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manifestation of potential toxicological manifestations in the neonate [ 4 ]. The vast majority of thyroid abnormalities are chronic autoimmune diseases, which are found in approximately 5% of new mothers in the general population [ 5 ]. Hyperthyroidism due to
Department of Clinical Institute, Aalborg University, Aalborg, Denmark
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Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
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Department of Clinical Institute, Aalborg University, Aalborg, Denmark
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Department of Clinical Institute, Aalborg University, Aalborg, Denmark
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Introduction Graves’ hyperthyroidism (GH) is an autoimmune disease mainly affecting the thyroid gland ( 1 , 2 ). The disease is usually transient with remission occurring within a period of 1–2 years after treatment with anti-thyroid drugs
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Introduction Hyperthyroidism affects approximately 1% of the adult population [ 1 , 2 ]. Antithyroid drugs are commonly used to control hyperthyroidism [ 3 , 4 ]. Assuming an incidence of Graves' disease in Europe of 21/100,000 per year [ 5
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Departments of Scuola Superiore Sant'Anna, Pisa, Italy
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TH distribution and the T 3 /T 4 ratio, and to evaluate whether the effects of experimental hypo- and hyperthyroidism were homogeneous in different organs. Methods Chemicals T 4 and 3,3′,5-T 3 were purchased from Sigma-Aldrich (St
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Hyperthyroid Graves’ disease (GD) is an autoimmune thyroid disease caused by stimulating thyrotropin (TSH) receptor antibodies (TRAb). As early as the 1940s, the three components of the current therapeutic armamentarium for hyperthyroidism were
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hyperthyroidism [ 20 ]. On the other hand, two randomized studies, from China [ 21 ] and from Sweden [ 22 ], reported a faster remission of GD with Se treatment, and the Chinese trial additionally demonstrated a decrease in serum TSH receptor antibody (TRAb
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Introduction Antithyroid drugs (ATDs) are the mainstay of medical treatment for Graves’ hyperthyroidism, occurring in approximately 0.2% during pregnancy [ 1 ]. All ATDs tend to be more potent in the fetus than in the mother [ 2 - 4 ]. ATD
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Objective:
Hyperthyroidism increases cardiovascular morbidity and mortality, but the underlying mechanisms are not fully understood. In this study we compared non-invasive haemodynamics between 20 hyperthyroid patients and 60 euthyroid subjects.
Methods:
The measurements were performed median 6 days after the initiation of antithyroid medication when the patients were still hyperthyroid. Three controls matched for age, sex, body mass index, and smoking status were selected for each patient. Recordings were performed during rest and passive head-up tilt using whole-body impedance cardiography, radial pulse wave analysis, and finger blood pressure measurements.
Results:
Systolic and diastolic blood pressures in the aorta and radial artery were similar in hyperthyroid and euthyroid subjects, while finger blood pressure was 16/12 mmHg lower in hyperthyroidism (p<0.001). Pulse wave velocity and aortic pulse pressure were similar, but radial pulse pressure was ~5 mmHg higher in hyperthyroidism (p=0.040) due to augmented amplification (p=0.045). Systemic vascular resistance was reduced (-18%), whereas heart rate (+19 beats/min), cardiac index (+28%), and left cardiac work (+31%) were increased in hyperthyroidism (p<0.001). Subendocardial viability ratio, reflecting the balance between coronary perfusion and pressure load, was reduced by 19% in hyperthyroidism (p<0.001). Compared with euthyroid subjects, hyperthyroid patients presented with reductions in systolic and diastolic finger blood pressures (p<0.001), and higher increase in heart rate (p=0.014) during upright posture.
Conclusions:
Hyperthyroid patients exhibited hyperdynamic circulation, reduced vascular resistance, reduced peripheral but not central blood pressure, and higher pulse pressure amplification. Furthermore, left cardiac workload was increased in parallel with unfavourable changes in coronary perfusion conditions.
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clinicians about the possibility of fluctuating disease course in GD. Fig. 2. a Hyperthyroidism/thyrotoxicosis. b Hypothyroidism. TSH, thyroid-stimulating hormone; TRAb, thyrotropin receptor autoantibodies; FT4, free-thyroxine; FT3, free
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Objective: Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.
Methods: Randomized clinical trial including patients 50 years and older, with TSH <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I131) or to be monitored and treated only if they underwent AF or evolved towards overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.
Results: 144 patients (mean age 65.3±8.9y, 76% female) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (p=0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (p=0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age>65y or TSH<0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.
Conclusions: Due to recruitment difficulties this study failed to demonstrate that SCH treatment can reduce significantly the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.
