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Thyroid hormone replacement

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https://www.readbyqxmd.com/read/28632526/persistent-hypothyroid-symptoms-in-a-patient-with-a-normal-thyroid-stimulating-hormone-level
#1
Jacqueline Jonklaas
PURPOSE OF REVIEW: A subset of patients being treated for hypothyroidism do not feel well while taking levothyroxine (LT4) replacement therapy, despite having a normal serum thyroid stimulating hormone level. Pursuing a relative triiodothyronine deficiency as a potential explanation for patient dissatisfaction, has led to trials of combination therapy with liothyronine (LT3), with largely negative outcomes. This review attempts to reconcile these diverse findings, consider potential explanations, and identify areas for future research...
June 16, 2017: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/28620499/intrauterine-death-following-intraamniotic-triiodothyronine-and-thyroxine-therapy-for-fetal-goitrous-hypothyroidism-associated-with-polyhydramnios-and-caused-by-a-thyroglobulin-mutation
#2
Pradeep Vasudevan, Corrina Powell, Adeline K Nicholas, Ian Scudamore, James Greening, Soo-Mi Park, Nadia Schoenmakers
In the absence of maternal thyroid disease or iodine deficiency, fetal goitre is rare and usually attributable to dyshormonogenesis, for which genetic ascertainment is not always undertaken in the UK. Mechanical complications include tracheal and oesophageal compression with resultant polyhydramnios, malpresentation at delivery and neonatal respiratory distress. We report an Indian kindred in which the proband (first-born son) had congenital hypothyroidism (CH) without obvious neonatal goitre. His mother's second pregnancy was complicated by fetal hypothyroid goitre and polyhydramnios, prompting amniotic fluid drainage and intraamniotic therapy (with liothyronine, T3 and levothyroxine, T4)...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28611949/pseudomalabsorption-of-levothyroxine-a-challenge-for-the-endocrinologist-in-the-treatment-of-hypothyroidism
#3
Nancy Van Wilder, Bert Bravenboer, Sarah Herremans, Nathalie Vanderbruggen, Brigitte Velkeniers
BACKGROUND: Hypothyroidism due to non-compliance with levothyroxine therapy (pseudomalabsorption) is rare. The diagnosis is considered in patients with persistent severe hypothyroidism despite treatment with large doses of levothyroxine. Intestinal malabsorption, drug and dietary interference with levothyroxine absorption and nephrotic syndrome should be excluded. The diagnosis of pseudomalabsorption can be demonstrated by using "an oral 1,000 µg of levothyroxine test" showing a rapid decrease in thyroid-stimulating hormone and increase in thyroxine...
February 2017: European Thyroid Journal
https://www.readbyqxmd.com/read/28608527/perfect-storm-therapeutic-plasma-exchange-for-a-patient-with-thyroid-storm
#4
Andrea M McGonigle, Aaron A R Tobian, Jennifer L Zink, Karen E King
Thyroid storm is a potentially lethal complication of hyperthyroidism with increased thyroid hormones and exaggerated symptoms of thyrotoxicosis. First-line therapy includes methimazole (MMI) or propylthiouracil (PTU) to block production of thyroid hormones as a bridge toward definitive surgical treatment. Untreated thyroid storm has a mortality rate of up to 30%; this is particularly alarming when patients cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy. Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature...
June 13, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28588554/female-reproductive-factors-and-differentiated-thyroid-cancer
#5
REVIEW
Mariacarla Moleti, Giacomo Sturniolo, Maria Di Mauro, Marco Russo, Francesco Vermiglio
Differentiated thyroid cancer (DTC) is markedly more common in women than men, the highest female-to-male ratio being recorded during the reproductive period. This evidence has led to the suggestion that female hormonal and reproductive factors may account for the observed DTC gender disparity. This review focuses on current evidence on the risk of DTC in conjunction with major female reproductive factors, including the impact of pregnancy on DTC occurrence and progression/recurrence. Overall, studies exploring the link between the risk of DTC and menstrual and menopausal factors, oral contraceptives and/or hormone replacement therapy, showed these associations, if any, to be generally weak...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28588551/functional-thyroid-follicular-cells-differentiation-from-human-induced-pluripotent-stem-cells-in-suspension-culture
#6
Ayumi Arauchi, Katsuhisa Matsuura, Tatsuya Shimizu, Teruo Okano
The replacement of regenerated thyroid follicular cells (TFCs) is a promising therapeutic strategy for patients with hypothyroidism. Here, we have succeeded in inducing functional TFCs from human-induced pluripotent stem cells (iPSCs) in scalable suspension culture. Differentiation of iPSCs with Activin A treatment produced Sox17- and FoxA2-expressing definitive endodermal cells that also expressed thyroid transcription factors Pax8 and Nkx2-1. Further treatment with thyroid-stimulating hormone (TSH) induced TFCs expressing various types of thyroid proteins including TSH receptor, sodium-iodide symporter, thyroglobulin, and thyroid peroxidase...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28583920/idiopathic-hypogonadotropic-hypogonadism-reversal-after-testosterone-replacement-in-a-34-year-old-male
#7
Owais Rashid, Nanik Ram, Saad Farooq, Zareen Kiran
A 34-year-old male presented to the endocrinology clinic with the complaint of the absence of facial, axillary and pubic hairs. Further history revealed absent ejaculations and decreased early morning erections. The patient had no history of headaches, visual problems or anosmia. On physical examination, there were sparse facial, axillary and pubic hairs, bilateral gynaecomastia, stretch penile length of 5 cm and bilateral testicular volume of 10 mL. Laboratory investigations showed low luteinising hormone, follicular stimulating hormone and testosterone with normal prolactin and thyroid profile...
June 5, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28578356/the-relationship-between-thyroid-antibody-titer-and-levothyroxine-dose-in-patients-with-overt-primary-hypothyroidism
#8
Nalan Okuroglu, Ali Ozdemir, Yasar Sertbas, Seda Sancak
BACKGROUND: Both excess and insufficient thyroid hormone replacement may produce adverse effects in various target tissues; therefore, understanding factors that affect achievement of target TSH levels is crucial. OBJECTIVE: Investigate the relationship between antibody titers and levothyroxine dose. DESIGN: Retrospective, review of data in medical records. SETTING: Thyroid center of Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey...
May 2017: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/28566564/effect-of-thyroxin-treatment-on-carotid-intima-media-thickness-cimt-reduction-in-patients-with-subclinical-hypothyroidism-sch-a-meta-analysis-of-clinical-trials
#9
Muhammad Aziz, Yugandhar Kandimalla, Archana Machavarapu, Anshul Saxena, Sankalp Das, Adnan Younus, Michelle Nguyen, Rehan Malik, Dixitha Anugula, Muhammad A Latif, Choudhry Humayun, Idrees M Khan, Ali Adus, Aisha Rasool, Emir Veledar, Khurram Nasir
AIM: Research shows that subclinical hypothyroidism (SCH) is related to an increased carotid intima-media thickness (CIMT), a surrogate marker of subclinical cardiovascular disease (CVD). It is controversial whether or not SCH should be treated to reduce CVD morbidity and mortality. This meta-analysis aimed to determine whether SCH is associated with an increase in CIMT as compared to Euthyroidism (EU) and whether thyroxin (T4) treatment in SCH can reverse the change in CIMT. METHODS: Two independent reviewers conducted an extensive database research up to December 2016...
May 31, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28566447/management-of-endocrine-disease-l-thyroxine-replacement-therapy-in-the-frail-elderly-a-challenge-in-clinical-practice
#10
Rosaria Maddalena Ruggeri, Francesco Trimarchi, Bernadette Biondi
The number of elderly people, mostly over 85 years (the "oldest old"), is increasing worldwide. As a consequence, accompanying morbidity and disability have been increasing, and frailty, defined as an age-related condition of decline of physiological reserves and vulnerability, represents an emerging problem. Caring for older frail people may represent a challenge, since the elderly differ significantly from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions...
May 31, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28561265/mild-tsh-resistance-clinical-and-hormonal-features-in-childhood-and-adulthood
#11
Maria Cristina Vigone, Marianna Di Frenna, Fabiana Guizzardi, Giulia Gelmini, Tiziana de Filippis, Stefano Mora, Silvana Caiulo, Micol Sonnino, Marco Bonomi, Luca Persani, Giovanna Weber
OBJECTIVE: Mutations in TSH receptor (TSHR) are associated with TSH resistance, a genetic defect characterized by a heterogeneous phenotype ranging from severe hypothyroidism to subclinical hypothyroidism (SCH). We assessed the clinical and hormonal pattern of TSHR variants in a series of pediatric patients, and the long-term outcome of growth, biochemical measurements of metabolism and neuropsychological functions in TSHR mutations carriers. DESIGN: Observational, retrospective study...
May 31, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28553600/knowledge-awareness-practices-and-adherence-to-treatment-of-patients-with-primary-hypothyroidism-in-delhi
#12
Pradeep Kumar, Deepak Khandelwal, Suresh Mittal, Deep Dutta, Sanjay Kalra, Pratima Katiyar, Vivek Aggarwal
BACKGROUND: There is a paucity of data on knowledge, awareness, and practices (KAP) of patients with hypothyroidism in India. AIMS AND OBJECTIVES: To study the KAP and adherence to treatment of participants with primary hypothyroidism. MATERIALS AND METHODS: An observational cross-sectional study was conducted in Endocrinology Outpatient Department of Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi. Two-fifty consecutive primary hypothyroidism participants, aged ≥18 years, who were on treatment for at least 3 months responded to a structured questionnaire, to assess their KAP about the disease and adherence to treatment...
May 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28553598/visual-evoked-potentials-in-overt-hypothyroid-patients-before-and-after-achievement-of-euthyroidism
#13
Aprajita, Geetanjali Sharma, Sameer Aggarwal
BACKGROUND: Visual evoked potential (VEP) measures the time taken for visual stimulus to travel from the eye to the occipital cortex. Hypothyroidism affects the central nervous system (CNS) through its role in gene expression, myelin production, axonal transportation, and neurotransmitters. Delay in the conduction of impulses results in abnormal VEP. OBJECTIVE: Correlate the electrophysiological findings of VEP in newly diagnosed treatment-naive hypothyroid patients before and after 3 months of treatment and to find the correlation with serum thyroid-stimulating hormone (TSH) levels...
May 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28553595/does-one-size-fit-everyone-replacement-dose-of-levothyroxine-in-long-standing-primary-hypothyroidism-in-adults
#14
Rekha Singh
OBJECTIVES: The recommended starting dose of levothyroxine (LT4) in primary hypothyroidism is 1.6 μg/kg body weight and is based on presumption of minimal residual thyroid function in autoimmune hypothyroidism. This study aimed at finding the range and determining factors for LT4 dose in long-standing hypothyroidism. METHODS: A cross-sectional study of individuals with primary autoimmune hypothyroidism on LT4 replacement was done between March 2015 and January 2016...
May 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28552871/a-case-of-stiff-person-syndrome-due-to-secondary-adrenal-insufficiency
#15
Yuri Mizuno, Hiroo Yamaguchi, Taira Uehara, Kenichiro Yamashita, Ryo Yamasaki, Jun-Ichi Kira
We report a case of flexion contractures in a patient's legs secondary to postpartum hypopituitarism. A 56-year-old woman presented with a 3-year history of worsening flexion contractures of the hips and knees. On admission, her hips and knees could not be extended, and she had muscle stiffness and tenderness to palpation of the lower extremities. We first suspected stiff-person syndrome or Isaacs' syndrome because of her muscle stiffness. However, multiple hormones did not respond to stimulation tests, and an MRI of the brain showed atrophy of the pituitary gland with an empty sella...
May 26, 2017: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/28552606/differentiation-and-transplantation-of-embryonic-stem-cell-derived-cone-photoreceptors-into-a-mouse-model-of-end-stage-retinal-degeneration
#16
Kamil Kruczek, Anai Gonzalez-Cordero, Debbie Goh, Arifa Naeem, Mindaugas Jonikas, Samuel J I Blackford, Magdalena Kloc, Yanai Duran, Anastasios Georgiadis, Robert D Sampson, Ryea N Maswood, Alexander J Smith, Sarah Decembrini, Yvan Arsenijevic, Jane C Sowden, Rachael A Pearson, Emma L West, Robin R Ali
The loss of cone photoreceptors that mediate daylight vision represents a leading cause of blindness, for which cell replacement by transplantation offers a promising treatment strategy. Here, we characterize cone differentiation in retinas derived from mouse embryonic stem cells (mESCs). Similar to in vivo development, a temporal pattern of progenitor marker expression is followed by the differentiation of early thyroid hormone receptor β2-positive precursors and, subsequently, photoreceptors exhibiting cone-specific phototransduction-related proteins...
June 6, 2017: Stem Cell Reports
https://www.readbyqxmd.com/read/28545515/outcome-of-in-vitro-fertilization-in-women-with-subclinical-hypothyroidism
#17
YunYing Cai, LanPing Zhong, Jie Guan, RuiJin Guo, Ben Niu, YanPing Ma, Heng Su
BACKGROUND: Previous studies examining associations between subclinical hypothyroidism (SCH) with in vitro fertilization (IVF) outcome indicate some benefits of levothyroxine (LT4) treatment. But IVF outcomes in treated SCH women whose serum Thyroid Stimulating Hormone (TSH) concentration did and did not exceed 2.5 mIU/L before the IVF cycle has not been studied thoroughly. METHODS: In this study, we performed a prospective cohort study with 270 treated subclinical hypothyroidism patients undergoing their first IVF retrieval cycle at a single cite...
May 25, 2017: Reproductive Biology and Endocrinology: RB&E
https://www.readbyqxmd.com/read/28540093/myxedema-crisis-presenting-with-seizures-a-rare-life-threatening-presentation-a-case-report-and-review-of-the-literature
#18
Sonali Sihindi Chapa Gunatilake, Uditha Bulugahapitiya
Myxedema crisis is a life-threatening extreme form of hypothyroidism with a high mortality rate if left untreated. Myxedema crisis is commonly seen in older patients, especially in women, and is associated with signs of hypothyroidism, hypothermia, hyponatraemia, hypercarbia, and hypoxemia. Patients might present with different organ specific symptoms. Seizures are a recognized but rare manifestation of myxedema with a very high mortality rate. Prompt diagnosis and appropriate management may improve the prognosis...
2017: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/28535579/review-of-heterotopic-thyroid-autotransplantation
#19
Mahmoud Sakr, Ahmed Mahmoud
Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs...
May 24, 2017: Clinical and Experimental Otorhinolaryngology
https://www.readbyqxmd.com/read/28525353/molecular-genetics-of-growth-hormone-deficient-children-correlation-with-auxology-and-response-to-first-year-of-growth-hormone-therapy
#20
Vaman Khadilkar, Nikhil Phadke, Kavita Khatod, Veena Ekbote, Supriya Phanse Gupte, Ruchi Nadar, Anuradha Khadilkar
BACKGROUND: With the paucity of available literature correlating genetic mutation and response to treatment, we aimed to study the genetic makeup of children with growth hormone (GH) deficiency in Western India and correlate the mutation with auxology and response to GH treatment at end of 1 year. METHODS: Fifty-three (31 boys and 22 girls) children with severe short stature (height for age z-score <-3) and failed GH stimulation test were studied. Those having concomitant thyroid hormone or cortisol deficiencies were appropriately replaced prior to starting GH treatment...
May 24, 2017: Journal of Pediatric Endocrinology & Metabolism: JPEM
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