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Clinical Thyroidology for Patients Volume 6 Issue 8 2013

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Clinical Thyroidology for Patients Volume 6 Issue 8 2013 Clinical THYROIDOLOGY th 90 ANNIVERSARY FOR PATIENTS VOLUME 6 ISSUE 8 2013 www.thyroid.org EDITOR’S COMMENTS . .2 Tanda ML et al Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed HYPOTHYROIDISM . 3 Graves’ hyperthyroidism seen at a single center. J Clin Desiccated thyroid extract vs Levothyroxine Endocrinol Metab 2013;98:1443-9. in the treatment of hypothyroidism Levothyroxine is the most common form of thyroid hormone THYROID CANCER . 8 replacement therapy. Prior to the availability of the pure levothy- Stimulated thyroglobulin levels obtained after roxine, desiccated animal thyroid extract was the only treatment thyroidectomy are a good indicator for risk of for hypothyroidism and some individuals still prefer dessicated future recurrence from thyroid cancer. thyroid extract as a more “natural” thyroid hormone. This study Thyroglobulin is a protein secreted only by thyroid cells, both was performed to compare levothyroxine to desiccated thyroid normal and cancerous thyroid cells. After thyroidectomy and extract in terms of thyroid blood tests, changes in weight, psy- removal of most of the normal thyroid cells, blood thyroglobu- chometric test results and patient preference. lin levels are used to detect thyroid cancer recurrence. In this Hoang TD et al Desiccated thyroid extract compared study, the authors examined the ability of thyroglobulin levels with levothyroxine in the treatment of hypothyroidism: measured after initial thyroidectomy to accurately predict the A randomized, double-blind, crossover study. J Clin Endo- chance for future thyroid cancer recurrence in high risk patients. crinol Metab 2013;98:1982-90. Epub March 28, 2013. Piccardo, A. et al. Focus on high-risk DTC patients: high postoperative serum thyroglobulin level is a strong predictor of THYROID AND PREGNANCY . .4 disease persistence and is associated to progression-free survival IVF pregnancy outcomes in women with and overall survival. Clin Nucl Med 38 (1): 18-24, 2013. treated hypothyroidism and women without thyroid disease THYROID CANCER . .10 Hypothyroidism is common among women of child-bearing Only a few thyroid cancer patients have a cancer age. Hypothyroidism that is either undiagnosed or under-treated recurrence within 8 years of initial therapy can contribute to infertility and can result in miscarriage. While only a small number of patients with papillary cancer die This study was designed to compare the success of IVF in from their cancer, recurrence of the cancer is relatively common hypothyroid women treated with adequate doses of levothy- and patients are followed for many years for recurrence of the roxine compared to women undergoing the same procedure cancer. However, it is not clear how long and how often patients with normal thyroid function. with papillary cancer need a follow up. This study was done to Busnelli A et al. In vitro fertilization outcomes in find out the time and rate of recurrence in patients with papillary treated hypothyroidism. Thyroid. April 2, 2013 thyroid cancer to improve the management of these patients. [Epub ahead of print]. Durante C et al, Papillary thyroid cancer: time course of recurrences during postsurgery surveillance. J Clin HYPERTHYROIDISM . .6 Endocrinol Metab 2013;98:636-42. Epub January 4, 2013. Severe sight-threatening orbitopathy is a very rare event in the natural history ATA ALLIANCE FOR THYROID of Graves’ disease PATIENT EDUCATION . 12 Graves’ orbitopathy is a severe complication of Graves’ ATA Alliance Calendar . .14 disease that can be disfiguring and affect vision. The prevalence and development of Graves’ orbitopathy has not been well studied. This study was designed to evaluate the occurrence and features of Graves’ orbitopathy in newly diagnosed patients with Graves’ disease who are started on antithyroid drugs and Follow us on Facebook Follow us on Twitter followed for 18 months. A publication of the American Thyroid Association CLINICAL THYROIDOLOGY FOR PATIENTS A publication of the American Thyroid Association VOLUME 6 ISSUE 8 2013 www.thyroid.org EDITOR’S COMMENTS Editor Welcome to Clinical Thyroidology for Patients, bringing to you, the Alan P. Farwell, MD patient, the most up-to-date, cutting edge thyroid research. What you Boston Medical Center Boston University School of Medicine read here as research studies will likely become the accepted practice in 88 East Newton St., Boston, MA 02115 the future. Clinical Thyroidology for Patients is published on a monthly Director of Patient Education basis and includes summaries of research studies that were discussed in American Thyroid Association e-mail: [email protected] a recent issue of Clinical Thyroidology, a publication of the American www.thyroid.org/patients/ct/index.html Thyroid Association for physicians. This means that you, the patients, are Editorial Board getting the latest information on thyroid research and treatment almost Gary Bloom New York, NY as soon as your physicians. Glenn Braunstein, MD Los Angeles, CA M. Regina Castro, MD Rochester, MN Frank Crantz, MD McLean, VA We will be providing even faster updates of late-breaking thyroid news Jamshid Farahati, MD Bottrop, Germany through Twitter at @thyroidfriends and on Facebook. Our goal is to Alina Gavrile-Filip, MD Boston, MA Heather Hofflich, DO San Diego, CA provide you with the tools to be the most informed thyroid patient in the Ronald Kuppersmith, MD College Station, TX waiting room. Also check out our friends in the ATA Alliance for Thyroid Angela Leung, MD Boston, MA Mona Sabra, MD New York, NY Patient Education. The Alliance member groups consist of: the American Anna M. Sawka, MD Toronto, ON, Thyroid Association, the Graves’ Disease and Thyroid Foundation, the Light Canada Philip Segal, MD Toronto, ON, of Life Foundation, ThyCa: Thyroid Cancer Survivors Association, Thyroid Canada Cancer Canada and Thyroid Federation International. Jerrold Stock, MD Morristown, NJ Whitney Woodmansee, MD Boston, MA In this issue, the studies ask the following questions: American Thyroid Association • Is there any difference between Levothyroxine and desiccated thyroid President Bryan R. Haugen, MD extract in the treatment of hypothyroidism? Secretary/Chief Operating Officer • Are IVF pregnancy outcomes any different in hypothyroid women? John C. Morris, III, MD Treasurer • How common is severe orbitopathy in patients with Graves’ disease? David H. Sarne, MD • Do stimulated thyroglobulin levels predict the risk for thyroid cancer President-Elect recurrence? Hossein Gharib, MD Treasurer-Elect • What is the risk of cancer recurrence in patients with thyroid cancer? Gregory W. Randolph, MD Past-President We welcome your feedback and suggestions. Let us know what you want James A. Fagin, MD to see in this publication. I hope you find these summaries interesting Executive Director Barbara R. Smith, CAE and informative. American Thyroid Association — Alan P. Farwell, MD 6066 Leesburg Pike, Suite 550 Falls Church, VA 22041 Telephone: 703-998-8890 Fax: 703-998-8893 Email: [email protected] Designed by Karen Durland Email: [email protected] Clinical Thyroidology for Patients Copyright © 2013 AmericanClinical Thyroid Thyroidology Association, Inc. for Patients (from recent articles in Clinical Thyroidology) Volume 6 Issue 8 2013 2 All rights reserved. Back to Table of Contents CLINICAL THYROIDOLOGY FOR PATIENTS A publication of the American Thyroid Association HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine www.thyroid.org in the treatment of hypothyroidism BACKGROUND the other option for another 16 weeks. The participants Hypothyroidism, or an underactive thyroid gland, is were “blinded” during both phases – they did not know a common endocrine problem and requires lifelong the type of pill they received. After each treatment period treatment with thyroid hormone pills. Untreated hypo- patients were weighed, had blood tests, underwent psy- thyroidism is associated with a wide variety of symptoms, chometric testing and were asked which therapy they many of which are nonspecific. In particular, memory preferred. The researchers report that 49% of the patients problems and depression (psychometric problems) as well preferred desiccated thyroid extract, 19% preferred levo- as weight gain are very common symptoms in hypothy- thyroxine and 23% had no preference. Desiccated thyroid roidism but also have multiple other nonthyroidal causes extract use was also associated with more weight loss. as well. Levothyroxine is the main thyroid hormone There was no difference in the psychometric testing or in produced by the thyroid gland and the synthetic form is any symptoms. Both types of thyroid hormone were able the most common form of thyroid hormone replacement to normalize the abnormal thyroid blood tests. therapy. Prior to the availability of the pure levothyroxine, desiccated animal thyroid extract was the only treatment WHAT ARE THE IMPLICATIONS for hypothyroidism. Today, some individuals prefer OF THIS STUDY? dessicated thyroid extract as a more “natural” thyroid Although desiccated thyroid extract is not widely used, hormone. In addition, some patients who continue to this study showed that many patients preferred this option have symptoms of hypothyroidism when taking levo- as compared with levothyroxine. This result was observed thyroxine report improvement in these symptoms when despite there being no differences in thyroid function blood switched to desiccated thyroid extract. This study was test
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