Clinical challenges in thyroid disease: Time for a new approach?

Juby, Angela; Hanly, Mark G.; Lukaczer, Dan

doi:10.1016/j.maturitas.2016.02.001

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Such mechanisms may be at the basis of CFS symptoms and may explain the lower urinary iodine excretion in CFS patients as compared with controls, although the latter also exhibited a relatively high prevalence of low iodine excretion (Table 1 ). Intracellular D3-catalyzed liberation of iodide from T4 and T3 may serve various antioxidant and defense functions that may potentially contribute to high intracellular “thyroid hormone consumption,” manifesting as the “low T3 syndrome” with negative iodine balance in the long term ( 67 , 83 , 97 ).…”

Section: Discussionmentioning

confidence: 99%

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Ruiz-Núñez

Tarasse

Vogelaar³

et al. 2018

Front. Endocrinol.

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Chronic fatigue syndrome (CFS) is a heterogeneous disease with unknown cause(s). CFS symptoms resemble a hypothyroid state, possibly secondary to chronic (low-grade) (metabolic) inflammation. We studied 98 CFS patients (21–69 years, 21 males) and 99 age- and sex-matched controls (19–65 years, 23 males). We measured parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. Most remarkably, CFS patients exhibited similar thyrotropin, but lower free triiodothyronine (FT3) (difference of medians 0.1%), total thyroxine (TT4) (11.9%), total triiodothyronine (TT3) (12.5%), %TT3 (4.7%), sum activity of deiodinases (14.4%), secretory capacity of the thyroid gland (14.9%), 24-h urinary iodine (27.6%), and higher % reverse T3 (rT3) (13.3%). FT3 below the reference range, consistent with the “low T3 syndrome,” was found in 16/98 CFS patients vs. 7/99 controls (OR 2.56; 95% confidence interval = 1.00–6.54). Most observations persisted in two sensitivity analyses with more stringent cutoff values for body mass index, high-sensitive C-reactive protein (hsCRP), and WBC. We found possible evidence of (chronic) low-grade metabolic inflammation (ferritin and HDL-C). FT3, TT3, TT4, and rT3 correlated positively with hsCRP in CFS patients and all subjects. TT3 and TT4 were positively related to hsCRP in controls. Low circulating T3 and the apparent shift from T3 to rT3 may reflect more severely depressed tissue T3 levels. The present findings might be in line with recent metabolomic studies pointing at a hypometabolic state. They resemble a mild form of “non-thyroidal illness syndrome” and “low T3 syndrome” experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation and extension by others. If confirmed, trials with, e.g., T3 and iodide supplements might be indicated.

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Section: Discussionmentioning

confidence: 99%

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Ruiz-Núñez

Tarasse

Vogelaar³

et al. 2018

Front. Endocrinol.

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“…Iodine defi ciency is the most common cause of hypothyroidism worldwide, however, autoimmune thyroiditis is the most common cause in regions with enough iodine in the diet [3]. Radioactive iodine treatment, total or subtotal thyroidectomy are other causes in hypothyroidism etiology [4]. Levothyroxine sodium (LT4) alone or combined with liothyronine protocols are given to maintain euthyroid state [5].…”

Section: Introductionmentioning

confidence: 99%

“…Levothyroxine sodium (LT4) alone or combined with liothyronine protocols are given to maintain euthyroid state [5]. Thyroid-stimulating hormone (TSH) levels are monitored to help determine whether the dose is adequate within 4-6 weeks period, follow-up must continue until to maintain euthyroid hormone levels [4]. Treatment goals in healthy young population are to achieve optimal TSH levels under 4 mIU/L [6].…”

Section: Introductionmentioning

confidence: 99%

The Comparison with the Rates of Control of Hypothyroidism in the Between Outpatient Clinics of Internal Medicine and Endocrinology

Ergin¹,

Akçay²

2017

Glob J Obes Diabetes Metab Syndr

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Background and aims: Hypothyroid patients are usually follow-up in internal diseases with endocrinology and metabolism clinics in Turkey. The aim in this study is to determine the differences between these two clinics in terms of reaching the target. Methods: 310 patients with hypothyroid that are under levothyroxine sodium treatment are involved this study. These 268 women and 42 men are applied to Atatürk University Medical School in 2015. Their TSH level are recorded during the application and used a sensitive immunometric assay for TSH measurement. TSH<4 mIU/L is considered as achievement of treatment goals and TSH≥4 is not. Data analysis are made by SPSS-20 and they evaluated regarding "man whitney u" and "chi-square" test. Results: The evidences show that there is a signifi cant difference between endocrinology and internal diseases clinics regarding their TSH averages. TSH averages are 4,48 mIU/L and 7,93 mIU/L p<0,001 respectively (man whitney u test). In addition, there is a signifi cant difference statisticly with regard to achievement of treatment goals, 77,6 %, 58% p<0,001 respectively (chi-square test). Conclusions: Hypothyroid patients are more successfully treated in endocrinology and metabolism outpatient clinics than internal diseases clinics, however, there should be more comparative analyses in order to get certain results.

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Circulating thyroid hormones and associated metabolites in white whales (Delphinapterus leucas) determined using isotope-dilution mass spectrometry

Hansen

Villanger

Bechshøft

et al. 2017

Environmental Research

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Clinical challenges in thyroid disease: Time for a new approach?

Cited by 4 publications

References 30 publications

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

The Comparison with the Rates of Control of Hypothyroidism in the Between Outpatient Clinics of Internal Medicine and Endocrinology

Circulating thyroid hormones and associated metabolites in white whales (Delphinapterus leucas) determined using isotope-dilution mass spectrometry

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