Thyrotoxicosis: Lazarus JH

Owen PJ, Lazarus JH. · No affiliation provided · J Endocrinol Invest. · Pubmed #12841533 No free full text.

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Lazarus JH, Kaklamanou M. · Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, UK. · Curr Opin Endocrinol Diabetes Obes. · Pubmed #17940469 No free full text.

Abstract: PURPOSE OF REVIEW: To describe the significance of low thyroid-stimulating hormone in pregnancy. RECENT FINDINGS: Interpretation of thyroid function in pregnancy must be seen in the context of changes in thyroid economy associated with gestation. Improvements in thyroid-stimulating hormone assay methodology have resulted in accurate identification of low and suppressed thyroid-stimulating hormone in pregnancy, and recent studies of screening thyroid function in pregnancy have found an incidence of low thyroid-stimulating hormone in up to 18% of women. Normative gestational-related reference ranges for thyroid hormones, particularly thyroid-stimulating hormone and thyroxine, should be established to identify the higher as well as the lower limits of these analytes. The adverse obstetric and neonatal outcomes associated with hyperthyroidism due to Graves' disease mean that this must be differentiated from the more common cause of suppressed thyroid-stimulating hormone, i.e. gestational transient thyrotoxicosis. It is suggested that estimation of thyroid peroxidase antibodies may be a useful initial diagnostic strategy in the evaluation of women with a low or suppressed thyroid-stimulating hormone. SUMMARY: In addition to identifying women with high thyroid-stimulating hormone levels at screening (with implications for child intelligence), establishing the cause of low thyroid-stimulating hormone will improve obstetric outcome in a number of pregnant women.

Owen PJ, Baghomian A, Lazarus JH, Godkin AJ. · Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff. · BMJ. · Pubmed #17932209 No free full text.

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Kirov G, Tredget J, John R, Owen MJ, Lazarus JH. · Department of Psychological Medicine, Cardiff University, Henry Wellcome Building, Heath Park, Cardiff CF14 4XN, Wales, UK. · J Affect Disord. · Pubmed #16051025 No free full text.

Abstract: BACKGROUND: The effects of lithium treatment on the thyroid gland have been demonstrated in a number of studies. Most of this research is based on cross-sectional studies and prospective studies are required to confirm these observations. METHOD: During our genetic association studies, we recruited 115 males and 159 females suffering with affective disorders who had received lithium treatment. We observed longitudinally 57 of these patients, who attended our clinic for between 1 and 7 years and had no thyroid abnormalities at baseline. We performed regular checks of thyroid antibodies, thyroid function tests and lithium levels. RESULTS: Hypo- and hyperthyroidism, including cases that developed prior to lithium treatment, were more common in women (25.8%) than in men (8.7%) and increased with age. By the age of 65, the risk in women increased to 50%. Hypothyroidism was induced by lithium in 17% women. In the prospective study, 4 out of 33 women developed hypothyroidism (an incidence of 27.4 cases per 1000 years). One woman developed thyrotoxicosis. CONCLUSIONS: The risk for hypothyroidism induced by lithium is especially increased in women over the age of 50. Women should be warned of the risks involved when offered lithium treatment. The frequency of lithium-induced thyrotoxicosis is very low.

Pearce EN, Bogazzi F, Martino E, Brogioni S, Pardini E, Pellegrini G, Parkes AB, Lazarus JH, Pinchera A, Braverman LE. · Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA. · Thyroid. · Pubmed #12964969 No free full text.

Abstract: C-reactive protein (CRP) levels have not been routinely used to diagnose thyroid disease, although many thyroid conditions involve inflammation. This study was intended to determine whether CRP levels could differentiate between inflammatory and noninflammatory thyroid conditions, especially between type II inflammatory amiodarone-induced thyrotoxicosis (AIT) and type I iodine-induced AIT. Serum high-sensitivity CRP levels were measured in 100 euthyroid controls (7 taking amiodarone) and 353 patients with one of the following thyroid conditions: AIT, subacute thyroiditis, toxic diffuse goiter, nodular goiter, Hashimoto's thyroiditis, shortterm hypothyroidism, or postpartum thyroiditis. No patients with nontoxic multinodular goiter (n = 34), toxic nodular goiter (n = 23), or toxic diffuse goiter, either untreated (n = 49) or euthyroid while taking methimazole (n = 33), had positive CRP levels (>10 mg/L). The occurrence of positive CRP levels among patients with Hashimoto's thyroiditis (n = 35), short-term hypothyroidism (n = 38), and postpartum thyroiditis (n = 70) did not differ significantly from controls. The occurrence of positive CRP values did not differ significantly between patients with type I and type II AIT and controls. Six of 7 patients (86%) with untreated subacute thyroiditis had positive CRP levels (p < 0.00001). These results indicate that there is only a limited role for measurement of CRP levels in the diagnosis of thyroid diseases other than subacute thyroiditis.

Owen PJ, Lazarus JH, Morse RE. · Department of Medicine, University Hospital of Wales, Cardiff, UK. · Postgrad Med J. · Pubmed #12566555 links to  free full text

Abstract: Thyroid carcinomas are the most frequent endocrine malignancies. Complications may arise from an established malignancy and these may lead to the initial clinical presentation or cause subsequent problems. In this case report two elderly patients with differentiated and undifferentiated thyroid carcinomas who suffered unusual medical complications are described. The incidence and treatment of thyroid carcinoma is discussed and the importance of fine needle aspiration of thyroid nodules and the recognition of iodine containing radiographic contrast media in the causation of iodine induced thyrotoxicosis is highlighted.

Obuobie K, Smith J, John R, Davies JS, Lazarus JH. · Department of Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF64 4XN, UK. · Eur J Endocrinol. · Pubmed #12088917 links to  free full text

Abstract: OBJECTIVE: To assess central arterial stiffness in thyrotoxicosis using the technique of pulse wave analysis. DESIGN: Case control study designed to determine the effect of thyrotoxicosis on central arterial stiffness and at 6 months after radioiodine treatment. PATIENTS: Twenty (18 women and 2 men) thyrotoxic patients and 20 age- and sex-matched controls were studied at baseline. Thyrotoxic patients were re-studied at 6 months following treatment of thyrotoxicosis with 555 MBq (131)I with no additional therapy for the six-month period. MEASUREMENTS: Using the sphygmocor apparatus, peripheral pressure waveforms were recorded non-invasively from the radial artery and central pressure waveforms were generated from these. Indices of arterial stiffness, central augmentation index (AI), augmentation of central arterial pressure (AG) and central blood pressures were derived. AI corrected for heart rate (AIc) was calculated. RESULTS: Thyrotoxic patients recorded a significantly lower AI (means+/-s.e.m.) compared with controls (15.0+/-2.1 vs 28.0+/-2.1%; P<0.0005) even when corrected for differences in heart rate AIc (20.0+/-2.1 vs 28.0+/-2.1%; P<0.005) as well as AG (6.0+/-0.8 vs 10.0+/-1.1 mmHg; P<0.002) but higher pulse pressure (58.0+/-3.5 vs 47.0+/-2.0 mmHg; P<0.02). At 6 months following treatment, a significant rise in AIc (27.0+/-1.8 vs 20.0+/-2.1%; P<0.005) and AG (11.0+/-1.0 vs 6.0+/-0.8 mmHg; P<0.005) was noted. Lipid profiles were comparable between the groups. CONCLUSIONS: These data suggested that subjects with untreated thyrotoxicosis have a decreased augmentation of central arterial pressure or lowered central arterial stiffness that would not appear to contribute to any excess cardiovascular risk in that condition.

Obuobie K, Al-Sabah A, Lazarus JH. · Department of Medicine, University Hospital of Wales, Cardiff, UK. · J Endocrinol Invest. · Pubmed #11929089 No free full text.

Abstract: Subacute thyroiditis is a well-recognized cause of transient thyrotoxicosis, resulting from a destruction injury to the thyroid. The pathogenesis of this condition is not completely understood and there is debate regarding the extent of the contribution of autoimmunity and external agents, such as infections, to this process. We present the first reported case of subacute thyroiditis in a patient who had been on chronic lithium therapy as well as long-term immunosuppression, with cyclosporin and prednisolone, following an allogeneic bone marrow transplant. We speculate that this case suggests a minimal role of autoimmunity in the development of subacute thyroiditis.

Obuobie K, Ogunko A, Lazarus JH. · Department of Medicine, Llandough Hospital, Vale of Glamorgan, Wales, UK. · J R Soc Med. · Pubmed #11385094 links to  free full text

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Lazarus JH, Delange F. · No affiliation provided · Lancet. · Pubmed #15031052 No free full text.

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