Volume 12 Issue 9

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Clinical Thyroidology for the Public Volume 12 Issue 9 (PDF file, 6.47 MB)

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Editor’s Comments

THYROID AND PREGNANCY Does treatment with thyroid hormone improve fertility in women with normal thyroid function but positive thyroid peroxidase antibodies?
Pregnant women who have positive TPO antibodies and even mild hypothyroidism are routinely treated with thyroid hormone replacement. The question is whether treatment with thyroid hormone helps women who have positive TPO antibodies only and normal thyroid hormone levels. This study looks at women who have a history of miscarriage and infertility to see if thyroid hormone replacement in TPO antibody positive women improves fertility.
DhillonSmith RK et al 2019 Levothyroxine in women with thyroid peroxidase antibodies before conception. N Engl J Med 380:1316–1325. Epub 2019 Mar 23. PMID: 30907987.
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IODINE AND PREGNANCY Mild to moderately low levels of iodine in early pregnancy may be associated with lower verbal IQ in children
If the mother is severely deficient in iodine in early pregnancy, the child may also have low intelligence. The effects of mother’s iodine levels during different periods of pregnancy have not been studied previously. The aim of this study was to assess the association between mother’s iodine status in pregnancy and child IQ, and to investigate the association at different pregnancy periods.
Levie D et al Association of maternal iodine status with child IQ: a meta-analysis of individual-participant data. J Clin Endocrinol Metab. Epub Mar 28. PMID: 30920622
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THYROID FUNCTION TESTS The value of thyroid testing in hospitalized children is low
Routine thyroid testing often occurs in hospitalized patients with nonspecific symptoms during the evaluation of the cause of the illness that brought the patient into the hospital. Many studies have shown that routine thyroid testing in adults without a high likelihood for thyroid problems causing the acute reasons for hospitalization is rarely helpful. The goal of this study is to evaluate how often thyroid testing is done in children who are hospitalized, how often the results are abnormal, and the impact of thyroid testing on patient care.
Torky A et al Low Value of Thyroid Testing in Pediatric Inpatient Setting. Hosp Pediatr 9:24-29. PMID: 30559318.
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THYROID HORMONE THERAPY Triiodothyronine (T₃) treatment after mild heart attacks is safe but not associated with a clear benefit
The most common finding during a major illness is a low T₃ level caused by the illness and not by a thyroid problem. While most researchers and physicians believe that the thyroid hormone changes during a sickness are beneficial for recovery, there is debate on whether treatment with T₃ may be helpful when it declines to very low levels. In this study, the authors tried to evaluate the effect of treatment with T₃ on recovery from heart attack; specifically, to assess the potential benefits of T₃ on the extent of heart muscle damage and its function.
Pingitore A et al 2018 Usefulness of triiodothyronine replacement therapy in patients with ST elevation myocardial infarction and borderline/reduced triiodothyronine levels (from the THIRST study). Am J Cardiol. Epub 2018 Dec 18. PMID: 30638544.
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HYPERTHYROIDISM Long-term methimazole is an effective treatment for toxic nodular goiters
Antithyroid medications, such as Methimazole, are used to treat a toxic nodular goiter short-term to get a patient ready for either surgery or radioactive iodine therapy. Long-term therapy with methimazole is not usually considered in treating patients with a toxic nodular goiter since this will never go into remission. This study was done to compare treatment of toxic nodular goiter with long-term methimazole as opposed to radioactive iodine therapy.
Azizi F, Takyar MA, Madreseh E, Amouzegar A. Treatment of toxic multinodular goiter: comparison of radioiodine and long-term methimazole treatment. Thyroid. Epub 2019
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THYROID NODULES Core needle biopsy does not prevent the need for thyroid surgery in indeterminate thyroid nodules
Up to 25% of thyroid biopsies result in an indeterminate biopsy result. While the use of molecular markers has greatly helped in the diagnosis of indeterminate nodules, these tests are expensive and may not be available everywhere. The purpose of this study was to compare the accuracy of fine needle vs core needle biopsies for the diagnosis of thyroid cancer in the evaluation of indeterminate nodules.
Yoon JH et al 2019 Ultrasonography-guided core needle biopsy did not reduce diagnostic lobectomy for thyroid nodules diagnosed as atypia of undetermined significance/ follicular lesion of undetermined significance. Ultrasound Q. Epub 2019 Feb 4. PMID: 30724862.
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ATA ALLIANCE FOR THYROID PATIENT EDUCATION