Author Interviews, Endocrinology, Thyroid Disease / 11.06.2020
MedicalResearch.com Interview with: Elizabeth H.Z. Thompson, Ph.D. Group vice president, Clinical Development and External Search Horizon Therapeutics MedicalResearch.com: What is the background for this study? Response: This study provides the first U.S.-based validation of the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. For your background, Graves’ Ophthalmopathy is another term used to describe Thyroid Eye Disease (TED). The GO-QOL questionnaire includes eight questions, each on visual functioning and appearance-related impacts of TED on patients. Though widely used and validated in Europe, the relevance of the questions for patients in the United States hasn’t previously been explored.For this evaluation, 13 eligible TED patients completed the questionnaire and then underwent a separate cognitive QOL-related interview. (more…)
Author Interviews, Endocrinology, Ophthalmology, Thyroid Disease / 06.04.2020
MedicalResearch.com Interview with: Dr. Raymond Douglas MD PhD Board Certified Oculoplastic Surgeon Beverly Hills, CA MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by proptosis? How does teprotumumab work? Response: This study provides pooled efficacy data from the Phase 2 and 3 clinical trials of teprotumumab showing that the recently FDA-approved medicine effectively reduces proptosis, also known as eye bulging, in patients with Thyroid Eye Disease (TED) regardless of age, gender and smoking status. Proptosis is one of the most debilitating symptoms of TED, especially given the accompanying pain, vision impairment and emotional distress. Teprotumumab is a fully human monoclonal antibody and a targeted inhibitor of the IGF-1 receptor. In patients with Thyroid Eye Disease, the IGF-1 receptor is overexpressed on orbital tissues and when activated, causes inflammation and enlargement of ocular muscles, expansion of orbital tissue and fat and forward displacement of the eye, resulting in eye bulging. The proteins in teprotumumab target and bind to the IGF-1 receptor and inhibit its function, thereby reducing inflammation, preventing tissue expansion behind the eye, and preventing muscle and fat tissue remodeling. Based on this mechanism of action, it is believed that teprotumumab addresses the underlying biology of the disease. (more…)
Author Interviews, Endocrinology, NEJM, Thyroid Disease / 23.01.2020
MedicalResearch.com Interview with: Raymond S Douglas MD PhD Professor of Surgery, Division of Ophthalmology Director of the Orbital and Thyroid Eye Disease Program Cedars Sinai Medical Center MedicalResearch.com: What is the background for this study? Response: Thyroid eye disease (TED) is a debilitating disease that affects all aspects of a patients life. It is often associated with Graves' disease and thyroid abnormalities. TED causes profound bulging of the eyes impairing vision, causing eye pain and facial disfigurement. (more…)
Author Interviews, Endocrinology, Geriatrics, Thyroid Disease / 15.12.2019
MedicalResearch.com Interview with: Carol Chiung-Hui Peng, MD Department of Internal Medicine University of Maryland Medical Center Baltimore, MD MedicalResearch.com: What is the background for this study? Response: In recently published meta-analyses, focusing on the general population, showed that both overt hypothyroidism and subclinical hypothyroidism were linked to higher all-cause and cardiovascular mortality. However, there is still debate and conflicting evidence on managing overt and subclinical hypothyroidism in the elderly. This study aimed to evaluate and confirm the association between hypothyroidism and mortality in the elderly population. (more…)
Author Interviews, Ophthalmology, Thyroid Disease / 26.11.2019
MedicalResearch.com Interview with: Raymond S. Douglas, MD, PhD Ophthalmology Cedars-Sinai, Los Angeles MedicalResearch.com: What is the background for this study? Response: The data presented at the American College of Rheumatology (ACR) annual meeting on November 11, 2019 are integrated, pooled efficacy data from the Phase 2 and Phase 3 clinical trials of teprotumumab for the treatment of active thyroid eye disease (TED) compared to placebo. The results support prior analyses of significant reductions in inflammation, proptosis (eye bulging) and diplopia (double vision), as well as improvements in quality of life (QoL). This presentation of the pooled analyses builds on the individual positive results of the Phase 2 and Phase 3 clinical studies. (more…)
MedicalResearch.com Interview with: Charit Taneja, MBBS Internal Medicine Resident Maria Brito, MD Co-Director, Mount Sinai’s Thyroid Center Assistant Professor, Medicine, Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: There have been reports of seasonal fluctuations in thyroid function, however there are no standard guidelines for management of such fluctuations and their clinical implications. It is not a well-studied subject and there are insufficient guidelines around its clinical implications. MedicalResearch.com: What are the main findings? Response: Our patient had winter elevation of TSH and summer normalisation repeatedly over a course of three years, but remained largely asymptomatic despite the biochemical alterations. (more…)
Author Interviews, CMAJ, Thyroid Disease / 18.11.2019
MedicalResearch.com Interview with: Dr. Richard Birtwhistle, Professor Departments of Family Medicine and Community Health and Epidemiology Director of the Centre for Studies, Primary Care, Department of Family Medicine Queen’s University MedicalResearch.com: What is the background for this study? Response: Testing for thyroid dysfunction is a commonly done by primary care practitioners. While the Thyroid stimulating hormone (TSH) test is an easy blood test to perform results outside the normal range are often found and will revert to normal over time without treatment in patients without symptoms. We wanted to see if there was any clinical benefit to patients by screening for thyroid dysfunction. (more…)
Author Interviews, Endocrinology, Stem Cells, Thyroid Disease / 05.11.2019
MedicalResearch.com Interview with: Terry Davies, MD Co-Director, The Thyroid Center at Mount Sinai Union Square Professor, Medicine, Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many tissues contain stem cells that are responsible for regeneration and repair after injury. The mechanism of thyroid regeneration and the role of thyroid stem cells in this process is poorly understood. This an exploration of how the thyroid gland repairs itself. Using a mouse model we found that a damaged gland can correct itself within 4 weeks and this involves a rapid increase in stem cells driving the repair. (more…)
Author Interviews, Endocrinology, Thyroid Disease / 31.03.2019
MedicalResearch.com Interview with: Terry Davies, MD, Professor Medicine, Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai Co-Director, The Thyroid Center, Mount Sinai Union Square MedicalResearch.com: What is the background for this study? What are the main findings? Response: The receptor for thyroid stimulating hormone (TSH) is the major antigen for Graves' disease and patients have unique antibodies to the TSHR which stimulate excessive thyroid hormone secretion. We have characterized a variant TSHR called v1.3 which is a splicing variant which we find expressed in thyroid, bone marrow, thymus and adipose tissue and incorporates an intronic sequence which is fully translated. (more…)
Author Interviews, Duke, Endocrinology, Environmental Risks, Thyroid Disease, Weight Research / 27.03.2019
MedicalResearch.com Interview with: Christopher D. Kassotis, Ph.D. NRSA Postdoctoral Research Scholar Stapleton Lab Duke University Nicholas School of the Environment Durham, NC 27708 MedicalResearch.com: What is the background for this study? What are the main findings?
- So this was something that Heather Stapleton had been curious about for years, as she's been one of several researchers characterizing the hundreds of chemicals that have been measured in indoor house dust. Before I came to Duke, one of her PhD students had measured the ability of many common indoor contaminants to activate the peroxisome proliferator activated receptor gamma (PPARg). The majority of these chemicals did, often quite well, which led to them testing indoor house dust extracts, also finding that the majority of dust extracts were also able to do so at very low levels. As PPARg is often considered the master regulator of fat cell development, the next obvious question was whether these common contaminants (and house dust) could promote fat cell development in cell models. My first work at Duke evaluated a suite of common indoor contaminants, finding that many of these chemicals could promote fat cell development, and that low levels of house dust extracts did as well.
- We next explored this more systematically in a group of adults involved in a thyroid cancer cohort (this was just recently published in Science of the Total Environment: https://www.sciencedirect.com/science/article/pii/S0048969719307715?dgcid=author
- In this study we evaluated the extent to which house dust extracts could promote fat cell development in a common cell model, and associated this with the metabolic health of adults living in these homes. We found that the greater extent of fat cell development was associated with significantly greater thyroid stimulating hormone concentrations (control residents only, with no evidence of thyroid dysfunction) and lower free triiodothyronine (T3) and thyroxine (T4). We further found a significant and positive association between extent of fat cell development and the body mass index (BMI) of all adults in the study. So this suggested that the indoor environment might play a role in the BMI and metabolic health of residents, and we next wondered if this would be more pronounced in children, who may be exposed to these contaminants during a critical window of development.
- The next step, for our current work, was to substantiate these effects in a larger group of households, each with children.
- Our major conclusions thus far have been that ~80% of house dust extracts promote significant fat cell development in a cell model - either via development from precursor cells into mature fat cells, measured via accumulation of lipids into the cells, or via the proliferation of those precursor fat cells. We also reported positive correlations of fat cell development with the concentrations of 70 different contaminants in the dust from these homes, suggesting that mixtures of contaminants are likely all acting weakly to produce these effects in combination. We’ve also begun to assess the other chemicals present in dust - chemistry can be either targeted (measuring concentrations of specific known chemicals in a sample), or non-targeted, where you try and determine the identity of the other chemicals in a sample. This has greater utility for identifying many more chemicals, though you will often not get chemical concentrations from this, nor absolute confirmed identification - just varying degrees of certainty based on evidence. Thus far we report approximately 35,000 chemicals in house dust samples across this study, and differential analyses have begun to pick out the few (less than 10 in each case) chemicals most differentially expressed between samples that exhibit high degrees of fat cell development in the lab vs inactive samples, for example, or which are differentially present in the homes of children categorized as obese or overweight. We are now working to confirm identity of these select contaminants that are more likely to be causative factors in the results we have observed.
Author Interviews, JAMA, Thyroid, Thyroid Disease / 04.02.2019
MedicalResearch.com Interview with: Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc. Assistant Clinical Investigator/Assistant Professor Metabolic Disease Branch/NIDDK/NIH Bethesda, MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: People with intermediate- and high-risk differentiated thyroid cancer (DTC) are treated with surgical removal of the thyroid gland and radioactive iodine therapy. After surgery and initial treatment, the thyroid hormone levothyroxine is used for long-term management not only to replace appropriate physiologic thyroid hormones post-surgery, but also to suppress thyrotropin (TSH) release from the pituitary gland at supraphysiologic doses. The current recommended American Thyroid Association TSH suppression goal in patients with a high-risk differentiated thyroid cancer presenting with distant metastases is less than 0.1mIU/ml, and between 0.1-0.5 mIU/ml for patients with intermediate-risk DTC presenting with local metastases to the neck lymph nodes. This TSH goal is much lower than physiologic TSH level, which ranges between 0.4-4.1 mIU/ml, depending on the measurement method and person’s age. TSH suppression is used because some preclinical evidence suggests that TSH can stimulate growth of cancer cells. However, several preclinical studies show that thyroid hormones may also stimulate cancer growth. In addition, too much levothyroxine, leading to TSH suppression, may cause side effects such as abnormal heart rhythms and decreased bone mass. In this study, based on a large multicenter database analysis, we found that continuous TSH suppression with levothyroxine was not associated with better progression-free survival and overall survival in patients with either intermediate- and high-risk differentiated thyroid cancer. The patients were followed for an average of 7 years after surgical thyroid cancer removal and radioactive iodine therapy. (more…)
Author Interviews, Heart Disease, JAMA, Thyroid Disease, Vanderbilt / 27.01.2019
MedicalResearch.com Interview with: Joe-Elie Salem, MD, PhD Associate Professor - MCU-PH, Sorbonne Université - INSERM - CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology Clinical Pharmacology, Nashville, TN MedicalResearch.com: What is the background for this study? What are the main findings? Response: A study by researchers at Vanderbilt University Medical Center has strengthened the link between thyroid function and atrial fibrillation (AF), an irregular heart rhythm that increases the risk of stroke and other heart-related complications. They phenome-wide association study scanned the medical records of more than 37,000 people for an association between genetically determined variation in thyroid stimulating hormone levels (a measure of thyroid function) and AF risk. Previous observational studies have found that subclinical hyperthyroidism, an overactive thyroid which does not meet the clinical threshold for diagnosis or treatment, nevertheless can increase the risk of atrial fibrillation. But whether to treat subclinical hypo- or hyperthyroidism to reduce AF risk remains a matter of debate in the medical community. (more…)
Author Interviews, Endocrinology, JAMA, Thyroid Disease / 02.10.2018
MedicalResearch.com Interview with: Dr. med. Martin Feller, MSc Epidemiology (LSHTM) FMH Allgemeine Innere Medizin & Prävention und Gesundheitswesen Scientific Research Coordinator INSELSPITAL, Universitätsspital Bern Universitätsklinik und Poliklinik für Allgemeine Innere Medizin (RodondiResearch) MedicalResearch.com: What is the background for this study? What are the main findings? Response: SUBCLINICAL HYPOTHYROIDISM IS VERY COMMON, WITH AN ESTIMATED 13 MILLION AMERICANS AFFECTED. SUBCLINICAL HYPOTHYROIDISM IS OFTEN TREATED WITH LEVOTHYROXINE, PARTICULARLY WHEN IT CO-OCCURS WITH SYMPTOMS POTENTIALLY ATTRIBUTABLE TO HYPOTHYROIDISM SUCH AS TIREDNESS, CONSTIPATION, AND UNEXPLAINED WEIGHT GAIN. THIS PRACTICE MAY CONTRIBUTE TO LEVOTHYROXINE BEING THE MOST PRESCRIBED DRUG FROM 2014 ONWARDS IN THE US. HOWEVER, IN OUR META-ANALYSIS OF 21 RANDOMIZED CLINICAL TRIALS, WE OBSERVED NO BENEFIT OF LEVOTHYROXINE THERAPY (COMPARED TO PLACEBO) REGARDING GENERAL QUALITY OF LIFE, THYROID-RELATED SYMPTOMS, DEPPRESSIVE SYMPTOMS, FATIGUE, COGNITIVE FUNCTION, BLOOD PRESSURE OR BODY-MASS INDEX. (more…)
Author Interviews, Endocrinology, Environmental Risks, JAMA, Pediatrics, Thyroid Disease / 17.09.2018
MedicalResearch.com Interview with: Carrie Breton ScD Associate Professor and Director of the MADRES Center Division of Environmental Health Los Angeles, CA 90032 MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am interested in how the environment can influence our very early development, starting in the womb. I have studied the health effects of air pollutants on children for several years and wanted to focus now on the earliest windows of susceptibility. Thyroid hormones play a critical role in fetal growth and development. We knew we could get information on newborn thyroid levels from the California Department of Public Health’s newborn screening program therefore look at this question in our study population. We found that exposure to high levels of PM2.5 and PM10 throughout most of pregnancy affected TT4 levels in newborns. (more…)
Author Interviews, Depression, Endocrinology, JAMA, Mental Health Research, Thyroid Disease / 14.05.2018
MedicalResearch.com Interview with: Teja Grömer PD Dr. med. Habil Facharzt für Psychiatrie und Psychotherapie Lehrbefugter der Universität Erlangen-Nürnberg im Fach Psychiatrie Bamberg MedicalResearch.com: What is the background for this study? 1) I had seen hundreds of clinical cases with combined depression and anxiety and noted end of 2015 that most (far more than 50%) from the subjective clinical impression were associated with autoimmune thyroiditis (AIT) 2) Autoimmune thyroiditis on the mental side leads to specific symptoms, exhaustion, tachycardia, restlessness. 3) I thus decided to do a systematic review and meta-analysis. (more…)
MedicalResearch.com Interview with: Begoña Ruiz Núñez PhD (c) Laboratory Medicine UMC Groningen Co-directora de Healthy Institute President of the Asociación Española de Psico-Neuro-Inmunologí MedicalResearch.com: What is the background for this study? Response: The diagnosis of Chronic Fatigue Syndrome (CFS) is based on the Fukuda criteria, i.e. symptoms, disability, and exclusion of explanatory illnesses, and not by means of physical signs or abnormalities in laboratory test results. CFS has been described as a ´allostatic overload condition´, where the physiological mechanisms employed to deal with stress contribute to the perpetuation of the disorder. Chronic Fatigue Syndrome patients are 1.9 times more likely to have a high allostatic load index than healthy controls. Thyroid allostasis-adaptive responses, presenting as non-thyroidal-illness syndrome, have been found in many conditions, ranging from critical illness, uremia and starvation to tumors. Taken together, it is possible that, despite TSH and T4 levels within reference ranges, Chronic Fatigue Syndrome symptoms may be attributable in part to allostatic responses, i.e. lower thyroid hormone activity, secondary to chronic (low-grade) inflammation caused by e.g. a compromised gut microbiome and gut wall integrity. (more…)
Author Interviews, Endocrinology, Fertility, JAMA, OBGYNE, Thyroid Disease / 13.12.2017
MedicalResearch.com Interview with: Professor Tianpei Hong, MD, PhD Of behalf of Prof. Jie Qiao and all the coauthors, Director, Department of Endocrinology & Metabolism Director, Department of Laboratory Medicine Peking University Third Hospital Beijing, China MedicalResearch.com: What is the background for this study?
- Women who test positive for thyroid autoantibodies have been reported to be at 2- to 3-fold higher risk of spontaneous miscarriage than those who test negative. However, the effect of levothyroxine on miscarriage among women with positive thyroid autoantibodies and normal thyroid function has been documented in limited studies with conflicting results.
- Given the substantial difficulty achieving successful pregnancy among infertile women, identifying optimal treatment for infertile women who test positive for thyroid autoantibodies is particularly important. There are a few randomized clinical trials showing a beneficial effect of levothyroxine treatment on pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET). However, the sample size of those trials was rather small which may weaken the quality of the evidence.
- Therefore, the Pregnancy Outcomes Study in euthyroid women with Thyroid Autoimmunity after Levothyroxine (POSTAL) study was conducted in Peking University Third Hospital to evaluate whether levothyroxine treatment initiated before IVF-ET could decrease the miscarriage rate and improve the live birth rate in infertile women who tested positive for antithyroperoxidase antibody but had normal thyroid function.
Author Interviews, Endocrinology, Heart Disease, Thyroid Disease / 09.04.2017
MedicalResearch.com Interview with: Arjola Bano, MD, DSc PhD candidate Departments of Internal Medicine and Epidemiology Erasmus Medical Center, Rotterdam, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atherosclerosis is a chronic condition, characterized by the accumulation of lipids and fibrous elements in the arterial walls. It can progress insidiously from an asymptomatic narrowing of the arterial lumen (subclinical phase) to the clinical onset of vascular events (as coronary heart disease or stroke) and death. Despite advances in prevention and treatment, atherosclerotic diseases remain a leading cause of mortality worldwide. Therefore, identifying additional modifiable risk factors for atherosclerosis is of major importance. So far, the role of thyroid hormone on atherosclerosis remains unclear. Moreover, a comprehensive investigation exploring the link of thyroid function with the wide spectrum of atherosclerosis, including subclinical atherosclerosis, clinical atherosclerosis and atherosclerotic mortality, within the same population is lacking. Therefore, in a prospective study of 9231 middle-aged and elderly people, we explored the association of thyroid function with subclinical atherosclerosis (coronary artery calcification), atherosclerotic events (fatal and nonfatal coronary heart disease or stroke) and atherosclerotic mortality (death from coronary heart disease, cerebrovascular or other atherosclerotic disease). Higher free thyroxine (FT4) levels were associated with higher risk of subclinical atherosclerosis, atherosclerotic events and atherosclerotic mortality, independently of cardiovascular risk factors. The risk of atherosclerotic mortality increased with higher FT4 levels (HR; CI: 2.35; 1.61-3.41 per 1 ng/dl) and lower thyroid-stimulating hormone (TSH) levels (HR; CI: 0.92; 0.84-1.00 per 1 logTSH), with stronger estimates among participants with a history of atherosclerotic disease (HR; CI: 5.76; 2.79-11.89 for FT4 and 0.81; 0.69-0.95 for TSH). (more…)
Author Interviews, Pharmacology, Thyroid Disease, UCLA / 07.04.2017
MedicalResearch.com Interview with: Deborah Chon MD Endocrinology fellow UCLA David Geffen School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study shows that drinking cow's milk concurrently with oral levothyroxine significantly reduces the absorption of the medication. Levothyroxine is used for the physiologic replacement of thyroid hormone in patients with hypothyroidism and for serum TSH suppression in patients with thyroid cancer. It is the mostly commonly prescribed medication in the United States as of 2014. Frequent dose adjustments of levothyroxine have been shown to be a costly burden to the national healthcare system. Previous studies have shown that certain foods and medication, such as calcium supplements, can interfere with levothyroxine absorption. However, this is the first study to demonstrate that ingesting cow?s milk, a common breakfast staple, affects oral levothyroxine absorption. To determine the possible effect of cow's milk ingestion, we measured levothyroxine absorption in humans with and without concurrent milk consumption. Pharmacokinetic studies were conducted in healthy adults without allergies to milk or levothyroxine, and who were not pregnant nor using oral contraceptives. All subjects had no history of known thyroid disease and normal thyroid hormone function at baseline. Following an overnight fast, serum total thyroxine T4 (TT4) concentrations were measured at baseline and at 1, 2, 4, and 6 hours after ingestion of 1,000 ?g of oral levothyroxine alone or when co-administered with 12 oz. of milk (2% fat). There was a four-week washout period between the two study visits. Ten subjects (mean age 33.7?10.2 years, 60% male) completed the study. The serum total T4 absorption over six hours, calculated as area under the curve (AUC), was significantly lower when taking cow?s milk concurrently with levothyroxine compared levothyroxine alone (mean?SD: 67.26?12.13 vs. 73.48?16.96; p = 0.02). Also, peak serum TT4 concentrations were significantly lower in those who ingested levothyroxine concurrently with milk, compared to taking levothyroxine alone (p=0.04). (more…)
Author Interviews, Environmental Risks, Thyroid, Thyroid Disease / 02.04.2017
MedicalResearch.com Interview with: Julie Sosa, MD MA FACS Professor of Surgery and Medicine Chief, Section of Endocrine Surgery Director, Surgical Center for Outcomes Research Leader, Endocrine Neoplasia Diseases Group Duke Cancer Institute and Duke Clinical Research Institute Durham, NC 2771 MedicalResearch.com: What is the background for this study? Response: The incidence of thyroid cancer has dramatically increased world-wide over the last several decades. In the United States, thyroid cancer is the fastest increasing cancer among women and men. This observation has been almost exclusively the result of an epidemic of papillary thyroid cancer, or PTC, which now comprises approximately 90% of new cases. The use of flame retardant chemicals, or Flame Retardant Chemicals, also increased over the last several decades due to the implementation of mandatory and voluntary flammability standards for furniture, electronics, and construction materials. Over time, FRs come out of these products and accumulate in indoor environments where humans are exposed. Animal studies suggest that FRs can disrupt thyroid function, and many contribute to cancer risk. But many human health endpoints have not been investigated. Our work was aimed at investigating whether exposure to Flame Retardant Chemicals could be associated with PTC. To address our research question, we recruited 140 adults, 70 with PTC and 70 who were healthy volunteers without evidence for thyroid cancer or thyroid disease. Then we visited participants’ homes and collected dust samples, a metric that we have previously shown is an indicator of long-term exposure to Flame Retardant Chemicals in the home. (more…)
Author Interviews, NEJM, OBGYNE, Thyroid Disease, UT Southwestern / 01.03.2017
MedicalResearch.com Interview with: Professor Brian Casey, M.D. Gillette Professorship of Obstetrics and Gynecology UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? Response: For several decades now, subclinical thyroid disease, variously defined, has been associated with adverse pregnancy outcomes. In 1999, two studies are responsible for increasing interest in subclinical thyroid disease during pregnancy because it was associated with impaired neuropsychological development in the fetus. One study showed that children born to women with the highest TSH levels had lower IQ levels. The other showed that children of women with isolated low free thyroid hormone levels performed worse on early psychomotor developmental tests. Together, these findings led several experts and professional organizations to recommend routine screening for and treatment of subclinical thyroid disease during pregnancy. Our study was designed to determine whether screening for either of these two diagnoses and treatment with thyroid hormone replacement during pregnancy actually improved IQ in children at 5 years of age. (more…)
Author Interviews, Endocrinology, Environmental Risks, Pediatrics, Thyroid Disease, Toxin Research / 27.02.2017
MedicalResearch.com Interview with: Jana Weiss PhD Department of Environmental Science and Analytical Chemistry Stockholm University MedicalResearch.com: What is the background for this study? What are the main findings? Response: In an earlier publication, we could see an association between elevated concentrations of brominated flame retardants (BFR) in the blood of cats with developed Feline hyperthyroidism, compared to healthy cats (Norrgran et al 2015, ES&T 49:5107-5014). To establish the exposure pathway we now took paired samples from healthy cats and dust from their households. We also analysed the cats food to include another major exposure pathway. In total 17 families participated. They lived in houses in the countryside or in apartments in the city. All families had kids under 12 years of age living at home, thus representing a household with typical child products. The dust was sampled from the living room, the child’s room and from the adult’s bedrooms. We could not see any difference in the composition of compounds between the rooms, but we saw that levels were in general higher in the living room compared to the other two rooms. This was expected as many products being treated with BFRs can be found in the living room. We could see that higher levels of some brominated flame retardants in the dust were correlated to elevated levels in the cat’s blood. Therefore, this hypothesized exposure pathways is now statistically established. We could also confirm cat food to be the major exposure pathway for naturally brominated compounds coming from the marine food web, such as6-OH-BDE47, a known thyroid hormone disruptor. (more…)
Author Interviews, BMJ, Endocrinology, Mayo Clinic, OBGYNE, Thyroid Disease / 27.01.2017
MedicalResearch.com Interview with: Dr. Spyridoula Maraka Assistant professor of medicine Division of Endocrinology and Metabolism Center for Osteoporosis and Metabolic Bone Diseases University of Arkansas for Medical Sciences and Central Arkansas Veterans Health Care System Little Rock Arkansas MedicalResearch.com: What is the background for this study? What are the main findings? Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism. Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated. Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women. (more…)
Author Interviews, Electronic Records, Endocrinology, Thyroid, Thyroid Disease / 25.01.2017
MedicalResearch.com Interview with: Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting. To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice. There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these. (more…)
Author Interviews, Endocrinology, JCEM, Thyroid Disease / 14.10.2016
MedicalResearch.com Interview with: Antonio C. Bianco, MD, PhD Rush University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The standard of care for patients with hypothyroidism is treatment with levothyroxine. The dosage of levothyroxine is adjusted for each patient with the goal of normalizing blood levels of TSH. About 15% of the patients treated this way exhibit variable degrees of residual symptoms, despite having a normal TSH level. These symptoms include difficulty losing weight, low energy and depression. However, given the subjective nature of these complains and that the blood levels of TSH are normal, many times such symptoms are dismissed by physicians as non-thyroid related. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Endocrinology, Heart Disease, Thyroid Disease / 17.09.2016
MedicalResearch.com Interview with: Layal Chaker, MD, MSc PhD candidate Department of Endocrinology and Epidemiology Erasmus Medical Center Rotterdam, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association of thyroid function with coronary heart disease is well–established but not much was known about the association of thyroid function with sudden cardiac death. We conducted the study with the hypothesis that thyroid hormone levels affect cardiovascular risk factors and therefore could also affect the risk of sudden cardiac death (SCD). We were surprised to see that when we control our analyses for these cardiovascular risk factors, the association of high and high-normal thyroid function with SCD remained similar, suggesting that other pathways could play a role. Thyroid hormone has different effects on the cardiovascular systems and future studies should identify which pathway could be responsible for the increased risk of sudden cardiac death with higher thyroid hormone levels. This could lead to better assessment of individual risk and identify possible prevention targets. (more…)
Author Interviews, Endocrinology, Hematology, OBGYNE, Thyroid Disease / 24.07.2016
MedicalResearch.com Interview with: Kris Poppe, MD, PhD Co-Head Endocrine Unit CHU St-Pierre UMC Université libre de Bruxelles MedicalResearch.com: What is the background for this study? Response: Pregnant women are often referred by gynecologists to my endocrine practice, for altered thyroid function. At that occasion, I often noticed that the women also had low iron/ferritin levels (ferritin is the iron reserve). Searching in literature did not reveal many publications on the association between iron (deficiency) and thyroid function during pregnancy and so that was the background/aim to perform this study. (more…)
Author Interviews, Brigham & Women's - Harvard, JCEM, Thyroid, Thyroid Disease / 14.12.2015
MedicalResearch.com Interview with: Dr. Erik K. Alexander, MD FACP Chief, Thyroid Section, Division of Endocrinology Brigham & Women's Hospital Associate Professor of Medicine, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Alexander: Thyroid nodular disease has become an increasingly common medical illness, with prevalence reported to range between 26-67% in the adult. Though advancing age is known to influence the formation of thyroid nodules, their precise relationship remains unclear. Furthermore, it is uncertain whether age influences the risk that any thyroid nodule may prove cancerous. Thus we conducted a study to determine the impact of patient age on nodule formation, the number of thyroid nodules, and risk of thyroid malignancy. Medical Research: What are the main findings? Dr. Alexander: Our study is a prospective cohort analysis of consecutive adults who presented for evaluation of nodular disease from 1995-2011 at Brigham and Women’s Hospital, Boston, MA. 6,391 patients underwent thyroid ultrasound and fine needle aspiration that resulted in 12,115 thyroid nodules ≥1 cm. Patients were stratified into six age groups and compared using sonographic, cytologic, and histologic endpoints. We found that the prevalence of thyroid nodular disease increases with advancing age. The mean number of nodules at presentation increased from 1.5 in the youngest cohort (ages 20–30) to 2.2 in the oldest cohort (>70 years). In contrast, the risk for malignancy in a newly identified nodule declined with advancing age. Thyroid cancer incidence per patient was 22.9% in the youngest cohort, but 12.6% in the oldest cohort. Despite a lower likelihood of malignancy, identified cancers in older patients demonstrated a more aggressive cancer subtype. While nearly all malignancies in younger patients were well-differentiated, older patients were more likely to have higher risk papillary thyroid cancer variants, poorly differentiated cancer, or anaplastic carcinoma. (more…)