MinTankesmie

- Sköldkörtelhormon viktigare för hjärnans funktion än man tidigare trott

Hormone Linked to Alzheimer’s (Hormon linket til Alzheimers sykdom)
ivanhoe.com 6.8.2008
(Ivanhoe Newswire) -- Et hormon som hjelper skjoldbruskkjertelens funksjon kan utsette kvinner for større risiko for å utvikle Alzheimers sykdom.. (-- A hormone that helps the thyroid gland function could be putting women at greater risk of developing Alzheimer’s Disease.)

I en ny studie av Beth Israel Deaconess Medical Center og Harvard Medical School, er påvist at kvinner med spesielt høyt eller lavt nivå av hormonet har dobbelt så stor sannsynlighet for å utvikle Alzheimers sykdom enn kvinner med mer gjennomsnittelige nivåer. (In a new study out of Beth Israel Deaconess Medical Center and Harvard Medical School, women with especially high or low levels of the hormone were found to be twice as likely to get Alzheimer’s than women with levels more in the middle range.)

Hormonet, tyrotropin, som utskilles av hypofysen, bidrar til å regulere skjoldbruskkjertelens funksjon og hormonnivåer. Leger har lenge vært oppmerksom på at en underaktiv eller overaktiv skjoldbruskkjertel øker folks risiko for demens. (...) (The hormone, known as thyrotropin, is secreted by the pituitary gland, but helps regulate thyroid gland function and thyroid hormone levels. Doctors have long known an under- or over-active thyroid puts people at risk for dementia.)

Sköldkörtelhormon viktigare för hjärnans funktion än man tidigare trott
Karolinska Institutet, Stockholm 30.8.2005
Professor Björn Vennström vid Karolinska Institutet har i samarbete med spanska forskare identifierat nya funktioner hos sköldkörtelhormon i nervsystemet. Resultaten visar att sköldkörtelhormonet behövs under flera specifika tidpunkter under hjärnans utveckling och hos vuxna individer för att normalt beteende skall utvecklas.

För studien använde forskarna genetiskt förändrade möss som har en muterad receptor TR alfa 1 med reducerad affinitet för sköldkörtelhormon. Resultaten visar att den lägre aktiviteten hos den mutanta receptorn leder till specifika neurologiska skador hos de vuxna djuren: extremt hög oro och rädsla, försämrad minnesfunktion, samt störningar i motorik. Särskilt betydelsefullt är att oro, rädslan och minnesfunktionen kunde återställas endast genom att vuxna djur behandlades med sköldkörtelhormon medan en behandling av prepubertala djur inte gav bestående effekter. Däremot krävdes att unga djur behandlades för att de annars permanenta motoriska skadorna skulle undvikas.

Resultaten kan ha stor betydelse för framtida förståelse och behandling av vissa psykiatriska sjukdomar där man länge misstänkt att flera gener är inblandade.

Artikeln publicerades den 29 augusti i den ansedda vetenskapliga tidskriften Genes & Development (http://www.genesdev.org/) under titeln "Anxiety, memory impairment and locomotor dysfunction caused by a mutant thyroid hormone receptor alpha 1 can be ameliorated by T3 treatment". (...)

Sjekk om du har lavt stoffskifte
dagbladet.no 7.1.2011
Trett, uopplagt og opp i vekt? Her er symptomene. (...)

Vanskelig diagnose
Det kan være vanskelig å stille diagnosen hvis du har lavt stoffskifte, fordi de tidlige symptomene ligner på mange andre tilstander.

Det kan lett forveksles med symptomene ved for eksempel depresjon, ME, hjertesykdom og kreft. En enkel blodprøve kan avsløre om lavt stoffskifte er problemet. (...)

- Pasientstemmer: Thyreoideasykdom

Patient Voices: Thyroid Disease (Pasientstemmer: Thyreoideasykdom)
nytimes.com 14.5.2010
The thyroid is a tiny gland in the neck whose overproduction or underproduction of hormones can cause a host of problems — including Graves’ disease, hyperthyroidism and the little-known Hashimoto’s syndrome. Here, six men and women speak about thyroid disease and its impact on their lives. (Join the discussion here.) (...)

- Det er vanlig at mennesker med skjoldbruskkjertelproblemer blir feildiagnostisert som psykisk syke

Autoimmunity in psychiatry
The British Journal of Psychiatry (2012) 200: 353-355 (May)
Abstract Current knowledge of the role of autoimmunity in the pathogenesis of the main psychiatric disorders is briefly outlined. The significance of immunological effects on synaptic transmission and associated neuropsychiatric syndromes is emphasised. Clinical psychiatrists are encouraged to keep abreast of developments in this increasingly important area. (...)

(Anm: Common Causes of Depression - The causes of depression are not entirely understood, but are thought to be multi-factorial (about.com).)

Prevalence of autoimmune diseases in in-patients with schizophrenia: nationwide population-based study
British Journal of Psychiatry 2012 (Published online ahead of print March 22)
Background The association between autoimmune diseases and schizophrenia has rarely been systematically investigated.
Aims To investigate the association between schizophrenia and a variety of autoimmune diseases and to explore possible gender variation in any such association.
Method Taiwan’s National Health Insurance Research Database was used to identify 10 811 hospital in-patients with schizophrenia and 108 110 age-matched controls. Univariate and multiple logistic regression analyses were performed, separately, to evaluate the association between autoimmune diseases and schizophrenia. We applied the false discovery rate to correct for multiple testing.
Results When compared with the control group, the in-patients with schizophrenia had an increased risk of Graves’ disease (odds ratio (OR) = 1.32, 95% CI 1.04–1.67), psoriasis (OR = 1.48, 95% CI 1.07–2.04), pernicious anaemia (OR = 1.71, 95% CI 1.04–2.80), celiac disease (OR = 2.43, 95% CI 1.12–5.27) and hypersensitivity vasculitis (OR = 5.00, 95% CI 1.64–15.26), whereas a reverse association with rheumatoid arthritis (OR = 0.52, 95% CI 0.35–0.76) was also observed. Gender-specific variation was found for Sjögren syndrome, hereditary haemolytic anaemia, myasthenia gravis, polymyalgia rheumatica and dermatomyositis.
Conclusions Schizophrenia was associated with a greater variety of autoimmune diseases than was anticipated. Further investigation is needed to gain a better understanding of the aetiology of schizophrenia and autoimmune diseases. (...)

For Some, Psychiatric Trouble May Start in Thyroid (For enkelte starter psykiatriske problemer i skjoldbruskkjertelen)
nytimes.com 21.11.2011
In patients with depression, anxiety and other psychiatric problems, doctors often find abnormal blood levels of thyroid hormone. Treating the problem, they have found, can lead to improvements in mood, memory and cognition.

Now researchers are exploring a somewhat controversial link between minor, or subclinical, thyroid problems and some patients’ psychiatric difficulties. After reviewing the literature on subclinical hypothyroidism and mood, Dr. Russell Joffe, a psychiatrist at the North Shore-Long Island Jewish Health System, and colleagues recently concluded that treating the condition, which affects about 2 percent of Americans, could alleviate some patients’ psychiatric symptoms and might even prevent future cognitive decline.

Patients with psychiatric symptoms, Dr. Joffe said, “tell us that given thyroid hormones, they get better.”

The thyroid, a bow-tie-shaped gland that wraps around the trachea, produces two hormones: thyroxine, or T4, and triiodothyronine, known as T3. These hormones play a role in a surprising range of physical processes, from regulation of body temperature and heartbeat to cognitive functioning.

Any number of things can cause the thyroid to malfunction, including exposure to radiation, too much or too little iodine in the diet, medications like lithium, and autoimmune disease. And the incidence of thyroid disease rises with age. Too much thyroid hormone (hyperthyroidism) speeds the metabolism, causing symptoms like sweating, palpitations, weight loss and anxiety. Too little (hypothyroidism) can cause physical fatigue, weight gain and sluggishness, as well as depression, inability to concentrate and memory problems.

“In the early 20th century, the best descriptions of clinical depression were actually in textbooks on thyroid disease, not psychiatric textbooks,” Dr. Joffe said.
But doctors have long disagreed about the nature of links between psychiatric symptoms and thyroid problems.

“It’s the chicken-and-egg question,” said Jennifer Davis, assistant professor of psychiatry and human behavior at Brown University. “Is there an underlying thyroid problem that causes psychiatric symptoms, or is it the other way around?”

Dr. davis sa at det er vanlig at mennesker med skjoldbruskkjertelproblemer blir feildiagnostisert som psykisk syke. (...) (Dr. Davis said it is common for people with thyroid problems to be given a misdiagnosis of psychiatric illness.)

Symptomer på lavt stoffskifte
nhi.no 12.1.2012
Tristhet, tiltaksløshet, økt søvnbehov og forstoppelse er bare noen av symptomene på lavt stoffskifte. Symptomene kommer ofte snikende.

Ifølge amerikanske tall er det anslått av 10-15 prosent av de som har fått diagnosen depresjon, i virkeligheten har en mangel på hormonet tyroksin - altså lavt stoffskifte.

Skjoldbruskkjertelen er en liten, sommerfugl-formet kjertel som befinner seg like under adamseplet, og den omslutter luftrøret. Skjoldbruskkjertelen produserer tyroksin - hormonene som kontrollerer stoffskiftet (metabolismen) og hastigheten kroppens celler arbeider i. Tyroksin påvirker funksjonsnivået i så og si alle kroppens celler. (...)

– De meldingene vi har fått inn om det som går på alvorlige bivirkninger, dreier seg om kramper, økt angst og lavt stoffskifte, sier overlegen

Bruk av antidepressiva blant unge kan ha ført til selvmord
nrk.no 16.5.2012
STORE MØRKETALL: Overlege I statens legemiddelverk, Sigurd Hortemo, sier at de bivirkningsmeldingene de får inn, trolig bare er toppen av isfjellet. (...)

I løpet av de siste fem årene har legemiddelverket fått inn 19 meldinger om alvorlige bivirkninger blant barn og unge som bruker antidepressiva midler.

I ett av tilfellene begikk en 17 år gammel jente selvmord - mens en 12 år gammel gutt forsøkte å ta livet sitt.

Overlege i Statens Legemiddelver, Sigurd Hortemo, sier de ikke vet om hendelsene kan knyttes til medisinen, men sier det likevel er bekymringsfullt.

– Det er alvorlig. Men vi må huske på at norske psykiatere er tilbakeholdne med å skrive ut medikamenter til unge, så dette er barn som har alvorlige lidelser som skal behandles. (...)

5600 barn og unge på antidepressiva
I går fortalte NRK at over 5600 barn og unge helt ned i 6-årsalderen i Norge fikk utskrevet antidepressiva i fjor.

Det er 1000 flere enn for fem år siden.

Midlet er omstridt, ettersom forskerne ikke vet nok om hvordan medisinen fungerer når den kommer inn i en ung kropp.

Hortemo i legemiddelverket sier de derfor følger nøye med på de meldingan de får om mulige bivirkninger hos unge mennesker på antidepressiva.

– De meldingene vi har fått inn om det som går på alvorlige bivirkninger, dreier seg om kramper, økt angst og lavt stoffskifte, sier overlegen. (...)

(Anm: Antidepressiva (nytteverdi) (mintankesmie.no).)

- Hypothyreose ikke uvanlig under graviditet

Low Thyroid Levels not Uncommon in Pregnancy (Lave thyreoideanivåer ikke uvanlig under graviditet)
medpagetoday.com 5.1.2012
Gestational hypothyroidism may be more common than thought, affecting nearly 500,000 women each year, researchers estimated.

Of 117,892 women from the ages of 18 to 40, 15% tested positive for gestational hypothyroidism, Jon M. Nakamoto, MD, PhD, and colleagues from Quest Diagnostics, reported online in the Journal of Clinical Endocrinology & Metabolism.

Based on this finding, the researchers estimated that as many as 483,000 pregnant women with gestational hypothyroidism may go undetected each year.

Asian women were almost five times more likely to test positive for gestational hypothyroidism than African-American women (19.3% compared with 6.7%) and slightly more likely than Caucasian and Hispanic women (16.4% and 15.2%, respectively). Positivity rates differed significantly across ethnicities at P<0.001. (...)

(Anm: National status of testing for hypothyroidism during pregnancy and postpartum" J Clin Endocrinol Metab 2012; 97.)

Ammetrøbbel kan gi fødselsdepresjon
aftenposten.no 8.2.2012
Vanskeligheter knyttet til amming er en viktig faktor i utvikling av fødselsdepresjon, viser en ny undersøkelse.

- Alle vil jo det beste for barnet sitt og selvsagt er amming viktig, men her i landet assosieres det å amme med å være en god mor. Dette setter stort press på nybakte mødre, ikke minst fordi svært mange har problemer med ammingen, sier Silje Marie Haga til forskning.no.

Hun har nylig gjennomført en undersøkelse av 350 nybakte mødre til sin doktoravhandling i psykologi om risikofaktorer for å utvikle fødselsdepresjon, og hun fant ut at mange mødre får for lite praktisk hjelp og oppfølging hvis de har ammeproblemer.

- Helsepersonell bør være mer tilgjengelig med konkret hjelp, og mødre må få lavere terskel for å be om hjelp med amming, mener Haga.

Hun understreker at fødselsdepresjon kan ha mange årsaker som virker sammen, og flere av dem som rammes har vært deprimerte tidligere i livet eller under graviditeten. (...)

The Debate over Thyroid-Function Screening in Pregnancy
N Engl J Med 2012; 366:562-563 (February 9)
Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.¹ In surveys, almost half the obstetricians in private practices in Maine² and the majority of obstetricians in a Boston academic center³ reported ordering thyroid-function tests for screening in pregnancy. Most guidelines recommend the testing of thyroid function only in women at increased risk, known as case finding, rather than universal screening.4,5 The case-finding approach overlooks a large number of women with abnormal thyroid-function tests^1,6; however, in a randomized trial, universal thyroid-function screening and treatment did not improve overall pregnancy outcomes as compared with testing only high-risk women.⁷

An association between maternal hypothyroxinemia and reduced IQ test performance in children has been recognized for decades.⁸ More recently, children of women with an elevated thyrotropin level (>99.7th percentile) in the second trimester of pregnancy were reported to have IQ scores at ages 7 to 9 years that on average were 4 points lower than children of euthyroid women; about one fifth of these children had an IQ of less than 85.9 These findings focused efforts on identifying and treating hypothyroidism in pregnancy with the aim of preventing cognitive deficits in offspring. (...)

Antenatal Thyroid Screening and Childhood Cognitive Function
N Engl J Med 2012; 366:493-501 (February 9)
Background Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function.

Methods We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T4). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T4 levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were assigned to 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments. (...)

Conclusions Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age. (Funded by the Wellcome Trust UK and Compagnia di San Paulo, Turin; Current Controlled Trials number, ISRCTN46178175.) (...)

- Mangel på jod i kostholdet kan føre til forstyrrelser i stoffskiftet

Melka har forandret seg
nrk.no 4.2.2012
De viktigste kildene til jod er saltvannsfisk, skalldyr, i tillegg til melkeprodukter.

Nye analyser tyder på at innholdet av jod i norsk melk er redusert med 40 prosent siden år 2000. Nå har Tine varslet helsemyndighetene.

Mangel på jod i kostholdet kan føre til forstyrrelser i stoffskiftet, og i verste fall sykdommen struma. Over halvparten av jodinnholdet i norsk kosthold kommer fra meieriprodukter.

Både Helsedirektoratet og Nasjonalt råd for ernæring er koblet inn. Også Mattilsynet er varslet etter de nye funnene, skriver Stavanger Aftenblad. (...)

(Anm: Matvareindustrien (helsekost versus junk-food).)

- Vanlige kontrastmiddel utgjør risiko for skjoldbrukkjertelen

Vanligt kontrastmedel risk för sköldkörteln
dagensmedicin.se 27.1.2012
Att exponeras för joderat kontrastmedel kan öka risken för rubbningar av sköldkörteln, enligt en ny studie.

Användningen av joderat kontrastmedel vid röntgenundersökningar har ökat flerfaldigt de senaste åren, på grund av bruket vid exempelvis datortomografi och hjärtkateterisering.

Det skriver amerikanska forskare, som nu har undersökt hur sköldkörteln påverkas hos patienter som genomgår undersökning med joderat kontrastmedel.

Forskarna har gått igenom data för patienter som vårdats på två amerikanska sjukhus under en tioårsperiod, och som hade normal sköldkörtelfunktion från början.

Data om exponering för joderat kontrastmedel inhämtades från ett sjukhusregister, och förändringen av nivåerna av sköldkörtelhormonet TSH bedömdes.

Totalt identifierades 178 patienter som utvecklat hypertyreos, överaktivitet av sköldkörteln, samt 213 patienter som fått hypotyreos, underfunktion av samma organ. De jämfördes med 655 respektive 779 personer med normal sköldkörtelfunktion.

Det visade sig att exponering för joderat kontrastmedel var kopplat till en ökad risk för hypertyreos. Däremot fanns inget tydligt statistiskt samband med underfunktion av sköldkörteln. Dock visade en mer detaljerad analys på en koppling mellan joderat kontrastmedel och mer uttalad, så kallad klinisk, hypotyreos. (...)

(Anm: Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism. Arch Intern Med. 2012;172(2):153-159 (January 23).)

Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism
Arch Intern Med. 2012;172(2):153-159 (January 23).)
Background Sudden exposure to high iodide levels may cause thyroid dysfunction. Despite compelling biological plausibility and clinical implication, the association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism has not been rigorously studied. (...)

Results In total, 178 and 213 incident hyperthyroid and hypothyroid cases, respectively, were matched to 655 and 779 euthyroid controls, respectively. Iodinated contrast media exposure was associated with incident hyperthyroidism (odds ratio [OR], 1.98; 95% CI, 1.08-3.60), but a statistically significant association with incident hypothyroidism was not observed (OR, 1.58; 95% CI, 0.95-2.62). In prespecified secondary analysis, iodinated contrast media exposure was associated with incident overt hyperthyroidism (follow-up thyrotropin level 0.1 mIU/L; OR, 2.50; 95% CI, 1.06-5.93) and with incident overt hypothyroidism (follow-up thyrotropin level >10 mIU/L; OR, 3.05; 95% CI, 1.07-8.72).

Conclusion Iodinated contrast media exposure is associated with subsequent development of incident hyperthyroidism and incident overt hypothyroidism. (...)

(Anm: Computertomografi (CT), magnetisk resonanstomografi (MR), ultrasonografi (ultralyd) og kontrastmidler (mintankesmie.no).)

- Fysiske problemer kan forårsake søvnløshet

Health Tip: Physical Problems May Cause Insomnia (Helsetips: Fysiske problemer kan forårsake søvnløshet)
news.yahoo.com 4.1.2012
(HealthDay News) -- Insomnia is the general term used to mean waking too early, or having difficulty falling asleep or staying asleep.
The National Heart, Lung and Blood Institute says many factors can lead to insomnia, including:

• Headache or arthritis.
• Heart failure or asthma.
• Hyperthyroidism, the term for an overactive thyroid.
• Heartburn.
• Menopause and associated hot flashes.
• Other sleep disorders, including sleep-related breathing problems or restless legs syndrome. (...)

- Forskere opdager tæt forbindelse mellem stofskifte og søvn

Forskere opdager tæt forbindelse mellem stofskifte og søvn
dagenspharma.dk 9.1.2012
Forskere har opdaget en hidtil skjult forbindelse mellem kroppens biologiske ur og stofskifte, fremgår det af et studie offentliggjort i tidsskriftet Nature.

ærmere bestemt har forskerne fundet ud af, at de bestemte proteiner, der styrer det biologiske ur, kaldet crytochromer, også vekselvirker med stofskifte-receptorer. Det kan give en bedre forståelse af, hvorfor personer med uregelmæssig søvnrytme har større risiko for at udvikle fedme og diabetes.

Da stofskifte-receptorerne samtidig er mål for en række anti-inflammatoriske lægemidler, kan opdagelsen lede til nye lægemidler mod astma og allergi med færre alvorlige bivirkninger.

Stofskifte-receptorerne er også mål for steroidhormonerne, glykocorticoider, der både hjælper med at kontrollere kroppens blodsukker og hæmme inflammation i kroppen. De benyttes derfor i en række anti-inflammatoriske lægemidler og til at behandle inflammation i kræftpatienter. Deres rolle i sukkerstofskiftet gør dog, at glykocorticoiderne kan forstyrre en persons normale stofskifte med diabetiske komplikationer til følge. (...)

(Anm: Cryptochromes mediate rhythmic repression of the glucocorticoid receptor. Nature 2011;480:552–556 (22 December).

- Økt forekomst av hyperthyreose?

Giftstruma ökar kraftig
dagensmedicin.se 10.11.2008
De senaste åren har antalet fall av giftstruma ökat markant, visar en studie i Norrbotten. Ökningen är förvånande eftersom de vanligaste sjukdomsorsakerna minskat.

De senaste åren har antalet fall av giftstruma ökat markant, visar en studie i Norrbotten. Ökningen är förvånande eftersom de vanligaste sjukdomsorsakerna minskat.

Läkare vid Sunderby sjukhus mellan Luleå och Boden har märkt av en ökning av patienter med giftstruma under de senaste åren. När de studerade hela Norrbotten visade det sig att ökningen kan ses även på övriga sjukhus, uppger Sveriges Radio.

Sannolikt ser det likadant ut i övriga landet, vilket skulle innebära att 3 000 personer får giftstruma varje år. Det gör i så fall giftstruma till den näst vanligaste hormonsjukdomen i Sverige, efter barn- och ungdomsdiabetes.
Mats Eliasson, överläkare vid Sunderby sjukhus och en av forskarna bakom studien, förvånas över ökningen eftersom de två vanligast kända orsakerna till sjukdomen, jodbrist och rökning, har minskat. Men senare forskning visar att en livskris kan vara en utlösande faktor.

– Skilsmässa, död i familjen eller arbetslöshet, stora händelser i livet tycks ha föregått insjuknandet, säger Mats Eliasson till Vetenskapsradion.

Giftstruma är en form av hypertyreos – överskott av sköldkörtelhormon, som yttrar sig genom diffusa symtom som svettningar, trötthet och hjärtklappning.

Tillståndet behandlas med läkemedel, tillskott av radioaktivt jod eller genom att sköldkörteln opereras bort. (...)

(Anm: Läkaren Mats Eliasson märker en ökning - webbradio - sr.se
sr.se 10.11.2008.)

Hyperthyreose linket til hjerneslag

Hyperthyroidism Linked to Stroke (Hyperthyreose linket til hjerneslag)
medpagetoday.com 1.4.2010
Younger adults with hyperthyroidism appear to have an increased risk of ischemic stroke, a Taiwanese study showed.

Adults younger than 45 who had the thyroid disorder were 44% more likely to have an ischemic stroke over a five-year period than their healthy peers (HR 1.44, 95% CI 1.02 to 2.12), according to Herng-Ching Lin, PhD, of Taipei Medical University in Taiwan, and colleagues.

Still, the absolute risk of stroke remained low, affecting just 1% in those with hyperthyroidism and 0.6% in the comparison group, the researchers reported online in Stroke: Journal of the American Heart Association. (...)

(Anm: Hyperthyroidism and Risk of Ischemic Stroke in Young Adults. A 5-Year Follow-Up Study. Stroke. 2010 ( Published online before print April 1, 2010).)

Hyperthyroidism
JAMA. 2011;306(3):330 (July 20)
The thyroid gland is located at the base of the neck, in front of the trachea (windpipe) and esophagus (tube that connects the mouth with the stomach). The thyroid produces thyroid hormone, which helps regulate many body functions. In hyperthyroidism, the thyroid is overactive and produces more thyroid hormone than the body needs. Women are more likely than men to have hyperthyroidism, and it affects younger persons more than elderly persons. This Patient Page is based on one published in the July 6, 2005, issue of JAMA. (...)

- Leger ikke alltid oppmerksom på skjoldbruskkjertelrelaterte øyesykdommer

Her er folkesykdommen som rammer i det stille
vg.no 29.5.2011
(...) Lavt stoffskifte har uriktig fått ry på seg for å være noe bare middelaldrende kvinner sliter med. Både menn, ungdom og eldre rammes. (...)

Snikende og lumsk
Sykdommen kommer snikende, og symptomene er diffuse. Det gjør den vanskelig å oppdage. Man føler seg gjerne sliten og slapp, ofte deprimert og glemsk. Noen fryser lett, andre får treg mage, mens atter andre får stive muskler og ledd.

- Slik kan jo alle føle seg fra tid til annen. Folk feilmedisineres blant annet med antidepressiva, sovemedisiner, medisiner mot høyt blodtrykk, høyt kolesterol og hjerteproblemer, sier Bente Bakke.

Etter hennes erfaring blir mange eldre blir feildiagnostisert med demens. Yngre pasienter kan få høre at det er psykisk, kanskje lider de av depresjon.

- Ingen bør få en psykiatrisk diagnose før stoffskiftet er sjekket, sier Bakke. Selv om resultatene fra blodprøven skulle ligge innenfor normalområdet, går det an å starte prøvebehandling for å se om det hjelper. (...)

Thyroid eye disease (Thyroid øyesykdom)
BMJ 2009;338:b560 (6 March)
Thyroid eye disease is a relatively rare condition, with an incidence of 2.9 to 16.0 cases per 100 000 population per year.¹ The disease mainly affects women. Many patients experience distressing symptoms, and a few develop sight threatening complications. Patients are often young or middle aged and at the peak of their career. Most patients are very aware of their altered appearance. Sight loss can be prevented by appropriate management, yet it still occurs even in countries with advanced healthcare systems. This problem is largely due to delays in starting treatment, because health professionals are not always aware of the remarkable difference that treatment can make in restoring visual function and appearance.² For example, treatment can reverse blindness and help a reclusive patient to become socially reintegrated. Referral to specialist centres is appropriate for all but the mildest cases.³ (...)

- Hypofysesykdommer

Hypofysesykdommer
pasienthandboka.no 9.10.2009
Hva er hypofysen?

Hypofysen (hjernevedhenget) er en hormonproduserende kjertel som er en del av hjernen. Den kalles nedre hjernevedhenget fordi den ligger like under hjernen og er forbundet med hjernen med en kort nervestreng. Kjertelen er liten, den måler ca. 1 cm i diameter og veier ca. 5 gram. Kjertelen skiller ut flere typer hormoner som regulerer en lang rekke kroppsfunksjoner, deriblandt en rekke livsviktige funksjoner. (...)

Dersom det er overproduksjon av TSH vil skjoldbruskkjertelen overstimuleres og skille ut unormale mengder med stoffskiftehormon (tyroxin). Stoffskiftet blir da for høyt. Ved sviktende TSH-produksjon vil stoffskiftet gradvis bli lavere. Både for høyt stoffskifte (hypertyreose), og for lavt stoffskifte (hypotyreose) er sykdommer som uten behandling er livstruende. Men det finnes effektiv behandling for begge. (...)

Demens, Alzheimers sykdom og thyreoideafunksjon

Thyroid Function and the Risk of Alzheimer Disease (Thyreoideafunksjon og risiko for Alzheimers sykdom)
Arch Intern Med. 2008;168(14):1514-1520 (July 28)
Background Clinical hypothyroidism and hyperthyroidism are recognized causes of reversible dementia, but previous studies relating thyrotropin levels to cognitive performance in clinically euthyroid persons have yielded inconsistent results. (...)

Conclusion Low and high thyrotropin levels were associated with an increased risk of incident AD in women but not in men. (...)

(Anm: euthyroid; eutyroid; med god (normal) skjoldkjertelteneste, normal tyreoideafunksjon; tilsvarande uttrykk er eutyreoid, eutyreot
EN euthyroid ET [gr eu- god- + thyreos skjold] Kilde: Norsk medisinsk ordbok.)

Alzheimer's Linked to Thyroid -Related Hormone (Alzheimers linket til thyroid-relatert hormon)
medpagetoday.com 28.7.2008
BOSTON, July 28 -- Abnormal levels of the hormone thyrotropin, which controls thyroid function, may be associated with an increased risk of Alzheimer's disease in women, researchers found.

Alzheimer's disease was more than twice as common among women with the highest and lowest levels of serum thyrotropin compared with those in the more normal range (P<0.001 and P=0.003, respectively), reported Zaldy S. Tan, M.D., M.P.H., of Harvard and Beth Israel Deaconess Medical Center, and colleagues, in the July 28 issue of the Archives of Internal Medicine.

However, the associations did not extend to men for either high or low levels of the hormone in the analysis of the longitudinal Framingham Study. (...)

Dementia as presenting symptom of primary hyperparathyroidism: Favourable outcome after surgery (Symptomer på demens ved primær hyperparatyreoidisme: Gunstig resultat med kirurgi)
Clin Neurol Neurosurg. 2008 Jul 24. [Epub ahead of print]
The case of a 76-year-old female patient is presented with a two-year history of progressive dementia, apathy and gait impairment. Initially, Alzheimer's disease was diagnosed and she was given donepezil for one year with no significant improvement. An extensive blood and biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones and anti-thyroid antibodies. Ultrasound of thyroid and parathyroid glands revealed an adenoma of the right parathyroid. (...)

Three weeks after the operation the neurological picture showed dramatical improvement. Parkinsonism and behavioural disorders were remarkably reduced and the MMSE score raised to 25. In summary we report an exceptional case of primary hyperparathyroidism (PHPT) presenting as dementia and treated successfully by parathyroidectomy. (...)

Demens og hypotyreose
Tidsskr Nor Lægeforen 2000; 120: 905-7 utga
(...) I en prospektiv studie fant Larson og medarbeidere at av fire pasienter med demens og hypotyreose og som etter behandling med tyroksin hadde fått sin tilstand klassifisert som reversibel demens, hadde tre i løpet av to år utviklet Alzheimers sykdom (16). Clarfield sammenfattet 32 demensstudier med til sammen 2 889 pasienter og fant at 13 % av pasientene hadde en potensielt reversibel demens, derav hadde 1,5 % metabolske forstyrrelser (bl.a. thyreoideasykdom, lavt kobalaminnivå, kalsiummetabolisme, leversykdom). Kun i 11 av studiene (med til sammen 1 051 pasienter) hadde man fulgt pasientene videre. Hos 32 pasienter (3 %), hvorav én med hypotyreose, var tilstanden fullstendig reversibel. Legemidler og depresjon var de vanligste årsakene til reversibel demens (17). I 1994 utførte Clarnette & Patterson en tilsvarende litteraturstudie. De konkluderer med at det ikke finnes støtte i litteraturen for den gjengse oppfatning at primær hypotyreose forårsaker demens, men at hypotyreose kan være assosiert med en kognitiv svikt som lar seg påvirke av tyroksinbehandling (15). (...)

- Skjoldbruskkjertelproblemer kan øke risiko for glaukom

Thyroid Trouble May Increase Glaucoma Risk (Skjoldbruskkjertelproblemer kan øke risiko for glaukom)
medpagetoday.com 16.10.2008
BIRMINGHAM, Ala., Oct. 16 -- Thyroid disorders may modestly increase risk of glaucoma, researchers here found.

Patients ever diagnosed with thyroid problems were 38% more likely to have been diagnosed with glaucoma (P<0.001), reported James M. Cross, M.D., of the University of Alabama at Birmingham, and colleagues online in the British Journal of Ophthalmology. (...)

Hypothyroidism has been linked to glaucoma in some prior studies, but the few primarily small case-control studies have yielded conflicting results, the researchers said. (...)

About 12% of participants reported that a doctor had ever told them they had a thyroid problem.

Those with thyroid conditions had a higher prevalence of self-reported glaucoma ever diagnosed by a health professional (6.5% versus 4.4%, P=0.0003). (...)

(Anm: Øyesykdommer (øyner er sjelens vindu). (mintankesmie.no).)

(Anm: glaukom; grøn stær, ei gruppe tilstandar med auka væsketrykk inne i auget, som ved å skada synsnervepapillen kan gi synsfeltutfall, stundom fullt synstap (amaurose); sjå openvinkelglaukom, trongvinkelglaukom, pigmentglaukom og glaucoma infantile; n.rettskr.: glaukom; EN glaucoma. ET [gr glaukos blågrøn] glaukomforsking: URL http://www.glaucoma.org/ Kilde: Norsk medisinsk ordbok.)

Glaucoma Clues (Glaukom ledetråder)
JAMA. 2007;298:1268
Research by scientists in England and Italy suggest that amyloid beta protein, the major constituent of the brain plaques that are a hallmark of Alzheimer disease, might also be responsible for retinal cell death in patients with glaucoma (Guo L et al. Proc Natl Acad Sci U S A. 2007;104[33]:13444-13449).

Using a rat model of glaucoma, the researchers found that amyloid beta accumulates in dying retinal ganglion cells and that adding this protein to retinal cells in vivo induced cell death. They also found that giving the animals agents that inhibit the formation and accumulation of amyloid beta reduced death of retinal ganglion cells, especially when given in combination.

Although current glaucoma therapy is aimed at lowering intraocular pressure, the disease can persist even when pressure-lowering medications are given or when pressure in the eye is normal. "Our work suggests that targeting the [amyloid beta] pathway provides a therapeutic avenue in glaucoma management," the researchers said. (...)

(Anm: Alzheimers sykdom og andre årsaker til demens. (mintankesmie.no).)

Glaucoma and Alzheimer's May Have Common Origins and Treatment (Glaukom og Alzheimers kan ha felles opprinnelse og behandling)
medpagetoday.com 6.8.2007
(...) The findings, published online in Proceedings of the National Academy of Sciences, suggest that blocking the action of amyloid-b peptide may offer a new method for slowing or preventing glaucoma progression. (...)

Dr. Cordeiro said that the findings also suggest possible methods for testing Alzheimer's disease therapies.

"Since we have shown that drugs for Alzheimer's disease can tackle glaucoma, then potentially we could use a damaged retina to screen Alzheimer's drugs that target beta-amyloid build up," she said. (...)

(Anm: Targeting amyloid-β in glaucoma treatment. PNAS ( Proceedings of the National Academy of Sciences) 2007;104(33):13444-13449.)

- Fete barn risikerer skade på skjoldbruskkjertel

Obese children risk thyroid damage (Fete barn risikerer skade på skjoldbruskkjertel)
reuters.com 3.12.2008
WASHINGTON (Reuters) - Obese children may be damaging their thyroids, creating a vicious cycle of metabolism and overweight, Italian researchers reported on Wednesday.

Obesity may cause inflammation that damages the thyroid, which secretes hormones to regulate metabolism and other important functions, Dr. Giorgio Radetti of the Regional Hospital of Bolzano in Italy and colleagues said.
They evaluated 186 overweight and obese children for about three years, testing thyroid hormone levels and thyroid antibodies and imaging the thyroid gland using ultrasound.

"Our study shows that alterations in thyroid function and structure are common in obese children and we may have uncovered the link," Radetti said in a statement.

"We found an association between body mass index and thyroid hormone levels which suggests that fat excess may have a role in thyroid tissue modification."

Writing in the Journal of Clinical Endocrinology & Metabolism, they said 73 of the children had inflamed-looking thyroids, but apparently not a condition called Hashimoto's thyroiditis, an autoimmune disease in which T-cells mistakenly attack the thyroid. (...)

- Diagnose og behandling av tyreotoksikose

Diagnosis and management of thyrotoxicosis (Diagnose og behandling av tyreotoksikose)
BMJ 2006;332:1369-1373 (10 June)
Thyrotoxicosis occurs in approximately 2% of women and 0.2% of men.^w1 Thyrotoxicosis due to Graves' disease most commonly develops between the second and fourth decades of life, whereas the prevalence of toxic nodular goitre increases with age. Autoimmune forms of thyrotoxicosis are more prevalent among smokers.^{w2 w3} Toxic nodular goitre is most common in regions where dietary iodine is insufficient. (...)

(Anm: tyreotoksikose; Graves sykdom; thyreotoxicosis; tilstand med auka stoffskifte, utståande auge, rask puls, sveitting, rastløyse, nervøsitet, vekttap, trøyttleik, veike musklar, skjelvande fingrar, struma m m; skuldast for sterk skjoldkjertelteneste, viser høge verdiar for tyroksin, låge TSH verdiar i serum, har autoimmun årsak (immunglobulin med TSH-liknande verknad stimulerer skjoldkjertelen) eller skuldast tyroksinproduserande knutar i kjertelvevet; også kalla morbus basedowi; Graves sjukdom; giftig struma; jf hypertyreose, T3-toksikose, tyroksin, tyreotoksisk krise, apatisk hypertyreoidisme, pretibialt myksødem, eksoftalmus, tyreotropin reseptor EN thyrotoxicosis; Graves disease. Kilde: Norsk medisinsk ordbok.)

(Anm: myksødem koma; myksødemkoma; Generelt: Myksødemkoma er en meget sjelden tilstand. Prognosen er dårlig, og bare omtrent halvparten av pasientene overlever. Tilstanden opptrer oftest hos eldre kvinner med langvarig udiagnostisert og/eller ubehandlet hypotyreose. Myksødemkoma utløses gjerne i forbindelse med infeksjoner, operasjoner, traumer, hjertesvikt, mage- og tarmblødninger, cerebrovaskulære katastrofer, avkjøling eller behandling med psykofarmaka. (legemiddelhandboka.no).)

(Anm: myxedema (en.wikipedia.org).)

- Diagnostisering og behandling av hypothyreose

Fatigue after traumatic brain injury: Association with neuroendocrine, sleep, depression and other factors.
Brain Inj. 2010;24(12):1379-88.
Objective: Define associations between post-traumatic brain injury (TBI) fatigue and abnormalities in neuroendocrine axes, sleep, mood, cognition and physical functioning. (...)

Conclusions: Robust correlates of fatigue were gender, depression, pain and memory and motor dysfunction. Investigation of post-TBI fatigue should include screening for depression, pain and sleep disturbance. There was no correlation between pituitary dysfunction and fatigue; however, the relatively high prevalence of hypothyroidism and adrenal dysfunction suggests screening for these hormone deficiencies. (...)

Diagnosis and treatment of primary hypothyroidism (Diagnostisering og behandling av hypothyreose)
BMJ 2009;338:b725
Editorials
New guidance highlights how to do it (...)

The Royal College of Physicians, working closely with several specialist professional associations and patient associations with interests in the safe management of thyroid diseases, has recently produced a statement on the diagnosis and management of primary hypothyroidism. This statement sets out clear guidance for general practitioners and the wider medical profession regarding the diagnosis and treatment of primary hypothyroidism in the United Kingdom.3 The box summarises the key messages of this statement. (...)

- Hypothyroidism affects one in 50 British women. So why did Sarah O'Neil's debilitating condition take more than six years to diagnose?

Hypothyroidism: Don't suffer in silence
independent.co.uk 5.9.2006
Hypothyroidism affects one in 50 British women. So why did Sarah O'Neil's debilitating condition take more than six years to diagnose? Natasha Courtenay-Smith investigates (...)

Located in our neck, the thyroid gland is one of a family that makes up our endocrine system. It contains the only cells in our body capable of absorbing and synthesising iodine, and also secretes hormones, such as thyroxine, that act as chemical messengers, telling organs and tissues what to do.

It plays a vital role controlling our metabolism and the conversion of oxygen and calories into energy. Symptoms of hypothyroidism including excessive tiredness, weight gain, constipation, aches and pains, feeling cold, dry skin, memory loss, reduced libido and depression. Hypothyroidism affects an estimated 1 in 50 women and 1 in 1,000 men in the UK.

"The sad truth for sufferers is that, with symptoms so general, they are usually sent away from their GP and told they're suffering from stress or depression," says Dr Durrant-Peatfield. "They're put on Prozac that does nothing to help the true cause." (...)

Hypothyreose kan mimikere depressive symptomer

Depression Blood Tests
about.com 15.12.2008
Is There a Blood Test for Depression? (...)

Hypothyroidism and Depression (Hypothyreose og depresjon)
depression.about.com 25.1.2007
Hypothyroidism Can Mimic Depression Symptoms (Hypothyreose kan mimikere depressive symptomer)
Have you been feeling tired and depressed lately? Before you assume that you need an antidepressant, you might want to consider having your thyroid checked. Hypothyroidism, a disease in which the thyroid gland fails to produce enough thyroid hormone, can mimic the symptoms of depression. Fatigue, sleepiness, slowing of speech, a lack of interest in personal relationships and general apathy are signs of clinical depression as well as hypothyroidism. (...)

Daily Mail: - Liv ødelagt av lykkepiller

Lives destroyed by happy pills: As our use of antidepressants DOUBLES in a decade, experts say thousands are being given dangerous drugs they don't need (Liv ødelagt av lykkepiller: Idet vårt forbruk av antidepressiva DOBLES på et tiår, sier eksperter at tusener er gitt legemidler de ikke trenger)
dailymail.co.uk 29.6.2010
(...) After about six weeks she went to see her doctor, who diagnosed depression and anxiety. 'I asked him if he was sure, because there were other symptoms such as diarrhoea, weight-loss and vomiting. But he confirmed his diagnosis and prescribed an antidepressant.' (...)

Unfortunately this only made her feel worse; she developed the shakes as well as suicidal thoughts. In an attempt to remedy this, her GP changed the medication three weeks later. But nothing changed.
And after mentioning her suicidal thoughts to her doctor, she was put under the supervision of a mental health team.

Six weeks later, Clare was put on yet another antidepressant, along with a tranquilliser and an anti-psychotic drug. She was now sleeping 14 hours a day; unable to work, she had to rely on her boyfriend for support.

'I was zombified, but still felt the anxiety and the terror, and that didn't seem right. However, my doctor simply increased my dose.' (...)

'The only good part was a brilliant nurse, who took me seriously when I said I'd always felt that something physical had caused my symptoms and put me in touch with a sympathetic private doctor,' she says.

A year-and-a-half after her symptoms began, Clare was diagnosed with an overactive thyroid and a problem with her adrenal glands. 'That was why I had been so bizarrely agitated, had diarrhoea and had lost weight.' (...)

Clare's story is extreme, but it is far from unique. Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month. In 2000, there were 20 million prescriptions - this rose to 39 million last year.

While this rise is partly being blamed on the recession, experts are concerned that misdiagnosis is a major factor. Indeed, a study published recently in The Lancet found that the average GP will wrongly diagnose 16 out of every 100 patients they see with depression and anxiety. (...)

- Krever test av alle gravide

Thyroid autoantibodies, preterm birth, and miscarriage (Thyreoidea antistoffer (anti-TPO), for tidlig fødsel, og abort)
BMJ 2011; 342:d2260 (9 May)
The association is clear, but the effects of levothyroxine treatment are uncertain
In the linked systematic review (doi:10.1136/bmj.d2616), Thangaratinam and colleagues assess the association of thyroid autoantibodies with miscarriage and preterm birth in biochemically euthyroid women and the effect of levothyroxine treatment on pregnancy outcomes.¹ (...)

Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence
BMJ 2011; 342:d2616 (9 May)
Abstract Objectives To evaluate the association between thyroid autoantibodies and miscarriage and preterm birth in women with normal thyroid function. To assess the effect of treatment with levothyroxine on pregnancy outcomes in this group of women. (...)

Conclusion The presence of maternal thyroid autoantibodies is strongly associated with miscarriage and preterm delivery. There is evidence that treatment with levothyroxine can attenuate the risks. (...)

Studies Evaluate Thyroid Treatment During Pregnancy
healthfinder.gov 25.9.2009
Efforts in U.S. and Europe are testing effects on women and their offspring.

FRIDAY, Sept. 25 (HealthDay News) -- Thyroid problems in pregnant women can cause serious consequences in both mothers and children, says an expert familiar with ongoing research into treatments.

An update on clinical trials was to be presented Friday at the annual meeting of the American Thyroid Association, in Palm Beach, Fla. (...)

The main goal of the study is to determine if thyroxine treatment in pregnant women is associated with improved intellectual function in their children at age 5. The researchers also want to find out whether thyroxine treatment affects fetal growth, preterm birth or preeclampsia.

"Newborn follow-ups are scheduled at 12, 24 and 36 months and at ages 4 and 5 years," Stagnaro-Green said.

A similar trial being carried out in Britain and Italy -- the Controlled Antenatal Thyroid Screening Study -- is investigating the effect of thyroid treatment on children's intellectual function at age 3. (...)

Sheehans syndrom
snl.no (21.2.2011) (Store norske leksikon)
Uttale: ʃˈi:ənz –Sheehans syndrom, tilstand som skyldes svikt i hypofysefunksjonen etter blødning i forbindelse med fødsel (eller stort blodtap i forbindelse med abort forholdsvis sent i svangerskapet).

Under svangerskapet tiltar hypofysen i størrelse, og krever større blodtilførsel enn ellers. Den blir derfor mer sårbar for skader på grunn av en forbigående svikt i blodtilførselen, som kan skje når blodtrykket faller ved et større blodtap. Symptomene ved Sheehans syndrom er preget av svikt i funksjonen til de indresekretoriske kjertlene som hypofysen stimulerer. Svikt i kjønnskjertlenes og skjoldbruskkjertelens funksjon preger oftest sykdomsbildet. Symptomene er mindre uttalte enn ved Simmonds syndrom. Behandlingen retter seg mot de hormonelle bortfallssymptomene og er vanligvis svært effektiv.

Den moderne overvåkningen av gravide og fødende har ført til at Sheehans syndrom i våre dager er en sjeldenhet.

Navn etter den britiske endokrinologen Harold L. Sheehan (1900–89). Se også hypofysesvikt og panhypopituitarisme. (...)

After year of pain, editor diagnosed with Sheehan Syndrome
beaconnews.suntimes.com 20.2.2011
(...) For the last year, since my daughter, Ashley, was born in September 2009, I had been in pain daily, barely able to walk up and down the stairs to put her to bed. As the year dragged on, carrying her became increasingly difficult. (...)

I began to think something was “fundamentally” wrong with me. Maybe I had a stroke, lupus, cancer ... I finally resigned to the doctor’s diagnosis. I took the recommended Prozac — and forgot for awhile. I was getting used to hurting. My hair was falling out; my legs ached; I couldn’t sit on the floor and get up; my brain seemed hidden in a fog; and I was struggling to keep up at work.

Life at home was suffering, too. I slept on the weekends, slept late on weekdays and went to bed early. My husband did everything: clean, cook, take care of our new baby. (...)

Summer passed without incident. I stopped taking Prozac because it made me not care whether I felt better. I pushed my doctors again. I hadn’t had a menstrual cycle since I’d had my now year-old daughter. The obstetrician said I was stressed — I needed to relax. No tests. (...)

After three days in the ICU, I was stabilized. I was halfway there. I had a diagnosis. Sheehan Syndrome. I was on my way to treatment.

I have my life back. (...)

Afterward
My condition isn’t a simple one. Sheehan Syndrome most often occurs when a woman loses too much blood during labor and delivery. The pituitary gland already is under stress, expanding triple its size during pregnancy.

However, Dr. Charles Miller, a specialist in reproductive endocrinology and infertility in private practice in Naperville, said the two factors pointing to Sheehan Syndrome in my case were the inability to lactate and inhibition of my menstrual cycle. (...)

Prenatal Testing of Thyroid Is Debated (Testing av skjoldbruskkjertel før fødselen drøftet)
NYTIMES.COM 13.4.2009
When women think about pregnancy, the thyroid gland is seldom the first thing that leaps to mind. Nestled in the neck, the gland makes hormones that govern metabolism, helping to regulate body weight, heart rate and a host of other factors.

But if the thyroid malfunctions, it can produce too little or too much of these hormones. During pregnancy those conditions, known as hypothyroidism and hyperthyroidism, respectively, may lead to miscarriage, premature birth and pre-eclampsia — and in the case of hypothyroidism, impaired intelligence in the child.

A decade and a half of research has now brought the cumulative evidence of these risks to a critical mass. Clinical guidelines call for vigilant monitoring and treatment of patients to keep thyroid reserves normal and to safely guide women through pregnancy and early motherhood. (...)

Hyperthyroidism and pregnancy
BMJ 2008;336:663-667 (22 March)
Pregnant women with hyperthyroidism need careful management as some may be at increased risk of fetal loss, pre-eclampsia, heart failure, premature labour, and having a low birthweight baby (...)

Hormonbrist farligt för foster
alltombarn.se 22.2.2008
Brist på hormon från sköldkörteln hos gravida kvinnor skadar fostrets hjärna, visar ny svensk forskning. Ett enkelt blodprov kan förhindra skadorna.

Blodprov på gravida kvinnor kan visa på hormonbrist och förhindra att deras barn får svåra mentala och fysiska utvecklingsstörningar.

– Problem med sköldkörtelns produktion av hormon är så vanligt bland kvinnor att en del läkare nästan glömt av det, säger Björn Vennström, professor i cell- och molekylärbiologi vid Karolinska institutet. Han är en av de forskare som kommit fram till att fostret får skador på hjärnvävnaden när kvinnan har brist på sköldkörtelhormon. Resultaten publiceras i Journal of Neuroscience.

Ett problem är, enligt Vennström, att kvinnor ofta inte är medvetna om ärftliga sköldkörtelsjukdomar. Helst ska testet göras redan före graviditeten eller under första besöket på mödravårdscentralen.

– Skadorna sker faktiskt ganska tidigt. Redan efter tre till fyra månaders graviditet, säger Vennström. (...)

Krever test av alle gravide
helserevyen.no 20.11.2007
Nordisk Thyreoidea Samarbeid (NTS) krever at alle gravide må testes for stoffskiftesykdom.

NTS, som er et samarbeidsorgan for seks pasientorganisasjoner for om lag 13 000 stoffskiftesyke fra Finland, Sverige, Danmark og Norge, vedtok nylig kravet på et styremøte i Helsingfors.

Organisasjonen peker på at uoppdaget eller dårlig regulert stoffskiftesykdom kan føre til skader på barnets fysiske og psykiske utvikling. (...)

Hypothyroidism in pregnancy
BMJ 2007;335:362 (25 August)
Three unresolved issues
We disagree with three points in the article on unresolved questions in managing hypothyroidism in pregnancy.¹ (...)

Unresolved questions in managing hypothyroidism during pregnancy
BMJ 2007;335:300-302 (11 August)
Diagnosing and managing hypothyroidism during pregnancy can be problematic. The scenario box on this page illustrates some typical problems encountered and raises pertinent questions concerning good medical practice. (...)

Graviditet og thyroideasygdom
Skrevet af Hans Perrild, Nils Knudsen, Peter Laurberg
mpl.dk (Januar 2007 / 1)
Mon ikke det er nyt for de fleste, at hver tiende kvinde i fertil alder har thyroideaperoxidase-antistoffer i blodet, og halvdelen af disse vil udvikle en eller anden grad af thyroideafunktionsforstyrrelse i post partum-perioden. Nogle kvinder får en tidlig fase med hyperthyroidisme, men det mest fremtrædende er hypothyroidisme med vage symptomer. (...)

Et nytt syndrom?
Heiko Santelmann
Tidsskr Nor Lægeforen 2007; 127: 461 (15.2.2007)
Halldis Ringvold etterlyser i Tidsskriftet nr. 17/2006 leger som har erfaring med pasienter med hypotyreose kombinert med glutenintoleranse og malabsorpsjon av laktose og fruktose (1).

I min legepraksis har jeg i over 20 år vært spesielt interessert i polysymptomatiske pasienter. Jeg har behandlet mer enn 400 pasienter med påvist glutenintoleranse, eller glutenallergi etter EAACIs definisjon (2) siden alle hadde forhøyede IgA- eller IgG-verdier mot gliadin eller gluten i serum uten å ha cøliaki. Nesten alle hadde symptomforverring ved inntak av laktose, fruktose, dekstrose og sukrose, og mange hadde hypotyreose etter tyreoiditt. Nesten alle klaget over utmattethet «uten grunn» og irritert tykktarm. Symptomer som sukkertrang, kløe og forverring av plager fra luftveier, muskler og skjelett samt av psykiske plager i tåke og regn var vanlig. Pasientgruppen responderte veldig bra på antimykotika og en diett uten sukker, laktose, gjær og gluten. Som Ringvold trodde jeg i 1986 at jeg var på sporet av et nytt syndrom, men måtte innse at kolleger i USA hadde beskrevet syndromet allerede (3) under navnet candidiasis-hypersensitivitets-syndrom. (...)

Hvis Ringvolds pasienteksempler ikke har positiv anti-TPO/TRAS-test og har malabsorbsjon bare av fruktose, er hun kanskje på sporet av et nytt syndrom likevel? (...)

- Tid er kritisk for barn med stoffskiftesykdom

Medfødt stoffskiftesykdom med akutt debut i nyfødtalderen
Tidsskr Nor Legeforen 2008; 128:1537 (26.6.2008)
Se også Et nyfødt barn med hyperventilasjon
Denne sykehistorien illustrerer godt en meget viktig problemstilling som alle som har ansvar for nyfødte barn må kjenne til, nemlig medfødt stoffskiftesykdom som debuterer intrauterint, eller vanligere de første dager eller uker etter fødselen. (...)

Tid er kritisk for barn med stoffskiftesykdom
helserevyen.no 17.10.2007
- Ubehandlet hypothyreose (lavt stoffskifte) hos barn kan føre til alvorlige svekkelser av hjernens og kroppens utvikling. (...)

Frustrerte foreldre
De 24 foreldrene som var til stede under seminaret, som ble arrangert av Norsk Thyreoideaforbund (NTF), klaget over at det er for lite informasjon og kunnskap om sykdommen rundt omkring i landet og om hvilke rettigheter disse barna har.

- Mange har derfor måttet kjempe en ensom kamp for å synliggjøre deres barns behov. Særlig bittert føles det når det tar tid før barn med ervervet hypothyreose får en diagnose og god behandling. De synes det må informeres bedre om denne sykdommen både overfor foreldre, helsestasjoner, barnehager og skoler slik at symptomene kan tas på alvor på et tidligere tidspunkt, sier forbundsleder Bente Bakke i NTF. (...)

- Stress kan utløse thyreoideasykdommer

Thyroid disease, a silent menace (Thyreoideasykdom, taus trussel)
latimes.com 24.9.2007
(...) The American Assn. of Clinical Endocrinologists estimates that about 27 million Americans have one of these problems, more than half of whom don't realize it. Possibly because of reproductive hormones or other still unknown reasons, women get autoimmune diseases more often then men, and about four times more women than men get thyroid disease.

Stress affects the immune system, but can stress spark an autoimmune disease that damages or impairs the thyroid gland? (...)

An obvious symptom of an overactive thyroid is a bulging of the eyes because the tissue behind them have become inflamed, pushing on the back of the eyeballs. "There are about 100,000 people or so who walk around with bulging eyes," says Smith. Some experience double vision and, in serious but rare cases, people can go blind. Smith and colleagues are developing a therapy that blocks the inflammation in that tissue. (...)

They can also have dry skin and hair, depression and other symptoms. Patients are treated with medications that replace the lost hormones. (...)

The American Thyroid Assn. recommends that everyone over 35 get tested for thyroid function because the diseases so often go undiagnosed. Winfrey was long overdue. (...)

- Skjulte folkesykdommer

Keld Heick ramt af mystisk sygdom
bt.dk 7.11.2007
Keld Heick havde svært ved at holde livet ud, da han i sommer var alvorligt syg med betændelse i skjoldbruskkirtlen. I lang tid slog lægen det hen som en banal halsbetændelse. (...)

- Det var et helvede, da det stod på. Og jeg var vred på min læge, fordi hun ikke fandt den rigtige diagnose. Men i dag er hun tilgivet, fordi jeg ved, at den er svær at diagnosticere, fortæller han.

Alligevel er han ikke i tvivl om, at det altid er godt at søge anden hjælp, hvis ens læge tager fejl. Selv de bedste kan overse en detalje, Og det var præcis, hvad der skete, da han i august gik til sin læge. (...)

Varsku om stoffskiftesykdom
aftenposten.no 30.5.2006
Over 100 000 personer har kronisk stoffskiftesykdom i skjoldbruskkjertelen.

Nærmere 30 000 av disse har redusert livskvalitet. En konstant følelse av å være utslitt er fellesnevner for de mange som er rammet.

Som tilleggsbelastning opplever mange at legene ikke tar dem alvorlig. Det hersker stor mangel på kunnskap om stoffskiftesykdom generelt. Også blant leger. Det kan ta 4 - 8år før diagnose stilles, hevder Norsk Thyreoideaforbund (NTF). Følgene blir ofte sykemeldinger og redusert innsats i arbeidslivet.
I håp om å vekke gehør hos helsepolitikere og spre informasjon om sykdommen arrangerte organisasjonen nylig en kampanje, der 5000 medlemmer var i aktivitet landet rundt. (...)

Dold folksjukdom stör ämnesomsättning
unt.se 29.5.2006
Patienter med den dolda folksjukdomen överaktiva bisköldkörtlar har ofta en rad störningar i kroppens socker- och fettomsättning. Med en operation kan störningarna minskas eller försvinna helt.

Det framgår av en doktorsavhandling av Emil Hagström vid Institutionen för kirurgiska vetenskaper, Uppsala universitet.
— Vi är faktiskt först att påvisa ett samband mellan överaktiva bisköldkörtlar och det så kallade metabola syndromet. Detta kan åtminstone delvis förklara varför patienter med överaktiva bisköldkörtlar löper ökad risk att dö i hjärtkärlsjukdomar, säger han.
Överaktiva bisköldkörtlar — eller så kallad primär hyperparatyreodism, HPT, som den kallas på fackspråk — är en vanlig sjukdom. Ungefär en procent av befolkningen och tre procent av kvinnorna som passerat klimakteriet har överaktiva bisköldkörtlar. (...)

- "Subklinisk" thyreoideasykdom og risiko for koronar hjertesykdom og dødelighet

Treatment of subclinical hypothyroidism linked with fewer ischemic heart events in younger patients (Behandling for subklinisk hypothyreose knyttet til færre iskemiske hjertehendelser hos yngre pasienter)
medicalxpress.com 23.4.2012
Treatment of subclinical hypothyroidism with the medication levothyroxine appears to be related to fewer ischemic heart disease events in younger patients but this finding was not evident in older patients, according to a report published Online First in Archives of Internal Medicine.

Subclinical hypothyroidism (SCH) is defined as an elevated serum thyrotropin level in the presence of normal thyroid hormone concentrations. The condition is relatively common and often asymptomatic, although recent meta-analyses have suggested that SCH is associated with increased cardiovascular events and death, especially in young to middle-aged adults, the authors write in their study background. But those epidemiologic associations do not prove that treatment of SCH would be effective, the authors note. (...)

(Anm: Iskemisk hjertesykdom (nhi.no).)

(Anm: Subklinisk hypotyreose. På fagspråket omtales dette som subklinisk hypotyreose. Hva menes med truende lavt stoffskifte? Subklinisk betyr at det ikke foreligger endringer i form av symptomer og tegn. Hypotyreose betyr lavt stoffskifte. Subklinisk hypotyreose dreier seg således om en beskjeden forstyrrelse i skjoldkjertelen i retning av lavere stoffskifte, men uten at det gir seg utslag i symptomer og tegn slik vi finner det ved hypotyreose. (nhi.no).)

Subclinical Hyperthyroidism and the Risk of Coronary Heart Disease and Mortality (Subklinisk hypothyreose og risiko for koronar hjertesykdom og dødelighet)
Arch Intern Med. 2012 (Published online April 23)
Background Data from prospective cohort studies regarding the association between subclinical hyperthyroidism and cardiovascular outcomes are conflicting. We aimed to assess the risks of total and coronary heart disease (CHD) mortality, CHD events, and atrial fibrillation (AF) associated with endogenous subclinical hyperthyroidism among all available large prospective cohorts.

Methods Individual data on 52 674 participants were pooled from 10 cohorts. Coronary heart disease events were analyzed in 22 437 participants from 6 cohorts with available data, and incident AF was analyzed in 8711 participants from 5 cohorts. Euthyroidism was defined as thyrotropin level between 0.45 and 4.49 mIU/L and endogenous subclinical hyperthyroidism as thyrotropin level lower than 0.45 mIU/L with normal free thyroxine levels, after excluding those receiving thyroid-altering medications.

Results Of 52 674 participants, 2188 (4.2%) had subclinical hyperthyroidism. During follow-up, 8527 participants died (including 1896 from CHD), 3653 of 22 437 had CHD events, and 785 of 8711 developed AF. In age- and sex-adjusted analyses, subclinical hyperthyroidism was associated with increased total mortality (hazard ratio [HR], 1.24, 95% CI, 1.06-1.46), CHD mortality (HR, 1.29, 95% CI, 1.02-1.62), CHD events (HR, 1.21; 95% CI, 0.99-1.46), and AF (HR, 1.68; 95% CI, 1.16-2.43). Risks did not differ significantly by age, sex, or preexisting cardiovascular disease and were similar after further adjustment for cardiovascular risk factors, with attributable risk of 14.5% for total mortality to 41.5% for AF in those with subclinical hyperthyroidism. Risks for CHD mortality and AF (but not other outcomes) were higher for thyrotropin level lower than 0.10 compared with thyrotropin level between 0.10 and 0.44 mIU/L (for both, P value for trend, .03).

Conclusions Endogenous subclinical hyperthyroidism is associated with increased risks of total, CHD mortality, and incident AF, with highest risks of CHD mortality and AF when thyrotropin level is lower than 0.10 mIU/L. (...)

(Anm: Skjoldbruskkjertelhormoner. Kilde: Store norske leksikon.)

(Anm: Subklinisk betegnelse på sykdom som forløper så lett at den ikke kan merkes av pasienten. Kilde: Store norske leksikon.)

(Anm: Subklinisk hypotyreose. På fagspråket omtales dette som subklinisk hypotyreose. Hva menes med truende lavt stoffskifte? Subklinisk betyr at det ikke foreligger endringer i form av symptomer og tegn. Hypotyreose betyr lavt stoffskifte. Subklinisk hypotyreose dreier seg således om en beskjeden forstyrrelse i skjoldkjertelen i retning av lavere stoffskifte, men uten at det gir seg utslag i symptomer og tegn slik vi finner det ved hypotyreose. (nhi.no).)

(Anm: Coronary Heart Disease (CHD). Koronar hjertesykdom. En sykdom der det er en innsnevring eller blokkering av koronararteriene (blodårer som frakter blod og oksygen til hjertet). Årsaken til koronar hjertesykdom er vanligvis åreforkalkning (en opphoping av fatty materiale og plakk på innsiden av koronararteriene). Sykdommen kan forårsake brystsmerter, kortpustethet under trening og hjerteinfarkt. Risikoen for koronar hjertesykdom øker med en familie historie av koronar hjertesykdom før fylte 50 år, høy alder, røyking, snus, lider av høyt blodtrykk, høyt kolesterol, har diabetes, mangel på mosjon og fedme . Også kalt CAD og koronarsykdom. (wikbio.com).)

Levothyroxine Treatment of Subclinical Hypothyroidism, Fatal and Nonfatal Cardiovascular Events, and Mortality
Arch Intern Med. 2012 (Published online April 23)
Background Subclinical hypothyroidism (SCH) has been associated with ischemic heart disease (IHD); however, it is unknown whether treatment of SCH with levothyroxine sodium will reduce the risk of IHD. The aim of this study was to investigate the association between levothyroxine treatment of SCH with IHD morbidity and mortality. (...)

Conclusions Treatment of SCH with levothyroxine was associated with fewer IHD events in younger individuals, but this was not evident in older people. An appropriately powered randomized controlled trial of levothyroxine in SCH examining vascular outcomes is now warranted. (...)

What Is the Clinical Importance of Subclinical Hyperthyroidism? (Hva er den kliniske viktigheten ved subklinisk hyperthyreose?)
Arch Intern Med. 2012 (Published online April 23)
Comment on "Subclinical Hyperthyroidism and the Risk of Coronary Heart Disease and Mortality"

Subclinical hyperthyroidism is defined as a patient having normal free thyroxine (FT4) and total triiodothyronine (T3) levels in conjunction with a thyrotropin (TSH) level persistently below the normal range in the absence of factors known to suppress TSH. Factors that may alter TSH value and thyroid function test results include medications such as corticosteroids and dopamine and clinical conditions to include hypothalamic or pituitary hypofunction and nonthyroid illness.^1-2 Nonthyroid illness is a general term that applies to a wide variety of patients who have systemic illness that can result in altered thyroid function test results. In general, the diagnosis of subclinical hyperthyroidism is made in ambulatory outpatients who are not taking medications known to affect thyroid function. The incidence of subclinical hyperthyroidism is approximately 1%.³ The most common causes of endogenous subclinical hyperthyroidism include Graves disease (usually younger patients), multinodular goiter (typically older patients), and solitary autonomous nodules. The discrimination between endogenous hyperthyroidism from exogenous hyperthyroidism is important, since exogenous hyperthyroidism can usually be treated by modulation of the levothyroxine dose. Although the study by Collet et al⁴ focuses on cardiovascular effects, subclinical hyperthyroidism is also associated with an increased risk of osteopenia and/or osteoporosis, especially in older women, which may improve following treatment of the hyperthyroidism.⁵ It is controversial whether cognitive function is altered by the presence of subclinical hyperthyroidism. (...)

In conclusion, the study by Collet et al⁴ provides important information regarding the importance of recognizing subclinical hyperthyroidism in anticipation of decreasing cardiac and osseous risks, although definitive prospective long-term, controlled studies proving the benefits of treatment in various age groups have not been performed. Until further data are available, the relationship between subclinical hyperthyroidism and increased mortality, CHD mortality, and atrial fibrillation presently provides sufficient evidence to consider treatment of subclinical hyperthyroidism, especially in elderly patients with cardiac risks, hyperthyroid symptoms, or osteoporosis. (...)

"Subklinisk" thyreoideasykdom
Tidsskr Nor Lægeforen 2002; 122: 938-40
Bakgrunn. Det er vanligvis lett å diagnostisere og behandle pasienter med manifest thyreoideasykdom. Derimot har behandling av "subklinisk" thyreoideasykdom vært omdiskutert.

Resultater. Hos pasienter med subklinisk hypotyreose (forhøyet nivå av thyreoideastimulerende hormon (TSH) og normalt nivå av fritt tyroksin (T4)) er det mulig at tyroksinbehandling kan bedre psykiske symptomer og være av betydning for lipidnivå og blodtrykk. Pasienter med subklinisk hypertyreose har overhyppighet av atrieflimmer og muligens økt risiko for demensutvikling.

Fortolkning. Subklinisk hypo- og hypertyreose er oftest progredierende. Dersom det viser seg at tilstanden ikke er forbigående, bør behandling iverksettes. (...)

Evaluation of clinical and psychiatric symptoms in sub clinical hypothyroidism
Rev Assoc Med Bras. 2006 Aug;52(4):222-228.)
BACKGROUND: This investigation evaluated and correlated clinical, laboratorial aspects and psychiatric symptoms in sub clinical hypothyroidism (SH). (...)

CONCLUSIONS: The study showed that SH was associated with clinical findings and with psychiatric symptoms. Clinical trials are required to evaluate possible improvement with levotiroxine. (...)

- Symptomer på subakutt tyreoiditt (Subacute thyroiditis)

Subacute thyroiditis (subakutt tyreoiditt)
merck.com (Merck Manual)
(...) Symptoms, Signs, and Prognosis (Symptomer, tegn, og prognoser)

Kliniske trekk innbefatter en begynnende "sår hals" (i virkeligheten halssmerter) med progressiv ømhet i hals og lav feber (37.8° til 38.3° C [100° til 101° F]). Nakkesmertene skifter karakteristisk fra side til side og kan sette seg i et område, ofte stråler smertene ut i kjeven og ørene. Det forveksles ofte med tannpine, hals-betennelse, eller ørebetennelse og forverres ved svelging eller vridning av hodet. Hyperthyreoidisme er vanlig tidlig i sykdommen fordi hormoner frigjøres fra de ødelagte follikkelene. Der er mer utmattelse og ekstrem fysisk svekkelse enn ved noen annen type thyreoid lidelse. Ved fysisk undersøkelse, er skjoldbruskkjertelen asymmetrisk forstørret, stiv, og øm. (Clinical features include the onset of "sore throat" (in reality, neck pain) with progressive tenderness in the neck and low-grade fever (37.8° to 38.3° C [100° to 101° F]). The neck pain shifts characteristically from side to side and may settle in one area, frequently radiating to the jaw and ears. It is often confused with dental pain, pharyngitis, or otitis and is aggravated by swallowing or turning the head. Hyperthyroidism is common early in the disease because of hormone release from the disrupted follicles. There is more lassitude and prostration than in other thyroid disorders. On physical examination, the thyroid is asymmetrically enlarged, firm, and tender.)

Subakutt thyreoiditt er selvbegrensende, og avtar som oftest i løpet av få måneder; iblant oppstår tilbakefall som vil kunne resultere i permanent hypothyreoidisme når det er omfattende ødeleggelser av follikkeler. (...) (Subacute thyroiditis is self-limited, generally subsiding in a few months; occasionally it recurs and may result in permanent hypothyroidism when there is extensive follicular destruction.)

Subacute thyroiditis (subakutt tyreoiditt)
nlm.nih.gov (National Institutes of Health)
(...) Symptomer på overskudd av skjoldbruskkjertelhormon (hypertyreoidisme), slik som nervøsitet, rask puls og varmeintoleranse, kan være tilstede tidlig i sykdommen. Senere kan det opptre symptomer på for lite skjoldbruskkjertelhormon (hypotyreose), slik som utmattelse, forstoppelse, eller kuldeintoleranse. (Symptoms of thyroid hormone excess (hyperthyroidism) such as nervousness, rapid heart rate, and heat intolerance may be present early in the disease. Later, symptoms of too little thyroid hormone (hypothyroidism) such as fatigue, constipation, or cold intolerance may occur.)

Subakutt tyreoiditt  opptrer oftest hos middelaldrende kvinner med nylige symptomer på virusinfeksjon i luftveiene. (Subacute thyroiditis occurs most often in middle-aged women with recent symptoms of viral respiratory tract infection.)

Symptoms (Symptomer)

• pain in the front of the neck (smerter i forkant av nakke)
• tenderness when gentle pressure is applied to the thyroid gland (palpation) (ømhet når det legges forsiktig trykk på skjoldbruskkjertel (palpasjon)
• fever (feber)
• weakness (svakhet)
• fatigue (utmattelse)

Other symptoms may include: (Andre symptomer inkluderer:)

• nervousness (nervøsistet)
• heat intolerance (varmeintoleranse)
• weight loss (vekttap)
• sweating (svetting)
• diarrhea (diaré)
• tremor (skjelving)
• palpitations (...) (hjertebank) (...)

(Anm: en rekke legemidler, bl.a. såkalte psykiatriske legemidler, kan mulig forårsake diverse alvorlige komplikasjoner/sykdommer i skjoldbruskkjertel.)

(Anm: tyreoidea; thyreoidea;1 skjoldforma; 2 glandula thyroidea (TA) d e tyreoidkjertelen; 3 namn på pulverisert tørka skjoldkjertelvev frå dyr til medisinsk bruk; stavemåten er ofte: thyroidea EN thyroid ET [gr thyreos stort, dørliknande skjold med hakk øverst (frå thura dør) + eidos form] Kilde: Norsk medisinsk ordbok.)

Hypoparathyroidisme (HPTH)

Leger skjuler feilbehandling
nrk.no 26.2.2007
Over 40 prosent av pasienter som får skader under behandling på norske sykehus, får aldri vite at de er blitt feilbehandlet. (...)

Seksjonsoverlege ved Haukeland Universitetssykehus, Guttorm Brattebø, forteller at det å innrømme feil for mange leger er forbundet med skam. (...)

For snart ni år siden ble Helle Jensen operert for struma. Skjoldbruskkjertelen var for stor og skulle reduseres.

Under operasjonen kom kirurgen til å skade én og fjerne tre biskjoldbruskkjertler i tillegg. Dette førte til at kroppen hennes ikke lenger var istand til å holde et stabilt kalsiumnivå.

Ingen fortalte henne at legene hadde gjort en feil. (...)

Gikk til sak
Helle Jensen gikk på eget initiativ til sak mot sykehuset som feilbehandlet henne. Etter flere runder i retten vant hun fram, og får i disse dager utbetalt erstatning for ødelagt helse.

- Det er klart jeg er sint på legene, sier hun. Jeg synes det er dårlig at de tenker mer på egen prestisje, enn på pasientene de skal behandle.

Helle Jensen er i dag hundre prosent ufør. De siste årene har hun brukt tiden sin på å starte en egen pasientorganisasjon for pasienter med samme sykdom som henne, hypoparathyroidisme.

Har du denne sykdommen og trenger hjelp, kan du ta kontakt via organisasjonens nettside www.hpth.no

LES MER: Vil melde feilbehandling anonymt. (...)

(Anm: Symptomer på Hypoparathyroidisme (HPTH) (hpth.no/symptomerl).

(Anm: hypoparatyreoidisme; nedsett funksjon i biskjoldkjertlane, d e skort på paratyreoideahormonet (PTH); fører til fall i kalsiuminnhaldet i blod; dette kan føra til muskelkrampar (tetani (s d)), grå stær, beinvevsforandringar m v; årsak har ofte vore tilfeldig fjerning av paratyreoidkjertlane ved strumaoperasjon men genetiske feil med hormonet eller hormonet sin reseptor, ev med den kalsiumsansande reseptoren e a kan gi ulike former for hypoparatyreoidisme; jf de Georges syndrom og automuun-polyendokrinopati-candidiasis-ectodermal dystrofi, pseudohypoparatyreoidisme EN hypoparathyroidism Kilde: Norsk medisinsk ordbok.)

Tilleggsmedisinering med liotyronin ved hypotyreose?

Do we need still more trials on T₄ and T₃ combination therapy in hypothyroidism? (Trenger vi fremdeles flere forsøk på T₄ og T₃ kombinasjonsterapi mot hypothyreose?)
European Journal of Endocrinology 2010;161(6): 955-959
Approximately 10% of hypothyroid patients are dissatisfied with the outcome of levothyroxine replacement. It is unlikely that slight over- or under-treatment with thyroxine (T₄) explains remaining complaints. Meta-analysis of randomized clinical trials shows no advantage of T₄/tri-iodothyronine (T₃) combination therapy over T₄ monotherapy. However, each of these trials can be criticized, and none is perfect: most of them failed to mimic the physiological ratio of serum free T₄ (FT₄) to free T₃ (FT₃) concentrations. Development of a sustained-release T₃ preparation given as a single nighttime dose (together with levothyroxine once daily) might maintain physiological serum FT₄–FT₃ ratio's throughout 24 h. Genetic polymorphisms in deiodinase 2 and thyroid hormone transporters have been associated with well-being, fatigue, depression, and greater improvement on combination therapy. Future trials should target carriers of these polymorphisms to see whether they do better on T₄/T₃ combination therapy than on T₄ monotherapy. (…)

(Anm: Hypertyreose er en sykdom som skyldes økt produksjon av hormonene tyroksin (T4) og trijodtyronin (T3), som lages i skjoldkjertelen (tyroidea). Forhøyet T4 og/eller T3 gir forhøyet stoffskifte, og dette kan føre til et mangfold av plager som: (...) (nhi.no).)

(Anm: Hypotyreose - En kort orientering (nhi.no).)

Thyroxine Monotherapy After Thyroidectomy
Vol. 299 No. 7, February 20, 2008
JAMA. 2008;299(7):817-819.
It may be the experience of many clinicians, as it has been ours, that a very small group of patients with hypothyroidism are not entirely well on thyroxine replacement alone.¹

The concept of hormone replacement therapy is commonly credited to Brown-Sequard, who in 1889 at age 72 years injected himself with an extract of dog testicles and noted enhanced vitality and mental acuity.² (...)

Det antas at noen pasienter, kanskje omtrent 10 %, mulig kan ha nytte av supplementering av T3 etter thyreoidektomi. (...) (One might speculate that some patients, perhaps approximately 10%, might potentially benefit from T3 supplementation after thyroidectomy.)

Tilleggsmedisinering med liotyronin ved hypotyreose?
Valdemar Grill
Tidsskr Nor Lægeforen 2006; 126: 3285
Jeg har med interesse lest et innlegg av Grete Aastorp i spalten Personlige opplevelser i Tidsskriftet nr. 17/2006 (1). Aastorp føler seg godt fornøyd med tilleggsmedisinering av liotyronin (T3) til den medisineringen hun tidligere hadde med levotyroksin (T4) grunnet hypotyreose.

De undersøkelser som er gjort vedrørende tilleggseffekt av liotyronin til behandling med levotyroksin, viser ikke noen dokumenterte effekter på velbefinnende eller andre forhold som kan være gunstig for den enkelte pasient (2). Man kan ikke helt utelukke at tillegg av liotyronin hos enkelte pasienter kan ha gunstig effekt. Men tyroksin omdannes til trijodtyronin i kroppen, og en forsiktig økning av levotyroksin vil kanskje gjøre samme nytte, i tillegg til at levotyroksin har en lengre halveringstid og derfor gir et jevnere nivå av stoffskiftehormon.

Våre egne erfaringer er at pasienter som bruker liotyronin i tillegg til levotyroksin - vi får en del av disse henvist til vår avdeling - som regel ikke får bedre allmenntilstand etter oppstart med liotyronin. Tvert imot synes de oftere å få problemer med hjertebank og andre symptomer som ses ved hypertyreose. Ut ifra tidligere kliniske studier og egen erfaring er holdningen ved Endokrinologisk avdeling, St. Olavs Hospital altså at behandling med liotyronin i tillegg til levotyroksin ikke er indisert ved hypotyreose. (...)

Om å fylle olje på en tørr motor
Grete Aastorp
Tidsskr Nor Lægeforen 2006; 126: 2293
Enkelte pasienter med hypotyreose har erfart at en kombinasjon av liotyronin og levotyroksin er nødvendig for tilfredsstillende behandling. (...)

Og, interessant nok, en rekke pasienthistorier forteller om at tilskudd av liotyronin (T₃) har gjort helsetilstanden mye bedre. (...)

(Anm: Når enkelte pasienter rapporterer en vesentlig bedring ved tilskudd av liotyronin (T₃), bl.a. mht. immunsystem, tretthet osv., bør de pasienter som måtte ønske det få mulighet til å prøve liotyronin (T3).)

Forbindelser mellom thyreoideafunksjon og kroppsvekt

Relations of Thyroid Function to Body Weight (Forbindelser mellom thyreoideafunksjon og kroppsvekt)
Cross-sectional and Longitudinal Observations in a Community-Based Sample
Arch Intern Med. 2008;168(6):587-592
(...) Conclusions Thyroid function (as assessed by serum TSH concentration) within the reference range is associated with body weight in both sexes. Our findings raise the possibility that modest increases in serum TSH concentrations within the reference range may be associated with weight gain. (...)

Thyreoideasykdommer linket til hjertesykdom

Fatal thyrotoxic cardiomyopathy in a young man (Dødelig tyreotoksisk kardiomyopati hos en ung mann)
BMJ 2008;337:a531 (28 November)
β blockers may precipitate circulatory collapse in thyrotoxic patients with low output heart failure (Betablokkere kan fremskynde sirkulasjonsstans hos tyreotoksiske pasienter med "low output heart failure")

Epidemiological studies show an excess vascular mortality associated with hyperthyroidism, even after radioiodine treatment, and in people aged under 50.^{1 2} Thyrotoxic cardiomyopathy is a distinct clinical entity with devastating clinical consequences. It can affect young people even in the absence of underlying cardiac disease.^{3 4} It often presents as heart failure. Most cases are reversible, with cardiac function improving after thyroid function returns to normal.^{4 5 6 7} However, in the acute setting, the severity of the illness may result in fatalities despite treatment.^{8 9 10} This represents an important exception to the general principle that β blockers should be used in most hyperthyroid patients with tachyarrhythmias.

We present the case of a young man with chronic hyperthyroid Graves’ disease, who was admitted to hospital with severe heart failure, rapid atrial fibrillation, and pneumonia and died despite resuscitation. (...)

(Anm: kardiomyopati; cardiomyopathia; samlenamn for fleire hjartemuskelsjukdommar, helst brukt om tilstandar med genetiske årsaker som kan gi feil i feittsyreoksidasjonen eller i kontraksjons- eller bygnadsprotein i hjartemuskulaturen, eller med autoimmune årsaker ev pga doksorubicin eller andre medikament; sjå hovudgruppene dilatert, hypertrofisk, restriktiv og arytmogen kardiomyopati; sjå dessutan under kongestiv, obstruktiv, alkoholisk og infiltrativ, kardiomyopati i høgre ventrikkel, hypertrofisk kardiomyopati og subaortastenose; ein sjeldan peripartum kardiomyopati finst også; jf myokarditt EN cardiomyopathy ET [gr kardia hjarte + mys muskel + pathos sjukdom] Kilde: Norsk medisinsk ordbok.)

High High-Normal Thyroid Function and Risk of Atrial Fibrillation (Høy høy-normal thyreoideafunksjon og risiko for atrieflimmer)
Arch Intern Med 2008;168(20):2219-2224 (November 10)
The Rotterdam Study
Background Overt and subclinical hyperthyroidism are both well-known independent risk factors for atrial fibrillation. We aimed to investigate the association of high-normal thyroid function with the development of atrial fibrillation in a prospective population-based study in the elderly. (...)

Results The risk of atrial fibrillation was associated with the TSH level. The multivariate adjusted HR was 1.94 (95% CI, 1.13-3.34, lowest vs highest quartile; P for trend, .02). The multivariate adjusted level of free thyroxine showed a graded association with risk of atrial fibrillation (HR, 1.62; 95% CI, 0.84-3.14, highest vs lowest quartile; P for trend, .06).

Konklusjon Innen de normale grenser for målte thyreoideaverdier, har personer med høy-normal thyreoideafunksjon en større risiko for atrielflimmer. (...) (Conclusion Within the normal range of thyroid parameters, persons with high-normal thyroid function are at an increased risk of atrial fibrillation.)

(Anm: atrieflimmer; ujamn takt og styrke av puls og hjarteslag fordi hjarteslaga vert stimulerte av impulsar frå raske, uregelbundne flimrande trekkingar i forkammermuskulaturen; orda flimmer, flimmerpuls, hjarteflimmer viser oftast til denne tilstanden som kan gi lite plager, men stundom tung pust, hjartebank og ein tendens til emboliar frå venstre atrium (auricula) gjerne til hjernen; årsakene er mangslungne, f eks revmatisk hjartesjukdom, hjartesvikt av ulike typar, koronarsjukdom, tyreotoksikose, alkohol, perikarditt, anomaliar i impulsleiinga, ofte er tilstanden idiopatisk – lone fibrillation, i sjeldne tilfelle arveleg pga mutasjon i eit gen på kromosom 10; jf ventrikkelflimmer EN atrial fibrillation Kilde: Norsk medisinsk ordbok.)

(Anm: Atrial fibrillation (wikipedia.org).)

(Anm: Hva er atrieflimmer og atrieflutter? (pasienthandboka.no).)

Silent thyroid dysfunction has risks: study
reuters.com 23.5.2008
NEW YORK (Reuters Health) - People who have an underactive or overactive thyroid without symptoms appear to have a modestly increased risk of heart disease.

The data suggest that silent or "subclinical" thyroid dysfunction "might represent a potentially modifiable -- albeit modest -- risk factor for coronary heart disease and mortality," Dr. Nicholas Rodondi, from the University of Lausanne in Switzerland, and colleagues wrote in a report.

Their findings are based on pooled data from 12 studies identified through a search of MEDLINE (1950 to 2008). Ten of the studies involved population-based groups that included 14,449 subjects. (...)

SOURCE: Annals of Internal Medicine, online May 20. (...)

Hegge i bokform
aftenposten.no 9.5.2008
(…) - Den viktigste heter Og så må du ikke stille spørsmål, fra 2000. Den er utsolgt fra forlaget. 3000 eksemplarer. Jeg får fremdeles to, tre forespørsler om den daglig. Den handlet om en stoffskiftesykdom.

- Hypotyreose, som rammet din kone i 1984 og førte deg dypt ned i en stabel medisinsk litteratur og deretter til 15 års kamp mot legestanden?

- Riktig. Jeg snakket litt om dette senest for noen få dager siden, på en helsekonferanse arrangert av Sylvia Brustad. Temaet var samarbeidet mellom lege og pasient. Legestanden består av flotte folk, men dette feltet var dominert av en bitte liten gjeng med en selvtillit det ikke var grunnlag for. Jeg har hørt om at det finnes journalister som har det på samme måte. (…)

(Anm: OG SÅ MÅ DU IKKE STILLE SPØRSMÅL! av Per Egil Hegge.)

Low thyroid output tied to heart attacks in women (Liten thyreoid produksjon knyttet til hjerteanfal hos kvinner)
reuters.com 29.4.2008NEW YORK (Reuters Health) - Women with a slightly underactive thyroid gland appear to be at increased risk for death from heart attacks and other types of heart disease, according to findings from a Norwegian study reported in the Archives of Internal Medicine.

Emerging evidence suggests that as thyroid function drops, blood pressure and cholesterol levels rise as does the risk of heart problems, note Dr. Bjorn O. Asvold at Trondheim University Hospital and colleagues. (...)

"To our knowledge, no clinical trial has tested whether (treatment with thyroid hormone) could protect against heart disease," the authors note. However, there is evidence that such treatment can reduce high blood pressure, cholesterol levels, and body weight, they add.

SOURCE: Archives of Internal Medicine, April 28, 2008. (...)

Underactive Thyroid Increases Risk of Heart Failure (Underaktiv thyreoidea øker risiko for hjertesykdom)
ivanhoe.com 8.10.2007
(...) A new study shows patients who have subclinical hypothyroidism, a mildly underactive thyroid, are twice as likely to suffer from heart failure compared to those who have normally functioning thyroids. (...)

Mildly underactive thyroid is usually only detectable by having a blood test to evaluate the body’s levels of thyroid-stimulating hormone (TSH). The Cardiovascular Health Study collected data from more than 3,000 adults 65 years and older. Researchers followed the study participants for 12 years to determine if those individuals who had subclinical hypothyroidism were more likely to develop heart failure. Their research indicated individuals with a TSH level equal or greater than 10 milliunits per liter were at double the risk of developing heart failure compared to participants who had normal TSH levels. (...)

SOURCE: Ivanhoe interview with Doug Bauer, M.D.; The 78th Annual Meeting of the American Thyroid Association in New York, N.Y., Oct. 3-7, 2007 (...)

Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients
Arch Intern Med. 2007;167:1526-1532
(...) Methods To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). (...)

Conclusion A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease. (...)

(Anm: euthyroid; eutyroid; med god (normal) skjoldkjertelteneste, normal tyreoideafunksjon; tilsvarande uttrykk er eutyreoid, eutyreot
EN euthyroid ET [gr eu- god- + thyreos skjold] Kilde: Norsk medisinsk ordbok.)

Hypothyroidism may be linked to heart disease
reutershealth.com 28.7.2006
NEW YORK (Reuters Health) - People who have an underactive thyroid without symptoms appear to have an increased risk of heart disease, according to a review of published studies that appears in the American Journal of Medicine.
However, more evidence is still needed before any recommendations for screening can be made. Better studies that include more people who have had an episode of coronary heart disease will help confirm these results, lead investigator Dr. Nicolas Rodondi told Reuters Health. (...)

However, "in my opinion, the data are not good enough to recommend screening in healthy adults without any symptoms," Rodondi added.

"Before recommending screening," he concluded, "clinical trials are needed to assess whether thyroxine treatment reduces the risk of coronary heart disease in subjects with subclinical hypothyroidism. (...)

Sjelden bivirkning fra struma-preparat

Medicin smeltede Ullas hjerne
bt.dk 31.3.2006
Det var med stor sandsynlighed medicinen, der gav den unge kvinde Ulla Poulsen varige hjerneskader.

»Jeg er ikke i tvivl. Alt tyder på, at Ulla Poulsen blev hjerneskadet og invalideret af struma-præparatet PTU,« forklarer speciallæge, ph.d. Allan Wiik, der fra 1990 til 2003 ledede Statens Seruminstitut for autoimmunologi.

Han er fortsat overlæge ved afdelingen og tilknyttet Statens Seruminstitut som konsulent.

Eneste logiske forklaring
Allan Wiik føler sig overbevist om, at det er struma-medicinen, der har fået Ulla Poulsens hjerne til at smelte. »Som jeg ser det, er det den eneste logiske forklaring på det sygdomsbillede, som Ulla Poulsen udviklede,« siger overlægen til B.T.

På trods af sin ekspertise kommer Allan Wiik ikke til orde i Højesteret, fordi han har rådgivet Ulla Poulsens familie.

Overlægen mener, at det bør få betydning for sagen, at B.T. har fundet lignende sygdomstilfælde i Thailand.

Hans synspunkter støttes af overlæge, dr.med. Poul Halberg, tidligere chef for reumatologisk afdeling på Hvidovre Hospital.

Poul Halberg kender to eksempler på patienter, der er blevet skadet af præparatet PTU flere måneder efter, at de havde stoppet med at bruge medicinen. (...)

(Anm: struma; stor skjoldkjertel (glandula thyroidea); auka storleik av heile skjoldkjertelen eller delar av han (e.n. tjukkhals); årsaka kan vera jodmangel i kosten, tyreotoksikose e a, sjå endemisk struma, Hashimotos struma, Riedels struma EN goiter; struma ET [lat. «halskjertlar»] Kilde: Norsk medisinsk ordbok.)

Kan man ha lavt stoffskifte uten at det syns på blodprøver?

Spørsmål til livsstilsekspertene
aftenposten.no 27.10.2004
Kan man ha lavt stoffskifte uten at det syns på blodprøver? (...)

Proton-Pump Inhibitors and Hypomagnesemic Hypoparathyroidism

Proton-Pump Inhibitors and Hypomagnesemic Hypoparathyroidism
N Engl J Med 2006; 355:1834-1836 (October 26)
To the Editor: We report two cases of hypomagnesemic hypoparathyroidism associated with the use of proton-pump inhibitors, in which patients presented with carpopedal spasm in association with severe hypomagnesemia and hypocalcemia without an appropriate increase in the level of parathyroid hormone.

Patient 1 was a 51-year-old premenopausal woman who had been taking omeprazole for more than a year (at a dose of 20 mg twice daily) and who presented with carpopedal and truncal spasm. She began receiving 2.4 g of elemental calcium per day and, later, high-dose magnesium (Figure 1A). Fourteen months later, omeprazole was discontinued, and ranitidine . . . [Full Text of this Article] (...)

(Anm: hypoparatyreoidisme; nedsett funksjon i biskjoldkjertlane, d e skort på paratyreoideahormonet (PTH); fører til fall i kalsiuminnhaldet i blod; dette kan føra til muskelkrampar (tetani (s d)), grå stær, beinvevsforandringar m v; årsak har ofte vore tilfeldig fjerning av paratyreoidkjertlane ved strumaoperasjon men genetiske feil med hormonet eller hormonet sin reseptor, ev med den kalsiumsansande reseptoren e a kan gi ulike former for hypoparatyreoidisme; jf de Georges syndrom og automuun-polyendokrinopati-candidiasis-ectodermal dystrofi, pseudohypoparatyreoidisme EN hypoparathyroidism Kilde: Norsk medisinsk ordbok.)

Øker hyperthyreose dødsrisiko ved inntak av Ecstasy?

Does Hyperthyroidism Increase Risk of Death Due to the Ingestion of Ecstasy? (Øker hyperthyreose dødsrisiko ved inntak av Ecstasy?)
J Forensic Sci. 2007 May 25; [Epub ahead of print]
Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a psychoactive amphetamine derivative widely used for recreational purposes. Deaths caused by acute drug intoxication with MDMA are rare but can often involve a severe hyperthermic episode. The factors underlying the increased risk of some ecstasy users to a fatal drug reaction are not known. We present a case report of a 24-year-old woman who developed fatal hyperthermia with multi-organ complications following MDMA use and was found at autopsy to have diffuse thyroid hyperplasia (Graves' disease). An antemortem blood MDMA concentration of 0.68 mg/L was measured in a sample obtained on admission to hospital. Although a cause and effect cannot be established, as the thyroid hormone is a major regulator of thermogenesis, we suggest that hyperthyroidism predisposed the subject to ecstasy-induced hyperthermia and that a pre-existing defect affecting temperature status could be one factor in explaining some ecstasy intoxication deaths. (...)

Chemical Flame Retardants Linked to Thyroid Disease in Cats

Chemical Flame Retardants Linked to Thyroid Disease in Cats
healthfinder.gov 15.8.2007
Finding could be a sign of possible health threat to humans, researchers say.

(SOURCES: Linda S, Birnbaum, Ph.D., director, Experimental Toxicology Division, U.S. Environmental Protection Agency, Research Triangle Park, N.C.; Aug. 15, 2007, Environmental Science & Technology, online)

WEDNESDAY, Aug. 15 (HealthDay News) -- A mysterious epidemic of thyroid disease in pet cats in the United States may be due to dust from fire-retardant chemicals used in carpets, furniture, mattresses, electronic products and even pet food, researchers report. (...)

Skråsikkerhetens pris

Skråsikkerhetens pris
PER EGIL HEGGE, Redaktør
aftenposten.no 25.1.2008
Lærevilje. 2007 ble et dårlig år for de skråsikre, og 2008 tegner ikke bedre. For de fleste av oss er det over all måte positivt.

For snart 20 år siden skrev jeg et brev til sosialminister Tove Strand Gerhardsen. Jeg ville fortelle henne at det kostet hennes budsjett, og staten, nokså mye at norske leger hadde utilstrekkelige kunnskaper om stoffskiftelidelser. Jeg fikk et høflig svar om at statsråden hadde undersøkt dette og var blitt forsikret om at de norske stoffskifteekspertene var helt på høyde med de beste medisinske miljøer i utlandet, og at utdannelsen var på samme nivå.

Dette var dessverre meget langt fra sannheten, men hva skulle statsråden tro? Hun er i dag lei seg for at hun slo seg til ro med denne forsikringen. Jeg bebreider henne ikke at hun gjorde det. (...)

Livsfarlig.
Jeg har hatt kontakt med noen andre norske medisinermiljøer, hvor de vet at skråsikkerheten bør vike for nysgjerrigheten. (...)

Og så må du ikke stille spørsmål (pdf)
Per Egil Hegge, Cappelen, 2000 (utdrag s. 11, 19, 20)
(...) Kapittel 1: TEKNOLOGIENS UROKKELIGE PÅLITELIGHET OG DEN MENNESKELIGE FAKTOR (...)

(...) Nesten 25 år senere, i siste halvdel av 1980-årene, satt en kvinne i slutten av 40-årene på kontoret hos en ledende norsk medisiner. Han hadde fått resultatet av noen prøver, og de viste flere ting - viktigst var at hun nå, slik man kunne vente etter datoen på fødselsattesten, var i klimakteriet og derfor ikke lenger menstruerte. "Men jeg har menstruasjon nå", sa hun, og den er så kraftig at det er så vidt jeg tør bli sittende i stolen din.

"Det kunne ikke stemme", forklarte han henne. "Prøveresultatene viste at hun ikke lenger produserte østrogen, og da var det opplagt at menstruasjonen hadde opphørt."

Hun fortalte meg historien senere, og jeg spurte hvorfor hun ikke tok bindet og klasket det i skrivebordet hans. Hun rødmet litt og sa: - "Jeg tenkte faktisk på det. Men du vet, man gjør ikke slikt".

Senere fortalte medisineren henne at hun var et interessant tilfelle, og at han foreleste om henne. Jeg hadde ikke inntrykk at hun følte seg beæret eller beroliget. (...)

Forord

Hvis noen hadde fortalt meg på forhånd at jeg skulle oppleve det jeg skildrer på de neste sidene, ville jeg ha møtt utsagnet med en blanding av vantro og hån. Det gjør at også leseren vil ha sine tvil på noen punkter, og jeg har ikke vanskelig for å forstå det. (...)

Dessuten er det en gjennomgående erfaring fra mine førti år som pressemann at maktmennesker som oppkaster seg til eksperter, uansett fagfelt, ofte blir farlige. De blir farlige fordi makt virker på dem som et narkotikum. Jeg kjenner ingen andre avvenningskurer enn innsyn og avsløring. Det eneste forebyggende middel jeg vet om, er mekanismer for maktfordeling på flere instanser, flere organer, flere personer. (...)

(Anm: OG SÅ MÅ DU IKKE STILLE SPØRSMÅL! av Per Egil Hegge.)

Thyroide forandringer innen norm linket til vektøkning

Thyroid Changes Within Norm Linked to Weight Gain (Thyroide forandringer innen norm linket til vektøkning)
medpagetoday.com 25.3.2008
FRAMINGHAM, Mass., March 24 -- Changes in thyroid function within the normal range may account for unexplained weight gain in some patients, according to an analysis of Framingham study data.

Baseline serum thyrotropin (TSH) levels correlated with body weight in men and women, and higher TSH values at follow-up correlated with weight gain in both sexes (P=0.007, P<0.001 for trend), Caroline S. Fox, M.D., of the Framingham Heart Study, and colleagues reported in the March 24 issue of Archives of Internal Medicine. (...)

Relations of Thyroid Function to Body Weight
Arch Intern Med. 2008;168(6):587-592
Cross-sectional and Longitudinal Observations in a Community-Based Sample (...)

Doctor Could It Be My Thyroid?
Arch Intern Med. 2008;168(6):568-569
Obesity is a result of net energy intake greater than energy expenditure. How many times have we told this to our patients and had them respond that, despite a vigorous commitment to a low-calorie diet and an exercise program, their weight continues to increase? Patients and investigators have long considered whether alterations in the hypothalamic-pituitary-thyroid (HPT) axis contribute to the energy equation such that low thyroid hormone levels result in obesity. Although thyroid hormone levels are frequently measured in the search for the holy grail of the overweight, the incidence of overt or subclinical hypothyroidism in subjects with obesity is relatively low.¹ However, several studies have demonstrated that thyroid hormone levels, even within the reference range for the population, may be associated with obesity. (...)

Bør subklinisk hypotyreose behandles?

Should we treat subclinical hypothyroidism? (Bør subklinisk hypotyreose behandles?)
BMJ 2008;337:a834 (16 July)
Subclinical hypothyroidism is a laboratory definition: a raised concentration of thyroid stimulating hormone (TSH) yet a normal concentration of free thyroid hormone, without specific symptoms of thyroid dysfunction. Patients with subclinical hypothyroidism have an increased risk of progressing to overt hypothyroidism. Yet uncertainty exists as to the benefits of treating such patients. (...)

What should we do in the light of the uncertainty?
In general, patients should not be routinely screened for or treated for subclinical hypothyroidism, as the end point of treatment is not certain, no evidence exists of long term benefit, and treatment may not be risk-free. However, mildly raised TSH concentrations accompanied by vague symptoms such as fatigue or depressive mood may justify a short trial of treatment as long as therapeutic goals are clearly outlined with the patient. If no demonstrable improvement in these outcomes occurs, the drug should be discontinued. Although no guidelines exist on how long to observe these patients for, a trial of three to six months would allow time to normalise the patient’s TSH level and assess for any improvement in symptoms. Patients who are discovered to have mildly raised TSH concentrations should be monitored yearly for development of overt hypothyroidism. (...)

Diverse artikler

Abnormal Thyroid Function Tests in Psychiatric Patients: A Red Herring?
Am J Psychiatry 2012;169:127-133 (February 1)
Abstract: Thyroid abnormalities can induce mood, anxiety, psychotic, and cognitive disorders. Thus, thyroid function tests are routinely checked in psychiatric patients. However, up to one-third of psychiatric patients may demonstrate thyroid function test abnormalities that do not reflect true thyroid disease, but rather are a manifestation of secondary effects on one or more levels of the hypothalamic-pituitary-thyroid (HPT) axis. Originally termed the euthyroid sick syndrome, this phenomenon is now more commonly referred to as “non-thyroidal illness.” In psychiatric patients with non-thyroidal illness, patterns of thyroid function test abnormalities may vary considerably based upon factors such as the underlying psychiatric disorder, the presence of substance abuse, or even the use of certain psychiatric medications. Thus, any abnormal thyroid function tests in psychiatric patients should be viewed with skepticism. Given the fact that thyroid function test abnormalities seen in non-thyroidal illness usually resolve spontaneously, treatment is generally unnecessary, and may even be potentially harmful. (...)

Doktoren svarer
morgenbladet.no 23.2.2012
Et skritt videre i arbeidet med å forstå autoimmune sykdommer.

– Hva er en autoimmun sykdom?

– Immunforsvarets oppgave er å angripe det som er fremmed i kroppen, som bakterier og virus. Alle mennesker har også en liten feil i immunforsvaret som gjør at det kan rense bort døde celler og i blant knekke noen begynnende kreftceller. Det er bra. Men av og til kommer det ut av kontroll, og kroppen skader eget vev. Diabetes type 1 er et eksempel på en sykdom som virker sånn; celler som produserer insulin blir ødelagt av immunforsvaret.
– Hvordan oppstår slike feil?

– Det er komplisert, og vi vet ennå ikke nok. Men det er en kombinasjon av arvelige risikogener og ulike miljøfaktorer som trigger sykdommen. (...)

Svensk lege mener omstridt sykdom ikke finnes
vg.no 16.1.2012
Svenske leger advarer pasienter mot å la seg behandle for en sykdom i skjoldbruskkjertelen, hypotyreose 2, som legene hevder ikke eksisterer. Behandlingen kan gi alvorlige bivirkninger, blir det sagt.

Hypotyreose er en lidelse som skyldes at skjoldbruskkjertelen produserer for lite hormoner, og kalles også lavt stoffskifte. For noen år siden lanserte en amerikansk lege det omstridte begrepet hypotyreose 2, skrev nyhetsbyrået TT mandag.

Overlege Mats Palmér ved Karolinska Universitetssjukhus i Huddinge ved Stockholm advarer pasienter mot å skaffe seg resept på dyre urin- og spyttester som skal avsløre denne lidelsen.

- Etter min mening er det ikke bevist at sykdommen finnes, sier Palmér.

- Jeg syns det er dypt uetisk å utnytte mennesker til å ta prøver og foreskrive medisiner for en ikke-eksisterende sykdom, fortsetter den svenske overlegen.

Sjefen for selskapet Scandlab, som selger testene, forsvarer virksomheten.

Scandlabs administrerende direktør Per Magnusson sier til TT at testene betraktes som troverdige blant 200 millioner amerikanere og av størstedelen av befolkningen i Storbritannia. Da bør de være bra nok for svenskene også, mener han. (...)

(Anm: Hypothyroidism Type 2: The Epidemic. Mark Starr M.D. (Author) (amazon.com).)

Hold øje med din hud
netdoktor.no 11.10.2011
Maveproblemer, jernmangel, stofskifteproblemer eller risiko for hjertesygdom. Huden kan afsløre meget mere, end du lige tror.

Hvis ikke du allerede gør det, kan du med fordel gøre det for vane at undersøge din hud med jævne mellemrum. Forandringer i huden kan nemlig afsløre flere forskellige sygdomme, hvoraf nogle af dem er af alvorlig karakter. Det viser en ny undersøgelse.

Se efter når du kigger dig selv i spejlet
Når du alligevel kigger dig selv i spejlet om morgenen, eller når du står og børste tænder, kan du ligeså godt kigge ekstra godt på din hud samtidig. Små hudforandringer kan nemlig være tegn på alvorlige sygdomme i lever, nyrer og skjoldbruskkirtel, hjertesygdom og kræft.

Peter Bjerring, der er professor i hudsygdomme og cheflæge på Mølholm Hospital i Vejle, ser hver uge en ny patient med hudforandringer, der signalerer en skjult sygdom. Han har for eksempel fundet tarmkræft hos en ældre herre.

”Han fik pludselig et udbrud af det, vi kalder ’gammelmandsvorter’ – rigtig mange vorter rundt om på kroppen. Forskning har vist, at det er en ret sikker markør for kræft et sted i kroppen, ofte i tarmsystemet. En efterfølgende scanning viste, at han havde fået tyktarmskræft. Han blev hurtigt opereret og har det fint nu”, siger Peter Bjerring.

Vi skal ikke være urolige
Har du hævet eller oppustet hud, kan det være tegn på for lavt stofskifte. Har du mange blå mærker, har du måske blødningsforstyrrelser. Og hvis du er gullig på huden eller i øjnene, kan det skyldes sygdom i leveren, galdeblæren eller bugspytkirtlen.

Måske har du sprækker i mundvigene. Det kan betyde, at du har maveproblemer. En bleg tunge kan være tegn på jernmangel, mens kraftig ansigtsbehåring kan skyldes hormonforstyrrelser. Og har du røde pletter på underbenene, kan det være, du er diabetiker. Desuden er det typisk et tegn på en svampeinfektion i munden eller underlivet.

Det kan altså godt betale sig at være opmærksom. Men vær endelig ikke urolig.

”Man skal ikke frygte, at enhver lille plet eller farveforskel på huden er et varsel om en skjult og måske alvorlig sygdom, men opstår der forandring, og er man i tvivl, er det oplagt at spørge i første omgang sin egen læge, som i tvivlstilfælde kan henvise til en erfaren hudlæge”, siger Peter Bjerring. (...)

Levotyroksin gir økt risiko for fraktur hos eldre
Tidsskr Nor Legeforen 2011; 131:1406 (9.8.2011)
Risikoen for fraktur ved bruk av levotyroksin er sterkt doseavhengig. Behandlingsdosen bør derfor vurderes jevnlig.

Høye doser levotyroksin og subklinisk hypertyreose er assosiert med lavere beintetthet, og kronisk hypertyreose kan øke risikoen for brudd hos eldre. Nå har kanadiske forskere undersøkt effekten av levotyroksindosen på risikoen for fraktur hos eldre (1).
I studien inngikk 213 511 personer over 70 år som brukte levotyroksin, hvorav 88 % var kvinner. Totalt hadde 10,3 % hatt et brudd i løpet av oppfølgingsperioden på gjennomsnittlig 3,8 år. Sammenliknet med tidligere levotyroksinbruk var nåværende bruk assosiert med høyere risiko for fraktur (justert OR 1,88). Blant nåværende brukere var høye og middels kumulative doser av levotyroksin forbundet med økt bruddrisiko sammenliknet med lave kumulative doser (justert OR henholdsvis 3,45 og 2,62).

- Studien tyder først og fremst på at det er viktig å monitorere substitusjonsbehandling med levotyroksin med jevnlige blodprøver, sier overlege Anders Svare ved Medisinsk avdeling, Sykehuset Namsos. - Slik monitorering er spesielt viktig hos eldre siden de ofte trenger lavere substitusjonsdoser, sier han. (...)

Thyroid drug boosts risk factor in older people
hc2d.co.uk 3.5.2011
A UK expert has warned that there needs to be more research into the area of excess thyroid hormone on bone.

The comments from Professor Graham Leese at Ninewells Hospital in Dundee come amid suggestions that many elderly people may be taking “excessive” medication for their thyroid problems, increasing their fracture risk.

A synthetic hormone – thyroxine - is given to people whose thyroid glands produce too little naturally.

Writing in the British Medical Journal, Professor Leese said ideal thyroxine doses may vary with age and be “unexpectedly low” in elderly people.

He added: “It is 120 years since the effect of excess thyroid hormone on bone was first described, yet research in this area still lacks funding.

“With the prevalence of treated hypothyroidism increasing, and the annual economic burden of fractures in the United Kingdom currently estimated at £5.1bn, such research warrants a higher priority."

In the same journal, Canadian researchers say having too much thyroxine boosts fracture risk and doses may need to be reduced as people age. (...)

(Anm: Levothyroxine dose and risk of fractures in older adults: nested case-control study (Dosering av levotyroksin og risiko for benbrudd hos eldre voksne: nøstet kasus-kontroll-studie) BMJ 2011; 342:d2238 (28 April).)

Levothyroxine dose and risk of fractures in older adults: nested case-control study (Dosering av levotyroksin og risiko for benbrudd hos eldre voksne: nøstet kasus-kontroll-studie)
BMJ 2011; 342:d2238 (28 April)
(...) Objective To quantify the effect of levothyroxine dose on risk of fractures in older adults. (...)

Results Of 213 511 prevalent levothyroxine users identified, 22 236 (10.4%) experienced a fracture over a mean 3.8 years of follow-up, 18 108 (88%) of whom were women. Compared with remote levothyroxine use, current use was associated with a significantly higher risk of fracture (adjusted odds ratio 1.88, 95% confidence interval 1.71 to 2.05), despite adjustment for numerous risk factors. Among current users, high and medium cumulative doses (>0.093 mg/day and 0.044-0.093 mg/day) were associated with a significantly increased risk of fracture compared with low cumulative doses (<0.044 mg/day): 3.45 (3.27 to 3.65) and 2.62 (2.50 to 2.76), respectively.

Conclusion Among adults aged 70 or more, current levothyroxine treatment was associated with a significantly increased risk of fracture, with a strong dose-response relation. Ongoing monitoring of levothyroxine dose is important to avoid overtreatment in this population. (...)

Thyroid Fears Aside, That X-Ray’s Worth It
nytimes.com 26.4.2011
It doesn’t take much to scare people when it comes to cancer, especially when the cause, unlike smoking, seems beyond one’s control.

So I was not surprised by a stream of panicked e-mails I received after a television show in which the popular Dr. Mehmet Oz called thyroid cancer “the fastest-growing cancer in women” and cited the harmful effects of radiation from sources like dental X-rays and mammograms.

Dr. Oz warned that people who have more than five X-rays a year have a fourfold greater risk of developing this cancer, and recommended the use of a lead thyroid shield when getting dental X-rays or mammograms. One of his guests on the program, Dr. Carolyn Runowicz, a gynecological cancer specialist, said she would not get dental X-rays if the only reason was to check her teeth. (...)

AACE: Thyroid Hormones May Trigger Baby Blues
medpagetoday.com 15.4.2011
(...) SAN DIEGO -- Even when they are within the normal range, thyroid hormone levels shortly before childbirth may help predict which women will develop mood disturbances, a Greek study showed.

Lower antenatal levels of free T3 and T4 were associated with higher scores on an assessment of maternity blues -- a transient occurrence of depressive symptoms -- in the days following delivery (P≤0.01 for both), according to Eleni Armeni, MD, of the University of Athens in Greece.

The results are consistent with two prior studies in U.S. women, Armeni said at the American Association of Clinical Endocrinologists meeting here.

"The levels of thyroid hormones should be measured throughout pregnancy, especially within the third trimester of the pregnancy," she said in an interview. "And women found to have lower levels of thyroid hormones should have better care after pregnancy ... in order to avoid this unnecessary period after pregnancy." (...)

Hypothyroidism has been associated with depression, and Armeni and her colleagues wanted to see if fluctuations in thyroid hormones within the normal range could also be related to mood.

They performed a study of 57 married women from across Greece who gave birth after 35 to 38 weeks of pregnancy. (...)

Through the fourth postpartum day, free T3 and T4 levels were inversely associated with depressive symptoms. The mean concentrations of free T3 and T4 were 1.22 pg/mL and 0.66 ng/dL, respectively, in the women with high "blues" scores and 1.64 pg/mL and 0.73 ng/dL in those with low levels of depressive symptoms. (...)

Lithium-Associated Hyperthyroidism Treated With Lithium Withdrawal: A Case Report
Am J Psychiatry 2011;168:438-439 (April)
TO THE EDITOR: Lithium, a first-line treatment for bipolar disorder, is a well-known cause of hypothyroidism; however, case reports have documented the emergence of thyrotoxicosis during lithium treatment, with evidence showing the incidence rate to be greater than expected in the general population (1–3). The recommended conservative management is antithyroid medication and continuation of lithium (4). It is advised that lithium not be withdrawn because of several reports of exacerbation of thyrotoxicosis (1, 2, 5). We report the case of a patient with lithium-associated hyperthyroidism treated with drug withdrawal, a treatment method documented in only one previous case (6). (...)

Theories that lithium causes hyperthyroidism include induction of autoimmunity and direct toxic effect causing thyroid hormone release (4). Notably, the three reports of exacerbation of thyrotoxicosis after withdrawal of lithium were in patients with Graves' disease. Conversely, our patient, who presented with thyroiditis, improved after withdrawal of lithium, which is consistent with the theory of lithium's direct toxic effect on thyrocytes. One could conclude that management of lithium-associated hyperthyroidism would differ based on the etiology of the thyroid overactivity. Our case suggests that patients who present with thyroiditis can be effectively treated with withdrawal of lithium. (...)

Thyroid Regulates More Than Just Hormones
ivanhoe.com 4.4.2011
(Ivanhoe Newswire) – Turns out our sensitivity to seeing in color is not only due to cone cells in the retina, but also through the thyroid gland by controlling which visual pigment is produced in the cones.

Research conducted on mice and rats has revealed that the production of visual pigment present in mature cones is regulated by the thyroid hormone. The team of researchers at the Max Planck Institute for Brain Research in Frankfurt/M., along with colleagues at the University of Frankfurt and universities in Vienna, assumed that this process must be present in all mammals, including humans. If this were the case, the adult-onset of thyroid hormone deficiency would affect color vision.

Most mammals have two types of spectral cones, which contain two different visual pigments (opsins). The first opsin is sensitive to shortwave light (UV/blue opsin), and the second is sensitive to middle-to-longwave light (green opsin). These cones are receptive to the thyroid hormone, and when activated by the hormone, the cones will suppress the production of UV/blue opsin, and activate the synthesis of green opsin.

It was long believed that the thyroid only controlled opsin production during developmental stages; in mature and established cones, the opsin had reached its plateau, needing no further regulation. However, this theory is now challenged. (...)

- Nærmer seg Tsjernobyl-nivå
aftenposten.no 26.3.2011
Utslippene av de to mest kreftfremkallende radioaktive stoffene fra det tsunamirammede atomkraftverket nærmer seg nivåene som ble sluppet ut fra Tsjernobyl.

Det viser en undersøkelse forskere i østerrikske Zentralanstalt für Meteorologie und Geodynamik (ZAMG) har lagt ut på forskningstidsskriftet New Scientists nettsider.

Beregningene deres viser Fukushima-anlegget i Japan har sluppet ut mellom 20 og 60 prosent av den mengden radioaktivt cesium som lekket fra atomkraftverket i Tsjernobyl i 1986, skriver tu.no. (...)

Kreftsyke
Det ble sluppet ut en hel rekke radioaktive stoffer fra Tsjernobyl, men det var hovedsakelig cesium og jod som gjorde folk i nærområdet syke, sier Malcolm Crick, som ledet FNs gjennomgang av Tsjernobyl-katastrofens helsemessige konsekvenser.

Det er fortsatt uklart hvor mange mange krefttilfeller som skyldes ulykken i 1986, men ifølge New Scientist skal 6000 barn ha fått kreft i skjoldbruskkjertelen i tiden som har gått etter katastrofen.

Forskerne bak et amerikansk studium som ble publisert forrige uke, slår fast at folk i området fortsatt er utsatt for en høyere kreftrisiko enn det som er normalt. (...)

Prevalence of autoimmune thyroid dysfunction in postpartum psychosis
Br J Psychiatry. 2011 Feb 22. [Epub ahead of print]
BACKGROUND: Postpartum psychosis is a life-threatening psychiatric emergency, which often occurs without significant premorbid symptoms. Although many studies have postulated an involvement of the immune and endocrine systems in the onset of postpartum psychosis, the specific aetiological factors have remained unknown. (...)

AIMS: To examine the hypothesis that autoimmune thyroid dysfunction may be associated with the onset of postpartum psychosis. (...)

CONCLUSIONS: Women with postpartum psychosis are at higher risk not only of AITD but also of clinical thyroid failure. These data implicate thyroid function as an important clinical outcome in patients with postpartum psychosis. Further, AITD represents a potentially strong aetiological factor for the development of postpartum psychosis. Therefore, screening for thyroperoxidase antibodies is warranted in patients with postpartum psychosis. (...)

Hva blir konsekvensene av atomulykken?
nrk.no 16.3.2011
(...) - Tsjernobyl er fortsatt et problem og mye av kunnskapen vi har etter ulykken i 1986 vil være nyttig hvis det store utslippet skulle komme, sier Skuterud til nrk.no. (...)

Senskader
Skuterud forteller at senskader i befolkningen begynte å vise seg fem år etter selve ulykken, blant annet har rundt 2000 barn i Ukraina, Russland og Hviterussland fått kreft i skjoldbruskkjertelen.

Hva er sjansen for at vi får de samme konsekvensene hvis det går riktig ille ved atomkraftanlegget i Fukushima i Japan? (...)

Paxil Birth Defects, Pregnancy Drugs and Finding Safer Alternatives (Seroxat-utløste fødselsdefekter, legemidler under graviditet, og finne sikrere alternativer)
news.yahoo.com 28.2.2011
(...) Would my baby be alive today if I had not taken Paxil? Further research revealed that the most common reason for second trimester pregnancy loss is hypothyroid (low functioning thyroid). I was discovered to have hypothyroid (when I was also taking the Paxil). I was on Synthroid (Levothyroxine) during that pregnancy. As thyroid was ruled out, as well as other possible causes eliminate by autopsy, then Paxil looks like the likely suspect. I was also able to wean myself off from seven years of Paxil in about two weeks, with minimal side effects. I've had multiple improvements in health since quitting. I don't think that proper research was conducted on quitting SSRIs at the time of my pregnancy.

It seems that pregnancy drugs are like traffic signals: there must be a certain number of traffic accidents in a given location to warrant municipalities setting up traffic signals. Do a certain number of miscarriages, stillborn infants and infant birth defects need to occur before a drug is declared unsafe? (...)

Sheehans syndrom
snl.no (21.2.2011) (Store norske leksikon)
Uttale: ʃˈi:ənz –Sheehans syndrom, tilstand som skyldes svikt i hypofysefunksjonen etter blødning i forbindelse med fødsel (eller stort blodtap i forbindelse med abort forholdsvis sent i svangerskapet).

Under svangerskapet tiltar hypofysen i størrelse, og krever større blodtilførsel enn ellers. Den blir derfor mer sårbar for skader på grunn av en forbigående svikt i blodtilførselen, som kan skje når blodtrykket faller ved et større blodtap. Symptomene ved Sheehans syndrom er preget av svikt i funksjonen til de indresekretoriske kjertlene som hypofysen stimulerer. Svikt i kjønnskjertlenes og skjoldbruskkjertelens funksjon preger oftest sykdomsbildet. Symptomene er mindre uttalte enn ved Simmonds syndrom. Behandlingen retter seg mot de hormonelle bortfallssymptomene og er vanligvis svært effektiv.

Den moderne overvåkningen av gravide og fødende har ført til at Sheehans syndrom i våre dager er en sjeldenhet.

Navn etter den britiske endokrinologen Harold L. Sheehan (1900–89). Se også hypofysesvikt og panhypopituitarisme. (...)

After year of pain, editor diagnosed with Sheehan Syndrome
beaconnews.suntimes.com 20.2.2011
(...) For the last year, since my daughter, Ashley, was born in September 2009, I had been in pain daily, barely able to walk up and down the stairs to put her to bed. As the year dragged on, carrying her became increasingly difficult. (...)

I began to think something was “fundamentally” wrong with me. Maybe I had a stroke, lupus, cancer ... I finally resigned to the doctor’s diagnosis. I took the recommended Prozac — and forgot for awhile. I was getting used to hurting. My hair was falling out; my legs ached; I couldn’t sit on the floor and get up; my brain seemed hidden in a fog; and I was struggling to keep up at work.

Life at home was suffering, too. I slept on the weekends, slept late on weekdays and went to bed early. My husband did everything: clean, cook, take care of our new baby. (...)

Summer passed without incident. I stopped taking Prozac because it made me not care whether I felt better. I pushed my doctors again. I hadn’t had a menstrual cycle since I’d had my now year-old daughter. The obstetrician said I was stressed — I needed to relax. No tests. (...)

After three days in the ICU, I was stabilized. I was halfway there. I had a diagnosis. Sheehan Syndrome. I was on my way to treatment.

I have my life back. (...)

Afterward

My condition isn’t a simple one. Sheehan Syndrome most often occurs when a woman loses too much blood during labor and delivery. The pituitary gland already is under stress, expanding triple its size during pregnancy.

However, Dr. Charles Miller, a specialist in reproductive endocrinology and infertility in private practice in Naperville, said the two factors pointing to Sheehan Syndrome in my case were the inability to lactate and inhibition of my menstrual cycle. (...)

Hva er mest effektiv trening?
melk.no (19.2.2011)
Den mest effektive mosjonen er aktiviteter som tar i bruk de store muskelgruppene, som f. eks rask gange eller jogging, sykling, svømming, aerobic, ballspill og lignende. (...)

Summen som teller
Det er summen av all aktivitet gjennom dagen som utgjør det totale energiforbruket. Det er derfor viktig å innarbeide bevegelse i de daglige rutinene (...)

Stoffskiftet påvirkes av trening
Stoffskiftet/ forbrenning er en betegnelse på den totale energiomsetningen i kroppen. Stoffskiftet påvirkes av mat, fysisk aktivitet, skjoldbrukskjertelens aktivitet, kjønn og alder. Det basale stoffskiftet tilsvarer den energien en person bruker dersom han/ hun holder seg fullstendig i ro. Basalstoffskiftet uttgjør vanligvis omtrent 60 prosent av det totale energiforbruket. 40 % påvirkes av matinntak, varme/kulde, stress og i hovedsak mengde fysisk aktivitet. (...)

- Tykk fordi jeg er syk
fotball.aftenposten.no 14.2.2011
(...) Ronaldo fortalte også at han for fire år siden fikk fastslått at han har en lidelse som påvirker skjoldbruskkjertelen og fører til nedsatt forbrenning. Det finnes medisiner mot lidelsen, men de er ikke tillatt for fotballspillere på grunn av antidopingreglementet.

– Jeg ville oppklare dette på den siste dagen av karrieren min. Mange vil sikkert nå angre på at de har spøkt om vekten min, men jeg er ikke sint på noen, la han til. (...)

Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults
Arch Intern Med. 2010;170(21):1876-1883 (November 22)
Background Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. (...)

Conclusions Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown. (...)

Outcome of protracted hypoparathyroidism after total thyroidectomy
Br J Surg. 2010 Nov;97(11):1687-95.
BACKGROUND: Although the variables that influence the development of post-thyroidectomy hypocalcaemia are now better understood, the risk factors and long-term outcome of persistent hypoparathyroidism (HPP) are poorly defined. A retrospective review of a prospective protocol for the management of post-thyroidectomy hypocalcaemia was performed. (...)

CONCLUSION: Higher serum calcium levels at 1 month after total thyroidectomy are associated with recovery of parathyroid function. It is hypothesized that intensive medical treatment of hypocalcaemia-'parathyroid splinting'-may improve the outcome of patients with protracted HPP. (...)

It wasn’t fat - it’s my hormones (Det var ikke fett - det var mine hormoner)
thesun.co.uk 6.10.2010
ROBBIE WILLIAMS lost all motivation during his three years in the wilderness.

Even a visit from Mr Motivator would have failed to kickstart him.

He piled on the pounds, grew a scruffy beard and holed up in his LA mansion watching DVDs, playing online pool and obsessing over aliens.

He thought he had got plain lazy and blamed his dead batteries on past excesses with drugs and booze.

But now Robbie has told how a recent visit to a doctor revealed it was all a HORMONE PROBLEM - for which he is now on medication. (...)

Robbie Williams undergoing treatment for mysterious illness (Robbie Williams får behandling for mystisk sykdom)
celebrities-with-diseases.com 17.10.2010
Robbie Williams says he is suffering from a mysterious illness, which is to blame for the limited success of his comeback album Rubebox. According to www.dailymail.com, the singer, who had taken his depressive state for granted earlier,woke up to realise that it was more than just a state of mind. He recently said in an interview : “I thought I was lethargic and depressed as a person. I thought that was my make-up.” (...)

Robbie Williams is hooked on anti-depressants Seroxat and Xanax, and the painkiller Vicodin, it has been reported
pr-inside.com 14.2.2007
(...) Robbie's fears of becoming addicted to prescription drugs were apparent in the lyrics of 'Good Doctor' - which features on latest album 'Rudebox'. (...)

Har du lavt stoffskifte?
side2.no 25.11.2010
Sliten, trøtt og energiløs er de første symptomene.

(SIDE2): Se om du er i faresonen. De generelle symptomene kan være tegn på så mange andre sykdommer at det eneste sikre beviset er å få legen din til å ta en blodprøve.

- Be om kopi av svaret og be om å få en prøve av antistoffene du har i blodet også, sier overlege Ingrid Norheim ved Endokrinologisk Avdeling Oslo Universitetssykehus - Aker til Side2.

Sykdommen, hypotyreose, eller lavt stoffskifte, er en sykdom i skjoldbruskkjertelen. Skjoldbruskkjertelhormonet tyroksin styrer cellenes stoffskifte i kroppen. Ved mangel på tyroksin synker celleaktiviteten og kroppen «går på sparebluss». (...)

Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults
Arch Intern Med. 2010;170(21):1876-1883
Background Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. (...)

Conclusions Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown. (...)

Subclinical hypothyroidism and the risk of coronary heart disease and mortality
JAMA. 2010 Sep 22;304(12):1365-74.
CONTEXT: Data regarding the association between subclinical hypothyroidism and cardiovascular disease outcomes are conflicting among large prospective cohort studies. This might reflect differences in participants' age, sex, thyroid-stimulating hormone (TSH) levels, or preexisting cardiovascular disease. (...)

CONCLUSIONS: Subclinical hypothyroidism is associated with an increased risk of CHD events and CHD mortality in those with higher TSH levels, particularly in those with a TSH concentration of 10 mIU/L or greater. (...)

Inhibitory role of brain stem serotoninergic neuron system on thyroid function in rat
Endocrinol Exp. 1979 Mar;13(1):9-18.
Abstract Thyroid function was investigated in adult male rats following the use experimental procedures which inhibit the activity of serotoninergic neuron system. Pharmacological blockade of the biosynthesis of sertonin by repeated administration of para-chlorophenylalanine (pCPA), or interruption (by Halász knife) of the serotoninergic pathways of the brain stem which terminate on hypothalamic nuclei equally resulted in an augmentation of the following parameters of hypothalamo-hypophysial-thyroid activity: T/S ratio, pituitary and blood TSH levels and blood thyroxine concentration as well as TRH content of the hypothalamus. The results suggest that the central nervous serotoninergic neuron system plays an inhibitory role in the regulation of TSH secretion, presumably acting upon the hypothalamus, thereby inhibiting hypothalamic TRH secretion. (...)

Reversible escitalopram-induced hypothyroidism
Gen Hosp Psychiatry. 2010 Sep-Oct;32(5):559.e5-7.
Some drugs can cause alterations in the concentration of thyroid hormones in blood even without clinical signs of dysfunction or pathology of the thyroid gland. Apart from the well-known relationship between depression and hypothalamic-pituitary-thyroid (HPT) axis, and the impact of selective serotonin reuptake inhibitors (SSRIs) on thyroid indices, hypothyroidism is a very rare adverse effect of SSRI treatment. However, the case presented here demonstrates that escitalopram may have the potential to induce hypothyroidism without any significant clinical signs and symptoms. Therefore, the possibility of SSRI-induced asymptomatic hypothyroidism presented here may help clinicians in this regard. (...)

Nuclear tests link to thyroid cancer
hc2d.co.uk 21.9.2010
People living in Polynesian islands who were exposed to radioactive fallout from French atmospheric nuclear tests in the 1960s and 1970s have a slight risk of developing thyroid cancer, according to a recent French study. (...)

Kidney Cancer Drug May Work in Thyroid Disease
medpagetoday.com 17.9.2010
The tyrosine kinase inhibitor pazopanib (Votrient) may provide a treatment option for patients with radioiodine-refractory, progressive differentiated thyroid cancer, a phase II study showed.

About half the 37 patients in the trial (49%) had a partial response, with a 66% likelihood that it would be sustained for at least a year, Keith Bible, MD, of the Mayo Clinic in Rochester, Minn., and colleagues reported online in The Lancet Oncology.

Adverse effects were common, and it remains unclear whether there would be a survival benefit from pazopanib.(...)

Health Tip: Recognizing Hypothyroidism
womenshealth.gov 17.9.2010
(HealthDay News) -- The thyroid gland, found in the front of the neck just below the voicebox, produces a vital hormone that helps control your body's metabolism. When it doesn't produce enough of this hormone, the condition is called hypothyroidism.
The U.S. National Library of Medicine says the following symptoms may indicate hypothyroidism:

• Greater sensitivity to cold.
• Constipation.
• Depression, feeling weak or fatigued.
• Pain in the joints and muscles.
• Above-normal bleeding during menstruation.
• Unexplained weight gain.
• Dry or pale skin.
• Thin, brittle hair and nails. (...)

Signs of Thyroid Trouble Tied to Raised Pregnancy Complication
usnews.com 22.7.2010
Placental separation 3 times more likely if antibodies linked to gland disease are high, study shows

THURSDAY, July 22 (HealthDay News) -- The risk of placental separation during labor is three times higher than normal in pregnant women with antibodies that indicate early thyroid disease, a new study has found.

However, the findings don't suggest that routinely screening pregnant women for thyroid problems or providing them with thyroid supplementation would offer any benefit, according to the researchers at the University of Texas Southwestern Medical Center in Dallas. (...)

Det synkende skip
PER EGIL HEGGE - redaktør
aftenposten.no 23.6.2010
BÆRUMSSAKEN. Helsedirektoratet var under Torbjørn Morks ledelse et synkende skip. Helsedirektør Anne Alvik bandt seg til masten. (...)

Sjelden setning.
Det er en sjelden setning i norsk forvaltning. Morks adferd gjaldt bl.a. behandlingen av en klagesak fra meg. Den angikk holdbarheten i undervisningen i skjoldbruskkjertelsykdommer på Medisinsk Fakultet ved Universitetet i Oslo. Saksbehandlingen har jeg skildret i boken Og så må du ikke stille spørsmål (Cappelen, 2000). Den siterte uttalelsen fra Veierød om løgnaktighet står ikke i boken. Jeg hadde Veierøds tillatelse til å gjengi den. Forlaget mente den er injurierende, og den kom ikke på trykk. Jeg fortalte en gang en person med familietilknytning til ledende kretser i Arbeiderpartiet om opplevelsen, og hun sa uten å blunke: «Jammen han løy for meg også, han.» (...)

Thyroid Cancer Survival in the United States
Observational Data From 1973 to 2005
Arch Otolaryngol Head Neck Surg. 2010;136(5):440-444 (May)
Objective To compare the survival rate of people with papillary thyroid cancer limited to the thyroid gland who have not had immediate, definitive treatment for their thyroid cancer with the survival rate of those who have had such treatment. (...)

Conclusion Papillary thyroid cancers of any size that are limited to the thyroid gland (no extraglandular extension or lymph node metastases at presentation) have favorable outcomes whether or not they are treated in the first year after diagnosis and whether they are treated by hemithyroidectomy or total thyroidectomy. (...)

AACE: Agent Orange Ups Some Thyroid Risks
medpagetoday.com 26.4.2010
BOSTON -- Vietnam veterans who came in contact with Agent Orange are more likely to develop Graves' disease than those who avoided exposure, researchers said here.

The autoimmune disorder was three times more prevalent among veterans who encountered the dioxin-containing chemical, Ajay Varanasi, MD, of SUNY Buffalo, and colleagues reported at the American Association of Clinical Endocrinologists meeting here.

"We also looked at other [thyroid] diagnoses," Varanasi told MedPage Today, "but we didn't find any significant differences in thyroid cancer or nodules." (...)

Hair Dyes, Smoking Raise Risk for Liver Disease (Hårfarging, røyking øker risiko for leversykdommer)
medpagetoday.com 24.3.2010
(...) Smoking was responsible for a 60% increase in risk for primary biliary cirrhosis, and hair dye use was associated with a 25% to 30% higher risk, the researchers indicated in the journal Gut.

Some illnesses, such as urinary tract infections and thyroid disease, also appeared to heighten the risk of developing this form of cirrhosis, an autoimmune disease that gradually destroys the bile ducts.

"These associations are extremely likely to be true associations rather than due to type 1 error or artifact," Prince and colleagues wrote. (...)

Cases and controls were sent questionnaires asking about certain potential risk factors, which had been identified from previous clinical and experimental studies. (...)

Only thyroid disease and urinary tract infections remained significantly associated with primary biliary cirrhosis in both cohorts in the multivariate analysis, with odds ratios in the vicinity of 2 (P<0.05). (...)

(Anm: Case–control studies of risk factors for primary biliary cirrhosis in two United Kingdom populations. Gut 2010;59:508-512.)

(Anm: primær biliær cirrhose (PBC); primær biliær cirrhose; PBC er en autoimmun sykdom, hvor immunforsvaret reagerer mot celler i gallegangene i leveren og gir betennelse, arrforandringer og forstyrrelser i leverfunksjonen. Tidlige symptomer er slapphet og plagsom kløe. Andre symptomer er fettglinsende avføring, gulsott og blodig oppkast. Symptomer ved langtkommen sykdom er pigmentering og fettknuter i huden. (nhi.no).)

(Anm: hepatisk kløe; Hepatisk kløe er et symptom på intra- og ekstrahepatisk kolestase. I den grad kløe forekommer ved parenchymatøse leversykdommer, skyldes det at også disse sykdommene, f.eks. hepatitt, hos en del pasienter gir intrahepatisk kolestase (...) Hepatisk kløe forekommer fortrinnsvis ved kolestatiske sykdommer, se nedenstående tilstander: (...) (laegehaandbogen.dk).)

An Association Between Subclinical Hypothyroidism And Sight-Threatening Diabetic Retinopathy In Type 2 Diabetic Patients
Diabetes Care ( Published online before print February 11, 2010)
Objective: To determine the relationship between subclinical hypothyroidism (SCH) and the prevalence of diabetic retinopathy (DR) in type 2 diabetic (T2D) patients. (...)

Conclusions: T2D patients with SCH are associated with an increased risk of STDR. (...)

Lavt stoffskifte gir økt vekt og mindre sexlyst
vg.no 7.3.2010
Lavt stoffskifte? Sjekk om du er i gråsonen (...)

I klassisk medisin påvises lavt stoffskifte ved å måle nivået i blodet av hormonene TSH (thyreoideastimulerende hormon) og såkalt fritt T4 (fritt tyroksin). Omdal mener at det er viktig også å teste for såkalt autoimmunitet (anti-TPO).

- Mange pasienter er i en gråsone der TSH- og T4-prøvene ikke er krystallklare. Om man i slike tilfeller påviser et høyt nivå av antistoffer via anti-TPO-testen, er dette en tidlig markør for at noe skjer i skjoldbruskkjertelen. Da kan behandling startes tidlig. Om hypotyreose oppdages på et veldig tidlig tidspunkt, kan man kanskje endre forløpet ved å påvirke miljøfaktorer som forstyrrer immunsystemet, sier Omdal. (...)

Underactive thyroid linked to pesticide exposure
reuters.com 21.1.2010
NEW YORK (Reuters Health) - Exposure to certain types of pesticides could up the risk of thyroid disease in women, according to a new study of thousands of women married to licensed pesticide applicators. (...)

There is growing evidence for a link between exposure to pesticides and thyroid problems, the authors note. They studied more than 16,500 women living in Iowa and North Carolina who were married to men seeking certification to use restricted pesticides in those states during the 1990s.

Overall, 12.5 percent of the women reported having thyroid disease; 7 percent had underactive thyroid glands (hypothyroidism) and 2 percent had overactive thyroids (hyperthyroidism). (...)

Thyroid disease in women is linked to non-stick chemicals, study finds (Thyreoideasykdom hos kvinner linket til “non-stick”-kjemikalier, ifølge studie)
BMJ 2010;340:c401 (21 January)
A raised serum concentration of an industrial chemical known to be toxic in laboratory animals is associated with thyroid disease in the human population in the United Sates, say researchers based at the UK’s Exeter University.

Reporting their findings in the February issue of the journal Environmental Health Perspectives (http://ehp03.niehs.nih.gov/home.action), the researchers say that women whose blood concentrations of perfluoro-octanoic acid were in the top quarter (5.7 ng/ml) were roughly twice as likely to have thyroid disease as those in the bottom quarter (4 ng/ml) (P=0.002). Thyroid disease is commoner in women than men, and although men showed a similar trend the difference in their case was not significant. (...)

Study links thyroid disease to non-stick chemicals (Studie linker thyreoideasykdom til "non-stick"-kjemikalier)
reuters.com 21.1.2010
LONDON (Reuters) - Scientists have linked a chemical used in consumer goods like non-stick pans and water-resistant fabrics with thyroid disease, raising questions about the potential health risks of exposure to the substance. A study by British researchers found that people with high levels of the chemical perfluorooctanoic acid (PFOA) in their blood have higher rates of thyroid diseases -- conditions which affect the body's metabolism.

PFOA is a common chemical, used in industrial and consumer products including non-stick cooking pans, stain-proof carpet coatings and waterproofing for fabrics.

The study, published in the Environmental Health Perspectives journal, did not establish whether PFOA was causing higher levels of thyroid disease. (...)

Paying Attention to Thyroid Disease
medpagetoday.com 8.1.2010
January is thyroid disease awareness month, and since an estimated 25 million people in the U.S. have various thyroid problems, I thought it would be a good idea to get an expert update on this often over-looked gland. (...)

Dr. Val: It is estimated that more than 25 million Americans have thyroid disease, and as many as half the people with thyroid problems don’t even know it. In your view, what are the main reasons why so many thyroid disorders go undiagnosed? (...)

Clinically significant cases of thyroid disease are often missed because we don’t screen for thyroid disease in the U.S. That’s because the U.S. Preventive Services Task Force (USPSTF) concluded that screening asymptomatic people with blood tests like TSH does not ultimately improve outcomes. However, some professional groups like the ATA (American Thyroid Association) and the ACP (American College ofPhysicians) think it’s prudent to screen at-risk subgroups such as the elderly, pregnant women, children with genetic syndromes like Down’s or Klinefelter’s, or people with a family history of autoimmune thyroid disease (e.g. Hashimoto’s thyroiditis or Graves Disease).

As far as TSH goals are concerned, historically the normal range has been about 0.45 mIU/L or 0.5 mIU/L to 4.5 mIU/L or 5.0 mIU/L. However, the very large NHANES study showed that actually most Americans, especially those confirmed not to have any underlying thyroid disease, have TSH levels between 0.5 mIU/L to 2.5 mIU/L, so we began to think of normal TSH as being in that narrower window. (...)

Thyroxine: anatomy of a health scare
BMJ 2009;339:b5613 (29 December)
(...) In 2007 and 2008 New Zealand pharmacies changed to the new formulation of Eltroxin. The old formulation had been used for more than 30 years without problems; but after the new tablets were introduced the rate of adverse event reporting rose nearly 2000-fold—from 14 reports in 30 years to more than 1400 in 18 months. What had happened? And does this incident provide important lessons for future formulation changes and migration to generic drugs? (...)

Low thyroid function ups metabolic syndrome risk in rheumatoid arthritis
rehabpub.com/ 25.12.2009 (Reuters Health)
NEW YORK (Reuters Health) - Hypothyroid rheumatoid arthritis (RA) patients have worse cardiovascular risk profiles - reflected by a higher prevalence of metabolic syndrome -- than those with normal thyroid function, new research shows. (...)

To investigate whether thyroid function was related specifically to metabolic syndrome, Dr. Raterman and colleagues looked at 257 patients taking part in a study of CVD and CVD risk factors in RA. Twenty-one, or 8.2%, were hypothyroid.

Among the hypothyroid patients, 43% had metabolic syndrome, as defined by the National Cholesterol Education Program Third Adult Treatment Panel criteria, compared to 20% of euthyroid RA patients. After adjusting for age and gender, hypothyroidism increased the likelihood of having metabolic syndrome 3.5-fold. (...)

TSH polymorphisms explain link of high thyrotropin with longevity
rehabpub.com 15.12.2009 (Reuters Health)
NEW YORK (Reuters Health) - Polymorphisms in the thyrotropin (TSH) receptor gene explain the link between elevated serum TSH and exceptional longevity, new research shows.

In earlier work, Dr. Ilan Gabriely from Albert Einstein College of Medicine, Bronx, New York and colleagues had shown in a population of Ashkenazi Jews that extreme longevity is associated with increased serum thyrotropin levels. (...)

"Small increases in plasma TSH, over the accepted upper reference limit, may be quite normal in older people, and not reflect hypothyroidism," Dr. Gabriely said. "In fact, this may represent a factor that enhances healthy aging and longevity."

"Up to 20% of people older than 60 years have TSH raised to values greater than 4.5 (mIU/L), and they have been considered to be hypothyroid," he continued. (...)

Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review.
CNS Drugs. 2009 Dec 1;23(12):1003-21.
The article critically reviews selected, clinically significant, adverse endocrine and metabolic effects associated with psychotropic drug treatments, including hyperprolactinaemia, hyponatraemia, diabetes insipidus, hypothyroidism, hyperparathyroidism, sexual dysfunction and virilization, weight loss, weight gain and metabolic syndrome (type 2 diabetes mellitus, dyslipidaemia and hypertension). Such effects are prevalent and complex, but can be managed clinically when recognized. They encourage continued critical assessment of benefits versus risks of psychotropic drugs and underscore the importance of close coordination of psychiatric and general medical care to improve long-term health of psychiatric patients. (...)

Myxedema Coma Associated with Combination Aripiprazole and Sertraline Therapy
Ann Pharmacother. 2009 Dec;43(12):2113-6. Epub 2009 Nov 24
OBJECTIVE: To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy. (...)

CONCLUSIONS: Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole. (...)

(Anm: myxedema (en.wikipedia.org).)

Subclinical Hypothyroidism and Functional Mobility in Older Adults
Arch Intern Med. 2009;169(21):2011-2017 (November 23)
Background Health risks associated with subclinical hypothyroidism in older adults are unclear. (...)

Conclusion Generally, well-functioning 70- to 79-year-old individuals with subclinical hypothyroidism do not demonstrate increased risk of mobility problems, and those with mild elevations in TSH level show a slight functional advantage. (...)

Preeclampsia Linked to Hypothyroidism
medscape.com 18.11.2009
November 18, 2009 — Women in whom preeclampsia develops during pregnancy are more likely than other women to have hypothyroidism in late pregnancy or subsequently, according to an analysis of a nested case-control study and a population-based study reported in the November 17 Online First issue of the BMJ.

"The findings suggest that the possible development of hypothyroidism is a consideration in patients with a history of preeclampsia," Susan B. Shurin, MD, acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), said in a news release. "Reduced thyroid functioning is easy to diagnose when suspected, and inexpensive to treat. Replacement therapy substantially improves quality of life of affected persons." (...)

(Anm: preeclampsia; preeklampsi; svangerskapsforgiftning (pasienthandboka.no).)

(Anm: Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-control and population based study. BMJ 2009;339:b4336 (17 November).)

Bivirkningsrapporter fra farmasøyter er viktige
farmatid.no 16.11.2009
Siden toppåret i 2005, meldes det nå færre bivirkninger fra farmasøyter. Dette er en trend som må snus, fordi farmasøyters bidrag er nyttige. En mistanke er nok for å melde! (...)

Interaksjon mellom levotyroksin og soyaprodukter
En pasient med overgangsplager hadde behov for stadig større doser Levaxin (levotyroksin) mot sin hypotyreose etter oppstart med et soyaprodukt. Etter seponering av soyaproduktet ble pasientens TSH og T4-verdier normalisert. Data som foreligger tyder på at komponenter i soya kan hemme absorpsjon av levotyroksin. Levotyroksin absorberes nesten fullstendig innen en time etter inntak, men siden tyroideahormonene har enterohepatisk sirkulasjon, kan man ikke utelukke interaksjon selv om man ikke tar soya og levotyroksin samtidig. Ønsker pasienter på levotyroksin å bruke soyaprodukt bør de få beskjed om å informere sin lege for oppfølging av tyroideahormonene, og fortrinnsvis ikke ta produktene samtidig. (...)

Persistent CV risk despite treatment of hypothyroidism
endocrinologyupdate.com 18.5.2009
Endothelial dysfunction – a marker of increased cardiovascular risk – persists in patients with newly-diagnosed hypothyroidism despite treatment with levothyroxine, a recent study has found. In comparison to controls, the 16 patients in the study had a lower dilatory response in the brachial artery after release of a tourniquet, a process dependent on healthy endothelium. The difference persisted after accounting for higher blood pressure and cholesterol levels in the patients. (...)

. The results suggested that close attention be paid to modifiable cardiovascular risk factors in patients with hypothyroidism, even after thyroid levels had been normalised. For example, lipid-lowering therapy might be considered even if lipids were within the normal range. Clinical Endocrinology 2009; 70: 932-937 (...)

(Anm: Endothelium (en.wikipedia.org).)

What Is Double Vision? What Is Diplopia? What Causes Double Vision? (Hva er dobbeltsyn? Hva er diplopi? Hva forårsaker dobbeltsyn?)
medicalnewstoday.com 11.11.2009
Double vision, also known as Diplopia, is the simultaneous perception of two images of a single object - the patient sees two images of a single thing either all the time, or some of the time. The displacement may be horizontally, vertically or diagonally. Diagonal double displacement (double vision) means both the horizontal lines and vertical lines are being perceived as doubled - also known as oblique separation. (...)

The most common reason for eyes not being completely aligned is a squint (strabismus). This is due to a weakened or paralyzed eye muscle. Not all squints cause double vision, but most cases of double vision are caused by squints. Squints are common among young children.

• The following conditions can cause binocular double vision:
  A thyroid disease, which results in weakened external eye muscles.
• An arterial disease. Especially one involving an artery which feeds the brain with blood and essential oxygen. (...)

ACG: Fatty Liver Risk Doubled with Hypothyroidism (Risiko for fettlever doblet ved hypothyreose) (American College of Gastroenterology)
medpagetoday.com 28.10.2009
SAN DIEGO -- Patients with nonalcoholic fatty liver disease (NAFLD) have a twofold increased risk of hypothyroidism, including a five-fold greater risk among women, data from a retrospective case-control study showed.

About one of every five patients with NAFLD had hypothyroidism. Although being female increased the odds, any history of alcohol consumption, no matter how modest, reduced the association between NAFLD and hypothyroidism.

"I think patients with hypothyroidism have to be considered as a risk group that might need to be screened for fatty liver disease, especially nonalcoholic steatohepatitis," Mangesh Pagadala, MD, of the Cleveland Clinic, said in an interview at the American College of Gastroenterology meeting. "This might help decrease the burden of cirrhosis by identifying and treating patients earlier." (...)

(Anm: fettlever; forstørrelse av leveren pga. opphoping av fett i levercellene. Leveren er kroppens viktigste «avgiftningssentral» (detoksifiseringssentral).
Kilde: Store norske leksikon.)

Thyroid cancer a risk after childhood cancer
reuters.com 27.10.2009
NEW YORK (Reuters Health) - Childhood cancer survivors are 18 times more likely to develop thyroid cancer than the general population, UK researchers report.

"Survival after childhood cancer has greatly improved over the last three decades with 5-year survival 75 percent during the 1990s compared to 25 percent during the 1960s in the United Kingdom," Dr. Aliki J. Taylor, of the University of Birmingham, and colleagues note in the latest issue of the International Journal of Cancer.

Childhood cancer survivors are at an increased risk of "late effects" of treatment, including the development of second cancers. (...)

Danskere har indberettet 2.296 bivirkninger ved stofskiftemedicin
dagensmedicin.dk 11.9.2009
En ændret formulering i stofskiftemedicinen Eltroxin har givet mange danske patienter bivirkninger.

Lægemiddelstyrelsen har modtaget et hav af rapporter om bivirkninger, efter GlaxoSmithKline ændrede formuleringen i den medicin, som 100.000 danskere er afhængige af. (...)

Ifølge Lægemiddelstyrelsen er de mest almindelige bivirkninger blandt de mere end 100.000 danske patienter blandt andet udmattelse, hovedpine og kvalme. (...)

STICKING OUT OUR NECKS -- AUGUST 2009
thyroid-info.com (August 2009)
(...) The first group are our mothers, friends, sisters, and neighbors in their 40s and 50s who are suffering symptoms they and their doctors are usually assuming to be related to perimenopause and menopause. For example, weight gain, fatigue, moodiness, erratic periods, sleep problems, hair loss, and loss of sex drive. They don't realize that these exact symptoms can be signs of hypothyroidism -- an underactive, slowed-down thyroid or "thyropause" so to speak. They also don't realize that after 40, their risk of developing thyroid problems goes up.

But rather than getting the proper tests and evaluation, many of these women are being sent off with estrogen and progesterone hormone treatments ("HRT"), antidepressants, cholesterol medication, diet pills, or sleeping pills -- which carry risks, miss the real problem entirely, and can even make symptoms worse! (...)

Thyroid swellings
BMJ 2009;339:b2563 (13 July)
Practice - 10-Minute Consultation
A 48 year old post-menopausal woman presents with a smooth midline swelling in her neck, which has been present for more than 10 years. On examination, you find that it is consistent with an enlarged thyroid gland. (...)

Thyroid Cancer Increase More Than Screening
medpagetoday.com 13.7.2009
LITTLE FALLS, N.J., July 13 -- The increasing incidence of thyroid cancer in the U.S. is more than the result of better screening, researchers said.

Incidence rates rose for tumors of all sizes -- not just the smallest ones, as it would if more cases were simply being caught by increased screening, Amy Y. Chen, MD, MPH, and colleagues reported online in Cancer.

"Our finding that even the largest tumors and tumors with distant spread of disease had an increasing incidence suggests that other reasons for this increase, including environmental, dietary, and genetic causes, need to be explored," the researchers said.

Previous studies have found an increasing incidence of thyroid cancer, and some researchers have pointed to increased detection through more widespread and aggressive use of ultrasound and image-guided biopsy. (...)

(Anm: Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005" Cancer 2009; DOI: 10.1002/cncr.24416.)

Finnålscytologi – komplement för diagnostik av hypothyreos
B Wikland P Sandberg
Tidsskr Nor Legeforen 2009; 129:1351 (25.6.2009)
Øivind Heggestad beskriver i Tidsskriftet nr. 8/2009 en mycket frustrerande situation, där på grund av «normala» sköldkörtelprover thyreoidea felaktigt har frikänts under flera år (1). I stället har man ställt diagnos «depression» eller annat psykiatriskt tillstånd.

Vilka kriterier som i Heggestads fall lett till diagnosen hypothyreos framgår inte av hans insändare. I Sverige liksom i Norge är biokemiska variabler med TSH i spetsen helt avgörande; i närvaro av «normalt» TSH anses primär hypothyreos utesluten. (...)

ENDO: Data Support Fasted Dosing of Thyroid Hormone
medpagetoday.com 17.6.2009
WASHINGTON, June 17 -- Upholding the conventional wisdom that patients should take thyroid hormone before breakfast, a randomized clinical trial showed that a fasting intake produced the least variation in serum thyrotropin.

Dosing at bedtime or with breakfast led to thyrotropin levels that were two to three times higher, Jacqueline Jonklaas, MD, of Georgetown University, reported here at the Endocrine Society meeting. (...)

Explain to patients that this study showed that people who need to take thyroid hormone should do so on an empty stomach before breakfast. (...)

Low thyroid? Maybe you're an "elephant"
news.yahoo.com 12.6.2009
Reuters – WASHINGTON (Reuters) – Low thyroid activity, one of the most treated conditions in the United States, may actually be a sign of longevity, researchers reported on Friday.

While they said it was far too soon for people taking thyroid pills to stop, they will be looking to see if the thyroid may hold the key to a long life, at least for some people. (...)

Nerveskade ved thyreoideakirurgi
Tidsskr Nor Legeforen 2009; 129: (11.6.2009)
Skade av n. laryngeus recurrens i forbindelse med tyroidektomi og paratyroidektomi er en sjelden, men kjedelig komplikasjon som kan medføre heshet når den er ensidig og luftveisobstruksjon når den er bilateral. I en finsk prospektiv randomisert studie undersøkte man 579 pasienter for å kartlegge nervens anatomi (Ann Surg 2009; 249: 648–52).

Ekstralaryngeal deling av nerven var i 26 % av tilfellene på høyre side og 23 % på venstre. Motorfibrene som styrer både adduksjon og abduksjon av stemmebåndene, var lokalisert kun anteriort. Denne kunnskapen om anatomiske varianter kan være nyttig for å forebygge nerveskade. (...)

Graves' Hyperthyroidism
NEJM 2009;(24)360:e31 (June 11)
A 42-year-old woman presented with palpitations, anxiety, tremor, and weight loss. She had received a diagnosis of Graves' disease 15 years previously but had discontinued therapy more than 5 years previously. Over the ensuing years she noticed a slowly enlarging anterior neck mass, and in the months before presentation, dyspnea and dysphagia developed. There was no hoarseness, stridor, menstrual irregularity, heart failure, or psychosis, but a widened pulse pressure, pretibial myxedema, and proximal muscle weakness were noted. She had a large, nodular, and firm goiter (Panel A), which was also visible on computed tomography of the neck (Panel B). There was evidence of eyelid retraction, diaphoresis, and jugular venous distention (Panel A and Video 1), which worsened with Pemberton's maneuver. (...)

Plasma parathyroid hormone and the risk of cardiovascular mortality in the community.
Circulation. 2009 Jun 2;119(21):2765-71. Epub 2009 May 18.
BACKGROUND: Diseases with elevated levels of parathyroid hormone (PTH) such as primary and secondary hyperparathyroidism are associated with increased incidence of cardiovascular disease and death. However, data on the prospective association between circulating PTH levels and cardiovascular mortality in the community are lacking. (...)

CONCLUSIONS: Plasma PTH levels predict cardiovascular mortality in the community, even in individuals with PTH within the normal range. Further studies are warranted to evaluate the clinical implications of measuring PTH in cardiovascular risk prediction and to elucidate whether PTH is a modifiable risk factor. (...)

Recent developments in hyperthyroidism
Lancet 2009;373(9679):1930-1932 (6 June)
Since the Seminar in The Lancet on hyperthyroidism in 2003, 1 several reports have enhanced our understanding of the end-organ manifestations of subclinical and overt hyperthyroidism, provided data that help refine therapeutic decision making, and suggested novel approaches to the treatment of Graves' disease.

In mild (ie, subclinical) hyperthyroidism, patients' serum levels of free thyroxine and tri-iodothyroxine or free tri-iodothyroxine are within the broad range of normal, but the serum concentra (...)

FDA Says Graves' Disease Drug Can Damage Liver (FDA sier legemiddel mot Graves sykdom kan skade lever)
medpagetoday.com 3.6.2009
WASHINGTON, June 3 -- The FDA today warned physicians that a drug used for 62 years to treat Graves' disease -- propylthiouracil, or PTU -- carries an increased risk for life-threatening liver injury.

The FDA said it has received 32 adverse event reports -- 22 in adults and 10 in children -- including 12 deaths and six transplants among adult users of the medication. In the pediatric population, the FDA said there were one death and six transplants linked to PTU use.

"Physicians should closely monitor patients on PTU therapy for symptoms and signs of liver injury, especially during the first six months after initiation of therapy," the FDA said.
The agency said that when PTU, which was approved in 1947, was compared with methimazole (MMI), approved in 1950, there was evidence of excess hepatotoxicity linked to PTU.

Among MMI users, the FDA identified five reports of serious liver injury. All five cases -- including three deaths -- were in adult patients.

Both drugs are approved for treatment of hyperthyroidism due to Graves' disease, and the FDA advised physicians to "carefully consider which drug to initiate in a patient recently diagnosed with Graves' disease." (...)

(Anm: Graves' sykdom (SML-artikkel); betegner en form for hypertyreose. Navn etter den irske legen Robert J. Graves (1796–1853). Kilde: Store norske leksikon.)

(Anm: tyreotoksikose; Graves sykdom; thyreotoxicosis; tilstand med auka stoffskifte, utståande auge, rask puls, sveitting, rastløyse, nervøsitet, vekttap, trøyttleik, veike musklar, skjelvande fingrar, struma m m; skuldast for sterk skjoldkjertelteneste, viser høge verdiar for tyroksin, låge TSH verdiar i serum, har autoimmun årsak (immunglobulin med TSH-liknande verknad stimulerer skjoldkjertelen) eller skuldast tyroksinproduserande knutar i kjertelvevet; også kalla morbus basedowi; Graves sjukdom; giftig struma; jf hypertyreose, T3-toksikose, tyroksin, tyreotoksisk krise, apatisk hypertyreoidisme, pretibialt myksødem, eksoftalmus, tyreotropin reseptor EN thyrotoxicosis; Graves disease. Kilde: Norsk medisinsk ordbok.)

Eltroxin: Flere bivirkningsindberetninger efter ændring i hjælpestofferne
laegemiddelstyrelsen.dk 29.5.2009
Lægemiddelstyrelsen har det seneste stykke tid oplevet en stigning i antallet af bivirkningsindberetninger på Eltroxin. Dette sker efter at GlaxoSmithKline (GSK) har ændret på hjælpestofferne i Eltroxin. De nye hjælpestoffer er almindeligt anvendt i lægemidler. (...)

De bivirkninger, der indberettes, skyldes formentlig, at biotilgængeligheden af den aktive substans levothyroxin for nogle patienter er en lille smule anderledes ved den nye formulering af Eltroxin. Dermed er det muligt, at disse patienter får enten for lidt eller for meget af den aktive substans levothyroxin, og derfor oplever symptomer forenelige med enten over- eller underdosering.

Det er derfor meget vigtigt, at lægen måler niveauet af thyreoidea stimulerende hormon (TSH) ved overgangen til den nye formulering, især hos de patienter som oplever bivirkninger. Bemærk dog, at pga. den lange halveringstid for levothyroxin (ca. 7 dage), bør der gå ca. 5-6 uger fra patienten er startet på den nye formulering eller har ændret i dosis før måling af TSH-niveauet udføres. (...)

Millions at risk as thyroid disorders remain undiagnosed
pharmatimes.com 26.5.2009
A campaign backed by Merck Serono is looking to raise awareness of thyroid disorders, which affects more than 300 million, although over half are thought to be unaware of the problem.

The first ever International Thyroid Awareness Week began yesterday and the company is working with the Thyroid Federation International to raise awareness of thyroid dysfunctions and their consequences. The campaign was launched last month at the European Congress of Endocrinology meeting in Istanbul where academics and the president of TFI, Yvonne Andersson, noted that millions of people are suffering needlessly because they are unaware of the symptoms and impact of thyroid disorders. (...)

Underactive Thyroid Linked to Liver Cancer Risk (Underaktiv skjoldbruskkjertel linket til risiko for leverkreft)
medpagetoday.com 6.5.2009
(...) These case-control study findings shouldn't be surprising, the researchers wrote in the May issue of Hepatology.

Hypothyroidism has been linked to chronic liver diseases and implicated in the pathogenesis of nonalcoholic steatohepatitis (NASH), which is considered a predisposing condition for liver cancer. (...)

(Anm: Association between hypothyroidism and hepatocellular carcinoma: a case-control study in the United States. Hepatology 2009; 49:1563-70.)

Eltroxin: Flere bivirkningsindberetninger efter ændring i hjælpestofferne
laegemiddelstyrelsen.dk 28.4.2009
Lægemiddelstyrelsen har det seneste stykke tid oplevet en stigning i antallet af bivirkningsindberetninger på Eltroxin. Dette sker efter at GlaxoSmithKline (GSK) har ændret på hjælpestofferne i Eltroxin. De nye hjælpestoffer er almindeligt anvendte i lægemidler.

De bivirkninger, der indberettes nu, skyldes formentlig, at bioækvivalensen af den aktive substans levothyroxin er ændret en smule ved den nye formulering af Eltroxin. Dermed er det muligt, at nogle patienter får enten for lidt eller for meget af den aktive substans levothyroxin, og derfor oplever bivirkninger.

Det er vigtigt at lægen monitorerer thyroideafunktionen ved overgangen til den nye formulering, især hos de patienter som oplever bivirkninger. Bemærk dog, at pga. den lange halveringstid for levothyroxin (ca. 7 dage), skal der gå ca. 5 uger fra patienten er startet på den nye formulering eller har ændret i dosis før monitorering af thyroidfunktionen udføres. (...)

Radiation Linked to Aggressive Thyroid Cancer
medpagetoday.com 20.4.2009
LITTLE FALLS, N.J., April 20 -- Thyroid cancer patients with a history of radiation exposure appear to develop more aggressive disease than those without such exposure, a retrospective chart review showed.

Patients who had been exposed to radiation were more likely to have stage IV and multifocal disease, as well as distant metastases, than the general thyroid carcinoma population, according to Jeremy Freeman, M.D., of Mount Sinai Hospital in Toronto and the University of Toronto, and colleagues.

These patients may require more aggressive treatment, they wrote in the April Archives of Otolaryngology -- Head & Neck Surgery. (...)

Normale prøver – men ikke frisk
Ø Heggestad
Tidsskr Nor Legeforen 2009; 129:771 (16.4.2009)
Etter å ha slitt med hypotyreose i fire år, vært aktiv i Norsk thyroideaforbund og hatt bred kontakt med andre som har sykdommen, kan jeg konkludere med at man ikke nødvendigvis er frisk selv om man har «normale prøver». (...) De mener altså at det må være noe annet som er årsaken til de fysiske og psykiske symptomene.

Om man orienterer seg litt blant pasientene, ser man at dette ikke medfører riktighet. En stor grad av utmattelse, psykiske symptomer og mange fysiske plager kan tilskrives hypotyreose, og sykdommen er svært omfattende for mange. Det er da svært krenkende stadig å få høre fra helsepersonell at man har en psykisk sykdom, og at utmattelsen, mageproblemer, problemer med hukommelsen og annet er forårsaket av depresjon. Behandling som passer for en depressiv tilstand er ikke alltid passende for en plaget hypotyreosepasient.

Ofte fører det å ta seg ut med fysisk og sosial aktivitet til kollaps i stedet for økt energi, slik tilfellet er med fysisk friske personer. Ofte får hypotyreosepasienter høre at de har helseangst på grunn av de mange symptomene, fordi man etter læreboken er frisk. Det er på tide at man revurderer denne påstanden. (...)

En kvinne med leggødem og arrforandringer
Tidsskr Nor Legeforen 2009; 129:750-2 (16.4.2009)
En kvinne utviklet bilateralt lymfødem i legg og fot med papillomatøse hudlesjoner. Dessuten var de ytterste delene av fingrene fortykket og hun hadde exophthalmus. Hos henne ga tidligere sykehistorie med Graves’ sykdom tips om diagnosen. (...)

Drug May Be Dangerous for Kids With Graves' Disease (Legemiddel kan være farlig for barn med Graves sykdom)
healthfinder.gov 14.4.2009
Medication known as PTU can cause liver disease, experts say.
(SOURCE: The Endocrine Society, news release, April 14, 2009)
FRIDAY, April 17 (HealthDay News) -- A recommendation to restrict the use of the antithyroid drug (PTU) in children has been endorsed by the Endocrine Society.

In a letter to the editor in the April 9 New England Journal of Medicine, two experts wrote that PTU can cause severe liver disease in children and should no longer be used as a first-line treatment for children with Graves' disease, a disorder in which the thyroid gland produces more thyroid hormone than the body needs. (...)

(Anm: Ending propylthiouracil-induced liver failure in children. N Engl J Med. 2009 ;360(15):1574-5. (Apr 9).)

(Anm: Graves' Disease; Graves' sykdom, betegner en form for hypertyreose. Navn etter den irske legen Robert J. Graves (1796–1853). Kilde: Store norske leksikon.)

(Anm: Graves' Disease (wikipedia.org).)

Question
Hypothyroidism: Can it cause peripheral neuropathy?
Can hypothyroidism cause peripheral neuropathy? (Kan hypothyreose forårsake perifer nevropati)
mayoclinic.com 11.4.2009
Rarely, hypothyroidism — a condition in which your thyroid gland doesn't produce enough thyroid hormone — may cause peripheral neuropathy, such as carpal tunnel syndrome.

Peripheral neuropathy is damage to your peripheral nerves — the nerves that carry information between your brain and spinal cord and the rest of your body, such as your arms and legs. Peripheral neuropathy is often caused by diabetes and autoimmune diseases such as rheumatoid arthritis. But it may also be caused by other conditions, such as severe, long-term untreated hypothyroidism. The association between hypothyroidism and peripheral neuropathy isn't fully understood.

Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.

Treatment of peripheral neuropathy due to hypothyroidism is directed at the underlying hypothyroidism. (...)

(Anm: nevropati; fellesbetegnelse på organiske nervesykdommer, se nervebetennelse. (...) Kilde: Store norske leksikon.)

(Anm: carpal tunnel syndrome; canalis carpi syndrom, karpaltunnelsyndrom, tilstand som gjør at en av underarmens store nerver (nervus medianus) utsettes for langvarig trykk ved sin passasje ut i hånden forbi håndleddet, hvor nerven ligger umiddelbart under et bredt og fast bindevevsbånd (ligament). (...) Kilde: Store norske leksikon.)

Investigating the thyroid nodule (Undersøkelse av thyreoideaknuter)
BMJ 2009;338:b733 (13 March)
Thyroid nodules are common: 4-7% of the adults have a palpable nodule, and up to 50-70% will have nodules on high definition ultrasonography, which may cause considerable concern to patients. In this article, we present an evidence based guide to investigating and managing thyroid nodules and we discuss the myths about nodules. Where relevant, we also highlight the differences between the two most widely used guidelines on this topic: the recently issued second edition of the British Thyroid Association’s guidelines on thyroid cancer¹ and the American Thyroid Association’s guidelines.² These guidelines were formulated by two large committees of experts, who reviewed all the available evidence, which mainly consists of prospective and retrospective cohorts; where there was no evidence, expert consensus opinion was used. (...)

Incidental thyroid nodule
BMJ 2009;338:b611 (4 March)
Thyroid nodules may be coincidentally detected as a result of neck imaging, and most are benign; the authors discuss how best to decide which nodules are most likely to be malignant and require further evaluation (...)

Glutenintolerans ökar risken för lever- och njurproblem
dagensmedicin.se 24.2.2009
Glutenintoleranta löper ökad risk att drabbas av leversjukdom och sköldkörtelrubbningar, enligt en aktuell svensk avhandling.

Studien har gjorts av doktoranden Peter Elfström, som är läkare på barnkliniken vid Universitetssjukhuset Örebro, USÖ. Den omfattar 15 000 glutenintoleranta patienter och är den hittills största i sitt slag, enligt ett pressmeddelande från Örebro universitet. (...)

Behandlingspraksis ved primær hyperparatyreoidisme
Tidsskr Nor Legeforen 2009; 129:300-2
Sammendrag
Bakgrunn. En studie viste betydelige regionale forskjeller i behandlingen av primær hyperparatyreoidisme i Norge. Det er uenighet om hvilke pasienter som har nytte av operasjon. Vi ønsket å undersøke synspunkter på behandlingsindikasjon for pasienter med primær hyperparatyreoidisme hos norske endokrinkirurger og et utvalg endokrinologer. (...)

Gene Study Finds Link to Cancer of Thyroid
nytimes.com 6.2.2009
Scientists have identified two genetic variations that account for 57 percent of cases of thyroid cancer, a finding that could lead to earlier detection among people at high risk for the disease. (...)

Smoking Alters Thyroid Hormones in Pregnant Women and Their Babies (Røyking endrer thyreoideahormoner hos gravide kvinner og deres spedbarn)
medpagetoday.com 13.1.2009
EXETER, England, Jan. 13 -- Smoking cigarettes during pregnancy is associated with small but potentially harmful changes in thyroid function both in mothers and offspring, researchers here found.

In a cohort study with a total of 2,355 pregnant women, those who smoked had lower levels of serum thyrotropin (TSH) and higher levels of free triiodothyronine (FT3) than nonsmokers, according to Bijay Vaidya, Ph.D., of Peninsula Medical School at Royal Devon and Exeter Hospital and colleagues.

Babies born to smokers in the study also had lower serum TSH in cord blood, Dr. Vaidya and colleagues reported online in the Journal of Clinical Endocrinology and Metabolism. (...)

(Anm: Cigarette smoking during pregnancy is associated with alterations in maternal and fetal thyroid function. J Clin Endocrinol Metab. 2008 Nov 18. [Epub ahead of print].)

The Association Between Weight Gain and Thyroid Function in an Older Population
Arch Intern Med. 2008;168(20):2283-2284 (November 10)
(...) Results
(...) Increasing TSH level (modeled as a continuous variable) during follow-up was associated with a 50% higher likelihood of weight gain of greater than 2 kg after adjusting for age, baseline body weight, and smoking in women (odds ratio, 1.50; 95% confidence interval, 1.10-2.05). This association persisted after further adjustment for physical activity and dietary covariates. (...)

Statin induced myopathy
BMJ 2008;337:a2286 (6 November)
(...) Thyroid stimulating hormone should be checked in patients on statins who develop a myopathy because hypothyroidism is a common cause of hypercholesterolaemia and raised creatine kinase.

If muscle-related symptoms or raised creatine kinase concentrations persist after statin therapy is stopped, consider further investigations such as electromyography and muscle biopsy, in conjunction with a specialist. (...)

Thyroid Function After Unilateral Total Lobectomy
Arch Otolaryngol Head Neck Surg 2008;134(10):1076-1079
Risk Factors for Postoperative Hypothyroidism (...)

Conclusions Postoperative hypothyroidism appeared in 32.8% of the cases in this series, especially among patients with elevated preoperative thyrotropin and postoperative thyroperoxidase antibody levels, after right lobectomy and when a smaller thyroid remnant was left. After confirmation with larger prospective series, these results may support the indication for early postoperative hormone supplementation in these instances. (...)

Problems Associated with the Use of Thyrogen in Patients with a Thyroid Gland
NEJM 2008;359:1738-1739 (October 16)
To the Editor: Juweid et al. (September 18 issue)1 describe the administration of thyrotropin alfa (Thyrogen) to a patient with thyroid cancer who still has a thyroid gland. Genzyme, the manufacturer of Thyrogen, wants to point out that all regulatory bodies, including the Food and Drug Administration, restrict the use of 0.9-mg intramuscular injections of the drug on two consecutive days to patients who have already had a total or near-total thyroidectomy. (...)

Some reactions to drug change may be psychological – experts
nbr.co.nz 11.9.2008
Government agencies are looking at two applications to sell and subsidise other brands of the thyroid drug levothyroxine after patient complaints about perceived side effects from GlaxoSmithKline's Eltroxin. (...)

But experts at today's press conference said some of the flood of reported reactions may actually be psychological, rather than physiological.

GSK began supplying the new formulation in July last year, and until April and May of this year there were only about 30 reports of side effects filed to the Centre for Adverse Reactions Monitoring (Carm).

When numbers hit 43 in June, the reactions were publicised in advertisements, triggering extensive media publicity, and by today, Carm had reports of 810 reactions from the 70,000 patients taking the drug.

"That increases every time a news item runs on it," said Dr Stewart Jessamine, group manager of the Ministry of Health's drug regulatory arm Medsafe. (...)

Extracapsular Hemorrhage from a Parathyroid Adenoma
NEJM 2008; 359:1155 (September 11)
A healthy 34-year-old woman presented with an acute, painful swelling and bluish discoloration of the anterior neck with no associated trauma. She reported having fatigue, anorexia, and depression during the past few weeks. (...)

(Anm: adenom; godarta svulst av kjertelvev (kjertelepitel); sjå også basofilt adenom, villøst adenom, eosinofilt adenom, kromofobt adenom, hovudcelleadenom; jf. adenocarcinoma EN adenoma ET [gr aden kjertel + -oma svulst]Kilde: Norsk medisinsk ordbok.)

Some Hiroshima Survivors at Thyroid Cancer Risk
healthfinder.gov 29.8.2008
Radiation may have caused chromosomal change that raises odds for malignancy, study finds (...)

FRIDAY, Aug. 29 (HealthDay News) -- Some Japanese survivors of the World War II atomic bomb blasts in Hiroshima and Nagasaki experienced key genetic changes that may have sparked the onset of a form of thyroid cancer, new research indicates.

Papillary thyroid cancer (PTC) is typically linked to a particular genetic mutation involving the so-called BRAF gene. But Japanese researchers say that among Japanese atom bomb survivors, a different and relatively rare disease trigger -- involving the chromosomal rearrangement of the RET/PTC gene -- seems to be to blame. (...)

Hamatani is chief of the laboratory of cell biology in the department of radiobiology/molecular epidemiology at the Radiation Effects Research Foundation (RERF), in Hiroshima. He and his colleagues reported their findings in the Sept. 1 issue of Cancer Research. (...)

For Rare Blood Disorder, Pumping Iron Is the Cure (For sjelden blodsykdom er kuren å pumpe jern)
healthfinder.gov 25.8.2008
Doctors say bloodletting is the best available option for people with hemochromatosis.

(SOURCES: Gerald Koenig, director, the Iron Disorders Institute, Greenville, S.C.; Eugene Weinberg, Ph.D., professor emeritus of biology and microbiology and immunology, Indiana University School of Medicine, Indianapolis; U.S. National Institutes of Health, Bethesda, Md.) (...)

Hemochromatosis is an inherited disease in which the body becomes overloaded with iron. When that occurs, the iron builds up in organs and tissues, causing slow damage from within that prompts a multitude of symptoms and illnesses.

"Until people get sick, they don't usually know it's there," said Gerald Koenig, director of the Iron Disorders Institute. "We think it's the most underdiagnosed disease in the country." (...)

Hereditary hemochromatosis is one of the most common genetic disorders in the United States, most often affecting Caucasians of northern European descent, although other ethnic groups are also at risk, according to the U.S. National Institutes of Health. (...)

The NIH lists other common symptoms and diseases related to hemochromatosis, including:
• Fatigue or lack of energy.
• Loss of sex drive or impotence.
• Early menopause.
• Abnormal pigmentation of the skin, making it look gray or bronze.
• Thyroid deficiency.
• Damage to the adrenal glands.

Some people might not suffer any problems at all. Weinberg said there's a 100-year-old retired faculty member he knows who has a very high iron load but no ill effects from it. (...)

(Anm: hemokromatose; haemochromatosis; bronsediabetes, jernlagringssjukdom med avleiring av jern i ymse lekamsdelar slik at det kan oppstå leversvikt pga avleiringar i levra eller sukkersjuke pga forandringar i bukspyttkjertelen; huda kan få «bronsefarge», trøyttleik, magesmerter, artrittar m v kan følgja med; jernet er i veva lagra som hemosiderin i staden for som ferritin; (jf hemosiderose, talassemi); der er auka overføring av jern frå tarmslimhinna til sirkulasjonen (d e auka jernopptak) og auka overføring frå RES til parenkymceller; tilstanden er recessivt arveleg; årsaka, som kan påvisast med ein gentest er mutasjon i gen på kromosom 6 (HFE-genet som kodar for eit glykoprotein som styrer jernopptaket), mykje jern i kosten er medverkande årsak; jf venesectio EN hemochromatosis Kilde: Norsk medisinsk ordbok.)

Skjoldkjertel beste betegnelse
PERSPEKTIV OG DEBATT Språkspalten
Tidsskr Nor Legeforen 2008; 128:1692 (14.8.2008)
Om kjertelen er forskjønnende kan disputeres, men den norske betegnelsen trenger ikke diskuteres. (...)

Management of hypothyroidism in adults (Behandling av hypotyreose hos voksne)
BMJ 2008;337:a801 (28 July)
(...) Summary points
In adults with newly diagnosed hypothyroidism who are under 60 and without ischaemic heart disease it is safe and efficient to start on a full replacement dose of levothyroxine

Levothyroxine replacement dose is related to body mass; a daily dose of about 1.6 µg levothyroxine/kg body mass is adequate replacement for most adults (equivalent to 100 µg daily or 125 µg daily for an average size woman or man, respectively)

Elderly people and those with ischaemic heart disease should start on a small dose of levothyroxine, and the dose increment should be gradual

Current evidence does not support a clinical benefit from the use of a combination of levothyroxine and liothyronine (triiodothyronine) over levothyroxine alone in the treatment of hypothyroidism (...)

Hypoparathyroidism (Hypoparathyroidisme (HPTH))
NEJM 359:391-403 (July 24)
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. (...)

(Anm: hypoparatyreoidisme; nedsett funksjon i biskjoldkjertlane, d e skort på paratyreoideahormonet (PTH); fører til fall i kalsiuminnhaldet i blod; dette kan føra til muskelkrampar (tetani (s d), grå stær, beinvevsforandringar m v; årsak har ofte vore tilfeldig fjerning av paratyreoidkjertlane ved strumaoperasjon men genetiske feil med hormonet eller hormonet sin reseptor, ev med den kalsiumsansande reseptoren e a kan gi ulike former for hypoparatyreoidisme; jf de Georges syndrom og automuun-polyendokrinopati-candidiasis-ectodermal dystrofi, pseudohypoparatyreoidisme EN hypoparathyroidism Kilde: Norsk medisinsk ordbok.)

Long-term Outcome of Patients With Elevated Parathyroid Hormone Levels After Successful Parathyroidectomy for Sporadic Primary Hyperparathyroidism
Arch Surg. 2008;143:659-663.
(...) Conclusion Although one-third of the patients had elevated PTH levels after successful parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia. (...)

Ny viten om stoffskiftesykdom
NYHETER Doktoravhandlinger
Tidsskr Nor Legeforen 2008; 128:1498 (26.6.2008)
Data fra Tromsøundersøkelsene viser sammenheng mellom mild stoffskiftesykdom med forhøyet TSH og økt blodtrykk og kolesterolnivå.

For høye eller for lave verdier av thyreoideahormoner gir stoffskiftesykdom som kan påvirke blodtrykk, kolesterolverdier og hjertets pumpefunksjon. Lavt nivå av thyreoideastimulerende hormon (TSH) kombinert med forhøyet nivå av trijodotyronin (T3) og tyroksin (T4) er et uttrykk for hypertyreose, og motsatte forandringer for hypotyreose. Disse tilstandene krever adekvat diagnostikk og behandling. (...)

- Resultatene kan kort oppsummeres slik: Vi fant positiv sammenheng mellom TSH-nivå og blodtrykk, selv om TSH er innenfor det som beskrives som normalverdier. Økende TSH-verdier er assosiert med økende blodtrykk. Vi fant også positiv sammenheng mellom kolesterolverdier og TSH-nivå. Senkning av TSH-nivå med medisiner ga bedre kolesterolverdier. (...)

(Anm: Rettelse. Ny viten om stoffskiftesykdom. Tidsskr Nor Legeforen 2008; 128:1685 (14.8.2008).

Hypertyreose: For høyt stoffskifte. Lave verdier av TSH, høye verdier av T4 og T3.

Hypotyreose: For lavt stoffskifte. Høye verdier av TSH, lave verdier av T4 og T3.)

Doctors Say Medication Is Overused in Dementia (Leger sier det er et overforbruk av demenslegemidler)
nytimes.com 24.6.2008
Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

“I knew the drugs were doing this to her,” her daughter said. “I told him to stop the medications and stay away from Mom.”

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve. (...)

Subclinical Hypothyroidism Common with Chronic Kidney Disease
medpagetoday.com 11.6.2008
DENVER, June 11 -- Almost 20% of patients with chronic kidney disease have subclinical primary hypothyroidism, according to data from a large cohort of outpatients. (...)

(Anm: Prevalence of Subclinical Hypothyroidism in Patients with Chronic Kidney Disease. Published ahead of print on June 11, 2008 Clinical Journal of the American Society of Nephrology.)

Thyroid Nodules and Cancer in Children and Adolescents Affected by Autoimmune Thyroiditis (Thyreoideaknuter og kreft hos barn og ungdommer angrepet av autoimmun thyreoiditt)
Arch Pediatr Adolesc Med. 2008;162(6):526-531
(...) Conclusions The observed prevalences of thyroid nodules and thyroid cancer in our JAT case series were 31.5% and 3.0%, respectively. Papillary carcinoma was the only histotype detected. The finding of lymphadenopathy, a lack of response to levothyroxine therapy, and nodule hypoechogenicity suggested malignancy. Fine-needle aspiration biopsy was reliable in selecting patients for referral to surgery. (...)

Low Vitamin D Linked to Depression in Older Adults (Lavt nivå av vitamin D linket til depresjon hos voksne)
medpagetoday.com 6.5.2008
AMSTERDAM, May 6 -- Depression in older adults may be related to poor vitamin D status and elevated parathyroid hormone levels, researchers here said.

In a population-based study, both major and minor depression in older adults was associated with 14% lower serum 25-hydroxyvitamin D levels than seen in those who did not suffer from depression, found Witte J. G. Hoogendijk, M.D., Ph.D., of the VU University Medical Center of Vrije Universiteit Amsterdam, and colleagues.

Average parathyroid hormone thyroid levels were 5% higher with minor depression and 33% higher with major depressive disorder, they reported in the May issue of Archives of General Psychiatry. (...)

Thyroid Hormone Could One Day Treat Osteoporosis (Thyreoideahormon kan en dag behandle benskjørhet)
healthfinder.gov 10.3.2008
Animal experiments show thyroid stimulating hormone prevented bone loss. (...)

"We found that TSH, which is a hormone that was thought to be exclusively involved in the release of thyroid hormones, which are essential for the homeostasis of the body, can directly affect bone remodeling," said lead researcher Dr. Mone Zaidi, a professor of medicine and physiology and director of the Mount Sinai Bone Program at Mount Sinai School of Medicine in New York City.

TSH inhibits the process of bone reabsorption by the body, Zaidi said. "This is a process that is fundamental for the renewal of the skeleton. Throughout life, old bone is replaced by new bone," he said. "Osteoporosis occurs when this process is exaggerated, and bone removal outpaces bone replacement." (...)

The findings were published in the March 10 issue of the Proceedings of the National Academy of Sciences. (...)

For højt stofskifte – Hypertyreose
medicinmedfornuft.dk 7.3.2008
Hypertyreose, også kaldet tyreotoksikose eller ”overaktiv skjoldbruskkirtel”, er den lægelige betegnelse for højt stofskifte. Det er en tilstand med for højt niveau af hormonet tyroksin fra skjoldbruskkirtlen på halsen. Det medfører en række symptomer som rastløshed, svedtendens og knuder på halsen. Behandling er sædvanligvis effektiv. (...)

Autoimmune Polyendocrine Syndrome Type 1 and NALP5, a Parathyroid Autoantigen
NEJM 2008;358:1018-1028 (March 6)
(...) Conclusions NALP5 appears to be a tissue-specific autoantigen involved in hypoparathyroidism in patients with APS-1. Autoantibodies against NALP5 appear to be highly specific and may be diagnostic for this prominent component of APS-1. (...)

En kald, uklar og ødematøs 56 år gammel mann
MEDISIN OG VITENSKAP Noe å lære av
Tidsskr Nor Legeforen 2008; 128:572-3
(...) En 56 år gammel, uføretrygdet mann uten tidligere journal ved vårt sykehus ble innlagt med uklar sykehistorie og uten opplysninger fra lege eller pårørende. Ved innkomst ga han uttrykk for at han alltid hadde vært frisk, og kunne ikke forklare hvorfor han var uføretrygdet. Han røykte, men brukte angivelig ingen andre rusmidler. Han brukte heller ingen faste medisiner. Pasienten bodde alene i et hybelhus, og ble innlagt etter initiativ fra hybelverten som mente pasienten hadde vært generelt dårlig i flere dager og at han nå pustet «svakt». (...)

Neste dag kom det svar på thyreoideafunksjonsprøver som avslørte uttalt hypotyreose (fritt T4 2,5 µmol/l (11,0 - 22,0), TSH > 150 mlE/l (0,26 - 5,0)) og det ble startet behandling med tyroksin i forsiktig dose (levotyroksin 12,5 µg) grunnet sannsynlig samtidig koronarsykdom.

Hjertesvikt er ikke uvanlig ved langvarig hypotyreose. Den hypotyreote kardiomyopatien karakteriseres vanligvis av lett sviktende venstre ventrikkel-funksjon, asymmetrisk septumhypertrofi og perikardvæske. Mekanismene antas å være redusert funksjon av hjertemuskelcellene som følge av redusert thyreoideahormonpåvirkning, mukopolysakkaridavleiringer i myokard og økt kapillær permeabilitet. Denne tilstanden er vanligvis fullt reversibel ved tyroksinbehandling (1). (...)

(Anm: ødematøs; med ødem, opptrutna EN edematous

ødem; oedema, opptrutning av vev pga auka væskemengd i cellemellomromma (interstitiet); dei vanlegaste årsakene er oppstuving av væske ved hjartesvikt, sviktande utskiljing av væske ved nyresvikt eller sviktande onkotisk trykk (s d) pga lågt proteininnhald i serum ved leversjukdom eller nefrose; underhudsødem viser gjerne «ståande grop etter trykk» med finger; engelsk stavemåte: edema; eldre norsk: vatersott, kvapsott, «vatn i hold»; jf angionevrotisk ødem, deklive ødem, kardiale ødem, hjerneødem, hungerødem, glottisødem, lungeødem, kollateralt ødem, nefrotisk ødem, ankelødem, sakralødem, anasarka, papillødem; sjå også lymfødem og myksødem EN edema ET [gr oidema opptrutning] Kilde: Norsk medisinsk ordbok.)

Thyroxine Monotherapy After Thyroidectomy
Vol. 299 No. 7, February 20, 2008
JAMA. 2008;299(7):817-819.
It may be the experience of many clinicians, as it has been ours, that a very small group of patients with hypothyroidism are not entirely well on thyroxine replacement alone.¹

The concept of hormone replacement therapy is commonly credited to Brown-Sequard, who in 1889 at age 72 years injected himself with an extract of dog testicles and noted enhanced vitality and mental acuity.² (...)

One might speculate that some patients, perhaps approximately 10%, might potentially benefit from T3 supplementation after thyroidectomy. (...)

Thyroid Cancer on the Rise
ivanhoe.com 21.11.2007
(Ivanhoe Newswire) – The incidence of thyroid cancer is increasing, but earlier detection might explain some – if not all -- of the rise. (...)

It kills thyroid cancer, but is radiation safe?
usatoday.com 18.11.2007
(...) The medicine, iodine 131, is a proven cancer fighter. But it's also radioactive, and in higher doses, can cause cancer. Russell-Milstein — like thousands of other thyroid cancer patients in the USA each year — worried that the radiation might pose a risk to her family. (...)

"It's an exciting time" for radioactive iodine treatment, says Russell-Milstein's doctor, Paul Ladenson, director of endocrinology at Johns Hopkins Medical Institutions. (...)

Thyroid function abnormalities during amiodarone therapy for persistent atrial fibrillation
Am J Med. 2007 Oct;120(10):880-5
(...) CONCLUSIONS: Hypothyroidism developed in 30.8% of older males treated with amiodarone and in only 6.9% of the controls. Hypothyroidism presented at an early stage of therapy. Hyperthyroidism occurred in 5.3% of amiodarone treated patients, and was a subclinical entity in all but 1 case. (...)

A pain in the neck
timesonline.co.uk 17.3.2007
The thyroid is a small gland that causes big problems - or does it? Vivienne Parry reports

What topic do you think would get one of the biggest listener responses in the history of the BBC Radio 4 medical programmes?

Obesity, asthma, heart disease? In fact, it was the thyroid, the tiny gland in the neck that controls the speed of the body’s metabolism. (...)

Degenerative Thyroid Cartilage Cysts as a Cause of Hoarseness
Report of 2 Cases
Arch Otolaryngol Head Neck Surg. 2007;133:936-938 (September 2007)
Cysts located in the thyroid cartilage proper are rare. A literature review identified only 4 cases.^1-4 (...)

In adults, the most common presenting symptom of laryngeal cysts is hoarseness. Other symptoms include a foreign body sensation, pain, dysphagia, and occasional difficulty in breathing.⁷ (...)

Ronaldos overvekt skyldtes lavt stoffskifte
dagbladet.no 24.8.2007
(...) Ronaldo var lenge regnet som verdens beste fotballspiller, men har de siste årene måttet tåle mye kritikk for liten bevegelighet og mange ekstra kilo på kroppen.

Stoffskifte-sykdom
Det har vært spekulert mye i om Ronaldo på sine eldre dager - han fyller snart 31 år - har blitt for glad i det søte stjerneliv.

Nå sier legene til Milan at så ikke er tilfellet. Ronaldos ekstra kilo skyldes sykdom.

De hevder Ronaldo lider av hypotyreose, en sykdom som gjerne kalles lavt stoffskifte. Det er forårsaket av nedsatt utskillelse av hormonet tyroksin, som produseres i skjoldbruskkjertelen.

Nå har Milan-legene gitt ham medisinsk behandling for sykdommen, og informert den italienske olympiske kommité og Verdens antidopingbyrå (Wada) om dette. (...)

Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients
Arch Intern Med. 2007;167:1526-1532
(...) Methods To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). (...)

Conclusion A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease. (...)

(Anm: euthyroid; eutyroid; med god (normal) skjoldkjertelteneste, normal tyreoideafunksjon; tilsvarande uttrykk er eutyreoid, eutyreot
EN euthyroid ET [gr eu- god- + thyreos skjold] Kilde: Norsk medisinsk ordbok.)

Diseases of the Thyroid in Childhood and Adolescence
NEJM 2007;357:202-203 (July 12) Number 2
(...) (Pediatric and Adolescent Medicine. Vol. 11.) Edited by Gerasimos E. Krassas, Scott A. Rivkees, and Wieland Kiess. 294 pp., illustrated. Basel, Switzerland, Karger, 2007. $196.50. ISBN 978-3-8055-8205-6.

From an adult endocrinologist's perspective, thyroid diseases of childhood fall into two categories. The first category includes well-known thyroid conditions that are commonly seen in adults. The second category consists of rare diseases that physicians who treat adult patients will encounter only many years after a pediatrician has made the diagnosis. This book will provide endocrinologists who treat adults or children with interesting insights into both categories of diseases of the thyroid in children. (...)

Feeling lethargic, moody, tired, fat? It could be your thyroid (Føler deg dvask, humørsyk, trett, feit? Det kan være din skjoldbruskkjertel)
cnn.com 10.5.2007
Men dersom du ønsker å vite noe om virkelig ekstrem utmattelse, den type som lenker deg til sengen, spør noen som har en skjoldbruskkjertellidelse. (...) (But if you want to know about real bone-crunching fatigue, the kind that chains you to your bed, ask someone with a thyroid disorder.)

Din skjoldbruskkjertel er en liten, sommerfugl-formet kjertel i nakkeroten. Enkelte ganger beskrevet som kroppens termostat, som kontrollerer energiflyten. (...) (Your thyroid is a tiny, butterfly-shaped gland at the base of your neck. Sometimes described as the body's thermostat, it controls energy flow.)

Selv om jeg nevnte problemet for min lege var alt han gjorde å tilby sovepiller. Men da min yngre søster oppdaget at hun hadde et thyreoideaproblem, sa hennes lege at det ligger i familien. (Health.com: Why thyroid disorders are so common) (...) (Though I mentioned the problem to my doctor, all he did was offer sleeping pills. But then my younger sister discovered she had a thyroid problem, and her doctor said it runs in families. (Health.com: Why thyroid disorders are so common))

Parathyreoideakirurgi i Norge 1999 – 2005
Tidsskr Nor Lægeforen 2007; 127: 1181-4 (3.5.2007)
Sammendrag
Bakgrunn. En rapport fra perioden 1990 - 94 viste til dels betydelige regionale forskjeller i behandlingen av hyperparatyreoidisme. Det er uenighet om indikasjonsstilling for kirurgi. Hensikten med denne studien er å undersøke regionale variasjoner i operasjonsfrekvens hos pasienter som opereres for hyperparatyreoidisme i Norge. (...)

Fortolkning. Økningen i antall inngrep og de store regionale variasjonene bør undersøkes nærmere. Ettersom adenomer i parathyreoidea ikke representerer en premalign tilstand og rapporteringen er mangelfull, er det grunnlag for å vurdere et generelt unntak i meldeplikten til Kreftregisteret. (...)

Norsk Thyreoideaforbund ønsker bedre samarbeid med legene
Bente Bakke
Tidsskr Nor Lægeforen 2007; 127: 1083 (19.4.2007)
Norsk Thyreoideaforbund er en pasientorganisasjon for alle med sykdom i skjoldkjertelen. Foreningen har over 5 500 medlemmer, regionråd i alle helseregioner og nesten 50 lokallag. Vi kan tilby informasjonsmateriell (www.stoffskifte.org), medlemsbladet Thyra, som kommer ut fire ganger i året, og kontakt med likesinnede med samme sykdom. Vi legger stor vekt på likemannsarbeidet og hjelp til mestring av sykdommen. (...)

Management of hypothyroidism during pregnancy (Behandling av hypothyreose under graviditet)
CMAJ 2007;176 (8) (April 10)
(...) Maternal hypothyroidism has been reported to affect as many as 2.5% of pregnancies. Low concentrations of maternal thyroid hormones during early gestation delays neurodevelopment of the fetus and may lead to lower intelligence quotient scores compared with those of age-matched controls.¹ It has long been recognized that women with known primary hypothyroidism should have their thyroid stimulating hormone level checked at least once per trimester. (...)

Dangers Of Drug Interactions, Incorrect Diagnoses
courant.com 6.4.2007
(...) I was diagnosed with "depression," and for several years I took a series of different antidepressant drugs.

The results were unsatisfactory, and I experienced many unpleasant side effects.

Then one year I was hospitalized for an unrelated medical problem. During the tests, I was found to be suffering from severe hypothyroidism. I needed Synthroid, not Zoloft! (...)

Total thyroidectomy is best operation for thyrotoxicosis
Letter
BMJ 2007;334:710 (7 April)
(...) Total thyroidectomy is the only appropriate procedure for the surgical management of thyrotoxicosis in the United Kingdom. It guarantees cure, and, although it also guarantees hypothyroidism, thyroxine replacement treatment is far more predictable as the operation is clearly defined. (...)

Sterkere fokus på lavt stoffskifte
aftenposten.no 15.3.2007
Det er positivt at den høyt profilerte indremedisineren Fedon Lindberg er opptatt av vår største stoffskiftesykdom diabetes, men vi er overrasket over at han ikke er mer opptatt av stoffskiftesykdommer knyttet til skjoldbruskkjertelen
(thyreoidea). Særlig lavt stoffskifte er i dag meget utbredt og trolig underdiagnostisert. De mest vanlige symptomene er ekstrem tretthet, depresjon, konsentrasjons og hukommelsesproblemer, leddsmerter, frossenhet og vektøkning.

Alle med slike symptomer bør sjekke stoffskiftet. Lindberg blir lyttet til når det gjelder vektkontroll, livsstil og kosthold. Men for en med uoppdaget lavt stoffskifte vil det være lite å hente ved å prøve Lindbergs oppskrifter for å gå ned i vekt. Mangel på produksjon av stoffskiftehormon er problemet, ikke for mye mat og for lite mosjon. Ved å få en tidlig diagnose og optimal behandling kan mange med lavt stoffskifte blant annet unngå å få store problemer med vekten. Bente Bakke, forbundsleder, Norsk Thyreoideaforbund. (...)

Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials
BMJ, doi:10.1136/bmj.39114.670150.BE (published 19 February 2007)
(...) Conclusions Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively. (...)

Clinical & Research NewsMany Bipolar Patients Face Multiple Medical Illnesses
Psychiatr News November 17, 2006
Volume 41, Number 22, page 21
© 2006 American Psychiatric Association
(...) Lithium treatment for bipolar illness might be responsible for the hypothyroidism and kidney failure from which the bipolar group suffered significantly more often than did the controls. (...)

Etablerer nye legespesialiteter innen kirurgi
helserevyen.no 2.11.2006
Brystkreftkirurgi og skjoldbruskkjertelkirurgi skal for framtiden håndteres av egne legespesialister, noe som vil føre til flere samlokaliseringer av fagområdene.

Beslutningen om å opprette en egen grenspesialitet i mamma– og para-/tyreoideakirurgi er tatt av Helse- og omsorgsdepartementet på grunnlag av råd fra blant andre Nasjonalt råd for spesialistutdanning av leger og Sosial- og helsedirektoratet, melder departementet. (...)

Daily Women's Health Policy
Pregnancy & Childbirth | Low Thyroid Levels During Pregnancy Increases Risk of Neurological Development Complications in Infants, Study Says
kaisernetwork.org 25.1.2006 (...)

Hashimoto's Encephalopathy: A Brief Introduction
thyroid.about.com 12.6.2005
Hashimoto's Thyroiditis is the autoimmune thyroid disease that is the most common cause of hypothyroidism, an underactive thyroid. A very rare condition associated with Hashimoto's Thyroiditis is Hashimoto's Encephalopathy, a neuroendocrine disorder. Much like the antibodies in Hashimoto's Thyroiditis attack the thyroid, in Hashimoto's Encephalopathy, antibodies attack neurons in the brain. While Hashimoto's Encephalopathy is quite rare (there may only be several dozen diagnosed patients in the U.S.) it is also likely that there are many more undiagnosed sufferers. Because it is little known and its symptoms are primarily neurological, it is easy to misdiagnosis or overlook and the symptoms frequently lead to mistaken neurological diagnoses. (...)

Subclinical Hypothyroidism and Cardiovascular Disease
Arch Intern Med. 2005;165:2451-2452.
The association of overt hypothyroidism with cardiovascular disease (CVD) is widely accepted with the implicit assumption that the risk of CVD rises as the severity of hypothyroidism increases. There are several possible mechanisms by which hypothyroidism could cause CVD, including increases in the probability of atherosclerosis by an adverse lipid or homocysteine profile, as well as direct adverse effects on myocardial or cardiovascular function.

In contrast, the association of subclinical hypothyroidism (defined as a serum-free thyroxine level within the reference range and an elevated serum thyroid-stimulating hormone [TSH] level) with CVD in studies to date has been controversial. Community-based, cross-sectional studies of the relationship between subclinical hypothyroidism (SH) and the prevalence of CVD at study entry have produced mixed results, with some showing a strong association,1 some a weak association,2-3 and others no association.4-5 Longitudinal studies1, 3, 6-8 . . . [Full Text of this Article] (...)

Behandling av hypotyreose
Egil Haug Tidsskr Nor Lægeforen 2002; 122: 935-7 utg
Bakgrunn. Hypotyreose er en vanlig sykdom. Forekomsten hos kvinner er 5 - 6 % og hos menn 1 - 2 %. Primær hypotyreose er den dominerende formen (> 98 %). Autoimmun tyreoiditt og thyreoideadestruksjon som følge av radiojodbehandling eller tyreoidektomi er de vanligste årsakene til primær hypotyreose. (...)

Perifer nevropati ved kreft
Tidsskr Nor Lægeforen 2001; 121:194-7 (20.1.2001)
(...) Nevropati sekundært til endokrin svikt
Tidligere kreftbehandling kan føre til svikt i endokrine organer, noe som igjen kan forårsake nevropati. Mest aktuelt i denne sammenheng er hypotyreose, som kan oppstå sekundært til hypofysedysfunksjon etter strålebehandling på grunn av hjernesvulster eller nasofaryngeale svulster. Hypotyreose kan også oppstå hos pasienter som tidligere har hatt Hodgkins lymfom og er blitt bestrålt mot regionale lymfeknuter på halsen (3). (...)