Optimal Thyroid Hormone Replacement

2021 ◽  
Author(s):  
Jacqueline Jonklaas
Keyword(s):  
Combination Therapy ◽  
Animal Studies ◽  
Randomized Clinical Trials ◽  
Phase 1 ◽  
Life Stage ◽  
Hormone Replacement ◽  
Thyroid Hormone Replacement ◽  
The Impact ◽  
Baseline Health

Abstract Hypothyroidism is a common endocrinopathy and levothyroxine is frequently prescribed. Despite the basic tenets of initiating and adjusting levothyroxine being agreed upon, there are many nuances and complexities to consistently maintaining euthyroidism. Understanding the impact of patient weight and residual thyroid function on initial levothyroxine dosage and consideration of age, co-morbidities, TSH goal, life stage, and quality of life as levothyroxine is adjusted can be challenging and continually evolving. As levothyroxine is a life-long medication it is important to avoid risks from periods of overtreatment or undertreatment. For the subset of patients not restored to baseline health with levothyroxine, causes arising from all aspects of the patient’s life (co-existent medical conditions, stressors, lifestyle, psychosocial factors) should be broadly considered. If such factors do not appear to be contributing, and biochemical euthyroidism has been successfully maintained, there may be benefit to a trial of combination therapy with levothyroxine and liothyronine. This is not supported by the majority of randomized clinical trials, but may be supported by other studies providing lower quality evidence and by animal studies. Given this discrepancy, it is important that any trial of combination therapy only be continued as long as a patient benefit is being enjoyed. Monitoring for adverse effects, particularly in older or frail individuals, is necessary and combination therapy should not be utilized during pregnancy. A sustained release liothyronine preparation has completed phase 1 testing and may soon be available for better designed and powered studies assessing whether combination therapy provides superior therapy for hypothyroidism.

Spa-therapy can improve quality of life in chronic musculoskeletal disorder subjects: a narrative review

2020 ◽  
Vol 96 (2) ◽  
pp. 3-6
Author(s):  
M.C. Maccarone ◽  
G. Magro ◽  
U. Solimene ◽  
S. Masiero
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Thermal Environment ◽  
Narrative Review ◽  
Spa Therapy ◽  
Age Related ◽  
Therapy Interventions ◽  
The Impact

Chronic Musculoskeletal Disorders (MSDs) are age-related conditions, linked to functional impairment and decreased quality of life (QoL). As a result of the increased life expectancy in Europe, great attention has been focused on investigating the impact of these diseases on QoL. Thermal environment is a suitable place for providing interventions (mud therapy, bath, exercise, etc.) for chronic MSD patients. Our narrative review aims to assess if Spa therapy may improve QoL in patients with chronic MSDs. We searched randomized clinical trials and clinical trials screening PubMed and Google Scholar databases from 2016 up to March 2020. We included 14 trials testing Spa therapy interventions concerning osteoarthritis, rheumatoid arthritis, chronic shoulder pain and fibromyalgia. In conclusion, even though limitations must be considered, evidence shows that Spa therapy, especially in combination with rehabilitation approach, can significantly improve QoL of patients with chronic MSDs.

Quality of design and reporting of animal research in peritoneal dialysis: A scoping review

2020 ◽  
Vol 40 (4) ◽  
pp. 394-404
Author(s):  
Janusz Witowski ◽  
Dorota Sikorska ◽  
András Rudolf ◽  
Izabela Miechowicz ◽  
Julian Kamhieh-Milz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Scoping Review ◽  
Animal Studies ◽  
Reporting Quality ◽  
Animal Research ◽  
Size Estimation ◽  
Quality Of Reporting ◽  
The Impact

The concerns about reproducibility and validity of animal studies are partly related to poor experimental design and reporting. Here, we undertook a scoping review of the literature to determine the extent and quality of reporting of animal studies on peritoneal dialysis (PD). Online databases were searched to identify 567 relevant original articles published between 1979 and 2018. These were analyzed with respect to bibliographic parameters and general aspects of animal experimentation. A subgroup of 120 studies was analyzed in detail in terms of the impact on the reporting quality of the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines for animal studies. The number of animal studies on PD increased continuously over the years with a thematic shift toward long-term preservation of the peritoneum as a dialyzing organ. There were significant deficiencies in research design with the lack of sample size estimation, randomization, and blinding being the commonest shortcomings. The description of animal numbers, housing conditions, use of medication, and statistical analysis was incomplete. The introduction in 2010 of the ARRIVE guidelines produced very little improvement in the completeness of reporting regardless of journal impact factor. The animal studies on PD suffer from deficits in experimental protocols and transparent reporting. These drawbacks need to be corrected to ensure high-quality and much-needed animal research in PD.

scholarly journals Combination Treatment with T4 and T3: Toward Personalized Replacement Therapy in Hypothyroidism?

2012 ◽  
Vol 97 (7) ◽  
pp. 2256-2271 ◽  
Author(s):  
Bernadette Biondi ◽  
Leonard Wartofsky
Keyword(s):  
Quality Of Life ◽  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Hormone Action ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Action ◽  
Thyroid Hormone Replacement Therapy ◽  
Hypothyroid Patients

Abstract Context: Levothyroxine therapy is the traditional lifelong replacement therapy for hypothyroid patients. Over the last several years, new evidence has led clinicians to evaluate the option of combined T3 and T4 treatment to improve the quality of life, cognition, and peripheral parameters of thyroid hormone action in hypothyroidism. The aim of this review is to assess the physiological basis and the results of current studies on this topic. Evidence Acquisition: We searched Medline for reports published with the following search terms: hypothyroidism, levothyroxine, triiodothyronine, thyroid, guidelines, treatment, deiodinases, clinical symptoms, quality of life, cognition, mood, depression, body weight, heart rate, cholesterol, bone markers, SHBG, and patient preference for combined therapy. The search was restricted to reports published in English since 1970, but some reports published before 1970 were also incorporated. We supplemented the search with records from personal files and references of relevant articles and textbooks. Parameters analyzed included the rationale for combination treatment, the type of patients to be selected, the optimal T4/T3 ratio, and the potential benefits of this therapy on symptoms of hypothyroidism, quality of life, mood, cognition, and peripheral parameters of thyroid hormone action. Evidence Synthesis: The outcome of our analysis suggests that it may be time to consider a personalized regimen of thyroid hormone replacement therapy in hypothyroid patients. Conclusions: Further prospective randomized controlled studies are needed to clarify this important issue. Innovative formulations of the thyroid hormones will be required to mimic a more perfect thyroid hormone replacement therapy than is currently available.

The Value of Stress-Management Interventions in Life-Threatening Medical Conditions

2003 ◽  
Vol 12 (4) ◽  
pp. 133-137 ◽  
Author(s):  
Robyn Lewis Claar ◽  
James A. Blumenthal
Keyword(s):  
Quality Of Life ◽  
Stress Management ◽  
Psychological Functioning ◽  
Randomized Clinical Trials ◽  
Medical Conditions ◽  
Management Interventions ◽  
Life Threatening ◽  
Management Techniques ◽  
The Impact

Emotional stress has been associated with the development and progression of several chronic medical conditions. Recently, researchers have assessed the impact of stress-management interventions on patients' psychological functioning, quality of life, and various disease outcomes, including survival. This review summarizes the value of stress-management techniques in the treatment of two important, life-threatening conditions: coronary heart disease and cancer. Results from randomized clinical trials indicate that psychological interventions can improve patients' psychological functioning and quality of life. However, there is limited evidence to suggest that these interventions significantly reduce morbidity and mortality.

scholarly journals Oxytocin and Naltrexone Successfully Treat Hypothalamic Obesity in a Boy Post-Craniopharyngioma Resection

2017 ◽  
Vol 103 (2) ◽  
pp. 370-375 ◽  
Author(s):  
Eugenie A Hsu ◽  
Jennifer L Miller ◽  
Francisco A Perez ◽  
Christian L Roth
Keyword(s):  
Parental Monitoring ◽  
Animal Studies ◽  
Phase 1 ◽  
Poor Quality ◽  
Free Access ◽  
Phase 2 ◽  
Z Score ◽  
Hypothalamic Obesity ◽  
Food Seeking

Abstract Context Hypothalamic obesity, a treatment-resistant condition common to survivors of craniopharyngioma (CP), is strongly associated with a poor quality of life in this population. Oxytocin (OT), a hypothalamic neuropeptide, has been shown to play a role in the regulation of energy balance and to have anorexigenic effects in animal studies. Naltrexone (NAL), an opiate antagonist, has been shown to deter hedonic eating and to potentiate OT’s effects. Design In this parent-observed study, we tested the administration of intranasal OT for 10 weeks (phase 1), followed by a combination of intranasal OT and NAL for 38 weeks (phase 2) in a 13-year-old male with confirmed hypothalamic obesity and hyperphagia post-CP resection. Treatment resulted in 1) reduction in body mass index (BMI) z score from 1.77 to 1.49 over 10 weeks during phase 1; 2) reduction in BMI z score from 1.49 to 0.82 over 38 weeks during phase 2; 3) reduced hyperphagia during phases 1 and 2; 4) continued hedonic high-carbohydrate food-seeking in the absence of hunger during phases 1 and 2; and 5) sustained weight reduction during decreased parental monitoring and free access to unlocked food in the home during the last 10 weeks of phase 2. Conclusion This successful intervention of CP-related hypothalamic obesity and hyperphagia by OT alone and in combination with NAL is promising for conducting future studies of this treatment-recalcitrant form of obesity.

scholarly journals An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

2013 ◽  
Vol 1 (15) ◽  
pp. 1-208 ◽  
Author(s):  
S Mason ◽  
C O’Keeffe ◽  
A Carter ◽  
R O’Hara ◽  
C Stride
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Longitudinal Study ◽  
Phase 1 ◽  
Well Being ◽  
Junior Doctors ◽  
Phase 2 ◽  
Adequate Quality ◽  
The Impact

BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review

2019 ◽  
Vol 30 (6) ◽  
pp. 527-535 ◽  
Author(s):  
Giampiero Rossi-Fedele ◽  
Bill Kahler ◽  
Nagendrababu Venkateshbabu
Keyword(s):  
Clinical Trials ◽  
Animal Studies ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Risk Of Bias ◽  
Permanent Teeth ◽  
Single Visit ◽  
Multiple Treatment ◽  
High Concentrations

Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE’s risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.

scholarly journals Assessing Quality of Life in Patients with Graves’ Disease Following Thyroidectomy

2019 ◽  
Vol 9 (1) ◽  
pp. 26-30
Author(s):  
S. N. Styazhkina ◽  
A. V. Ledneva ◽  
E. L. Poryvaeva
Keyword(s):  
Quality Of Life ◽  
Hormone Replacement Therapy ◽  
Surgical Treatment ◽  
Thyroid Gland ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Subtotal Resection ◽  
Graves Disease ◽  
The Impact

Introduction. Graves’ disease is a disorder associated with thyroid gland producing excessive amounts of hormones which causes changes in the functional status of various organs and systems. Among thyroid disorders it takes the second place (after endemic goitre) in prevalence. Until now, there is no consensus on a single strategy for the treatment of disorders of the thyroid gland. This is why this paper aims to assess the impact of surgical treatment of Graves’ disease on patients’ quality of life and whether it would be possible to improve it by following the surgery with hormone replacement therapy.Materials and methods. This paper presents a retrospective analysis of 70 case histories of patients who received surgical treatment for diffuse toxic goitre at the BIH UR “First Republican Teaching Hospital” MH UR,Izhevsk, in the period from 2008 to 2014. Percentages of the disease by stage were as follows: stage II — 20%, stage III — 70%, stage 4 — 10%. One lobe resection was performed in 3% of patients, two lobe resection — in 1%, hemithyroidectomy — in 18±4.6%, subtotal resection — in 8%, thyroidectomy — in 70±5.5%.Results. Percentages of patients with various degrees of severity of postoperative hypothyroidism were as follows: severe — 66%, medium — 29%, light — 5%; there were no Graves’ disease recurrences. Patients’ complaints following thyroidectomy included body weight gain — 79.1±4.8%, cold in extremities — 83.3±4.4%, cardiac arrhythmia — 85.2±4.2%, oedemas — 84.3±4.3%, drowsiness, atonia — 67.1±5.6%, changes in appetite — 21±4.8%, skin pallor — 47.6±5.9%, brittle nails, hair loss — 51.2±5.9%, joint pain — 31.2±5.53%.Conclusion. Hypothyroidism always follows thyroidectomy and requires ongoing hormone replacement therapy with L-thyroxine. Th quality of life does not have to suffer if an individual dosage is established and followed on a permanent basis.

scholarly journals Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress

2020 ◽  
Author(s):  
Cinzia Cecchetto ◽  
Marilena Aiello ◽  
Silvio Ionta ◽  
Claudio Gentili ◽  
Sofia Adelaide Osimo
Keyword(s):  
Binge Eating ◽  
Emotional Eating ◽  
Online Survey ◽  
Phase 1 ◽  
Eating Behaviour ◽  
Phase 2 ◽  
Emotional Wellbeing ◽  
Negative Effects ◽  
The Impact

Due to the spread of COVID 2019, the Italian government imposed a lockdown on the national territory. Initially, citizens were required to stay at home and not to mix with others outside of their household (Phase 1); eventually, some of these restrictions were lifted (Phase 2). To investigate the impact of lockdown on emotional and binge eating, an online survey was conducted to compare measures of self-reported physical (BMI), psychological (Alexithymia), affective (anxiety, stress, and depression) and social (income, workload) state during Phase 1 and Phase 2. Data from 365 Italian residents showed that increased emotional eating was predicted by higher depression, anxiety, quality of personal relationships, and quality of life, while the increase of bingeing was predicted by higher stress. Moreover, we showed that higher alexithymia scores were associated by increased emotional eating and higher BMI scores were associated with both increased emotional eating and binge eating. Finally, we found that from Phase 1 to Phase 2 binge and emotional eating decreased. These data provide evidence of the negative effects of isolation and lockdown on emotional wellbeing, and, relatedly, on eating behaviour.

Sign in / Sign up

Export Citation Format

Share Document