Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE

Volume 17 Issue 4

March is Medullary Thyroid Cancer Awareness Month

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Clinical Thyroidology for the Public Volume 17 Issue 4 (PDF file, 2.34 MB)



Thyroid hormone replacement therapy in patients with hypothyroidism: Understanding patient outcomes.
A significant proportion of patients with hypothyroidism (up to 15%) experience persistent symptoms that affect their quality of life. This study aimed to investigate how patients use levothyroxine in real life. The study also assessed the effectiveness of levothyroxine in keeping thyroid levels in the normal range as indicated by TSH levels, and health-related quality of life questionnaires (HRQoL) to determine whether correct levothyroxine use is associated with better thyroid health.
Mehuys E et al 2023 Investigating levothyroxine use and its association with thyroid health in patients with hypothyroidism: A community pharmacy study. Thyroid 33:918–926. PMID: 37184683.

Which thyroid pill is better for a stomach with low acid?

Levothyroxine (L-T4) tablets need an acidic stomach to be best absorbed. Proton pump inhibitors (PPI’s) are very commonly used medications to decrease the stomach acid and can cause poor L-T4 absorption. There are few reports that absorption of L-T4 in the form of gelatin pills may not be affected as much from acid changes in the stomach. The authors designed this study to find out the effects of switching from a standard L-T4 tablet to the same dose of L-T4 soft capsules in hypothyroid patients who were taking PPI’s.
Sachmechi I et al. Efficacy of levothyroxine sodium soft gelatin capsules in thyroidectomized patients taking proton pump inhibitors: an open-label study. Thyroid 2023;33(12):1414-1422; doi: 10.1089/thy.2023.0382. PMID: 37885233.

Can Vitamin D supplementation prevent autoimmune thyroid disease leading to hypothyroidism?

Hypothyroidism is quite common, most often as a result of autoimmune thyroid disease. In some studies, lower vitamin D levels correlate with an increased risk of autoimmune thyroid disease. This study was performed to answer the question of whether vitamin D supplementation could decrease the chances of developing hypothyroidism.
Waterhouse M et al. The effect of vitamin D supplementation on hypothyroidism in the randomized controlled D-Health Trial. Thyroid 2023;33(11):1302-1310; doi: 10.1089/ty.2023.0317. PMID: 37698908.

Thyroid function testing to predict gestational diabetes mellitus: a significant association but with limited clinical implication

Gestational diabetes mellitus (GDM), is common. Hypothyroidism in adults is associated with resistance to insulin and altered glucose metabolism. Further, type 2 diabetes and thyroid disorders have been reported to be related. Studies have investigated correlations between thyroid disease and GDM, with varying results. In this study, the authors conducted a large study to investigate the association between thyroid function test results in early pregnancy and the subsequent risk of developing GDM.
Huang K et al 2023 Association between maternal thyroid function in early pregnancy and gestational diabetes: A prospective cohort study. J Clin Endocrinol Metab. Epub 2023 Aug 30:dgad518. PMID: 37647889.

Predicting thyroid cancer outcomes using machine learning: a move toward precision medicine

The ATA Risk Stratification System is a widely used method to estimate the prognosis and recurrence risk of thyroid cancer based on specific features and helps to guide treatment and follow-up for thyroid cancer patients. The goal of this study was to develop a comprehensive data-driven model to predict the risk of thyroid cancer persistence/recurrence by including all available patient- and cancer-related features at the time of initial treatment. The performance of this model, which determines the impact of each feature on prognosis was compared to the ATA Risk Stratification System.
Grani G, et al. A data-driven approach to refine predictions of differentiated thyroid cancer outcomes: a prospective multicenter study. J Clin Endocrinol Metab 2023;108(8):1921-1928; doi: 10.1210/clinem/dgad075. PMID: 36795619.

Is my race and income going to affect my thyroid cancer outcomes?

Poor socioeconomic factors have been shown to contribute to poor thyroid cancer outcomes in adults. In particular, adults of certain races and with poor socioeconomic have been shown to correlate with more advanced stages of thyroid cancer at diagnosis and poorer outcomes with thyroid cancer treatments. This study was done to analyze the effect of race and socioeconomic status on the outcomes of thyroid cancer in the pediatric population.
Zhao HH and Wilhelm SM Pediatric thyroid cancer: socioeconomic disparities and their impact on access to care. Surgery 2023;18:S0039-6060(23)00600-1; doi: 10.1016/j. surg.2023.08.036. PMID: 3783694.