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Thursday, 28 November 2013

Thyroid disease: Hypothyroidism – Diseases associated to hypothyroidism

Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones.
C.2. Diseases associated to hypothyroidism
1. Systemic Sclerosis
Context:Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology, and several studies reported its association with thyroid autoimmune disorders, according to the study by the University of Pisa and University of Modena and Reggio Emilia, there is a high incidence of new cases of hypothyroidism and thyroid dysfunction in female sclerodermic patients. Female sclerodermic patients, who are at high risk (a borderline high [even if in the normal range] TSH value, anti-thyroperoxidase antibody positivity, and a hypoechoic and small thyroid) should have periodic thyroid function follow-up(26).
2. Osteoarthritis and fibromyalgia
In the study of 91 women with RA evaluated, 29 (30%) had evidence of thyroid dysfunction compared with 10 (11%) of 93 controlsto determine whether thyroid dysfunction is found with increased frequency in patients with rheumatoid arthritis (RA), showed that thyroid dysfunction is seen at least three times more often in women with RA than in women with similar demographic features with non-inflammatory rheumatic diseases such as osteoarthritis and fibromyalgia(27).
3. Type 1 diabetes mellitus (T1DM)
In the study of the data of consecutive patients of T1DM presenting to department of Endocrinology from May 1997 to December 2011 were retrospectively analyzed in context of associated clinical profile, found that among 260 patients diagnosed as T1DM, 21 (8%) had hypothyroidism, 4 (1.5%) had hyperthyroidism and 2 (0.7%) had primary adrenal insufficiency. Eighteen patients (7%) had celiac disease, 9 (3.5%) had Turner’s syndrome, 5 patients (1.9%) had Klinefelter’s syndrome, whereas Down’s syndrome and Noonan’s syndrome was present in 2 and 1 patients (0.7%) respectively(28).
4. Increased pituitary corticotroph responsiveness to CRH and abnormalities in all three components of the HPA axis
According to the study by the, long-term hypothyroidism is associated with adrenal insufficiency with abnormalities in all three components of the HPA axis. Short-term hypothyroidism, on the other hand, is associated with increased pituitary corticotroph responsiveness to CRH(29).
5. Hyponatremia
According to the study by the Leiden University Medical Center, hyponatremia in hypothyroidism is due to a pure renal mechanism, and cannot be ascribed to inappropriate secretion of antidiuretic hormone(30).
6. Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis is the most common cause of hypothyroidismas a result of an autoimmune disease.
7. Solitary toxic thyroid nodules
According to the study lead by Ross DS of the Forty-five patients with solitary toxic thyroid adenomas received 131I (mean dose, 10.3 mCi) for treatment of hyperthyroidism and were followed for 4.9 +/- 3.2 years (range, 0.5 to 13.5). Seventy-seven percent were euthyroid by 2 months, 91% by 6 months, and 93% by 1 year. Only 3 patients did not respond to a single dose of 131I, but all responded to multiple doses. Late recurrent hyperthyroidism occurred in 3 patients at 4.5, 6, and 10 years after treatment with a single dose of 131I(31).
8. Rhabdomyolysis
There is a report of a case of rhabdomyolysis associating hypothyroidism. Hypothyroidism frequently leads to myalgias, muscle stiffness, cramps and sometimes elevated levels of muscle enzymes, but rhabdomyolysis is quite rare, according to the study by the Selcuk University(32).
9. Thyroid cancer
Acute hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer during monitoring for remnant or metastatic disease, seriously affects multiple organs and systems, and especially in severe cases can impair quality of life, according to the study by the University of Athens(33).
10. Restless leg syndrome
There is a study indicated that Restless leg syndrome as a result of moderate hypothyroidism(34).
11. Myxedema coma
Myxedema coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual, according to the study by the Prince Charles Hospital(35).
12. Tarsal Tunnel Syndrome
Tarsal tunnel syndromeis associated to hypothyroidism, according to the study by the
Atkinson Morley’s Hospital, Wimbledon(36).
13. Carpal Tunnel Syndrome
There is a report of a patient who developed symptoms of bilateral carpal tunnel syndrome following radioactive iodine induced hypothyroidism(37).
14. Fatty liver
According to the study by the research team lead by Xu L, there is an Impact of subclinical hypothyroidism on the development of non-alcoholic fatty liver disease(38).
15. Sleep apnea and sleep disorders
Hypothyroidism is associated with abnormal ventilatory drive, abnormal sleep architecture, and sleep apnea. Central, obstructive, and mixed patterns of sleep apnea are commonly observed in hypothyroidism, according to the study by the Medical College of Georgia(39).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/17933284
(26) http://www.ncbi.nlm.nih.gov/pubmed/23780374
(27) http://www.ncbi.nlm.nih.gov/pubmed/8323398
(28) http://www.ncbi.nlm.nih.gov/pubmed/23153973
(29) http://www.ncbi.nlm.nih.gov/pubmed/22695985
(30) http://www.ncbi.nlm.nih.gov/pubmed/11246114
(31) http://www.ncbi.nlm.nih.gov/pubmed/6476634
(32) http://www.ncbi.nlm.nih.gov/pubmed/12803243
(33) http://www.ncbi.nlm.nih.gov/pubmed/17218721
(34) http://www.ncbi.nlm.nih.gov/pubmed/3158897
(35) http://www.ncbi.nlm.nih.gov/pubmed/21058937
(36) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1027394/
(37) http://www.ncbi.nlm.nih.gov/pubmed/7310927
(38) http://www.ncbi.nlm.nih.gov/pubmed/22940010
(39) http://www.ncbi.nlm.nih.gov/pubmed/2764018