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Advances in Thyroid Diseases: Focus on Hypothyroidism and Hyperthyroidism

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 4057

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Special Issue Editor

Prof. Dr. Nanwei Tong

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Guest Editor

West China School of Medicine, West China Hospital of Sichuan University, Chengdu 332001, China
Interests: thyroid dysfunction; diabetes mellitus; adrenal disease

Special Issue Information

Dear Colleagues,

Guidelines for the management of thyroid dysfunction have been updated in recent years. However, despite the lack of strong evidence for their support, there remain a number of very pragmatic clinical issues regarding practices that are not recommended, such as dietary iodine intake for patients with Grave’s disease. We hope and anticipate this Special Issue will initiate further discussion on the following aspects: 1) the effect of different iodine nutritional status (according to WHO criteria) on the outcome of hypothyroidism or hyperthyroidism/thyrotoxicosis during the treatment course; 2) the effect of different treatment options on the outcome of hypothyroidism or hyperthyroidism/thyrotoxicosis; 3) the pathogenesis of thyroid disease.

Prof. Dr. Nanwei Tong
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

thyrotoxicosis
hyperthyroidism
hypothyroidism
thyroid diseases
management
pathogenesis
iodine

Published Papers (3 papers)

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Research

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10 pages, 277 KiB

Open AccessArticle

Therapeutic Management and Long-Term Outcome of Hyperthyroidism in Patients with Antithyroid-Induced Agranulocytosis: A Retrospective, Multicenter Study

by Carlos García Gómez, Elena Navarro, Victoria Alcázar, Antonio López-Guzmán, Francisco Arrieta, Emma Anda, Betina Biagetti, Fernando Guerrero-Pérez, Carles Villabona, Andrés Ruiz de Assín Valverde, Cristina Lamas, Beatriz Lecumberri, José Antonio Rosado Sierra, Julia Sastre, Juan José Díez and Pedro Iglesias

J. Clin. Med. 2023, 12(20), 6556; https://doi.org/10.3390/jcm12206556 - 16 Oct 2023

Cited by 1 | Viewed by 1308

Abstract

Background: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. Methodology: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves’ disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. Results: The median (IQR) time to development of agranulocytosis was 6.0 (4.0–11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves’ disease), and two patients died of septic shock secondary to AIA. Conclusions: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously. Full article

(This article belongs to the Special Issue Advances in Thyroid Diseases: Focus on Hypothyroidism and Hyperthyroidism)

9 pages, 425 KiB

Open AccessArticle

Unexplained Hyperthyrotropinemia: A Biochemical and Clinical Challenge

by Laura Croce, Spyridon Chytiris, Francesca Coperchini, Giovanni Ferraro, Linda Minelli, Antonella Navarra, Flavia Magri, Luca Chiovato, Pierpaolo Trimboli and Mario Rotondi

J. Clin. Med. 2023, 12(8), 2934; https://doi.org/10.3390/jcm12082934 - 18 Apr 2023

Cited by 3 | Viewed by 1267

Abstract

Background: A raised serum TSH in the absence of a clear etiology, or “unexplained hyperthyrotropinemia” (UH), can be challenging for clinicians. The aim of the present study was to evaluate potential strategies aimed at a clinical and biochemical characterization of UH patients. Methods: We compared 36 patients with UH with a control group of 14 patients with chronic autoimmune thyroiditis (CAT) and subclinical hypothyroidism. The two groups were compared in terms of the following: (i) the rate of normalization of TSH after repeating with another assay; (ii) the rate of normalization of TSH over time with the same assay; (iii) the reduction in TSH after precipitation with polyethilenglycole (PEG); and (iv) free thyroxine (FT4) levels. Results: Similar TSH levels were observed in UH [5.65 (5.21–6.37)] and CAT [5.62 (5.17–8.50)] (p = 0.489). TSH measurement with another assay method showed a normal TSH value in 41.9% of UH vs. 46.1% of CAT patients (p = 0.797). After repeating the TSH measurement in time with the same assay method, an increased TSH value was confirmed in all cases, in both groups (0% in the UH group vs. 0% in the CAT group, p = 1.000). TSH recovery after PEG precipitation was similar in the two groups (% precipitable post-PEG: 68.75 ± 3.14 in UH vs. 68.67 ± 7.18 in CAT, p = 0.960). FT4 levels were similar in the two groups (FT4 1.02 ± 0.20 ng/dl in UH vs. 1.00 ± 0.20 ng/dl in CAT, p = 0.789). Conclusions: The results do not support the concept that laboratory interferences are more frequent in UH patients, suggesting that patients with UH should be managed in the same way as patients with CAT until proven otherwise. Full article

(This article belongs to the Special Issue Advances in Thyroid Diseases: Focus on Hypothyroidism and Hyperthyroidism)

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Other

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10 pages, 1094 KiB

Open AccessCase Report

The Utility of Intravenous Methylprednisolone as an Adjunct Treatment for Drug-Resistant Amiodarone-Induced Thyrotoxicosis

by Krzysztof Cezary Lewandowski, Joanna Kawalec, Michał Kusiński, Katarzyna Dąbrowska, Aleksandra Ewa Matusiak, Iga Dudek and Andrzej Lewiński

J. Clin. Med. 2024, 13(2), 324; https://doi.org/10.3390/jcm13020324 - 6 Jan 2024

Cited by 1 | Viewed by 836

Abstract

Background: Amiodarone-induced thyrotoxicosis (AIT) may pose treatment challenges. We present a series of patients in which we achieved the normalisation of free T3 (FT3) using intravenous methylprednisolone (ivMP) in AIT refractory to thiamazole and oral prednisone. Namely, in three males (aged 56, 50 and 64, all with a history of AF and/or a low ejection fraction), an addition of ivMP resulted in the normalisation of FT3, which allowed successful thyroidectomy. In another case of a 65-year-old man, we initially succeeded in the normalisation of FT3 using ivMP from FT4 > 7.77 ng/dL (0.93–1.7) to 2.41 ng/dL and in that of FT3 from 14.95 pg/mL (2–4.4) to 2.05 pg/mL), but four weeks after stopping ivMP, despite the continuation of thiamazole and prednisone, there was rebound thyrotoxicosis: FT4 > 7.77 ng/dL and FT3—5.46 pg/mL. Intravenous MP was restated leading to a decline in FT4 to 2.51 ng/dL and in FT3 to 1.92 pg/mL, thus allowing a successful thyroidectomy. Finally, in a 78-year-old man with AF, goitre, and AIT resistant to thiamazole, prednisone and lithium carbonate, we obtained a reduction in FT4 to 1.51 ng/dL and in FT3 to 3.17 pg/mL after seven pulses of ivMP. Oral prednisone was gradually reduced and successfully stopped about six months later. He remained on low-dose thiamazole (5 mg od). Conclusions: Pulse ivMP in addition to oral steroids may be a useful adjunct therapy either for the preparation of a thyroidectomy or as a treatment modality in drug-resistant AIT. Though a total cure is possible, there is a danger of a rebound worsening of thyrotoxicosis after premature discontinuation of ivMP. Full article

(This article belongs to the Special Issue Advances in Thyroid Diseases: Focus on Hypothyroidism and Hyperthyroidism)

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