scholarly journals Low Growth Hormone Levels in Short-Stature Children with Pituitary Hyperplasia Secondary to Primary Hypothyroidism

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Minghua Liu ◽  
Yanyan Hu ◽  
Guimei Li ◽  
Wenwen Hu
Keyword(s):  
Thyroid Hormones ◽  
Short Stature ◽  
Primary Hypothyroidism ◽  
Thyroid Antibodies ◽  
Gh Secretion ◽  
Pituitary Hyperplasia ◽  
Stimulation Tests ◽  
The Mean ◽  
Tsh Levels

Objective. The follow-up of GH levels in short-stature children with pituitary hyperplasia secondary to primary hypothyroidism (PPH) is reported in a few cases. We aimed to observe changes in GH secretion in short-stature children with PPH. Methods. A total of 11 short-stature children with PPH accompanied by low GH levels were included. They received levothyroxine therapy after diagnosis. Their thyroid hormones, IGF-1, PRL, and pituitary height were measured at baseline and 3 months after therapy. GH stimulation tests were performed at baseline and after regression of thyroid hormones and pituitary. Results. At baseline, they had decreased GH peak and FT3 and FT4 levels and elevated TSH levels. Decreased IGF-1 levels were found in seven children. Elevated PRL levels and positive thyroid antibodies were found in 10 children. The mean pituitary height was 14.3±3.8 mm. After 3 months, FT3, FT4, and IGF-1 levels were significantly increased (all p<0.01), and values of TSH, PRL, and pituitary height were significantly decreased (all p<0.001). After 6 months, pituitary hyperplasia completely regressed. GH levels returned to normal in nine children and were still low in two children. Conclusion. GH secretion can be resolved in most short-stature children with PPH.

scholarly journals Is it necessary to increase the dose of levothyroxine in patients with hypothyroidism who use omeprazole?

2014 ◽  
Vol 58 (7) ◽  
pp. 731-736 ◽  
Author(s):  
Raquel de Carvalho Abi-Abib ◽  
Mário Vaisman
Keyword(s):  
Treatment Protocol ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Sample Median ◽  
Significant Difference ◽  
The Mean ◽  
One Year ◽  
Dose Dependent ◽  
Entire Treatment ◽  
Tsh Levels

Objective It is believed that gastric pH interferes in levothyroxine absorption. Omeprazole, which acts by blocking the secretion of gastric acid, might interfere in hypothyroidism control in patients using levothyroxine and this effect could be dose dependent. The present study aimed to investigate this possibility. Subjects and methods Twenty-one patients with primary hypothyroidism who had been using a stabilized levothyroxine dosage for at least one year were selected and randomly assigned to take omeprazole at the dosage of 40 mg or 20 mg per day. The mean levels of thyroid-stimulating hormone (TSH) before and 3 months after omeprazole usage were compared in the entire sample and in each group. Results Ten patients concluded the entire treatment protocol in the 20 mg group and nine patients in the 40 mg group. There was no significant difference in TSH levels before and 3 months after omeprazole treatment in the entire patient sample (median levels: 2.28 vs. 2.30 mU/L, respectively: p = 0.56). Analysis of each subgroup (20 and 40 mg) showed no significant variation in TSH levels before and 3 months after omeprazole treatment (median levels: 2.24 vs. 2.42 mU/L, p = 0.62, and 2.28 vs. 2.30 mU/L, p = 0.82, respectively). No significant difference in the absolute (p = 0.93) or relative (p = 0.87) delta were observed between the two subgroups. Conclusion Omeprazole in the dosage of 20 or 40 mg/day does not interfere in a clinically relevant manner in the treatment of patients with hypothyroidism that was previously under control.

scholarly journals Effect of thyroxine on initial catch-up growth in children with hypothyroidism

2019 ◽  
Vol 7 (1) ◽  
pp. 159
Author(s):  
Ami H. Patel ◽  
Pinakin P. Trivedi
Keyword(s):  
Growth Parameters ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Height Velocity ◽  
Total Serum ◽  
P Value ◽  
Adequate Treatment ◽  
The Mean ◽  
Catch Up

Background: Hypothyroidism is a common endocrinal cause of growth retardation in children. Following adequate treatment with thyroxine, growth resumes at an accelerated rate which is known as catch-up growth. There are few observational studies from India on the growth parameters following treatment with thyroxine in children with hypothyroidism.Methods: A retrospective study was done in children aged 2-10 years who were newly diagnosed cases of primary hypothyroidism [Total serum Thyroxine (T4) levels <5 µg/dl and serum Thyroid Stimulating Hormone (TSH) levels ˃15 µU/ml] and treated with oral thyroxine to attain euthyroid state. Height measured before starting treatment and at the time of follow up visits was noted, the Height Standard Deviation Scores (HSDS) were calculated. The effect of thyroxine on linear growth was studied.Results: There were 23 children who were diagnosed as having primary hypothyroidism of whom 16(69.6%) were females and 7(30.4%) were males. The mean age of the children studied was 7.3±2.3 years. The mean dose of thyroxine required to maintain euthyroid status was 4.6±2.2 µg/kg/day. Mean duration of follow up was 13.7±2.4 months. The initial HSDS was - 2.31±0.9 which improved to a final value of - 1.7±0.76 (ΔHSDS0.61, p value <0.0001). Mean height velocity was 8.1 cms/year.Conclusions: Following adequate thyroxine replacement therapy catch-up growth occurs and increased growth velocity leads to partial regain of height deficit in the first couple of years of treatment.

scholarly journals RANDOMIZED CONTROLLED TRIAL COMPARING MORNING VERSUS NIGHT ADMINISTRATION OF LEVOTHYROXINE IN OLDER PERSONS

2021 ◽  
Author(s):  
Karina Giassi ◽  
Renato Gorga Bandeira de Mello ◽  
Bruna Cambrussi de Lima ◽  
Gabriela Stahl ◽  
Raquel Almeida de Oliveira ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Older Persons ◽  
Controlled Trial ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Randomized Controlled ◽  
Baseline Visit ◽  
Morning Administration ◽  
Tsh Levels

OBJECTIVE: To evaluate the effectiveness of levothyroxine administration strategies in the treatment of hypothyroidism in older persons in a tertiary outpatient clinic. METHODS: A randomized controlled trial of older persons with a diagnosis of primary hypothyroidism who had been receiving levothyroxine for at least 6 months with a stable dose in the last 3 months. Patients were randomly assigned to one of two administration strategies: morning (1 hour before breakfast) or night (1 hour after the last meal). In a period ≥ 12 weeks, patients were instructed to cross over between strategies. Laboratory tests for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were performed at visit 0 (baseline), visit 1 (period ≥ 12 weeks), and visit 2 (completion — period ≥ 24 weeks); a standardized questionnaire was also applied. Preliminary analyses of the period before crossover are presented. RESULTS: The preliminary sample consisted of 98 patients, with a mean age of 71.26 (SD 7.12) years; 83.67% were women. Fifty-three patients started with the morning strategy and 45 with the night strategy, and one patient did not return for reassessment. Median TSH levels ranged from 2.74 (IQR 1.06–4.19) at baseline to 2.77 (IQR 0.75–4.41) after a 12-week follow-up in the morning group, and from 2.36 (IQR 1.48–4.85) to 2.28 (IQR 1.69–3.56) in the night group. Mean FT4 levels ranged from 1.44 (SD 0.39) to 1.42 (SD 0.36) in the morning group, and from 1.35 (SD 0.27) to 1.37 (SD 0.32) in the night group. CONCLUSIONS: The administration of levothyroxine at night was as effective as morning administration at controlling primary hypothyroidism in older persons. Therefore, this can be considered an alternative dosage strategy for the treatment of this condition.

scholarly journals EFFECTIVENESS OF KANCHANARA KWATHA IN THE MANAGEMENT OF PRIMARY HYPOTHYROIDISM: CASE SERIES

2020 ◽  
Vol 11 (5) ◽  
pp. 9-14
Author(s):  
Anju S Lal ◽  
Arun Pratap ◽  
Arjun Chand C.P ◽  
Miharjan K
Keyword(s):  
Thyroid Gland ◽  
Hormone Secretion ◽  
Case Series ◽  
Clinical Score ◽  
Primary Hypothyroidism ◽  
P Value ◽  
Slow Movement ◽  
Cold Intolerance ◽  
Tsh Levels

Primary hypothyroidism is a condition that results due to the decreased ability of thyroid gland to produce its hormones Tri-iodothyronine (T3) and Thyroxin (T4) and results in increased TSH production from the Pituitary gland. This decreased hormone secretion may result in reduced metabolism and in Ayurveda, this metabolism may be explained in terms of Dhatu Parinama Siddhanta and this reduced metabolism with Dhatva agnimandya condition. Ten subjects having high TSH levels and one or multiplicity of the symptoms like Lethargy, hairfall, dryness of skin, less appetite, cold intolerance, puffiness of face, hoarseness of voice, muscle aches, menstrual disturbances were selected for the study. They were gradually developing these symptoms since 1 year. They all were given Kanchanara Kwatha 24 ml with 1.5 g Shunthi Choorna as Prakshepaka Dravya twice daily before food for 60 days. Follow up was done on 30th day after the intervention. Assessment of subjects was done by using TSH levels and Zulewski’s clinical score for on 0th, 61th and 90th day. The results were analysed statistically. Statistically highly significant result (i.e. p-value = 0.003) were obtained for TSH. When the subjective criteria is analysed, statistically highly significant result (p-value < 0.001) were obtained for the criteria slow movement and statistically significant results (p value < 0.05) were obtained for the criteria’s hoarseness of voice, constipation, weight increase, periorbital puffiness. The change obtained for symptoms after the treatment was maintained in the follow-up period too. Above results showed that the drug Kanchanara Kwathais effective in primary hypothyroidism.

scholarly journals The Clinical Implications of Thyroid Hormones and its Association with Lipid Profile: A Comparative Study from Western Nepal

1970 ◽  
Vol 1 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Ankush Mittal ◽  
Brijesh Sathian ◽  
Arun Kumar ◽  
Nishida Chandrasekharan ◽  
Sanjeev Dwedi
Keyword(s):  
Thyroid Hormones ◽  
Lipid Profile ◽  
Total Cholesterol ◽  
Subclinical Hypothyroidism ◽  
Laboratory Tests ◽  
Thyroid Dysfunction ◽  
Reference Range ◽  
Thyroid Disorder ◽  
The Mean ◽  
Tsh Levels

BackgroundThyroid dysfunction is one of the major public health problems in Nepal. Laboratory tests facilitate early diagnosis before clinical features are obvious, increased sensitivity carries the price of decreased diagnostic specificity. Laboratory tests coupled with supportive clinical findings are frequently used to diagnose thyroid dysfunction. Historically, hypercholesterolemia and raised serum low density lipoprotein (LDL) cholesterol levels have been found to be associated with subclinical hypothyroidism. Therefore, assessment of altered lipid profile plays a supportive role in diagnosis of thyroid dysfunction. The aim of our study was to find out the variations of thyroid hormones and lipid profile in hyperthyroidism and hypothyroidism with their clinical implications.Materials and Methods  It was a hospital based retrospective study carried out from the  data  retrieved  from  the  register  maintained  in  the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st July, 2009 and 30th June, 2010. The variables collected were age, gender, T4, T3, TSH, fT4, total cholesterol and triglyceride levels. Descriptive statistics and testing of hypothesis were used for the analysis of data.Results122 out of the 365 subjects selected for the study had some form of thyroid disorder. Of the 122 cases, 40 had hyperthyroidism, 42 had hypothyroidism and the remaining 40 were diagnosed to have subclinical hypothyroidism.  The frequency of thyroid disorders was much higher in females as compared to their male counterparts. The mean value of each variable in cases, except for age, was statistically significant as compared to controls (p=0.001). Elevated levels of total T3 (CI 2.14 to 2.59), T4 (CI 13.00 to 15.30) and fT4 (CI 2.51 to 2.81) associated with decreased TSH levels (CI 0.29 to 0.35) were found in cases of hyperthyroidism. The TSH values (CI 17.05 to 22.85) were markedly increased while T4 and T3 values were found to be less than the reference range in cases of hypothyroidism. There was significant increase in the mean concentration of total cholesterol (CI 268.83 to 289.79) and triglycerides (CI 154.81to 182.05) in cases of hypothyroidism. The fT4 (CI 1.08 to 1.22) levels were in reference range and TSH levels (CI 9.59 to 10.50) were moderately raised in cases of subclinical hypothyroidism.ConclusionThyroid dysfunction is common across all age groups and shows a strong female preponderance in Pokhara valley. It necessitates the measurement of thyroid hormones in women after the age of 50, in pregnancy and after delivery, and in women and men with hypercholesterolemia. Therefore, timely screening and check ups are necessary in order to curtail the problem of undiagnosed cases, giving specific consideration to patients who have high artherogenic profile. This will reduce the risk of future negative health events in older adults.Key Words: Thyroid hormones; Hyperthyroidism; Hypothyroidism; Lipid profile; NepalDOI: 10.3126/nje.v1i1.4102Nepal Journal of Epidemiology 2010;1 (1):11-16

scholarly journals Prescription of the thyroid test results at the biochemistry laboratory in Antananarivo in 2018

2021 ◽  
Vol 5 (2) ◽  
pp. 019-024
Author(s):  
Rakotoniaina TL ◽  
Ranaivosoa MK ◽  
Rakotonindrina FI ◽  
Rakoto Alson OA ◽  
Rasamindrakotroka A
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Thyroid Dysfunction ◽  
Test Results ◽  
First Line ◽  
National Authority ◽  
Biochemical Tests ◽  
Blood Tests ◽  
The Mean

According to National Authority for Health, the isolated dosage of TSH, in first-line, is a sufficient supply for the diagnosis and monitoring of thyroid dysfunction. The purpose of this study are to determine the prevalence of prescriptions of thyroid test, evaluate the practices on the prescription of thyroid tests compared to international recommendations. It is a descriptive retropective study within a period of 12 months. All the files with a request for TSH and / or thyroid hormone were included in this study. All files with a previous thyroid check-up or as part of a dysthyroidism follow-up assessment were excluded. Among the 72600 prescriptions for biochemical tests, 184 corresponded to the prescription of thyroid tests, it means 0.25% compared to other biochemical blood tests recorded. Among the 184 prescriptions requesting thyroid tests,117 files were retained. The mean age of the patients was 42.3 years, with a sex ratio of 0.18. One hundred sixteen files included a request of TSH dosage; 28,21% included only a TSH dosage and 70.94% included a request of simultaneous TSH dosage with one of two thyroid hormones. One prescription (0.85%) asked for a thyroid hormones dosage only without preliminary TSH dosage. TSH ranged from <0.05 to 93.97µUI/mL. It was normal in 68.96%, reduced in 16.39% and increased in 14.65% of the dosages. The number of thyroid hormone dosage in first-line in this study is important. Their prescription should be adapted to current recommendations in order to avoid the additional cost of unnecessary dosages for patients.

scholarly journals Wide Diversity in Measurements of Growth Hormone after Stimulation Tests in Short Children are Due to Assay Variability

1995 ◽  
Vol 32 (4) ◽  
pp. 369-372 ◽  
Author(s):  
J H Barth ◽  
J H Smith ◽  
P Clarkson
Keyword(s):  
Growth Hormone ◽  
Mean Difference ◽  
Gh Secretion ◽  
Short Children ◽  
Pharmacological Stimulation ◽  
Stimulation Tests ◽  
The Mean

A comparison of three commercially available assays for growth hormone (Pharmacia hGH RIA, IDS Gamma-BCT GH and Delfia 22 kDa hGH) were used to measure growth hormone (GH) secretion in 26 short children after pharmacological stimulation. The IDS Gamma-BCT assay was compared with Pharmacia assay in 15 provocative tests (13 children; n = 94). The Pharmacia assay showed a strong positive proportional bias and this was particularly marked at GH > 20 mU/L; the mean difference between the assays at GH < 10 mU/L was 12%. The IDS Gamma-BCT assay was also compared with the Delfia 22 kDa assay in 18 provocative tests (13 children; n = 100). Results from the IDS assay was higher throughout the range 0−90mU/L with a mean difference of 11·4% in the range 10−90 mU/L; the mean difference between the assays at GH< 10 mU/L was −39%.

scholarly journals Primary hypothyroidism in dogs is associated with elevated GH release

2001 ◽  
Vol 168 (1) ◽  
pp. 59-66 ◽  
Author(s):  
WM Lee ◽  
M Diaz-Espineira ◽  
JA Mol ◽  
A Rijnberk ◽  
HS Kooistra
Keyword(s):  
Thyroid Tissue ◽  
Area Under The Curve ◽  
Primary Hypothyroidism ◽  
Surgical Removal ◽  
Gh Secretion ◽  
Remnant Thyroid ◽  
Significant Difference ◽  
Igf I ◽  
The Mean ◽  
Physical Changes

The pulsatile secretion patterns of GH were investigated in seven beagle bitches by collecting blood samples every 10 min for 6 h during euthyroidism and 1.5 years after induction of primary hypothyroidism. Hypothyroidism was induced by surgical removal of the thyroid gland and subsequent destruction of any remnant thyroid tissue by oral administration of sodium [(131)I]iodide. Some of the physical changes observed in the dogs with primary hypothyroidism mimicked those of acromegaly. During both euthyroidism and hypothyroidism GH was secreted in a pulsatile fashion. The mean (+/-s.e.m. ) basal plasma GH concentration was significantly higher (P=0.003) in the hypothyroid state (4.1+/-1.6 microg/l) than in the euthyroid state (1.2+/-0.4 microg/l). Likewise, the mean area under the curve (AUC) for GH above the zero-level during hypothyroidism (27.0+/-10.0 microg/lx6 h) was significantly higher (P=0.004) than that during euthyroidism (11.7+/-2.0 microg/l x 6 h). The mean AUC for GH above the baseline was significantly lower (P=0.008) during hypothyroidism (2.4+/-0.8 microg/l x 6 h) than during euthyroidism (4.5+/-1.8 microg/lx6 h), whereas there was no significant difference in GH pulse frequency. The mean plasma IGF-I level was significantly higher (P<0.01) in the hypothyroid state (169+/-45 microg/l) than in the euthyroid (97+/-15 microg/l). The results of this study demonstrate that primary hypothyroidism in dogs is associated with elevated basal GH secretion and less GH secreted in pulses. This elevated GH secretion has endocrine significance as illustrated by elevated plasma IGF-I levels and some physical changes mimicking acromegaly. It is discussed that the increased GH release in hypothyroid dogs may be the result of the absence of a response element for thyroid hormone within the canine pituitary GH gene and alterations in supra-pituitary regulation.

scholarly journals SUN-290 Pituitary Hyperplasia Due to Uncontrolled Primary Hypothyroidism: Case Series and Literature Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Pablo Godoy Alonso ◽  
Germán González de la Cruz ◽  
Marlon Vladimir Vázquez-Aguirre ◽  
Andrea Rocha Haro ◽  
Karla Krystel Ordaz Candelario ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Feedback Inhibition ◽  
Case Series ◽  
Optic Chiasm ◽  
Primary Hypothyroidism ◽  
Autoimmune Hypothyroidism ◽  
Hormonal Replacement ◽  
Pituitary Hyperplasia ◽  
History Of

Abstract Background: Pituitary hyperplasia secondary to primary hypothyroidism results from the loss of thyroxine feedback inhibition and the subsequent overproduction of TSH. Case 1: A 18-year-old female presented with a chronic history of spontaneous galactorrhea, headache and malaise. Autoimmune primary hypothyroidism was diagnosed, with elevated TSH of 490 mIU/L (0.3-5) and low fT4 of 0.33 ng/dL (0.63-1.34). Pituitary MRI showed an enlarged pituitary with compression of the optic chiasm. Hormonal replacement with levothyroxine 75 mcg qd was started. Five months later she was asymptomatic, and normal TSH (1.64 mIU/L) and fT4 (0.9 ng/dL) levels. A new MRI revealed normal size of pituitary gland, with no compression of the optic chiasm and an intact infundibulum. Case 2: A 24-year-old female with type 1 diabetes and autoimmune primary hypothyroidism, presented with a five-year history of galactorrhea and oligomenorrhea. She was treated with insulin glargine 20U qd, and levothyroxine 200 mcg/day. However, patient’s adherence was bad. She consulted a primary health physician who suspected a prolactinoma after high prolactin levels (77.65, normal 2.64-13.13 ng/mL). Cabergoline was started without any clinical improvement. She then was referred to our service for follow-up. TSH results showed 500 mIU/L, with low fT4 (0.08 ng/dL). Prolactin levels was normal. Pituitary MRI revealed diffuse enlargement of the gland, with compression of infundibulum and optic chiasm. Treatment was modified to levothyroxine/liothyronine 100/20mcg 1 ½ tablet qd. After 7 months, we confirmed normal TSH (0.76 mIU/L) and fT4 (1.23 ng/dL), and the patient was asymptomatic. After 17 months, new MRI showed normal pituitary gland without any compression. Case 3: A 23-year-old female with a history of Addison′s disease and hypothyroidism diagnosed at age 17 presented with a 6-month history of somnolence, fatigue, headache and amenorrhea. She was previously treated with hydrocortisone 25mg/day, fludrocortisone 0.1mg/day, and levothyroxine 200mcg/day. Patient’s adherence was bad, and multiple hospitalizations because of adrenal crises were reported. Her initial hormonal evaluation revealed high TSH of 460 mIU/L and low fT4 of 0.25 ng/dL, mild hyperprolactinemia (32.16 ng/mL), and very high ACTH levels (2,700 pg/mL, normal 10-100). Pituitary MRI revealed an enlarged pituitary with mild compression of the optic chiasm. Hormonal replacement was modified to fasting levothyroxine alternating 200mcg and 300mcg qd. Her last follow-up showed normal TSH (0.53 mIU/L) and fT4 (1.18 ng/dL) levels. New MRI showed normal pituitary size Conclusion: We presented three young women, with autoimmune hypothyroidism, who developed pituitary hyperplasia and responded to proper hormonal replacement normalizing pituitary size. Reference: Endocrinol Diabetes Metab Case Rep. 2015; 2015: 150056.

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