Discovery of a crucial link between chronic fatigue syndrome and lower levels of key thyroid hormones raises hopes for treating this common yet debilitating disease

New research demonstrates a link between chronic fatigue syndrome (CFS) symptoms and lower thyroid hormone levels. Published in Frontiers in Endocrinology, the study indicates that CFS, a condition with unknown causes, can be explained by lower thyroid hormones — but may be distinct from thyroidal disease. This finding can be seen as a first step to finding treatment for a debilitating illness for which there is no recognized treatment.

Chronic fatigue syndrome is a common disease marked by lengthy spells of weakness, fatigue and depression. Its diagnosis is predominantly based on symptoms and on ruling out any underlying medical condition, rather than on laboratory tests and physical examination.

Interestingly, several symptoms resemble those of hypothyroidism — a condition where the thyroid gland does not produce enough thyroid hormone. In hypothyroidism, the body tries to encourage thyroid hormone activity by releasing more thyroid-stimulating hormone — however, this does not happen in patients with chronic fatigue syndrome.

This contrast in thyroid-stimulating activity led the study’s authors to hypothesize that chronic fatigue syndrome is caused by low activity of thyroid hormones in the absence of thyroidal disease.

Led by Dr. Begoña Ruiz-Núñez at the University Medical Center Groningen, The Netherlands, the researchers compared thyroid function and markers of inflammation between 98 CFS patients and 99 healthy controls. Remarkably, the CFS patients had lower serum levels of certain key thyroid hormones such as triiodothyronine (T3) and thyroxine (T4), but normal levels of thyroid-stimulating hormone.

Additional analyses indicated that CFS patients had a lower urinary iodine status and low-grade inflammation, which possibly mirrored the symptoms of patients with hypothyroidism. These CFS patients, however, had relatively higher levels of another thyroid hormone called “reverse T3” or rT3. This appeared to be due to a shift in hormone production, where the body preferred to convert T4 to rT3 instead of producing T3. The low T3 levels found in CFS patients coupled with this switchover to rT3 could mean that T3 levels are severely reduced in tissue.

“One of the key elements of our study is that our observations persisted in the face of two sensitivity analyses to check the strength of the association between CFS and thyroid parameters and low-grade inflammation,” says Dr. Ruiz-Núñez. “This strengthens our test results considerably.”

The researchers believe inclusion of patient information, such as duration of illness, would enable a correlation with their biochemical profiles. Further, even though the study demonstrates a link between chronic fatigue syndrome symptoms and low levels of key thyroid hormones, a definitive cause for CFS remains unknown.

If the study findings are confirmed by additional research, it may pave the way for a treatment for chronic fatigue syndrome.

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Materials provided by Frontiers. Note: Content may be edited for style and length.

Journal Reference:

Begoña Ruiz-Núñez, Rabab Tarasse, Emar F. Vogelaar, D. A. Janneke Dijck-Brouwer, Frits A. J. Muskiet. Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study. Frontiers in Endocrinology, 2018; 9 DOI: 10.3389/fendo.2018.00097

Source: Science Daily 

Published in JUN 25, 2018 Mais notícias.

May 25th is World Thyroid Day (WTD), a special Day on the calendar dedicated to thyroid patients round the globe. It is a Day of respect towards the many millions of patients who suffer from a variety of disorders that cover a whole spectrum of disease, ranging from subclinical to overt hypothyroidism and hyperthyroidism, autoimmune thyroid diseases and thyroid cancer.

It is a Day of reflection on the factors causing thyroid disease, made up of the interplay of genetics and environmental factors that, by disrupting the thyroid, sooner or later can lead to the manifestation of the disease. For a full decade, the American Thyroid Association (ATA) together with the European Thyroid Association (ETA), the Latin American Thyroid Society (LATS) and the Asia Oceania Thyroid Association (AOTA), fully endorsing and supporting WTD, have called and continue to call for action on the part of all those who are involved in the care of thyroid patients.

This they do by, among many other activities, organizing and holding open-door events via which they will have direct access to patients everywhere as well as to local authorities, Town Halls and municipalities with the express aim of arousing and further increasing among them all the level of awareness and of education regarding thyroid diseases.

Surrounding and further supporting World Thyroid Day is International Awareness Thyroid Week (IATW).

Thus, a Day and a Week to highlight the importance of maintaining a healthy thyroid and thus better caring for the entirety of our health.
Wishing you all a successful 25th of May…and don’t forget to check your Thyroid!

Leonidas Duntas
Member of the Clinical Affairs Board of the ATA



Published in JUN 11, 2018 Mais notícias.

Nodules located in the upper pole of the thyroid gland may carry a greater risk for malignancy than those in the lower pole, new research suggests.

The findings were presented May 19 here at the American Association of Clinical Endocrinologists (AACE) 2018 Annual Scientific & Clinical Congress by Fan Zhang, MD, PhD, a resident in the Department of Internal Medicine at Brookdale University Hospital and Medical Center, Brooklyn, New York.

Sonographic characteristics of nodules such as microcalcifications, hypoechoicity (does not bounce back sound), infiltrative margins, increased vascularity, and taller-than-wide are all known to be associated with greater malignancy risk, but no prior study has examined the risk in relation to location in the upper versus lower pole of the thyroid, Zhang and colleagues explain in their poster.

In their study of nearly 200 patients, nodules located in the upper pole of the thyroid were nearly five-times more likely to be malignant than those in the lower pole.

If replicated in subsequent research, the findings suggest that thyroid nodule location should be included in ultrasound classification guidelines to enhance the predictive value for malignancy, diagnostic accuracy, and reliability as an indication for performing fine-needle aspiration biopsy, the authors say.

“Obviously this has to be confirmed by others,” said lead investigator Tooraj Zahedi, MD, endocrinologist, Division of Endocrinology, Brookdale University Hospital and Medical Center. If the findings are replicated, “We may start considering location as a possible addition to the guidelines,” he told Medscape Medical News.

Why Does Nodule Location Seem to Affect Malignancy Rate?

The reason for the increased risk in the upper pole isn’t known. The authors theorize that perhaps it’s related to anatomy, as venous drainage from the upper lobe is more tortuous and therefore slower than that of the lower lobe. This could result in delayed clearing of the by-products of normal metabolism in the upper poles. These by-products may include reactive oxygen species that could promote and propagate cancer, the authors hypothesize.

Ali M. Safa, MD, an endocrinologist from Vienna, Virginia, who stopped by the poster, had a different hypothesis: the upper lobe may receive more radiation exposure because of dental X-rays or other imaging such as sinus CT.

Safa suggested the authors examine the results by patient age, as those who are older would be more likely to have undergone nondigital dental X-rays that involved more radiation exposure. He pointed out that although the protective shield should cover the neck, it can slide down, potentially exposing the upper part of the thyroid.

And he noted that sinus CTs are fairly common and protection of the thyroid gland isn’t typically a focus. “I worry about a lot of these exposures…You have to think it’s a possibility,” Safa said, adding, “if you do prove this, it could be major in terms of policymaking.”

First Study to Examine Malignancy Risk by Nodule Location

As the high prevalence of thyroid nodules demands accurate assessment to avoid unnecessary biopsies and overtreatment, this study examined whether nodule location affects outcomes.

Researchers retrospectively reviewed data from 188 clinic patients (82% women) with thyroid nodules who underwent fine-needle aspiration biopsy from July 2016 to June 2017. The nodules were evenly distributed in the right and left lobes of the thyroid gland (47% and 51%, respectively), while 2% were in the isthmus.

Most nodules (79%) were located in the lower thyroid pole, compared with just 10% in the upper pole and 11% in the middle pole. Multiple nodules were present in 40% of the patients.

Malignancy was identified in 7.4% of nodules (n = 14), including 22.2% (4 of 18) in the upper pole, 4.7% (7 of 149) in the lower pole, and 14.3% (3 of 21) in the middle pole.

The difference between malignancies located in the upper and lower poles was highly significant (odds ratio [OR], 5.8; P = .01), and remained significant after adjustment for number of nodules, age, gender, body mass index, and laterality (OR, 4.6; P = .03).

“I think other people have to start looking at their own series and see if they can replicate our findings,” Zahedi said.

Zhang, Zahedi, and Safa have reported no relevant financial relationships.

American Association of Clinical Endocrinologists (AACE) 2018 Annual Scientific & Clinical Congress. May 19, 2018; Boston, Massachusetts.

Source: Medscape

Published in JUN 1, 2018 Mais notícias.

LATS Eletronic Journal

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