Search Results

You are looking at 1 - 5 of 5 items for

  • Author: Simon H S Pearce x
Clear All Modify Search
Simon H.S. Pearce Institute of Genetic Medicine, Newcastle University and Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK;

Search for other papers by Simon H.S. Pearce in
Google Scholar
PubMed
Close
,
Mario Vaisman Department of Endocrinology, Faculdade de Medicina, UFRJ, Rio de Janeiro, Brazil;

Search for other papers by Mario Vaisman in
Google Scholar
PubMed
Close
, and
Jean-Louis Wemeau Clinique Endocrinologique Marc Linquette, CHU, Lille, France

Search for other papers by Jean-Louis Wemeau in
Google Scholar
PubMed
Close

Subclinical hypothyroidism is a common finding when serum thyrotropin and thyroid hormones are measured, but the benefits of treating such patients with levothyroxine remain unproven. During the 14th International Thyroid Congress, a debate and discussion relating to three different clinical case scenarios of subclinical hypothyroidism was held. The audience consisted predominantly of members of the European Thyroid Association. Participants (n = 380) voted using an electronic system to express their opinion about the treatment of the 3 cases. For a 53-year-old woman with fatigue and difficulty losing weight, who has a serum TSH of 6.8 mU/l, 49% would treat with levothyroxine. Whereas, for an 84-year-old woman with a serum TSH of 6.8 mU/l, only 8% of participants would treat with levothyroxine. In contrast, for a 39-year-old woman who is trying to become pregnant, with a serum TSH of 4.5 mU/l and strongly positive thyroid peroxidase antibodies, 95% of respondents would treat with levothyroxine. This article details the clinical case scenarios and the results of the thyroidologists’ opinions on treatment. It forms a snapshot of the range of accepted clinical practice in this common condition.

Free access
Simon H.S. Pearce Institute of Genetic Medicine, Newcastle University
Royal Victoria Infirmary, Newcastle upon Tyne, UK

Search for other papers by Simon H.S. Pearce in
Google Scholar
PubMed
Close
,
Georg Brabant Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

Search for other papers by Georg Brabant in
Google Scholar
PubMed
Close
,
Leonidas H. Duntas Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece

Search for other papers by Leonidas H. Duntas in
Google Scholar
PubMed
Close
,
Fabio Monzani Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy

Search for other papers by Fabio Monzani in
Google Scholar
PubMed
Close
,
Robin P. Peeters Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

Search for other papers by Robin P. Peeters in
Google Scholar
PubMed
Close
,
Salman Razvi Institute of Genetic Medicine, Newcastle University
Queen Elizabeth Hospital, Gateshead, UK

Search for other papers by Salman Razvi in
Google Scholar
PubMed
Close
, and
Jean-Louis Wemeau Clinique Endocrinologique Marc Linquette, CHU, Lille, France

Search for other papers by Jean-Louis Wemeau in
Google Scholar
PubMed
Close

Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT<sub>4</sub> within reference range, should be investigated with a repeat measurement of both serum TSH and FT<sub>4</sub>, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with <smlcap>L</smlcap>-thyroxine is recommended for younger patients (<65-70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of <smlcap>L</smlcap>-thyroxine replacement therapy should be considered. For such patients who have been started on <smlcap>L</smlcap>-thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, <smlcap>L</smlcap>-thyroxine therapy should generally be stopped. Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people. The oldest old subjects (>80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral <smlcap>L</smlcap>-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting <smlcap>L</smlcap>-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on <smlcap>L</smlcap>-thyroxine treatment, then serum TSH should be monitored at least annually thereafter.

Free access
Leonidas H. Duntas Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece

Search for other papers by Leonidas H. Duntas in
Google Scholar
PubMed
Close
,
Georg Brabant Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

Search for other papers by Georg Brabant in
Google Scholar
PubMed
Close
,
Fabio Monzani Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy

Search for other papers by Fabio Monzani in
Google Scholar
PubMed
Close
,
Simon H.S. Pearce Institute of Genetic Medicine, Newcastle University, UK
Royal Victoria Infirmary, Newcastle upon Tyne, UK

Search for other papers by Simon H.S. Pearce in
Google Scholar
PubMed
Close
,
Robin Patrick Peeters Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

Search for other papers by Robin Patrick Peeters in
Google Scholar
PubMed
Close
,
Salman Razvi Institute of Genetic Medicine, Newcastle University, UK
Queen Elizabeth Hospital, Gateshead, UK

Search for other papers by Salman Razvi in
Google Scholar
PubMed
Close
, and
Jean-Louis Wemeau Clinique Endocrinologique Marc-Linquette, CHU, Lille, France

Search for other papers by Jean-Louis Wemeau in
Google Scholar
PubMed
Close
Free access
Christiaan F Mooij Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

Search for other papers by Christiaan F Mooij in
Google Scholar
PubMed
Close
,
Timothy D Cheetham Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
Department of Pediatric Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

Search for other papers by Timothy D Cheetham in
Google Scholar
PubMed
Close
,
Frederik A Verburg Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands

Search for other papers by Frederik A Verburg in
Google Scholar
PubMed
Close
,
Anja Eckstein Department of Ophthalmology, University Duisburg Essen, Essen, Germany

Search for other papers by Anja Eckstein in
Google Scholar
PubMed
Close
,
Simon H Pearce Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
Endocrine Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

Search for other papers by Simon H Pearce in
Google Scholar
PubMed
Close
,
Juliane Léger Department of Pediatric Endocrinology and Diabetes, Reference Center for Rare Endocrine Growth and Development Diseases, Endo-ERN HCP, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, University of Paris, NeuroDiderot Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France

Search for other papers by Juliane Léger in
Google Scholar
PubMed
Close
, and
A S Paul van Trotsenburg Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

Search for other papers by A S Paul van Trotsenburg in
Google Scholar
PubMed
Close

Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults – antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (3 years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.

Open access
Claire L Wood Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

Search for other papers by Claire L Wood in
Google Scholar
PubMed
Close
,
Niamh Morrison Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

Search for other papers by Niamh Morrison in
Google Scholar
PubMed
Close
,
Michael Cole Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK

Search for other papers by Michael Cole in
Google Scholar
PubMed
Close
,
Malcolm Donaldson Department of Child Health, University of Glasgow School of Medicine, Glasgow, UK

Search for other papers by Malcolm Donaldson in
Google Scholar
PubMed
Close
,
David B Dunger Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
Wellcome Trust-MRC Institute of Metabolic Sciences, University of Cambridge, Cambridge, UK

Search for other papers by David B Dunger in
Google Scholar
PubMed
Close
,
Ruth Wood Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK

Search for other papers by Ruth Wood in
Google Scholar
PubMed
Close
,
Simon H S Pearce Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
Department of Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

Search for other papers by Simon H S Pearce in
Google Scholar
PubMed
Close
, and
Timothy D Cheetham Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

Search for other papers by Timothy D Cheetham in
Google Scholar
PubMed
Close
on behalf of the British Society for Paediatric Endocrinology and Diabetes (BSPED)

Objective

Patients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT).

Design

A multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We compared the biochemical response to BR/DT in the first 6 months of therapy.

Methods

Patients commenced 0.75 mg/kg carbimazole (CBZ) daily with randomisation to BR/DT. We examined baseline patient characteristics, CBZ dose, time to serum thyroid-stimulating hormone (TSH)/free thyroxine (FT4) normalisation and BMI Z-score change.

Results

There were 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in time to non-suppressed TSH concentration; 16 of 39 patients (BR) and 11 of 39 (DT) had suppressed TSH at 6 months. Patients with suppressed TSH had higher mean baseline FT4 levels (72.7 vs 51.7 pmol/L; 95% CI for difference 1.73, 31.7; P = 0.029). Time to normalise FT4 levels was reduced in DT (log-rank test, P = 0.049) with 50% attaining normal FT4 at 28 days (95% CI 25, 32) vs 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (95% CI for difference 0.57, 0.86; P < 0.001) and was greatest in patients with higher baseline FT4 concentrations.

Conclusions

DT-treated patients normalised FT4 concentrations more quickly than BR. Overall, 94% of patients have normal FT4 levels after 6 months, but 33% still have TSH suppression. Excessive weight gain occurs with both BR and DT therapy.

Open access