Adolescent thyroid disorders

Thyroid disorders are common in adolescence. Thyroid nodules can present in this age group, and although most are benign, malignancy is not unheard of. Chronic lymphocytic thyroiditis can present as hypothyroidism, while the adolescent with a goiter due to autoimmune thyroid disease is frequently euthyroid. Graves disease is a common etiology of hyperthyroid presentation in this age group. While there are known genetic and iatrogenic conditions that may predispose thyroid problems, they may also happen randomly in the general population. Thyroid problems may present as a goiter, a nodule, or a general cluster of abnormal symptoms and physical findings. The unique challenge to the provider of adolescent health care is that thyroid problems can adversely affect growth and development during puberty, a crucial period of hormonal interaction. This chapter addresses the diagnosis, treatment alternatives, and prognosis for a variety of common and uncommon thyroid abnormalities in adolescents. Many are readily treatable if recognized promptly, and even thyroid cancer often can be effectively treated and managed. Physicians treating the adolescent population have to be aware of the various thyroid problems that their patients can face.     

吸烟与甲状腺疾病的关系

大规模人口调查统计显示,吸烟能够降低血清TSH,升高FT3、FT4水平,这一作用与是否存在缺碘有直接的相关性,现有资料表明碘充足地区存在这一效应,即吸烟提高了甲状腺功能亢进症的发病率。而在碘缺乏地区,吸烟者非毒性甲状腺肿大的发病率更高且甲状腺体积更大。吸烟者不易患甲状腺癌,尤其是乳头状甲状腺癌,这跟吸烟的年限及吸烟量有关,但这一观点尚需更多的证据支持,且其相关机制尚不清楚。     

Diabetes and eating disorders in primary care

OBJECTIVE: To determine the relationship between diabetes and eating disorders among primary care patients. METHOD: Data on 3,000 patients were obtained from eight primary care and family practice settings, including the PRIME-MD Patient Health Questionnaire (PHQ), self-reported physical illness, and social functioning information. Multivariate logistic regression analyses were used to determine the association between diabetes and eating disorders. RESULTS: Diabetes was associated with an increased likelihood of eating disorders [OR = 2.3 (1.4, 3.9)], after adjusting for differences in demographic characteristics and comorbid mental disorders. This effect was specific to diabetes. Eating disorder was the only mental disorder associated with a significantly increased risk of diabetes, odds ratio (OR) = 2.4 (1.4, 4.0), after adjusting for demographic characteristics and comorbid mental and physical disorders. Patients with both diabetes and eating disorders had significantly higher levels of comorbid anxiety, panic attacks, and alcohol use disorders, compared with those with one but not both. DISCUSSION: Consistent with reports from community-based samples, these data suggest that diabetes may be associated with an increased likelihood of eating disorders among patients in primary care. Clinicians who treat patients with diabetes, a common condition in primary care, should screen for eating disorders. In addition, patients with eating disorders may be at risk for the development of diabetes. Further work is needed to determine the generalizability of these findings and to understand the mechanism of this association.     

Renin-angiotensin-aldosterone system in thyroid disorders

Alterations of the renin-angiotensin-aldosterone system activity occur in patients with thyroid disfunction. This paper is a review of the effect of hyperthyroidism or hypothyroidism in human beings and experimental animals on changes of the renin, angiotensinogen, angiotensin converting enzyme, angiotensin II and aldosterone concentrations and plasma renin activity.     

甲状腺功能与月经失调的相关性研究

甲状腺功能从多方面影响卵巢轴功能,无论是甲状腺功能亢进(甲亢)或甲状腺功能减退(甲减),都可能会发生月经不规律、生殖力减退及卵泡发育停滞.该文综述结论 为甲减患者的月经失调类型偏多于月经过少或月经稀发,甲减程度重者可为月经过多或月经频发甚至功血.甲亢患者的月经失调以月经过少或月经稀发为主要类型.妇产科医生在诊断和治疗月经失调时应关注月经失调与甲状腺功能的相关性.     

Dyslipidemia in patients with thyroid disorders

Thyroid disorders are known to influence lipid metabolism and are common in dyslipidemic patients. Overt and subclinical hypothyroidism have an adverse effect on the serum lipid profile that may predispose to the development of atherosclerotic disease. Although thyroid substitution therapy is beneficial for patients with overt hypothyroidism, the question of whether subclinical hypothyroidism must be treated remains unanswered. The association between thyroid autoimmunity and lipoprotein (a) levels is controversial. Hyperthyroidism may be the underlying cause for acquired hypocholesterolemia or unexpected improvement of the lipid profile of a previously hyperlipidemic patient.     

Influence of cigarette smoking on thyroid function, goiter formation and autoimmune thyroid disorders

Both smoking and thyroid dysfunction are frequent in the general population. Many studies have shown that cigarette smoking interferes with thyroid function and with the evolution of thyroid pathology (e.g. goiter formation and thyroid cancer development). Some studies have also suggested a significant correlation of Graves' hyperthyroidism and Graves' ophthalmopathy with the severity of smoking. In addition, cigarette smoking may reduce the effectiveness of some therapeutic modalities, such as orbital radiotherapy or high-dose systemic glucocorticoid administration for severe thyroid eye disease. Tobacco smoking seems to induce similar changes in thyroid function in the adult and the fetus. This review article discusses the effect of cigarette smoking on thyroid function and morphology as well as on thyroid autoimmunity.     

Subclinical functional disorders of the thyroid gland

Subclinical hypothyroidism is associated with aspecific complaints such as tiredness, cognitive and depressive complaints, subtle disturbances in lipid values, an increased risk of cardiovascular disease, ovulatory dysfunction and a negative effect on foetal psychomotor development and pregnancy outcome. Subclinical hyperthyroidism is associated with atrial fibrillation, osteoporosis and dementia. Not enough prospective randomised studies with hard outcomes are available to provide evidence-based general recommendations. Therefore, the decision as to whether or not a patient should be treated needs to be made on an individual basis. For subclinical hypothyroidism it is advisable to consider treatment in the case of positive thyroid peroxidase antibody tests, a TSH concentration higher than 10 mU/l, the presence of one or more risk factors for cardiovascular disease, infertility on the basis of ovulatory dysfunction, and pregnancy. In the case of complaints of tiredness and certainly in the case of depression or cognitive dysfunction, a 3-month trial treatment can be considered. This leads to a decrease of the complaints in about 25% of cases. As negative effects are associated with the treatment, we advise an expectant approach in all other cases with a yearly monitoring of the TSH concentration. For subclinical hyperthyroidism it is advisable to consider treatment in the case of a nodular goitre, and especially in the case of atrial fibrillations. If subclinical hyperthyroidism persists in the absence of nodular thyroid disease, an expectant approach appears to be justified.     

Incidence of thyroid disorders in children in Hungary

Author gives information to the home tendencies of incidence of some important thyroid disorders in childhood mainly on the basis of his studies done with his coworkers. Results are compared with the standpoints raised since Chernobyl accident. It is verified on the basis of cca one million neonatal TSH screening that the frequency of congenital hypothyroidism in Hungary corresponds to those of European countries in the last 17 years. Changes connected with Chernobyl has not occurred. It deals with incidence of Graves' disease as the main form of hyperthyroidism relying upon TSH receptor antibody positivity. The yearly distribution of the 176 proved cases shows a slow increasing trend in the same period of time (17 yrs). In this radiation does not play a role. The paper treats of the topic of iodine deficiency with of high priority. Author draws the attention again to the fact that the iodine nutrition in significant part of the population is behind of optimum in harmony with the results of some other national studies also according to their own three thousand urinary iodine tests and more than four thousand thyroid sonographies. This iodine deficiency should be regarded as a potential risk from the viewpoint of radiation hazard! While enlargement of thyroid was often found by sonography, the formation of nodules only rarely in contrast to those of the Chernobyl area. The frequency of thyroiditis, especially in puberty increases too, but the degree of it falls far behind from those of published around of Chernobyl. The incidence of differentiated thyroid carcinoma--according to the available data--moderately increases as well, without any connection between the residence and the geographical distribution of radiation pollution. The epidemiological, clinical, and histological characteristics of the Hungarian children are similar to the so-called sporadic (non-radiation induced) form and different from the cases of the Chernobyl area.     

Health-related quality of life in patients with thyroid disorders

Limited reports are available on quality of life (HRQL) in thyroid diseases, and no data are available in euthyroid disorders, such as goiter and Hashimoto thyroiditis. Also, asymptomatic patients may suffer a reduction in perceived health status due to distress related to physical appearance and awareness of disease. We measured HRQL by means of Medical Outcome Study Short Form-36 (SF-36) and Nottingham Health Profile (NHP) questionnaires in 368 patients (hypothyroid, 81; hyperthyroid, 45 (for both states including overt and subclinical states); Hashimoto thyroiditis, 51; euthyroid goiter, 191). The final scores of the domains were compared with age- and sex-adjusted Italian normative values, by computing the effect size. All domains of SF-36, except bodily pain, were reduced in thyroid disease; this was mainly the case of role limitation (both physical and emotional), general health and social functioning. The domains of NHP were less severely affected. HRQL was impaired also in the absence of altered hormone levels. Mood/behavior disturbances were present in a large proportion of patients and were significantly associated with poor HRQL. HRQL was significantly reduced in patients with thyroid diseases referred to a secondary level endocrinology unit. Perceived health status may be considered as an additional outcome of management and therapy of thyroid disorders.     

Incidence of postpartum thyroid function disorders in The Netherlands]

In a longitudinal study the incidence of postpartum thyroid dysfunction in the Netherlands was investigated in an unselected open population. There were 293 women who were screened by repeated assessments of thyroid function until 34 weeks postpartum at 6-week intervals. Thyroid dysfunction was defined as abnormal TSH values accompanied by abnormal FT4 and (or) FT3 values. The frequency of postpartum thyroid dysfunction was 7.2% (n = 21). Most of the thyroid dysfunction occurred between 16 and 28 weeks postpartum. There were five women with subclinical thyroid dysfunction: abnormal TSH values with complementary FT4 and (or) FT3 changes within normal limits. Four of them showed (marked) increase in antimicrosomal antibody titres. With the inclusion of the five women the frequency rose to 8.9%. These data appear representative for the Netherlands as a whole, suggesting that every year 14,000 women suffer from (transient) postpartum thyroid dysfunction.