Background. The question is debated on whether maternal hypothyroidism or use of thyroxin in early pregnancy affects the risk for infant congenital malformations. Objectives. To expand the previously published study on maternal thyroxin use in early pregnancy and the risk for congenital malformations. Methods. Data from the Swedish Medical Birth Register were used for the years 1996&#x2013;2011 and infant malformations were identified from national health registers. Women with preexisting diabetes or reporting the use of thyreostatics, anticonvulsants, or antihypertensives were excluded from analysis. Risk estimates were made as odds ratios (ORs) or risk ratios (RRs) after adjustment for year of delivery, maternal age, parity, smoking, and body mass index. Results. Among 23&#x2009;259 infants whose mothers in early pregnancy used thyroxin, 730 had a major malformation; among all 1&#x2009;567&#x2009;736 infants, 48012 had such malformations. The adjusted OR was 1.06 (95&#x25; CI 0.98&#x2013;1.14). For anal atresia the RR was 1.85 (95&#x25; CI 1.00&#x2013;1.85) and for choanal atresia 3.14 (95&#x25; CI 1.26&#x2013;6.47). The risk of some other malformations was also increased but statistical significance was not reached. Conclusions. Treated maternal hypothyroidism may be a weak risk factor for infant congenital malformations but an association with a few rare conditions is possible.

Bengt K&#xe4;ll&#xe9;n

Birgitta Norstedt Wikner

Maternal Hypothyroidism in Early Pregnancy and Infant Structural Congenital Malformations

Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Factors like high-carbohydrate meal exercise, steroid, and stress can precipitate an attack of TPP. Evidence is building up showing role of genetic mutations in Kir2.6 channel in the pathogenesis of TPP. Loss of function of Kir2.6 together with increased activity of Na+/K+ ATPase may trigger a positive feed-forward cycle of hypokalemia. Biochemical hyperthyroidism with normal urinary potassium excretion and ECG changes are characteristic of TPP. Treatment with low-dose potassium supplements and nonselective beta-blockers should be initiated upon diagnosis, and the serum potassium level should be frequently monitored to prevent rebound hyperkalemia.

Abhishek Vijayakumar

Giridhar Ashwath

Durganna Thimmappa

[Retracted] Thyrotoxic Periodic Paralysis: Clinical Challenges

Background. Graves&#x2019; disease may have a number of clinical manifestations with varying degrees of activity that may not always run in parallel. Objectives. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves&#x2019; disease (hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism. Methods. We describe a cohort of 208 patients with newly diagnosed Graves&#x2019; hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves&#x2019; hyperthyroidism, entitled &#x201C;Remission Induction and Sustenance in Graves&#x2019; Disease (RISG).&#x201D; Patients were systematically tested for degree of biochemical hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy. Results. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves&#x2019; disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25&#x2013;30&#x25; had orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves&#x2019; disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis.

Peter Laurberg

Birte Nygaard

Stig Andersen

Allan Carl&#xe9;

Jesper Karmisholt

Anne Krejbjerg

Inge B&#xfc;low Pedersen

Stine Linding Andersen

Association between TSH-Receptor Autoimmunity, Hyperthyroidism, Goitre, and Orbitopathy in 208 Patients Included in the Remission Induction and Sustenance in Graves&#x2019; Disease Study

The obstetric consequences of abnormal thyroid function during pregnancy have been established. Less understood is the influence of maternal thyroid autoantibodies on infant outcomes. The objective of this study was to examine the influence of maternal thyroperoxidase (TPO) status on fetal/infant brain and body growth. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida, and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. Regression analysis revealed maternal that TPO positivity was significantly associated with smaller head circumference, reduced brain weight, and lower brain-to-body ratio among infants born to TPO+ white, non-Hispanic mothers only, distinguishing race/ethnicity as an effect modifier in the relationship. No significant differences were noted in body growth measurements among infants born to TPO positive mothers of any racial/ethnic group. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations; therefore autoantibody screening among high-risk subgroups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted.

Rone&#xe9; E. Wilson

Hamisu M. Salihu

Maureen W. Groer

Getachew Dagne

Kathleen O&#x2019;Rourke

Alfred K. Mbah

Impact of Maternal Thyroperoxidase Status on Fetal Body and Brain Size

Objective. To study histopathology of the thyroid and parathyroid glands in HIV-infected African Americans in the United States. 
Methods. A retrospective review of 102 autopsy cases done by the Department of Pathology at Howard University Hospital from 1980 through 2007 was conducted. The histopathological findings of the thyroid and parathyroid glands were reviewed, both macroscopically and microscopically. A control group of autopsy patients with chronic non-HIV diseases was examined. Results. There were 71 males (70&#x25;) and 31 females (30&#x25;) with an average age of 38 years (range: 20&#x2013;71&#x2009;y). Thirteen patients with abnormal thyroid findings were identified. Interstitial fibrosis was the most common histological finding (4.9&#x25;), followed by thyroid hyperplasia (1.9&#x25;). Infectious disease affecting the thyroid gland was limited to 2.9&#x25; and consisted of mycobacterium tuberculosis, Cryptococcus neoformans, and cytomegalovirus. Kaposi sarcoma of the thyroid gland was present in only one case (0.9&#x25;). Parathyroid hyperplasia was the most common histological change noted in the parathyroid glands. Comparing the histological findings of cases and controls, we found a similar involvement of the thyroid, with a greater prevalence of parathyroid hyperplasia in HIV patients. Conclusion. Thyroid and parathyroid abnormalities are uncommon findings in the HIV-infected African American population.

Rabia Cherqaoui

K. M. Mohamed Shakir

Babak Shokrani

Sujay Madduri

Faria Farhat

Vinod Mody

Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients

Background. Subtotal thyroidectomy (STT) was previously considered the gold standard in the surgical management of multinodular goitre despite its propensity for recurrence. Our aim was to assess whether prior STT or unilateral lobectomy was associated with increased reoperative morbidity. Methods. A retrospective analysis was conducted extracting data from our endocrine surgical database for the period from January 1991 to June 2006. Two patient groups were defined: Group 1 consisted of patients with previous unilateral thyroid lobectomy; Group 2 had undergone previous STT. Specific outcomes investigated were transient and permanent recurrent laryngeal nerve (RLN) injury and hypoparathyroidism. Results. 494 reoperative cases were performed which consisted of 259 patients with previous unilateral lobectomy (Group 1) and 235 patients with previous subtotal thyroidectomy (Group 2). A statistically significant increase relating to previous STT was demonstrated in both permanent RLN injury (0.77&#x25; versus 3.4&#x25;, RR 4.38, <svg style="vertical-align:-0.1638pt;width:66.875px;" id="M1" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>) and permanent hypoparathyroidism (1.5&#x25; versus 5.1&#x25;, RR 3.14, <svg style="vertical-align:-0.1638pt;width:66.875px;" id="M2" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>). Transient nerve injury and hypocalcaemia incidence was comparable. Conclusions. Reoperative surgery following subtotal thyroidectomy is associated with a significantly increased risk of permanent recurrent laryngeal nerve injury and hypoparathyroidism when compared with previous unilateral thyroidectomy. Subtotal thyroidectomy should therefore no longer be recommended in the management of multinodular goitre.

Navin Rudolph

Claudia Dominguez

Anthony Beaulieu

Pierre De Wailly

Jean-Louis Kraimps

The Morbidity of Reoperative Surgery for Recurrent Benign Nodular Goitre: Impact of Previous Unilateral Thyroid Lobectomy versus Subtotal Thyroidectomy

The frequency and types of adverse events after initial antithyroid drug (ATD) therapy during pregnancy have never been reported, nor has whether the frequency of adverse events is the same as among nonpregnant subjects ever been investigated. We investigated retrospectively the frequency of adverse events after initial ATD administration to previously untreated Graves&#x2019; disease (GD) patients during pregnancy.  We reviewed the charts of cases of 91 untreated pregnant women who came to our hospital for the first time and were newly diagnosed with GD during the period between January 1, 1999, and December 31, 2011.  Thiamazole (MMI) was used to treat 40 patients and 51 patients were treated with propylthiouracil (PTU). Adverse events occurred in 5 patients (5/40; 12.5&#x25;) treated with MMI, and they consisted of cutaneous reactions in 5 patients. Adverse events occurred in five patients (5/51; 9.8&#x25;) treated with PTU, and they consisted of hepatotoxicity in two patients and cutaneous reactions in three patients. No patients experienced agranulocytosis or ANCA-related vasculitis. Comparison with the expected rate of adverse events in nonpregnant individuals showed that the frequency of adverse events in pregnant individuals was low.

Ai Yoshihara

Jaeduk Yoshimura Noh

Natsuko Watanabe

Kenji Iwaku

Sakiko Kobayashi

Miho Suzuki

Hidemi Ohye

Masako Matsumoto

Yo Kunii

Koji Mukasa

Kiminori Sugino

Koichi Ito

Frequency of Adverse Events of Antithyroid Drugs Administered during Pregnancy

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Journal of Thyroid Research publishes articles on the molecular and cellular biology, immunology, biochemistry, physiology and pathology of thyroid diseases, with a specific focus on thyroid cancer.

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title

Journal of Thyroid Research publishes articles on the molecular and cellular biology, immunology, biochemistry, physiology and pathology of thyroid diseases, with a specific focus on thyroid cancer.

Journal of Thyroid Research