scholarly journals Amiodarone-Induced Thyrotoxic Thyroiditis: A Diagnostic and Therapeutic Challenge

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Umang Barvalia ◽  
Barkha Amlani ◽  
Ram Pathak
Keyword(s):  
Adverse Effects ◽  
Best Practices ◽  
Thyroid Tissue ◽  
Overt Hypothyroidism ◽  
Structural Resemblance ◽  
Thyroid Function Testing ◽  
Function Testing ◽  
Thyroid Abnormalities

Amiodarone is an iodine-based, potent antiarrhythmic drug bearing a structural resemblance to thyroxine (T4). It is known to produce thyroid abnormalities ranging from abnormal thyroid function testing to overt hypothyroidism or hyperthyroidism. These adverse effects may occur in patients with or without preexisting thyroid disease. Amiodarone-induced thyrotoxicosis (AIT) is a clinically recognized condition commonly due to iodine-induced excessive synthesis of thyroid, also known as type 1 AIT. In rare instances, AIT is caused by amiodarone-induced inflammation of thyroid tissue, resulting in release of preformed thyroid hormones and a hyperthyroid state, known as type 2 AIT. Distinguishing between the two states is important, as both conditions have different treatment implications; however, a mixed presentation is not uncommon, posing diagnostic and treatment challenges. We describe a case of a patient with amiodarone-induced type 2 hyperthyroidism and review the current literature on the best practices for diagnostic and treatment approaches.

scholarly journals A novel melanoma therapy stirs up a storm: ipilimumab-induced thyrotoxicosis

2015 ◽  
Vol 2015 ◽  
Author(s):  
Christine Yu ◽  
Inder J Chopra ◽  
Edward Ha
Keyword(s):  
Adverse Effects ◽  
T Lymphocyte ◽  
Autoimmune Thyroiditis ◽  
Cytotoxic T Lymphocyte ◽  
Alternative Therapy ◽  
Thyroid Storm ◽  
Iopanoic Acid ◽  
Immune Mediated ◽  
Thyroid Function Testing ◽  
Function Testing

Summary Ipilimumab, a novel therapy for metastatic melanoma, inhibits cytotoxic T-lymphocyte apoptosis, causing both antitumor activity and significant autoimmunity, including autoimmune thyroiditis. Steroids are frequently used in treatment of immune-related adverse events; however, a concern regarding the property of steroids to reduce therapeutic antitumor response exists. This study describes the first reported case of ipilimumab-associated thyroid storm and implicates iopanoic acid as an alternative therapy for immune-mediated adverse effects. An 88-year-old woman with metastatic melanoma presented with fatigue, anorexia, decreased functional status, and intermittent diarrhea for several months, shortly after initiation of ipilimumab – a recombinant human monoclonal antibody to the cytotoxic T-lymphocyte-associated antigen 4 (CTLA4). On arrival, she was febrile, tachycardic, and hypertensive with a wide pulse pressure, yet non-toxic appearing. She had diffuse, non-tender thyromegaly. An electrocardiogram (EKG) revealed supraventricular tachycardia. Blood, urine, and stool cultures were collected, and empiric antibiotics were started. A computed tomography (CT) angiogram of the chest was negative for pulmonary embolism or pneumonia, but confirmed a diffusely enlarged thyroid gland, which prompted thyroid function testing. TSH was decreased at 0.16 μIU/ml (normal 0.3–4.7); free tri-iodothyronine (T3) was markedly elevated at 1031 pg/dl (normal 249–405), as was free thyroxine (T4) at 5.6 ng/dl (normal 0.8–1.6). With iopanoic acid and methimazole therapy, she markedly improved within 48 h, which could be attributed to lowering of serum T3 with iopanoic acid rather than to any effect of the methimazole. Ipilimumab is a cause of overt thyrotoxicosis and its immune-mediated adverse effects can be treated with iopanoic acid, a potent inhibitor of T4-to-T3 conversion. Learning points While ipilimumab more commonly causes autoimmune thyroiditis, it can also cause thyroid storm and clinicians should include thyroid storm in their differential diagnosis for patients who present with systemic inflammatory response syndrome. Immune-related adverse reactions usually occur after 1–3 months of ipilimumab and baseline thyroid function testing should be completed before initiation with ipilimumab. Conflicting data exist on the use of prednisone for treatment of CTLA4 adverse effects and its attenuation of ipilimumab's antitumor effect. Iopanoic acid may be considered as an alternative therapy in this setting.

scholarly journals Changes in the prevalence of hypothyroidism: the HUNT Study in Norway

2013 ◽  
Vol 169 (5) ◽  
pp. 613-620 ◽  
Author(s):  
Bjørn Olav Åsvold ◽  
Lars J Vatten ◽  
Trine Bjøro
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Prevalence Ratio ◽  
Easy Access ◽  
Overt Hypothyroidism ◽  
Population Surveys ◽  
Thyroid Function Testing ◽  
Hunt Study ◽  
Function Testing ◽  
Levothyroxine Treatment

ObjectiveUntreated hypothyroidism is common in iodine-replete areas. Frequent thyroid function testing and use of levothyroxine treatment for subclinical hypothyroidism suggest that the prevalence may have decreased. Therefore, in this study, we examined changes in the prevalence of hypothyroidism in a Norwegian county from 1995–1997 to 2006–2008.DesignPopulation surveys of 33 917 individuals in 1995–1997 and 49 180 individuals in 2006–2008 were carried out.MethodsWe compared the prevalence of untreated overt, untreated subclinical, and treated hypothyroidism between 1995–1997 and 2006–2008.ResultsThe prevalence of untreated overt hypothyroidism among women decreased by 84% from 1995–1997 (0.75%) to 2006–2008 (0.12%) (prevalence ratio (PR) 0.16; 95% CI 0.10–0.26). The corresponding decrease among men was 43% from 0.21 to 0.12% (PR 0.57; 95% CI 0.28–1.16). The prevalence of untreated subclinical hypothyroidism decreased by 64% from 3.0 to 1.1% in women (PR 0.36; 95% CI 0.31–0.42) and decreased by 54% from 2.1 to 1.0% in men (PR 0.46; 95% CI 0.38–0.56). Conversely, the prevalence of treated hypothyroidism among women increased by 60% from 5.0 to 8.0% (PR 1.60, 95% CI 1.50–1.71), and the corresponding prevalence in men doubled from 1.0 to 2.0% (PR 1.96; 95% CI 1.59–2.41). The prevalence of any form of hypothyroidism remained essentially similar at 9% in women and 3% in men.ConclusionsThe prevalence of untreated hypothyroidism in this Norwegian county decreased strongly from 1995–1997 to 2006–2008. The findings suggest that the prevalence of untreated hypothyroidism in populations with easy access to thyroid function testing and levothyroxine treatment may now be low.

scholarly journals Diagnostic Values of Free Triiodothyronine and Free Thyroxine and the Ratio of Free Triiodothyronine to Free Thyroxine in Thyrotoxicosis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Xinxin Chen ◽  
Yulin Zhou ◽  
Mengxi Zhou ◽  
Qinglei Yin ◽  
Shu Wang
Keyword(s):  
Operating Characteristic ◽  
Thyroid Tissue ◽  
Curve Analysis ◽  
Free Thyroxine ◽  
Roc Curve Analysis ◽  
Free Triiodothyronine ◽  
Diagnostic Values ◽  
Painless Thyroiditis

Background. The results of previous studies on the usefulness of free triiodothyronine (FT3) to free thyroxine (FT4) are controversial. We investigated the usefulness of FT3, FT4, and FT3/FT4 ratio in differentiating Graves’ disease (GD) from destructive thyroiditis. Methods. A total of 126 patients with untreated GD, 36 with painless thyroiditis, 18 with painful subacute thyroiditis, and 63 healthy controls, were recruited. The levels of FT3 and FT4 and the FT3/FT4 ratios for the different etiologies of thyrotoxicosis were evaluated separately by receiver operating characteristic (ROC) curve analysis. The expression levels of type 1 and type 2 deiodinase (DIO1 and DIO2) in thyroid tissues were also investigated. Results. The optimal cut-off values were 7.215 pmol/L for FT3, 21.71 pmol/L for FT4, and 0.4056 for the FT3/FT4 ratio. The specificity and positive predictive value of the FT3/FT4 ratio were highest for values > 0.4056. DIO1 mRNA expression was significantly higher in the thyroid tissue of patients with GD (P=0.013). Conclusions. We demonstrated that the FT3/FT4 ratio was useful in differentiating GD from destructive thyroiditis. In addition, a relatively high expression of type 1 deiodinase in the thyroid might be responsible for the high FT3/FT4 ratio in patients with GD.

Thyroid disease during pregnancy

2011 ◽  
pp. 547-552 ◽  
Author(s):  
John H. Lazarus ◽  
L.D. Kuvera ◽  
E. Premawardhana
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Childbearing Age ◽  
Thyroid Function Testing ◽  
Appropriate Therapy ◽  
Function Testing ◽  
In Pregnancy

Thyroid disorders are common. The prevalence of hyperthyroidism is around 5/1000 in women and overt hypothyroidism about 3/1000 in women. Subclinical hypothyroidism has a prevalence in women of childbearing age in iodine-sufficient areas of between 4% and 8%. As these conditions are generally much more common in females, it is to be expected that they will appear during pregnancy. Developments in our understanding of thyroid physiology (1) and immunology (2) in pregnancy, as well as improvements in thyroid function testing (3), have highlighted the importance of recognizing and providing appropriate therapy to women with gestational thyroid disorders. Before considering the clinical entities occurring during and after pregnancy it is useful to briefly review thyroid physiology and immunology in relation to pregnancy.

scholarly journals Thyroid Abnormalities in Relation to Type 1 and Type 2 Diabetes Mellitus Patients in Quetta, Balochistan

2020 ◽  
Author(s):  
Mohsin Ali ◽  
Nargis Haider Kakar ◽  
Rida Dawood ◽  
Qurat-ul-ain Fatima ◽  
Zunera Tanveer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Thyroid Abnormalities

scholarly journals Ocular Dominance and Visual Function Testing

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
D. Lopes-Ferreira ◽  
H. Neves ◽  
A. Queiros ◽  
M. Faria-Ribeiro ◽  
S. C. Peixoto-de-Matos ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Visual Function ◽  
Ocular Dominance ◽  
Low Contrast ◽  
Dominant Eye ◽  
Type 3 ◽  
Function Testing

Purpose. To show the distribution of ocular dominance as measured with sensory and eye sighting methods and its potential relationship with high and low contrast LogMAR visual acuity in presbyopic subjects.Method. Forty-four presbyopes (48.5 ± 3.5 years) participated in this study. Ocular dominance was determined by eye sighting (hole-in-card) and sensorial (+1.50 D lens induced blur) methods. According to the dominance detected with each method (RE: right eye or LE: left eye), patients were classified in dominance type 1 (RE/RE), type 2 (RE/LE), type 3 (LE/RE) and type 4 (LE/LE).Results. Baseline refractive error (MSE) was RE:−0.36 ± 1.67 D and LE:−0.35 ± 1.85 D (P=0.930). RE was the dominant eye in 61.4% and 70.5% of times as obtained from sensorial and sighting methods, respectively. Most frequent dominance was of type 1 (52.3%), in this case the RE showed statistically significant better distance low contrast LogMAR VA (0.04 LogMAR units) compared to the LE (P<0.05).Conclusions. The dominance was more frequent in RE in this sample. The eye sighting and sensorial methods to define ocular dominance agreed in more than half of cases. Amount of MSE was not significantly different between dominant and non-dominant eye. But in case of right dominance, the RE presented better distance low contrast VA compared to the LE.

scholarly journals Dealing with pre-exposure prophylaxis-associated condom migration: changing the paradigm for men who have sex with men

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 106 ◽  
Author(s):  
Richard A. Crosby
Keyword(s):  
Best Practices ◽  
Population Level ◽  
Dual Use ◽  
Sexually Transmissible Infections ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Type 2 Errors ◽  
Behavioural Aspects

The behavioural aspects of pre-exposure prophylaxis (PrEP) are challenging, particularly the issue of condom migration. Three vital questions are: (1) at the population-level, will condom migration lead to increases in non-viral sexually transmissible infections?; (2) how can clinic-based counselling best promote the dual use of condoms and PrEP?; and (3) in future PrEP trials, what are the ‘best practices’ that should be used to avoid type 1 and type 2 errors that arise without accounting for condom use behaviours? This communication piece addresses each question and suggests the risk of a ‘PrEP only’ focus to widening health disparities.

scholarly journals Thyroid Dysfunction in Non-Interferon Treated Hepatitis C Patients Residing in Hepatitis Endemic Area

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Nayab Batool ◽  
Shan Elahi ◽  
Nazish Saleem ◽  
Abrar Ashraf
Keyword(s):  
Hepatitis C ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Overt Hypothyroidism ◽  
Interferon Treatment ◽  
Thyroid Function Testing ◽  
Male Patients ◽  
The Difference ◽  
Function Testing

Background. Association of thyroid dysfunction (TD) with interferon treatment of HCV is well known to clinicians. However, a few studies have highlighted the role of hepatitis C virus per se in the development of TD. The aim of this study was to know the prevalence of TD in non-interferon treated HCV infected patients referred for thyroid function testing.Patients and Methods. Among 557 ELISA-positive HCV patients 446 (341 females, 105 males) were selected for this study. Serums FT4, FT3, and TSH were determined by radioimmunoassay method.Results. TD was detected in 15.2% of patients: 9.0% hypothyroidism and 6.3% hyperthyroidism. In increasing order subclinical hypothyroidism, overt hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism were found in 4.7%, 4.3%, 3.6%, and 2.7% patients, respectively. Overall TD was more common in female than in male HCV patients but the difference was not significant (16.1% versus 12.4%;p=0.648). Hyperthyroidism and subclinical hypothyroidism were slightly more common in female and overall hypothyroidism and overt hypothyroidism in male patients but the difference was not statistically significant (p>0.05). The incidence of TD was relatively high in patients above 36 years (median age) but the difference was not statistically significant either collectively or in gender base groups (p>0.05).Conclusion. Prior to interferon treatment, HCV infection itself causes biochemical thyroid dysfunction in 15.2% of local HCV patients.

scholarly journals Thyroid over-expression of type 1 and type 2 deiodinase may account for the syndrome of low thyroxine and increasing triiodothyronine during propylthiouracil treatment

2003 ◽  
pp. 443-447 ◽  
Author(s):  
AP Weetman ◽  
CA Shepherdley ◽  
P Mansell ◽  
CS Ubhi ◽  
TJ Visser
Keyword(s):  
Thyroid Tissue ◽  
Graves Disease ◽  
Similar Response ◽  
Over Expression ◽  
Thyroid Stimulating Antibodies ◽  
Hormone Profile ◽  
Rapid Fall ◽  
Very High

Although propylthiouracil inhibits type 1 deiodinase, leading to a more rapid fall in triiodothyronine (T(3)) than thyroxine (T(4)) levels in patients treated for hyperthyroidism, we report a patient with Graves' disease whose free T(3) paradoxically rose during such treatment, despite low free T(4) levels and increasing doses of propylthiouracil. A similar response has previously been associated with high levels of thyroid stimulating antibodies, but it has been unclear why there should be a dichotomy in the circulating thyroid hormone profile. Thyroid tIssue from our patient contained very high levels of type 1 and, especially, type 2 deiodinase, in contrast to other patients treated with Graves' disease, which were most likely secondary to high levels of thyroid stimulating antibodies. This unusual response to propylthiouracil is important to recognise therapeutically, and represents a further situation in which abnormal expression of deiodinase enzymes has clinical significance.

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