갑상샘 기능 이상에 따른 우울증 환자의 임상적 특징에 대한 후향적 연구

김재민,이은,윤혜진,송윤주 대한우울조울병학회 2011 우울조울병 Vol.9 No.3

Objectives : Many clinicians emphasized the importance of thyroid function test in all patients with depressive symptoms. But, there’s no data of thyroid dysfunction in depressed patients. The authors studied the prevalence of thyroid dysfunction in depressive patients. Next we compared the clinical characteristics between depressive patients with thyroid dysfunction and the patients with normal thyroid function. Method : We reviewed medical records of the inpatients and the outpatients who were diagnosed as depression between October 2009 and October 2010. Review of demographic factor, medico-surgical or psychiatric history, family history of thyroid disease or psychiatric disorder, medications, somatic symptoms and the values of thyroid function test were performed. Results : Twenty nine persons in total 137 depressed patients showed abnormal thyroid function ; 7 showed hyperthyroidism and 20 showed hypothyroidism. Comparing the patients with normal thyroid function, 20 patients with hypothyroidism showed higher female ratio, older age, and more psychiatric past history and more medical history other than thyroid disease. Conclusion : The prevalence of abnormal thyroid function in depressive patients was 20%, which is higher than those in general populations. Our result may help clinicians consider clinical characteristics of depression with hypothyroidism. (J of Kor Soc for Dep and Bip Disorders 2011;9:171-176)

Genome-Wide Association Studies of Autoimmune Thyroid Diseases, Thyroid Function, and Thyroid Cancer

황보율,박영주 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.2

Thyroid diseases, including autoimmune thyroid diseases and thyroid cancer, are known to have high heritability. Family and twin studies have indicated that genetics plays a major role in the development of thyroid diseases. Thyroid function, represented by thyroid stimulating hormone (TSH) and free thyroxine (T4), is also known to be partly genetically determined. Before the era of genome-wide association studies (GWAS), the ability to identify genes responsible for susceptibility to thyroid disease was limited. Over the past decade, GWAS have been used to identify genes involved in many complex diseases, including various phenotypes of the thyroid gland. In GWAS of autoimmune thyroid diseases, many susceptibility loci associated with autoimmunity (human leukocyte antigen [HLA], protein tyrosine phosphatase, non-receptor type 22 [PTPN22], cytotoxic T-lymphocyte associated protein 4 [CTLA4], and interleukin 2 receptor subunit alpha [IL2RA]) or thyroid-specific genes (thyroid stimulating hormone receptor [TSHR] and forkhead box E1 [FOXE1]) have been identified. Regarding thyroid function, many susceptibility loci for levels of TSH and free T4 have been identified through genome-wide analyses. In GWAS of differentiated thyroid cancer, associations at FOXE1, MAP3K12 binding inhibitory protein 1 (MBIP)-NK2 homeobox 1 (NKX2-1), disrupted in renal carcinoma 3 (DIRC3), neuregulin 1 (NRG1), and pecanex-like 2 (PCNXL2) have been commonly identified in people of European and Korean ancestry, and many other susceptibility loci have been found in specific populations. Through GWAS of various thyroid-related phenotypes, many susceptibility loci have been found, providing insights into the pathogenesis of thyroid diseases and disease co-clustering within families and individuals

A Study of Thyroid Function in Partial Thyroxine-Binding Globulin Deficiency

Jae Won Lee,Jang Yong Jin,Jungho Lee,Dong Hwan Lee,Yong Hee Hong 순천향대학교 순천향의학연구소 2015 Journal of Soonchunhyang Medical Science Vol.21 No.2

Objective: It is generally thought that thyroxine-binding globulin (TBG)-deficient individuals are euthyroid and do not require treatment. However, there have been case reports of TBG deficiency combined with hypothyroidism. The purpose of this study was to investigate the relationship between TBG deficiency and thyroid function. Methods: We reviewed the medical records of 32 patients diagnosed with TBG deficiency between 1997 and 2008 in Soonchunhyang University Seoul Hospital. All were partial TBG deficiency. Eighteen patients had combined hypothyroidism, and 14 patients had normal thyroid function. We compared the TBG, thyroid-stimulating hormone, free thyroxine, and total triiodothyronine levels between these 2 groups. Eighteen patients with TBG deficiency with hypothyroidism started thyroxine medication and continued for 2-3 years. After, they were followed up with thyroid function tests after discontinuing medication for 4 weeks at 2-3 years of age. Results: The TBG level in TBG deficiency with hypothyroidism patients was significantly lower than that in TBG deficiency with normal thyroid function (4.43±2.22 mg/L vs. 6.23±1.81 mg/L; P=0.02). The percent TBG compared with normal mean TBG level according to age in the hypothyroidism patients was also significantly lower than that of patients with normal thyroid function (13.42%±6.92% vs. 19.08%±4.87%; P=0.014). Sixteen of 18 patients diagnosed with TBG deficiency with hypothyroidism showed persistent hypothyroidism at 2-3 years of age. Conclusion: We conclude that TBG-deficient patients should be observed closely and undergo thyroid function testing in order not to miss hypothyroidism. More investigations of TBG deficiency and thyroid function are needed in the future.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

David Tak Wai Lui,Chi-Ho Lee,Wing-Sun Chow,Alan Chun Hong Lee,Anthony Raymond Tam,Carol Ho Yi Fong,Chun Yiu Law,Eunice Ka Hong Leung,Kelvin Kai Wang To,Kathryn Choon Beng Tan,Yu-Cho Woo,Ching Wan Lam 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.3

Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Association between Iodine Intake, Thyroid Function, and Papillary Thyroid Cancer: A Case-Control Study

김경식,조선욱,박영주,이규은,이동욱,박수경 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4

Background: This study aimed to assess the effects of iodine intake, thyroid function, and their combined effect on the risk of papillary thyroid cancer (PTC) and papillary thyroid microcarcinoma (PTMC). Methods: A case-control study was conducted including 500 community-based controls who had undergone a health check-up, and446 overall PTC cases (209 PTC and 237 PTMC) from the Thyroid Cancer Longitudinal Study. Urinary iodine concentration (UIC),was used as an indicator of iodine intake, and serum for thyroid function. The risk of PTC and PTMC was estimated using unconditional logistic regression. Results: Excessive iodine intake (UIC ≥220 µg/gCr) was associated with both PTC (odds ratio [OR], 18.13 95% confidence interval [CI], 8.87 to 37.04) and PTMC (OR, 8.02; 95% CI, 4.64 to 13.87), compared to adequate iodine intake (UIC, 85 to 219 µg/gCr). Free thyroxine (T4) levels ≥1.25 ng/dL were associated with PTC (OR, 1.97; 95% CI, 1.36 to 2.87) and PTMC (OR, 2.98; 95% CI,2.01 to 4.41), compared to free T4 levels of 0.7 to 1.24 ng/dL. Individuals with excessive iodine intake and high free T4 levels had agreatly increased OR of PTC (OR, 43.48; 95% CI, 12.63 to 149.62), and PTMC (OR, 26.96; 95% CI, 10.26 to 70.89), compared toindividuals with adequate iodine intake and low free T4 levels. Conclusion: Excessive iodine intake using creatinine-adjusted UIC and high free T4 levels may have a synergistic effect on PTCand PTMC. Considering both iodine intake and thyroid function is important to assess PTC and PTMC risk.

Thyroid dysfunction in very low birth weight preterm infants

Lee, Ji Hoon,Kim, Sung Woo,Jeon, Ga Won,Sin, Jong Beom The Korean Pediatric Society 2015 Clinical and Experimental Pediatrics (CEP) Vol.58 No.6

Purpose: Thyroid dysfunction is common in preterm infants. Congenital hypothyroidism causes neurodevelopmental impairment, which is preventable if properly treated. This study was conducted to describe the characteristics of thyroid dysfunction in very low birth weight infants (VLBWIs), evaluate risk factors of hypothyroidism, and suggest the reassessment of thyroid function with an initially normal thyroid-stimulating hormone (TSH) as part of a newborn screening test. Methods: VLBWIs (January 2010 to December 2012) were divided into two groups according to dysfunction-specific thyroid hormone replacement therapy, and associated factors were evaluated. Results: Of VLBWIs, 246 survivors were enrolled. Only 12.2% (30/246) of enrolled subjects exhibited thyroid dysfunction requiring thyroid hormone replacement. Moreover, only one out of 30 subjects who required thyroid hormone treatment had abnormal thyroid function in the newborn screening test with measured TSH. Most of the subjects in the treatment group (22/30) exhibited delayed TSH elevation. Gestational age, Apgar score, antenatal steroids therapy, respiratory distress syndrome, patent ductus arteriosus, sepsis, intraventricular hemorrhage, postnatal steroids therapy, and duration of mechanical ventilation did not differ between the two groups. Birth weight was smaller and infants with small for gestational age were more frequent in the treatment group. Conclusion: Physicians should not rule out suggested hypothyroidism, even when thyroid function of a newborn screening test is normal. We suggest retesting TSH and free thyroxine in high risk preterm infants with an initially normal TSH level using a newborn screening test.

Thyroid dysfunction in very low birth weight preterm infants

이지훈,김성우,전가원,신종범 대한소아청소년과학회 2015 Clinical and Experimental Pediatrics (CEP) Vol.58 No.6

Purpose: Thyroid dysfunction is common in preterm infants. Congenital hypothyroidism causes neurodevelopmental impairment, which is preventable if properly treated. This study was conducted to describe the characteristics of thyroid dysfunction in very low birth weight infants (VLBWIs), evaluate risk factors of hypothyroidism, and suggest the reassessment of thyroid function with an initially normal thyroid-stimulating hormone (TSH) as part of a newborn screening test. Methods: VLBWIs (January 2010 to December 2012) were divided into two groups according to dysfunction-specific thyroid hormone replacement therapy, and associated factors were evaluated. Results: Of VLBWIs, 246 survivors were enrolled. Only 12.2% (30/246) of enrolled subjects exhibited thyroid dysfunction requiring thyroid hormone replacement. Moreover, only one out of 30 subjects who required thyroid hormone treatment had abnormal thyroid function in the newborn screening test with measured TSH. Most of the subjects in the treatment group (22/30) exhibited delayed TSH elevation. Gestational age, Apgar score, antenatal steroids therapy, respiratory distress syndrome, patent ductus arteriosus, sepsis, intraventricular hemorrhage, postnatal steroids therapy, and duration of mechanical ventilation did not differ between the two groups. Birth weight was smaller and infants with small for gestational age were more frequent in the treatment group. Conclusion: Physicians should not rule out suggested hypothyroidism, even when thyroid function of a newborn screening test is normal. We suggest retesting TSH and free thyroxine in high risk preterm infants with an initially normal TSH level using a newborn screening test.

Comparison of the Influence on the Liver Function Between Thyroid Hormone Withdrawal and rh-TSH Before High-Dose Radioiodine Therapy in Patients with Well-Differentiated Thyroid Cancer

Han, Yeon-Hee,Lim, Seok-Tae,Yun, Kuk-No,Yim, Sung-Kyun,Kim, Dong-Wook,Jeong, Hwan-Jeong,Sohn, Myung-Hee The Korea Society of Nuclear Medicine 2012 핵의학 분자영상 Vol.46 No.2

Purpose : An elevated thyroid stimulating hormone level (TSH) is essential to stimulate the uptake of radioiodine into thyroid remnants andmetastases of thyroid cancer when a patient undergoes high-dose radioiodine therapy. Nowadays, recombinant human thyroid stimulating hormone (rh-TSH) is increasingly used instead of the classic method of thyroid hormone withdrawal (THW). However, beyond the therapeutic effects, clinical differences between the two methods have not yet been clearly demonstrated. The aim of this work was to investigate the effects of the two methods, especially on liver function. Methods : We identified 143 evaluable patientswho were further divided into two groups: THW and rh-TSH. We first reviewed the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, which were measured during the admission period for total thyroidectomy. We called these liver enzyme levels "base AST" and "base ALT." We also assessed other chemistry profiles, including AST, ALT, total cholesterol, LDL cholesterol, alkaline phosphatase (ALP), total bilirubin (TB), and triglyceride (TG), which were measured on admission day for high-dose radioiodine therapy. We called these liver enzyme levels "follow-up AST" and "follow-up ALT." We compared the changes in base and follow-up liver enzyme levels and the other chemistry profiles between the two groups. Results : The base AST and base ALT levels of the two groups were within normal range, and there was no significant difference between the two groups. In contrast to these base liver enzyme levels, follow-up liver enzyme levels between the two groups showed significant differences. Patients in the THW group had higher follow-up AST and ALT levels than did the rh-TSH group. Patients in the THW group also had higher levels of total cholesterol and LDL cholesterol than did the patients in the rh-TSH group. However there were no statistically significant differences in ALP, total bilirubin, and triglyceride levels between the two groups. Conclusions : In this retrospective analysis of liver function, the use of rh-TSH for high-dose radioiodine therapy had less of an effect on liver function and cholesterol levels than dose thyroid hormone withdrawal. This suggests that rh-TSH can be used effectively and safely especially for patients with metabolic syndrome.

항경련제가 갑상선기능에 미치는 영향

서은숙,이동환,문경상 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Object: Many studies on the effect of long-term treatment with anticonvulsant on thyroid function in children have been reported. Because the mechanism and metabolism of each drugs are different, the effect of anticonvulsants on thyroid function is controversial. And it has been reported that competitive binding with serum protein, increased intrahepatic excretion and more recently effects on hypothalamus and pituitary gland make changes in thyroid hormones. Therefore, we checked T₃, T₄, TSH levels of the patients who have been taking anticonvulsants for more than 1 years, in order to the influence of carbamazepine and valproic acid on thyroid function. Method: 38 patients (male 18, female 18) who have been diagnosed as epilepsy during the period of Jan 1996 to Dec 1996 at SoonChunHyang University Hospital, and being treated with anticonvulsant, the serum levels of triiodothyronine(T₃) thyroxine(T₄) and TSH were measured were measured by RIA. Result: Of these 38 patients, 18 were males and 18 were females. The mean age of the patients was 9.46 ±3.86(2 to 17 years old) years old. In 10 cases were treated with valproic acid, in 7 cases received carbamazepine and in 11 cases were treated with combined therapy. In valproic acid treated group, T₃, T₄, TSH levels were 145.05±25.34ng/dl, 8.86±2.17㎍/dl, 2.73±0.86 μU/ml respectively. In Carbamazepine treated group. T₃, T₄, TSH levels were group, T₃, T₄, TSH levels were 162.06 ±26.78ng/dl, 9.66 ±4.18㎍/dl 2.01 ±0.78 μU/ml respectively. Although the levels of T₃, T₄, TSH were within normal range, they were relatively decreased compared to the control group. The carbamazepine treated group was revield lower T₃, T₄ levels compared to those treated with valproic acid, but we couldn't find out statistical significance. Conclusion: In our study we found out long-term treatment with anticonvulsants including carbamzepine and valproic acid had effects on thyroid function and follow-up test with larger group of patients should be proceeded.

한국 성인 남성에서 갑상선 기능과 대사증후군의 관련성: 제6기국민건강영양조사를 바탕으로

박수경,김도훈,박주현,김이연,최문영,김현정,설다은,김현진,이강욱,남명지,한경도,김다혜 대한가정의학회 2019 Korean Journal of Family Practice Vol.9 No.2

연구배경: 갑상선 호르몬은 에너지 대사 및 지질 대사 등에 관여하는 중요한 인자 중 하나로 갑상선 기능과 대사 증후군과의 연관성을밝히기 위한 많은 연구가 진행되어 왔다. 본 연구에서는 정상 갑상선기능을 가지는 한국 성인 남성을 대상으로 갑상선 호르몬과 대사 증후군 간의 관련성을 밝히고자 하였다. 방법: 본 연구는 제6기 국민건강영양조사 참여자 중 만 19세 이상의성인 남성이며 갑상선 질환의 기왕력이 없고 갑상선 호르몬 농도가정상인 2,285명을 연구 대상으로 선정하여 단면 연구를 시행하였다. 유리 티록신 및 갑상선 자극 호르몬을 농도에 따라 4분위수로 나누어 대사 증후군 및 대사 증후군의 진단 구성 항목에 대한 유병률 및교차비를 구하였다. 결과: 유리 티록신 농도가 가장 낮은 1분위수에서 가장 높은 4분위수로 갈수록 대사 증후군의 유병률이 감소하였으며 이러한 양상은대사 증후군의 각 진단 구성 항목에서도 동일하게 확인되었다. 고중성지방혈증은 유리 티록신 1분위수에 비해 4분위수의 교차비가 유의하게 낮은 것으로 나타났다. 결론: 정상 갑상선 기능을 가지는 경우라도 유리 티록신 농도는 대사 증후군과 밀접한 관련을 보였다. 유리 티록신이 정상 범위에 있더라도 농도가 낮은 경우 대사증후군 및 심혈관 질환 위험성 평가에대한 재고가 필요하다. Background: Thyroid hormones are one of the key factors involved in energy, lipid, and glucose metabolisms. Many studies have been conducted to establish the association between thyroid function and metabolic syndrome. This study aimed to identify the association between thyroid hormone and metabolic syndrome in euthyroid Korean male adults. Methods: Using data from the sixth Korea National Health and Nutrition Examination Survey from 2013 to 2015, this cross-sectional study of 2,285 male adults was conducted. Subjects who had thyroid diseases and were not euthyroid were excluded. The included subjects were divided into four groups according to free thyroxine (fT4) and thyroid-stimulating hormone levels. We analyzed the prevalence and adjusted odds ratio of metabolic syndrome according to thyroid hormone levels. Results: The prevalence of metabolic syndrome and its components decreased constantly from the lowest fT4 quartile to the highest fT4 quartile. Compared with that in the lowest fT4 quartile, the adjusted odds ratio of hypertriglyceridemia in the highest fT4 quartile was 0.651. Conclusion: In euthyroid subjects, fT4 levels are associated with metabolic syndrome and all its components.