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1.
Evid. actual. práct. ambul ; 25(1): e2087, 2022.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367592

ABSTRACT

Un estudio mostró que el aumento de valores de la hormona estimulante de la tiroides se asoció a un aumento de mortalidad por todas las causas, estimando que las enfermedades cardiovasculares mediaban dicha asociación en aproximada-mente el 14 % de los casos. Asimismo se observó que el reemplazo con levotiroxina disminuiría los niveles de colesterol, lo cual podría tener un efecto en la reducción de enfermedades cardiovasculares. Partiendo de una viñeta clínica la autora intenta, a través de una búsqueda bibliográfica y análisis de la evidencia, determinar si el tratamiento del hipotiroidismo subclínico en adultos mayores reduciría la morbimortalidad por eventos cardiovasculares. (AU)


A study showed that increased thyroid-stimulating hormone levels were associated with increased all-cause mortality, with cardiovascular disease estimated to mediate this association in approximately 14 % of cases. Additionally, levothyroxine replacement was found to lower cholesterol levels, which could have an effect in reducing cardiovascular diseases. Basedon a clinical vignette, the author attempts, through a literature search and an analysis of the evidence, to determine whether treatment of subclinical hypothyroidism in older adults would reduce morbidity and mortality from cardiovascular events. (AU)


Subject(s)
Humans , Female , Aged , Thyroxine/therapeutic use , Cardiovascular Diseases/mortality , Cardiovascular Diseases/epidemiology , Hypothyroidism/drug therapy , Indicators of Morbidity and Mortality , Age Factors , Hypothyroidism/blood
2.
repert. med. cir ; 31(1): 89-93, 2022. ilus.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1367104

ABSTRACT

Introducción: en el presente reporte de caso se presenta una urgencia endocrinológica, el coma mixedematoso. Se considera una descompensación del hipotiroidismo y su mortalidad es alta alcanzando hasta 52% en algunas series de casos. Puede desencadenarse por múltiples factores y su presentación clínica es muy variada ya que comprende la afección de diversos sistemas. Presentación del caso: se presenta el caso de una paciente femenina de 42 años de edad que consultó al servicio de urgencias del Hospital de San José de Bogotá con sospecha inicial de una de falla cardiaca descompensada, sin embargo, cursó con pobre mejoría ante el manejo instaurado, por lo cual se realizaron estudios de extensión en donde se encontró una función tiroidea deprimida. Discusión y conclusiones: en este momento se consideró que la paciente padecía un coma mixedematoso, se instauró manejo con dosis altas de levotiroxina oral con lo cual evolucionó de manera favorable y se logró dar de alta a los pocos días.


Introduction: herein we present an endocrine emergency, myxedema coma, which is a form of decompensated hypothyroidism, whose mortality may be as high as 52% as evidenced in some case series. It may be triggered by multiplefactors and has varied clinical presentations for it affects diverse organ systems. Case presentation:we present the case of a 42-year-old female who presented to the emergency department of Hospital de San José in Bogotá with clinical suspicion of decompensated heart failure upon admission, however, her response was poor to the treatment she received. Extension studies were performed which showed low thyroid function. Discussion and conclusions: at this point the patient was diagnosed with myxedema coma, and was started on high doses of oral levothyroxine, with which she evolved favorably and was discharged a few days later.


Subject(s)
Humans , Female , Adult , Thyroid Gland , Hypothyroidism , Myxedema , Thyroxine , Emergencies
3.
Braz. j. biol ; 81(3): 592-600, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153379

ABSTRACT

Abstract Understanding the relation between the environmental stress factors and the hypothalamus-pituitary-thyroid (HPT) axis efficiency can reduce the susceptibility to thyroid diseases. In our study, thyroid dysfunction was induced in female rats by administration of 40 mg Na F/kg.bd.wt/day for a month. Co-administration of the water extract of Arca noae (300 mg/kg. bw) was tested as a treatment for Na F induced thyroid dysfunction. A group of rats injected Arca noae extract only (300 mg/kg.bd.wt) was performed to observe the impact of the extract on the (HPT) axis in addition to the normal control group. Results showed that there was a significant decrease in serum triglycerides, total protein and albumin levels in the fluoride supplemented group in addition to abnormal levels of TSH, (T4) and (T3) compared to the control group. In the treated group there was an improvement in the proteins level and lipid profile but pseudo-corrected serum (T4) and (T3) levels were observed in addition to a continuous increase in TSH level. Histological findings confirmed the harmful effect of fluoride on both the non treated and the treated groups. Consequently, fluoride supplementation must be considered as a harmful stress that may affect permanently the HPT axis.


Resumo Compreender a relação entre os fatores de estresse ambiental e o eixo hipotálamo-hipófise-tireoide (HPT) pode reduzir a suscetibilidade a doenças da tireoide. Em nosso estudo, a disfunção tireoidiana foi induzida em ratos fêmeas pela administração de 40 mg Na F/kg.bw/dia durante um mês. A administração concomitante do extrato aquoso de Arca noae (300 mg/kg.Pc) foi testada como tratamento para a disfunção tireoidiana induzida por Na F. Um grupo de ratos injetados apenas com extrato de Arca noae (300 mg/kg. Pc) foi pré-formado com o intuito de observar o impacto do extrato no eixo (HPT), além do grupo controle normal. Os resultados mostraram que houve uma diminuição significativa nos níveis séricos de triglicerídeos, proteína total e albumina no grupo suplementado com fluoreto, além de níveis anormais de TSH, (T4) e (T3) em comparação ao grupo controle. No grupo tratado, houve uma melhora no nível de proteínas e perfil lipídico. Os níveis séricos pseudocorrigidos (T4) e (T3) foram observados, além de um aumento contínuo no nível de TSH. Os achados histológicos confirmaram o efeito prejudicial do flúor nos grupos não tratado e tratado. Consequentemente, a suplementação de flúor é considerada um estresse prejudicial que pode afetar permanentemente o eixo HPT.


Subject(s)
Animals , Female , Rats , Thyroid Diseases , Thyrotropin , Thyroxine , Aquatic Organisms
4.
Arq. bras. med. vet. zootec. (Online) ; 73(4): 955-965, Jul.-Aug. 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1285270

ABSTRACT

The aim of this study was to evaluate the reasons of quality deviation of a concentrate from a predefined standard. Five treatments were established: T1 - Control, standard concentrate formulation (SCF); T2 - PXMore5, SCF with more 5% vitamin-mineral premix (VMP); T3 - PXLess5, SCF with less 5% VMP. All three treatments used a 400kg batches in an INTECNIAL mixer; T4 - FeedMixer, SCF using a 4,000kg batch in an IMOTO mixer; T5 - PremixMixer, SCF using a 1,200kg batch in an MUYANG mixer. For each treatment, bags of 20 kg were stored in three storage places for four months. Water activity of concentrate was affected by temperature and air relative humidity in different storage places. Regarding the kind of mixer, the greatest variation in concentration of crude protein, mineral residue, copper, zinc, and selenium was observed in the PremixMixer. Adjustments are imperative in the handling and use procedures of this kind of mixer to meet the quality requirements required in the concentrate production. Analyzing the effect of the mineral-vitamin premix level, no difference could be defined with the evaluated parameters.(AU)


O objetivo deste estudo foi avaliar as razões do desvio de qualidade de um concentrado de um padrão predefinido. Foram estabelecidos cinco tratamentos: T1 - controle, concentrado com formulação padrão (CFP); T2 - PXMais5, CFP com 5% a mais de vitaminas e minerais da pré-mistura (PVM); T3 - PXMenos5, CFP com 5% a menos de PVM. Todos esses três tratamentos utilizaram lotes de 400kg em um misturador INTECNIAL; T4 - FeedMixer, CFP usando um lote de 4.000kg em um misturador IMOTO; T5 - PremixMixer, CFP usando um lote de 1.200kg em um misturador MUYANG. Para cada tratamento, sacos de 20kg foram armazenados em três ambientes distintos por quatro meses. A atividade de água do concentrado foi afetada pela temperatura e umidade relativa do ar em diferentes locais de armazenamento. Em relação ao tipo de misturador, a maior variação na concentração de proteína bruta, resíduo mineral, cobre, zinco e selênio foi devido ao PremixMixer. Ajustes são imperativos nos procedimentos de manuseio e uso desse tipo de misturador para atender aos requisitos de qualidade exigidos na produção de concentrado. Ao se analisar o efeito do nível da pré-mistura de vitaminas e minerais, nenhuma diferença pôde ser definida com os parâmetros avaliados.(AU)


Subject(s)
Animals , Swine , Nutrients/administration & dosage , Animal Feed/analysis , Selenium , Thyroxine , Triiodothyronine , Vitamins , Zinc , Copper
5.
Rev. bras. med. fam. comunidade ; 16(43): 2486, 20210126. tab, ilus
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1292038

ABSTRACT

Introdução: As interações medicamentosas podem alterar a segurança e/ou efetividade no tratamento das doenças. Alguns medicamentos precisam ser utilizados em jejum e a literatura apresenta informações divergentes sobre o real impacto clínico do uso destes no mesmo horário. Objetivos: Analisar as evidências sobre a relevância clínica de potenciais interações entre inibidores da bomba de prótons (IBPs), levotiroxina e alendronato de sódio. Métodos: Realizou-se uma revisão narrativa de artigos disponíveis na base de dados PubMed, além de consulta de potenciais interações medicamentosas em fontes de informações sobre medicamentos disponíveis na World Wide Web. Resultados: Em apenas três das 17 fontes de informações consultadas foi relatado uma possível redução dos níveis plasmáticos e/ou da efetividade da levotiroxina, quando administrada de forma concomitante com omeprazol ou outro da classe. Somente uma fonte relata leve redução dos níveis plasmáticos de alendronato de sódio por interação com a levotiroxina, e apenas duas fontes evidenciam possível redução do efeito terapêutico do alendronato de sódio por interação com IBPs. Apenas dois estudos relatam resultados significativos relacionados à existência de interação entre levotiroxina ou alendronato no uso concomitante de IBPs. Em todas as fontes consultadas, as interações são descritas como menores, leves, moderadas ou de significado desconhecido. Todas as fontes de informações sugerem a continuidade da terapia para manejo da interação. Conclusão: Até o momento não há evidências robustas que demonstrem impedimento de uso de inibidores da bomba de prótons, levotiroxina e alendronato de sódio no mesmo horário, sendo essencial o acompanhamento dos parâmetros clínicos e laboratoriais.


Introduction: Drug interactions can alter safety and/or effectiveness in the treatment of diseases. Some medications need to be used on an empty stomach and the literature presents divergent information about the real clinical impact of using them at the same time. Objectives: To analyze the evidence on the clinical relevance of potential interactions between proton pump inhibitors, levothyroxine and sodium alendronate. Methods: A narrative review of articles available in the PubMed database was carried out, in addition to consulting potential drug interactions in sources of information on drugs available on the World Wide Web. Results: In only three of the 17 information sources consulted, a report was reported possible reduction in plasma levels and the effectiveness of levothyroxine, when administered concomitantly with omeprazole or another in the class. Only one source reports a slight reduction in plasma sodium alendronate levels due to interaction with levothyroxine, and only two sources show a possible reduction in the therapeutic effect of sodium alendronate through interaction with PPIs. Only two studies report significant results related to the existence of an interaction between levothyroxine or alendronate in concomitant use of PPIs. In all sources consulted, interactions are described as minor, mild, moderate or of unknown significance. All sources of information suggest the continuity of therapy to manage the interaction. Conclusion: To date, there is no robust evidence demonstrating that it is impossible to use proton pump inhibitors, levothyroxine and sodium alendronate at the same time, and it is essential to monitor clinical and laboratory parameters.


Introducción: Las interacciones farmacológicas pueden alterar la seguridad y / o efectividad en el tratamiento de enfermedades. Algunos medicamentos deben usarse con el estómago vacío y la literatura presenta información divergente sobre el impacto clínico real de usarlos al mismo tiempo. Objetivo: Analizar la evidencia sobre la relevancia clínica de las posibles interacciones entre los inhibidores de la bomba de protones, la levotiroxina y el alendronato de sodio. Métodos: Se realizó una revisión narrativa de los artículos disponibles en la base de datos Pubmed, además de la consulta de posibles interacciones farmacológicas en las fuentes de información sobre medicamentos disponibles en la World Wide Web. Resultados: En solo tres de las 17 fuentes de información consultadas, se informó posible reducción en los niveles plasmáticos y la efectividad de la levotiroxina, cuando se administra concomitantemente con omeprazol u otro en la clase. Solo una fuente informa una ligera reducción en los niveles plasmáticos de alendronato de sodio debido a la interacción con levotiroxina, y solo dos fuentes muestran una posible reducción en el efecto terapéutico del alendronato de sodio a través de la interacción con los IBP. Solo dos estudios informan resultados significativos relacionados con la existencia de una interacción entre levotiroxina o alendronato en el uso concomitante de IBP. En todas las fuentes consultadas, las interacciones se describen como leves, moderadas o de significancia desconocida. Todas las fuentes de información sugieren la continuidad de la terapia para gestionar la interacción. Conclusión: Hasta la fecha, no existe evidencia sólida que demuestre que es imposible usar inhibidores de la bomba de protones, levotiroxina y alendronato de sodio al mismo tiempo, y es esencial monitorear los parámetros clínicos y de laboratorio.


Subject(s)
Thyroxine , Alendronate , Proton Pump Inhibitors , Drug Interactions
7.
Chinese Medical Journal ; (24): 1064-1069, 2021.
Article in English | WPRIM | ID: wpr-878160

ABSTRACT

BACKGROUND@#Thyroid dysfunction is associated with cardiovascular diseases. However, the role of thyroid function in lipid metabolism remains partly unknown. The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization (MR).@*METHODS@#The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial. A two-sample MR was performed to assess the causal association, using summary statistics from the Atrial Fibrillation Genetics Consortium (n = 537,409) and the Global Lipids Genetics Consortium (n = 188,577). The clinical measures of thyroid function include thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, FT3:FT4 ratio and concentration of thyroid peroxidase antibodies (TPOAb). The serum lipid metabolism traits include total cholesterol (TC) and triglycerides, high-density lipoprotein, and low-density lipoprotein (LDL) levels. The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism.@*RESULTS@#The results demonstrated that increased TSH levels were significantly associated with higher TC (β = 0.052, P = 0.002) and LDL (β = 0.041, P = 0.018) levels. In addition, the FT3:FT4 ratio was significantly associated with TC (β = 0.240, P = 0.033) and LDL (β = 0.025, P = 0.027) levels. However, no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids.@*CONCLUSION@#Taken together, the results of the present study suggest an association between thyroid function and serum lipid metabolism, highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.


Subject(s)
Lipid Metabolism/genetics , Mendelian Randomization Analysis , Thyroid Function Tests , Thyroid Gland , Thyrotropin , Thyroxine , Triiodothyronine
8.
Article in English | WPRIM | ID: wpr-880621

ABSTRACT

OBJECTIVES@#A variety of causes can lead to cholestasis, however, cholestasis caused by Graves' disease is usually overlooked clinically. Here we analyze the clinical characteristics of Graves' disease associated cholestasis so as to have a better understanding for the disease.@*METHODS@#We retrospectively collected 13 inpatients' data who suffered from the Graves' disease associated cholestasis in the Department of Infectious Disease of Xiangya Hospital from January 2000 to December 2018. The characteristics of the patients' age, gender, liver function, thyroid function, coagulation function, the special cardiac examination, treatment, and follow-up data were analyzed.@*RESULTS@#Thirteen patients, including 10 males and 3 females with the age range from 33 to 55 (median 43) years old presented cholestasis, pruritus, and hypermetabolic symptoms. The levels of total bilirubin (TBIL), direct bilirubin (DBIL), glutamic-pyruvic transferase, glutamic-oxaloacetic transferase, alkaline phosphosphatase, and gamma glutamyl transpeptidase were 170.4-976.7 (median 388.8) µmol/L, 93.2-418.1 (median 199.2) µmol/L, 25.1-182.1 (median 106.4) U/L, 38.2-265.7 (median 59.7) U/L, 105.3-332.0 (median 184.5) U/L, and 20.7-345.1 (median 47.6) U/L, respectively. The levels of free triiodothyronine (FT@*CONCLUSIONS@#Graves' disease can cause cholestasis, with the low incidence. The symptoms of cholestasis can be improved or even eradicated with the cure of the Graves' disease. The cholestasis may be idiopathic. For patients with cholestasis and hyperthyroidism, Graves' disease should be considered for differential diagnosis.


Subject(s)
Adult , Cholestasis/etiology , Female , Graves Disease/complications , Humans , Male , Middle Aged , Retrospective Studies , Thyroid Function Tests , Thyroxine , Triiodothyronine
9.
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(4): 587-590, dez 30, 2020. fig
Article in Portuguese | LILACS | ID: biblio-1355171

ABSTRACT

Introdução: o presente artigo analisou e avaliou a prevalência de dinapenia em associação da idade dos Hormônio Estimulador da tireoide (TSH) e T3 em idosos da Universidade Aberta à Terceira Idade ­ UATI. A tireoide produz e secreta os hormônios triiodotironina (T3) e tiroxina (T4), responsáveis por controlar o metabolismo celular. O termo dinapenia tem sido utilizado para descrever a diminuição da força muscular relacionada à idade separando desta forma, a dinapenia da redução da massa muscular. Metodologia: trata-se de um estudo de corte transversal que investigou 63 mulheres com idade entre 60 e 95 anos, resultando numa idade média das participantes foi de 69,6 anos, não institucionalizadas, matriculados no projeto "Universidade Aberta à Terceira Idade (UATI)", da Universidade Estadual da Bahia (UNEB). A força de preensão palmar (FPP) foi avaliada em quilograma (kg), por meio do dinamômetro digital manual da marca INSTRUTHERM. Resultados: foram diagnosticados com dinapenia as pacientes que possuíram a FPP inferior a 20 kg. Descobriu-se que 23 idosas (36,51%) foram diagnosticadas com dinapenia. A correlação entre as variáveis TSH e dinapenia foi positiva e fraca Spearman=0.17 (p-valor= 0.22). Assim, a relação entre o FPP e a idade não parece ser linear possuindo uma correlação negativa e fraca: Spearman= -0.11 (p-valor= 0.39). Conclusão: o nível sérico de TSH e idade não tiveram associação significativa com a presença de dinapenia. Houve associação entre T3 sérico e dinapenia, porém não é possível identificar em qual quartil está essa associação.


Introduction: this article analyzed and evaluated the prevalence of dynapenia in association with the age of thyroid stimulating hormones (TSH) and T3 in the elderly at Universidade Aberta do Idoso ­ UATI. The thyroid produces and secretes the hormones triiodothyronine (T3) and thyroxine (T4) responsible for the control of cellular metabolism. The term dynapenia has been used to describe the decrease in muscle strength related to age, separating dynapenia from the reduction of muscle mass. Methodology: this is a cross-sectional study that investigated 63 women between 60 and 95 years old, resulting in an average age of participants of 69.6 years old, non-institutionalized, registered in the project the Open University Of The Elderly (UATI)", of Bahia State University (UNEB). The Hand Grip Strength (HGS) was measured in kilograms (kg), using the INSTRUTHERM manual digital dynamometer. Results: patients with FPP less than 20 kg were diagnosed with dynapenia. It was found that 23 elderly women (36.51%) were diagnosed with dynapenia. The correlation between TSH and dynapenia variables was positive and weak Spearman = 0.17 (p-value = 0.22). Thus, the relationship between (FPP) and age does not appear to be linear with a weak and negative correlation: Spearman = -0.11 (p-value = 0.39). Conclusion: the serum TSH level and age had no significant association with the presence of dynapenia. There was an association between(T3) and serum dinapenia, but it is not possible to identify in which quartile this association is found.


Subject(s)
Humans , Female , Aged , Aged, 80 and over , Thyroid Gland , Thyroxine , Aged , Thyrotropin , Hormones , Demography
10.
An. bras. dermatol ; 95(6): 721-723, Nov.-Dec. 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1142123

ABSTRACT

Abstract Thyroid hormone has effects on the skin. Patients with hypothyroidism have changes such as dry, scaly and rough skin. Increase carotene in the dermis becomes a yellowish tone to the skin of the patient with hypothyroidism. There is an increase in capillary cycle (anagen phase) and nail growth and a reduction in eccrine gland secretion. It is a case of primary hypothyroidism with nail manifestations associated with dermatologic disorders and successful treatment with levothyroxine. Receptors for thyroid hormone have already been found in keratinocytes, fibroblasts, hair follicles and sebaceous glands. Genes responsive to thyroid hormones and elements of the hypothalamic-pituitary-thyroid axis were identified on the skin. This report highlights the importance of cutaneous manifestations as markers of thyroid disease.


Subject(s)
Humans , Hypothyroidism/drug therapy , Skin , Thyroid Hormones , Thyroxine , Hair Follicle
11.
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 95-104, sept. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1128985

ABSTRACT

La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)


The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)


Subject(s)
Humans , Endocrine System Diseases/chemically induced , Immunotherapy/adverse effects , Thyroid Diseases/diagnosis , Thyroid Diseases/chemically induced , Thyroid Diseases/pathology , Thyroid Diseases/therapy , Thyroxine/administration & dosage , Triiodothyronine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/chemically induced , Adrenal Insufficiency/pathology , Adrenal Insufficiency/therapy , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/chemically induced , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Endocrine System Diseases/diagnosis , Endocrine System Diseases/physiopathology , Endocrine System Diseases/therapy , Hypophysitis/diagnosis , Hypophysitis/chemically induced , Hypophysitis/pathology , Hypophysitis/therapy , Glucocorticoids/administration & dosage , Insulin/therapeutic use , Methimazole/therapeutic use , Mineralocorticoids/therapeutic use , Antibodies, Monoclonal/therapeutic use , Neoplasms/immunology
12.
Rev. méd. Chile ; 148(6): 740-745, jun. 2020. tab
Article in English | LILACS | ID: biblio-1139366

ABSTRACT

ABSTRACT Background: Hypothyroidism occurs in 1-2% of the general population, is associated with significant morbidity and requires continuous treatment with levothyroxine. Aim: To determine the effectiveness, adherence and safety of levothyroxine therapy in patients with hypothyroidism. Material and Methods: The Morisky-Green adherence test was applied, and effectiveness was determined by measuring thyroid-stimulating hormone (TSH) in 330 patients with with hypothyroidism; the mean age was 64+-15 years and 76% was women. Results: Median TSH was 2.09 mIU/L (interquartile range: 1.16-3.61 mIU/L). Two hundred thirty-five (71%) patients had TSH levels in the euthyroid range, 64 (19%) in the hypothyroid range and 31 (9%) in the hyperthyroid range. Complete, moderate and lack of adherence with levothyroxine was reported in 283 (86%), 29 (9%) and 18 (5%) of patients, respectively. The presence of anemia (odds ratio (OR): 0.37, 95% confidence intervals (CI): 0.15-0.98) or the need of doses over 100 µg/day (OR: 0.47, 95%CI: 0.28-0.80) increased the probability of having an abnormal TSH level. Conclusions: In a large proportion of these patients, TSH levels were controlled, and most patients were adherent to levothyroxine therapy.


Antecedentes: El hipotiroidismo se presenta entre el 1-2% de la población general, genera importante morbilidad y requiere tratamiento con levotiroxina de manera continua. Objetivo: Determinar la efectividad, adherencia y seguridad de la terapia con levotiroxina en pacientes con hipotiroidismo. Material y Métodos: Se aplicó test de adherencia de Morisky-Green y se determinó efectividad mediante medición de TSH en 330 pacientes con edad promedio 63 ± 15 años (76% mujeres). Resultados: La mediana de TSH fue 2,09 mUI/l, (rango intercuartílico: 1,16mUI/l-3,61mUI/l). Un total de 235 (71,2%) tenían cifras de TSH en rango de estado eutiroideo, 64 (19,4%) se catalogaron hipotiroideos y 31 (9,4%) hipertiroideos. El 86% (n = 283) manifestó tener adherencia completa al medicamento, 29 (9%) moderada y 18 (5%) se clasificaron poco adherentes. Tener diagnóstico de anemia (razón de riesgo (RR): 0,37; intervalos de confianza (IC) 95%: 0,15-0,98) o necesitar dosis mayores de 100 µg/día (RR: 0,47; IC95%: 0,28-0,80) elevaron la probabilidad de no controlar el hipotiroidismo. Conclusiones. Una alta proporción de pacientes se encuentran controlados y con mucha frecuencia son adherentes a la terapia con levotiroxina.


Subject(s)
Humans , Female , Middle Aged , Aged , Thyroxine/therapeutic use , Hyperthyroidism , Hyperthyroidism/drug therapy , Thyrotropin , Prescriptions
13.
Arch. endocrinol. metab. (Online) ; 64(1): 52-58, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088768

ABSTRACT

ABSTRACT Objective This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroxine/blood , Triiodothyronine/blood , Thyrotropin/blood , Sex Factors , Age Factors , Reference Values , Thyroid Function Tests , Retrospective Studies , Asian Continental Ancestry Group
14.
Rev. chil. endocrinol. diabetes ; 13(1): 20-23, 2020. tab
Article in English | LILACS | ID: biblio-1048916

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Middle Aged , Thyroid Hormones/blood , Hypothyroidism/diagnosis , Hypothyroidism/blood , Thyroxine/administration & dosage , Immunoglobulin G , Hypothyroidism/drug therapy
15.
Med. lab ; 24(2): 91-92, 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1097034

ABSTRACT

El desarrollo de las pruebas de función tiroidea no ha sido fácil, con múltiples retos para mejorar algunas características que son insatisfactorias, incluso en la actualidad. En 1960 se logró la medición de tiroxina total (T4 total), y aunque fue un gran avance, los investigadores sabían que era insuficiente para una evaluación precisa de la función tiroidea. Uno de los problemas importantes radica en que existen diferencias marcadas interindividuales en la composición y en las cantidades de las proteínas de transporte de la T4 y la triyodotironina (T3). Por lo tanto, los depósitos de T4 y T3 son muy diferentes a los valores de T4 libre (T4L) y T3 libre (T3L). Por ejemplo, la mujer embarazada tiene el doble de globulina fijadora de tiroxina (TBG) y tres cuartas partes de la cantidad de albúmina que tenía cuando no estaba embarazada. También se pierde transtiretina y albúmina en enfermedades graves o con traumas, como quemaduras o sepsis. Entre 1963 y 1965 se desarrolló una prueba para tratar de obtener una estimación de la T4L, con el método de absorción de la hormona tiroidea a partir de la T4 total. Sin embargo, este análisis no funcionó correctamente, especialmente teniendo en cuenta la variabilidad en la TBG


Subject(s)
Humans , Thyroid Function Tests , Thyroxine , Triiodothyronine
16.
Med. lab ; 24(2): 93-109, 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1097051

ABSTRACT

Los desórdenes de la glándula tiroides son comunes y pueden afectar hasta el 10% de la población en general. En muchas ocasiones los síntomas pueden ser inespecíficos, por lo que el médico en busca de un trastorno tiroideo debe llegar a un diagnóstico funcional y anatómico. Las mediciones séricas de las hormonas tiroideas confirman si hay un exceso, un déficit o si las concentraciones son normales. Para ello, se requiere un rango de referencia de la población local, y específicamente por grupos de edad, para una correcta interpretación de las pruebas de función tiroidea. Las hormonas tiroideas juegan un papel fundamental en el sistema endocrino, controlan el metabolismo general del cuerpo, el desarrollo neural, el crecimiento normal y la maduración de los huesos, así como funciones cardiovasculares y renales, entre otras. En esta revisión se pretende dar una aproximación a las pruebas tiroideas más relevantes, partiendo de la biosíntesis y secreción de las hormonas tiroideas, hasta llegar al abordaje para un diagnóstico inicial del paciente con trastorno tiroideo, mencionando los aspectos más importantes de los diferentes patrones tiroideos. El tratamiento detallado de cada uno de ellos, supera las expectativas de esta revisión


Thyroid gland disorders are common and can affect up to 10% of the general population. In many cases the symptoms can be nonspecific, so the physician in search for a thyroid disorder should reach a functional and anatomical diagnosis. Serum measurements of thyroid hormones confirm if there is an excess, a deficit, or if concentrations are normal. For this, reference ranges of the local population, and specifically by age groups, are required for a correct interpretation of thyroid function tests. Thyroid hormones play a fundamental role in the endocrine system, control of the general metabolism of the body, neural development, normal growth and maturation of bones, as well as in cardiovascular and renal functions, among others. In this review, the most relevant thyroid tests will be described, starting with the biosynthesis and secretion of thyroid hormones, and continuing with an approach to reach an initial diagnosis. Finally, the most important aspects of the different thyroid patterns will be mentioned. It is beyond the scope of this review, to describe the treatment for thyroid disorders.


Subject(s)
Humans , Thyroid Diseases , Thyroid Function Tests , Thyroid Hormones , Thyroxine , Triiodothyronine , Thyrotropin
18.
Article in Chinese | WPRIM | ID: wpr-878841

ABSTRACT

To systemically evaluate the clinical efficacy and safety of oral preparation of Xiakucao with levothyroxine(LT4) on Hashimoto's thyroiditis(HT), so as to provide the evidence for its clinical application in the future. All the included studies were retrieved from four Chinese databases and three English databases from their inception to December 2019. ROB assessment tool of cochrane system and the evidence classification recommended by GRADE were used to evaluate the quality of evidences in all included studies. RevMan 5.3 was used for Meta-analysis of the outcomes. Software TSA 0.9(trail sequential analysis) was used to estimate the sample size for Meta-analysis. The results showed that 11 randomized controlled trials and totaling 1 215 patients were included. Preparation of Xiakucao combined with LT4 was adopted as intervention in experimental group, while patients in control group were treated with LT4 alone. Meta-analysis results showed that as compared with control group, the rate of total efficacy in experimental group was significant improved, including improvement of thyroid function and thyroid autoantibodies, shrinkage of thyroid gland and nodule, and improvement of clinical symptoms such as fatigue and cold intolerance(RR=1.15, 95%CI[1.09, 1.21]). The experimental group significantly decreased the serum level of thyroperoxidase antibody TPO-Ab(SMD=-0.91, 95%CI[-1.40,-0.41]), and reduced the size of left thyroid lobe(MD=-1.46, 95%CI[-1.82,-1.11]), right thyroid lobe(MD=-1.45, 95%CI[-1.96,-0.94]) and isthmus of thyroid gland(MD=-1.08, 95%CI[-1.20,-0.95]). After evaluation based on GRADEpro, the results showed that the evidence quality of all included studies was low or very low. The result of TSA showed that the cumulative sample size had reached the expected value. However, the pooled results may be affected by one study with high bias risk, with not so high effect intensity of evidences. From this review, we can see that in treatment of HT, intervention of preparation of Xiakucao combined with LT4 has advantages on improvement of clinical efficiency, decreasing serum level of TPO-Ab and shrinkage of thyroid gland. However, due to the quality of evidence, more rigorously designed and high-quality trials are needed in the future to verify the clinical efficacy and safety of preparation of Xiakucao in treating HT.


Subject(s)
Hashimoto Disease , Humans , Iodide Peroxidase , Prunella , Thyroxine
19.
Article in English | WPRIM | ID: wpr-816634

ABSTRACT

In 2017, the first Korean nationwide data on serum thyroid stimulating hormone (TSH) levels, serum free thyroxine (fT4) levels, and urinary iodine concentration (UIC) were published based on a population of 7,061 Koreans who participated in the Korea National Health and Nutrition Examination Survey VI. The mean TSH level was 2.16 mIU/L, with a reference interval of 0.59 to 7.03 mIU/L (men 2.09 mIU/L, women 2.24 mIU/L, P<0.001). A U-shaped association was found between serum TSH levels and age. The mean fT4 level was 1.25 ng/dL, and its reference interval was 0.92 to 1.60 ng/dL (men 1.29 ng/dL, women 1.20 ng/dL, P<0.0001). Serum fT4 levels decreased with age (P for trend <0.0001). Serum thyroid peroxidase antibody (TPOAb) was detected in 7.30% of participants (men 4.33%, women 10.62%). TPOAb titers tended to increase with age, and were higher in women than in men. The median UIC was 294 µg/L, and UIC showed a U-shaped relationship with age. According to the World Health Organization recommendations, only 23% of participants were in the adequate range of iodine intake, while 65% were in the above requirements or excessive, and 12% in insufficient. The prevalence of overt hyperthyroidism and hypothyroidism in Koreans was 0.34% to 0.54% and 0.73% to 1.43%, respectively.


Subject(s)
Female , Humans , Hyperthyroidism , Hypothyroidism , Iodide Peroxidase , Iodine , Korea , Male , Nutrition Surveys , Prevalence , Thyroid Gland , Thyrotropin , Thyroxine , World Health Organization
20.
Article in English | WPRIM | ID: wpr-816623

ABSTRACT

BACKGROUND: Studies on the relationship between thyroid function and anemia in the euthyroid range are scarce. We aimed to evaluate the association between anemia and serum free thyroxine (fT4) and thyrotropin (TSH) in euthyroid adults.METHODS: Data on 5,352 participants aged ≥19 years were obtained from the Korea National Health and Nutrition Examination Survey VI (2013 to 2015). Anemia was defined as hemoglobin (Hb) <13 and <12 g/dL for men and women, respectively.RESULTS: Overall, 6.1% of participants had anemia, and more women (9.9%) had anemia than men (2.8%, P<0.001). In multivariate analysis, serum fT4 levels, but not TSH, were positively associated with serum Hb levels in both sexes (P<0.001, each). Serum Hb levels linearly reduced across decreasing serum fT4 quartile groups in both sexes (P<0.001, each). After adjusting for potential confounding factors, participants with low-normal fT4 had 4.4 (P=0.003) and 2.8 times (P<0.001) higher risk for anemia than those with high-normal fT4 among men and women, respectively. When participants were divided into two groups at 50 years of age, in younger participants, men and women with the first quartile were at higher risk of anemia than men with the second quartile (odds ratio [OR], 3.3; P=0.029) and women with the forth quartile (OR, 3.2; P<0.001), respectively. This association was not observed in older participants.CONCLUSION: These results suggest that a low-normal level of serum fT4 was associated with a lower serum Hb level and a higher risk of anemia in euthyroid adults, especially in younger participants.


Subject(s)
Adult , Anemia , Female , Humans , Korea , Male , Multivariate Analysis , Nutrition Surveys , Thyroid Function Tests , Thyroid Gland , Thyrotropin , Thyroxine
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