Clinical ® for the Thyroidology Public VOLUME 12 | ISSUE 5 | MAY 2019 EDITOR’S COMMENTS . 2 It is well known that overt hypothyroidism has negative effects on the heart function that improve with levothyroxine IODINE DEFICIENCY . 3 treatment. While levothyroxine replacement may improve heart Iodine content is low or absent in some US failure, it is possible that in this group it could have harmful multivitamin and prenatal vitamin brands effects, especially if the levothyroxine dose is too high. This Iodine is essential for the production of thyroid hormone and study evaluated the long-term effects of levothyroxine therapy in for normal development of the baby during pregnancy. It has patients with heart failure. been reported that only 60% of the different types of prenatal Einfeldt MN 2018 Long-term outcome in heart failure multivitamin supplements marketed in the US list iodine patients treated with levothyroxine: an observational among the ingredients. This study aimed to assess whether mul- nationwide cohort study. J Clin Endocrinol Metab. Epub tivitamins are a significant source of iodine by looking at the 2018 Dec 4. PMID: 30517746. iodine content reported in the most frequently purchased US adult and prenatal multivitamin preparations. THYROID CANCER . 11 Patel A et al 2018 Iodine content of the best-selling United Active surveillance for low risk papillary thyroid States adult and prenatal multivitamin preparations. Thyroid. cancer can be considered in select patients Epub 2018 Oct 30. PMID: 30266075. Active surveillance involves closely monitoring the thyroid cancer over time, instead of treating it with immediate surgery. THYROID AND PREGNANCY . 5 Prior studies have shown that active surveillance is safe in Pregnancy and perinatal outcome among papillary thyroid cancers measuring 1 cm or smaller and hypothyroid mothers confined to the thyroid without any lymph node involvement Hypothyroidism is common in women of reproductive age and has or spread outside of the neck. This study compared outcomes of known adverse effects on pregnancy. This study took advantage of active surveillance for patients with cancers <1 cm to those with national registries in Finland where nearly all women receive free larger cancers (1-2 cm). maternity care and deliver at national hospitals and data is collected. Sakai T et al 2019 Active surveillance for T1bN0M0 The goal of the study was to look at pregnancy complications in papillary thyroid carcinoma. Thyroid 29:59–63. Epub 2019 a large group of patients and evaluate whether consistent use of Jan 8. PMID: 30560718. thyroid hormone in hypothyroid mothers affected the outcomes. Turunen S et al Pregnancy and perinatal outcome among THYROID CANCER . 13 hypothyroid mothers: a population-based cohort study. The TIRADS ultrasound system can decrease Thyroid 2019 29:135–141 unnecessary biopsies of PET-positive thyroid nodules HYPERTHYROIDISM . 7 Occasionally, PET scanning will identify unexpected/previously Treatment of hyperthyroidism resulting in undetected thyroid nodules. Since ~1/3 of PET-positive hypothyroidism decreases the risk of heart thyroid nodules will end up being thyroid cancer, most experts disease related hospitalization and death risk recommend biopsy of these nodules. The purpose of this study Thyroid hormone has major effects on the heart and hyper- is to determine if the TIRADS ultrasound system can predict thyroidism can cause major problems and symptoms such as the absence of thyroid cancer in previously undetected thyroid irregular heart rhythms and palpitations. Despite treatment, the nodules identified during PET scanning and, thus, avoid negative effects related to hyperthyroidism may persist. This study thyroid biopsy. examined the effect of radioactive iodine therapy and surgery on Trimboli P et al 2018 Fine-needle aspiration in all thyroid heart disease related problems, hospitalizations and mortality. incidentalomas at 18F-FDG PET/CT: can EU-TIRADS Essi et al 2018 Cardiovascular morbidity and mortality after revise the dogma? Clin Endocrinol (Oxf) 89:642–648. Epub treatment of hyperthyroidism with either radioactive iodine or 2018 Aug 6. PMID: 30019402. thyroidectomy. Thyroid 28:1111–1120. Epub 2018 Jul 23. ATA ALLIANCE FOR THYROID HYPOTHYROIDISM . 9 PATIENT EDUCATION . 15 Levothyroxine treatment increases mortality in Friends of the ATA . 16 patients with heart failure ATA Brochure: Iodine Deficiency . .18 A publication of the American Thyroid Association® ® Clinical Thyroidology for the Public VOLUME 12 | ISSUE 5 | MAY 2019 www .thyroid .org EDITOR’S COMMENTS Editor Alan P. Farwell, MD, FACE Boston Medical Center Welcome to another issue of Clinical Thyroidology for the Public. In this Boston University School of Medicine journal, we will bring to you the most up-to-date, cutting edge thyroid 720 Harrison Ave., Boston, MA 02115 American Thyroid Association research. We also provide even faster updates of late-breaking thyroid news Email: [email protected] through Twitter at @thyroidfriends and on Facebook. Our goal is to provide www.thyroid.org/patients/ct/index.html patients with the tools to be the most informed thyroid patient in the waiting Editorial Board Jessie Block-Galaraza, MD, Albany, NY room. Also check out our friends in the Alliance for Thyroid Patient Gary Bloom, New York, NY Education. The Alliance member groups consist of: the American Thyroid Alina Gavrila, MD, MMSC, Boston, MA Association, Bite Me Cancer, the Graves’ Disease and Thyroid Foundation, Melanie Goldfarb, MD, MS, FACS, FACE, Santa Monica, CA the Light of Life Foundation, ThyCa: Thyroid Cancer Survivors’ Association, Shirin Haddady, MD, MPH, Boston, MA Thyroid Cancer Canada, Thyroid Cancer Allianceand Thyroid Federation Sun Lee, MD, Boston, MA Joshua Klopper, MD, Denver, CO International. Angela Leung, MD, Los Angeles, CA Priya Mahajan, MD, Houston, TX The American Thyroid Association (ATA) extends its appreciation to all of Maria Papaleontiou, MD, Ann Arbor, MI Jason D. Prescott, MD PhD, Baltimore, MD the patients and their families that are part of the ATA community — our Marjorie Safran, MD, Worcester, MA Friends of the ATA. It is for you that the ATA is dedicated to carrying Anna M. Sawka, MD, Toronto, ON, Canada out our mission of providing reliable thyroid information and resources, Phillip Segal, MD, Toronto, ON, Canada Vibhavsu Sharma, MD, Albany, NY clinical practice guidelines for thyroid detection and treatments, resources Ebru Sulanc, MD , Detroit, MI for connecting you with other patients affected by thyroid conditions, and Valentina Tarasova, MD, Tampa, FL Whitney Woodmansee, MD, Gainesville, FL cutting edge thyroid research as we search for better diagnoses and treatment outcomes for thyroid disease and thyroid cancer. American Thyroid Association President Elizabeth N. Pearce, MD, MSc (2018–2019) May is International Thyroid Awareness Month. Celebrate World Thyroid Secretary/Chief Operating Officer Day is on May 25! Victor J. Bernet, MD (2015–2019) Treasurer Julie Ann Sosa, MD (2017–2021) In this issue, the studies ask the following questions: Secretary-Elect ● Jacqueline Jonklaas, MD (2018–2019) Is iodine content in prenatal vitamins adequate? President-Elect ● Does adequate levothyroxine therapy in hypothyroid mothers Martha Zeiger, MD (2018–2019) improve pregnancy outcomes? Past-President Charles H. Emerson, MD (2018–2019) ● Does treatment of hyperthyroidism affect the risk for cardiac problems? Executive Director ● Barbara R. Smith, CAE Does levothyroxine therapy affect the death rate in patients with American Thyroid Association heart failure? 6066 Leesburg Pike, Suite 550 Falls Church, VA 22041 ● Can low risk thyroid cancers be safely watched without surgery? Telephone: 703-998-8890 ● Fax: 703-998-8893 Can a new radiology grading system decrease the need for biopsy Email: [email protected] of thyroid nodules discovered on PET scans? Designed by Karen Durland, [email protected] Clinical Thyroidology for the Public We welcome your feedback and suggestions. Let us know what you want to see Copyright © 2019 by the American Thyroid in this publication. I hope you find these summaries interesting and informative. Association, Inc. All rights reserved. — Alan P. Farwell, MD, FACE A publication of the American Thyroid Association® ® Clinical Thyroidology for the Public VOLUME 12 | ISSUE 5 | MAY 2019 IODINE DEFICIENCY Iodine content is low or absent in some US multivitamin and prenatal vitamin brands BACKGROUND types of prenatal multivitamin supplements marketed Iodine is essential for the production of thyroid hormone in the US list iodine among the ingredients. It also has and for normal development of the baby during been shown that iodine content is the most variable and pregnancy. During pregnancy and breastfeeding there least accurately labeled nutrient contained in US adult is an increased requirement for iodine both because of multivitamins. a need for higher thyroid hormone production and for secretion of iodine into breast milk. Many studies have This study aimed to assess whether multivitamins are a shown that iodine deficiency has been associated with significant source of iodine in nonpregnant and pregnant adverse effects in babies and infants that range from severe adults by looking at the iodine content reported in the mental retardation to mild brain deficits. Therefore, orga- most frequently purchased US adult and prenatal multi- nizations such as the American Thyroid Association and vitamin preparations, knowing how many purchases for the American