The Effect of TSH-Suppressive Dose of Levothyroxine On Skeletal Muscle In Ovariectomized Rats

Hyperthyroidism is often observed in postmenopausal women due to conditions such as thyroiditis and toxic nodular goiter, Grave’s disease or thyroid stimulating hormone suppressive therapy for treating differentiated thyroid carcinoma (DTC). However, the effect of such hormonal changes on skeletal muscles in females remain unclear. Therefore, this study aimed to observe the effects of hyperthyroidism on the skeletal muscle of ovariectomized rats. We randomly divided female Sprague-Dawley rats into sham-operated (Sham), ovariectomized (OVX), and levothyroxine-treated ovariectomized groups (OVX+LT4). Levothyroxine was administered intraperitoneally at 0.3 mg/kg, daily for six weeks. Protein synthesis was increased after ovariectomy whereas protein synthesis was suppressed and protein degradation was increased in response to levothyroxine treatment. However, there was no difference in lean mass between the two groups. Collagen I levels were similar between the Sham and OVX groups, but were significantly decreased in the OVX+LT4 group. The mRNA levels of matrix metalloproteinase (MMP) ‐2 and ‐9 were similar between the Sham and OVX groups but were upregulated in the OVX+LT4 group. After ovariectomy, mitochondrial biogenesis and dynamics were changed; these changes were exacerbated in hyperthyroidism. Our findings indicate that in postmenopausal rats with hyperthyroidism, the progression of muscle weakness occurs through impaired regulation of signaling pathways related to extracellular matrix homeostasis, protein turnover, and mitochondrial quality.

Hyperthyroidism in adolescents

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.

Peculiarities of individual miniinvasive surgery in the surgical treatment of nodular pathology of the thyroid gland in children

Peculiarities of individual mini-invasive surgery in the surgical treatment of nodular pathology of the thyroid gland in children. During 40 years in the clinic „Surgery of tumors of the head and neck region” of the Oncological Institute of Republic of Moldova were treated 18549 patients with thyroid nodular pathologies, of which 1078 were children. 105 (9,7%) children were diagnosed with thyroid cancer, 534 (49,5%) – with adenomas, 213 (19,7%) – with toxic nodular goiter, 226 (21%) – with Hashimoto’s stroke. The ratio of affecting girls / boys 6: 1, the most vulnerable age – 9-16 years. The most common morphological forms were papillary and follicular cancer 97 children (92,3%). During 2020, the method of mini-invasive organ-threatening operations in children with thyroid nodular processes was implemented. The main advantages of mini-invasive operations are the following:Intraoperative safety The small cost Minimal postoperative complications.

Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature

Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.

Nodular toxic goiter in children: clinical features, morphological variants

BACKGROUND: Toxic nodular goiter (TNG) is a rare disease in which the cause of hyperthyroidism is the presence of a node or nodes that autonomously secrete thyroid hormones. With children and adolescents this condition is extremely rare — in 5–7.5% of all cases of nodular goiter. Therapy of toxic nodular goiter is aimed at relieving the symptoms of hyperthyroidism taking into account the malignant potential of the nodular formation. In the available literature, there are no data on the clinical course, comparative results of cytological and histological data in patients with toxic nodular goiter, which debuted in their childhood.AIM: Analysis of the features of the clinical course, comparison of the results of cytological and histological studies of toxic nodular goiter in children and adolescents.MATERIALS AND METHODS: A retrospective, single-center study of 21 patients with single-nodular toxic goiter, hospitalized at the Endocrinology Research Centre in the period from January 2016 to December 2019.RESULTS: The mean age at the time of the survey was 13.9 years. Thirteen patients (65%) had manifest thyrotoxicosis, and seven (35%) had subclinical hyperthyroidism. More than half of children — 57.1% (n = 12) did not receive thyreostatic therapy. The cytological picture in 11 patients (61.1%) corresponded to benign changes (nodular colloid goiter or adenomatous goiter) — Bethesda II, in 4 patients — follicular tumor — Bethesda IV, in 4 children the study was not informative. 19 patients (90.5%) underwent surgical treatment (hemithyroidectomy). According to the results of histological examination, follicular adenoma was found in 44.4% of children with nodular toxic goiter with benign results of TAB (Bethesda II) and was found in 50% with revealing follicular neoplasia (Bethesda IV).CONCLUSION: For the first time in the Russian Federation was carried out a comparative analysis of the characteristics of cytological and histological studies in children with toxic nodular goiter. It is significant that only in 10.5% (n=2) cytological and morphological results were consistent. The choice of radical treatment tactics should take into account the high frequency of mismatches between histological and morphological studies.

Graves’ Disease

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.

Treatment of hyperthyroidism reduces systemic oxidative stress, as measured by markers of RNA and DNA damages

Background Whole-body oxidative stress can be estimated by the urine excretion of oxidized guanosine species, 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), derived from RNA and DNA, respectively. These oxidative stress markers are not well explored in thyroid disorders. Methods Urinary excretion of 8-oxoGuo and 8-oxodG was measured in 51 hyperthyroid patients (toxic nodular goiter (TNG), n=30; Graves’ disease (GD), n=21) before or shortly after initiation of therapy and when stable euthyroidism had been achieved for at least 12 months. Results Adjusting for age, the baseline urinary excretion of oxidative stress markers correlated positively with plasma thyroxine (8-oxoGuo: p=0.002; 8-oxodG: p=0.021) and was significantly higher in GD than in TNG patients (p=0.001 for both oxidative stress markers). Restoration of euthyroidism significantly affected the excretion of the oxidative stress markers. In TNG, 8-oxoGuo decreased from geometric mean 2.11 nmol/mmol creatinine (95%CI:1.85-2.39) to 1.91 nmol/mmol (95%CI:1.67-2.19), p=0.001, while 8-oxodG decreased from 1.65 nmol/mmol (95%CI:1.41-1.93) to 1.48 nmol/mmol (95%CI:1.27-1.74), p=0.026. In GD, 8-oxoGuo decreased from 2.25 nmol/mmol (95%CI:1.95-2.59) to 1.79 nmol/mmol (95%CI:1.63-1.97), p=0.0003, while 8-oxodG decreased from 2.02 nmol/mmol (95%CI:1.73-2.38) to 1.54 nmol/mmol (95%CI:1.31-1.81), p=0.001. In the euthyroid state, there were no differences between groups. Conclusion Restoration of euthyroidism in patients with hyperthyroidism significantly decreased the systemic oxidative stress load by 10-25%. Our findings may help to explain the higher morbidity and mortality linked to hyperthyroid diseases, as shown in observational studies.

Serum thyroglobulin level in newly detected thyrotoxicosis and its role in differential diagnosis of thyrotoxicosis

Background: Elevated serum thyroglobulin (Tg) level is commonly observed in various forms of thyrotoxicosis; the levels vary according to different etiologies. This study aimed at identifying the value of serum Tg level in the differential diagnosis of common etiologies of thyrotoxicosis. Methods: This cross-sectional study was conducted at the endocrine outpatient department of a tertiary hospital in Bangladesh from March 2015 to May 2017. In this study, 200 subjects with newly detected untreated thyrotoxicosis were evaluated. Serum Tg was assayed by chemiluminescent immunometric assay. Results: Serum Tg level was raised in 48% of subjects. Subjects aged ≥40 years, and those having a family history of thyroid disorders had relatively higher thyroglobulin levels. The frequency of subjects with an elevated Tg was highest in subacute thyroiditis (89.5%) followed by toxic nodular goiter (77.3%) and Graves’ disease (32.9%); the difference in the frequencies was statistically significant (p<0.001). Median Tg was highest in the subjects with subacute thyroiditis (132.6 ng/ml) followed by toxic nodular goiter (99.55 ng/ml); those with Graves’ disease had the lowest Tg level (12.5 ng/ml); the differences in median Tg levels across the three groups were also statistically significant (p<0.001). Conclusions: Serum thyroglobulin level may be useful for the etiological diagnosis of thyrotoxicosis.

Monitoring And Evaluation Of Hemodynamic Parameters During Anesthesia In Endocrine Surgery

The article presents the results of preoperative preparation, anesthesia and surgical treatment of patients operated on for non-toxic nodular goiter. A new approach to preoperative preparation for thyroid surgery is described. The effectiveness in the preoperative period of using the modified method of preoperative preparation using sibazon and droperidol and anesthesia with the use of ketamine and the advantages of this method compared with other methods of general anesthesia are shown.

Radioiodine therapy outcome in toxic multinodular goiter patient with concomitant hereditary Hasharon hemoglobinopathy

This research describes a clinical case of treatment of a patient with thyrotoxicosis with concomitant hematological pathology carriage of unstable hemoglobin Hasharon. A patient diagnosed with Diffuse toxic nodular goiter. Thyrotoxicosis of medium severity. Drug-induced hypothyroidism was admitted to the Department of radionuclide therapy for the purpose of treatment with radioactive iodine. Onset of disease - summer 2018 (thyroid-stimulating hormone (TSH) 0 mIU/ml). The instrumental studies (ultrasound, scintillation scanning of the thyroid gland) were performed at the pre-radioiodine therapy (RIT) diagnostic stage. The history of the disease indicates, that in 2000 the patient was suspected of having abnormal hemoglobin, since then no examinations have been conducted and anemia has never been detected. The diagnosis of ancestral hemoglobinopathy with the presence (17%) of unstable Hasharon-Sinai-Sealy hemoglobin in a heterozygous form was verified during the preparation to RIT. The radionuclide therapy I131 with activity of 400 MBq was performed on 02.07.2019. The monthly monitoring of laboratory and instrumental indicants was carried out during the post-therapeutic period: the state of hypothyroidism was reached by the end of 2 months after RT, no episodes of significant increase in bilirubin levels were observed during the observation period; no side effects from RT were stated. It becomes possible based on the example of the above observation, to judge the safety of conducting RT for treatment of thyrotoxicosis in patients with similar hemoglobinopathy, without excluding, however, the need for an individual approach in each case.