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Abstract
SummaryThyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth.A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.
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Carlé A, Faber J, Steffensen R, Laurberg P, Nygaard B. Hypothyroid Patients Encoding Combined MCT10 and DIO2 Gene Polymorphisms May Prefer L-T3 + L-T4 Combination Treatment - Data Using a Blind, Randomized, Clinical Study. Eur Thyroid J 2017; 6:143-151. [PMID: 28785541 PMCID: PMC5527224 DOI: 10.1159/000469709] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In previous studies, around half of all hypothyroid patients preferred levo-thyroxine (L-T4) + levo-triiodothyronine (L-T3) combination therapy, 25% preferred T4, and 25% had no preference. The reason for this is yet to be explored. METHODS A total of 45 overtly autoimmune, hypothyroid patients - now euthyroid on ≥6 months' L-T4 therapy - participated in a prospective, double-blind, cross-over study. The patients were randomized into 2 groups of either 3 continuous months' L-T4 therapy followed by 3 months' combination therapy or vice versa. In all periods, 50 μg L-T4 was blindly replaced by either (identical) 50 μg L-T4 or by 20 μg T3. L-T4 was hereafter adjusted to obtain normal serum TSH values. We investigated 3 single nucleotide polymorphisms (SNPs) on the type II iodothyronine deiodinase (DIO2) gene (rs225014 (Thr92Ala), rs225015, and rs12885300 (ORFa-Gly3Asp)) and 1 SNP on the cellular membrane transport-facilitating monocarboxylate transporter (MCT10) gene (rs17606253), and asked in which of the 2 treatment periods patients felt better (i.e., which treatment was preferred). RESULTS 27 out of 45 patients (60%) preferred the combination therapy. Two polymorphisms (rs225014 (DIO2, Thr92Ala) and rs17606253 (MCT10)) were combined yielding 3 groups: none vs. 1 of 2 vs. both SNPs present, and 42 vs. 63 vs. 100% of our patients in the 3 groups preferred the combined treatment (Jongheere-Terpstra trend test, p = 0.009). CONCLUSION The present study indicates that the combination of polymorphisms in DIO2 (rs225014) and MCT10 (rs17606253) enhances hypothyroid patients' preference for L-T4 + L-T3 replacement therapy. In the future, combination therapy may be restricted or may be even recommended to individuals harbouring certain polymorphisms.
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Affiliation(s)
- Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- *Allan Carlé, MD, PhD, Department of Endocrinology, Aalborg University Hospital, DK–9000 Aalborg (Denmark), E-Mail
| | - Jens Faber
- Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Birte Nygaard
- Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Carlé A, Andersen SL, Boelaert K, Laurberg P. MANAGEMENT OF ENDOCRINE DISEASE: Subclinical thyrotoxicosis: prevalence, causes and choice of therapy. Eur J Endocrinol 2017; 176:R325-R337. [PMID: 28274949 DOI: 10.1530/eje-16-0276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 12/23/2016] [Accepted: 03/08/2017] [Indexed: 12/25/2022]
Abstract
Subclinical thyrotoxicosis is a condition affecting up to 10% of the population in some studies. We have reviewed literature and identified studies describing prevalences, causes and outcomes of this condition. Treatment should be considered in all subjects if this biochemical abnormality is persistent, especially in case of symptoms of thyrotoxicosis or in the presence of any complication. In particular, treatment should be offered in those subclinically thyrotoxic patients with a sustained serum TSH below 0.1 U/L. However it is important to recognise that there are no large controlled intervention studies in the field and thus there is no high quality evidence to guide treatment recommendations. In particular, there is no evidence for therapy and there is weak evidence of harm from thyrotoxicosis if serum TSH is in the 0.1-0.4 IU/L range. In this review, we describe the different causes of subclinical thyrotoxicosis, and how treatment should be tailored to the specific cause. We advocate radioactive iodine treatment to be the first-line treatment in majority of patients suffering from subclinical thyrotoxicosis due to multinodular toxic goitre and solitary toxic adenoma, but we do generally not recommend it as the first-line treatment in patients suffering from subclinical Graves' hyperthyroidism. Such patients may benefit mostly from antithyroid drug therapy. Subclinical thyrotoxicosis in early pregnancy should in general be observed, not treated. Moreover, we advocate a general restriction of therapy in cases where no specific cause for the presumed thyroid hyperactivity has been proven.
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Affiliation(s)
| | - Stine Linding Andersen
- Department of Endocrinology
- Department of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
| | - Kristien Boelaert
- Institute of Metabolism and Systems ResearchSchool of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Laurberg
- Department of Endocrinology
- Department of Clinical MedicineAalborg University, Aalborg, Denmark
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Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315-389. [PMID: 28056690 DOI: 10.1089/thy.2016.0457] [Citation(s) in RCA: 1282] [Impact Index Per Article: 183.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
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Affiliation(s)
- Erik K Alexander
- 1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Gregory A Brent
- 3 Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Rosalind S Brown
- 4 Division of Endocrinology, Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Herbert Chen
- 5 Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chrysoula Dosiou
- 6 Division of Endocrinology, Stanford University School of Medicine , Stanford, California
| | - William A Grobman
- 7 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois
| | - Peter Laurberg
- 8 Departments of Endocrinology & Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - John H Lazarus
- 9 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Susan J Mandel
- 10 Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robin P Peeters
- 11 Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Scott Sullivan
- 12 Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, South Carolina
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Skakkebæk A, Moore PJ, Pedersen AD, Bojesen A, Kristensen MK, Fedder J, Laurberg P, Hertz JM, Østergaard JR, Wallentin M, Gravholt CH. The role of genes, intelligence, personality, and social engagement in cognitive performance in Klinefelter syndrome. Brain Behav 2017; 7:e00645. [PMID: 28293480 PMCID: PMC5346527 DOI: 10.1002/brb3.645] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/12/2016] [Accepted: 12/23/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The determinants of cognitive deficits among individuals with Klinefelter syndrome (KS) are not well understood. This study was conducted to assess the impact of general intelligence, personality, and social engagement on cognitive performance among patients with KS and a group of controls matched for age and years of education. METHODS Sixty-nine patients with KS and 69 controls were assessed in terms of IQ, NEO personality inventory, the Autism Spectrum Quotient (AQ) scale, and measures of cognitive performance reflecting working memory and executive function. RESULTS Patients with KS performed more poorly on memory and executive-function tasks. Patients with KS also exhibited greater neuroticism and less extraversion, openness, and conscientiousness than controls. Memory deficits among patients with KS were associated with lower intelligence, while diminished executive functioning was mediated by both lower intelligence and less social engagement. CONCLUSION Our results suggest that among patients with KS, memory deficits are principally a function of lower general intelligence, while executive-function deficits are associated with both lower intelligence and poorer social skills. This suggests a potential influence of social engagement on executive cognitive functioning (and/or vice-versa) among individuals with KS, and perhaps those with other genetic disorders. Future longitudinal research would be important to further clarify this and other issues discussed in this research.
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Affiliation(s)
- Anne Skakkebæk
- Department of Endocrinology and Internal Medicine (MEA) Aarhus University Hospital Aarhus Denmark; Department of Clinical Genetics Aarhus University Hospital Aarhus Denmark
| | - Philip J Moore
- Department of Psychology The George Washington University Washington DC USA
| | - Anders Degn Pedersen
- Department of Psychology and Behavioral Sciences Aarhus University Aarhus Denmark
| | - Anders Bojesen
- Department of Clinical Genetics Aarhus University Hospita Aarhus Denmark; Department of Clinical Genetics Sygehus Lillebaelt Vejle Denmark
| | | | - Jens Fedder
- Fertility Clinic Department of Gynecology and Obstetrics Odense University Hospital Odense Denmark
| | - Peter Laurberg
- Department of Endocrinology Aalborg University Hospital Aalborg Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics Odense University Hospital Odense Denmark
| | | | - Mikkel Wallentin
- Center for Semiotics Aarhus University Aarhus Denmark; Center of Functionally Integrative Neuroscience Aarhus University Hospital Aarhus Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine (MEA) Aarhus University Hospital Aarhus Denmark; Department of Molecular Medicine Aarhus University Hospital Aarhus Denmark
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Abstract
OBJECTIVES It is important to know the starting point when describing changes in Inuit in transition. STUDY DESIGN The original charts of 1,852 individuals from the epidemiological investigation in East Greenland around 1963 performed by Littauer and colleagues were recovered recently. They included height, weight and a physical investigation. METHODS AND RESULTS The focus of this paper was adult Inuit body proportions in 1963 by ten-year age groups excluding participants with disabilities affecting body build. Relatively stable values were seen in both genders with age. Median values in men/women aged 20 years and above were: height 164/153.5 cm, weight 64/54 kg and BMI 23.7/23.1. Men aged 50 years and above had a little lower height and weight than young men. Women aged 40-49 years had a higher weight and BMI, but this evened out in the older age groups. Median BMI was relatively high compared to WHO definition. CONCLUSIONS The data from 1963 gives a starting point for evaluating changes in Inuit body build and the prevalence of overweight. Furthermore, they indicate a need for Inuit-specific normal BMI delineation.
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Affiliation(s)
- Stig Andersen
- Department of Medicine, Queen Ingrids Hospital, Nuuk, Greenland.
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Abstract
BACKGROUND Bone strength decreases with age. Bone mineral density (BMD) is a measure of bone strength. Data on BMD in present-day Inuit are limited, and data on circumpolar populations using Dual Energy X-ray Absorptiometry (DEXA scanning) are lacking. OBJECTIVES Our aims were to validate DEXA scanning for use in field studies in the Arctic region and to obtain data on BMD in Greenland Inuit. METHODS We measured BMD in 52 healthy Inuit living in Ilulissat and Saqqaq in North Greenland using a portable peripheral DEXA scanner. The measurement sites were forearms and calcaneal bones. Two measurements were performed at both radii and both calcanei. Triplicate measurements were performed in eleven Inuit. RESULTS The portable scanner fitted into a standard bag suitable for transportation in the arctic winter. Imprecision was well within 2% for all calibrations. CV% were 0.16% to 1.79% in the forearms and 0.38% to 1.53% in the heels. The overall CV% was 1.09% in forearm and 1.01% in heel. Mean BMD in men was 0.569 g/cm2 in forearms and 0.542 in heel. In women it was 0.479 in forearms and 0.468 in heel. CONCLUSION DEXA scanning is a feasible, reliable and comfortable method in rural Greenland. BMD values are now available for Greenland Inuit.
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Affiliation(s)
- Stig Andersen
- Department of Endocrinology and Medicine, Arhus University Hospital, Reberbansgade, Denmark.
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Andersen SL, Olsen J, Laurberg P. Hypothyroidism and pregnancy loss: comparison with hyperthyroidism and diabetes in a Danish population-based study. Clin Endocrinol (Oxf) 2016; 85:962-970. [PMID: 27312058 DOI: 10.1111/cen.13136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/22/2016] [Accepted: 06/14/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypothyroidism is a common endocrine disease. The frequency of pregnancy loss in women with known hypothyroidism as opposed to women with a later diagnosis of hypothyroidism has not been evaluated and compared with other common endocrine diseases. DESIGN Population-based cohort study using Danish nationwide registers. PARTICIPANTS All pregnancies in Denmark, 1997-2008, resulting in live birth (n = 732 533), spontaneous abortion (n = 112 487) or stillbirth (n = 2937) were identified together with information on maternal hypothyroidism, hyperthyroidism and diabetes. METHODS Cox model was used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (95%CI) for spontaneous abortion and stillbirth, reference: no hypo- or hyperthyroidism or diabetes (n = 824 310). RESULTS We identified 4951 pregnancies where maternal hypothyroidism was diagnosed before the pregnancy (group 1) and 2464 pregnancies where maternal hypothyroidism was diagnosed in the 2-year period after the pregnancy (group 2). In group 1, 825 pregnancies (16·7%) resulted in spontaneous abortion which was more frequent than in nonexposed (13·2%), (aHR 1·19 (95%CI 1·12-1·27)), and of the same magnitude as in hyperthyroidism (17·2%, P = 0·5) and diabetes (17·5%, P = 0·2) diagnosed before the pregnancy. In group 2, the frequency was 12·2% (aHR 0·92 (0·84-1·02)). In group 2, 16 pregnancies (0·65%) resulted in stillbirth which was more frequent than in nonexposed (0·36%), (aHR 1·81 (1·11-2·97)), of the same magnitude as in hyperthyroidism (0·82%, P = 0·5) and less frequent than in diabetes (2·9%, P < 0·001) diagnosed after the pregnancy. In group 1, the frequency was 0·40% (aHR 1·11 (0·68-1·82)). CONCLUSIONS Hypothyroidism increased the risk of both early and late pregnancy loss as did hyperthyroidism and in particular diabetes. We hypothesize that undetected or insufficiently treated maternal disease in the pregnancy may be of causal importance.
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Affiliation(s)
- Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Andersen SL, Laurberg P. Authors' reply re: Attention deficit hyperactivity disorder and autism spectrum disorder in children born to mothers with thyroid dysfunction: a Danish nationwide cohort study. BJOG 2016; 123:2051-2052. [DOI: 10.1111/1471-0528.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- SL Andersen
- Department of Endocrinology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Biochemistry; Aalborg University Hospital; Aalborg Denmark
| | - P Laurberg
- Department of Endocrinology; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University; Aalborg Denmark
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Laurberg P, Andersen SL. ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves' disease. Eur J Endocrinol 2016; 175:R219-30. [PMID: 27280373 DOI: 10.1530/eje-16-0410] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022]
Abstract
Thyroid hormones are essential developmental factors, and Graves' disease (GD) may severely complicate a pregnancy. This review describes how pregnancy changes the risk of developing GD, how early pregnancy by several mechanisms leads to considerable changes in the results of the thyroid function tests used to diagnose hyperthyroidism, and how these changes may complicate the diagnosing of GD. Standard therapy of GD in pregnancy is anti-thyroid drugs. However, new studies have shown considerable risk of birth defects if these drugs are used in specific weeks of early pregnancy, and this should be taken into consideration when planning therapy and control of women who may in the future become pregnant. Early pregnancy is a period of major focus in GD, where pregnancy should be diagnosed as soon as possible, and where important and instant change in therapy may be warranted. Such change may be an immediate stop of anti-thyroid drug therapy in patients with a low risk of rapid relapse of hyperthyroidism, or it may be an immediate shift from methimazole/carbimazole (with risk of severe birth defects) to propylthiouracil (with less risk), or maybe to other types of therapy where no risk of birth defects have been observed. In the second half of pregnancy, an important concern is that not only the mother with GD but also her foetus should have normal thyroid function.
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Affiliation(s)
- Peter Laurberg
- Department of Endocrinology Department of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Endocrinology Department of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark,
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Andersen SL, Carlé A, Olsen J, Laurberg P. Hypothyroidism incidence in and around pregnancy: a Danish nationwide study. Eur J Endocrinol 2016; 175:387-93. [PMID: 27511824 DOI: 10.1530/eje-16-0446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. DESIGN Population-based cohort study using Danish nationwide registers. METHOD All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997-2010 and the IR in three-month intervals before, during and after the woman's first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. RESULTS Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66-1.19), second trimester: 0.71 (0.52-0.97), third trimester: 0.29 (0.19-0.45)) and increased after birth with the highest level at 4-6 months postpartum (IRR 3.62 (2.85-4.60)). CONCLUSION These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase.
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Affiliation(s)
- S L Andersen
- Departments of Endocrinology Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
| | - A Carlé
- Departments of Endocrinology
| | - J Olsen
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
| | - P Laurberg
- Departments of Endocrinology Department of Clinical MedicineAalborg University, Aalborg, Denmark
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Kirkegaard-Klitbo DM, Perslev K, Andersen SL, Perrild H, Knudsen N, Weber T, Rasmussen LB, Laurberg P. Iodine deficiency in pregnancy is prevalent in vulnerable groups in Denmark. Dan Med J 2016; 63:A5286. [PMID: 27808034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Iodine is essential for the production of thyroid hormones. In pregnancy, physiological changes occur that can lead to iodine deficiency and impairment of fetal neurological development. We aimed to assess the iodine intake in pregnant women in Eastern Denmark, compare iodine levels in Eastern and Western Denmark and to identify potentially vulnerable groups. METHODS This was a cross-sectional cohort study of pregnant Danish women (n = 240). Questionnaires and urine samples were collected at the Ultrasound Clinic, Hvidovre Hospital, Denmark, and urinary iodine concentrations (UIC) (µg/l) were measured. Predictors of iodine supplement use were examined by multivariate logistic regression models. RESULTS The pregnant women from Eastern Denmark had a median age of 30 years and the median gestational week at which they were included in the study was week 19. The majority took iodine-containing supplements (86%). The median UIC was 118 (interquartile range (IQR): 79-196) µg/l in iodine supplement users and 82 (IQR: 41-122) µg/l in non-users (p < 0.001). Predictors of not using iodine supplement in Eastern and Western Denmark were short maternal education, non-Danish origin and pre-pregnancy obesity. CONCLUSIONS The iodine status in Danish pregnant women was below WHO recommendations. Iodine supplement non-users are at a particular risk of iodine deficiency. Low maternal education, non-Danish origin and pre-pregnancy obesity are predictors of non-iodine supplement use. An increase in iodine fortification may be recommended to improve the iodine status in pregnant Danish women. FUNDING none. TRIAL REGISTRATION not relevant.
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Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Andersen S, Laurberg P. Hypothyroid Symptoms Fail to Predict Thyroid Insufficiency in Old People: A Population-Based Case-Control Study. Am J Med 2016; 129:1082-92. [PMID: 27393881 DOI: 10.1016/j.amjmed.2016.06.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinic-based studies have indicated that older hypothyroid patients may present only few symptoms. METHODS In this population-based study of hypothyroidism, we investigated how the power of symptom presence predicts overt hypothyroidism in both young and older subjects. We identified patients newly diagnosed with overt autoimmune hypothyroidism in a population (n = 140, median thyroid-stimulating hormone, 54.5; 95% confidence interval [CI], 28.3-94.8; median total T4, 37; 95% CI, 18-52) and individually matched each patient with 4 controls free of thyroid disease (n = 560). Participants filled out questionnaires concerning the presence and duration of symptoms. We compared the usefulness of hypothyroidism-associated symptoms in predicting overt hypothyroidism in different age groups (young: <50 years, middle age: 50-59 years, old: ≥60 years) also taking various confounders into account. RESULTS In young hypothyroid patients, all 13 hypothyroidism-associated symptoms studied were more prevalent than in their matched controls, whereas only 3 of those (tiredness, shortness of breath, and wheezing) were more prevalent in old patients. The mean numbers of symptoms presented at disease onset were 6.2, 5.0, and 3.6 at the ages of 0 to 49 years, 50 to 59 years, and 60+ years, respectively. In young versus old people with 0 to 1 symptoms, the odds ratio for being hypothyroid was 0.04 (95% CI, 0.007-0.18) versus 0.34 (95% CI, 0.15-0.78) (reference all other groups). In young versus old subjects reporting ≥4 symptoms, the odds ratio for being hypothyroid was 16.4 (95% CI, 6.96-40.0) versus 2.22 (95% CI, 1.001-4.90). Receiver operating characteristic analyses revealed that the symptom score was an excellent tool for predicting hypothyroidism in young men (area under the receiver operating characteristic curve, 0.91; 95% CI, 0.82-0.998), whereas it was poor in evaluating older women (area under the receiver operating characteristic curve, 0.64; 95% CI, 0.54-0.75). CONCLUSION Hypothyroid symptom score is a good discriminating tool to identify hypothyroidism in young patients but fails to identify hypothyroidism in the elderly. Thus, thyroid function should be tested on wide indications in old age.
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Affiliation(s)
- Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Denmark; Diagnostic Centre, Region Hospital Silkeborg, Denmark.
| | | | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Lars Ovesen
- Department of Internal Medicine, Slagelse Hospital, Denmark
| | - Stig Andersen
- Department of Geriatry, Aalborg University Hospital, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1255] [Impact Index Per Article: 156.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
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Abstract
Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves' disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6-10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy.
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Affiliation(s)
- Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital
- Department of Clinical Biochemistry, Aalborg University Hospital
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Krejbjerg A, Pedersen IB, Laurberg P. Can Elastography Predict Growth of Incidental Thyroid Nodules? A Pilot Two-Year Follow-Up Study. Ultrason Imaging 2016; 38:303-313. [PMID: 26346886 DOI: 10.1177/0161734615604626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study was to examine the ultrasonography (US) and ultrasound elastography (USE) features of thyroid incidentalomas in a population exposed to iodine deficiency and to investigate whether baseline elasticity scores (ES) predicted changes in thyroid nodule US characteristics. We conducted a two-year follow-up pilot study of thyroid incidentalomas by US and USE. One sonographer performed the US and USE examination on the same apparatus at baseline and at follow-up. We evaluated 83 incidental thyroid nodules detected in a population study. The follow-up period saw no change in median thyroid nodule diameter (p = 0.18) or in the prevalence of thyroid nodule US characteristics (hypoechoic: p = 0.05; solid nodule: p = 1.00; microcalcifications: p = 0.55). Individual changes in thyroid nodule diameter (>20%) were seen in 23% (11% had decreased, and 12% had increased in diameter). Changes in ES were frequently observed; 37% changed from ES A + B to ES C + D, and 27% changed from ES C + D to ES A + B. In a multivariate logistic regression model, we found no association between baseline ES and individual changes in nodule size. In an area with mild iodine deficiency and a high prevalence of thyroid nodules, thyroid USE performed on thyroid incidentalomas did not predict individual changes in thyroid nodule size.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Inge Bülow Pedersen
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Krejbjerg A, Bjergved L, Bülow Pedersen I, Carlé A, Knudsen N, Perrild H, Ovesen L, Banke Rasmussen L, Laurberg P. Serum thyroglobulin as a biomarker of iodine deficiency in adult populations. Clin Endocrinol (Oxf) 2016; 85:475-82. [PMID: 26851767 DOI: 10.1111/cen.13037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/13/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To clarify which factors may influence the serum Tg level in an adult population and how this may affect Tg as a biomarker of iodine deficiency (ID). DESIGN AND METHODS Two identical cross-sectional studies were performed before (C1a: 1997-98, n = 4649) and after (C2: 2004-05, n = 3570) the Danish mandatory iodine fortification (IF) of salt (2000). Additionally, a follow-up study of C1a was performed after IF (C1b: 2008-10, n = 2465). The studies took place in two regions with mild (Copenhagen) and moderate (Aalborg) ID before IF. Serum Tg was measured by immunoradiometric method and investigated as outcome variable in multivariate models. RESULTS Multiple factors were associated with serum Tg. Some were directly related to iodine intake (cohort, urinary iodine concentration (UIC) level and region), and some were likely mediators of iodine intake effects on Tg (thyroid nodularity, thyroid size and autonomy with low TSH). Others were caused by Tg assay interference (Tg-Ab positivity), aggravation of ID (childbirths and smoking) or TSH stimulation of the thyroid. Estimated 24-h urinary iodine excretion was a more sensitive predictor of Tg than UIC. Iodine supplement users had low median Tg values compared with nonusers both before and after IF. CONCLUSIONS Multiple factors should be taken into consideration when evaluating Tg as a marker of ID in adult populations, and the Tg results may depend on the assay used. Still, Tg is a sensitive marker of ID. We suggest including a reference population with known sufficient iodine intake when Tg is used to evaluate ID.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Lena Bjergved
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Inge Bülow Pedersen
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Allan Carlé
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
- Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Lars Ovesen
- Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark
| | - Lone Banke Rasmussen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Peter Laurberg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Bülow Pedersen I, Laurberg P. Biochemical Hyperthyroidism in a Newborn Baby Caused by Assay Interaction from Biotin Intake. Eur Thyroid J 2016; 5:212-215. [PMID: 27843813 PMCID: PMC5091267 DOI: 10.1159/000448034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/21/2016] [Indexed: 11/19/2022] Open
Abstract
We describe a case of biochemical neonatal thyrotoxicosis caused by biotin supplementation. Biotin may interact with thyroid function testing to imitate thyrotoxicosis with low thyroid-stimulating hormone and elevated triiodothyronine and thyroxine levels.
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Affiliation(s)
- Inge Bülow Pedersen
- *Inge Bülow Pedersen, Department of Endocrinology and Medicine, Medicinerhuset, Aalborg University Hospital, Moelleparkvej 4, DK-9000 Aalborg (Denmark), E-Mail
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Dal J, Feldt-Rasmussen U, Andersen M, Kristensen LØ, Laurberg P, Pedersen L, Dekkers OM, Sørensen HT, Jørgensen JOL. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol 2016; 175:181-90. [PMID: 27280374 DOI: 10.1530/eje-16-0117] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/26/2016] [Indexed: 01/01/2023]
Abstract
DESIGN Valid data on acromegaly incidence, complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence, prevalence, complications and mortality in a population-based cohort study. METHOD All incident cases of acromegaly in Denmark (1991-2010) were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10(6) person-years (py) with 95% confidence intervals (95% CIs). For every patient, 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used. RESULTS Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10(6) persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)), heart failure (HR: 2.5 (95% CI: 1.4-4.5)), venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)), sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality. CONCLUSION (i) The incidence rate and age at diagnosis of acromegaly have been stable over decades, and the prevalence is higher than previously reported. (ii) The risk of complications is very high even before the diagnosis. (iii) Mortality risk remains elevated but uninfluenced by mode of treatment.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, Denmark
| | | | - Marianne Andersen
- Department of EndocrinologyOdense University Hospital, Odense, Denmark
| | | | - Peter Laurberg
- Department of EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Lars Pedersen
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus N, Denmark
| | - Olaf M Dekkers
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus N, Denmark Department of MedicineSection of Endocrinology Department of Clinical EpidemiologyLeiden University Medical Center, Leiden, The Netherlands
| | - Henrik Toft Sørensen
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus N, Denmark
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, Denmark
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20
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Nyström HF, Brantsæter AL, Erlund I, Gunnarsdottir I, Hulthén L, Laurberg P, Mattisson I, Rasmussen LB, Virtanen S, Meltzer HM. Iodine status in the Nordic countries - past and present. Food Nutr Res 2016; 60:31969. [PMID: 27283870 PMCID: PMC4901513 DOI: 10.3402/fnr.v60.31969] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Adequate iodine nutrition is dependent on ground water content, seafood, and, as many countries use iodized cow fodder, dairy products. In most countries, salt fortification programs are needed to assure adequate iodine intake. Objectives The objectives are threefold: 1) to describe the past and present iodine situation in the Nordic countries, 2) to identify important gaps of knowledge, and 3) to highlight differences among the Nordic countries’ iodine biomonitoring and fortification policies. Design Historical data are compared with the current situation. The Nordic countries’ strategies to achieve recommended intake and urine iodine levels and their respective success rates are evaluated. Results In the past, the iodine situation ranged from excellent in Iceland to widespread goiter and cretinism in large areas of Sweden. The situation was less severe in Norway and Finland. According to a 1960 World Health Organization (WHO) report, there were then no observations of iodine deficiency in Denmark. In Sweden and Finland, the fortification of table salt was introduced 50–75 years ago, and in Norway and Finland, the fortification of cow fodder starting in the 1950s helped improve the population's iodine status due to the high intake of milk. In Denmark, iodine has been added to household salt and salt in bread for the past 15 years. The Nordic countries differ with regard to regulations and degree of governmental involvement. There are indications that pregnant and lactating women, the two most vulnerable groups, are mildly deficient in iodine in several of the Nordic countries. Conclusion The Nordic countries employ different strategies to attain adequate iodine nutrition. The situation is not optimal and is in need of re-evaluation. Iodine researchers, Nordic national food administrations, and Nordic governmental institutions would benefit from collaboration to attain a broader approach and guarantee good iodine health for all.
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Affiliation(s)
- Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden;
| | | | - Iris Erlund
- National Institute for Health and Welfare, Helsinki, Finland
| | - Ingibjörg Gunnarsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland
| | - Lena Hulthén
- Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lone Banke Rasmussen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Suvi Virtanen
- National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Finland
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Laurberg P, Andersen SL, Hindersson P, Nohr EA, Olsen J. Dynamics and Predictors of Serum TSH and fT4 Reference Limits in Early Pregnancy: A Study Within the Danish National Birth Cohort. J Clin Endocrinol Metab 2016; 101:2484-92. [PMID: 27115059 DOI: 10.1210/jc.2016-1387] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Thyroid hormones are important developmental factors and levels should be adequate both in the pregnant woman and in the fetus. However, there is no consensus on maternal thyroid test reference limits in early pregnancy. OBJECTIVE Estimation of week-to-week changes in and predictors of TSH and free T4 (fT4) reference limits in the first trimester of pregnancy. DESIGN Measurement of TSH and fT4 in biobank sera collected in pregnancy weeks 5-19 from a random sample of the Danish National Birth Cohort that enrolled 101 032 pregnant in 1996-2002. SETTING National cohort of pregnant women. PARTICIPANTS Healthy participants (n = 6671) were identified and individual characteristics retrieved using interview data and data from Danish national health registers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Reference limits for TSH and fT4 in each first trimester pregnancy week and predictors of these reference limits. RESULTS TSH reference limits were very variable. Up to and including week 6, nonpregnancy reference limits could be used. In weeks 9-12, TSH upper reference limit was approximately 0.4 mU/L lower than the nonpregnancy upper limit. The TSH lower reference limit was approximately 0.1 mU/L. fT4 variations were reverse to those of TSH, but changes were small with approximately 4% higher reference limits during the weeks 9-12. TSH upper reference limit was lower in multiparous women and women with lower iodine intake but higher in obese women. fT4 was lower in smokers. CONCLUSIONS TSH reference limits differ widely in the first trimester of pregnancy. The use of a uniform set of reference limits is an inordinate simplification that will lead to frequent misclassification and possibly to incorrect choice of therapy.
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Affiliation(s)
- Peter Laurberg
- Department of Endocrinology (P.L., S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Medicine (P.L.), Aalborg University, DK-9100 Aalborg, Denmark; Department of Clinical Biochemistry (S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Biochemistry (P.H.), Regionshospital Nordjylland, DK-9800 Hjørring, Denmark; Research Unit for Gynecology and Obstetrics (E.A.N.), Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; and Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, DK-8200 Aarhus, Denmark
| | - Stine Linding Andersen
- Department of Endocrinology (P.L., S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Medicine (P.L.), Aalborg University, DK-9100 Aalborg, Denmark; Department of Clinical Biochemistry (S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Biochemistry (P.H.), Regionshospital Nordjylland, DK-9800 Hjørring, Denmark; Research Unit for Gynecology and Obstetrics (E.A.N.), Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; and Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, DK-8200 Aarhus, Denmark
| | - Peter Hindersson
- Department of Endocrinology (P.L., S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Medicine (P.L.), Aalborg University, DK-9100 Aalborg, Denmark; Department of Clinical Biochemistry (S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Biochemistry (P.H.), Regionshospital Nordjylland, DK-9800 Hjørring, Denmark; Research Unit for Gynecology and Obstetrics (E.A.N.), Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; and Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, DK-8200 Aarhus, Denmark
| | - Ellen A Nohr
- Department of Endocrinology (P.L., S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Medicine (P.L.), Aalborg University, DK-9100 Aalborg, Denmark; Department of Clinical Biochemistry (S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Biochemistry (P.H.), Regionshospital Nordjylland, DK-9800 Hjørring, Denmark; Research Unit for Gynecology and Obstetrics (E.A.N.), Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; and Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, DK-8200 Aarhus, Denmark
| | - Jørn Olsen
- Department of Endocrinology (P.L., S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Medicine (P.L.), Aalborg University, DK-9100 Aalborg, Denmark; Department of Clinical Biochemistry (S.L.A.), Aalborg University Hospital, DK-9000 Aalborg, Denmark; Department of Clinical Biochemistry (P.H.), Regionshospital Nordjylland, DK-9800 Hjørring, Denmark; Research Unit for Gynecology and Obstetrics (E.A.N.), Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark; and Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, DK-8200 Aarhus, Denmark
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Rasmussen LB, Kirkegaard-Klitbo DM, Laurberg P, Jørgensen T, Ovesen L, Perrild H. Iodine excretion in school children in Copenhagen. Dan Med J 2016; 63:A5223. [PMID: 27127012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Studies of dietary habits show a high iodine intake in children in Denmark. Iodine excretion in children has not previously been assessed. Iodine excretion in adults is below the recommended threshold, and it is therefore being discussed to increase the fortification level. The main objective of this study was to assess iodine excretion in children living in Copenhagen to establish whether a moderate increase in iodine fortification would lead to excess iodine intake in this group. METHODS Children in first and fifth grade were recruited through schools in Copenhagen. In total, 244 children de-ivered a urine sample. Urine samples were analysed for iodine and creatinine, and the results were expressed as urinary iodine concentration (UIC) and as estimated 24-h iodine excretion. Iodine excretion in children was also compared with that of adults living in the same area, investigated in a prior study. RESULTS The median UIC was within the recommended level; 145 (range: 116-201) µg/l for boys and 128 (range: 87-184) µg/l for girls, and was lower in fifth grade students than in first grade students. Estimated 24-h iodine excretion was higher in boys than in girls, but did not differ according to grade. The UIC was higher in children than in adults from the same area. CONCLUSIONS The iodine excretion among schoolchildren in Copenhagen, an area with a relatively high iodine content in tap water, was within the recommended range as assessed by the UIC. An increased iodine fortification will not have negative consequences for this group. FUNDING The Ministry of Food, Agriculture and Fisheries. TRIAL REGISTRATION not relevant.
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Abstract
OBJECTIVE Methimazole (MMI) and propylthiouracil (PTU) are both associated with birth defects and may also rarely be associated with agranulocytosis and liver failure. The frequency of these side effects when antithyroid drugs (ATDs) are used in the population in general or in pregnancy remains to be elucidated. DESIGN All individuals registered as the parent of a live-born child in Denmark, 1973–2008, were identified (n = 2 299 952) and studied from 1995 through 2010 for the use of ATDs. Outcomes were agranulocytosis, liver failure, and birth defects in their offspring. To evaluate the frequency of these side effects associated with the use of ATDs in pregnancy, all live-born pregnancies (n = 830 680), 1996–2008, were identified in a subanalysis. RESULTS In the population studied, 28 998 individuals redeemed prescriptions of ATDs (exposure in 2115 pregnancies), which was associated with 45 cases of agranulocytosis (one in pregnancy) and 10 cases of liver failure (one in pregnancy). This corresponded to 41 and 11 cases of agranulocytosis and liver failure per 5 million inhabitants during a 10-year period (agranulocytosis: 0.16% of ATDs exposed [MMI: 0.11% vs PTU: 0.27%, P = .02]; liver failure: 0.03% of ATDs exposed [MMI: 0.03% vs PTU: 0.05%, P = .4]). The majority (83%) developed the side effect within 3 months of ATD treatment and 25% during hyperthyroidism relapse. The use of ATDs in pregnancy was associated with birth defects in 3.4% of exposed children (44 cases per 5 million inhabitants per 10 y), and the frequency of birth defects after ATD exposure was 75 times higher than both maternal agranulocytosis and liver failure in pregnancy. CONCLUSIONS In the Danish population in general, ATDs associated birth defects and agranulocytosis had similar frequencies and were more common than liver failure, whereas for the use of ATDs in pregnancy, birth defects were dominant. The burden of side effects to the use of ATDs can be reduced by restricting the use of ATDs in early pregnancy.
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Affiliation(s)
- Stine Linding Andersen
- Departments of Endocrinology (S.L.A., P.L.) and Clinical Biochemistry (S.L.A.), Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, 8000 Aarhus, Denmark; and Department of Clinical Medicine (P.L.), Aalborg University, 9220 Aalborg, Denmark
| | - Jørn Olsen
- Departments of Endocrinology (S.L.A., P.L.) and Clinical Biochemistry (S.L.A.), Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, 8000 Aarhus, Denmark; and Department of Clinical Medicine (P.L.), Aalborg University, 9220 Aalborg, Denmark
| | - Peter Laurberg
- Departments of Endocrinology (S.L.A., P.L.) and Clinical Biochemistry (S.L.A.), Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Clinical Epidemiology (J.O.), Aarhus University Hospital, 8000 Aarhus, Denmark; and Department of Clinical Medicine (P.L.), Aalborg University, 9220 Aalborg, Denmark
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Laurberg P. Guidance on That Damned Elusive Orbitopathy of Graves' Disease. Eur Thyroid J 2016; 5:4-6. [PMID: 27099833 PMCID: PMC4836116 DOI: 10.1159/000442245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter Laurberg
- *Peter Laurberg, MD, Department of Endocrinology and Medicine, Aalborg Hospital, Aalborg University, DK-9000 Aalborg (Denmark), E-Mail
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Andersen SL, Laurberg P. Iodine Supplementation in Pregnancy and the Dilemma of Ambiguous Recommendations. Eur Thyroid J 2016; 5:35-43. [PMID: 27099837 PMCID: PMC4836119 DOI: 10.1159/000444254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/26/2016] [Indexed: 01/02/2023] Open
Abstract
Iodine requirements are increased during pregnancy, predominantly caused by an increase in renal iodide clearance and in the use of iodine for thyroid hormone production. Because iodine deficiency (ID) in pregnancy may be associated with neurodevelopmental deficits in the offspring, a pertinent question is at what level of iodine intake pregnant women should be advised to take iodine-containing supplements. The consensus reached by the WHO/UNICEF/ICCIDD in 2007 was that pregnant women should not be recommended to take iodine-containing supplements if the population in general had been iodine sufficient for at least 2 years. However, guidance on this differs between scientific societies. This review discusses iodine supplementation in pregnancy. Based on current evidence, the recommendations given by WHO/UNICEF/ICCIDD in 2007 provide a valid guidance on the use of iodine supplements in pregnant women. Women living in a population with a median urinary iodine concentration (UIC) at or above 100 µg/l are not in need of iodine supplementation in pregnancy. On the other hand, if the population median UIC is below 100 µg/l, pregnant women should take iodine-containing supplements until the population in general has been iodine sufficient for at least 2 years by way of universal salt iodization.
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Affiliation(s)
- Stine Linding Andersen
- Departments of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Departments of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- *Stine Linding Andersen, Department of Endocrinology, Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg (Denmark), E-Mail
| | - Peter Laurberg
- Departments of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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26
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Rex KF, Krarup HB, Laurberg P, Andersen S. Liver biochemistry and associations with alcohol intake, hepatitis B virus infection and Inuit ethnicity: a population-based comparative epidemiological survey in Greenland and Denmark. Int J Circumpolar Health 2016; 75:29528. [PMID: 26928535 PMCID: PMC4772703 DOI: 10.3402/ijch.v75.29528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Hepatitis B virus (HBV) infection is common in Arctic populations and high alcohol intake has been associated with an increased risk of a number of diseases. Yet, a description of the influence of alcohol intake in persons with HBV infection on liver biochemistry is lacking. Objective We aimed to describe the association between reported alcohol intake and liver biochemistry taking into account also HBV infection, ethnicity, Inuit diet, body mass index (BMI), gender and age in an Arctic population. Design and methods Population-based investigation of Inuit (n=441) and non-Inuit (94) in Greenland and Inuit living in Denmark (n=136). Participants filled in a questionnaire on alcohol intake and other life style factors. Blood samples were tested for aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, albumin, hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. We also performed physical examinations. Results Participation rate was 95% in Greenland and 52% in Denmark. An alcohol intake above the recommended level was reported by 12.9% of non-Inuit in Greenland, 9.1% of Inuit in East Greenland, 6.1% of Inuit migrants and 3.4% of Inuit in the capital of Greenland (p=0.035). Alcohol intake was associated with AST (p<0.001) and GGT (p=0.001), and HBV infection was associated with ALP (p=0.001) but not with AST, GGT, bilirubin or albumin in the adjusted analysis. Inuit had higher AST (p<0.001), GGT (p<0.001) and ALP (p=0.001) values than non-Inuit after adjustment for alcohol, diet, BMI and HBV exposure. Ethnic origin modified the association between alcohol and AST, while HBV infection did not modify the associations between alcohol and liver biochemistry. Conclusions Non-Inuit in Greenland reported a higher alcohol intake than Inuit. Ethnic origin was more markedly associated with liver biochemistry than was alcohol intake, and Greenlandic ethnicity modified the effect of alcohol intake on AST. HBV infection was slightly associated with ALP but not with other liver biochemistry parameters.
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Affiliation(s)
- Karsten Fleischer Rex
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.,Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark;
| | - Henrik Bygum Krarup
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Andersen
- Department of Internal Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.,Arctic Health Research Centre, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
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27
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Wallentin M, Skakkebæk A, Bojesen A, Fedder J, Laurberg P, Østergaard JR, Hertz JM, Pedersen AD, Gravholt CH. Klinefelter syndrome has increased brain responses to auditory stimuli and motor output, but not to visual stimuli or Stroop adaptation. Neuroimage Clin 2016; 11:239-251. [PMID: 26958463 PMCID: PMC4773384 DOI: 10.1016/j.nicl.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/24/2016] [Accepted: 02/10/2016] [Indexed: 11/20/2022]
Abstract
Klinefelter syndrome (47, XXY) (KS) is a genetic syndrome characterized by the presence of an extra X chromosome and low level of testosterone, resulting in a number of neurocognitive abnormalities, yet little is known about brain function. This study investigated the fMRI-BOLD response from KS relative to a group of Controls to basic motor, perceptual, executive and adaptation tasks. Participants (N: KS = 49; Controls = 49) responded to whether the words "GREEN" or "RED" were displayed in green or red (incongruent versus congruent colors). One of the colors was presented three times as often as the other, making it possible to study both congruency and adaptation effects independently. Auditory stimuli saying "GREEN" or "RED" had the same distribution, making it possible to study effects of perceptual modality as well as Frequency effects across modalities. We found that KS had an increased response to motor output in primary motor cortex and an increased response to auditory stimuli in auditory cortices, but no difference in primary visual cortices. KS displayed a diminished response to written visual stimuli in secondary visual regions near the Visual Word Form Area, consistent with the widespread dyslexia in the group. No neural differences were found in inhibitory control (Stroop) or in adaptation to differences in stimulus frequencies. Across groups we found a strong positive correlation between age and BOLD response in the brain's motor network with no difference between groups. No effects of testosterone level or brain volume were found. In sum, the present findings suggest that auditory and motor systems in KS are selectively affected, perhaps as a compensatory strategy, and that this is not a systemic effect as it is not seen in the visual system.
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Affiliation(s)
- Mikkel Wallentin
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, building 10-G-5, Nørrebrogade, 8000 Aarhus C, Denmark; Center for Semiotics, Aarhus University, Denmark.
| | - Anne Skakkebæk
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Anders Bojesen
- Department of Clinical Genetics, Vejle Hospital, Sygehus Lillebaelt, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Jens Fedder
- Centre of Andrology & Fertility Clinic, Department D, Odense University Hospital, 5000 Odense C, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, 5000 Odense, Denmark
| | - Anders Degn Pedersen
- Vejlefjord Rehabilitation Center, 7140 Stouby, Denmark; Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
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28
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Bjergved L, Carlé A, Jørgensen T, Perrild H, Laurberg P, Krejbjerg A, Ovesen L, Bülow Pedersen I, Rasmussen LB, Knudsen N. Parity and 11-Year Serum Thyrotropin and Thyroid Autoantibody Change: A Longitudinal Population-Based Study. Thyroid 2016; 26:203-11. [PMID: 26711373 DOI: 10.1089/thy.2014.0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A role for female reproductive factors in the pathogenesis of thyroid autoimmunity has been suggested. This study investigated the prospective association between parity, abortion, use of oral contraceptive pill (OCP), and use of hormone replacement therapy (HRT), and 11-year change in serum thyrotropin (TSH), as well as change in thyroid peroxidase autoantibody (TPOAb) status. METHODS A random sample of 4649 people aged 18-65 years participated in a population-based study in the period 1997-1998. In the study presented here, 1749 non-pregnant women with no history of thyroid disease were included who participated in the 11-year follow-up examination in the period 2008-2010. Gynecological exposures were reported in a self-administered questionnaire at baseline and follow-up. TSH and TPOAb were measured at baseline and follow-up. Increased TPOAb status during follow-up was defined as a TPOAb below the assay cutoff (<30 kIU/L) at baseline and a TPOAb ≥30 kIU/L at follow-up. Multiple linear regression models were used, adjusted for age, smoking status, and urinary iodine excretion. RESULTS An inverse association was found between the number of years on HRT and the risk (odds ratio) of increased TPOAb status during follow-up (0.735 [confidence interval 0.558-0.968], p = 0.03). However, this association was not statistically significant when applying the Bonferroni adjusted significance level. The remaining reproductive factors showed no statistically significant association with risk of increased TPOAb during follow-up. Furthermore, parity, abortions, use of OCP, HRT use, age at menarche, and being pre- or postmenopausal were not significantly associated with 11-year TSH change. CONCLUSIONS No statistically significant association was found between the studied female reproductive measures and 11-year risk of TSH or TPO change. A possible protective role for HRT in the etiology of thyroid autoimmunity, however, deserves further research.
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Affiliation(s)
- Lena Bjergved
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Allan Carlé
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Torben Jørgensen
- 1 Research Centre for Prevention and Health , The Capital Region of Denmark, Glostrup, Denmark
- 4 Faculty of Health Sciences, University of Copenhagen , Copenhagen, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Hans Perrild
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
| | - Peter Laurberg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
- 5 Faculty of Medicine, Aalborg University , Aalborg, Denmark
| | - Anne Krejbjerg
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lars Ovesen
- 6 Department of Gastroenterology, Slagelse Hospital , Slagelse, Denmark
| | - Inge Bülow Pedersen
- 3 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Lone Banke Rasmussen
- 7 Department of Nutrition, National Food Institute, Technical University of Denmark , Søborg, Denmark
| | - Nils Knudsen
- 2 Department of Endocrinology, Bispebjerg University Hospital , Copenhagen, Denmark
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Völzke H, Caron P, Dahl L, de Castro JJ, Erlund I, Gaberšček S, Gunnarsdottir I, Hubalewska-Dydejczyk A, Ittermann T, Ivanova L, Karanfilski B, Khattak RM, Kusić Z, Laurberg P, Lazarus JH, Markou KB, Moreno-Reyes R, Nagy EV, Peeters RP, Pīrāgs V, Podoba J, Rayman MP, Rochau U, Siebert U, Smyth PP, Thuesen BH, Troen A, Vila L, Vitti P, Zamrazil V, Zimmermann MB. Ensuring Effective Prevention of Iodine Deficiency Disorders. Thyroid 2016; 26:189-96. [PMID: 26700864 DOI: 10.1089/thy.2015.0543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Programs initiated to prevent iodine deficiency disorders (IDD) may not remain effective due to changes in government policies, commercial factors, and human behavior that may affect the efficacy of IDD prevention programs in unpredictable directions. Monitoring and outcome studies are needed to optimize the effectiveness of IDD prevention. SUMMARY Although the need for monitoring is compelling, the current reality in Europe is less than optimal. Regular and systematic monitoring surveys have only been established in a few countries, and comparability across the studies is hampered by the lack of centralized standardization procedures. In addition, data on outcomes and the cost of achieving them are needed in order to provide evidence of the beneficial effects of IDD prevention in countries with mild iodine deficiency. CONCLUSION Monitoring studies can be optimized by including centralized standardization procedures that improve the comparison between studies. No study of iodine consumption can replace the direct measurement of health outcomes and the evaluation of the costs and benefits of the program. It is particularly important that health economic evaluation should be conducted in mildly iodine-deficient areas and that it should include populations from regions with different environmental, ethnic, and cultural backgrounds.
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Affiliation(s)
- Henry Völzke
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Philippe Caron
- 2 Department of Endocrinology, Centre Hospitalier Universitaire de Larrey , Toulouse, France
| | - Lisbeth Dahl
- 3 Human Studies, National Institute of Nutrition and Seafood Research , Bergen, Norway
| | - João J de Castro
- 4 Department of Endocrinology, Hospital das Forças Armadas , Lisbon, Portugal
| | - Iris Erlund
- 5 Disease Risk Unit, National Institute for Health and Welfare , Helsinki, Finland
| | - Simona Gaberšček
- 6 Department of Nuclear Medicine, University Medical Centre , Ljubljana, Slovenia
| | - Ingibjörg Gunnarsdottir
- 7 Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital , Reykjavik, Iceland
| | | | - Till Ittermann
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Ludmila Ivanova
- 9 Faculty of Medicine, Sofia University Sv. Kliment Ohridski , Sofia, Bulgaria
| | - Borislav Karanfilski
- 10 Centre for Regional Policy Research and Cooperation "Studiorum," Skopje, Macedonia
| | - Rehman M Khattak
- 1 Institute for Community Medicine, University Medicine Greifswald , Greifswald, Germany
| | - Zvonko Kusić
- 11 University of Zagreb, School of Medicine, Department of Oncology and Nuclear Medicine, University Hospital Centre Sestre Milosrdnice , Zagreb, Croatia
| | - Peter Laurberg
- 12 Departments of Endocrinology and Clinical Medicine, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - John H Lazarus
- 13 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Kostas B Markou
- 14 Department of Endocrinology, Institute University of Patras Medical School , Patras, Greece
| | - Rodrigo Moreno-Reyes
- 15 Nuclear Medicine Department, Erasme Hospital, Université Libre de Bruxelles , Brussels, Belgium
| | - Endre V Nagy
- 16 Division of Endocrinology, University of Debrecen , Debrecen, Hungary
| | - Robin P Peeters
- 17 Department of Internal Medicine, Rotterdam Thyroid Center , Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Valdis Pīrāgs
- 18 Department of Internal Medicine, University of Latvia , Riga, Latvia
| | - Ján Podoba
- 19 Department of Endocrinology, Slovakian Medical University , Bratislava, Slovakia
| | - Margaret P Rayman
- 20 Department of Nutritional Sciences, Faculty Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Ursula Rochau
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Uwe Siebert
- 21 Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Science , Medical Informatics and Technology, Hall, Austria
| | - Peter P Smyth
- 22 National University of Ireland, Galway and Centre for Public Health, Queen's University , Belfast, North Ireland
| | - Betina H Thuesen
- 23 Research Centre for Prevention and Health , The Capital Region of Denmark, Rigshospitalet, Glostrup, Denmark
| | - Aron Troen
- 24 Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem , Jerusalem, Israel
| | - Lluís Vila
- 25 Department of Endocrinology and Nutrition, Hospital de Sant Joan Despi Moisès Broggi , Barcelona, Spain
| | - Paolo Vitti
- 26 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | | | - Michael B Zimmermann
- 28 Swiss Federal Institute of Technology , Zürich Department of Health Sciences and Technology, Zürich, Switzerland
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30
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Andersen SL, Olsen J, Laurberg P. Maternal thyroid disease in the Danish National Birth Cohort: prevalence and risk factors. Eur J Endocrinol 2016; 174:203-12. [PMID: 26582484 DOI: 10.1530/eje-15-0816] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/18/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Thyroid disorders are common in women of reproductive age, but the exact burden of disease before, during and after a pregnancy is not clear. We describe the prevalence of thyroid disease in women enrolled in the Danish National Birth Cohort (DNBC) and investigate some of its risk factors. DESIGN Population-based study within the DNBC, which included 101,032 pregnancies (1997-2003). METHODS We studied women enrolled in the DNBC who gave birth to a live-born child. Information on maternal thyroid disease (hyperthyroidism, hypothyroidism, benign goiter/nodules, thyroid cancer, and other) before, during and up to 5 years after the woman's first pregnancy in the cohort was obtained from self-report (telephone interview in median gestational week 17) and from nationwide registers on hospital diagnosis of thyroid disease/thyroid surgery (from 1977) and prescriptions of thyroid drugs (from 1995). RESULTS Of the 77,445 women studied, 3018 (3.9%) were identified with an onset of thyroid disease before (2.0%), during (0.1%) or in the 5-year period after the pregnancy (1.8%). During the pregnancy, 153 (0.2%) women received antithyroid drugs and 365 (0.5%) received thyroid hormone for hypothyroidism (83 after previous hyperthyroidism, 42 after previous surgery for benign goiter/nodules or thyroid cancer). Significant risk factors for maternal thyroid disease were age, parity, origin, iodine intake, smoking, alcohol, and BMI. CONCLUSIONS Around 4% of Danish pregnant women had either a history of thyroid disease or thyroid disease during pregnancy or were diagnosed with thyroid disease for the first-time in the years following a pregnancy. The spectrum of thyroid disease was influenced by demographic and environmental factors.
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Affiliation(s)
- Stine Linding Andersen
- Departments of EndocrinologyClinical BiochemistryAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical EpidemiologyAarhus University Hospital, 8000 Aarhus, DenmarkDepartment of Clinical MedicineAalborg University, 9000 Aalborg, Denmark Departments of EndocrinologyClinical BiochemistryAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical EpidemiologyAarhus University Hospital, 8000 Aarhus, DenmarkDepartment of Clinical MedicineAalborg University, 9000 Aalborg, Denmark
| | - Jørn Olsen
- Departments of EndocrinologyClinical BiochemistryAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical EpidemiologyAarhus University Hospital, 8000 Aarhus, DenmarkDepartment of Clinical MedicineAalborg University, 9000 Aalborg, Denmark
| | - Peter Laurberg
- Departments of EndocrinologyClinical BiochemistryAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical EpidemiologyAarhus University Hospital, 8000 Aarhus, DenmarkDepartment of Clinical MedicineAalborg University, 9000 Aalborg, Denmark Departments of EndocrinologyClinical BiochemistryAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical EpidemiologyAarhus University Hospital, 8000 Aarhus, DenmarkDepartment of Clinical MedicineAalborg University, 9000 Aalborg, Denmark
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31
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Skakkebæk A, Gravholt CH, Rasmussen PM, Bojesen A, Jensen JS, Fedder J, Laurberg P, Hertz JM, Østergaard JR, Pedersen AD, Wallentin M. Corrigendum to "Neuroanatomical correlates of Klinefelter syndrome studied in relation to the neuropsychological profile" [NeuroImage:Clin 4 (2014) 1-9]. Neuroimage Clin 2016; 11:52. [PMID: 26909328 PMCID: PMC4732184 DOI: 10.1016/j.nicl.2016.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Anne Skakkebæk
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Peter Mondrup Rasmussen
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Anders Bojesen
- Department of Clinical Genetics, Vejle Hospital, Sygehus Lillebaelt, 7100 Vejle, Denmark
| | - Jens Søndergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jens Fedder
- Fertility Clinic, Department of Gynecology and Obstetrics, Odense University Hospital, 5000 Odense, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, 5000 Odense, Denmark
| | - John Rosendahl Østergaard
- Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Anders Degn Pedersen
- Vejlefjord Rehabilitation Center, 7140 Stouby, Denmark; Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus C, Denmark
| | - Mikkel Wallentin
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Semiotics, Aarhus University, 8000 Aarhus C, Denmark
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Andersen SL, Olsen J, Laurberg P. Foetal programming by maternal thyroid disease. Clin Endocrinol (Oxf) 2015; 83:751-8. [PMID: 25682985 DOI: 10.1111/cen.12744] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/18/2022]
Abstract
Foetal programming is an emerging concept that links a wide range of exposures during foetal life to later development of disease. Thyroid disorders are common in women of reproductive age, and careful management of pregnant women suffering from thyroid disease is important considering the crucial role of thyroid hormones during early brain development. It is possible that maternal thyroid dysfunction in pregnancy may lead to structural and/or functional changes during foetal brain development. Such an effect could later predispose the offspring to an increased risk of neurologic or psychiatric disease. We recently observed that children born to mothers with thyroid dysfunction had an increased risk of developing seizure disorders, autism spectrum disorders, attention-deficit hyperactivity disorders and psychiatric disease in adolescence and young adulthood. In the review, we discuss the concept of potential foetal programming by maternal thyroid disease.
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Affiliation(s)
- Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. Gender differences in symptoms of hypothyroidism: a population-based DanThyr study. Clin Endocrinol (Oxf) 2015; 83:717-25. [PMID: 25845636 DOI: 10.1111/cen.12787] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 02/28/2015] [Accepted: 03/27/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES We examined the gender-specific symptom prevalences in hypothyroidism and in healthy controls and explored the extent to which symptoms indicative of thyroid status may be different in women and men. DESIGN AND METHODS Patients newly diagnosed with overt autoimmune hypothyroidism (n = 140) and controls free of thyroid disease (n = 560) recruited from the same population participated in a population-based study of The Danish Investigation of Iodine Intake and Thyroid Diseases (DanThyr). Participants underwent a comprehensive programme including blood tests and completion of questionnaires. The gender-specific distribution of 13 hypothyroidism-associated symptoms and a simple combined score (0-13) was explored in conditional uni- and multivariate models taking into account a broad spectrum of possible confounders. Diagnostic odds ratios (DORs) were calculated as measures for the association between participant status (case vs control) and presence of symptoms (yes vs no). RESULTS In overt autoimmune hypothyroidism, 94·9% of women and 91·3% of men (P = 0·62) reported at least one of the hypothyroidism-associated symptoms, with tiredness as the most common symptom followed by dry skin and shortness of breath. In contrast, women free of thyroid disease self-reported at least one hypothyroidism-associated symptom considerably more often than men (73·7% vs 51·1%, P < 0·001). DORs (±SEM) for 0-1/2-3/4-13 symptoms were 0·07 (0·04-0·10)/2·15 (1·57-2·94)/7·99 (6·15-10·4) in men and 0·21 (0·16-0·28)/0·62 (0·58-0·66)/1·99 (1·90-2·09) in women. CONCLUSION The presence of symptoms is more indicative for overt autoimmune hypothyroidism in men than in women, and presumably persistent symptoms after therapy of hypothyroidism will be more common in women.
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Affiliation(s)
- Allan Carlé
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark
| | | | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Lars Ovesen
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Krejbjerg A, Bjergved L, Pedersen IB, Carlé A, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Laurberg P. Serum thyroglobulin before and after iodization of salt: an 11-year DanThyr follow-up study. Eur J Endocrinol 2015; 173:573-81. [PMID: 26245764 DOI: 10.1530/eje-15-0339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our objective was to investigate individual serum thyroglobulin (Tg) changes in relation to iodine fortification (IF) and to clarify possible predictors of these changes. DESIGN We performed a longitudinal population-based study (DanThyr) in two regions with different iodine intake at baseline: Aalborg (moderate iodine deficiency (ID)) and Copenhagen (mild ID). Participants were examined at baseline (1997) before the mandatory IF of salt (2000) and again at follow-up (2008) after IF. METHODS We examined 2465 adults and a total of 1417 participants with no previous thyroid disease and without Tg-autoantibodies were included in the analyses. Serum Tg was measured by immunoradiometric method. We registered participants with a daily intake of iodine from supplements in addition to IF. RESULTS Overall, the follow-up period saw no change in median Tg in Copenhagen (9.1/9.1 μg/l, P=0.67) while Tg decreased significantly in Aalborg (11.4/9.0 μg/l, P<0.001). Regional differences were evident before IF (Copenhagen/Aalborg, 9.1/11.4 μg/l, P<0.001), whereas no differences existed after IF (9.1/9.0 μg/l, P=1.00). Living in Aalborg (P<0.001) and not using iodine supplements at baseline (P=0.001) predicted a decrease in Tg whereas baseline thyroid enlargement (P=0.02) and multinodularity (P=0.01) were associated with an individual increase in Tg during follow-up. CONCLUSIONS After IF we observed a decrease in median Tg in Aalborg and the previously observed regional differences between Aalborg and Copenhagen had levelled out. Likewise, living in Aalborg was a strong predictor of an individual decrease in serum Tg. Thus, even small differences in iodine intake at baseline were very important for the individual response to IF.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Lena Bjergved
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Inge Bülow Pedersen
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Allan Carlé
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Nils Knudsen
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Hans Perrild
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Lars Ovesen
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Lone Banke Rasmussen
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
| | - Peter Laurberg
- Departments of Clinical Medicine and EndocrinologyAalborg University and Aalborg University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, DenmarkResearch Centre for Prevention and HealthThe Capital Region of Denmark, Glostrup, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of GastroenterologySlagelse Hospital, Slagelse, DenmarkDepartment of NutritionNational Food Institute, Technical University of Denmark, Søborg, Denmark
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Abstract
BACKGROUND Rare cases of birth defects after the use of methimazole (MMI) or carbimazole to treat hyperthyroidism in early pregnancy have been reported since 1972, whereas propylthiouracil (PTU) has not been considered teratogenic. Recently, two studies reported birth defects after the use of MMI in early pregnancy to affect 2-4% of exposed children, and one study also found birth defects after the use of PTU. On the other hand, some published studies did not find associations between the use of thionamides and birth defects. SUMMARY The methods used in the two positive and the four negative reports are reviewed. The two positive studies included a sufficient number of children exposed to MMI (n = 1231 and 1097) to evaluate the studied outcomes, whereas the four negative studies included a much lower number of exposed children (n = 73, 108, 30, and 124). Considering PTU, the birth defects observed in one study were in general milder and tended to be diagnosed and registered only when they resulted in complications and led to surgery after one year of age. None of the negative studies has investigated outcomes after one year of age. CONCLUSION Studies finding no associations between early pregnancy exposure to antithyroid drugs and birth defects were either not sufficiently powered or did not study outcomes at optimal ages.
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Affiliation(s)
- Peter Laurberg
- 1 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
- 2 Department of Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - Stine Linding Andersen
- 1 Department of Endocrinology, Aalborg University Hospital , Aalborg, Denmark
- 3 Department of Clinical Biochemistry, Aalborg University Hospital , Aalborg, Denmark
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Biondi B, Bartalena L, Cooper DS, Hegedüs L, Laurberg P, Kahaly GJ. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J 2015; 4:149-63. [PMID: 26558232 PMCID: PMC4637513 DOI: 10.1159/000438750] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/16/2015] [Indexed: 12/12/2022] Open
Abstract
Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- *Bernadette Biondi, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, IT-80131 Naples (Italy), E-Mail
| | - Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Varese, Italy
| | - David S. Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
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Brabant G, Peeters RP, Chan SY, Bernal J, Bouchard P, Salvatore D, Boelaert K, Laurberg P. Management of subclinical hypothyroidism in pregnancy: are we too simplistic? Eur J Endocrinol 2015; 173:P1-P11. [PMID: 25650404 DOI: 10.1530/eje-14-1005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/03/2015] [Indexed: 01/09/2023]
Abstract
Guideline advice of many societies on the management of subclinical hypothyroidism in pregnancy suggests treatment when TSH serum levels exceed 2.5 mU/l. Justification of this procedure is based on limited experience, mainly from studies carried out in patients with positive thyroid-specific antibodies and higher TSH levels that classically define the condition in the non-pregnant state. Taking into account a lack of clear understanding of the regulation of thyroid hormone transport through the utero-placental unit and in the absence of foetal markers to monitor the adequacy of thyroxine treatment, this review attempts to discuss currently available data and suggests a more cautious approach.
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Affiliation(s)
- Georg Brabant
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hos
| | - Robin P Peeters
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Shiao Y Chan
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Juan Bernal
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hos
| | - Philippe Bouchard
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Domenico Salvatore
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Kristien Boelaert
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Peter Laurberg
- Experimental and Clinical EndocrinologyUniversity of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, GermanyDepartment of EndocrinologyUniversity of Manchester, Manchester, UKDepartment of Internal MedicineRotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The NetherlandsDepartment of Obstetrics and GynaecologyNational University of Singapore, Singapore, SingaporeInstituto de Investigaciones BiomedicasConsejo Superior de Investigaciones Cientificas and Universidad Autonoma de Madrid, Madrid, SpainCenter for Biomedical Research on Rare DiseasesMadrid, SpainPierre et Marie Curie UniversityParis, FranceDepartment of Clinical Medicine and SurgeryUniversity of Naples 'Federico II', Naples 80131, ItalyCollege of Medical and Dental SciencesInstitute for Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Level 2, University of Birmingham, Birmingham B15 2TT, UKDepartment of EndocrinologyInstitute of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
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Klose M, Stochholm K, Janukonyté J, Christensen LL, Cohen AS, Wagner A, Laurberg P, Christiansen JS, Andersen M, Feldt-Rasmussen U. Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism. Eur J Endocrinol 2015; 172:753-62. [PMID: 25766045 DOI: 10.1530/eje-14-1069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. DESIGN AND METHODS We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue (MFI-20) were completed in parallel to pituitary assessment. RESULTS Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. CONCLUSIONS Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.
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Affiliation(s)
- Marianne Klose
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jurgita Janukonyté
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Louise Lehman Christensen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Arieh S Cohen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Aase Wagner
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jens Sandahl Christiansen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Marianne Andersen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
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Laurberg P, Berman DC, Pedersen IB, Andersen S, Carlé A. Double vision is a major manifestation in moderate to severe graves' orbitopathy, but it correlates negatively with inflammatory signs and proptosis. J Clin Endocrinol Metab 2015; 100:2098-105. [PMID: 25695893 DOI: 10.1210/jc.2014-4557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Double vision (diplopia) is a major determinant of work disability in patients with Graves' orbitopathy (GO), but is not part of the classification NOSPECS classification of GO. OBJECTIVE The objectives of the study were to quantitate diplopia in patients with moderate to severe GO and to study associations with other disease and patient variables. DESIGN This was a single-center prospective study of consecutive patients at the time of referral. SETTING The study was conducted at the University Hospital Thyroid-Eye Clinic. PATIENTS Patients included 216 patients diagnosed with moderate to severe and active GO. MAIN OUTCOME MEASURES Binocular diplopia in field of gaze and monocular fields of motility were prospectively recorded on diagrams and measured by planimetry. Fields of diplopia were correlated to other disease and patient variables. RESULTS Six patients had only one functional eye and were excluded. Among the remaining 210 patients, diplopia was present in 75.2%. In patients with diplopia, this ranged from 5% to 100% (observed in 11.4% of patients) of binocular field of gaze. The field of diplopia correlated positively with eye motility restriction and with asymmetrical affection of orbits but negatively with signs of inflammation and proptosis that often are the main outcome measures in clinical studies of GO therapy. CONCLUSION Diplopia is very common in moderate to severe GO and a major cause for active therapy. In moderate to severe GO, the field of diplopia correlates negatively with some other indicators of disease activity, which may be explained by the physiological properties of binocular fusion.
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Affiliation(s)
- Peter Laurberg
- Departments of Endocrinology (P.L., I.B.P., A.C.), Ophthalmology (D.C.B.) and Geriatric Medicine (S.A.), Aalborg University Hospital, and Institute of Clinical Medicine (P.L., I.B.P., S.A.), Aalborg University, DK-9000 Aalborg Denmark; and Diagnostic Centre (A.C.), Silkeborg Hospital, DK-8600 Silkeborg, Denmark
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Affiliation(s)
- Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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Andersen SL, Olsen J, Carlé A, Laurberg P. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J Clin Endocrinol Metab 2015; 100:1164-71. [PMID: 25485728 DOI: 10.1210/jc.2014-3588] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Hyperthyroidism in women of reproductive age is predominantly caused by Graves' disease. Pregnancy associated changes in the immune system may influence the onset of disease, but population-based incidence rates in and around pregnancy have not been reported. OBJECTIVE The objective of the study was to estimate the incidence of maternal hyperthyroidism (defined by redeemed prescription of antithyroid drugs) in and around pregnancy and to compare this with the incidence of other autoimmune diseases such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). DESIGN This was a population-based cohort study. SETTING The study used the Danish nationwide registers. PARTICIPANTS The participants were women who gave birth to singleton liveborn children in Denmark from 1999 to 2008 (n = 403,958). MAIN OUTCOME MEASURE(S) Incidence rates (IR) of maternal hyperthyroidism during a 4-year period beginning 2 years before and ending 2 years after the date when the mother was giving birth for the first time in the study period were measured. RESULTS Altogether 3673 women (0.9%) were identified with an onset of hyperthyroidism from 1997 to 2010, and the overall IR of maternal hyperthyroidism was 65.0/100,000/year. The IR of hyperthyroidism in and around pregnancy varied widely and was high in the first 3 months of pregnancy [incidence rate ratio (IRR) vs the remaining study period: 1.50 (95% CI 1.09-2.06)), very low in the last 3 months of pregnancy (0.26 (0.15-0.44)], and reached the highest level 7-9 months postpartum [3.80 (2.88-5.02)]. The incidence variation in and around pregnancy was different for RA and IBD. CONCLUSION These are the first population-based data on the incidence of hyperthyroidism in and around pregnancy. The incidence of hyperthyroidism was high in early pregnancy and postpartum, whereas such particular pattern was not observed for other diseases of autoimmune origin.
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Affiliation(s)
- Stine Linding Andersen
- Departments of Endocrinology (S.L.A., A.C., P.L.) and Clinical Biochemistry (S.L.A.), Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Clinical Medicine (S.L.A., P.L.), Aalborg University, 9000 Aalborg, Denmark; Section for Epidemiology, Department of Public Health (J.O.), Aarhus University, 8000 Aarhus, Denmark; and Department of Internal Medicine (A.C.), Silkeborg Hospital, 8600 Silkeborg, Denmark
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Krejbjerg A, Brilli L, Pikelis A, Pedersen HB, Laurberg P. Thyroid malignancy markers on sonography are common in patients with benign thyroid disease and previous iodine deficiency. J Ultrasound Med 2015; 34:309-316. [PMID: 25614404 DOI: 10.7863/ultra.34.2.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the characteristics of benign thyroid nodules on sonography and ultrasound elastography in a population exposed to iodine deficiency. METHODS We conducted a prospective systematic evaluation of preoperative thyroid sonography and elastography in patients assigned for surgical excision of benign thyroid nodules. Two experienced sonographers performed all sonographic and elastographic examinations. Thyroid nodules were evaluated by 7 generally accepted sonographic malignancy risk markers and assigned an elasticity score on elastography. The final diagnosis of a benign thyroid nodule was based on histopathologic analysis of resected thyroid gland tissue. RESULTS We evaluated 232 thyroid nodules in 105 patients (86 women and 19 men). In total, 57% of the examined nodules had 1 or 2 malignancy risk markers present, and 24% did not have any markers present. A solid nodule larger than 15 mm was the most common malignancy risk marker observed (63%), followed by low elasticity (33%), microcalcifications (26%), and hypoechogenicity (15%). In an analysis stratified according to the number of nodules (solitary versus multiple), low elasticity was described more frequently in solitary nodules (61.9% versus 30.4%; P= .004). A large nodular volume was a predictor (P < .05) of microcalcifications and intranodular vascularization, whereas an absent halo sign and a solid nodule were found less frequently in nodules with larger volumes. CONCLUSIONS Our results show that routine preoperative malignancy risk evaluation of presumably benign thyroid nodules is of little value when performed on patients exposed to iodine deficiency.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.).
| | - Lucia Brilli
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Arunas Pikelis
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Henrik Baymler Pedersen
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Peter Laurberg
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
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Laurberg P, Andersen SL. Graves'-Basedow disease in pregnancy. New trends in the management and guidance to reduce the risk of birth defects caused by antithyroid drugs. Nuklearmedizin 2015; 54:106-111. [PMID: 26105719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/20/2015] [Indexed: 06/04/2023]
Abstract
Thyroid hormones are essential development factors and maternal thyroid dysfunction may cause pregnancy complications and diseases in the fetus/child. In the present review we discuss new data on the incidence of Graves'-Basedow disease (GBD) in and around pregnancy, and how hyperthyroidism may affect the risk of spontaneous abortion and stillbirth. A special concern in pregnant women is the potential side effects from the use of antithyroid drugs (ATDs). One type of side effects is the allergic/toxic reactions to the drugs, which seem to be similar in and outside pregnancy, and another is that ATDs tend to over treat the fetus when the mother with GBD is made euthyroid. To avoid fetal hypothyroidism, the lowest possible ATD dose should be used to keep maternal thyroid function at the upper limit of normality with low serum TSH. Birth defects after the use of methimazole (MMI) (or its prodrug carbimazole) have been considered to be very rare, and no risk has previously been associated with the use of propylthiouracil (PTU). However, a recent Danish national study found that 1/30 of children exposed to MMI in early pregnancy had birth defects associated with this, and many defects were severe. PTU exposure was associated with defects in 1/40, and these defects were less severe. Proposals are given on how to reduce the risk of ATD associated birth defects.
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Affiliation(s)
- Peter Laurberg
- Peter Laurberg, professor, M.D., Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark, E-mail:
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Andersen SL, Sørensen LK, Krejbjerg A, Møller M, Klitbo DM, Nøhr SB, Pedersen KM, Laurberg P. Iodine status in Danish pregnant and breastfeeding women including studies of some challenges in urinary iodine status evaluation. J Trace Elem Med Biol 2015; 31:285-9. [PMID: 25535149 DOI: 10.1016/j.jtemb.2014.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/28/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022]
Abstract
Denmark was previously iodine deficient with regional differences. Moderate iodine deficiency appeared in West Denmark and mild iodine deficiency in East Denmark and also Danish pregnant and breastfeeding women suffered from iodine deficiency. The Danish mandatory iodine fortification of salt was introduced in the year 2000 and has increased iodine intake in the Danish population. However, median urinary iodine concentration in the general population and in pregnant and breastfeeding women is still below the level recommended, corresponding to mild iodine deficiency. Certain characteristics may challenge the evaluation of urinary iodine status in pregnancy and during breastfeeding. This review also addresses methodological challenges related to spot urine sampling conditions and the use of iodine supplement and discusses the use of non-pregnant population groups as a proxy for iodine intake in pregnant women.
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Affiliation(s)
- Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Anne Krejbjerg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Margrethe Møller
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Susanne Backman Nøhr
- Department of Postgraduate Education, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Krejbjerg A, Bjergved L, Pedersen IB, Knudsen N, Jørgensen T, Perrild H, Ovesen L, Rasmussen LB, Laurberg P. Thyroid nodules in an 11-year DanThyr follow-up study. J Clin Endocrinol Metab 2014; 99:4749-57. [PMID: 25233154 DOI: 10.1210/jc.2014-2438] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Limited longitudinal data are available on changes in the thyroid gland structure in a population and how this is influenced by iodine fortification (IF). OBJECTIVE Our objective was to clarify how IF influenced thyroid gland structure in 2 regions with different iodine intake at baseline (Copenhagen, mild iodine deficiency [ID]; Aalborg, moderate ID). DESIGN AND SETTING We conducted a longitudinal population-based study (DanThyr) where participants were examined before (1997) and after (2008) the Danish mandatory IF of salt (2000). PARTICIPANTS We examined 2465 adults, and ultrasonography was performed by the same sonographers using the same equipment, after controlling performances. MAIN OUTCOME MEASURE Change in thyroid gland structure was evaluated. RESULTS The follow-up period saw an increased prevalence of multinodularity (9.8%-13.8 %, P < .001), especially in the previously moderate ID region of Aalborg (9.1%-15.4%, P < .001), whereas no change in prevalence was seen for solitary nodules (5.6%-5.1%, P = .34). In individual participants, changes in thyroid structure and disappearance of thyroid nodules during the 11 years was common with an overall normalization rate of 21.2 (95% confidence interval [CI] = 17.9-24.9) per 1000 person-years. Solitary nodules had a significantly higher normalization rate than multiple nodules (normalization rate ratio 0.47 [95% CI = 0.32-0.67]). A regional difference (Aalborg vs Copenhagen) was seen between normalization rates of multiple nodules (normalization rate ratio 0.29 [95% CI = 0.12-0.64]), but not for solitary nodules (normalization rate ratio 0.81 [95% CI = 0.53-1.21]). CONCLUSIONS Changes in the thyroid gland structure with both appearance and disappearance of thyroid nodules are common after an iodization program.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Clinical Medicine and Endocrinology (A.K., I.B.P., P.L.), Aalborg University and Aalborg University Hospital, and Faculty of Medicine (T.J.), Aalborg University, DK-9000 Aalborg, Denmark; Research Centre for Prevention and Health (L.B., T.J.), The Capital Region of Denmark, DK-2600 Glostrup, Denmark; Department of Endocrinology (L.B., N.K., H.P.), Bispebjerg University Hospital, DK-2400 Copenhagen, Denmark; Faculty of Health Sciences (T.J.), DK-2200 Copenhagen, Denmark; Department of Gastroenterology (L.O.), Slagelse Hospital, DK-4200 Slagelse, Denmark; and Department of Nutrition (L.B.R.), National Food Institute, Technical University of Denmark, DK-2860 Søborg, Denmark
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Affiliation(s)
- Stine Linding Andersen
- Department of EndocrinologyAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of EndocrinologyAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of Clinical BiochemistryAalborg University Hospital, Aalborg, Denmark
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Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study. Eur J Endocrinol 2014; 171:593-602. [PMID: 25305308 DOI: 10.1530/eje-14-0481] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is generally accepted that patients suffering from hypothyroidism may express few symptoms, but this has not been studied in a population-based study design. OBJECTIVES To study the array of symptoms as they are reported in newly diagnosed overt autoimmune hypothyroidism using a population-based case-control design. METHODS Patients with new overt autoimmune hypothyroidism (n=140) and their individually matched thyroid disease-free controls (n=560) recruited from the same population underwent a comprehensive program and self-reported a number of symptoms. We identified the symptoms associated with overt hypothyroidism and calculated positive (LR+) and negative (LR-) likelihood ratios as well as diagnostic odds ratios (DORs) as measures for the association between disease state and symptoms. RESULTS Among 34 symptoms investigated, 13 symptoms were statistically overrepresented in hypothyroidism. Hypothyroid patients suffered mostly from tiredness (81%), dry skin (63%), and shortness of breath (51%). Highest DORs (95% CI) were reported for tiredness (5.94 (3.70-9.60)), hair loss (4.58 (2.80-7.51)), and dry skin (4.09 (2.73-6.16)). A hypothyroidism-component-score was defined as the number of hypothyroidism-associated symptoms (range: 0-13). LR+ for participants with a hypothyroidism-component-score of 0 was 0.21 (0.09-0.39), meaning that the post-test probability was lowered to 21% of what it was before asking for symptoms. LR+ for scores of 1-2/3/4-6/7-9/10-13 were: 0.47 (0.30-0.72)/1.16 (0.70-1.87)/1.90 (1.29-2.45)/3.52 (2.30-5.36)/6.29 (2.30-17.7). CONCLUSIONS None of the individual symptoms of hypothyroidism had high LRs or DORs. Thus, neither the presence nor absence of any individual hypothyroidism symptom was reliable in the decision making of who should have their thyroid function tested. Therefore, even minor suspicion should lead to a blood test.
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Affiliation(s)
- Allan Carlé
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Inge Bülow Pedersen
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Nils Knudsen
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Hans Perrild
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Lars Ovesen
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Peter Laurberg
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDiagnostic CentreRegion Hospital Silkeborg, Silkeborg, DenmarkDepartment of EndocrinologyBispebjerg University Hospital, Copenhagen, DenmarkDepartment of Internal MedicineSlagelse Hospital, Slagelse, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
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Andersen S, Dehnfeld M, Laurberg P. Ethnicity is important for creatinine excretion among Inuit and Caucasians in Greenland. Scand J Clin Lab Invest 2014; 75:44-50. [PMID: 25347361 DOI: 10.3109/00365513.2014.965737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Human nutrition, contamination and renal function are commonly assessed by the analysis of urine. A complete 24-hour urine sample is the ideal but it is inconvenient and unreliable. Thus, spot urine sampling with creatinine adjustment is widely used. Stratification for age and gender is recommended. Still, ethnicity may influence creatinine excretion. METHODS We collected 104 24-h urine samples among Inuit and non-Inuit living in Greenland. Completeness of sampling was checked by using para-amino benzoic acid (PABA) that also allowed for compensation of creatinine excretion when sampling was incomplete. We measured creatinine using the Jaffe method and PABA by the HPLC method. RESULTS Participants were recruited from the capital city, a major town and a settlement (n = 36/48/20). They were aged 30-69 years with 78 Inuit and 26 non-Inuit. Inuit were smaller than non-Inuit (Caucasians): height, 163 vs. 177 cm, p < 0.001; weight, 71 vs. 84 kg, p = 0.001 with similar BMI. Creatinine excretion was lower in Inuit compared to non-Inuit (men, 1344/1807 mg/24 h; women 894/1259 mg/24 h; p = 0.002; 0.02). It was influenced by age (p < 0.001), gender (p < 0.001), weight (p = 0.001) and ethnicity (p = 0.030) while not by the intake of the protein-rich Inuit diet in the adjusted analysis. Creatinine excretion was described by: Inuit men, 1925 mg - (13.1 × age); Inuit women, 1701 mg - (17.0 × age). CONCLUSION Inuit and Caucasians have different creatinine excretion. It is recommended to stratify by ethnicity in addition to adjustment for age and gender when using creatinine correction of spot urine samples.
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Affiliation(s)
- Stig Andersen
- Arctic Health Research Centre, Institute of Clinical Medicine, Aalborg University Hospital , Denmark
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Abstract
PURPOSE OF REVIEW In most patients with hyperthyroidism caused by Graves' disease, antithyroid drug (ATD) therapy is followed by a gradual amelioration of the autoimmune abnormality, but about half of the patients will experience relapse of hyperthyroidism when the ATDs are withdrawn after a standard 1 to 2 years of therapy. This is a major drawback of ATD therapy, and a major concern to patients. We review current knowledge on how to predict and possibly reduce the risk of such relapse. RECENT FINDINGS Several patient and disease characteristics, as well as environmental factors and duration of ATD therapy, may influence the risk of relapse after ATD withdrawal. Depending on the presence of such factors, the risk of relapse after ATD withdrawal may vary from around 10 to 90%. Risk factors for relapse should be taken into account when choosing between therapeutic modalities in a patient with newly diagnosed disease, and also when discussing duration of ATD therapy. SUMMARY Prolonged low-dose ATD therapy may be feasible in patients with high risk of relapse, such as children and patients with active Graves' orbitopathy, and in patients with previous relapse who prefer such therapy rather than surgery or radioiodine.
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Affiliation(s)
- Peter Laurberg
- aDepartment of Endocrinology, Aalborg University Hospital bDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Abstract
BACKGROUND Propylthiouracil (PTU) used in the treatment of maternal hyperthyroidism in early pregnancy may be associated with a higher prevalence of birth defects in the face and neck region and in the urinary system but the severity of these complications remains to be elucidated. METHODS Review of hospital-registered cases of birth defects in the face and neck region and in the urinary system after PTU exposure in early pregnancy. We obtained information on maternal redeemed prescription of PTU and child diagnosis of birth defect from nationwide registers for all children born in Denmark between 1996 and 2008 (n=817,093). The children were followed until December 31, 2010 (median age, 8.3 years) and the Cox proportional hazards model was used to estimate adjusted hazard ratio (HR) with 95% confidence interval (CI) for having a birth defect after PTU exposure versus nonexposed children (n=811,730). RESULTS Fourteen cases of birth defects were identified in the face and neck region and in the urinary system after PTU exposure in early pregnancy; 11 children were exposed to PTU only (n=564), whereas 3 children were born to mothers who switched from methimazole (MMI)/carbimazole (CMZ) to PTU in early pregnancy (n=159). Among children exposed to PTU only, the adjusted HR for having a birth defect in the face and neck region was 4.92 (95% CI 2.04-11.86) and in the urinary system 2.73 (1.22-6.07). Looking into details of the 14 cases, 7 children were diagnosed with a birth defect in the face and neck region (preauricular and branchial sinus/fistula/cyst) and 7 children had a birth defect in the urinary system (single cyst of kidney and hydronephrosis). Surgical treatment was registered in 6 of the cases with a birth defect in the face and neck region and 3 of the cases with a birth defect in the urinary system. Two of the children with a birth defect in the urinary system also had other birth defects (genital organs). CONCLUSIONS We report details on possible PTU-associated birth defects. They tend to be less severe than the defects observed after MMI/CMZ exposure. Yet, the majority of affected children had to undergo surgery.
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Affiliation(s)
- Stine Linding Andersen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Sen Wu
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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