The Role of Clinical Guidelines in Patient Care: Thyroid Hormone Replacement in Women of Reproductive Age

238 Background: Little is known about treatment practices in thyroid cancer, a cancer that is increasing in incidence. We sought to identify aspects of thyroid cancer management that have the greatest variation and thereby uncertainty in management. Methods: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the U.S. National Cancer Database. Using vignettes and additional survey items, physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement post-surgery, and long-term thyroid cancer management. To identify aspects of thyroid cancer management with the greatest uncertainty, we calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater uncertainty. Results: There is large uncertainty in multiple aspects of thyroid cancer management, including the role of central lymph node dissections, the role of pretreatment scans before radioactive iodine treatment, and all aspects of long-term thyroid cancer management, including applications of ultrasound and radioactive iodine scans. For the management of small thyroid cancers, uncertainty exist in all domains, including optimal extent of surgery and the role of both radioactive iodine treatment and suppressive doses of thyroid hormone replacement. Conclusions: We identified areas of uncertainty in thyroid cancer management. Since both a lack of data and a lack of acceptance of the existing data may be contributing to the variation demonstrated, to improve the management of thyroid cancer there is a need for more research and more research dissemination.

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Acute Delirium in the Setting of Primary Hypothyroidism: The Role of Thyroid Hormone Replacement Therapy

Thyroid ◽

10.1089/thy.2005.15.1099 ◽

2005 ◽

Vol 15 (9) ◽

pp. 1099-1101 ◽

Cited By ~ 12

Author(s):

Samer El-Kaissi ◽

Mark A. Kotowicz ◽

Michael Berk ◽

Jack R. Wall

Keyword(s):

Hormone Replacement Therapy ◽

Thyroid Hormone ◽

Replacement Therapy ◽

Hormone Replacement ◽

Primary Hypothyroidism ◽

Thyroid Hormone Replacement ◽

Thyroid Hormone Replacement Therapy

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The role of orexin A in pathophysiological mechanisms of sleep disorder in postmenopausal women

GYNECOLOGY ◽

10.26442/20795696.2020.1.200038 ◽

2020 ◽

Vol 22 (1) ◽

pp. 50-54

Author(s):

Zukhra Kh. Ebzieva ◽

Svetlana V. Yureneva ◽

Tatiana Yu. Ivanets

Keyword(s):

Hormone Therapy ◽

Sleep Disorder ◽

Postmenopausal Women ◽

Menopausal Hormone Therapy ◽

Reproductive Age ◽

Vasomotor Symptoms ◽

Women Of Reproductive Age ◽

Orexin A ◽

Group 1

Aim. To conduct a comparative analysis of serum orexin A levels in women of different age periods with and without sleep disorder and vasomotor symptoms. To evaluate the dynamics of orexin A levels under menopausal hormone therapy. Materials and methods. The study included 50 postmenopausal women and 30 women of reproductive age with a regular menstrual cycle. Using block randomization, patients are divided into 3 groups: group 1 (main group), n=25, -STRAW+ 10 (+1b and +1c), patients with sleep disorder and vasomotor symptoms; group 2 (comparison group), n=25, STRAW+ 10 (+1b and +1c), patients with vasomotor symptoms without sleep disorder; group 3 (control group), n=30, STRAW+ 10 (-4), women of reproductive age without sleep disorder. Group 1 patients were given menopausal hormone therapy. A comparative analysis was carried out using the questionnaire for assessing menopausal symptoms severity by the Greene Scale (the Greene Climacteric Scale) and Rating Scale for subjective sleep characteristics. After 12 weeks of treatment, a control examination was performed. Results. In group 1 women, the serum orexin A levels were significantly higher compared to the women without the symptoms. The link between the orexin A levels and menopause syndrome severity was established. A significant decrease in the menopausal symptoms severity after 12 weeks of menopausal hormone therapy was shown. It was accompanied by a 1,3-fold decrease in orexin A levels. Conclusions. The obtained data indicate the possible role of orexin A and the orexin neuropeptide system in the pathogenesis of sleep disorder and vasomotor symptoms in postmenopausal women.

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Linear modulation of serum thyrotrophin by thyroid hormone treatment in hypothyroidism

Acta Endocrinologica ◽

10.1530/acta.0.0950472 ◽

1980 ◽

Vol 95 (4) ◽

pp. 472-478 ◽

Cited By ~ 6

Author(s):

A. Eugene Pekary ◽

Jerome M. Hershman ◽

Clark T. Sawin

Keyword(s):

Thyroid Hormone ◽

Hormone Replacement ◽

Hormone Treatment ◽

Significant Negative Correlation ◽

Thyroid Hormone Replacement ◽

Basal Serum ◽

Thyroid Hormone Levels ◽

Peak Versus ◽

Hypothyroid Patients ◽

Serum Tsh

Abstract. Basal serum TSH and the peak TSH response to a 500 μg TRH bolus were measured in 57 euthyroid and in 29 hypothyroid subjects either receiving graded thyroid hormone replacement or acutely removed from full replacement therapy. Serum TSH, total T4 and T3 were determined by sensitive radioimmunoassay methods. The peak versus basal TSH data for hypothyroid patients were linear within individuals. The regression slope of the peak versus basal TSH data for all hypothyroid subjects did not differ significantly from the corresponding slope for all euthyroid subjects. Basal and peak TSH versus T3 and T4 data for hypothyroid patients were also linear within each individual. Moreover, the regression of the basal TSH values averaged over the non-replacement to full replacement state against the TSH versus T3 slope had a significant negative correlation. This trend leads to an array of regression lines which average to the familiar hyperbolic relationship between thyrotrophin and thyroid hormone levels in man.

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Role of husband’s attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan

BMC Women s Health ◽

10.1186/s12905-021-01314-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Muhammad Farhan Asif ◽

Zahid Pervaiz ◽

Jawad Rahim Afridi ◽

Ghulam Abid ◽

Zohra S. Lassi

Keyword(s):

Family Planning ◽

Unmet Need ◽

Wealth Quintile ◽

Married Women ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

Family Planning Programs ◽

Contraception Use ◽

Wide Range

Abstract Background Family planning services deliver a wide range of benefits to the well-being of females and the community. It can curtail the risk of maternal and neonatal mortality through the reduction in abortions and pregnancies. The government of Pakistan has been struggling to convince people about the usefulness of family planning programs. However, different factors related to social norms, values, and culture are important to determine the success of these programs. One such factor is the patriarchal structure of Pakistani society where most of the household decisions are made by men. The objective of this research is to examine the role of the husband’s attitude towards the usage of contraceptives for the unmet need of family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan. Method The dataset of Pakistan Demographic and Health Survey 2017–18 is utilized to examine the role of the husband’s attitude towards the usage of contraceptives in UMNFP among MWRA in Pakistan. Results The UMNFP was considerably lower among MWRA between 40 years and above compared to women 15–19 years. The odds of UMNFP were higher among women and men who were educated up to the primary level compared to those with no education. Odds of UMNFP were higher among women from the poor wealth quintile compared to the poorest wealth quintile; similarly, it was significantly lower among women who were from the richer and the richest wealth quintile compared to the poorest wealth quintile. The odds of UMNFP were lower among women who were employed compared to those who were not employed. Lastly, the odds of UMNFP were higher among women whose husbands opposed to using contraceptives, who perceived that there was a religious prohibition for such use and when a decision on the contraception use was solely made by the husband. Conclusions Husband’s attitude towards the usage of contraceptives is an important predictor of UMNFP. Liaising with the community and religious leaders to persuade people particularly men about the usefulness of family planning programs and encouraging men to understand their women’s say in using contraceptives should be encouraged.

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