1
|
Ettleson MD, Penna GCE, Wan W, Benseñor IM, Laiteerapong N, Bianco AC. TSH Trajectories During Levothyroxine Treatment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Cohort. J Clin Endocrinol Metab 2024:dgae294. [PMID: 38780968 DOI: 10.1210/clinem/dgae294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Indexed: 05/25/2024]
Abstract
CONTEXT Thyroid-stimulating hormone (TSH) trajectory classification represents a novel approach to defining the adequacy of levothyroxine (LT4) treatment for hypothyroidism over time. OBJECTIVE This is a proof of principle study that uses longitudinal clinical data, including thyroid hormone levels from a large prospective study to define classes of TSH trajectories and examine changes in cardiovascular (CV) health markers over the study period. METHODS Growth mixture modeling (GMM), including latent class growth analysis (LCGA), was used to classify LT4-treated individuals participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) based on serial TSH levels. Repeated measure analyses were then utilized to assess within-class changes in blood pressure, lipid levels, hemoglobin A1c, and CV-related medication utilization. RESULTS From the 621 LT4-treated study participants, the best-fit GMM approach identified 4 TSH trajectory classes, as defined by their relationship to the normal TSH range: (1) high-high normal TSH, (2) normal TSH, (3) normal to low TSH, and (4) low to normal TSH. Notably, the average baseline LT4 dose was lowest in the high-high normal TSH group (77.7 µg, P < .001). There were no significant differences in CV health markers between the classes at baseline. At least 1 significant difference in CV markers occurred in all classes, highlighted by the low to normal class, in which total and high-density lipoprotein cholesterol, triglycerides, and A1c all increased significantly (P = .049, P < .001, P < .001, and P = .001, respectively). Utilization of antihypertensive, antihyperlipidemic, and antidiabetes medications increased in all classes. CONCLUSION GMM/LCGA represents a viable approach to define and examine LT4 treatment by TSH trajectory. More comprehensive datasets should allow for more complex trajectory modeling and analysis of clinical outcome differences between trajectory classes.
Collapse
Affiliation(s)
- Matthew D Ettleson
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA
| | - Gustavo C E Penna
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA
| | - Wen Wan
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Clinical Hospital, Department of Medicine, University of Sao Paulo, Sao Paulo, 05508-000, Brazil
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
2
|
Martins RS, Nadeem S, Aziz A, Raja S, Pervez A, Islam N, Ahmed A, Sheikh A, Furqan S, Ram N, Rizwan A, Rizvi NA, Mustafa MA, Aamdani SS, Ayub B, Masood MQ. GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context. BMC Endocr Disord 2024; 24:41. [PMID: 38509509 PMCID: PMC10956339 DOI: 10.1186/s12902-023-01493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/17/2023] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION The prevalence of hyperthyroidism in Pakistan is 2.9%, which is two times higher than in the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of hyperthyroidism in Pakistan. METHODS We employed the GRADE-ADOLOPMENT approach utilizing the 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context. RESULTS The source guideline included a total of 124 recommendations, out of which 71 were adopted and 49 were excluded. 4 recommendations were carried forward for adaptation via the ETD process, with modifications being made to 2 of these. The first addressed the need for liver function tests (LFTs) amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs (ATDs). The second pertained to thyroid status testing post-treatment by radioactive iodine (RAI) therapy for Graves' Disease (GD). Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. CONCLUSION Our newly developed hyperthyroidism CPGs for Pakistan contain two context-specific modifications that prioritize patients' finances during the course of hyperthyroidism management and to limit the overuse of laboratory testing in a resource-constrained setting. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.
Collapse
Affiliation(s)
- Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Sarah Nadeem
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan.
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan.
- FACE (Fellow American College of Endocrinology), Internal Medicine & Endocrinology, Diabetes & Metabolism, Internal Medicine, and Endocrinology, Women in Medicine Committee, Associate Dean's Women Faculty Forum, Aga Khan University, Karachi, Pakistan.
| | - Abeer Aziz
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Sajjan Raja
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Alina Pervez
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Asma Ahmed
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Aisha Sheikh
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Saira Furqan
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Nanik Ram
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Azra Rizwan
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Nashia Ali Rizvi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Mohsin Ali Mustafa
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | | | - Bushra Ayub
- Learning Research Centre, Patel Hospital, Karachi, 75300, Pakistan
| | - Muhammad Qamar Masood
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| |
Collapse
|
3
|
Meneghini V, Tebar WR, Santos IS, Janovsky CCPS, de Almeida-Pititto B, Birck MG, Lotufo PA, Goulart AC, Sgarbi JA, Teixeira PDFDS, Silva GTD, Benseñor IM. Potential Determinants of Thyroid Peroxidase Antibodies and Mortality Risk: Results From the ELSA-Brasil Study. J Clin Endocrinol Metab 2024; 109:e698-e710. [PMID: 37698138 DOI: 10.1210/clinem/dgad539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 09/09/2023] [Indexed: 09/13/2023]
Abstract
CONTEXT The presence of thyroid peroxidase antibodies (TPOAbs) may be considered as an indicator of adverse health outcomes. OBJECTIVE We aimed to investigate the potential determinants of TPOAb levels and to analyze the association between TPOAb titers and the risk of all- and specific-cause mortality. METHODS Baseline and longitudinal data of 13 187 participants from the ELSA-Brasil Study were analyzed. We investigated the association of TPOAb, detectability, positivity, and persistent positivity with sociodemographic and lifestyle factors using logistic regressions. Cox proportional hazards and Fine-Gray subdistribution hazard regression analyses were used to verify the association of TPOAbs with mortality. RESULTS The determinants of TPOAb detectability and positivity were younger age, higher body mass index, female sex, and former and current smoking status. Black, mixed, and other self-reported races, intermediate and higher education, and heavy drinking were determinants of detectable and positive TPOAb levels. Female sex, White race, and former smoking were determinants of persistent TPOAb positivity at 2 visits, although only the female sex maintained its association at 3 visits. Moreover, after multivariate adjustment, there were associations between higher levels of TPOAbs and higher risk of cancer-related mortality among men, and TPOAb detectability and mortality by other causes among women. CONCLUSION Sociodemographic and lifestyle-related factors were determinants of multiple TPOAb categories. TPOAb levels were associated with mortality risk; however, the low mortality rate in this sample might have compromised this finding. We suggest further studies to explore the clinical importance of detectable TPOAb levels, not only its positivity, as a potential marker of inflammation.
Collapse
Affiliation(s)
- Vandrize Meneghini
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - William Rodrigues Tebar
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Itamar Souza Santos
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | | | - Bianca de Almeida-Pititto
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Marina Gabriela Birck
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| | - José Augusto Sgarbi
- Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marilia, Marilia, SP 17519-030, Brazil
| | | | - Gisela Tunes da Silva
- Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo, SP 05508-090, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
- Department Internal Medicine, Universidade de São Paulo, São Paulo, SP 05508-000, Brazil
| |
Collapse
|
4
|
Fernandes LDC, Arruda ACBB, Baeninger LG, Almeida DP, Villagelin D. Thyroid abnormality in patients with psoriasis: prevalence and association with severity. An Bras Dermatol 2024; 99:80-89. [PMID: 37598033 DOI: 10.1016/j.abd.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/07/2022] [Accepted: 12/26/2022] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Psoriasis is associated with several comorbidities and its association with thyroid abnormality has been hypothesized. OBJECTIVE To assess the prevalence of thyroid abnormality in Brazilian patients with psoriasis and to analyze its association with severity, presence of psoriatic arthritis and immunobiological treatment. Additionally, to compare results with literature as a control. METHODS In this observational study, clinical and laboratory data of patients followed from January 2018 to December 2019 were analyzed. Thyroid abnormality was assessed through the current history of thyroid disease and laboratory tests - thyrotropin (TSH), free thyroxine (FT4), antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibodies. Patients were classified according to psoriasis severity - Psoriasis Area and Severity Index (PASI), presence of psoriatic arthritis, and current treatment. Subsequently, the results were compared with a control group selected from the literature review. RESULTS Of the 250 included patients, 161 were eligible. The prevalence of thyroid abnormality was 28.57% and of hypothyroidism, 14.91%. The mean age was 55 years and the median PASI was 2.2. There was no association between thyroid abnormality and PASI (p=0.8), presence of psoriatic arthritis (p=0.87), or use of immunobiological therapy (p=0.13). The literature control group included 6,227 patients and there was a statistically significant difference for the hypothyroidism variable (p<0.0001). STUDY LIMITATIONS Absence of a control group from the same center. CONCLUSION This was one of the first Brazilian studies on the prevalence of thyroid abnormality in patients with psoriasis.
Collapse
Affiliation(s)
| | | | - Lisa Gava Baeninger
- Department of Dermatology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | - Debora Pedroso Almeida
- Department of Dermatology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | - Danilo Villagelin
- Department of Internal Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil; Department of Endocrinology and Metabology, Hospital da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| |
Collapse
|
5
|
Spilack ADM, Goulart AC, Janovsky CCPS, de Almeida-Pittito B, Lotufo PA, Sommer Bittencourt M, Generoso G, de Souza Santos I, Bensenor IM. The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 68:e220375. [PMID: 37988662 PMCID: PMC10916802 DOI: 10.20945/2359-4292-2022-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/23/2023] [Indexed: 11/23/2023]
Abstract
Objective We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.
Collapse
Affiliation(s)
- Aída de Melo Spilack
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina C P S Janovsky
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bianca de Almeida-Pittito
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo A Lotufo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Giuliano Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Itamar de Souza Santos
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
6
|
Pokhrel BR, Jha AC, Ghimire R, Shrestha J, Tamang B, Gautam N, Yadav T, Gharti SB. Hypothyroidism among Patients Visiting the Department of Biochemistry in Central Laboratory of a Tertiary Care Center: A Descriptive Cross-Sectional Study. JNMA J Nepal Med Assoc 2023; 61:413-416. [PMID: 37203890 PMCID: PMC10896450 DOI: 10.31729/jnma.8163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction The global burden of thyroid disorders, especially hypothyroidism, is high and increasing. Prevalence studies of such disorders are limited in Nepal. The aim of this study was to find out the prevalence of hypothyroidism among patients visiting the Department of Biochemistry in the central laboratory of a tertiary care centre. Methods A descriptive cross-sectional study was conducted among patients visiting the Department of Biochemistry in the central laboratory from 1 August 2020 to 31 July 2021 after taking ethical approval from the Institutional Review Committee (Reference number: UCMS/IRC/054/20). Patients of all age groups and gender were considered. Hypothyroid patients were identified based on the thyroid function parameters. They were further categorized as sub-clinical and overt hypothyroid. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among 3,010 patients, the prevalence of hypothyroidism was seen in 770 (25.58%) (24.02-27.14, 95% Confidence Interval). Out of total hypothyroid patients, 555 (72.08%) were females. Overt hypothyroidism 519 (67.40%) was the most prevalent hypothyroid disorder, followed by subclinical hypothyroidism 251 (32.60%). Conclusions The prevalence of hypothyroidism among patients visiting the Department of Biochemistry in the central laboratory of a tertiary care centre was higher than in other studies done in similar settings. Keywords hypothyroidism; Nepal; thyroid-stimulating hormone.
Collapse
Affiliation(s)
- Buddhi Raj Pokhrel
- Department of Biochemistry, Universal College of Medical Sciences, Ranigaun, Rupandehi, Nepal
| | - Amit Chandra Jha
- Department of Biochemistry, National Medical College, Birguni, Parsa, Nepal
| | - Rachita Ghimire
- Universal College of Medical Sciences, Ranigaun, Rupandehi, Nepal
| | - Jharana Shrestha
- Department of Biochemistry, Universal College of Medical Sciences, Ranigaun, Rupandehi, Nepal
| | - Binaya Tamang
- Department of Biochemistry, Universal College of Medical Sciences, Ranigaun, Rupandehi, Nepal
| | - Narayan Gautam
- Department of Biochemistry, Universal College of Medical Sciences, Ranigaun, Rupandehi, Nepal
| | - Tapeshwar Yadav
- Department of Biochemistry, Madan Bhandari Academy of Health Sciences, TCN Road, Hetauda, Nepal
| | | |
Collapse
|
7
|
Díez JJ, Iglesias P. Prevalence of thyroid dysfunction and its relationship to income level and employment status: a nationwide population-based study in Spain. Hormones (Athens) 2023; 22:243-252. [PMID: 36805924 DOI: 10.1007/s42000-023-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The influence of socioeconomic conditions on the prevalence of thyroid dysfunction in the population has been scarcely studied to date. The aim of this study has been to evaluate the influence of income level and employment status on the prevalence of hypothyroidism and hyperthyroidism. METHODS A cross-sectional study was performed using the population-based database BDCAP (Base de Datos Clínicos de Atención Primaria, Primary Care Clinical Database) to analyze the prevalence of thyroid dysfunction in the Spanish population classified by income groups and employment status. RESULTS Of the 40,613,229 people registered in the BDCAP in 2020, there were 2,596,041 (6.39%) with a diagnosis of hypothyroidism and 418,722 (1.03%) with hyperthyroidism. The prevalence of hypothyroidism in people with high income (≥ 100,000 euros/year), medium income (18,000-99,999 euros/year), low income (< 18,000 euros/year), and very low income were, respectively, 4.23%, 5.74%, 6.75%, and 7.01% (P < 0.001). The prevalence of hyperthyroidism in the same income groups also showed an increasing trend as income decreased (0.65%, 0.94%, 1.08%, and 1.10%; P < 0.001). Unemployed people had higher frequencies of hypothyroidism (7.35%) and hyperthyroidism (1.22%) than working people (5.80 and 1.00%, respectively) and inactive people (4.21 and 0.52%, respectively; P < 0.001). CONCLUSION Socioeconomic conditions are related to the prevalence of thyroid dysfunction. Low-income or unemployed people have a higher frequency of both hypothyroidism and hyperthyroidism.
Collapse
Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
8
|
Kumar R, Bansal R, Shergill HK, Garg P. Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2022.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
9
|
Spilack ADM, Goulart AC, de Almeida-Pititto B, Janovsky CCPS, Lotufo PA, Santos IDS, Benseñor IM. The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). Clinics (Sao Paulo) 2023; 78:100154. [PMID: 36669424 PMCID: PMC9868869 DOI: 10.1016/j.clinsp.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval ‒ 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. RESULTS After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). DISCUSSION Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected.
Collapse
Affiliation(s)
- Aída de Melo Spilack
- Post-Graduate Student, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bianca de Almeida-Pititto
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, SP, Brasil
| | | | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, RS, Brasil.
| |
Collapse
|
10
|
Kocełak P, Mossakowska M, Puzianowska-Kuźnicka M, Sworczak K, Wyszomirski A, Handzlik G, Stefański A, Zdrojewski T, Chudek J. Prevalence and risk factors of untreated thyroid dysfunctions in the older Caucasian adults: Results of PolSenior 2 survey. PLoS One 2022; 17:e0272045. [PMID: 35994462 PMCID: PMC9394816 DOI: 10.1371/journal.pone.0272045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction To determine the prevalence of treated and untreated thyroid dysfunction and to identify factors associated with increased risk of undiagnosed thyroid dysfunction in older adults. Methods The population of 5987 community-dwelling Polish Caucasian seniors aged 60 years and above who participated in the PolSenior 2 study (2018–2019). Population-based cross-sectional multidisciplinary study in design. Data from structured questionnaires, geriatric tests, and scales were obtained from all study participants who underwent anthropometric and blood pressure measurements during three home visits. Assessment of thyroid function was based on TSH serum measurements. Results The prevalence of thyroid dysfunction in the Polish population aged 60 years or above was estimated at 15.5% (21.5% in women and 7.2% in men), with 3.2% of undiagnosed individuals among them. The prevalence of hypothyroidism and hyperthyroidism in the studied group was 13.9% (19.4% in women and 6.3% in men) and 1.6% (2.1% in women and 0.9% in men) respectively, untreated hypothyroidism was revealed in 21.9% (in 160 out of 732 subjects) and untreated hyperthyroidism in 34.2% of subjects (in 41 out of 120 participants). In multiple regression analysis independent risk factors for thyroid disorders being untreated were older age (> 75 years), male sex, a low education level (primary or lower), and low utilization of medical services. Conclusions One-fifth of Polish Caucasian seniors with hypothyroidism and one-third with hyperthyroidism are untreated. Older, poorly educated and rarely utilizing medical services seniors, especially men, are more frequently untreated for thyroid dysfunction and some of them do not benefit from contemporary achievements in medicine.
Collapse
Affiliation(s)
- Piotr Kocełak
- Medical Faculty in Katowice, Department of Pathophysiology, Pathophysiology Unit, The Medical University of Silesia, Katowice, Poland
- * E-mail:
| | | | - Monika Puzianowska-Kuźnicka
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Adam Wyszomirski
- Faculty of Medicine, Department of Adult Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Gabriela Handzlik
- Medical Faculty in Katowice, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland
| | - Adrian Stefański
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Zdrojewski
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Jerzy Chudek
- Medical Faculty in Katowice, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
11
|
Economic and Cardiometabolic Risk Factors Are Predictors of Lower Thyroid Stimulating Hormone (TSH) Levels in Hispanic/Latinx Adults with Euthyroidism-A Community-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138142. [PMID: 35805800 PMCID: PMC9265905 DOI: 10.3390/ijerph19138142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Thyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM), and within the euthyroid range they may also impact other outcomes, such as mood disorders. This study aimed to observationally examine the relationship between TSH and social determinants of health and clinical measures in a euthyroid Hispanic/Latinx patient sample with a diagnosis of anxiety and/or depression disorders from a community health clinic. A needs assessment was completed using a random sample of 100 de-identified medical records of individuals who received free medical care, including mental health, at a community-based clinic. Those with low normal TSH (<2 mIU/L) compared with high normal TSH (≥2 mIU/L) had a greater odds of food insecurity (p = 0.016) and being at 100% of the federal poverty level (p = 0.015). The low normal TSH group had significantly higher fasting glucose (p = 0.046), hemoglobin A1c (p = 0.018), and total cholesterol (p = 0.034) compared with the high normal TSH group. In those with T2DM, individuals with low normal TSH had six-times greater odds of having high fasting glucose (p = 0.022) and high hemoglobin A1c (p = 0.029). These relationships warrant further study, to inform future public health policies and follow-up care for underserved and vulnerable communities.
Collapse
|
12
|
Birck MG, Almeida-Pititto BD, Janovsky CCPS, Goulart AC, Santos IS, Teixeira PDFDS, Sgarbi JA, Barreto SM, Duncan BB, Schmidt MI, Lotufo PA, Bensenor IM. Thyroid-Stimulating Hormone and Thyroid Hormones and Incidence of Diabetes: Prospective Results of the Brazilian Longitudinal Study of Adult Health (ELSA-BRASIL). Thyroid 2022; 32:694-704. [PMID: 35473396 DOI: 10.1089/thy.2021.0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: There are conflicting data regarding the association of thyroid function with incident diabetes. We prospectively investigated thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and its conversion ratio (fT3:fT4) with the risk of developing diabetes in euthyroid subjects and those with subclinical thyroid dysfunction. Our hypothesis is that this relationship is a U-shaped curve since both subclinical thyroid diseases may be associated with diabetes. Methods: ELSA-Brasil is a highly admixed cohort study of 35-74 years old at baseline (2008-2010). Levels of TSH, fT4, fT3, and fT3:fT4 ratio were evaluated at baseline and incident diabetes was estimated over an 8.2-year follow-up (2017-2019). Diabetes was identified based on medical diagnosis, prescriptions, and laboratory tests. The risk of diabetes was evaluated according to quintiles of TSH, fT4, fT3, and fT3:fT4 ratio using Poisson regression with robust variance presented as relative risk (RR) with confidence interval [CI] of 95% after multivariable adjustment for sociodemographic and cardiovascular risk factors (reference third quintile), and as continuous variables. Results: We included 7948 participants (mean age, 50.2 [standard deviation 8.6] years; 54.4% female): 7177 euthyroid, 726 with subclinical hypothyroidism, and 45 with subclinical hyperthyroidism. Incidence of diabetes was 14.8%. No association was found for TSH, fT4, fT3, and fT3:fT4 ratio quintiles with incident diabetes. Using continuous variables, the increase of 1-unit (1-U) of fT4 decreased the risk of diabetes (RR 0.94 [CI 0.91-0.99]), while the increase of 1-U of the fT3:fT4 ratio increased the diabetes risk (RR 1.37 [CI 1.15-1.63]). The increase of 1-U of fT3 was associated with an increased risk of diabetes, but without significance after multivariable adjustment. In body mass index-stratified analysis, people with overweight or obesity presented a modest significantly higher risk of diabetes in the lowest quintile of fT4 (RR 1.04 [CI 1.01-1.07]) and an inverse association with incident diabetes in the first quintile of fT3:fT4 ratio (RR, 0.95 [CI 0.93-0.98]). The analyses using continuous variables presented similar findings. Conclusion: These findings suggest that fT4 and fT3 levels and the conversion rate might be additional risk factors associated with incident diabetes, especially in the presence of overweight or obesity. However, they need to be confirmed in future studies. (ClinicalTrials.gov Identifier: NCT02320461).
Collapse
Affiliation(s)
| | - Bianca de Almeida-Pititto
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina C P S Janovsky
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Jose A Sgarbi
- Thyroid Unit, Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marilia, Marilia, Brazil
| | - Sandhi M Barreto
- Medical School and Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
13
|
Shaka H, Manz S, El-amir Z, Wani F, Salim M, Kichloo A. Ten-year trends in adrenal insufficiency admissions. Proc AMIA Symp 2022; 35:297-300. [DOI: 10.1080/08998280.2022.2039503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Shannon Manz
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, Michigan
| | - Zain El-amir
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, Michigan
| | - Farah Wani
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, Michigan
| | - Michael Salim
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, Michigan
- Department of Medicine, Samaritan Medical Center, Watertown, New York
| |
Collapse
|
14
|
Chen Y, Xiang Q, Wang N, Zhang W, Zhu C, Wang Y, Wan H, Cheng J, Zhang K, Cai Y, Lu Y. Are ethnic differences, urinary iodine status, lead and cadmium exposure associated with thyroid autoimmunity and hypothyroid status? A cross-sectional study. BMJ Open 2022; 12:e056909. [PMID: 35177462 PMCID: PMC8860026 DOI: 10.1136/bmjopen-2021-056909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the effects of different ethnicities and potential environmental exposure on the prevalence of thyroid autoimmune status and hypothyroid status. DESIGN The data were obtained from two cross-sectional studies. PARTICIPANTS 2105 participants in Shanghai (Han) and 772 participants in Yunnan Honghe Prefecture (Han, Yi, Miao and Hani), aged 18-75 were enrolled. METHODS Participants underwent several checkups, including urinary iodine concentration, blood lead (BPb) and blood cadmium (BCd), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid stimulating hormone (TSH) as well as thyroid ultrasonography (US). Thyroid autoimmune status was defined as: antithyroid antibody positive (ATA+): TPOAb + or TgAb+; and ATA + and US+: TPOAb + or TgAb + together with characteristic US features. RESULTS The standardised prevalence of thyroid autoimmune positivity in Yunnan were higher than those in Shanghai (TPOAb+: 13.56% vs 8.27%, p<0.001; TgAb+: 9.28% vs 7.09%, p=0.045; ATA+: 16.96% vs 11.10%, p<0.001; ATA + and US+: 8.96% vs 6.64%, p=0.036). For urinary iodine-to-creatinine ratio (UI/Cr), compared with the level of 100.00-199.99 µg/g, the level of ≥300.00 µg/g had a 1.5-fold risk for ATA + and US+ (OR 1.455, p=0.041). The levels of 200.00-299.99 µg/g and ≥300.00 µg/g were positively associated with hypothyroid status (OR 1.509, p=0.002 and OR 1.338, p=0.043). Compared with the first quartiles, the fourth quartiles of BPb were positively associated with TPOAb+: (OR 1.637, p=0.006), ATA+ (OR 1.435, p=0.025), ATA + and US+ (OR 1.641, p=0.013), hypothyroid status (OR 1.467, p=0.013) and TSH levels (B 0.092, p=0.021). The fourth quartile of BCd was positively associated with the prevalence of ATA+ (OR 1.427, p=0.036). CONCLUSIONS Higher levels of UI/Cr, BPb and BCd may be associated with thyroid autoimmunity and hypothyroid status.
Collapse
Affiliation(s)
- Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qian Xiang
- Department of Endocrinology, the Fifth affiliated Hospital of Kunming Medical University, Yunnan Honghe Prefecture Central Hospital (Ge Jiu People's Hospital), Yunnan, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chunfang Zhu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Cheng
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yan Cai
- Department of Endocrinology, the Fifth affiliated Hospital of Kunming Medical University, Yunnan Honghe Prefecture Central Hospital (Ge Jiu People's Hospital), Yunnan, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
15
|
Begum J, Umaramani G, Ali SI. Evaluation of Factors Affecting Thyroid Levels and its Relationship with Salt Iodine to Suggest the Way Forward! Int J Prev Med 2022; 12:166. [PMID: 35070199 PMCID: PMC8724628 DOI: 10.4103/ijpvm.ijpvm_594_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background: In India, 42 million people suffer from thyroid diseases. One in 10 adults suffer from hypothyroidism. Although coverage of iodized salt utilization has increased after universal salt iodization, we are yet to achieve the goals of NIDDCP for which the present study was planned to identify the hidden factors. The aim is to identify the factors affecting thyroid hormone levels, their association with salt iodine content and suggest strategies for improvement based on patient perceptions. Methods: A hospital based prospective follow up study was conducted among 140 patients, with an in depth interview and testing of salt iodine content. Data were analyzed using the SPSS software. Results: 96 (69%) patients were of age 18–35 years. 129 (92%) were females, 120 (86%) were from rural areas, 95 (68%) were literate, 116 (83%) were unemployed, and 115 (82%) were of low socioeconomic status. Most of them had poor cooking practices and dietary habits. The T3, T4, and TSH levels were within the normal range in 84 (60%) patients. Only in 28 (20%) salt samples, the iodine content was adequate. The association between factors like intake of inadequately iodized salt (P < 0.01), rural distribution (P < 0.05), illiteracy, presence of the comorbid conditions (P < 0.0001), and thyroid hormone abnormality was found to be statistically significant. Conclusion: The factors that adversely affect thyroid levels were higher age, female gender, rural distribution, comorbid conditions and patients with low salt iodine were prone to abnormal levels. Monitoring salt iodine content, training of health care workers to create awareness were the key strategies proposed for improvement.
Collapse
Affiliation(s)
- Jarina Begum
- Department of Community Medicine, Great Eastern Medical School, Ragolu, Srikakulam, Andhra Pradesh, India
| | - Ganta Umaramani
- Department of Biochemistry, NRI Institute of Medical Sciences, Vishakhapatnam, Andhra Pradesh, India
| | - Syed I Ali
- Department of Community Medicine, Great Eastern Medical School, Ragolu, Srikakulam, Andhra Pradesh, India
| |
Collapse
|
16
|
Benseñor IM, Junior FB, Janovsky CCPS, Marchioni D, de Fátima Haueisen Sander Diniz M, de Souza Santos I, de Almeida-Pititto B, Sgarbi JA, Del Carmen B Molina M, Mill JG, Lotufo PA. Urinary iodine and sodium concentration and thyroid status in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Trace Elem Med Biol 2021; 68:126805. [PMID: 34247033 DOI: 10.1016/j.jtemb.2021.126805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate urinary iodine concentration (UIC) in civil servants aged 35-74 years of the Brazilian Study of Adults Health (ELSA-Brasil) to analyze its relationship with sociodemographic, clinical risk factors, lifestyle, urinary Na and thyroid status. DESIGN Cross-sectional study in six Brazilian cities. METHODS This analysis included 792 participants with information about urinary iodine concentration (UIC). Thyroid status was defined by serum levels of TSH/FT4 and the current use of antithyroid drugs for treatment of overt hyperthyroidism or levothyroxine to treat overt hypothyroidism. The determination of UIC was carried out with an inductively coupled plasma mass spectrometer (ICP-MS) and was expressed as median with Interquartile Range (IQR). RESULTS In 792 participants, thereof 52% women, mean age was 51.9 (9.0) years. The median UIC was 219 (IQR, 166-291) for all persons studied, thereof 211 (IQR, 157-276) for women and 231 (IQR, 178-304) for men. According to the WHO classification, for all persons studied, 60% had more than adequate iodine-supply (UIC ≥200 μg/L), 37% were adequately supplied (UIC 100-199 μg/L) and <3% had a deficient iodine status (<100 μg/L). In the 35-44-year age strata, which includes women of childbearing age, 23.2% of women presented less than 150 μg/L of UIC. No differences in UIC were detected according to thyroid status. (P = 0.39) The correlation between Ur-Na and UIC showed a Spearman coefficient of 0.52 (P < 0.0001) and it was also found an association of Ur-Na with UIC: Beta of 1.76 (95% Confidence Interval (95% CI): 1.01 to 2.51. The urinary Na concentration showed a synergy with the UIC, that means medians of 57, 72, 107 and 141 mmol Na/L urine (P < 0.001) in the groups with the four UIC classes according to the WHO grading mentioned above. The very low Na content in the persons exhibiting <100 μg/L UIC seems to reflect also a higher urine volume due to the frequent use of diuretics. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. The strong relationship between the urinary Na concentration and the UIC points to a dependence of the UIC on the individual consumption of iodized salt, which should be more considered in future studies. CONCLUSIONS Euthyroid persons were dominating by more than four fifths and no significant association was found between UIC and thyroid status. Although most of the persons studied present more than adequate iodine intake it was observed that nearly a quarter of women in childbearing age are iodine deficient.
Collapse
Affiliation(s)
- Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| | - Fernando Barbosa Junior
- Department of Clinical, Toxicological and Bromatological Analyzes. ASTox - Laboratory of Analytical and Systems Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Dirce Marchioni
- Department of Nutrition, School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, Brazil.
| | | | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| | | | - José Augusto Sgarbi
- Thyroid Unit, Division of Endocrinology and Metabolism, Department of Medicine, Faculdade de Medicina de Marília, São Paulo, Brazil.
| | | | | | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
17
|
Appunni S, Rubens M, Ramamoorthy V, Saxena A, Tonse R, Veledar E, McGranaghan P. Association between vitamin D deficiency and hypothyroidism: results from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. BMC Endocr Disord 2021; 21:224. [PMID: 34772378 PMCID: PMC8590325 DOI: 10.1186/s12902-021-00897-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/05/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Many smaller studies have previously shown a significant association between thyroid autoantibody induced hypothyroidism and lower serum vitamin D levels. However, these finding have not been confirmed by large-scale studies. In this study, we evaluated the relationship between hypothyroidism and vitamin D levels using a large population-based data. METHODS For this study, we used National Health and Nutrition Examination Survey (NHANES) during the years 2007-2012. We categorized participants into three clinically relevant categories based on vitamin D levels: optimal, intermediate and deficient. Participants were also split into hypothyroid and hyperthyroid. Weighted multivariable logistic regression analyses were used to calculate the odds of being hypothyroid based on vitamin D status. RESULTS A total of 7943 participants were included in this study, of which 614 (7.7%) were having hypothyroidism. Nearly 25.6% of hypothyroid patients had vitamin D deficiency, compared to 20.6% among normal controls. Adjusted logistic regression analyses showed that the odds of developing hypothyroidism were significantly higher among patients with intermediate (adjusted odds ratio [aOR], 1.7, 95% CI: 1.5-1.8) and deficient levels of vitamin D (aOR, 1.6, 95% CI: 1.4-1.9). CONCLUSION Low vitamin D levels are associated with autoimmune hypothyroidism. Healthcare initiatives such as mass vitamin D deficiency screening among at-risk population could significantly decrease the risk for hypothyroidism in the long-term.
Collapse
Affiliation(s)
- Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala, India
| | | | | | | | | | - Emir Veledar
- Baptist Health South Florida, Miami, Florida, USA
- Department of Biostatistics, Florida International University, Miami, FL, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter McGranaghan
- Miami Cancer Institute, Miami, Florida, USA.
- Baptist Health South Florida, Miami, Florida, USA.
- Department of Internal Medicine and Cardiology, Charité - Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
18
|
Benseñor IM, Janovsky CCPS, Goulart AC, de Souza Santos I, de Fátima Haueisen Sander Diniz M, de Almeida-Pititto B, Sgarbi JA, Lotufo PA. Incidence of TPOAb over a 4-year follow-up period: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:832-840. [PMID: 34762792 PMCID: PMC10065385 DOI: 10.20945/2359-3997000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Although some previous data have suggested a high iodine intake in Brazil, the prevalence of antithyroperoxidase antibodies (TPOAb) in the country is compatible with rates from countries with adequate iodine intake. This observation emphasizes the importance of knowing the incidence of TPOAb in Brazil. Methods This prospective analysis included euthyroid participants with negative TPOAb at baseline and a thyroid function assessment at a 4-year follow-up. TPOAb was measured by electrochemiluminescence and considered positive when titers were ≥34 IU/mL. TSH and free T4 (FT4) levels were determined by a third-generation immunoenzymatic assay. The incidence of TPOAb is expressed in percentage per year or as a cumulative incidence within the 4-year follow-up period. Results Of 8,922 euthyroid participants (mean age 51.1 years; 50.9% women) with a negative TPOAb test at baseline, 130 presented incident TPOAb at the 4-year follow-up, yielding an annual incidence of TPOAb of 0.38%/year (95% confidence interval [95% CI], 0.37-0.39%/year) and a cumulative incidence over 4 years of 1.46% (95% CI, 1.21-1.71%). In men, the annual incidence was 0.32% (95% CI, 0.31-0.33%), and the cumulative incidence over 4 years was 1.23% (95% CI, 0.90-1.56%). In women, the annual incidence was 0.43%/year (95% CI, 0.42-0.44%/year) and the cumulative incidence over 4 years was 1.67% (95% CI, 1.30-2.04%). The only factor associated with incident TPOAb was the occurrence of thyroid diseases at follow-up. No differences in TPOAb incidence were detected across ELSA-Brasil research centers. Conclusion Based on the results of this study, the incidence of TPOAb per year and at a 4-year follow-up period are compatible with those of a country with adequate iodine intake.
Collapse
Affiliation(s)
- Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Divisão de Clínica Médica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina Castro Porto Silva Janovsky
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Divisão de Clínica Médica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Divisão de Clínica Médica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Divisão de Clínica Médica, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Bianca de Almeida-Pititto
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Augusto Sgarbi
- Unidade de Tireoide, Divisão de Endocrinologia e Metabolismo, Departamento de Medicina, Faculdade de Medicina de Marília, Marília, SP, Brasil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Divisão de Clínica Médica, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
19
|
Benseñor IM, Sgarbi JA, Janovsky CCPS, Pittito BA, de Fátima Haueisen Sander Diniz M, da Conceição Chagas de Almeida M, Alvim SM, Barreto SM, Giatti L, Duncan BB, Schmidt MI, de Jesus M Fonseca M, Griep RH, Del Carmen B Molina M, Mill JG, de Souza Santos I, Goulart AC, Lotufo PA. Incidence of thyroid diseases: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:468-478. [PMID: 33844894 PMCID: PMC10522183 DOI: 10.20945/2359-3997000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate incidence of subclinical and overt hyperthyroidism and hypothyroidism. METHODS The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of 15,105 civil servants, examined at baseline and over a 4-year follow-up. This analysis included 9,705 participants with normal thyroid function at baseline, follow-up information about thyroid function and with no report of using drugs that may interfere in the thyroid function. Thyroid function was defined by TSH/FT4 levels or routine use of thyroid hormones/anti-thyroid medications. Annual and cumulative (over 4-year) incidence rates were presented as percentages (95% Confidence Intervals). RESULTS The incidence of all overt and subclinical thyroid disease was 6.7% (1.73%/year): 0.19% for overt hyperthyroidism (0.048%/year), 0.54% for subclinical hyperthyroidism (0.14%/year), 1.98% for overt hypothyroidism (0.51%/year), and 3.99% for subclinical hypothyroidism (1.03%/year). The incidence of all thyroid diseases was higher in women, when compared to men, with a low women:men ratio (1.36). For Blacks the highest incidence was for overt hyperthyroidism, while for Whites, the highest incidence was for overt hypothyroidism. However, the highest incidence of overt hyperthyroidism was detected in Asian descendants. The presence of antithyroperoxidase antibodies at baseline was associated with higher incidence of overt thyroid diseases. CONCLUSION These results showed a high incidence of hypothyroidism, which is compatible with a country with a more-than-adequate iodine intake. The low women:men ratio of the incidence of thyroid dysfunction highlights the importance of the diagnosis of thyroid diseases among men in Brazil.
Collapse
Affiliation(s)
- Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Augusto Sgarbi
- Divisão de Endocrinologia, Faculdade de Medicina de Marília, Marília, SP, Brasil
| | | | - Bianca Almeida Pittito
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | - Sheila Maria Alvim
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Sandhi M Barreto
- Medicina Preventiva, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Luana Giatti
- Medicina Preventiva, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Bruce B Duncan
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Maria Inês Schmidt
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Maria de Jesus M Fonseca
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Rosane H Griep
- Laboratório de Educação em Saúde e Meio Ambiente, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - José Geraldo Mill
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
20
|
Sgarbi JA, Ward LS. A practical contemporary approach to decision-making on subclinical hypothyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:32-39. [PMID: 33320453 PMCID: PMC10528698 DOI: 10.20945/2359-3997000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 11/23/2022]
Abstract
Subclinical hypothyroidism (Shypo) is an increasingly frequent condition in common medical practice. Its diagnosis continues to pose a challenge since a series of non-thyroidal and temporary conditions can elevate serum TSH levels. In addition, the consequences of Shypo are still up for debate. Although detrimental cardiovascular effects have been consistently demonstrated in the young, they are less evident in older adults (65-79 years), and even more so in the oldest old (≥80 years). In the absence of evidence of any benefits of treating Shypo in patients' clinical manifestations and unfavorable outcomes, the most effective decision-making approach should include a thorough investigation of the patient's condition integrating all relevant clinical data, such as TSH levels, age, quality of life, comorbidities, cardiovascular risk, safety, and personal preferences. The decision-making process needs to take into account the risk of levothyroxine overtreatment and the resulting adverse consequences, such as reduction of bone mineral density, heart failure, and atrial fibrillation. Hence, current evidence suggests that individuals with TSH > 10 mU/L, who test positive for TPO Ab or are symptomatic may benefit from levothyroxine treatment. However, a more cautious and conservative approach is required in older (≥65 years of age), and oldest-old (≥80 years) patients, particularly those with frailty, in which the risk of treatment can outweigh potential benefits. The latter may benefit from a wait-and-see approach.
Collapse
Affiliation(s)
- José Augusto Sgarbi
- Unidade de Tireoide, Divisão de Endocrinologia e Metabolismo, Faculdade de Medicina de Marília (Famema), Marília, SP, Brasil,
| | - Laura Sterian Ward
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| |
Collapse
|
21
|
Keestra S, Högqvist Tabor V, Alvergne A. Reinterpreting patterns of variation in human thyroid function: An evolutionary ecology perspective. EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9:93-112. [PMID: 34557302 PMCID: PMC8454515 DOI: 10.1093/emph/eoaa043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
Thyroid hormone reference intervals—used to determine normal thyroid
function —currently don’t take into account many significant
factors that can cause variation in thyroid hormone levels. These factors
include age, sex, ethnicity, season, time of day, iodine content in the diet,
socioeconomic status, stress levels, body composition, immune status, menstrual
cycle phase, and overall health status. This paper shows how early life
experiences as well as short term stressors may affect variation in thyroid
function. These are energetic challenges to which the thyroid physiology can
respond to. Our investigation shows that much variation in thyroid function is
natural. It may result from a complex interplay of evolutionary, genetic,
developmental, and physiological factors in response to energetic challenges in
the environment, beyond what is currently considered in biomedicine. A new
research agenda for thyroid health should explore the way that diversity in
thyroid function has evolved as a response to different contexts people live
in—like focusing on how people’s metabolisms adapt to the
energetic requirements of their environments. Two hundred million people worldwide experience some form of thyroid disorder,
with women being especially at risk. However, why human thyroid function varies
between populations, individuals, and across the lifespan has attracted little
research to date. This limits our ability to evaluate the conditions under which
patterns of variation in thyroid function are best understood as
‘normal’ or ‘pathological’. In this review, we
aim to spark interest in research aimed at understanding the causes of variation
in thyroid phenotypes. We start by assessing the biomedical literature on
thyroid imbalance to discuss the validity of existing reference intervals for
diagnosis and treatment across individuals and populations. We then propose an
evolutionary ecological framework for understanding the phylogenetic, genetic,
ecological, developmental, and physiological causes of normal variation in
thyroid function. We build on this approach to suggest testable predictions for
how environmental challenges interact with individual circumstances to influence
the onset of thyroid disorders. We propose that dietary changes, ecological
disruptions of co-evolutionary processes during pregnancy and with pathogens,
emerging infections, and exacerbated stress responses can contribute to
explaining the onset of thyroid diseases. For patients to receive the best
personalized care, research into the causes of thyroid variation at multiple
levels is needed.
Collapse
Affiliation(s)
- Sarai Keestra
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford, UK.,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alexandra Alvergne
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford, UK.,ISEM, Université de Montpellier, CNRS, IRD, EPHE, Montpellier, France
| |
Collapse
|
22
|
Møllehave LT, Jacobsen RK, Linneberg A, Skaaby T, Knudsen N, Jørgensen T, Kårhus LL, Kriegbaum M, Grand MK, Siersma V, Lind B, Andersen CL, Nygaard B, Medici BB, Pedersen IB, Ravn-Haren G, Thuesen BH. Influence of educational level on test and treatment for incident hypothyroidism. Clin Endocrinol (Oxf) 2021; 94:1025-1034. [PMID: 33512012 DOI: 10.1111/cen.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The incidence of hypothyroidism is not expected to differ by socioeconomic factors. However, the decision to test and initiate treatment may differ. We aimed to examine whether educational level influences the probability of thyroid stimulation hormone (TSH)-measurement and initiation of levothyroxine treatment. DESIGN Citizens in the greater Copenhagen Area during 2001-2015 were included. Individual-level data on educational level, diagnoses, GP-contact, TSH-measurement and medication were derived from administrative and healthcare registers. The relative risks (RR) between educational levels of annual TSH-measurement and treatment initiation following a TSH-measurement were analysed in Poisson regression models with generalized estimation equations. RESULTS A TSH-measurement was performed in 19% of 9,390,052 person years. The probability of TSH-measurement was higher with short (RR 1.16 [95% CI 1.15-1.16]) and medium (RR 1.11 [95% CI 1.06-1.12]) compared with long education. Treatment was initiated after 0.8% of 2,049,888 TSH-measurements. For TSH < 5 mIU/L, RR for treatment initiation ranged between 0.47 (95%CI 0.39-0.57) and 0.78 (95%CI 0.67-0.91) for short and medium compared with long education. For TSH 5-10 mIU/L, there was no statistically significant difference. For TSH > 10 mIU/L, RR was 1.07 (95% CI 1.02-1.12) for short and 1.08 (95% CI 1.03-1.13) for medium compared with long education. CONCLUSION The probability of TSH-measurement was higher with shorter education, and the probability of treatment initiation with TSH > 10 mIU/L was marginally higher with short-medium education compared with long education. However, the probability of treatment initiation with TSH < 5 mIU/L, that is treatment incongruous with guidelines, was substantially higher in persons with long education.
Collapse
Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tea Skaaby
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Birte Nygaard
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bjarke Borregaard Medici
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Inge Bülow Pedersen
- Department of Endocrinology and Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Ravn-Haren
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Betina Heinsbaek Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| |
Collapse
|
23
|
Martins JRM, Villagelin DGP, Carvalho GA, Vaisman F, Teixeira PFS, Scheffel RS, Sgarbi JA. Management of thyroid disorders during the COVID-19 outbreak: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:368-375. [PMID: 33844898 PMCID: PMC10065338 DOI: 10.20945/2359-3997000000352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This position statement was prepared to guide endocrinologists on the best approach to managing thyroid disorders during the coronavirus disease (COVID-19) pandemic. The most frequent thyroid hormonal findings in patients with COVID-19, particularly in individuals with severe disease, are similar to those present in the non-thyroidal illness syndrome and require no intervention. Subacute thyroiditis has also been reported during COVID-19 infection. Diagnosis and treatment of hypothyroidism during the COVID-19 pandemic may follow usual practice; however, should avoid frequent laboratory tests in patients with previous controlled disease. Well-controlled hypo and hyperthyroidism are not associated with an increased risk of COVID-19 infection or severity. Newly diagnosed hyperthyroidism during the pandemic should be preferably treated with antithyroid drugs (ATDs), bearing in mind the possibility of rare side effects with these medications, particularly agranulocytosis, which requires immediate intervention. Definitive treatment of hyperthyroidism (radioiodine therapy or surgery) may be considered in those cases that protective protocols can be followed to avoid COVID-19 contamination or once the pandemic is over. In patients with moderate Graves' ophthalmopathy (GO) not at risk of visual loss, glucocorticoids at immunosuppressive doses should be avoided, while in those with severe GO without COVID-19 and at risk of vision loss, intravenous glucocorticoid is the therapeutic choice. Considering that most of the thyroid cancer cases are low risk and associated with an excellent prognosis, surgical procedures could and should be postponed safely during the pandemic period. Additionally, when indicated, radioiodine therapy could also be safely postponed as long as it is possible.
Collapse
Affiliation(s)
- João Roberto M Martins
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Laboratório de Endocrinologia Molecular e Translacional, Disciplina de Endocrinologia e Metabologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp/EPM), São Paulo, SP, Brasil
| | - Danilo G P Villagelin
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Endocrinologia e Metabolismo, Hospital da PUC-Campinas, Campinas, SP, Brasil.,Pós-graduação em Clínica Médica, Unicamp, Campinas, SP, Brasil
| | - Gisah A Carvalho
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Departamento de Endocrinologia e Metabologia (SEMPR), Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR),Curitiba, PR, Brasil
| | - Fernanda Vaisman
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brasil
| | - Patrícia F S Teixeira
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Rafael S Scheffel
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - José A Sgarbi
- Departamento de Tireoide, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.,Unidade de Tireoide, Disciplina de Endocrinologia e Metabolismo, Departamento de Medicina, Faculdade de Medicina de Marília, Marília, SP, Brasil,
| |
Collapse
|
24
|
Santos IDS, Suemoto CK, ValladÃo-Junior JBR, Liu S, Barreto SM, Fedeli LMG, Lotufo PA, Bensenor IM. Serum folate levels and cognitive performance in the ELSA-Brasil baseline assessment. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:672-680. [PMID: 33263638 DOI: 10.1590/0004-282x20200074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Most studies that analyze the association between serum folate levels and cognitive function either restrict their assessments to specific clinical scenarios or do not include middle-aged individuals, to whom strategies for preventing cognitive impairment may be more feasible. OBJECTIVE To examine the association between serum folate levels and cognitive function in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. METHODS Data from 4,571 ELSA-Brasil participants who live in the state of São Paulo, aged 35-74 years, were analyzed. The word list learning, delayed recall, word recognition, verbal fluency, and Trail Making Test Part B consisted in the cognitive tests. For each test, age, sex, and education-specific standardized scores and a global cognitive score were calculated. Crude and adjusted linear regression models were used to examine the associations of serum folate levels with cognitive test scores. RESULTS In multivariable-adjusted models, serum folate was not associated with global cognitive score (β=-0.043; 95% confidence interval [95%CI] -0.135 to 0.050 for lowest vs. highest quintile group), nor with any cognitive test performance. We did not find associations between serum folate and global cognitive scores in subgroups stratified by age, sex, or use of vitamin supplements either. CONCLUSIONS We did not find significant associations between serum folate and cognitive performance in this large sample, which is characterized by a context of food fortification policies and a consequent low frequency of folate deficiency. Positive results from previous studies may not apply to the increasingly common contexts in which food fortification is implemented, or to younger individuals.
Collapse
Affiliation(s)
- Itamar de Souza Santos
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.,Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil
| | - Claudia Kimie Suemoto
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.,Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil
| | | | - Simin Liu
- Brown University, School of Public Health, Department of Epidemiology, Providence, RI, United States of America
| | - Sandhi Maria Barreto
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Medicina Preventiva e Social, Belo Horizonte MG, Brazil
| | - Ligia Maria Giongo Fedeli
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil
| | - Paulo Andrade Lotufo
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.,Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil
| | - Isabela Martins Bensenor
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Clínica e Epidemiológica, São Paulo SP, Brazil.,Universidade de São Paulo. Faculdade de Medicina, Departamento de Clínica Médica, São Paulo SP, Brazil
| |
Collapse
|
25
|
Ettleson MD, Bianco AC. Individualized Therapy for Hypothyroidism: Is T4 Enough for Everyone? J Clin Endocrinol Metab 2020; 105:dgaa430. [PMID: 32614450 PMCID: PMC7382053 DOI: 10.1210/clinem/dgaa430] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT It is well recognized that some hypothyroid patients on levothyroxine (LT4) remain symptomatic, but why patients are susceptible to this condition, why symptoms persist, and what is the role of combination therapy with LT4 and liothyronine (LT3), are questions that remain unclear. Here we explore evidence of abnormal thyroid hormone (TH) metabolism in LT4-treated patients, and offer a rationale for why some patients perceive LT4 therapy as a failure. EVIDENCE ACQUISITION This review is based on a collection of primary and review literature gathered from a PubMed search of "hypothyroidism," "levothyroxine," "liothyronine," and "desiccated thyroid extract," among other keywords. PubMed searches were supplemented by Google Scholar and the authors' prior knowledge of the subject. EVIDENCE SYNTHESIS In most LT4-treated patients, normalization of serum thyrotropin levels results in decreased serum T3/T4 ratio, with relatively lower serum T3 levels; in at least 15% of the cases, serum T3 levels are below normal. These changes can lead to a reduction in TH action, which would explain the slower rate of metabolism and elevated serum cholesterol levels. A small percentage of patients might also experience persistent symptoms of hypothyroidism, with impaired cognition and tiredness. We propose that such patients carry a key clinical factor, for example, specific genetic and/or immunologic makeup, that is well compensated while the thyroid function is normal but might become apparent when compounded with relatively lower serum T3 levels. CONCLUSIONS After excluding other explanations, physicians should openly discuss and consider therapy with LT4 and LT3 with those hypothyroid patients who have persistent symptoms or metabolic abnormalities despite normalization of serum thyrotropin level. New clinical trials focused on symptomatic patients, genetic makeup, and comorbidities, with the statistical power to identify differences between monotherapy and combination therapy, are needed.
Collapse
Affiliation(s)
- Matthew D Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
26
|
Abstract
Overt hypothyroidism is a common endocrine disorder affecting 1-2% of women of reproductive age. Optimizing treatment in pregnant women with overt hypothyroidism can reduce adverse fetal and maternal outcomes. Ideally, women who are known to have a history of hypothyroidism or those with risk factors for becoming hypothyroid, should have adequate preconception care to ensure euthyroidism from the onset of pregnancy, with a TSH target of below 2.5mIU/L. On women who are already on levothyroxine, an empirical dose increase of 30-50% as soon as pregnancy is confirmed may be considered. During pregnancy, levothyroxine doses should be titrated against TSH, which have trimester-specific ranges. In women who are known to be hypothyroid but are inadequately treated, we recommend a doubling of levothyroxine dose on at least three days a week to rapidly achieve euthyroidism. In newly diagnosed overt hypothyroidism in pregnancy, starting doses of either 100 or 150 mg daily may be considered safe.
Collapse
Affiliation(s)
- Sarah Weiling Li
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228.
| |
Collapse
|
27
|
Szlejf C, Suemoto CK, Janovsky CCPS, Barreto SM, Diniz MDFHS, Lotufo PA, Bensenor IM. Thyroid Function and Sarcopenia: Results from the ELSA-Brasil Study. J Am Geriatr Soc 2020; 68:1545-1553. [PMID: 32167571 DOI: 10.1111/jgs.16416] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We aimed to investigate the association of subclinical thyroid disease and thyroid hormone levels with sarcopenia and its defining components in community-dwelling middle-aged and older adults without overt thyroid dysfunction. DESIGN Cross-sectional study. SETTING Active and retired employees from public institutions located in six Brazilian cities. PARTICIPANTS A total of 6974 participants from the ELSA-Brasil study's second wave, aged 50 years and older, without overt thyroid dysfunction and with complete data for exposure, outcome, and covariates. METHODS Serum levels of thyrotropin (TSH), free thyroxine, and free triiodothyronine (FT3) were measured and divided in quintiles for the analyses. Participants were classified with euthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism. Muscle mass was assessed by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Possible confounders included sociodemographic characteristics, clinical conditions, and lifestyle. Analyses were performed separately for middle-aged and older adults (≥65 y). RESULTS The frequencies of sarcopenia, low muscle mass, low muscle strength, subclinical hypothyroidism, and subclinical hyperthyroidism were 1.5%, 20.8%, 3.8%, 9.1%, and .9%, respectively. Subclinical thyroid dysfunction was not associated with sarcopenia and its defining components. Among older adults, TSH had a U-shaped association with sarcopenia and low muscle strength. The odds ratios (ORs) (95% confidence intervals [CIs]) for the associations of the first, second, fourth, and fifth quintile with sarcopenia, respectively, were 5.18 (1.47-18.28), 6.28 (1.82-21.73), 4.12 (1.15-14.76), and 4.81 (1.35-17.10), and with low muscle strength was (OR (95% CI) for the first, second, and fifth quintiles, respectively: 1.43 (1.16-5.07), 2.07 (1.24-4.70), and 2.18 (1.03-4.60). Additionally, FT3 had a negative association with muscle mass in both age strata. CONCLUSION Subtle thyroid hormone alterations are associated with sarcopenia or its defining components in middle-aged and older adults without overt thyroid dysfunction. J Am Geriatr Soc 68:1545-1553, 2020.
Collapse
Affiliation(s)
- Claudia Szlejf
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Claudia K Suemoto
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Carolina C P S Janovsky
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
28
|
Tamatea JAU, Reid P, Conaglen JV, Elston MS. Thyrotoxicosis in an Indigenous New Zealand Population - a Prospective Observational Study. J Endocr Soc 2020; 4:bvaa002. [PMID: 32161829 PMCID: PMC7060792 DOI: 10.1210/jendso/bvaa002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background Reported international incidence rates of thyrotoxicosis vary markedly, ranging from 6 to 93 cases per 100 000 per annum. Along with population demographics, exposures, and study design factors, ethnicity is increasingly being recognized as a potential factor influencing incidence. This study aimed to document the epidemiology and clinical presentation of thyrotoxicosis for Māori, the indigenous population in New Zealand. Methods A prospective study of adult patients presenting with a first diagnosis of thyrotoxicosis between January 2013 and October 2014 to a single New Zealand center. Demographic data were collected, and detailed clinical assessment performed. Results With 375 patients, an incidence rate of thyrotoxicosis of 73.0 per 100 000 per annum was identified. Of these, 353 (94.1%) participated in the study. The median age of the cohort was 47 years, 81% were female, and 58% had Graves disease. The overall incidence of thyrotoxicosis for Māori, the indigenous people of New Zealand, was higher than non-Māori (123.9 vs 57.3 per 100 000 per annum). Rates of both Graves disease and toxic multinodular goiter were higher in Māori as compared to non-Māori (incidence rate ratios of 1.9 [1.4, 2.6] and 5.3 [3.4, 8.3], respectively), with this increase being maintained after controlling for age, deprivation, and smoking. Conclusions Māori, the indigenous people of New Zealand, have an increased incidence of thyrotoxicosis compared to non-Māori and, in particular, toxic multinodular goiter. A greater understanding of the epidemiology of thyrotoxicosis in other indigenous and marginalized ethnic groups may help to optimize therapeutic pathways, equitable care and outcomes.
Collapse
Affiliation(s)
- Jade A U Tamatea
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand.,Te Kupenga Hauora Māori, Tamaki Campus, University of Auckland Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Tamaki Campus, University of Auckland Auckland, New Zealand
| | - John V Conaglen
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand
| | - Marianne S Elston
- Department of Medicine, Waikato Clinical Campus, University of Auckland. Hamilton, New Zealand
| |
Collapse
|
29
|
Benseñor IM, Lotufo PA. Subclinical thyroid diseases as a non-classical risk factor for cardiovascular diseases. SAO PAULO MED J 2020; 138:95-97. [PMID: 32491081 PMCID: PMC9662841 DOI: 10.1590/1516-3180.2020.138230032020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Isabela Martins Benseñor
- MD, PhD. Full Professor, Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo (SP), Brazil
| | - Paulo Andrade Lotufo
- MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo (SP), Brazil
| |
Collapse
|
30
|
Granzotto PCD, Mesa Junior CO, Strobel R, Radominski R, Graf H, de Carvalho GA. Thyroid function before and after Roux-en-Y gastric bypass: an observational study. Surg Obes Relat Dis 2019; 16:261-269. [PMID: 31924503 DOI: 10.1016/j.soard.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Population studies have shown a positive association between thyroid-stimulating hormone (TSH) and body mass index. Recent studies have shown a significant increase in the prevalence of subclinical hypothyroidism (SCH) in obesity. Weight reduction after Roux-en-Y gastric bypass (RYGB) seems to significantly decrease TSH levels. OBJECTIVES The purpose of this study was to evaluate the prevalence of SCH in obese patients (class II and III) and to observe the behavior of thyroid hormones (TSH, hormone triiodothyronine, thyroxine, free thyroxine) with significant weight loss after RYGB. SETTING Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil. METHODS We retrospectively reviewed the medical records of 215 obese patients who underwent RYGB between 2005 and 2012 with a follow-up of at least 2 years. The study was observational and descriptive. The selected times for clinical and laboratory evaluations were preoperative, 3, 6, 12, and 24 months after the procedure. Association, correlation, and variance analyses were performed. RESULTS The prevalence of SCH preoperatively was 9.3%. SCH was corrected in 89.5% of patients 12 months after RYGB. We did not find an association between TSH and BMI (r = .002, P = .971). There was a positive impact of bariatric surgery on all metabolic variables. We showed that serum TSH level had no positive correlation with the presence or absence of metabolic syndrome. CONCLUSIONS Weight loss after bariatric surgery leads to normalization of TSH levels in most patients and none developed overt hypothyroidism. Obese patients with SCH should not be treated with thyroid hormone replacement. Serial monitoring of thyroid function after obesity therapy seems to be a reasonable approach.
Collapse
Affiliation(s)
| | - Cleo Otaviano Mesa Junior
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Rodrigo Strobel
- Bariatric and Metabolic Surgery Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Rosana Radominski
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Hans Graf
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gisah Amaral de Carvalho
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| |
Collapse
|
31
|
Jung SJ, Kang JH, Roberts AL, Nishimi K, Chen Q, Sumner JA, Kubzansky L, Koenen KC. Posttraumatic stress disorder and incidence of thyroid dysfunction in women. Psychol Med 2019; 49:2551-2560. [PMID: 30488818 DOI: 10.1017/s0033291718003495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women. METHODS We used data from 45 992 women from the ongoing Nurses' Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants' self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves' hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves' hyperthyroidism. RESULTS In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02-1.15); 1-3 PTSD symptoms, 1.12 (95% CI 1.04-1.21); 4-5 PTSD symptoms, 1.23 (95% CI 1.13-1.34); and 6-7 PTSD symptoms, 1.26 (95% CI 1.14-1.40)]. PTSD was not associated with risk of Graves' hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed. CONCLUSIONS PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.
Collapse
Affiliation(s)
- Sun Jae Jung
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kristen Nishimi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Laura Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
32
|
Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction. J Thyroid Res 2019; 2019:4106816. [PMID: 31662841 PMCID: PMC6778876 DOI: 10.1155/2019/4106816] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/01/2019] [Indexed: 12/16/2022] Open
Abstract
The pituitary hormone, thyrotropin (TSH), is regarded as the primary biomarker for evaluating thyroid function and is useful in guiding treatment with levothyroxine for patients with hypothyroidism. The amplified response of TSH to slight changes in thyroid hormone levels provides a large and easily measured signal in the routine care setting. Laboratories provide reference ranges with upper and lower cutoffs for TSH to define normal thyroid function. The upper limit of the range, used to diagnose subclinical (mild) hypothyroidism, is itself a matter for debate, with authoritative guidelines recommending treatment to within the lower half of the range. Concomitant diseases, medications, supplements, age, gender, ethnicity, iodine status, time of day, time of year, autoantibodies, heterophilic antibodies, smoking, and other factors influence the level of TSH, or the performance of current TSH assays. The long-term prognostic implications of small deviations of TSH from the reference range are unclear. Correction of TSH to within the reference range does not always bring thyroid and other biomarkers into range and will not always resolve the patient's symptoms. Overt hypothyroidism requires intervention with levothyroxine. It remains important that physicians managing a patient with symptoms suggestive of thyroid disease consider all of the patient's relevant disease, lifestyle, and other factors before intervening on the basis of a marginally raised TSH level alone. Finally, these limitations of TSH testing mitigate against screening the population for the undoubtedly substantial prevalence of undiagnosed thyroid disease, until appropriately designed randomised trials have quantified the benefits and harms from this approach.
Collapse
|
33
|
Frahm N, Hecker M, Zettl UK. Polypharmacy in patients with multiple sclerosis: a gender-specific analysis. Biol Sex Differ 2019; 10:27. [PMID: 31133051 PMCID: PMC6537438 DOI: 10.1186/s13293-019-0243-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Multiple sclerosis (MS) affects about three times more women than men. Due to variable MS courses, multiple therapies are necessary in clinical practice. Objective We aimed at conducting sex-specific analyses of MS patients regarding polypharmacy (≥ 5 drugs) and at identifying differences in the medication spectrum. Methods Clinico-demographic data were gathered from 306 patients using clinical examinations, structured patient interviews, and patient records. Statistical data analyses were performed to evaluate whether the same or different factors are associated with polypharmacy in both genders. Results Women (N = 218) and men (N = 88) showed similar polypharmacy rates (56.0% vs. 58.0%; p = 0.799). For both genders, higher age, severe disability degrees, comorbidities, and inpatient treatment were significantly associated with a higher polypharmacy risk. Low educational levels were predictors of polypharmacy only in women. Fampridine (p < 0.021) and antispasmodics (p < 0.010) were used more often by men, while women took more frequently thyroid medications (p < 0.001) and contraceptives (p < 0.001). The age-related increase in medication use was much stronger in women (p < 0.001). Conclusion Male and female MS patients with older age, comorbidities, higher disability degree, and inpatient treatment are at greater risk of polypharmacy. Future studies should examine the occurrence of clinically relevant drug interactions in MS patients stratified by sex.
Collapse
Affiliation(s)
- Niklas Frahm
- Department of Neurology, Neuroimmunology Section, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany.
| | - Michael Hecker
- Department of Neurology, Neuroimmunology Section, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunology Section, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| |
Collapse
|
34
|
Serum 25-hydoxyvitamin D concentrations in relation to Hashimoto’s thyroiditis: a systematic review, meta-analysis and meta-regression of observational studies. Eur J Nutr 2019; 59:859-872. [DOI: 10.1007/s00394-019-01991-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 12/29/2022]
|
35
|
Bensenor IM. Thyroid disorders in Brazil: the contribution of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res 2019; 52:e8417. [PMID: 30785482 PMCID: PMC6376318 DOI: 10.1590/1414-431x20198417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
Thyroid disorders are common diseases, both in Brazil and worldwide. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study that investigates cardiovascular diseases, diabetes, and associated factors, including non-classical cardiovascular risk factors such as thyroid function. Thyroid function was classified according to thyrotropin stimulating hormone (TSH), free thyroxine (FT4), and use of medication to treat thyroid disorders, after excluding participants who reported use of any medication that could alter the results of the TSH and FT4 tests. All analyses included in this review are cross-sectional using baseline data (2008 to 2010). The results showed an association of subclinical thyroid disorders with biomarkers of subclinical atherosclerosis, measured by carotid intima-media thickness and coronary artery calcium, insulin resistance, metabolic syndrome, and some psychiatric disorders. No association was found with the biomarker of inflammation high-sensitivity C-reactive protein, or changes in pulse wave velocity or heart rate variability.
Collapse
Affiliation(s)
- I M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
36
|
Taylor PN, Eligar V, Muller I, Scholz A, Dayan C, Okosieme O. Combination Thyroid Hormone Replacement; Knowns and Unknowns. Front Endocrinol (Lausanne) 2019; 10:706. [PMID: 31695677 PMCID: PMC6817486 DOI: 10.3389/fendo.2019.00706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
Hypothyroidism is common throughout the world and readily diagnosed with thyroid function tests. Management should be straightforward but appears not to be the case. Thyroid hormone replacement with levothyroxine monotherapy is the standard treatment which is effective in the majority of cases. However, 10-15% of patients established on levothyroxine do not feel their health is entirely restored and some patients prefer the addition of liothyronine. Proponents of liothyronine argue that the ratio of T3 and T4 hormones is substantially altered on T4 monotherapy and therefore both hormones may be needed for optimal health. This remains controversial as clinical trials have not demonstrated superiority of combination therapy (levothyroxine and liothyronine) over levothyroxine monotherapy. There is now a pressing need for further studies and in particular randomized controlled trials in this area. To help design and facilitate dedicated trials and better understand thyroid hormone replacement, this review summarizes the evidence where there is established knowledge and agreement (knowns) and areas where research is lacking (unknowns). Agreements include the extent of dissatisfaction with levothyroxine monotherapy, biases in testing for hypothyroidism and prescribing levothyroxine, as well as variable thresholds for prescribing levothyroxine and challenges in liothyronine dosing. The review will also highlight and summarize the unknowns including the long-term safety profile of liothyronine, and potential biomarkers to identify individuals who might benefit most from combination therapy.
Collapse
|
37
|
Andrade GRG, Gorgulho B, Lotufo PA, Bensenor IM, Marchioni DM. Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study. Nutrients 2018; 10:E693. [PMID: 29848946 PMCID: PMC6024881 DOI: 10.3390/nu10060693] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022] Open
Abstract
Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years. Dietary data was collected using a previously validated food frequency questionnaire. Subclinical hypothyroidism was categorized as thyroid-stimulating hormone levels of >4.0 IU/mL and free prohormone thyroxine levels within normal limits, without administering drugs for thyroid disease. A multiple logistic regression model was used to assess the relationship between the presence of subclinical hypothyroidism and tertiles of Se consumption. The prevalence of subclinical hypothyroidism in the study sample was 5.4% (95% confidence interval [CI], 3.8⁻7.0%). Compared with the first tertile of Se intake, the second (odds ratio [OR], 0.79; 95% CI, 0.65⁻0.96%) and third (OR, 0.72; 95% CI, 0.58⁻0.90%) tertiles were inversely associated with subclinical hypothyroidism, however further research is needed to confirm the involvement of Se in subclinical hypothyroidism using more accurate methodologies of dietary assessment and nutritional status to evaluate this relationship.
Collapse
Affiliation(s)
- Gustavo R G Andrade
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo CEP 03178-200, Brazil.
| | - Bartira Gorgulho
- Department of Food and Nutrition, School of Nutrition, Federal University of Mato Grosso, Cuiabá CEP 78060-900, Brazil.
| | - Paulo A Lotufo
- Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo CEP 05508-000, Brazil.
| | - Isabela M Bensenor
- Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo CEP 05508-000, Brazil.
| | - Dirce M Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo CEP 03178-200, Brazil.
| |
Collapse
|
38
|
Affiliation(s)
- Paulo Andrade Lotufo
- MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| |
Collapse
|
39
|
Aquino EML, Almeida MDCC, Menezes GMS, de Figueiredo RC, Bensenor IM, Mengue SS, da Fonseca MDJM, Gabrielli L. Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): who still uses it? Pharmacoepidemiol Drug Saf 2016; 25:609-17. [DOI: 10.1002/pds.3992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/26/2016] [Accepted: 02/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Estela M. L. Aquino
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
| | | | - Greice M. S. Menezes
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
| | | | | | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina; Universidade Federal do Rio Grande do Sul; Porto Alegre Rio Grande do Sul Brazil
| | | | - Ligia Gabrielli
- Instituto de Saúde Coletiva; Universidade Federal da Bahia; Salvador Bahia Brazil
- Centro de Diabetes e Endocrinologia do Estado da Bahia; Secretaria de Saúde do Estado da Bahia; Salvador Bahia Brazil
| |
Collapse
|