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Radiopharmaceuticals for Diagnostics
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Jim Ballinger, Jacek Koziorowski
Hypothyroidism is diagnosed as reduced accumulation of 123I-iodide and is associated with sensitivity to cold, little appetite, and low energy. In children it can result in cretinism with abnormal bone formation and mental retardation. Hypothyroidism can be treated with thyroxine tablets. In contrast, hyperthyroidism (increased accumulation of 123I-iodide) is associated with sensitivity to heat, excessive appetite, and hyperactivity. It may be evident as a goiter or bulge in the neck. Hyperthyroidism can be treated with drugs, but radioiodine is also used. Hyperthyroidism can also result from thyroiditis, an inflammation that can eventually lead to hypothyroidism. The thyroid image in hypo- or hyperthyroidism is relatively uniform; however, in other conditions focal hot or cold spots may be seen. Solitary thyroid nodules are generally benign but should be investigated with a fine needle aspiration (FNA) biopsy to determine if it is cancerous.
Hyperthyroidism
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
ThyroiditisTreatment is supportive as there is no active production of thyroid hormone by the thyroid gland.β-blocker20Propranolol is recommended as there is minimal secretion into breast milk, and no monitoring of the infant is indicated. Dosing recommendation: 10–40 mg every 6–8 hoursReduce dose as symptoms allowCalms sympathomimetic actions of T4 and T3Slows conversion of T4 to the more active T3Extended use is discouraged due to risk of IUGR, neonatal hypoglycemia, and neonatal bradycardiaHemodialysis can be considered in severe thyroiditis
Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Diagnosis is often made by palpation, but must be confirmed by biopsy. FNA has been shown to be a safe and effective technique in pregnant women, with false-positive results being exceedingly rare and false-negative results occurring in only 5% to 10% of cases (252). Some advocate fine-needle aspiration of all thyroid nodules prior to 20 weeks of gestation, and after 20 weeks, only those that grow during suppressive therapy should be sampled (264). Radioisotope nuclear scanning is contraindicated in pregnancy, because radioactive isotopes are taken up by the fetus. Other methods, such as ultrasound, can be used to distinguish solid-form cystic nodules. Thyroid function tests may also be helpful and can diagnose unsuspected thyroiditis. If medullary thyroid cancer is suspected, a calcitonin level should be checked as well. Normally, pregnancy witnesses a hypertrophy of the thyroid gland from follicular cell hyperplasia, and total triiodothyronine and thyroxine levels are elevated while triiodothyronine resin uptake is decreased secondary to increased thyroid-binding globulin. Thyroid-stimulating hormone is in the normal to slightly elevated range.
Approaches for development of LAG-3 inhibitors and the promise they hold as anticancer agents
Published in Expert Opinion on Drug Discovery, 2022
Martin Perez-Santos, Maricruz Anaya-Ruiz, Luis Villafaña-Diaz, Gabriela Sánchez Esgua
Treatment-related adverse events observed in at least 10% of patients were pruritus, fatigue, rash, hypothyroidism, diarrhea, and vitiligo. Treatment with antibodies can lead to immune-mediated adverse reactions, including pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, and myocarditis, among others. 3.7% of treated patients developed pneumonitis, which was resolved in 85% with corticosteroid treatment. Colitis occurred in 7% of treated patients and resolved in 83% with corticosteroid treatment. Hepatitis was found in 6% of the treated patients, which resulted in 70% after of corticosteroid treatment. Adrenal insufficiency occurred in 4% of patients, where 87% were treated with hormone replacement therapy and corticosteroids. Thyroiditis was present in 2.8% of treated patients, which resulted in 90% after corticosteroid treatment. Nephritis and renal dysfunction were observed in 2% of patients, which resolved in 71% with corticosteroid treatment. Dermatitis occurred in 9% of patients, resulting in 70% after corticosteroid treatment. Myocarditis was present in 1.7% of patients and was 100% resolved after treatment with corticosteroids.
Nivolumab-Related Dry Mouth and Dry Eye: Cross-Sectional Study
Published in Cancer Investigation, 2021
Ozgen Ahmet Yildirim, Kerem Poyraz, Erkan Erdur, Canan Can, Cihan Gundogan, Yunus Guzel, Hülya Etem, Halil Kömek
The immune system can be called the most critical threshold to be crossed in cancer pathogenesis (1). Immune checkpoint inhibitors (ICIs), which are the cornerstones of cancer therapy with their evident prognosis-changing effects, work mainly by acting on cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) (2–4). In 2010, ipilimumab, acting on the CTLA-4 pathway, achieved clinical efficacy in metastatic melanoma. In the following years nivolumab, pembrolizumab, and atezolizumab, which are active on the PD-1 pathway, were approved for use for widespread cancer types (5,6). In addition to their dramatic efficacy in advanced cancer, these agents, which break self-tolerance against the tumor, unfortunately have immune-related side effects (irAEs). A wide range of irAEs are observed, such as arthritis, inflammatory bowel disease, autoimmune thyroiditis, hypophysitis, and vitiligo. Although immune-related thyroiditis rarely triggers thyrotoxicosis, it usually manifests itself with subclinical or clinically undiagnosed hypothyroidism. This presents itself with an elevated thyroid stimulating hormone (TSH) level and is a relatively frequent irAE. Sicca syndrome has been reported on a rather anecdotal level compared to other irAEs (7,8). Multiple irAEs can coexist at the same time. For example; immune related inflammatory bowel disease, which may be considered as one of the more severe irAEs, is usually accompanied by arthritis (8).
Thyrotoxicosis secondary to thyroiditis following SARS-CoV-2 infection
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Ankia Coetzee, Raisa Bhikoo, Bianca Berndorfler, Wilhelmina Conradie, Jantjie J Taljaard, Marli Conradie-Smit
The differential diagnoses for painful thyroiditis include subacute post-viral thyroiditis or de Quervain’s thyroiditis, acute suppurative thyroiditis and painful Hashimoto’s thyroiditis. Acute suppurative thyroiditis is a medical emergency that may lead to airway compromise. It usually follows a procedural intervention (e.g. fine needle aspiration), does not cause thyrotoxicosis per se, and appears as an abscess on ultrasound.6 Hashimoto’s thyroiditis is usually painless, mostly affects women and infrequently presents with thyrotoxicosis. A rare variant of painful Hashimoto’s has been described but, contrary to our patient, painful Hashimoto’s typically features an elevated serum level of thyroid antibodies (antithyroperoxidase or antithyroglobulin).7 Thyrotoxicosis in subacute thyroiditis is the result of the destruction of thyroid follicles and the release of thyroid hormones, as opposed to increased production of FT3 and FT4 as seen in Graves’ disease. The destruction of thyroid follicles is represented by the absence of uptake on the thyroid scintigram in our patient.