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Park, Sang-In, Young Joon Lee, Seong Hun Choi, Soo Jin Park, Chang-Hyun Song, and Sae-Kwang Ku. "Therapeutic Effects of Blue Honeysuckle on Lesions of Hyperthyroidism in Rats." American Journal of Chinese Medicine 44, no. 07 (January 2016): 1441–56. http://dx.doi.org/10.1142/s0192415x16500804.
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Hyperthyroidism is a hypermetabolic syndrome characterized by an overproduction of thyroid hormones, which enhances the hormone-induced oxidative stress responsible for some complications in the liver, heart and muscle. Blue honeysuckle (BH) is an edible berry, rich in polyphenols, especially flavonoids or anthocyanins, known as strong antioxidants. The chemo-protective activities of the berry have been connected to the improvement of symptoms in cancer, diabetes mellitus, tumor or cardiovascular diseases. Therefore, the therapeutic effects of BH were examined in hyperthyroidism rat model. The hyperthyroidism was induced by injection with levothyroxine (LT4), and the model was treated with distilled water (LT4 control), propylthiouracil (PTU) or BH at 3 dosages of 500, 250 and 125[Formula: see text]mg/kg. The treatment was performed once a day for 15 days. Compared to LT4 control, the oral administration of BH dose-dependently ameliorated the hyperthyroidism, reducing thyroid hormones and increasing thyroid stimulating hormones. These effects were accompanied by improvement of body weight loss and atrophy in the thyroid gland, liver and epididymal fat pads. BH treatments also reduced the levels of hepatic enzymes (AST and ALT), which suggests BH exerts protective effects on hepatocytes. BH might also be involved in the augmentation of the anti-oxidant activities, supported by increased endogenous antioxidant (glutathione). In addition, the histopathological analyses revealed the beneficial effects of BH on the atrophic changes and cellular injuries in the thyroid gland, liver and epididymal fat pads. The therapeutic potentials of BH were either similar or more effective than PTU. These results provide valuable information that will guide more detailed studies to use the BH as a complementary and alternative medicine.
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Pekic, Sandra, and Vera Popovic-Brkic. "Advances in Our Understanding of Pituitary Adenoma." US Endocrinology 04, no. 01 (2008): 88. http://dx.doi.org/10.17925/use.2008.04.01.88.
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Pituitary adenomas are common benign monoclonal neoplasms— accounting for 15% of intracranial neoplasms—that may be clinically silent or secrete anterior pituitary hormones such as prolactin, growth hormone (GH), adrenocorticotrophic hormone (ACTH), or, rarely, thyroid-stimulating hormone (TSH) or gonadotrophins. Radiological studies for other reasons using high-resolution computed tomography (CT) or magnetic resonance imaging (MRI) detect incidental pituitary adenomas in approximately 20% of asymptomatic patients.1The incidence of the various types of adenoma varies;2prolactinomas are the most common pituitary adenomas. Clinically non-functioning pituitary adenomas (NFPAs), which do not secrete hormones, often cause local mass symptoms and represent one-third of pituitary adenomas. GH- and ACTH-producing adenomas each account for 10–15% of pituitary adenomas, while TSH-producing adenomas are rare. Pituitary adenomas are infrequent in childhood: fewer than 10% of pituitary adenomas are diagnosed before 20 years of age.3These adenomas can be either microor macroadenomas. The natural course of microadenomas is that a few tumors enlarge over a period of more than eight years.Although several genes and signaling pathways have been identified as important factors in the development of pituitary tumors, our understanding of pituitary tumorigenesis remains incomplete and is the focus of current research. The reason for this is that current treatment modalities fail to completely control this disorder and prevent the associated morbidity and mortality. This article reviews the advances in our understanding of pituitary adenoma, especially in the field of pathogenesis of pituitary tumors, and the possibility of new therapeutic approaches.
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Groeneweg, Stefan, Robin P. Peeters, Theo J. Visser, and W. Edward Visser. "Diagnostic and Therapeutic Challenges in the Allan—Herndon—Dudley Syndrome." US Endocrinology 12, no. 02 (2016): 90. http://dx.doi.org/10.17925/use.2016.12.02.90.
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Thyroid hormone (TH) is important for normal brain development. The TH transporter protein monocarboxylate transporter 8 (MCT8) is crucial to maintain adequate TH levels in the brain during development and throughout life. Mutations in MCT8 result in the Allan–Herndon–Dudley syndrome (AHDS), which is characterized by a severe delay in neurocognitive development, combined with abnormal serum thyroid function tests (TFTs). The combination of an increased (F)T3 and decreased (F)T4 and rT3 serum levels are characteristic for the presence of AHDS in male patients with moderate to severe delay in neurocognitive development. Here, we provide an overview of current insights, challenges and pitfalls in the diagnosis and management of patients with AHDS.
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Brossaud, J., V. Pallet, and J.-B. Corcuff. "Vitamin A, endocrine tissues and hormones: interplay and interactions." Endocrine Connections 6, no. 7 (October 2017): R121—R130. http://dx.doi.org/10.1530/ec-17-0101.
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Vitamin A (retinol) is a micronutrient critical for cell proliferation and differentiation. In adults, vitamin A and metabolites such as retinoic acid (RA) play major roles in vision, immune and brain functions and tissue remodelling and metabolism. This review presents the physiological interactions of retinoids and endocrine tissues and hormonal systems. Two endocrine systems have been particularly studied. In the pituitary, retinoids target the corticotrophs with a possible therapeutic use in corticotropinomas. In the thyroid, retinoids interfere with iodine metabolism and vitamin A deficiency aggravates thyroid dysfunction caused by iodine-deficient diets. Retinoids use in thyroid cancer appears less promising than expected. Recent and still controversial studies investigated the relations between retinoids and metabolic syndrome. Indeed, retinoids contribute to pancreatic development and modify fat and glucose metabolism. However, more detailed studies are needed before planning any therapeutic use. Finally, retinoids probably play more minor roles in adrenal and gonads development and function apart from their major effects on spermatogenesis.
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Celi, Francesco S. "A MUCH-NEEDED HISTORIC PERSPECTIVE ON THE THERAPEUTIC USE OF THYROID HORMONES." Endocrine Practice 21, no. 10 (October 2015): 1171–74. http://dx.doi.org/10.4158/ep15875.co.
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Korbozova, Nazym K., Nataliya O. Kudrina, Nataliya A. Zhukova, Alexander E. Grazhdannikov, Irina V. Blavachinskaya, Gulnaz A. Seitimova, Timur E. Kulmanov, Tatyana G. Tolstikova, and Nina V. Terletskaya. "Antihypothyroid Effect of Salidroside." Molecules 27, no. 21 (November 2, 2022): 7487. http://dx.doi.org/10.3390/molecules27217487.
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In terms of prevalence, thyroid pathology, associated both with a violation of the gland function and changes in its structure, occupies one of the main places in clinical endocrinology. The problem of developing low-toxic and highly effective herbal preparations for the correction of thyroid hypofunction and its complications is urgent. Salidroside is a glucoside of tyrosol, found mostly in the roots of Rhodiola spp., and has various positive biological activities. The purpose of this study was to study the antihypothyroid potential of salidrosid-containing extract from R. semenovii roots, which was evaluated on a mercazolyl hypothyroidism model. We showed that extract containing salidroside is a safe and effective means of hypothyroidism correction, significantly reducing (p ≤ 0.001) the level of thyroid-stimulating hormone and increasing the level of thyroid hormones. The combined use of R. semenovii extract with potassium iodide enhances the therapeutic effect of the extract by 1.3-times.
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Janett-Pellegri, Camilla, Lea Wildisen, Martin Feller, Cinzia Del Giovane, Elisavet Moutzouri, Oliver Grolimund, Patrick Walter, et al. "Prevalence and factors associated with chronic use of levothyroxine: A cohort study." PLOS ONE 16, no. 12 (December 20, 2021): e0261160. http://dx.doi.org/10.1371/journal.pone.0261160.
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Importance Levothyroxine prescriptions are rising worldwide. However, there are few data on factors associated with chronic use. Objective To assess the prevalence of chronic levothyroxine use, its rank among other chronic drugs and factors associated with chronic use. To assess the proportion of users outside the therapeutic range of thyroid-stimulating hormone (TSH). Design Cohort study (CoLaus|PsyCoLaus) with recruitment from 2003 to 2006. Follow-ups occurred 5 and 10 years after baseline. Participants A random sample of Lausanne (Switzerland) inhabitants aged 35–75 years. Main outcomes We evaluated the prevalence of chronic levothyroxine use and we then ranked it among the other most used chronic drugs. The ranking was compared to data from health insurance across the country. We assessed the association between each factor and chronic levothyroxine use in multivariable logistic regression models. The proportion of chronic levothyroxine users outside the usual TSH therapeutic range was assessed. Results 4,334 participants were included in the analysis (mean±SD age 62.8±10.4 years, 54.9% women). 166 (3.8%) participants were chronic levothyroxine users. Levothyroxine was the second most prescribed chronic drug after aspirin in the cohort (8.2%) and the third most prescribed when using Swiss-wide insurance data. In multivariable analysis, chronic levothyroxine use was associated with increasing age [odds ratio 1.03, 95% confidence interval 1.01–1.05 per 1-year increase]; female sex [11.87 (5.24–26.89)]; BMI [1.06 (1.02–1.09) per 1-kg/m2 increase]; number of concomitant drugs [1.22 (1.16–1.29) per 1-drug increase]; and family history of thyroid pathologies [2.18 (1.37–3.48)]. Among chronic levothyroxine users with thyroid hormones assessment (n = 157), 42 (27%) were outside the TSH therapeutic range (17% overtreated and 10% undertreated). Conclusions In this population-based study, levothyroxine ranked second among chronic drugs. Age, female sex, BMI, number of drugs and family history of thyroid pathologies were associated with chronic levothyroxine use. More than one in four chronic users were over- or undertreated.
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Barwinek, Katarzyna, Danuta Gąsior-Perczak, Sławomir Trepka, Artur Szczodry, Janusz Kopczyński, Zdzisława Sitarz-Żelazna, and Aldona Kowalska. "Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis." Medicina 56, no. 6 (June 12, 2020): 290. http://dx.doi.org/10.3390/medicina56060290.
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Agranulocytosis is a rare but very serious complication of thyrostatic therapy. In severe hyperthyroidism, the removal of circulating thyroid hormones by plasmapheresis may be an effective therapeutic option. This report describes the therapeutic difficulties and successful preoperative treatment with plasmapheresis in a 63-year-old patient admitted to the Endocrinology Clinic with severe hyperthyroidism, during the course of giant toxic nodular goiter and agranulocytosis, which occurred after 2 weeks of taking methimazole. During hospitalization, methimazole treatment was discontinued and therapy with steroids, a beta blocker, propylthiouracil, Lugol’s solution, lithium carbonate, and antibiotics were initiated. Granulocyte colony growth stimulating factor was also used to resolve agranulocytosis. Due to the failure to achieve euthyreosis using this approach, we decided to conduct thyroid surgery, as a life-saving action, after preparation of the patient by plasmapheresis. Two plasmapheresis procedures were performed, resulting in a decrease in the concentration of free thyroid hormones. Total thyroidectomy was performed and there were no complications during surgery. We conclude that plasmapheresis may be considered as an effective alternative treatment option for the preparation of patients with hyperthyroidism for surgery, when the clinical situations prevent the use of conventional treatments for hyperthyroidism and when immediate life-saving surgery is necessary.
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Safer, Joshua D. "Thyroid Hormone and Wound Healing." Journal of Thyroid Research 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/124538.
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Although thyroid hormone is one of the most potent stimulators of growth and metabolic rate, the potential to use thyroid hormone to treat cutaneous pathology has never been subject to rigorous investigation. A number of investigators have demonstrated intriguing therapeutic potential for topical thyroid hormone. Topical T3has accelerated wound healing and hair growth in rodents. Topical T4has been used to treat xerosis in humans. It is clear that the use of thyroid hormone to treat cutaneous pathology may be of large consequence and merits further study. This is a review of the literature regarding thyroid hormone action on skin along with skin manifestations of thyroid disease. The paper is intended to provide a context for recent findings of direct thyroid hormone action on cutaneous cellsin vitroandin vivowhich may portend the use of thyroid hormone to promote wound healing.
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Vegt, M., J. A. Bruijn, and T. K. Birkenhäger. "The use of thyroid hormone in the treatment of depression: a review." Acta Neuropsychiatrica 3, no. 2 (June 1991): 17–21. http://dx.doi.org/10.1017/s0924270800035006.
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SummaryThe writers of this paper made an inventory of the studies on the use of thyroid hormone in the treatment of depression. Fifteen clinical trials (353 patients), published between 1969 and 1987. were found, that can be described, as to their design, in two seperate groups:One group (7 studies) administers thyroid hormone simultaneously with a tricyclic antidepressant to reach a faster effect of the antidepressant. The other group (8 studies) adds thyroid hormone to a tricyclic antidepressant in patients who fail to respond to this treatment, with the aim to convert therapeutic failure to success. After studying the literature we think we are able to conclude that it can be usefull to combine the antidepressant with thyroid hormone in view of the fact that, in a number of depressed patients, it shortens the duration of the illness. The augmentation of tricyclics by thyroid hormone needs further study.
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GOEDE, SIMON L., KEITH R. LATHAM, MELVIN KHEE-SHING LEOW, and JACQUELINE JONKLAAS. "HIGH RESOLUTION FREE TRIIODOTHYRONINE-THYROTROPIN (FT3-TSH) RESPONSES TO A SINGLE ORAL DOSE OF LIOTHYRONINE IN HUMANS: EVIDENCE OF DISTINCT INTER-INDIVIDUAL DIFFERENCES UNRAVELED USING AN ELECTRICAL NETWORK MODEL." Journal of Biological Systems 25, no. 01 (March 2017): 119–43. http://dx.doi.org/10.1142/s0218339017500073.
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The effects of a single oral dose of liothyronine (L-T3) on thyroid stimulating hormone (TSH) and other related thyroid system parameters are partly understood despite therapeutic use of this hormone over many decades. We characterize individualized responses of the hypothalamus-pituitary-thyroid (HPT) axis and its related temporal hormonal profile using an electrical network model. Based on thyroid hormone responses from blood samples using a single 50[Formula: see text][Formula: see text]g oral dose of liothyronine in healthy persons with a normal operating euthyroid feedback HPT system, we derived an equivalent electrical circuit model for the system’s responses. The mathematical model was tested with a circuit simulator and validated with individualized clinical data. This signal processing technique makes the evaluation of bioequivalence and bioavailability of various preparations of liothyronine at an individualized level a feasible endeavor for clinical application.
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Csako, Gyorgy, Diane M. Corso, Jane Kestner, Allan D. Bokser, Paul E. Kennedy, and Frank Pucino. "Evaluation of Two Over-the-Counter Natural Thyroid Hormone Preparations in Human Volunteers." Annals of Pharmacotherapy 26, no. 4 (April 1992): 492–94. http://dx.doi.org/10.1177/106002809202600408.
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OBJECTIVE: To determine the pharmacologic activity of over-the-counter (OTC) thyroid preparations. DESIGN: In vitro analysis and a prospective, crossover study in vivo. SETTING: Tertiary care center. PARTICIPANTS: Two healthy adult volunteers INTERVENTION: Three OTC preparations (Thytrophin PMG [bovine thyroid PMG extract], Thyro Forte [thyroid lyphogland concentrate with synergistic complex], and Thyro Complex [thyroid lyophilized gland concentrate with synergistic complex]) were analyzed in vitro. Volunteers were administered two times the manufacturer's maximum recommended daily dose of either Thytrophin PMG or Thyro Forte for one week, washed out for four to five weeks, and crossed over to receive the opposite tablet preparation for an additional week. MAIN OUTCOME MEASURES: The triiodothyronine (T3) and thyroxine (T4) contents of OTC preparations were measured by HPLC. Vital signs, serum total and free T4, total T3, thyroid stimulating hormone, thyroxine binding globulin, thyroglobulin, and general chemistry tests (including glucose and cholesterol) were monitored before, during, and between administration of the products. RESULTS: HPLC analysis of the three OTC preparations showed no T4 but did show possible T3 in two of these products. We found no definite clinical or laboratory evidence of thyroid hormone excess with either product. CONCLUSIONS: Healthcare professionals should advise against the use of these scientifically unsound and relatively expensive OTC thyroid preparations, of which the therapeutic efficacy is unknown.
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Grbovic, Leposava, and Miroslav Radenkovic. "Therapeutic use of glucocorticoids and immunosuppressive agents." Srpski arhiv za celokupno lekarstvo 133, Suppl. 1 (2005): 67–73. http://dx.doi.org/10.2298/sarh05s1067g.
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Pharmacotherapy of autoimmune thyroid disease (AITD) is complex. Apart from the replacement hormone therapy, antithyroid agents, beta adrenoceptor blockers and other drugs, in regard to the present symptoms, it also includes the administration of glucocorticoids and immunosuppressive agents. Physiological actions of glucocorticoids are significant in number, well known and described in details. The most prominent pharmacological properties of glucocorticoids, that are important for their clinical use, are antiinflammatory and immunosuppressive actions. In this article, the most notable clinical pharmacology aspects of glucocorticoids have been presented, including the basic principles of their therapeutic use, as well as the most important indications with the examples of dosing regiments (rheumatic disorders, renal diseases, allergic reactions, bronchial asthma, gastrointestinal inflammatory diseases, thrombocytopenia, organ transplantation, and Graves? ophthalmopathy). In addition, adverse and toxic effects of glucocorticoids as well as their interactions with other drugs have been described. Immunosuppressive agents have important role in treatment of immune disorders, including the reduction of immune response in autoimmune diseases and organ transplantation. Apart from glucocorticoids, immunosuppressive agents consist of calcineurin inhibitors (cyclosporine, tacrolimus), antiproliferative and antimetabolic agents (sirolimus, azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide), monoclonal antibodies: anti-CD3 antibody (muromonab-CD3), anti- CD25 antibody (daclizumab), anti-TNF-alpha antibody (infliximab). In this part, the most updated facts about mechanism of action, rational therapeutic use, as well as adverse and toxic effects of immunosuppressive agents have been reviewed.
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Savchuk, Tatiana. "Thyroid gland – historical essay." Current issues of social sciences and history of medicine 30, no. 2 (May 13, 2021): 88–90. http://dx.doi.org/10.24061/2411-6181.2.2021.275.
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Formulation of the problem. The first imagest hyroid gland can be found in ancient Egyptian and ancient Chinese sculptures date back 2700 years to oursera. Historiographical base. The thyroid gland was known already the authors of antiquity and the Middle Ages, although they described goiter and cretinism, but have not yet linked these diseases to the disorder gland function. The purpose of the study - to analyze the historical milestones in the formation of thyroidology. Main part. As early as 1600 year BC were among the first, Chinese doctors in treatment of enlarged thyroid gland steel use seafood and seaweed, but they do not knew that the therapeutic effect arises from iodine. Large scientist Gallen believed that the thyroid gland is a kind"Buffer" between the heart and the brain. In the 19th century it became actively develop thyroid surgery, with the main problem of surgeons remained high mortality. In 1881, Billroth was one of the first in Europe to report 48 successful thyroid surgeries. Upon receipt artificial thyroxine in the treatment of hypothyroidism (insufficiency thyroid hormones) a new era began. Another half of the 20th century was marked by active research causes of autoimmune diseases such as diffuse toxic goiter, autoimmune thyroiditis. Detected antibodies to thyroperoxidase, antibodies to thyroglobulin, antibodies to TSH receptors. Conclusion. Definitely the future of development knowledge in the field of thyroid gland according to research in the field genetics of diseases, creation of new drugs and methods diagnosis of autoimmune diseases of the thyroid gland.
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Veeramachaneni, Ravali, Ravali Veeramachaneni, Samantha Milanes, and Daniela Pirela-Araque. "ODP524 Thyroid Storm Precipitated by COVID-19 Infection: A Case Report." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A785. http://dx.doi.org/10.1210/jendso/bvac150.1623.
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Abstract Background Thyroid storm is an endocrinological emergency caused by severe thyrotoxicosis. COVID-19, caused by the novel coronavirus SARS-CoV-2, is known to cause thyroid-related complications of subacute thyroiditis but the occurrence of thyroid storm is rare. The use of first line therapies for thyrotoxicosis/thyroid storm, such as thioamides, radioactive iodine, and surgery, may be precluded by leukopenia, hemodynamic instability, and liver failure, which are commonly seen in severe COVID-19 infection. The necessity for isolation creates a challenge for surgical intervention for these patients. Here we present a unique case of thyroid storm secondary to Graves’ disease, reactivated by COVID-19 infection and managed with therapeutic plasma exchange (TPE). Clinical Case A 56-year-old African American female with history of hyperthyroidism for the past 13 years, presented to the emergency department with sore throat and fatigue for one week prior. On arrival, she was febrile with temperature of 101.1° Fahrenheit, tachycardic with heart rate of 163 bpm and tachypenic with respiratory rate of 41 rpm. Patient had bilateral orbitopathy, tender thyromegaly, thyroid bruit and fine tremors. She also had atrial fibrillation, right-sided heart failure, acute liver failure. Nasopharyngeal COVID-19 testing was positive; laboratory tests revealed TSH <0. 01 uIU/mL (n 0.450 - 5.330), free T4 >5.60 ng/dL (n 0.45 - 1.8), direct bilirubin 1.8 (n 0.1-0.3 mg/dl), mild transaminitis and INR 2.21 (n 0.9-1.1). White blood cell count was 5.4 K/uL (n 4.5-11.5) with 50.8% neutrophils (n 31-76%). Ultrasound of abdomen revealed decompensated cirrhosis with ascites. The Burch-Wartofsky score was 75 points, indicative of thyroid storm. Acute liver failure precluded the use of thioamides; due to the severity of the hyperthyroidism, ablation was not considered. The use of Lugol's iodine was held pending surgical clearance due to active COVID-19 infection. Eventually, patient underwent a total of four sessions of TPE. With each session free T4 levels decreased: 4.12 ng/dl, 2.73 ng/dl, 2.52 ng/dl, and 1.53 ng/dl, respectively. Six days after the last TPE, patient developed complications related to COVID-19 infection and expired before undergoing total thyroidectomy. Conclusion This is a complicated case of a patient with thyroid storm, acute liver failure in the setting of COVID-19 infection. SARS-CoV-2 virus may not only be a trigger for thyroid storm but also represents a challenge in the management of thyroid disease. During TPE, patients’ plasma is extracted from the components of the blood and a colloid replacement solution is infused back. Thyroxine binding globulin bound to thyroid hormones is removed with plasma and colloid replacement provides new binding sites for circulating free thyroid hormone. TPE is effective but rarely used in the past and can be considered as therapeutic for thyrotoxic patients with COVID-19 infection, in whom conventional methods of treatment are not feasible options. Presentation: No date and time listed
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Fragu, Philippe. "Calcitonin’s Fantastic Voyage: from Hormone to Marker of a Genetic Disorder." Gesnerus 64, no. 1-2 (November 11, 2007): 69–92. http://dx.doi.org/10.1163/22977953-0640102004.
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The story of thyroid calcitonin is an illuminating example of the voyage of hormone from a therapeutic tool for bone disease to a tumour marker to screen for subclinical forms of cancer. Identified as a new thyroid hormone implicated in calcium metabolism, its pharmacological action offered a new therapeutic tool for the management of bone disease. By measuring the circulating calcitonin, a range of values was obtained for oncologists because the evolution of a newly identified form of thyroid cancer – medullary (MTC) – was poorly understood. Researchers’ interest shifted from calcitonin physiological action to its use as tumour marker able to diagnose MTC, especially in genetically predisposed families.Then, oncologists and geneticists combined their efforts to identify genetic mutation(s) implicated in MTC, an example of the decoding that is demanded of contemporary laboratory-based medicine to recognise a pathological entity.
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SERAFINI, ALDO N., RALF P. CLAUSS, and SILVINA LEVIS-DUSSEAU. "Protocol for the Combined Diagnostic and Therapeutic Use of Recombinant Human Thyroid-Stimulating Hormone." Clinical Nuclear Medicine 28, no. 1 (January 2003): 14–17. http://dx.doi.org/10.1097/00003072-200301000-00004.
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Cadeliña, Jekrylei, Michael Villa, Hanna Jessa Morales, and Ferdinand Santoceldes. "ODP536 Rapid, Successful Control of Thyrotoxicosis Using Therapeutic Plasma Exchange as a Bridge to Thyroidectomy in an Adult Patient With Cardiogenic Shock and Hepatic Dysfunction." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A791. http://dx.doi.org/10.1210/jendso/bvac150.1635.
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Abstract Background Uncontrolled Graves’ disease is associated with significant morbidity and mortality. Treatment of such patients who have developed multi-organ dysfunction is challenging, and novel interventions have to be explored. We present a case of uncontrolled thyrotoxicosis with cardiogenic shock and hepatic dysfunction successfully controlled using therapeutic plasma exchange as a bridge to definitive management with total thyroidectomy. Case Presentation Our patient is a 36-year-old Filipina with known Graves’ disease for three years but with poor compliance to medications. She was admitted due to one-month history of progressive bipedal edema, easy fatigability, palpitations, and increasing abdominal girth. On examination, she had hypotension, irregular cardiac rhythm at 120's, mild respiratory distress, jaundice, enlarged thyroid gland, decreased breath sounds, distended abdomen, and grade 2 bipedal edema. Work-up showed atrial fibrillation with rapid ventricular response, global hypokinesia, pericardial effusion, pulmonary edema, elevated liver enzymes and bilirubins, and dilated hepatic veins. The thyroid stimulating hormone was at 0. 014 uIU/mL (0.55-4.78 uIU/mL). Free T4 was at 2.54 ng/dL (0.89-1.76 ng/dL) and free T3 was at 4.1 pg/mL (2.30-4.20 pg/mL). Thyroid stimulating immunoglobulins (TSI) were positive at 7.59 IU/L (<0.10 IU/L). Ultrasound revealed an enlarged thyroid gland with increased vascular flow and a complicated cyst measuring 0.7×0.2×0.5 cm in the right lobe. The ongoing hepatic dysfunction precluded the use of thionamides. Radioactive iodine treatment was not considered because of its gradual effect and need for isolation which could not be done in a clinically unstable patient. Total thyroidectomy was deemed to be the best option for rapid and definitive management. Adequate pre-operative preparation was important to minimize the surgical risk. The patient was started on hydrocortisone. The medical team performed two sessions of therapeutic plasma exchange with fluid removal. The free T4 and free T3 levels decreased to 1. 0 ng/dL and 2. 04 pg/mL, respectively. The TSI level decreased to 1.45 IU/L. The liver function improved and the cardiac status stabilized. She was able to safely undergo total thyroidectomy on the ninth hospital day. Repeat 2D-echocardiogram done two days post-operatively showed improvement in ejection fraction from 33.7% to 53.1%. She was extubated three days after surgery, weaned off dobutamine within one week, and discharged nine days after surgery. Histopathology of the thyroid gland revealed papillary thyroid microcarcinoma in the right lobe. Conclusion Therapeutic plasma exchange, also known as plasmapheresis, is an extracorporeal blood purification technique that can remove circulating thyroid hormones and TSH-receptor antibodies. It's a novel treatment for complicated cases of thyroid storm but its utility is limited by cost, invasiveness, and lack of technical expertise. Our case report demonstrates that therapeutic plasma exchange is also an effective and safe treatment option for unstable patients who require rapid control of thyrotoxicosis prior to definitive treatment with thyroidectomy. Presentation: No date and time listed
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Segocio, Donnie Jan D., and Joseph E. Cachuela. "Levothyroxine versus Levothyroxine with Iodine in Reduction of Thyroid Nodule Volume: A Double-Blind Randomized Controlled Trial." Philippine Journal of Otolaryngology-Head and Neck Surgery 34, no. 1 (June 18, 2019): 14–19. http://dx.doi.org/10.32412/pjohns.v34i1.959.
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Objective: To compare levothyroxine alone and in combination with iodine on thyroid nodule volume reduction.
Methods:
Design: Double-Blind Randomized Controlled Trial
Setting: Tertiary Government Hospital
Participants: Nineteen (19) euthyroid patients age 19-54 with at least 1 cytologically benign thyroid nodule were randomized to receive either levothyroxine + iodine or levothyroxine + placebo, taken once a day for 6 months with ultrasound and thyroid stimulating hormone monitoring on the 3rd and 6th month of intervention.
Results: Main outcome measures included thyroid nodule volume reduction after six months of intervention. The mean change in volume from baseline to six months of levothyroxine + iodine group showed no statistically significant difference in nodule volume across time between levothyroxine + placebo group, -0.010 ± 1.250 (CI -0.521 - 0.501) versus 0.507 ± 1.128 (CI 0.025 - 0.990), p=.158. There were also new nodules (4 nodules) in the placebo group and none in the iodine group. No major adverse events were noted during the study.
Conclusion: The two groups did not significantly differ in terms of nodule volume reduction.
Keywords: thyroid nodule, prevention and control; drug therapy; iodine compounds, therapeutic use; levothyroxine, therapeutic use
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Feldt-Rasmussen, Ulla. "Subclinical Hypothyroidism and Cardiovascular Risk—An Overview of Current Understanding." US Endocrinology 06, no. 01 (2010): 92. http://dx.doi.org/10.17925/use.2010.06.1.92.
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Subclinical or mild hypothyroidism is often associated with adverse cardiovascular risk factors, such as high cholesterol, together with hypertension, endothelial dysfunction and other atherosclerotic cardiovascular risk factors. The ischemic abnormalities are probably related to long-term consequences of a slowly progressing development of hypothyroidism. In recent years, it has become evident that a consensus on the exact limits for cut-off between normal and subclinically hypothyroid individuals is not currently possible. The main reasons for this are differences for measurement of serum thyroid-stimulating hormone (TSH), that reference populations are very different, and that a person’s intra-individual variability is much narrower than any population-based interval. Finally, the prevalence of subclinical hypothyroidism varies from 4 to 17% in different normal populations. Available evidence indicates that patients with subclinical hypothyroidism have developed or are at risk for developing an adverse cardiovascular profile, and subclinical hypothyroidism is most likely a mild variant of overt hypothyroidism. There is currently no evidence for a treatment benefit, but studies to demonstrate the expected minor improvements have not been performed on a sufficiently large scale. Patients should be informed about the disease and, based on a combined clinical and laboratory judgement, should be offered a therapeutic trial in case of even vague symptoms.
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Carvalho, Denise P., and Andrea C. F. Ferreira. "The importance of sodium/iodide symporter (NIS) for thyroid cancer management." Arquivos Brasileiros de Endocrinologia & Metabologia 51, no. 5 (July 2007): 672–82. http://dx.doi.org/10.1590/s0004-27302007000500004.
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The thyroid gland has the ability to uptake and concentrate iodide, which is a fundamental step in thyroid hormone biosynthesis. Radioiodine has been used as a diagnostic and therapeutic tool for several years. However, the studies related to the mechanisms of iodide transport were only possible after the cloning of the gene that encodes the sodium/iodide symporter (NIS). The studies about the regulation of NIS expression and the possibility of gene therapy with the aim of transferring NIS gene to cells that normally do not express the symporter have also become possible. In the majority of hypofunctioning thyroid nodules, both benign and malignant, NIS gene expression is maintained, but NIS protein is retained in the intracellular compartment. The expression of NIS in non-thyroid tumoral cells in vivo has been possible through the transfer of NIS gene under the control of tissue-specific promoters. Apart from its therapeutic use, NIS has also been used for the localization of metastases by scintigraphy or PET-scan with 124I. In conclusion, NIS gene cloning led to an important development in the field of thyroid pathophysiology, and has also been fundamental to extend the use of radioiodine for the management of non-thyroid tumors.
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Rodpai, Rutchanee, Oranuch Sanpool, Tongjit Thanchomnang, Pokkamol Laoraksawong, Lakkhana Sadaow, Patcharaporn Boonroumkaew, Arporn Wangwiwatsin, et al. "Exposure to dexamethasone modifies transcriptomic responses of free-living stages of Strongyloides stercoralis." PLOS ONE 16, no. 6 (June 28, 2021): e0253701. http://dx.doi.org/10.1371/journal.pone.0253701.
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Hyperinfection and disseminated infection by the parasitic nematode Strongyloides stercoralis can be induced by iatrogenic administration of steroids and immunosuppression and lead to an elevated risk of mortality. Responses of free-living stages of S. stercoralis to the therapeutic corticosteroid dexamethasone (DXM) were investigated using RNA-seq transcriptomes of DXM-treated female and male worms. A total of 17,950 genes representing the transcriptome of these free-living adult stages were obtained, among which 199 and 263 were differentially expressed between DXM-treated females and DXM-treated males, respectively, compared with controls. According to Gene Ontology analysis, differentially expressed genes from DXM-treated females participate in developmental process, multicellular organismal process, cell differentiation, carbohydrate metabolic process and embryonic morphogenesis. Others are involved in signaling and signal transduction, including cAMP, cGMP-dependent protein kinase pathway, endocrine system, and thyroid hormone pathway, as based on Kyoto Encyclopedia of Genes and Genomes analysis. The novel findings warrant deeper investigation of the influence of DXM on growth and other pathways in this neglected tropical disease pathogen, particularly in a setting of autoimmune and/or allergic disease, which may require the clinical use of steroid-like hormones during latent or covert strongyloidiasis.
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Duntas, Leonidas H., and Bernadette Biondi. "Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences." European Journal of Endocrinology 156, no. 1 (January 2007): 13–19. http://dx.doi.org/10.1530/eje.1.02310.
Full textAbstract:
Acute hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer during monitoring for remnant or metastatic disease, seriously affects multiple organs and systems, and especially in severe cases can impair quality of life. Indeed, it may induce untoward cardiovascular effects and can be hazardous in patients with underlying cardiovascular disease, particularly in the elderly. Moreover, acute hypothyroidism deranges the lipid profile and exacerbates neuropsychiatric illness. The introduction of recombinant human TSH (rhTSH) as a diagnostic and therapeutic tool in the care of patients with thyroid cancer has widened the scope of disease management. The use of rhTSH prevents derangement of various systems at approximately equivalent societal costs to that of withdrawal and promotes compliance while preserving the patient’s normal daily functioning and productivity. Its reliability allied with its safety render this compound a valid alternative in the monitoring of patients with differentiated thyroid carcinoma as well as providing an alternative therapeutic procedure whenever LT4-withdrawal may be hazardous or in cases of patient non-compliance.
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Liu, Yingheng, Dajun Wang, Rebecca A. Redetzke, Benjamin A. Sherer, and A. Martin Gerdes. "Thyroid hormone analog 3,5-diiodothyropropionic acid promotes healthy vasculature in the adult myocardium independent of thyroid effects on cardiac function." American Journal of Physiology-Heart and Circulatory Physiology 296, no. 5 (May 2009): H1551—H1557. http://dx.doi.org/10.1152/ajpheart.01293.2008.
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Patients with hypothyroidism are at a higher risk for coronary vascular disease. Patients with diabetes and related vascular complications also have an increased incidence of low thyroid function. While thyroid hormones (THs) may be key regulators of a healthy vasculature, potential undesirable side effects hinder their use in the treatment of vascular disorders. TH analogs such as 3,5-diiodothyropropionic acid (DITPA) may provide a safer treatment option. However, the relative potency of DITPA on vascular growth, cardiac function, and metabolism is poorly understood. We hypothesized that the vascular growth-promoting effects of DITPA can be obtained with a minimum effect on cardiac function. Thyroidectomized Sprague-Dawley rats were given slow-release pellets with either thyroxine (T4, 2.7 or 5.2 mg) or DITPA (80 mg) for 6 wk and were compared with placebo. Heart mass, body mass, body temperature, serum THs, cardiac function (echocardiograms and hemodynamics), and myocardial arteriolar density were determined. Hypothyroidism led to reductions in cardiac function, heart mass, body temperature, and myocardial arterioles. High-dose T4 prevented arteriolar loss and the development of hypothyroidism. Low-dose T4 partially prevented the reduction in cardiac function but had minimal effects on arteriolar loss. In contrast, DITPA treatment prevented myocardial arteriolar loss but not the progression of hypothyroid-induced changes in cardiac function. The results suggested that DITPA can promote a healthy vasculature independently from its thyroid-related metabolic effects. Drugs in this class may provide new therapeutic options for patients with vascular disease.
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Nikolic, Aleksandra, Dragan Micic, Dejan Nikolic, and Violeta Stanimirovic. "Trab determination in newly detected patients with hyperthyroidism and their prognostic importance." Medical review 62, no. 7-8 (2009): 304–7. http://dx.doi.org/10.2298/mpns0908304n.
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Introduction. In more than 50 years since the first demonstration of the immune basis for thyroiditis was done, the autoimmune disease has been identified as a major cause of disfunction of all endocrine organs. Identification of the antithyroid with the radio-receptor assay is widespread in clinical use for differential diagnosis of other thyroid disorders manifesting with the hyperthyroidism. Material and methods. Our study included 44 patients with new onset Graves disease which was primarily verified according to the objective status of the patients (signs of hyperthyroidism), biochemical parameters (which included thyroid hormones) and detection of the TRAb (TSAb-thyreotropin-stimulanting antibodies) at the beginning of diagnosis and in the first, second and after the third month since the introduction of antithyroid therapy (propiltiouracil). RESULTS. On the basis of the TSAb concentration level, we found that the response to the therapy was positive in 65.9% ('responders') of the patients and negative in 22.7% ('non responders') of the patients and without therapeutic effect were 11.4% of the patients. During the therapy (after the first month), in the group of non responders we found increased values of the TSAb (p<0.05) and in the group of responders we found reduction of the TSAb levels (p<0.05). Conclusion. Our study demonstrated that the therapy with propiltiouracil, after the first month divide patients with positive and negative response, which could change the therapeutic, options in the future.
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Chugh, Radhika, and Wiley Harkens. "RF23 | PSAT301 Plasmapheresis and Extracorporeal Membrane Oxygenation (ECMO) for Treatment of Thyroid Storm with Multiorgan Failure." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A858—A859. http://dx.doi.org/10.1210/jendso/bvac150.1775.
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Abstract Introduction Thyroid storm is a life-threatening condition with a high morbidity and mortality rate. It can lead to severe end organ damage including liver injury, which can preclude the use of thionamides. Therapeutic plasma exchange can be a lifesaving option for treatment of thyroid storm in such cases. Multiorgan failure can also necessitate the use of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Case Presentation A 34-year-old woman with a history of Graves’ disease, untreated for several years, presented to the emergency department with fatigue, palpitations, dyspnea, and edema which developed over 1 month. Labs showed suppressed thyroid stimulating hormone (TSH) with significantly elevated free T4 of 10.8 ng/dL (normal 0.89-1.76 ng/dL). She had evidence of atrial fibrillation and heart failure. She was started on treatment with propylthiouracil, propranolol, and hydrocortisone and then Lugol's iodine was added. However, she quickly deteriorated with worsening mentation, dyspnea, and hypotension. She progressed to multiorgan failure including significant liver injury likely due to ischemic hepatitis. Thus, thianomides could not be used any further. She was started on cholestyramine; hydrocortisone and Lugol's iodine were continued.An echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%. Beta blockers were discontinued due to hypotension. The cardiogenic shock worsened despite aggressive medical therapy requiring initiation of veno-arterial (V-A) ECMO. She also required CRRT due to renal failure.Plasmapheresis was initiated for treatment of thyroid storm and she received 4 treatments with normalization of free T4: 1.48 ng/dL and T3 levels: 3.4 ng/dL (normal 2.3-4.2 ng/dL). Her condition subsequently improved and she was decannulated from the ECMO device after 5 days. She was then able to receive definitive treatment with thyroidectomy 11 days following admission. The patient was discharged in improved condition after a 10-week hospital course. Discussion Thyroid storm is a rare complication of thyrotoxicosis with a mortality rate of 10-30%. Treatment classically involves inhibiting the synthesis, release, and peripheral conversion of thyroid hormone as well as supportive management. Major causes of mortality in thyroid storm, present in our patient, include cardiogenic shock, arrhythmia, and multiorgan failure. Cardiac and hepatic failure can preclude the use of beta blockers and thionamides, which may necessitate the use of extracorporeal treatments, such as plasmapheresis for clearance of high burden of circulating thyroid hormone; V-A ECMO and CRRT for end organ damage. These therapeutic measures were used in our patient and led to a favorable outcome. This case highlights the successful use of these extracorporeal treatments as a bridge to thyroidectomy when standard medical treatment is contraindicated or unsuccessful. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:42 p.m. - 12:47 p.m.
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Candellone, Alessia, Vittorio Saettone, Paola Badino, Flavia Girolami, Elisabetta Radice, Domenico Bergero, Rosangela Odore, and Giorgia Meineri. "Management of Feline Hyperthyroidism and the Need to Prevent Oxidative Stress: What Can We Learn from Human Research?" Antioxidants 10, no. 9 (September 20, 2021): 1496. http://dx.doi.org/10.3390/antiox10091496.
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Feline hyperthyroidism is a clinical syndrome related to an excessive production of thyroid hormones, and it is considered as a spontaneous animal model for human thyrotoxicosis. Many shared features between the feline and the human disease have been identified so far, including pathogenesis, clinical signs, and treatment options. Although methimazole is considered the first-choice drug in both species, several side effects have been described. Furthermore, methimazole could interfere with the oxidative status, already perturbated by the disease. It has been reported in humans that dietary management, mainly through antioxidant supplementation, could mitigate this oxidative burden. The purpose of the review is to describe current therapeutic options in the course of feline hyperthyroidism and to summarize the state of the art relationship between dietary antioxidants administration and the reduction of methimazole side-effects in humans to support the use of this approach also in cats.
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Medenica, Sanja, Dzihan Abazovic, Aleksandar Ljubić, Jovana Vukovic, Aleksa Begovic, Gaspare Cucinella, Simona Zaami, and Giuseppe Gullo. "The Role of Cell and Gene Therapies in the Treatment of Infertility in Patients with Thyroid Autoimmunity." International Journal of Endocrinology 2022 (August 30, 2022): 1–10. http://dx.doi.org/10.1155/2022/4842316.
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There is a rising incidence of infertility worldwide, and many couples experience difficulties conceiving nowadays. Thyroid autoimmunity (TAI) is recognized as one of the major female infertility causes related to a diminished ovarian reserve and potentially impaired oocyte maturation and embryo development, causing adverse pregnancy outcomes. Growing evidence has highlighted its impact on spontaneously achieved pregnancy and pregnancy achieved by in vitro fertilization. Despite the influence of thyroid hormones on the male reproductive system, there is insufficient data on the association between TAI and male infertility. In past years, significant progress has been achieved in cell and gene therapies as emerging treatment options for infertility. Cell therapies utilize living cells to restore healthy tissue microenvironment and homeostasis and usually involve platelet-rich plasma and various stem cells. Using stem cells as therapeutic agents has many advantages, including simple sampling, abundant sources, poor immunogenicity, and elimination of ethical concerns. Mesenchymal Stem Cells (MSCs) represent a heterogeneous fraction of self-renewal, multipotent non-hematopoietic stem cells that display profound immunomodulatory and immunosuppressive features and promising therapeutic effects. Infertility has a genetic component in about half of all cases, although most of its genetic causes are still unknown. Hence, it is essential to identify genes involved in meiosis, DNA repair, ovarian development, steroidogenesis, and folliculogenesis, as well as those involved in spermatogenesis in order to develop potential gene therapies for infertility. Despite advances in therapy approaches such as biological agents, autoimmune disorders remain impossible to cure. Recent research demonstrates the remarkable therapeutic effectiveness of MSCs in a wide array of autoimmune diseases. TAI is one of many autoimmune disorders that can benefit from the use of MSCs, which can be derived from bone marrow and adipose tissue. Cell and gene therapies hold great potential for treating autoimmune conditions, although further research is still needed.
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Groeneweg, Stefan, Robin P. Peeters, Theo J. Visser, and W. Edward Visser. "Triiodothyroacetic acid in health and disease." Journal of Endocrinology 234, no. 2 (August 2017): R99—R121. http://dx.doi.org/10.1530/joe-17-0113.
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Thyroid hormone (TH) is crucial for development and metabolism of many tissues. The physiological relevance and therapeutic potential of TH analogs have gained attention in the field for many years. In particular, the relevance and use of 3,3′,5-triiodothyroacetic acid (Triac, TA3) has been explored over the last decades. Although TA3 closely resembles the bioactive hormone T3, differences in transmembrane transport and receptor isoform-specific transcriptional activation potency exist. For these reasons, the application of TA3 as a treatment for resistance to TH (RTH) syndromes, especially MCT8 deficiency, is topic of ongoing research. This review is a summary of all currently available literature about the formation, metabolism, action and therapeutic applications of TA3.
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Williams, James D., Oleh Slupchinskij, Anthony P. Sclafani, and Claude Douge. "Evaluation and Management of the Lingual Thyroid Gland." Annals of Otology, Rhinology & Laryngology 105, no. 4 (April 1996): 312–16. http://dx.doi.org/10.1177/000348949610500414.
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Lingual thyroid gland is a rare clinical entity that is due to failure of descent of the gland anlage early in the course of embryogenesis. It may present with symptoms of dysphagia, upper airway obstruction, or even hemorrhage at any time from infancy through adulthood. We present two illustrative cases of lingual thyroid gland along with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment The natural history of the condition is reviewed and a treatment strategy is outlined that focuses on the use of suppressive doses of thyroid hormone as the initial therapy. Surgical excision of the gland is reserved for more advanced cases of gland enlargement resulting in airway compromise, severe dysphagia that limits oral intake, or ongoing hemorrhage.
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Ringel, M. D., and P. W. Ladenson. "Controversies in the follow-up and management of well-differentiated thyroid cancer." Endocrine-related cancer 11, no. 1 (March 2004): 97–116. http://dx.doi.org/10.1677/erc.0.0110097.
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Thyroid cancer is a common malignancy with an apparent increasing incidence and a wide spectrum of clinical behavior and therapeutic responsiveness. Recent advances in diagnosis, primary treatment, and long-term monitoring have led to enhanced detection of primary and recurrent disease and improvements in therapy. Controversy still surrounds several issues: the most accurate predictive staging system and histological subclassification scheme, optimal preoperative assessment and surgical extent, appropriate use of radioiodine for remnant ablation, goal for thyrotropin-suppressive thyroid hormone therapy, best practices in immediate postoperative and long-term monitoring, and approach to the patient with thyroglobulin evidence of residual disease. In this paper, recent data related to these controversial issues are critically reviewed.
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Younes, Younes R., and Benjamin C. T. Field. "Survey of Practice: The Current Extent of Adjunctive Use of Lithium in the UK During Radioactive Iodine Therapy for Hyperthyroidism." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A843—A844. http://dx.doi.org/10.1210/jendso/bvab048.1721.
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Abstract Background: The latest United Kingdom National Institute for Health and Care Excellence (NICE) guideline recommends 131I as first-line definitive treatment for Graves’ disease in patients who are unlikely to achieve remission with antithyroid medication. A small but significant proportion of patients have recurrence of hyperthyroidism after 131I therapy. Lithium enhances thyroidal iodine retention and thus increases radiation dose delivered to the thyroid gland during 131I therapy. While clinical trial findings with adjuvant Lithium have not been universally positive, several studies have demonstrated a favorable effect on cure rate, speed of cure and stabilization of thyroid hormone status during131I therapy. Aim: To determine the extent to which Lithium is used as an adjunct to 131I therapy for hyperthyroidism in the UK. Methods: We conducted a survey of 82 nuclear medicine departments and 236 consultant endocrinologists in National Health Service (NHS) hospitals across the UK. Results: Responses were received from 43 departments and 64 endocrinologists. Ten nuclear medicine departments reported that they do not perform therapeutic procedures. Amongst the remainder, only one department stated that Lithium is considered routinely as an adjunct to 131I for selected patients. Amongst consultant endocrinologists, only two indicated that they use Lithium as an adjunct to 131I therapy. Conclusions: Owing to mixed trial evidence and a lack of guideline support for adjunctive Lithium with 131I, its use is not widespread the UK at present. However, some researchers report that it might offer faster control of hyperthyroidism and reduce the amplitude of post-therapy thyroid function fluctuations. As these could be important determinants not only of quality of life but also of safety of treatment, our findings may be valuable to those planning randomized controlled trials of adjunctive Lithium with 131I therapy for Graves’ disease.
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Hönes, Georg Sebastian, Ramona Gowry Sivakumar, Christoph Hoppe, Jörg König, Dagmar Führer, and Lars Christian Moeller. "Cell-Specific Transport and Thyroid Hormone Receptor Isoform Selectivity Account for Hepatocyte-Targeted Thyromimetic Action of MGL-3196." International Journal of Molecular Sciences 23, no. 22 (November 8, 2022): 13714. http://dx.doi.org/10.3390/ijms232213714.
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Thyroid hormones (THs) and TH receptor-beta (TRβ) reduce hepatic triglycerides, indicating a therapeutic potential for TH analogs in liver steatosis. To avoid adverse extrahepatic, especially TRα-mediated effects such as tachycardia and bone loss, TH analogs with combined TRβ and hepatocyte specificity are desired. MGL-3196 is a new TH analog that supposedly meets these criteria. Here, we characterize the thyromimetic potential of MGL-3196 in cell-based assays and address its cellular uptake requirements. We studied the contribution of liver-specific organic anion transporters (OATP)1B1 and 1B3 to MGL-3196 action. The TR isoform-specific efficacy of MGL-3196 compared with 3,5,3′-triiodothyronine (T3) was determined with luciferase assays and gene expression analysis in OATP1B1 and OATP1B3 and TRα- or TRβ-expressing cells and in primary murine hepatocytes (PMHs) from wild-type and TRβ knockout mice. We measured the oxygen consumption rate to compare the effects of MGL-3196 and T3 on mitochondrial respiration. We identified OATP1B1 as the primary transporter for MGL-3196. MGL-3196 had a high efficacy (90% that of T3) in activating TRβ, while the activation of TRα was only 25%. The treatment of PMHs with T3 and MGL-3196 at EC50 resulted in a similar induction of Dio1 and repression of Serpina7. In HEK293 cells stably expressing OATP1B1, MGL-3196 had comparable effects on mitochondrial respiration as T3. These data indicate that MGL-3196’s hepatic thyromimetic action, the basis for its therapeutic use, results from a combination of hepatocyte-specific transport by OATP1B1 and the selective activation of TRβ over TRα.
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Fux Otta, Carolina, Laura Moreno, Roberto Vitaloni, and Gabriel S. Iraci. "Favorable outcome of SARS-CoV-2 infection in a patient with pituitary insufficiency." Revista de la Facultad de Ciencias Médicas de Córdoba 77, no. 4 (December 1, 2020): 363–66. http://dx.doi.org/10.31053/1853.0605.v77.n4.29997.
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Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak originated in Wuhan (China) rapidly turned into a pandemic. Due to a national compulsive decree of quarantine, office visits for chronic disease control were delay.
Hypopituitarism includes all clinical conditions that result in partial or complete failure of the pituitary gland's ability to secrete hormones. Pituitary insufficiency per se has been associated with an increase in both morbidity and mortality, particularly due to cardiovascular disease, which is an important risk factor for COVID-19 disease severity.
Objective: To report the first case of SARS-CoV-2 infection in a patient with hypopituitarism, discuss the implications of the treatments the patient was taking and grade up the value of telemedicine in the present scenario.
Methods: Report of the clinical record of a patient with hypopituitarism and infection with SARS-CoV-2.
Results: During the span of the infection, the patient remained on the same hormonal therapeutic scheme (thyroid, gonadal and adrenal axis). The dose of hydrocortisone was not changed during the course of the infection as she was asymptomatic. We use telemedicine to control and advise her on the treatment.
Conclusion: Health care professionals should carefully follow up on the evolution of patients with hypopituitarism to provide them a safer outcome. The use of telemedicine as a methodology for selected patients acquires relevance in the present epidemiological context.
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Nkire, Nnamdi, Michael Doran, and John J. O'Connor. "Hypogonadism in an opioid dependent man." Irish Journal of Psychological Medicine 28, no. 3 (September 2011): 168–70. http://dx.doi.org/10.1017/s0790966700012209.
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AbstractWe describe here the case of a 45-year-old man with a chronic history of heroin abuse who has received methadone maintenance therapy for 12 years. At admission, on this occasion, for stabilisation on methadone, he reported a two-year history of painful gynaecomastia and testicular atrophy. Investigations revealed abnormal sex hormone levels. Liver function tests, thyroid function tests, Brain (pituitary) MRI and viral screens were normal. Following assessment and abnormality in two morning total testosterone level measurements he was diagnosed with hypogonadism secondary to opioid use. Although he had a previous history of alcohol abuse, he was abstinent from alcohol use for five years at time of assessment. He was commenced on parenteral testosterone replacement with therapeutic benefit.In light of the increased use of opioids, it is important to recognise and manage the endocrine complications of opioid use. The need for an empathic and adequate sexual history, physical examination and investigation is essential in patients who use opioids to ensure that cases of hormonal dysfunction are detected early and managed appropriately.
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Khine, Aye, and Ngwe Yin. "LBODP104 Thyroid Plasmapheresis: An Alternative Option For Thyroid Storm." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A743. http://dx.doi.org/10.1210/jendso/bvac150.1533.
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Abstract Introduction Thyroid storm is a rare, life-threatening condition with a high mortality rate approaching 10-30%. The mainstay of treatment includes initiation of therapy directed against the thyroid, supportive intensive care, and treatment of any precipitating factors. We report three cases of patients with thyroid storm and successful therapeutic use of plasmapheresis when traditional therapy was contraindicated. Clinical Cases Case 1 A 22-year-old male with no known past medical history, presented with fever, shortness of breath, and syncope. Labs showed TSH 0. 014 mIU/L (range 0.4-4.5), FT4 4.30 ng/dL (range 0.9-2.2), TSI 546% (range <140), and TPO 20 U/mL (range <60). He was diagnosed with thyroid storm due to Graves’ disease (Burch-Wartofsky score of 60). He was initially treated with propylthiouracil (PTU), hydrocortisone, propranolol, and Lugol's iodine solution. He developed transaminitis and shock liver so was not able to continue PTU or trial methimazole. He underwent 4 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy. Case 2 A 37-year-old female with known Graves’ disease (non-adherent to antithyroid drug), presented with shortness of breath and palpitations. Labs showed TSH <0. 01 mIU/L (range 0.4-4.5), FT4 4.83 ng/dL (range 0.9-2.2), and FT3 6. 0 pg/mL (range 2.3-4.2). Burch-Wartofsky score was 40 and supported the diagnosis of thyroid storm. She was initially treated with methimazole, hydrocortisone, propranolol, and Lugol's iodine solution. She developed transaminitis and there was also concern for methimazole-induced insulin autoimmune syndrome, so methimazole was discontinued. She underwent 3 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy. Case 3 A 31-year-old female with no known past medical history, presented with shortness of breath and altered mental status requiring intubation. Labs showed TSH <0. 01 mIU/L (range 0.4-4.5), FT4 4.65 ng/dL (range 0.9-2.2), FT3 25.2 pg/mL (range 2.3-4.2), TSI 467% (range <140), TPO 375 U/mL (range <60). She was diagnosed with thyroid storm due to Graves’ disease (Burch-Wartofsky score of 90). She was initially treated with methimazole, hydrocortisone, propranolol, and Lugol's iodine solution. She developed pulmonary alveolar hemorrhage and it was unclear if this was due to methimazole, thus methimazole was discontinued. She underwent 5 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy. Conclusion Plasmapheresis can be an effective and safe treatment option in thyroid storm when there are contraindications for antithyroid drugs or when rapid normalization of thyroid hormone levels is needed. It should be considered as a stabilizing measure as it leads to marked improvement of thyrotoxicosis within 3-5 days, allowing thyroidectomy for definitive therapy. Presentation: No date and time listed
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Shurpyak, S. O. "The substantiation of differentiated therapy of the combined disgormonal pathology of reproductive organs in women of reproductive age with comorbid conditions." Reproductive health of woman, no. 4 (August 17, 2022): 30–37. http://dx.doi.org/10.30841/2708-8731.4.2022.262768.
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The objective: substantiation of differentiated therapeutic approaches to the treatment of combined dyshormonal pathology of the reproductive organs, taking into account the comorbidity of patients.Materials and methods. 300 women of reproductive age (20–42 years, mean age – 29.9±5.6 years) with dyshormonal pathology of reproductive organs were examined: the main group included 180 patients who were prescribed complex differentiated pharmacotherapy for the treatment of combined dyshormonal pathology of the reproductive organs with correction of comorbid conditions, and the comparison group included 120 patients who received a standard set of measures. The control group included 50 healthy women without somatic and gynecological pathology. All women had ultrasound examination of the pelvic organs, mamma glands, thyroid gland, determination of the levels of pituitary tropic hormones and steroid ovary hormones, thyroid hormones, antibodies to thyroperoxidase, and the level of 25 (OH) D in blood serum. Results. Obesity of various degrees was observed in 31.0% of examined patients with dyshormonal pathology of the reproductive system, the prevalence of autoimmune thyroiditis in patients was 36.0%, and subclinical hypothyroidism was diagnosed in 21.3%. Among women with autoimmune thyroiditis, the frequency of subclinical hypothyroidism was 59.3% with 3.7% of manifest hypothyroidism. Vitamin D insufficiency was found in 34.0% of patients with dyshormonal pathology, vitamin D deficiency – in 44.3%, severe deficiency – in 21.7%. Treatment of patients in the main group led to the normalization of the menstrual cycle in 97.2% of cases, in the comparison group – in 73.3%, to a reduction of pain syndrome severity – in 94.7% and 60.6%, respectively, cyclic mastodynia – in 93.9% and 43.9%, manifestations of vegetative-vascular and non-specific symptoms – in 94.8±3.9% and 24.3±16.7% of cases, contributed to achieving the desired pregnancy – in 64.1% and 30.6% of patients, respectively, and also there was a reducing the frequency of relapses during 6 months of observation from 14.5% to 4.1%.Conclusions. The use of complex differentiated pharmacotherapy for the treatment of combined dyshormonal pathology of the reproductive organs with the correction of comorbid conditions makes possible to achieve higher efficiency, which is manifested in a greater reduction in the frequency of clinical symptoms and disease relapses compared to the usual practice.
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Olsson-Brown, Anna Claire, Rosemary Lord, Joseph J. Sacco, Mark Christopher Coles, Jonathan Wagg, and Munir Pirmohamed. "Two distinct clinical trajectories of inflammatory thyroiditis evoked by checkpoint blockade in malignant melanoma." Journal of Clinical Oncology 36, no. 5_suppl (February 10, 2018): 131. http://dx.doi.org/10.1200/jco.2018.36.5_suppl.131.
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131 Background: Oncological immune checkpoint inhibitors (CPI) commonly cause immune related adverse events (irAEs). Thyroid irAEs have a significant clinical impact requiring therapeutic intervention and clinical coordination whilst often causing treatment delays. Methods: Retrospective review of all patients treated with CPIs (pembrolizumab, nivolumab +/- ipilimumab) for metastatic melanoma at the Clatterbridge Cancer Centre, UK identified patients experiencing thyroid irAEs. Clinical/biochemical course (T4 and thyroid stimulating hormone (TSH) levels) and autoantibody titers were evaluated to identify characterisable trajectories. Results: From February 2016 to May 2017, 103 patients received anti-PD1 therapy; 90 receiving monotherapy and 13 combination. Thyroid irAEs were seen in 13(14.4%) and 3(23%) patients respectively. Two distinct trajectories were identified: a hyperthyroid phase with subsequent hypothyroidism (HH) and de novo hypothyroidism (DN). There were no outliers. HH was the predominant pattern (75%) and the sole manifestation in combination therapy. In the HH cohort 69% of patients were female. The peak T4 was 39.3pmol/L occurring, on average, 7.5 weeks after CPI initiation. T4 levels declined within 6-21 days and hypothyroidism occurred within 8 weeks. The DN cohort was exclusively female. Thyroid irAE occurred 12 weeks after CPI initiation. Baseline TSH in HH (2.49mU/l) was significantly lower than DN (5.77mU/l); p = 0.0092. Positive thyroid autoantibodies were detected in 5 patients across both groups. One patient (HH) had symptomatic thyroid dysfunction. Corticosteroids conveyed no benefit. All patients had permanent dysfunction requiring long term levothyroxine replacement. All continued with immunotherapy treatment; however notable irAE-related treatment hiatuses occurred. Conclusions: Retrospective review revealed two distinct thyroid irAE trajectories, HH and DN. The trajectories may have biochemical predictors, are rarely associated with symptoms and appear unrelated to thyroid autoantibodies. Trajectory identification will optimise patient outcomes, reduce ineffective steroid use and promote early hormone replacement.
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Hassan, Amal I., Ibrahim I. Bondouk, Khalid Omar, Heba A. Esawii, and Hosam M. Saleh. "Chemical toxicity assessment and Physiological investigation in rats exposed to pyrethroid insecticide type 1 and possible mitigation of propolis." EuroBiotech Journal 6, no. 1 (January 1, 2022): 9–26. http://dx.doi.org/10.2478/ebtj-2022-0002.
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Abstract The current investigation aims to study the potential protective effects of propolis methanolic extract (100 mg/kg BW) on the systemic toxic effects after dietary exposure concentration (1/100 LD50 for 30 days) of permethrin (PM) administered in experimental rats. In this experiment, we added propolis four weeks after PM -administration to examining the medicinal effects. Therapeutic use of propolis mitigated PM -induced deterioration of liver and kidney functions and myocardial damage measured by cardiac enzymes lactate dehydrogenase (LDH) and creatine kinase MB (CK-MB) in serum. In addition, propolis treatment (prophylactic and therapeutic) prevented PM-induced apoptosis index, including B-cell lymphoma protein 2 (BCL-2)-associated X (BAX) protein activates, and lipid peroxide (LP). The results showed propolis induced a significant decrease in serum levels of thyroid hormones (T3 and T4), proinflammatory cytokines tumor necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ), interleukin one beta (IL-1β), interleukin 12 (IL-12), and interleukin 6 (IL-6). Besides, nuclear factor-kappa B (NF-kB), acetylcholine esterase (AChE), and hematological constituents. Cardiac biomarkers, liver, and kidney functions were substantially lower in propolis treatment. High-performance liquid chromatography (HPLC) and Gas chromatography–mass spectrometry (GC- MS) of the propolis-MeOH extract showed valuable antioxidant phenolics and flavonoids capable of alleviating oxidative stress through the free-radical scavenging efficacy and regulating signaling pathways of proinflammatory cytokines.
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Ruzhylo, Sofiya, Nataliya Zakalyak, Dariya Popovych, Volodymyr Kikhtan, Teodor Seniv, Oksana Novak, Oksana Mats’ko, and Xawery Żukow. "Thyrotropic effects of balneotherapy in Truskavets’ spa and their endocrine, vegetative and metabolic accompaniments." Journal of Education, Health and Sport 12, no. 4 (April 10, 2022): 94–104. http://dx.doi.org/10.12775/jehs.2022.12.04.008.
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Background. Previous studies of the Truskavetsian Scientific School of Balneology have studied the effects of course use of bioactive water Naftussya - the main therapeutic factor of the spa - on plasma levels of thyroid hormones in males and females healthy rats and women with thyroid hyperplasia. In men with chronic cholecystitis, the immediate thyrotropic effects of a single use of Naftussya water have been studied. The aim of this study is thyrotropic effects of balneotherapy in Truskavets’ spa and their endocrine, vegetative and metabolic accompaniments in men and women with chronic cholecystitis and pyelonephritis. Materials and Methods. The object of clinical-physiological observation were 34 men (23-70 years) and 10 women (39-76 years), who underwent rehabilitation treatment of chronic cholecystitis and pyelonephritis in remission in the Truskavets’ spa. The examination was performed twice, before and after a 7-10-day course of balneotherapy. The main object of study was the plasma level of Triiodothyronine. We determined also content in plasma Cortisol, Aldosterone, Testosterone and Calcitonin as well as the parameters of the HRV and metabolism. Results. We find in 16 patients (12 men and 4 women) inhibitory thyrotropic effect, in 22 (16 men and 6 women) neutral, and in 6 men only – enhancing effect of balneotherapy. Each variant of the thyrotropic effect is accompanied by characteristic changes in testosteronemia, calcitoninemia, parathyroid activity, Heart Rate, Baevskiy’s Activity Regulatory Systems Index, HRV-markers of vagal tone, Calciemia as well as VLD and LD lipoproteins Cholesterol plasma. Conclusion. Our data confirmed and supplemented the provisions on the multivariate effects of balneotherapy in the spa of Truskavets’ on the endocrine and autonomic nervous systems and metabolism of patients.
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Toloza, Freddy J. K., Nataly R. Espinoza Suarez, Omar El Kawkgi, Elizabeth H. Golembiewski, Oscar J. Ponce, Lixia Yao, Spyridoula Maraka, Naykky M. Singh Ospina, and Juan P. Brito. "Patient Experiences and Perceptions Associated with the Use of Desiccated Thyroid Extract." Medicina 56, no. 4 (April 3, 2020): 161. http://dx.doi.org/10.3390/medicina56040161.
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Background and objectives: It is unclear why many patients with hypothyroidism prefer the use of desiccated thyroid extract (DTE) as a thyroid hormone replacement formulation over levothyroxine (LT4) treatment, as recommended by clinical practice guidelines. We analyzed patient-reported information from patient online forums to better understand patient preferences for and attitudes toward the use of DTE to treat hypothyroidism. Materials and Methods: We conducted a mixed-methods study by evaluating the content of online posts from three popular hypothyroidism forums from patients currently taking DTE (n = 673). From these posts, we extracted descriptive information on patient demographics and clinical characteristics and qualitatively analyzed posts’ content to explore patient perceptions on DTE and other therapies further. Results: Nearly half (46%) of the patients reported that a clinician initially drove their interest in trying DTE. Patients described many reasons for switching from a previous therapeutic approach to DTE, including lack of improvement in hypothyroidism-related symptoms (58%) and the development of side effects (22%). The majority of patients described DTE as moderately to majorly effective overall (81%) and more effective than the previous therapy (77%). The most frequently described benefits associated with DTE use were an improvement in symptoms (56%) and a change in overall well-being (34%). One-fifth of patients described side effects related to the use of DTE. Qualitative analysis of posts’ content supported these findings and raised additional issues around the need for individualizing therapy approaches for hypothyroidism (e.g., a sense of each patient has different needs), as well as difficulties obtaining DTE (e.g., issues with pharmacy availability). Conclusions: Lack of individualized treatment and a feeling of not been listened to were recurrent themes among DTE users. A subset of patients may prefer DTE to LT4 for many reasons, including perceived better effectiveness and improved overall well-being, despite the risks associated with DTE.
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Watari, Jessica, and Navinder Jassil. "CONVERSION OF HYPOTHYROIDISM TO HYPERTHYROIDISM: A RARE CLINICAL PHENOMENON." AACE Clinical Case Reports 6, no. 5 (September 2020): e279-e281. http://dx.doi.org/10.4158/accr-2020-0076.
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Objective: We present a patient with long standing hypothyroidism who developed hyperthyroidism secondary to Graves disease. Recognition of this disease phenomenon is crucial to ensure prompt diagnosis and close follow-up. Methods: The patient was evaluated with thyroid function testing and thyroid antibody testing. Further evaluation included ophthalmologic examination and radioactive iodine uptake imaging. Results: A 56-year-old female with past medical history of human immunodeficiency virus, hepatitis C infection, and hypothyroidism presented for evaluation of thyroid disease. She had been off of levothyroxine for the last 8 months due to biochemical findings of thyrotoxicosis. Her family history was significant for hyperthyroidism and hypothyroidism. Laboratory tests were consistent with hypothyroidism so levothyroxine was restarted. Physical exam showed lid lag and proptosis. Ophthalmologic evaluation found bilateral 23 mm proptosis. Additional lab testing was positive for thyroid peroxidase antibody and thyroid stimulating immunoglobulin. Following levothyroxine use, the patient developed subclinical hyperthyroidism and thyroid replacement was stopped. The patient remained euthyroid for 1 year off of levothyroxine. Following 1 year, she developed mild hyperthyroidism with increased radioactive iodine uptake. She was placed on propranolol for symptomatic relief. Months later, thyroid function testing normalized. Conclusion: In Graves disease, hypothyroidism and conversion of hypothyroidism to hyperthyroidism are rare, yet important to recognize, clinical phenomenon. The stimulatory and inhibitory properties of thyroid-stimulating hormone receptor antibodies are speculated to play a role in individuals with alternating hypothyroidism and hyperthyroidism. These individuals can present a diagnostic and therapeutic challenge. Clinicians must maintain a high clinical suspicion for this disease entity.
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Cocco, Pierluigi. "On the rumors about the silent spring: review of the scientific evidence linking occupational and environmental pesticide exposure to endocrine disruption health effects." Cadernos de Saúde Pública 18, no. 2 (April 2002): 379–402. http://dx.doi.org/10.1590/s0102-311x2002000200003.
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Occupational exposure to some pesticides, and particularly DBCP and chlordecone, may adversely affect male fertility. However, apart from the therapeutic use of diethylstilbestrol, the threat to human reproduction posed by "endocrine disrupting" environmental contaminants has not been supported by epidemiological evidence thus far. As it concerns other endocrine effects described in experimental animals, only thyroid inhibition following occupational exposure to amitrole and mancozeb has been confirmed in humans. Cancer of the breast, endometrium, ovary, prostate, testis, and thyroid are hormone-dependent, which fostered research on the potential risk associated with occupational and environmental exposure to the so-called endocrine-disrupting pesticides. The most recent studies have ruled out the hypothesis of DDT derivatives as responsible for excess risks of cancer of the reproductive organs. Still, we cannot exclude a role for high level exposure to o,p'-DDE, particularly in post-menopausal ER+ breast cancer. On the other hand, other organochlorine pesticides and triazine herbicides require further investigation for a possible etiologic role in some hormone-dependent cancers.
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Zhanga, Yuanyuan, Xiaoyan Xiaoa, Qiufa Haoa, Xianhua Lia, Jianmin Renb, and Zhao Hu. "The onset of systemic lupus erythematosus and thyroid dysfunction following graves’ disease - a case report and literature review." Srpski arhiv za celokupno lekarstvo 144, no. 11-12 (2016): 639–44. http://dx.doi.org/10.2298/sarh1612639z.
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Introduction. Graves? disease is a multifactorial autoimmune thyroid disease, with the presence of typical circulating autoantibodies that can activate the thyroid hormone receptors, resulting in hyperthyroidism, goiter, and ophthalmopathy. Systemic lupus erythematosus is a multi-systemic autoimmune disease that involves almost all the organs of the human body and is characterized by autoantibodies formation. Several studies have reported that autoimmune thyroid and rheumatic disorders can present an unusual relationship. Case Outline. We report a case of a middle-aged woman who presented with systemic lupus erythematosus one year after being diagnosed with Graves? disease. Prednisone and cyclophosphamide were administered to control the development of systemic lupus erythematosus. Furthermore, a percutaneous thyroid biopsy was performed for further confirmation of Graves? disease. Methimazole instead of propylthiouracil was added into the therapeutic scheme. A month later, the patient?s clinical manifestation and laboratory tests got significant improvement, except that new thyr o id dysfunction appeared opposite to the original one. The administration of anti-thyroid drug was discontinued. With a period of decreased administration of prednisone, the patient?s thyroid function gradually got back to normal levels without any levothyroxine replacement. Conclusion. In conclusion, the clinical use of prednisone and antithyroid drugs may result in instability of the hypothalamus-pituitary-thyroid axis, and thyroid function should be carefully monitored in such patients. <br><br><font color="red"><b> This article has been corrected. Link to the correction <u><a href="http://dx.doi.org/10.2298/SARH1702101E">10.2298/SARH1702101E</a><u></b></font>
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Schifano, Fabrizio. "The pharmacotherapeutic management of rapid cycling affective disorder: an update." Irish Journal of Psychological Medicine 7, no. 1 (March 1990): 71–78. http://dx.doi.org/10.1017/s0790966700017080.
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AbstractIn the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.
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Dederichs, B., C. Kobe, P. Theissen, M. Schmidt, H. Schicha, and M. Dietlein. "Therapy for non-toxic multinodular goiter." Nuklearmedizin 45, no. 01 (2006): 21–34. http://dx.doi.org/10.1055/s-0038-1623928.
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SummaryThe need for therapy for nodular goiter results from the growth of thyroid nodules over decades and from the possibility of tracheal compression and worsening of respiratory function. Given the high prevalence of non-toxic goiter, the epidemiologically low incidence of clinically apparent thyroid cancer justifies non-surgical strategies. Randomised studies have shown that levothyroxine offers limited therapeutic effects and is inferior to radioiodine therapy regarding goiter shrinkage. When indication for a definitive therapy is given, the choice between resection and radioiodine therapy should consider volume of goiter, severity of clinical symptoms, thyroid uptake, patient’s age, co-morbidity, previous resection of goiter, patient’s profession and patient’s wish. Even in large goiters between 100 and 300 ml radioiodine therapy showed consistent results with goiter size reduction from 35-40% one year and 40-60% two years after radioiodine therapy. Thyroid hormones to prevent recurrence of goiter are not necessary. Recurrent goiters were seldom observed after radioiodine therapy and resulted from initially very large goiters or uptake in dominante nodules or from low 131I activities. Recombinant human TSH (rhTSH) offers the opportunity to enhance the effect of radioiodine therapy. Observational studies have shown that rhTSH increases low 131I uptake in case of high alimentary iodine-supply by the factor 4, causes a more homogenous 131I distribution within the goiter and improves goiter reduction. A phase I study for dose finding is running in the USA. Conclusion: Radioiodine therapy for shrinkage of large non-toxic goiter should not be restricted to elderly patients, or to patients with co-morbidity or high operative risk, but is an attractive alternative to surgery in patients with special professions (singer, teacher, speaker) or with the wish for a non-invasive treatment modality.
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Brubaker, Patricia L. "Minireview: Update on Incretin Biology: Focus on Glucagon-Like Peptide-1." Endocrinology 151, no. 5 (March 19, 2010): 1984–89. http://dx.doi.org/10.1210/en.2010-0115.
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The incretin hormone, glucagon-like peptide-1 (GLP-1), is now being used in the clinic to enhance insulin secretion and reduce body weight in patients with type 2 diabetes. Although much is already known about the biology of GLP-1, much remains to be understood. Hence, this review will consider recent findings related to the potential for enhancing endogenous levels of GLP-1 through selective use of secretagogues and the beneficial cardiovascular, neuroprotective, and immunomodulatory effects of GLP-1, as well as the possible effects of GLP-1 to enhance β-cell growth and/or to induce pancreatitis or thyroid cancer. Finally, the potential for molecular medicine to enhance the success of GLP-1 therapy in the clinic is considered. A better understanding of the fundamental biology of GLP-1 may lead to new therapeutic modalities for the clinical use of this intestinal hormone.
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Boguszewski, Cesar Luiz, Leila Caroline Bianchet, Salmo Raskin, Luiz M. Nomura, Luis Alencar Borba, and Teresa Cristina Santos Cavalcanti. "Application of genetic testing to define the surgical approach in a sporadic case of multiple endocrine neoplasia type 1." Arquivos Brasileiros de Endocrinologia & Metabologia 54, no. 8 (November 2010): 705–10. http://dx.doi.org/10.1590/s0004-27302010000800007.
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We report the use of a genetic test for therapeutic decision making in a case of primary hyperparathyroidism associated with Cushing's disease (CD). A 20-year-old woman was evaluated for gradual weight gain, asthenia, muscle pain, and hypertension. Biochemical and radiologic tests confirmed CD and she underwent transsphenoidal surgery. Immunohistochemistry of the microadenoma was positive for adrenocorticotropic hormone (ACTH). On follow-up, hypercalcemia with high parathyroid hormone (PTH) levels was detected, associated with nephrolithiasis and low bone mineral density in the spine and hip. Parathyroid scintigraphy showed tracer uptake in the inferior region of the left thyroid lobe, and cervical ultrasound showed a heterogeneous nodule in the same area, suggestive of a parathyroid adenoma (PA). Genetic testing detected mutation in the MEN 1 gene and total parathyroidectomy with the implantation of a fragment of one gland in the forearm was performed. Pathology showed a PA and 3 normal parathyroid glands, without hyperplasia, despite the diagnosis of MEN 1. This case illustrates the role of genetic testing in defining the therapeutic approach for sporadic MEN 1.
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Hedayati, Mehdi, Sadegh Rajabi, and Abdolrahim Nikzamir. "Papillary Thyroid Cancer-Promoting Activities of Combined Oral Contraceptive Components." Galen Medical Journal 9 (May 21, 2020): 1648. http://dx.doi.org/10.31661/gmj.v9i0.1648.
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Background: Thyroid cancer is more common in women at reproductive age, suggesting the relationship between its high-incidence and therapeutic use of hormonal medications, such as oral contraceptives (OCPs). The aim of this study was to identify the effect of low-dose combined OCP (LD-COC) on proliferation, apoptosis, and migration of human papillary thyroid cancer (PTC) BCPAP cell line. Materials and Methods: BCPAP cells were cultured and treated with the combination of 90nM levonorgestrel (LNG) and 20nM ethinylestradiol (EE) for 48 hours. Afterward, using 3-(4, 5-dimethylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide (MTT) assay, the proliferation of the cells was measured. Apoptosis was determined by using a Caspase-3 ELISA kit. Migratory properties of combined LNG and EE were studied through wound scratch assay. The expression levels of pro-apoptotic factor BAX, anti-apoptotic factor Bcl2, and proliferation marker Ki67 were analyzed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and western blotting. Results: Upon treatment with the combination of LNG and EE, proliferation and migration of BCPAP cells were significantly enhanced. However, LNG and EE remarkably inhibited apoptosis of these cells. Furthermore, treating PTC cells with combined LNG and EE caused a marked increase in the expression of Bcl2 and Ki67 and a considerable decrease in BAX levels (P˂ 0.05). Conclusion: Our data linked the use of COCs and the progression and aggressiveness of PTC, suggesting the role of these hormonal compounds as promoting factors for PTC tumors. Despite these observations, further investigations will be required to fully establish the pathogenic impact of these medications on PTC. [GMJ.2020;9:e1648]
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Okudan, Berna, Bedri Seven, Nedim C. M. Gülaldı, Mustafa Çapraz, and Yusuf Açıkgöz. "The Value of 99mTc-MIBI SPECT/CT in the Postoperative Assessment of Patients with Differentiated Thyroid Carcinoma." Current Medical Imaging Formerly Current Medical Imaging Reviews 18, no. 4 (April 2022): 404–8. http://dx.doi.org/10.2174/1573405617666211108154028.
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Background: The therapeutic approaches of differentiated thyroid carcinoma (DTC) are surgery, ablation therapy with the postoperative use of radioiodine-131 (131I), and thyroid-stimulating hormone (TSH) suppression therapy. After the surgical therapy, the patient should be assessed for remnants/metastases. Objective: The purpose of this research was to investigate the role of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in the postoperative management of patients with DTC. Methods: The study comprised 22 DTC patients (13 women, 9 men; mean age 46.55 ± 13.27 y) who underwent a total thyroidectomy previously. All patients were investigated for thyroid remnants/ metastases by 99mTc-MIBI SPECT/CT, posttherapy 131I whole-body scan (WBS) and ultrasound (US). Serum TSH, thyroglobulin and anti-Tg antibody levels were measured. Results of imaging modalities and laboratory measurements were compared with each other. Results: 99mTc-MIBI SPECT/CT, 131I WBS and US respectively demonstrated thyroid remnants in 15 (68.18%), 22 (100%) and 14 (63.63%) of all patients and metastatic lymph nodes in 8 (100%), 6 (75%) and 6 (75%) of the 8 patients with lymph node metastases. 99mTc-MIBI SPECT/CT also demonstrated lung metastases in 2 patients (9.09% of all patients). The same result was obtained with 131I WBS. Conclusion: The findings of this study show that 99mTc-MIBI SPECT/CT can be effective for detecting metastases in patients with DTC who underwent surgery prior to 131I therapy.