Abstract #589 Graves’ Disease Presenting After 25 Years of Stable Thyroid Hormone Replacement Therapy for Primary Hypothyroidism

Abstract Context Hypothyroidism is associated with reversible decline in kidney function as measured by estimated glomerular filtration rate (eGFR). eGFR and proteinuria are the most important markers for clinical assessment of kidney function. Though hypothyroidism is associated with proteinuria in cross-sectional data, the impact of treatment on proteinuria is unknown. Objective This study explores the effect of thyroid hormone replacement therapy on eGFR and 24-hour urine protein excretion in patients with severe primary hypothyroidism. Design and Participants This study was a prospective, observational cohort study in adults with severe primary hypothyroidism (serum thyrotropin [TSH] > 50 µIU/mL). Individuals with preexisting or past kidney disease, kidney or urinary tract abnormalities, calculi or surgery, diabetes mellitus, or hypertension were excluded. The participants received thyroid hormone replacement therapy. Thyroid functions, eGFR, 24-hour urine protein excretion, and biochemical parameters were measured at baseline and 3 months. Setting This study took place at a single center, a tertiary care referral and teaching hospital. Results Of 44 enrolled participants, 43 completed 3 months of follow-up. At 3 months, serum TSH levels decreased and thyroxine levels increased (P < .001 for both). Significant increases in eGFR (mean difference, 18.25 ± 19.49 mL/min/1.73 m2; 95% CI, 12.25 to 24.25, P < .001) and declines in 24-hour urine protein excretion (mean difference, –68.39 ± 125.89 mg/day; 95% CI, –107.14 to –29.65, P = .001) were observed. Serum cholesterol and low-density lipoprotein levels also significantly decreased (P < .001). Conclusions Thyroid hormone replacement therapy in patients with severe primary hypothyroidism improves eGFR and decreases 24-hour urine protein excretion, thereby suggesting reversible alterations.

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Thyroid Hormone Replacement Therapy in Primary Hypothyroidism: A Randomized Trial Comparing L-Thyroxine Plus Liothyronine With L-Thyroxine Alone

Yearbook of Medicine ◽

10.1016/s0084-3873(08)70611-4 ◽

2006 ◽

Vol 2006 ◽

pp. 501-504

Author(s):

E.L. Mazzaferri

Keyword(s):

Hormone Replacement Therapy ◽

Thyroid Hormone ◽

Randomized Trial ◽

Replacement Therapy ◽

Hormone Replacement ◽

Primary Hypothyroidism ◽

Thyroid Hormone Replacement ◽

Thyroid Hormone Replacement Therapy

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Graves’ Disease Presenting After 25 Years of Stable Thyroid Hormone Replacement Therapy

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1901 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A930-A930

Author(s):

Kathleen Wyne

Keyword(s):

Hormone Replacement Therapy ◽

Thyroid Hormone ◽

Replacement Therapy ◽

Dose Reduction ◽

Hormone Replacement ◽

Graves Disease ◽

Thyroid Hormone Replacement ◽

Autoimmune Thyroid ◽

Wide Range ◽

Thyroid Hormone Replacement Therapy

Abstract Background: Autoimmune thyroid disease may present with a wide range of symptoms. When the presentation is hyperthyroidism due to Graves’ Disease the symptoms generally subside over the subsequent two years but may recur at any time months to years later. When the initial presentation is hypothyroidism that person usually remains hypothyroid, requiring thyroid hormone replacement therapy for the rest of their life. Clinical Case: 67 year old woman presenting with hyperthyroidism after 25 years of stable dose thyroid hormone replacement therapy (THRT). She recalls being diagnosed with hyperthyroidism in her late 30s. She did not take any medication at that time. She is very clear that she was not treated with radioactive iodine or surgery. She recalls presenting with fatigue and weight gain about 2 years later at which time she was initiated on thyroid hormone replacement therapy. After multiple dose changes in the first few years she was stabilized on 90 mg daily of Armour thyroid. After more than 20 years on this dose the hyperthyroid symptoms recurred. Her symptoms persisted after decreasing then, ultimately, stopping the Armour Thyroid. Evaluation for causes of hyperthyroidism revealed the presence of both TRAb and TSI antibodies that have decreased in titer but are now still present more than 4 years after the diagnosis of hyperthyroidism. Symptoms have been controlled over this time period with low dose (5-10 mg/day) methimazole. Conclusion: Hypothyroidism is very common in women, with Hashimoto’s Thyroiditis as the usual etiology. When patients on thyroid hormone replacement therapy (THRT) present with symptoms of hyperthyroidism they are usually managed with dose reduction. However, complete cessation of THRT is unusual, especially after more than 10-20 years of therapy. Dose reduction of more than 50% without contributing factors such as significant weight loss should prompt measurement of TRAb and/or TSI to evaluate for Graves’ Disease regardless of the duration of the THRT.

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