scholarly journals Use of Thyroid Hormones in Hypothyroid and Euthyroid Patients: A 2020 THESIS Questionnaire Survey of Members of the Swedish Endocrine Society

2021 ◽  
Vol 12 ◽  
Author(s):  
Tereza Planck ◽  
Mikael Lantz ◽  
Petros Perros ◽  
Enrico Papini ◽  
Roberto Attanasio ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Thyroid Hormones ◽  
Online Survey ◽  
Thyroid Peroxidase ◽  
Endocrine Society ◽  
Persistent Symptoms ◽  
Liquid Solutions ◽  
Antibody Levels ◽  
E Mail ◽  
Hypothyroid Patients

BackgroundThe standard treatment of hypothyroidism is levothyroxine (LT-4). However, there are several controversies regarding treatment of hypothyroid patients.AimTo investigate the Swedish endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid individuals.MethodsPhysician members of the Swedish Endocrine Society (SEF) were invited by e-mail to participate in an online survey investigating this topic.ResultsOut of the eligible 411 members, 116 (28.2%) responded. The majority (98.9%) stated that L-T4 is the treatment of choice. However, around 50% also prescribed liothyronine (L-T3) or a combination of L-T4+L-T3 in their practice. Combination therapy was mostly (78.5%) used in patients with persistent hypothyroid symptoms despite biochemical euthyroidism on L-T4 treatment. Most respondents prescribed L-T4 tablets and did not expect any major changes with alternative formulations such as soft-gel capsules or liquid formulations in situations influencing the bioavailability of L-T4. In euthyroid patients, 49.5% replied that treatment with thyroid hormones was never indicated, while 47.3% would consider L-T4 for euthyroid infertile women with high thyroid peroxidase (TPO) antibody levels.ConclusionThe treatment of choice for hypothyroidism in Sweden is L-T4 tablets. Combination therapy with L-T4+L-T3 tablets was considered for patients with persistent symptoms despite biochemical euthyroidism. Soft-gel capsules and liquid solutions of L-T4 were infrequently prescribed. Swedish endocrinologists’ deviation from endocrine society guidelines merits further study.

scholarly journals Individualized Therapy for Hypothyroidism: Is T4 Enough for Everyone?

2020 ◽  
Vol 105 (9) ◽  
pp. e3090-e3104 ◽  
Author(s):  
Matthew D Ettleson ◽  
Antonio C Bianco
Keyword(s):  
Combination Therapy ◽  
Statistical Power ◽  
Evidence Synthesis ◽  
Elevated Serum ◽  
Review Literature ◽  
Lower Serum ◽  
Clinical Factor ◽  
Persistent Symptoms ◽  
Serum T3 ◽  
Hypothyroid Patients

Abstract Context It is well recognized that some hypothyroid patients on levothyroxine (LT4) remain symptomatic, but why patients are susceptible to this condition, why symptoms persist, and what is the role of combination therapy with LT4 and liothyronine (LT3), are questions that remain unclear. Here we explore evidence of abnormal thyroid hormone (TH) metabolism in LT4-treated patients, and offer a rationale for why some patients perceive LT4 therapy as a failure. Evidence Acquisition This review is based on a collection of primary and review literature gathered from a PubMed search of “hypothyroidism,” “levothyroxine,” “liothyronine,” and “desiccated thyroid extract,” among other keywords. PubMed searches were supplemented by Google Scholar and the authors’ prior knowledge of the subject. Evidence Synthesis In most LT4-treated patients, normalization of serum thyrotropin levels results in decreased serum T3/T4 ratio, with relatively lower serum T3 levels; in at least 15% of the cases, serum T3 levels are below normal. These changes can lead to a reduction in TH action, which would explain the slower rate of metabolism and elevated serum cholesterol levels. A small percentage of patients might also experience persistent symptoms of hypothyroidism, with impaired cognition and tiredness. We propose that such patients carry a key clinical factor, for example, specific genetic and/or immunologic makeup, that is well compensated while the thyroid function is normal but might become apparent when compounded with relatively lower serum T3 levels. Conclusions After excluding other explanations, physicians should openly discuss and consider therapy with LT4 and LT3 with those hypothyroid patients who have persistent symptoms or metabolic abnormalities despite normalization of serum thyrotropin level. New clinical trials focused on symptomatic patients, genetic makeup, and comorbidities, with the statistical power to identify differences between monotherapy and combination therapy, are needed.

scholarly journals Seasonality of month of birth of patients with Graves’ and Hashimoto’s diseases differ from that in the general population

2007 ◽  
Vol 156 (6) ◽  
pp. 631-636 ◽  
Author(s):  
Gerasimos E Krassas ◽  
Konstantinos Tziomalos ◽  
Nikolaos Pontikides ◽  
Hadas Lewy ◽  
Zvi Laron
Keyword(s):  
General Population ◽  
Perinatal Period ◽  
Thyroid Peroxidase ◽  
Month Of Birth ◽  
Autoimmune Thyroid ◽  
Common Etiology ◽  
Antibody Titers ◽  
Low Levels ◽  
Antibody Levels

Objective: We aimed to test the viral hypothesis in the pathogenesis of autoimmune thyroid disease (AITD). Design: We determined the pattern of month of birth (MOB) distribution in patients with AITD and in the general population and searched for differences between them. Methods: A total of 1023 patients were included in this study; 359 patients had Graves’ hyperthyroidism (GrH) and 664 had Hashimoto’s hypothyroidism (HH). We divided the patients with HH into three subgroups according to their thyroid peroxidase (TPO) antibody titers at diagnosis: low levels (<500 IU/ml), high levels (500–1000 IU/ml), and extremely high levels (>1000 IU/ml). We used cosinor analysis to analyze the data. Results: Overall, patients with GrH and HH had a different pattern of MOB distribution when compared with the general population and between groups. Furthermore, among both patients with GrH and HH, both genders had a different pattern of MOB distribution when compared with the general population and this pattern was also different between genders. Finally, only women with extremely high titers of TPO antibodies at diagnosis and men with low or extremely high TPO antibody levels showed rhythmicity in MOB, with a pattern of MOB distribution different from that in controls. Conclusions: The different MOB seasonality in both GrH and HH points towards a similar maybe even common etiology with type 1 diabetes mellitus and multiple sclerosis, namely a seasonal viral infection as the initial trigger in the perinatal period, the clinical disease resulting from further specific damage over time.

scholarly journals An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction

Thyroid ◽  
2018 ◽  
Vol 28 (6) ◽  
pp. 707-721 ◽  
Author(s):  
Sarah J. Peterson ◽  
Anne R. Cappola ◽  
M. Regina Castro ◽  
Colin M. Dayan ◽  
Alan P. Farwell ◽  
...  
Keyword(s):  
Online Survey ◽  
Hypothyroid Patients

STUDY OF GHRELIN LEVELS IN HYPOTHYROID PATIENTS BEFORE AND AFTER TREATMENT

2021 ◽  
pp. 52-54
Author(s):  
Peeyush Yadav ◽  
G. G. Kaushik
Keyword(s):  
Treatment Group ◽  
Thyroid Hormones ◽  
Hdl Cholesterol ◽  
Metabolic Disturbances ◽  
Free T4 ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Serum Ghrelin ◽  
Hypothyroid Patients

Objective: Aim of the present study was to evaluate the levels of ghrelin in hypothyroid patients before and after treatment with L-thyroxine and to nd a possible relationship between ghrelin and thyroid hormones. Material & Methods: The present study was conducted on 100 hypothyroid patients (44 Males & 56 Females) before treatment (Group A) and after treatment (Group B) attending the outpatient clinics or admitted in wards of J.L.N. Hospitals, Ajmer. 100 healthy control subjects (Group C) of same age group of either gender were selected for the study. Blood samples were drawn from patients and controls, after overnight fast of at least 8 hours. Estimation of Serum Ghrelin, free T3, free T4, and TSH was done by using Enzyme- Linked Immunosorbant Assay (ELISA) technique. Total Cholesterol, Triglyceride, HDL – Cholesterol were measured by automated analyser (Beckman & Coulter's AU680). VLDL – Cholesterol, LDL – Cholesterol were calculated by Friedwald's formula. Differences in the parameters among the groups were analyzed by ANOVA test followed by its Tukey HSD post hoc analysis. Correlations between variables were tested using the Pearson rho (r: Correlation coefcient) correlation test. Results: Findings of the present study shows that the levels of serum fT3 (1.79 ± 0.29 pg/mL) and serum fT4 (0.34 ± 0.11 ng/dL) were signicantly lower in Group A compared to Group B (fT3 = 3.00 ± 0.32 pg/mL & fT4 = 0.81 ± 0.15 ng/dL) and Group C (fT3 = 3.12 ± 0.31 pg/mL & fT4 = 0.85 ± 0.11ng/dL) whereas serum TSH levels were signicantly higher in Group A (40.59 ± 13.55 μIU/mL) compared to Group B (5.34 ± 1.47 μIU/mL) and Group C (3.23 ± 1.04 μIU/mL). Levels of serum Ghrelin were signicantly higher in Group A (918.19 ± 48.47 pg/mL) compared to Group B (700.34 ± 46.35 pg/mL) and Group C (681.49 ± 35.80 pg/mL). A non signicant correlation of Ghrelin with S.fT4 and TSH was found in both Group A and Group B whereas S.fT3 and BMI shows a non signicant correlation in Group A in comparison to a signicant correlation in Group B. Conclusion: There is a reversible increase in the levels of serum ghrelin which became normalized after L-thyroxine substitution in hypothyroid patients. Alteration in the levels of serum ghrelin in thyroid disorders indicates a compensatory role of ghrelin in metabolic disturbances and also suggests a possible association between thyroid hormones and serum ghrelin levels.

Hospital discharge planning for Canadians experiencing homelessness

2018 ◽  
Vol 22 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Kristy Buccieri ◽  
Abram Oudshoorn ◽  
Tyler Frederick ◽  
Rebecca Schiff ◽  
Alex Abramovich ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Online Survey ◽  
Discharge Planning ◽  
Policy Recommendations ◽  
Content Type ◽  
Non Profit ◽  
Key Stakeholders ◽  
Communication Privacy ◽  
E Mail

Purpose People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue. Design/methodology/approach The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia. Findings Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures. Research limitations/implications The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views. Practical implications Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms. Originality/value This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally.

scholarly journals Email Vs. Instagram Recruitment Strategies For Online Survey Research

2021 ◽  
Vol 32 (1) ◽  
pp. 67-77
Author(s):  
Rafael R. Moraes ◽  
Marcos B. Correa ◽  
Ândrea Daneris ◽  
Ana B. Queiroz ◽  
João P. Lopes ◽  
...  
Keyword(s):  
Survey Research ◽  
Online Survey ◽  
Large Population ◽  
Population Sample ◽  
Target Population ◽  
Recruitment Strategies ◽  
The Public ◽  
Conversion Rates ◽  
Methodological Aspects ◽  
E Mail

Abstract In this study, we describe a method for reaching a target population (i.e., dentists practicing in Brazil) to engage in survey research using traditional e-mail invites and recruitment campaigns created on Instagram. This study addresses methodological aspects and compares respondents reached by different methods. A pre-tested questionnaire was used and participants were recruited for 10 days via a source list of email addresses and two discrete Instagram organic open campaigns. A total of 3,122 responses were collected: 509 participants were recruited by email (2.1% response rate) and 2,613 by the two Instagram campaigns (20.7% and 11.7% conversion rates), respectively. Response/min collection rates in the first 24 h ranged between 0.23 (email) and 1.09 (first campaign). In total, 98.8% of all responses were received in the first 48 h for the different recruitment strategies. There were significant differences for all demographic variables (p< 0.001) between email and Instagram respondents, except for sex (p=0.37). Instagram respondents were slightly older, had more professional experience (years in practice), and a higher graduate education level than email respondents. Moreover, most email and Instagram respondents worked in the public sector and private practice, respectively. Although both strategies could collect responses from all Brazilian regions, email responses were slightly better distributed across the five territorial areas compared to Instagram. This study provides evidence that survey recruitment of a diverse, large population sample using Instagram is feasible. However, combination of email and Instagram recruitment led to a more diverse population and improved response rates.

scholarly journals Role of reduced thyroid hormone status on bone mineral metabolism

2021 ◽  
Vol 19 (2) ◽  
pp. 26-29
Author(s):  
X Lourdes Sandy ◽  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Bone Mineral ◽  
Serum Calcium ◽  
Mineral Metabolism ◽  
Bone Mineral Metabolism ◽  
Hormone Status ◽  
Calcium And Phosphorus ◽  
Hypothyroid Patients

Background: The most common endocrine disorder is hypothyroidism which accounts to 11%. Thyroid hormones have a wide array of functions such as physiological growth and development of skeletal system, maintenance of basal metabolic rate and regulation of various metabolisms, including mineral metabolism. Nowadays due to its direct action on bone turn over, thyroid hormones are considered to have an important role on bone mineral metabolism. Thyroid disorders are important cause for secondary osteoporosis. So the present study was done to know the levels of bone minerals, calcium and phosphorus in hypothyroidism and its relation with thyroid hormone levels. Methods: A case-control study was conducted on 30 hypothyroid patients and 30 euthyroid healthy controls in the age group of 20-60 years. Blood samples were collected from all the study population. Serum total triiodothyronine, total thyroxine and TSH by Enzyme-Linked Immunosorbent Assay, Serum calcium by Arsenazo III method, phosphorous by ammonium molybdate method were estimated. Results: Serum calcium levels in cases was found to significantly reduced when compared to controls (p<0.001). Serum phosphorous levels also showed considerable elevation in cases when compared to controls (p<0.001). There was a significant negative correlation between TSH and serum calcium in cases. Conclusion: The present study indicated the important role of reduced thyroid hormone status on bone mineral metabolism. This study concludes that serum calcium was significantly reduced and phosphorus levels were significantly increased in hypothyroid patients when compared to euthyroid control subjects. So frequent monitoring of serum calcium and phosphorus in hypothyroid patients would reduce the burden of bone pathologies.

scholarly journals THERAPY OF ENDOCRINE DISEASE: T4 + T3 combination therapy: is there a true effect?

2017 ◽  
Vol 177 (6) ◽  
pp. R287-R296 ◽  
Author(s):  
Wilmar M Wiersinga
Keyword(s):  
Combination Therapy ◽  
Thyroid Function ◽  
Healthy Subjects ◽  
Randomized Clinical Trials ◽  
Peripheral Tissue ◽  
Thyroid Function Tests ◽  
Peripheral Tissues ◽  
Persistent Symptoms ◽  
Function Tests ◽  
Number Of Patients

About 5%–10% of hypothyroid patients on T4 replacement therapy have persistent symptoms, despite normal TSH levels. It was hoped that T4 + T3 combination therapy might provide better outcomes, but that was not observed according to a meta-analysis of 11 randomized clinical trials comparing T4 monotherapy with T4 + T3 combination therapy. However, the issue is still subject of much research because normal thyroid function tests in serum may not necessarily indicate an euthyroid state in all peripheral tissues. This review evaluates recent developments in the field of T4 + T3 combination therapy. T4 monotherapy is associated with higher serum FT4 levels than in healthy subjects, and subnormal serum FT3 and FT3/FT4 ratios are observed in about 15% and 30% respectively. T4 + T3 combination therapy may mimic more closely thyroid function tests of healthy subjects, but it has not been demonstrated that relatively low serum FT3 or FT3/FT4 ratios are linked to persistent symptoms. One study reports polymorphism Thr92Ala in DIO2 is related to lower serum FT3 levels after thyroidectomy, and that the D2-Ala mutant reduces T4 to T3 conversion in cell cultures. Peripheral tissue function tests such as serum cholesterol reflect thyroid hormone action in target tissues. Using such biochemical markers, patients who had a normal serum TSH during postoperative T4 monotherapy, were mildly hypothyroid, whereas those with a TSH 0.03–≤0.3 mU/L were closest to euthyroidism. Peripheral tissue function tests suggest euthyroidism more often in patients randomized to T4 + T3 rather than that to T4. Preference for T4 + T3 combination over T4 monotherapy was dose-dependently related to the presence of two polymorphisms in MCT10 and DIO2 in one small study. It is not known if persistent symptoms during T4 monotherapy disappear by switching to T4 + T3 combination therapy. The number of patients on T4 + T3 therapy has multiplied in the last decade, likely induced by indiscriminate statements on the internet. Patients are sometimes not just asking but rather demanding this treatment modality. It creates tensions between patients and physicians. Only continued research will answer the question whether or not T4 + T3 combination therapy has true benefits in some patients.

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