Thursday, 28 November 2013

Thyroid disease: Hypothyroidism – The Complications

Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones.
C.1. Complications
1. Coronary heart disease and mortality
In the study to assess the risks of coronary heart disease (CHD) and total mortality for adults with subclinical hypothyroidism of Individual data on 55,287 participants with 542,494 person-years of follow-up between 1972 and 2007 were supplied from 11 prospective cohorts in the United States, Europe, Australia, Brazil, and Japan. The risk of CHD events was examined in 25,977 participants from 7 cohorts with available data. showed that subclinical hypothyroidism is associated with an increased risk of CHD events and CHD mortality in those with higher TSH levels, particularly in those with a TSH concentration of 10 mIU/L or greater(19).
2. Recurrent pregnancy loss
Thyroid disturbances are common in women during their reproductive years. Thyroid dysfunction interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome, thus becoming relevant in the algorithm of reproductive dysfunction. According to the study by the MGM Medical College, pregnant women with subclinical hypothyroidism or thyroid antibodies have an increased risk of complications, especially pre-eclampsia, perinatal mortality, and miscarriage. Universal screening for thyroid hormone abnormalities is not routinely recommended at present, but thyroid function must be examined in female with fetal loss or menstrual disturbances. Practitioners providing health care for women should be alert to thyroid disorders as an underlying etiology for recurrent pregnancy loss(21).
3. Ovulatory dysfunction, adverse pregnancy, miscarriage rate, sperm motility, decrease fertility and increased genetic malformation rate
Subclinical hypothyroidism may be associated with ovulatory dysfunction and adverse pregnancy outcome. Thyroid autoimmunity increases the miscarriage rate, and thyroxine treatment does not seem to protect. Menstrual disturbances, frequent in thyrotoxicosis are restored following treatment. In males, thyrotoxicosis has a significant but reversible effect on sperm motility. Although radioactive Iodine (I) in ablation doses may transiently affect the gonads, it does not decrease fertility or increase genetic malformation rate in the offspring, according to the study by the Pedieos IVF Center, Cyprus(21).
Other study indicated that pregnant women with subclinical hypothyroidism or thyroid antibodies have an increased risk of complications, especially pre-eclampsia, perinatal mortality, and miscarriage(22)
4. Increased susceptibility to inflammatory diseases in the CNS of offspring
A deficiency in maternal thyroid hormones during gestation can influence the outcome of a CNS inflammatory disease, such as EAE, in their offspring. These data strongly support evaluating thyroid hormones in pregnant women and treating hypothyroidism during pregnancy to prevent increased susceptibility to inflammatory diseases in the CNS of offspring, according to the study by the Universidad Andres Bello, Ciencias Biologicas(23).
5. Auditory function
Although only a limited number of studies have directly investigated the relationship between iodine deficiency and auditory function, most studies point toward an association. However, evidence from good randomised controlled trials is lacking. Inclusion of auditory outcomes in iodine supplementation studies is therefore to be recommended, especially for trials in pregnancy. Hearing deficit is an invisible abnormality, but has major consequences for educational and social skills if not detected, according to the study by the Wageningen University, Wageningen(24).
6. Hearing loss
In the study to assess hearing and its determinants in a population-based registry of young adult patients with CH, showed that despite major improvements in prognosis, hearing loss remains a significant problem, particularly in patients with severe CH. Parents and primary care providers should be aware of this risk, as early diagnosis and intervention could improve the long-term prognosis of these patients(25).
7. Goiter
There is a report of IgG4 thyroiditis in a Graves’ disease patient with large goiter developing hypothyroidism, according to the study by the Kuma Hospital(25a)
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