scholarly journals Hyperthyroidism in adolescents

2021 ◽  
Author(s):  
Marek Niedziela
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Clinical Presentation ◽  
Diagnostic Testing ◽  
Nodular Goiter ◽  
Treatment Modalities ◽  
Clinical State ◽  
Toxic Nodular Goiter ◽  
Biochemical Evaluation ◽  
Potential Risks

The term 'hyperthyroidism' refers to a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause of hyperthyroidism in adolescents is Graves’ disease (GD); however, one should also consider other potential causes, such as toxic nodular goiter (single or multinodular) and other rare disorders leading to excessive production and release of thyroid hormones. The term 'thyrotoxicosis' refers to a clinical state resulting from inappropriately high thyroid hormone action in tissues, generally due to inappropriately high tissue thyroid hormone levels. Thyrotoxicosis is a condition with multiple aetiologies, manifestations, and potential modes of therapy. By definition, the extrathyroidal sources of excessive amounts of thyroid hormones, such as iatrogenic thyrotoxicosis, factitious ingestion of thyroid hormone, or struma ovarii, do not include hyperthyroidism. The aetiology of hyperthyroidism/and thyrotoxicosis should be determined. Although the diagnosis is apparent based on the clinical presentation and initial biochemical evaluation, additional diagnostic testing is indicated. This testing should include (1) measurement of TSHR antibodies (TRAb); (2) analysis of thyroidal echogenicity and blood flow on ultrasonography; or (3) determination of radioactive iodine uptake (RAIU). A 123I or 99mTc pertechnetate scan is recommended when the clinical presentation suggests toxic nodular goiter. Different treatment modalities might be preferred to achieve euthyroidism and to avoid potential risks from the treatment. The vast majority of patients with thyroid disorders require life-long treatment; therefore, the collaboration of different specialists is warranted to achieve these goals and improve patients’ quality of life.

scholarly journals Challenges in interpretation of thyroid hormone test results

2016 ◽  
Vol 144 (3-4) ◽  
pp. 200-203
Author(s):  
Tijana Lalic ◽  
Biljana Beleslin ◽  
Slavica Savic ◽  
Mirjana Stojkovic ◽  
Jasmina Ciric ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Thyroid Function ◽  
Genetic Disorder ◽  
Clinical Status ◽  
Nodular Goiter ◽  
Thyroid Function Tests ◽  
Thyroid Status ◽  
First Case ◽  
Secondary Hypothyroidism

Introduction. In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. Outline of Cases. We present two patients with discrepancy between the results of thyroid function tests and clinical status. The first case presents a 62-year-old patient with a nodular goiter and Hashimoto thyroiditis. Thyroid function test showed low thyroid-stimulating hormone (TSH) and normal to low fT4. By determining thyroid status (?SH, T4, fT4, T3, fT3) in two laboratories, basal and after dilution, as well as thyroxine-binding globulin (TBG), it was concluded that the thyroid hormone levels were normal. The results were influenced by heterophile antibodies leading to a false lower TSH level and suspected secondary hypothyroidism. The second case, a 40-year-old patient, was examined and followed because of the variable size thyroid nodule and initially borderline elevated TSH, after which thyroid status showed low level of total thyroid hormones and normal TSH. Based on additional analysis it was concluded that low T4 and T3 were a result of low TBG. It is a hereditary genetic disorder with no clinical significance. Conclusion. Erroneous diagnosis of thyroid disorders and potentially harmful treatment could be avoided by proving the interference or TBG deficiency whenever there is a discrepancy between the thyroid function results and the clinical picture.

scholarly journals Graves’ Disease

2021 ◽  
Author(s):  
Paula Aragão Prazeres de Oliveira ◽  
Beatriz Nayara Muniz de Oliveira ◽  
Eduarda da Silva Souza Paulino ◽  
Fernanda Carolinne Marinho de Araujo ◽  
Paula Gabriele Tabosa Lyra
Keyword(s):  
Thyroid Gland ◽  
Thyroid Hormones ◽  
Radioactive Iodine ◽  
Clinical Manifestations ◽  
Nodular Goiter ◽  
Graves Disease ◽  
Decompression Surgery ◽  
Excessive Sweating ◽  
Toxic Nodular Goiter ◽  
Diffuse Goiter

DG presents with three main presentations: hyperthyroidism with diffuse goiter, infiltrative ophthalmopathy and pre-tibial myxedema. Patients with Graves’ disease can rarely develop severe hyperthyroidism. The hyperthyroidism of Graves’ disease is characterized immunologically by the lymphocytic infiltration of the thyroid gland and by the activation of the immune system with elevation of the circulating T lymphocytes. In GD, goiter is characteristically diffuse. May have asymmetric or lobular character, with variable volume. The clinical manifestations of hyperthyroidism are due to the stimulatory effect of thyroid hormones on metabolism and tissues. Nervousness, eye complaints, insomnia, weight loss, tachycardia, palpitations, heat intolerance, damp and hot skin with excessive sweating, tremors, hyperdefecation and muscle weakness are the main characteristics. In the laboratory diagnosis, biochemical and hormonal exams will be done to assess thyroid hormones and the antithyroid antibodies. Additionally, imaging tests may be performed, such as radioactive iodine capture in 24 hours, ultrasonography, thyroid scintigraphy and fine needle aspiration. It is necessary to make the differential diagnosis of Graves’ disease for thyrotoxicosis, subacute lymphocytic thyroiditis and toxic nodular goiter. The treatment of DG aims to stop the production of thyroid hormones and inhibit the effect of thyroid hormones on the body. Hyperthyroidism caused by DG can be treated in the following ways: it may be the use of synthetic antithyroid medicines, thionamides, MMI being a long-term medicine, it allows a single daily dose, and adherence to treatment occurs, a disadvantage is that it cannot be used in pregnant women; beta-blockers, preferably used in the initial phase of DG with thionamides; radioactive iodine therapy (RAI), being the best cost–benefit and preventing DG recurrence; finally the total thyroidectomy, causing the withdrawal of the thyroid gland. Therefore, it should be discussed with the patient what is the best treatment for your case, with a view to the post and against each approach. If the patient develops Graves ophthalmopathy, in lighter cases the artificial tears should be used, and in more severe cases can be used as treatment, corticosteroids, orbital decompression surgery, prisms and orbital radiotherapy. In addition, the patient should keep their body healthy, doing exercise and healthy eating, following the guidance of their doctor.

scholarly journals Effective Preoperative Plasmapheresis Treatment of Severe Hyperthyroidism in a Patient with Giant Toxic Nodular Goiter and Methimazole-Induced Agranulocytosis

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 290 ◽  
Author(s):  
Katarzyna Barwinek ◽  
Danuta Gąsior-Perczak ◽  
Sławomir Trepka ◽  
Artur Szczodry ◽  
Janusz Kopczyński ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Therapeutic Option ◽  
Nodular Goiter ◽  
Lithium Carbonate ◽  
Colony Growth ◽  
Preoperative Treatment ◽  
Free Thyroid Hormones ◽  
Toxic Nodular Goiter ◽  
Life Saving ◽  
Alternative Treatment Option

Agranulocytosis is a rare but very serious complication of thyrostatic therapy. In severe hyperthyroidism, the removal of circulating thyroid hormones by plasmapheresis may be an effective therapeutic option. This report describes the therapeutic difficulties and successful preoperative treatment with plasmapheresis in a 63-year-old patient admitted to the Endocrinology Clinic with severe hyperthyroidism, during the course of giant toxic nodular goiter and agranulocytosis, which occurred after 2 weeks of taking methimazole. During hospitalization, methimazole treatment was discontinued and therapy with steroids, a beta blocker, propylthiouracil, Lugol’s solution, lithium carbonate, and antibiotics were initiated. Granulocyte colony growth stimulating factor was also used to resolve agranulocytosis. Due to the failure to achieve euthyreosis using this approach, we decided to conduct thyroid surgery, as a life-saving action, after preparation of the patient by plasmapheresis. Two plasmapheresis procedures were performed, resulting in a decrease in the concentration of free thyroid hormones. Total thyroidectomy was performed and there were no complications during surgery. We conclude that plasmapheresis may be considered as an effective alternative treatment option for the preparation of patients with hyperthyroidism for surgery, when the clinical situations prevent the use of conventional treatments for hyperthyroidism and when immediate life-saving surgery is necessary.

scholarly journals Serum Cytokines in Thyrotoxicosis1

1999 ◽  
Vol 84 (2) ◽  
pp. 435-439
Author(s):  
A. Siddiqi ◽  
J. P. Monson ◽  
D. F. Wood ◽  
G. M. Besser ◽  
J. M. Burrin
Keyword(s):  
Thyroid Hormone ◽  
Tumor Necrosis Factor ◽  
Thyroid Carcinoma ◽  
Thyroid Hormones ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Nodular Goiter ◽  
Free T4 ◽  
Factor Α ◽  
Necrosis Factor

Overproduction of thyroid hormones promotes bone resorption in vivo and in vitro, and we have evaluated whether mediators of such effects could include the osteotropic cytokines. Previous studies have demonstrated raised serum interleukin (IL)-6 in thyrotoxic patients, but differentiating the contribution of the elevated thyroid hormones from that of the autoimmune inflammation present in Graves’ disease (GD) has been difficult. We undertook a longitudinal study of 34 patients (19–45 yr old) with GD, toxic nodular goiter (TNG), or a history of thyroid carcinoma but no evidence of disease recurrence, receiving sufficient T4 to suppress TSH. Controls were 12 euthyroid females. The following measurements were made basally and for 6 months after carbimazole treatment: serum free T4, T3, bone-specific alkaline phosphatase (b-ALP), IL-6, IL-8, IL-1β, tumor necrosis factor-α, IL-11, and urinary deoxypyridinoline (Udpd). Compared with controls (IL-6, 1.1 ± 0.3 ng/L; IL-8, 3.2 ± 0.8 ng/L), untreated patients with GD and TNG had elevated IL-6 (GD, 7.11 ± 0.88 ng/L; TNG, 7.30 ± 0.77 ng/L; P < 0.001) and IL-8 (GD, 10.3 ± 1.23 ng/L; TNG, 9.81 ± 1.27 ng/L; P < 0.001). These levels fell after treatment and were then indistinguishable from those in control subjects. Thyroid carcinoma patients on TSH suppressive therapy also had significantly raised levels of IL-6 (2.5 ± 0.42 ng/L) and IL-8 (4.4 ± 0.63 ng/L). When data from all the patients were pooled, the levels of IL-6 and IL-8 correlated with serum T3 and free T4 but not with Udpd or b-ALP. IL-1β, IL-11, and tumor necrosis factor-α were not raised in any patient. The elevations in serum IL-6 and -8 that occur in hyperthyroidism seem to result from the chronic effects of thyroid hormone excess rather than the accompanying autoimmune inflammatory condition produced by Graves’ thyroid or eye disease. The site of the presumed increased production of IL-6 and -8 is most likely from bone osteoblasts, despite the inability of bone markers (such as Udpd and b-ALP) to correlate with acute changes in thyroid hormone status produced by antithyroid therapy.

Establishment of Early Pregnancy Related Thyroid Hormone Models and Reference Intervals for Pregnant Women in China Based on Real World Data

2021 ◽  
Vol 53 (04) ◽  
pp. 272-279
Author(s):  
Chaochao Ma ◽  
Xiaoqi Li ◽  
Lixin Liu ◽  
Xinqi Cheng ◽  
Fang Xue ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Dynamic Change ◽  
Reference Intervals ◽  
Thyroid Stimulating Hormone ◽  
Free Thyroxine ◽  
Stimulating Hormone

AbstractThyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052–3.393 μIU/ml, 1.01–1.54 ng/dl, and 2.51–3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.

scholarly journals Blood Micronutrient and Thyroid Hormone Concentrations in the Oldest-Old

2000 ◽  
Vol 85 (6) ◽  
pp. 2260-2265 ◽  
Author(s):  
Giovanni Ravaglia ◽  
Paola Forti ◽  
Fabiola Maioli ◽  
Barbara Nesi ◽  
Loredana Pratelli ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Oldest Old ◽  
Serum Zinc ◽  
Blood Levels ◽  
Elderly Age ◽  
Blood Concentrations ◽  
Significant Difference ◽  
Plasma Retinol ◽  
Age Range

Several micronutrients are involved in thyroid hormone metabolism, but it is unclear whether their marginal deficits may contribute to the alterations in thyroid function observed in extreme aging. The relationships among blood concentrations of thyroid hormones and selenium, zinc, retinol, and α-tocopherol were studied in 44 healthy Northern Italian oldest-old subjects (age range, 90–107 yr), selected by the criteria of the SENIEUR protocol. Control groups included 44 healthy adult (age range, 20–65 yr) and 44 SENIEUR elderly (age range, 65–89 yr) subjects. Oldest-old subjects had higher TSH (P &lt; 0.01) and lower free T3 (FT3)/freeT4 (FT4) ratio, zinc, and selenium serum values (P &lt; 0.001) than adult and elderly control subjects. No significant difference was found for plasma retinol and α-tocopherol values. The associations between micronutrients and thyroid hormones were evaluated by multivariate analysis. In oldest-old subjects, plasma retinol was negatively associated with FT4 (P = 0.019) and TSH serum levels (P = 0.040), whereas serum zinc was positively associated with serum FT3 (P = 0.010) and FT3/FT4 ratio (P = 0.011). In younger subjects, no significant association was found among thyroid variables and micronutrients. In conclusion, blood levels of specific micronutrients are associated with serum iodothyronine levels in extreme aging.

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