scholarly journals Over-the-counter protein supplement resulting in impaired thyroxine absorption in a hypothyroid patient

2021 ◽  
Vol 2021 (21-0070) ◽  
Author(s):  
P A D M Kumarathunga ◽  
N S Kalupahana ◽  
C N Antonypillai
Keyword(s):  
Gastric Emptying ◽  
Whey Protein ◽  
Thyroid Stimulating Hormone ◽  
Protein Supplement ◽  
Hypothyroid Patient ◽  
Soy Lecithin ◽  
Over The Counter ◽  
Protein Supplements ◽  
Recent Introduction ◽  
Tsh Levels

Summary Whey protein is a popular dietary supplement that is claimed to provide multiple health benefits. It has been shown to delay gastric emptying and impair ileal nutrient absorption. Additionally, some of the other additives like papain enzyme, soy lecithin in these protein supplements could interfere with L-thyroxine absorption. There is no evidence in the literature for the effects of protein supplements on L-thyroxine absorption. Herein, we describe a case of a 34-year-old lady who was on endocrinology follow up for primary hypothyroidism with stable thyroid-stimulating hormone (TSH) levels within the normal range while on L-thyroxine with a dose of 125 µg daily for the last 3 years, presenting with mild hypothyroid symptoms and elevated TSH level following a recent introduction of a protein supplement by her physical care adviser. Her treatment adherence and ingestion technique were good throughout, she was not on other medications or herbal remedies, there were no other changes in her food pattern or features suggestive of malabsorption, she was not pregnant, was taking the same L-thyroxine brand and TSH test was done from the routine lab. Since the only factor which could have contributed to the deranged TSH levels was the recent introduction of the whey protein supplement, we advised her to stop the protein supplement while continuing the same dose of L-thyroxine. Her TSH level was repeated in 6 weeks and was found to be normal (1.7 mIU/L). Our case report demonstrates that over-the-counter protein supplements could interfere with L-thyroxine absorption. Therefore, patients on L-thyroxine should be cautious when taking them. Learning points Over-the-counter protein supplements could interfere with oral L-thyroxine absorption. The underlying mechanism could be the effect of whey protein by delaying gastric emptying and reduced responsiveness of organic anion transporters in the ileum, and there may be a contribution from other additives like papain and soy lecithin present in these supplements. When there is an elevation of previously stable thyroid-stimulating hormone (TSH) value in a hypothyroid patient on oral L-thyroxine, the patient's assessment should include inquiring for a recent introduction of protein supplement, in the absence of other well-known risk factors. Discontinuation of protein supplement results in normalization of thyroid function tests. Patients on oral L-thyroxine should be cautious when taking over-the-counter protein supplementation.

Biotin-induced thyroid stimulating hormone aberrations in the setting of immunotherapy

2021 ◽  
pp. 107815522110179
Author(s):  
Forrest N Ridgway ◽  
Kathryn A Gold ◽  
Linda C Barnachea
Keyword(s):  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Immune Checkpoint Blockade ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Over The Counter ◽  
Routine Monitoring ◽  
Tsh Levels ◽  
Stimulating Hormone

Introduction Immune checkpoint inhibitors are associated with immune-mediated thyroid disease and other endocrinopathies. Biotin is an over-the-counter supplement known to interfere with lab assays, including thyroid function tests. Biotin-induced complications with lab monitoring during immunotherapy have not been previously reported. Case report We present a case of a 68-year old woman with hypothyroidism after initiating immune checkpoint blockade therapy and abnormal laboratory monitoring values while concurrently taking biotin supplements. Management & outcome: The patient was initiated on levothyroxine with subsequent dose increases over a period of weeks with resolution of symptoms and normalization of free thyroxine levels. Thyroid stimulating hormone (TSH) levels appeared to remain elevated until biotin supplements were held and levels normalized. Discussion The purpose of this report is to provide the first known incidence of biotin complicating the routine monitoring of immune checkpoint inhibitors with elevated TSH levels and to alert providers to elicit accurate medication histories regarding over-the-counter supplements.

Association of maternal serum trace elements with newborn screening-thyroid stimulating hormone

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Yasemin Ucal ◽  
Muhittin Serdar ◽  
Cansu Akın-Levi ◽  
Zeynep Zulfiye Yıldırım-Keles ◽  
Cem Turam ◽  
...  
Keyword(s):  
Trace Elements ◽  
Newborn Screening ◽  
Thyroid Stimulating Hormone ◽  
Maternal Serum ◽  
Blood Samples ◽  
Free T3 ◽  
Flame Atomic Absorption ◽  
Serum Trace Elements ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractObjectivesTrace elements are essential in thyroid functioning as they incorporate into biologically important enzymes as cofactors. The placenta can either activate or inhibit the transfer of maternal trace elements to the unborn. An imbalance of maternal trace elements in pregnancy may affect both maternal and newborn thyroid function.MethodsBlood samples from 315 lactating mothers were collected in the first 48 h after delivery and evaluated for selenium (Se), copper (Cu), manganese (Mn), and zinc (Zn) using flame atomic absorption spectroscopy (FAAS) and quadrupole inductively coupled plasma-mass spectrometer (ICP-MS). Thyroid hormones and auto-antibodies (thyroid-stimulating hormone (TSH), free T3 (fT3), free T3 (fT4), anti–thyroid peroxidase (anti-TPO), and antithyroglobulin (anti-TG)) were analyzed in maternal blood using an electro-chemiluminescence immunoassay (ECLIA). Between 48 and 72 postpartum hours, spot blood samples were used for newborn screening-TSH measurement. Correlation and multivariate analyses were performed to evaluate the effect of maternal trace element levels on newborn screening-TSH levels.ResultsThe medians (min-max) of maternal Se (45.16 µg/L (21.28–79.04)), Cu (210.10 µg/dL (117.04–390.64)), Mn (2.11 µg/L (0.20–3.46)), and Zn (0.43 mg/L (0.24–0.66)) were determined. A positive correlation was detected between Zn and maternal TSH levels (r=0.12, p < 0.05). Newborn screening-TSH was significantly correlated with maternal Cu (r=0.14, p < 0.01). Similarly, Cu exhibited weak associations in clustering analysis while others shared common clusters with newborn-screening TSH.ConclusionsThere was no significant association between most of the maternal serum trace elements and maternal thyroid hormone parameters, with an only exception between maternal Zn and maternal serum TSH. Finally, the association between maternal serum Cu levels and newborn screening-TSH levels may highlight the importance of maternal Cu levels on the newborn thyroid health.

scholarly journals A REVIEW: MECHANISTIC INSIGHTS INTO THE EFFECT OF THYROID DISORDERS ON ESTROGEN LEVEL AND BONE MINERAL DENSITY

2019 ◽  
pp. 9-17
Author(s):  
MINAKSHI JOSHI ◽  
SHRADHA BISHT ◽  
MAMTA F. SINGH
Keyword(s):  
Bone Mineral Density ◽  
Thyroid Hormone ◽  
Bone Turnover ◽  
Bone Mineral ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Disorders ◽  
Hypothyroid Patient ◽  
Mineral Density ◽  
Estrogen Level ◽  
The Impact

Thyroid hormone serves as an indispensable component for the optimum functioning of various biological systems. They curb body’s metabolism, regulates the estrogen level, regulates bone turnover, essential for skeletal development and mineralization. Within the scope of knowledge, it is intimately familiar that thyroid disorders have widespread systemic manifestations, among which in hypothyroidism, even though elevated TSH (thyroid-stimulating hormone) may reduce estrogen level which in turn stimulates osteoclasts and thus cause osteoporosis, while hyperthyroidism accelerates bone turnover. Hypothyroidism does not directly interfere with the skeletal integrity, but treatment with levothyroxine for the suppression of TSH to bring the hypothyroid patient to euthyroid state for a long haul; lead to simultaneous reduction in bone mass and in (bone mineral density) BMD. After the initial relevation of the correlation between thyroid disorders and osteoporosis in numerous studies have emphasized that both hypo and hyperthyroidism either directly or indirectly affects the bone mineral density or leads to the progression of osteoporosis. Therefore the present study is aimed and so designed to review all the possible associations between them and the impact of thyroid disorders on estrogen level and bone mineral density. The main findings of this review indicate that both excesses as well as deficiency of thyroid hormone can be potentially deleterious for bone tissue.

Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽  
2021 ◽  
Author(s):  
Luiz Carlos Esteves Grelle ◽  
Luiz Antonio Bastos Camacho
Keyword(s):  
Subclinical Hypothyroidism ◽  
Clinical Importance ◽  
Clinical Problem ◽  
Thyroid Stimulating Hormone ◽  
Exclusion Criteria ◽  
The Mean ◽  
Common Clinical Problem ◽  
Prompt Diagnosis ◽  
Serum Tsh ◽  
Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

Risk of over- and undertreatment with levothyroxine in primary care in Copenhagen, Denmark

2021 ◽  
Author(s):  
Jeppe Lerche la Cour ◽  
Bjarke Røssner Medici ◽  
Mia Klinten Grand ◽  
Dagny Ros Nicolaisdottir ◽  
Bent Lind ◽  
...  
Keyword(s):  
Primary Care ◽  
Proportional Hazards ◽  
Cumulative Risk ◽  
Thyroid Stimulating Hormone ◽  
Primary Objective ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Time Period ◽  
Primary Care Patients ◽  
Tsh Levels

Objective: A decrease over time in thyroid stimulating hormone (TSH) levels when initiating levothyroxine (L-T4) therapy for hypothyroidism has been reported, where treatment most often is initiated with TSH levels below 10 mIU/L. The primary objective of this study was to investigate whether this lower TSH threshold resulted in an increased number of overtreated patients. Design and Method: Retrospective cohort study comprising inhabitants in Copenhagen who had TSH measurements requested by general practitioners which led to a new prescription of L-T4 between 2001 and 2012. Over- and undertreatment were defined as TSH < 0.1 mIU/L or above 10 mIU/mL, respectively, in three consecutive measurements. Data were analysed by Aalen-Johansen estimators and Cox proportional hazards models. Results: In total, 14,533 initiations of L-T4 in the study. The cumulative risk of being over- or undertreated, was 4.7% and 7.4% after 10 years. The hazard of overtreatment was higher among women, younger adults and with lower initial TSH levels. The hazard of overtreatment decreased over the time period from 2001 to 2012. Among overtreated individuals, the chance of returning to a normal TSH was about 55% after 10 years. In 18% of the cases, L-T4 therapy was initiated on TSH levels less than 5 mIU/L. Conclusion: Although a still decreasing threshold for initiating L-T4 therapy is known, the risk of overtreatment (and undertreatment) was low and lessened in the period 2001 – 2012 among Danish primary care patients. Nevertheless, as many as 18% were started on L-T4 with normal TSH levels.

scholarly journals Obese patients with higher TSH levels had an obvious metabolic improvement after bariatric surgery

2021 ◽  
Vol 10 (10) ◽  
pp. 1326-1336
Author(s):  
Nannan Bian ◽  
Xiaomeng Sun ◽  
Biao Zhou ◽  
Lin Zhang ◽  
Qiu Wang ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Bariatric Surgery ◽  
Thyroid Function ◽  
Fasting Blood Glucose ◽  
Thyroid Stimulating Hormone ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Free Triiodothyronine ◽  
The Relationship ◽  
Tsh Levels

Objective Bariatric surgery has become the most effective treatment for morbid obesity. Increasing evidence showed that bariatric surgery can alleviate insulin resistance and influence thyroid function. This study aimed to investigate the relationship between changes in thyroid function and adipose tissue insulin resistance (adipo-IR) after bariatric surgery. Methods A total of 287 non-diabetic participants with regular thyroid function were recruited and divided into the lean, overweight and obese groups. Among them, 50 morbidly obese patients submitted to bariatric surgery. Results The obese group had a higher level of adipo-IR, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), FT3/free thyroxine (FT4) and metabolism disorders than the lean and overweight groups. BMI was correlated with TSH, FT3, FT3/FT4 and adipo-IR (r = 0.309, 0.315, 0.322 and 0.651, respectively, all P < 0.001). Adipo-IR was significantly correlated with TSH (r = 0.402, P < 0.001), FT3 (r = 0.309, P < 0.001), and FT3/FT4 (r = 0.228, P < 0.05). Bariatric surgery resulted in a sharp decline in BMI, adipo-IR, TSH, FT3 and FT3/FT4 levels, meanwhile, metabolic disorders improved. The decrease in BMI after bariatric surgery was significantly correlated with reductions in adipo-IR (r = 0.577, P < 0.001) and TSH (r = 0.401, P = 0.005). Interestingly, the fasting blood glucose, fasting insulin, adipo-IR and TSH in the higher TSH group decreased more remarkably than in the lower TSH group. Conclusion Obese individuals with higher TSH levels had an obvious metabolic improvement after bariatric surgery.

scholarly journals Comparison of Whey Versus Almond Protein Powder on Nitrogen Balance in Female College Students; The California Almond Protein Powder Project (CAlmond-P3)

2021 ◽  
Vol 18 (22) ◽  
pp. 11939
Author(s):  
Adeline Maykish ◽  
Morgan M. Nishisaka ◽  
Courtney K. Talbott ◽  
Scott K. Reaves ◽  
Aleksandra S. Kristo ◽  
...  
Keyword(s):  
College Students ◽  
Body Composition ◽  
Whey Protein ◽  
Nitrogen Balance ◽  
Day Treatment ◽  
Female College Students ◽  
Future Research ◽  
Hydration Status ◽  
Protein Supplement ◽  
Female College

Plant-based diets have become increasingly popular in the past decade, with approximately 11% of Americans self-identifying as vegan or vegetarian and many others trying to reduce meat consumption. Due to increasing interest, the plant-based food market has significantly expanded, with several innovative products serving as alternatives to animal-based products. One such example is almond protein powder, a new protein supplement created as an alternative to whey protein. Due to the novelty of almond protein products, little is known regarding how well the protein supplement supports nitrogen metabolism. The effects of both an almond-based protein beverage and a whey-based protein beverage on nitrogen balance are investigated in the work presented herein. Twenty female college students aged 20–25 years were randomly assigned to consume either an almond- or whey-based protein drink twice daily for one week; 24-h urine collection was performed at the baseline and endpoint of the 7-day treatment period and nitrogen balance was assessed. Body composition and hydration status were also assessed. Both protein sources (almond and whey) were able to notably improve nitrogen balance, thus indicating that almond protein powder may be a functional plant-based alternative to whey protein powder and may be of interest in future research regarding muscle mass and body composition improvement.

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