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intake causes a decrease in the incidence of AITD [ 21 ]. Xu et al. [ 22 ] found that excess iodine suppressed autophagy and promoted apoptosis of thyroid follicular cells and is thus associated with Hashimoto thyroiditis. Iodine excess also increases
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) Regarding maternal complications, the gestational period in the high-dosage group was 259.4 ± 18.1, which was significantly shorter than that in the no-ATD (276.6 ± 9.0) and low-dosage groups (276.8 ± 10.3; Table 1 ). In line with this, the incidence of
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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.
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Background: The incidence and prevalence of hypothyroidism are increasing and the threshold for the treatment of hypothyroid as well as individuals without evident thyroid disease with thyroid hormone is declining. Objective: To investigate endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients in Italy, a country where different formulations of levothyroxine (LT4; tablet, liquid solution and soft-gel capsule) are available on the market. Methods: Members of the Associazione Medici Endocrinologi (Italian Association of Clinical Endocrinologists) were invited to participate in a web-based survey investigating the topic. Results: A total of 797 of 2,028 (39.3%) members completed all the sections of the survey; 98.7% declared that the treatment of choice for hypothyroidism is LT4. A significant minority (37.3%) indicated that LT4 may be considered in infertile euthyroid women seeking pregnancy and harbouring positive thyroperoxidase antibodies (TPOAb) and in goitre increasing in size (18.1%). LT4 + LT3 was considered by 43.2% for LT4-replaced patients and normal TSH, if they reported persistent symptoms. High percentages of respondents chose LT4 in a liquid solution or soft-gel capsules when taken together with other drugs interfering with LT4 absorption (81.8%), in patients with a history of celiac disease, malabsorption, lactose intolerance, intolerance to common excipients (96.6%), or unexplained poor biochemical control of hypothyroidism (74.4%), or in patients not able to adhere to ingesting LT4 fasted and/or separated from food/drink (98.9%). In total, 43.6% of responders would use LT4 in a liquid solution or soft-gel capsules for hypothyroid patients with biochemical euthyroidism on LT4, who had persistent symptoms. Conclusions: The preferred treatment for hypothyroidism is LT4; LT3 + LT4 combination treatment is mainly considered in patients with persistent symptoms. A significant minority would offer LT4 to euthyroid women with positive TPOAb and infertility and to euthyroid patients with progressive simple goitre. Alternative LT4 formulations like liquid solution or soft-gel capsules are largely reserved for specific conditions (interfering drugs, actual or suspected malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).
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Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health (NCCH), Beijing, China
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Introduction Thyroid cancer is rare in the childhood period, the incidence in children is much lower than that in adults. In China, the incidence of differentiated thyroid cancer (DTC) in children is about 0.44 cases per 1,00,000 persons, and
Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
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risk of thyroid cancer in longstanding nodular goitre but the number of patients is small and they are not adequately followed up in some of these studies [ 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 ]. Thus, the true incidence of hormonal dysfunction
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termination of the RLN. A bilobed TZ was identified in 12 cases (4.7%). In 2 cases (0.8%), the TZ extended medial to the RLN. There was no significant difference in incidence of bilobed or retroneural TZ between left and right sides (p = 0.14 and p = 1
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Introduction The incidence of papillary thyroid cancer (PTC) has almost doubled over the last three decades mainly due to the higher incidence of papillary thyroid microcarcinoma (MPTC) [ 1 , 2 ]. In Italy, a remarkably high PTC incidence has
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] show a rapidly rising incidence of TC. This may partly be due to radiation exposure [ 9 , 10 ] and a family history of TC [ 3 ], but there is also evidence suggesting that the more widespread utility of sensitive imaging techniques has led to increased
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35.6% [ 4 , 5 ] but such tumors were definitely occult and not life threatening for these patients. The incidence of PMC has increased in recent years due to thinner histopathologic slices, advances in US and FNAB, iodine deficiency, ionized
