Thyroid disorders in the first trimester of pregnancy: a cross-sectional study

Background: Thyroid disorders in pregnancy are common and are associated with adverse maternal, fetal and neonatal effects. When the prevalence of thyroid disorders is high, then screening for thyroid disorders in early pregnancy can help improve the obstetrical outcome.Methods: Five hundred and fifty women in their first trimester of pregnancy were studied. They were investigated for estimation of free triiodo thyronine (FT3), free thyroxine (FT4) and thyroid stimulation hormone (TSH). The upper normal limit for TSH considered was 4.0 mIU/L.Results: Prevalence of thyroid disorders in the study was 12.6%. Hypothyroidism (12%) was more common than hyperthyroidism (0.6%). Subclinical hypothyroidism was present in 10%.Conclusions: Screening of thyroid disorders is to be considered for all pregnant women. As the prevalence of thyroid disorders is high, early recognition and treatment shall reduce maternal and fetal morbidity.

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.

Bilateral femoral capital physeal fractures in an adult cat with suspected congenital primary hypothyroidism

A 4-year-old, neutered male European shorthair was presented for evaluation of right hind limb lameness. Radiographs revealed bilateral femoral capital physeal fractures, widened vertebral growth plates and constipation. Physical findings included lethargy, mental dullness, mild hypothermia, retarded growth, pharyngeal stridor, moderate muscle atrophy of pelvic limbs, hair coat abnormalities, and lack of defecation and urination. A thyroid panel revealed thyroid hormone values below detection limits and high thyroid stimulation hormone values. A presumptive diagnosis of congenital primary hypothyroidism was made, however also an early onset acquired primary hypothyroidism could not be ruled out. Results of the insulin-like growth factor (IGF-1) and the parathyroid hormone as well as an adrenocorticotropic hormone stimulating test were normal. A bilateral femoral head and neck excision was performed. Levothyroxine supplementation was started at a dosage of 50 µg (11 µg/kg) BID and later adjusted to 100 µg (22 µg/kg) BID based on total thyroxine concentrations. The tomcat showed full clinical recovery and normal clinical behaviour. The case shows that primary hypothyroidism may be considered in cats presented with femoral capital physeal fractures.

Perbedaan Fungsi Tiroid pada Epilepsi yang Mendapat Pengobatan Asam Valproat dan Karbamazepin

Latar belakang. Obat-obat antiepilepsi seperti asam valproat (AVP) dan karbamazepin (KBZ) mempengaruhifungsi tiroid dengan adanya perubahan kadar TSH (thyroid stimulation hormone) dan fT4 serum(free tetraiodothyroxine). Kadar AVP meningkatkan akumulasi GABA (gama amino-butiric acid) dalamhipofisis, hal ini diduga sebagai penyebab meningkatnya kadar TSH serum karena reseptor GABA-Amempunyai afinitas yang kuat terhadap TRH (thyroid releasing hormone) untuk mengeluarkan TSH.Karbamazepin meningkatkan induksi enzim sitokrom P450 hepar, akibatnya eliminasi hormon tiroiddapat meningkat.Tujuan. Mengetahui perbedaan kadar TSH dan fT4 serum anak epilepsi yang mendapat pengobatan AVPdibandingkan KBZ.Metode. Penelitian cross sectional terhadap 60 anak epilepsi (30 AVP dan 30 KBZ) yang memenuhi kriteriainklusi dan dipilih secara selektif sampling pada bulan Juni-Juli 2007 di Poliklinik Neuropediatrik AnakRSHS, kemudian dilakukan pemeriksaan kadar TSH dan fT4 serum. Perbedaan hasil kedua kelompokdianalisis dengan uji-t untuk data distribusi normal dan uji Mann-Whitney bila uji normalitas data tidakberdistribusi normal.Hasil. Pada kelompok AVP 12 (40%) anak perempuan dan 18 (60%) laki-laki. Tidak didapatkan perbedaankarakteristik antara kedua kelompok. Sembilan subjek mempunyai kadar TSH serum meningkat, satu subjekkadar fT4 serum rendah. Kelompok KBZ, 16 (53%) perempuan dan 14 (47%) laki-laki, dua subjek kadarfT4 serum di bawah normal sedangkan TSH serum normal. Kadar TSH serum kedua kelompok berbedabermakna (p=0,043), sedangkan kadar fT4 serum tidak berbeda (p=0,871).Kesimpulan. Obat asam valproat cenderung menyebabkan subklinik hipotiroid dibanding karbamazepin

Thyroid-stimulation hormone - receptor antibodies as a predictor of thyrosuppressive drug therapy outcome in Graves’ disease patients

Introduction. Graves? disease is autoimmune hyperthyroidism caused by pathological stimulation of thyroid-stimulation hormone - receptor antibodies. The decision on changing the therapy can be made on time by determining the prognostic factors of thyrosuppressive drug therapy outcome. The aim of the study was to determine the significance of thyroid-stimulation hormone-receptor antibodies level on the prediction of therapy outcome. Material and Methods. The study was prospective and involved 106 drug-treated patients with newly diagnosed Graves? disease. Thyroid- stimulation hormone - receptor antibodies level was measured at the beginning of therapy, during therapy and 12 months after it had been introduced. Results. No statistically significant difference in the level of thyroid-stimulation hormone - receptor antibodies was found at the beginning of disease and 12 months after the introduction of thyrosuppressive drug therapy among the patients who had been in remission and those who had not. Regardless of the outcome, thyroid-stimulation hormone - receptor antibodies level significantly decreased in all patients 12 months after the therapy had been introduced. Conclusion. The level of thyroid-stimulation hormone - receptor antibodies at the beginning of disease and 12 months after the introduction of therapy cannot predict the outcome of thyrosuppressive drug therapy.