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Guidelines for the Treatment of Hypothyroidism

Abhilash Chandra
BACKGROUND: There is an increased prevalence of hypothyroidism in chronic kidney disease (CKD) patients as the glomerular filtration rate falls. However, there is a paucity of Indian data in this respect. METHODS: A cross-sectional analysis was performed based on the database of the information system of a tertiary care hospital in northern India to retrieve results of nephrology CKD outpatients (> 18 years of age) from September 2013 to October 2015 to determine the prevalence of hypothyroidism in the non-dialysis-dependent CKD population...
September 2016: Kidney Research and Clinical Practice
Won Sang Yoo, Hyun Kyung Chung
Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus...
September 2016: Endocrinology and Metabolism
Patrick Hanley, Katherine Lord, Andrew J Bauer
Importance: Normal thyroid gland function is critical for early neurocognitive development, as well as for growth and development throughout childhood and adolescence. Thyroid disorders are common, and attention to physical examination findings, combined with selected laboratory and radiologic tools, aids in the early diagnosis and treatment. Objective: To provide a practical review of the presentation, evaluation, and treatment of thyroid disorders commonly encountered in a primary care practice...
October 1, 2016: JAMA Pediatrics
R Guglielmi, A Frasoldati, M Zini, F Grimaldi, H Gharib, J R Garber, E Papini
INTRODUCTION: Hypothyroidism requires life-long thyroid hormone replacement therapy in most patients. Oral levothyroxine (L-T4) is an established safe and effective treatment for hypothyroidism but some issues remain unsettled. METHODS: The Italian Association of Clinical Endocrinologists (AME) appointed a panel of experts to provide an updated statement for appropriate use of thyroid hormone formulations for replacement of hypothyroidism. The AACE protocol for standardized production of clinical practice guidelines was followed...
August 2, 2016: Endocrine Practice
Atsushi Uchiyama, Sigetaka Sugihara, Satoshi Kusuda
BACKGROUND: Recently, a revised version of the Guidelines for Mass Screening of Congenital Hypothyroidism (CH) was published in Japan. However, it is unknown whether the guidelines have been widely known and applied in neonatal intensive care units (NICUs). METHODS: To clarify the current status and issues of newborn screening (NBS) for CH in Japanese NICUs, we sent a questionnaire by mail or email to neonatologists who were responsible for 100 tertiary NICUs in Japan and analyzed their responses...
May 18, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
V Eligar, P N Taylor, O E Okosieme, G P Leese, C M Dayan
BACKGROUND: Hypothyroidism affects 2-5% of the general population. Patients with uncorrected disease suffer significant morbidity and have an increased risk of cardiovascular disease and neurocognitive impairment. Levothyroxine, the treatment of choice, is inexpensive, easy to administer and in most cases restores well-being while normalizing thyroid function. However, 30-50% of individuals on levothyroxine are either over-treated or under-treated and others remain dissatisfied with treatment despite achieving thyroid hormone concentrations within the laboratory reference interval...
July 2016: Annals of Clinical Biochemistry
Noelle Whyte, Christopher Sullivan
When patients who are thin present with knee pain, it can be easy to overlook the possibility of slipped capital femoral epiphysis (SCFE). Although 80% of patients with a "slip" are obese, thin children are not immune to this problem. Endocrinopathies, especially hypothyroidism, can be associated with SCFE. This article describes guidelines for evaluating patients for a slip and highlights some important considerations for the atypical SCFE. Patients with open growth plates with thigh or knee pain should routinely have a hip examination as part of the evaluation...
April 2016: Pediatric Annals
C Huchon, X Deffieux, G Beucher, P Capmas, X Carcopino, N Costedoat-Chalumeau, A Delabaere, V Gallot, E Iraola, V Lavoue, G Legendre, V Lejeune-Saada, J Leveque, S Nedellec, J Nizard, T Quibel, D Subtil, F Vialard, D Lemery
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C)...
June 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Daniëlle C M van der Kaay, Jonathan D Wasserman, Mark R Palmert
Neonates born to mothers with Graves' disease are at risk for significant morbidity and mortality and need to be appropriately identified and managed. Because no consensus guidelines regarding the treatment of these newborns exist, we sought to generate a literature-based management algorithm. The suggestions include the following: (1) Base initial risk assessment on maternal thyroid stimulating hormone (TSH) receptor antibodies. If levels are negative, no specific neonatal follow-up is necessary; if unavailable or positive, regard the newborn as "at risk" for the development of hyperthyroidism...
April 2016: Pediatrics
Yosuke Ono, Masanori Fujita, Sachiko Ono, Sho Ogata, Shoichi Tachibana, Yuji Tanaka
Myxedema coma (MC) is a life-threatening endocrine crisis caused by severe hypothyroidism. However, validated diagnostic criteria and treatment guidelines for MC have not been established owing to its rarity. Therefore, a valid animal model is required to investigate the pathologic and therapeutic aspects of MC. The aim of the present study was to establish an animal model of MC induced by total thyroidectomy. We utilized 14 male New Zealand White rabbits anesthetized via intramuscular ketamine and xylazine administration...
June 30, 2016: Endocrine Journal
Zeeshan Javed, Thozhukat Sathyapalan
Subclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) and a severe form with TSH >10.0 mIU/l (severe-SCH). SCH is a common problem (prevalence is greater in women than men), which increases further with increasing age and TSH levels. Even though the risk of progression to overt hypothyroidism is higher in patients with severe-SCH, the risk is also significant in patients having mild-SCH; it has been suggested that every twofold rise in serum TSH would increase the risk from 1 to 4%, which further increases to 38% if thyroid antibodies are positive...
February 2016: Therapeutic Advances in Endocrinology and Metabolism
Jeremy J Prunty, Crystal D Heise, David G Chaffin
Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists...
January 2016: Pharmacotherapy
Nannan Gao, Zhongshang Yuan, Xulei Tang, Xiaoming Zhou, Meng Zhao, Lu Liu, Jiadong Ji, Fuzhong Xue, Guang Ning, Jiajun Zhao, Haiqing Zhang, Ling Gao
AIM: To gain more precise understanding of the epidemiology of comorbidities with diabetes and to clarify the correlation with coronary heart disease (CHD) in Chinese population. METHODS: Based on REACTION study, 18,696 participants aged over 40 years were included in the cross-sectional analysis. Prevalence and patterns of comorbid diseases were demonstrated, and their impact on CHD was also analyzed by logistic regression. RESULTS: Diabetes was more prevalent in patients with older age and lower education level, with relatively low awareness (36...
March 2016: Journal of Diabetes and its Complications
Eyal Kraut, Pendar Farahani
PURPOSE: Patients with hypothyroidism are increasingly enquiring about the benefit of using combination therapy of levothyroxine (LT4) and liothyronine (LT3) as a potential treatment for hypothyroidism. Combination therapy, however, remains controversial. The purpose of this study was to systematically review available hypothyroidism treatment recommendations from clinical practice guidelines from around the world to identify the consensus regarding combination therapy. SOURCE: Clinical practice guidelines were obtained from searches of PubMed, EMBASE, and MEDLINE, using several combinations of MeSH terms...
2015: Clinical and Investigative Medicine. Médecine Clinique et Experimentale
(no author information available yet)
Hypothyroidism is a common disorder due to inadequate thyroid hormone secretion. When a patient has signs and symptoms suggestive of hypothyroidism, how is it determined whether thyroid hormone replacement therapy will have a favourable harm-benefit balance? How should treatment be managed? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. The symptoms of hypothyroidism are due to slow metabolism (constipation, fatigue, sensitivity to cold, weight gain, etc...
October 2015: Prescrire International
Keisuke Nagasaki, Kanshi Minamitani, Makoto Anzo, Masanori Adachi, Tomohiro Ishii, Kazumichi Onigata, Satoshi Kusuda, Shohei Harada, Reiko Horikawa, Masanori Minagawa, Haruo Mizuno, Yuji Yamakami, Masaru Fukushi, Toshihiro Tajima
Purpose of developing the guidelines: Mass screening for congenital hypothyroidism started in 1979 in Japan, and the prognosis for intelligence has been improved by early diagnosis and treatment. The incidence was about 1/4000 of the birth population, but it has increased due to diagnosis of subclinical congenital hypothyroidism. The disease requires continuous treatment, and specialized medical facilities should make a differential diagnosis and treat subjects who are positive in mass screening to avoid unnecessary treatment...
July 2015: Clinical Pediatric Endocrinology: Case Reports and Clinical Investigations: Official Journal of the Japanese Society for Pediatric Endocrinology
Carlo Cappelli, Ilenia Pirola, Linda Daffini, Annamaria Formenti, Carmelo Iacobello, Alessandra Cristiano, Elena Gandossi, Enrico Agabiti Rosei, Maurizio Castellano
BACKGROUND: Levothyroxine (LT4) is the recommended treatment for millions of hypothyroid patients. Current guidelines recommend that LT4 tablets be taken in a fasting state, but inability to adhere to this often leads to poor therapy compliance. METHODS: A randomized, double-blind, placebo-controlled, crossover trial was conducted in previously untreated hypothyroid patients randomly assigned to receive an oral solution of LT4 either at least 30 minutes before breakfast or directly at breakfast time...
February 2016: Thyroid: Official Journal of the American Thyroid Association
Juanita K Hodax, Steven E Reinert, Jose Bernardo Quintos
OBJECTIVE: This study evaluates the clinical characteristics, workup, treatment, and outcomes of pediatric patients diagnosed with an autonomously functioning thyroid nodule (AFTN) in a large cohort of patients presenting for evaluation of a thyroid nodule. There are few prior studies on AFTN in pediatrics, with limited data on treatment and outcomes. Rates of malignancy in AFTN are perceived as low, but prior studies have varying reports. METHODS: This is a retrospective chart review of patients less than 21 years of age at Rhode Island Hospital over an 11-year period (2003-2013)...
March 2016: Endocrine Practice
Luba Freja Michaelsson, Bjarke Borregaard Medici, Jeppe Lerche la Cour, Christian Selmer, Michael Røder, Hans Perrild, Nils Knudsen, Jens Faber, Birte Nygaard
BACKGROUND: Five to ten percent of patients with hypothyroidism describe persistent symptoms despite being biochemically well regulated on levothyroxine (L-T4). Thyroxine (T4)/triiodothyronine (T3) combination therapy [L-T4/liothyronine (L-T3) or desiccated thyroid] are still regarded as experimental with no evidence of superior effect on persistent symptoms according to meta-analyses. However, some randomized controlled trials have demonstrated patients' preference for T4/T3 combination therapy as compared to L-T4 monotherapy...
September 2015: European Thyroid Journal
Jacqueline Jonklaas
PURPOSE OF REVIEW: Differentiated thyroid cancer is a malignancy that is rapidly increasing in frequency. As thyroidectomy plays a central role in the treatment of thyroid cancer, it is incumbent on physicians treating this patient group to be well versed in the intricacies of treating hypothyroidism. RECENT FINDINGS: Treatment of hypothyroidism may be refined by careful attention to dose selection, monitoring of therapy and achievement of thyrotropin goals that are specific to the individual patient's overall clinical situation...
January 2016: Current Opinion in Oncology
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