Symptomer, tegn, og prognoser - subakutt tyreoiditt (merck.com (Merck Manual)) - tyreotoksikose (BMJ)

Sköldkörtelhormon viktigare för hjärnans funktion än man tidigare trott (Karolinska Institutet 30.8.2005)

Bilder før og etter behandling (sonjas-stoffskifteforum.info)

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

Hvorfor går det så langsomt? (aftenposten.no 24.6.2013)

...dersom du ønsker å vite noe om virkelig ekstrem utmattelse, den type som lenker deg til sengen, spør noen som har en skjoldbruskkjertellidelse. (cnn.com 10.5.2007)

En kald, uklar og ødematøs 56 år gammel mann (Tidsskr Nor Legeforen 2008; 128:572-3)

Tid er kritisk for barn med stoffskiftesykdom (helserevyen.no 17.10.2007)

Krever test av alle gravide (helserevyen.no 20.11.2007)

Ronaldos overvekt skyldtes lavt stoffskifte (dagbladet.no 24.8.2007)

Robbie Williams (thesun.co.uk 6.10.2010)

Ti tegn på at du kan ha et thyreoideaproblem (Top Ten Signs That You Might Have a Thyroid Problem) (about.com)

Thyreoidea (bilde thyreoidea)

Sterkere fokus på lavt stoffskifte (aftenposten.no 15.3.2007)

Tilleggsmedisinering med liotyronin ved hypotyreose? (Tidsskr Nor Lægeforen 2006; 126: 3285)

Synthroid (levothyroxine sodium) (fda.gov) (Forgiftninger)

- Sköldkörtelhormon viktigare för hjärnans funktion än man tidigare trott.

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". (...)

(Anm: Anxiety, memory impairment, and locomotor dysfunction caused by a mutant thyroid hormone receptor alpha1 can be ameliorated by T3 treatment. Genes Dev. 2005 Sep 15;19(18):2152-63.)

(Anm: 15 Cancer Symptoms to Know (webmd 28.3.2016).)

(Anm: Do You Have a Hormone Imbalance? (webmd.com 4.11.2016).)

(Anm: Common Thyroid Problems. Common Thyroid Problems. (medicinenet.com 1.8.2017).)

(Anm: Hyperthyroidism Symptoms and Treatment (medicinenet.com 27.7.2016).)

(Anm: What Does It Mean When Your Body Aches? (medicinenet.com 31.8.2017).)

(Anm: Slideshow: Thyroid Symptoms and Solutions (webmd.com 15.4..2014).)

(Anm: Health Secrets Your Hair May Reveal. What Your Hair & Scalp Say About Your Health (webmd.com 11.12.2015).)

(Anm: How does the thyroid manage your metabolism? - Emma Bryce (ed.ted.com).)

(Anm: Thyroid cancer patients opting for non-intervention face challenging path, study reveals (news-medical.net 10.3.2017).)

(Anm: Exposure to EDCs alters thyroid hormone signalling, early brain development in frog embryos (news-medical.net 13.3.2017).)

(Anm: Blood levels of thyroid hormone may help identify individuals at risk for irregular heartbeat. Individuals with higher levels of thyroid hormone (free thyroxine, FT4) circulating in the blood were more likely than individuals with lower levels to develop irregular heartbeat, or atrial fibrillation, even when the levels were within normal range, according to new research in the American Heart Association's journal Circulation. (news-medical.net 23.10.2017).)

(Anm: Thyroid cancer surgery complications higher than previously thought, study suggests. As thyroid cancer rates rise, more people are having surgery to remove all or part of their thyroid. A new study suggests complications from these procedures are more common than previously believed. Overall, 6.5 percent of thyroid cancer patients had general post-operative complications in the month after surgery, and 12 percent had complications specific to thyroid surgery within the year after their operation. But the risks were significantly higher for certain groups, suggesting the opportunity for targeted interventions and education to improve outcomes. (news-medical.net 16.5.2017).)

(Anm: Thyroid Allostasis–Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. The hypothalamus–pituitary–thyroid feedback control is a dynamic, adaptive system. In situations of illness and deprivation of energy representing type 1 allostasis, the stress response operates to alter both its set point and peripheral transfer parameters. In contrast, type 2 allostatic load, typically effective in psychosocial stress, pregnancy, metabolic syndrome, and adaptation to cold, produces a nearly opposite phenotype of predictive plasticity. Front. Endocrinol., 20 July 2017.)

- Patienterna: Stora brister inom sköldkörtelvården. En majoritet av de som lider av sköldkörtelsjukdom är missnöjda med vården, det visar en undersökning som Netdoktor har gjort på uppdrag av Sköldkörtelförbundet. ”Alarmerande”, säger förbundets ordförande Anders Palm. Sköldkörteln producerar livsviktiga hormoner som reglerar kroppens ämnesomsättning, det vill säga hur kroppen utvinner energi från det vi äter och omvandlar det till bränsle för cellerna.

(Anm: Patienterna: Stora brister inom sköldkörtelvården. En majoritet av de som lider av sköldkörtelsjukdom är missnöjda med vården, det visar en undersökning som Netdoktor har gjort på uppdrag av Sköldkörtelförbundet. ”Alarmerande”, säger förbundets ordförande Anders Palm. Sköldkörteln producerar livsviktiga hormoner som reglerar kroppens ämnesomsättning, det vill säga hur kroppen utvinner energi från det vi äter och omvandlar det till bränsle för cellerna. Om sköldkörteln inte fungerar går den här processen antingen snabbare eller långsammare än normalt. Om sköldkörteln är underaktiv kan man bland annat bli sjukligt trött, få koncentrationssvårigheter, sömnproblem och sämre minne. Man kan också gå upp i vikt, känna sig frusen och ha problem att skaffa barn. 80 procent av de som drabbas är kvinnor. Läs mer: Hypotyreos (låg ämnesomsättning) (netdoktor.se 26.9.2017).)

- Autoimmun tyreoiditt (betennelse i skjoldbruskkjertel) og myasthenia gravis.

(Anm: Autoimmune Thyroiditis and Myasthenia Gravis. Autoimmune diseases (AIDs) are the result of specific immune responses directed against structures of the self. In normal conditions, the molecules recognized as “self” are tolerated by immune system, but when the self-tolerance is lost, the immune system could react against molecules from the body, causing the loss of self-tolerance, and subsequently the onset of AID that differs for organ target and etiology. Autoimmune thyroid disease (ATD) is caused by the development of autoimmunity against thyroid antigens and comprises Hashimoto’s thyroiditis and Graves disease. They are frequently associated with other organ or non-organ specific AIDs, such as myasthenia gravis (MG). In fact, ATD seems to be the most associated pathology to MG. The etiology of both diseases is multifactorial and it is due to genetic and environmental factors, and each of them has specific characteristics. The two pathologies show many commonalities, such as the organ-specificity with a clear pathogenic effect of antibodies, the pathological mechanisms, such as deregulation of the immune system and the implication of the genetic predisposition. They also show some differences, such as the mode of action of the antibodies and therapies. In this review that focuses on ATD and MG, the common features and the differences between the two diseases are discussed. Front. Endocrinol. 2017 (13 July 2017).)

(Anm: Myasthenia gravis. Myasthenia gravis er en sykdom som fører til muskelsvakhet og økt trettbarhet i muskulaturen. Forskjellige muskelgrupper kan rammes i ulik grad. Hva er myasthenia gravis? Myasthenia gravis er en sykdom som fører til muskelsvakhet og økt trettbarhet i muskulaturen. (…) Symptomer. Symptomutviklingen er oftest langsom, men sykdommen kan også debutere raskt med fullt utviklet sykdom. Tidlige symptomer er ofte nedsiging av øyelokk og dobbeltsyn, dette er debutsymptomet hos 3/4 av pasientene. Andre symptomer som kan komme tidlig, er nasal tale, tale- og svelgebesvær, svikt i kraften til å holde eller bevege hodet. Pasienter med myasteni blir bedre etter hvile. (…) Blodprøver med måling av ulike typer antistoffer er viktige i utredningen. Antistoffer mot acetylkolinreseptorer påvises hos ca. 85%. Ved usikkerhet om diagnosen finnes det også andre antistofftester som kan benyttes. (nhi.no 27.4.2015).)

- Skjoldbruskkjertelsykdommer: En undervurdert lidelse. Visste du at skjoldbruskkjertelproblemer er blant de vanligste sykdommer i verden? Faktisk er rundt 1,6 milliarder mennesker over hele verden utsatt for risiko, og de aller fleste er kvinner.

(Anm: Thyroid disorders: An illness underestimated. Did you know that thyroid disorders are among the most common diseases in the world? In fact, about 1.6 billion people worldwide are at risk, and the vast majority of those are women. The hormones produced in the thyroid gland help regulate many different functions in the body, thus making symptoms of thyroid disorders very diverse. The inconspicuous symptoms make thyroid disorders difficult to spot and can lead to low awareness; for example, in the United States up to 60% of people who suffer from thyroid disease are unaware of their condition. (pharmafile.com 29.8.2017).)

- Hvordan legemidler påvirker skjoldbruskfunksjonen. Unormale resultater av skjoldbruskfunksjonstester er vanlige i klinisk praksis.

(Anm: How medications affect thyroid function. Abnormal results of thyroid function tests are common in clinical practice. The diagnosis of thyroid dysfunction is easily made, especially if the clinical signs and symptoms of thyroid dysfunction are also present. In elderly patients aged 65 years and older, who often have atypical presentations, the diagnosis of thyroid dysfunction is more difficult. Sometimes laboratory findings are abnormal because of a patient's use of medications or the presence of unrelated and nonthyroidal medical illnesses. Many abnormalities identified by thyroid laboratory tests can be caused by various illnesses that do not directly involve the thyroid gland. This “euthyroid sick syndrome” occurs in as many as 70% of patients who have been admitted to a hospital., Recognition is critical because therapy is not necessary and may be detrimental. There results of thyroid function tests often revert to normal once the patient recovers from the illness. In this review, I focus on medications that interfere with the proper interpretation of thyroid function test results, cause thyroid illnesses, influence levothyroxine requirements, and impair absorption of exogenous levothyroxine. (…) Serotonin reuptake inhibitors may also alter T4 requirements. In nine patients receiving thyroxine therapy, an elevation in thyrotropin levels and a reduction in FT4 levels were noted after the addition of sertraline hydrochloride. An increase in thyroxine clearance was thought to have occurred. West J Med. 2000 Feb; 172(2): 102–106.)

(Anm: Elevated serum thyrotropin in thyroxine-treated patients with hypothyroidism given sertraline. N Engl J Med. 1997 Oct 2;337(14):1010-1.)

(Anm: Developmental Exposure to Fluoxetine Modulates the Serotonin System in Hypothalamus. PLoS One. 2013; 8(1): e55053.)

(Anm: Effects of Citalopram on Serotonin and CRF Systems in the Midbrain of Primates with Differences in Stress Sensitivity. J Chem Neuroanat. 2011 Jul; 41(4): 200–218.)

- Hunder og serotonin (Dogs and Serotonin). (- Artikkelen advarer om farene ved antidepressiva-indusert serotonin syndrom (SS), en tilstand som kan føre til «sykdom, endrede mentale tilstander og til og med død» hvis tilstanden er ubehandlet.)

(Anm: Dogs and Serotonin. Editorial Note: This post by Leonie Fennell is the first of two on related themes. We would love to hear any observations you or your veterinarian have on drugs in animals in general. Depression, once a disease deemed too rare to merit study, has become so common that it is now a booming business. More and more people are asking: “When we stop at the pharmacy to pick up our Prozac, are we simply buying a drug? Or are we buying into a disease as well?” In the last 20 years depression numbers have rocketed and according to the World Health Organisation, more than 300 million people of all ages are suffering globally. And it seems to be spreading to pets. An article last week caught my attention – ‘Serotonin Syndrome in Dogs: Symptoms, Causes, & Treatment’. The article warns of the dangers of antidepressant-induced Serotonin Syndrome (SS), a condition that if left untreated, can result in ‘illness, altered mental states, and even death’. Considering I’ve seen first-hand the effects that antidepressants can have on humans, particularly depersonalization, aggression and suicidality, I have always wondered whether similar effects can be seen in canines. What might the growing practice of drugging our pets lead to? (…) Lilly’s own literature(1) report the following adverse reactions with dogs taking Reconcile/Prozac: -  Calm/Lethargy/Depression – 32.9% - Shaking/Shivering/Tremor – 11.1% - Restlessness – 7.4% - Aggression –  4.2% (davidhealy.org 16.10.2017).)

- Alt du trenger å vite om ductus thyreoglossus cyster.

(Anm: All you need to know about thyroglossal duct cysts. A thyroglossal duct cyst is a fluid-filled pocket in the front of the neck, just above the voice box. The cyst forms in tissue that is sometimes left over from the development of the thyroid gland. Thyroglossal cysts are present at birth and often occur in children. Contents of this article: How do they form within the neck? Symptoms How are they diagnosed? Treatment What are the risks and complications? Takeaway (medicalnewstoday.com 19.10.2017).)

(Anm: Toxic nodular goiter. Toxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of these nodules produce too much thyroid hormone. (medlineplus.gov 3.10.2017).)

(Anm: T3 Test. (…) High T3 levels If you’re not pregnant or suffering from liver disease, elevated T3 levels might indicate thyroid issues, such as: - Graves’ disease – hyperthyroidism - painless (silent) thyroiditis - thyrotoxic periodic paralysis - toxic nodular goiter. High T3 levels might also indicate high levels of protein in the blood. In rare cases, these elevated levels could indicate thyroid cancer or thyrotoxicosis.  (healthline.com 8.4.2016).)

(Anm: Spyttkjerteldrenasje til ductus thyreoglossus. Manglende tilbakedanning av ductus thyreoglossus er en av de vanligste årsakene til ekspansjoner i halsens midtlinje. Det er beskrevet flere tilfeller av residiverende thyreoglossus-cyster med påfølgende sinusdanninger og plagsom sekresjon. Få har beskrevet aksessorisk spyttkjertel som tømmer seg i ductus thyreoglossus og som kan føre til residiv ved suboptimal kirurgi. Vi ønsker å gjøre oppmerksom på denne varianten via to kasuistiske meddelelser om pasienter som etter grundig preoperativ utredning ble vellykket kirurgisk behandlet. Tidsskr Nor Legeforen 2001 121:166-7 (20.1.2001).)

- Høy normal skjoldbruskkjertelfunksjon knyttet til tidlig død. Lengre liv uten CV-sykdom observert med lav normal funksjon. Skjoldbruskkjertelfunksjon i den lave enden av normal er forbundet med bedre forventet levetid uten kardiovaskulær sykdom enn høy normal funksjon, viste en populasjonsbasert studie.

(Anm: High-Normal Thyroid Function Tied to Early Death. Longer life free of CV disease observed with low-normal function. Thyroid function on the low end of normal is associated with better life expectancy free of cardiovascular disease than is high-normal function, a population-based study showed. Participants with low-normal thyroid function -- by tertile within the normal range for thyrotropin and free thyroxine (FT4) -- lived up to 3.5 years longer overall and up to 3.1 years longer without cardiovascular disease (CVD) than did those in the high-normal tertiles for the two hormones. The highest FT4 tertile had 32% higher incident cardiovascular disease risk than the lowest tertile, "meaning an earlier clinical manifestation of CVD and more years lived with CVD," and a 64% higher mortality risk when they did have CVD, "which explains the decrease in the number of years lived with CVD." For thyrotropin, life expectancy increased from the lowest to the middle tertile without much change thereafter. It didn't correlate with cardiovascular disease, reported Robin Peeters, MD, PhD, of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues in JAMA Internal Medicine. The analysis of the Rotterdam Study included a prospective cohort of 7,785 participants ages ≥45 (average age 64.7) without known thyroid disease, and with thyrotropin and FT4 levels within the reference range (0.40-4.0 mIU/L thyrotropin and 0.86-1.94 ng/dL FT4). The study isn't the first to suggest that high-normal thyroid function is associated with risk, but "it extends the previous literature by revealing considerable differences in life expectancy within the reference range of thyroid function," the researchers wrote. (medpagetoday.com 19.9.2017).)

- Lavere enn normale TSH-nivåer knyttet til økt risiko for skjoldbruskkjertelkreft.

(Anm: Lower-than-normal TSH levels linked to increased risk of thyroid cancer. hormone levels, a finding that could have a major impact on patients fighting the disease. The Yale-led study, published in American Association for Cancer Research journal examined the effect of Thyroid Stimulating Hormone (TSH) on the development of human papillary thyroid cancer (PTC). (…) Thyroid cancer has the highest prevalence of all endocrine malignancies, and its incidence is increasing faster than any other malignancy among both men and women. In the United States, thyroid cancer is the ninth most common cancer and PTC accounts for more than 80 percent of all thyroid cancers. But causal factors underlying thyroid cancer remain poorly understood. TSH is the major growth factor of thyroid cells and regulator of thyroid functions. (news-medical.net 28.9.2017).)

- For lavt jodinntak hos mor påvirker barnets utvikling.

(Anm: For lavt jodinntak hos mor påvirker barnets utvikling. En ny studie fra Folkehelseinstituttet viser at for lavt jodinntak hos mor under graviditeten er assosiert med økt risiko for språkforsinkelse, atferdsproblemer og forsinket finmotorisk utvikling. (…) Studien er publisert i julinummeret av det vitenskapelige tidsskriftet Journal of Nutrition, og bruker data fra Den norske mor og barn-undersøkelsen (MoBa). Brantsæter forklarer at forskerne har sett en tydelig dose-respons-sammenheng mellom mors rapporterte jod-inntak og barnas utvikling ved tre-års alder. (…) Endringer i hjernen. Denne kunnskapen bygger opp under tidligere studier som viser at jodmangel hos gravide kan påvirke barnets utvikling negativt. Næringsstoffet jod inngår i skjoldbruskkjertelhormonene thyroxin og T3. (dagensmedisin.no 2.8.2017).)

(Anm: Phthalates and thyroid function in preschool age children: Sex specific associations. (…) Conclusions The data show inverse and sex specific associations between specific phthalate metabolites measured in children at age 3 and thyroid function in preschool children. These results may provide evidence for the hypothesis that reductions in thyroid hormones mediate associations between early life phthalate exposure and child cognitive outcomes. Environment International 2017;106:11–18 (September 2017).)

(Anm: Skeptisk forsker: Vi ved ikke, om hormonforstyrrende stoffer overhovedet er skadelige. (…) Sådan siger professor emeritus Steen Honoré Hansen, der er tilknyttet Department of Pharmacy, Analytical Biosciences på Københavns Universitet i kølvandet på Videnskab.dk's artikelserie 'Forstyrrede hormoner'. (…) Dyreforsøg er det bedste, vi har. Selvom vi ikke kan teste stofferne på mennesker, er dyreforsøg trods alt det bedste redskab, vi har til at undersøge hormonforstyrrende stoffer, mener Niels Erik Skakkebæk. Han får opbakning fra professor Anders Juul, der er leder af Rigshospitalets afdeling for Vækst og Reproduktion. »Jeg er ikke i tvivl om, at hormonforstyrrende stoffer kan være meget farlige og lede til en række sygdomme, men der vil altid være skeptikere,« afslutter han. (jyllands-posten.dk 4.6.2017).)

- Forskere undersøker link mellom skjoldbruskkjertelhormoner og produksjon av røde blodceller. (- Med denne bedre forståelsen av sammenhengen mellom skjoldbruskkjertelhormoner og modning av røde blodceller kan forskere identifisere nye terapier som utløser modning av røde blodceller hos pasienter med bestemte typer anemier, inkludert de med en underaktiv skjoldbruskkjertel.)

(Anm: Researchers investigate link between thyroid hormone and red blood cell production. For more than a century, physicians have anecdotally noted that patients with an underactive thyroid- often caused by iodine deficiency- tended to also have anemia. But the link between thyroid hormone and red blood cell production has remained elusive. That is, until two postdoctoral researchers in the lab of Whitehead Institute Founding Member Harvey Lodish, Xiaofei Gao and Hsiang-Ying "Sherry" Lee, decided to investigate. (…) Thyroid hormone's role is so important in stimulating red blood cell maturation, they discovered, that if it is added at an earlier stage of development, red blood cells short-circuit their usual developmental processes and begin turning into mature red blood cells. Gao and Lee then teased apart the mechanism behind thyroid hormone's effect on red blood cell maturation. They pinpointed the specific type of receptor inside maturing red blood cells to which thyroid hormone binds. From there, they identified a protein that is necessary for thyroid hormone stimulation and that acts as a regulator of the final step of red blood cell production. With this better understanding of the connection between thyroid hormone and red blood cell maturation, scientists may be able to identify new therapies that trigger red blood cells maturation in patients with specific types of anemia, including those with an underactive thyroid. (news-medical.net 6.9.2017).)

- Scientists show how receptors for drugs act inside cells. (- The signal is then transmitted inside the cell, mainly through the production of an intracellular second messenger such as cyclic adenosine monophosphate (short cAMP). This second messenger, in turn, is involved in the regulation of a large number of cell functions, such as gene transcription and cell division.) (- The newly described mechanism of GPCR signaling inside thyroid cells can be recapitulated as follows: upon TSH binding, TSH receptors are taken up by the cells (internalized) and transported to the trans-Golgi network.)

(Anm: Scientists show how receptors for drugs act inside cells. G protein-coupled receptors are the key target of a large number of drugs. Würzburg scientists have now been able to show more precisely how these receptors act in the cell interior. The human genome encodes hundreds of G protein-coupled receptors (GPCRs). These form the largest group of receptors through which hormones and neurotransmitters exert their functions on our cells. Therefore, they are of highest importance as drug targets: around half of all prescribed drugs act on these receptors - and thus GPCRs help in the treatment of widespread diseases such as hypertension, asthma or Parkinson. Publication in Nature Communications. For a long time, scientists were convinced that GPCRs sit at the cell surface and only from there influence the activity of the cell via activation of various intracellular signaling cascades. This belief has been shaken by a series of recent studies. (…) The results of their work are presented in the current issue of the journal Nature Communications. In simplified terms, G-protein-coupled receptors sit at the cell membrane waiting for a hormone or neurotransmitter to bind and thereby activate them. The signal is then transmitted inside the cell, mainly through the production of an intracellular second messenger such as cyclic adenosine monophosphate (short cAMP). This second messenger, in turn, is involved in the regulation of a large number of cell functions, such as gene transcription and cell division. Receptors are also active in the cell interior. "The first indication that GPCRs also initiate the production of cAMP in the cell interior came from two studies of typical protein hormone receptors," says Davide Calebiro. He and his team were responsible for one of these studies; they had investigated a receptor important for the production of thyroid hormones - the so-called thyroid-stimulating hormone (TSH) receptor. "Those studies independently showed that GPCRs are able to induce a second, persistent phase of cAMP production in the cell interior," said Davide Calebiro. In fact, this phenomenon was shown to be "biologically relevant". However, the exact mechanism was largely unknown. (…) The newly described mechanism of GPCR signaling inside thyroid cells can be recapitulated as follows: upon TSH binding, TSH receptors are taken up by the cells (internalized) and transported to the trans-Golgi network. There, the receptors induce the production of cAMP and activate another enzyme - protein kinase A. Since these events happen in close proximity to the nucleus, where the genetic information of the cell is stored, they modify gene transcription. (…) (news-medical.net 5.9.2017).)

- Eksponering for spesifikke toksiner og næringsstoffer under sen graviditet og tidlig i livet korrelerer med autismerisiko.

(Anm: Eksponering for spesifikke toksiner og næringsstoffer under sen graviditet og tidlig liv korrelerer med autismerisiko. Exposure to specific toxins and nutrients during late pregnancy and early life correlate with autism risk. Using evidence found in baby teeth, researchers from The Senator Frank R. Lautenberg Environmental Health Sciences Laboratory and The Seaver Autism Center for Research and Treatment at Mount Sinai found that differences in the uptake of multiple toxic and essential elements over the second and third trimesters and early postnatal periods are associated with the risk of developing autism spectrum disorders (ASD), according to a study published June 1 in the journal Nature Communications. (sciencedaily.com 10.6.2017).)

(Anm: Babytenner linket til autisme, tungmetaller. Babytenner hos barn med autisme inneholder mer giftig bly og mindre av de essensielle næringsstoffene sink og mangan, sammenlignet med tenner fra barn uten autisme, ifølge en studie publisert i journal Nature Communications. Forskjellene i metallopptak mellom barn med og uten autisme var spesielt bemerkelsesverdige i løpet av månedene like før og etter at barna ble født. Forskere bestemte dette ved å bruke lasere til å kartlegge vekstringene i baby-tenner generert under ulike utviklingsperioder. (dgnews.docguide.com 2.6.2017).)

(Anm: Bruk av Paracetamol i svangerskapet linket til autisme, ADHD hos barn (Acetaminophen use in pregnancy linked to autism, ADHD in offspring) (medicalnewstoday.com 4.7.2016).)

(Anm: Discovery of steroid hormone in fruit flies may shed new light on maternal hypothyroidism. (…) Their discovery -- a fundamental advance for biology and neuroscience, and detailed in a paper published April 10 in the journal eLife -- also may shed new light on maternal hypothyroidism, a human condition in which too little thyroid is produced and is dangerous for pregnant women and their developing babies. (…) Normal thyroid production in people controls food metabolism, which, in turn, regulates body temperature and heart rhythm. When thyroid levels are too low, pregnant women are at risk for miscarriage, hypertension and premature birth. (news-medical.net 16.5.2017).)

(Anm: Steroid hormone induction of temporal gene expression in Drosophila brain neuroblasts generates neuronal and glial diversity. Elife. 2017 Apr 10;6. pii: e26287.)

(Anm: Study on brain formation finds possible link to human disease. (around.uoregon.edu 15.5.2017).)

(Anm: TV-værten Lene Beier har i dagbladet BT netop fortalt om den stofskiftesygdom, hun har levet med i mange år. Den hedder myksødem - i daglig tale lavt stofskifte. I artiklen fortæller hun om, hvordan hun følte, at hun var tæt på at dø, og hvor svært det var for lægerne at finde ud af, hvad hun fejlede. (netdoktor.dk 2.11.2016).)

(Anm: Thyroid Storm: What You Need to Know. (…) What is thyroid storm? Without treatment for overactive thyroid problems, people can develop serious health problems. These can include heart problems, weak and brittle bones, and even death. Thyroid storm is a rare but life-threatening condition that can occur if hyperthyroidism is not treated. Thyroid storm can occur in any patient with untreated hyperthyroidism.  (medicalnewstoday.com 22.8.2016).)

- Encefalopati assosiert med autoimmun thyreoideasykdom. (- De fleste tilfeller er forbundet med Hashimotos tyreoiditt, men et antall pasienter med Graves 'sykdom er også blitt beskrevet.)

Encephalopathy Associated With Autoimmune Thyroid Disease. (Encefalopati assosiert med autoimmun thyreoideasykdom.)
EMJ Neurol. 2014;1:72-77.
Autoimmune skjoldbrusksykdommer (ATD-er) er en immunendokrine lidelser som påvirker skjoldbruskkjertelen og til slutt også en rekke andre systemiske mål, inkludert hjernen og nervesystemet. Encefalopati som er assosiert med autoimmun thyreoideasykdom (EAATD) er en sjelden heterogen tilstand som oppstår på bakgrunn av en ATD. Den er preget av nevrologiske og / eller psykiatriske symptomer med akutt eller subakutt debut, og praktisk talt alle nevrologisk eller psykiatriske symptom kan opptre. Imidlertid presenteres ofte EAATD med forvirring, endret bevissthet, kramper, eller myoklonus. De fleste tilfeller er forbundet med Hashimotos tyreoiditt, men et antall pasienter med Graves 'sykdom er også blitt beskrevet. (…) (Autoimmune thyroid diseases (ATDs) are immune-endocrine disorders affecting the thyroid gland and, eventually, also a number of other systemic targets, including the brain and the nervous system. Encephalopathy associated with autoimmune thyroid disease (EAATD) is a rare, heterogeneous condition arising from the background of an ATD. It is characterised by neurological and/or psychiatric symptoms with acute or sub-acute onset, and virtually any neurological or psychiatric symptom can appear. However, EAATD often presents with confusion, altered consciousness, seizures, or myoclonus. The majority of cases are associated with Hashimoto’s thyroiditis, but a number of patients with Graves’ disease have also been described.)

(Anm: Encefalopati, sykdom i hjernen. Brukes oftest sammen med et adjektiv som angir årsaken, f.eks. traumatisk encefalopati etter hodeskader, vaskulær encefalopati ved karsykdommer i hjernen, toksisk encefalopati ved forgiftninger o.l. Kilde: Store norske leksikon.)

(Anm: Cardiac arrhythmias reduced by thyroid hormones in rat model (medicalnewstoday.com 16.12.2014).)

(Anm: Thyroid Function Linked With Dementia Risk. (...) -- Thyroid function appears to play a role in the development of dementia, researchers said here at the 15th International Thyroid Congress (ITC).  (…) “The researchers found that a higher TSH level correlated with lower risk of dementia. TSH level yielded a hazard ratio of 0.90 for dementia. The reverse was also true: lower TSH correlated with a higher risk of dementia. (dgnews.docguide.com 21.10.2015).)

(Anm: Potensielt reversibel encefalopati-syndrom? Tidsskr Nor Lægeforen 2007; 127:596 (1.3.2007).)

(Anm: Det er vanlig at mennesker med skjoldbruskkjertelproblemer blir feildiagnostisert som psykisk syke (For enkelte starter psykiatriske problemer i skjoldbruskkjertelen) (nytimes.com 21.11.2011).)

(Anm: Subclinical hyperthyroidism associated with an increased risk of hip and other fractures (medicalnewstoday.com 26.5.2015).)

(Anm: High-normal thyroid hormone level in pregnancy may affect fetal brain development (medicalnewstoday.com 10.3.2015).)

- Oppdagelse kan påvirke forståelse, behandling av autoimmune og inflammatoriske sykdommer.

(Anm: Discovery could impact understanding, treatment of autoimmune and inflammatory diseases. Scientists from the Research Institute of the McGill University Health Centre (RI-MUHC) may have cracked the code to understanding the function of special cells called regulatory T Cells. Treg cells, as they are often known, control and regulate our immune system to prevent excessive reactions. The findings, published in Science Immunology, could have a major impact in our understanding and treatment of all autoimmune diseases and most chronic inflammatory diseases such as arthritis, Crohn's disease as well as broader conditions such as asthma, allergies and cancer. Researchers made this discovery by investigating a rare human mutation in a gene called FOXP3. Although the importance of the FOXP3 gene in the proper function of Treg cells has been well documented, its mechanisms were still not fully understood by scientists. (news-medical.net 5.7.2017).)

(Anm: Surprising finding provides more support for Alzheimer's being an autoimmune disease. Brain levels of the lipid ceramide are high in Alzheimer's disease, and now scientists have found increased levels of an antibody to the lipid in their disease model. (medicalnewstoday.com 10.3.2015).)

(Anm: Relationships Between Mitochondria and Neuroinflammation: Implications for Alzheimer's Disease. Curr Top Med Chem. 2015 Aug 26. [Epub ahead of print].)

(Anm: Problems finding your way around may be earliest sign of Alzheimer's disease (medicalnewstoday.com 22.4.2016).)

(Anm: T cell type that promotes damaging immune response discovered. For the first time, researchers have identified a type of T cell that plays a key role in promoting the damaging autoimmune response that inflames and attacks the joints in rheumatoid arthritis. The discovery - made with technologies that help to analyze just a "handful of cells" - offers vital new clues to the biology of the disease and could lead to more powerful, targeted treatments. The study - led by Brigham and Women's Hospital (BWH), a teaching affiliate of Harvard Medical School in Boston, MA - is published in the journal Nature. (medicalnewstoday.com 2.2.2017).)

- Høyere hormonnivåer for skjoldbruskkjertel linket til plutselig død

Higher thyroid hormone levels linked to sudden cardiac death (Høyere hormonnivåer for skjoldbruskkjertel linket til plutselig død)
medicalnewstoday.com 7.9.2016
Risiko for død grunnet plutselig tap av hjertefunksjon var betydelig større for pasienter med høyere hormonnivåer for skjoldbruskkjertel i den øvre del av normalområdet, sammenlignet med pasienter med nivåer i den lavere del, ifølge ny forskning i American Heart Associations tidsskrift Circulation. (Risk of death from a sudden loss of heart function was significantly greater in patients with thyroid hormone levels at the higher end of normal range, compared to patients with levels at the lower end, according to new research in the American Heart Association's journal Circulation.)

Sudden cardiac death, occurs when the heart's normal electrical rhythm malfunctions, causing the heart to stop beating. According to a 2012 Circulation study, more than half of all cardiovascular deaths stem from sudden cardiac death, and in many instances no previous symptoms of heart disease were apparent.
"Currently, we do not have a good way to predict sudden cardiac death in the general population," said Layal Chaker, M.D., M.Sc., study lead author and doctoral candidate and research fellow in endocrinology and epidemiology at Erasmus University Medical Center Rotterdam in the Netherlands. "Thus identifying additional risk factors is crucial. Our results indicate that thyroid hormone levels may be useful for assessing risk to prevent sudden cardiac death." (…)

Researchers linked the association of thyroid-stimulating hormone and free thyroxine thyroid hormone levels in blood samples with sudden cardiac deaths listed on medical records and death certificates. During an average follow-up of nine years they found:

  • Participants with free thyroxine hormone levels at the high end of the normal range were 2.5 times more likely to die of sudden cardiac death, compared to patients with levels at the lower end.
  • The ten-year risk of sudden cardiac death was four times greater among patients with higher free thyroxine levels compared to those with lower levels - 4 percent versus 1 percent.
  • The increased risk persisted even after controlling for other risk factors, such as high cholesterol and high blood pressure.
  • 261 cases of sudden cardiac death occurred.

"We know that a considerable proportion of patients on thyroid hormone replacement therapy are over-treated and so have high blood levels of thyroid hormone," Chaker said. "Our study suggests more caution is warranted in the treatment of thyroid hormone replacement. Replacement therapy is often aimed at the high normal range which carries a risk of overtreatment." (…)

(Anm: Thyroid Function and Sudden Cardiac Death: A Prospective Population-Based Cohort Study. (…) CONCLUSIONS: Higher FT4 levels are associated with an increased risk of SCD, even in euthyroid participants. Circulation. 2016 Sep 6;134(10):713-22.)

(Anm: Pregnancy: Low Iron Linked to Thyroid Dysfunction? —Increased risk of thyroid autoimmunity, hypothyroidism (medpagetoday.com 23.7.2016).)

(Anm: Are we overtreating subclinical hypothyroidism in pregnancy? (…)The upper limit for TSH outside of pregnancy is 4.12 mU/L.3 However, guidelines recommend a TSH concentration of less than 2.5 mU/L in the first trimester,1 despite the fact that observational studies give a much broader normative range for TSH, especially when ethnicity is considered. BMJ 2015;351:h4726 (Published 12 October 2015).)

(Anm: Overdiagnosis is a major driver of the thyroid cancer epidemic Up to 50-90% of thyroid cancers in women in high-income countries estimated to be overdiagnoses. (…) The article, published in The New England Journal of Medicine, used high-quality cancer registry data from IARC's reference publication Cancer Incidence in Five Continents to estimate the number of overdiagnosed cases of thyroid cancer in 12 countries (Australia, Denmark, England, Finland, France, Italy, Japan, Norway, Republic of Korea, Scotland, Sweden, and the USA). (medicalnewstoday.com 19.8.2016).)

(Anm: Ökande incidens av tyreoideacancer. Cancer i tyreoidea är en relativt ovanlig cancertyp. Totalt 157 män och 429 kvinnor diagnostiserades år 2013. Yngre drabbas oftare jämfört med vid andra cancersjukdomar. Av kvinnor var 55 procent och bland män 47 procent under 60 år vid diagnos. Den papillära typen är vanligast och utgör 60–70 procent av all cancer i tyreoidea. Läkartidningen. 2016;113:D9CH.)

- Har du en vettug lege til meg?»

Har du en vettug lege til meg?»
aftenposten.no 20.4.2017
Per Egil Hegge, journalist, forfatter og tidligere redaktør i Aftenposten

I fjor høst ble jeg oppringt av en mann som ba om hjelp til å finne en fornuftig lege. Han bor i en norsk by og har diagnosen lavt stoffskifte. (…)

Heller ikke jeg kritiserer leger uten at det er grunn til det, men jeg sa at dette dessverre stemmer med mine erfaringer gjennom over 50 år, da min mor fikk en stoffskiftesykdom. (…)

Spinnvill veiledning
Jeg gjør mitt beste for å skaffe lege når folk ringer. Det femte tilfellet dreier seg om en kvinne som har vært plaget med symptomer på lavt stoffskifte i ti år. Hun har en TSH på 4,2, noe som tilsier øyeblikkelig medisinering når pasienten har kliniske symptomer. TSH står for det thyreoideastimulerende hormon, og prøvesvaret bør ligge lavere enn 3,6. Men i en pasientveiledning står det at man «bare» har subklinisk lavt stoffskifte så lenge TSH er under 10, og at det derfor ikke bør medisineres. Dette er spinnvilt, men generelt vet norsk-utdannede leger så lite om disse sykdommene at de retter seg etter denne «veiledningen». (…)

- Bisköldkörtelsjuka verkar inte få rätt vård. (- Obehandlad kan sjukdomen öka risken för exempelvis benskörhet och hjärt-kärlsjukdomar.) (- Joakim Hennings berättar att sjukdomen vanligtvis har diffusa symtom, som lätt nedstämdhet och trötthet. Troligtvis bidrar det till att många läkare kan missa diagnosen, påpekar han.)

Bisköldkörtelsjuka verkar inte få rätt vård
dagensmedicin.se 24.8.2016
Många patienter med en överaktiv bisköldkörtel får aldrig en diagnos på sin sjukdom, enligt en ny svensk pilotstudie som presenteras vid årets kirurgvecka i Malmö. (…)

Att ha en överproduktion av bisköldkörtelhormon, så kallad primär hyperparatyreoidism, är en av de vanligaste endokrina sjuk­domarna i landet. Obehandlad kan sjukdomen öka risken för exempelvis benskörhet och hjärt-kärlsjukdomar. (...)

Joakim Hennings berättar att sjukdomen vanligtvis har diffusa symtom, som lätt nedstämdhet och trötthet. Troligtvis bidrar det till att många läkare kan missa diagnosen, påpekar han.

– I dag saknas tydliga nationella riktlinjer för hur milda former av primär hyperparatyreoidism ska handläggas. Om läkare hade den typen av verktyg skulle bilden möjligtvis se annorlunda ut. (…)

(Anm: Biskjoldkjertlene. PTH er viktig i forbindelse med kroppens kalsiumregulering. Kalsium har flere funksjoner i kroppen, blant annet er det en viktig komponent i skjelett og tenner. Også i forbindelse med muskelsammentrekning og ledning av nerveimpulser spiller kalsium en vesentlig rolle. Det er svært viktig at mengden kalsium i blodet og i cellene er nøye regulert. (nhi.no 16.10.2009).)

- Hypotyreos (underfunktion i sköldkörteln / låg ämnesomsättning)

Hypotyreos (underfunktion i sköldkörteln / låg ämnesomsättning)
netdoktor.se 16.6.2016
Hypotyreos uppstår när sköldkörteln producerar otillräckliga mängder av de två ämnesomsättningshormonerna, tyroxin (T4) och trijodthyronin (T3).

Låg ämnesomsättning ger en rad olika symptom, typiskt trötthet, viktökning och frusenhet. Hypotyreos kan förkomma i alla åldrar men är vanligast hos kvinnor i 40-70 års ålder.

Risken för att få hypotyreos är ökat om man har en annan autoimmun sjukdom (att immunsystemet angriper kroppens egna celler) eller om någon annan i släkten har hypotyreos.

Vanligaste orsakerna till hypotyreos:

  • Autoimmun thyreoidit, kallas också Hashimotothyroidit, och är en kronisk inflammation i sköldkörteln.
  • Efter tidigare operation av sköldkörteln
  • Efter behandling med radioaktivt jod
  • Medfödd hypotyreos
  • Efter behandling med vissa läkemedel (, t.ex. Thacapzol, Tiotil, Amiodarone och Litium)
  • Efter intag av stora mängder jod (t.ex naturmedel, röntgenkontrastmedel).
  • Efter graviditet (oftast övergående).

När kan man misstänka hypotyreos?

Typiska symptom på hypotyreos är:

  • trötthet
  • frusenhet
  • viktökning
  • förstoppning
  • torr hud
  • hes och djup röst
  • tunnare hår
  • mensrubbningar
  • infertilitet
  • nedstämdhet
  • minnessvårigheter

Symptomen kommer oftast gradvis under lång. tid, Symptomen är ganska ospecifika och kan , speciellt hos äldre, lätt förväxlas med vanliga åldersberoende besvär (…)

(Anm: Depresjonen var lavt stoffskifte. (…) – Legene ville ikke høre på meg og kalte det for en depresjon. Jeg var for syk for skole, for syk til å jobbe, men siden jeg ikke hadde en diagnose kunne ikke NAV ta hensyn til stoffskiftesykdommen. (lommelegen.no 14.3.2017).)

(Anm: Discovery of steroid hormone in fruit flies may shed new light on maternal hypothyroidism. (…) Their discovery -- a fundamental advance for biology and neuroscience, and detailed in a paper published April 10 in the journal eLife -- also may shed new light on maternal hypothyroidism, a human condition in which too little thyroid is produced and is dangerous for pregnant women and their developing babies. (…) Normal thyroid production in people controls food metabolism, which, in turn, regulates body temperature and heart rhythm. When thyroid levels are too low, pregnant women are at risk for miscarriage, hypertension and premature birth. (news-medical.net 16.5.2017).)

(Anm: Steroid hormone induction of temporal gene expression in Drosophila brain neuroblasts generates neuronal and glial diversity. Elife. 2017 Apr 10;6. pii: e26287.)

(Anm: Study on brain formation finds possible link to human disease. (around.uoregon.edu 15.5.2017).)

- Kristin ble sykmeldt, men kom tilbake i full jobb igjen etter å ha brukt det naturlige stoffskiftehormonen, Thyroid, i 10 måneder.

Kristin tilbake i jobb da hun fikk ny medisin
nrk.no 25.4.2017
Kristin Julnes presset seg til å gå på jobb, helt til det sa stopp. Den elendige formen skyldtes lavt stoffskifte. Men medisinen hun fikk virket ikke. Helt til hun fikk en for henne ny medisin. Men helsemyndighetene markedsfører ikke medisinen fordi det ikke er forsket nok.

– Jeg skjønte at jeg måtte være syk. Det var vondt i hele kroppen. Jeg frøs hele tida.

Hun fikk tatt blodprøve hos fastlegen og fikk påvist at stoffskiftet var ekstremt lavt.

I jobb igjen
Kristin ble sykmeldt, men kom tilbake i full jobb igjen etter å ha brukt det naturlige stoffskiftehormonen, Thyroid, i 10 måneder.

200.000 mennesker i Norge går på medisin fordi de har stoffskiftesykdom. De fleste som har lavt stoffskifte får den syntetiske medisinen Levaxin, som virker godt for en svært stor andel av pasientene. Men ikke for alle og ikke for Kristin, Karin Elstad og Olve Sem.

De ble alle klar over den nye medisinen på sosiale medier og på Facebook-gruppa som het "Lavt stoffskifte – behandling med Thyroid". Siden hadde mange tusen medlemmer med samme historie. De ble ikke frisk av medisinen som ble gitt.

– Vi er nødt til å få mulighet til å prøve andre typer medisiner når det ikke fungere med den medisinen vi får. Uten at vi skal slåss for å få det, sier Olve som fikk medisinen for bare fem måneder siden. (…)

Markedsfører ikke medisin
Helsemyndighetene markedsfører ikke denne medisinen fordi det ikke er forsket nok.

I den nasjonale veilederen for behandling av stoffskiftesykdommen står det: «Anbefaler generelt ikke tyroidea-ekstrakt på grunn av manglende dokumentasjon av effekt og sikkerhet. Slik behandling kan gi større mengder enn normalt av trijodtyronin (T3), og det mangler gode studier av effekt og sikkerhet på lengre tids bruk». (…)

(Anm: HUNT-professor ønsker å forske på stoffskiftemedisin. Leger vil ikke anbefale medisinen Thyroid fordi det finnes for lite kunnskap om den, likevel mener flere pasienter at den fungerer best for dem. NRK skrev i går om pasienter som mener de hadde blitt bedre med medisinen Thyroid. Nå tar professoren til orde at det må forskes mer på akkurat denne. – Basert på den kunnskapen vi har i dag, vil jeg ikke anbefale Thyroid. Dersom det kan forekomme hjerteflimmer eller beinskjørhet er viktig å unngå. Vi trenger mer kunnskap fra gode studier for å kunne anbefale behandlingen. (nrk.no 26.4.2017).)

(Anm: Pressemeddelelse. Stofskiftepatienter stigmatiseres i sundhedsvæsenet. Den danske standardbehandling af syge med lavt stofskifte virker ikke for 10-15 pct. af patienterne. De svigtes og stigmatiseres af læger og endokrinologer, og må i stedet købe deres livsvigtige stofskiftemedicin fra privatlæger eller i udlandet. ”Helt uacceptabelt”, mener formand Anette Ulstrup, Patientforeningen Danmark, der nu vil klage til Sundhedsministeren over forholdene. (…)  ”Det er helt uacceptabelt, at 4-5000 stofskiftepatienter ikke bliver set, hørt og taget alvorligt. De fleste læger og endokrinologer tør ikke andet end at følge den standardbehandling, som Sundhedsstyrelsen har vedtaget, selv om international forskning, viser, at visse patienter får det bedre med naturligt stofskiftehormon frem for syntetisk”, siger formand Anette Ulstrup, Patientforeningen Danmark. (...) Patienternes eneste redning for at få deres livsvigtige medicin, er at gå til privatlæger i ind- og udland for at få recept på det naturlige stofskiftehormon, Thyroid, der er udvundet af skjoldbruskkirtlen fra grise. Thyroid har været anvendt i et århundrede mod lavt stofskifte, og anvendes fortsat af millioner patienter på verdensplan, herunder den tidligere præsidentkandidat Hillary Clinton. (...) (patientdanmark.dk 17.3.2017).)

Bilag: Link til klagebrev DR : http://patientdanmark.dk/til_seernes_redaktoer_i_dr.html

(Anm: Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. Conclusions Treatment for subclinical hypothyroidism or hypothyroxinemia beginning between 8 and 20 weeks of gestation did not result in significantly better cognitive outcomes in children through 5 years of age than no treatment for those conditions. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00388297 .). N Engl J Med. 2017 Mar 2;376(9):815-825.)

(Anm: Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. (…) Conclusions Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126. N Engl J Med. 2017 Apr 3.)

- NHI spør eksperten: Lavt stoffskifte. (- Hvorfor er det så vanskelig å få prøve behandling med andre medisiner enn Levaxin? Og hva kan være årsaken til at mange pasienter med lavt stoffskifte føler seg underbehandlet eller misforstått?)

NHI spør eksperten: Lavt stoffskifte
nhi.no 25.5.2016
- Hvorfor er det så vanskelig å få prøve behandling med andre medisiner enn Levaxin? Og hva kan være årsaken til at mange pasienter med lavt stoffskifte føler seg underbehandlet eller misforstått? Dette er blant de spørsmålene vi har stilt til Ingrid Norheim, som er seksjonsoverlege ved Tyroideaseksjonen ved Oslo Universitetssykehus.

Hva er årsaken til lavt stoffskifte?
- Den vanligste årsaken er autoimmun tyroiditt, som ofte utvikler seg over tid og etterhvert leder til lavt stoffskifte. Positivt anti-TPO antistoff er første tegn på sykdommen. Da er man i fin form. Etterhvert klarer ikke skjoldkjertelen å lage like mye stoffskiftehormon, og TSH begynner å stige. (TSH er et hormon som utskilles fra hypofysen og som regulerer produksjonen av hormon (tyroksin, T3 og T4) i skjoldkjertelen.) Tilstanden kalles da subklinisk eller mild hypotyreose. Har man også symptomer på hypotyreose, anbefaler man i dag å starte behandling, selv om stoffskifteverdiene (T4 og T3) er normale. De siste årene har legene sett viktigheten av å starte behandling med tyroksin før stoffskiftet er blitt lavt. (…)

(Anm: Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. (…) Conclusions Levothyroxine provided no apparent benefits in older persons with subclinical hypothyroidism. (Funded by European Union FP7 and others; TRUST ClinicalTrials.gov number, NCT01660126. N Engl J Med. 2017 Apr 3.)

(Anm: Resveratrol Ameliorates the Anxiety- and Depression-Like Behavior of Subclinical Hypothyroidism Rat: Possible Involvement of the HPT Axis, HPA Axis, and Wnt/β-Catenin Pathway. Front. Endocrinol. 2016 (24 May 2016).)

(Anm: Exposure to endocrine disruptors during pregnancy affects the brain two generations later (medicalnewstoday.com 10.3.2015).)

(Anm: Endocrine disruptors are chemicals that, at certain doses, can interfere with the endocrine (or hormone) system in mammals. These disruptions can cause cancerous tumors, birth defects, and other developmental disorders. (en.wikipedia.org).)

(Anm: Breast cancer risk higher in women with overactive thyroid. (medicalnewstoday.com 11.2.2016).)

(Anm: How the brain wakes you up. (…) Chronic sleep perturbances affect 10-20% of the population of Switzerland and almost everyone experiences sleep problems at least once in a lifetime.  (…) "The consequences of sleep perturbations on life quality go far beyond daytime sleepiness and mood alteration. Cognitive impairment, hormonal imbalance and high susceptibility to cardiac or metabolic disorders are amongst some of the negative impacts frequently associated with subtle chronic sleep problems" (medicalnewstoday.com 21.12.2015).)

(Anm: Slideshow: Thyroid Symptoms and Solutions (webmd.com 15.4..2014).)
(Anm: 15 Cancer Symptoms to Know (webmd 28.3.2016).)
(Anm: Slideshow: Causes of Fatigue and Sleepiness and How to Fight Them. (webmd).)
(Anm: Slideshow: A Visual Guide to Fibromyalgia (webmd.com 10.11.2014).)
(Anm: Slideshow: A Visual Guide to Understanding Lupus (webmd.com 2.2.2016).)
(Anm: Gout Pictures Slideshow: Causes, Symptoms, and Treatments of Gout (webmd.com 3.2.2016).)
(Anm: Slideshow: What Your Nails Say About Your Health (webmd.com 8.4.2014).)
(Anm: Sinusitis Slideshow: Symptoms, Diagnosis, Treatment (webmd 8.12.2014).)
(Anm: What Your Skin Says About Your Health Slideshow. (webmd.com 2.2.2016).)
(Anm: Type 2 Diabetes Overview (webmd.com 2.2.2016).)
(Anm: What Eye Problems Look Like (webmed).)

(Anm: Fibromyalgi: Fibromyalgi rammer over 100.000 norske kvinner. - En del tror sykdommen bare er tøys. Også blant leger er det en del som flirer av den, forteller professor. (…)   Når leger blir bedt om å rangere hvilke sykdommer det er mest prestisje å jobbe med, så havner alltid fibromyalgi nederst, forteller hun. Professor Egil Andreas Fors ved Institutt for samfunnsmedisin og allmennmedisinsk forskningsenhet ved NTNU er blant Norges fremste eksperter på sykdommen. Han bekrefter holdningene Slydal beskriver. (…) Sykdommen kjennetegnes gjerne ved at man har kroniske muskelsmerter, andre symptomer kan være utmattelse, hodepine, stivhet i kroppen, svimmelhet, kvalme, indre frost, depresjoner, angst og søvnproblemer. (kk.no 8.3.2016).)

(Anm: Lettere at diagnosticere fibromyalgi. På University of Colorado har forskere opdaget en speciel hjernesignatur, der med 93 pct. sikkerhed kan fastslå, hvorvidt en person lider af fibromyalgi eller ej. (pharmadanmark.anp.se 27.10.2016).)

(Anm: Management of interstitial lung disease associated with connective tissue disease. (…) Shrinking lung syndrome. (…) Systemic lupus erythematosus. BMJ 2016;352:h6819 (Published 24 February 2016).)

(Anm: Systemic Lupus Erythematosus and Thyroid Autoimmunity. Most of the studies present in the literature show a high prevalence, and incidence, of new cases of hypothyroidism and autoimmune thyroiditis (AT) in systemic lupus erythematosus (SLE) patients, overall in female gender. A limited number of cases of Graves’ disease have been also reported in SLE patients, in agreement with the higher prevalence of thyroid autoimmunity. Front. Endocrinol., 19 June 2017.)

- Underaktiv skjoldbruskkjertel linket til risiko for leverkreft / diabetes 2

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.)

(Anm: Selective Toxicity of Persian Gulf Sea Cucumber (Holothuria parva) and Sponge (Haliclona oculata) Methanolic Extracts on Liver Mitochondria Isolated from an Animal Model of Hepatocellular Carcinoma. Hepat Mon. 2015 Dec 27;15(12):e33073. eCollection 2015).)

(Anm: Hepatocellular carcinoma (HCC), also called malignant hepatoma, is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of liver cirrhosis). (en.wikipedia.org).)

(Anm: Study links low thyroid function to greater odds of type 2 diabetes. Having too little thyroid hormone in the blood--even in the low-normal range--raises the risk of developing Type 2 diabetes, especially in people with prediabetes, a new study in nearly 8,500 people finds. The study results were presented Sunday at the Endocrine Society's 98th annual meeting in Boston. (medicalnewstoday.com 4.4.2016).)

(Anm: Thyroid cancer subtype downgraded to non-cancer. Encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), an international panel has announced.Lancet Oncology 2016 (Published Online: 21 April 2016).)

(Anm: Low Maternal Thyroid Hormone During Pregnancy Increases Schizophrenia Risk in Offspring. PHILADELPHIA -- June 22, 2016 -- A study published in Biological Psychiatry reveals a new link between low levels of the thyroid hormone thyroxine during pregnancy and risk of schizophrenia in the offspring. (dgnews.docguide.com 22.6.2016).)

(Anm: Overdiagnosis is a major driver of the thyroid cancer epidemic Up to 50-90% of thyroid cancers in women in high-income countries estimated to be overdiagnoses. (…) The article, published in The New England Journal of Medicine, used high-quality cancer registry data from IARC's reference publication Cancer Incidence in Five Continents to estimate the number of overdiagnosed cases of thyroid cancer in 12 countries (Australia, Denmark, England, Finland, France, Italy, Japan, Norway, Republic of Korea, Scotland, Sweden, and the USA). (medicalnewstoday.com 19.8.2016).)

- Diabetes-induserte endringer i munnens mikrobiom fremmer periodontalt bentap. (- Frem til nå har det ikke vært konkrete bevis på at diabetes påvirker oralt mikrobiom.) (- Forskerne fant at av de 1 500 australske testede menn ble ftalater påvist i urinprøver hos 99,6 % av de i alderen 35 og over.) - Forskere finner link mellom skadelige kjemikalier og kroniske sykdommer hos menn. (- Kjemikalier som finnes i hverdagslige plastmaterialer er knyttet til hjerte- og karsykdommer, type-2 diabetes og høyt blodtrykk hos menn, ifølge australske forskere.

(Anm: Researchers find link between harmful chemicals and chronic diseases in men. Chemicals found in everyday plastics materials are linked to cardiovascular disease, type-2 diabetes and high blood pressure in men, according to Australian researchers. Researchers from the University of Adelaide and the South Australian Health and Medical Research Institute (SAHMRI) investigated the independent association between chronic diseases among men and concentrations of potentially harmful chemicals known as phthalates. The results of the study are now published in the international journal Environmental Research. Phthalates are a group of chemicals widely used in common consumer products, such as food packaging and wrappings, toys, medications, and even medical devices. Researchers found that of the 1500 Australian men tested, phthalates were detected in urine samples of 99.6% of those aged 35 and over. (news-medical.net 12.7.2017).)

- Hypertyreose kan være en stor kostnad for lands uføretrygd. (- Mennesker diagnostisert med hypertyreose er 88 % mer sannsynlig å få uføretrygd enn de uten tilstanden.)

Hyperthyroidism could be great cost to countries in disability benefits (Hypertyreose kan være en stor kostnad for land i uføretrygd)
medicalnewstoday.com 25.9.2015
People diagnosed with hyperthyroidism are 88% more likely to receive disability benefits than people without the condition; reports a Danish study published this week in the European Journal of Endocrinology.
People with hyperthyroidism produce too much thyroid hormone which can make them feel anxious and hyperactive. It is a common hormone-related disorder which affects 5 -10 % of the population. Hyperthyroid patients often have difficulty with everday routines but until now, nobody has looked in depth at the effect of hyperthyroidism on people's ability to work.

Researchers at the Odense University Hospital in Denmark studied 1942 hyperthyroid and 7768 non-hyperthyroid individuals for 9 years to determine their risk of receiving disability pension. To rule out differences in environment and upbringing, the researchers also looked at 584 pairs of twins in which one twin was hyperthyroid and the other not. (...)

(Anm: Hyperthyroidism could be great cost to countries in disability benefits. People diagnosed with hyperthyroidism are 88% more likely to receive disability benefits than people without the condition; reports a Danish study published this week in the European Journal of Endocrinology. People with hyperthyroidism produce too much thyroid hormone which can make them feel anxious and hyperactive. It is a common hormone-related disorder which affects 5 -10 % of the population. Hyperthyroid patients often have difficulty with everday routines but until now, nobody has looked in depth at the effect of hyperthyroidism on people's ability to work. (medicalnewstoday.com 25.9.2015).)

(Anm: Nedsatt følsomhet for thyreoideahormon. (…) FORTOLKNING Thyreoideahormonresistens kan ut fra kliniske og biokjemiske funn feiltolkes som hypertyreose, og pasientens tilstand kan bli forverret dersom den behandles som dette. Det er derfor viktig å kjenne de forskjellige sykdomsmanifestasjonene og differensialdiagnoser. Tidsskr Nor Legeforen 2016; 136:618 – 22 (19.4.2016).)

- Forskere får ny innsikt i hypotyreose.

Researchers gain new insights into hypothyroidism
medicalnewstoday.com 29.1.2015
Results suggest why standard treatments fail some patients and how to help them

An international research team led by physician-scientists at Rush University Medical Center has gained new insights into hypothyroidism - a condition affecting about 10 million people in the U.S. - that may lead to new treatment protocols for the disease, particularly among the approximately 15 percent of patients for whom standard treatments are less effective.

The researchers published their findings at the beginning of the new year in a pair of articles in the Journal of Clinical Investigation (JCI) and the Journal of Clinical Endocrinology & Metabolism (JCEM).
Hypothyroidism occurs when the thyroid gland fails to produce sufficient quantities of two hormones, thyroxine (known as T4) and its more active form, called T3. The condition can cause a number of health problems, including weight gain, fatigue and so-called "foggy brain."

For decades, the standard treatment has been a daily T4 supplement named levothyroxine. Once absorbed into the body, T4 is transformed to T3, in theory fully normalizing blood levels of T3. However, physicians have long been puzzled by why this type of treatment fails to relieve all symptoms in up to 15 percent of patients.

The puzzle persists in large part because the efficacy of treatments for hypothyroidism relies also on patients' subjective reports of how they feel - patients with a normal thyroid may experience symptoms similar to those of hypothyroidism but due to other conditions, such as post-menopause syndrome or clinical depression.

The study published in the JCI was performed on rats whose thyroid glands had been removed and explains the cellular basis for why circulating levels of T3 are not fully normalized by levothyroxine alone. In addition, the study reveals that circulating T3 levels and hypothyroidism can be corrected fully when the levothyroxine regimen is supplemented with T3.

Studien fant at enkelte rotter, som kun fikk levotyroksin, hadde høyere kolesterolnivå i blodet enn rotter som fikk terapi med kombinasjonen T4 og T3. De hadde også tegn på hypotyreose i hjernen, noe som potensielt kan forklare "tåkete hjerne", som er et vanlig symptom på hypotyreose. Derfor etablerte den kombinerte terapi normal thyroid hormonvirkning i de områder av kroppen som vanligvis påvirkes av hypotyroidisme - hjernen, leveren og også skjelettmusklene. (The study found that some of the rats that only received levothyroxine had higher cholesterol levels in their blood than rats that received the combination T4 and T3 therapy. They also had signs of hypothyroidism in their brains, which could potentially explain the "foggy brain" that is a common symptom of hypothyroidism. Therefore, the combined therapy established normal thyroid hormone action in the areas of the body commonly affected by hypothyroidism -- the brain, the liver and also the skeletal muscles.)

"Of course it's important to confirm these studies clinically," says Antonio Bianco, MD, PhD, head of Rush's Division of Endocrinology and Metabolism and senior author of both journal articles. Bianco also co-chaired an American Thyroid Association task force that updated the association's guidelines for the treatment of hypothyroidism published this past December in the journal Thyroid. (…)

(Anm: Three toxic gases meet in the mitochondria. Front. Physiol. 2015 (20 August 2015).)

(Anm: Do flame retardants cause attention problems in children? (medicalnewstoday.com 11.10.2015).)

(Anm: Kan du ha en hormonsykdom? Kan påvirke både vekt, hårvekst og humør. UBALANSE: Dersom hormonproduksjonen kommer i ubalanse kan dette føre til flere ulike sykdommer og plager, og symptomene kan være svært mange. (kk.no 25.2.2015).)

- Våre data viser således at T(3) har en viktig rolle i å åpne mitokondrie-membranpermeabilitet-pore og aktiverer funksjonen av de to viktige fysiologiske svellende induserende, kalsium- og fosfationer

In vitro and in vivo activation of mitochondrial membrane permeability transition pore using triiodothyronine.
Physiol Res. 2016 Jun 20;65(2):321-31. Epub 2015 Oct 8.
Abstract Using a novel method for evaluating mitochondrial swelling (Drahota et al. 2012a) we studied the effect of calcium (Ca(2+)), phosphate (P(i)), and triiodothyronine (T(3)) on the opening of mitochondrial membrane permeability transition pore and how they interact in the activation of swelling process. We found that 0.1 mM P(i), 50 microM Ca(2+) and 25 microM T(3) when added separately increase the swelling rate to about 10 % of maximal values when all three factors are applied simultaneously. Our findings document that under experimental conditions in which Ca(2+) and P(i) are used as activating factors, the addition of T(3) doubled the rate of swelling. T(3) has also an activating effect on mitochondrial membrane potential. The T(3) activating effect was also found after in vivo application of T(3). Our data thus demonstrate that T(3) has an important role in opening the mitochondrial membrane permeability pore and activates the function of the two key physiological swelling inducers, calcium and phosphate ions. (…)

(Anm: Regulation of skeletal muscle mitochondrial activity by thyroid hormones: focus on the “old” triiodothyronine and the “emerging” 3,5-diiodothyronine. Front. Physiol.2015 (21 August 2015).)

(Anm: A Thyroid hormone induction of mitochondrial activity is coupled to mitophagy via ROS-AMPK-ULK1 signaling.utophagy. (…) These findings demonstrate a novel ROS-AMPK-ULK1 mechanism that couples T3-induced mitochondrial turnover with activity, wherein mitophagy is necessary not only for removing damaged mitochondria but also for sustaining efficient OXPHOS.2015 Jun 23:0. [Epub ahead of print].)

(Anm: Implications of mitochondrial dynamics on neurodegeneration and on hypothalamic dysfunction. Front. Aging Neurosci. 2015 (10 June 2015).)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

(Anm: Thyroid Hormone Mediated Modulation of Energy. Expenditure. Int J Mol Sci. 2015 Jul 16;16(7):16158-16175.)

(Anm: Flame retardants could contribute to hyperthyroidism in older cats (medicalnewstoday.com 26.4.2015).)

(Anm: Neuroendocrinology of the hair follicle: principles and clinical perspectives. Trends Mol Med. 2014 Oct;20(10):559-70. Epub 2014 Jul 21.)

(Anm: USPSTF: Not Enough Evidence for Thyroid Screening —Decision leaves providers and patients in 'familiar vacuum.' (medpagetoday.com 25.3.2015).)

(Anm: Water fluoridation in England linked to higher rates of underactive thyroid (medicalnewstoday.com 24.2.2015).)

- Link påvist mellom autoimmune sykdommer, legemidler (bl.a. antidepressiva, antihistaminer etc.) og farlig tilstand mht. hjerterytme

Link found between autoimmune diseases, medications, and a dangerous heartbeat condition medicalnewstoday.com 7.7.2015
Mohamed Boutjdir, PhD, professor of medicine, cell biology, and physiology and pharmacology at SUNY Downstate Medical Center, has led a study with international collaborators identifying the mechanism by which patients with various autoimmune and connective tissue disorders may be at risk for life-threatening cardiac events if they take certain anti-histamine or anti-depressant medications. Dr. Boutjdir is also director of the Cardiac Research Program at VA New York Harbor Healthcare System.

The researchers published their findings in the online edition of the American Heart Association Journal Circulation in an article titled, "Pathogenesis of the Novel Autoimmune-Associated Long QT Syndrome."
The team established for the first time the molecular and functional mechanism by which adult patients with autoimmune diseases, particularly systemic lupus erythematosus, Sjogren's syndrome, and other connective tissue diseases (CTD), including mixed CTD, undifferentiated CTD,

Polymyositis/dermatomyositis, systemic sclerosis, and rheumatoid arthritis, develop abnormal electrical activity on their electrocardiogram (ECG) known as Long QT syndrome or QT interval prolongation.
Long QT prolongation can be inherited due to abnormal genes or acquired, often due to medication side effects, all of which affect the heartbeat cycle in a way that increases the risk of irregular heartbeat episodes that originate from the ventricles. These episodes may lead to palpitations, fainting, and sudden death due to ventricular fibrillation. (…)

(Anm: Pathogenesis of the Novel Autoimmune-Associated Long QT Syndrome.Circulation. 2015 May 20. pii: CIRCULATIONAHA.115.009800. [Epub ahead of print].)

- Lavt nivå av et stoffskiftehormon fra skjoldbruskkjertelen kan gi økt risiko for lav IQ

Medicin kan give børn højere IQ
jyllands-posten.dk 9.5.2014 
Forskere har påvist en sammenhæng mellem lav intelligens og en særlig genvariant. De mener, at børnene kan behandles medicinsk. Bør vi screene og behandle raske børn for at gøre dem klogere? Eksperterne er uenige.

I fremtiden bliver det muligt at give nyfødte med en genetisk øget risiko for lav IQ en hormonbehandling, der med stor sandsynlighed kan gøre dem mere intelligente.

Det er britiske forskere fra bl.a. Cardiff University, som med ny opsigtsvækkende forskning har fundet frem til, at børn, der både har en bestemt genvariant, og som har et lavt niveau af et stofskiftehormon fra skjoldbruskkirtlen, har mere end fire gange forøget risiko for at få en lav IQ – under 85. Ifølge forskerne kan man sandsynligvis højne børnenes intelligens ved på et tidligt tidspunkt at behandle dem medicinsk med stofskiftehormonet. Forskerne anbefaler derfor screening og gentestning af nyfødte.

Forskningsresultaterne rejser så mange etiske dilemmaer, at vi er nødt til at diskutere dem, mener en række danske eksperter.

»Spørgsmålet er bl.a., om vi bør behandle raske børn medicinsk, fordi de har en markant øget risiko for at ligge meget lavt – men formentlig stadig inden for normalområdet – på intelligensskalaen,« siger professor i biomedicin og genetik Thomas G. Jensen, Aarhus Universitet. (...)

(Anm: Severe Hypothyroidism Caused by Type 3 Iodothyronine Deiodinase in Infantile Hemangiomas (N Engl J Med 2000; 343:185-189 (July 20, 2000).)

(Anm: FDA Okays Hypoparathyroid Drug —After an extended review, the FDA okayed Natpara, a parathyroid replacement therapy. (medpagetoday.com 28.1.2015).)

(Anm: Behandling av pasienter med hypotyreose. De anbefalingene vi gir om behandling av pasienter med hypotyreose, er basert på europeiske og amerikanske retningslinjer, som tar utgangspunkt i eksisterende forskningsresultater. (dagensmedisin.no 16.6.2015).)

- Sygdom i skjoldbruskkirtlen giver øget risiko for langvarigt sygefravær

Sygdom i skjoldbruskkirtlen giver øget risiko for langvarigt sygefravær
arbejdsmiljoforskning.dk 18.6.2014
Medarbejdere med forhøjet stofskifte forårsaget af sygdom i skjoldbruskkirtlen har større risiko for langvarigt sygefravær end deres raske kollegaer. Det gælder særligt inden for det første år med sygdommen.

Øget risiko for langvarigt sygefravær ved hyperthyroidisme

Medarbejdere med forhøjet stofskifte på grund af sygdom i skjoldbruskkirtlen (hyperthyroidisme), og som samtidigt har komplikationer med øjnene i form af fx hævelser og dobbeltsyn(Graves’orbitopati), har i det første år med diagnosen syv gange større risiko end raske kolleger for at få langvarigt sygefravær på over tre uger. Efter et år falder risikoen, men den bliver dog ved med at være dobbelt så høj som hos raske kolleger. Der kan også være problemer med at vende tilbage til arbejde efter sygefravær og/eller ledighed samt fire gange så stor risiko for at få førtidspension sammenlignet med kontrolgruppen.

Det viser resultater af en registerundersøgelse, som er den første, større systematiske undersøgelse, hvor forskere har undersøgt, hvilken betydning sygdomme i skjoldbruskkirtlen har for sygefravær, arbejdsløshed og førtidspension. Resultaterne er netop publiceret i Journal of Clinical Endocrinology & Metabolism (JCEM) og omtales i en pressemeddelelse fra den amerikanske forening the Endocrine Society i dag. (...)

(Anm: Increased Risk of Long-Term Sickness Absence, Lower Rate of Return to Work, and Higher Risk of Unemployment and Disability Pensioning for Thyroid Patients: A Danish Register-Based Cohort Study. The Journal of Clinical Endocrinology & Metabolism (Published Online: June 17, 2014).)

(Anm: National study finds autoimmune disease severely impacts quality of life and employment (medicalnewstoday.com 26.5.2015).)

(Anm: Rare autoimmune disease may be more common than we thought. Mutations in a key autoimmunity-associated gene are surprisingly common and are responsible for a previously unknown form of a rare autoimmune disorder called APS-1, according to a study published on June 16 in the journal Immunity. Contrary to past findings, the study reveals that mutations in only one copy of the autoimmune regulator (AIRE) gene can produce symptoms of the disease. (medicalnewstoday.com 17.6.2015).)

(Anm: Skjoldkjertelbetennelse etter svangerskap Postpartum tyreoiditt er hos de fleste en forbigående betennelse i skjoldkjertelen som opptrer etter en barnefødsel. Tilstanden vil kunne gi økt stoffskifte en periode før stoffskiftet blir lavt. Ca. 90% gjenvinner funksjonen i kjertelen innen 1 år. (nhi.no 19.1.2015).)

(Anm: Cellular Action of Thyroid Hormone. (ncbi.nlm.nih.gov 12.2.2014).)

(Anm: Hypothyroidism Can Mimic Depression Symptoms (depression.about.com 14.7.2013).)

(Anm: The Potential Application of Mitochondrial Medicine in Toxicologic Poisoning. J Med Toxicol. 2015 Apr 24. [Epub ahead of print].)

- Subklinisk hypotyreose-assosiert risiko for diabetes mellitus er fremtredende bare ved statin bruk.

Hypothyroidism Is a Risk Factor for New-Onset Diabetes Mellitus: A Cohort Study
Diabetes Care 2015 (Published online before print June 12)
OBJECTIVE To identify risk factors for the development of statin-associated diabetes mellitus (DM).

RESEARCH DESIGN AND METHODS The study was conducted in two phases. Phase one involved high-throughput in silico processing of a large amount of biomedical data to identify risk factors for the development of statin-associated DM. In phase two, the most prominent risk factor identified was confirmed in an observational cohort study at Clalit, the largest health-care organization in Israel. Time-dependent Poisson regression multivariable models were performed to assess rate ratios (RRs) with 95% CIs for DM occurrence. (…)

CONCLUSIONS Hypothyroidism is a risk factor for DM. Subclinical hypothyroidism-associated risk for DM is prominent only upon statin use. Identifying and treating hypothyroidism and subclinical hypothyroidism might reduce DM risk. Future clinical studies are needed to confirm the findings. (…)

(Anm: Statiner etc. (mot høyt kolesterol) (mintankesmie.no).)

- Nivåer av thyreoideahormoner modifiseres av protein avhengig av kroppstemperatur

Thyroid hormone levels modified by protein according to body temperature
medicalnewstoday.com 3.2.2014
The thyroid hormone thyroxine, which controls our day-to-day activity and was previously believed to remain at a constant level in the blood, actually fluctuates as a result of a protein which modifies the release of the hormone depending on body temperature, new research reveals. The research was published in the journal Proceedings of the Royal Society B.

The hormone thyroxine regulates metabolism in all mammals, including humans. If there is too much, it leads to hyperactivity, and if there is too little, it leads to dormancy. This essential hormone is carried and stored in the blood by the protein thyroxine-binding globulin (TBG). It was previously thought that the levels of the hormone remained constant. However, the new research, led by Robin Carrell, Emeritus Professor of Haematology at the University of Cambridge, found that when the body's temperature rises, TBG's affinity for thyroxine decreases, resulting in an increase of the available hormone and a subsequent increase in metabolism. If the body temperature drops, such as when an animal goes into hibernation, TBG's affinity for thyroxine increases, resulting in a decrease in the availability of the hormone and a decrease in metabolism.

The findings provide insight into the changes that occur during fevers, when the body accelerates its metabolism to counter infection and inflammation. The research shows that TBG has an inbuilt booster which gives a surge in thyroxine release as the body temperature rises above 37ºC. The study found that a body temperature of 39ºC will result in a 23 per cent increase in concentration of thyroxine levels in the blood - temporarily moving into the range seen in patients with hyperthyroidism.

Professor Carrell said: "The effect of temperature on thyroxine levels has been largely overlooked because most measurements of the hormone are carried out when the blood is at room temperature. As a result, blood samples taken from hypothermia or heatstroke patients, or from an infant with fever, would not show the change of free thyroxine in the blood. We are excited by our findings as they are directly relevant to better understanding fevers, which, although beneficial, can pose problems, especially to young children." (...)

(Anm: Thyroid activity within normal range tied to depression in older adults (medicalnewstoday.com 24.2.2014).)

(Anm: Thyroid hormone and seasonal rhythmicity. Thyroid hormone and seasonal rhythmicity. Front. Endocrinol. 2014;5:19 (26 February 2014).)

- Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS)

Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS).
Clin Endocrinol (Oxf). 2014 Jul 17. [Epub ahead of print]
(…) OBJECTIVE: The aim of this study was to determine the extent of drug interactions affecting levothyroxine, using study drugs often co-administered to patients on long-term levothyroxine therapy.

DESIGN: A retrospective population analysis linking biochemistry and prescription data between 1 January 1993 and 31 December 2012 was used.

PATIENTS: The study population was Tayside residents prescribed levothyroxine on at least three occasions, within a six-month period, prior to the start of a study drug. Individuals acted as their own controls pre- and postinitiation of study drug. Overall, 10 999 patients (mean age 58 years, 82% female) being treated with thyroxine were included in the study.

MEASUREMENTS: Changes in TSH following initiation of study drug.

RESULTS: Iron, calcium, proton pump inhibitors and oestrogen all increased serum TSH concentration: an increase of 0•22 mU/l (P < 0.001), 0•27 mU/l (P < 0•001), 0•12 mU/l (P < 0•01), and 0•08 mU/l (P < 0•007), respectively. For these four study drugs, there was a clinically significant increase of over 5 mU/l in serum TSH, in 7•5%, 4•4%, 5•6% and 4•3% patients, respectively. There was a decrease of 0•17 mU/l (P-value 0.01) in the TSH concentration for those patients on statins. The TSH decreased by 5 mU/l in 3•7% of patients. There was no effect with H2 receptor antagonists or glucocorticoids.

CONCLUSION: This large population-based study demonstrates significant interaction between levothyroxine and iron, calcium, proton pump inhibitors, statins and oestrogens. These drugs may reduce the effectiveness of levothyroxine, and patients' TSH concentrations should be carefully monitored. (…)

(Anm: Pregnancy: Low Iron Linked to Thyroid Dysfunction? —Increased risk of thyroid autoimmunity, hypothyroidism (medpagetoday.com 23.7.2016).)

- 'Thyroid' Issues May Really Be Hypothalamic

'Thyroid' Issues May Really Be Hypothalamic
medpagetoday.com 16.5.2014
LAS VEGAS -- Obese patients who continue to have "thyroid symptoms" even when their levels are normalized may have a hypothalamic dysfunction, researchers reported here.

In a single-center study of 50 patients referred for evaluation of thyroid symptoms, 68% had at least four symptoms that were characteristic of hypothalamic obesity disorder, Saad Sakkal, MD, and colleagues reported during a late-breaking poster session at the American Association of Clinical Endocrinologists meeting here.

Those include fatigue, temperature dysregulation, weight change, changes in sleeping patterns, pain, and mood disorders, the researchers said.

Sakkal explained that every endocrinologist sees patients who have been referred for "thyroid symptoms" with normal or low thyroid-stimulating hormone (TSH) levels.

But some overweight patients continue to have these thyroid symptoms even when they've had sufficient hormone replacement.

"Patients who insist they have thyroid disease causing their weight problems are frequent," the researchers said. "Some try thyroid medications, yet they feel worse and don't lose weight. These patients would only benefit from therapy for their hypothalamic dysfunction."

Sakkal and colleagues hypothesized that their symptoms may relate to hypothalamic dysfunction instead.

There are no studies, however, that document the prevalence of hypothalamic obesity disorder among patients referred for thyroid disease. (…)

(Anm: Hypothalamic sidedness in mitochondrial metabolism: new perspectives. Reprod Sci. 2014 Dec;21(12):1492-8. Epub 2014 Apr 16.)

- Polikarpov and colleagues used x-ray crystallography to identify a second binding site for T3 and T4

New Thyroid Receptor Binding Site Mapped
medpagetoday.com 17.3.2014
Thyroid hormones may bind to a second site not previously reported, located on the surface of the thyroid hormone receptor, researchers found. This second binding site may modulate changes in activity and interaction with ligands in the ligand binding pocket (LBP), the main binding site for thyroid hormones, Igor Polikarpov, PhD, of the University of Sao Paulo in Brazil, and colleagues reported in Molecular Endocrinology.

"Binding of a new molecule to a second binding site could be useful as a new target for [thyroid receptor] drug design and could modulate selectively nuclear receptor functions," they wrote.

Thyroid hormone receptors are members of the nuclear receptor superfamily of ligand-activated transcription factors involved in cell differentiation, growth, and homeostasis. X-ray structures of many nuclear receptor ligand binding domains (LBD) have shown that ligands like thyroid hormone bind within the hydrophobic core of the ligand binding pocket (LBP) -- but some studies have suggested the possibility of ligands binding to other sites. So Polikarpov and colleagues used x-ray crystallography to identify a second binding site for T3 and T4. (...)

- Sköldkörtelhormon minskar i hjärnan vid Alzheimers

Sköldkörtelhormon minskar i hjärnan vid Alzheimers
sahlgrenska.gu.se 25.5.2013
Människor med begynnande Alzheimers har en signifikant lägre nivå av sköldkörtelhormon i hjärnan. Upptäckten öppnar för att begynnande demenssjukdomar skulle kunna behandlas med sköldkörtelhormonet tyroxin. Det visar en avhandling vid Sahlgrenska akademin.

Alzheimerforskningen fokuserar idag mycket på att identifiera nya möjligheter för att tidigt upptäcka och behandla demenssjukdomar. En avhandling vid Sahlgrenska akademin, Göteborgs universitet, visar att hjärnans sköldkörtelhormoner minskar hos personer som drabbas av Alzheimers sjukdom.

Minskar i hjärnan hos Alzheimers-patienter
I sköldkörteln produceras huvudsakligen hormonet tyroxin (T4), som i kroppens vävnader omvandlas till det mer aktiva hormonet T3. Hormonerna är avgörande för ämnesomsättningen och leder till ökad fettförbränning. Medicine doktor Per Johansson visar i sin avhandling att tyroxin minskar i hjärnan hos patienter med tidig Alzheimer.

Patienter riskerar att förbises
Skillnaden kan mätas i personens ryggvätska, men syns inte i de blodprov som idag är standard.

– Det innebär att patienter med glömska, trötthet, apati, nedstämdhet eller andra symtom som överlappar mellan demenssjukdom och underfunktion i sköldkörteln, riskerar att förbises om man enbart mäter blodvärden. Vi tror att halterna i ryggvätskan avspeglar förhållandena i hjärnan bättre, och att en del av dessa patienter skulle kunna erbjudas hormonbehandling, säger Per Johansson vid Sahlgrenska akademin, Göteborgs universitet. (...)

Avhandlingen Endocrine and diagnostic aspects of cognitive impairment with special reference to Alzheimer’s disease försvarades vid en disputation den 17 maj.

Länk till avhandling: https://gupea.ub.gu.se/handle/2077/32374 (...)

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

(Anm: Hva er symptomene på Hashimotos sykdom? (Faktaark Hashimotos sykdom) (womenshealth.gov).)

- Hormon linket til Alzheimers sykdom

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.)

- Alzheimers linket til thyroid-relatert hormon

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. (...)

(Anm: Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (en.wikipedia.org).)

- Hyperthyroide legemidler knyttet til fødselsskader

Hyperthyroid Drugs Tied to Birth Defects (Hyperthyroide legemidler knyttet til fødselsskader)
medpagetoday.com 20.10.2013
SAN JUAN -- Two of the most commonly used drugs for treating hyperthyroidism were linked to birth defects when used in early pregnancy, though they have differing effects, researchers reported here.

In an analysis of Danish national data, infants born to mothers taking propylthiouracil (PTU) early in pregnancy had about a 50% higher risk of birth defects, and those taking methimazole (MMI) had a 75% greater risk than children born to women in the general population not taking the drug, Peter Laurberg, MD, of Aalborg University Hospital in Denmark, and colleagues reported at the Amerian Thyroid Association meeting. (...)

- Å leve med høyt stoffskifte

Å leve med høyt stoffskifte
nhi.no 19.2.2014
- Ikke spør om hvorfor dette skjedde med meg. Hvorfor skulle det ikke det? Alle får noe. Jeg fikk dette. Da må jeg takle det. Ingen har gitt oss en garanti for et liv uten utfordringer, sier Anne Lein. (...)

Snikende sykdom
Til tross for at hun er utdannet sykepleier, og symptomene var mange, forsto ikke Anne Lein selv at hun var syk. Sykdommen kom snikende, men i 2008 begynte hun for alvor å kjenne at noe var galt. Hun gjennomgikk da en stor omstilling i arbeidslivet, samtidig som hun hadde flere andre stresstopper. Det var et år med både sykdom og dødsfall i familien.

- Over tid ble dette en ubalanse, som førte til at jeg følte jeg mistet kontrollen, og som endte det med kollaps.

Blant symptomene som kom snikende, var hjertebank og høy hvilepuls - til tross for at hun trente mye og alltid hadde vært i god form. Hun opplevde også nedsatt konsentrasjon, tretthet, nedsatt muskelkraft, skjelvende hender og generell uro i kroppen. Det var vanskelig å slappe av og sove om natten, og hun gikk ned 8 kg i vekt. Hyperaktivitet, forvirring, nervøsitet, irritabilitet, svingende humør, økt appetitt, hevelse rundt øynene, følelse av rusk i øyet, lav toleranse for høye lyder og skarpt lys, var også blant de mange symptomene hun levde med.

Les også vår pasientinformasjon: Høyt stoffskifte (...)

- Thyroid hormones (THs), T3 and T4, play an essential role in the development and metabolism of many tissues and organs, and have profound metabolic effects in adult life

THYROID HORMONES RECEPTORS ARE PRESENT AND EFFECTIVE ON HEALTHY AND RUPTURED ROTATOR CUFF TENDONS. A PRELIMINARY REPORT
Br J Sports Med 2013;47:e3
Abstracts from the 3rd European College of Sports and Exercise Physicians (ECOSEP) conference on 25–27 April 2013

Abstract Thyroid hormones (THs), T3 and T4, play an essential role in the development and metabolism of many tissues and organs, and have profound metabolic effects in adult life. Thyroid hormone receptors (TRs) seem to be ubiquitous, but, to our knowledge, their presence in tenocytes has not been investigated. We therefore evaluated the expression pattern of TRs isoforms in three groups of patients: one with rotator cuff tendons tears and with thyroid diseases, one with rotator cuff tendons tears without thyroid diseases, and one with healthy rotator cuff tendons and no thyroid disease. In addition, we evaluated the action of THs on growth and apoptosis of primary tenocyte cultures. The α/β nuclear receptor isoforms are present in healthy and pathologic rotator cuff tendons. THs enhance the growth and counteract apoptosis in primary tenocyte cultures in a dose and time dependent manner. (...)

Thyroid hormones and mitochondria: with a brief look at derivatives and analogues
Mol Cell Endocrinol. 2013 Jun 12. pii: S0303-7207(13)00244-X
Abstract Thyroid hormones (TH) have a multiplicity of effects. Early in life, they mainly affect development and differentiation, while later on they have particularly important influences over metabolic processes in almost all tissues. It is now quite widely accepted that thyroid hormones have two types of effects on mitochondria. The first is a rapid stimulation of respiration, which is evident within minutes/hours after hormone treatment, and it is probable that extranuclear/non-genomic mechanisms underlie this effect. The second response occurs one to several days after hormone treatment, and leads to mitochondrial biogenesis and to a change in mitochondrial mass. The hormone signal for the second response involves both T3-responsive nuclear genes and a direct action of T3 at mitochondrial binding sites. T3, by binding to a specific mitochondrial receptor and affecting the transcription apparatus, may thus act in a coordinated manner with the T3 nuclear pathway to regulate mitochondrial biogenesis and turnover. Transcription factors, coactivators, corepressors, signaling pathways and, perhaps, all play roles in these mechanisms. This review article focuses chiefly on TH, but also looks briefly at some analogues and derivatives (on which the data is still somewhat patchy). We summarize data obtained recently and in the past to try to obtain an updated picture of the current research position concerning the metabolic effects of TH, with particular emphasis on those exerted via mitochondria. (...)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

- Sjekk om du har lavt stoffskifte

Guide: Så farligt er lavt stofskifte
bt.dk 4.11.2013
Det er en god idé at få tjekket dit stofskifte. Har du lavt stofskifte, kan du nemlig få svært ved at blive gravid – eller, når du er blevet det, risikere at skade barnet. Se faresignalerne, symptomer og løsninger i denne guide. (...)

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. (...)

(Anm: Skjoldkjertel (no.wikipedia.org).)

- Symptomer på lavt stoffskifte

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. (...)

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

(Anm: Behandling af hyper- og hypotyreose (irf.dk 13.8.2013 (Institut for Rationel Farmakoterapi (IRF).)

- Thyreoideahormonavhengige nerveceller styrer blodtrykket

Thyreoideahormonavhengige nerveceller styrer blodtrykket
tidsskriftet.no 15.3.2013
En nyoppdaget gruppe nerveceller i hjernen regulerer blodtrykk og pulsfrekvens hos mus. De kontrolleres av thyreoideahormoner.

Forskere har nylig identifisert en ny gruppe nerveceller i fremre hypothalamus hos mus (1). Cellene ble karakterisert ved nærvær av proteinet parvalbumin. De hadde spesifikke intracellulære reseptorer for thyreoideahormoner. Selektiv fjerning av disse nevronene førte til økning i gjennomsnittlig arterietrykk og pulsfrekvens. Hos mus med en inaktiv hormonreseptor ble det identifisert færre parvalbuminpositive nerveceller. Dette tyder på at thyreoideahormoner påvirker utviklingen av disse kontrollnevronene. Hypotyreose hos mor kunne ha en avgjørende rolle i utviklingen av denne nevrongruppen hos fosteret og være en risikofaktor for hjerte- og karsykdom senere i livet.

– Thyreoideahormoner virker inn på hjertet og det sympatiske nervesystem ved å øke hjertefrekvens, slagvolum og blodtrykk, sier professor Joel Glover ved Institutt for medisinske basalfag, Universitetet i Oslo. – I denne studien oppdaget man at thyreoideahormoneksponering i fosterlivet hos mus er nødvendig for utviklingen av en spesifikk nervecellepopulasjon i hypothalamus som regulerer kardiovaskulær funksjon. Fordi hypothalamus står for en overordnet styring av både thyreoidea og det sympatiske nervesystemet, viser denne oppdagelsen en tidligere ukjent interaksjon mellom nervøs og endokrin regulering av kardiovaskulær funksjon, sier han.

– Spesielt interessant er det utviklingsmessige aspektet. For lavt thyreoideahormonnivå i fosterlivet gir færre nerveceller i den nyoppdagede populasjonen og dermed irreversibel hypertensjon senere i livet. Fosterets thyreoideahormonnivå bestemmes av dets egen produksjon og av overføring fra moren. Dette kan være både genetiske og epigenetiske effekter. Funnene kan føre til endringer i dagens behandling av kardiovaskulær sykdom og thyreoideaforstyrrelser og viser en potensielt viktig utviklingsmessig patofysiologisk mekanisme for hjerte- og karsykdommer, sier Glover. (...)

(Anm: Thyroid hormone is required for hypothalamic neurons regulating cardiovascular functions. J Clin Invest. 2013;123(1):509–516 (January 2, 2013).)

(Anm: Thyroid hormone and seasonal rhythmicity. Thyroid hormone and seasonal rhythmicity. Front. Endocrinol. 2014;5:19 (26 February 2014).)

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

For Some, Psychiatric Trouble May Start in Thyroid (For enkelte starter psykiatriske problemer i skjoldbruskkjertelen)
nytimes.com 21.11.2011
Hos pasienter med depresjon, angst og andre psykiske problemer finner leger ofte unormale blodnivåer av skjoldbruskhormoner. De har funnet at behandling av problemet kan føre til forbedringer i humør, minne og kognisjon. (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.)

Forskere har nå oppdaget en litt kontroversiell link mellom små, eller subkliniske, skjoldbruskproblemer og noen pasienters psykiske problemer. Etter gjennomgang av litteraturen om subklinisk hypotyreose og sinnstemninger, har dr. Russell Joffe, psykiater ved North Shore-Long Island Jewish Health System og kolleger nylig konkludert at behandling av tilstanden, som påvirker omtrent to prosent av amerikanerne, kan lindre noen pasienters psykiske symptomer og hindre fremtidig kognitiv svikt. (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.)

Ifølge dr. Joffe forteller pasienter med psykiske symptomer at "de får det bedre når de får skjoldbruskhormoner." (Patients with psychiatric symptoms, Dr. Joffe said, “tell us that given thyroid hormones, they get better.”)

Skjoldbruskkjertelen er en knuteformet kjertel bundet til luftrøret som produserer to hormoner: tyroksin, eller T4 og trijodtyronin, kjent som T3. Disse hormonene spiller en rolle i et overraskende antall fysiske prosesser, fra regulering av kroppstemperatur og hjerteslag til kognitiv funksjon. (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.)

(Anm: Antidepressiva - deprimert, litt trist, angst, stresset eller utbrent? (mintankesmie.no).)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

- Virusinfeksjon kan gi autoimmun tyreoiditt

Virusinfeksjon kan gi autoimmun tyreoiditt
Tidsskr Nor Legeforen 2013; 133:1570 (20.8.2013)
Virusinfeksjon kan ha betydning for utvikling av autoimmune tyreoiditter, viser funn fra Sara Salehi Hammerstads doktorgrad.

Autoimmune tyreoiditter består hovedsakelig av Graves sykdom og Hashimotos tyreoiditt og er blant de hyppigste stoffskifte- og autoimmune sykdommer. Årsaken til sykdommene er ikke kjent, men antas å være en kombinasjon av predisponerende gener og miljøfaktorer som kan utløse en autoimmun reaksjon.

– I mitt doktorgradsarbeid har jeg påvist virus i thyreoideavev fra tidlig stadium av autoimmune tyreoiditter. I vev fra pasienter med Graves sykdom ble enterovirus-RNA og viruskapsidprotein 1 oftere påvist enn i vev fra kontrollgruppen. Ved Hashimotos tyreoiditt fant vi betydelig destruksjon av vevet og uttalt betennelse. Dette viser at sykdomsprosessen har startet mye tidligere enn på det tidspunktet tilstanden ble oppdaget, sier Hammerstad.

– Vi har også undersøkt ekspresjonen av myksovirus-resistansprotein A (MxA), en surrogatmarkør for lokal produksjon av interferonsom respons på virusinfeksjon. Antall MxA-positive celler og ekspresjon av MxA i epitelceller og endotelceller var økt i alle stadier i Hashimotos tyreoiditt og tidlig i forløpet av Graves sykdom. Dette kan være et indirekte tegn på virusinfeksjon.

– Tidligere studier har basert seg på funn fra blodprøver hos pasienter med mangeårig sykdom og som var under behandling. Funn fra vev i tidlig stadium av tyreoiditten bidrar til en bedre forståelse av mekanismene bak sykdommen. Hvis virus er en utløsende faktor for sykdommen, er det mulig å forebygge med vaksiner eller behandle med antivirale medisiner før vevet og hormonproduksjonen blir ødelagt. (...)

(Anm: A trigger that likely unleashes autoimmune disease (…) Dubbed 'rogue germinal centre B cells', these previously undetected cells are renegade versions of the germinal centre B cells that make the 'high affinity' antibodies required for long-term immunity. (medicalnewstoday.com 15.5.2015).)

(Anm: Hva er symptomene på Hashimotos sykdom? (Faktaark Hashimotos sykdom) (womenshealth.gov).)

- Autoimmune sykdommer og alvorlige infeksjoner som risikofaktorer for sinnslidelser en landsomfattende studie

Autoimmune Diseases and Severe Infections as Risk Factors for Mood Disorders A Nationwide Study (Autoimmune sykdommer og alvorlige infeksjoner som risikofaktorer for sinnslidelser en landsomfattende studie)
JAMA Psychiatry. 2013;():1-9 (Published online )
Importance Mood disorders frequently co-occur with medical diseases that involve inflammatory pathophysiologic mechanisms. Immune responses can affect the brain and might increase the risk of mood disorders, but longitudinal studies of comorbidity are lacking.

Objective To estimate the effect of autoimmune diseases and infections on the risk of developing mood disorders.

Design Nationwide, population-based, prospective cohort study with 78 million person-years of follow-up. Data were analyzed with survival analysis techniques and adjusted for calendar year, age, and sex.

Setting Individual data drawn from Danish longitudinal registers.

Participants A total of 3.56 million people born between 1945 and 1996 were followed up from January 1, 1977, through December 31, 2010, with 91 637 people having hospital contacts for mood disorders.

Main Outcomes and Measures The risk of a first lifetime diagnosis of mood disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% CIs are used as measures of relative risk.

Results A prior hospital contact because of autoimmune disease increased the risk of a subsequent mood disorder diagnosis by 45% (IRR, 1.45; 95% CI, 1.39-1.52). Any history of hospitalization for infection increased the risk of later mood disorders by 62% (IRR, 1.62; 95% CI, 1.60-1.64). The 2 risk factors interacted in synergy and increased the risk of subsequent mood disorders even further (IRR, 2.35; 95% CI, 2.25-2.46). The number of infections and autoimmune diseases increased the risk of mood disorders in a dose-response relationship. Approximately one-third (32%) of the participants diagnosed as having a mood disorder had a previous hospital contact because of an infection, whereas 5% had a previous hospital contact because of an autoimmune disease.

Conclusions and Relevance Autoimmune diseases and infections are risk factors for subsequent mood disorder diagnosis. These associations seem compatible with an immunologic hypothesis for the development of mood disorders in subgroups of patients. (...)

(Anm: Autoimmune sykdommer. (nhi.no 23.8.2013).)

(Anm: Immuno-psychiatry: when your body makes its own angel dust - anti-NMDA receptor encephalitis. A new study in Biological Psychiatry reports structural brain damage from an autoimmune encephalitis that impairs behavior in ways that are somewhat similar to the effects of "angel dust". The body sometimes makes substances that have effects on the brain in ways that resemble the effects of illicit drugs. In their paper, the authors report findings on a syndrome called anti-NMDA receptor encephalitis that arises when the body makes antibodies that target one of the subunits of the N-methyl-D-aspartate (NMDA) subtype of receptor for the chemical messenger, glutamate. The antibodies appear to mimic effects produced by the drug phencyclidine (PCP), also known as "angel dust", which produces a schizophrenia-like syndrome by blocking the NMDA glutamate receptor. Schizophrenia itself is also associated with NMDA receptor dysfunction. Senior author of the study, Dr. Carsten Finke, Professor at Charité-Universitätsmedizin Berlin, explains, "Anti-NMDA receptor encephalitis is a recently discovered autoimmune disorder of the brain, which causes a severe neuropsychiatric syndrome with behavioral changes, psychosis, memory loss, and decreased levels of consciousness. Although many patients recover well, the majority suffer from long-term cognitive impairment." (medicalnewstoday.com 26.4.2016).)

(Anm: Autoimmune attack underlying kidney failure. Interstitial nephritis, a common cause of kidney failure, has a complex and largely unknown pathogenesis. In a new published paper in The Journal of the American Society of Nephrology, a team of researchers led from Karolinska Institutet shows how interstitial nephritis can develop from an autoimmune attack on the kidney's collecting duct. (medicalnewstoday.com 24.3.2016).)

(Anm: Imbalance between gut microorganisms, immune cells could set stage for autoimmune disease. An imbalance in the reciprocal relationship between common gut bacteria and certain immune cells can set the stage for the development of autoimmune inflammation, according to a study conducted by researchers at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, who described their findings recently in Immunity. (...) (medicalnewstoday.com 18.3.2016).))

(Anm: Cellfälla nytt vapen mot autoimmuna sjukdomar. En fälla som fångar in celler som eldar på inflammationer i kroppen: Den nya svenska metoden att behandla autoimmuna sjukdomar kan komma ut på klinikerna nästa år. Först ut är ulcerös kolit. (…) Dit hör tarmsjukdomarna ulcerös kolit och Crohns sjukdom, MS, psoriasis samt förlamningssjukdomen ALS. (nyteknik.se 4.2.2016).)

- Autoimmunitet i psykiatri

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. (...)

(Anm: Myasthenia gravis er en sykdom som fører til muskelsvakhet og økt trettbarhet i muskulaturen. Forskjellige muskelgrupper kan rammes i ulik grad. Tilstanden regnes som en autoimmun sykdom der impulsoverføringen fra nerve til muskel er forstyrret. (nhi.no).)

(Anm: Localised myxoedema complicating Graves’ disease. A 48 year old man diagnosed as having Graves’ disease (ophthalmopathy and thyrotoxicosis) eight years earlier presented with progressive, non-pitting thickening of the skin in both feet and the pretibial and lateral area of each leg. BMJ 2016;352:i156 (Published 19 January 2016).)

(Anm: Unilateral facial swelling in a thyrotoxic patient. BMJ 2017;356:j534 (Published 09 February 2017).)

- Levothyroxine (T4) i psykiatrien: Problem knyttet til absorpsjon etter oral dosering i psykiatrien

Levothyroxine in Psychiatry: Issues Related to Absorption After Oral Dosing (Levothyroxine i psykiatrien: Problem knyttet til absorpsjon etter oral dosering)
J Clin Psychiatry 2013;74(8):e744–e746
Levothyroxine (T4) supplementation may be necessary in various psychiatric contexts. There are many circumstances that result in diminished T4absorption after oral dosing. These include drugs and disorders associated with decreased gastric acidity; constituents of food such as fiber; items of consumption such as soy, coffee, and grapefruit juice; and drugs or supplements such as calcium, iron, sucralfate, orlistat, phosphate binders, and others. Patients are therefore best advised to take T4on an empty stomach, as distant as possible from food, beverages, and other medications; if this is not feasible, possible impairment in absorption can be accepted and the dose of T4titrated to target hormonal levels. However, if this is done, an unexpected hyperthyroid state may arise if the circumstances impairing T4absorption change. (...)

- Hva er symptomene på Hashimotos sykdom?

Hashimoto's disease fact sheet (Faktaark Hashimotos sykdom)
womenshealth.gov
What is Hashimoto's disease? (Hva er Hashimotos sykdom?)

Hashimotos sykdom er en autoimmun sykdom som påvirker skjoldbruskkjertelen. Den er også kalt Hashimotos tyreoiditt. Skjoldbruskkjertelen er en liten kjertel på forsiden av halsen. Skjoldbruskkjertelen produserer hormoner kalt T3 og T4 som regulerer hvordan kroppen bruker energi. Skjoldbruskkjertelens hormonnivåer er kontrollert av hypofysen, som er en kjertel i hjernen på størrelse med en ert. Den produserer thyreoideastimulerende hormon (TSH), som trigger skjoldbruskkjertelen til å produsere skjoldbruskkjertelhormoner. (Hashimoto’s disease is an autoimmune disease that affects the thyroid. It also is called Hashimoto’s thyroiditis (theye-royd-EYET-uhss). The thyroid is a small gland in the front of the neck. The thyroid makes hormones called T3 and T4 that regulate how the body uses energy. Thyroid hormone levels are controlled by the pituitary, which is a pea-sized gland in the brain. It makes thyroid stim ulating hormone (TSH), which triggers the thyroid to make thyroid hormone.)

Med Hashimotos sykdom lager immunsystemet antistoffer som skader skjoldbruskceller og forstyrre deres evne til å lag thyreoideahormon. Over tid kan thyroid skade forårsake for lave thyreoideahormonnivåer. Dette kalles en underaktiv skjoldbruskkjertel eller hypothyreose. En underaktiv skjoldbruskkjertel forårsaker hver funksjon av kroppen til å bremse ned, som hjertefrekvens, hjernefunksjon og hastigheten kroppen din omgjør mat til energi. Hashimotos sykdom er den vanligste årsaken til en underaktiv skjoldbruskkjertel. Det er nært knyttet til Graves syndrom, en annen autoimmun sykdom som påvirker skjoldbruskkjertel. (With Hashimoto’s disease, the immune system makes antibodies that damage thyroid cells and interfere with their ability to make thyroid hormone. Over time, thyroid damage can cause thyroid hormone levels to be too low. This is called an underactive thyroid or hypothyroidism (heye-poh-THEYE-royd-ism). An underactive thyroid causes every function of the body to slow down, such as heart rate, brain function, and the rate your body turns food into energy. Hashimoto’s disease is the most common cause of an underactive thyroid. It is closely related to Graves’ disease, another autoimmune disease affecting the thyroid.)

What are the symptoms of Hashimoto's disease? (Hva er symptomene på Hashimotos sykdom?)
Mange mennesker med Hashimotos sykdom har i mange år ingen symptomer. En forstørret skjoldbruskkjertel, kalt en struma, er ofte de første tegn på sykdom. Struma kan føre til forsiden av halsen hovner opp. Du eller din lege legger kanskje merke til struma. Hvis den er stor kan det føre til en tykkhetsfølelse i halsen eller gjør det vanskelig å svelge. Det fører sjelden til smerte. (Many people with Hashimoto’s disease have no symptoms for years. An enlarged thyroid, called a goiter, is often the first sign of disease. The goiter may cause the front of the neck to look swollen. You or your doctor may notice the goiter. If large, it may cause a feeling of fullness in the throat or make it hard to swallow. It rarely causes pain.)

Mange mennesker med Hashimotos sykdom utviklet en underaktiv skjoldbruskkjertel. De kan ha milde eller ingen symptomer først. Men symptomene har en tendens til å forverres over tid. Symptomer på en underaktiv skjoldbruskkjertel er: (Many people with Hashimoto’s disease develop an underactive thyroid. They may have mild or no symptoms at first. But symptoms tend to worsen over time. Symptoms of an underactive thyroid include:)

•Fatigue (Utmattelse)
•Weight gain (Vektøkning)
•Pale, puffy face (Blekt, oppsvulmet ansikt)
•Feeling cold (Kuldefølelse)
•Joint and muscle pain (Ledd- og muskelsmerter)
•Constipation (Forstoppelse)
•Dry, thinning hair (Tørt, tynt hår)
•Heavy menstrual flow or irregular periods (Kraftig menstrajon eller uregelmessige perioder)
•Depression (Depresjon)
•A slowed heart rate (Redusert hjerterytme)
•Problems getting pregnant (Problemer med å bli gravis)

Når du starter behandlingen vil du trenger oppfølging med TSH- test så legen kan finjustere din dose. Thyreoideahormon fungerer veldig langsomt i kroppen så det kan ta flere måneder etter starten av behandling for symptomer å forsvinne og struma å krympe. Hvis dosen er for sterk blir thyreoideahormonnivåer for høye. Dette kalles hyperthyrose. For mye thyreoideahormon kan føre til hjerteproblemer og bentap. Så det å finne riktig dose er viktig. (...) (When you start treatment, you will need a follow-up TSH test so your doctor can fine-tune your dose. Thyroid hormone acts very slowly in the body, so it can take several months after the start of treatment for symptoms to go away and goiter to shrink. If the dose is too strong, thyroid hormone levels will become too high. This is called hyperthyroidism. Too much thyroid hormone can cause heart problems and bone loss. So finding the right dose is important.)

(Anm: Localised myxoedema complicating Graves’ disease. A 48 year old man diagnosed as having Graves’ disease (ophthalmopathy and thyrotoxicosis) eight years earlier presented with progressive, non-pitting thickening of the skin in both feet and the pretibial and lateral area of each leg. BMJ 2016;352:i156 (Published 19 January 2016).)

What would happen if Hashimoto's disease is not treated? (Hva skjer hvis Hashimotos sykdom ikke behandles?)
Uten behandling kan Hashimotos sykdom utvikle seg og symptomer på en underaktiv skjoldbruskkjertel bli verre. En ubehandlet underaktiv skjoldbruskkjertel kan føre til ytterligere problemer, inklusive: (Without treatment, Hashimoto’s disease may progress and symptoms of an underactive thyroid can get worse. An untreated underactive thyroid can cause further problems, including:)

•Infertility (Barnløshet)
•Miscarriage (Spontanabort)
•Giving birth to a baby with birth defects (Fødseledefekter hos spedbarn)
•High cholesterol (Forhøyet kolesterolinnhold i blodet)

Severe underactive thyroid called myxedema (mik-suh-DEE-muh) can very rarely lead to:

•Heart failure (Hjertesvikt)
•Seizures (Anfall)
•Coma (Koma)
•Death (...) (Dødsfall)

Noen kvinner utvikler problemer med skjoldbruskkjertelen i det første året etter fødselen. Dette kalles postpartum tyreoiditt. Det begynner ofte med symptomer på en overaktiv skjoldbruskkjertel, som varer 2-4 måneder. Milde symptomer kan bli oversett. De fleste kvinner så utvikler symptomer på en lite aktiv skjoldbruskkjertel, som kan vare opptil et år. En underaktiv skjoldbruskkjertel må behandles. I de fleste tilfeller returnerer skjoldbruskkjerte til normal funksjon idet skjoldbruskkjertelen leges. (...) (Some women develop thyroid problems in the first year after giving birth. This is called postpartum thyroiditis (theye-royd-EYET-uhss). It often begins with symptoms of an overactive thyroid, which last 2 to 4 months. Mild symptoms might be overlooked. Most women then develop symptoms of an underactive thyroid, which can last up to a year. An underactive thyroid needs to be treated. In most cases, thyroid function returns to normal as the thyroid heals.)

(Anm: Skjoldbruskkjertelhormoner Kilde: Store norske leksikon.)

- Hva er en autoimmun sykdom?

Autoimmune sykdommer
nhi.no 23.8.2013
Autoimmune sykdommer utgjør en stor gruppe sykdommer som har det til felles at kroppens immunsystem feilaktig angriper friske celler, ødelegger disse og det vevet de tilhører.

Hva er en autoimmun sykdom?
I kroppen har vi spesialceller som danner stoffer som hjelper oss mot infeksjoner. Disse stoffene produseres av en bestemt type immunceller i lymfevevet. Stoffene som produseres, kalles antistoff. Antistoff har en rekke spesialiserte funksjoner, som vi ikke skal gå i detalj på her. Deres hovedfunksjon er å beskytte kroppen mot mikrober, som for eksempel bakterier og virus. Når slike mikrober kommer inn i kroppen blir de identifisert og immuncellene lager antistoffer som er skreddersydd for å angripe den inntrengende mikroben. Sammen med de hvite blodlegemene går de til angrep mot mikroben og tilintetgjør den. Denne prosessen tar noen dager. Hvis den samme mikroben på et senere tidspunkt trenger inn i kroppen, så er antistoffene ferdigkonstruerte og de masseproduseres for å gå til øyeblikkelig angrep.

Autoimmune sykdommer oppstår som følge av at kroppen feilaktig starter å produsere antistoff som angriper kroppens egne friske celler og vev - om igjen og om igjen. Det finnes mer enn 80 sykdommer som er av autoimmun karakter, mange av dem med overlappende symptomer. Nedenfor er en liste over noen av de vanligste: (...)

(Anm: Cellfälla nytt vapen mot autoimmuna sjukdomar. En fälla som fångar in celler som eldar på inflammationer i kroppen: Den nya svenska metoden att behandla autoimmuna sjukdomar kan komma ut på klinikerna nästa år. Först ut är ulcerös kolit. (…) Dit hör tarmsjukdomarna ulcerös kolit och Crohns sjukdom, MS, psoriasis samt förlamningssjukdomen ALS. (nyteknik.se 4.2.2016).)

– 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

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).)

(Anm: Ny forskning: Lykkepiller gør mere skade end gavn. Folk med depression får intet ud af at tage antidepressivet SSRI, bedre kendt som lykkepiller, viser nyt dansk studie. (jyllands-posten.dk 13.2.2017).)

(Anm: Forskere finner link mellom bruk av antidepressiva, medfødte misdannelser eller dødfødsler. (Researchers Find Link Between Antidepressant Use, Congenital Anomalies or Stillbirths) (…) "Mens denne ekstra risikoen kan virke liten er resultatene etter mitt syn så alvorlig som de kan være." (“While this extra risk may seem small, in my view, the outcomes are as serious as they can be.”) (dgnews.docguide.com 5.12.2016).)

(Anm: Eksponering av foster for antidepressiva kan endre Corpus Callosums mikrostruktur: Presentert ved PAS / ASPN. (…) Fordi "den neonate (nyfødtes) corpus callosum mikrostruktur er assosiert med utero (livmor) SSRI-eksponering og prenatal (før fødsel) mødredepresjon, er tidlige modningsprosesser i denne regionen følsomme for endret 5-hydroksytryptamin (5-HT) signalering under tiden i utero (livmor)," bemerket Campbell. "Disse resultatene - sammen med forstyrret hvit substans’ mikrostruktur i genu hos premature spedbarn - tyder dette på at utviklingen av [corpus callosum] kan være følsom for tidlige uheldige påvirkninger. (Fetal Exposure to Antidepressants May Alter Corpus Callosum Microstructure.) (dgnews.docguide.com 10.5.2017).)

(Anm: Unormal sæd med SSRI antidepressiva. Flere studier har funnet endrede sædparametere etter eksponering for SSRI-antidepressiva. Selv om SSRIs rolle er usikker, er det berettiget å ta hensyn til de observerte effektene på sædkvalitet og informere eksponerte pasienter. (Semen abnormalities with SSRI antidepressants. Several studies have found altered semen parameters after exposure to SSRI antidepressants. Although the role of SSRIs is uncertain, it is justified to take into account the observed effects on sperm quality and to inform exposed patients.) Prescrire Int 2015; 24 (156): 16-17.)

(Anm: Gravide kvinner som tar antidepressiva er mer sannsynlig å få barn med autisme, ifølge studie. Pregnant women who take antidepressants more likely to have a child with autism, study finds. Research data published in the BMJ reveal that antidepressant use during pregnancy increases the risk of autism in children, as reported The Independent Thursday. (firstwordpharma.com 20.7.2017).)

(Anm: - Nye data viser økt risiko for misdannelser når antidepressiva brukes under graviditet. (…) En studie publisert i British Medical Journal (BMJ) avslører at antidepressiva forskrevet til gravide kan øke sjansen for å få en baby med misdannelser.) (New Data Show Heightened Risk of Birth Defects When Antidepressants Are Used During Pregnancy.) (dgnews.docguide.com 19.1.2017).)

(Anm: - Utviklingen av et potensielt livstruende serotonergt syndrom eller nevroleptisk malignt syndrom (NMS)-lignende reaksjoner er rapportert for SNRI-er og SSRI-er alene, inkludert Celexa-behandling, men spesielt ved samtidig bruk av serotonerge legemidler (inklusive triptaner) og legemidler som svekker metabolisme av serotonin (inklusive MAO-hemmere), eller med antipsykotika eller andre dopaminantagonister (fda.gov 6.3.2009).)

(Anm: Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. (…) Conclusions Antidepressants with effects on serotonin reuptake during embryogenesis increased the risk of some organ-specific malformations in a cohort of pregnant women with depression. BMJ Open 2017;7:e013372.)

(Anm: Bruk av antipsykotika er assosiert med en 60 % økt risiko for dødelighet hos pasienter med Alzheimers sykdom. (…) Bruk av to eller flere antipsykotika samtidig ble knyttet til nesten doblet dødsrisiko (200 %) enn ved monoterapi.) (Antipsychotic Drug Use Increases Risk of Mortality Among Patients With Alzheimer’s Disease. JOENSUU, Finland -- December 12, 2016 -- Antipsychotic drug use is associated with a 60% increased risk of mortality among patients with Alzheimer's disease, according to a study published in the Journal of Alzheimer’s Disease. The risk was highest at the beginning of drug use and remained increased in long-term use. Use of 2 or more antipsychotic drugs concomitantly was associated with almost 2 times higher risk of mortality than monotherapy.) (dgnews.docguide.com 12.12.2016).)

(Anm: Antipsykotika dobler dødsrisiko allerede etter 180 dagers bruk. Greater Mortality Risk With Antipsychotics in Parkinson's (Større dødsrisiko med antipsykotika ved Parkinsons) (medicalnewstoday.com 21.6.2015).)

(Anm: (...) For ytterligere å illustrere problemet kan nevnes at antipsykotika forårsaker parkinsonisme (5), og en studie fant at mennesker med Parkinsons sykdom og psykose hadde fire ganger større sannsynlighet for å dø etter tre til seks måneders behandling enn de som ikke fikk antipsykotika. (6) De var også mer utsatt for kognitiv svikt, forverring av parkinsonsymptomer, hjerneslag, infeksjoner og fall. RE: Psykisk syke lever kortere. Tidsskr Nor Legeforen 10.11.2015.)

(Anm: Legemidler som kan gi delirium hos eldre. Delirium ses særlig hos eldre ved akutte sykdommer og skader eller som følge av toksisk eller farmakologisk påvirkning. Eldre personer har mange sykdommer og bruken av legemidler er høy. Mange legemidler, og særlig de med antikolinerg eller dopaminerg effekt, kan gi delirium. Kjennskap til legemidler og kombinasjoner av legemidler som kan gi delirium, er viktig for å kunne forebygge og behandle tilstanden. Tidsskr Nor Legeforen 2005; 125:2366-7 (8.9.2005).)

(Anm: Delirium in hospitalized patients: Risks and benefits of antipsychotics. ABSTRACT Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose. Cleveland Clinic Journal of Medicine. 2017 August;84(8):616-622.)

(Anm: Post injektionssyndrom. (…) De fleste af disse patienter udviklede symptomer på sedation (fra mild sedation til koma) og/eller delirium (herunder forvirring, desorientering, ophidselse/ uro, angst og anden kognitiv svækkelse). Andre symptomer inkluderede ekstrapyramidale symptomer, dysartri, ataksi, aggression, svimmelhed, svaghed, hypertension eller krampe.) (sundhedsstyrelsen.dk 29.6.2014).)

(Anm: Mødre til børn med misdannelser har øget dødelighed. (…) Bivirkninger har ført til to dødsfald. Den største del af bivirkningerne (42 procent) af de 429 blev indberettet for såkaldte psykostimulerende lægemidler - eksempelvis til behandling af ADHD - efterfulgt af 31 procent for antidepressiver og 24 procent for antipsykotiske lægemidler. (videnskab.dk 20.12.2016).)

(Anm: Antikolinerge effekter av vanlige legemidler knyttet til økt dødelighet hos mennesker over 65. De kombinerte antikolinerge effektene av mange vanlige legemidler øker risikoen for kognitiv svekkelse og død hos personer over 65 år, ifølge resultater fra en storskala studie på den langsiktige helseeffekten av legemidler.(Anticholinergic effects of common drugs are associated with increased mortality in over 65s. The combined anticholinergic effects of many common drugs increase the risk of cognitive impairment and death in people aged over 65, a large scale study of the long term effect of drugs on health has found.) BMJ 2011; 342:d4037 (28 June).)

(Anm: Men experience greater cognitive impairment and increased risk of death following hip surgery. In a study of hip fracture patients, men displayed greater levels of cognitive impairment within the first 22 days of fracture than women, and cognitive limitations increased the risk of dying within six months in both men and women. "While men make up only about 25 percent of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture," said Dr. Ann Gruber-Baldini, lead author of the Journal of the American Geriatrics Society study. (medicalnewstoday.com 10.2.2017).)

(Anm: Det autonome nervesystemet. Det autonome nervesystemets hovedoppgave er å bidra til likevekt i kroppens basale funksjoner. Det vil blant annet si kroppstemperatur, blodtrykk, åndedrett og fordøyelse. (nhi.no 4.3.2015).)

(Anm: Ulike selektive serotonin reopptakshemmeres (SSRI-er) cytotoksisitet mot kreftceller. (Cytotoxicity of different selective serotonin reuptake inhibitors (SSRIs) against cancer cells.) (…) Vi har funnet at paroxetine (paroksetin; Seroxat; Paxil etc.) har cytotoksisk aktivitet mot tumorceller. J Exp Ther Oncol. 2006;6(1):23-9.)

(Anm: Could antidepressants stop prostate cancer from spreading? In almost all cases where prostate cancer spreads to other areas of the body, the disease spreads to the bone first. In a new study, researchers reveal the discovery of an enzyme that helps prostate cancer cells to invade bone. Furthermore, certain antidepressant medications may have the potential to block this enzyme. Study co-author Jason Wu, of Washington State University-Spokane, and colleagues recently reported their findings in the journal Cancer Cell. (medicalnewstoday.com 13.3.2017).)

(Anm: Classic cytotoxic drugs: a narrow path for regulatory approval. Several classic cytotoxic drugs have shown encouraging activity in the treatment of metastatic breast cancer.1–3 However, only a few have received an overwhelming welcome from regulatory authorities and succeeded in obtaining widespread regulatory approval for routine use. For example eribulin was approved for treatment of metastatic breast cancer in several countries including Japan, USA, and Europe, based on data that showed longer overall survival in patients treated with eribulin compared with patients treated with physician's choice of treatment. In contrast ixabcpilone with capecitabine gained approval from the US Food and Drug Agency based on data showing longer progression-free survival compared with capccitabine alone, but did not obtain rcgulatory authorisation in Europc because it is associated with a high incidence of nevropathy.5 Lancet Oncol. 2017 Feb 10. pii: S1470-2045(17)30089-X. [Epub ahead of print].)

(Anm: Ødelagt cellulær "klokke" linket til hjerneskade (Broken Cellular 'Clock' Linked to Brain Damage) (sciencedaily.com 25.11.2013).)

(Anm: Signaling Pathways Linked to Serotonin-Induced Superoxide Anion Production: A Physiological Role for Mitochondria in Pulmonary Arteries. Abstract. Serotonin (5-HT) is a potent vasoconstrictor agonist and contributes to several vascular diseases including systemic or pulmonary hypertension and atherosclerosis. Although superoxide anion ([Formula: see text]) is commonly associated to cellular damages due to [Formula: see text] overproduction, we previously demonstrated that, in physiological conditions, [Formula: see text] also participates to the 5-HT contraction in intrapulmonary arteries (IPA). Front Physiol. 2017 Feb 9;8:76. eCollection 2017.)

(Anm: Bruk av antidepressiva ble assosiert med et betydelig eldre utseende og forskere fant også ut at vekten spilte en viktig faktor. I de sett med tvillinger som var yngre enn 40 år ble tyngre tvillinger oppfattet som eldre. (…) I tillegg mistenker forskerne at den vedvarende avslapping av ansiktsmuskler som antidepressiva forårsaker kan forklare årsaken til at ansiktet faller sammen (henger). (mintankesmie.no).)

(Anm: Minislag (ministroke: transient ischemic attack (TIA)) linket til lavere forventet levetid. (- Minislag kan forårsake demens.) (- Enkelte psykofarmaka kan øke risiko for minislag / demens.) (mintankesmie.no).)

(Anm: Stumme infarkt rammer oftere folk med høy smertetoleranse. Stumme hjerteinfarkt gir ikke de klassiske brystsmertene som ved vanlige infarkt. - Denne pasientgruppen tar enten ikke kontakt med lege, eller de har ikke fått riktig diagnose, sier lege og forsker Andrea Milde Øhrn. (…) Det er vanlig å tenke sterke brystsmerter og akutt behandling når det er snakk om hjerteinfarkt. Det mange kanskje ikke vet, er at man kan ha hatt et hjerteinfarkt uten å vite det. Dette kalles et stumt infarkt, et hjerteinfarkt med få eller ingen symptomer. - Et stumt hjerteinfarkt er et hjerteinfarkt som ikke er erkjent. (nhi.no 3.2.2017).)

(Anm: Sannsynlig karotidyni forårsaket av fluoxetine (Prozac; SSRI-er). (Probable fluoxetine-induced carotidynia.)  Karotidyni er en fokal nakkesmerte (bestemt, avgrenset område), som involverer anatomiske områder til den berørte arteria carotis, og stråler ofte ut i den ipsilateral side (samme side) av ansiktet eller øret. På grunnlag av medisinsk historie og alder har karotidyni konvensjonelt vært klassifisert i klassisk (ikke-migrenøs), migrenøs, og vaskulære varianter. The Lancet 2009;374(9695):1061-1062 (26 September).)

(Anm: Nakkesmerter sætter forskerne skakmat. Kroniske nakkesmerter koster samfundet milliarder og er en af de hyppigste årsager til, at danskere melder sig syge fra job. Forskerne er i vildrede: Ingen behandling er effektiv. (videnskab.dk 22.12.2016).)

(Anm: Antidepressiva linket til hjerterisiko: tvillingstudie. (Antidepressants linked to heart risk: twins study) - Middelaldrende menn som bruker antidepressiva er mer sannsynlig å ha en innsnevring av blodårer, noe som øker risikoen for hjerteinfarkt og slag, enn de som ikke bruker legemidlene, ifølge en studie presentert på lørdag. (Reuters) - Middle-age men who use antidepressants are more likely to have a narrowing of blood vessels, increasing the risk of heart attacks and strokes, than those who do not use the medications, according to a study presented on Saturday.) (reuters.com 2.4.2011).)

(Anm: - Pfizers Zyvoxid (Zyvox) og antidepressiva kan være en dødelig kombinasjon. (- Det antas at når linezolid gis til pasienter, som behandles med serotonerge psykofarmaka, kan forhøyede nivåer av serotonin bygge seg opp i hjernen og forårsake toksisitet (giftighet). Dette er referert til som Serotonin syndrom - tegn og symptomer inkluderer mentale endringer (forvirring, hyperaktivitet, minneproblemer), muskelrykninger, overdreven svetting, skjelving eller risting, diaré, problemer med koordinasjon og / eller feber.) (fda.gov 21.10.2011).)

(Anm: Hva er det forskrivere og pasienter ikke vet om bivirkninger av antidepressiva? (What do prescribers and patients not know about the side effects of antidepressant drugs?) (medicalnewstoday.com 15.9.2016).)

(Anm: Forskere: Alvorlige bivirkninger, når antidepressiver droppes. Angst, depression og selvmordstanker er nogle af de bivirkninger, som tit forekommer, når man holder op med at tage antidepressiv medicin. Bivirkningerne kan i nogle tilfælde være langvarige og kroniske, viser et nyt studie. (videnskab.dk 16.3.2015).)

(Anm: Bruk av visse smertestillende midler (og antidepressiva (+ 31 %)) forbundet med økt risiko for drap (Use of certain painkillers linked with increased risk of homicide) Enkelte legemidler som påvirker sentralnervesystemet - som smertestillende og beroligende benzodiazepiner - er assosiert med økt risiko for å begå et drap, finner en ny studie publisert i tidsskriftet World Psychiatry. (medicalnewstoday.com 1.6.2015).)

(Anm: Psykiatriske patienter ender i private botilbud. Drab og vold har de seneste år fyldt debatten om de danske bosteder for patienter med psykiske problemer. (…) Psykiatriske patienter ender i private botilbud. (…) Mens Folketinget kæmper for en løsning på problemet med vold på offentlige bosteder, vælger flere kommuner at sende tunge patienter til private tilbud. (politiken.dk 18.3.2017.)

(Anm: Aggresjon knyttet til økt risiko for substansmisbruk. Aggression disorder linked to greater risk of substance abuse. (…) In the study, published in the Journal of Clinical Psychiatry, Emil Coccaro, MD, and colleagues analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States. They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use. The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and effective treatment of aggression could delay or even prevent substance abuse in young people. (medicalnewstoday.com 2.3.2017).)

(Anm: Halvparten av norske drap begått av rusede. (…) I 125 av drapene – eller 54 prosent – er det beskrevet i dommen at gjerningspersonen var påvirket av rusmidler under drapet. (nrk.no 13.12.2016).)

- En pasient på UNN døde av blodforgiftning som følge av et legemiddel mot psykiske lidelser, opplyser Statens helsetilsyn.

(Anm: En pasient på UNN døde av blodforgiftning som følge av et legemiddel mot psykiske lidelser, opplyser Statens helsetilsyn. (- Pasienten døde etter kort tid, og dødsårsaken var nøytropen sepsis (blodforgiftning), heter det i tilsynets rapport. (nrk.no 12.10.2016).)

(Anm: Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection. (en.wikipedia.org).)

(Anm: Sepsis. Definisjon: SIRS + påvist/mistenkt infeksjon (f. eks. positiv blodkultur). SIRS- kriteriene er: - Feber > 38 ºC eller hypotermi < 36 ºC - Puls > 90/minutt - Respirasjonsfrekvens > 20/minutt eller hypokapni med pCO2 < 4,3 kPa i blodgass - Leukocytose ≥ 12 × 109/l eller leukopeni < 4 × 109/l eller > 10 % umodne leukocytter. (helsebiblioteket.no - Metodebok for indremedisinere, 2012).)

(Anm: Rollen til mitokondriell dysfunksjon (mitokondriedysfunksjon) ved sepsis (blodforgiftning)-indusert multiorgansvikt. (The role of mitochondrial dysfunction in sepsis-induced multi-organ failure). (Virulence. 2013 Nov 1;5(1).)

- Diagnostisering av sepsis. Sepsis, også kjent som blodforgiftning, er kroppens hyperaktive respons på en infeksjon som kan føre til betennelse, vevskader, organsvikt etc.

(Anm: Diagnosing Sepsis. Sepsis, also known as blood poisoning, is the body’s hyperactive response to an infection that can lead to inflammation, tissue damage, organ failure etc. It is a very dangerous state in which the immune system stops fighting with the invading agents  and turns to itself. Around one-third of patients who are affected with sepsis die every year. (news-medical.net 7.9.2017).)

- Å anerkjenne sepsis som en global helseprioritet - En WHO- resolusjon.

(Anm: Å anerkjenne sepsis som en global helseprioritet - En WHO- resolusjon. Recognizing Sepsis as a Global Health Priority — A WHO Resolution. “Some very important clinical issues, some of them affecting life and death, stay largely in a backwater which is inhabited by academics and professionals and enthusiasts, dealt with very well at the clinical and scientific level but not visible to the public, political leaders, leaders of healthcare systems... The public and political space is the space in which [sepsis] needs to be in order for things to change.” NEJM (June 28, 2017).)

(Anm: Sepsis – den dödliga sjukdomen som glöms bort. Trots att infektionssjukdomen sepsis förekommer oftare än de vanligaste formerna av cancer och att upp emot hälften som drabbas av den allvarligaste formen dör, så har många knappt hört talas om sjukdomen. Sepsis som är den medicinska termen på blodförgiftning, drabbar omkring 40 000 svenskar varje år. (netdoktor.se 7.6.2017).)

- Hurtigtest finner tegn på sepsis i en enkelt dråpe blod.

(Anm: Hurtigtest finner tegn på sepsis i en enkelt dråpe blod. (- Sepsis, en potensielt livstruende komplikasjon av en infeksjon, har den høyeste byrde mht. død og medisinske utgifter på sykehus over hele verden.) (- Quick test finds signs of sepsis in a single drop of blood. (…) Sepsis, a potentially life-threatening complication of an infection, has the highest burden of death and medical expenses in hospitals worldwide. (medicalnewstoday.com 5.7.2017).)

(Anm: Nye sepsiskriterier kan føre til forsinket behandling. (…) Sepsis er en svært alvorlig tilstand med høy morbiditet og mortalitet (2). Den totale insidensen er ukjent, men man regner med at sepsis er en av de viktigste årsakene til alvorlig, akutt sykdom på verdensbasis (1). (…) Sepsis har inntil nylig vært definert som mistenkt infeksjon med samtidig tilstedeværelse av to eller flere SIRS-kriterier (1). Endringer i hjertefrekvens, kroppstemperatur, respirasjonsfrekvens og leukocytter er kroppens tegn på inflammasjon, og de indikerer ikke nødvendigvis en livstruende, dysregulert vertsrespons på infeksjon. Tidsskr Nor Legeforen 2017; :609-10 (20.4.2017).)

(Anm: LEGENE FORSTO IKKE AT HAN VAR DØDSSYK: Stian (19) døde etter 18 timer på sykehus uten legetilsyn. (…) Helsetilsynet konkluderer med at sykehusets behandling var uforsvarlig. (…) Fikk ikke beskjed. (…) Fastlegen sendte med dem papirer som foreldrene leverte på Akuttmottaket ved Ahus, der sto det; «Diagnose: Obs sepsis».  (tv2.no 29.4.2017).)

(Anm: Svikt i behandlingen av akutt syk ung mann i akuttmottaket – brudd på helselovgivningen. (…) Pasienten ble lagt på observasjonsposten (Akutt 24) ved akuttmottaket frem til neste morgen. I løpet av tiden på observasjonsposten ble han ikke tilsett av lege. På morgenen var han betydelig verre og han fikk tegn på fullt utviklet blodforgiftning. Behandling med antibiotika ble iverksatt, men han døde kort tid etter som følge av meningokokksepsis og hjerneødem. (helsetilsynet.no 2.5.2017).)

(Anm: Sepsis; grunnleggende kliniske observasjoner. Sepsis= En systemisk inflammatorisk respons (SIRS) pga. en infeksjon Tre alvorlighetsgrader: 1) Sepsis (to eller flere symptomer på SIRS som følge av infeksjon) 2) Alvorlig sepsis (sepsis med akutt organdysfunksjon, hypoperfusjon eller hypotensjon) 3) Septisk sjokk (hypotensjon til tross for adekvat væsketerapi, samt forekomst av perfusjonsforstyrrelser og organdysfunksjon) (hnt.no 5.11.2013).)

- Alle bryt lova i behandling av blodforgifting. Pasientar med alvorleg blodforgifting (sepsis) blir undersøkt av lege for seint.

(Anm: Alle bryt lova i behandling av blodforgifting. Pasientar med alvorleg blodforgifting blir undersøkt av lege for seint. Helsetilsynet fann brot ved 24 akuttmottak over heile landet. – Svært alvorleg. – Dette er svært alvorleg, for det dreier seg om ein alvorleg infeksjonssjukdom som i verste fall kan medføra død dersom behandlinga ikkje blir igangsett til riktig tid, seier avdelingsdirektør i Helsetilsynet, Ragnar Hermstad. OVER EIN TIME: Pasientar som kjem inn med teikn på alvorleg infeksjonssjukdom som blodforgifting skal ifølge nasjonale retningslinjer få anitibiotikabehandling innan maks ein time. Alle dei 24 akuttmottaka hadde svikt på dette området. (nrk.no 16.6.2017).)

(Anm: Lege sier improvisert «kur» for sepsis har hatt bemerkelsesverdige resultater. (…) Spesialist i intensivbehandling Paul Marik sier at enkel behandling med infusjon av vitamin C og steroider har bemerkelsesverdig effekt på pasienter med potensielt dødelig tilstand. (independent.co.uk 24.3.2017).)

(Anm: Bivirkninger underrapporteres i videnskabelige tidsskrifter. (...) Mellem 43 og 100 procent af de bivirkninger, der, ifølge det ikke-publicerede materiale, er fundet ved de testede lægemidler, er ikke lagt frem i de videnskabelige artikler, viser Yoon Loke og kollegernes gennemgang. (videnskab.dk 5.10.2016).)

(Anm: Dødsfall på grunn av nøytropen sepsis (blodforgiftning) etter behandling med legemiddelet klozapin – uforsvarlig oppfølging – mangelfull samhandling og informasjon. (…)  Manglende informasjon fra spesialisthelsetjenesten og mangelfull samhandling mellom kommunehelsetjenesten, fastlegen, pasienten og pårørende bidro til hendelsen. Helseforetaket skal gjennomgå hendelsen for å redusere risikoen ved lignende tilfeller. (helsetilsynet.no 12.10.2016).)

(Anm: Eksplosjon av antidepressiva til unge jenter. De ønsker psykologhjelp. I stedet blir de fôret med piller fra fastlegen. Unge jenter har aldri brukt mer antidepressiver. (vg.no 10.9.2016).)

(Anm: Flere barn og unge akuttinnlegges for psykisk sykdom. I fjor utgjorde andelen øyeblikkelig hjelp innleggelser 61 prosent av alle innleggelser. Det er en økning fra 47 prosent i 2012. (dagensmedisin.no 19.9.2016).)

(Anm: Eksplosjon av antidepressiva til unge jenter: Lykkepillegenerasjonen. «Lykkepillen» gjorde Sandra så dårlig at hun ble innlagt på psykiatrisk avdeling. På ti år har bruken av antidepressiver blant unge jenter økt med 83 prosent. Mange får pillene uten en gang å ha snakket med psykolog.  (vg.no 10.9.2016).)

(Anm: Helseminister Bent Høie reagerer på «lykkepille»-praksis: – Veldig urovekkende. ** Kraftig økning i antidepressiva til unge jenter. Helseminister Bent Høie reagerer på den sterke økningen i lykkepillebruk blant unge jenter. Han mener manglende ressurser og fastlegers holdninger er årsaker. Lørdag dokumenterte VG Helg og VG+ konsekvensene av den økende lykkepille-bruken blant unge jenter. (vg.no 10.9.2016).)

(Anm: LO advarer mot trygdebombe. En stadig større del av nordmenn i arbeidsfør alder er uten jobb. LO mener dette er en potensiell trygdebombe. (…) Det trengs 180.000 nye jobber for å få yrkesdeltakelsen opp på samme nivå som i 2008, viser en rapport fra samfunnsøkonomene i LO. I 2008 var 70 prosent av befolkningen mellom 15 og 74 år i jobb. Nå er yrkesdeltakelsen nede i 67,3 prosent., og det er nedgang i alle fylker. (hegnar.no 6.10.2016).)

(Anm: Rekordmange søger akut psykisk hjælp. (- Mens kun 12.099 danskere i 1995 besøgte de psykiatriske akutmodtagelser og skadestuer, er det steget til hele 33.333 i 2015, viser opgørelse fra Sundhedsdatastyrelsen og Danske Regioner, der for kort tid siden blev sendt til Folketinget. (politiken.dk 9.7.2016).)

(Anm: Har vi blitt psykisk sykere? (- Vi vet også at stadig flere får uførepensjon på grunn av psykiske lidelser og at sykefraværet på grunn av psykiske plager og lidelser har økt. Vi tror alle disse forholdene bidrar til vår oppfatning om at stadig flere får en psykisk lidelse eller plage.) (Folkehelseinstituttet fhi.no 10.10.2013).)

(Anm: Høyt fravær på grunn av ME. Minst 270 elever var borte fra skolen i fjor fordi de hadde ME. (aftenposten.no 6.2.2017).)

(Anm: Psykisk ohälsa fortsätter att öka. Antalet svenskar som sjukskrivs på grund av psykisk ohälsa ökar kontinuerligt sedan 2010. Den vanligaste diagnosen är stressrelaterad psykisk ohälsa som till mångt och mycket är arbetsrelaterad. Då evidensbaserad behandling saknas står förebyggande arbete i fokus. (netdoktor.se 14.9.2016).)

(Anm: Psykiatriske skadestuer kan ikke klare presset. Psykiske lidelser hører til nogle af de største sygdomsbyrder, som hvert år koster samfundet et svimlende milliardbeløb i tabt arbejdsfortjeneste og sociale ydelser. (politiken.dk 11.7.2016).)

(Anm: - 9 ting som skjer i hjernen og kroppen på MDMA (Ecstasy). (- 9 Things That Happen in the Brain and Body on MDMA.) (- Derfor, når substansen avsluttes, sitter mennesker igjen med mindre serotonin enn vanlig, noe som kan føre til følelser av depresjon, irritabilitet og tretthet.) (- Siden MDMA frigir så mye serotonin, ødelegger kroppen deretter mer serotonin enn vanlig, ifølge AsapSCIENCE.) (thescienceexplorer.com 24.6.2016).)

(Anm: Flere unge bruker antidepressiva enn for ti år siden. Dette viser en ny studie fra Folkehelseinstituttet gjort i samarbeid med Høgskolen i Hedmark. Studien viser også at færre barn i 1-2-årsalderen får sovemidler. (…) Bruk av et psykofarmaka er i denne studien definert som uttak av minst én resept i løpet av et år på følgende legemidler: •sovemiddel inkludert alimemazin (Vallergan) •midler mot depresjon (antidepressiva) •midler mot psykose (antipsykotika) •angstdempende midler (anxiolytika) •midler i behandling av ADHD (fhi.no 2.2.2016).)

- Antidepressiva etc. påvirker stoffskiftet

Paxil Birth Defects, Pregnancy Drugs and Finding Safer Alternatives (Seroxat-utløste fødselsdefekter, legemidler under graviditet, og det å 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? (...)

Thyroid hormones in the rat amygdala as common targets for antidepressant drugs, mood stabilizers, and sleep deprivation
Biol Psychiatry. 2003 Nov 15;54(10):1049-59.
BACKGROUND: There have been repeated reports of antidepressant effects of thyroid hormones. In this study, we investigated whether antidepressant treatments enhance the concentrations of thyroid hormones in rat brain.

METHODS: Each of the groups of rats was treated for 14 days with one of the following: an antidepressant drug (desipramine, paroxetine, venlafaxine, or tianeptine); a mood stabilizer (lithium or carbamazepine); or 8 hours' partial sleep deprivation. Thyroid hormone concentrations were quantified in homogenates, nuclei, mitochondria, synaptosomes, myelin, and microsomes in 11 rat brain areas.

RESULTS: No drug effects were seen on nuclear triiodothyronine (T(3)) concentrations in any brain area. In the amygdala, all antidepressant drugs enhanced the levels of T(3) in the myelin fraction. Triiodothyronine molecules were identified in the myelin by immunogold labeling. Quantification of the major lipid components showed a selective decrease in cholesterol in the myelin of the amygdala after desipramine treatment. Desipramine induced an increase in protein concentrations, 3,5-diiodothyronine levels, and the activity of the mitochondrial enzyme succinate dehydrogenase in the mitochondria of the amygdala. Lithium, carbamazepine, and partial sleep deprivation raised the levels of T(3) in synaptosomes of the amygdala.

CONCLUSIONS: These results demonstrate that thyroid hormones in the amygdala are a common target of different antidepressant and mood-stabilizing therapies. (...)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

(Anm: Venlafaxine-Induced Cytotoxicity Towards Isolated Rat Hepatocytes Involves Oxidative Stress and Mitochondrial/Lysosomal Dysfunction. Purpose: Depression is a public disorder worldwide. Despite the widespread use of venlafaxine in the treatment of depression, it has been associated with the incidence of toxicities. Hence, the goal of the current investigation was to evaluate the mechanisms of venlafaxine-induced cell death in the model of the freshly isolated rat hepatocytes. (…) Conclusion: Therefore, our data indicate that venlafaxine induces oxidative stress towards hepatocytes and our findings provide evidence to propose that mitochondria and lysosomes are of the primary targets in venlafaxine-mediated cell damage. Adv Pharm Bull. 2016 Dec;6(4):521-530.)

(Anm: Akutt toksisitet for 8 antidepressiva: hva er deres virkningsmekanismer? (Acute toxicity of 8 antidepressants: what are their modes of action? Currently, the hazard posed by pharmaceutical residues is a major concern of ecotoxicology. Most of the antidepressants belong to a family named the Cationic Amphipathic Drugs known to have specific interactions with cell membranes. The present study assessed the impact of eight antidepressants belonging to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors.) Chemosphere. 2014 Aug;108:314-9. Epub 2014 Feb 14. (PDF).)

(Anm: Cytotoxic immune cell in sick and healthy skin a key to understanding vitiligo. With the aid of thousands of skin biopsies and over a hundred kilograms of skin, researchers at Karolinska Institutet have observed how two subgroups of immune cell behave in healthy skin. This functional dichotomy is preserved in the inflammatory diseases psoriasis and vitiligo. The study, which is published in the journal Immunity, opens the way for more targeted local treatments for patchy inflammatory skin disorders. (medicalnewstoday.com 22.2.2017).)

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.

part 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. (...)

- Bruk av antiepileptika gir økt risiko for hypotyreose

Use of antiepileptic drugs and risk of hypothyroidism (Bruk av antiepileptika og risiko for hypotyreose)
Pharmacoepidemiol Drug Saf. 2013 Aug 15. [Epub ahead of print]
PURPOSE: This study aimed to investigate the risk of clinically significant hypothyroidism among all the currently available antiepileptic drugs (AED). (...)

CONCLUSION: The results indicated an increased risk of hypothyroidism among patients using AEDs, especially phenytoin, valproate, phenobarbital, carbamazepine, and oxcarbazepine. The findings also provided strong grounds for further investigations on acute thyroid adverse effect induced by phenytoin. (...)

- Synaptic and Non-Synaptic Mitochondria in Hippocampus of Adult Rats Differ in Their Sensitivity to Hypothyroidism

Synaptic and Non-Synaptic Mitochondria in Hippocampus of Adult Rats Differ in Their Sensitivity to Hypothyroidism
Cell Mol Neurobiol. 2012 Jun 17. [Epub ahead of print]
Abstract Hypothyroidism in humans provokes various neuropsychiatric disorders, movement, and cognitive abnormalities that may greatly depend on the mitochondrial energy metabolism. Brain cells contain at least two major populations of mitochondria that include the non-synaptic mitochondria, which originate from neuronal and glial cell bodies (CM), and the synaptic (SM) mitochondria, which primarily originate from the nerve terminals. Several parameters of oxidative stress and other parameters in SM and CM fractions of hippocampus of adult rats were compared among euthyroid (control), hypothyroid (methimazol-treated), and thyroxine (T4)-treated hypothyroid states. nNOS translocation to CM was observed with concomitant increase of mtNOS's activity in hypothyroid rats. In parallel, oxidation of cytochrome c oxidase and production of peroxides with substrates of complex I (glutamate + malate) were enhanced in CM, whereas the activity of aconitase and mitochondrial membrane potential (ΔΨ(m)) were decreased. Furthermore, the elevation of mitochondrial hexokinase activity in CM was also found. No differences in these parameters between control and hypothyroid animals were observed in SM. However, in contrast to CM, hypothyroidism increases the level of pro-apoptotic K-Ras and Bad in SM. Our results suggest that hypothyroidism induces moderate and reversible oxidative/nitrosative stress in hippocampal CM, leading to the compensatory elevation of hexokinase activity and aerobic glycolysis. Such adaptive activation in glycolytic metabolism does not occur in SM, suggesting that synaptic mitochondria differ in their sensitivity to the energetic disturbance in hypothyroid conditions. (...)

(Anm: Understanding mitochondrial complex I assembly in health and disease. Biochim Biophys Acta. 2012 Jun;1817(6):851-62. Epub 2011 Sep 2.)

(Anm: Selective inhibition of deactivated mitochondrial complex I by biguanides. Biochemistry. 2015 Feb 26. [Epub ahead of print].)

(Anm: Exercise increases mitochondrial complex I activity and DRP1 expression in the brains of aged mice. Abstract. Exercise is known to have numerous beneficial effects. Recent studies indicate that exercise improves mitochondrial energetics not only in skeletal muscle but also in other tissues. (…) Our results suggest that exercise training in old mice can improve brain mitochondrial function through effects on electron transport chain function and mitochondrial dynamics without increasing mitochondrial biogenesis. Exp Gerontol. 2017 Jan 17. pii: S0531-5565(16)30505-8. [Epub ahead of print].)

(Anm: Exercise prevents cellular aging by boosting mitochondria (medicalnewstoday.com 8.3.2017).)

(Anm: Trening er best for å redusere tilbakefall av brystkreft. Exercise is best for reducing breast cancer recurrence. The research was conducted by Dr. Ellen Warner, of the Sunnybrook Health Sciences Centre in Canada, in collaboration with coauthor Dr. Julia Hamer, and the findings were published in the Canadian Medical Association Journal (CMAJ). (medicalnewstoday.com 22.2.2017).)

(Anm: Perinatal vs. Genetic Programming of Serotonin States Associated with Anxiety. Neuropsychopharmacology. 2014 Dec 19.)

(Anm: Early exposure to antidepressants affects adult anxiety, serotonin transmission (sciencedaily.com 19.12.2014).)

(Anm: Bruk av antidepressiva i svangerskapet kan gi mer engstelige barn. Tre år gamle barn av mødre som hadde brukt antidepressiva i svangerskapet viste flere symptomer på angst enn deres søsken som ikke hadde blitt eksponert for antidepressiva i svangerskapet. (fhi.no 15.4.2015).)

(Anm: Serotonin i hjerne og blod (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.)

(Anm: Neonatal Thyrotoxicosis Engl J Med 2014; 370:1237 (March 27, 2014).)

(Anm: Diagnosis and management of thyrotoxicosis. BMJ 2014;349:g5128 (21 August 2014).)

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 tests1,6; 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) (Big Food).)

- Effekten av utilstrekkelig jod-status hos britiske gravide kvinner på kognitive resultater hos deres barn

Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC) (Effekten av utilstrekkelig jod-status hos britiske gravide kvinner på kognitive resultater hos deres barn: resultater fra Avon longitudinell (kohortstudie) studie av foreldre og barn (ALSPAC))
Lancet 2013 (Early Online Publication, 22 May 2013)
(...) Background As a component of thyroid hormones, iodine is essential for fetal brain development. Although the UK has long been considered iodine replete, increasing evidence suggests that it might now be mildly iodine deficient. We assessed whether mild iodine deficiency during early pregnancy was associated with an adverse effect on child cognitive development.

Methods We analysed mother—child pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort by measuring urinary iodine concentration (and creatinine to correct for urine volume) in stored samples from 1040 first-trimester pregnant women. We selected women on the basis of a singleton pregnancy and availability of both a urine sample from the first trimester (defined as ≤13 weeks' gestation; median 10 weeks [IQR 9—12]) and a measure of intelligence quotient (IQ) in the offspring at age 8 years. Women's results for iodine-to-creatinine ratio were dichotomised to less than 150 μg/g or 150 μg/g or more on the basis of WHO criteria for iodine deficiency or sufficiency in pregnancy. We assessed the association between maternal iodine status and child IQ at age 8 years and reading ability at age 9 years. We included 21 socioeconomic, parental, and child factors as confounders.

FindingsThe group was classified as having mild-to-moderate iodine deficiency on the basis of a median urinary iodine concentration of 91•1 μg/L (IQR 53•8—143; iodine-to-creatinine ratio 110 μg/g, IQR 74—170). After adjustment for confounders, children of women with an iodine-to-creatinine ratio of less than 150 μg/g were more likely to have scores in the lowest quartile for verbal IQ (odds ratio 1•58, 95% CI 1•09—2•30; p=0•02), reading accuracy (1•69, 1•15—2•49; p=0•007), and reading comprehension (1•54, 1•06—2•23; p=0•02) than were those of mothers with ratios of 150 μg/g or more. When the less than 150 μg/g group was subdivided, scores worsened ongoing from 150 μg/g or more, to 50—150 μg/g, to less than 50 μg/g.

Interpretation Our results show the importance of adequate iodine status during early gestation and emphasise the risk that iodine deficiency can pose to the developing infant, even in a country classified as only mildly iodine deficient. Iodine deficiency in pregnant women in the UK should be treated as an important public health issue that needs attention. (...)

(Anm: Konfunder – ikke confounder – på norsk. Et av de viktigste begrepene i epidemiologi er «confounder». På norsk bør det skrives «konfunder». Når noen påstår at en faktor A er årsak til en effekt B, lurer vi på om det finnes en faktor som kan påvirke både A og B og derved tilsløre en reell årsakssammenheng (1). Denne faktoren kalles på engelsk «confounder» eller «confounding factor». Det dreier seg om kjente eller ukjente bakenforliggende forhold som kan påvirke utfallet og som er ulikt fordelt mellom eksponerte og ikke-eksponerte (2). Eksempel: Er vindrikking (faktor A) årsak til bedre helse (effekt B)? Kanskje, men det finnes selvsagt en rekke bakenforliggende variabler, f.eks. sosial klasse, som kan være den egentlige forklaringen. Vi kan også snakke om spuriøs sammenheng. Det er betegnelsen på en skinnsammenheng som fremstår som ekte årsakvirkning-forhold, men ikke er det. Det er en bakenforliggende variabel, en «confounder», som er den egentlige årsaken til sammenhengen (3, 4). Tidsskr Nor Legeforen 2013; 133:2280  (12.11.2013).)

- Hyperthyreose kan belaste hjertet

Hyperthyroidism May Put Strain on Heart (Hyperthyreose kan belaste hjertet)
medpagetoday.com 1.5.2013
An overactive thyroid -- even one working in the high-normal range -- may put some people at risk for death from heart disease, researchers found.

In a retrospective Danish cohort study, patients with subclinical hyperthyroidism had a 24% increased risk of cardiovascular death (95% CI 1.09 to 1.41), Christian Selmer, MD, of Gentofte University Hospital in Denmark, and colleagues reported at the European Congress of Endocrinology meeting in Copenhagen.

Those who had high-normal levels of thyroid-stimulating hormone (TSH) also had a 21% increased risk of death from heart disease.

"I think that the take-home message is that if a person has a family history with any thyroid problem, or has any signs of thyroid problems, then they should go for a check-up," Selmer said in a statement. "More than that, their family doctors need to be aware that any sign of thyroid abnormality can affect cardiovascular health, and they should act accordingly."

Irene Weiss, MD, of New York Medical College, who was not involved in the study, told MedPage Today that other studies have also suggested a mild increase in cardiovascular and all-cause mortality in patients with subclinical hyperthyroidism.

"This area is controversial," she said, "but other studies support these kinds of results."

In subclinical hyperthyroidism, levels of TSH are low, but levels of thyroid hormones thyroxine (T4) and triiodothyronine (T3) are normal. Low levels of TSH, which is produced in the pituitary gland and signals the body to produce more thyroid hormones, may indicate thyroid overactivity.

Hyperthyroidism has been linked to cardiovascular problems, but it remains unclear if subclinical hyperthyroidism and high-normal thyroid function are risk factors for cardiovascular death. (...)

(Anm: Subclinical hyperthyroidism and risk of cardiovascular and all-cause mortality. Endocrine Abstracts 2013;32:OC3.6.)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

- 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.) (...)

(Anm: Localised myxoedema complicating Graves’ disease. A 48 year old man diagnosed as having Graves’ disease (ophthalmopathy and thyrotoxicosis) eight years earlier presented with progressive, non-pitting thickening of the skin in both feet and the pretibial and lateral area of each leg. BMJ 2016;352:i156 (Published 19 January 2016).)

- Vanlige kontrastmiddel utgjør risiko for skjoldbrukkjertelen (- FDA flags underactive thyroid cases in babies receiving iodine-containing contrast agents.)

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).)

(Anm: FDA flags underactive thyroid cases in babies receiving iodine-containing contrast agents. The FDA is alerting the public that rare cases of underactive thyroid were reported in babies who were given iodine-containing contrast agents for X-rays and other medical imaging procedures. (fiercepharma.com 18.11.2015).)

(Anm: FDA launches probe into safety of common MRI contrast agent. Amid a growing body of research that shows deposits of gadolinium-based contrast agents (GBCAs) remain in the brain after repeat MRI procedures, the FDA is investigating the products' safety and risks. (fiercepharma.com 28.7.2015).)

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), positronemisjonstomografi (PET), ultrasonografi (ultralyd), kontrastmidler etc. (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).)

(Anm: Bare én av ti nordmenn som rammes av hjerneslag får behandling i tide (tv2.no 16.2.2014).)

(Anm: – Får du hjerneslag har du dårlig tid. Dersom du rammes av hjerneslag risikerer du å miste to millioner hjerneceller hvert minutt. Får du ikke behandling innen 4,5 timer, er risikoen for invaliditet og uførhet stor. (…) Slagambulanse med CT. (nrk.no 8.2.2016).)

(Anm: Ja til ny akuttmetode: Flere slagpasienter kan få tilbud om å «fiske ut» blodpropp av hjernen. To år etter mange andre land gis det nå klarsignal til å videreføre ny og effektiv behandlingsmetode for slagpasienter. I fjor fikk bare 150 pasienter inngrepet - som opptil tusen kan ha nytte av hvert år. (aftenposten.no 2.5.2017).)

(Anm: - Plutselig oppstått dobbeltsyn (- Visuelle komplikasjoner er vanlig etter hjerneslag) Sudden onset double vision BMJ 2014;348:g3286 (19 May 2014).)

(Anm: En av tre blev dement efter återkommande stroke. (…) Den nya analysen, som publiceras i dag, torsdag, på tidskriften Lancet Neurologys hemsida, baseras på 22 sjukhusstudier och åtta populationsstudier. Undersökningarna är utförda mellan 1950 och 2009. (dagensmedicin.se 24.9.2009).)

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. (...)

(Anm: Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (en.wikipedia.org).)

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: Immune response damaging in acute glaucoma (medicalnewstoday.com 16.7.2014).)

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

(Anm: Large eyes come at a high cost. (…)"Animals with large and well-developed eyes, necessary for their survival, pay a high price for them. As all animals have a strictly limited energy budget, a major investment in the visual system only occurs at a cost to other organ systems", says Eric Warrant, researcher in Functional Zoology at Lund University.  (mmedicalnewstoday.com 14.9.2015).)

(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).)

(Anm: Immune response damaging in acute glaucoma (medicalnewstoday.com 16.7.2014).)

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: Immunglobulin, ofte forkortet Ig, en bestemt gruppe proteiner i blodet som virker som antistoffer. Produksjon av antistoffer er av livsviktig betydning i forsvar mot infeksjon. Immunglobulinene blir produsert i spesielle celler i lymfeknuter, milt og benmarg. Inndeling Immunglobulinene er inndelt i fem klasser: immunglobulin G (IgG), immunglobulin A (IgA), immunglobulin M (IgM), immunglobulin D (IgD) og immunglobulin E (IgE). Alle virker som antistoffer, men hver enkelt klasse har sine typiske egenskaper og funksjoner. Kilde: Store norske leksikon.).)

(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).)

(Anm: Diagnosis and management of thyrotoxicosis. BMJ 2014;349:g5128 (21 August 2014).)

- 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. (...)

(Anm: Recovery from brain injury and better sleep go hand in hand. After a traumatic brain injury (TBI), people also experience major sleep problems, including changes in their sleep-wake cycle. A new study shows that recovering from these two conditions occurs in parallel. The study is published in Neurology®, the medical journal of the American Academy of Neurology. (medicalnewstoday.com 23.12.2016).)

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. (...)

(Anm: Misdiagnosis common in rheumatologic diseases like lupus (medicalnewstoday.com 20.8.2014).)

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.)

- Takykardi (thyreotoksikose; tyreotoksikose)

Styrelse vil have undersøgt sammenhæng mellem HPV-vaccine og hjerteproblemer
dagenspharma.dk 3.10.2013
Indberetninger af bivirkninger viser, at hjertesygdommen POTS kan have sammenhæng med vaccination for livmoderhalskræft. EMA skal undersøge sammenfaldet nærmere. (...)

(Anm: Takykardi hurtig hjertevirksomhet. Oppstår ved legemsanstrengelser, psykiske påkjenninger, feber, blødning, thyreotoksikose, hjertesykdom, forgiftning. I akutte anfall (paroksystisk tachykardi) ofte hos helt hjertefriske individer. Uregelmessig hjertevirksomhet ved takykardi kan være tegn på hjertesykdom. Kilde: Store norske leksikon.)

(Anm: Postural orthostatic tachycardia syndrome (POTS). BMJ Case Rep. 2013 Sep 16;2013.)

(Anm: Postural orthostatic tachycardia syndrome (POTS, also postural tachycardia syndrome) is a condition of dysautonomia,[1] to be more specific orthostatic intolerance, in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia. (en.wikipedia.org).)

- 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.)

(Anm: Localised myxoedema complicating Graves’ disease. A 48 year old man diagnosed as having Graves’ disease (ophthalmopathy and thyrotoxicosis) eight years earlier presented with progressive, non-pitting thickening of the skin in both feet and the pretibial and lateral area of each leg. BMJ 2016;352:i156 (Published 19 January 2016).)

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.)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

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. (...)

- 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.)

(Anm: Thyroidectomy complication rates are lower if surgeon performs 25 or more cases yearly. A new study is one of the first to identify a minimum surgeon volume that is associated with improved patient outcomes for this common thyroid operation (medicalnewstoday.com 8.10.2015).)

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. (...)

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. (...)

(Anm: Do flame retardants cause attention problems in children? (medicalnewstoday.com 11.10.2015).)

(Anm: Kan du ha en hormonsykdom? Kan påvirke både vekt, hårvekst og humør. UBALANSE: Dersom hormonproduksjonen kommer i ubalanse kan dette føre til flere ulike sykdommer og plager, og symptomene kan være svært mange. (kk.no 25.2.2015).)

- 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

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.)

- Hvorfor går det så langsomt?

Hvorfor går det så langsomt?
aftenposten.no 24.6.2013
Per Egil Hegge tidligere redaktør i Aftenposten

1. september 2010 var jeg i audiens hos daværende helsedirektør Bjørn-Inge Larsen.

Jeg tilbød ham en historie. Et par år før hadde en venn jeg tok med, en professor i medisin, bedt meg om å finne en lege til et familiemedlem med lavt stoffskifte hypotyreose). Pasienten, en ung kvinne, ble trett og sløv, falt ut av skolen, la på seg 25 kilo, og var nå innlagt for livstruende depresjon.

Min venn hadde sendt pasienten til en av Norges mer ansette endokrinologer, som ikke gjorde noe.

Jeg spurte hvem det var. Navnet sa meg at da ble det ingen hjelp å få. – Nei, og det skuffet meg dypt, sa min venn.

Vi fant frem til en lege, pasienten ble utskrevet, har siden født barn og er på bedringens vei. Noen år gikk tapt. Mye mer kunne ha gjort det: et menneskeliv.

Har ikke skjedd noe
Det lot til at min venns historie gjorde inntrykk på direktør Larsen. Men ut over at jeg i fjor fikk et brev fra en av hans underordnede med en forsikring om at forståelsen og behandlingen av stoffskiftesykdommer er god i Norge, er det ikke skjedd noe.

I mai i år kom en henvendelse fra en annen professor i medisin. Hans datter, som har en meget krevende offentlig stilling, har plager, symptomer og prøvesvar som tyder på lavt stoffskifte. Hun får medisinering nå. Hennes far er sur på seg selv fordi han ikke grep inn tidligere.

Hvor smigrende det enn er for meg, synes jeg ikke at jeg som legmann skal sitte og fortelle professorer i medisin hvilke leger de bør skygge unna. Heller ikke bør jeg fremdeles, 27 år etter at jeg reddet min kone fra livstruende feilbehandling, igjen få et par henvendelser hver uke fra pasienter og pårørende som nektes medisin, tross store plager og klare symptomer på lavt stoffskifte.

Hvorfor skjer det, over 12 år etter at Legeforeningen snudde og besluttet at dens medlemmer behøvde mer opplysning om stoffskiftesykdommer?

Professor B. hadde svaret.

I veiledningen om disse sykdommene i Norsk Elektronisk Legehåndbok står det ingen ting om hvor farlige og plagsomme disse lidelsene kan være. Vurderingen av prøvesvarene er direkte misvisende og helseskadelig.

Mangler kunnskap
Altfor mange norske leger er fremdeles ikke klar over hvor sammensatt sykdomsbildet kan være, og de mangler kunnskap om kliniske symptomer. Følgelig sender de pasienten inn i en karusell: til gynekolog pga. kraftige blødninger, til fordøyelsesspesialist for treg mage, til revmatiker pga. ledd- og muskelsmerter, og til
psykiater pga. depresjon. Alle disse symptomene kan være en del av det kliniske bildet, ikke det subkliniske, særlig når de opptrer samlet. Da er det bare én sykdom, og det er skadelig å la være å behandle med tyroksin, det hormonet som det produseres for lite av, eller som kroppen ikke klarer å nyttiggjøre seg.

Det vegrer man seg for på grunn av «kostnader». Pillene koster litt mindre enn Dispril. Det er billigere enn sykmelding og uførepensjon. Men slikt kommer vel på et annet budsjett. (...)

- Faglig isolasjon

Norge – best i verden
Per Egil Hegge - redaktør
Utenlandsk ekspertise. Det er ingen skam å lære av andre.

Professor dr. med Ola Didrik Saugstad hadde en tankevekkende kronikk i Aftenposten 30. desember. Jeg vil ta utgangspunkt i hans antydede påstand om en sammenheng mellom de kritikkverdige forhold for nyfødte på Rikshospitalet, og det forhold at sykehuset ikke vil prioritere tilknytningen til utenlandske faglige nettverk.

Dette er både uforsvarlig og uforstandig. Det er også uforståelig i lys av at det høye nivå som norsk hjerte-, kreft- og transplantasjonsmedisin, ligger på, klart henger sammen med de internasjonale kontakter som norske eksperter på disse viktige feltene har bygget opp. Vår storfamilie er blant mange som har høstet uvurderlige gevinster av dette.

Faglig isolasjon
Som legmann har jeg lite forstand på nyfødtmedisin. Men på ett område var faglig isolasjon, sjåvinistisk selvgodhet og standhaftig avvisning av praksis og vurderinger i utenlandske miljøer i sin tid nær ved å gjøre meg til enkemann. Vi tilbrakte noen år i medisinsk eksil for å få rettet opp skadene. Saugstads problemstilling interesserer meg derfor.

Fremdeles, 27 år etter at jeg skrev den første artikkelen om mangelfull forståelse av stoffskiftesykdommer, får jeg et par henvendelser hver uke fra personer, gjennomgående kvinner, som systematisk er blitt feilbehandlet for slike lidelser. I 2001, etter min bok Og så må du ikke stille spørsmål, tok Den norske legeforening initiativet til en serie artikler om stoffskifteplager. Jeg regnet med at problemet da ville løse seg. Jeg tok feil.

I løpet av de siste tre-fire årene har jeg fått to henvendelser som er spesielt interessante: Uavhengig av hverandre har to norske medisinske professorer henvendt seg til meg og bedt meg finne en forstandig lege for familiemedlemmer, begge feilbehandlede voksne kvinner med lange sykdomsperioder. Jeg har selvsagt gjort det.

Det er jo smigrende, men de fleste vil nok, med en viss rett, mene at mitt selvbilde er så pass solid at det klarer seg uten ytterligere polstring. Og tross defekte anlegg for egen beskjedenhet synes jeg ikke vi bør ha det slik her i landet at medisinske professorer skal spørre meg om hvilke leger de kan bruke og hvilke de bør holde seg unna.

Om det siste vet jeg mer enn jeg skulle ønske jeg gjorde. Det er de som har til motto «Du må ikke stille spørsmål» – eller «du oppfører deg som en Goebbels» – eller «dette kan ikke stemme, for da ville jeg ha hørt om det».

Alt dette er autentiske sitater, fra eksperter med doktorgrad og professorstatus – og et hovmod som gjør at de avviser alle antydninger om at det kan være interessant å se på hvordan stoffskiftesykdommer behandles i Tyskland, Frankrike, Storbritannia, USA eller for den del Romania.

På noen felter er Norge sikkert best i verden, også utenom vinteridretten. Men kanskje er det lurt iblant å trekke gardinet fra og slippe både lys og opplysning inn. Det er ingen skam å lære av andre. (...)

- 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. (...)

- Å gjenopprette sunn balanse for tarmbakterier kan redusere autisme (ASD)-symptomer.

(Anm: Å gjenopprette sunn balanse for tarmbakterier kan redusere autisme (ASD)-symptomer. Restoring healthy balance in gut bacteria may reduce ASD symptoms. Experts have called for large-scale studies into altering the make-up of bacteria in the gut, after a review showed that this might reduce the symptoms of Autism Spectrum Disorder (ASD). Until now, caregivers have relied on rehabilitation, educational interventions and drugs to reduce ASD symptoms, but now researchers suggest that treating this condition could be as simple as changing their diet. A review of more than 150 papers on ASD and gut bacteria found that since the 1960s, scientists have been reporting links between the composition of bacteria in the gut and autistic behavior. The review highlights many studies showing that restoring a healthy balance in gut bacteria can treat ASD symptoms. (news-medical.net 19.6.2017).)

Diverse artikler

Proton-Pump Inhibitors Inhibit Absorption of Levothyroxine in Tablet Form
jwatch.org/ 24.12.2014
A levothyroxine solution appears to circumvent this problem. Allan S. Brett, MDStudies have shown that gastric acidity enhances the dissolution of levothyroxine tablets. Thus, proton-pump inhibitors (PPIs), which suppress gastric acid secretion, might be expected to inhibit absorption of levothyroxine delivered as a tablet, but not as liquid.

To examine this issue, Italian researchers identified 24 patients who took both levothyroxine tablets and a PPI daily and whose thyroid-stimulating hormone (TSH) levels were around the upper limit of normal (mean level, 4.1 mU/L). All patients were switched from levothyroxine in tablet form to the same dose in an oral solution (while PPIs were continued), and TSH was remeasured 8 weeks later. After the switch, the mean TSH level fell markedly, to 0.9 mU/L. (…)

Tyreoidektomi eller lobektomi ved thyreoideakreft?
Tidsskr Nor Legeforen 2014; 134:2255 (9.12.2014)
Det var ingen forskjell i overlevelse etter henholdsvis tyreoidektomi og lobektomi ved papillær thyreoideakreft i en ny amerikansk registerstudie.

Papillær thyreoideakreft utgjør om lag 90 % av alle tilfeller av thyreoideakreft, og over 90 % av pasientene lever lenger enn 20 år etter kirurgisk behandling. I mange retningslinjer anbefales total tyreoidektomi fremfor lobektomi når tumor er > 1 cm, men det er usikkert om dette har betydning for prognosen etter operasjon 1. (…)

– Overlevelsen etter operasjon for papillær thyreoideakreft er god – derfor må man være spesielt oppmerksom på over- og underbehandling, sier Jan Erik Varhaug, som er professor emeritus ved Universitetet i Bergen. – Studien sier ikke noe om morbiditet, men gjentatte residiver kan kreve en rekke inngrep med forhøyet komplikasjonsrisiko. Derfor kan totalbelastningen for pasientene være betydelig høyere enn overlevelsen alene gir inntrykk av. Residiv etter primærbehandling kan komme over 20 år etterpå, sier Varhaug. (…)

(Anm: Thyroid cancer patients opting for non-intervention face challenging path, study reveals (news-medical.net 10.3.2017).)

Thyroid Hormones and the Metabolic Syndrome
Eur Thyroid J. 2013 Jun;2(2):83-92. Epub 2013 May 28.
(...) BACKGROUND: Clustering of various metabolic parameters including abdominal obesity, hyperglycaemia, low high-density lipoprotein cholesterol, elevated triglycerides and hypertension have been used worldwide as metabolic syndrome to predict cardiometabolic risk. Thyroid dysfunction impacts on various levels of these components. OBJECTIVES: The purpose of the present review is to summarize available data on thyroid hormone-dependent action on components of the metabolic syndrome. METHODS A PubMed search for any combination of hyperthyroidism, thyrotoxicosis or hypothyroidism and metabolic syndrome, blood pressure, hypertension, hyperlipidaemia, cholesterol, high-density lipoprotein cholesterol, glucose, diabetes mellitus, body weight or visceral fat was performed. We included papers and reviews published between 2000 and today but accepted also frequently cited papers before 2000. RESULTS: There is convincing evidence for a major impact of thyroid function on all components of the metabolic syndrome, reflecting profound alterations of energy homeostasis at many levels. CONCLUSION: Even though the interactions shown in animal models and man are complex, it is evident that insulin sensitivity is highest and adverse thyroid effects on the metabolic system are lowest in euthyroid conditions. (…)

– Jeg kan ikke gå rundt å være redd
namdalsavisa.no 28.4.2014
I dag skal Trondheims-Ørn-spiller Martine Flakk (21) opereres for en ondartet svulst i skjoldbruskkjertelen.

TRONDHEIM: I november i fjor gikk Flakk til legen med halsonde. Hun fikk beskjed om at det var en vanlig halsbetennelse. Men hun ble ikke bedre.

– Legen sa smertene og kulen på halsen ville gå bort om tre til fire uker. Det gjorde den ikke, sier Martine.

Hun tok kontakt med fastlegen som henviste henne videre til sykehus. Der ble det foretatt celleprøver i cysten som satt på skjoldbruskkjertelen.

– Det ble tatt celleprøver, noe som var en utrolig ubehagelig og vond opplevelse. Prøvene viste at det var en cyste på kjertelen, som må opereres bort, sier Ørn-spilleren. (…)  

Thyroid Cancer Cases Soar; Is it Overdiagnosed?
pharmatimes.com 21.2.2014
CHICAGO (AP) — A dramatic rise in thyroid cancer has resulted from overdiagnosis and treatment of tumors too small to ever cause harm, according to a study that found cases nearly tripled since 1975.

The study is the latest to question whether all cancers need aggressive treatment. Other research has suggested that certain cancers of the prostate, breast and lung as well as thyroid grow so slowly that they will never become deadly, and that overzealous screening leads to overtreatment.

The thyroid is a hormone-releasing gland in the neck that helps regulate the body's metabolism. Thyroid cancer treatment often includes surgery to remove the butterfly-shaped gland, followed by lifelong daily hormone pills.

Thyroid removal is done for 85 percent of all people diagnosed despite guidelines that say less aggressive surgery is reasonable for lower-risk thyroid tumors, the study authors said. (...)

(Anm: Lenvatinib Outperforms Placebo for Thyroid Ca —But also associated with significant adverse events. (medpagetoday.com 13.2.2015).)

(Anm: Long-term follow-up of benign thyroid nodules shows favorable prognosis (medicalnewstoday.com 5.3.2015).)

(Anm: Breast cancer risk higher in women with overactive thyroid. (medicalnewstoday.com 11.2.2016).)

(Anm: Higher thyroid hormone levels linked to sudden cardiac death. Risk of death from a sudden loss of heart function was significantly greater in patients with thyroid hormone levels at the higher end of normal range, compared to patients with levels at the lower end, according to new research in the American Heart Association's journal Circulation. Sudden cardiac death, occurs when the heart's normal electrical rhythm malfunctions, causing the heart to stop beating. According to a 2012 Circulation study, more than half of all cardiovascular deaths stem from sudden cardiac death, and in many instances no previous symptoms of heart disease were apparent. (medicalnewstoday.com 7.9.2016).)

Forskare varnar för thyroidmedicin
lakemedelsvarlden.se 22.1.2014
En av trettio kvinnor som behandlades med tiamazol tidigt i graviditeten födde barn med skador enligt en dansk studie.

Att tiamazol kan orsaka fosterskador är känt sedan tidigare. Men enligt den danska tidskriften Dagens Pharma har läkare ansett att risken är försvinnande liten om man byter till annan medicinering under första trimestern.

Forskare vid Aalborg universitet menar nu att det inte är nog säkert.

– Vår undersökning tyder på att risken inte är så liten som man hittills trott. En av 30 gravida som får standardbehandling med tiamazol tidigt i graviditeten har fött barn med skador orsakade av medicineringen, hävdar Peter Laurberg professor vid den endokrinologiska avdelningen på Aalborgs universitetssjukhus på universitetets hemsida.

I studien har forskarna analyserat data från över 800 000 födslar. (...)

I Sverige är det ett knappt tusental kvinnor i fertil ålder som behandlas med tiamazol. (...)

Hypothyroidism and Risk of Mild Cognitive Impairment in Elderly PersonsA Population-Based Study
JAMA Neurol. 2013 (Published online December 30, 2013)
Importance An association of clinical and subclinical hypothyroidism with mild cognitive impairment (MCI) has not been established.

Objective To evaluate the association of clinical and subclinical hypothyroidism with MCI in a large population-based cohort.

Design, Setting, and Participants A randomized, cross-sectional, population-based cohort study was conducted in Olmsted County, Minnesota. Participants were aged 70 to 89 years on October 1, 2004, and were without documented prevalent dementia. A total of 2050 participants were evaluated and underwent in-person interview, neurologic evaluation, and neuropsychological testing to assess performance in memory, attention/executive function, and visuospatial and language domains. Participants were categorized by consensus as being cognitively normal, having MCI, or having dementia according to published criteria. Clinical and subclinical hypothyroidism were ascertained from a medical records linkage system.

Main Outcomes and Measures Association of clinical and subclinical hypothyroidism with MCI.

Results Among 1904 eligible participants, the frequency of MCI was 16% in 1450 individuals with normal thyroid function, 17% in 313 persons with clinical hypothyroidism, and 18% in 141 individuals with subclinical hypothyroidism. After adjusting for covariates (age, educational level, sex, apolipoprotein E ε4, depression, diabetes mellitus, hypertension, stroke, body mass index, and coronary artery disease) we found no significant association between clinical or subclinical hypothyroidism and MCI (odds ratio [OR], 0.99 [95% CI, 0.66-1.48] and 0.88 [0.38-2.03], respectively). No effect of sex interaction was seen on these effects. In stratified analysis, the odds of MCI with clinical and subclinical hypothyroidism among men was 1.02 (95% CI, 0.57-1.82) and 1.29 (0.68-2.44) and, among women, was 1.04 (0.66-1.66) and 0.86 (0.37-2.02), respectively.

Conclusions and Relevance In this population-based cohort of elderly people, neither clinical nor subclinical hypothyroidism was associated with MCI. Our findings need to be validated in a separate setting using the published criteria for MCI and confirmed in a longitudinal study. (...)

Hypothyroidism is still prevalent in India despite promotion of iodised salt, study shows
BMJ 2013;347:f7693 (24 December 2013)
India has a high prevalence of hypothyroidism, which affects one in 10 people, a study says.1 This compares with a prevalence of less than 2% in the United Kingdom and less than 5% in the United States.2 3

The study’s authors express surprise at India’s prevalence because in recent years the government has promoted consumption of iodised salt.

Published in the Indian Journal of Endocrinology and Metabolism, the study looked at 5360 adults in eight major Indian cities: Bangalore, Chennai, Delhi, Goa, Mumbai, Hyderabad, Ahmedabad, and Kolkata. (...)

Investigating low thyroid stimulating hormone (TSH) level
BMJ 2013;347:f6842 (20 November 2013)
Learning points

  • The commonest causes of a low serum level of thyroid stimulating hormone (TSH) are excessive levothyroxine replacement, non-thyroidal illness, and subclinical hyperthyroidism.
  • In a patient who is not taking levothyroxine treatment, a low TSH level should prompt measurement of free thyroxine (FT4) and free triiodothyronine (FT3). If these are normal, the TSH level should be measured after six weeks to rule out non-thyroidal illness.
  • Subclinical hyperthyroidism is common in elderly people, and treatment may be indicated before progression to overt thyrotoxicosis to minimise bone loss and risk of atrial fibrillation (...)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

My Thyroid Story
JAMA Intern Med. 2013;173(19):1769 (October 28, 2013)
When I was a first-year medical student just learning physical examination skills, a classmate felt a lump in my neck. A radioactive iodine scan revealed a “hot” nodule. I was advised that the nodule was likely benign, but I needed to have my thyroid checked and thyroid function tested annually. For 20 years I followed this advice, more or less, although I did not have my thyroid function tested annually. In 2000, during a visit to my primary care physician for an unrelated issue, she felt my neck and told me the lump seemed bigger. My endocrinology colleagues had been suggesting a fine-needle biopsy, but I had always quietly demurred. Now, it was my esteemed primary care physician who wanted me to have the biopsy performed. So I did, thinking it would show the benign nodule that I had had forever.

You can imagine my shock and dismay when I got a call from her a few days later, telling me I had “thyroid cancer.” Honestly, I do not think I heard anything except the word cancer. My thoughts leapt to my 2 young daughters, to who would help my husband raise them, and to how much I wanted to be around for their graduation, marriage, and grandchildren. I became a compliant patient and did everything I was told. (...)

Levothyroxine for Borderline Thyroid Hormone Levels Overprescribed?
ivanhoe.com 9.10.2013
(Ivanhoe Newswire) –Widespread prescribing of the medication levothyroxine sodium to boost thyroid function in patients with borderline high levels of the thyroid-stimulating hormone thyrotropin (a sign of low thyroid function), might raise the possibility of overtreatment, according to research in the United Kingdom.

Hypothyroidism is one of the most chronic conditions in Western populations, with levothyroxine prescriptions increasing in the U.S., England, and Whales. Peter N. Taylor, M.Sc., M.R.C.P., of the Cardiff University School of Medicine, United Kingdom, and colleagues examined trends in thyrotropin levels before and after levothyroxine therapy.

Researchers found that between 2001 and 2009, the median (midpoint) thyrotropin level at the start of levothyroxine treatment declined from 8.7 to 7.9 mIU/L, with an increase in the odds of having levothyroxine therapy start at a thyrotropin level of 10 mIU/L or less. “In the United Kingdom, 1.6 million individuals are on long-term levothyroxine regimens, most of whom have been prescribed it for primary hypothyroidism. If current practice continues, up to 30 percent of persons receiving levothyroxine therapy may have been prescribed it without an accepted indication and with the potential for net harm if they develop even a low thyrotropin level,” researchers were quoted as saying. (...)

(Anm: Study Examines Widespread Prescribing of Levothyroxine for Borderline Thyroid Hormone Levels, Overtreatment. JAMA Internal Medicine Releases for October 07, 2013.)

Roy Aleksander må leve med kreften
nrk.no 6.10.2013
Roy Aleksander Farstad har bestemt seg for at kreftdiagnosen skal brukast til noko positivt.

Då sunnmørsguten var 15 år fekk han kreft i skjoldbruskkjertelen. Han blir aldri frisk att. (...)

Må leve med kreft
I fleire år etterpå trudde Roy Aleksander at kreften var eit tilbakelagt stadium. Det skulle vise seg at kreftdiagnosen er kronisk og arveleg. No 12 år etterpå fann legane nye svulstar i halsen.

– Det betyr at eg må leve med kreften resten av livet, seier restaurantsjefen. (...)

Han veit at sjølv om han vart operert for nokre dagar sidan, har han framleis kreft i kroppen, som ikkje forsvinn med cellegift og stråling. Men sjukdomen er ikkje aggressiv og difor kan Roy Aleksander leve eit langt liv med kreften.

Han vert følgt nøye opp og tar blodprøver og røntgen ein gong i året.

Bør genteste småbarn
Overlege ved Haukeland universitetssjukehus, Michael Brauckhoff seier at denne kreftforma, medullær skjoldbruskkjertelkreft, er svært sjeldan. Berre 30 pasientar får diagnosen i året. I 25 prosent av tilfella er sjukdomen arveleg og skuldast ein genfeil.

– Vi anbefaler å genteste små barn i familiar der ein veit at sjukdomen finst. Då opererer ein bort skjoldbruskkjertelen og unngår å utvikle krefttypen seinare i livet, seier Brauckhoff. Helst bør operasjonen skje før 6-årsalderen. (...)

Too Much Medicine
Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours

BMJ 2013;347:f4706 (Published 27 August 2013)
(...) Clinical context—Thyroid cancer is the most common endocrine malignancy and one of the fastest growing diagnoses

Diagnostic change—Introduction of neck ultrasonography into routine endocrinological practice in the 1980s with guided biopsy in the late 1990s, plus increased use of computed tomography and magnetic resonance imaging for other conditions (...)

Conclusion – The incidence of small and indolent thyroid cancer is increasing, exposing patients to treatments inconsistent with their prognosis. We suggest a term that conveys the favourable prognosis for low risk thyroid cancers (micropapillary lesions of indolent course or microPLICs) and call for research to identify the appropriate care for these patients. (...)

(Anm: Lenvatinib Outperforms Placebo for Thyroid Ca —But also associated with significant adverse events. (medpagetoday.com 13.2.2015).)

(Anm: Breast cancer risk higher in women with overactive thyroid. (medicalnewstoday.com 11.2.2016).)

Risk of Thyroid Cancer Based on Thyroid Ultrasound Imaging CharacteristicsResults of a Population-Based Study
JAMA Intern Med. 2013 (Published online August 26, 2013)
Importance There is wide variation in the management of thyroid nodules identified on ultrasound imaging.

Objective To quantify the risk of thyroid cancer associated with thyroid nodules based on ultrasound imaging characteristics. (...)

Conclusions and Relevance Thyroid ultrasound imaging could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. On the basis of these results, these findings should be validated in a large prospective cohort. (...)

(Anm: Lenvatinib Outperforms Placebo for Thyroid Ca —But also associated with significant adverse events. (medpagetoday.com 13.2.2015).)

My Thyroid Story
JAMA Intern Med. 2013 (Published online August 26, 2013)
When I was a first-year medical student just learning physical examination skills, a classmate felt a lump in my neck. A radioactive iodine scan revealed a “hot” nodule. I was advised that the nodule was likely benign, but I needed to have my thyroid checked and thyroid function tested annually. For 20 years I followed this advice, more or less, although I did not have my thyroid function tested annually. In 2000, during a visit to my primary care physician for an unrelated issue, she felt my neck and told me the lump seemed bigger. My endocrinology colleagues had been suggesting a fine-needle biopsy, but I had always quietly demurred. Now, it was my esteemed primary care physician who wanted me to have the biopsy performed. So I did, thinking it would show the benign nodule that I had had forever.

You can imagine my shock and dismay when I got a call from her a few days later, telling me I had “thyroid cancer.” Honestly, I do not think I heard anything except the word cancer. My thoughts leapt to my 2 young daughters, to who would help my husband raise them, and to how much I wanted to be around for their graduation, marriage, and grandchildren. I became a compliant patient and did everything I was told. (...)

As a physician, I knew back then that thyroid cancer is generally benign. But hearing a diagnosis of cancer makes most people, including me at the time, not consider whether there is evidence to support or to question the need for aggressive treatments. We were all, my physicians and I, well intentioned and operating under the best information available, but I do not think I took the time to truly weigh the potential benefits and harms of thyroidectomy. Better data for such decisions and encouragement of opportunities for such discussion would be welcomed by patients and their physicians. (...)

Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy
Cochrane Database Syst Rev. 2013 May 31;5:CD007752
(...) BACKGROUND: Over the last decade there has been enhanced awareness of the appreciable morbidity of thyroid dysfunction, particularly thyroid deficiency. Since treating clinical and subclinical hypothyroidism may reduce adverse obstetric outcomes, it is crucial to identify which interventions are safe and effective.

OBJECTIVES: To identify interventions used in the management of hypothyroidism and subclinical hypothyroidism pre-pregnancy or during pregnancy and to ascertain the impact of these interventions on important maternal, fetal, neonatal and childhood outcomes. (...)

AUTHORS' CONCLUSIONS: This review found no difference between levothyroxine therapy and a control for treating pregnant euthyroid women with thyroid peroxidase antibodies for the outcome of pre-eclampsia, however a reduction in preterm birth and a trend towards reduced miscarriage with levothyroxine was shown. This review also showed no difference for pre-eclampsia or preterm birth when selenium was compared with placebo, however a promising reduction in postpartum thyroiditis was shown. Childhood neurodevelopmental delay was not assessed by any trial included in the review.Given that this review is based on four trials of moderate risk of bias, with only two trials contributing data (n = 284), there is insufficient evidence to recommend the use of one intervention for clinical or subclinical hypothyroidism pre-pregnancy or during pregnancy over another, for improving maternal, fetal, neonatal and childhood outcomes. (...)

(Anm: Does Levothyroxine in Pregnancy Reduce Adverse Outcomes? Subclinical hypothyroidism or hypothyroxinemia during pregnancy may be associated with impaired cognitive function in offspring. Do screening and treatment improve outcomes? New research findings are summarized in a short video. NEJM.org | March 2, 2017.)

(Anm: Subclinical Hypothyroidism and Hypothyroxinemia in Pregnancy — Still No Answers. Transplacental passage of maternal thyroxine (T4) is essential for the maintenance of pregnancy and for normal fetal development, especially in the first half of gestation. Mild or subclinical hypothyroidism in pregnancy has been linked to adverse outcomes, including miscarriage, preterm delivery, low birth weight, and lower-than-normal IQ in offspring,1 although the data are conflicting.2 N Engl J Med 2017; 376:876-877 (March 2, 2017).)

(Anm: Decreased risk of colorectal cancer linked with higher selenium levels (medicalnewstoday.com 16.12.2014).)

(Anm: Low selenium levels linked to liver cancer development. A new study, published in The American Journal of Clinical Nutrition, shows that the highest levels of blood selenium or of selenoprotein P, the protein that distributes selenium from the liver around the body, are associated with a decreased risk of developing liver cancer (particularly hepatocellular carcinoma), even when all other major liver cancer risk factors are taken into account. The study also shows that selenium level is not associated with the development of gall bladder or biliary tract tumours.  (medicalnewstoday.com 5.7.2016).)

Diabetes And Glucose Meters, Prostate Cancer Bone Metastases, Thyroid Autoimmunity And More
medicalnewstoday.com 18.6.2013
Mount Sinai researchers demonstrate new data on diabetes self-management, as well as the role of prostastic acid phosphatase (PAP) in Prostate Cancer (PCa) bone metastases; identify new molecules that can stimulate the thyroid gland; reveal the prevalence of primary aldosteronism (PA) in an urban population; and show how thyroid autoimmunity may be triggered by endoplasmic reticulum (ER) stress. (...)

"This study showed that one of the main proteins produced by cells in response to infection can also cause ER stress in thyroid cells which can trigger thyroid autoimmunity," said Dr. Tomer. "This discovery will enable us to test ER stress blockers for their effectiveness to treat and prevent thyroid immunity in the future." (...)

Saving the Voice after Thyroid Surgery
ivanhoe.com 7.6.2013
(Ivanhoe Newswire) — Research shows that up to 80 percent of patients who undergo thyroid surgery experience problems with their voice. The American Academy of Otolaryngology—Head and Neck Surgery Foundation published a new Clinical Practice Guideline on "Improving Voice Outcomes after Thyroid Surgery" to recognize the importance of the patient's voice and the potential impact thyroid surgery can have on it.

The guideline's recommendations were developed to empower physicians and surgeons to optimize voice outcomes for adult patients undergoing thyroid surgery. Also, researchers wanted to educate patients of the potential impact on their voices and to counsel those patients whose voice does change after surgery about rehabilitation options.

SOURCE: American Academy of Otolaryngology - Head and Neck Surgery, June 2013 (...)

Surgical Approaches to the Thyroid GlandWhich Is the Best for You and Your Patient?
JAMA Otolaryngol Head Neck Surg. 2013;139(5):515-517 (May 2013)
It turns out that the question of which surgical approach is best has many different answers, which depend in no small measure on the characteristics of the patient and the characteristics of the surgeon. This is because the most fundamental change that has occurred in the field of thyroid and parathyroid surgery is the capacity to customize the surgery to the patient and his or her disease characteristics (eg, the approach to a 2-cm follicular neoplasm in a slender, 28-year-old woman should be different from the approach for a 4.5-cm papillary cancer with aggressive features in an obese 68-year-old man). This capacity to personalize the procedure has been facilitated by the remarkable technological advances in surgery that have eventually found their way to the thyroid compartment, and have spawned the development of novel and creative ways of safely removing the thyroid gland. (...)

Når er det indikasjon for thyreoideascintigrafi?
Tidsskr Nor Legeforen 2013 (26. april )
De siste årene er indikasjonene for thyreoideascintigrafi betydelig endret. Spesielt gjelder dette for knutediagnostikk i thyreoidea hvor ultralyd med finnålsbiopsi har tatt over fullstendig. Undersøkelsen er fremdeles indisert ved mistanke om autonomt thyreoideaadenom samt tyreoiditt med hypertyreose.

Scintigrafi har i mange år vært brukt som ledd i utredning av forskjellige thyreoidealidelser. Etter hvert har ultralyd med finnålscytologisk prøve (FNAC) overtatt mange av de indikasjonene som scintigrafi tidligere hadde, spesielt innen knutediagnostikk. At enkelte internasjonale retningslinjer er foreldet, og ikke i tråd med dagens praksis, gjør ikke situasjonen enklere (1, 2). Generelle norske retningslinjer for thyreoideascintigrafi mangler, men for tumorutredning har vi slike retningslinjer i Norge hvor det heter: «Tyreoideascintigrafi har ikke rutinemessig plass i primærutredning av tumor i glandula tyreoidea med mindre TSH er lav og autonomt adenom kan foreligge» (3).

Ved Seksjon for radiologi og nukleærmedisin, Oslo universitetssykehus blir mer enn halvparten av henvisningene hvor pasientene skal utredes for ikke-malign sykdom, nå avvist. Avvisning av en henvisning er problematisk på mange vis. Pasienten kan bli i villrede om hva som skal gjøres, og eventuelt stille spørsmål ved legens/sykehusets kompetanse. I tillegg sløses det med verdifull tid for legen som henviser, som må ta pasienten tilbake og eventuelt henvise til annen instans, og ikke minst for pasienten som ønsker og forventer en løsning på sine problemer. Ved vår seksjon går det med tid og ressurser til å gi en skriftlig avvisning og et kortfattet resymé av hvorfor thyreoideascintigrafi ikke er indisert i det enkelte tilfellet.

For å unngå unødig tidsspille er det derfor viktig at potensielle henvisere kjenner til hvilke indikasjoner som gjelder for thyreoideascintigrafi, og kanskje spesielt ved hvilke tilstander thyreoideascintigrafi ikke er til nevneverdig hjelp. (...)

Subclinical Hypothyroidism and Cardiovascular Disease
Arch Intern Med. 2012;172(19):1523-1524
Comments We thank Razvi et al1 for their informative article on subclinical thyroid disease. The study by Razvi et al1 provides useful information regarding the importance of recognizing subclinical hypothyroidism (SCH) in anticipation of decreasing cardiac risks, although definitive long-term prospective controlled studies proving the benefits of treatment in various age groups have not been performed. In this context, we observed that innate immune overactivity is associated with an unstable phenotype of atherosclerotic plaques in patients with SCH enlisted to undergo endoarterectomy for high-grade (>70%) carotid artery stenosis.2 In particular, macrophages were significantly more abundant in SCH atherosclerotic lesions compared with control lesions, and it was associated with higher nuclear-factor–κB, tumor necrosis factor, and matrix-metalloproteinase-9 levels, along with less interstitial collagen content. All of this might increase the risk of acute ischemic events precipitated by inflammatory-dependent rupture of atherosclerotic plaques.3 (...)

Subclinical Hypothyroidism and Cardiovascular Disease—Reply
Arch Intern Med. 2012;172(19):1523-1524
In reply We agree with Marfella et al that innate immune overactivity may explain the increased cardiovascular (CV) risk seen in subclinical hypothyroidism (SCH). However, several other possible mechanisms may also be responsible.1 An atherogenic lipid profile is seen in SCH that is improved with levothyroxine treatment.2 In addition, abnormal rheology,3 diastolic dysfunction,4 and impaired endothelial function2 are also seen in SCH, most of which are reversed with treatment. The mechanistic processes that underlie the high CV risk in SCH as well their effect on “hard” vascular outcomes need to be studied in a future randomized controlled trial. Furthermore, as noted in our recent analysis,5 the reasons for differences in outcomes of treatment in younger and older individuals with SCH also require study. (...)

Association between thyroid function, thyroid autoimmunity, and state and trait factors of depression
Acta Psychiatrica Scandinavica 2012;126(5):377-384 (November 2012)
Objective: The aim of this study was to investigate whether thyroid function and thyroid peroxidase antibodies (TPOAb) are associated with depression, when using both state and trait parameters of depression. (...)

Conclusion: Thyroid peroxidase antibodies are positively associated with trait markers of depression. The presence of TPOAb may be a vulnerability marker for depression. (...)

Hormone-Producing Thyroid Grown from Embryonic Stem Cells
scientificamerican.com 12.10.2012
The achievement is the latest success in the relatively new field of regenerative medicine

From Nature magazine

A series of achievements have stoked excitement about the potential of regenerative medicine, which aims to tackle diseases by replacing or regenerating damaged cells, tissues and organs. A paper in Nature today reports another step towards this goal: the generation of working thyroid cells from stem cells.

Sabine Costagliola, a molecular embryologist at the Free University of Brussels, and her team study the development of the thyroid gland, which regulates how the body uses energy and affects sensitivity to other hormones. Their research shows that thyroid function can be re-established even after the gland has been destroyed — at least in mice. If the same technique could be applied to humans, it would help the roughly 1 in 3,000 babies born with deficient thyroid activity, or hypothyroidism, which can result in stunted physical and mental development. (...)

The thyroid is the latest in a growing list of body parts that can now be ‘fixed’ in mice, with the potential to treat diseases from diabetes to Parkinson’s (see 'We can rebuild him'). “Progress has been very rapid over the past decade,” says Charles ffrench-Constant, director of the MRC Centre for Regenerative Medicine at the University of Edinburgh, UK. “In recent years we’ve seen a number of very important studies in which mouse stem cells have been converted to a desired cell type that has then been shown to be functional in vivo, and to confer benefits in mouse models of human diseases.” (...)

Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: A systematic review and meta-analysis
Arthritis Rheum. 2012 Sep;64(9):3034-42. doi: 10.1002/art.34512.
OBJECTIVE: To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease.

METHODS: The major databases Medline, EMBase, and the Cochrane Library were searched for studies published between January 1966 and October 2011 that evaluated procalcitonin, alone or in comparison with other laboratory markers such as C-reactive protein (CRP), as a diagnostic marker for bacterial infection in patients with autoimmune disease and provided sufficient data to permit construction of 2 × 2 tables.

RESULTS: Nine studies were included in the final meta-analysis. The area under the summary receiver operating characteristic curve values were 0.91 (95% confidence interval [95% CI] 0.88-0.93) for procalcitonin and 0.81 (95% CI 0.78-0.84) for CRP. In general, testing for procalcitonin was highly specific for identifying infectious complications, although it was not as sensitive as testing for CRP. Pooled sensitivity was 0.75 (95% CI 0.63-0.84) for procalcitonin tests and 0.77 (95% CI 0.67-0.85) for CRP tests. Pooled specificity was 0.90 (95% CI 0.85-0.93) for procalcitonin tests and 0.56 (95% CI 0.25-0.83) for CRP tests. The positive likelihood ratio for procalcitonin (7.28 [95% CI 5.10-10.38]) was sufficiently high to qualify procalcitonin testing as a rule-in diagnostic tool, while the negative likelihood ratio (0.28 [95% CI 0.18-0.40]) was not sufficiently low to qualify procalcitonin testing as a reliable rule-out diagnostic tool.

CONCLUSION: Procalcitonin has higher diagnostic value than CRP for the detection of bacterial sepsis in patients with autoimmune disease, and the test for procalcitonin is more specific than sensitive. A procalcitonin test is not recommended to be used in isolation as a rule-out tool. (...)

(Anm: Sepsis; grunnleggende kliniske observasjoner (hnt.no 5.11.2013).)

(Anm: Drug-resistant bacteria in patients' urine or stools raise risk of drug-resistant sepsis (medicalnewstoday.com 26.4.2017).)

(Anm: «Alle» har fått avvik. Ikke ett eneste av akuttmottakene som Helsetilsynet har gjort tilsyn ved, unngikk avvik når det gjelder gjenkjennelse og behandling av sepsis. (…) Rundt 50 prosent av alle pasienter som utvikler sepsis, kommer inn via akuttmottaket. – Pasientene kommer da gjerne med en infeksjon, eller med en uavklart tilstand. (…) Sepsis som oppstår på sengepost ser ikke Fylkesmennene på i dette tilsynet. (sykepleien.no 23.2.2017).)

(Anm: Hvordan hjernen hjelper kroppen å bekjempe bakterier. (How the brain helps the body fight bacteria. The brain may not only control our thoughts and basic physical functions. Recent studies indicate that it also controls the way our body responds to the threat of bacterial infections. It does this by boosting the production of a protective molecule called PCTR1 that helps white blood cells kill the invading bacteria. Our body is in constant contact with bacteria. For the most part these do not pose a threat since we have evolved defence systems to keep these organisms at bay. But in some instances, especially when the body’s defence systems are weakened or fail, bacteria may invade, leading to infection and, in extreme cases, sepsis, which can result in death.) (theconversation.com 5.1.2017).)

(Anm: New Sepsis-3 Definitions Await Confirmatory Data. Since publication of Sepsis-3, substantial debate has occurred about how and when to incorporate these new definitions into practice. In February 2016, the European Society of Intensive Care Medicine and the Society of Critical Care Medicine Third International Consensus Task Force published “Sepsis-3” — new definitions for sepsis and septic shock. Sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection,” and septic shock is defined as “a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality” (NEJM JW Gen Med Mar 15 2016 and JAMA 2016; 315:775). (NEJM 2017 (December 29, 2016).)

(Anm: Blodforgiftning: William (1) døde av sepsis fordi ingen innså hvor alvorlig situasjonen var. Opp mot 12 000 nordmenn får sepsis årlig. (dagbladet.no 14.9.2016).)

(Anm: Avdekker lovbrudd ved akuttmottak. AKUTTMOTTAK: Flere av avvikene ved tilsyn viser at pasienter med sepsis blir for dårlig observert og ikke får rask nok behandling på akuttmottaket. Alle sykehusene som hittil har vært gjenstand for tilsyn med akuttmottakenes håndtering av pasienter med blodforgiftning (sepsis), har fått avvik, som er brudd på loven. (dagensmedisin.no 21.9.2016).)

(Anm: Belgian scientists discover missing link in septic shock. Researchers at VIB and Ghent University have discovered an important mechanism of sepsis, an overreaction of the body's immune system to an infection. In this condition, the brain is unable to curb an inflammatory response, causing organ failure or 'septic shock'. This scenario is the most frequent cause of death in intensive care units. As it turns out, information about infections is passed to our brain via extracellular vesicles, small particles in brain fluid. These insights will be published in the leading scientific journal EMBO Molecular Medicine and might give rise to new strategies to treat sepsis and even other inflammatory conditions. (medicalnewstoday.com 15.9.2016).)

(Anm: - Zyprexa (olanzapin) og indberetninger om dødsfald. (…) SEPSIS. (…) Olanzapin og indberetninger om dødsfald. (sundhedsstyrelsen.dk 31.5.2015 (NYT OM BIVIRKNINGER 2015(6) MAJ 2015).)

(Anm: Snabbare vård vid blodförgiftning ska rädda liv. Svår sepsis, blodförgiftning, är vanligt förekommande och ett livshotande tillstånd som kräver snabb vård. Därför ska nu ambulanspersonal bli bättre på att identifiera patienter med sepsis. Sepsis orsakas av bakterier som sprider sig till blodbanan och leder till en allmän infektion. Kroppen utsöndrar då signalsubstanser, cytokiner, vilka påverkar kroppen på flera sätt, som höjd puls och lägre blodtryck. (netdoktor.se 10.8.2016).)

(Anm: Slideshow: What is Sepsis? Symptoms, Treatment, and More (wbmed.com 27.7.2016).)

(Anm: Simple measures cut sepsis deaths nearly in half. Sepsis, commonly called blood poisoning, is a common affliction that can affect people of all ages. A series of simple measures tested at a Norwegian hospital can make a difference in successfully treating sepsis. (medicalnewstoday.com 3.9.2016).)

(Anm: Blodförgiftning. Blodförgiftning, även kallat sepsis, är en form av infektion där bakterier har infekterat blodet. Kroppen reagerar då med ett starkt inflammatoriskt svar som i sin tur kan skada organ. Blodförgiftning är ett allvarligt, livshotande tillstånd som kan utvecklas på bara några timmar och som kräver tidig medicinsk vård. (netdoktor.se 11.4.2016).)

(Anm: Startar storkontroll av blodforgiftning på norske sjukehus. Fleire pasientar har døydd av alvorleg blodforgifting fordi dei ikkje har fått behandling i tide. (…) – Når ein får ein sepsis-tilstand er det veldig viktig at ein startar antibiotikabehandling raskt. Og det ser me ofte at sviktar, forklarar Rudi. (...) Pasienten døydde av blodforgifting som komplikasjon til strikkbehandling av hemoroidar. (nrk.no 22.6.2016).)

(Anm: Sepsis: pathophysiology and clinical management. Sepsis, severe sepsis, and septic shock represent increasingly severe systemic inflammatory responses to infection. Sepsis is common in the aging population, and it disproportionately affects patients with cancer and underlying immunosuppression. In its most severe form, sepsis causes multiple organ dysfunction that can produce a state of chronic critical illness characterized by severe immune dysfunction and catabolism. BMJ 2016;353:i1585 (Published 23 May 2016).)

(Anm: Late mortality after sepsis: propensity matched cohort study BMJ 2016;353:i2375 (Published 17 May 2016).)

(Anm: Editorial. Late mortality after sepsis. A new series of definitions of sepsis1 along with simple guidance for early diagnosis has recently been published, and a NICE guideline is due shortly.2 Sepsis is an extreme manifestation of the body responding to a severe infection—in part adaptive and protective, but potentially maladaptive and life threatening. Naturally, perhaps, the focus has been on early diagnosis and management. This is not always performed well, as highlighted by a 2015 report from the UK National Confidential Enquiry into Patient Outcome and Death.3 In a linked paper, Prescott and colleagues (doi:10.1136/bmj.i2375) report that patients who survive an episode of sepsis have a significant excess risk of mortality for a prolonged period of time.4 BMJ 2016;353:i2735 (Published 17 May 2016).)

(Anm: Bloodstream Infections: The peak of the iceberg. Virulence. 2016 Apr 2;7(3):248-51. Epub 2016 Feb 18.)

(Anm: Bloodstream infection pathogens becoming more resilient. A recently published special issue of Virulence, "Bloodstream Infections", focuses on the resilience of bloodstream infections (BSI) and is endorsed by the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases. (medicalnewstoday.com 5.5.2016).)

(Anm: Blodforgiftning og Bakterier i blodet (Sepsis og Bakteriæmi) (sundhedsguiden.dk 18.9.2006).)

(Anm: - Symptomene tilsvarer symptomer på olanzapinforgiftning, som kan være sløvhet (fra trøtthet til koma) og/eller forvirring, desorientering, agitasjon, angst og annen kognitiv svekkelse. Andre symptomer kan være ekstrapyrimidale symptomer, som muskelstivhet eller risting og vanskeligheter med å gå og snakke, kramper, svimmelhet, økning i blodtrykk og svakhet. Symptomene kan være alvorlige og kreve sykehusinnleggelse. Derfor skal pasienter som behandles med Zypadhera observeres de første timene etter hver eneste injeksjon. legemiddelverket.no 25.11.2016 (legemiddelverket.no 21.11.2016).)

(Anm: To av tre med blodforgifting får ikkje hjelpa dei skal ha. Pasientar med blodforgifting (sepsis) blir nedprioriterte når dei kjem til akuttmottak i Helse Vest, viser rapport.  (…) Sepsis-pasientar skal få antibiotikabehandling innan ein time, etter nasjonale retningslinjer, men dei fleste får ikkje dette. (nrk.no 21.9.2016).)

(Anm: Legar sende heim alvorleg sjuk pasient. Ein erfaren kommunelege får sterk kritikk etter at ein mann blei sendt heim utan at det blei oppdaga at han var alvorleg sjuk. (…) Pasienten vart sendt heim og vart raskt dårlegare. Pasienten vart frakta til sjukehus der ein konstaterte at det var snakk om alvorleg blodforgifting. Ut frå funn ved undersøking var årsaka til blodforgiftinga uklar fram til dagen etter innlegginga, då det kom tydelege teikn. – Ved blodforgifting er det spesielt at ein ikkje har så mange timar å gå på, fortel fylkeslegen. (nrk.no 7.3.2017).)

(Anm: MITOCHONDRIAL FUNCTION IN SEPSIS. Shock. 2016 Mar;45(3):271-281.)

(Anm: Cause of immune system paralysis in sepsis identified. New insights into how the immune system can malfunction during sepsis are reported in a paper published online in Nature Immunology. The study demonstrates a new approach for reversing the paralysis of the immune system that characterizes the late stages of sepsis. (…) The team was also able to restore metabolic activity and responsiveness in white blood cells from patients with fungal sepsis by treating them with interferon-γ - a factor released by normal white blood cells responding in a healthy way. (medicalnewstoday.com 7.3.2016).)

(Anm: Statins and brain dysfunction in intensive care. Severe critical illness, the leading medical causes of which are sepsis and acute respiratory distress syndrome, is often complicated by acute brain dysfunction, which is mainly characterised by changes in consciousness (ranging from delirium to coma) and various electrophysiological changes. Lancet Respir Med. 2016 Jan 28. pii: S2213-2600(16)00028-X.)

(Anm: Delirium is associated with 5-fold increased mortality in acute cardiac patients. (medicalnewstoday.com 16.3.2017).)

(Anm: Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis. CONTEXT: Late-onset sepsis (LOS) is a major cause of mortality and morbidity in preterm infants. (…) CONCLUSIONS: Probiotic supplementation reduces the risk of LOS in preterm infants. Pediatrics 2016;137(3) (March 2016).)

Effect of short-term thyroxine administration on energy metabolism and mitochondrial efficiency in humans
PLoS One. 2012;7(7):e40837. Epub 2012 Jul 26.
Abstract The physiologic effects of triiodothyronine (T3) on metabolic rate are well-documented; however, the effects of thyroxine (T4) are less clear despite its wide-spread use to treat thyroid-related disorders and other non-thyroidal conditions. Here, we investigated the effects of acute (3-day) T4 supplementation on energy expenditure at rest and during incremental exercise. Furthermore, we used a combination of in situ and in vitro approaches to measure skeletal muscle metabolism before and after T4 treatment. Ten healthy, euthyroid males were given 200 µg T4 (levothyroxine) per day for 3 days. Energy expenditure was measured at rest and during exercise by indirect calorimetry, and skeletal muscle mitochondrial function was assessed by in situ ATP flux ((31)P MRS) and in vitro respiratory control ratio (RCR, state 3/state 4 rate of oxygen uptake using a Clark-type electrode) before and after acute T4 treatment. Thyroxine had a subtle effect on resting metabolic rate, increasing it by 4% (p = 0.059) without a change in resting ATP demand (i.e., ATP flux) of the vastus lateralis. Exercise efficiency did not change with T4 treatment. The maximal capacity to produce ATP (state 3 respiration) and the coupled state of the mitochondria (RCR) were reduced by approximately 30% with T4 (p = 0.057 and p = 0.04, respectively). Together, the results suggest that T4, although less metabolically active than T3, reduces skeletal muscle efficiency and modestly increases resting metabolism even after short-term supplementation. Our findings may be clinically relevant given the expanding application of T4 to treat non-thyroidal conditions such as obesity and weight loss. (...)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

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. (...)

(Anm: Mitochondria (mitokondrie) (mitokondriesykdommer) (mitokondrielle sykdommer). (mintankesmie.no).)

(Anm: Linking telomere loss and mitochondrial dysfunction in chronic disease. (…) Drawing a mechanistic connection between telomere function and mitochondria biology will provide a broader perspective for understanding the pathophysiology of diseases and their relation to the aging process, and may provide opportunities for new possible treatments. Front Biosci (Landmark Ed). 2017 Jan 1;22:117-127.)

(Anm: Extreme short and long telomeres linked to increased cancer risk (news-medical.net 5.4.2017).)

(Anm: Scientists discover master regulator of cellular aging. (…) "Telomeres represent the clock of a cell," said TSRI Associate Professor Eros Lazzerini Denchi, corresponding author of the new study, published online in the journal Science. "You are born with telomeres of a certain length, and every time a cell divides, it loses a little bit of the telomere. Once the telomere is too short, the cell cannot divide anymore." (medicalnewstoday.com 13.1.2017).)

(Anm: Betennelser endrer mitokondrier til giftige fabrikker. Å lære hvordan å kontrollere betennelser kan ha store implikasjoner for behandlingen av mange sykdommer. Banebrytende forskning oppdager hvordan makrofager endrer mitokondriene til giftige kjemisk-produserende betennelsespromotører. (Inflammation turns mitochondria into toxic factories. Learning how to control inflammation could have huge implications for the treatment of many diseases. Breaking research discovers how macrophages turn mitochondria into toxic chemical-producing inflammation-promoters.) (medicalnewstoday.com 25.9.2016).)

(Anm: Research may show new ways to repress inflammation at outset. (…) Professor Alexander Weber of the Interfaculty Institute of Cell Biology says the enzyme - Bruton's tyrosine kinase or BTK - is switched on when an inflammation occurs in the body, playing a key role in the inflammation's subsequent development. (medicinenet.com 21.2.2017).)

(Anm: Ørsmå mitokondrier spiller en svært stor rolle mht. menneskets evolusjon og sykdom (Tiny mitochondria play outsized role in human evolution and disease.) (medicalnewstoday.com 25.9.2015).)

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. (...)

(Anm: Autoimmune sykdommer. (nhi.no 23.8.2013).)

(Anm: Immuno-psychiatry: when your body makes its own angel dust - anti-NMDA receptor encephalitis. A new study in Biological Psychiatry reports structural brain damage from an autoimmune encephalitis that impairs behavior in ways that are somewhat similar to the effects of "angel dust". The body sometimes makes substances that have effects on the brain in ways that resemble the effects of illicit drugs. In their paper, the authors report findings on a syndrome called anti-NMDA receptor encephalitis that arises when the body makes antibodies that target one of the subunits of the N-methyl-D-aspartate (NMDA) subtype of receptor for the chemical messenger, glutamate. The antibodies appear to mimic effects produced by the drug phencyclidine (PCP), also known as "angel dust", which produces a schizophrenia-like syndrome by blocking the NMDA glutamate receptor. Schizophrenia itself is also associated with NMDA receptor dysfunction. Senior author of the study, Dr. Carsten Finke, Professor at Charité-Universitätsmedizin Berlin, explains, "Anti-NMDA receptor encephalitis is a recently discovered autoimmune disorder of the brain, which causes a severe neuropsychiatric syndrome with behavioral changes, psychosis, memory loss, and decreased levels of consciousness. Although many patients recover well, the majority suffer from long-term cognitive impairment." (medicalnewstoday.com 26.4.2016).)

(Anm: Autoimmune attack underlying kidney failure. Interstitial nephritis, a common cause of kidney failure, has a complex and largely unknown pathogenesis. In a new published paper in The Journal of the American Society of Nephrology, a team of researchers led from Karolinska Institutet shows how interstitial nephritis can develop from an autoimmune attack on the kidney's collecting duct. (medicalnewstoday.com 24.3.2016).)

(Anm: Imbalance between gut microorganisms, immune cells could set stage for autoimmune disease. An imbalance in the reciprocal relationship between common gut bacteria and certain immune cells can set the stage for the development of autoimmune inflammation, according to a study conducted by researchers at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, who described their findings recently in Immunity. (...) (medicalnewstoday.com 18.3.2016).))

(Anm: Cellfälla nytt vapen mot autoimmuna sjukdomar. En fälla som fångar in celler som eldar på inflammationer i kroppen: Den nya svenska metoden att behandla autoimmuna sjukdomar kan komma ut på klinikerna nästa år. Först ut är ulcerös kolit. (…) Dit hör tarmsjukdomarna ulcerös kolit och Crohns sjukdom, MS, psoriasis samt förlamningssjukdomen ALS. (nyteknik.se 4.2.2016).)

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.dk 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? (...)

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. (...)

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.(...)

(Anm: Drug—drug interactions with tyrosine-kinase inhibitors: a clinical perspective. The Lancet Oncology 2014;15(8):e315-e326 (July 2014).)

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).)

(Anm: Mange tusen med hepatitt oppdages ikke. Folkehelseinstituttet anslår at opptil 30.000 mennesker her i landet kan være bærere av hepatitt B, mange uten å vite om det. Disse kan både smitte andre, og står selv i fare for å bli alvorlig syke dersom de ikke oppdages. (nrk.no 1.2.2016).)

(Anm: Fler dör av hepatit än av aids. Virushepatit har blivit en ledande orsak till dödsfall i världen. Sjukdomen dödar fler människor varje år än aids, tuberkulos och malaria, visar en ny rapport. Dödsfall orsakade av infektioner, leversjukdomar eller cancer som beror på virushepatit ökade med 63 procent från 890 000 år 1990, till 1,45 miljoner 2013, visar statistik från 183 länder. (…) Hepatit är en inflammation i levern, oftast orsakad av ett virus men ibland av drog- eller alkoholmissbruk eller andra sjukdomar. Ungefär 95 procent är omedvetna om att de har en infektion, men behandling av hepatit B och C kan förebygga kronisk leversjukdom. 96 procent av de dödsfall som är med i studien är av typen B eller C. De flesta av dödsfallen inträffade i östra och södra Asien. – Vi kan behandla den här sjukdomen – vi har vaccin mot hepatit A och B och vi har nya behandlingar mot C, säger Cooke och läger till att priset för nya mediciner kan vara för höga för både rika och fattiga länder. (dagensmedicin.se 7.7.2016).)

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: Svangerskapsforgiftning dobler risikoen for hjerteinfarkt. Kvinner som har hatt svangerskapsforgiftning har økt risiko for å rammes av akutt hjerteinfarkt, viser ny studie. (…) Er barnet født med lavere vekt enn forventet er risikoen tredoblet. Og den er femdoblet for kvinner med svangerskapsforgiftning som føder før uke 37. (nrk.no 1.4.2017).)

(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).)

(Anm: Mindre svangerskapsforgiftning med probiotika. Gravide som fikk i seg probiotiske melkeprodukter tilsvarende ett glass daglig hadde lavere forekomst av svangerskapsforgiftning enn andre gravide. (…) Det er imidlertid viktig å merke seg at denne sammenhengen må bekreftes av andre studier før vi kan si at probiotika faktisk beskytter mot svangerskapsforgiftning, uttaler forsker Ronny Myhre ved Folkehelseinstituttet (FHI) på FHIs hjemmeside. (dagensmedisin.no 9.8.2016).)

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.)

(Anm: Immunglobulin, ofte forkortet Ig, en bestemt gruppe proteiner i blodet som virker som antistoffer. Produksjon av antistoffer er av livsviktig betydning i forsvar mot infeksjon. Immunglobulinene blir produsert i spesielle celler i lymfeknuter, milt og benmarg. Inndeling Immunglobulinene er inndelt i fem klasser: immunglobulin G (IgG), immunglobulin A (IgA), immunglobulin M (IgM), immunglobulin D (IgD) og immunglobulin E (IgE). Alle virker som antistoffer, men hver enkelt klasse har sine typiske egenskaper og funksjoner. Kilde: Store norske leksikon.).)

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.)

(Anm: Selective Toxicity of Persian Gulf Sea Cucumber (Holothuria parva) and Sponge (Haliclona oculata) Methanolic Extracts on Liver Mitochondria Isolated from an Animal Model of Hepatocellular Carcinoma. Hepat Mon. 2015 Dec 27;15(12):e33073. eCollection 2015).)

(Anm: Hepatocellular carcinoma (HCC), also called malignant hepatoma, is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of liver cirrhosis). (en.wikipedia.org).)

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.)

(Anm: Brain discovery may lead to new treatments for peripheral neuropathy. (…) Blocking HCN channels may help relieve chronic pain. (medicalnewstoday.com 12.10.2015).)

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].)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [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 (...)

(Anm: Triiodothyronine Prevents Cardiac Ischemia/Reperfusion Mitochondrial Impairment and Cell Loss by Regulating miR30a/p53 Axis. Endocrinology. 2014 Aug 19:en20141106. [Epub ahead of print].)

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.)

(Anm: Objective To describe the estimated prevalence and temporal trends of chronic kidney disease (CKD) treatment patterns, and the association between CKD and potential factors for type 2 diabetes mellitus (T2DM) in different demographic subgroups. (…) Conclusions CKD continued to be prevalent in the T2DM population; prevalence remained fairly consistent over time, suggesting that current efforts to prevent CKD could be improved overall, especially by monitoring certain populations more closely. BMJ Open Diab Res Care  2016;4:e000154.)

(Anm: Chronic Kidney Disease (CKD) (webmd.com 18.12.2016).)

(Anm: LNT - Landsforeningen for Nyrepasienter og Transplanterte (lnt.no).)

(Anm: LNT - Statistikk (lnt.no).)

(Anm: Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. (…) Interpretation. Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening.Lancet Glob Health 2016;4(5):e307–19 (May 2016).)

(Anm: IgA Nephropathy: New Aspects in Pathophysiology and Pathogenesis. (…) This disease may also be acquired depending on numerous environmental factors: exposure to certain exoantigens (infectious organisms, food, etc.), involvement of specific cytokines that can induce the production of Gd-IgA1, and modification of the different players potentially involved (immune response to autoantigens, abnormalities in receptors such as TfR and CD89, tissue TG2 status, etc.). EMJ Neph. 2015;3[1]:97-103.)

(Anm: Autoimmun attack kan ligga bakom njursvikt. Interstitiell nefrit, som är en vanlig orsak till njursvikt, har en komplex och i stora delar okänd bakgrund. Nu visar forskare i en studie ledd från Karolinska institutet hur interstitiell nefrit kan utvecklas genom en autoimmun attack mot njurens samlingsrör. Fynden publiceras i tidskriften Journal of the American Society of Nephrology (JASN). (ki.se 11.11.2015) (Karolinska Institutet).)

(Anm: Identification of a driver of fibrosis in chronic kidney disease. (medicalnewstoday.com 22.1.2016).)

(Anm: Chronic kidney disease in elderly people: disease or disease label? Timothy Ellam and colleagues argue for a focus on what diagnosis means for individual patients rather than population risks. Around half of people aged over 75 meet current diagnostic criteria for chronic kidney disease (CKD). However, labelling them all as diseased is controversial and may cause unnecessary anxiety.1 2 The classification system defining this epidemic of CKD in elderly people is validated primarily as an epidemiological risk stratification tool rather than a clinical aid to patient management. We highlight the need to focus the debate on improving patient centred outcomes rather than just identifying everyone at above average risk. BMJ 2016;352:h6559 (Published 18 January 2016).)

(Anm: Polycystic kidney disease: a diet dividend. New research from UC Santa Barbara suggests that reducing food intake may slow the growth of the cysts that are symptomatic of PKD, an inherited disorder in which clusters of cysts develop in the kidneys. (medicalnewstoday.com 29.1.2016).)

(Anm: Mitochondria: a new therapeutic target in chronic kidney disease. Nutr Metab (Lond). 2015 Nov 25;12:49.) (PDF)

(Anm: Chronic kidney disease may cause diabetes. A team from the University of Montreal Hospital Research Centre (CRCHUM) has discovered a novel link between chronic kidney disease and diabetes. When kidneys fail, urea that builds up in the blood can cause diabetes, concludes a study published today in the Journal of Clinical Investigation. (medicalnewstoday.com 16.8.2016).)

(Anm: Kidney Impairment Decreases Blood Flow to the Brain, Boosting Risk of Stroke and Dementia (dgnews.docguide.com 6.8.2015).) 

(Anm: Chronic kidney disease may cause diabetes. A team from the University of Montreal Hospital Research Centre (CRCHUM) has discovered a novel link between chronic kidney disease and diabetes. When kidneys fail, urea that builds up in the blood can cause diabetes, concludes a study published today in the Journal of Clinical Investigation. (medicalnewstoday.com 16.8.2016).) (PDF)

(Anm: Abdominal Obesity Is More Closely Associated With Diabetic Kidney Disease Than General Obesity. Diabetes Care  2016 Aug; dc161025).) 

(Anm: Kidney Function: What Do The Kidneys Do? Contents of this article: 1.Structure and function of the kidneys 2.Diseases of the kidney and their cause 3. Kidney dialysis and maintaining healthy kidneys. (medicalnewstoday.com 4.2.2016).)

(Anm: IgA Nephropathy. What is IgA nephropathy? IgA nephropathy is a kidney disorder that occurs when IgA—a protein that helps the body fight infections—settles in the kidneys. After many years, the IgA deposits may cause the kidneys to leak blood and sometimes protein in the urine. (niddk.nih.gov).) 

(Anm: Even small reductions in kidney function may damage heart, blood vessels. Even small reductions in kidney function are associated with heart and blood vessel damage, according to new research in the American Heart Association's journal Hypertension. (medicalnewstoday.com 8.1.2016).)

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. (...)

(Anm: Vitamin D-brist kopplad till alzheimer (mentornewsroom.se 7.8.2014).)

(Anm: Utilstrekkelige nivåer av vitamin D i svangerskapet er skadelige for barnets utvikling. Insufficient levels of Vitamin D in pregnancy detrimental to child development. Vitamin D deficiency in expectant mothers during pregnancy has a negative effect on the social development and motor skills of pre-school age children, a new study in the British Journal of Nutrition reports.  (medicalnewstoday.com 13.7.2017).)

(Anm: Vitamin D guidelines may be changed following new study. A new study finds that, contrary to popular belief, vitamin D-2 and D-3 do not have equal nutritional value. (…) New research demonstrates that the two forms of vitamin D, D-2 and D-3, are not equal. D-3 is twice as effective. Guidelines may need to be altered. (…) With vitamin D deficiency on the rise, the authors call for a rethink of official guidelines. (…) Not all vitamin D types are equal. There are two types of vitamin D, which are known as D-2 and D-3. The former is derived from plant sources, particularly fungi, while the latter comes from animal sources. (medicalnewstoday.com 6.7.2017).)

(Anm: Standard Definition of Vitamin D Deficiency Is Challenged. Allan S. Brett, MD reviewing Shah S et al. J Clin Endocrinol Metab 2017 Mar 30. A research team suggests that a 25-hydroxyvitamin D level of 12 ng/mL (30 nmol/L) might be a more appropriate cutoff. (…) Comment In the U.S., many laboratories define 25(OH)D levels <20 ng/mL (50 nmol/L) as deficient, and levels between 20 and 30 ng/mL (50−75 nmol/L) as “insufficient” (J Clin Endocrinol Metab 2011; 96:1911). However, the current study authors believe their data justify a cutoff of 12 ng/mL (30 nmol/L) for deficiency, and they challenge the idea of a specific insufficiency range. This study might not settle the controversy about the optimal cutoff for deficiency, but it supports my concern that many clinicians push vitamin D supplementation excessively, without evidence of clinical or physiological benefit. NEJM 2017 (August 15, 2017).)

(Anm: Study highlights risk factors for widespread vitamin D deficiency. Results from a clinical review published in The Journal of the American Osteopathic Association find nearly 1 billion people worldwide may have deficient or insufficient levels of vitamin D due to chronic disease and inadequate sun exposure related to sunscreen use. The study also found that 95 percent of African American adults may have vitamin D deficiency or insufficiency. Vitamin D variations among races are attributed to differences in skin pigmentation. (news-medical.net 2.5.2017).)

(Anm: Vitamin D levels in pregnant women could be linked to some learning disabilities in children (medicalnewstoday.com 22.9.2016).)

(Anm: High vitamin D intake could reduce the risk of an early menopause. A new study published in the American Journal of Clinical Nutrition has revealed that women can cut their risk of an early menopause, by having a high vitamin D intake. (news-medical.net 11.5.2017).)

(Anm: Evidence 'does not support use of vitamin D supplements', say researchers. Current evidence does not support the use of vitamin D supplements to prevent disease, a study published in BMJ has concluded. (pulsetoday.co.uk 25.11.2016).)

(Anm: Vitamin D supplementation does cut respiratory infections, new study suggests. Researchers from Queen Mary University of London argued that their findings, published in The BMJ,1 support the introduction of food fortification in the UK. BMJ 2017;356:j847 (Published 16 February 2017).)

(Anm: Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. (…) Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit. BMJ 2017;356:i6583 (Published 15 February 2017).)

(Anm: Vitamin D supplements in pregnancy could help protect children against asthma. A new study published today in the Journal of Allergy and Clinical Immunology has found that taking Vitamin D supplements in pregnancy can positively modify the immune system of the newborn baby, which could help to protect against asthma and respiratory infections, a known risk factor for developing asthma in childhood. (news-medical.net 26.5.2017).)

(Anm: Vitamin D Supplements May Benefit Children With Autism. HOBOKEN, NJ -- November 22, 2016 -- Vitamin D supplementation improved symptoms of autism, according to a study published in the Journal of Child Psychology and Psychiatry. Although pharmacological therapies provide an adjunct to behavioural therapy for autism spectrum disorder (ASD), they have no significant effects on improving the core symptoms of autism. Vitamin D has an important role in brain homeostasis, neurodevelopment, and aging, and it plays a significant role in gene regulation. It has also been suggested that vitamin D acts as a neuroactive steroid, affecting neuronal differentiation, axonal connectivity, and brain structure and function. (dgnews.docguide.com 22.11.2016)

(Anm: Low Vitamin D Levels Linked to Ulcerative Colitis Relapse. CLINICAL relapse risk amongst individuals with ulcerative colitis (UC) more common if the levels of vitamin D in the blood are lower than required, according to researchers at the Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. (emjreviews.com 3.4.2017).)

(Anm: Low Vitamin D Linked with All-Cause Death. —There was a significant interaction by race, with greater risks for whites. ATLANTA -- Low vitamin D levels were associated with increased all-cause mortality, a comprehensive population-based study found. For instance, one study found levels of 25(OH)D deficiency or insufficiency had increased cardiovascular, cancer, and respiratory disease mortality. (medpagetoday.com 17.9.2016).)

- Lavt nivå av vitamin D preger alle nivåer av psykose. - Mangel på vitaminet linket til dårligere funksjon og høyere skår for depresjon.

(Anm: Lavt nivå av vitamin D preger alle nivåer av psykose. - Mangel på vitaminet linket til dårligere funksjon og høyere skår for depresjon.  (Low Vitamin D Permeates All Stages of Psychosis. — Lack of vitamin linked with poorer function, higher depression scores.) (medpagetoday.com 8.4.2015).)

(Anm: Successful treatment of reactive airways dysfunction syndrome by high-dose vitamin D.J Asthma Allergy. 2011; 4: 87–91. Published online 2011 Sep 22.)

(Anm: Should healthy people take a vitamin D supplement in winter months? (…) Limited evidence The government should not recommend any intervention without convincing evidence of benefit. Despite a few hundred systematic reviews and meta-analyses, a recent review found highly convincing evidence of a clear causal role of vitamin D does not exist for any of 137 outcomes. BMJ 2016;355:i6183  (Published 23 November 2016).)

(Anm: Vitamin D improves heart function, study finds. A daily dose of vitamin D3 improves heart function in people with chronic heart failure, a five-year University of Leeds research project has found. Dr Klaus Witte, from the School of Medicine and Consultant Cardiologist at Leeds Teaching Hospitals NHS Trust, led the study, known as VINDICATE. (worldpharmanews.com 5.4.2016).)

(Anm: Low vitamin D levels associated with IBS. Many people living with irritable bowel syndrome are vitamin D deficient, according to a new study published in the BMJ Open Gastroenterology. Irritable bowel syndrome (IBS) is a chronic and debilitating functional disorder of the gastrointestinal (GI) tract, affecting around 9-23% of people worldwide and 10-15% of people in the US. (medicalnewstoday.com 21.12.2015).)

(Anm: Fewer indications of ADHD in children whose mothers took vitamin D during pregnancy. Children of mothers who took vitamin D during pregnancy with resultant high levels of the vitamin in the umbilical blood have fewer symptoms of ADHD at the age of 2½ years. These were the findings in a new study from the Odense Child Cohort just published in The Australia & New Zealand Journal of Psychiatry. (medicalnewstoday.com 11.10.2016).)

(Anm: Vitamin D supplements may lower risk of severe asthma attacks (medicalnewstoday.com 7.9.2016).)

(Anm: Depresjon kan skyldes vitaminmangel. - Mange deprimerte har vitamin D-mangel, sier professor. (…) Ifølge Norsk Helseformatikk vil cirka 25 prosent av alle kvinner og 15 prosent av alle menn oppleve en depresjon som trenger behandling i løpet av livet. (…) - Vitamin D er nødvendig for opptak og utnyttelse av kalsium, vedlikehold av skjelettet og tennene våre, normal muskelfunksjon og immunforsvar. Det er også viktig for kroppens forsvarssystem, og for mange hjerneprosesser. (…) - Én teori er at vitamin D påvirker mengden av kjemikalier som kalles monoaminer. Mange antidepressive medikamenter virker ved å øke mengden av monoaminer i hjernen. (kk.no 7.8.2016).)

(Anm: D-vitaminer mot irritabel tarm. En ny studie viser at mange med irritabel tarm også har mangel på vitamin D. Irritabel tarm (IBS) er en forstyrrelse i tarmens funksjon. Kjennetegnene er magesmerter, ubehag, oppblåsthet og forstyrret avføringsmønster med diaré eller forstoppelse. (nhi.no 13.1.2016).)

(Anm: D-vitaminer under graviditeten kan mindske risiko for ADHD. Hvis mor tager D-vitaminer, når hun er gravid, ser det nemlig ud til at give færre tegn på ADHD, viser et nyt studie fra Odense Børnekohorte. Det skriver Syddansk Universitet (SDU) i en pressemeddelelse. (videnskab.dk 4.10.2016).)

(Anm: New evidence for treating depression in women with vitamin D supplements (medicalnewstoday.com 10.4.2015).)

(Anm: D-vitamin kan booste immunforsvarets kamp mod en af verdens største dræbere. D-vitamin styrker immunforsvarets evne til at bekæmpe tuberkulose, lyder konklusionen i et nyt dansk studie. I fremtiden kan vitaminet måske hjælpe mange millioner mennesker, der er i fare for at dø af sygdommen. Men der skal flere studier til, mener forsker. (videnskab.dk 12.6.2017).)

- D-vitamin kan forbedre sårheling i pasienter ved brannskader. (- For noen mennesker tar brannskader lang tid å hele, så vel som at det også er risiko for infeksjon. De med alvorlige forbrenninger er spesielt utsatt for sepsis (blodforgifning), hvilket er en potensielt livstruende tilstand som utløses av infeksjon.)

(Anm: Vitamin D may improve wound healing in burns patients. (…) This was the conclusion of the first study to examine the effects of vitamin D in burn injury recovery. The research — which was led by the Institute of Inflammation and Aging in Birmingham, United Kingdom — is to feature at the Society for Endocrinology annual conference, held in Harrogate, U.K. Burns are wounds to the skin and other tissues that are caused by heat — including exposure to a flame or fire, or from scalding. They can also result from friction, radiation, radioactivity, electricity, and contact with chemicals. Burn injuries are considered a global public health problem and are responsible for around 180,000 deaths every year. (…) For some people, their burn injuries take a long time to heal, as well as there also being a risk of infection. Those with severe burns are particularly vulnerable to sepsis, which is a potentially life-threatening condition triggered by infection. (medicalnewstoday.com 6.11.2017).)

(Anm: Lupus: Low vitamin D may raise risk of kidney failure. (…) Dr. Michelle A. Petri, Ph.D., director of the Hopkins Lupus Center is the lead author of the study, and the findings were presented at the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in San Diego, CA. Lupus is an autoimmune disease characterized by inflammation throughout the body. This occurs because the body does not recognize its own tissues and starts attacking them. The disease can affect various organ systems, from the cardiovascular and immune systems to vital organs such as the lungs and the kidneys. (medicalnewstoday.com 6.11.2017).)

(Anm: Lupus: Probiotics could help to reduce kidney inflammation. (…) Researchers have found that adding Lactobacillus to the diets of mice with lupus-induced kidney inflammation - also known as lupus nephritis - led to improvements in kidney function and increased their survival, but only in female mice. Lactobacillus are a type of "good" bacteria that reside in the digestive, urinary, and genital systems. These bacteria are also present in yogurt, kefir, and other fermented foods, as well as dietary supplements. While further studies are needed to confirm the possible benefits of Lactobacillus, the researchers believe that their findings indicate that women with lupus and kidney inflammation may benefit from taking probiotics. Study co-author Xin Luo, from the Department of Biomedical Sciences and Pathobiology at Virginia-Maryland College of Veterinary Medicine at Virginia Tech, and colleagues recently reported their results in the journal Microbiome. (medicalnewstoday.com 6.11.2017).)

(Anm: Skal raske tage D-vitamintilskud? Vi skal ikke følge i englændernes fodspor og anbefale D-vitamintilskud til alle, mener dansk ekspert, mens en anden ekspert efterlyser en nuanceret dansk debat om D-vitamin. (…) Det anerkendte tidsskrift British Medical Journal har netop bragt et debatindlæg, hvor eksperter fra New Zealand og Skotland taler de engelske myndighederne imod. Og de har bragt et andet såkaldt head-to-head-indlæg, hvor to eksperter tørner sammen – den ene fra de engelske myndigheder. Spørgsmålet er, om vi i Danmark kan lære noget af den engelske debat?  (videnskab.dk 13.12.2016).)

(Anm: Lavt nivå av vitamin D preger alle nivåer av psykose. - Mangel på vitaminet linket til dårligere funksjon og høyere skår for depresjon.  (Low Vitamin D Permeates All Stages of Psychosis. — Lack of vitamin linked with poorer function, higher depression scores.) (medpagetoday.com 8.4.2015).)

(Anm: Low vitamin D predicts more severe strokes, poor health post-stroke (medicalnewstoday.com 12.2.2015).)

(Anm: Low vitamin D levels and depression linked in young women, new OSU study shows  (medicalnewstoday.com 21.3.2015).)

(Anm: Forskning: For meget D-vitamin er livsfarligt. Opsigtsvækkende dansk forskning afslører, at D-vitamin i høje doser øger risikoen for slagtilfælde og blodprop. (…) Det bedste niveau synes at ligge mellem 50 og 100 nanomol per liter og det bedste er cirka 70 ifølge vores undersøgelse," fastslår Peter Schwarz. (medwatch.dk 10.3.2015).)

(Anm: Women using IVF 'half as likely to conceive if vitamin D deficient' (medicalnewstoday.com 15.8.2014).)

(Anm: Vitamin D found to increase bowel cancer survival (medicalnewstoday.com 11.7.2014).)

(Anm: Vitamin D in inflammatory diseases Front. Physiol. 2014 (01 July 2014).)

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. (...)

(Anm: Autoimmune attack underlying kidney failure. Interstitial nephritis, a common cause of kidney failure, has a complex and largely unknown pathogenesis. In a new published paper in The Journal of the American Society of Nephrology, a team of researchers led from Karolinska Institutet shows how interstitial nephritis can develop from an autoimmune attack on the kidney's collecting duct. (medicalnewstoday.com 24.3.2016).)

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. (...)

(Anm: Stofskiftepatienter tager til udlandet for at få behandling og medicin. Sundhed: En gruppe stofskiftepatienter er utilfredse med danske læger og med regler for medicin. En forkert og farlig idé at rejse til udlandet for behandling, siger en professor. (jyllands-posten.dk 5.12.2015).)

(Anm: Tråd: Til udlandet for at få behandling og medicin. (sonjas-stoffskifteforum.info 7.12.2015).)

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). (...)

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