Management of thyroid dysfunction and thyroid nodules in the ageing patient

Martínez‐Montoro, José Ignacio; Doulatram-Gamgaram, Viyey; Olveira, Gabriel; Valdés, Sergio; Fernández‐García, José Carlos

doi:10.1016/j.ejim.2023.06.005

Cited by 3 publications

(1 citation statement)

References 121 publications

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“…Thyroid nodules represent the most frequent endocrine condition, affecting 2-6% of the population according to clinical evaluations, with up to one third of adults, based on anterior neck ultrasound assessments, and up to two thirds, as shown by the autopsy investigations in some cohorts [73][74][75]. Whether subjects confirmed with LP/OLP are prone to develop this pathology or whether they represent an incidental finding due to consistent thyroid screening in these patients is yet an open topic [76].…”

Section: Lp/olp and The Co-presence Of Thyroid Nodules/malignancymentioning

confidence: 99%

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

Radu,

Carsote,

Nistor

et al. 2023

Biomedicines

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In this narrative review, we aimed to overview the interplay between lichen planus (LP) and thyroid conditions (TCs) from a dual perspective (dermatologic and endocrine), since a current gap in understanding LP-TC connections is found so far and the topic is still a matter of debate. We searched PubMed from Inception to October 2023 by using the key terms “lichen planus” and “thyroid”, (alternatively, “endocrine” or “hormone”). We included original clinical studies in humans according to three sections: LP and TC in terms of dysfunction, autoimmunity, and neoplasia. Six studies confirmed an association between the thyroid dysfunction (exclusively hypothyroidism) and LP/OL (oral LP); of note, only one study addressed cutaneous LP. The sample size of LP/OLP groups varied from 12–14 to 1500 individuals. Hypothyroidism prevalence in OLP was of 30–50%. A higher rate of levothyroxine replacement was identified among OLP patients, at 10% versus 2.5% in controls. The highest OR (odd ratio) of treated hypothyroidism amid OLP was of 2.99 (p < 0.005). Hypothyroidism was confirmed to be associated with a milder OLP phenotype in two studies. A single cohort revealed a similar prevalence of hypothyroidism in LP versus non-LP. Non-confirmatory studies (only on OLP, not cutaneous LP) included five cohorts: a similar prevalence of hypothyroidism among OLP versus controls, and a single cohort showed that the subjects with OLP actually had a lower prevalence of hypothyroidism versus controls (1% versus 4%). Positive autoimmunity in LP/OLP was confirmed in eight studies; the size of the cohorts varied, for instance, with 619 persons with LP and with 76, 92, 105, 108, 192, 247, and 585 patients (a total of 1405) with OLP, respectively; notably, the largest control group was of 10,441 individuals. Four clusters of approaches with respect to the autoimmunity in LP/OLP were found: an analysis of HT/ATD (Hashimoto’s thyroiditis/autoimmune thyroid diseases) prevalence; considerations over the specific antibody levels; sex-related features since females are more prone to autoimmunity; and associations (if any) with the clinical aspects of LP/OLP. HT prevalence in OLP versus controls was statistically significantly higher, as follows: 19% versus 5%; 12% versus 6%; and 20% versus 9.8%. A single study addressing LP found a 12% rate of ATDs. One study did not confirm a correlation between OLP-associated clinical elements (and OLP severity) and antibody values against the thyroid, and another showed that positive TPOAb (anti-thyroperoxidase antibodies) was more often found in erosive than non-erosive OLP (68% versus 33%). Just the reverse, one cohort found that OLP subjects had a statistically significantly lower rate of positive TPOAb versus controls (9% versus 15%). Five case-control studies addressed the issue of levothyroxine replacement for prior hypothyroidism in patients that were diagnosed with OLP (no study on LP was identified); three of them confirmed a higher rate of this treatment in OLP (at 8.9%, 9.7%, and 10.6%) versus controls. In conclusion, with regard to LP/OLP-TC, we note several main aspects as practical points for multidisciplinary practitioners: OLP rather than LP requires thyroid awareness; when it comes to the type of thyroid dysfunction, mostly, hypothyroidism should be expected; female patients are more prone to be associated with ATDs; a potential higher ratio of OLP subjects taking levothyroxine was found, thus a good collaboration with an endocrinology team is mandatory; and so far, OLP individuals have not been confirmed to be associated with a higher risk of thyroid nodules/cancer.

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Section: Lp/olp and The Co-presence Of Thyroid Nodules/malignancymentioning

confidence: 99%

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

Radu,

Carsote,

Nistor

et al. 2023

Biomedicines

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Selenium Status Associates with Thyroid Hormone and Thyroid Dysfunction in Older Chinese Adults

Li,

Su,

Shao

et al. 2024

Biol Trace Elem Res

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Thyroid dysfunction in the ageing patient

Bilookyi,

Vasiuk,

Shupik

2024

Mìžnarodnij endokrinologìčnij žurnal

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Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10–15 %. This rate is higher in older adults, with an estimated prevalence of 25 % in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. Clinical experience shows that older people with hyperthyroidism display fewer signs or symptoms compared to younger people with hyperthyroidism. Moreover, older people with normal thyroid function tests have several clinical features of hypothyroidism. These observations suggest that there may be an age-related resistance to the actions of thyroid hormones. Laboratory experiments have consistently documented an age-related blunting of response to exogenously administered thyroid hormones. This resistance to thyroid hormones action has been attributed to reduced cellular transport of thyroid hormones. In light of these observations, along with epidemiologic studies, the diagnosis and treatment of thyroid disease in older people differ from the current treatment guidelines of younger people with thyroid disease. It is noteworthy that the age-related resistance to thyroid hormones is distinct from the congenital thyroid hormone resistance syndromes. This distinction is explained by the age-related changes in pituitary responsiveness to the feedback inhibition by thyroid hormones and reduced thyroid gland response to thyrotropin. The current evidence suggests that the age-related resistance to thyroid hormones is an adaptive process to prolong life span. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients.

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Management of thyroid dysfunction and thyroid nodules in the ageing patient

Cited by 3 publications

References 121 publications

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

Selenium Status Associates with Thyroid Hormone and Thyroid Dysfunction in Older Chinese Adults

Thyroid dysfunction in the ageing patient

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