Jodové zásobení těhotných a kojících žen je klíčové pro zdraví plodu a novorozence, zejména pro správnou funkci štítné žlázy. Nedostatečná jodová saturace může vést k závažným následkům, včetně trvalého poškození zdraví dítěte. V České republice využíváme pro monitoring jodového zásobení novorozenců neonatální TSH získané v rámci celoplošného novorozeneckého screeningu kongenitální hypotyreózy. Výsledky monitoringu byly až do nedávné doby příznivé (do roku 2018 v Čechách a do roku 2022 na Moravě), nicméně v posledních letech se zvyšuje procentuální zastoupení novorozenců se zvýšeným TSH, což naznačuje prohlubující se jodový deficit této křehké populace. Jednou z příčin může být nedostatečná jodová suplementace těhotných žen nad rámec běžného alimentárního příjmu (tj. 150–200 μg jodu denně) a snížení konzumace mléka, mléčných produktů, vajec a soli s jodem. Česká republika se nyní opět musí zaměřit na tuto rizikovou populaci stran prohlubujícího se jodového deficitu. Důležité je zaměřit se především na osvětové aktivity a zajistit adekvátní suplementaci jodu již v období těhotenství.
The iodine supply of pregnant and lactating women is crucial for the health of the fetus and newborn, especially for the proper function of the thyroid gland. Inadequate iodine saturation can lead to serious consequences, including permanent health damage to the child. In the Czech Republic, we use neonatal TSH obtained within the Nationwide Newborn Screening Program for Congenital Hypothyroidism to monitor the iodine supply of newborns. The monitoring results were favorable until recently (until 2018 in Bohemia and until 2022 in Moravia); however, in recent years, there has been an increase in the percentage of newborns with elevated TSH, indicating a deepening iodine deficiency in this vulnerable population. One of the reasons may be inadequate iodine supplementation of pregnant women beyond the normal dietary intake (i.e., 150–200 μg of iodine per day) and a decrease in the consumption of dairy, eggs and iodized salt. The Czech Republic must now focus again on this at-risk population regarding the deepening iodine deficiency. It is important to focus primarily on educational activities and ensure adequate iodine supplementation during pregnancy.
- MeSH
- jod * metabolismus nedostatek terapeutické užití MeSH
- kongenitální hypotyreóza diagnóza etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecký screening MeSH
- těhotenství MeSH
- thyreotropin krev MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- lidé MeSH
- nemoci štítné žlázy diagnóza MeSH
- thyreotropin * analýza MeSH
- virové nemoci MeSH
- Check Tag
- lidé MeSH
OBJECTIVE: Trace elements are essential for the biochemistry of the cell. Their reference values have been found to differ considerably in pregnant women stratified by age, place of residence, anthropometric status, and length of pregnancy. In optimal amounts, these elements reduce the risk of pregnancy complications. Subclinical hypothyroidism in pregnancy is associated with adverse maternal and neonatal outcomes. The aim of the study was to determine the effects of zinc (Zn), copper (Cu), magnesium (Mg), and rubidium (Rb) on pregnant women in an iodine deficiency region and find the relationship with the thyroid status and nutrition. METHODS: We evaluated the iodine status of 61 healthy pregnant women from an iodine deficient region in Bulgaria. Thyroid stimulating hormone (TSH) and thyroxin free (FT4) levels were measured using ELISA. RESULTS: We found elevated levels of copper that differed the most between the first and second trimesters; Cu and TSH were found to be positively correlated (р < 0.05). Lower Cu levels were found in pregnant women consuming pulses more than 2-3 times a week (р = 0.033). The women consuming fish more than 2-3 times a week had higher levels of Rb. We found a pronounced iodine deficiency in more than half of the examined women in the first to third trimesters, without any effect of pregnancy on the ioduria (р=0.834). All second and third trimester cases were associated with severe ioduria (< 150 μg/L). CONCLUSION: The high Cu levels were associated with subclinical hypothyroidism (SCH) and less pulse consumption during pregnancy in an iodine deficiency endemic area. SCH was found in 24% of the pregnant women in such an area while in 13% of them SCH had progressed to overt hypothyroidism.
- MeSH
- dospělí MeSH
- hořčík krev analýza aplikace a dávkování MeSH
- hypotyreóza epidemiologie MeSH
- jod * nedostatek aplikace a dávkování MeSH
- komplikace těhotenství epidemiologie MeSH
- lidé MeSH
- měď * nedostatek krev MeSH
- nutriční stav * MeSH
- stopové prvky nedostatek MeSH
- těhotenství MeSH
- thyreotropin krev MeSH
- zinek * nedostatek krev MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Bulharsko MeSH
Background: Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices. Methods: Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey. The survey included respondent demographic data and treatment choices for hypothyroid patients with persistent symptoms. Geo-economic data for each country were included in the analyses. Results: The response rate was 32.9% (6058 respondents out of 17,247 invitees). Levothyroxine (LT4) was the initial treatment preferred by the majority (98.3%). Persistent symptoms despite normal serum thyrotropin (TSH) while receiving LT4 treatment were reported to affect up to 10.0% of patients by 75.4% of respondents, while 28.4% reported an increasing such trend in the past 5 years. The principal explanations offered for patients' persistent symptoms were psychosocial factors (77.1%), comorbidities (69.2%), and unrealistic patient expectations (61.0%). Combination treatment with LT4+liothyronine (LT3) was chosen by 40.0% of respondents for patients who complained of persistent symptoms despite a normal TSH. This option was selected more frequently by female thyroid specialists, with high-volume practice, working in countries with high gross national income per capita. Conclusions: The perception of patients' dissatisfaction reported by physicians seems lower than that described by hypothyroid patients in previous surveys. LT4+LT3 treatment is used frequently by thyroid specialists in Europe for persistent hypothyroid-like symptoms even if they generally attribute such symptoms to nonendocrine causes and despite the evidence of nonsuperiority of the combined over the LT4 therapy. Pressure by dissatisfied patients on their physicians for LT3-containing treatments is a likely explanation. The association of the therapeutic choices with the clinician demographic characteristics and geo-economic factors in Europe is a novel information and requires further investigation.
- MeSH
- demografie MeSH
- hypotyreóza * farmakoterapie epidemiologie MeSH
- lidé MeSH
- thyreotropin * MeSH
- thyroxin MeSH
- trijodthyronin MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Subklinická hypotyreóza je poměrně častým jevem, zejména u starších pacientů. Je definována zvýšeným TSH spolu s normálními hladinami volných hormonů štítné žlázy. Oproti klinicky vyjádřené hypotyreóze jsou její rizika podstatně menší, a proto je klíčové vybrat pacienty, u kterých potencionální benefit léčby převáží její nežádoucí účinky. K tomu je třeba vzít v potaz věk pacienta, komorbidity, příznaky a míru elevace TSH. Léčba spočívá v substituci levothyroxinem s šetrnou titrací dávky vedoucí k normalizaci TSH. Neléčení pacienti by měli být sledováni v závislosti na rizikových faktorech, zejména pak na riziku progrese do klinicky vyjádřené hypotyreózy. Přístup ke každému pacientovi by měl být vždy individuální a flexibilní.
Subclinical hypothyroidism is a relatively common condition characterized by elevated serum TSH levels, but normal free thyroxine levels. The risks associated with subclinical hypothyroidism are less severe compared to those with overt hypothyroidism, making it essential to carefully select patients who would benefit from the treatment. Factors such as the patient ́s age, comorbidities, symptoms, and TSH concentration need to be considered in this selections proces. The therapy, if required, consists of levothyroxine substitution with carefull dose titration to avoid overtreatment. The goal is to normalize TSH levels. Untreated patients should be folowed up accordingly to their risk factors mainly the risk of progression to overt hypothyroidism. Aproach to each patient should be individulized and flexible.
- MeSH
- hormony štítné žlázy krev MeSH
- hypotyreóza * diagnóza farmakoterapie komplikace MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- testy funkce štítné žlázy MeSH
- thyreotropin krev MeSH
- thyroxin aplikace a dávkování terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
OBJECTIVES: This study aimed at evaluating the serum redox status in type 2 diabetes mellitus (T2DM) accompanied with an imbalance in iron concentrations. METHODS: Diabetic patients were grouped according to serum iron levels [normal (DNFe), low (DLFe), and high (DHFe)], and their clinical and redox parameters [total sulfhydryl groups (tSH), uric acid (UA), and total bilirubin (tBILI) as non-enzymatic antioxidants, and malondialdehyde (MDA) and advanced oxidation products of proteins (AOPP) as markers of oxidative stress] were determined. RESULTS: Glucose and HbA1c levels in the T2DM patients did not differ in function of serum iron. T2DM was associated with reduced tSH levels. In the diabetic patients, tSH, UA, and tBILI negatively correlated with MDA, as well as HbA1c with UA. Accordingly, AOPP and MDA were higher in the diabetic groups compared to the controls. The reduced antioxidant capacity was particularly pronounced in the DLFe group, which was further characterized by lower levels of UA and tBILI compared to the other groups. Subsequently, the level of MDA in the DLFe group was higher compared to the DNFe and DHFe groups. The positive correlation between serum iron levels and the antioxidants UA and tBILI, in conjunction with the negative correlation between serum iron levels and the markers of oxidative stress in the diabetic patients, corroborated the indication that comparatively higher level of oxidative stress is present when T2DM coexists with decreased iron levels. CONCLUSIONS: T2DM-associated redox imbalance is characterized by a decrease in serum total sulfhydryl groups and low serum iron-associated reduction in uric acid and total bilirubin levels, accompanied by increased oxidative stress markers. The relatively noninvasive and simple determination of these parameters may be of considerable interest in monitoring the pathophysiological processes in T2DM patients, and may provide useful insights into the effects of potential therapeutic or nutritional interventions.
- MeSH
- antioxidancia * metabolismus MeSH
- bilirubin metabolismus MeSH
- biologické markery MeSH
- diabetes mellitus 2. typu * komplikace MeSH
- glykovaný hemoglobin MeSH
- kyselina močová MeSH
- lidé MeSH
- oxidace-redukce MeSH
- oxidační stres MeSH
- produkty pokročilé oxidace proteinů metabolismus MeSH
- thyreotropin metabolismus MeSH
- železo MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic. METHODS: We gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0-18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0-5 years and 6-18 years. RESULTS: Our study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 μg/l, p < 0.001). Notably, the lowest (5.99 μg/l) and highest (991.80 μg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 μg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 μg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups. CONCLUSION: We have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 μg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.
- MeSH
- dítě MeSH
- jod * MeSH
- lidé MeSH
- prevalence MeSH
- průřezové studie MeSH
- thyreotropin MeSH
- vegani * MeSH
- vegetariáni MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
x
x
- Klíčová slova
- levotyroxin,
- MeSH
- adherence k farmakoterapii MeSH
- dospělí MeSH
- hypotyreóza * diagnóza farmakoterapie MeSH
- lidé MeSH
- thyreotropin analýza krev účinky léků MeSH
- thyroxin aplikace a dávkování metabolismus terapeutické užití MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Terapie levothyroxinem je součástí léčby diferencovaného karcinomu štítné žlázy již po desetiletí. Levothyroxin je podáván pacientům po totální tyreoidektomii (s nebo bez následné aplikace radiojodu) nejen k navození eutyreózy, ale také k potlačení produkce thyreotropního hormonu (TSH), protože TSH je považován za růstový faktor pro folikulární buňky štítné žlázy. Hlavní nevýhodou této léčby jsou známá rizika spojená s iatrogenně navozenou subklinickou či až klinickou hypertyreózou. Proto je nezbytný individuální přístup s porovnáním rizika rekurence onemocnění a rizika nežádoucích účinků supresní terapie v korelaci s komorbiditami a celkovým stavem pacienta. Časté a důsledné sledování pacientů s adekvátní úpravou dávky levothyroxinu k udržení TSH v cílovém rozmezí dle doporučení Americké tyroidální asociace (ATA) je zcela klíčové.
Levothyroxine therapy in management of diferentiated thyroid carcinoma (DTC) has been common practice for decades. Levothyroxine is being administered to patiens with DTC after total thyreoidectomy (with or without postopreative radioiodine treatment) not only to restore euthyroidism but to suppress the production of thyroid-stimulating hormone (TSH) as well because TSH is considered as a growth factor for thyroid follicular cells. However there has been a downside to this threatment recently. The main concerns are the known risks related to iatrogenic subclinical or even mild but clinicaly overt iatrogenic hyperthyroidism. Therefore individualized treatment approach aiming to balance between the risk of tumor recurence and the risks related to hypertyhroidism in view of pateints age, risk factors and comorbidities is essential. Close folow-up is therefore necessary with frequent dose adjustments according to target TSH values published in American Thyroid Association guidelines.
- MeSH
- hormonální substituční terapie MeSH
- karcinom chirurgie farmakoterapie MeSH
- lidé MeSH
- nádory štítné žlázy * chirurgie farmakoterapie MeSH
- nežádoucí účinky léčiv MeSH
- rizikové faktory MeSH
- thyreotropin účinky léků MeSH
- thyroxin * aplikace a dávkování terapeutické užití MeSH
- tyreoidektomie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
