Thyroid gland changes in patients with acromegaly

ABSTRACT Objective Acromegaly is characterized by high neoplastic morbidity as a side effect of growth hormone (GH) hypersecretion. Increased incidence of goiter, thyroid carcinoma, and thyroid dysfunction is also reported. The aim of the present study was to find the prevalence of thyroid dysfunction and goiter in patients with acromegaly and determine its relationship to disease activity, disease duration, and the presence of secondary hypothyroidism. Subjects and methods In a cross-sectional study of the period 2008-2012 were included 146 patients with acromegaly (56 men, 90 women) of mean age 50.3 ± 12.4 years. Acromegaly disease activity and thyroid function were evaluated in all patients. Thyroid ultrasonography was performed to calculate thyroid volume and detect the presence of nodular goiter. Results Ninety-one patients were determined to have an active disease, and 55, a controlled disease. The mean thyroid volume in patients without previous thyroid surgery was 37.6 ± 38.8 mL. According to disease activity, thyroid volume was significantly higher in patients with active disease (38.5 ± 45.4 mL vs. 27.2 ± 18.4 mL, p = 0.036). A weak positive correlation was found between thyroid volume and insulin-like growth factor 1 (IGF-1) in the whole group and in females (R = 0.218; p = 0.013, and R = 0.238; p = 0.037, respectively). There was no significant correlation of thyroid volume with disease duration and GH level in the whole group and in both sexes. The patients with secondary hypothyroidism had twofold smaller thyroid volume, relative to the rest of the group. The prevalence of thyroid dysfunction was 39%, with a female to male percentage ratio of 1.73. Goiter was diagnosed in 87% of patients, including diffuse goiter (17.1%) and nodular (69.9%), with no significant difference between patients with active and controlled disease or the presence of secondary hypothyroidism. Conclusions Thyroid volume in patients with acromegaly depends on disease activity and the presence of secondary hypothyroidism as a complication. The increased prevalence of nodular goiter determines the need of regular ultrasound thyroid evaluation in the follow-up of patients with acromegaly. Arch Endocrinol Metab. 2020;64(3):269-75

Macro TSH como causa de hipotiroidismo refractario: a propósito de dos casos clínicos / Macro TSH as a cause of refractory hypothyroidism: based on two clinical cases

Se presenta el caso de dos mujeres con hipotiroidismo, con TSH persistentemente elevada, lo que hacía aumentar la dosis de levotiroxina y llegar a un hipertiroidismo clínico con TSH anormalmente alto. Se realizó un seguimiento de los niveles de TSH y T4 libre, durante un período de 20 y 10 meses respectivamente. En ambas situaciones no hubo una respuesta esperable a las dosis de levotiroxina ascendentes. Después de descartar causas posibles que explicaran esta situación, se sospechó y confirmó la presencia de Macro TSH, que es un complejo biológicamente inactivo de TSH e Inmunoglobulina G. Se obtiene como resultado la estabilidad de ambas pacientes siendo su seguimiento prioritariamente clínico y con mediciones de T4L, comprendiendo por qué la TSH persiste elevada. Nos pareció interesante la comunicación de estos casos, que permite recordar causas atípicas de refractariedad al tratamiento con levotiroxina, como es la macro TSH, indispensable pesquisar para el manejo adecuado de estos pacientes.

An inadequate response to levothyroxine treatment in a patient with hypothyroidism suggests lack of intake, lack of absorption, nephrotic syndrome, thyroid hormone resistance among other reasons. We present the case of two women with hypothyroidism and a persistently elevated level of TSH, which required increasing the dose of levothyroxine, resulting in a clinical hyperthyroidism with an abnormally high TSH. A TSH and free T4 follow up was performed during a period of 20 and 10 months respectively, in both situations there was not an adequate response to rising levothyroxine treatment. After ruling out other possible causes that could explain this situation, it was suspected and then confirmed the presence of Macro TSH, which is a biologically inactive complex of TSH and Immunoglobulin G. Therefore, both patients achieved disease stability once controlled by clinical state and free T4 measurements, understanding why THS persited high. We present these interesting cases, because this allows us to remember atypical causes of refractory treatment with levothyroxine, such as the Macro TSH, indispensable to search for the proper management of these patients.

Thyroid function in pediatric population with different nutritional status / Función tiroidea en población pediátrica con diferente estado nutricional

Abstract: Background: Thyroid dysfunction has been associated with the development of obesity. There are few studies describing their status in Mexican schoolchildren, in whom obesity and subclinical hypothyroidism (SCH) prevail. Methods: Levels of stimulating thyroid hormone (TSH) and thyroid hormones (TH) were correlated with anthropometric variables as indicators of nutritional status in schoolchildren residents of Mexico City. The thyroid status and prevalences of SCH were compared between all the nutritional conditions, considering the degree of pubertal development. Results: The mean of TSH was 2.96 ± 1.48 mIU/L, and the prevalence of SCH was 11.30%. TSH levels are higher in prepubertal (5.21 ±1.24 mIU/L (95% confidence interval [CI]: 3.72-6.69) versus pubertal children (2.96 ± 1.48 mIU/L [95% CI: 2.61-3.30), as well as in children with obesity (3.5 ± 1.13 mIU/L [95% CI: 2.98-4.02]) versus normal weight children (2.43 ± 1.37 mIU/L [95% CI: 1.88 - 2.97]). The TH is similar in the whole population, although triiodothyronine total levels tend to be lower in malnourished children. There is a positive correlation between TSH levels and all anthropometric variables. The prevalences of SCH were higher in groups of children with overweight and obesity. Conclusions: The body fat content is associated with thyroid status in Mexican schoolchildren. In addition, it is relevant to consider the degree of pubertal development for diagnosing hyperthyrotropinemia in children and adolescents.

Resumen: Introducción: La disfunción tiroidea se ha asociado con el desarrollo de obesidad. Existen pocos estudios descritos en población escolar mexicana, en quienes prevalece la obesidad y el hipotiroidismo subclínico (HSC). Métodos: Los niveles de hormona estimulante de tiroides (TSH) y hormonas tiroideas (HT) se correlacionaron con variables antropométricas indicadoras del estado nutricional de niños escolares residentes de la Ciudad de México. El estado tiroideo y las prevalencias de HSC se compararon entre todas las condiciones nutricionales, considerando el grado de desarrollo puberal. Resultados: La media de TSH fue 2.96 ± 1.48 mUI/L, y la prevalencia de HSC fue de 11.30%. Los niveles de TSH fueron mayores en los niños prepúberes (5.21 ± 1.24 mUI/L [intervalo de confianza (IC) 95%: 3.72-6.69]) vs. los niños púberes (2.96 ± 1.48 mUI/L [IC 95%: 2.61-3.30); así como en los niños con obesidad (3.50 ± 1.13 mUI/L [IC 95%: 2.98-4.02]) vs. los niños con peso normal (2.43 ± 1.37 mUI/L [IC 95%: 1.88-2.97]). Los niveles de HT son similares en toda la población, aunque los niveles de triiodothyronine total (T3) tienden a ser menores en niños desnutridos. Existe correlación positiva entre los niveles de TSH y todas las variables antropométricas. Las prevalencias de HSC fueron mayores en los grupos de niños con sobrepeso y obesidad. Conclusiones: El contenido de grasa corporal está asociado con el estado tiroideo en escolares mexicanos. Adicionalmente, es relevante considerar el grado de desarrollo puberal para el diagnóstico adecuado de hipertirotropinemia en niños y adolescentes.

Discrepancia en concentraciones de hormonas tiroideas libres medidas por distintos inmunoensayos / Discrepancy in concentrations of free thyroid hormones measured by different immunoassays

Abstract: Thyroid function is assessed by measuring thyrotropin and free and total thyroid hormone concentrations. There are interferences with the results of immunoassays that can lead to an incorrect diagnosis, of which the most frequent are the binding of thyroid hormones to heterophile antibodies, rheumatoid factor, anti-Ruthenium antibodies, the intake of biotin and anti-streptavidin antibodies. We present three cases of clinically euthyroid patients, with normal TSH, high free T4 and T3, and normal total T4 and T3 performed in a Roche Diagnostics ® COBAS 8000 device. When the test was repeated on a Siemens® Immulite device, the free and total hormones were within normal ranges. In the Roche Diagnostics ® assay, the presence of biotin or anti-Ruthenium or anti-streptavidin antibodies interferes with the formation of the complex responsible for the emission of light that allows inferring concentrations of thyroid hormones. The Siemens test works differently since the emission of light depends on the binding of T4 to an antibody conjugated with alkaline phosphatase not participating in the process biotin, streptavidin or ruthenium so this interference is avoided. This possible interference in immunoassays should be taken into account in case clinical manifestations differ from these laboratory determinations, to avoid a diagnosis and potential inappropriate treatment.

Resumen: La función tiroidea se evalúa midiendo tirotropina y concentraciones de hormonas tiroideas libres y totales. Existen interferencias con los resultados de inmunoensayos que pueden llevar a un diagnóstico incorrecto, de ellas, las más frecuentes son la unión de hormonas tiroideas a anticuerpos heterófilos, el factor reumatoide, anticuerpos anti Rutenio, la ingesta de biotina y anticuerpos anti estreptavidina. Se presentan tres casos de pacientes clínicamente eutiroideos, con TSH normal, T4 y T3 libres elevadas, y T4 y T3 totales normales realizadas en un equipo COBAS 8000 de Roche Diagnostics®. Cuando se repitió el ensayo en un equipo Immulite de Siemens®, las hormonas libres y totales estaban dentro de rangos normales. En el ensayo de Roche Diagnostics ®, la presencia de biotina o anticuerpos anti Rutenio o anti estreptavidina, interfiere con la formación del complejo responsable de la emisión de luz que permite inferir las concentraciones de las hormonas tiroideas. El ensayo de Siemens funciona de manera diferente ya que la emisión de luz depende de la unión de la T4 a un anticuerpo conjugado con fosfatasa alcalina no participando en el proceso biotina, estreptavidina o Rutenio por lo que se evita esta interferencia. Esta posible interferencia en inmunoensayos debe ser tenida en cuenta en caso de que las manifestaciones clínicas difieran de estas determinaciones de laboratorio, para evitar un diagnóstico y potencial tratamiento inadecuado.

Decompensated cirrhosis; thyroid hormone levels in patients

Objective: The objective of the study is to find out, the levels of thyroid hormones in serum of the patients having decompensate cirrhosis and to determine the frequency of signs and symptoms of thyroid dysfunctions in such patients. Study design: Prospective descriptive study. Setting: All medical wards of Civil Hospital and Ojha campus, Dow University of Health Sciences, Karachi, Pakistan. Period: May 2013 to January 2015

Methodology: 76 patients having decompensated liver cirrhosis with various presentations, which were fulfilling the inclusion and exclusion criteria and were admitted in medical wards during the study period, were included in this study. Detailed history and examination of each case was performed. Thyroid hormone levels were performed along with other relative laboratory investigations and the results were obtained

Results: Out of 76 patients 58 patients had low serum T3 levels, whereas 18 had normal T3 levels. 65 patients had normal T4 levels and 11 had low serum T4 levels. The TSH levels were found normal in 74 patients and two patients had raised TSH levels

Conclusion: It is concluded that T3 levels is low in cirrhotic patients but at the same time T4 and TSH levels remains normal in majority of cases and the patients remain euthyroid. As far as the clinical scenario is concern, no significance was found in the frequency of sign and symptoms of thyroid dysfunction. Most of the patients did not show signs and symptoms of hyper and hypothyroids

Lethal pulmonary thromboembolism associated with decreased thyroid hormone levels

Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people. We report here the cases of two young patients with decreased levels of thyroid hormones whose death was caused by an increased thrombotic status, with venous thrombosis and pulmonary thromboembolism. In both cases the thyroid pathology was not considered as the underlying cause of death as the association between this condition and venous thrombosis is still debatable. However its presence may be considered a circumstantial factor, which could increase the severity of the disease and subsequently the lethality rate in pulmonary thromboembolism. An increased awareness for hypothyroidism or subclinical hypothyroidism in clinical practice may lead to a decrease in mortality secondary to thromboembolic disease. Also, increased awareness for thyroid pathology during forensic autopsy in sudden deaths may lead to potentially significant results, that could explain some of the sudden death with an unknown cause, and decrease the number of the so called blank autopsies.

The influence o end-stage liver disease and liver transplantation on thyroid hormoess / Avaliação do impacto da cirrose e do transplante hepático na função tireoidiana

Background Thyroid dysfunction has been reported in most chronic illnesses including severe liver disease. These defects in thyroid hormone metabolism result in the sick euthyroid syndrome, also known as low T3 syndrome. Objectives Our objective was to evaluate the thyroid function in patients with end stage liver disease prior and after deceased donor liver transplantation and to correlate thyroid hormonal changes with the MELD score (Model for End stage Liver Disease). Methods In a prospective study, serum levels of thyrotropin (thyroid stimulating hormone TSH), total thyroxine (tT4), free thyroxine (fT4) and triiodothyronine (T3) from 30 male adult patients with end stage liver disease were measured two to four hours before and 6 months after liver transplantation (LT). MELD was determined on the day of transplant. For this analysis, extra points were not added for patients with hepatocellular carcinoma. Results The patients had normal TSH and fT4 levels before LT and there was no change after the procedure. Total thyroxine and triiodothyronine were within the normal range before LT, except for four patients (13.3%) whose values were lower. Both hormones increased to normal values in all four patients after LT (P=0.02 and P<0.001, respectively). When the patients were divided into two groups (MELD <18 and MELD >18), it was observed that there was no change in the TSH, freeT4, and total T4 levels in both groups after LT. Although there was no significant variation in the level of T3 in MELD <18 group (P=0.055), there was an increase in the MELD >18 group after LT (P=0.003). Conclusion Patients with end stage liver disease subjected to liver transplantation had normal TSH and fT4 levels before and after LT. In a few patients with lower tT4 and T3 levels before LT, the level of these hormones increased to normal after LT. .

Contexto A disfunção tireoidiana tem sido relatada em associação com a maioria das doenças crônicas, incluindo a doença hepática terminal. Estes defeitos no metabolismo dos hormônios tireoidianos resultam na síndrome do doente eutireoideo ou, também conhecida como síndrome do T3 baixo. Objetivos Avaliar a função tireoidiana em pacientes com doença hepática avançada, antes e depois de serem submetidos ao transplante hepático cadavérico (THC) e, correlacionar as alterações hormonais da tireóide com o MELD. Métodos Em um estudo prospectivo, os níveis séricos de tireotropina (hormônio estimulante da tireóide TSH), tiroxina total (T4 total), tiroxina livre (T4 livre) e triiodotironina (T3) de 30 pacientes adultos do sexo masculino com doença hepática terminal foram dosados 2 e 4 horas antes e 6 meses após o THC. O valor do MELD foi determinado no dia do procedimento. Para esta análise, os pontos extras não foram adicionados para os pacientes com carcinoma hepatocelular. Resultados Os pacientes apresentaram níveis de TSH e T4 livre normais antes do THC e não houve nenhuma alteração após o procedimento. As dosagens de T4 total e T3 no início do estudo estavam dentro da faixa normal, exceto por quatro pacientes (13,3%), os quais apresentavam valores abaixo da referência. Ambos os hormônios apresentaram um aumento 6 meses após o THC (P=0,02 e P<0,001, respectivamente). Quando os pacientes foram divididos em dois grupos (MELD <18 e MELD >18) não observamos diferença nos níveis de TSH, T4 total e T4 livre entre os grupos após THC. Apesar de não haver variação nos níveis de T3 no grupo com MELD <18 (P=0,055), houve um aumento no grupo MELD >18 após THC (P=0,003). Conclusão Os pacientes com cirrose hepática submetidos a transplante hepático tinham valores normais de TSH e T4 livre antes e após o THC. Nos poucos pacientes que apresentavam valores baixos de T4 total e T3 antes do THC, houve normalização destes hormônios após o THC. .

Synergic actions of polyphenols and cyanogens of peanut seed coat (Arachis hypogaea) on cytological, biochemical and functional changes in thyroid.

In animals, long-term feeding with peanut (Arachis hypogaea) seed coats causes hypertrophy and hyperplasia of the thyroid gland. However, to date there have been no detailed studies. Here, we explored the thyroidal effects of dietary peanut seed coats (PSC) in rats. The PSC has high levels of pro-goitrogenic substances including phenolic and other cyanogenic constituents. The PSC was mixed with a standard diet and fed to rats for 30 and 60 days, respectively. Animals fed with the PSC-supplemented diet showed a significant increase in urinary excretion of thiocyanate and iodine, thyroid enlargement, and hypertrophy and/or hyperplasia of thyroid follicles. In addition, there was inhibition of thyroid peroxidase (TPO) activity, 5’-deiodinase-I (DIO1) activity, and (Na+-K+)-ATPase activity in the experimental groups of rats as compared to controls. Furthermore, the PSC fed animals exhibited decreased serum circulating total T4 and T3 levels, severe in the group treated for longer duration. These data indicate that PSC could be a novel disruptor of thyroid function, due to synergistic actions of phenolic as well as cyanogenic constituents.

Fármacos de amplo uso na prática clínica que interagem com os hormônios tireoidianos / Widely used drugs in clinical practice that interact with thyroid hormones

Vários fármacos de amplo uso na prática clínica interagem com os hormônios tireoidianos, alterando a função da tireoide. Boa parte dos pacientes submetidos à avaliação da tireoide faz uso de diversos fármacos, sendo importante saber quais são as interações. O objetivo deste estudo foi rever, na literatura, os principais medicamentos amplamente utilizados na prática clínica que interagem com os hormônios tireoidianos. A produção desses hormônios ocorre por meio de diversos mecanismos, que podem interagir com várias drogas, resultando em disfunção tireoidiana. Alguns fármacos podem causar tanto tireotoxicose, como hipotireoidismo; é o caso do iodo, da amiodarona e da interleucina-2. A radiação ionizante pode produzir tireoidite aguda, crônica e câncer de tireoide. O carbonato de lítio inibe a secreção dos hormônios tireoidianos, estimulando o hormôniotireo estimulante e levando à formação de bócio. A quimioterapia citotóxica pode causar alterações no hipotálamo, na hipófise e na tireoide. Os glicocorticoides apresentam efeitos variáveis e múltiplos. Alguns fármacos afetam as proteínas transportadoras de hormônios tireoidianos, como os salicilatos, a heparina e o estrogênio. Anticonvulsivantes atuam sobre os hormônios tireoidianos, interferindo na ligação com proteínas transportadoras e acelerando o metabolismo hepático. A dopamina inibe diretamente a secreção do TSH. O propranolol tem efeito discreto, relacionado a doses >160mg/dia.O conhecimento sobre as interações permite identificar uma droga como causa de disfunção da tireóide, a execução de testes de triagem em indivíduos expostos a elas e evitar seu uso em pacientes com risco de desenvolver doenças da tireóide...

Many drugs of wide use in clinical practice interact with thyroid hormones, changing thyroid function. Much of the patients that have their thyroid studied make use of multiple medications, being important to know which the interactionsare. The aim of this study was to review in the literature the main drugs widely used in clinical practice that interacts with thyroid hormones. The production of these hormones occurs through several mechanisms which may interact with various drugs, causing thyroid dysfunction. Some medicines cancause both thyrotoxicosis and hypothyroidism, such as iodine, amiodarone and interleukin-2. Ionizing radiation may produce acute thyroiditis, chronic thyroiditis and thyroid cancer. Lithium carbonate inhibits the secretion of thyroid hormones, stimulating TSH, leading to the formation of goiter. Cytotoxic chemotherapy can cause changes in the hypothalamus, pituitary and thyroid. Glucocorticoids have multiple and variables effects. Some drugs affect thyroid hormones transporter proteins, such assalicylates, heparin and estrogen. Anticonvulsants have effect on thyroid hormones, interfering with protein binding carriers and accelerating hepatic metabolism. Dopamine inhibits directly the secretion of TSH. Propranolol has slight effect, related to doses>160mg/day. The knowledge about the interactions allows to identify a drug as a cause of thyroid dysfunction, the execution of screening tests in individuals exposed to them and avoid its use in patients with risk of developing thyroid disease...

Urinary iodine excretion in healthy Mexican adults / Excreción urinaria de yodo en adultos sanos mexicanos

The iodine nutritional status of a population is mainly measured by urinary iodine excretion (UI) and thyroid volume determined by ultrasound (US). The surveillance of nutritional iodine levels in the Mexican population has been insufficient. Our aim was to determine the UI in random samples from adults living in an urban area. We selected a sample of healthy individuals over the age of 18 that were students, physicians or administrative personnel at our Institution and had no known thyroid disease. Thyroid volume was determined by ultrasound in all volunteers as well as thyroid hormones and antithyroid antibodies and a urine sample was obtained. One hundred and two volunteers with a median age of 29, participated in the study. The group’s median UI was 221 μg/L,interquartile range (IQR)(135.0 to 356.8) and no differences were observed between genders: women had a UI of 218.0 μg/L IQR (129.0 a 351.0) vs. 223.0 μg/L IQR (138.0 to 374.0) in males, p 0.941. Excessive dietary iodine intake was established in 31.4% of all volunteers according to their UI, placing them at risk of thyroid dysfunction. It is fundamental to evaluate the national iodine nutritional status in Mexico. We discuss the current status of the nutritional state in the Americas, emphasizing that in Latin America and the observed tendency in the region to ingest a diet high in iodine.

El estatus nutricional del yodo en una población, principalmente es medido por la excreción del yodo urinario (UI) y el cálculo del volumen tiroideo por ultrasonido (US). La vigilancia nutricional del yodo en la población en México ha sido escasa. El objetivo fue determinar la UI en una muestra casual en adultos sanos que habitan en un área urbana. Se seleccionó una muestra de individuos mayores de 18 años, entre estudiantes, médicos y trabajadores administrativos de nuestra institución, sanos, sin enfermedad tiroidea conocida. A todos los voluntarios se les determinó el volumen tiroideo por US, hormonas y anticuerpos antitiroideos y se les solicitó una muestra de orina. Participaron 102 voluntarios, mediana de 29 años. La mediana de la UI del grupo fue 221 μg/L, rango intercuartílico (RIQ) (135.0 a 356.8), no hubo diferencias entre géneros, las mujeres tuvieron una UI de, 218.0 μg/L RIQ (129.0 a 351.0) vs 223.0 μg/L RIQ (138.0 a 374.0) p 0.941. El 31.4% de los voluntarios mostraron una ingestión excesiva de yodo en la dieta de acuerdo a la UI, lo cual los coloca en riesgo de sufrir disfunción tiroidea. Es necesario considerar la evaluación Nacional del estatus nutricional del yodo, en México. En el artículo se discute la situación actual del estatus nutricional en las Américas, haciendo énfasis en Latinoamérica y a la tendencia de la región a la dieta excedida en yodo.

Polineuropatia hipotireóidea em um paciente com síndrome poliglandular autoimune tipo 2: relato de caso / Hypothyroid polyneuropathy in a patient with autoimmune polyglandular syndrome type 2: case report

A incidência de polineuropatia em indivíduos com hipotireoidismo não é precisamente conhecida, mas alguns estudos relatam que cerca de 25% a 42% dos pacientes podem apresentar sinais clínicos neuropáticos. A seguir, relataremos um caso de síndrome poliglandular autoimune tipo 2 (SPA-2), cuja apresentação inicial foi uma polineuropatia hipotireóidea. Homem de 41 anos com queixas de parestesias e fraqueza lentamente progressiva acometendo os quatro membros associadas a sonolência frequente, astenia, intolerância ao frio, vertigens, náuseas e avidez por sal. O exame físico geral evidenciava hiperpigmentação de pele e mucosas, além de hipotensão. O exame neurológico demonstrou apenas hiporreflexia profunda global e simétrica com discretos sinais de hipoestesia superficial em extremidades dos membros. O estudo eletroneuromiográfico (ENMG), juntamente com a avaliação laboratorial, confirmou a suspeita de tireoidite de Hashimoto associada à doença de Addison, caracterizando o quadro de SPA-2. O paciente foi tratado com fludrocortisona 0,05 mg/dia e levotiroxina 100 mcg/dia e apresentou resolução gradual e completa das queixas e das alterações encontradas nos exames físico geral e neurológico. O ENMG, repetido após seis meses, evidenciou resolução completa do quadro neuropático. Este relato mostra um caso raro de SPA-2 apresentando-se como uma polineuropatia hipotireóidea e reforça a relevância da dosagem de hormônios tireoideanos em síndromes polineuropáticas. A reposição de levotiroxina mostrou-se efetiva em reverter o quadro clínico e eletrofisiológico da neuropatia. .

The incidence of polyneuropathy in patients with hypothyroidism is not precisely known, but some studies report that about 25% to 42% of patients may show neuropathic clinical signs. We report a case of autoimmune poliglandular syndrome type 2 (APS-2), whose initial presentation was hypothyroid polyneuropathy. A 41-year-old man complained of slowly progressive paresthesias and weakness affecting all four limbs, and associated with frequent drowsiness, weakness, cold intolerance, dizziness, nausea, and craving for salt. General physical examination showed hyperpigmentation of skin and mucous membranes, and hypotension. Neurological examination showed global, deep, and symmetrical hyporeflexia with slight signs of superficial hypoesthesia in the limbs. Electrodiagnostic studies (ENMG) together with laboratory tests, confirmed the suspicion of Hashimoto’s thyroiditis associated with Addison’s disease featuring the picture of APS-2. The patient was treated with fludrocortisone 0.05 mg/day and levothyroxine 100 mcg/day, and showed gradual and complete resolution of complaints. Changes were found in general physical and neurological examinations. ENMG repeated six months later showed complete resolution of neuropathy. This report shows a rare case of APS-2 presented as polyneuropathy hypothyroidism, and reinforces the importance of dosing thyroid hormone in polyneuropathy syndromes. Levothyroxine replacement was shown to be effective in reversing clinical and electrophysiologic neuropathy.

Antepartal insulin-like growth factor concentrations indicating differences in the metabolic adaptive capacity of dairy cows

Cows with different Insulin-like Growth Factor-I (IGF-I) concentrations showed comparable expression levels of hepatic growth hormone receptor (GHR). Suppressor of cytokine signaling 2 (SOCS2), could be responsible for additional inhibition of the GHR signal cascade. The aims were to monitor cows with high or low antepartal IGF-I concentrations (IGF-I(high) or IGF-I(low)), evaluate the interrelationships of endocrine endpoints, and measure hepatic SOCS2 expression. Dairy cows (n = 20) were selected (240 to 254 days after artificial insemination (AI)). Blood samples were drawn daily (day -17 until calving) and IGF-I, GH, insulin, thyroid hormones, estradiol, and progesterone concentrations were measured. Liver biopsies were taken (day 264 +/- 1 after AI and postpartum) to measure mRNA expression (IGF-I, IGFBP-2, IGFBP-3, IGFBP-4, acid labile subunit (ALS), SOCS2, deiodinase1, GHR1A). IGF-I concentrations in the two groups were different (p 0.05). Thyroxine levels and ALS expression were higher in the IGF-I(high) cows compared to IGF-I(low) cows. Estradiol concentration tended to be greater in the IGF-I(low) group (p = 0.06). It was hypothesized that low IGF-I levels are associated with enhanced SOCS2 expression although this could not be decisively confirmed by the present study.

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome. .

relationship between iron status and thyroid hormone concentration among females [15 - 49] years old attending primary health care centers [PHCC] in Baghdad governorate

Several minerals and trace elements are essential for normal thyroid hormone metabolism, e.g., iodine, iron, and zinc. Coexisting deficiencies of these elements can impair thyroid function. The present study is an attempt to estimate the impact of iron deficiency anemia among women of child birth on thyroid function. The study was conducted during the period from the April to July 2009; the sample was comprised of 300 women who were between 15 to 49 years old attending the antenatal care clinics in Baghdad governorate. Cross - sectional study was carried out in six primary health care centers [PHCC], selected conveniently. The data were collected through direct interview, for each women Serum samples were collected and assayed for serum ferritin, thyroid stimulating hormone [TSH], thyroxin [T4], triiodothyronine [T3] and hemoglobin [Hb], The study showed that 30% of women were anemic; the effect of anemia on thyroid function was not clear as 98% of the studied women have normal thyroxin and only 1% has low thyroxin level while 1% showed high concentration of thyroxin level. "This research did not find any correlation between anemia markers and thyroxin concentrations. These data suggest that anemia does not influence thyroid function in our study population"

Avaliação do peso corporal em pacientes com doença de Graves durante o tratamento com metimazol / Evaluation of body weight in patients with Graves' disease during the treatment with methimazole

OBJETIVO: Avaliar a alteração de peso durante o tratamento do hipertiroidismo e correlacioná-la com IL-6 e TNF-alfa. SUJEITOS E MÉTODOS: Quarenta e dois pacientes foram incluídos. Peso corporal (PC), índice de massa corpórea (IMC), características clínicas e laboratoriais foram registrados. IL-6 e TNF-alfa foram determinados antes do tratamento com metimazol (MMI) e no estado de eutiroidismo. RESULTADOS: O PC foi de 59,62 ± 11,5 kg no estado de hipertiroidismo e de 69,91 ± 14,4 kg no estado de eutiroidismo (p < 0,001). O IMC aumentou de 23,1 ± 3,8 kg/m² para 27 ± 4,7 kg/m² durante o tratamento (p < 0,0001). Antes da terapia, 66,6% tinham IMC < 25 kg/m² e 33,3%, IMC > 25 kg/m². No estado de eutiroidismo, 38% dos pacientes apresentavam IMC < 25 kg/m² e 62%, IMC > 25 kg/m² (p = 0,01). No estado de eutiroidismo, encontrou-se significativa diminuição nos valores de IL-6 e TNF-alfa, mas nenhuma correlação entre IL-6 e TNF-alfa com PC ou IMC. CONCLUSÃO: Um importante aumento no PC e IMC foi observado durante o tratamento do hipertiroidismo e alterações de IL-6 e TNF-alfa relacionam-se somente com o retorno ao eutiroidismo.

OBJECTIVE: To evaluate weight change during hyperthyroidism treatment, and to correlate it with IL-6 and TNF-alpha concentrations. SUBJECTS AND METHODS: Forty two patients were included. Body weight (BW), body mass index (BMI), clinical and laboratory characteristics were recorded. IL-6 and TNF-alpha were determined before treatment with methimazole (MMI) and in euthyroidism. RESULTS: BW was 59.62 ± 11.5 kg in hyperthyroidism, and 69.91 ± 14.4 kg in euthyroidism (p < 0.001). BMI increased from 23.1 ± 3.8 kg/m² to 27 kg/m² ± 4.7 during treatment (p < 0.0001). Before treatment, 66.6% subjects had BMI < 25 kg/m² and 33.3%, BMI > 25 kg/m². In euthyroidism, 38% of patients had BMI < 25 kg/m² and 62%, BMI > 25 kg/m² (p = 0.01). In euthyroidism, we found a significant reduction in IL-6 and TNF-alpha concentrations, but no correlation between IL-6 and TNF-alpha, and BW or BMI. CONCLUSION: An important increase in BW and BMI was observed during hyperthyroidism treatment, and IL-6 and TNF-alpha alterations were only related with return to euthyroidism.

Perfil dos hormônios da tireoide em pacientes com câncer de mama em estado de menopausa / Thyroid hormone profile in breast cancer patients in postmenopause

OBJETIVO: Verificar o perfil dos hormônios tireóideos (HTs) em pacientes pós-menopausa portadoras de carcinoma de mama (CaM). SUJEITOS E MÉTODOS: Participaram 12 pacientes com CaM em estádio I ou II sem intervenções que pudessem interferir na progressão tumoral e um grupo controle com 18 pacientes em pós-menopausa sem CaM. Foram dosados os níveis séricos de anticorpo antitiroperoxidase (TPOAB), hormônio estimulante da tireoide (TSH), tiroxina livre (T4L), estradiol (E2), hormônio folículo estimulante (FSH) e hormônio luteinizante (LH) antes e após a cirurgia, e realizada a imunoistoquímica dos receptores de estrógeno (ER) e progesterona (PR). RESULTADOS: Quatro pacientes com CaM apresentaram alterações do perfil hormonal tireoidiano: dois hipertireoidismo, um hipotireoidismo e positividade TPO-AB, todas com ER e PR positivos. Os níveis de TSH dessas pacientes não foram diferentes dos níveis encontrados no grupo controle (1,89 ± 1,56 vs. 2,86 ± 3,12 mUI/mL), porém os níveis de T4L nas pacientes com CaM foram estatisticamente maiores que o controle (1,83 ± 0,57 vs. 1,10 ± 0,20 ng/dL). CONCLUSÃO: Esses resultados reforçam a necessidade de avaliação do status tireoidiano em pacientes com CaM, uma vez que, na ausência de E2, mudanças clínicas nos HTs podem atuar em vias controladas pelo E2.

OBJECTIVE: The aim of this study was to determine thyroid hormone (TH) profile in postmenopausal patients with breast cancer (BC). SUBJECTS AND METHODS: 12 CaM patients stages I or II, without interventions that could interfere with tumor progression were selected, as well as and a control group with 18 postmenopausal women without CaM. We measured serum anti-thyroperoxidase antibody (TPOAB), thyroid-stimulating hormone (TSH), free thyroxine (T4L), estradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH), before and after surgery, besides immunohistochemistry for estrogen (ER) and progesterone (PR) receptors. RESULTS: Four patients with CaM showed changes in thyroid hormone profile: two had hyperthyroidism, one hypothyroidism, and one was positive for TPO-AB. All of them positive for ER and PR. TSH levels in breast cancer patients were not different from levels found in the control group (1.89 ± 1.56 vs. 2.86 ± 3.12 mIU/mL), but the levels of T4L in patients with CaM were statistically higher than those of the control group (1.83 ± 0.57 vs. 1.10 ± 0.20 ng/dL). CONCLUSION: These results reinforce the need for assessment of thyroid status in CaM patients, since in the absence of E2, changes in clinical HTs can act in E2-controlled processes.

Effects of heat stress on endocrine functions & behaviour in the pre-pubertal rat.

Background & objectives: Heat stress related hyperthermia may cause damage to various organ systems. There are very few studies on the effects of hyperthermia on the endocrine system. We therefore, investigated effects of exogenously induced hyperthermia on adrenal, testicular and thyroid functions and behavioural alterations in pre-pubertal male Sprague-Dawley rats. Methods: Three groups of 30-day old rats (n=7 per group) were used. Body temperature was increased to 39°C (Group I) and 41°C (Group II) in a hyperthermia induction chamber for 30 min. The rats in the Group III served as control (36 °C). All animals received saline and were decapitated 48 h after the experiments. Serum free triiodothyronin (fT3), free thyroxine (fT4), total testosterone and dehydroepiandrosterone sulphate (DHEA-S) levels were determined by chemiluminescence assay, and corticosterone by enzyme immunoassay. Testes, pituitary and adrenal glands were dissected out and processed for histopathological examination. To assess activity and anxiety of the animals, the open field test and elevated-0-maze test, respectively, were used in all groups 24 h before (day 29) and after (day 31) hyperthermia induction. Results: Serum corticosterone levels (3.22±1.3) were significantly reduced in the 39°C (1.3±0.9) and 41°C (1.09±0.7) hyperthermia groups (P<0.01) compared to controls. Serum levels of thyroid hormones did not significantly differ among the groups. DHEA-S and testosterone values were below the limit of detection in all groups. Histopathological examination revealed that there was mild hydropic degeneration in the pituitary and adrenal glands. Apoptotic germ cells were seen in the seminiferous tubules of pre-pubertal male rats exposed to hyperthermia (41°C). Progression time in the open field test was significantly decreased and anxiety test scores increased in animals exposed to 39°C compared to the control group (P<0.01). These parameters were more pronounced in the 41°C hyperthermia group. Interpretation & conclusions: Our results show that heat exposure-induced stress may cause delayed reduction in serum corticosterone levels which may be associated with behavioural deficits in pre-pubertal male rats.

Histological, histometrical and thyroid hormones serum level evaluation after chronic nicotine exposure in mice

Nicotine is an ingredient of cigarette smoke that has a lot of psychological and physical effects on addicted persons. The aim of this study was to evaluate nicotine effects on functional and histological alteration in thyroid gland that has important role on metabolic activities. In this experimental study, 40 mature male mice [25-30 gr] were divided to one control group and 3 experimental groups that received nicotine with dosage of 100, 200 and 400 micro g/kg via oral gavage once a day for 60 days. Then, T[3], T[4] and TSH serum levels were measured and histomorphometric evaluation of thyroid gland was done. Significant decrease in body weight and thyroid follicular epithelial height and significant increase in serum level of T[3] were noted. This study showed that nicotine can cause alteration on metabolic activities of thyroid gland via the increase of T[3] serum level and the decrease of follicular epithelial height

Effect of posttraumatic serum thyroid hormone levels on severity and mortality of patients with severe traumatic brain injury

Traumatic brain injury [TBI] is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale [GCS] score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission

Inhibited thyroid function, impaired lipid metabolism and increased tissue oxidative stress in rats native to high altitude

To evaluate the effect of high altitude on markers of thyroid function, serum lipid profile and tissues oxidative stress in male Wistar rats native to high altitude [HA] with male rats native to low altitude [LA]. Randomized experimental animal study. Physiology laboratory, Medical School of King Khalid University. Male rats aged six months, weighing 250 gm were bred and maintained at low altitude [LA, 600 m above sea level, n=6] or high altitude [HA, 2800 m, n=6], under the same laboratory conditions and fed the same diet. Blood samples were obtained for thyroid hormones and lipid profile analysis. Livers, kidneys, lungs and testes were collected and used for determination levels of thiobarbituric acid reactive substances [TBARS], reduced glutathione [GSH], Superoxide Dismutase [SOD] and Catalase Activity [CAT]. HA rats had significantly [P<0.05] lower serum T3 [17.14%], T4 [13.75%], TSH [39.29%] and total cholesterol [15.84%] and LDL [60.90%].There were no significant differences in TAG or HDL. All tissues from HA rats showed significant decreases in SOD and CAT activities compared to LA rats. These rats showed significantly higher oxidative stress in the lungs and the liver, but lower oxidative stress in the kidney and no difference in the testes. Living at high altitude environment results in impaired thyroid function and lipid metabolism and causes increased tissue oxidative stress