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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.
Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
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Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
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Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
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Objective
This study aimed to assess selenium status in South Korean pregnant women and its impact on maternal thyroid function and pregnancy outcomes.
Methods
‘Ideal Breast Milk (IBM) Cohort Study’ included 367 pregnant women out of 442 participants and categorized into three groups based on plasma selenium levels: deficient (< 70 μg/L), suboptimal (70–99 μg/L), and optimal (≥ 100 μg/L). During the second or third trimester, various blood parameters, including selenium, thyroid-stimulating hormone, free T4, free T3, and anti-thyroid peroxidase antibody levels, were measured. Thyroid parenchymal echogenicity was assessed as another surrogate marker for thyroid autoimmunity using ultrasonography.
Results
The median plasma selenium was 98.8 (range: 46.7–206.4) μg/L, and 30 individuals (8%) were categorized as deficient, while 164 (45%) were classified in the suboptimal group. Selenium deficiency was associated with markers of autoimmune thyroiditis, including positive anti-thyroid peroxidase antibody results (13.3 (deficient) vs 4.6 (optimal) %, P = 0.031) and thyroid parenchymal heterogeneity on ultrasound (33.3 (deficient) vs 14.6 (suboptimal) vs 17.3 (optimal) %, P = 0.042), independently of gestational age. The incidence of severe preeclampsia was higher in the group not taking selenium supplements, particularly among those with twin pregnancies, compared to the group taking selenium supplements (0 (selenium supplement) vs 9.0 (no supplement) %, P = 0.015).
Conclusion
Pregnant women experience mild selenium deficiency, which can lead to significant health issues including maternal thyroid autoimmunity and obstetrical complications during pregnancy. Guidelines for appropriate selenium intake according to the stage of pregnancy and the number of fetuses are needed.
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(ATA) [ 2 ] and in 2012 the Endocrine Society (ES) [ 3 ] published clinical guidelines on thyroid and pregnancy. Both sets of guidelines cover the entire gamut of thyroid dysfunction during pregnancy and postpartum including hypothyroidism
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possible to insure a fair quality of life and prevent long-term complications. To provide patients with the best quality care, an overwhelming amount of recent scientific information has to be mastered. To that end, guidelines have been issued by scientific
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, the ‘European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques' report the consensus of a panel of experts in the postoperative management of patients with thyroid cancer [ 2 ]. Based on the current
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. References 1 Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L: European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: The EU-TIRADS. Eur Thyroid J 2017; 6: 225–237. 10
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rejection rate has gone up to 57%. In 2013 we published 3 Editorials, 3 European Thyroid Association (ETA) Guidelines, 9 Reviews (3 on basic, 2 on translational, and 4 on clinical topics in thyroidology), 18 Original Papers, and 4 Letters to the Editor
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grown-up, mature and robust scientific publication. To support my conclusion, here are some figures. We published 6 editorials, 4 guidelines, 11 reviews, 18 original papers, and 6 letters to the editor, dealing with both basic, translational and clinical
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The ETA guidelines on subclinical hyperthyroidism (SHyper) in the present issue of European Thyroid Journal [ 1 ], together with the previously published ETA guidelines on subclinical hypothyroidism (SHypo) [ 2 , 3 ], offer up
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Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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In the present issue of European Thyroid Journal , Papini et al. [ 1 ] published guidelines for the use of thermal ablation (TA) in benign thyroid nodules, sponsored by the European Thyroid Association (ETA). The guidelines highlight the state
