OBJECTIVES: The use of levothyroxine (LT4) treatment aiming to improve fertility in euthyroid women with positive thyroid peroxidase antibodies (TPOAb) is not supported by the available evidence. The aim of the study was to document the use of LT4 by European thyroid specialists in such patients. DESIGN: The data presented derive from Treatment of Hypothyroidism in Europe by Specialists, an International Survey (THESIS), a questionnaire conducted between 2019 and 2021 to document the management of hypothyroidism by European thyroid specialists. Here, we report the aggregate results on the use of LT4 in infertile, euthyroid women with positive TPOAb. RESULTS: A total of 2316/5406 (42.8%) respondents stated that LT4 may be indicated in TPOAb positive euthyroid women with infertility. The proportion of those replying positively to this question varied widely across different countries (median 39.4, range 22.9%-83.7%). In multivariate analyses males (OR: 0.8; CI: 0.7-0.9) and respondents >60 years (OR: 0.7; 0.6-0.8) were the least inclined to consider LT4 for this indication. Conversely, respondents managing many thyroid patients ("weekly" [OR: 1.4; CI: 1.0-1.9], "daily" [OR: 1.8; CI: 1.3-2.4]) and practicing in Eastern Europe (OR: 1.5; CI: 1.3-1.9) were most likely to consider LT4. CONCLUSIONS: A remarkably high number of respondents surveyed between 2019 and 2021, would consider LT4 treatment in TPOAb positive euthyroid women with infertility. This view varied widely across countries and correlated with sex, age and workload, potentially influencing patient management. These results raise concerns about potential risks of overtreatment.
- Klíčová slova
- antithyroid antibodies, female infertility, levothyroxine, survey, thyroid hormone, treatment,
- MeSH
- autoprotilátky * krev MeSH
- dospělí MeSH
- hypotyreóza * farmakoterapie krev MeSH
- jodidperoxidasa imunologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- thyroxin * terapeutické užití MeSH
- ženská infertilita * farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- autoprotilátky * MeSH
- jodidperoxidasa MeSH
- thyroxin * MeSH
AIM: The aim of this study was to determine the prevalence of maternal hypothyroidism in the first trimester from 11 to 14 weeks of gestation according to the American Thyroid Association (ATA) guidelines from 2017 and to compare the rates for singleton and twin pregnancies. METHODS: A total of 4965 consecutive Caucasian singleton pregnancies and 109 Caucasian twin pregnancies were included in the investigation. Patients with a history of thyroid gland disorder were excluded. Subclinical maternal hypothyroidism was defined as a thyroid stimulating hormone (TSH) concentration above the 97.5th percentile and free thyroxine (fT4) within the range of a reference population of women at 11-14 weeks of gestation. Overt maternal hypothyroidism was defined as a TSH concentration above the 97.5th percentile and an fT4 below the 2.5th percentile of the reference population.TSH, fT4, and anti thyroid peroxidase antibody (TPOAb) were measured by immunochemiluminescent assays on an 16200 Abbott Architect analyzer. RESULTS: The prevalence of hypothyroidism for twin pregnancies was no higher than that for singleton pregnancies; 6.42% (7/109) vs. 5.32% (264/4965), respectively; P=0.61. All twin pregnancies were subclinical. Singleton hypothyroid pregnancies included 4.91% (244 cases) of subclinical and 0.41% (20 cases) of overt hypothyroidism. The prevalence of TPOAb positive hypothyroid women for twin pregnancies and singleton pregnancies was 71% (5/7) vs. 52% (137/264 cases), respectively but the differences were not statistically significant; P=0.31. CONCLUSION: Each first trimester screening center should establish its TSH and fT4 reference ranges. Our center had higher upper reference limits of TSH than that of the universally fixed limit of 2.5 mU/L, which led to a lower measured prevalence of maternal hypothyroidism. A large number of hypothyroid women were TPOAb positive.
- Klíčová slova
- gestation, hypothyroidism, immunoassay, pregnancy, thyroid disease,
- MeSH
- dospělí MeSH
- hypotyreóza krev diagnóza MeSH
- imunoanalýza metody MeSH
- jodidperoxidasa imunologie MeSH
- komplikace těhotenství krev diagnóza MeSH
- lidé MeSH
- protilátky metabolismus MeSH
- první trimestr těhotenství MeSH
- retrospektivní studie MeSH
- těhotenství s dvojčaty fyziologie MeSH
- těhotenství MeSH
- thyreotropin metabolismus MeSH
- thyroxin metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Názvy látek
- jodidperoxidasa MeSH
- protilátky MeSH
- thyreotropin MeSH
- thyroxin MeSH
Importance of subclinical thyroid disease (STh) is now a matter of discussion. Definition of this unit is laboratory: in presence of normal level of thyroxine (T4) TSH value is changed: in lower TSH level the subclinical hyperthyroidism (STx) in increase TSH levels subclinical hypothyroidism (SH) is present. Risk of clinical manifestation is two three times highter in comparison with persons with normal TSH level. Clinical importance STh is still not evaluated definitively. SH caused disturbance of lipid metabolism, elasticity of vessels and endothelial function and therefore increases risk of atherosclerosis. STx causes electrical instability of myocardium with increased risk of arythmias, increases risk of osteoporosis and other changes. Most important are effects of STh in cardiology, reproductive medicine and gynecology. Clinical significance of these effects is not definitively evaluated.
- MeSH
- hypertyreóza krev komplikace diagnóza etiologie MeSH
- hypotyreóza krev komplikace diagnóza etiologie MeSH
- komplikace těhotenství krev diagnóza etiologie MeSH
- lidé MeSH
- nemoci štítné žlázy krev komplikace diagnóza etiologie MeSH
- referenční hodnoty MeSH
- těhotenství MeSH
- thyreotropin krev MeSH
- thyroxin krev MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- thyreotropin MeSH
- thyroxin MeSH
OBJECTIVE: To determine the diagnostic and predictive value of ultrasound and radioisotope scans of the thyroid, alone and in combination, during a single visit after initial referral by the screening laboratory with thyroid-stimulating hormone (TSH) elevation. STUDY DESIGN: Retrospective blind review of ultrasound and radioisotope images followed by final diagnosis based on clinical features, biochemistry, imaging, and molecular genetic study. RESULTS: Infants (n = 97; 61 female) with median birthweight 3.38 kg (range 2.04-4.86) and gestation 40 weeks (range 33-42), underwent successful dual thyroid ultrasound and technetium-99m pertechnetate radioisotope scan in a single center. Combined scanning at the initial visit resulted in a correct final diagnosis in 79 of 97 (81%) cases. One patient was misdiagnosed initially as having athyreosis as the result of delayed radioisotope scan and the diagnosis of ectopia made later on diagnostic challenge. The specificity/sensitivity for radioisotope scan and for ultrasound was as follows: 100%/97% and 100%/55% for ectopia (n = 39); 81%/100% and 54%/100% for athyreosis (n = 18); and 89%/90% and 80%/95% for dyshormonogenesis (n = 20). Neither modality, alone or in combination, predicted final diagnosis in eutopic glands due to hypoplasia (n = 4), transient TSH elevation (n = 12), and status still uncertain (n = 4). CONCLUSION: More than 80% of newborn infants with TSH elevation can be diagnosed correctly on initial imaging with combined radioisotope scan and ultrasound. Ultrasound cannot reliably detect thyroid ectopia. Radioisotope scan, especially if performed late, may show no uptake despite the presence of a eutopic gland.
- MeSH
- 99mTc-technecistan sodný * MeSH
- hypotyreóza krev diagnostické zobrazování MeSH
- konziliární vyšetření a konzultace MeSH
- lidé MeSH
- multimodální zobrazování * MeSH
- novorozenec MeSH
- novorozenecký screening metody MeSH
- prediktivní hodnota testů MeSH
- radiofarmaka * MeSH
- radioisotopová scintigrafie MeSH
- retrospektivní studie MeSH
- thyreotropin krev MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- 99mTc-technecistan sodný * MeSH
- radiofarmaka * MeSH
- thyreotropin MeSH
OBJECTIVES: The objective of the study was to assess the metabolic risk of excessive dietary iodine intake in ewes and neonatal lambs. DESIGN: Pregnant Šumava ewes received an experimental diet containing 3.1 mg iodine per kg of dietary dry matter in Group A (control, n=13, 6 ewes and 7 lambs) and 5.1 mg iodine per kg of dietary dry matter in Group B (experimental, n=12, 6 ewes, 6 lambs) for eight months. Iodine was administered to ewes as calcium iodate. TSH in blood serum; TT3, TT4, fT3, and fT4 in blood plasma were examined in both groups of ewes and lambs to assess the risks of iodine intake above the permitted limit, as it applies to thyroid gland activity. RESULTS: Group B ewes showed a significant increase in TSH and TT4 only on day 1 after parturition. The highest values of TT4, TT3, and fT3 in lambs were recorded on day 1 after birth. The lowest values of fT3 and fT4 in lambs were measured on day 60 after birth with no differences observed between the groups. In lambs of Group B the lower concentration of TSH until day 3 after birth was followed by a significant increase from day 10 after birth. CONCLUSION: Our results indicate a risk of postnatal hypothyroidism among lambs from pregnant and lactating ewes having a high iodine intake.
- MeSH
- hypotyreóza krev chemicky indukované MeSH
- jod toxicita MeSH
- laktace MeSH
- náhodné rozdělení MeSH
- novorozená zvířata MeSH
- ovce MeSH
- štítná žláza účinky léků fyziologie MeSH
- stopové prvky toxicita MeSH
- těhotenství MeSH
- thyreotropin krev MeSH
- thyroxin krev MeSH
- trijodthyronin krev MeSH
- zpožděný efekt prenatální expozice krev chemicky indukované MeSH
- zvířata MeSH
- Check Tag
- těhotenství MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- jod MeSH
- stopové prvky MeSH
- thyreotropin MeSH
- thyroxin MeSH
- trijodthyronin MeSH
OBJECTIVE: Screening of thyroid disorders in pregnancy has been controversial. Recent recommendations favour targeted high-risk case finding, though this approach may miss a significant number of those affected. We aimed to assess the prevalence of accepted high-risk criteria in women with autoimmune thyroiditis and/or hypothyroidism detected from universal screening in an iodine-sufficient population. DESIGN: In 400 non-selected women in the 9-11th gestational week, thyroid-related tests were performed, and those with abnormalities were offered consultation. METHODS: TSH was determined by IRMA, and the upper cut-off value for screening was set at 3.5 mIU/l. For free thyroxine (FT(4)) and thyroperoxidase antibodies (TPO-Ab), RIAs were used, with cut-offs of <10 pmol/l and >50 IU/ml respectively. Endocrinological consultation included Doppler ultrasonography and was aimed to confirm autoimmune thyroiditis and/or hypothyroidism. The prevalence of consensus high-risk criteria was assessed. RESULTS: Among the 400 women, 65 (16.3%) had ≥1 abnormality: higher TSH was found in 10.3%, lower FT(4) in 2% and positive TPO-Ab in 8.3%. Fifty-one women were examined and followed up. Levo-T(4) treatment was initiated in 49 women for autoimmune thyroiditis (in 42), hypothyroidism (in 34) or both (in 27). Only 22 (45%) of 49 treated women fulfilled ≥1 high-risk criterion: most commonly family history (31%), history of miscarriage or preterm delivery (14%) and personal history (8%). CONCLUSIONS: Over half (55%) of pregnant women with abnormalities suggestive of autoimmune thyroiditis and/or hypothyroidism would be missed if only those with high-risk criteria were examined. A more extensive screening of thyroid autoimmunity and dysfunction seems warranted.
- MeSH
- autoimunitní tyreoiditida krev diagnóza MeSH
- autoprotilátky krev MeSH
- gestační stáří MeSH
- hypotyreóza krev diagnóza MeSH
- komplikace těhotenství krev MeSH
- lidé MeSH
- nemoci štítné žlázy krev diagnóza MeSH
- radioimunoanalýza MeSH
- těhotenství MeSH
- thyreotropin krev MeSH
- thyroxin krev MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- autoprotilátky MeSH
- thyreotropin MeSH
- thyroxin MeSH
OBJECTIVES - While carbamazepine (CBZ) decreases thyroid hormone concentrations it rarely causes hypothyroidism. We assessed prospectively the early effect of CBZ on thyroid status in thyroxine-supplemented hypothyroid patients, when compared with patients without a thyroid disorder. METHODS - In 29 patients, thyrotropin (TSH), total thyroxine (TT4) and free thyroxine (FT4) serum levels were assayed before starting CBZ, and then weekly for 7 weeks. Nineteen patients with no thyroid disorder (group A) were compared with 10 thyroxine-supplemented hypothyroid patients, stable before CBZ treatment (group B). RESULTS - In group A, TT4 decreased significantly by ca. 15-25%, starting from the first week (Friedman, P < 0.001). FT4 decline was smaller (ca. 10-15%) and delayed till the second week. FT4/TT4 ratio increased significantly (P < 0.001), while TSH only slightly (P = 0.073), never exceeding normal range. In group B, similar TT4 and FT4 decline was followed by significantly increasing TSH (P = 0.011), while the FT4/TT4 ratio was not significantly changed. In 3 of 10 patients TSH rose over 5 mIU/l, necessitating treatment adjustment. CONCLUSIONS - In patients with no thyroid disorder, CBZ causes hormonal changes of no clinical relevance, due to adaptive response. In T4-supplemented hypothyroid patients this adaptation is lacking, CBZ may precipitate subclinical or overt hypothyroidism, and early thyroid function monitoring seems advisable.
- MeSH
- antikonvulziva škodlivé účinky MeSH
- diabetické neuropatie farmakoterapie MeSH
- dospělí MeSH
- down regulace účinky léků fyziologie MeSH
- epilepsie farmakoterapie MeSH
- hypotyreóza krev chemicky indukované patofyziologie MeSH
- karbamazepin škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolická clearance účinky léků fyziologie MeSH
- monitorování fyziologických funkcí normy MeSH
- neuralgie trigeminu farmakoterapie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- štítná žláza účinky léků metabolismus patofyziologie MeSH
- thyreotropin krev MeSH
- thyroxin krev farmakologie terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antikonvulziva MeSH
- karbamazepin MeSH
- thyreotropin MeSH
- thyroxin MeSH
INTRODUCTION: Hypothyroidism (HT) has been found a predictor of cardiovascular diseases. We aimed to ascertain the prevalence of HT in patients with manifest coronary heart disease (CHD), and to establish its association with conventional risk factors. METHODS: 410 patients, 6-24 months after hospitalization for acute coronary syndrome, and/or revascularization, were included into the cross-sectional study. RESULTS: The prevalence of thyroid dysfunction was found in males and females as follows: overt HT, ie, thyroid stimulating hormone (TSH) > 3.65 mIU/L and free thyroxine (fT4) < 9 pmol/L and/or L-thyroxine substitution, in 2.6% and 8.4%, respectively; subclinical HT (TSH > 3.65, fT4 9-23 and no substitution) in 4.3% and 15.0%, respectively. Higher prevalence of HT was found in females with hypercholesterolemia, and in males and females with concomitant positive thyroid peroxidase antibodies. Hypothyroid subjects had higher total homocysteine in both genders and von Willebrand factor in males only. Hypothyroid females had higher total and LDL cholesterol, and were more often treated for diabetes. CONCLUSIONS: HT was found highly prevalent in patient with clinical coronary heart disease, mainly in females, and was associated with several cardiovascular risk factors.
- MeSH
- autoantigeny imunologie MeSH
- autoprotilátky krev MeSH
- časové faktory MeSH
- dospělí MeSH
- homocystein krev MeSH
- hypercholesterolemie komplikace epidemiologie MeSH
- hypotyreóza krev komplikace epidemiologie MeSH
- jodidperoxidasa imunologie MeSH
- koronární nemoc etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- odds ratio MeSH
- prevalence MeSH
- proteiny vázající železo imunologie MeSH
- průřezové studie MeSH
- rizikové faktory MeSH
- rozložení podle pohlaví MeSH
- senioři MeSH
- sexuální faktory MeSH
- stupeň závažnosti nemoci MeSH
- thyreotropin krev MeSH
- von Willebrandův faktor metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Názvy látek
- autoantigeny MeSH
- autoprotilátky MeSH
- homocystein MeSH
- jodidperoxidasa MeSH
- proteiny vázající železo MeSH
- thyreotropin MeSH
- TPO protein, human MeSH Prohlížeč
- von Willebrandův faktor MeSH
Sex hormone-binding globulin (SHBG) levels were followed in three groups of female subjects to evaluate interrelationships between its levels and parameters characterizing thyroid function. In the first part of the study the data from 201 patients with thyroid and other endocrine dysfunctions were grouped according to SHBG or basic laboratory parameters of thyroid function (thyrotropin, free thyroxine). Particular attention was paid to the presence of antithyroid antibodies (against thyroglobulin or thyroid peroxidase). Analysis of covariance revealed that SHBG changes were significant only in hyperthyroidism, and were not influenced by the presence of antibodies. Age was a minor factor influencing SHBG levels, in contrast to thyroid status. In a well-defined group of 16 females with severe hypothyroidism after total thyroidectomy because of thyroid cancer the low SHBG levels increased significantly to physiologic values after reaching normal thyroid function, irrespective of contraceptive use. In the final part of the study SHBG levels were correlated with the basic laboratory data, reflecting thyroid function in a sample of normal female population (129 subjects) screened for iodine deficiency in one region of the Czech Republic. After adjustment for age, the only significant positive correlation was between SHBG and free triiodothyronine.
- MeSH
- autoprotilátky krev MeSH
- biologické markery krev MeSH
- dítě MeSH
- dospělí MeSH
- globulin vázající pohlavní hormony metabolismus MeSH
- hypotyreóza krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- nemoci štítné žlázy krev MeSH
- referenční hodnoty MeSH
- senioři MeSH
- štítná žláza imunologie MeSH
- thyreotropin krev MeSH
- thyroxin krev MeSH
- trijodthyronin krev MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- autoprotilátky MeSH
- biologické markery MeSH
- globulin vázající pohlavní hormony MeSH
- thyreotropin MeSH
- thyroxin MeSH
- trijodthyronin MeSH
Iodine is an essential element with unique role in organism: it is indispensable component of thyroid hormones. After binding with specific nuclear receptor, T3/T4 induce transcription of genetic code via mRNA and regulate proteosynthesis in most tissues. Thyroid hormones regulate rate of metabolic processes and consequently development of organism. Czech Republic was in past typical region with moderate to severe iodine deficiency. Therefore epidemiological survey was started in randomly selected samples of peoples. Thereafter a complex program of improving iodine supply was realized. Prompt effects of this changes were recorded, namely increase of ioduria and decrease of thyroid volume. Essential trace element selenium has a fundamental importance to the cell and body metabolism regulation by thyroid hormones. Activities of selenoenzymes deiodinases lead to the activation of prohormone T4 to active hormone T3 and the inactivation of T3 and of T4, as well. There is unfortunately moderate to mild Se deficit in the CR. Average serum Se concentrations for the populations from 6 to 65 years are in the regions of the CR between 42 and 62 micrograms/l and urine Se values are between 8 and 15 micrograms/l. We have found statistically significant correlations among indexes of selenium status and indexes of thyroid hormone metabolism and function. Especially dangerous are concomitant deficiencies of both key elements for thyroid hormone metabolism--I and Se--from the point of thyroid hormone regulative functions.
- MeSH
- dijodthyroniny chemie metabolismus MeSH
- dítě MeSH
- dospělí MeSH
- hormony štítné žlázy chemie metabolismus MeSH
- hypotyreóza krev epidemiologie moč MeSH
- jod krev chemie nedostatek moč MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- selen krev chemie nedostatek moč MeSH
- senioři MeSH
- štítná žláza patologie fyziologie MeSH
- trijodthyronin chemie metabolismus MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Názvy látek
- dijodthyroniny MeSH
- hormony štítné žlázy MeSH
- jod MeSH
- selen MeSH
- trijodthyronin MeSH
