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Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma ISSN 2472-1972 Update on Multiple Endocrine Neoplasia Type 2: Focus on Medullary Thyroid Carcinoma Friedhelm Raue 1 and Karin Frank-Raue 1 1 Endocrine Practice Heidelberg, Molecular Genetic Laboratory, 69120 Heidelberg, Germany Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant hereditary cancer syndrome causedbymissensegain-of-functionmutationsintheRETproto-oncogeneonchromosome10.Specific RET (...) mutations can predispose toward a particular phenotype and clinical course, with strong genotype–phenotype correlations. MEN2 is highly penetrant in medullary thyroid carcinoma (MTC), and it can be associated with bilateral pheochromocytoma and primary hyperparathyroidism. Two different clinical variants of MEN2 are known: MEN2A, which includes the familial subtype, and MEN2B. Treatment includes early thyroidectomy. Recommendations on the timing and extent
Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Thyroid Testing for Hypothyroidism: Clinical Effectiveness and Guidelines Last updated: November 15, 2018 Project Number: RB1281-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report (...) Question What is the effectiveness of assessing free T3 or T4 to screen for hypothyroidism? What is the effectiveness of assessing free T3 or T4 levels to monitor or adjust levothyroxine dose? What are the evidence-based guidelines regarding thyroid testing for screening or monitoring patients with hypothyroidism? Key Message Two systematic reviews, one non-randomized study, four evidence-based guidelines, and one systematic review of guidelines were identified regarding the assessment of free T3 or T4
Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer: A Randomized Clinical Trial. Presence of thyroid autoantibodies in women with normal thyroid function is associated with increased risk of miscarriage. Whether levothyroxine treatment improves pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET) is unknown.To determine the effect of levothyroxine (...) on miscarriage among women undergoing IVF-ET who had normal thyroid function and tested positive for thyroid autoantibodies.An open-label, randomized clinical trial involving 600 women who tested positive for the antithyroperoxidase antibody and were being treated for infertility at Peking University Third Hospital from September 2012 to March 2017.The intervention group (n = 300) received either a 25-μg/d or 50-μg/d dose of levothyroxine at study initiation that was titrated according to the level
Ventricular Fibrillation Associated With Dynamic Changes in J-Point Elevation in a Patient With Silent Thyroiditis A J wave is a common electrocardiographic finding in the general population. Individuals with prominent J waves in multiple electrocardiogram (ECG) leads have a higher risk of lethal arrhythmias than those with low-amplitude J waves. There are few reports about the relationship between thyroid function and J-wave amplitude. We report the case of a 45-year-old man who had unexpected (...) ventricular fibrillation (VF). He had dynamic J-point elevation in multiple ECG leads. Possible early repolarization syndrome was diagnosed. He also had thyrotoxicosis caused by silent thyroiditis, and his J-wave amplitude decreased according to changes in thyroid function because of spontaneous remission of silent thyroiditis. There was a positive correlation between serum triiodothyronine levels and J-wave amplitudes. The findings in case suggested silent thyroiditis may contribute to the occurrence
Aberrant Iodine Autoregulation Induces Hypothyroidism in a Mouse Strain in the Absence of Thyroid Autoimmunity We investigated factors underlying the varying effects of a high dietary iodide intake on serum T4 levels in a wide spectrum of mouse strains, including thyroiditis-susceptible NOD.H2h4, NOD.H2k, and NOD mice, as well as other strains (BALB/c, C57BL/6, NOD.Lc7, and B10.A4R) not previously investigated. Mice were maintained for up to 8 months on control or iodide-supplemented water (NaI (...) 0.05%). On iodized water, serum T4 was reduced in BALB/c (males and females) in association with colloid goiters but was not significantly changed in mice that developed thyroiditis, namely NOD.H2h4 (males and females) or male NOD.H2k mice. Neither goiters nor decreased T4 developed in C57BL/6, NOD, NOD.Lc7, or B10.A4R female mice. In further studies, we focused on males in the BALB/c and NOD.H2h4 strains that demonstrated a large divergence in the T4 response to excess iodide. Excess iodide
CRACKCast E128 – Thyroid and Adrenal Disorders CRACKCast E128 – Thyroid and Adrenal Disorders - CanadiEM CRACKCast E128 – Thyroid and Adrenal Disorders In , , by Chris Lipp November 20, 2017 This episode of CRACKCast covers Rosen’s Chapter 120, Thyroid and Adrenal disorders. This episode is going to have a nice breakdown of how each of these major endocrine glands can go haywire and what to do when the storm approaches. The shownotes also have some additional material worth checking out (...) ! Shownotes – Key Concepts Hyperthyroidism Thyroid hormone exerts effects on nearly every organ system. A high degree of suspicion is needed to diagnose hyperthyroidism. The laboratory evaluation of choice is determination of the TSH concentration with free T4 and T3 levels. Total T4 and T3 levels are of limited value. Thyroid storm is a life-threatening thyrotoxic crisis that requires prompt recognition and therapy, as well as identification and treatment of any precipitating cause, such as infection
[Pooled Analysis of RET/PTC Gene Rearrangement Rate in Sporadic and Radiogenic Thyroid Papillary Carcinoma]. The database of publications on molecular epidemiology of RET/PTC rearrangements in sporadic and radiogenic thyroid papillary carcinoma has been formed (197 sources at the end of 2014; coverage of 100%). Based on this database a pooled analysis of data on the rates of RET/PTC1, RET/PTC3 and RET/PTC in total was conducted. Statistical approach involves a simple pooling, as well
The association between anti-thyroid antibodies and quality of life in patients with thyroid disorders: a systematic review protocol. The objective of this systematic literature review is to identify the association between anti-thyroid antibodies and quality of life in patients with thyroid disorders.
Multiple steroid and thyroid hormones detected in baleen from eight whale species Recent studies have demonstrated that some hormones are present in baleen powder from bowhead (Balaena mysticetus) and North Atlantic right (Eubalaena glacialis) whales. To test the potential generalizability of this technique for studies of stress and reproduction in large whales, we sought to determine whether all major classes of steroid and thyroid hormones are detectable in baleen, and whether these hormones (...) , corticosterone, aldosterone, thyroxine and tri-iodothyronine, representing a wide array of steroid and thyroid hormones of interest for whale physiology research. In total, 64 parallelism tests (8 species × 8 hormones) were evaluated to verify good binding affinity of the assay antibodies to hormones in baleen. We also tested assay accuracy, although available sample volume limited this test to progesterone, testosterone and cortisol. All tested hormones were detectable in baleen powder of all species
Lenvatinib (Lenvima) - thyroid carcinoma AWMSG ADVICE SUPERSEDED BY NICE GUIDANCE (TA535) NICE GUIDANCE ISSUED JULY 2018 (Refer to NICE website for full guidance on NICE recommendations, including any specific restrictions on the use of the technology) Final Appraisal Recommendation Advice No: 1817 – October 2017 Lenvatinib (Lenvima ® ) 4 mg and 10 mg hard capsules Submission by Eisai Ltd Additional note(s): ? AWMSG considered that lenvatinib (Lenvima ® ) satisfied the AWMSG criteria for orphan (...) perspective. This recommendation has been ratified by Welsh Government and will be considered for review every three years. Recommendation of AWMSG Lenvatinib (Lenvima ® ) is recommended as an option for use within NHS Wales for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI). This recommendation applies only in circumstances where the approved Wales Patient
Ectopic Thyroid Tissue in the Adrenal Gland Mimicking a Pheochromocytoma Ectopic thyroid tissue in the adrenal gland (ETTAG) usually presents as a well-circumscribed cystic mass on a CT scan. However, the MRI features of ETTAG are incompletely understood. We report a case of ectopic thyroid tissue in the adrenal gland, which demonstrates findings similar to those of a pheochromocytoma on the MRI.
Second generation of familial nonmedullary thyroid carcinoma: A meta-analysis on the clinicopathologic features and prognosis. Whether the second generation of parent/offspring type familial nonmedullary thyroid carcinoma (FNMTC) is more aggressive and has worse prognosis than their first generation counterpart is controversial. To evaluate the clinicopathologic features and prognosis of the second generation via a comparison between the two groups, We searched three databases (PubMed, EMBASE
Effects of Inorganic Iodine Therapy Administered to Lactating Mothers With Graves Disease on Infant Thyroid Function The effects of maternal inorganic iodine therapy on infant thyroid function are not well known.This study investigated the effects on infant thyroid function of maternal inorganic iodine therapy when administered to lactating mothers with Graves disease.This study was a prospective case series performed at the Tajiri Thyroid Clinic, Kumamoto, Japan.Subjects were 26 infants (...) of lactating mothers with Graves disease treated with potassium iodide (KI) for postpartum thyrotoxicosis.Infant blood levels of thyroid-stimulating hormone (TSH) and free thyroxine were measured using the dried filter-paper method. Iodine concentrations in breast milk and infant urine were measured on the same day. Subclinical hypothyroidism was defined as a blood TSH level of ≥10 or ≥5 μIU/mL in <6-month-old and 6- to 12-month-old infants, respectively.The median age of the infants was 3 months (range, 0
An association of myasthenia gravis with Hashimoto's thyroiditis in a patient with a multinodular goitre The association of myasthenia gravis (MG) with other autoimmune diseases including autoimmune thyroid disease (ATD) is well recognised, although rare. The occurrence of both diseases can occur in two ways: either disease preceding the other, or concurrently. The presentation of MG in association with ATD can range from ocular to generalised disease.A 26-year-old Malay female with persistent (...) hyperthyroidism secondary to Hashimoto's thyroiditis in multinodular goitre was diagnosed with generalised MG after 2 years. She presented with right eye ptosis (ocular) and difficulty in swallowing and chewing (bulbar). The diagnosis of MG was confirmed by fatigability testing, electromyography and the presence of AChR antibodies. Her symptoms showed improvement with pyridostigmine (Mestinon) 60 mg 6-hourly. Her antithyroid drug was tapered down according to her thyroid function test. Throughout a year
Thyroid Cancer Incidences From Selected South America Population-Based Cancer Registries: An Age-Period-Cohort Study The incidence of thyroid cancer (TC) has increased substantially worldwide. However, there is a lack of knowledge about age-period-cohort (APC) effects on incidence rates in South American countries. This study describes the TC incidence trends and analyzes APC effects in Cali, Colombia; Costa Rica; Goiânia, Brazil; and Quito, Ecuador.Data were obtained from the Cancer Incidence
Evaluating the effectiveness of prophylactic central neck dissection with total thyroidectomy for cN0 papillary thyroid carcinoma: An update meta-analysis. The effectiveness of prophylactic central neck dissection (pCND) following total thyroidectomy (TT) in patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) is still controversial. The aim of this meta-analysis is to evaluate the outcome of pCND and to provide quantitative evidence.A detailed literature search
Homozygous Resistance to Thyroid Hormone Î²: Can Combined Antithyroid Drug and Triiodothyroacetic Acid Treatment Prevent Cardiac Failure? Resistance to thyroid hormone β (RTHβ) due to homozygous THRB defects is exceptionally rare, with only five kindreds reported worldwide. Cardiac dysfunction, which can be life-threatening, is recognized in the disorder. Here we describe the clinical, metabolic, ophthalmic, and cardiac findings in a 9-year-old boy harboring a biallelic THRB mutation (R243Q (...) ), along with biochemical, physiologic, and cardiac responses to carbimazole and triiodothyroacetic acid (TRIAC) therapy. The patient exhibits recognized features (goiter, nonsuppressed thyroid-stimulating hormone levels, upper respiratory tract infections, hyperactivity, low body mass index) of heterozygous RTHβ, with additional characteristics (dysmorphic facies, winging of scapulae) and more markedly elevated thyroid hormone levels, associated with the homozygous form of the disorder. Notably
An Unusual Case of Metastatic Functional Thyroid Carcinoma With a Remarkable Treatment Response to Radioactive Iodine Functional thyroid carcinoma is an unusual cause of thyrotoxicosis. We describe the clinical presentation and treatment of a patient with thyrotoxicosis due to functional thyroid carcinoma and Graves disease, and discuss potential mechanisms causing the thyrotoxicosis. A 79-year-old woman with a remote history of hemithyroidectomy and current hyperthyroidism came to the hospital (...) with upper and lower extremity weakness. Hospital evaluation revealed a suppressed thyroid-stimulating hormone (TSH) level, positive test for thyroid-stimulating immunoglobulins, as well as a thyroid nodule, lung masses, and a 4.4-cm gluteal mass. Fine-needle aspiration of the gluteal mass revealed metastatic differentiated thyroid carcinoma. Even after completion thyroidectomy and excision of her gluteal mass, her hyperthyroid status continued when she was not receiving levothyroxine. A radioactive