Endocrine Abstracts

Thyrotoxicosis is a common disorder which induces many cardiovascular effects and is associated with increased cardiovascular mortality. We recruited 283 consecutive unselected thyrotoxic subjects attending our thyroid clinic and 283 age and sex-matched euthyroid controls. All completed a structured cardiovascular history and examination, resting 12-lead ECG and 24-hour Holter recording. Follow up data on mortality was collected for a year. The median age of the cohorts was 49...

With treatment of endocrine myopathies increased proximal muscle strength is generally attributed to increased bulk. However in hypothyroid myopathy individuals have been shown to increase strength despite reduction in bulk.We studied 25 hyperthyroid and 27 hypothyroid randomly selected patients, measuring body weight, quadriceps and deltoid force using strain gauge techniques or with a myometer. Cross sectional area (CSA) of the quadriceps and Right de...

Radioiodine therapy (RAI) is widely used as definitive treatment for hyperthyroidism. Of the several regimes in use, we have used a standard 555 MBq dose of RAI to treat all patients with hyperthyroidism. Treatment is considered to have failed if patients remain hyperthyroid at 12 months and a repeat 555 MBq dose is administered. We have studied 584 consecutive patients for failure rate of RAI when it is used according to this regime (mean follow-up 3 years (range 1-10)). We h...

Autoimmune thyroid diseases (AITD), such as Graves' disease (GD) and autoimmune thyroiditis (AT), cluster within families and within individuals and exhibit a strong female preponderance. The type 1 diabetes Warren Repository was established between 1989 and 1996 and contains 505 families of British white Caucasian origin. Each family consists of both parents and at least two siblings with type 1 diabetes. We have examined the clinical data collected to establish the frequency...

We analysed thyroid function tests (TFT; tT4 +TSH ±fT4) and clinical outcomes in patients with thyrotoxicosis managed with the aid of a computerised Thyrotoxicosis Shared-Care Scheme (TSC) between 1994 and 2001. During this 7-year period, 900 patients had been managed via TSC. 319 were in TSC since receipt of the initial referral letter, of whom 268 commenced TSC by mid-2000 with at least 6 months subsequent follow up (FU) data in the same tT4 assay and were analysed i...

Hyperthyroidism has a profound effect on the cardiovascular system. Heart failure is common in the elderly patients with hyperthyroidism who have co-existing cardiac disease.We report a case of severe heart failure in a 43-year-old woman with Graves' disease. She presented with cough and breathlessness for 3 weeks. There was a strong family history of thyroid disease. On presentation, she had florid hyperthyroidism with features of Graves' disease. Exam...

Endothelial dysfunction contributes to the cardiovascular complications in Diabetes mellitus and hypertension. The effects of hyperthyroidism on the peripheral vasculature are not fully understood. Decreased central arterial stiffness is a feature of thyrotoxicosis and normalises with treatment (1). The purpose of our study was to establish the effect of thyrotoxicosis and its treatment on surrogate humoral markers of endothelial function; Von Willebrand factor (VWF), Soluble ...

Introduction: One of the major causes of deaths in pediatric patients is malignancy. Radiotherapy, which is one of the protocols used in their treatment, may have some disadvantages such as impairing thyroid function. Considering these facts, we decided to determine the incidence of post radiotherapy hypothyroidism in pediatric patients with malignancy.Methods: In a cross-sectional study 180 patients ranging in age from 1 to 20 years old who survived fr...

Subtle irregularity in maternal thyroid status during the 1st trimester of pregnancy is associated with abnormalities of neurodevelopment in childhood. Both iodothyronine deiodinase and TR expression in the fetoplacental unit are fundamental in controlling active TH delivery to the fetus. Using real time RT-PCR and gene specific Taqman probes and primers, we quantified mRNA expression of the deiodinase enzymes D2 and D3, and TRalpha1, TRalpha2 and TRbeta1 in the absence and pr...

Differentiated thyroid cancers are the commonest endocrine malignancies, but there are no reliable molecular markers of prognosis. Pituitary tumor transforming gene (PTTG) plays several potential roles in tumour initiation and progression, including regulating mitosis and stimulating expression of fibroblast growth factor-2 (FGF-2). PTTG expression has been identified as a potential prognostic marker in pituitary adenomas and colon carcinomas. We postulated that PTTG and FGF-2...

Radioiodine(RI) is an effective treament for thyrotoxicosis, being used with increasing frequency. Since 1998 an initial dose of 400 MBq has been used in the treatment of thyrotoxicosis, with a standard second dose of 550 and third dose of 799 MBq. The efficacy of this dosing regimen in controlling hyperthyroidism was studied by a questionnaire survey of the GPs of 259 patients treated between November 1998 and January 1999. RI was deemed a success if patients were rendered eu...

Objective: All neonates should be screened for congenital hypothyroidism in the first week of their lives. To evaluate the reliability of thyroid function tests in neonates who undergo exchange transfusion (ET), we decided to study the alteration of thyroid hormones after ET in term neonates.Method: From April 2001 to August 2001, eighteen full term neonates (gestation age > 37 weeks) undergoing ET due to hyperbilirubinemia at neonatal wards of Al-Zahra and Shahid-Beheshti...

BACKGROUND Recent evidence has suggested that minor degrees of thyroid dysfunction are associated with adverse outcomes and this argues for tight control of thyroid hormone replacement. Thyroxine (T4) tablets are available in 25, 50 and 100 microgram strengths in the UK but some patients require doses which cannot be obtained with these strengths. We have examined data from a thyroid register to determine the proportion of patients whose mean daily T4 dose cannot be achieved w...

Up to 90% of patients treated with radioactive iodine treatment for hyperthyroidism develop hypothyroidism, in some cases many years after treatment. The majority of patients receiving RI in our clinic were referred from clinics throughout the northwest of England and attend on one occasion for RI treatment with follow-up by the referring physician. The Royal College of Physicians guidelines recommend centres administering RI have a system for regular patient monitoring to ide...

Several cases of subacute thyroiditis were noted over the autumn and winter period of 2000-1 in one endocrine referral centre. This study was undertaken to determine if the incidence of subacute thyroiditis was different from the previous year, whether a seasonal clustering had occurred and whether a specific viral pathogen was responsible.A diagnosis of subacute thyroididits was made if the patient had evidence of transient hyperthyroidism or biphasic ...

Maternal thyroxine (T4) deficiency is associated with adverse outcome for mother and infant such that selective screening has been advocated. Thyroid hormone production increases in pregnancy, T4-dependent patients requiring increased treatment. To highlight aspects of current service delivery and guide service development, we audited management of pregnant women requiring T4 in our city over one year.Cases were identified retrospectively through a data...

Hypothyroidism is common with lithium therapy. Thyrotoxicosis is rare. Of 81 cases of thyrotoxicosis related to lithium therapy reported 22 were silent thyroiditis , 39 Graves' disease and 11 autonomous nodule.We report a 56 year old male who had been on lithium for the last four years for bipolar illness, was referred to us when he was found to be biochemically thyrotoxic on routine testing. The TSH was less than 0.01, FT37.3, FT4 154. On his visit to ...

Introduction and aims: The role of screening for thyroid disease in diabetes (DM) remains controversial. We assessed the prevalence of thyroid dysfunction on first screening in a population of patients with diabetes who previously had thyroid function tests (TFT) only on clinical suspicion.Methods: TFT and thyroid peroxidase antibodies (TPO) were measured in 236 consecutive patients with DM (mean age 59±13 years, type1 16%, type2 84%, female 48%)...

The performance of a commercial method (RSR) for measuring TBII was compared prospectively with an in-house method. TBII data were correlated with clinical information available at the time of clinic attendance and with the ultimate diagnosis in the light of additional independent information (isotope scan, thyroid microsomal antibodies, response to treatment). Serum samples were collected prospectively from subjects attending an endocrine clinic and from normal subjects (grou...

Graves' disease (GD) is caused by thyroid stimulating antibodies (TSAb) which are thyrotropin (TSH) agonists. Thyroid peroxidase (TPO) antibodies, although markers of thyroid auto-immunity are not involved in the pathogenesis of GD. Despite this, TPO antibodies are frequently used to establish the etiology of thyrotoxicosis. It was our aim to compare TPO antibodies with TSAb in a cohort of thyrotoxic patients to determine whether TPO antibodies and TSAb could be regarded as eq...

Congenital hypothyroidism (CH) occurs in approximately 1 in 3000 individuals. Rapid detection by neonatal screening and T4 administration is essential to prevent severe mental retardation and impaired growth. About one third of CH is due to mutations in known genes including the thyrotropin receptor (TSHR).Two Welsh male siblings with CH were detected, both had normally sized and located thyroid glands, no iodide uptake and were negative for thyroid bloc...

Increased blood activities of some enzymes, participating in pyrimidine and purine metabolism, were found in blood fractions of patients suffering from autoimmunological thyroid diseases (AITD), i.e., Graves' or Hashimoto's disease. The aim of the study was to estimate the expression of RNA specific for the enzymes in question. An approval of the Ethical Committee of the Medical University of Lodz has been obtained. The expression of the following enzymes was estimated in huma...

Because the sodium iodide symporter, NIS, may be artificially expressed in cells to introduce ablative doses of radioactive iodide, it may be of clinical use. NIS is normally found in the basolateral membrane of thyrocytes and its expression and activity are known to be regulated by TSH. We have used primary cultures of human thyrocytes to examine other regulators of NIS activity. NIS activity was measured as uptake of 125I into cells in the presence of the thyroper...

Subclinical thyroid dysfunction associated with a poor lipid profile and cardiac dysfunction. Patients with DM2 suffer from a greater risk of vascular disease, often in association dislipidemia. Thyroid dysfunction might either contribute to these factors or make them worse.Objective: To assess the prevalence of thyroid dysfunction among patients with diabetes and the relationship between that condition the control of diabetes and lipid profile.<p ...

There is ample evidence that despite an overall improvement of iodine intake, not only in Germany but also in many European countries pregnant woman may be deficient of this trace element.Healthy pregnant women (n=66) without a thyroid history volunteered for an ultrasound scan of the thyroid and for a blood sample; TSH, free T ¾ and TPO - antibodies were measured of the thyroid.21 (32%) of the pregnant women exhibited an ...

Hyperthyroidism is a common disorder, most usually caused by Graves' Disease (GD), in which thyroid-stimulating antibodies (TSAB) mimic thyrotropin. Since the diagnosis of GD is made clinically and its signs and symptoms are indistinguishable from those of patients harboring an activating germline thyrotropin receptor (TSHR) mutation, incorrect diagnoses have been made. Point mutations in more than 30 residues, predominantly in exon 10, of the TSHR cause constitutivity making ...

In August 1999, to reduce pressure on an overcrowded outpatient department and the incidence of undetected early hypothyroidism, we implemented a new protocol for the follow-up of patients undergoing radioiodine treatment for recurrent thyrotoxicosis. Suitable patients are invited to participate in follow-up by telephone. Thyroid function tests are checked at 3, 6, 9 and 12 weeks post-treatment. Patients who become hypothyroid post-treatment (fT4 <14 picomoles per litre) a...

An established murine model of thyroid eye disease is induced by transfer of thyrotropin receptor (TSHR) primed T-cells to syngeneic recipients. Our aim was to extend the model to determine if: there are gender differences, Rundle's curve occurs and magnetic resonance imaging (MRI) could be applied as an in vivo marker. Orbital MRI on non-living mice used a surface coil and 1.5T MRI. 0.75mm slices have resolution sufficient to image ocular muscles. TSHR primed T-cells were gen...

Following the establishment of a telephone clinic follow-up for patients receiving radioiodine for recurrent thyrotoxicosis, we wished to further improve our results in achieving hypo(eu)thyroidism while minimising the risk of transient hyperthyroidism and thyroid storm post-therapy. Although not widely used, lithium has been shown to increase the effectiveness of radioiodine therapy, leading to prompter control of hyperthyroidism. Since August 2001, patients undergoing radioi...

We have recently shown that Tie-2, the receptor for the angiopoietins, is expressed on thyroid follicular cells. This angiogenic receptor was previously thought to be restricted to the endothelium where it influences the maturation of blood vessels. The role of Tie-2 in the growth, function and follicular architecture of thyroid cells is unknown. We have used primary cultures of human thyroid cells and the rat thyroid cell line, FRTL5 to examine the role of this axis. We have ...

Thyroid eye disease (TED) represents the most frequent and important extrathyroidal manifestation of Graves' disease. Less commonly the eye changes may occur in euthyroid individuals without a preceding history of thyrotoxicosis, represents approximately 8-21% of TED cases. Patients with the rare combination of primary hypothyroidism and TED are predisposed to severe eye disease and atypical presentation of such patients may delay diagnosis and treatment . The primary importan...

Various abnormalities of coagulation may occur in patients with thyroid disorders and may range from subclinical laboratory abnormalities to clinically significant disturbances of coagulation. Tissue factor pathway inhibitor (TFPI) is a newly determined potent inhibitor of tissue factor dependent coagulation system. TFPI changes in various thyroid disorders has not been evaluated yet. In this study we have evaluated total TFPI (tTFPI), free TFPI (fTFPI), tissue plasminogen act...

Introduction: We recently reported a high prevalence of |TgAb in sera from healthy Sri Lankan subjects. To characterise these further we have studied the reactions of these Abs with Tg in a competitive ELISA with a panel of 10 Tg monoclonal Abs (TgMabs). This is compared to a similar UK population of healthy subjects and AITD patients.Methods: The sera, all from females, comprised: 1. Healthy SL schoolgirls with high TgAb (HSL; n=33) 2. Healthy SL Tamil...

Background: Substantial deposition of iron in the thyroid gland is a frequent autopsy finding in patients with genetic haemochromatosis. Despite this there have been relatively few reports, mainly isolated cases, of significant thyroid dysfunction in such patients. In one large study Edwards et al. (1983) observed primary hypothyroidism in 6.1% of cases, all subjects were male and had elevated titres of antithyroid antibodies.Aim: The aim of this prosp...