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Livadas S, Angelopoulos N, Kollias A, Paparodis RD, Androulakis I, Anagnostis P, Boniakos A, Askitis D, Macut D, Jaume JC, Duntas L. Thyroxine overuse and clinical indices guiding successful treatment withdrawal. J Endocrinol Invest 2025; 48:1139-1147. [PMID: 39899246 DOI: 10.1007/s40618-025-02543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 01/26/2025] [Indexed: 02/04/2025]
Abstract
PURPOSE Levothyroxine (LT4) is commonly prescribed, but there is evidence strongly suggesting that a significant proportion of these patients are on treatment without solid evidence of hypothyroidism. Small trials on treatment discontinuation, did not detect any predictors of success. Therefore, we conducted this study in an attempt to identify predicting factors for successful LT4 withdrawal. METHODS In 802 consecutive patients (83% females, mean age 48 ± 16 years) on LT4 treatment for 8.8 ± 7.3 years without a solid diagnosis of hypothyroidism, therapy was abruptly discontinued. A total of 387 persons were followed up for up to 4 months (group A) and 415 individuals who were euthyroid at 4 months post LT4 discontinuation, were followed up for up to 60 months (group B). Recurrent hypothyroidism was defined if thyrotropin (TSH) level exceeded 4.5mIU/L. RESULTS Among the entire cohort, 182 patients (23%) became hypothyroid, 40% of group A and 7% of group B (p < 0.001). The Τhyroid treatment Discrimination Index (T4RxDI), the product of TSH levels multiplied by the daily LT4 dose divided by BMI, was calculated. In group A, successful LT4 withdrawal was strongly indicated by a T4RxDI value < 2.78 (72% sensitivity, 66% specificity), while in group B, the corresponding value was 3.75 (100% sensitivity, 48% specificity). CONCLUSIONS Our findings reveal considerable overuse of LT4 and propose a T4RxDI product of < 3 as a valuable predictive factor of recurrent hypothyroidism, justifying a treatment discontinuation trial. If hypothyroidism does not resume within 4 months, the risk of developing long-term hypothyroidism is likely to be minimal.
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Affiliation(s)
- Sarantis Livadas
- Endocrine Unit, Athens Medical Center, Athens, Greece.
- Hellenic Endocrine Network, Athens, Greece.
| | | | - Anastasios Kollias
- Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Rodis D Paparodis
- Hellenic Endocrine Network, Athens, Greece
- Department of Medicine, Jr. VA Hospital, Edward Hines, Loyola University Chicago, Hines, IL, 60141, USA
| | | | - Panagiotis Anagnostis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Djuro Macut
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University of Belgrade, University Clinical Center of Serbia, Belgrade, Serbia
| | - Juan C Jaume
- Department of Medicine, Jr. VA Hospital, Edward Hines, Loyola University Chicago, Hines, IL, 60141, USA
| | - Leonidas Duntas
- Evgenideion Hospital, Unit of Endocrinology, Metabolism and Diabetes, University of Athens, Athens, Greece
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Motegi S, Adachi M, Nagahara K, Ishida T, Ochi A, Mizuno K. Multifaceted delineation of atrophic thyroiditis among pediatric population: An extensive literature survey. Clin Pediatr Endocrinol 2025; 34:27-35. [PMID: 39777125 PMCID: PMC11701016 DOI: 10.1297/cpe.2024-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 10/01/2024] [Indexed: 01/11/2025] Open
Abstract
Autoimmune hypothyroidism is categorized into Hashimoto thyroiditis (HT) and atrophic thyroiditis (AT). Although a consensus exists among Japanese endocrinologists that pediatric AT is associated with severe hypothyroidism, the question remains whether AT and HT are separate conditions. To investigate the clinical characteristics of pediatric AT, we conducted a comprehensive literature review using PubMed and ICHUSHI, a local database. We identified 54 patients (43 females), diagnosed ≤ 18 yr of age, based on 19 English- and 28 Japanese-language publications; 45 patients were Japanese. The onset of the disease typically occurs before puberty. The patients exhibited severe hypothyroidism, with median TSH level of 518.8 μIU/mL (interquartile range [IQR]: 333.0-808.6) and median Free T4 level of 0.16 ng/dL (IQR: 0.08-0.40). Common findings included a low height SD score (median -2.54 SD), low height-velocity SD score (median -3.60 SD), body mass index +1 SD (40%), delayed bone age (64%), pericardial effusion (70%), and an enlarged pituitary gland (78%). Abnormal blood test results were frequently observed, including Hb (82%), CPK (83%), AST (94%), ALT (82%), and total cholesterol (95%). Ultrasound 3D volumetry, conducted for 14 thyroid lobes, revealed 13 lobes below the 25th percentile. In conclusion, our study underscores the clinical presentation of pediatric AT, marked by severe hypothyroidism and a small thyroid gland. Nevertheless, the paucity of data on non-Japanese patients suggests a need for further research to determine if AT and HT are indeed distinct entities.
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Affiliation(s)
- Sakura Motegi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Masanori Adachi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Keiko Nagahara
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuyuki Ishida
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Ayako Ochi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Katsumi Mizuno
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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Aksu O, Can U, Celikdelen SO, Yortanli BC, Kizilarslanoglu MC, Gunay A. Evaluation of spexin levels in euthyroid patients with Hashimoto thyroiditis and its relation to autoimmunity. Medicine (Baltimore) 2024; 103:e40321. [PMID: 39470502 PMCID: PMC11520995 DOI: 10.1097/md.0000000000040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 10/02/2024] [Accepted: 10/11/2024] [Indexed: 10/30/2024] Open
Abstract
Hashimoto thyroiditis (HT) is chronic lymphocytic thyroiditis. Cytokines and chemokines such as tumor necrosis factor-alpha, interferon-gamma, and interleukin-1 beta originating from immune cells are involved in the etiopathogenesis of HT. Spexin (SPX) is a recently identified novel peptide hormone consisting of 14 amino acids and has been demonstrated in follicle epithelial cells in thyroid tissue. SPX has been shown to affect the inflammatory response and play a role in its regulation in various diseases. There is a need for markers for diagnosis and treatment of HT patients with negative antibody levels. We found that there is no study in the literature that investigates the HT and the role of spexin in this inflammatory process. Forty-five patients aged 18 to 70 years with HT or newly diagnosed HT and 42 healthy subjects as the control group were included in the study. Patients in the HT group were divided into 3 categories according to ultrasound findings. Mild heterogeneity was called grade 1 (G1), moderate heterogeneity was called grade 2 (G2), and high heterogeneity was called grade 3 (G3). Laboratory parameters and anthropometric measurements of all patients participating in the study were performed, and SPX was measured by the ELISA method. There was no significant difference between the HT and control groups in terms of SPX levels (P = .27). In HT subgroup analysis, SPX levels were found to be borderline statistically significantly higher in the G2 group, where antibody levels were higher compared to other groups (P = .061). In our study, we evaluated SPX levels in HT patients, which has never been done before in the literature. We found high SPX levels in HT patients with high antibody levels. Multicenter studies with high case series, especially at the tissue level, are needed to fully explain the role of SPX in HT immunoetiopathogenesis and to understand immune-checkpoint pathways more clearly.
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Affiliation(s)
- Oguzhan Aksu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Health Sciences, Konya, Turkey
| | - Ummugulsum Can
- Department of Biochemistry, Konya State Hospital, Konya, Turkey
| | | | | | | | - Ayse Gunay
- Department of Clinical Pharmacy, Konya State Hospital, Konya, Turkey
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Eftekharian F, Ranjbar Omrani G, Dabbaghmanesh MH, Sahraei R, Behnam MA, Bakhshayeshkaram M, Dabbaghmanesh MM. Comparison of Thyroid Gland Sonography Index with Serum Antithyroid Peroxidase, Antithyroglobulin, and Thyroid Function Tests in Patients with Hashimoto Thyroiditis. Galen Med J 2024; 13:e3309. [PMID: 39224552 PMCID: PMC11368473 DOI: 10.31661/gmj.v13i.3309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/16/2024] [Accepted: 06/25/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Ultrasound examination of the thyroid has emerged as a useful diagnostic and prognostic tool, along with measuring serum titers of anti-thyroid peroxidase (TPO), anti-thyroglobulin (Tg), and thyroid hormones, in patients with Hashimoto's thyroiditis. So, we aimed at considering correlations of ultrasonographic, antibodies, and thyroid hormone levels. MATERIALS AND METHODS A total of 149 patients (118 females, 31 males; aged 18-60 years; mean age: 38.60 ± 8.03 years) who were diagnosed with Hashimoto's thyroiditis were enrolled in the study. The blood sample was taken to measure serum titers of free T3 (FT3) and T4 (FT4), TSH, anti-TPO, and anti-Tg antibody titers. The thyroid sonography of each patient was classified into one of the five grades by real-time ultrasound (US) based on echogenicity, thyroid size, and thyroid pattern. We evaluated whether there was a correlation between thyroid characteristics observed via ultrasound and serum levels of thyroid hormones, anti-TPO antibodies, and anti-Tg antibodies. RESULTS Nodular structures were detected in 54 (36.2%) patients (38 micro-nodular and 16 macro-nodular). Echogenicity was recorded as isoechoic in 15(10.07%) and hypoechoic in 119 (79.87%) subjects. Euthyroid subjects had significantly thicker isthmus than overt and subclinical hypothyroid patients (P=0.018). Mean serum TSH, anti-Tg, and anti-TPO antibody titers showed a significant increase in patients with macro-nodules compared to those with micro-nodules and individuals without nodules (P0.05). The thickness of the isthmus had a significant negative correlation with FT4 (P=0.046; r=0.11) and FT3 (P=0.017; r=0.15), respectively. Thyroid autoantibodies had positive significant correlations with different parameters of thyroid volume (P0.05). CONCLUSIONS Thyroid US findings, in addition to serum anti-Tg and anti-TPO antibody titers, might be correlated with the severity and extent of Hashimoto's thyroiditis, but further evaluations are needed.
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Affiliation(s)
- Fatemeh Eftekharian
- Endocrinology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Internal Medicine Department, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | | | - Reza Sahraei
- Anesthesiology Department, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Ali Behnam
- Medical Physics and Engineering Department, Shiraz University of Medical Sciences,
Shiraz, Iran
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Li W, Wang Y, Gao L, Feng R, Lv K, Wu X, Yang X, Cai S, Wang H, Li J. Sonographic characteristics of diffuse sclerosing variant of papillary thyroid carcinoma with histopathological correlation: a preliminary study. Orphanet J Rare Dis 2024; 19:136. [PMID: 38532506 DOI: 10.1186/s13023-023-02867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/23/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) is a rare but high invasive subtype of papillary thyroid carcinoma, which mandates an aggressive clinical strategy. Few studies have focused on the sonographic characteristics of DSVPTC and the role of ultrasound in diagnosis and treatment of this variant remains unknown. This study aimed to identify and understand DSVPTC more accurately under ultrasound in correlation with pathology. METHODS The ultrasound characteristics and histopathologic sections of 10 lesions in 10 DSVPTC patients who underwent thyroid surgery at our center between 2014 and 2020 were reviewed and compared with 184 lesions in 168 classic variant of papillary thyroid carcinoma (cPTC) patients. RESULTS 6 DSVPTC cases (60%) showed the "snowstorm" pattern on sonogram and 4 cases (40%) presented hypoechoic solid nodules only. Vague borders (100.0% vs. 18.5%, P = 0.019) and abundant microcalcifications (66.7% vs. 10.9%, P = 0.037) were more common in DSVPTC nodules than in cPTC nodules, corresponding to the infiltrating boundaries and numerous psammoma bodies under the microscope respectively. Most of the DSVPTC cases had a heterogeneous background (80%) and suspicious metastatic cervical lymph nodes (80%) on sonograms. All DSVPTC cases had histopathological metastatic cervical lymph nodes. CONCLUSION The sonographic "snowstorm" pattern indicated DSVPTC with whole-lobe occupation. Hypoechoic solid nodules with vague borders and abundant microcalcifications on sonogram suggested DSVPTC lesion with an ongoing invasion. Regardless of which of the two sonograms was shown, the corresponding DSVPTC lesions were aggressive and required the same attention from the surgeons.
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Affiliation(s)
- Wanying Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ying Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Luying Gao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ke Lv
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xining Wu
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiao Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Sheng Cai
- Department of Health Management, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Hongyan Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Fadlalbari GF, Musa SA, Hassan SS, Ibrahim AA, Abdullah MA. Characterization of Hashimoto´s thyroiditis in Sudanese children: a cross-sectional study at Gaafar Ibnauf Hospital, Khartoum. Pan Afr Med J 2023; 44:86. [PMID: 37193101 PMCID: PMC10182378 DOI: 10.11604/pamj.2023.44.86.35649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/04/2022] [Indexed: 05/18/2023] Open
Abstract
Introduction literature on Hashimoto´s thyroiditis, the common thyroid illness in the young populations, in Sudan and Africa is scarce. We aimed to study its clinical profile and outcome among Sudanese children and adolescents. Methods records of 73 patients were reviewed. Data related to demographics, presenting features, family history and coexistence of autoimmune diseases, physical examination findings, and biochemical progression over time were obtained. Results patients´ mean age at the diagnosis was 10.6 ± 2.9 years, 80.8% (n = 59) of them were female and 83.6% (n = 61) were residing in iodine-sufficient areas. The commonest presenting features were thyromegaly and fatigability (79.5%, n = 58 and 43.8%, n = 32, respectively) after an illness duration of 0.5-48 months. Autoimmune comorbidities were documented in 8.2% (n = 6) of our series and more than half (53.4%, n = 39) of them were pre-pubertal at the diagnosis. Sixty point three percent (60.3%) (n = 44), 20.5% (n = 15), 13.7% (n = 10) and 5.5% (n = 4) of patients presented with overt hypothyroidism, sub-clinical hypothyroidism, euthyroidism and hyperthyroidism respectively, and there were no significant differences in the clinical profile between them. In patients' continued follow-up, 94.1% (n = 32/34) of those presented with overt hypothyroidism required levothyroxine therapy to maintain euthyroidism for 0.5-13 years, while 85.7% (n = 6/7) of those with euthyroidism remained so for 0.5-6 years. Remission was reported in all hyperthyroid patients and in only 5.9% (n = 2/34) of those with overt hypothyroidism at diagnosis. The majority of our patients with subclinical hypothyroidism were treated with levothyroxine and continued to be euthyroid for 10 months to 13 years. Conclusion goiter was the commonest presenting feature of Hashimoto´s thyroiditis. The majority of patients had overt or subclinical hypothyroidism and almost all of them required long-term levothyroxine therapy.
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Affiliation(s)
- Ghassan Faisal Fadlalbari
- Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan
- Corresponding author: Ghassan Faisal Fadlalbari, Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan.
| | - Salwa Abdelbagi Musa
- Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan
| | - Samar Sabir Hassan
- Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan
| | - Areej Ahmed Ibrahim
- Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan
| | - Mohamed Ahmed Abdullah
- Gaafar Ibnauf Pediatric Tertiary Hospital, Pediatric Endocrinology Unit, Khartoum, Sudan
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Hwang SM, Hwang JY, Moon JH, Yang I, Woo JY, Lee HJ. Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases. Medicine (Baltimore) 2022; 101:e30095. [PMID: 36107500 PMCID: PMC9439828 DOI: 10.1097/md.0000000000030095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 10/29/2022] Open
Abstract
This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.
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Affiliation(s)
- Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Hee Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye Jin Lee
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Choi I, Na DG. Can ultrasound echogenicity of normal parotid and submandibular glands be used as a reference standard for normal thyroid echogenicity? Ultrasonography 2022; 41:678-688. [PMID: 35909317 PMCID: PMC9532199 DOI: 10.14366/usg.21254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aimed to determine whether the normal parotid gland (PG) and submandibular gland (SMG) can be used as reference standards for normal thyroid echogenicity. Methods In total, 1,302 consecutive patients with normal salivary glands were included in this study. The echogenicity of the SMG and PG was assessed during real-time ultrasound examinations, and the glands were categorized as hyperechogenic, isoechogenic, and hypoechogenic relative to the thyroid parenchyma in patients without diffuse thyroid disease (group 1, n=1,106) and with diffuse thyroid disease (group 2, n=196). The frequency of the echogenicity categories of the normal PG and SMG was assessed according to patients’ age. Results In group 1, the normal PG showed isoechogenicity in 94.0% and hypoechogenicity or hyperechogenicity in 6.0%, and the normal SMG showed isoechogenicity in 73.6% and hypoechogenicity in 26.4% of patients (P<0.001). There was no significant association of the frequency of isoechoic PG with age (P=0.834); however, there was a trend for an increasing frequency of isoechoic SMG with aging (22.9%-81.4%) (P<0.001). Similar findings were found in group 2 patients without decreased thyroid echogenicity. Conclusion The normal PG was mostly isoechoic to the normal thyroid parenchyma, whereas the normal SMG showed hypoechogenicity at various frequencies according to age. The echogenicity of the normal PG can be used as an alternative reference standard for normal thyroid echogenicity; however, the normal SMG is not suitable for a reference standard when assessing thyroid nodule echogenicity in patients who have diffuse thyroid disease with decreased parenchymal echogenicity.
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Affiliation(s)
- Insik Choi
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
- Correspondence to: Dong Gyu Na, MD, PhD, Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Gangneung 25440, Korea Tel. +82-33-610-4310 Fax. +82-33-610-3490 E-mail:
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Zhang XH, Yuan GP, Chen TL. Clinical effect of methimazole combined with selenium in the treatment of toxic diffuse goiter in children. World J Clin Cases 2022; 10:1190-1197. [PMID: 35211552 PMCID: PMC8855191 DOI: 10.12998/wjcc.v10.i4.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of toxic diffuse goiter (Graves’ disease) is higher in adolescents and preschool-aged children, with an upward trend. The incidence at 6–13 years of age is approximately 11.0%, and the incidences in men and women are 7.8% and 14.3%, respectively.
AIM To explore the clinical effect of methimazole combined with selenium in the treatment of toxic diffuse goiter (Graves’ disease) in children and its effect on serum anti-thyroglobulin antibody (TRAb) and anti-thyroid peroxidase antibody (TPOAb).
METHODS A total of 103 children with Graves’ disease treated in our hospital from January 2018 to June 2021 were divided into a traditional group and a combined group (15-20 mg methimazole orally given to children) and a combined group (50 µg selenium added on the basis of traditional treatment) according to different treatment methods to explore the therapeutic effects of the two methods and to observe the changes in thyroid volume and serum TRAb, TPOAb, free thyroxine (FT4) and inflammatory factor levels before and after treatment. The time taken for FT4 to return to normal was compared between the two groups.
RESULTS Treatment was significantly more effective in the combined group than in the traditional group (P < 0.05). The thyroid volumes of the children in the two groups was measured before and after treatment. Thyroid volume decreased significantly after treatment in both groups, and the thyroid volume was significantly lower in the combined group than in the traditional group (P < 0.05). The serum levels of interleukin-6 (IL-6), IL-8, TRAb, TPOAb and FT4 in the two groups were detected before and after treatment. The levels of IL-6, IL-8, TRAb, TPOAb and FT4 were significantly lower in the combined group than in the traditional group (P < 0.05). Follow-up of the children in the two groups showed that compared with the traditional group, it took less time for children in the combined group to return to the normal level (P < 0.05).
CONCLUSION Methimazole combined with selenium can effectively treat Graves’ disease in children, reduce the expression of TRAb, TPOAb, FT4 and inflammatory factors, and improve the curative effect. Thus, the combined treatment warrants further clinical research.
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Affiliation(s)
- Xiao-Hong Zhang
- Department of Pediatric Endocrinology, Quanzhou Women and Children’s Hospital, Quanzhou 362000, Fujian Province, China
| | - Gao-Pin Yuan
- Department of Pediatric Endocrinology, Quanzhou Women and Children’s Hospital, Quanzhou 362000, Fujian Province, China
| | - Ting-Li Chen
- Department of Pediatric Endocrinology, Quanzhou Women and Children’s Hospital, Quanzhou 362000, Fujian Province, China
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Park JE, Hwang SM, Hwang JY, Moon JH, Yang I, Woo JY, Lee HJ. The relationship between ultrasound findings and thyroid function in children and adolescent autoimmune diffuse thyroid diseases. Sci Rep 2021; 11:19709. [PMID: 34611214 PMCID: PMC8492727 DOI: 10.1038/s41598-021-99016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Abstract
To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD). From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades. Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p = 0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p = 0.035) and hypothyroid (p = 0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US. In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Korea
| | - Sook Min Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea.
| | - Ji-Young Hwang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Jin Hee Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Ik Yang
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea
| | - Hye Jin Lee
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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de Souza LRMF, Sedassari NDA, Dias EL, Dib FCM, Palhares HMC, da Silva AP, Tomé JM, Borges MDF. Ultrasound measurement of thyroid volume in euthyroid children under 3 years of age. Radiol Bras 2021; 54:94-98. [PMID: 33854263 PMCID: PMC8029934 DOI: 10.1590/0100-3984.2020.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective To establish ultrasound reference values for thyroid volumes in children up to 3 years of age, given that ultrasound of the thyroid is an essential examination in the diagnosis of childhood thyroid disease. Materials and Methods This was a prospective study conducted in an iodine-sufficient city in southeastern Brazil. A total of 100 healthy children underwent clinical evaluation, anthropometric examination, and cervical ultrasound in accordance with conventional protocols. We evaluated characteristics such as echotexture, thyroid lobe volume, and total thyroid volume. The children were divided into five groups, by age: < 2 months; 2-12 months; 12-18 months; 18-24 months; and 24-36 months. Results The mean thyroid volume was lower in the < 2 month age group than in the other groups (0.4 mL vs. 0.18-0.70 mL; p < 0.001). For the subjects between 2 and 36 months of age, the mean volume was 1.0 mL (range, 0.30-2.0 mL). No other significant differences were observed between groups, thyroid lobes, or gender. However, body mass index correlated significantly with total thyroid volume (r = 0.347; p = 0.001). Conclusion The mean thyroid dimensions were smallest in the < 2 month age group (0.35 ± 0.16 mL). For the subjects between 2 and 36 months of age, a reference value of 0.85 ± 0.42 mL can be used. Our data could guide the diagnostic investigation of thyroid disease, especially congenital hypothyroidism, in childhood.
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Kim MJ, Kim SC, Chung S, Kim S, Yoon JW, Park YJ. Exploring the role of copper and selenium in the maintenance of normal thyroid function among healthy Koreans. J Trace Elem Med Biol 2020; 61:126558. [PMID: 32480050 DOI: 10.1016/j.jtemb.2020.126558] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Selenium and iodine are trace elements well known to have important roles in the synthesis and metabolism of thyroid hormones. However, the effects of other trace elements on thyroid hormones are still inconclusive. We investigated the association between several trace elements and thyroid hormones. METHODS The data of 448 subjects who were measured for both, trace elements and TSH/free T4, at the Heath Checkup Center were retrospectively reviewed. The presence of thyroiditis (from thyroid echogenicity) and thyroid nodules were reviewed in the subjects who underwent thyroid ultrasonography. RESULTS Blood concentrations of manganese, copper, selenium, and molybdenum were associated with TSH or free T4. After adjusting for age, sex, BMI, smoking, and alcohol consumption, blood copper levels were positively associated with free T4 in both sexes and selenium levels were positively associated with free T4 in women. There was no association between trace elements and thyroiditis. Blood copper concentration had a weak non-linear association with the presence of thyroid nodules. CONCLUSIONS This study demonstrated that blood concentrations of copper and selenium were significantly associated with free T4 in healthy Korean subjects with sufficient iodine intake suggesting their role in maintaining normal thyroid function.
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Affiliation(s)
- Min Joo Kim
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Soo Chin Kim
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Soie Chung
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Serim Kim
- Department of Laboratory Medicine, Green Cross Laboratories, Yongin, Gyeonggi, Republic of Korea
| | - Ji Won Yoon
- Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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13
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Bauer AJ, Wassner AJ. Thyroid hormone therapy in congenital hypothyroidism and pediatric hypothyroidism. Endocrine 2019; 66:51-62. [PMID: 31350727 DOI: 10.1007/s12020-019-02024-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022]
Abstract
The evaluation and management of hypothyroidism in children are similar to adults, but there are important differences based on the dependence on normal thyroid function for neurocognitive and physical development. In the pediatric population, hypothyroidism is frequently categorized as congenital or acquired hypothyroidism, depending on the age of presentation and the underlying etiology. The evaluation and management of children and adolescents with hypothyroidism are determined by the etiology as well as by the age at diagnosis, severity of the hypothyroidism, and the response to thyroid hormone replacement therapy. Children and adolescents require higher weight-based doses for thyroid hormone replacement than do adults, likely due to a shorter half-life of thyroxine (T4) and triiodothyronine (T3) in children, but weight-based dose requirements decrease as the child advances into adulthood. Multiple gaps in knowledge remains regarding how to optimize the treatment of hypothyroidism in pediatric patients, including (but not limited to) the selection of patients with subclinical hypothyroidism for treatment, and the potential benefit of combined LT3/LT4 therapy for patients with persistent symptoms and/or low T3 on LT4 monotherapy. The life-long impact on growth and development, and potentially on long-term cardiovascular and psychosocial health, are significant and highlight the importance of future prospective studies in pediatric patients to explore these areas of uncertainty.
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Affiliation(s)
- Andrew J Bauer
- The Thyroid Center, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, The Perelman School of Medicine, The University of Pennsylvania, 3500 Civic Center Boulevard, Buerger Center, 12-149, Philadelphia, PA, 19104, USA.
| | - Ari J Wassner
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, 333 Longwood Avenue, 2nd floor, Boston, MA, 02115, USA
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