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1.
Thyrotoxicosis: Diagnosis and Management.
Sharma, A, Stan, MN
Mayo Clinic proceedings. 2019;(6):1048-1064
Abstract
Thyrotoxicosis is the clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. Hyperthyroidism, a subset of thyrotoxicosis, refers specifically to excess thyroid hormone synthesis and secretion by the thyroid gland. We performed a review of the literature on these topics utilizing published data in PubMed and MEDLINE. In this review, we discuss the more common etiologies of thyrotoxicosis, focusing on the current approach to diagnosis and management, new trends in those directions, and potential upcoming changes in the field.
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2.
Congenital Hypothyroidism.
Wassner, AJ
Clinics in perinatology. 2018;(1):1-18
Abstract
Congenital hypothyroidism is common and can cause severe neurodevelopmental morbidity. Prompt diagnosis and treatment are critical to optimizing long-term outcomes. Universal newborn screening is an important tool for detecting congenital hypothyroidism, but awareness of its limitations, repeated screening in high-risk infants, and a high index of clinical suspicion are needed to ensure that all affected infants are appropriately identified and treated. Careful evaluation will usually reveal the etiology of congenital hypothyroidism, which may inform treatment and prognosis. Early and adequate treatment with levothyroxine results in excellent neurodevelopmental outcomes for most patients with congenital hypothyroidism.
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3.
Bilateral Keratoconus Induced by Secondary Hypothyroidism After Radioactive Iodine Therapy.
Lee, R, Hafezi, F, Randleman, JB
Journal of refractive surgery (Thorofare, N.J. : 1995). 2018;(5):351-353
Abstract
PURPOSE To present a case of new-onset, bilateral, rapidly progressive keratoconus induced by secondary hypothyroidism after radioactive iodine therapy during the sixth decade of life that was successfully treated with corneal cross-linking. METHODS Case report and literature review. RESULTS A 53-year-old woman with no ocular complaints but with a history of Graves' disease and thyrotoxicosis was treated with radioactive iodine therapy and oral levothyroxine for secondary acquired hypothyroidism 3 years prior. Initially, uncorrected distance visual acuity (UDVA) was 20/40 and corrected distance visual acuity (CDVA) was 20/25 in both eyes. Over the following 3 years, the patient developed worsening UDVA and CDVA, with increasing manifest astigmatism of greater than 7.00 diopters (D) in the right eye and 4.75 D in the left eye, with corneal thinning and focal steepening and was diagnosed as having bilateral progressive keratoconus. The patient underwent sequential corneal cross-linking with resultant postoperative CDVA of 20/20 and reduced maximum keratometry and manifest astigmatism in both eyes. The patient's thyroid levels were within normal limits throughout the clinical course. CONCLUSIONS This case provides evidence of the relationship between keratoconus development and thyroid gland dysfunction. The pathophysiology of this relationship has yet to be completely elucidated, but elevated levels of thyroxine in the aqueous humor and tear film and thyroxine receptors in the cornea likely play a role. Screening topographies for patients with thyroid gland dysfunction may be of value for these higher risk patients. [J Refract Surg. 2018;34(5):351-353.].
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4.
Horner syndrome as a complication after thyroid microwave ablation: Case report and brief literature review.
Zhang, X, Ge, Y, Ren, P, Liu, J, Chen, G
Medicine. 2018;(34):e11884
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Abstract
RATIONALE Horner's syndrome (HS) can present as a complication of thyroid surgery, particularly after thyroid microwave ablation (MWA). HS presents clinically with eyelid ptosis, miosis, enophthalmos, anhidrosis, and vascular dilatation, all of which result from a damaged oculosympathetic chain. We aimed to try to avoid such devastating symptoms in future cases by exploring reasons for the destruction of the cervical sympathetic trunk. PATIENT CONCERNS HS has previously been reported in the literature as a complication of thyroid surgery. Here, we report the case of a 44-year-old female patient who presented with miosis and eyelid ptosis following thyroid MWA. DIAGNOSES This patient was subsequently diagnosed with HS. INTERVENTIONS Mecobalamin was administered immediately. OUTCOMES After 5 months of follow up, the patient's miosis and ptosis was incompletely relieved. LESSONS Although HS is a rare complication of thyroid MWA, surgeons must be aware of the anatomic relationship of the cervical sympathetic trunk and thyroid gland with adjacent structures. Moreover, we hope this case presentation enables surgeons to take measures to minimize the possibility of oculosympathetic damage. Long-term follow up and comprehensive assessments are important for the patient's prognosis.
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5.
Neuroendocrine aspects of anorexia nervosa and bulimia nervosa.
Baranowska, B, Kochanowski, J
Neuro endocrinology letters. 2018;(3):172-178
Abstract
Endocrine dysfunctions in eating disorders (anorexia nervosa, bulimia nervosa) result from disturbed regulation of hypothalamo-pituitary-gonadal, hypothalamo-pituitary-adrenal, hypothalamo-pituitary-thyroid and hypothalamo-pituitary-GH-IGF1 axes as well as of altered peripheral endocrine metabolism. Some peptides of hypothalamic origin, as well as those secreted by the adipose tissue and gastrointestinal tract including pancreatic hormones, are involved in the control of appetite and satiety. These peptides play also an important role in the mechanism of hormonal secretion. Altered activity of these biologically active substances may lead to the disturbances in the regulation of energy and hormonal homeostasis.
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6.
WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 4. Thyroid.
Cosgrove, D, Barr, R, Bojunga, J, Cantisani, V, Chammas, MC, Dighe, M, Vinayak, S, Xu, JM, Dietrich, CF
Ultrasound in medicine & biology. 2017;(1):4-26
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques including basic science, breast and liver. Here we present elastography in thyroid diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of thyroid diseases.
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7.
The Role of Radiopharmaceuticals in Amiodarone-Induced Thyroid Pathology.
Irimie, A, Piciu, D
Current radiopharmaceuticals. 2017;(3):146-154
Abstract
BACKGROUND AND OBJECTIVE The use of amiodarone for the treatment of ventricular and supraventricular dysrhythmias brings in organism an increased amount of iodine, interfering with thyroid function. If the treatment needs to be interrupted, iodine remains at abnormal levels for months or even years. The aim of the study was to review the literature regarding the optimal tests for early diagnostic and to analyze the role of nuclear medicine tests in the differential and correct assessment of the amiodarone-induced thyroid pathology. METHODS We made a review of available publications in PUBMED referring the amiodaroneinduced thyroid pathology, focusing on the differential diagnosis, made by nuclear medicine tests, of hypothyroidism (AIH) and hyperthyroidism expressed as: type I amiodarone induced thyrotoxicosis (AIT I), type II amiodarone induced thyrotoxicosis (AIT II), and less frequently as a mixt form, type III amiodarone induced thyrotoxicosis (AIT III). We presented cases from the database of a tertiary center in Cluj-Napoca, Romania. RESULTS Despite the frequent complication of thyroid function, this pathology is underestimated and diagnosed. There is a limited number of studies and clear protocols, especially in the mixed forms cases. This increase in iodine uptake interferes seriously with thyroid hormone production and release. The nuclear medicine tests are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The destruction of the follicular cells can result in the release of excessive thyroid hormone into the circulation, with potential development of atrial fibrillation, worsening the cardiac disease, so any benefic therapeutic procedure should be known; the use of radioiodine as therapy alternative, despite the known limitations induced by blockade was clear benefic in the case presented. A special attention needs to be addressed to those patients with differentiated thyroid cancer, which will be submitted to radioiodine therapy and are under chronic therapy with amiodarone. CONCLUSION The nuclear medicine procedures are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The radioiodine is not recommended in AIT, due to stunning effect induced by iodine excess, but in some special, lifethreatening condition, radioiodine I-131 might be a treatment option.
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8.
A Systematic Review of the Methods of Diagnostic Accuracy Studies of the Afirma Gene Expression Classifier.
Duh, QY, Busaidy, NL, Rahilly-Tierney, C, Gharib, H, Randolph, G
Thyroid : official journal of the American Thyroid Association. 2017;(10):1215-1222
Abstract
BACKGROUND The Afirma® Gene Expression Classifier (GEC) risk stratifies The Bethesda System for the Reporting of Thyroid Cytopathology class III/IV (indeterminate) thyroid nodules (ITNs) as suspicious for malignancy or benign. Several authors have published studies describing the diagnostic accuracy of the GEC. However, the quality of these methods has not been rigorously examined. SUMMARY In this study, MEDLINE and EMBASE were searched for studies published between January 1, 2010, and June 30, 2016, examining the sensitivity, specificity, negative predictive value, and positive predictive value of the GEC. The Quality of Diagnostic Accuracy Studies 2 was customized to evaluate the methods of included studies in each of four domains: nodule selection, index test execution, reference standard assignment, and flow and timing. Signaling questions were used to identify sources of potential bias in calculation of diagnostic accuracy, and issues of applicability were assessed. Three panelists applied the Quality of Diagnostic Accuracy Studies 2 tool to each study included, and divergence was resolved in conference. In 12 studies evaluated, the most common methodologic flaw was lack of reference standard diagnosis assignment to un-excised GEC-benign ITNs. Exclusion of these ITNs from the analyses resulted in unreliable estimates of specificity and negative predictive value. Other flaws identified included restriction to ITNs that had already been selected for referral for thyroidectomy or lobectomy. CONCLUSIONS Future studies should define and assign a "true negative" label to GEC-benign nodules that do not develop malignant signs or symptoms during a pre-specified period of follow-up, and these nodules should be included in calculations of diagnostic accuracy.
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9.
Effect of excess iodine intake on thyroid on human health.
Koukkou, EG, Roupas, ND, Markou, KB
Minerva medica. 2017;(2):136-146
Abstract
The recommended daily intake of iodide, is 150 μg for adolescents and adults, 250 μg for pregnancy and lactation. Thyroid gland is an effective collector of iodine. The active iodine uptake along the basolateral membrane of thyroid cell is followed by its transport to the apical edge of the cell and then to the follicle lumen. TSH acts through cAMP and stimulates NIS gene expression and protein synthesis. The major proportion of iodine in the thyroid gland is bound to Thyroglobulin. The non-organic intrathyroidal iodine is usually low, but significantly greater compared to plasma. Large doses of iodine reduce both the uptake and the organification (Wolff-Chaikoff effect) and cause partial inhibition of Tg proteolysis. The thyroid gland has several protective mechanisms resulting on the maintenance of normal thyroid function despite wide fluctuations of the daily iodine intake. Ingestion of several commonly used drugs and food conservatives results in acute or chronic excessive iodine intake. Failure to escape from the iodine induced organification inhibition can cause hypothyroidism, which is temporary and subsides after iodine exposure ceases. Iodine excess may also establish a status of excessive thyroid hormone synthesis and release, thus inducing autonomic thyroid function in iodopenic areas or can contribute to the development of iodine-induced hyperthyroidism in iodine abundant areas. The anti-arrhythmic Amiodarone, is a benzofuranic product with a very high iodine content, is associated with either hypo- or hyperthyroidism development. In the presence of defective auto-protective mechanisms, excessive iodine ingestion can divert the normal thyroid function.
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10.
Role of Iodine in Metabolism.
Zbigniew, S
Recent patents on endocrine, metabolic & immune drug discovery. 2017;(2):123-126
Abstract
The natural resources of iodine are seawater, seaweeds and saltpeter-nitrate deposits in Chile. Over 1/3 of the global population is exposed to iodine deficiency, especially in the mountains. Iodine is a component of the thyroid hormones and a strong antioxidant with electric potential of -0.54 V. Iodine as iodide is taken up by the thyroid gland, gastric mucosa, salivary glands and mammary glands in pregnant and breast-feeding women. The transport of iodine to the thyroid gland is regulated by specific enzymes: Natrium Iodine Symporter, Na+/K+ATPase, Pendrin and Apical Iodine Transporter. In the thyrocytes, the thyroid hormones biosynthesis is carried out by iodization of tyrosine to T3 and T4. Secretion of T3 and T4 is regulated by TSH. On the tissue level, the active hormones are T3 and its derivative thyroamine. The most important target is the cardiac muscle, where T3 action results in an increase in the inotropic action and thyroamines exert a negative inotropic and chronotropic effects. The consequences of iodine deficiency are endemic goiter, irreversible brain damage, cretinism, impaired thyroid function and thyroid, gastric and mammary glands cancers. In 1994, the World Health Organization proposed the main strategy for iodine prophylaxis, i.e. Universal Salt Iodization. In Poland, a new model of iodine prophylaxis was introduced in 1996; the model includes obligatory iodization of household salt and neonate formulas and recommendation to take an additional daily dose of iodine for pregnant and breast-feeding women. This model allowed for eliminating endemic goiter in schoolchildren, eradicating cretinism in mountainous areas, and markedly diminished thyroid and gastric cancer incidence. In 2002, WHO classified Poland as a country with a proper daily iodine intake on the population level. No relevant patents were reported for this WHO report.