measurement of TT4 and/or FT4I is necessary. A 2-yr follow-up of patients with subclinical thyroid dysfunction did not show progression to clinical disease. In some of the patients with subclinical hypothyroidism, substitution therapy with thyroxine had been started after initial testing. Indications for treatment of subclinical thyroid dysfunction are discussed.

Adolescent↗
PubMed1988

Antithyroid microsomal autoantibodies and HLA-DR5 are associated with postpartum thyroid dysfunction: evidence supporting an autoimmune pathogenesis.

Antithyroid microsomal antibodies (AMA) and human leukocyte antigen (HLA) haplotypes were assessed as markers for the occurrence of postpartum thyroid dysfunction (all forms) and postpartum painless thyroiditis with transient hyperthyroidism, respectively. AMA titers and thyroid function tests were measured sequentially in 261 mothers from delivery to up to 1 yr postpartum. To test for the association of HLA haplotypes in the subgroup of women with postpartum painless thyroiditis with hyperthyroidism, typing for HLA-A, -B, -C, -DR, and -DQ antigens was carried out in a selected group of 38 mothers with this syndrome. Their results were compared to those in 60 women with hypothyroid goitrous autoimmune thyroiditis and 98 regional controls. In the AMA study, 40 (15%) of the 261 mothers had positive AMA titers (titer, less than or equal to 1:80) at delivery, 54 (21%) 2-4 months postpartum, 69 (26%) 5-7 months postpartum, and 60 (23%) 1 yr postpartum. Among 55 mothers who developed postpartum thyroid dysfunction, 25 (47%) had positive AMA at delivery [relative risk (RR), 10.0; P less than 0.001; sensitivity, 45%; specificity, 95%]. Two to 4 months postpartum, 46 mothers had thyroid dysfunction, of whom 35 (76%) had positive AMA, while only 19 of the 215 euthyroid mothers (9%) had positive tests for AMA. Positive AMA tests at these times resulted in a RR for postpartum thyroid dysfunction of 32.8 (P less than 0.0001; sensitivity, 76%; specificity, 91%). Five to 7 months postpartum, 55 mothers had thyroid dysfunction, of whom 47 (86%) had positive AMA, while only 22 of 206 euthyroid mothers (11%) were positive (RR, 59.0; P less than 0.0001; sensitivity, 86%; specificity, 90%). In the HLA studies, DR5 occurred in 11 of 38 (29%) women with postpartum painless thyroiditis with hyperthyroidism vs. 12 of 98 (12%) controls, resulting in a RR of 2.9 (P less than 0.05). HLA-DR5 was present in 22 of 60 (37%) patients with goitrous autoimmune thyroiditis (RR, 4.2; P less than 0.01). HLA-DR4 and HLA-DQw3 were slightly but not significantly increased in women with postpartum painless thyroiditis with hyperthyroidism and goitrous autoimmune thyroiditis compared to those in normal controls. DQw1 was reciprocally decreased (P less than 0.025) in the women with goitrous autoimmune thyroiditis, but not in the women with postpartum painless thyroiditis with hyperthyroidism compared to that in normal controls...

Adult↗
PubMedDate not supplied

Transient post-partum thyroid dysfunction and postnatal depression.

In the course of a population study of thyroid dysfunction in pregnancy and the post-partum period, 65 women, considered to be antibody-positive (microsomal and thyroglobulin), and 82 antibody-negative women were assessed for postnatal depression at 6-8 weeks post partum. The women were also assessed for the development of post-partum thyroid dysfunction. Of the 147 women, 22 met DSM-III criteria for major depression. The presence of autoantibodies showed little association with depressed mood but there was a minor association of postnatal depression with actual thyroid dysfunction in that incidence of the latter condition was higher in depressed women (Raskin scale P less than 0.01; Edinburgh scale P less than 0.05; Montgomery-Asberg scale P less than 0.1). Three of eight mothers with thyroid dysfunction had major depression and were depressed on all three scales.

Adult↗
PubMed1987

Thyroid dysfunction after delivery: incidence and clinical course.

In a prospectively planned study of 591 Danish women thyroid dysfunction after delivery was found in 23 (3.9%). Seven women were hypothyroid and 16 were thyrotoxic. In seven of the thyrotoxic subjects a hypothyroid phase followed. Thyroid dysfunction was mostly transient with complete resolution within a year but persisted in three women (13%). Three months after delivery a positive titre of thyroid microsomal antibodies (TMAb) was found in 38 women (6.4%). Positive titres of TMAb were more often found in women with thyroid dysfunction than in those without (20/38 vs. 3/553). Maximal TMAb titres were seen 5-6 months after delivery and were associated with the occurrence of hypothyroidism. Postpartum thyroid dysfunction was found more often in women with a personal or family history of autoimmune thyroid disorder.

Antibodies↗
PubMed1991

Thyroid dysfunction can predict response to immunotherapy with interleukin-2 and interferon-2 alpha.

Thyroid dysfunction is a well-recognised side-effect of treatment with interleukin-2 (IL2). We assessed the correlation between the development of abnormal thyroid function and tumour response in 13 patients receiving IL2 and interferon-2 alpha (IFN2 alpha) for advanced malignancy. Seven patients had normal thyroid function during treatment, and all of these patients have since died of progressive disease. Of six patients who did develop thyroid dysfunction during treatment, one patient has died of progressive disease. However, statistically we were unable to confirm a definite correlation between the development of thyroid dysfunction and survival in this small group of patients.

Adult↗
PubMedDate not supplied

Thyroid dysfunction after radiation therapy in head and neck cancer patients.

INTRODUCTION: The reported incidence of hypothyroidism following surgery and/or radiation therapy for head and neck cancer varies widely. Most patients undergo thyroid lobectomy during laryngectomy. Standard radiation treatment portals often include the thyroid gland. The insidious development of hypothyroidism may be misdiagnosed. This study examines the incidence of thyroid dysfunction in the setting of head and neck cancer therapy. MATERIALS AND METHODS: Thyroid function tests were performed on 100 consecutive patients treated in the head and neck tumor clinic. Statistical inferences on proportions were made using chi-square analysis. RESULTS: Therapy included surgery only (10 patients), radiation therapy only (28 patients), and combined therapy (62 patients). These patients experienced thyroid dysfunction in 0%, 29%, and 45% of individuals respectively. These differences were statistically significant (P < .05). The highest rate of dysfunction (69%) was associated with patients undergoing laryngectomy and radiation therapy. When laryngectomy was not performed, thyroid dysfunction occurred in 28%. CONCLUSION: The likelihood of thyroid dysfunction after radiation therapy is high particularly when combined with surgery in which thyroid lobectomy is performed and the contralateral lobe is potentially devascularized. These results suggest that radiation therapy is a primary factor in alteration of thyroid function. We recommend that routine thyroid function testing be part of follow-up of all head and neck cancer patients.

Chi-Square Distribution↗
PubMed1989

Thyroid dysfunction after radiotherapy and chemotherapy of brain tumours.

We investigated thyroid function in 119 survivors of treatment for brain tumours not involving the hypothalamo-pituitary region. Cranial irradiation did not effect thyroid function but 11 of 47 children (23%) who had spinal irradiation had raised concentrations of thyroid stimulating hormone. Chemotherapy further increased the incidence of thyroid dysfunction: two of four patients who had cranial irradiation and chemotherapy and 20 of 29 patients (69%) who had spinal irradiation and chemotherapy had increased thyroid stimulating hormone concentrations. Only six patients with raised thyroid stimulating hormone concentrations had low serum thyroxine concentrations. Four children had secondary hypothyroidism. Thyroid function should be monitored in children who have received chemotherapy or radiotherapy. A rise in thyroid stimulating hormone concentrations is the most sensitive indicator of thyroid dysfunction. Children with raised thyroid stimulating hormone concentrations should be treated with thyroxine.

Brain Neoplasms↗
PubMed1991

Thyroid dysfunction associated with immunotherapy for patients with cancer.

The authors performed a prospective study to evaluate thyroid dysfunction in 130 patients with cancer who were receiving interleukin-2 (IL-2)-based immunotherapy. Primary hypothyroidism was the most common abnormality, occurring in 12% of patients before, 38% during, and 23% after immunotherapy. Hyperthyroidism occurred in 1%, 4%, and 7% of patients at those time intervals. Among patients initially euthyroid (n = 111), primary hypothyroidism developed in 32% during and 14% after immunotherapy, persisting a median of 54 days. Three patients required levothyroxine. Hyperthyroidism developed in 2% of patients during immunotherapy and 6% after. Thyroid dysfunction was not a function of sex, diagnosis, type of treatment, or response to immunotherapy. Elevated titers of antithyroglobulin and antithyroid microsomal antibodies were detected after treatment in 9% and 7%, respectively, of all patients without prior antibody abnormalities and did not correlate with response to therapy. The high incidence of therapy-induced thyroid dysfunction suggests that thyroid function should be carefully monitored in all patients receiving IL-2-based immunotherapy.

Adolescent↗