scholarly journals Interfering Medications in Older Adults on Thyroid Hormone Replacement: Who Is at Risk?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A831-A831
Author(s):  
Rachel Beeson ◽  
Antoinette B Coe ◽  
David Reyes-Gastelum ◽  
Megan R Haymart ◽  
Maria Papaleontiou
Keyword(s):  
Older Adults ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Hormone Replacement ◽  
Patient Characteristics ◽  
Population Based ◽  
Thyroid Function Tests ◽  
Thyroid Hormone Replacement ◽  
Function Tests ◽  
Concurrent Use

Abstract Background: Thyroid hormone prescriptions have steadily increased in the past few years with levothyroxine being one of the most frequently prescribed medications in the United States. Population-based studies have shown that older age is a significant predictor for thyroid hormone initiation, with use continuing long-term. Thyroid hormone management in older adults is complicated by the presence of comorbidities and polypharmacy, particularly due to medications that can interfere with thyroid function tests. However, the prevalence of concurrent use of thyroid hormone and interfering medications in older adults and patient characteristics associated with this practice remain unknown. Methods: We conducted a population-based, retrospective cohort study of 538,137 thyroid hormone users aged ≥65 years from the Corporate Data Warehouse of the Veterans Health Administration (2004-2017). First, we described the prevalence of concurrent use of thyroid hormone and medications that commonly interfere with thyroid function tests (i.e., prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, amiodarone, lithium, interferon-alpha, tamoxifen). Then, we performed a multivariable logistic regression analysis to determine patient characteristics associated with concurrent use of thyroid hormone and at least one interfering medication during the study period. Covariates included in the model were patient age, sex, race, ethnicity and number of comorbidities. Results: Overall, 170,261 (31.6%) of patients were on at least one interfering medication while on thyroid hormone during the study period (median follow up 56 months). Non-white race [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.15-1.21], compared to white race), Hispanic ethnicity (OR 1.11, 95% CI 1.08-1.14, compared to non-Hispanic), female sex (OR 1.12, 95% CI 1.08-1.15, compared to male sex), and presence of comorbidities (e.g. Charlson-Deyo Comorbidity Score ≥2, OR 2.47, 95% CI 2.43-2.52, compared to zero) were more likely to be associated with concurrent use of thyroid hormone and interfering medications. Older age (e.g., ≥85 years, OR 0.47, 95% CI 0.46 - 0.48, compared to age 65-74 years) was less likely to be associated with concurrent use of thyroid hormone and interfering medications. Conclusions: Almost one-third of older adults on thyroid hormone were taking medications that have been known to interfere with thyroid function tests. Our study highlights the complexity of managing thyroid hormone replacement in older patients, many of whom are at risk for adverse effects in the context of polypharmacy and comorbidities.

scholarly journals DIAGNOSTIC DILEMMA IN DISCORDANT THYROID FUNCTION TESTS DUE TO THYROID HORMONE AUTOANTIBODIES

2017 ◽  
Vol 3 (1) ◽  
pp. e22-e25 ◽  
Author(s):  
Panudda Srichomkwun ◽  
Neal H. Scherberg ◽  
Jasminka Jakšić ◽  
Samuel Refetoff
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Thyroid Function Tests ◽  
Diagnostic Dilemma ◽  
Thyroid Hormone Autoantibodies ◽  
Function Tests

The Association Between Blood Pressure and Normal Range Thyroid Function Tests in a Population Based Tehran Thyroid Study

2015 ◽  
Vol 48 (03) ◽  
pp. 151-156 ◽  
Author(s):  
A. Amouzegar ◽  
M. Heidari ◽  
S. Gharibzadeh ◽  
L. Mehran ◽  
M. Tohidi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Thyroid Function ◽  
Population Based ◽  
Thyroid Function Tests ◽  
Normal Range ◽  
Function Tests

Repeat thyroid function tests for healthy older people are not needed

BMJ ◽  
2019 ◽  
pp. l805
Author(s):  
Rob Cook ◽  
Duncan Fortescue-Webb ◽  
Rachel Taft
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Older People ◽  
Thyroid Function ◽  
Health Research ◽  
Thyroid Function Tests ◽  
Research School ◽  
Primary Care Research ◽  
Care Research ◽  
Function Tests

The study Roberts L, McCahon D, Johnson O, Haque MS, Parle J, Hobbs FR. Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study. Published on 28 August 2018 Br J Gen Pract 2018;68:e718-26. This study was funded by the National Institute for Health Research School for Primary Care Research (SPCR). To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000703/repeat-thyroid-function-tests-for-healthy-older-people-are-not-needed

scholarly journals MON-499 Nivolumab-Induced Hypothyroidism Is Irreversible in Most Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jee Hee Yoon ◽  
Ji Yong Park ◽  
A Ram Hong ◽  
Hee Kyung Kim ◽  
Ho-Cheol Kang
Keyword(s):  
Hormone Replacement Therapy ◽  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Cancer Patients ◽  
Thyroid Dysfunction ◽  
Clinical Course ◽  
Hormone Replacement ◽  
Thyroid Function Tests ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Replacement Therapy

Abstract Background Thyroid dysfunction caused by the immune checkpoint inhibitor (ICPI) is common, however mild dysthyroidism could occur easily in cancer patients due to other causes. The aim of this study was to investigate the incidence and clinical course of ICPI-induced hypothyroidism requiring thyroid hormone replacement. Patients and methods We analyzed baseline and follow up thyroid function tests of cancer patients treated with nivolumab between March 2016 and March 2019 at Chonnam University Hwasun Hospital retrospectively. Results Among 265 cancer patients treated with nivolumab therapy, six patients were excluded from the study because they were on thyroid hormone replacement therapy before starting nivolumab therapy. Twenty-one patients (8.1%) newly developed thyroid dysfunction during nivolumab therapy and sixteen patients (6.2%) required thyroid hormone replacement therapy due to drug-induced hypothyroidism. Cancer diagnoses included lung cancer (n=7), renal cell carcinoma (n=4), malignant melanoma (n=2), hepatocellular carcinoma (n=2), and esophageal cancer (n=1). Six patients (37.5%) showed thyrotoxic phase prior to overt hypothyroidism and the others (n=10, 62.5%) revealed hypothyroidism without thyrotoxic phase. Most ICPI-induced hypothyroidism was irreversible, only one patient was able to discontinue thyroid hormone replacement after quitting nivolumab therapy. Conclusion A significant number of patients treated with nivolumab developed ICPI-induced hypothyroidism requiring thyroid hormone replacement and its clinical course was irreversible in most patients.

scholarly journals SAT-LB85 Use of Weekly Levothyroxine Regimen for Rapid Normalization of Thyroid Hormone Levels: A Case Report

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jose Renato Martinez Escudero ◽  
Johnathan Kirupakaran ◽  
Alice Yau ◽  
Giovanna Rodriguez ◽  
Gul Bahtiyar
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Time Course ◽  
Sinus Bradycardia ◽  
Hormone Replacement ◽  
Tertiary Care ◽  
Thyroid Function Test ◽  
Tertiary Care Centre ◽  
Endocrine Society ◽  
Thyroid Hormone Replacement

Abstract Background: Hypothyroidism affects around 4.6% of the U.S. population1. Non-adherence with thyroid hormone replacement is one of the biggest challenges in treating hypothyroidism1. The half-life of T4 and T3 in hypothyroidism is about 7.5 and 1.4 days respectively2. A large dose once-weekly administration of levothyroxine (Lt4) is possible3, 4. Recent publications suggest that once-weekly Lt4 does not increase the risk of cardiovascular events and is well tolerated by most of patients4. Once weekly Lt4 produces similar results as daily Lt4 as evidenced by thyroid function tests3,4, and potentially improves patient compliance and satisfaction with the treatment4. Clinical Course: A 29-year-old female with a history of Hashimoto’s hypothyroidism, polycystic ovarian syndrome, depression, presented with irregular menses. Her symptoms included depression, fatigue, increased appetite. Her TSH was grossly elevated at 217 uIU/mL (0.27-4.20 uIU/mL). However upon re-visit, after increasing Lt4 to 100 mcg daily her TSH increased to 280 uIU/mL. She admitted to non-adherence with her daily Lt4 prescription. Physical exam was notable for sinus bradycardia and slow mentation, otherwise unremarkable. Blood count, basic metabolic panel and hemoglobin A1C were within normal limits. Liver function tests showed mild transaminitis, ALT 46 U/L (10-45 U/L). Lt4 was started at 875 mcg per week. At five weeks, her TSH was 6.31 uIU/mL and at seven weeks, the patient was euthyroid with a TSH of 2.53 uIU/mL. Her periods have since normalized. Conclusion: The current discourse on weekly dosing mainly focuses on its use for non-adherent patients. This case provides a clear time course also demonstrating rapid normalization of TSH using weekly dosing. Weekly Lt4 dosing as first-line therapy in noncompliant depressed patients with severe hypothyroidism should be considered. 1.Hepp, Z., Wyne, K., Manthena, S., Wang, S. and Gossain, V. (2018). Adherence to thyroid hormone replacement therapy: a retrospective, claims database analysis. Current Medical Research and Opinion, 34(9), pp.1673-1678.2.Colucci, P., Yue, C., Ducharme, M. and Benvenga, S. (2010). A Review of the Pharmacokinetics of Levothyroxine for the Treatment of Hypothyroidism. European Endocrinology, 9(1), p.40.3.Jayakumari, C., Nair, A., Puthiyaveettil Khadar, J., Das, D., Prasad, N., Jessy, S., Gopi, A. and Guruprasad, P. (2019). Efficacy and Safety of Once-Weekly Thyroxine for Thyroxine-Resistant Hypothyroidism. Journal of the Endocrine Society, 3(12), pp.2184-2193.4.Rajput, R. and Pathak, V. (2017). The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana. European Thyroid Journal, 6(5), pp.250-254.

Thyroid function tests (TFTs) abnormalities in patients (pts) with metastatic renal cell carcinoma (mRCC) treated with sunitinib

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4605-4605 ◽  
Author(s):  
P. E. Shaheen ◽  
I. R. Tamaskar ◽  
R. N. Salas ◽  
B. I. Rini ◽  
J. Garcia ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Growth Factor ◽  
Thyroid Hormone ◽  
Kinase Inhibitor ◽  
Hormone Replacement ◽  
Signs And Symptoms ◽  
Thyroid Function Tests ◽  
Thyroid Hormone Replacement ◽  
Treatment Tolerance ◽  
Endothelial Growth Factor

4605 Background: Sunitinib is a multi-targeted receptor tyrosine kinase inhibitor of vascular endothelial growth factor and platelet-derived growth factor receptors. It has anti-tumor activity in mRCC pts with toxicity including fatigue. We investigated TFTs abnormalities and related signs and symptoms in pts with mRCC receiving sunitinib. Methods: The medical records of pts with mRCC enrolled in 4 ongoing clinical trials of sunitinib were reviewed. TFTs assessment (TSH, T3 and T4) was undertaken based on the clinical suspicion of treating physicians. Patient demographics, frequency and values of TFTs and any signs and symptoms of thyroid dysfunction were collected. Abnormal TFTs and treatment outcome were correlated. Results: Between 5/2004 and 12/2005, 62 pts (43 males, 19 females) were treated with sunitinib. The median age was 58 years (range, 23–72). Fifty-five pts had TFTs assessed while on treatment and 40 pts (65% of total) had one or more abnormality. Two pts had well-controlled hypothyroidism prior to initiation of sunitinib. TFTs abnormalities were consistent with hypothyroidism in all pts including one who initially developed transient hyperthyroidism. Signs and symptoms possibly related to hypothyroidism were found in 33 pts (53% of total) with abnormal TFTs and were initially attributed to sunitinib. Signs and symptoms included fatigue in 33 pts, anorexia in 20 pts, fluid retention in 17 pts, and skin/hair changes in 13 pts. Thyroid hormone replacement was undertaken in 12 pts and resulted in improvement of symptoms in 6 pts. Among the 40 pts with abnormal TFTs 29 pts had tumor evaluation; 13 had SD, 8 had PR, 2 had CR. There was no correlation between abnormal TFTs and treatment outcome. Conclusions: TFTs abnormalities are common in pts with mRCC treated with sunitinib. Thyroid hormone replacement is indicated in such pts to improve hypothyroidism-related symptoms and possibly to improve treatment tolerance. [Table: see text]

scholarly journals Genetic variation in thyroid hormone pathway genes; polymorphisms in the TSH receptor and the iodothyronine deiodinases

2006 ◽  
Vol 155 (5) ◽  
pp. 655-662 ◽  
Author(s):  
Robin P Peeters ◽  
Wendy M van der Deure ◽  
Theo J Visser
Keyword(s):  
Genetic Variation ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Individual Variability ◽  
Tsh Receptor ◽  
Thyroid Function Tests ◽  
Mineral Density ◽  
Clinical Endpoints ◽  
Iodothyronine Deiodinases ◽  
Function Tests

Serum thyroid parameters show substantial inter-individual variability, in which genetic variation is a major factor. Findings in patients with subclinical hyper- and hypothyroidism illustrate that even minor alterations in serum thyroid function tests can have important consequences for a variety of thyroid hormone-related clinical endpoints, such as atherosclerosis, bone mineral density, obesity, and heart rate. In the last few years, several studies described polymorphisms in thyroid hormone pathway genes that alter serum thyroid function tests. In this review, we discuss the genetic variation in the TSH receptor and iodothyronine deiodinases. We discuss the possible consequences of these studies for the individual patient and also the new insights in thyroid hormone action that can be obtained from these data.

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