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 15 Issue 7

July is Graves' Disease Awareness Month

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Clinical Thyroidology for the Public Volume 15 Issue 7 (PDF file, 2.54 MB)



Subclinical hypothyroidism without thyroid peroxidase antibodies during pregnancy may affect the brain development of the baby

The effect of treating subclinical hypothyroidism in the mother on the child’s brain development is not clear. TPO antibodies are a marker of autoimmune thyroid disease, which is the most common cause of hypothyroidism in the United States. This study was designed to evaluate the brain development of children whose mothers had subclinical hypothyroidism without TPO antibodies and the impact of treatment with thyroid hormone in early pregnancy.
Chen J et al 2022 Subclinical hypothyroidism with negative for thyroid peroxidase antibodies in pregnancy: Intellectual development of offspring. Thyroid. Epub 2022 Jan 11. PMID: 34915770.

No benefit of levothyroxine in women with recurrent pregnancy loss with normal thyroid function despite positive thyroid antibodies

TPO antibodies are a marker for autoimmune thyroid disease and are one of the factors associated with pregnancy loss, even when the thyroid levels are normal. It is not clear that treatment with thyroid hormone prevents miscarriage in women with thyroid autoimmunity alone. This study was done to find out if treatment with thyroid hormone in women with history of previous pregnancy losses and TPO antibodies but normal thyroid function helps prevent miscarriage.
Van Dijk MM et 2022 Levothyroxine in euthyroid thyroid peroxidase antibody positive women with recurrent pregnancy loss (T4LIFE trial): A multicentre, randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Diabetes Endocrinol. Epub 2022 Mar 14. PMID: 35298917.

Treatment of mild hypothyroidism in older adults does not affect anemia

Both subclinical hypothyroidism and anemia are common in the elderly. In addition, prior studies have shown that patients with subclinical hypothyroidism may have lower hemoglobin levels compared to persons with normal thyroid function. The aim of this study was to assess whether hemoglobin levels improved after treating subclinical hypothyroidism with levothyroxine in older adults.
Du Puy RS et al 2022 No effect of levothyroxine on hemoglobin in older adults with subclinical hypothyroidism: Pooled results from two RCTs. J Clin Endocrinol Metab. Epub 2022 Feb 26. PMID: 35218666.

Is thyroid storm a concern when operating on hyperthyroid patients?

If surgery is needed in patients with hyperthyroidism, it usually is recommended that they be treated until thyroid hormone levels are normal first. There have been case reports of thyroid storm occurring in hyperthyroid patients after non-thyroid surgery. This study was done to determine whether there is evidence for any treatment prior to surgery to decrease the risk of thyroid storm.
de Mul N et al 2021 Risk of perioperative thyroid storm in hyperthyroid patients: A systematic review. Br J Anaesth 127:879–889. PMID: 34389171.

Radiofrequency ablation for thyroid papillary microcarcinoma

RFA is a nonsurgical, minimally invasive technique that has been shown to shrink thyroid nodules. It is less invasive than surgery yet may be a suitable treatment option for those who do not wish to pursue active surveillance alone. Currently, the literature lacks large-scale studies examining the effectiveness of RFA in treating mPTCs. The primary goal of this article was to analyze the efficacy and safety of RFA for low-risk mPTC.
van Dijk SPJ et al Assessment of radiofrequency ablation for papillary microcarcinoma of the thyroid: A systematic review and meta-analysis JAMA Otolaryngol Head Neck Surg. Epub 2022 Feb 10

Adrenal insufficiency in patients being treated with Lenvatinib for thyroid cancer

Lenvatinib is a chemotherapy drug that is effective against advanced thyroid cancer that is not responsive to other treatments. Side effects of the drug are similar to the symptoms of adrenal insufficiency. This study describes a patient with adrenal insufficiency while taking lenvatinib and discusses the natural history of adrenal insufficiency in patients undergoing this treatment.
Monti S et al 2022 Cortisol deficiency in lenvatinib treatment of thyroid cancer: An underestimated common adverse event. Thyroid 32:46–53. PMID: 34663079