Severe hypothyroidism following a single topical exposure to iodine in a premature neonate

A neonate, born at 24 weeks, underwent a patent ductus arteriosus ligation, with previous normal thyroid stimulating hormone (TSH) levels, developed severe hypothyroidism from topical exposure to iodine following a single surgical procedure at 28 days of life. A low free T4 level of 0.05 ng/dL and a high TSH level of 228 mIU/L was detected with an increased urinary iodine excretion level of 178 mg/L (reference range 0.30–1.97 mg/L). The thyroid ultrasound was normal. Levothyroxine was started immediately but thyroid function did not recover fully during admission and levothyroxine was required beyond term corrected. This case highlighted how susceptible extremely preterm infants are to iodine induced hypothyroidism, even short-term topical exposure. Delayed treatment of hypothyroidism can lead to profound neurodevelopmental delay. As surgical advances allow for interventions at earlier gestations, the importance of early thyroid function testing postexposure to iodine is highlighted and ultimately topical iodine should be avoided in these susceptible infants.

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Urinary Iodine Excretion and Serum Thyroid Function in Adults After Iodinated Contrast Administration

Thyroid ◽

10.1089/thy.2015.0024 ◽

2015 ◽

Vol 25 (5) ◽

pp. 471-477 ◽

Cited By ~ 24

Author(s):

Sun Y. Lee ◽

Donny L.F. Chang ◽

Xuemei He ◽

Elizabeth N. Pearce ◽

Lewis E. Braverman ◽

...

Keyword(s):

Thyroid Function ◽

Urinary Iodine ◽

Urinary Iodine Excretion ◽

Contrast Administration ◽

Iodinated Contrast ◽

Iodine Excretion

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INTRAVENOUS LEVOTHYROXINE DURING HEMODIALYSIS IN A PATIENT WITH HYPOTHYROIDISM AND NON-ADHERENCE TO ORAL MEDICATIONS

AACE Clinical Case Reports ◽

10.4158/accr-2020-0020 ◽

2020 ◽

Vol 6 (5) ◽

pp. e230-e233

Author(s):

Dipa Avichal ◽

Igor Kravets

Keyword(s):

Renal Disease ◽

Thyroid Function ◽

End Stage Renal Disease ◽

Hashimoto Thyroiditis ◽

Thyroid Stimulating Hormone ◽

Psychiatric Medication ◽

Medication Regimen ◽

Free T4 ◽

Stage Renal Disease ◽

End Stage

Objective: We describe an unusual and challenging clinical scenario: a patient with end-stage renal disease on hemodialysis with severely uncontrolled hypothyroidism and worsening psychosis, who refused both oral and intramuscular levothyroxine, but was successfully treated with intravenous (IV) levothyroxine given on hemodialysis days. Methods: The patient was interviewed and examined on admission and during hospitalization. Thyroid function was assessed through thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, and triiodothyronine (T3) by electrochemiluminescence immunoassay. Thyroid function was measured on admission, before and after each hemodialysis session for 1 week, and monthly thereafter. Results: The patient was a 71-year-old female with schizoaffective disorder, end-stage renal disease on hemodialysis, and uncontrolled Hashimoto thyroiditis due to non-adherence to oral levothyroxine therapy. On admission her TSH was 172.6 mIU/mL, free T4 was 0.59 ng/dL, and total T3 was 52 ng/dL. She presented to the hospital from her nursing home after repeated refusal to go to hemodialysis sessions secondary to worsening psychosis. At the hospital, she agreed to undergo hemodialysis and receive IV medications, but refused oral and intramuscular levothyroxine. After initiation of IV levothyroxine therapy 3 times weekly during hemodialysis, the patient’s thyroid function normalized within 19 weeks (TSH was 2.2 mIU/L, free T4 was 1.3 ng/dL, total T3 was 60 ng/dL). The achievement of the euthyroid status and adjustment of the patient’s psychiatric medication regimen were followed by a resolution of the patient’s psychosis. Conclusion: This case report demonstrates an unusual approach to the successful control of hypothyroidism, namely administration of IV levothyroxine 3 times weekly during hemodialysis sessions when conventional routes of levothyroxine administration could not be used due to the patient’s refusal.

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A comparative study on outcomes of preprandial versus postprandial thyroid function test

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194945 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1662

Author(s):

Vasim Ismail Patel ◽

Akshay B. K.

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Clinical Symptoms ◽

Thyroid Function Test ◽

Thyroid Stimulating Hormone ◽

Endocrine Gland ◽

Thyroid Function Tests ◽

Sample Collection ◽

Free T4 ◽

Group 2

Background: The thyroid is an endocrine gland. It secretes two hormones thyroxine (T4), triiodothyronine (T3). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.Methods: The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially. Results: TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.Conclusions: There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.

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Two Sources of Maternal Iodine Intake and Their Effect on Maternal and Infant Iodine Status and Thyroid Function and Infant Information Processing in Southern Ethiopia (P11-007-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-007-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Tafere Gebreegziabher ◽

Barbara Stoecker

Keyword(s):

Information Processing ◽

Thyroid Function ◽

Visual Information ◽

Urinary Iodine ◽

Iodine Concentration ◽

Thyroid Stimulating Hormone ◽

Iodized Salt ◽

Southern Ethiopia ◽

Urinary Iodine Concentration ◽

Iodine Supplementation

Abstract Objectives The objective of this study was to assess the effects of two sources of iodine supplementation on maternal and infant thyroid function and on visual information processing (VIP) of infants in southern Ethiopia Methods A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were recruited within the first week after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 µg iodine) daily for 26 weeks or appropriately iodized salt weekly for 26 weeks for household consumption. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. Results At baseline, neither mothers nor infants in the two groups (capsule and iodized salt groups) were significantly different in any of the biomarkers and anthropometry measurements. Maternal TSH and goiter rate significantly decreased following iodine supplementation but T3, T4 and Tg didn't change. Maternal UIC and BMIC and infant UIC were not different among groups. Conclusions A maternal dose of 225 µg iodine daily or adequately iodized salt initiated within a week after delivery decreased goiter and TSH but did not impact infant T4, TSH or VIP. The two treatment groups didn't differ in any of the outcome variables. Funding Sources The study was funded by Nestlé Foundation and Oklahoma State University.

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The Association of Therapy Adherence and Thyroid Function in Adult Patients with Phenylketonuria

Annals of Nutrition and Metabolism ◽

10.1159/000501301 ◽

2019 ◽

Vol 75 (1) ◽

pp. 16-23 ◽

Cited By ~ 1

Author(s):

Csaba Sumanszki ◽

Erika Kiss ◽

Erika Simon ◽

Erika Galgoczi ◽

Aron Soos ◽

...

Keyword(s):

Thyroid Function ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Thyroid Stimulating Hormone ◽

Healthy Controls ◽

Serum Thyroglobulin ◽

Therapy Adherence ◽

Iodine Status ◽

Amino Acid Mixtures ◽

Therapy Compliance

Background: The standard, lifelong therapy of phenylketonuria (PKU) is a natural protein-restricted diet complemented with phenylalanine (Phe)-free L-amino acid mixtures that provide the daily necessary micronutrients. Objective: To assess thyroid function and structure and the iodine status of early-treated adult PKU (ETPKU) patients in Hungary. Methods: Sixty-nine PKU patients (aged 18–41 years) and 50 healthy controls were enrolled in the study. Thyroid hormones, serum thyroglobulin, thyroid antibodies, urinary iodine, and selenium concentrations were measured, and thyroid ultrasound was performed. Results: The incidence of thyroid dysfunction was infrequent (n = 2). Blood Phe was negatively correlated with thyroid-stimulating hormone (TSH), and PKU patients had higher free thyroxine and lower TSH levels than healthy controls. Although optimal iodine status was found in the entire PKU population, by dividing the patients according to their therapy compliance, we observed that lower therapy adherence was associated with mild iodine deficiency and lower urinary selenium levels. Conclusions: The results of this study suggest that iodine status is strongly influenced by the adherence to therapy in ETPKU patients. No or not enough medical food consumption combined with a low-Phe diet can lead to subclinical iodine deficiency.

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Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2020.605134 ◽

2020 ◽

Vol 8 ◽

Author(s):

Se In Sung ◽

Yun Sil Chang ◽

So Yoon Ahn ◽

Heui Seung Jo ◽

Misun Yang ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Ductus Arteriosus ◽

Intervention Approach ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surgical Treatments ◽

Minimal Evidence ◽

Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

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Duration of significant patent ductus arteriosus and bronchopulmonary dysplasia in extremely preterm infants

Journal of Perinatology ◽

10.1038/s41372-019-0496-5 ◽

2019 ◽

Vol 39 (12) ◽

pp. 1648-1655 ◽

Cited By ~ 6

Author(s):

Hussnain Mirza ◽

Jorge Garcia ◽

Genevieve McKinley ◽

Laura Hubbard ◽

Wendla Sensing ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Ductus Arteriosus ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

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Evaluation of the impact of an iodine supplementation programme on severely iodine-deficient schoolchildren with hypothyroidism

Public Health Nutrition ◽

10.1079/phn2003471 ◽

2003 ◽

Vol 6 (6) ◽

pp. 529-533 ◽

Cited By ~ 8

Author(s):

Nahid Salarkia ◽

Mehdi Hedayati ◽

Parvin Mirmiran ◽

Masood Kimiagar ◽

Fereidoun Azizi

Keyword(s):

Thyroid Hormones ◽

Rural Areas ◽

Urinary Iodine ◽

Thyroid Stimulating Hormone ◽

World Health ◽

Urinary Iodine Excretion ◽

Iodised Salt ◽

Iodine Supplementation ◽

Normal Ranges ◽

The Impact

AbstractBackground:Northern rural areas of Tehran have been shown to have severe iodine deficiency in our previous studies. In 1989 the inhabitants of these villages received an injection of iodised oil, followed by iodised salt distribution in 1993. The aim of the present study was to evaluate the effect of the iodine supplementation on iodine-deficient schoolchildren with hypothyroidism in these villages.Methods:In total, 571 students aged 6–14 years were studied. Goitre was graded according to the World Health Organization classification. Serum concentrations of thyroid hormones (thyroxine (T4) and triiodothyronine (T3)) and thyroid-stimulating hormone (TSH) were determined using commercial kits, and urinary iodine was measured using a digestion method. The results were compared with data from our previous study in 1989.Results:Total goitre rate decreased by 42% in 1999 compared with that in 1989. A significant decrease in Grade 2 goitre concomitant with an increase in Grade 1 goitre was seen (P < 0.001). Values of the variables studied before (1989) and 10 years after iodine supplementation (1999) were: median urinary iodine excretion, 2.0 vs. 19.0 μg dl−1 (P < 0.001); T4, 6.5 ± 2.0 vs. 8.4 ± 1.6 μg dl−1 (P < 0.001); T3, 177 ± 38.0 vs. 145 ± 29.0 ng dl−1 (P < 0.001); TSH, 10.8 ± 15.1 vs. 1.8 ± 0.8 μU ml−1 (P < 0.001). No correlation was found between thyroid hormones and TSH on the one hand, and goitre and urinary iodine, on the other. Serum T4, T3 and TSH concentrations were within normal ranges in all schoolchildren in 1999.Conclusion:This study showed that euthyroidism induced by administration of iodised oil in iodine-deficient schoolchildren with hypothyroidism is sustained following the consumption of iodised salt.

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Iodine Intake and Thyroid Function in Pregnant Women in a Private Clinical Practice in Northwestern Sydney before Mandatory Fortification of Bread with Iodised Salt

Journal of Thyroid Research ◽

10.1155/2012/798963 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Norman Blumenthal ◽

Karen Byth ◽

Creswell J. Eastman

Keyword(s):

Pregnant Women ◽

Thyroid Function ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Iodine Intake ◽

Urinary Iodine Excretion ◽

Blood Collection ◽

Antenatal Visit ◽

Urinary Iodine Concentration ◽

Cross Sectional

Aim. The primary objective of the study was to assess the iodine nutritional status, and its effect on thyroid function, of pregnant women in a private obstetrical practice in Sydney.Methods. It was a cross-sectional study undertaken between November 2007 and March 2009. Blood samples were taken from 367 women at their first antenatal visit between 7 and 11 weeks gestation for measurement of thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels and spot urine samples for urinary iodine excretion were taken at the same time as blood collection.Results. The median urinary iodine concentration (UIC) for all women was 81 μg/l (interquartile range 41–169 μg/l). 71.9% of the women exhibited a UIC of <150 μg/l. 26% of the women had a UIC <50 μg/l, and 12% had a UIC <20 μg/l. The only detectable influences on UIC were daily milk intake and pregnancy supplements. There was no statistically significant association between UIC and thyroid function and no evidence for an effect of iodine intake on thyroid function.Conclusions. There is a high prevalence of mild to moderate iodine deficiency in women in Western Sydney but no evidence for a significant adverse effect on thyroid function. The 6.5% prevalence of subclinical hypothyroidism is unlikely to be due to iodine deficiency.

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