Thyroid status in long-term, high-dose oral contraceptive users

The effect of high-dose, long-term oral contraceptive use on thyroid function and thyroid disease was investigated. Between 1956 and 1962 there were 836 patients treated with Enovid. Initially doses of 10 mg were given, then 5 mg, and finally 2.5 mg. 53 patients used oral contraceptives continuously through a total of 8111 cycles with an average of 156 cycles and an average dose of 3.75 mg/day/cycle. These 53 women were studied for protein bound iodine (PBI), resin triiodothyronine (T3) uptake, total thyroxine (TT), free thyroxine level (FT), radioiodine uptake, and a thyroid scan. Fractional uptakes were done on some. The PBI, T3, TT, and FT tests were done at the Bio-Science Laboratories in California, the others at a local laboratory. Uptake values were abnormally low in 40% of patients. This finding had not been previously reported. Thyroid scannings for 48 patients showed 44 were normal. In 3 patients the thyroid appeared uniformly enlarged but this was not apparent on physical examination. A small cold area was noted in 1 thyroid. No nodule or other variation was found on physical examination. A combination of the PBI test and T3 would be most helpful in evaluating hypo or hyperthyroidism. In the presence of a nontoxic goiter the PBI would be normal or high and the T3 normal or low. Though individual tests showed alterations no definite e vidence of thyroid disease was found in the patients studied.     

Complementary role of 18F-fluorodeoxyglucose positron emission tomography and 131I scan in the follow-up of post-therapy differentiated thyroid cancer.

BACKGROUND AND PURPOSE: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a relatively new modality in the follow-up of patients with differentiated thyroid cancer (DTC) who have undergone total thyroidectomy and postoperative radioiodine therapy. The aim of this study was to assess the diagnostic value of FDG-PET, comparing it with 131I whole-body scan (WBS) and 201Tl WBS. METHODS: Fifteen selected patients with local invasive and/or aggressive DTC were included in this study. The follow-up period ranged from 1 to 12 years, with a mean +/- standard error of 6 +/- 3 years. FDG-PET was performed when patients were still receiving thyroxin therapy. RESULTS: In the cervical region, residual cancer in two patients was demonstrated by FDG-PET, but could not be detected using 131I WBS or 201Tl WBS. Pathology of the surgical specimen showed dedifferentiation of thyroid cancer in one of these patients. Metastatic cervical lymph nodes were detected using FDG-PET in three patients, but in only one patient using 131I WBS and in another one patient using 201Tl WBS. Mediastinal metastases were detected using FDG-PET in three patients, 131I WBS in two patients, and 201Tl WBS in one patient. Diffuse lung metastasis was detected only by 131I WBS in two patients. The use of FDG-PET in conjunction with computerized tomography provided useful diagnostic information about small nodular lesions of the lung which could not be localized by 131I WBS or 201Tl WBS in three patients. In skeletal metastases, 131I WBS detected more metastatic lesions than FDG-PET or 201Tl WBS, especially when the lesions were located in the pelvis. CONCLUSIONS: In the follow-up evaluation of patients with post-therapy DTC, FDG-PET was useful for detecting dedifferentiated lesions and was superior to 131I WBS in detecting residual cervical or mediastinal lesions and suspected small metastatic foci in the lung. FDG-PET was inferior to 131I WBS in detecting diffuse lung metastases and distant bone metastases.     

Effect of autoimmune thyroid disease in older euthyroid infertile woman during the first 35 days of an IVF cycle

In this case-control study of euthyroid first-cycle IVF patients ≥ 38 years old with singleton baby, miscarriage, biochemical pregnancy, and no pregnancy outcomes from 2005-2008, we assayed frozen serum for autoimmune thyroid disease (AITD) and thyroid function at cycle start, trigger, and 4 and 5 weeks' gestation. AITD prevalence in older infertile women was similar across clinical outcomes, and although AITD was associated with a higher baseline TSH, TSH remained within acceptable ranges, suggesting that T(4) supplementation may not affect maternal outcomes in older euthyroid AITD patients through 5 weeks gestation.     

Subclinical hyperthyroidism as a potential factor for dysfunctional uterine bleeding.

OBJECTIVE: To evaluate the functional status of the thyroid gland in apparently euthyroid women with dysfunctional uterine bleeding. MATERIALS AND METHODS: Forty apparently euthyroid women with menorrhagia and no pathologic lesion in the genital tract were compared with 20 women having normal menstrual cycles as controls. All women underwent hormonal evaluation: serum total and free triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH) and serum prolactin. RESULTS: Statistically significant differences were observed in the values of TSH, total T3, free T3, free T4 and total T4 between the menorrhagia and the control group. Prolactin was increased significantly in the menorrhagia group. CONCLUSION: Subclinical hyperthyroidism can be a potential risk factor for dysfunctional uterine bleeding. Other studies are needed to confirm our findings.     

The effect of an oral contraceptive on tests of thyroid function

To determine the effect of a combined oral progestin on 5 tests of thyroid function, 21 parous women at least 8 weeks postpartum and with histories of regular menses were studied. A complete physical examination showed all to be normal. The 5 tests performed were radioactive iodine uptake (RAI) at 2 and 24 hours, serum protein-bound iodine (PBI), thyroxine iodine by column, triiodothyronine absorption test, and serum cholesterol. 2 baseline determinations of each test except the RAI were performed on each subject on separate days. Only euthyroid subjects were further tested. Of these 16 were given 10 mg of medroxyprogesterone acetate in combination with .05 mg of ethinyl estradiol cyclically for 20 days. Thyroid function tests were repeated at various intervals from the end of the first week of therapy to over 4 months after starting therapy. Cholesterol and RAI determinations were extremely variable precluding any evidence of drug effect. The other 3 tests showed consistent changes in all patients studied. The serum PBI and thyrozine-iodine by column tests both showed slight elevation within the first week of therapy and further elevation 1 months thereafter. These changes approached hyperthyroidism levels. The triiodothyronine absorption test showed little change in the first week but a definite downward shift thereafter with a maximum depression at 3 months of therapy. This change reached hypothyroidism level. If test were done during the 1 week each month patients were not taking the drug, results were the same. These changes are thought to be due to the estrogen component of the contraceptive drugs. Those physicians depending on these thyroid tests for diagnosis should be aware of these changes in patients taking these drugs.     

应用锝标记卵巢癌单克隆抗体进行放射免疫显象的研究

目的：探讨卵巢癌单克隆抗体（单抗）进行放射免疫显象（放免显象），对卵巢癌追踪和治疗的临床价值。方法：应用锝标记卵巢癌单抗，对荷瘤裸鼠进行放免显象（实验组），以应用锝标记正常小鼠免疫球蛋白进行对照（对照组）。并且与经腹腔与经静脉注射单抗进行比较。结果：实验组裸鼠肿瘤部位全部显象，对照组全部不显象，两组肿瘤及非肿瘤组织放射强度与显象结果一致。经静脉注射单抗的放射本底优于经腹腔注射。结论：锝标记卵巢癌单抗进行放免显象特异性强，可用于临床。     

99mTc标记抗卵巢癌单克隆抗体放射免疫导向手术的实验研究

进行＾９９ｍＴｃ标记卵巢癌单抗放射免疫导向手术研究，为临床应用提供基础。方法：彩用改进预锡法标记ＣＯＣ１８２Ｂ２－Ｆ（ａｂ’）２（单抗组）和＾９９ｍＴｃ－ＭＭＩｇＧ（对照组）。首先在体外进行放射免疫显像（ＲＩＩ）初步决定探测时机，然后采用探讨测仪（ＧＤＰ）首先在外体进行放射免疫显及临年正常组织放射性测量，并计算肿瘤与非肿瘤放射性比值（Ｔ／ＮＴ）。．结果１改进预锡法单抗＾９９ｍＴｃ标记率达计算肿瘤与     

Effect of long-term hormone substitution therapy on serum TSH level in postmenopausal women

OBJECTIVE: Dysfunction's of the thyroid gland are one of the most important endocrinological diseases. We report serum TSH levels in postmenopausal women before and during long-term hormone replacement therapy. MATERIAL AND METHODS: 107 postmenopausal patients participated in this study. Criteria for inclusion were: no known thyroid dysfunction and request for hormone replacement. Before starting therapy TSH serum levels were measured in each patient. If basal levels were within normal range TSH serum levels were reported over 4 years of hormone replacement therapy. RESULTS: More than 10% of the postmenopausal women showed pathological TSH-levels without clinical symptoms requiring further diagnostic. During subsequent treatment cycles (4 years) serum TSH in euthyroid patients did not show significant changes. Women using hormone replacement therapy developed no new manifestation of thyroid disease. CONCLUSION: In euthyroid women using long-term hormone replacement therapy are no changes in thyroid function caused by hormone replacement therapy to expect.     

Hirsutism: diagnostic approach and stimulation-suppression dynamics of androgens in the female

Total 24-hour urinary 17-ketosteroid (17-KS) and serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured before and after the administration of Cortrosyn and dexamethasone in 46 hirsute and 18 nonhirsute women. Both the baseline urinary 17-KSs and serum androgen levels were significantly higher (P less than 0.05) in hirsute than in nonhirsute subjects. In 58% of the patients in the hirsute group serum androgen concentrations were found to be elevated, while 17-KS levels in 24-hour urine collections were within normal limits. In 87% of our hirsute subjects at least one serum androgen was elevated. Serum DHEA-S concentration was elevated in almost half of the patients with hirsutism. For the evaluation of hyperandrogenism, measurements of serum androgens give more accurate information to the clinician. Dynamic stimulation-suppression studies do not appear to offer any better understanding of the type of androgens involved or a rational guide to the choice of therapy. Hirsute patients were found to be responding less to corticotropin stimulation in comparison to nonhirsute patients. The stimulation rate was significantly higher in 17-KS, A, T, and DHEA-S concentrations in nonhirsute than in hirsute patients.     

Intraperitoneal radiolabeled OC 125 in patients with advanced ovarian cancer

Twenty patients with recurrent or persistent epithelial ovarian cancer failing conventional therapies were treated with a single intraperitoneal injection of iodine-131-labeled OC 125 monoclonal antibody. Rare acute side effects were nausea and mild diarrhea. At doses up to 120 mCi of iodine-131, median white blood cell and platelet count nadirs were 3.6k/microliters and 187k/microliters, respectively. Two patients acquired thyroid toxicities despite thyroid blockage with "cold" iodine. One patient had transient TSH elevation while remaining clinically euthyroid, and 1 patient developed activation of a thyroid nodule and clinical hyperthyroidism. Dose-limiting toxicity has not yet been observed. Twelve of 20 patients are alive 3 to 17 months following therapy. Tumor progression was noted in the majority of patients, although 3 patients had documented decreases in tumor burden of short duration. We conclude that, at the doses examined, iodine-131 OC 125 can be safely administered intraperitoneally.     

Concurrent papillary thyroid cancer with pituitary ACTH-secreting tumor.

Concomitant thyroid cancer with pituitary tumor is uncommon. This study reports a case of advanced papillary thyroid carcinoma with pituitary adrenocorticotropic hormone (ACTH)-secreting tumor. A 58-year-old male patient had thyroid cancer in 1991 and presented with headache caused by pituitary tumor with apoplexy in 1993. Due to hypopituitarism, the patient underwent radioactive iodide ((131)I) for detection and treatment of metastatic thyroid cancer after the use of recombinant human thyroid-stimulating hormone (rhTSH) in 2000. During follow-up for thyroid cancer, (201)thallium scan proved to be an effective tool for detecting metastatic thyroid cancer in the patient without pituitary TSH reserve. Pituitary ACTH-secreting tumor was confirmed in 2001 based on the high serum ACTH level and positive immunohistochemical stain for ACTH. The patient had no Cushingoid features. Moreover, serum ACTH levels were 337 and 232 pg/mL with normal serum cortisol and urine-free cortisol. Although the patient underwent three operations and a total of 370 mCi (131)I therapy for recurrent thyroid cancer, the cancer continued to progress. Finally, the patient died of pneumonia with septic shock 12 years after the diagnosis of thyroid cancer.     

Incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer: functional imaging studies and follow-up

BACKGROUND: Struma ovarii is a rare ovarian germ-cell tumor containing thyroid tissue. We report an unusual case of incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer. CASE: A 24-year-old woman presented with a papillary thyroid carcinoma (pT3N1). After (131)I administration for thyroid remnant ablation, whole-body scan showed a thyroid bed uptake and a right pelvic uptake corresponding to an ovarian cyst on ultrasonography. Preablation thyroglobulin was more elevated than usually found after total thyroidectomy. (18)F-FDG PET was normal. Histopathological analysis revealed a benign struma ovarii. At 6 months, after oophorectomy, serum-stimulated Tg returned to undetectable value and diagnostic WBS was negative. CONCLUSION: Only few cases of incidental scintigraphic diagnosis of struma ovarii have been described. To our knowledge, it is the first case revealed after remnant ablation for thyroid carcinoma. The distinction with ovarian metastasis is discussed.     

Pregnancy following operative and complementary treatment of thyroid cancer

In 1974-1998, 18,602 patients were operated on due to goitre, including 16,575 (89.1%) women and 2,027 (10.9%) men. Thyroid cancer was diagnosed in 975 (5.2%) by histopathologic examination. According to the WHO classification, there were 449 (46.1%) patients with papillary carcinoma, 309 (31.7%) with follicular, 54 (5.5%) with medullary, 106 (10.9%) with anaplastic, and 57 (5.8%) with other types of thyroid malignant neoplasms. Among them, there were 812 (83.3%) women and 163 (16.7%) men. Out of 758 patients with differentiated thyroid cancer, 545 (71.8%) were treated complementarily with 131I. After surgery and complementary treatment, 23 (3%) thyroid cancer women (19 with papillary cancer and 4 with follicular one) became pregnant. Seven (30.5%) women were treated complementarily with 131I and levothyroxine, 3 (13.0%) with teleradiotherapy, 131I and levothyroxine, 1 (4.3%) with teleradiotherapy and thyroxine, and 12 (52.2%) only with levothyroxine. All women gave birth to healthy children. None of them developed recurrence before, during and after pregnancy. On the basis of the results obtained and the literature data one can conclude that it is possible to give birth to a healthy child after thyroidectomy and complementary treatment due to thyroid cancer, and that conception should occur after remission is confirmed and not earlier than 1 year after 131I treatment.     

The accuracy of urine dipsticks as a screening test for proteinuria in hypertensive disorders of pregnancy.

BACKGROUND: Proteinuria is used as a criterion in the classification system for hypertensive disorders of pregnancy including preeclampsia. The aim of the study was to evaluate the accuracy of dipstick urinalysis in a single voided urine sample and in an aliquot of a 24-hour urine collection in the assessment of proteinuria in hypertensive pregnant women, using the 24-hour urine protein excretion as the gold standard. METHODS: One hundred ninety-eight women who presented with hypertension in pregnancy were recruited at the antenatal clinic at King Edward VIII Hospital in Durban, South Africa, a tertiary referral center. Exclusion criteria included women with eclampsia, urinary tract infection, and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives for proteinuria, and a 24-hour urine specimen was collected for quantitative protein assessment. A laboratory technician performed urine dipstick test for protein on a mixed aliquot of the 24-hour urine specimen. This result, together with that of the screening dipstick urinalysis, was compared to the 24-hour urine protein excretion. RESULTS: The results of the 198 patients were analyzed, of the total, 72 had preeclampsia. Using a value of = 0.3 g protein excretion per 24 hours (1 + to 4 + on urine dipsticks) as positive, sensitivity, specificity, and predictive values for dipstick urinalysis were calculated. The positive predictive value for dipstick urinalysis ranged from 64.9% (single voided urine sample) to 94.2% (24-hour urine aliquot). The negative predictive value ranged from 75.2% (single voided urine sample) to 84.2% (24-hour urine aliquot). CONCLUSION: Dipstick urinalysis is not very accurate: therefore, all women presenting with hypertension during pregnancy should have a 24-hour urine protein measurement.     

Early hypothyroidism in patients with menorrhagia

The functional status of the thyroid gland was evaluated in 67 apparently euthyroid menorrhagic women by a thyrotropin-releasing hormone test. Fifteen of 67 showed mild primary hypothyroidism characterized by a small but significant elevation of basal levels of thyroid-stimulating hormone (5.9 +/- 0.76 versus 2.4 +/- 0.24 mU/L) and lowering of serum thyroxine levels (85 +/- 4.2 versus 105 +/- 3.0 nmol/L) to levels that were nevertheless within the normal range and exaggerated response of serum thyroid-stimulating hormone and thyroxine to administration of thyrotropin-releasing hormone. Triiodothyronine levels showed no significant change. The terms early and potential hypothyroidism appear to better describe the preliminary phases of hypothyroidism than do other terms in current use. Menorrhagia disappeared within 3 to 6 months and did not reappear in 1 to 3 years of follow up in all patients with early hypothyroidism to whom L-thyroxine was given. This was accompanied by a significant decline in random serum thyroid-stimulating hormone levels and rise of thyroxine levels to those found in the group with a negative response to the thyrotropin-releasing hormone test, with no change in levels of triiodothyronine. Further systematic study of thyroid function in menorrhagia is warranted.     

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state

Introduction: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM.

Patients and methods: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles).

Results: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid.

The number of gravida and the levels of serum β-human chorionic gonadotropin (β-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p?=?0.033, p?=?0.001, p?=?0.001 and p?=?0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p?p?p?Conclusions: Our results demonstrated that HM-related β-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.     

Evaluation of the patient with a suspected thyroid disorder.

The principal types of thyroid disorders described herein can be recognized and evaluated clinically and biochemically by the obstetrician/gynecologist. Most patients with diffuse goiter should be referred for further evaluation and an RAI scan arranged while this consultation is awaited. Patients with solitary thyroid nodules should be referred for FNAB. Primary hypothyroidism without significant goiter can be treated without specialist referral, except in patients at high risk for ischemic coronary disease or arrhythmia. Primary hyperthyroidism, apart from subacute and postpartum thyroiditis, should be referred for specialist evaluation and definitive therapy. An RAI scan and uptake should be ordered, and beta-blocker therapy can be initiated as interim therapy in symptomatic patients. Patients with secondary (i.e., hypothalamic- or pituitary-based) thyroid dysfunction should always be referred for evaluation and treatment of the primary intracranial cause. There are several causes of abnormal thyroid function tests in apparently euthyroid patients, and the clinical context often provides important evidence of their nature. Clinical judgment is an important factor in knowing when to arrange specialist consultation.     

The Accuracy of Urine Dipsticks as a Screening Test for Proteinuria in Hypertensive Disorders of Pregnancy

Background. Proteinuria is used as a criterion in the classification system for hypertensive disorders of pregnancy including preeclampsia. The aim of the study was to evaluate the accuracy of dipstick urinalysis in a single voided urine sample and in an aliquot of a 24-hour urine collection in the assessment of proteinuria in hypertensive pregnant women, using the 24-hour urine protein excretion as the gold standard. Methods. One hundred ninety-eight women who presented with hypertension in pregnancy were recruited at the antenatal clinic at King Edward VIII Hospital in Durban, South Africa, a tertiary referral center. Exclusion criteria included women with eclampsia, urinary tract infection, and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives for proteinuria, and a 24-hour urine specimen was collected for quantitative protein assessment. A laboratory technician performed urine dipstick test for protein on a mixed aliquot of the 24-hour urine specimen. This result, together with that of the screening dipstick urinalysis, was compared to the 24-hour urine protein excretion. Results. The results of the 198 patients were analyzed, of the total, 72 had preeclampsia. Using a value of ≥ 0.3 g protein excretion per 24 hours (1 + to 4 + on urine dipsticks) as positive, sensitivity, specificity, and predictive values for dipstick urinalysis were calculated. The positive predictive value for dipstick urinalysis ranged from 64.9% (single voided urine sample) to 94.2% (24-hour urine aliquot). The negative predictive value ranged from 75.2% (single voided urine sample) to 84.2% (24-hour urine aliquot). Conclusion. Dipstick urinalysis is not very accurate: therefore, all women presenting with hypertension during pregnancy should have a 24-hour urine protein measurement.     

Thyroid autoimmunity and infertility

We aimed to study the prevalence of thyroid autoimmunity in infertile women; to assess whether thyroid autoantibodies were associated with non-organ-specific autoantibodies; and to investigate the influence of this dysfunction on the couples' chances of pregnancy. We assayed serum levels of thyroid stimulating hormone (TSH) ,free thyroxine ,and microsomal and thyroglobulin autoantibodies in 149 infertile women. In patients with serum TSH levels in the hypothyroid or hyperthyroid range and/or with thyroid autoantibodies ,we performed thyroid ultrasound examinations and assayed some non-organ-specific autoantibodies. We compared the duration of infertility in infertile patients with normal thyroid (control group) ,with thyroid abnormalities ,and with thyroid autoantibodies in euthyroidism. Thirty infertile patients (20.1%) had thyroid abnormalities. The prevalence of thyroid autoantibodies was 17.4%. In infertile patients with thyroid autoantibodies ,we found a poor association with non-organ-specific autoantibodies. Only the women with thyroid abnormalities and ovulatory dysfunction had a mean duration of infertility significantly longer than that of the control group. When the data were analyzed for euthyroid women with thyroid autoantibodies ,we found no significant variation in the duration of infertility. Although we found a high prevalence of thyroid autoantibodies in infertile patients ,the presence of these autoantibodies per se did not reduce the chance of pregnancy.     

De novo clinical hypothyroidism in pregnancies complicated by type I diabetes, subclinical hypothyroidism, and proteinuria: a new syndrome

Fifty-one women with type I diabetes who had normal thyroxine values before becoming pregnant were evaluated. Abnormalities of thyroid tests other than thyroxine were encountered in 26 women, of whom 8 developed a low serum thyroxine level, an elevated thyroid-stimulating hormone level, and a low insulin requirement in the second trimester subsequent to an increase in 24-hour urinary protein excretion to greater than 4 gm/24 hr. Thyroid replacement led to an increase in insulin requirement to levels appropriate for gestational age. It is concluded that the woman with type I diabetes who develops proteinuria greater than 4 gm/24 hr during gestation is at risk for the development of de novo hypothyroidism during pregnancy, evidenced by a low serum thyroxine level, an elevated thyroid-stimulating hormone level, and a drop in insulin requirement.