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Peter Laurberg - One of the best experts on this subject based on the ideXlab platform.

  • association between tsh receptor autoimmunity Hyperthyroidism goitre and orbitopathy in 208 patients included in the remission induction and sustenance in graves disease study
    Journal of Thyroid Research, 2014
    Co-Authors: Peter Laurberg, Allan Carle, Inge Bulow Pedersen, Birte Nygaard, Stig Andersen, Jesper Karmisholt, Anne Krejbjerg, Stine Linding Andersen
    Abstract:

    Background. Graves’ disease may have a number of clinical manifestations with varying degrees of activity that may not always run in parallel. Objectives. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves’ disease (Hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of Hyperthyroidism. Methods. We describe a cohort of 208 patients with newly diagnosed Graves’ Hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves’ Hyperthyroidism, entitled “Remission Induction and Sustenance in Graves’ Disease (RISG).” Patients were systematically tested for degree of biochemical Hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy. Results. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves’ disease: severeness of Hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of Hyperthyroidism, whereas 25–30% had orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves’ disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis.

  • Hyperthyroidism in pregnancy
    The Lancet Diabetes & Endocrinology, 2013
    Co-Authors: David S Cooper, Peter Laurberg
    Abstract:

    Summary Changes in thyroid hormone concentrations that are characteristic of Hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. Approximately one to two cases of gestational Hyperthyroidism occur per 1000 pregnancies. Identification of Hyperthyroidism in a pregnant woman is important because adverse outcomes can occur in both the mother and the offspring. Graves' disease, which is autoimmune in nature, is the usual cause; but Hyperthyroidism in pregnancy can be caused by any type of Hyperthyroidism—eg, toxic multinodular goitre or solitary autonomously functioning nodule. Gestational transient thyrotoxicosis is typically reported in women with hyperemesis gravidarum, and is mediated by high circulating concentrations of human chorionic gonadotropin. Post-partum thyroiditis occurs in 5–10% of women, and many of those affected ultimately develop permanent hypothyroidism. Antithyroid drug treatment of Hyperthyroidism in pregnant women is controversial because the usual drugs—methimazole or carbimazole—are occasionally teratogenic; and the alternative—propylthiouracil—can be hepatotoxic. Fetal Hyperthyroidism can be life-threatening, and needs to be recognised as soon as possible so that treatment of the fetus with antithyroid drugs via the mother can be initiated. In this Review, we discuss physiological and pathophysiological changes in thyroid hormone economy in pregnancy, the diagnosis and management of Hyperthyroidism during pregnancy, severe life-threatening thyrotoxicosis in pregnancy, neonatal thyrotoxicosis, and post-partum Hyperthyroidism.

  • epidemiology of subtypes of Hyperthyroidism in denmark a population based study
    European Journal of Endocrinology, 2011
    Co-Authors: Allan Carle, Inge Bulow Pedersen, Nils Knudsen, Hans Perrild, Lars Ovesen, Lone Banke Rasmussen, Peter Laurberg
    Abstract:

    Objective: Few population-based studies have described the epidemiology of subtypes of Hyperthyroidism. Design: A prospective population-based study, monitoring two well-defined Danish cohorts in Aalborg with moderate iodine deficiency (nZ311 102) and Copenhagen with only mild iodine deficiency (nZ227 632). Methods: A laboratory monitoring system identified subjects with thyroid function tests suggesting overt Hyperthyroidism (low s-TSH combined with high s-thyroxine or s-triiodothyronine). For all subjects, we collected information on medical history, thyroid scintigraphy and thyroid hormone receptor antibody (TRAb) measurement. Information was used to disprove or verify primary overt Hyperthyroidism and to subclassify Hyperthyroidism into nosological disorders. Results: From 1997 to 2000 (2 027 208 person-years of observation), we verified 1682 new cases of overt Hyperthyroidism. The overall standardized incidence rate (SIR) per 100 000 person-years was 81.6, and was higher in Aalborg compared with Copenhagen (96.7 vs 60.0, P!0.001), giving an SIR ratio (SIRR (95% confidence interval (CI))) between moderate versus mild iodine-deficient areas of 1.6 (1.4–1.8). Nosological types of Hyperthyroidism (percentage/SIRR (95% CI)): multinodular toxic goitre (MNTG) 44.1%/1.9 (1.6–2.2), Graves’ disease (GD) 37.6%/1.2 (0.99–1.4), solitary toxic adenoma (STA) 5.7%/2.4 (1.3–3.5), ‘mixed type’ Hyperthyroidism (TRAb-positive, scintigraphicly multinodular) 5.4%/6.0 (3.0–12), subacute thyroiditis 2.3%/0.9 (0.4–1.4), postpartum thyroid dysfunction 2.2%/1.6 (0.8–3.0), amiodarone-associated Hyperthyroidism 0.8%/7.1 (1.1–65), Hyperthyroidism after thyroid radiation 0.7%/12.3 (0.8–50), lithium-associated Hyperthyroidism 0.7%/0.97 (0.4–4.8) and Hyperthyroidism caused by various other factors 0.7%. Lifetime risk for overt Hyperthyroidism was 10.5%/6.5%/2.4% (females/all/males). Conclusion: Hyperthyroidism was common in Denmark with MNTG and GD as dominating entities. The higher incidence of Hyperthyroidism in the most iodine-deficient region was caused by higher frequency of MNTG, ‘mixed-type’, STA and amiodarone-associated Hyperthyroidism.

  • management of graves Hyperthyroidism in pregnancy focus on both maternal and foetal thyroid function and caution against surgical thyroidectomy in pregnancy
    European Journal of Endocrinology, 2009
    Co-Authors: Peter Laurberg, Jesper Karmisholt, Claire Bournaud, Jacques Orgiazzi
    Abstract:

    Graves’ disease is a common autoimmune disorder in women in fertile ages. The Hyperthyroidism is caused by generation of TSH-receptor activating antibodies. In pregnancy both the antibodies and the antithyroid medication given to the mother pass the placenta and affect the foetal thyroid gland. Thyroid function should be controlled not only in the mother with Graves’ Hyperthyroidism but also in her foetus. The review includes two cases illustrating some of the problems in managing Graves’ disease in pregnancy. Major threats to optimal foetal thyroid function are inadequate or over aggressive antithyroid drug therapy of the mother. It should be taken into account that antithyroid drugs tend to block the foetal thyroid function more effectively than the maternal thyroid function, and that levothyroxin (L-T4) given to the mother will have only a limited effect in the foetus. Surgical thyroidectomy of patients with Graves’ Hyperthyroidism does not lead to immediate remission of the autoimmune abnormality, and the combination thyroidectomyCwithdrawal of antithyroid medicationCL-T4 replacement of the mother involves a high risk of foetal Hyperthyroidism. Conclusion: Antithyroid drug therapy of pregnant women with Graves’ Hyperthyroidism should be balanced to control both maternal and foetal thyroid function. Surgical thyroidectomy of a pregnant woman with active disease may lead to isolated foetal Hyperthyroidism.

Jorge H Mestman - One of the best experts on this subject based on the ideXlab platform.

  • Graves’ Hyperthyroidism in pregnancy: a clinical review
    Clinical Diabetes and Endocrinology, 2018
    Co-Authors: Caroline T. Nguyen, Elizabeth B. Sasso, Lorayne Barton, Jorge H Mestman
    Abstract:

    Background Graves’ Hyperthyroidism affects 0.2% of pregnant women. Establishing the correct diagnosis and effectively managing Graves’ Hyperthyroidism in pregnancy remains a challenge for physicians. Main The goal of this paper is to review the diagnosis and management of Graves’ Hyperthyroidism in pregnancy. The paper will discuss preconception counseling, etiologies of Hyperthyroidism, thyroid function testing, pregnancy-related complications, maternal management, including thyroid storm, anti-thyroid drugs and the complications for mother and fetus, fetal and neonatal thyroid function, neonatal management, and maternal post-partum management. Conclusion Establishing the diagnosis of Graves’ Hyperthyroidism early, maintaining euthyroidism, and achieving a serum total T4 in the upper limit of normal throughout pregnancy is key to reducing the risk of maternal, fetal, and newborn complications. The key to a successful pregnancy begins with preconception counseling.

  • graves Hyperthyroidism and pregnancy a clinical update
    Endocrine Practice, 2010
    Co-Authors: Komal Patilsisodia, Jorge H Mestman
    Abstract:

    Objective: To provide a clinical update on Graves' Hyperthyroidism and pregnancy with a focus on treatment with antithyroid drugs. Methods: We searched the English-language literature for studies published between 1929 and 2009 related to management of Hyperthyroidism in pregnancy. In this review, we discuss differential diagnosis of Hyperthyroidism, management, importance of early diagnosis, and importance of achieving proper control to avoid maternal and fetal complications. Results: Diagnosing Hyperthyroidism during pregnancy can be challenging because many of the signs and symptoms are similar to normal physiologic changes that occur in pregnancy. Patients with Graves disease require prompt treatment with antithyroid drugs and should undergo frequent monitoring for signs of fetal and maternal Hyperthyroidism and hypothyroidism. Rates of maternal and perinatal complications are directly related to control of Hyperthyroidism in the mother. Thyroid receptor antibodies should be assessed in all women with Hyperthyroidism to help predict and reduce the risk of fetal or neonatal Hyperthyroidism or hypothyroidism. The maternal thyroxine level should be kept in the upper third of the reference range or just above normal, using the lowest possible antithyroid drug dosage. Hyperthyroidism may recur in the postpartum period as Graves disease or postpartum thyroiditis; thus, it is prudent to evaluate thyroid function 6 weeks after delivery. Preconception counseling, a multidisciplinary approach to care, and patient education regarding potential maternal and fetal complications that can occur with different types of treatment are important. Conclusion: Preconception counseling and a multifaceted approach to care by the endocrinologist and the obstetric team are imperative for a successful pregnancy in women with Graves Hyperthyroidism.

  • Hyperthyroidism in pregnancy
    Endocrinology and Metabolism Clinics of North America, 1998
    Co-Authors: Jorge H Mestman
    Abstract:

    The interpretation of thyroid tests and the diagnosis of thyroid pathology may be a challenge for the physician caring for pregnant women. In the last decade, improvements in the sensitivity of thyroid tests, such as serum thyrotropin (TSH), have clarified some issues related to thyroid physiology in the pregnant state. 22 Although autoimmunity has traditionally been considered to be the most common etiology of disorders of the thyroid gland affecting pregnant women, new studies indicate that Hyperthyroidism caused by the inappropriate production of human chorionic gonadotropin (hCG) is the leading cause of abnormalities in thyroid tests during the first half of pregnancy. 23 However, from a clinical point of view, Hyperthyroidism owing to Graves' disease remains the most important cause of maternal and fetal morbidity. 47 Hyperthyroidism is second to diabetes mellitus as the most common endocrine disorder seen in pregnancy. Women with active or treated Hyperthyroidism need to be advised concerning the potential medical problems that they and their fetuses may encounter during gestation, particularly if thyroid dysfunction is not managed properly. The outcome of pregnancy may be affected not only in women with active Hyperthyroidism but in some patients with Graves' disease who have previously been treated with ablation therapy, involving either surgery or radioactive iodide (RAI). A team approach to management is strongly recommended, with the participation of an endocrinologist, obstetrician, perinatologist, neonatologist, and anesthesiologist. This article reviews the prevalence and etiology of Hyperthyroidism in pregnancy; Hyperthyroidism caused by the inappropriate secretion of hCG; potential maternal, fetal, and neonatal morbidity in Hyperthyroidism associated with Graves' disease; management of Hyperthyroidism during gestation; prepregnancy counseling; issues related to breast-feeding in mothers taking antithyroid drugs (ATD); and postpartum thyroid dysfunction in patients with Graves' disease.

Mina Matsushita - One of the best experts on this subject based on the ideXlab platform.

R E Coleman - One of the best experts on this subject based on the ideXlab platform.

  • Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease
    British Journal of Cancer, 2011
    Co-Authors: L Walkington, J Everard, J Webster, B W Hancock, R E Coleman
    Abstract:

    Background: Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Patients with persistent disease require treatment with chemotherapy. For the vast majority, prognosis is excellent. Occasionally, GTD is complicated by Hyperthyroidism, which may require treatment. This is thought to occur due to molecular mimicry between human chorionic gonadotrophin (HCG) and thyroid-stimulating hormone (TSH), and hence cross-reactivity with the TSH receptor. Hyperthyroidism usually resolves as the GTD is successfully treated and correspondingly HCG levels normalise. Methods: This paper reviews cases of GTD treated over a 5-year period at one of the three UK centres and identifies the prevalence of Hyperthyroidism in this population. Four cases with clinical Hyperthyroidism are discussed. Results: On review of the 196 patients with gestational trophoblastic neoplasia treated with chemotherapy in Sheffield since 2005, 14 (7%) had biochemical Hyperthyroidism. Of these, four had evidence of clinical Hyperthyroidism. Conclusion: Concomitant biochemical thyroid disease in patients with GTD is relatively common, and measurement of thyroid function in patients with persistent GTD is, therefore, important. The development of Hyperthyroidism is largely influenced by the level of HCG and disease burden, and usually settles with treatment of the persistent GTD. However, rarely the thyroid stimulation can have potentially life-threatening consequences.

  • Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease
    British Journal of Cancer, 2011
    Co-Authors: L Walkington, J Everard, J Webster, B W Hancock, R E Coleman
    Abstract:

    Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Patients with persistent disease require treatment with chemotherapy. For the vast majority, prognosis is excellent. Occasionally, GTD is complicated by Hyperthyroidism, which may require treatment. This is thought to occur due to molecular mimicry between human chorionic gonadotrophin (HCG) and thyroid-stimulating hormone (TSH), and hence cross-reactivity with the TSH receptor. Hyperthyroidism usually resolves as the GTD is successfully treated and correspondingly HCG levels normalise. This paper reviews cases of GTD treated over a 5-year period at one of the three UK centres and identifies the prevalence of Hyperthyroidism in this population. Four cases with clinical Hyperthyroidism are discussed. On review of the 196 patients with gestational trophoblastic neoplasia treated with chemotherapy in Sheffield since 2005, 14 (7%) had biochemical Hyperthyroidism. Of these, four had evidence of clinical Hyperthyroidism. Concomitant biochemical thyroid disease in patients with GTD is relatively common, and measurement of thyroid function in patients with persistent GTD is, therefore, important. The development of Hyperthyroidism is largely influenced by the level of HCG and disease burden, and usually settles with treatment of the persistent GTD. However, rarely the thyroid stimulation can have potentially life-threatening consequences.

Nobuyuki Takasu - One of the best experts on this subject based on the ideXlab platform.