Endocrine Practice最新文献

Objective: Obesity and thyroid dysfunction are among the most significant challenges in endocrinology, frequently overlapping to create complexities in weight management. Even after achieving euthyroidism, weight variations persist, significantly affecting patients' quality of life. This review explores the mechanisms linking hypothyroidism and hyperthyroidism to weight fluctuations, emphasizing their impact on basal metabolic rate, appetite regulation, glucose and lipid metabolism, and thermogenesis.

Methods: We conducted a comprehensive review using PubMed and Google Scholar, applying the search criteria: (obesity OR overweight) AND (Hashimoto's thyroiditis OR hyperthyroidism OR hypothyroidism OR Thyroid Cancer). From this search, we reviewed 500 publications and finally included 71 publications, focusing on broad clinical questions regarding the role of thyroid hormones in weight regulation and metabolism, the impact of thyroid disorders and their treatments on obesity, and approaches for managing obesity in the context of thyroid dysfunction.

Results: In hypothyroidism, the impact of levothyroxine therapy on weight changes is discussed, along with the potential role of T3 supplementation. For hyperthyroid patients, the effects of antithyroid medications, radioactive iodine therapy, and thyroidectomy on weight regulation are explored. Pharmacological and nonpharmacological strategies for managing obesity in thyroid disorders are reviewed. Lifestyle interventions and pharmacotherapies are evaluated for their efficacy and potential effects on thyroid function. Lastly, the implications of bariatric surgery are explored, including its effects on thyroid function, medication absorption, and postsurgical management of thyroid disorders.

Conclusion: This review underscores the importance of an integrated, multidisciplinary approach to managing obesity in the context of thyroid dysfunction to optimize patient outcomes.

Objectives: Thyroid eye disease (TED) seriously affects patients' quality of life (QoL), even if the disease is stable and nonactive. Data on clinical factors negatively influencing the QoL of patients with TED and long-term outcomes are limited. This study aims to evaluate the lasting impact of TED on QoL, focusing on the effects of previous TED treatments and identifying factors influencing long-term outcomes.

Methods: A retrospective cohort study included 151 patients treated for active, moderate-to-severe and severe TED, with a mean follow-up of 8 years.

Results: Higher clinical activity scores at diagnosis correlated with lower QoL scores. Thyroidectomy before immunosuppressive treatment was associated with lower QoL and an increased likelihood of orbital decompression. Any disease progression necessitating second-line treatments also negatively affected QoL. A decrease in thyrotropin receptor antibodies during active treatment and early treatment initiation positively affected visual functioning. Time-dependent regression analysis demonstrated no significant trend in QoL changes over time.

Conclusion: Our data reveal that disease severity, the timing of interventions and disease progression contribute to less favorable long-term QoL outcomes, extending years beyond active treatment. Early and accurate diagnosis and appropriate treatment can minimize poor long-term QoL in patients with TED.

Objective: Central hypothyroidism is a rare disorder resulting from impaired thyroid hormone production due to deficiencies in TSH secretion from the pituitary or TRH secretion from the hypothalamus. This review aims to summarize recent advances in the etiology, diagnosis, and treatment of central hypothyroidism, with an emphasis on diagnostic and therapeutic challenges.

Methods: A comprehensive review of the literature was conducted, focusing on genetic and acquired causes, particularly those related to hypothalamic-pituitary tumors and the effects of surgical and radiotherapeutic interventions. Diagnostic approaches and treatment strategies, including levothyroxine therapy and monitoring, are analyzed.

Results: Early diagnosis requires simultaneous measurement of free T4 and TSH to prevent neurological sequelae, especially in congenital cases. Central hypothyroidism is associated with risks such as growth and developmental impairment, as well as metabolic and cardiovascular disturbances. Levothyroxine therapy is crucial for correcting hormonal deficits and improving patient outcomes; however, careful dosing is necessary to avoid potential complications, particularly in vulnerable populations.

Conclusions: Personalized treatment and continuous monitoring are essential to optimize clinical outcomes and enhance the quality of life in affected individuals. A thorough understanding of central hypothyroidism's etiology and management is necessary to improve early detection and therapeutic strategies.

Objectives: The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing in women with polycystic ovary syndrome (PCOS). Epidemiologic literature regarding the risk factors for MASLD in PCOS women in East Asia is inconsistent. Studies of PCOS and MASLD in East Asia are restricted by limited data and various biases. Therefore, this meta-analysis was conducted.

Methods: This meta-analysis followed the MOOSE statement. Relevant studies published before July 13, 2023 were retrieved from the PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, Wan Fang, KISS, and Japan medical online databases. The related data were extracted, and the weighted mean difference, odds ratios and 95% confidence intervals were calculated.

Results: Twenty-four studies were included. Through univariate analysis, age, body mass index, waist-to-hip ratio (WHR), blood pressure, alanine transaminase, aspartate transaminase, fasting blood glucose, fasting insulin, homeostatic model assessment for insulin resistance (HOMA-IR), 2-hour postprandial blood glucose, 2 hour insulin, HBA1C, low-density lipoprotein cholesterol, triglyceride, total cholesterol, and testosterone were notably higher in PCOS women with MASLD, with high-density lipoprotein cholesterol markedly lower in PCOS women with MASLD. According to the pooled multivariate analysis, the WHR (P < .001), testosterone (P = .034), and HOMA-IR (P = .02) were substantially greater in PCOS women with MASLD.

Conclusion: MASLD is associated with obesity, IR, and hyperandrogenemia among PCOS women in East Asia. The abnormality of WHR, HOMA-IR, and testosterone suggested early screening of MASLD in this population.

Objective: Persons living with type 2 diabetes mellitus (T2DM) have a significantly greater risk of stroke (1.5 to 3 times higher than normoglycemic individuals). The traditional approach to primary and secondary stroke prevention has been control of risk factors. While this has resulted in prolongation of life in patients with diabetes, the risk for recurrent stroke in these patients still remains higher than in the normoglycemic population, and patients with T2DM post stroke have a poorer quality of life (increases in handicap and death).

Methods: Multiple publications on the pathophysiology which increases stroke in T2DM were reviewed as well as new publications looking at the effect of traditional and new risk factor modification on stroke are summarized.

Results: Traditional risk factor modification is refined with recommended levels of lipids and blood pressure and methods of anticoagulation. More recently, studies with antidiabetic drugs (glucagon-like peptide 1 RA and pioglitazone) have been shown to prevent both primary and secondary stroke in patients with diabetes.

Conclusions: Worldwide, stroke is the second leading cause of death and the third leading cause of disability. Both risk and the outcomes are greatly worsened by the presence of T2DM. Newer recommendations can improve these outcomes.