Endocrine Abstracts

This review will address the following questions i) what is the evidence that levothyroxine replacement alone is insufficient to deal with the treatment of hypothyroidism; ii) what is the evidence form randomised control studies that combinations of tri-iodothyronine and levothyroxine are superior to levothyroxine alone in replacement treatment for hypothyroidism; iii) what other factors may be involved in the optimal replacement of thyroid hormone deficiency and iv) what conc...

It is a clinical commonplace is that many other autoimmune conditions are associated with Hashimoto’s thyroiditis and Graves’ disease, but the breadth of these associations makes it clear that the classically defined spectrum of autoimmune diseases, ranging from organ- to non-organ-specific, does not in fact exist. All of these associations originate primarily in shared genetic predisposition. As well as HLA alleles, polymorphisms in CTLA-4, PTPN22 and ...

A Weetman, University of Sheffield, Sheffield, UK AbstractTony Weetman has been the Sir Arthur Hall Professor of Medicine at the University of Sheffield, and Consultant Endocrinologist at the Sheffield Teaching Hospitals Trust, since 1991. He was Dean of the School of Medicine and Biomedical Sciences from 1999 to 2008 when he became Pro-Vice-Chancellor for the Faculty of Medicine, Dentistry and Health.<p class="ab...

Graves' disease is characterised by a T and B cell lymphocytic infiltrate in the thyroid which can all but disappear after antithyroid drug treatment. The intrathyroidal lymphocytes are a major site of autoantibody synthesis and the disappearance of this population with treatment indicates a direct role for antithyroid drugs in modulating the immune response. The cytokine profile of the infiltrating lymphocytes is a mixture of TH1 and TH2, and altering the balance between thes...

In the 46 years since the discovery of thyroid autoimmunity, the same questions have recurred: why does it start, why does it progress, albeit slowly, to disease and what is the nature of the interaction between the autoantigen(s) and the immune system? Answers to these should allow us to address the most important question, namely, can we improve present treatment, especially in the case of Graves' disease with ophthalmopathy? Susceptibility to thyroid autoimmunity and progre...

Radioiodine is indeed the best first line treatment in all patients with Graves’ disease. Except in those who want to try for pregnancy in the next few months, those with significant child care or work responsibilities that will not allow them to take the necessary radioprotection precautions, those who are breast feeding or who smoke and have ophthalmopathy, and those who have been exposed to stable iodine. Oh, and those who are not very happy to accept the risk of perma...

Amiodarone was first introduced in the 1960s and is now widely used to treat and prevent arrhythmias but it has a number of side effects, which include a perplexing array of thyroid effects. The latter stem from three features of the drug: its high iodine content, its ability to affect deiodination of T4 and its inhibition of T3 receptor binding. Around 3% of amiodarone-treated patients in areas with high iodine intake develop amiodarone-induced thyrotoxicosis (AIT), whereas t...

The debate on the utility of TSH receptor (TSH-R) measurement in the management of Graves’ patients has a long history (see for instance J Clin Endocrinol Metab 1998; 83: 3777–3785), and despite advances in assay techniques, the use of TSH-R antibodies in clinical practice is determined more by local custom and practice than evidence base. The diagnosis of Graves’ disease itself is usually straightforward and surrogates for TSH-R antibody testing, such as thyroi...

It is the 50th anniversary of the discovery of thyroid autoimmunity by Rose and Witebsky in suitably immunised rabbits and then by Doniach and Roitt who identified thyroglobulin antibodies in the serum of patients with Hashimoto’s thyroiditis. This is really the exemplar or paradigm of an autoimmune disease and subsequent discoveries have provided new paradigms. Graves’ disease is a prime example of disease apparently caused exclusively by an autoantibody while unrav...

Hypothyroidism is readily dealt with in pregnancy by ensuring optimal thyroxine replacement as early as possible - recent research suggests increasing the thyroxine by two extra days' dosage a week from the time pregnancy is confirmed is worthwhile (Alexander et al 2004).Hyperthyroidism in pregnancy is usually caused by molar pregnancy, gestational thyrotoxicosis (GT) or Graves' disease. GT affects 1-3% of pregnancies and is 3 times more common in Asian ...