Hypothyroidism: Etiology, Diagnosis, and Management

Almandoz, Jaime P.; Gharib, Hossein

doi:10.1016/j.mcna.2012.01.005

Cited by 159 publications

(131 citation statements)

References 111 publications

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“…Especially, in young children, L-T 4 supplementation should be performed with more accuracy (24). Monitoring of treatment solely based on a patient's signs and symptoms is not feasible, and supplementation is monitored by measuring thyroid function determinants and comparing these values with those of the reference ranges (24).…”

Section: Discussionmentioning

confidence: 99%

The different requirement of l-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic–pituitary level

Bagattini

Cosmo

Montanelli

et al. 2014

European Journal of Endocrinology

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Background: Levothyroxine (L-T 4 ) is commonly employed to correct hormone deficiency in children with congenital hypothyroidism (CH) and in adult patients with iatrogenic hypothyroidism. Objective: To compare the daily weight-based dosage of the replacement therapy with L-T 4 in athyreotic adult patients affected by CH and adult patients with thyroid nodular or cancer diseases treated by total thyroidectomy. Design and methods: A total of 36 adult patients (27 females and nine males) aged 18-29 years were studied; 13 patients (age: 21.5G2.1, group CH) had athyreotic CH treated with L-T 4 since the first days of life. The remaining 23 patients (age: 24G2.7, group AH) had hypothyroidism after total thyroidectomy (14 patients previously affected by nodular disease and nine by thyroid carcinoma with clinical and biochemical remission). Patient weight, serum free thyroid hormones, TSH, thyroglobulin (Tg), anti-Tg, and anti-thyroperoxidase antibodies were measured. Required L-T 4 dosage was evaluated. At the time of the observations, all patients presented free thyroid hormones within the normal range and TSH between 0.8 and 2 mIU/ml. Results: Patients had undetectable Tg and anti-thyroid antibodies. The daily weight-based dosage of the replacement therapy with L-T 4 to reach euthyroidism in patients of group CH was significantly higher than that in those of group AH (2.16G0.36 vs 1.73G0.24 mg/kg, P!0.005). Patients of group CH treated with L-T 4 had significantly higher serum TSH levels than patients of group AH (PZ0.05) as well as higher FT 4 concentrations. Conclusions: To correct hypothyroidism, patients of group CH required a daily L-T 4 dose/kg higher than group AH patients, despite higher levels of TSH. The different requirement of replacement therapy between adult patients with congenital and those with surgical athyroidism could be explained by a lack of thyroid hormones since fetal life in CH, which could determine a different set point of the hypothalamus-pituitary-thyroid axis.

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Section: Discussionmentioning

confidence: 99%

The different requirement of l-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic–pituitary level

Bagattini

Cosmo

Montanelli

et al. 2014

European Journal of Endocrinology

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“…SCH may be graded as mild (serum TSH, 4.5-9 mU/l) or moderate/severe (serum replacement (7,8,9,10). Previous studies have also suggested an association between SCH and coronary artery disease (CAD) (11,12,13,14).…”

Section: Introductionmentioning

confidence: 99%

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Silva¹,

Santos²,

Morais³

et al. 2014

European Journal of Endocrinology

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Objective: Several studies have suggested an association between subclinical hypothyroidism (SCH) and increased cardiovascular risk. The aim of this study was to evaluate the presence of coronary artery disease (CAD) in asymptomatic patients with SCH by measuring the coronary artery calcium score (CACS). Design: A total of 222 asymptomatic subjects (103 SCH and 119 euthyroid (EU)), who were between the ages of 35 and 65 years and had no previous history of CAD, were enrolled for this cross-sectional analysis. Methods: The criteria for SCH included a confirmed normal serum free thyroxine and high TSH levels. Lipid profile, Framingham risk score (FRS) and CACS analyses were performed for all subjects. Results: The SCH and EU groups were comparable with respect to age, gender, BMI and frequency of diabetes, systemic arterial hypertension, hypercholesterolaemia and smoking. There was no difference in the median CACS between the SCH and EU groups. However, in the subgroup of subjects with intermediate/high FRS (AR 10y R10%), CACS was higher in the SCH subjects compared with EU subjects (EU vs SCH, 0.0 (57.0) vs 23.0 (161.5); PZ0.045). Multivariate analysis revealed that the risk for CACS O100 was independently associated with male gender, age O55 years, and the presence of simultaneous SCH and AR 10y R10% (ORZ87.5 (CIZ2.1-3500); PZ0.001). Serum TSH was positively correlated with CACS, especially in intermediate/high FRS subjects (r s Z0.301, PZ0.045). Conclusions: It was demonstrated that SCH represents an additional risk factor for CAD, notably in intermediate and high FRS subjects.

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“…It weakens the activity of the enzyme thyroid peroxidase, which is required for the liberation of iodine for addition onto tyrosine residues on thyroglobulin for the production of thyroxine (T4) or triiodothyronine (T3), thyroid hormones (Almandoz and Gharib, 2012). Goitrogenic foods can act like antithyroid drugs, slowing down the thyroid and ultimately causing hypothyroidism (Shomon, 2012).…”

Section: Resultsmentioning

confidence: 99%

Hypothyroidism among females and differences in their dietary patterns and urinary iodine concentrations compared to normal subjects

Budhalakoti

Kannan

2017

AJDFR

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Thyroid disorders are among the most common endocrine disorders in India. Hypothyroidism is a very common condition. The condition is more common in women than in men, and its incidence increases with age. For the present study 150 females of 21 to 50 years of age were selected via random sampling from Pantnagar area of Udham Singh Nagar District, Uttarakhand and were interviewed using a predesigned proforma. The subjects mainly belonged to middle and upper income groups. Among 150 subjects, 30 were found to be suffering from hypothyroidism of which six were the newly diagnosed cases who had not started medications. Subjects were assessed for their dietary intakes and differences in the food habits based on food avoidance, food preferences, dietary habits and dietary diversity scores. Based on the analysis of the dietary intakes of normal (n=120) and hypothyroid (n=30) subjects not much difference was found, as was also evident from the dietary diversity scores (where non-significant difference was observed) except for in case of some dietary habits which showed significant differences. The mean dietary diversity scores of hypothyroid and normal subjects were 5.8±0.88 and 6.0±0.90 respectively. Urine samples were also collected for the measurement of urinary iodine concentration of only 30 subjects which included six of the newly detected hypothyroid cases not on medication and the remaining 24 normal subjects. Only 2 hypothyroid subjects and 3 normal subjects were found to be suffering from mild iodine deficiency with values of urinary iodine ranging from 76.5 to 94.6µg/l. Median urine iodine excretion in the present study was 172 µg/l (mean 186.5±58.4 µg/l) indicating iodine sufficiency.

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Hypothyroidism: Etiology, Diagnosis, and Management

Cited by 159 publications

References 111 publications

The different requirement of l-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic–pituitary level

The different requirement of l-T4 therapy in congenital athyreosis compared with adult-acquired hypothyroidism suggests a persisting thyroid hormone resistance at the hypothalamic–pituitary level

Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores

Hypothyroidism among females and differences in their dietary patterns and urinary iodine concentrations compared to normal subjects

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