Iodine deficiency during pregnancy is an important global public health issue and the leading preventable cause of neurodevelopmental impairments worldwide. The effects of severe iodine deficiency during pregnancy, including adverse obstetric outcomes and decreased child intelligence quotient, have been clearly established. However, the effects of mild-to-moderate deficiency remain less well understood. Pregnant and lactating women have higher iodine requirements than other adults; intakes of 220 to 250 µg/d in pregnancy and 250 to 290 µg/d in lactation. In this article, we describe iodine metabolism, iodine requirements in pregnancy and lactation, the effects of both iodine deficiency and excessive iodine intakes in pregnancy, and the efficacy of iodine supplementation.
Background and Objective
Recombinant human thyrotropin (rhTSH) is currently not FDA-approved for the treatment of high-risk patients with differentiated thyroid cancer (DTC). The goal of our study was to compare the outcomes in higher risk patients with metastatic DTC prepared for radioiodine (RAI) therapy with rhTSH versus thyroid hormone withdrawal (THW).
Methods
Retrospective chart review of patients with metastatic DTC in follow-up at MedStar Washington Hospital Center and MedStar Georgetown University Hospital from 2009 to 2017. Patients were divided according to their preparation for RAI therapy, with assessment of progression free survival (PFS) and overall survival (OS).
Results
Fifty-five patients with distant metastases (16 men, 39 women) were prepared for RAI therapy exclusively either with rhTSH (n= 27) or with THW (n= 28). There were no statistically significant differences between the groups regarding clinicopathological features and history of RAI therapies. The median follow-up time for patients with rhTSH-aided therapies was 4.2 yr (range 3.3 – 5.5 yr) and for patients with THW-aided therapies was 6.8 yr (range 4.2- 11.6 yr) (p=0.002). Multivariate analysis showed that the method of TSH stimulation was not associated with a difference in PFS or OS.
Conclusion
As has been shown previously for low-risk DTC, this study indicates that the mode of preparation for RAI therapy does not appear to influence the outcomes of patients with metastatic DTC. PFS and OS were similar for patients with THW-aided or rhTSH-aided RAI therapies.
A 61-year-old female with past medical history of prediabetes and infiltrating ductal carcinoma of the right breast with bone and lung metastases, status post-partial mastectomy and hormonal therapy, was referred for management of hyperglycemia.
This chapter represents a selection of 8 clinical scenarios that may commonly be encountered. They help summarize some of the literature and teaching points of the previous chapters. They are not meant to represent every possible presentation of thyroid disease, but rather to present common symptoms and findings that may aid a clinician in making a diagnosis or in selecting initial treatment.
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