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Benign Thyroid Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Hashimoto's thyroiditis is characterised by diffuse lymphocytic infiltration of the thyroid gland in the presence of circulating anti-TPO antibodies causing follicular destruction and fibrosis. Patients may have subclinical hypothyroidism at initiation but progress to hypothyroidism over the years.
Thyroid heart disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Myron Miller, Steven R. Gambert
The development of hypothyroidism is usually gradual and accompanied by the classical symptoms of fatigue, lethargy, cold intolerance, dry skin, and constipation. Laboratory evaluation with measurement of serum T4, free T4, and TSH will confirm the presence of either overt hypothyroidism or of subclinical hypothyroidism.
Hypothyroidism
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
While data on the long-term consequences of overt thyroid failure are lacking, there have been numerous longitudinal observational studies of patients with untreated mild (“subclinical”) hypothyroidism. A meta-analysis of 11 prospective cohort studies involving over 55,000 subjects examined the risk of fatal and non-fatal coronary heart disease (CHD) events associated with mild hypothyroidism. The authors reported an increasing risk of all CHD events with increasing baseline serum TSH levels, although statistical significance was found only for those with serum TSH levels in the 10.0–19.9 mU/L range (HR 1.89; 95% confidence interval 1.28–2.80) (3). A literature review in 2013 concluded that current evidence supports mild hypothyroidism being a risk factor for cardiovascular disease in younger patients (<60 years of age) but the risk is less evident after age 65, particularly in those with TSH values <10 mU/L (50).
Focus on cardiometabolic risk factors
Published in Acta Cardiologica, 2023
Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a group of novel antidiabetic agents, demonstrated beneficial cardiovascular effects in recent large, placebo-controlled randomised clinical trials (RCTs) [18]. In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias [19]. The abnormal composition of the gut microbiota is linked to the pathogenesis and propagation of CVD and CVD risk factors. Nagarajan’s review discussed various aspects of the interaction between the microbiome and the immune system in order to reveal causative links relating dysbiosis and autoimmune diseases with special emphasis on rheumatic heart disease [20]. Hypothyroidism can result in decreased cardiac output, increased systemic vascular resistance, decreased arterial compliance, and atherosclerosis. Subclinical hypothyroidism is a highly prevalent disease worldwide but remains challenging to diagnose. The influence of subclinical thyroid dysfunction on the heart and cardiovascular system has been much less studied, necessitating additional studies [21]. Beta-blockers block are widely prescribed for angina, heart failure and some heart rhythm disorders, and to control blood pressure. In patients with myocardial bridge, beta-blockers have a beneficial effect on left ventricular function [22].
Low awareness and under-diagnosis of hypothyroidism
Published in Current Medical Research and Opinion, 2022
Ulrike Gottwald-Hostalek, Barbara Schulte
People with hypothyroidism present typically with a range of relatively nonspecific symptoms, such as, fatigue, feeling cold, weight gain, constipation, low mood, slowed cognition, muscle aches/cramps, weakness, muscle cramps, dry skin, brittle hair and nails, diminished libido, carpal tunnel syndrome, or dysmenorrhea20. Some of these symptoms are more prevalent in people with overt or subclinical hypothyroidism, compared with euthyroid subjects; however, the symptoms are found commonly in hypothyroid and euthyroid populations, and their presence or absence is not a reliable predictor of thyroid status2,21. The symptoms reminiscent of hypothyroidism are similar to those of advancing age22, and persist in some individuals even after optimization of the TSH level with levothyroxine23. Inevitably, many people will persevere with these nonspecific symptoms, perhaps attributing them to other causes, without discussing them with a healthcare professional. This may be especially true for subclinical hypothyroidism, where the severity of thyroid-related symptoms is likely to be lower than in an individual with overt clinical hypothyroidism.2
Pregnancy-related reference intervals for serum thyrotropin based on real-life clinical data
Published in Gynecological Endocrinology, 2021
Simone Canovi, Silvia Vezzani, Alessandra Polese, Andrea Frasoldati, Clara Schiatti, Cristina Preda, Michele Corradini Zini, Antonio Vitiello, Marco Foracchia, Giuseppina Comitini, Lorenzo Aguzzoli, Tommaso Fasano, Luigi Vecchia
Finally, in accordance with other authors [16,17], the use of locally derived TSH reference intervals significantly decreases the prevalence of women with concentrations above the upper reference limit, compared to the fixed reference limits recommended in 2011 ATA guidelines [5] and endorsed by ETA in 2014 [7]. This implies a concomitant reduction in the risk of subclinical hypothyroidism misclassification and overtreatment. The latest 2017 ATA recommendations [8], recently endorsed by the Italian Society of Endocrinology and the Italian Thyroid Association [25], suggest to establish local reference limits or, if not possible, to adopt a 4 mIU/L cutoff starting from late first trimester. However, according to our data, this limit may lead to underestimation of thyroid dysfunction: in fact, this cutoff value is higher than more than 90% (11/12) of first-trimester upper limits reported by studies based on our laboratory method [15–22]. This further stresses the importance of adopting local method- and population-specific reference intervals to optimize management of thyroid disease during pregnancy.