scholarly journals Comparative study on efficacy and safety of morning dose versus evening dose of levothyroxine in treatment of hypothyroidism: an outpatient department based prospective interventional study

2020 ◽  
Vol 9 (10) ◽  
pp. 1554
Author(s):  
Umakanta Mahapatra ◽  
Ram N. Maiti ◽  
Bulbul Purkait ◽  
Dipan Saha ◽  
Sekhar Mandal
Keyword(s):  
Good Alternative ◽  
Early Morning ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Target Range ◽  
Endocrine Disorders ◽  
Evening Dose ◽  
Administration Time ◽  
Group 2 ◽  
Thyroid Profile

Background: One of the common endocrine disorders in India as well as in the world is hypothyroidism. The treatment of choice is giving levothyroxine supplement orally to the patient in an empty stomach mostly in the morning. Often many patients feel uncomfortable or inconvenient to take levothyroxine in the early morning. In those patients changing the administration time of levothyroxine may get necessary to increase the patient compliance.Methods: Drug naïve patients with primary hypothyroidism, randomly selected and assigned into two groups. Patients in group 1 received levothyroxine in the morning minimum one hour before breakfast and in group 2 levothyroxine was given at least two hours after dinner. Thyroid profile of the subjects was assessed at the baseline and reassessed after 8 and 24 weeks and compared with the baseline values.Results: After 24 weeks we found significant differences in the thyroid profile of the subjects between two groups. Serum thyroid stimulating hormone (TSH) was found to be 8.70 ± 3.3 in the morning group and 7.0 ± 2.3 in the evening group. TSH levels in the subjects taking the evening dose got closer to the therapeutic target range earlier than the ones taking the drug in the morning.Conclusions: Levothyroxine intake at bedtime can be a good alternative to levothyroxine intake in the morning for the patients taking concomitant medications.

scholarly journals Severe depression and rhabdomyolysis as “masks” of primary hypothyroidism: clinical cases

2019 ◽  
Vol 47 (2) ◽  
pp. 186-194 ◽  
Author(s):  
T. I. Kulagina ◽  
N. V. Koriakova ◽  
O. A. Rodionova ◽  
N. N. Vezikova ◽  
I. I. Kannoeva
Keyword(s):  
Clinical Case ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Severe Depression ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Endocrine Disorders ◽  
Medical Specialties ◽  
Clinical Cases

Rationale: Primary hypothyroidism is one of the most common endocrine disorders. Difficulties in its diagnosis are related to the lack of specific and pathognomonic clinical symptoms of the disease. It is not infrequent that before the right diagnosis is made, patients with hypothyroidism go a  long way of examinations and consultations of various specialists; we have illustrated this by two clinical cases.Clinical case No. 1 was a 69-year old woman with a  late diagnosis of severe primary hypothyroidism. Despite the presence of typical clinical signs of hypothyroidism, such as epidermal and edematous syndromes, encephalopathy, depression, and anemia, some clinical patterns (significant weight loss, ascites, low cholesterol, protein, electrolyte levels, and severe anemia) directed the diagnostic search towards oncology. It was the oncologist who was the first to suggest hypothyroidism that was later confirmed by high thyroid-stimulating hormone (TSH) levels.Clinical case No. 2 was a case of hypothyroidism in a young man with a baseline history of kidney disease. Fatigue, myalgia, neurological abnormalities, cytolysis and hypercholesterolemia were the leading symptoms that progressed steadily and led to disability.Conclusion: These clinical cases demonstrate the variety of clinical symptoms in manifest hypothyroidism and emphasize the significance of high awareness of this disorder among various medical specialties. It is of note that laboratory tests to diagnose primary hypothyroidism are very simple and available (high serum TSH level is enough for the diagnosis) and treatment with levothyroxine sodium is very effective. 

scholarly journals Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening Dose of Levothyroxine in Treatment of Hypothyroidism

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Rajesh Rajput ◽  
Sumanto Chatterjee ◽  
Meena Rajput
Keyword(s):  
Clinical Symptoms ◽  
Evening Dose ◽  
Similar Dose ◽  
Intergroup Comparison ◽  
Significant Difference ◽  
Drug Naïve ◽  
The Difference ◽  
Group 2 ◽  
Thyroid Profile ◽  
Group 1

152 drug naïve primary hypothyroid patients were divided into morning (Group 1) and evening (Group 2) dosing group and evaluated for change in biochemical profile, physical functioning and Quality of Life during the course of 12 weeks of study. At the end of 12 weeks 70 (90.90%) subjects in Group 1 and 72 (96%) in Group 2 achieved euthyroidism. On evaluation clinical symptoms and total clinical scores improved in both the groups at the end of 6 and 12 weeks. Significant improvement in thyroid profile was seen in both the groups at the end of 6 and 12 weeks (Pvalue <.0001). On intergroup comparison, no significant difference in thyroid profile was seen at 6 and 12 weeks between the morning and the evening dose group. Similar dose of levothyroxine was required to achieve euthyroidism in both the groups. Though an early restoration of euthyroidism was seen in evening group, the difference when compared to the morning group was not statistically significant. On assessment of QoL, statistically significant improvement in various parameters was seen in both the groups. Hence, from the study we inferred that evening dose is as efficacious as morning dose and provides an alternate dosing regimen.

scholarly journals Prevalence of Thyroid Dysfunction in Community of Duwakot, Bhaktapur

2017 ◽  
Vol 7 (2) ◽  
pp. 1184-1187
Author(s):  
Binita Pradhan ◽  
Sailesh Bahadur Pradhan
Keyword(s):  
Thyroid Dysfunction ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Endocrine Disorders ◽  
Free Triiodothyronine ◽  
Function Test ◽  
History Of ◽  
The Common ◽  
Primary Hyperthyroidism

Background: Thyroid dysfunction is one of the major public health problems in the Nepalese community and of the common endocrine disorders diagnosed in community primary health care centres.  The aim of this study is to analyze the prevalence of Thyroid dysfunction in Duwakot, NepalMaterials and Methods:  All the patients from Duwakot community who presented with the history of weight gain with tiredness and weight loss with palpitation were subjected to thyroid function test free triiodothyronine, free thyroxine and thyroid stimulating hormone. Results: Thyroid dysfunction was  found in 26% with M:F ratio of 1:5.  Subclinical hypothyroidism 62 (11.44%) was the most prevalent one followed by Primary hypothyroidism  48 (8.85%), primary hyperthyroidism 16 (2.95%) and subclinical hyperthyroidism 15 (2.76%).Conclusion: Thyroid dysfuntion has been observed despite of nationwide program regarding supplementation of micronutrient iodised salt.  Key words: Euthyroid, Hyperthroidism, Hypothyroidism, Iodine, Prevalence, Thyroid dysfunction

scholarly journals MANAGEMENT OF CASE OF PRIMARY HYPOTHYROIDISM ON THE PRINCIPLES OF DHATWAGNIMANDYA - A CASE REPORT

2021 ◽  
Vol p6 (1) ◽  
pp. 3258-3261
Author(s):  
Neetu Sharma ◽  
Shalini Rai ◽  
Sisir Kumar Mandal ◽  
Anand More
Keyword(s):  
Case Report ◽  
Symptomatic Relief ◽  
Clinical Manifestations ◽  
Biochemical Parameter ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Management Approach ◽  
Endocrine Disorders ◽  
Dietary Regimen

Hypothyroidism is a condition caused by thyroid hormone deficiency. It occurs due to hormonal imbalance & decreased metabolism. Clinical manifestations range from no signs or symptoms to life-threatening conditions. In Ayurveda, it corresponds to Dhatvagni Mandya. In this case report the patient presented with puffiness of the face, swelling in both the limbs, muscle (back) pain, loss of appetite, constipation and abnormal weight gain. According to symptomatic presentations, the case was diagnosed as Dhatvagni mandya. Clinical presentation and biochemical parameter i.e., Thyroid Stimulating Hormone (TSH) was 12.07uIU/ml which confirmed the case as Hypothyroidism in modern medicine. The multimodal Ayurvedic management approach incorporating ahara, vihara and aushadha was adopted. The case was treated on the line of principles of Agnimandya. Shaman Chikitsa (pacifying therapy) including internal administration of herbo-mineral formulations such as Arogyavardhini vati, Kanchnaar guggul, Punarnava mandur, Avipattikar churna, Swarna vanga along with a dietary regimen was prescribed to the patient. After 3 months’ treatment, significant symptomatic relief along with reduction of serum TSH level (3.05uIU/ml) without any adverse effects was observed in the patients. It can be inferred from the case that Ayurvedic intervention has enough potential to be employed and utilized in such endocrine disorders. Keywords- Ayurveda, Dhatawagni, Agni, Hypothyroidism, Kanchnar Guggul, Arogyavardhini vati.

scholarly journals Randomized Trial Comparing Two Algorithms for Levothyroxine Dose Adjustment in Pregnant Women With Primary Hypothyroidism

2017 ◽  
Vol 102 (9) ◽  
pp. 3499-3507 ◽  
Author(s):  
Shannon D Sullivan ◽  
Erin Downs ◽  
Geanina Popoveniuc ◽  
Alexander Zeymo ◽  
Jacqueline Jonklaas ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Dose Adjustment ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Washington Dc ◽  
Dose Increase ◽  
Specific Goal ◽  
Group 2 ◽  
Maternal Thyroid ◽  
Group 1

Abstract Context Regulation of maternal thyroid hormones during pregnancy is crucial for optimal maternal and fetal outcomes. There are no specific guidelines addressing maternal levothyroxine (LT4) dose adjustments throughout pregnancy. Objective To compare two LT4 dose-adjustment algorithms in hypothyroid pregnant women. Design Thirty-three women on stable LT4 doses were recruited at &lt;10 weeks gestation during 38 pregnancies and randomized to one of two dose-adjustment groups. Group 1 (G1) used an empiric two-pill/week dose increase followed by subsequent pill-per-week dose adjustments. In group 2 (G2), LT4 dose was adjusted in an ongoing approach in micrograms per day based on current thyroid stimulating hormone (TSH) level and LT4 dose. TSH was monitored every 2 weeks in trimesters 1 and 2 and every 4 weeks in trimester 3. Setting Academic endocrinology clinics in Washington, DC. Main Outcome Measure Proportion of TSH values within trimester-specific goal ranges. Results Mean gestational age at study entry was 6.4 ± 2.1 weeks. Seventy-five percent of TSH values were within trimester-specific goal ranges in G1 compared with 81% in G2 (P = 0.09). Similar numbers of LT4 dose adjustments per pregnancy were required in both groups (G1, 3.1 ± 2.0 vs G2, 4.1 ± 3.2; P = 0.27). Women in G1 were more likely to have suppressed TSH &lt;0.1 mIU/L in trimester 1 (P = 0.01). Etiology of hypothyroidism, but not thyroid antibody status, was associated with proportion of goal TSH values. Conclusions We compared two options for LT4 dose adjustment and showed that an ongoing adjustment approach is as effective as empiric dose increase for maintaining goal TSH in hypothyroid women during pregnancy.

scholarly journals Effect of the Cut-Off Level for Thyroid-Stimulating Hormone on the Prevalence of Subclinical Hypothyroidism among Infertile Mexican Women

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 417
Author(s):  
Lidia Arce-Sánchez ◽  
Salvatore Giovanni Vitale ◽  
Claudia Montserrat Flores-Robles ◽  
Myrna Souraye Godines-Enriquez ◽  
Marco Noventa ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Subclinical Hypothyroidism ◽  
Thyroid Autoimmunity ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Mexican Women ◽  
Cross Sectional ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886; Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390; and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3–43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7–16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p < 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.

Evaluation of clinical, endocrine and metabolic findings in obese children with and without hepatosteatosis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Gunce Basarir ◽  
Bahar Ozcabi ◽  
Ozden Aksu Sayman ◽  
Hatice Ozturkmen Akay ◽  
Feyza M. Yildiz
Keyword(s):  
Uric Acid ◽  
Density Lipoprotein ◽  
Thyroid Stimulating Hormone ◽  
Fasting Insulin ◽  
Obese Children ◽  
Pubertal Stage ◽  
Alcoholic Fatty Liver ◽  
Group 2 ◽  
Group 1

Abstract Objectives Non-alcoholic fatty liver disease (NAFLD) is a common obesity-related comorbidity in childhood. In this study, we aimed to evaluate predictors of NAFLD by comparing clinical, endocrine and metabolic findings in obese children with and without hepatosteatosis. Methods Two hundred and eight obese children aged 6–18 years were included. The patients were divided into group 1 (patients with NAFLD, n=94) and group 2 (patients without NAFLD, n=114). Anthropometric measurements, pubertal stage, lipid profiles, fasting glucose and insulin, homeostatic model of assessment for insulin resistance (HOMA-IR), uric acid, total bilirubin, alanine aminotransferase (ALT), blood urea nitrogen, thyroid-stimulating hormone and free thyroxine parameters were compared retrospectively. Results The mean body weight, body mass index (BMI), height, tri-ponderal mass index (TMI), insulin, HOMA-IR, triglyceride, ALT and uric acid values were significantly higher, while high-density lipoprotein-cholesterol (HDL-C) values were significantly lower in group 1. The 70.7% of obese children with hepatosteatosis and 83.9% of those without hepatosteatosis were correctly estimated by parameters including age, gender, ALT, HDL-C, fasting insulin and uric acid values. Conclusions Since obesity-associated hepatosteatosis induces various long-term metabolic impacts in children, early detection is of critical importance. Age, gender, TMI, BMI, ALT, HDL-C, fasting insulin and uric acid values may help to predict the risk of hepatosteatosis. Besides, we assessed whether TMI compared to BMI does not have a better utility in estimating obesity-induced hepatosteatosis in children. This is the first study to show the association between TMI and hepatosteatosis in children.

scholarly journals Non-Alcoholic Fatty Liver Disease in Primary Hypothyroidism

2020 ◽  
Vol 15 (2) ◽  
pp. 206-208
Author(s):  
Nasir Uddin Ahmed ◽  
Md Anwarul Kabir ◽  
Farzana Kalam ◽  
Shaheda Akter
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
World Wide ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Age Group ◽  
Cross Sectional ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition world-wide. Hypothyroidism is also a common disorder affecting general population especially in women. Objectives: To determine the association between primary hypothyroidism and NAFLD. Materials and Method: This is a cross-sectional descriptive type of observational study where 100 cases of primary hypothyroidism in age group 15-75 years of both sexes were selected from February 2018 to January 2019 in CMH Momenshahi having higher level of Thyroid stimulating hormone(TSH). In all cases ultra-sonogram of hepatobiliary system was done by efficient sonologist who was blind about clinical scenario of the patients. Results: Mean age of patients 29±SD7.57.Among 100 cases 56(56%) having NAFLD among them 95% were female and 5% were male. Conclusion: NAFLD was significantly correlated with primary hypothyroidism. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 206-208

scholarly journals The difference in outcome of patients with open inguinal hernia repair by using delayed absorbable sutures instead of non-absorbable sutures for mesh fixation

2020 ◽  
Vol 8 (1) ◽  
pp. 24
Author(s):  
Ali G. Mohammed Redha ◽  
Adil A. Jaber ◽  
Aqeel M. Nasser
Keyword(s):  
Hernia Repair ◽  
Mesh Fixation ◽  
Good Alternative ◽  
P Value ◽  
Absorbable Sutures ◽  
Significant Difference ◽  
The Difference ◽  
Group 2 ◽  
One Year ◽  
Group 1

Background: Different methods are found for mesh fixation in inguinal hernioplasty both open and laparoscopic. In open technique, sutures have been the method of choice for their reduced costs and surgeons’ habits. Whether absorbable instead of non-absorbable sutures can be used still a matter of debate in view of hernia recurrence and post-operative complications.Methods: This is a prospective done on 158 male patients with uncomplicated unilateral inguinal hernias. Two groups of 69 patients were evaluated after periods up to 1 year after open hernioplasty by using delayed absorbable sutures in one group (group 1) and non-absorbable sutures in the other group (group 2) for fixation of mesh.Results: In spite of a noticeable reduction in complication in the group 1 in term of number and percentage when compared with group 2 mainly chronic pain, there is no significant difference (p value>0.05). However, these results are associated with zero recurrence in both groups during a period of one year follow up.Conclusions: Delayed absorbable sutures are good alternative of non-absorbable sutures in open mesh hernia repair associated with less complications and almost no increase in chance of recurrence.  

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