Study Fails To Support Routine Screening For Subclinical Hypothyroidism During Pregnancy

MedicalResearch.com Interview with:

Professor, Brian Casey, M.D. Gillette Professorship of Obstetrics and Gynecology UT Southwestern Medical Center

Dr. Casey

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.

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Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism

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 the Central Arkansas Veterans Health Care System Little Rock Arkansas

Dr. Spyridoula Maraka

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.

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Thyroid Care Collaborative Improves Adoption of Thyroid Cancer Clinical Guidelines

MedicalResearch.com Interview with:

Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai

Dr. Ilya Likhterov

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.

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Even With Normal TSH, Some Patients Still Feel Hypothyroid

MedicalResearch.com Interview with:

Antonio C. Bianco, MD, PhD Rush University Medical Center

Dr. Antonio C. Bianco

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.

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High and High-Normal Thyroid Levels Linked To Increased Risk of Sudden Cardiac Death

MedicalResearch.com Interview with:

Layal Chaker, MD, MSc Research and Curriculum Fellow Department of Epidemiology Harvard T.H. Chan School of Public Health Boston, MA

Dr. Layal Chaker

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.

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Study Calls For Curbing of Excessive Imaging after Thyroid Cancer Treatment

MedicalResearch.com Interview with:

Megan Haymart, M.D. Assistant Professor Institute for HealthCare Policy and Innovation University of Michigan

Dr. Megan Haymart

Megan Haymart, M.D.
Assistant Professor
Institute for HealthCare Policy and Innovation
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the past three decades the incidence of thyroid cancer has risen. The majority of this rise in incidence is secondary to an increase in low-risk disease. In the setting of this rise in low-risk thyroid cancer, our team noted that over time there was a dramatic rise in imaging after initial treatment for thyroid cancer. We subsequently wanted to understand the implications of this increase in imaging. Does more imaging equal improved outcomes? In this study published in BMJ, we found that this marked rise in imaging after primary treatment of differentiated thyroid cancer was associated with increased treatment for recurrence but with the exception of radioiodine scans in presumed iodine-avid disease, no clear improvement in disease specific survival.

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Thyroid Gland’s Importance Recognized During Thyroid Awareness Month

Marita Teng, MD Associate Professor of Otolaryngology Head and Neck Institute Icahn School of Medicine at Mount Sinai

Dr. Marita Teng

MedicalResearch.com Interview with:
Marita Teng, MD
Associate Professor of Otolaryngology
Head and Neck Institute
Icahn School of Medicine at Mount Sinai

MedicalResearch.com Editor’s note: January is Thyroid Awareness Month. In recognition, Dr. Teng discusses the thyroid gland’s important role in the production of  hormones that help the body regulate its metabolism.  Dr. Teng also discusses the recognition of thyroid nodules and cancer.

MedicalResearch: What does the thyroid gland do?  Why is it important for health?

Dr. Teng: The thyroid gland produces thyroid hormone, which is carried through the circulation to the other organs in the body.  Thyroid hormone is responsible for the body’s metabolism, and therefore maintains functions such as keeping the body warm, and properly use the energy we derive from food.

MedicalResearch: What is are some signs or symptoms of an underactive or overactive thyroid?

Dr. Teng: Thyroid overactivity (hyperactivity) results in heat intolerance, weight loss, rapid heartbeat, nervousness, increased appetite, difficulty sleeping, skin thinning, and hair loss, among other symptoms.  Thyroid underactivity (hypothyroidism) causes fatigue, weight gain, cold sensitivity, slowed heart rate, depression, memory impairment, and weakness, among other symptoms.  It should be noted that these symptoms are all nonspecific and can certainly be caused by other medical conditions as well.

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Most Benign Thyroid Nodules Remain Benign

Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma RomaMedicalResearch.com Interview with;
Sebastiano Filetti MD

Dipartimento di Medicina Interna
Università di Roma Roma

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Filetti: Thyroid nodule diagnosis is becoming more and more frequent in clinical practice. This trend stems largely from the incidental discovery of small nodules due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Ultrasound studies, for example, are widely used for evaluating other structures in the neck, such as the carotid arteries, parathyroid glands, lymph nodes, and salivary glands. Over 90% of detected thyroid nodules are clinically insignificant, in that they have been cytologically proven to be benign or they have no ultrasound features that raise the suspicion of malignancy. However, consensus is lacking regarding the best way to follow these nodules, mainly because little is known about the actual frequency and magnitude of their growth. The results of our study suggest that most benign nodules exhibit no significant size changes over time, and some actually decrease in size. Only a small subgroup of nodules can be expected to grow, about 15% in our series. However, the growth is slow and limited in magnitude. Most important, the occurrence of cancer is very rare in nodules like this, that appear to be benign.

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High Fluoride in Drinking Water May Be Linked To Hypothyroidism

Professor Stephen Peckham Director, Centre for Health Services Studies Professor of Health Policy Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine Director, Policy Research Unit in Commissioning and the Healthcare System University of KentMedicalResearch.com Interview with:
Professor Stephen Peckham

Director, Centre for Health Services Studies
Professor of Health Policy
Department of Health Services Research and Policy
London School of Hygiene and Tropical Medicine
Director, Policy Research Unit in Commissioning and the Healthcare System University of Kent

 

Medical Research: What is the background for this study? What are the main findings?

Response: Community water fluoridation remains a controversial public health measure. There have been continued debates about both its effectiveness in the prevention of dental caries and also its safety. Previous studies have suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism few population level studies have been undertaken. In April 2014 Public Health England published a monitoring report that used secondary analysis of routine health statistics to identify whether water fluoridation in England was associated with any adverse health outcomes. While hypothyroidism data is available this was not included in their monitoring report.  In England approximately 10% of the population lives in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. Tt examine whether there is a relationship – as suggested in smaller studies – we used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/13 Quality Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner (GP) registered patient numbers, and 2012 practice level Index of Multiple Deprivation scores. We found a positive association between fluoride levels and hypothyroidism. High hypothyroidism prevalence was found to be at least 30% more likely in practices located in areas with fluoride levels in excess of 0.3mg/L. This population study supports earlier hypotheses that fluoride is associated with hypothyroidism. In the UK water is fluoridated at 1ppm (1mg/L) and in areas where water is fluoridated the model predicts that after controlling for other factors, practice populations are significantly more likely to have higher levels of hypothyroidism than those in non-fluoridated areas. Higher levels of fluoride in drinking water, therefore, provide a useful contribution for predicting prevalence of hypothyroidism. For example in contrasting two urban areas we found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).

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Metformin May Alter Thyroid Hormone in Diabetics

MedicalResearch.com Interview with:
Jean-Pascal Fournier, MD, PhD

Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada and

Laurent Azoulay, PhD
Centre for Clinical Epidemiology,
Lady Davis Institute, Jewish General Hospital, Montreal,
Department of Oncology, McGill University, Montreal, Quebec, Canada

Medical Research: What are the main findings of the study?

Response: Patients with type II diabetes and treated hypothyroidism showed a 55% increased risk for low levels of thyroid stimulating hormone (TSH) (below 0.4 mIU/L) when initiating metformin, compared with those initiating sulfonylurea (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.09–2.20). In contrast, this effect of metformin was not observed in euthyroid patients, with an adjusted HR for low TSH of 0.97(95% CI 0.69–1.36).

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How Does Thyroid Disease Affect Ability To Work?

Mette Andersen Nexø Psychologist, Ph.D. student at The National Research Center for the Working Environment Copenhagen Area, DenmarkMedicalResearch.com: Interview with
Mette Andersen Nexø
Psychologist, Ph.D. student at The National Research Center for the Working Environment
Copenhagen Area, Denmark


MedicalResearch: What is the background for this study?

Answer: The present study is a systematic assessment of the influence of a spectrum of thyroid diseases on ability to work. By presenting new information on the possible socioeconomic consequences of thyroid diseases, the results can help bring awareness to important needs for rehabilitation of thyroid patients.
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Thyroid Dysfunction and Hyperlipidemia

Angela M. Leung, MD, MSc Clinical Assistant Professor of Medicine Division of Endocrinology, Department of Medicine University of California Los AngelesMedicalResearch.com Interview with:
Angela M. Leung, MD, MSc
Clinical Assistant Professor of Medicine
Division of Endocrinology, Department of Medicine
University of California Los Angeles

 

MedicalResearch.com: What are the main findings of the study?

Dr. Leung: Despite current guidelines to screen for thyroid dysfunction as a secondary cause of newly-diagnosed hyperlipidemia, this was performed only about 50% of the time by primary care providers in over 8,700 patients at a large, urban Boston academic medical center. Approximately 5% of patients who had thyroid function checked were found to have hypothyroidism. The majority of hypothyroid patients who received treatment with levothyroxine had successful correction of the initial hyperlipidemia within one year.
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