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Muller I, Taylor PN, Daniel RM, Hales C, Scholz A, Candler T, Pettit RJ, Evans WD, Shillabeer D, Draman MS, Dayan CM, Tang HKC, Okosieme O, Gregory JW, Lazarus JH, Rees DA, Ludgate ME. CATS II Long-term Anthropometric and Metabolic Effects of Maternal Sub-optimal Thyroid Function in Offspring and Mothers. J Clin Endocrinol Metab 2020; 105:5836234. [PMID: 32396189 DOI: 10.1210/clinem/dgaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/10/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT AND OBJECTIVES The Controlled Antenatal Thyroid Screening Study I (CATS-I) was a randomized controlled trial investigating the effects of levothyroxine therapy for suboptimal gestational thyroid function (SGTF), comparing outcomes in children of treated (SGTF-T) with untreated (SGTF-U) women during pregnancy. This follow-up study, CATS-II, reports the long-term effects on anthropometric, bone, and cardiometabolic outcomes in mothers and offspring and includes a group with normal gestational thyroid function (NGTF). DESIGN & PARTICIPANTS 332 mothers (197 NGTF, 56 SGTF-U, 79 SGTF-T) aged 41.2±5.3 years (mean±SD) and 326 paired children assessed 9.3±1.0 years after birth for (i) body mass index (BMI); (ii) lean, fat, and bone mass by dual-energy X-ray absorptiometry; (iii) blood pressure, augmentation index, and aortic pulse-wave-velocity; and (iv) thyroid function, lipids, insulin, and adiponectin. The difference between group means was compared using linear regression. RESULTS Offspring's measurements were similar between groups. Although maternal BMI was similar between groups at CATS-I, after 9 years (at CATS-II) SGTF-U mothers showed higher BMI (median [interquartile ratio] 28.3 [24.6-32.6] kg/m2) compared with NGTF (25.8 [22.9-30.0] kg/m2; P = 0.029), driven by fat mass increase. At CATS-II SGTF-U mothers also had higher thyroid-stimulating hormone (TSH) values (2.45 [1.43-3.50] mU/L) than NGTF (1.54 [1.12-2.07] mU/L; P = 0.015), since 64% had never received levothyroxine. At CATS-II, SGTF-T mothers had BMI (25.8 [23.1-29.8] kg/m2, P = 0.672) and TSH (1.68 [0.89-2.96] mU/L; P = 0.474) values similar to NGTF mothers. CONCLUSIONS Levothyroxine supplementation of women with SGTF did not affect long-term offspring anthropometric, bone, and cardiometabolic measurements. However, absence of treatment was associated with sustained long-term increase in BMI and fat mass in women with SGTF.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Peter N Taylor
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhian M Daniel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Charlotte Hales
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Scholz
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Toby Candler
- MRC The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Pettit
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - William D Evans
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - Dionne Shillabeer
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mohd S Draman
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Colin M Dayan
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Hiu K C Tang
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Oncology, Nottingham University NHS Trust, Nottingham, UK
| | - Onyebuchi Okosieme
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - John H Lazarus
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Marian E Ludgate
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Hales C, Taylor PN, Channon S, McEwan K, Thapar A, Langley K, Muller I, Draman MS, Dayan C, Gregory JW, Okosieme O, Lazarus JH, Rees DA, Ludgate M. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Behavior. J Clin Endocrinol Metab 2020; 105:5608609. [PMID: 31665323 DOI: 10.1210/clinem/dgz098] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/24/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT & OBJECTIVES The Controlled Antenatal Thyroid Screening (CATS) study was the first randomized controlled trial to investigate effects of treating suboptimal gestational thyroid function (SGTF) on child cognition. Since observational studies indicated that SGTF may also increase symptoms of autism and attention-deficit/hyperactivity disorder (ADHD), the CATS cohort was used to investigate whether treatment of mothers affected their children's behavior. DESIGN & PARTICIPANTS Mothers (N = 475) completed 3 questionnaires: the Strengths and Difficulties Questionnaire (SDQ), the Child ADHD Questionnaire, and the Social Communication Questionnaire (SCQ, used as a screen for autism spectrum disorder [ASD]), about their children (mean age 9.5 years). Group comparisons of total scores, numbers of children above clinical thresholds, and association between high maternal free thyroxine (FT4) (> 97.5th percentile of the UK cohort, "overtreated") and child neurodevelopment were reported. RESULTS There were no differences in total scores between normal gestational thyroid function (GTF) (n = 246), treated (n = 125), and untreated (n = 104) SGTF groups. More children of treated mothers scored above clinical thresholds, particularly the overtreated. Scores were above thresholds in SDQ conduct (22% vs 7%), SCQ total scores (7% vs 1%), and ADHD hyperactivity (17% vs 5%) when comparing overtreated (n = 40) and untreated (N = 100), respectively. We identified significantly higher mean scores for SDQ conduct (adjusted mean difference [AMD] 0.74; 95% confidence interval [CI], 0.021-1.431; P = 0.040, effect size 0.018) and ADHD hyperactivity (AMD 1.60, 95% CI, 0.361-2.633; P = 0.003, effect size 0.028) comparing overtreated with normal-GTF children. CONCLUSIONS There was no overall association between SGTF and offspring ADHD, ASD, or behavior questionnaire scores. However, children of "overtreated" mothers displayed significantly more ADHD symptoms and behavioral difficulties than those of normal-GTF mothers. Thyroxine supplementation during pregnancy requires monitoring to avoid overtreatment.
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Affiliation(s)
- Charlotte Hales
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Peter N Taylor
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Wales, UK
| | - Kirsten McEwan
- Centre for Trials Research, Cardiff University, Wales, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Wales, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Wales, UK
| | - Ilaria Muller
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Mohd S Draman
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Colin Dayan
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - John W Gregory
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - Onyebuchi Okosieme
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - John H Lazarus
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Wales, UK
| | - Marian Ludgate
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Wales, UK
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Okosieme OE, Taylor PN, Evans C, Thayer D, Chai A, Khan I, Draman MS, Tennant B, Geen J, Sayers A, French R, Lazarus JH, Premawardhana LD, Dayan CM. Primary therapy of Graves' disease and cardiovascular morbidity and mortality: a linked-record cohort study. Lancet Diabetes Endocrinol 2019; 7:278-287. [PMID: 30827829 DOI: 10.1016/s2213-8587(19)30059-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 12/06/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Graves' disease is routinely treated with antithyroid drugs, radioiodine, or surgery, but whether the choice of initial therapy influences long-term outcomes is uncertain. We evaluated cardiovascular morbidity and mortality according to the method and effectiveness of primary therapy in Graves' disease. METHODS In this retrospective cohort study, we identified patients with hyperthyroidism, diagnosed between Jan 1, 1998, and Dec 31, 2013, from a thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) test register in south Wales, UK, and imported their clinical data into the All-Wales Secure Anonymised Information Linkage (SAIL) Databank (Swansea University, Swansea, UK). Patients with Graves' disease, defined by positive TRAb tests, were selected for the study, and their clinical data were linked with outcomes in SAIL. We had no exclusion criteria. Patients were matched by age and sex to a control population (1:4) in the SAIL database. Patients were grouped by treatment within 1 year of diagnosis into the antithyroid drug group, radioiodine with resolved hyperthyroidism group (radioiodine group A), or radioiodine with unresolved hyperthyroidism group (radioiodine group B). We used landmark Kaplan-Meier and Cox regression models to analyse the association of treatment with the primary outcome of all-cause mortality and the secondary outcome of major adverse cardiovascular events (myocardial infarction, heart failure, ischaemic stroke, or death) with the landmark set at 1 year after diagnosis. We analysed the association between outcomes and concentration of TSH using Cox regression and outcomes and free thyroxine (FT4) concentration using restricted cubic-spline regression models. FINDINGS We extracted patient-level data on 4189 patients (3414 [81·5%] females and 775 [18·5%] males) with Graves' disease and 16 756 controls (13 656 [81·5%] females and 3100 [18·5%] males). In landmark analyses, 3587 patients were in the antithyroid drug group, 250 were in radioiodine group A, 182 were in radioiodine group B. Patients had increased all-cause mortality compared with controls (hazard ratio [HR] 1·22, 95% CI 1·05-1·42). Compared with patients in the antithyroid drug group, mortality was lower among those in radioiodine group A (HR 0·50, 95% CI 0·29-0·85), but not for those in radioiodine group B (HR 1·51, 95% CI 0·96-2·37). Persistently low TSH concentrations at 1 year after diagnosis were associated with increased mortality independent of treatment method (HR 1·55, 95% CI 1·08-2·24). Spline regressions showed a positive non-linear relationship between FT4 concentrations at 1 year and all-cause mortality. INTERPRETATION Regardless of the method of treatment, early and effective control of hyperthyroidism among patients with Graves' disease is associated with improved survival compared with less effective control. Rapid and sustained control of hyperthyroidism should be prioritised in the management of Graves' disease and early definitive treatment with radioiodine should be offered to patients who are unlikely to achieve remission with antithyroid drugs alone. FUNDING National Institute for Social Care and Health Research, Wales.
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Affiliation(s)
- Onyebuchi E Okosieme
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK; Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK.
| | - Peter N Taylor
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Carol Evans
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - Dan Thayer
- Secure Anonymised Information Linkage Databank, School of Medicine, Swansea University, Swansea, UK
| | - Aaron Chai
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Ishrat Khan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Mohd S Draman
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Brian Tennant
- Clinical Biochemistry Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK
| | - John Geen
- Clinical Biochemistry Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, UK; Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Adrian Sayers
- Department of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Robert French
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - John H Lazarus
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
| | - Lakdasa D Premawardhana
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK; Section of Endocrinology, Department of Medicine, Ysbyty Ystrad Fawr Hospital, Aneurin Bevan University Health Board, Ystrad Mynach, UK
| | - Colin M Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, UK
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Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, Ludgate ME. Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years. Thyroid 2018; 28:1682-1693. [PMID: 30351224 DOI: 10.1089/thy.2018.0232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid autoimmunity, especially Graves' disease or hypothyroidism with positive autoantibodies (TRAb) to the thyrotropin receptor (TSHR), occurs in 30-40% of patients with relapsing multiple sclerosis following treatment with alemtuzumab (ALTZ). ALTZ therapy therefore provides a unique opportunity to study the evolution of TRAb prior to clinical presentation. TRAb can stimulate (TSAb), block (TBAb), or not affect ("neutral") the TSHR function, causing hyperthyroidism, hypothyroidism, or euthyroidism, respectively. METHODS A longitudinal retrospective analysis was conducted of TRAb bioactivity over a period of nine years in 45 multiple sclerosis patients receiving ALTZ using available stored serum. Of these 45 patients, 31 developed thyroid dysfunction (TD) and 14 remained euthyroid despite being followed for a minimum of five years (NO-TD). The presence of TRAb was evaluated at standardized time points: (i) before ALTZ, (ii) latest time available following ALTZ and before TD onset, and (iii) following ALTZ during/after TD onset. Serum TRAb were detected by published in-house assays (ihTRAb): flow cytometry detecting any TSHR-binding TRAb, and luciferase bioassays detecting TSAb/TBAb bioactivity. Purified immunoglobulin G was used to verify TSAb/TBAb in selected hypothyroid cases. Standard clinical automated measurements of TRAb, antithyroid peroxidase autoantibodies (TPOAb), thyrotropin, free thyroxine, and free triiodothyronine were also collected. RESULTS Before ALTZ, combined ihTRAb (positive with flow cytometry and/or luciferase bioassay) but not automated TRAb were present in 5/16 (31.2%) TD versus 0/14 (0%) NO-TD (p = 0.017). Detectable ihTRAb preceded TD development in 9/28 (32.1%) and by a median of 1.2 years (range 28 days-7.3 years). Combination testing of ihTRAb and TPOAb at baseline predicted 20% of subsequent cases of hyperthyroidism and 83% of hypothyroidism. CONCLUSIONS Evidence is presented that TRAb measured with custom-made assays can be detected prior to any change in thyroid function in up to a third of cases of ALTZ-related TD. Furthermore, the presence of ihTRAb prior to ALTZ treatment was strongly predictive of subsequent TD. The findings suggest that a period of affinity maturation of TRAb may precede clinical disease onset in some cases. Combined testing of TPOAb and ihTRAb may increase the ability to predict those who will develop TD following ALTZ.
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Affiliation(s)
- Ilaria Muller
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Mark Willis
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Sarah Healy
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Taha Nasser
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Samantha Loveless
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Sara Butterworth
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Lei Zhang
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Mohd S Draman
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter N Taylor
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Neil Robertson
- 2 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Colin M Dayan
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Marian E Ludgate
- 1 Thyroid Research Group, Division of Infection and Immunity, School of Medicine; School of Medicine; Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
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Hales C, Taylor PN, Channon S, Paradice R, McEwan K, Zhang L, Gyedu M, Bakhsh A, Okosieme O, Muller I, Draman MS, Gregory JW, Dayan C, Lazarus JH, Rees DA, Ludgate M. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Cognition. J Clin Endocrinol Metab 2018; 103:1583-1591. [PMID: 29346569 DOI: 10.1210/jc.2017-02378] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 10/30/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVE The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment of suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in intelligence quotient (IQ) at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5 years and included children from normal gestational thyroid function (normal-GTF) mothers. DESIGN, SETTING, AND PARTICIPANTS One examiner, blinded to participant group, assessed children's IQ (Wechsler Intelligence Scale for Children, Fourth Edition UK), long-term memory, and motor function (Developmental Neuropsychological Assessment II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of an IQ < 85 in the groups. RESULTS There was no difference in IQ < 85 between children of mothers with normal-GTF and combined SGTF, i.e., treated and untreated (fully adjusted odds ratio [OR] = 1.15 [95% confidence interval (CI) 0.52, 2.51]; P = 0.731). Furthermore, there was no significant effect of treatment [untreated OR = 1.33 (95% CI 0.53, 3.34); treated OR = 0.75 (95% CI 0.27, 2.06) P = 0.576]. IQ < 85 was 6.03% in normal-GTF, 7.56% in treated, and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with free thyroxine > 97.5th percentile of the entire CATS-I cohort revealed no significant effect on a child's IQ < 85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (P < 0.0001) and accounted for 45% of the variation. CONCLUSIONS Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be a result of the similar proportion of IQ < 85 in children of women with normal-GTF and SGTF.
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Affiliation(s)
- Charlotte Hales
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Peter N Taylor
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ruth Paradice
- St David's Hospital, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Kirsten McEwan
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Lei Zhang
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Michael Gyedu
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ameen Bakhsh
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | | | - Ilaria Muller
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Mohd S Draman
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John W Gregory
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Colin Dayan
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John H Lazarus
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, Wales, United Kingdom
| | - Marian Ludgate
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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Taylor PN, Sayers A, Okosieme O, Das G, Draman MS, Tabasum A, Abusahmin H, Rahman M, Stevenson K, Groom A, Northstone K, Woltersdorf W, Taylor A, Ring S, Lazarus JH, Gregory JW, Rees A, Timpson N, Dayan CM. Maturation in Serum Thyroid Function Parameters Over Childhood and Puberty: Results of a Longitudinal Study. J Clin Endocrinol Metab 2017; 102:2508-2515. [PMID: 28472343 PMCID: PMC5505201 DOI: 10.1210/jc.2016-3605] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/24/2017] [Indexed: 01/19/2023]
Abstract
CONTEXT Serum thyroid hormone levels differ between children and adults, but have not been studied longitudinally through childhood. OBJECTIVE To assess changes in thyroid-stimulating hormone (TSH) and thyroid hormone levels over childhood and their interrelationships. DESIGN Cohort study. SETTING The Avon Longitudinal Study of Parents and Children, a population-based birth cohort. PARTICIPANTS A total of 4442 children who had thyroid function measured at age 7, and 1263 children who had thyroid function measured at age 15. Eight hundred eighty-four children had measurements at both ages. MAIN OUTCOME MEASURES Reference ranges for TSH, free tri-iodothyronine (FT3), free thyroxine (FT4), their longitudinal stability, and interrelationships. RESULTS Children at age 7 years had a higher FT3 [6.17 pmol/L, standard deviation (SD) 0.62] than children at age 15 (5.83 pmol/L, SD 0.74); P < 0.0001 with 23.2% of children at age 7 having FT3 above the adult reference range. Higher FT3 levels at age 7 in boys (P = 0.0001) and girls (P = 0.04) were associated with attainment of a more advanced pubertal stage at age 13. TSH was positively associated with FT3 at age 7 and age 15 even after adjusting for confounders. In contrast, TSH was negatively associated with FT4. CONCLUSIONS There are substantial changes in TSH and thyroid hormone levels over childhood, in particular for FT3, which appear to relate to pubertal readiness. Our data provide increased insight into the evolution of the pituitary-thyroid axis over childhood and may have implications for determining optimal ranges for thyroid hormone replacement in children.
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Affiliation(s)
- Peter N. Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
- Department of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Adrian Sayers
- Department of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
- Musculoskeletal Research Unit, University of Bristol, Learning and Research, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, United Kingdom
| | - Onyebuchi Okosieme
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, United Kingdom
| | - Gautam Das
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil CF47 9DT, United Kingdom
| | - Mohd S. Draman
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
| | - Arshiya Tabasum
- Endocrinology and Diabetes Department, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
| | - Hussam Abusahmin
- Endocrinology and Diabetes Department, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
| | - Mohammad Rahman
- Endocrinology and Diabetes Department, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
| | - Kirsty Stevenson
- Department of Biochemistry, Bristol Royal Infirmary University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
| | - Alix Groom
- Department of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Kate Northstone
- Department of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Wolf Woltersdorf
- Department of Biochemistry, Bristol Royal Infirmary University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
- Facharzt für Laboratoriumsmedizin Geschäftsleiter MVZ Labor, Dr. Reising-Ackermann and Kollegen Strümpellstrasse, 40 04289 Leipzig, Germany
| | - Andrew Taylor
- Department of Biochemistry, Royal United Hospital, Bath BA1 3NG, United Kingdom
| | - Susan Ring
- Department of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - John H. Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
| | - John W. Gregory
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
| | - Aled Rees
- Endocrinology and Diabetes Department, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
- Neuroscience and Mental Health Research, Cardiff University School of Medicine, Cardiff CF24 4HQ, United Kingdom
| | - Nicholas Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Colin M. Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
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Taylor P, Dehbozorgi S, Tabasum A, Scholz A, Bhatt H, Stewart P, Kumar P, Draman MS, Watt A, Rees A, Hayhurst C, Davies S. Cerebral salt wasting following traumatic brain injury. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160142. [PMID: 28458890 PMCID: PMC5404462 DOI: 10.1530/edm-16-0142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022] Open
Abstract
Summary Hyponatraemia is the most commonly encountered electrolyte disturbance in neurological high dependency and intensive care units. Cerebral salt wasting (CSW) is the most elusive and challenging of the causes of hyponatraemia, and it is vital to distinguish it from the more familiar syndrome of inappropriate antidiuretic hormone (SIADH). Managing CSW requires correction of the intravascular volume depletion and hyponatraemia, as well as mitigation of on-going substantial sodium losses. Herein we describe a challenging case of CSW requiring large doses of hypertonic saline and the subsequent substantial benefit with the addition of fludrocortisone. Learning points:
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Affiliation(s)
- Peter Taylor
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Thyroid Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, CardiffUK
| | - Sasan Dehbozorgi
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Arshiya Tabasum
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Anna Scholz
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Harsh Bhatt
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Philippa Stewart
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Pranav Kumar
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
| | - Mohd S Draman
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Thyroid Research Group, Division of Infection and Immunity, School of Medicine, Cardiff University, Heath Park, CardiffUK
| | - Alastair Watt
- Department of Diabetes and Endocrinology, North Devon District Hospital, BarnstapleUK
| | - Aled Rees
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK.,Institute of Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, CardiffUK
| | - Caroline Hayhurst
- Department of Neurosurgery, University Hospital of Wales, Heath Park, CardiffUK
| | - Stephen Davies
- Department of Diabetes and Endocrinology, University Hospital of Wales, Heath Park, CardiffUK
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Hales C, Channon S, Taylor PN, Draman MS, Muller I, Lazarus J, Paradice R, Rees A, Shillabeer D, Gregory JW, Dayan CM, Ludgate M. The second wave of the Controlled Antenatal Thyroid Screening (CATS II) study: the cognitive assessment protocol. BMC Endocr Disord 2014; 14:95. [PMID: 25495390 PMCID: PMC4276267 DOI: 10.1186/1472-6823-14-95] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/08/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Children whose mothers had low thyroid hormone levels during pregnancy have been reported to have decreased cognitive function. The reported research is part of the follow-on study of the Controlled Antenatal Thyroid Screening Study (CATS I), a randomised controlled trial which investigated the impact of treated vs. untreated low thyroid hormone level in women during pregnancy with the primary outcome being the child's IQ at age 3. No significant differences in IQ were found between the treated and untreated groups. These children are now aged between 7 and 10 years and aspects of their cognitive functioning including their IQ are being reassessed as part of CATS II. METHODS/DESIGN Cognitive assessments generate an IQ score and further tests administered will investigate long term memory function and motor coordination. The aim is to complete the assessments with 40% of the children born to mothers either in the treated or untreated low thyroid hormone groups (n = 120 per group). Also children born to mothers who had normal thyroid functioning during CATS I are being assessed for the first time (n = 240) to provide a comparison. Assessments are conducted either in the research facility or the participant's home. DISCUSSION The study is designed to assess the cognitive functioning of children born to mothers with low thyroid hormone levels and normal thyroid functioning during pregnancy. This is the largest study of its type and also is distinguishable in its longitudinal design. The research has the potential to have a significant impact on public health policy in the UK; universal screening of thyroid hormone levels in pregnancy may be the recommendation.
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Affiliation(s)
- Charlotte Hales
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Sue Channon
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Peter N Taylor
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Mohd S Draman
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Ilaria Muller
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - John Lazarus
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Ruth Paradice
- />Department for Paediatric Psychology, St. David’s Children’s Centre, Cardiff, UK
| | - Aled Rees
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Dionne Shillabeer
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - John W Gregory
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Colin M Dayan
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
| | - Marian Ludgate
- />Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN UK
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Zhang L, Grennan-Jones F, Draman MS, Lane C, Morris D, Dayan CM, Tee AR, Ludgate M. Possible targets for nonimmunosuppressive therapy of Graves' orbitopathy. J Clin Endocrinol Metab 2014; 99:E1183-90. [PMID: 24758182 DOI: 10.1210/jc.2013-4182] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 02/09/2023]
Abstract
CONTEXT Graves' orbitopathy (GO) is caused by expansion of the orbital contents by excess adipogenesis and overproduction of hyaluronan (HA). Immunosuppressive and antiinflammatory treatments of GO are not always effective and can have side effects, whereas targeting GO-associated tissue remodeling might be a more logical therapeutic strategy. Previously we reported that signaling cascades through IGF1 receptor and thyrotropin receptor within orbital preadipocytes/fibroblasts drove adipogenesis and HA production. Our current study combined the stimulation of IGF1 receptor and thyrotropin receptor increase of HA accumulation, which we hypothesize is by activation of phosphatidylinositol 3-kinase (PI3K)-1A/PI3K1B, respectively. The central aim of this study was to investigate whether PI3K/mammalian target of rapamycin complex 1 (mTORC1) inhibitors affected adipogenesis and/or HA production within orbital preadipocyte/fibroblasts. METHODS Human orbital preadipocytes were treated with/without inhibitors, LY294002 (PI3K1A/mTORC1), AS-605240 (PI3K1B), or PI103 (PI3K1A/mTORC1) in serum-free medium for 24 hours or cultured in adipogenic medium for 15 days. Quantitative PCR was used to measure hyaluronan synthases (HAS2) transcripts and the terminal adipogenesis differentiation marker lipoprotein lipase. HA accumulation in the medium was measured by an ELISA. RESULTS Unlike AS-605240, both LY294002 (10 μM) and PI-103 (5 μM) significantly decreased HAS2 transcripts/HA accumulation and adipogenesis. Because PI-103 and LY294002 are dual PI3K/mTOR inhibitors, we investigated the inhibition of mTORC1 (rapamycin 100 nM), which significantly decreased adipogenesis but had no effect on HAS2 transcripts/HA, implicating PI3K-1A in the latter. CONCLUSIONS The combined inhibition of PI3K1A and mTORC1 signaling in vitro decreased both HA accumulation and adipogenesis. Because PI3K and mTOR inhibitors are clinically used to treat other conditions, they have the potential to be repositioned to be used as an alternative nonimmunosuppressive therapy of GO.
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Affiliation(s)
- L Zhang
- Institute of Molecular and Experimental Medicine (L.Z., F.G.-J., M.S.D., C.M.D., M.L.), Department of Medical Genetics (A.R.T.), Institute of Cancer and Genetics, School of Medicine, Cardiff University, and Department of Ophthalmology (C.L., D.M.), Cardiff and Vale University Health Board, Heath Park, Cardiff CF14 4XN, United Kingdom
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Taylor PN, Iqbal A, Minassian C, Sayers A, Draman MS, Greenwood R, Hamilton W, Okosieme O, Panicker V, Thomas SL, Dayan C. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Intern Med 2014; 174:32-9. [PMID: 24100714 DOI: 10.1001/jamainternmed.2013.11312] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Rates of thyroid hormone prescribing in the United States and the United Kingdom have increased substantially. If some of the increase is due to lowering the thyrotropin threshold for treatment, this may result in less benefit and greater harm. OBJECTIVE To define trends in thyrotropin levels at the initiation of levothyroxine sodium therapy and the risk of developing a suppressed thyrotropin level following treatment. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE: Retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. Among 52,298 individuals who received a prescription for levothyroxine between January 1, 2001, and October 30, 2009, we extracted data about the thyrotropin level before levothyroxine therapy initiation, clinical symptoms, and thyrotropin levels up to 5 years after levothyroxine was initiated. We excluded persons who had a history of hyperthyroidism, pituitary disease, or thyroid surgery; those who were taking thyroid-altering medication or if the levothyroxine prescription was related to pregnancy; and those who did not have a thyrotropin level measured within 3 months before the initiation of levothyroxine. MAIN OUTCOMES AND MEASURES The median thyrotropin level at the time of the index levothyroxine prescription, the odds of initiation of levothyroxine therapy at thyrotropin levels of 10.0 mIU/L or less, and the age-stratified odds of developing a low or suppressed thyrotropin level after levothyroxine therapy. RESULTS Between 2001 and 2009, the median thyrotropin level at the initiation of levothyroxine therapy fell from 8.7 to 7.9 mIU/L. The odds ratio for prescribing levothyroxine at thyrotropin levels of 10.0 mIU/L or less in 2009 compared with 2001 (adjusted for changes in population demographics) was 1.30 (95% CI, 1.19-1.42; P < .001). Older individuals and individuals with cardiac risk factors had higher odds of initiation of levothyroxine therapy with a thyrotropin level 10.0 mIU/L or less. At 5 years after levothyroxine initiation, 5.8% of individuals had a thyrotropin level of <0.1 mIU/L. Individuals with depression or tiredness at baseline had increased odds of developing a suppressed thyrotropin level, whereas individuals with cardiac risk factors (eg, atrial fibrillation, diabetes mellitus, hypertension, and raised lipid levels) did not. CONCLUSIONS AND RELEVANCE We observed a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism and a substantial risk of developing a suppressed thyrotropin level following therapy. Large-scale prospective studies are required to assess the risk-benefit ratio of current practice.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom2Department of Social and Community Based Medicine, University of Bristol, Bristol, United Kingdom
| | - Ahmed Iqbal
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - Caroline Minassian
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adrian Sayers
- Department of Social and Community Based Medicine, University of Bristol, Bristol, United Kingdom
| | - Mohd S Draman
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Rosemary Greenwood
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | | | - Onyebuchi Okosieme
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Vijay Panicker
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom3Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, University of Bristol, Bristol, United Ki
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Draman MS, Thabit H, Kiernan TJ, O'Neill J, Sreenan S, McDermott JH. A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature. Endocrinol Diabetes Metab Case Rep 2013; 2013:130058. [PMID: 24616778 PMCID: PMC3921998 DOI: 10.1530/edm-13-0058] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/10/2013] [Indexed: 02/01/2023] Open
Abstract
Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.
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Affiliation(s)
- M S Draman
- Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland
| | - H Thabit
- Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland
| | - T J Kiernan
- Department of Cardiology University of Limerick Limerick Ireland
| | - J O'Neill
- Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland
| | - S Sreenan
- Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland
| | - J H McDermott
- Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland
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Das JP, Draman MS, Cormican L, O'Neill J. Morning report: a recommendation to improve medical handover. Ir Med J 2012; 105:59. [PMID: 22455245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Behan LA, Draman MS, Moran C, King T, Crowley RK, O'Sullivan EP, Smith D, Thompson CJ, Agha A. Secondary resistance to cabergoline therapy in a macroprolactinoma: a case report and literature review. Pituitary 2011; 14:362-6. [PMID: 19191028 DOI: 10.1007/s11102-009-0168-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 10/21/2022]
Abstract
Primary resistance to dopamine agonists occurs in 10-15% of prolactinomas but secondary resistance following initial biochemical and anti-proliferative response is very rare and has only been hitherto described in four previous cases, two with bromocriptine and two with cabergoline. We describe a case of a 57-year-old woman who presented with a large macroprolactinoma with suprasellar extension. She was initially treated with bromocriptine therapy with a resolution of symptoms, marked reduction in prolactin concentration and complete tumour shrinkage; a response which was subsequently maintained on cabergoline. After 8 years of dopamine agonist therapy, her prolactin concentration began to rise and there was symptomatic recurrence of her tumour despite escalating doses of cabergoline up to 6 mg weekly. Non-compliance was outruled by observed inpatient drug administration. The patient underwent surgical debulking followed by radiotherapy with good response. This case adds to the previous two cases of secondary resistance to cabergoline therapy in prolactinomas a marked initial response. While the mechanism of secondary resistance remains unknown and not possible to predict, close observation of prolactinoma patients on treatment is necessary.
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Affiliation(s)
- L A Behan
- Department of Academic Endocrinology and Diabetes, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
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