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Cuttingâ€edge endonasal surgical approaches to thyroid ophthalmopathy Thyroid orbitopathy is a poorly understood extrathyroidal manifestation of Graves' disease that can cause disfiguring proptosis and vision loss. Orbital decompression surgery for Graves' orbitopathy (GO) can address both cosmetic and visual sequelae of this autoimmune condition. Endonasal endoscopic orbital decompression provides unmatched visualization and access to inferomedial orbital wall and orbital apex. This review
Maternal thyroid function and child educational attainment: prospective cohort study. To determine if first trimester maternal thyroid dysfunction is a critical determinant of child scholastic performance and overall educational attainment.Prospective cohort study.Avon Longitudinal Study of Parents and Children cohort in the UK.4615 mother-child pairs with an available first trimester sample (median 10 weeks gestation, interquartile range 8-12).Free thyroxine, thyroid stimulating hormone (...) , and thyroid peroxidase antibodies assessed as continuous measures and the seven clinical categories of maternal thyroid function.Five age-specific national curriculum assessments in 3580 children at entry stage assessment at 54 months, increasing up to 4461 children at their final school assessment at age 15.No strong evidence of clinically meaningful associations of first trimester free thyroxine and thyroid stimulating hormone levels with entry stage assessment score or Standard Assessment Test scores
Patients With Antithyroid Antibodies Are Prone To Develop Destructive Thyroiditis by Nivolumab: A Prospective Study Immune checkpoint inhibitors, including anti-programmed cell death-1 (PD-1) antibodies, have become promising treatments for a variety of advanced malignancies. However, these medicines can cause immune-related adverse events (irAEs), including endocrinopathies.This study examined the incidence of endocrine irAEs induced by nivolumab.Sixty-six patients treated with nivolumab (...) at Nagoya University Hospital were prospectively evaluated for pituitary hormones, thyroid function, antithyroid antibodies (Abs), and glucose levels every 6 weeks after the initiation of nivolumab for 24 weeks.Four out of 66 patients developed destructive thyroiditis, and three patients developed hypothyroidism requiring levothyroxine replacement. The prevalence of positive anti-thyroglobulin Abs (TgAbs) and/or anti-thyroid peroxidase Abs (TPOAbs) at baseline was significantly higher in the group
From Consternation to Revelation: Discovery of a Role for IGSF1 in Pituitary Control of Thyroid Function Immunoglobulin superfamily, member 1 (IGSF1) is a transmembrane glycoprotein highly expressed in the mammalian pituitary gland. Shortly after its discovery in 1998, the protein was proposed to function as a coreceptor for inhibins (and was even temporarily renamed inhibin binding protein). However, subsequent investigations, both in vitro and in vivo, failed to support a role for IGSF1 (...) in inhibin action. Research on IGSF1 nearly ground to a halt until 2011, when next-generation sequencing identified mutations in the X-linked IGSF1 gene in boys and men with congenital central hypothyroidism. IGSF1 was localized to thyrotrope cells, implicating the protein in pituitary control of the thyroid. Investigations in two Igsf1 knockout mouse models converged to show that IGSF1 deficiency leads to reduced expression of the receptor for thyrotropin-releasing hormone (TRH) and impaired TRH
Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Last updated: November 15, 2018 Project Number: RB1281-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report (...) Question What is the effectiveness of assessing free T3 or T4 to screen for hypothyroidism? What is the effectiveness of assessing free T3 or T4 levels to monitor or adjust levothyroxine dose? What are the evidence-based guidelines regarding thyroid testing for screening or monitoring patients with hypothyroidism? Key Message Two systematic reviews, one non-randomized study, four evidence-based guidelines, and one systematic review of guidelines were identified regarding the assessment of free T3 or T4
Assessment of thyroid mass Assessment of thyroid mass - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of thyroid mass Last reviewed: February 2019 Last updated: January 2019 Summary Thyroid parenchymal expansion can result from diffuse enlargement or infiltration of the thyroid gland or from the presence of one or more thyroid nodules. A thyroid nodule is a discrete lesion distinct from the surrounding (...) thyroid parenchyma. Enlargement of other nearby anatomical structures, such as the parathyroid glands or regional lymph nodes, as well as branchial cleft and thyroglossal duct cysts, may sometimes be confused with thyroid nodules. Thyroid nodules may be palpable at presentation or may be incidentally detected during an imaging procedure (40% are self-identified, 30% are physician-identified, and 30% are incidentally discovered on imaging Mevawalla N, McMullen T, Sidhu S, et al. Presentation
Thyroid function testing Thyroid function testing - Medical information | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Thyroid function testing Last reviewed: February 2019 Last updated: February 2018 Summary Thyroid hormones thyroxine (T4) and tri-iodothyronine (T3) are produced, stored, and secreted by the thyroid gland. These hormones, particularly T3, play a major role in multiple biological and metabolic processes. They act by binding to thyroid (...) receptors that are distributed in almost every organ. Typically, this process regulates gene transcription and the subsequent production of various proteins that are involved in development, growth, and cellular metabolism. Kronenberg HM, Melmed S, Polonsky KS, et al, eds. Williams textbook of endocrinology. 12th ed. Philadelphia, PA: Saunders/Elsevier; 2011. Thyroid function tests (TFTs) are the most commonly used endocrine test. Details Thyroid hormone production Thyroid hormone-binding proteins
Overview of thyroid dysfunction Overview of thyroid dysfunction - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of thyroid dysfunction Last reviewed: February 2019 Last updated: October 2018 Introduction The thyroid gland produces, stores, and secretes thyroxine (T4) and triiodothyronine (T3) through a negative feedback process involving the hypothalamus and pituitary gland. Thyroid dysfunction can result when (...) any part of this process is affected, and is usually characterised by the presence of high or low levels of thyroid-stimulating hormone (TSH, secreted by the pituitary gland) and free thyroid hormones. Causes of thyroid disorders include autoimmunity (e.g., Graves' disease), infections (e.g., post-viral inflammation), other systemic medical conditions, medications (e.g., lithium, amiodarone), nutritional excesses or deficiencies (e.g., of iodine), tumours (thyroid, or rarely pituitary), trauma
Subacute granulomatous thyroiditis Subacute granulomatous thyroiditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Subacute granulomatous thyroiditis Last reviewed: February 2019 Last updated: March 2018 Summary Inflammation of the thyroid characterised by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by a return to euthyroidism. The thyrotoxic phase is due to thyroid (...) follicular damage and release of preformed hormone and is characterised by low thyroid uptake on nuclear scan and elevated ESR or CRP. Thyroid pain and tenderness, which may be migratory and affect different areas of the gland at different times, is typical of the thyrotoxic phase. Thyroid is often enlarged, firm, and tender to palpation. Ultrasound of the thyroid shows areas of hypoechoic echotexture with decreased or normal vascular flow by Doppler. The condition is self-limited, and no specific
Painless lymphocytic thyroiditis Painless lymphocytic thyroiditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Painless lymphocytic thyroiditis Last reviewed: February 2019 Last updated: May 2018 Summary Autoimmune-mediated inflammation of the thyroid gland with release of thyroid hormone resulting in transient hyperthyroidism, frequently followed by a hypothyroid phase before recovery of normal thyroid function (...) -mediated lymphocytic inflammation of the thyroid gland resulting in a destructive thyroiditis with release of thyroid hormone and transient thyrotoxicosis (hyperthyroidism). Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov
Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma ISSN 2472-1972 Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma Friedhelm Raue 1 and Karin Frank-Raue 1 1 Endocrine Practice Heidelberg, Molecular Genetic Laboratory, 69120 Heidelberg, Germany Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant hereditary cancer syndrome causedbymissensegain-of-functionmutationsintheRETproto-oncogeneonchromosome10.Specific RET (...) mutations can predispose toward a particular phenotype and clinical course, with strong genotype–phenotype correlations. MEN2 is highly penetrant in medullary thyroid carcinoma (MTC), and it can be associated with bilateral pheochromocytoma and primary hyperparathyroidism. Two different clinical variants of MEN2 are known: MEN2A, which includes the familial subtype, and MEN2B. Treatment includes early thyroidectomy. Recommendations on the timing and extent
Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer: A Randomized Clinical Trial. Presence of thyroid autoantibodies in women with normal thyroid function is associated with increased risk of miscarriage. Whether levothyroxine treatment improves pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET) is unknown.To determine the effect of levothyroxine (...) on miscarriage among women undergoing IVF-ET who had normal thyroid function and tested positive for thyroid autoantibodies.An open-label, randomized clinical trial involving 600 women who tested positive for the antithyroperoxidase antibody and were being treated for infertility at Peking University Third Hospital from September 2012 to March 2017.The intervention group (n = 300) received either a 25-μg/d or 50-μg/d dose of levothyroxine at study initiation that was titrated according to the level
Ventricular Fibrillation Associated With Dynamic Changes in J-Point Elevation in a Patient With Silent Thyroiditis A J wave is a common electrocardiographic finding in the general population. Individuals with prominent J waves in multiple electrocardiogram (ECG) leads have a higher risk of lethal arrhythmias than those with low-amplitude J waves. There are few reports about the relationship between thyroid function and J-wave amplitude. We report the case of a 45-year-old man who had unexpected (...) ventricular fibrillation (VF). He had dynamic J-point elevation in multiple ECG leads. Possible early repolarization syndrome was diagnosed. He also had thyrotoxicosis caused by silent thyroiditis, and his J-wave amplitude decreased according to changes in thyroid function because of spontaneous remission of silent thyroiditis. There was a positive correlation between serum triiodothyronine levels and J-wave amplitudes. The findings in case suggested silent thyroiditis may contribute to the occurrence
Aberrant Iodine Autoregulation Induces Hypothyroidism in a Mouse Strain in the Absence of Thyroid Autoimmunity We investigated factors underlying the varying effects of a high dietary iodide intake on serum T4 levels in a wide spectrum of mouse strains, including thyroiditis-susceptible NOD.H2h4, NOD.H2k, and NOD mice, as well as other strains (BALB/c, C57BL/6, NOD.Lc7, and B10.A4R) not previously investigated. Mice were maintained for up to 8 months on control or iodide-supplemented water (NaI (...) 0.05%). On iodized water, serum T4 was reduced in BALB/c (males and females) in association with colloid goiters but was not significantly changed in mice that developed thyroiditis, namely NOD.H2h4 (males and females) or male NOD.H2k mice. Neither goiters nor decreased T4 developed in C57BL/6, NOD, NOD.Lc7, or B10.A4R female mice. In further studies, we focused on males in the BALB/c and NOD.H2h4 strains that demonstrated a large divergence in the T4 response to excess iodide. Excess iodide
CRACKCast E128 – Thyroid and Adrenal Disorders CRACKCast E128 – Thyroid and Adrenal Disorders - CanadiEM CRACKCast E128 – Thyroid and Adrenal Disorders In , , by Chris Lipp November 20, 2017 This episode of CRACKCast covers Rosen’s Chapter 120, Thyroid and Adrenal disorders. This episode is going to have a nice breakdown of how each of these major endocrine glands can go haywire and what to do when the storm approaches. The shownotes also have some additional material worth checking out (...) ! Shownotes – Key Concepts Hyperthyroidism Thyroid hormone exerts effects on nearly every organ system. A high degree of suspicion is needed to diagnose hyperthyroidism. The laboratory evaluation of choice is determination of the TSH concentration with free T4 and T3 levels. Total T4 and T3 levels are of limited value. Thyroid storm is a life-threatening thyrotoxic crisis that requires prompt recognition and therapy, as well as identification and treatment of any precipitating cause, such as infection
Multiple steroid and thyroid hormones detected in baleen from eight whale species Recent studies have demonstrated that some hormones are present in baleen powder from bowhead (Balaena mysticetus) and North Atlantic right (Eubalaena glacialis) whales. To test the potential generalizability of this technique for studies of stress and reproduction in large whales, we sought to determine whether all major classes of steroid and thyroid hormones are detectable in baleen, and whether these hormones (...) , corticosterone, aldosterone, thyroxine and tri-iodothyronine, representing a wide array of steroid and thyroid hormones of interest for whale physiology research. In total, 64 parallelism tests (8 species × 8 hormones) were evaluated to verify good binding affinity of the assay antibodies to hormones in baleen. We also tested assay accuracy, although available sample volume limited this test to progesterone, testosterone and cortisol. All tested hormones were detectable in baleen powder of all species
Lenvatinib (Lenvima) - thyroid carcinoma AWMSG ADVICE SUPERSEDED BY NICE GUIDANCE (TA535) NICE GUIDANCE ISSUED JULY 2018 (Refer to NICE website for full guidance on NICE recommendations, including any specific restrictions on the use of the technology) Final Appraisal Recommendation Advice No: 1817 – October 2017 Lenvatinib (Lenvima ® ) 4 mg and 10 mg hard capsules Submission by Eisai Ltd Additional note(s): ? AWMSG considered that lenvatinib (Lenvima ® ) satisfied the AWMSG criteria for orphan (...) perspective. This recommendation has been ratified by Welsh Government and will be considered for review every three years. Recommendation of AWMSG Lenvatinib (Lenvima ® ) is recommended as an option for use within NHS Wales for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI). This recommendation applies only in circumstances where the approved Wales Patient
Ectopic Thyroid Tissue in the Adrenal Gland Mimicking a Pheochromocytoma Ectopic thyroid tissue in the adrenal gland (ETTAG) usually presents as a well-circumscribed cystic mass on a CT scan. However, the MRI features of ETTAG are incompletely understood. We report a case of ectopic thyroid tissue in the adrenal gland, which demonstrates findings similar to those of a pheochromocytoma on the MRI.
Effects of Inorganic Iodine Therapy Administered to Lactating Mothers With Graves Disease on Infant Thyroid Function The effects of maternal inorganic iodine therapy on infant thyroid function are not well known.This study investigated the effects on infant thyroid function of maternal inorganic iodine therapy when administered to lactating mothers with Graves disease.This study was a prospective case series performed at the Tajiri Thyroid Clinic, Kumamoto, Japan.Subjects were 26 infants (...) of lactating mothers with Graves disease treated with potassium iodide (KI) for postpartum thyrotoxicosis.Infant blood levels of thyroid-stimulating hormone (TSH) and free thyroxine were measured using the dried filter-paper method. Iodine concentrations in breast milk and infant urine were measured on the same day. Subclinical hypothyroidism was defined as a blood TSH level of ≥10 or ≥5 μIU/mL in <6-month-old and 6- to 12-month-old infants, respectively.The median age of the infants was 3 months (range, 0