Clinical Thyroidology for the Public summarizes selected research studies discussed in the previous month’s issue of Clinical Thyroidology, an official publication of the American Thyroid Association. Editor-in-chief, Alan Farwell, MD, FACE
Volume 17 Issue 11
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Clinical Thyroidology for the Public Volume 17 Issue 11 (PDF file, 2.64 MB)
TABLE OF CONTENTS – Web Format
HYPERTHYROIDISM
How has the trend for Graves’ disease treatment changed in the last 10 years?
Treatment options for Graves’ disease include antithyroid drugs (ATDs), radioactive iodine (RAI) ablation or thyroid surgery. Traditionally, RAI ablation was the most common form of therapy in the United States. In recent years, there has been more data showing the safety and higher chance of remission with long-term ATD treatments. This study was done to evaluate current clinical practices in Graves’ disease treatment and to identify any changes in trends over the past 10 years.
Villagelin D et al. A 2023 international survey of clinical practice patterns in the management of Graves’ disease: a decade of change. J Clin Endocrinol Metab. Epub 2024 Apr 5:dgae222; doi: 10.1210/clinem/dgae222. PMID: 38577717.
THYROID AND PREGNANCY
How well can we predict thyroid problems in the mother during pregnancy?
Guidelines recommend screening for thyroid problems in the mother based on both major established risk factors (such as positive TPO antibodies, a marker of autoimmune thyroid disease) as well as more common characteristics, such as advanced maternal age and number of pregnancies. However, studies have shown that using these risk factors alone is likely insufficient to identify all cases of thyroid problems in the mother that my need to be treated. This study looks at additional risk factors that may predict risk for thyroid problems in the mother than are recommended by current guidelines.
Osinga JAJ et al. Risk factors for thyroid dysfunction in pregnancy: an individual participant data meta-analysis. Thyroid 2024;34(5):646-658; doi: 10.1089/thy.2023.0646. PMID: 38546971.
THYROID FUNCTION
Is my TSH normal – for me?
The standard, population-based reference range for TSH is found by checking the TSH levels of healthy people who do not have thyroid disease or other problems that may affect the thyroid. Serum TSH levels can vary a lot between different people, so the reference range defining what is normal for the population is wide. The authors designed this study to learn more about the effects of genetic factors on TSH reference ranges by using a method for the first time to determine genetically determined reference ranges.
Kuś A, et al. Towards personalized TSH reference ranges: a genetic and population-based approach in three independent cohorts. Thyroid. Epub 2024 Jun 26; doi: 10.1089/ thy.2024.0045. PMID: 38919119.
HYPOTHYROIDISM
Personality traits and patient satisfaction in hypothyroidism
While the symptoms of most hypothyroid patients resolve on thyroid hormone replacement, 15% still report symptoms despite achieving normal serum thyroid hormones levels. In this study, the authors analyzed if some personality traits could be the association between hypothyroidism and residual symptoms, especially type D personality, which is characterized by a tendency to pessimism, worry, and negativity.
Perros P, et al. Hypothyroidism and type D personality: results from E-MPATHY, a cross-sectional international online patient survey. J Clin Endocrinol Metab. Epub 2024 Apr 9; doi: 10.1210/clinem/dgae140. PMID: 38591918.
HYPOTHYROIDISM .
What is the association between TSH levels and heart health in patients with hypothyroidism?
We know that many people with hypothyroidism on levothyroxine do not always have normal TSH, with frequent high (undertreatment) and low (overtreatment) TSH levels commonly seen. Studies have shown that both under and over treatment with levothyroxine are also associated with increased heart problems and can lead to an increased risk of death. This study sought to assess changes in thyroid function (called the TSH trajectory) over a longer time frame and evaluate how that correlated with heart health markers.
Ettleson MD, et al. TSH trajectories during levothyroxine treatment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. J Clin Endocrinol Metab. Epub 2024 May 23:dgae294; doi: 10.1210/clinem/dgae294. PMID: 38780968.
THYROID CANCER
Do patients choosing active surveillance for their small, low risk papillary thyroid cancer experience regret for their decision?
Although the standard of care for papillary thyroid cancers is surgery, some patients have opted for following small cancers with ultrasound instead, called active surveillance. Since the patient is living with a known cancer, there is the possibility that their quality of life may be affected with regret for the decision for active surveillance. This study assessed the presence and extent of decision regret and fear of cancer progression 1 year after choosing between active surveillance and immediate surgery for low-risk papillary thyroid cancer.
Sawka AM, et al. Decision regret following the choice of surgery or active surveillance for small, low-risk papillary thyroid cancer: a prospective cohort study. Thyroid 2024;34(5):626-634. doi: 10.1089/thy.2023.0634. PMID: 38481111.
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