Clinical Thyroidology for Patients

Clinical Thyroidology for Patients is a collection of summaries of recently published articles from the medical literature that covers the broad spectrum of thyroid disorders.

Starting with the May 2009 issue, Clinical Thyroidology for Patients will be published on a monthly basis and include summaries of research studies that were discussed in the previous month’s issue of Clinical Thyroidology, a publication of the American Thyroid Association for physicians. Dr. Mazzaferri is the Editor-in-Chief of Clinical

Current Issue – July 2009 Volume 2 Issue 3

Now available in pdf format for saving and printing and Web page format for viewing online

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Clinical Thyroidology for Patients July 2009 Volume 2 Issue 3 (PDF file, 388 KB)


Editor’s Comments

THYROID AND PREGNANCY During pregnancy, thyroid hormone is very important for the baby to develop normally. While it is rare, fetal and neonatal death is often due to hypothyroidism in their mothers. Further, it appears that the rate of miscarriage is higher in mothers that are hypothyroid during their pregnancy. The purpose of this study was to examine the association between the mother’s TSH and FT4 levels during pregnancy and the rate of miscarriage and fetal and neonatal death.
Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Bonsel GJ. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 2009;160:985-91.
(PDF File for saving and printing, 118 KB)

HYPOTHYROIDISM The diagnosis of hypothyroidism is made most often by increased levels of Thyroid Stimulating Hormone (TSH). The upper normal limit of TSH is the subject of considerable controversy. As a result, the TSH normal range limits, as determined from national databases, have not yet been uniformly applied to clinical practice. This study looked at whether the levels of TSH changed according to age groups and ethnic groups.
Boucai L, Surks MI. Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical practice. Clin Endocrinol (Oxf) 2009;70:788-93.
(PDF File for saving and printing, 108 KB)

GOITER Multinodular goiters are very common as we get older. Most function normally and do not require any treatment. Occasionally, multinodular goiters can enlarge and put pressure on structures in the neck, causing choking and difficulty swallowing. When that occurs, the usual treatment is surgery. Recently, some studies have suggested that large multinodular goiters can shrink if treated with radioactive iodine (RAI). Further, some studies have shown that the RAI can be more effective if the thyroid is turned on first by treatment with recombinant human TSH (rhTSH), a compound used in patients with thyroid cancer. The aim of this study was to determine how long before the RAI treatment that rhTSH should be given to get the best effect.
Fast S, Nielsen VE, Grupe P, Bonnema SJ, Hegedus L. Optimizing 131I uptake after rhTSH Stimulation in patients with nontoxic multinodular goiter: evidence from a prospective, randomized, double- blind study. J Nucl Med 2009;50:732-7.
(PDF File for saving and printing, 114 KB)

GRAVES’ DISEASE Graves’ disease is the most common form of hyperthyroidism in the United States. A mild anemia, with low hemoglobin levels, can sometimes develop in patients with Graves’ disease. A major symptom of anemia is fatigue, so this may play a role in the tiredness that some patients have when the Graves’ disease is active. The cause of this anemia is uncertain. The aim of this study was to determine how common it occurs and what might be the cause of anemia associated with Graves’ disease.
Gianoukakis AG, Leigh MJ, Richards P, Christenson PD, Hakimian A, Fu P, Niihara Y, Smith TJ. Characterization of the anaemia associated with Graves’ disease. Clin Endocrinol (Oxf) 2009;70:781-7.
(PDF File for saving and printing, 110 KB)

THYROID CANCER After surgery, most thyroid cancer patients are treated with radioactive iodine (RAI) to destroy any remaining thyroid cells, both normal and cancerous. In order for the RAI to be effective, the patient’s TSH levels need to be increased to stimulate the thyroid cells to take up the RAI and be destroyed. There are two ways to increase TSH: 1) withdraw the patient from thyroid hormone (THW), making the patient hypothyroid for a short period of time or 2) use recombinant human TSH (rhTSH) to allow patients to stay on their thyroid hormone and avoid the short term hypothyroidism. Recently, smaller doses of I-131 have been used effectively with THW to destroy remaining thyroid cells in low-risk-patients with thyroid cancer. This study was done to find out whether smaller amounts of I-131 would also be effective using rhTSH.
Chianelli M, Todino V, Graziano FM, Panunzi C, Pace D, Gugelielmi R, Signore A, Papini E. Low- activity (2.0 GBq; 54 mCi) radioiodine post-surgical remnant ablation in thyroid cancer. Endocrinol 2009;160:431-6.
(PDF File for saving and printing, 129 KB)