Abstract Background Common autoimmune disorders tend to coexist in the same subjects and to cluster in families. Methods We performed a cross-sectional multicenter study of 3286 Caucasian subjects ...(2791 with Graves' disease; 495 with Hashimoto's thyroiditis) attending UK hospital thyroid clinics to quantify the prevalence of coexisting autoimmune disorders. All subjects completed a structured questionnaire seeking a personal and parental history of common autoimmune disorders, as well as a history of hyperthyroidism or hypothyroidism among parents. Results The frequency of another autoimmune disorder was 9.67% in Graves' disease and 14.3% in Hashimoto's thyroiditis index cases ( P =. 005). Rheumatoid arthritis was the most common coexisting autoimmune disorder (found in 3.15% of Graves' disease and 4.24% of Hashimoto's thyroiditis cases). Relative risks of almost all other autoimmune diseases in Graves' disease or Hashimoto's thyroiditis were significantly increased (>10 for pernicious anemia, systemic lupus erythematosus, Addison's disease, celiac disease, and vitiligo). There was relative “clustering” of Graves' disease in the index case with parental hyperthyroidism and of Hashimoto's thyroiditis in the index case with parental hypothyroidism. Relative risks for most other coexisting autoimmune disorders were markedly increased among parents of index cases. Conclusion This is one of the largest studies to date to quantify the risk of diagnosis of coexisting autoimmune diseases in more than 3000 index cases with well-characterized Graves' disease or Hashimoto's thyroiditis. These risks highlight the importance of screening for other autoimmune diagnoses if subjects with autoimmune thyroid disease present with new or nonspecific symptoms.
Summary Background Iodine deficiency is the most common cause of preventable mental impairment worldwide. It is defined by WHO as mild if the population median urinary iodine excretion is 50–99 μg/L, ...moderate if 20–49 μg/L, and severe if less than 20 μg/L. No contemporary data are available for the UK, which has no programme of food or salt iodination. We aimed to assess the current iodine status of the UK population. Methods In this cross-sectional survey, we systematically assessed iodine status in schoolgirls aged 14–15 years attending secondary school in nine UK centres. Urinary iodine concentrations and tap water iodine concentrations were measured in June–July, 2009, and November–December, 2009. Ethnic origin, postcode, and a validated diet questionnaire assessing sources of iodine were recorded. Findings 810 participants provided 737 urine samples. Data for dietary habits and iodine status were available for 664 participants. Median urinary iodine excretion was 80·1 μg/L (IQR 56·9–109·0). Urinary iodine measurements indicative of mild iodine deficiency were present in 51% (n=379) of participants, moderate deficiency in 16% (n=120), and severe deficiency in 1% (n=8). Prevalence of iodine deficiency was highest in Belfast (85%, n=135). Tap water iodine concentrations were low or undetectable and were not positively associated with urinary iodine concentrations. Multivariable general linear model analysis confirmed independent associations between low urinary iodine excretion and sampling in summer (p<0·0001), UK geographical location (p<0·0001), low intake of milk (p=0·03), and high intake of eggs (p=0·02). Interpretation Our findings suggest that the UK is iodine deficient. Since developing fetuses are the most susceptible to adverse effects of iodine deficiency and even mild perturbations of maternal and fetal thyroid function have an effect on neurodevelopment, these findings are of potential major public health importance. This study has drawn attention to an urgent need for a comprehensive investigation of UK iodine status and implementation of evidence-based recommendations for iodine supplementation. Funding Clinical Endocrinology Trust.
Placental transport of thyroid hormone James, Sally R., MBiochem; Franklyn, Jayne A., MD, PhD, FRCP, FMedSci; Kilby, Mark D., MBBS, MD, MRCOG
Best Practice & Research Clinical Endocrinology & Metabolism,
06/2007, Letnik:
21, Številka:
2
Journal Article
Recenzirano
Thyroid hormones are vital for fetal development and can act directly on placental tissues to modify their metabolism, differentiation and development. There is evidence that maternal thyroid ...hormones can cross the human placenta and act to modulate fetal development before the onset of the fetus's own thyroid hormone production. Plasma membrane transport of thyroid hormones has now been shown to require specific transporter proteins. Several proteins have recently been identified as specific thyroid hormone transporters. However, as yet few data are available to define the functionally important transporter proteins in the human placenta. To date, members of the organic anion-transporting polypeptide, L-type amino acid, and of the monocarboxylate transporter families, have been identified as thyroid hormone transporters that are active in a variety of placental cell types. However, further research is necessary to determine the role of these and other proteins in placental transport of thyroid hormone, and to investigate how modulations of their function could affect fetal pathologies such as intrauterine growth restriction.
Cardiovascular Manifestations of Hyperthyroidism Before and After Antithyroid Therapy: A Matched Case-Control Study Faizel Osman, Jayne A. Franklyn, Roger L. Holder, Michael C. Sheppard, Michael D. ...Gammage Overt hyperthyroidism is associated with well-recognized cardiovascular effects believed to be reversed by antithyroid therapy; however, increasing data suggest significant long-term cardiovascular mortality. A total of 393 patients with overt hyperthyroidism were compared with 393 age- and gender-matched euthyroid control subjects. Cardiovascular symptoms and signs, abnormal blood pressure measurements, and rhythm disturbances were more prevalent in patients at presentation, during antithyroid therapy (when patients showed the biochemistry of subclinical hyperthyroidism), and after restoration of biochemical euthyroidism in hyperthyroid patients compared with control subjects.
Reply Gammage, Michael D., MD, FRCP, FESC; Osman, Faizel, MD, MRCP; Sheppard, Michael C., PhD, FRCP ...
Journal of the American College of Cardiology,
2007, Letnik:
49, Številka:
22
Journal Article
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