Endocrinology and Metabolism

Original Articles

Thyroid
Prevalence of Subclinical Hypothyroidism in a Non-Diabetic Young Female Population and Its Impact on Diabetes and Cardiometabolic Risk: Nawoda Hewage, Udaya Wijesekara, Rasika Perera; Endocrinol Metab. 2024;39(6):864-876. Published online November 5, 2024; DOI: https://doi.org/10.3803/EnM.2024.2015

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Background
We evaluated the influence of subclinical hypothyroidism (SCH) on insulin resistance (IR), cardiometabolic risk, and obesity in childbearing-age women without diabetes.
Methods
This cross-sectional investigation included 282 women, aged 18 to 35 years, from rural and suburban Sri Lanka. Anthropometric and biochemical parameters, including IR and lipid/thyroid profiles, were recorded. Data were compared between SCH and euthyroidism (EU) for controls (normal weight) and cases (overweight/obese).
Results
The overall rates of SCH, EU, IR, and metabolic syndrome (MetS) were 40.42%, 59.57%, 73.40%, and 24.46%, respectively. Both controls and cases included individuals with SCH; overall, 168 participants (59.57%) had EU, while 114 (40.42%) exhibited SCH. IR was significantly associated with SCH in both weight groups (P<0.05). Among those with SCH, the odds ratios (ORs) for IR were >2 (95% confidence interval [CI], 0.45 to 3.87) in controls and >6 (95% CI, 3.52 to 8.41) in cases. Similarly, the ORs for MetS were >1 (95% CI, 0.38 to 4.16) in controls and >11 (95% CI, 8.73 to 15.01) in cases. Dyslipidemia and hypertriglyceridemia were significantly more prevalent in the SCH group (P<0.05). Women with SCH exhibited higher mean values for all obesity indices compared to their EU counterparts, surpassing normal thresholds (P<0.05). Among obesity measures, visceral adiposity index (VAI) demonstrated the highest area under the curve and sensitivity for assessing SCH and cardiovascular disease (CVD) risk.
Conclusion
SCH must be identified and managed in young women to help prevent diabetes and cardiometabolic disorders. VAI may aid in precisely detecting SCH and CVD.

Citations

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Increased Serum Lipopolysaccharide Levels are Related to a Higher Prevalent Risk of Subclinical Hypothyroidism
Xuan An, Xiaoyi Wang, Jin Zhang, Mingtong Xu, Muchao Wu, Suraiya Saleem
International Journal of Endocrinology.2025;[Epub] CrossRef
Incidence of Subclinical Hypothyroidism in Obese Adults and Its Metabolic Implications: A Prospective Cohort Study
Umer Jameel, Obaidullah Durrani, Ahmad Munib, Amanullah Khan
Cureus.2025;[Epub] CrossRef

Thyroid Big Data Articles (National Health Insurance Service Database)
Rising Incidence and Comorbidities of Endogenous Hypothyroidism in Republic of Korea from 2004 to 2018: A Nationwide Population Study: Chae Won Chung, Hwa Young Ahn, Sun Wook Cho, Ka Hee Yi; Endocrinol Metab. 2024;39(6):891-898. Published online September 23, 2024; DOI: https://doi.org/10.3803/EnM.2024.1996

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Background
Hypothyroidism, a prevalent endocrine disorder, results from insufficient thyroid hormone production or release, affecting metabolism. However, disparities in comorbidities and treatment trajectories may exist between endogenous and exogenous hypothyroidism.
Methods
Data from the Korean National Health Insurance Service from 2004 to 2018. Endogenous hypothyroidism was defined as cases with two or more diagnostic codes for hypothyroidism coupled with a history of thyroid hormone intake exceeding 60 days. To eliminate iatrogenic hypothyroidism, individuals with diagnosis codes for thyroid cancer, treatment codes for thyroid surgery, or radiotherapy were excluded. Hypothyroidism-related comorbidities were defined as new occurrences of the corresponding diagnosis code after the diagnosis of hypothyroidism during the entire study period.
Results
The age-standardized incidence of endogenous hypothyroidism among men was 0.2 per 1,000 person-years in 2004, increasing to 0.8 in 2018. Among women, the incidence increased from 1.6 per 1,000 person-years in 2004 to 3.7 in 2018. When comparing age groups of 20s–50s and 60s–90s, both sexes in the 60s–90s demonstrated a more rapid increase in incidence than those in the 20s–50s age range. Patients with endogenous hypothyroidism demonstrated a higher incidence of mood disorders across all age groups and cerebrovascular disease in individuals ≥60 years old, regardless of sex.
Conclusion
In Republic of Korea, endogenous hypothyroidism incidence has been increased in recent years. The incidence of endogenous hypothyroidism is increasing more rapidly in men than in women, especially in the elderly. Patients with endogenous hypothyroidism seem to have a heightened risk for cerebrovascular disease and mood disorders.

Citations

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Comorbidities of hypothyroidism
Gabriela Brenta, Ulrike Gottwald-Hostalek
Current Medical Research and Opinion.2025; 41(3): 421. CrossRef

Review Articles

Thyroid
Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines: Eu Jeong Ku, Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2023;38(4):381-391. Published online August 8, 2023; DOI: https://doi.org/10.3803/EnM.2023.1778

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Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.

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Drug Metabolism and Personalized Therapy.2025; 40(2): 121. CrossRef
Macro-Thyrotropin Syndrome: Prevalence and Clinical Profile of an Under-Recognised Rare Entity in Thyroidology
Maitri M. Patel, Dhara K. Patel, Lalitkumar B. Patel, Chetan B. Dharaiya, Dhruvkumar M. Patel, Ravi M. Vasani, Mukundkumar V. Patel
Indian Journal of Endocrinology and Metabolism.2025; 29(1): 95. CrossRef
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Lilly Josephine Bindel, Roland Seifert
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Jesús M. Villar-del-Moral, Juan I. Arcelus-Martínez, Antonio Becerra-Massare, Nuria Muñoz-Pérez, María C. Olvera-Porcel, Cristina Martínez-Santos
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DIAGNÓSTICO E MANEJO DO HIPOTIREOIDISMO SUBCLÍNICO: UMA REVISÃO DE LITERATURA
Dayane Beserra Costa Felício, Mariana Barbosa Silva, Mileide Beatriz de Lima Santos, Yasmin Cabral Menezes de Oliveira, Vinícius de Lima Paes, Ana Paula Simadon, Cleyciane Camila de Souza Belo Nogueira, Giulia Costa Moura
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Subclinical Hypothyroidism after a Three-Month Course of Low-Dose Amiodarone.
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Clinical Implications of Different Thyroid-Stimulating Hormone (TSH) Reference Intervals between TSH Kits for the Management of Subclinical Hypothyroidism
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Serum Vitamin B12 and Holotranscobalamin Levels in Subclinical Hypothyroid Patients in Relation to Thyroid-Stimulating Hormone (TSH) Levels and the Positivity of Anti-thyroid Peroxidase Antibodies: A Case-Control Study
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Hugo Goncalves, Francisco De Oliveira Simões, Rosa Sá, Bárbara Fraga Campos, Rui M Domingues, Narciso Oliveira, Teresa Pimentel
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Thyroid
Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum: 2023 Revised Korean Thyroid Association Guidelines: Hwa Young Ahn, Ka Hee Yi; Endocrinol Metab. 2023;38(3):289-294. Published online June 9, 2023; DOI: https://doi.org/10.3803/EnM.2023.1696

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Thyroid hormone plays a critical role in fetal growth and development, and thyroid dysfunction during pregnancy is associated with several adverse outcomes, such as miscarriage and preterm birth. In this review, we introduce and explain three major changes in the revised Korean Thyroid Association (KTA) guidelines for the diagnosis and management of thyroid disease during pregnancy: first, the normal range of thyroid-stimulating hormone (TSH) during pregnancy; second, the treatment of subclinical hypothyroidism; and third, the management of euthyroid pregnant women with positive thyroid autoantibodies. The revised KTA guidelines adopt 4.0 mIU/L as the upper limit of TSH in the first trimester. A TSH level between 4.0 and 10.0 mIU/L, combined with free thyroxine (T4) within the normal range, is defined as subclinical hypothyroidism, and a TSH level over 10 mIU/L is defined as overt hypothyroidism regardless of the free T4 level. Levothyroxine treatment is recommended when the TSH level is higher than 4 mIU/L in subclinical hypothyroidism, regardless of thyroid peroxidase antibody positivity. However, thyroid hormone therapy to prevent miscarriage is not recommended in thyroid autoantibody-positive women with normal thyroid function.

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Thyroid
Thyroid Function across the Lifespan: Do Age-Related Changes Matter?: John P. Walsh; Endocrinol Metab. 2022;37(2):208-219. Published online April 14, 2022; DOI: https://doi.org/10.3803/EnM.2022.1463

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Circulating concentrations of thyrotropin (TSH) and thyroxine (T4) are tightly regulated. Each individual has setpoints for TSH and free T4 which are genetically determined, and subject to environmental and epigenetic influence. Pituitary-thyroid axis setpoints are probably established in utero, with maturation of thyroid function continuing until late gestation. From neonatal life (characterized by a surge of TSH and T4 secretion) through childhood and adolescence (when free triiodothyronine levels are higher than in adults), thyroid function tests display complex, dynamic patterns which are sexually dimorphic. In later life, TSH increases with age in healthy older adults without an accompanying fall in free T4, indicating alteration in TSH setpoint. In view of this, and evidence that mild subclinical hypothyroidism in older people has no health impact, a strong case can be made for implementation of age-related TSH reference ranges in adults, as is routine in children.

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Original Articles

Thyroid
Developmental Hypothyroidism Influences the Development of the Entorhinal-Dentate Gyrus Pathway of Rat Offspring: Ting Jin, Ranran Wang, Shiqiao Peng, Xin Liu, Hanyi Zhang, Xue He, Weiping Teng, Xiaochun Teng; Endocrinol Metab. 2022;37(2):290-302. Published online April 8, 2022; DOI: https://doi.org/10.3803/EnM.2021.1343

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Background
Developmental hypothyroidism impairs learning and memory in offspring, which depend on extensive neuronal circuits in the entorhinal cortex, together with the hippocampus and neocortex. The entorhinal-dentate gyrus pathway is the main entrance of memory circuits. We investigated whether developmental hypothyroidism impaired the morphological development of the entorhinal-dentate gyrus pathway.
Methods
We examined the structure and function of the entorhinal-dentate gyrus pathway in response to developmental hypothyroidism induced using 2-mercapto-1-methylimidazole.
Results
1,1´-Dioctadecyl-3,3,3´,3´-tetramethylindocarbocyanine perchlorate tract tracing indicated that entorhinal axons showed delayed growth in reaching the outer molecular layer of the dentate gyrus at postnatal days 2 and 4 in hypothyroid conditions. The proportion of fibers in the outer molecular layer was significantly smaller in the hypothyroid group than in the euthyroid group at postnatal day 4. At postnatal day 10, the pathway showed a layer-specific distribution in the outer molecular layer, similar to the euthyroid group. However, the projected area of entorhinal axons was smaller in the hypothyroid group than in the euthyroid group. An electrophysiological examination showed that hypothyroidism impaired the long-term potentiation of the perforant and the cornu ammonis 3–cornu ammonis 1 pathways. Many repulsive axon guidance molecules were involved in the formation of the entorhinaldentate gyrus pathway. The hypothyroid group had higher levels of erythropoietin-producing hepatocyte ligand A3 and semaphorin 3A than the euthyroid group.
Conclusion
We demonstrated that developmental hypothyroidism might influence the development of the entorhinal-dentate gyrus pathway, contributing to impaired long-term potentiation. These findings improve our understanding of neural mechanisms for memory function.

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Thyroid
Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism: Ki-Hun Kim, Juhui Lee, Chang Ho Ahn, Hyeong Won Yu, June Young Choi, Ho-Young Lee, Won Woo Lee, Jae Hoon Moon; Endocrinol Metab. 2021;36(5):1121-1130. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1216

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Background
Heart rate (HR) monitored by a wearable device (WD) has demonstrated its clinical feasibility for thyrotoxicosis subjects. However, the association of HR monitored by wearables with hypothyroidism has not been examined. We assessed the association between serum thyroid hormone concentration and three WD-HR parameters in hypothyroid subjects.
Methods
Forty-four subjects scheduled for radioactive iodine therapy (RAI Tx) after thyroid cancer surgery were included. Thirty subjects were prepared for RAI Tx by thyroid hormone withdrawal (hypothyroidism group) and 14 subjects by recombinant human thyrotropin (control group). Three WD-HR parameters were calculated from the HR data collected during rest, during sleep, and from 2:00 AM to 6:00 AM, respectively. We analyzed the changes in conventionally measured resting HR (On-site rHR) and WDHR parameters relative to thyroid hormone levels.
Results
Serum free thyroxine (T4) levels, On-site rHR, and WD-HR parameters were lower in the hypothyroid group than in the control group at the time of RAI Tx. WD-HR parameters also reflected minute changes in free T4 levels. A decrease in On-site rHR and WD-HR parameters by one standard deviation (On-site rHR, approximately 12 bpm; WD-HR parameters, approximately 8 bpm) was associated with a 0.2 ng/dL decrease in free T4 levels (P<0.01) and a 2-fold increase of the odds ratio of hypothyroidism (P<0.01). WD-HR parameters displayed a better goodness-of-fit measure (lower quasi-information criterion value) than On-site rHR in predicting the hypothyroidism.
Conclusion
This study identified WD-HR parameters as informative and easy-to-measure biomarkers to predict hypothyroidism.

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Thyroid
The Positive Association between Subclinical Hypothyroidism and Newly-Diagnosed Hypertension Is More Explicit in Female Individuals Younger than 65: Xichang Wang, Haoyu Wang, Li Yan, Lihui Yang, Yuanming Xue, Jing Yang, Yongli Yao, Xulei Tang, Nanwei Tong, Guixia Wang, Jinan Zhang, Youmin Wang, Jianming Ba, Bing Chen, Jianling Du, Lanjie He, Xiaoyang Lai, Yanbo Li, Zhaoli Yan, Eryuan Liao, Chao Liu, Libin Liu, Guijun Qin, Yingfen Qin, Huibiao Quan, Bingyin Shi, Hui Sun, Zhen Ye, Qiao Zhang, Lihui Zhang, Jun Zhu, Mei Zhu, Yongze Li, Weiping Teng, Zhongyan Shan; Endocrinol Metab. 2021;36(4):778-789. Published online August 10, 2021; DOI: https://doi.org/10.3803/EnM.2021.1101

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Background
Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension.
Methods
Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017.
Results
The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years.
Conclusion
The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

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Review Articles

Thyroid
Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape: Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2021;36(3):500-513. Published online June 18, 2021; DOI: https://doi.org/10.3803/EnM.2021.1066

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Subclinical hypothyroidism (sHypo) is defined as normal serum free thyroid hormone levels coexisting with elevated serum thyroid-stimulating hormone (TSH) levels. sHypo is a common condition observed in clinical practice with several unique features. Its diagnosis should be based on an understanding of geographic and demographic differences in biochemical criteria versus a global reference range for TSH that is based on the 95% confidence interval of a healthy population. During the differential diagnosis, it is important to remember that a considerable proportion of sHypo cases are transient and reversible in nature; the focus is better placed on persistent or progressive forms, which mainly result from chronic autoimmune thyroiditis. Despite significant evidence documenting the health impacts of sHypo, the effects of levothyroxine treatment (LT4-Tx) in patients with sHypo remains controversial, especially in patients with grade 1 sHypo and older adults. Existing evidence suggests that it is reasonable to refrain from immediate LT4-Tx in most patients if they are closely monitored, except in women who are pregnant or in progressive cases. Future research is needed to further characterize the risks and benefits of LT4-Tx in different patient cohorts.

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Miscellaneous
Clinical Characteristics, Management, and Potential Biomarkers of Endocrine Dysfunction Induced by Immune Checkpoint Inhibitors: Shintaro Iwama, Tomoko Kobayashi, Hiroshi Arima; Endocrinol Metab. 2021;36(2):312-321. Published online April 27, 2021; DOI: https://doi.org/10.3803/EnM.2021.1007

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Immune-related adverse events (irAEs) affecting the endocrine glands are among the most frequent irAEs induced by immune checkpoint inhibitors (ICIs) and include hypopituitarism, primary adrenal insufficiency, thyrotoxicosis, hypothyroidism, hypoparathyroidism, and type 1 diabetes mellitus. Since the incidence and clinical features of endocrine irAEs vary according to the ICI used, it is important to understand the characteristics of these irAEs and to manage each one appropriately. Since some endocrine irAEs, including adrenal crisis and diabetic ketoacidosis, are potentially life-threatening, predicting the risk of endocrine irAEs before their onset is critical. Several autoantibodies have been detected in patients who develop endocrine irAEs, among which anti-thyroid antibodies may be predictive biomarkers of thyroid dysfunction. In this review, we describe the clinical features of each endocrine irAE induced by ICIs and discuss their potential biomarkers, including autoantibodies.

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Original Articles

Clinical Study
Characteristics of Immune-Related Thyroid Adverse Events in Patients Treated with PD-1/PD-L1 Inhibitors: Jee Hee Yoon, A Ram Hong, Hee Kyung Kim, Ho-Cheol Kang; Endocrinol Metab. 2021;36(2):413-423. Published online April 6, 2021; DOI: https://doi.org/10.3803/EnM.2020.906

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Background
Thyroid immune-related adverse events (IRAEs) have been reported in patients treated with programmed cell death protein-1 (PD-1) and programmed cell death protein-ligand 1 (PD-L1) inhibitors. We investigated the incidence and clinical course of PD-1/PD-L1 inhibitor-induced thyroid IRAEs, and identified predictable clinical risk factors of thyroid IRAEs, in particular, overt hypothyroidism (OH).
Methods
We retrospectively reviewed the medical records of 325 cancer patients receiving PD-1/PD-L1 inhibitor in a tertiary referral center.
Results
A total of 50.5% (164/325) of patients experienced at least one abnormal thyroid function following PD-1/PD-L1 inhibitor. Eighty-four patients (51.2%) of them recovered to normal thyroid function during follow-up. In overall population, 25 patients (7.7%) required thyroid hormone replacement therapy due to PD-1/PD-L1 inhibitor-induced OH. Patients who progressed to OH showed significantly higher baseline thyroid stimulating hormone level and longer duration of PD-1/PD-L1 inhibitor therapy than those without thyroid dysfunction or OH (both P<0.001). Median time interval to the development of OH was 3 months after the therapy. OH was significantly associated with positive anti-thyroid peroxidase antibody at baseline and anti-thyroglobulin antibody during the therapy than those without thyroid dysfunction or OH (P=0.015 and P=0.005, respectively). We observed no patients with OH who were able to stop levothyroxine replacement after the cessation of PD-1/PD-L1 inhibitor therapy.
Conclusion
PD-1/PD-L1 inhibitor-induced thyroid dysfunctions are considerably reversible; however, OH is irreversible requiring levothyroxine replacement even after stopping the therapy. Positive thyroid autoantibodies may predict the progression to OH.

Citations

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Clinical Study
Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery: Hana Kim, Sung Hye Kong, Jae Hoon Moon, Sang Yoon Kim, Kay-Hyun Park, Jun Sung Kim, Joong Haeng Choh, Young Joo Park, Cheong Lim; Endocrinol Metab. 2020;35(2):308-318. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.308

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Background
The aim of this study was to determine the associations between subclinical hypothyroidism (SCH) and long-term cardiovascular outcomes after coronary artery bypass grafting (CABG) or heart valve surgery (HVS).
Methods
We retrospectively reviewed and compared all-cause mortality, cardiovascular mortality, and cardiovascular events in 461 patients who underwent CABG and 104 patients who underwent HVS.
Results
During a mean±standard deviation follow-up duration of 7.6±3.8 years, there were 187 all-cause deaths, 97 cardiovascular deaths, 127 major adverse cardiovascular events (MACE), 11 myocardial infarctions, one unstable angina, 70 strokes, 30 hospitalizations due to heart failure, 101 atrial fibrillation, and 33 coronary revascularizations. The incidence of all-cause mortality after CABG was significantly higher in patients with SCH (n=36, 55.4%) than in euthyroid patients (n=120, 30.3%), with a hazard ratio of 1.70 (95% confidence interval, 1.10 to 2.63; P=0.018) after adjustment for age, sex, current smoking status, body mass index, underlying diseases, left ventricular dysfunction, and emergency operation. Interestingly, low total triiodothyronine (T3) levels in euthyroid patients who underwent CABG were significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and MACE, but those associations were not observed in HVS patients. Both free thyroxine and thyroid-stimulating hormone levels in euthyroid patients were not related with any cardiovascular outcomes in either the CABG or HVS group.
Conclusion
SCH or low total T3 might be associated with a poor prognosis after CABG, but not after HVS, implying that preoperative thyroid hormonal status may be important in ischemic heart disease patients.

Citations

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Case Report

A Case of Pituitary Feedback Adenoma Caused by Primary Hypothyroidism.: Soon Jib Yoo, Sang A Chang, Yoo Bae Ahn, Hyun Sik Son, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung; J Korean Endocr Soc. 1996;11(2):199-206. Published online November 7, 2019

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Abstract PDF: A 14-year-old girl presented with severe headache and grand mal seizure. A magnetic resonance imaging(MRI) of brain showed a pituitary mass(1.0X1.5X1.3cm) incidentally during seizure evaluation. On physical examination, nodular goiter was detected on her anterior neck. The hormone study showed markdly increased basal thyroid stimulating hormone(TSH) level compared to thyroid hormone level, hyperprolactinemia and decreased basal growth hormone level. TSH and prolactin showed exaggerated response to thyrotropin releasing hormone(TRH) and the growth hormone showed delayed and blunted response to insulin-induced hypoglycemia. With the results of thyroid autoantibody and thyroid scan, the diagnosis of Hashimoto's thyroiditis was possible. Thyroid hormone and anticonvulsant drug were started with close observation of clinical status under the impression of pituitary feedback adenoma caused by hypothyroidism. After 3 months replacement therapy of levothyroxine sodium, she achieved euthyroid state with disappearance of headache and nodular goiter. After continuous replacement therapy for 9 months more, the pituitary mass was successfully regressed on follow up MRI with normalization of basal prolactin level. Grand mal seizure was developed after withholding anticonvulsant drug even though continuous admmistration of thyroid hormone. Because of similarity among pituitary adenoma discovered incidentally, careful hormonal study and high index of suspicion should be maintained to achieve correct diagnosis in order to avoid unnecessary pituitary surgery in these patients.

Original Articles

Serum Insulin-like Growth Factor-1(IGF-1) and Insulin-like Growth Factor Binding Proteins in Hyperthyroidism and Hypothyroidism.: Hyun Mo Song, Sang Seok Park, Tae Seon Park, Hong Sun Baek, Dae Yeol Lee; J Korean Endocr Soc. 1996;11(1):52-60. Published online November 7, 2019

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Abstract PDF: Background
s: Thyroid hormones play a fundamental role in the initiation and maintenance of somatic growth in mammalian species, and the insulin-like growth factors(IGFs) occupy a position of central importance in the growth of all tissues. To evaluate the changes in serum insulin-like growth factor-I(IGF-I) and insulin-like growth factor binding proteins in hyperthyroid and hypothyroid patients, sera was obtained from 19 hyperthyroid patients, 9 hypothyroid patients, and 10 healthy volunteers. Methods: IGF-I concentration was determined by radioimmunoassay, and changes in IGFBPs were assesed by Western Ligand Blotting. To evaluate the binding pattern of IGF-I & IGFBPs, autoradiographs were obtained. Results & Conclusion: IGF-I levels were increased significantly in hyperthyroid patients(mean ±SE, 267.88±9.80 ng/ml, p<0.05) and decreased significantly in hypothyroid patients(154.81±1.43 ng/ml, p<0.01) compaired to healthy control group(209.45±.60 ng/ml). Autoradiograph of serum IGFBPs from patients with hyperthyroidism and hypothyroidism did not show any change in the intensity of IGFBP-3 bands(40-45 KD) and IGFBP-1 bands, but in hyperthyroid patients, it showed increased intensity of IGFBP-2 band compared to healthy control group and hypothyroid patients.

Changes in Serum Lipids and Apolipoproteins Levels According to the Thyroxine Treatment in The Patients with Subclinical Hypothyroidism.: Hye Young Park, Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Geon Sang Park, Hyung Kyu Park, Sook Kyung Kim, Chan Soo Shin, Seong Yeon Kim; J Korean Endocr Soc. 1996;11(1):41-51. Published online November 7, 2019

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Abstract PDF: Background
Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies.

Spontaneous Recovery from Hypothyroidism in Autommune Thyroiditis.: Bo Youn Cho, Jae Hoon Chung, Kwang Won Kim, Kyu Jeung Ahn, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee; J Korean Endocr Soc. 1996;11(1):30-40. Published online November 7, 2019

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Abstract PDF: Background
A lifelong thyroxine therapy is indicated in all patients who have hypothyroidism as a result of autoimmune thyroiditis. However, it has been reported that some hypothyroid patients with autoimmune thyroiditis have spontaneous remission with restriction of iodine intake instead of thyroxine therapy. The purpose of study was to investigate how many hypothyroid patients with autoimmune thyroiditis can recover from hypothyroidism with restriction of iodine intake instead of thyroxine therapy and which factors predict recovery from hypothyroidism. Methods: We studied 64 patients with autoimmune thyroiditis(goitrous autoimmune thyroiditis 56, atrophic autoimmune thyroiditis 8). Thyroxine therapy was discontinued in patients with goitrous autoimmune thyroiditis on the way(group 1, n=32) or from the beginning(group 2, n=24) and atrophic autoimmune thyroiditis on the way(group 3, n-8). All patients were asked to avoid iodine-rich foods and thyroid function was monitored every one to two months for up to 35 months. Serum T3, T4, TSH concentrations, antithyroglobulin and antimicrosomal antibodies were measured by radioimmunoassay(RIA). TSH binding inhibitor immunoglobulin(TBII) was measured in serum using radioreceptor assay. Two hundred micrograms of thyrotropin releasing hormone (TRH) were given as intravenous bolus and TSH levels were measured in blood samples taken at 0, 30, and 60 minutes. All values were expressed as mean+-SEM. Statistical analysis was done with paired or non-paired t-test, ANOVA, and the Chi-square test. Statistical significance was defined as p-value below 0.05. Results: Thirteen(40.6%) of 32 patients in group 1 remained euthyroid after 12-35 months of discontinuation of thyroxine therapy. The other 19(59.4%) patients in group 1 had recurrences of hypothyroidism within 3 months after discontinuation of thyroxine therapy. In 11(45.8%) out of 24 patients in group 2, serum TSH concentrations declined below 5 mU/L within 3 months without thyroxine therapy. The other 13(54.2%) patients in group 2 remained hypothyroid till 2-16 months and the thyroxine was given. In contrast, all 8 patients in group 3 had recurrences of hypothy- roidism within 3 months after stopping thyroxine therapy. When we compared the recovered patients of goitrous autoimmune thyroiditis with the non-recovered patients of goitrous autoimmune thyroiditis, regardless of thyroxine therapy from the beginning, age at onset of disease of the 24 recovered patients was significantly younger than the 32 non-recovered patients(30.1+2.0 years vs. 40.2+ 2.4 years; p=0.004). Concl#usion: These findings suggest that 42.9% of hypothyroid patients with goitrous autoim- mune thyroiditis remain or become spontaneously euthyroid with restriction of iodine intake instead of thyroxine therapy. Young age may be a predicting factor of recovery from hypothyroidism in goitrous autoimmune thyroiditis.

Case Report

A Case of Subclinical Hypothyroidism Associated with Turner's Syndrome.: In Kwon Han, Jung Gil Lee, Sun Wha Lee, Seong Kyu Lee, Chan Moon Pak, Ho Yeon Chung; J Korean Endocr Soc. 1994;9(1):35-38. Published online November 6, 2019

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Abstract PDF: Recently it is known that Turner's syndrome is frequently associated with hypothyroidism. We report a case of Turner's syndrome associated with subclinical hypothyroidism. A 23-year-old female was admitted to the hospital with complaints of amenorrhea and short stature. She had a mosaicism of 45, X0/46, Xi(X_q) in the cell, cultured from the peripheral blood. The plasma thyroxine and triiodothyronine were normal and there was no clinical symptom of hypothyroidism. But the thyroid-stimulating hormone(TSH) concentration was unusually higher(184 uU/L). She has been treated with the cyclic therapy of conjugated estrogen and medroxyprogesterone, in addition to the thyroxine replacement therapy. After 2 months, the menstruation was restored and TSH was normalized.

Review Article

Thyroid
Digital Medicine in Thyroidology: A New Era of Managing Thyroid Disease: Jae Hoon Moon, Steven R. Steinhubl; Endocrinol Metab. 2019;34(2):124-131. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.124

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Digital medicine has the capacity to affect all aspects of medicine, including disease prediction, prevention, diagnosis, treatment, and post-treatment management. In the field of thyroidology, researchers are also investigating potential applications of digital technology for the thyroid disease. Recent studies using artificial intelligence (AI)/machine learning (ML) have reported reasonable performance for the classification of thyroid nodules based on ultrasonographic (US) images. AI/ML-based methods have also shown good diagnostic accuracy for distinguishing between benign and malignant thyroid lesions based on cytopathologic findings. Assistance from AI/ML methods could overcome the limitations of conventional thyroid US and fine-needle aspiration cytology. A web-based database has been developed for thyroid cancer care. In addition to its role as a nationwide registry of thyroid cancer, it is expected to serve as a clinical platform to facilitate better thyroid cancer care and as a research platform providing comprehensive disease-specific big data. Evidence has been found that biosignal monitoring with wearable devices may predict thyroid dysfunction. This real-world thyroid function monitoring could aid in the management and early detection of thyroid dysfunction. In the thyroidology field, research involving the range of digital medicine technologies and their clinical applications is expected to be even more active in the future.

Citations

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Original Articles

Thyroid
Thyroid-Stimulating Hormone Reference Ranges in the First Trimester of Pregnancy in an Iodine-Sufficient Country: Carmen Castillo, Nicole Lustig, Paula Margozzini, Andrea Gomez, María Paulina Rojas, Santiago Muzzo, Lorena Mosso; Endocrinol Metab. 2018;33(4):466-472. Published online November 30, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.4.466

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Background

Thyroid dysfunction is associated with negative neonatal and obstetric outcomes. Large differences in thyroid function reference intervals exist across different populations. These differences can be explained by population-specific factors, such as iodine status. Many countries in Latin America report iodine sufficiency, but relatively few countries have published up-to-date data on iodine levels and thyroid function in the overall population, and especially in pregnant women. We evaluated the iodine status of pregnant women in Chile and determined thyroid hormone reference ranges in this population.

Methods

This was a prospective observational study of healthy Chilean women at their first prenatal visit before week 14. Thyroid-stimulating hormone (TSH), total thyroxine (T₄), free T₄, antithyroid peroxidase antibody (TPOAb), and iodine levels from spot urine samples were measured. Iodine status and the reference ranges for TSH were calculated.

Results

A total of 1,022 pregnant women in the first trimester were selected. Urinary iodine levels were measured in 302 randomly-selected women. The median urinary iodine concentration was 173.45 µg/L (interquartile range, 108.11 to 249.35).The reference ranges of TSH were calculated in 670 patients selected according to the National Academy of Clinical Biochemistry guidelines. The median TSH level was 1.88 µIU/mL (2.5th percentile: 0.13 to 97.5th percentile: 5.37). Using the reference range in the 1,022 women, the prevalence of clinical hypothyroidism was 1.76%, and that of subclinical hypothyroidism was 3.92%. TPOAb positivity was more common in women with TSH levels above 3.5 µIU/mL.

Conclusion

We found adequate iodine intake and a right-shifted distribution of serum TSH levels in pregnant women in Chile. The prevalence of hypothyroidism in our sample of pregnant women was higher than has been described in the literature.

Citations

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Thyroid
Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study: Hyemi Kwon, Jin-hyung Jung, Kyung-Do Han, Yong-Gyu Park, Jung-Hwan Cho, Da Young Lee, Ji Min Han, Se Eun Park, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2018;33(2):260-267. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.260

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Background

The incidence of thyroid nodules has increased worldwide in recent years. Thyroid dysfunction is a potential risk factor for hypercholesterolemia, cardiovascular disease, osteoporosis, arrhythmia, and neuropsychiatric disease. This study investigated the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism in Koreans.

Methods

In this nationwide population-based cohort study, 51,834,660 subjects were included using the National Health Information database from 2006 to 2015, after the exclusion of subjects with thyroid cancer.

Results

The prevalence in Korea in 2015 of thyroid nodules, hypothyroidism in patients taking thyroid hormone, and hyperthyroidism in patients undergoing treatment was 15.82/1,000 population, 15.94/1,000 population, and 2.76/1,000 population, respectively. All these diseases were more prevalent among women than among men. The number of incident cases of these three thyroid diseases steadily increased from 2006 to 2012, and then decreased through 2015. The incidence of thyroid nodules, hypothyroidism treated with thyroid hormone, and treated hyperthyroidism was 6.79/1,000 population, 1.76/1,000 population, and 0.55/1,000 population, respectively, in Korea in 2015. The use of methimazole continuously increased, from 33% of total antithyroid drug prescriptions in 2006 to 74.4% in 2015, and it became the most frequently prescribed antithyroid drug in Korea. In contrast, the use of propylthiouracil continuously decreased.

Conclusion

This was the first nationwide study of the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism to take into account recent changes and to include the current status of patients receiving treatment.

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The Effects of Altered Membrane Cholesterol Levels on Sodium Pump Activity in Subclinical Hypothyroidism: Suparna Roy, Anindya Dasgupta; Endocrinol Metab. 2017;32(1):129-139. Published online February 28, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.129

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Abstract PDF PubReader: Background
Metabolic dysfunctions characteristic of overt hypothyroidism (OH) start at the early stage of subclinical hypothyroidism (SCH). Na⁺/K⁺-ATPase (the sodium pump) is a transmembrane enzyme that plays a vital role in cellular activities in combination with membrane lipids. We evaluated the effects of early changes in thyroid hormone and membrane cholesterol on sodium pump activity in SCH and OH patients.
Methods
In 32 SCH patients, 35 OH patients, and 34 euthyroid patients, sodium pump activity and cholesterol levels in red blood cell membranes were measured. Serum thyroxine (T₄) and thyroid stimulating hormone (TSH) levels were measured using enzyme-linked immunosorbent assays. Differences in their mean values were analysed using post hoc analysis of variance. We assessed the dependence of the sodium pump on other metabolites by multiple regression analysis.
Results
Sodium pump activity and membrane cholesterol were lower in both hypothyroid groups than in control group, OH group exhibiting lower values than SCH group. In SCH group, sodium pump activity showed a significant direct dependence on membrane cholesterol with an inverse relationship with serum TSH levels. In OH group, sodium pump activity depended directly on membrane cholesterol and serum T₄ levels. No dependence on serum cholesterol was observed in either case.
Conclusion
Despite the presence of elevated serum cholesterol in hypothyroidism, membrane cholesterol contributed significantly to maintain sodium pump activity in the cells. A critical reduction in membrane cholesterol levels heralds compromised enzyme activity, even in the early stage of hypothyroidism, and this can be predicted by elevated TSH levels alone, without any evident clinical manifestations.

Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015: Won Gu Kim, Won Bae Kim, Gyeongji Woo, Hyejin Kim, Yumi Cho, Tae Yong Kim, Sun Wook Kim, Myung-Hee Shin, Jin Woo Park, Hai-Lin Park, Kyungwon Oh, Jae Hoon Chung; Endocrinol Metab. 2017;32(1):106-114. Published online January 23, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.1.106; Correction in: Endocrinol Metab 2023;38(3):357

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Abstract PDF PubReader

Background

No nationwide epidemiological study evaluating the prevalence of subclinical and overt forms of hypothyroidism and hyperthyroidism has yet been conducted in Korea. This study aimed to evaluate the reference range of serum thyroid stimulating hormone (TSH) and the national prevalence of thyroid dysfunctions in Korea.

Methods

Nation-wide cross-sectional data were analyzed from a representative sample of the civilian, non-institutionalized Korean population (n=6,564) who underwent blood testing for thyroid function and anti-thyroid peroxidase antibody (TPOAb) as part of the Korea National Health and Nutrition Examination Survey VI (2013 to 2015).

Results

The reference interval of serum TSH in the Korean reference population was 0.62 to 6.68 mIU/L. Based on this reference interval, the prevalence of overt and subclinical hypothyroidism was 0.73% (males 0.40%, females 1.10%) and 3.10% (males 2.26%, females 4.04%), respectively. The prevalence of hypothyroidism increased with age until the age group between 50 to 59 years. Positive TPOAb were found in 7.30% of subjects (males 4.33%, females 10.62%). The prevalence of overt and subclinical hypothyroidism TPOAb-positive subjects was 5.16% and 10.88%, respectively. The prevalence of overt and subclinical hyperthyroidism was 0.54% (males 0.30%, females 0.81%) and 2.98% (males 2.43%, females, 3.59%), respectively.

Conclusion

The Serum TSH reference levels in the Korean population were higher than the corresponding levels in Western countries. Differences were found in the prevalence of hypothyroidism and hyperthyroidism according to age, sex, and TPOAb positivity. This study provides important baseline information for understanding patterns of thyroid dysfunction and diseases in Korea.

Citations

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Clinical Study
Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience: Juan Carlo P. Dayrit, Elaine C. Cunanan, Sjoberg A. Kho; Endocrinol Metab. 2016;31(3):410-415. Published online August 17, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.410

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Background

Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established.

Methods

Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age.

Results

Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age.

Conclusions

The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.

Citations

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Epidemiology, Diagnosis, and Management of Thyroid Cancer in the Philippines
Karol Ann T. Baldo, Ruby Anne N. King, Florence Giannina F. San Juan, Cecile C. Dungog, Jea Giezl N. Solidum, Jeremy A. Ceriales, Ma. Carmela P. dela Cruz, Frances Dominique V. Ho, Nicole Picart, Aldrin Nico R. Plantado, Jessica Perez, Jervy P. Garcia, Jo
Indian Journal of Surgical Oncology.2025;[Epub] CrossRef
Is there a causal relationship between hypothyroidism and hyponatremia?
Julie Chen
Therapeutic Advances in Endocrinology and Metabolism.2023;[Epub] CrossRef
Endocrinopathy-induced euvolemic hyponatremia
Talia Diker-Cohen, Benaya Rozen-Zvi, Dana Yelin, Amit Akirov, Eyal Robenshtok, Anat Gafter-Gvili, Daniel Shepshelovich
Internal and Emergency Medicine.2018; 13(5): 679. CrossRef

Review Article

Thyroid
Update on the Management of Thyroid Disease during Pregnancy: Chang Hoon Yim; Endocrinol Metab. 2016;31(3):386-391. Published online August 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.386

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Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant; however, these complications can be prevented by optimal treatment of maternal overt thyroid dysfunction. Although several studies have demonstrated that maternal subclinical hypothyroidism is associated with obstetric complications and neurocognitive impairments in offspring, there is limited evidence that levothyroxine treatment can improve these complications. Therefore, most professional societies do not recommend universal screening for thyroid dysfunction during pregnancy, and instead recommend a case-finding approach in which only high-risk women are tested. However, recent studies have estimated that targeted thyroid function testing misses approximately 30% to 55% of hypothyroidism cases in pregnant women, and some associations and researchers have recommended universal screening of pregnant women to facilitate the early detection and treatment of overt hypothyroidism. This review summarizes recent data on thyroid function test changes, thyroid functional disorder management, and thyroid screening during pregnancy.

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Prevalence of congenital hypothyroidism in infants of mothers with hypothyroidism: a meta-analysis
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Journal of Back and Musculoskeletal Rehabilitation.2024; 37(6): 1663. CrossRef
The Effect of Inflammatory Markers in the Hemogram Parameters of Pregnant Women with Thyroid Disease on Obstetric and Neonatal Outcomes
Funda DEMİREL, Ünal TURKAY
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Decreased Expression of Ileal Thyroid Hormone Transporters in a Hypothyroid Patient: A Case Report
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Elly Morros González, Leonardo Javier Rojas Melo, Viviana Cruz Ramírez, Angélica Imitola
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Case Report

Thyroid
A Rare Manifestation of Hypothyroid Myopathy: Hoffmann's Syndrome: Kang Won Lee, Sun Hwa Kim, Kyoung Jin Kim, Sang Hyun Kim, Hee Young Kim, Byung-Jo Kim, Sin Gon Kim, Dong Seop Choi; Endocrinol Metab. 2015;30(4):626-630. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.626

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Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

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Review Article

Thyroid
Subclinical Hypothyroidism and Cardiovascular Disease: Sunghwan Suh, Duk Kyu Kim; Endocrinol Metab. 2015;30(3):246-251. Published online August 4, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.3.246

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Subclinical hypothyroidism (SCH) is a common disorder that is characterized by elevated thyroid-stimulating hormone levels in conjunction with free thyroxine concentrations within the normal reference range. Thyroid hormones are known to affect the heart and vasculature and, as a result, the impact of SCH on the cardiovascular (CV) system has recently become an important topic of research. Strong evidence points to a link between SCH and CV risk factors such as alterations in blood pressure, lipid levels, and atherosclerosis. Additionally, accumulating evidence indicates that SCH is associated with metabolic syndrome and heart failure. The present review proposes that SCH may be a potentially modifiable risk factor of CV disease and mortality. However, large-scale clinical trials with appropriate power investigating the risks and benefits of SCH treatment are required to determine whether these benefits can be achieved with levothyroxine therapy.

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Impaired Hemorheological Parameters and Increased Carotid Intima-Media Thickness in Children with Subclinical Hypothyroidism
Yasemin Isik-Balci, Sebahat Agladioglu, Kadir Agladioglu, Emine Kilic-Toprak, Ozgen Kilic-Erkek, Bayram Ozhan, Aziz Polat, Melek Bor-Kucukatay
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Original Articles

Thyroid
Incidence and Prevalence of Overt Hypothyroidism and Causative Diseases in Korea as Determined Using Claims Data Provided by the Health Insurance Review and Assessment Service: Gi Hyeon Seo, Jae Hoon Chung; Endocrinol Metab. 2015;30(3):288-296. Published online January 5, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.3.288

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Background

The incidence and prevalence of overt hypothyroidism have been reported to be 2 to 4/1,000 population/year and 8 to 13/1,000 population, respectively, in foreign countries. As there has been no nationwide survey to obtain data in Korea, the present study investigated the incidence and prevalence of overt hypothyroidism in Korea using claims data provided by the Health Insurance Review and Assessment Service. The proportions of causative diseases for hypothyroidism were also analyzed.

Methods

This study was retrospectively performed with 541,969 Korean patients (92,832 men and 449,137 women), with overt hypothyroidism, treated with thyroid hormone between 2008 and 2012.

Results

The incidence of overt hypothyroidism in Korea was 2.26/1,000 population/year (0.78 in men and 3.72 in women), and the prevalence was 14.28/1,000 population (4.40 in men and 24.03 in women). When patients with thyroid cancer were excluded, the incidence was 1.56/1,000 population/year (0.54 in men and 2.57 in women). The incidence increased with age, with peaks in and after the late 60s in men and in the early 50s in women. The prevalence peaked in the early 70s in men and in the late 50s in women.

Conclusion

This is a report of the first nationwide investigation of the incidence and prevalence of overt hypothyroidism in Korea, although it is limited to patients treated with thyroid hormone.

Citations

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Saemi Han, Seogsong Jeong, Seulggie Choi, Sun Jae Park, Kyae Hyung Kim, Gyeongsil Lee, Yoosun Cho, Joung Sik Son, Sang Min Park
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Chung-Ming Huang, Fung-Chang Sung, Hsuan-Ju Chen, Che-Chen Lin, Cheng-Li Lin, Po-Hao Huang
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Thyroid
The Biochemical Prognostic Factors of Subclinical Hypothyroidism: Myung Won Lee, Dong Yeob Shin, Kwang Joon Kim, Sena Hwang, Eun Jig Lee; Endocrinol Metab. 2014;29(2):154-162. Published online June 26, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.2.154

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Background

Patients with subclinical hypothyroidism (SHT) are common in clinical practice. However, the clinical significance of SHT, including prognosis, has not been established. Further clarifying SHT will be critical in devising a management plan and treatment guidelines for SHT patients. Thus, the aim of this study was to investigate the prognostic factors of SHT.

Methods

We reviewed the medical records of Korean patients who visited the endocrinology outpatient clinic of Severance Hospital from January 2008 to September 2012. Newly-diagnosed patients with SHT were selected and reviewed retrospectively. We compared two groups: the SHT maintenance group and the spontaneous improvement group.

Results

The SHT maintenance group and the spontaneous improvement group had initial thyroid-stimulating hormone (TSH) levels that were significantly different (P=0.035). In subanalysis for subjects with TSH levels between 5 to 10 µIU/mL, the spontaneous improvement group showed significantly lower antithyroid peroxidase antibody (anti-TPO-Ab) titer than the SHT maintenance group (P=0.039). Regarding lipid profiles, only triglyceride level, unlike total cholesterol and low density lipoprotein cholesterol, was related to TSH level, which is correlated with the severity of SHT. Diffuse thyroiditis on ultrasonography only contributed to the severity of SHT, not to the prognosis. High sensitivity C-reactive protein and urine iodine excretion, generally regarded as possible prognostic factors, did not show any significant relation with the prognosis and severity of SHT.

Conclusion

Only initial TSH level was a definite prognostic factor of SHT. TPO-Ab titer was also a helpful prognostic factor for SHT in cases with mildly elevated TSH. Other than TSH and TPO-Ab, we were unable to validate biochemical prognostic factors in this retrospective study for Korean SHT patients.

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Case Reports

Thyroid
Hypoparathyroidism and Subclinical Hypothyroidism with Secondary Hemochromatosis: Hyung Ki Jeong, Joon Hwan An, Hyoung Sang Kim, Eun Ae Cho, Min Gui Han, Jung Sik Moon, Hee Kyung Kim, Ho-Cheol Kang; Endocrinol Metab. 2014;29(1):91-95. Published online March 14, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.1.91

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Hemochromatosis is an inherited genetic disorder of iron metabolism which can also occur as a secondary result of iron-overload. It leads to organ damage such as cardiomyopathy, liver cirrhosis, hypogonadism, and diabetes. This paper discusses a case of secondary hemochromatosis associated with repeated transfusions, presenting as asymptomatic hypoparathyroidism and subclinical hypothyroidism with multiple organ involvement. The 29-year-old female, who had severe aplastic anemia, received multiple transfusions totaling approximately 1,400 units of red blood cells over 15 years. During her routine laboratory examination, hypocalcemia was detected with decreased intact parathyroid hormone and increased thyroid stimulating hormone. Serum ferritin, iron, and total iron binding capacity had increased to 27,583.03 ng/mL, 291 µg/dL, and 389 µg/dL, respectively. She had unusually bronze skin and computed tomography revealed iron deposition in the thyroid, liver, and heart. Multiorgan involvement as seen in this case is rare in hemochromatosis associated with secondary transfusions. To the best of the author's knowledge, this is the first case report in Korea of hypoparathyroidism and subclinical hypothyroidism due to iron deposition in the parathyroid and thyroid gland.

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Thyroid
Hyponatremia after Thyroid Hormone Withdrawal in a Patient with Papillary Thyroid Carcinoma: Hyo Jin Jo, Yong Hyun Kim, Dong Hyun Shin, Mi Jeoung Kim, Sang Jin Lee, Dong Ok Jeon, Sung Gyu Im, Sun Kyung Jang, Jin Young Choi; Endocrinol Metab. 2014;29(1):77-82. Published online March 14, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.1.77

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Hyponatremia is an electrolyte abnormality commonly found in clinical practice. It is important to diagnose the underlying etiology of the hyponatremia and correct it appropriately because severe hyponatremia can cause serious complications and substantially increase the risk of mortality. Although hypothyroidism is known to be a cause of hyponatremia, it is rare that hyponatremia occurs in relation to hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer. We report a case of a 76-year-old woman with papillary thyroid carcinoma presenting with severe hyponatremia related to hypothyroidism induced by thyroid hormone withdrawal for radio-active iodine whole-body scanning, who was treated by thyroid hormone replacement and hydration. Considering that the incidence of differentiated thyroid cancer is rapidly increasing, physicians should be aware that, although uncommon, hyponatremia can occur in patients undergoing radioiodine therapy or diagnostic testing.

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Review Article

Thyroid
Prevalence and Risk Factors of Subclinical Thyroid Disease: Ye An Kim, Young Joo Park; Endocrinol Metab. 2014;29(1):20-29. Published online March 14, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.1.20

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Subclinical thyroid disease is defined biochemically by an abnormal thyrotropin (TSH) level and normal serum-free thyroxine level. The prevalence of this condition varies according to the reference range for TSH and geographic or demographic factors. Recently, several studies, including our community-based cohort studies, have reported on the incidence of subclinical thyroid disease in Korea. Using these studies, we reviewed the prevalence and risk factors of subclinical thyroid disease, focusing on subclinical hypothyroidism.

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Sohei Kimoto, Kazuhiko Yamamuro, Toshifumi Kishimoto
Psychiatry and Clinical Neurosciences.2019; 73(6): 348. CrossRef
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Francesca Reyes Domingo, Marc T. Avey, Marion Doull
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Age-sex disparities and sub-clinical hypothyroidism among patients in Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia
Habtamu Azene Tekle, Tesfahun Molla Bobe, Efrata Girma Tufa, Fithamlak Bisetegen Solomon
Journal of Health, Population and Nutrition.2018;[Epub] CrossRef
Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies
Shinje Moon, Min Joo Kim, Jae Myung Yu, Hyung Joon Yoo, Young Joo Park
Thyroid.2018; 28(9): 1101. CrossRef
Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: Data from Korean National Health and Nutrition Examination Survey IV (2013–2015)
So Young Park, Hae In Kim, Hyun-Kyung Oh, Tae Hyuk Kim, Hye Won Jang, Jae Hoon Chung, Myung-Hee Shin, Sun Wook Kim, Sun Y Lee
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Evaluation of Thyroid Hormone Levels and Urinary Iodine Concentrations in Koreans Based on the Data from Korea National Health and Nutrition Examination Survey VI (2013 to 2015)
Jae Hoon Chung
Endocrinology and Metabolism.2018; 33(2): 160. CrossRef
Transcriptome Network Analysis Reveals Aging-Related Mitochondrial and Proteasomal Dysfunction and Immune Activation in Human Thyroid
Byuri Angela Cho, Seong-Keun Yoo, Young Shin Song, Su-jin Kim, Kyu Eun Lee, Minho Shong, Young Joo Park, Jeong-Sun Seo
Thyroid.2018; 28(5): 656. CrossRef
Relation of Subclinical Hypothyroidism is Associated With Cardiovascular Events and All-Cause Mortality in Adults With High Cardiovascular Risk
Shinje Moon, Sung Hye Kong, Hoon Sung Choi, Yul Hwangbo, Moon-Kyu Lee, Jae Hoon Moon, Hak Chul Jang, Nam Han Cho, Young Joo Park
The American Journal of Cardiology.2018; 122(4): 571. CrossRef
Subclinical Hypothyroidism and Coronary Revascularization After Coronary Artery Bypass Grafting
Sung Hye Kong, Ji Won Yoon, Sang Yoon Kim, Tae Jung Oh, Kay-Hyun Park, Joong Haeng Choh, Young Joo Park, Cheong Lim
The American Journal of Cardiology.2018; 122(11): 1862. CrossRef
A Case of Subclinical Hyperthyroidism Treatment with Herbal Medicine
Dong-eun Jin, Seok-woo Kim, Hyeon-cheo Shin
The Journal of Internal Korean Medicine.2018; 39(4): 831. CrossRef
Cardiovascular Risk in Subclinical Hypothyroidism
Mariana Dobrescu, Diana Păun, Daniel Grigorie, Cătălina Poiană
Internal Medicine.2018; 15(3): 51. CrossRef
Association between thyroid autoimmunity and Helicobacter pylori infection
Yun Mi Choi, Tae Yong Kim, Eui Young Kim, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
The Korean Journal of Internal Medicine.2017; 32(2): 309. CrossRef
Effect of Marijuana Use on Thyroid Function and Autoimmunity
Sonali Malhotra, Rubina A. Heptulla, Peter Homel, Roja Motaghedi
Thyroid.2017; 27(2): 167. CrossRef
Insidious danger in childhood era's: subclinical hypothyroidism
Ayşegül Alpcan, Ayça Törel Ergür, Serkan Tursun
Ortadoğu Tıp Dergisi.2017; 9(1): 34. CrossRef
Thyroid Stimulating Hormone Reference Range and Prevalence of Thyroid Dysfunction in the Korean Population: Korea National Health and Nutrition Examination Survey 2013 to 2015
Won Gu Kim, Won Bae Kim, Gyeongji Woo, Hyejin Kim, Yumi Cho, Tae Yong Kim, Sun Wook Kim, Myung-Hee Shin, Jin Woo Park, Hai-Lin Park, Kyungwon Oh, Jae Hoon Chung
Endocrinology and Metabolism.2017; 32(1): 106. CrossRef
Thyroid diseases and risk of non-thyroidal pathology
R I Glushakov, E V Kozyrko, I V Sobolev, S A Ermolova, O V Vlaseva, A A Kuzin, N I Tapilskaya
Kazan medical journal.2017; 98(1): 77. CrossRef
Hipertiroidismo
M. Toni, J. Pineda, E. Anda, J.C. Galofré
Medicine - Programa de Formación Médica Continuada Acreditado.2016; 12(13): 731. CrossRef
Subclinical Hypothyroidism in Childhood Cancer Survivors
Hyun Joo Lee, Seung Min Hahn, Song Lee Jin, Yoon Jung Shin, Sun Hee Kim, Yoon Sun Lee, Hyo Sun Kim, Chuhl Joo Lyu, Jung Woo Han
Yonsei Medical Journal.2016; 57(4): 915. CrossRef
Comparison of universal screening with targeted high-risk case finding for diagnosis of thyroid disorders
Sima Nazarpour, Fahimeh Ramezani Tehrani, Masoumeh Simbar, Maryam Tohidi, Hamid AlaviMajd, Fereidoun Azizi
European Journal of Endocrinology.2016; 174(1): 77. CrossRef
Association of low baseline free thyroxin levels with progression of coronary artery calcification over 4 years in euthyroid subjects: the Kangbuk Samsung Health Study
Hye‐Jeong Park, Jihyun Kim, Eun Jin Han, Se Eun Park, Cheol‐Young Park, Won‐Young Lee, Ki‐Won Oh, Sung‐Woo Park, Eun‐Jung Rhee
Clinical Endocrinology.2016; 84(6): 889. CrossRef
Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases
Woo Kyung Lee, Sena Hwang, Daham Kim, Seul Gi Lee, Seonhyang Jeong, Mi-Youn Seol, Hyunji Kim, Cheol Ryong Ku, Dong Yeop Shin, Woong Youn Chung, Eun Jig Lee, Jandee Lee, Young Suk Jo
Medicine.2016; 95(14): e3346. CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef
Reference interval for thyrotropin in a ultrasonography screened Korean population
Mijin Kim, Tae Yong Kim, Soo Han Kim, Yunkyoung Lee, Su-yeon Park, Hyung-don Kim, Hyemi Kwon, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
The Korean Journal of Internal Medicine.2015; 30(3): 335. CrossRef
Incidence and Prevalence of Overt Hypothyroidism and Causative Diseases in Korea as Determined Using Claims Data Provided by the Health Insurance Review and Assessment Service
Gi Hyeon Seo, Jae Hoon Chung
Endocrinology and Metabolism.2015; 30(3): 288. CrossRef
Subclinical Hypothyroidism and Cardiovascular Disease
Sunghwan Suh, Duk Kyu Kim
Endocrinology and Metabolism.2015; 30(3): 246. CrossRef
Bone Health and Clinical Results after Hip Fracture Surgery in Patients with Subclinical Hypothyroidism
Ki-Choul Kim, Young-Kyun Lee, You Jin Lee, Yong-Chan Ha, Kyung-Hoi Koo
Journal of Bone Metabolism.2014; 21(3): 213. CrossRef
Subclinical Thyroid Dysfunction in the Elderly
Ki Dong Ko
Journal of the Korean Geriatrics Society.2014; 18(3): 111. CrossRef
Subclinical hypothyroidism in addition to common risk scores for prediction of cardiovascular disease: a 10-year community-based cohort study
Tae Hyuk Kim, Hoon Sung Choi, Ji Cheol Bae, Jae Hoon Moon, Hyung-Kwan Kim, Sung Hee Choi, Soo Lim, Do Joon Park, Kyong Soo Park, Hak Chul Jang, Moon-Kyu Lee, Nam H Cho, Young Joo Park
European Journal of Endocrinology.2014; 171(5): 649. CrossRef

Case Reports

Thyroid
Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy: Pyoung Ahn, Hyun-Jun Min, Sang-Hyun Park, Byoung-Mu Lee, Myung-Jin Choi, Jong-Woo Yoon, Ja-Ryong Koo; Endocrinol Metab. 2013;28(4):331-334. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.331

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Abstract PDF PubReader

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Citations

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Hypothyreoïdie en statine-geïnduceerde rhabdomyolyse: case report en literatuurstudie
T. ENGELEN, A.H. VAN CRAENENBROECK
Tijdschrift voor Geneeskunde.2025;[Epub] CrossRef
The Hidden Hazard of Hypothyroidism: Statin-Associated Rhabdomyolysis With Life-Threatening Complications
George Bechir, Angelina Bechir
Cureus.2025;[Epub] CrossRef
Effects of statin use on serum creatinine phosphokinase levels in normal thyroid function
Jeonghoon Ha, Joonyub Lee, Jin Yu, Hakyoung Park, Jiwon Shinn, Seung-Hwan Lee, Jae-Hyoung Cho, Hun-Sung Kim
The Korean Journal of Internal Medicine.2024; 39(4): 650. CrossRef
Is Kidney Stone Associated with Thyroid Disease? The United States National Health and Nutrition Examination Survey 2007-2018
Wenya Xue, Zihan Xue, Yanbing Liu, Pan Yin, Luyu Liu, Shen’ao Qu, Shaobo Wu, Chuance Yang
Endocrine, Metabolic & Immune Disorders - Drug Targets.2024; 24(11): 1323. CrossRef
Systematic Review on Efficacy, Effectiveness, and Safety of Pitavastatin in Dyslipidemia in Asia
Nam Xuan Vo, Huong Lai Pham, Tan Trong Bui, Tien Thuy Bui
Healthcare.2024; 13(1): 59. CrossRef
Dyslipidémies secondaires
S. Chalopin, A. Gallo
EMC - Endocrinologie - Nutrition.2024; 35(1): 1. CrossRef
Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone
Wen-Fang Chiang, Jenq-Shyong Chan, Po-Jen Hsiao, Shih-Hua Lin
Frontiers in Medicine.2022;[Epub] CrossRef
Secondary dyslipidemia: its treatments and association with atherosclerosis
Hidekatsu Yanai, Hiroshi Yoshida
Global Health & Medicine.2021; 3(1): 15. CrossRef
Hypothyroidism-associated rhabdomyolysis
Fahmi Yousef Khan, Theeb Osama Sulaiman, Raza Ali Akbar
Imam Journal of Applied Sciences.2021; 6(2): 31. CrossRef
Phenotyping of Korean patients with better-than-expected efficacy of moderate-intensity statins using tensor factorization
Jingyun Choi, Yejin Kim, Hun-Sung Kim, In Young Choi, Hwanjo Yu, Katriina Aalto-Setala
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Statin‐related aminotransferase elevation according to baseline aminotransferases level in real practice in Korea
H.‐S. Kim, S. H. Lee, H. Kim, S.‐H. Lee, J. H. Cho, H. Lee, H. W. Yim, S.‐H. Kim, I.‐Y. Choi, K.‐H. Yoon, J. H. Kim
Journal of Clinical Pharmacy and Therapeutics.2016; 41(3): 266. CrossRef
Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis
R. Baeza‐Trinidad, A. Brea‐Hernando, S. Morera‐Rodriguez, Y. Brito‐Diaz, S. Sanchez‐Hernandez, L. El Bikri, E. Ramalle‐Gomara, J. L. Garcia‐Alvarez
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Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
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A Case of Lingual Thyroid Treated by 131I Ablation.: Myeong Ho Yeon, Yong Hyeok Choi, Young Rak Choi, Woo Ri Park, Hyung Jin Choi, Tae Keun Oh, Hyun Jeong Jeon; Endocrinol Metab. 2012;27(4):303-307. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.303

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Abstract PDF: A lingual thyroid is a rare developmental anomaly caused by the failure of the descent of the thyroid gland anlage early in the course of embryogenesis. The incidence of lingual thyroid has been reported to be 1/100,000. Lingual thyroid is often asymptomatic but may cause dysphagia, dysphonia, upper airway obstruction and hemorrhage. In this report, we described the case of a 50-year-old women experiencing lingual thyroid who had subclinical hypothyroidism. She underwent successful 131I ablation and has done well on thyroid hormone replacement therapy.

A Case of Hypothyroidism in Remission during Pregnancy.: Ha Do Song, Eun Jin Han, Sung Ja Lee, Ji Hoon Yang, So Young Park, Sung Hoon Kim, Ki Ok Han, Hyun Koo Yoon, Chang Hoon Yim; Endocrinol Metab. 2012;27(4):295-298. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.295

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Abstract PDF: Hypothyroidism should be treated in pregnancy, because it has been associated with an increased risk of adverse pregnancy complications, as well as detrimental effects upon fetal neurocognitive development. The goal of L-thyroxine (LT4) treatment is to normalize maternal serum TSH values within the trimester-specific pregnancy reference range. 50% to 85% of hypothyroid women being treated with exogenous LT4 need to increase the dose during pregnancy. In this study, we report a case of a 29-year-old woman with hypothyroidism who had been in remission and discontinued LT4 treatment during her pregnancy. Three months after delivery she had a relapse of hypothyroidism and was retreated with LT4. Many factors can influence the gestational requirement for LT4, therefore maternal serum TSH should be monitored and the LT4 dose should be adjusted in pregnant patients with treated hypothyroidism.

Original Article

Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism.: Joo Hyung Kim, Sol Ah Park, Nam Hoon Kim, Jae Hee Ahn, Yoon Jung Kim, Myongjin Cho, Yoon Jung Lee, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim; Endocrinol Metab. 2012;27(3):200-207. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.200

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Abstract PDF

BACKGROUND
Thyroid function depends on ethnic and environmental factors. North Korean refugees have the same genetic background as South Koreans, but they have been exposed to different environments. This study examines the prevalence and pattern of thyroid disorders in North Korean women living in South Korea, focusing on subclinical hypothyroidism (SCH). METHODS: The intended sample was a total of 327 North Korean women residing in Seoul. Health questionnaires and medical examinations, including serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine, and thyroid autoantibodies, were conducted. RESULTS: The prevalence of SCH was 9.4%. In logistic regression analysis, smoking, menopause, length of stay in South Korea, body mass index, history of thyroid disease, and metabolic syndrome were not associated with the risk of SCH. Whereas, the positivity of autoantibodies were associated with a high risk for SCH (odds ratio [OR], 4.840; 95% confidence interval [CI], 1.80-13.017; P = 0.002), and age was associated with a low risk for SCH (OR, 0.94; 95% CI, 0.888-0.994; P = 0.031). The serum TSH levels also decreased with increasing age, and in particular, there was significant difference between 30-39 years, and over 60 years (2.33 +/- 1.51 microIU/mL vs. 1.54 +/- 0.73 microIU/mL, P = 0.028). CONCLUSION: In North Korean women, the positivity of autoantibodies was associated with a high risk for SCH. But interestingly, a younger age was associated with a high risk for SCH. Considering that they suffered from severe famine at the period of growth, and this led to malnutrition, their thyroid dysfunction might be associated with the peculiar environment that they experienced.

Citations

Citations to this article as recorded by

Systematic review of evidence on public health in the Democratic People’s Republic of Korea
John J Park, Ah-Young Lim, Hyung-Soon Ahn, Andrew I Kim, Soyoung Choi, David HW Oh, Owen Lee-Park, Sharon Y Kim, Sun Jae Jung, Jesse B Bump, Rifat Atun, Hee Young Shin, Kee B Park
BMJ Global Health.2019; 4(2): e001133. CrossRef
Environmental Factors and Thyroid Dysfunction
Hyun-Kyung Chung
Endocrinology and Metabolism.2012; 27(3): 191. CrossRef

Case Reports

Thyroid Dysfunction Induced by Metastatic Thyroid Cancer: Report of Two Cases.: Kang Hee Ahn, Bo Kyung Choi, Won Jin Kim, Bo Gwang Choi, Yun Kyung Jeon, Sang Soo Kim, Soo Hyung Lee, Bo Hyun Kim, Yong Ki Kim, In Ju Kim; Endocrinol Metab. 2010;25(4):370-373. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.370

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Abstract PDF

Metastases to the thyroid gland are not frequently observed in clinical practice, although an overall incidence of secondary thyroid malignant tumors has been reported to range from 1.25% to 24% in autopsy series. Generally, patients with metastatic thyroid cancer present with euthyroidism and they do not develop thyroid dysfunction. Thyroid dysfunctions, including hypothyroidism and hyperthyroidism, rarely occur in patients with metastatic thyroid cancer. We describe here a case of hypothyroidism induced by thyroid metastasis from cancer of an unknown primary site in a 53-year-old man and another case of thyrotoxicosis induced by thyroid metastasis from lung cancer in a 65-year-old man.

Citations

Citations to this article as recorded by

Thyroid metastases from breast cancer: a case report and brief literature review
Siqi He, Jicheng Li, Donglai Wang, Qiaohong Nong, Guangxin Li, Ying Yin, Xiaoling Liu
Frontiers in Oncology.2025;[Epub] CrossRef

Secondary Pituitary Hyperplasia Induced by Hashimoto's Thyroiditis Related Hypothyroidism: A Case Report.: Kwang Joon Kim, Hyun min Kim, Obin Kwon, Eun Young Park, Yong ho Lee, Jae Won Hong, Jin Wi, Eun Jig Lee; J Korean Endocr Soc. 2010;25(1):72-77. Published online March 1, 2010; DOI: https://doi.org/10.3803/jkes.2010.25.1.72

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Abstract PDF

Pituitary hyperplasia associated with untreated primary hypothyroidism in children is a rare condition. There are only a few reports on this condition in children, and especially when pituitary hyperplasia is accompanied with Hashimoto thyroiditis and growth arrest. Here, we describe an unusual association of pituitary hyperplasia with hypothyroidism and growth retardation, and this was all caused by Hashimoto thyroiditis. Hormonal testing showed a low thyroxine level and a high thyroid stimulating hormone level, elevated anti-thyroglobulin, low growth hormone levels and prepubertal levels of gonadotropins. A large intrasellar mass expanding beyond the sella turcica was detected on magnetic resonance imaging (MRI). Homogeneous contrast enhancement of mass highly suggested that it was a pituitary hyperplasia rather than a pituitary tumor. Therapy with L-thyroxine resulted in rapid improvement of the clinical signs, including renewed growth, normalization of the hormone levels and resolution of the pituitary hyperplasia on MRI within 90 days. In children, prolonged unrecognized primary hypothyroidism might be accompanied by growth deficiency and pubertal disharmony. Physicians must be aware of pituitary hyperplasia in these cases.

Citations

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Pituitary macroadenoma secondary to Hashimoto’s thyroiditis: inadvertent diagnosis in a pre-pubertal girl
Deepanjan Bhattacharya, Rakesh Kumar, Jaivinder Yadav
Tropical Doctor.2020; 50(3): 240. CrossRef
Pituitary Hyperplasia Secondary to Hypothyroidism Caused by Hashimoto's Thyroiditis in a Female Adolescent
Jeoung Suk Kim, Min Sun Kim, Sun Jun Kim, Gyung Ho Chung, Pyoung Han Hwang, Dae-Yeol Lee
Journal of Korean Society of Pediatric Endocrinology.2011; 16(3): 185. CrossRef

Autoimmune Thyroiditis during Antiviral Therapy with Peginterferon.: Jung Min Roh, Jeong Seon Yoo, Yoon Bum Lee, Hye Rim An, Hong Kyu Choi, Kyo Tae Jung, Jong Suk Park, Kwan Sik Lee, Kyung Rae Kim; J Korean Endocr Soc. 2010;25(1):68-71. Published online March 1, 2010; DOI: https://doi.org/10.3803/jkes.2010.25.1.68

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Abstract PDF: Combination treatment with pegylated interferon and ribavirin has been established as a standard therapy for chronic hepatitis C. Although interferon therapy is relatively safe, an important side effect is the induction of autoantibodies and autoimmune disease, especially autoimmune thyroid disease. Interferon associated autoimmune thyroid disease can consist of autoimmune hypothyroidism, Graves' disease, and destructive thyroiditis. Thyroid disease may lead to dose reduction or discontinuation of therapy.

Original Articles

Association between Cigarette Smoking and Thyroid Function in Adults without Previous History of Thyroid Disease.: Bo Hyun Kim, Won Bae Kim, Tae Yong Kim, Hong Kyu Kim, Seong Hoon Jeon, Chang Won Lee, Young Kee Shong; J Korean Endocr Soc. 2008;23(2):123-128. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.123

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Abstract PDF

BACKGROUND
Cigarette smoking has a significant impact on thyroid function. However, the association between smoking and thyroid function is incompletely understood. METHODS: We conducted a cross-sectional study that included 90,970 adults (age range: 20 to 79) who had visited the health promotion center at Asan Medical Center between January 1, 2001, and December 31, 2003. Those subjects with previous known thyroid disease, a history of thyroid operation, a history of thyroid function altering medication (herb, estrogen or digestive) or a family history of thyroid disease were excluded. Finally, 47,577 subjects (males: 30,726, females: 16,851) were included in this study. We calculated the age-adjusted geometric mean of the serum TSH and the age-adjusted mean of the serum free T4 among the current, former and never smokers. We also analyzed the age-adjusted prevalence of hypothyroidism and hyperthyroidism among each group. RESULTS: Among men, the geometric mean TSH level was significantly low in the current (1.40 mIU/L, 95% confidence interval [CI]: 1.38-1.41) and former smokers (1.59 mIU/L, 95% CI: 1.57-1.61) compared with the never smokers (1.65 mIU/L, 95% CI: 1.63-1.68). The mean free T4 level was high in the current smokers (1.236 ng/dL, 95% CI: 1.234-1.239) compared with the never smokers (1.234 ng/dL, 95% CI: 1.230-1.238). Similarly, among women, the geometric mean TSH level was low in the current smokers (1.75 mIU/L, 95% CI: 1.67-1.87) compared with the never smokers (1.85 mIU/L, 95% CI: 1.83-1.87). The mean free T4 level was high in the current smokers (1.149 ng/dL, 95% CI: 1.139-1.159) compared with the never smokers (1.138 ng/dL, 95% CI: 1.135-1.140). Among the current male smokers, heavy daily smoking (over 2 packs per day) was more associated with low TSH levels than moderate smoking (less than 1 pack per day). In men, the prevalence of subclinical hypothyroidism was low in the current smokers compared with the never smokers (odds ratio: 0.53, 95% CI: 0.43-0.66). CONCLUSION: We found that current smokers had lower TSH levels and higher free T4 levels than never smokers in both men and women and smoking was associated with a low prevalence of subclinical hypothyroidism in men, which may be of importance when evaluating subjects with subclinical hypothyroidism in Korea.

Citations

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Evaluation of Serum Biochemical Parameters Primarily Liver Functions in Smokers: A Case-control Study
Yılmaz Sezgin, Sinan Becel, Abdurrahman Polat
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi.2024; 13(3): 1125. CrossRef
Reference interval for thyrotropin in a ultrasonography screened Korean population
Mijin Kim, Tae Yong Kim, Soo Han Kim, Yunkyoung Lee, Su-yeon Park, Hyung-don Kim, Hyemi Kwon, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
The Korean Journal of Internal Medicine.2015; 30(3): 335. CrossRef
Clinical Review of Thyroid Dysfunction in the Subjects for Health Check-up
Ji Eun Park, Ho Chan Cho
Journal of Korean Thyroid Association.2012; 5(1): 52. CrossRef
Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism
Joo Hyung Kim, Sol Ah Park, Nam Hoon Kim, Jae Hee Ahn, Yoon Jung Kim, Myongjin Cho, Yoon Jung Lee, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim
Endocrinology and Metabolism.2012; 27(3): 200. CrossRef

Comparison of Common Carotid Artery Intima-Media Thickness between Subclinical Hypothyroidism and Euthyroidism.: Kyung Sun Park, Jung Im Rue, Soo Kyung Kim, In Jae Kim, Sang Wook Lim, Seok Won Park, Yu Lee Kim, Dong Hoon Cha, Yong Wook Cho, Young Kil Choi, Sang Jong Lee; J Korean Endocr Soc. 2006;21(6):490-496. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.490

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Abstract PDF

BACKGROUND
Common carotid artery intima-media thickness (IMT), which is increased in patients with overt hypothyroidism, is an independent risk factor of the atherosclerosis-related disease. This study was performed to compare serum lipid level and common carotid artery IMT among patients with overt hypothyroidism, subclinical hypothyroidism and euthyroidism. METHODS: Patients with newly-diagnosed subclinical (n=32) and overt (n=32) hypothyroidism were selected for this study. All of the patients and an age- and sex-matched euthyroidism cohort were checked for clinical characteristics and serum lipid levels. Common carotid artery IMT was also measured using high resolution B-mode ultrasonography. RESULTS: Statistically significant differences were observed between the total cholesterol levels of patients with subclinical hypothyroidism and those with euthyroidism. When common carotid artery IMT measured by ultrasonography, subclinical (0.67 +/- 0.11 mm) and overt (0.71 +/- 0.12 mm)) hypothyroidism showed significantly increased mean IMT compared to that of euthyroidism (0.58 +/- 0.07 mm, P < 0.05, respectively), but no differences were found between subclinical and overt hypothyroidism. CONCLUSION: We concluded that subclinical hypothyroidism is related to increased common carotid artery IMT as well as dyslipidemia. Therefore, we recommend that treatment principle of subclinical hypothyroidism be established through large-scale, prospective studies performed to determine the effect of thyroid hormone replacement on the reduction of common carotid artery IMT.

Citations

Citations to this article as recorded by

The Effect of Brief Thyroid Functional Changes on Arterial Stiffness in Patients Who Preparing Radioactive Iodine Administration
Ho-Su Kim, Jae-Hoon Jung, Jung Hwa Jung, Soo Kyoung Kim, Sungsu Kim, Jeong Rang Park, Rock Bum Kim, Jong Ryeal Hahm
International Journal of Thyroidology.2015; 8(2): 161. CrossRef
Changes of Body Composition, Blood Concentrations of Lipid Profiles and Thyroid Hormone After Exercise Training in Hypothyroid-induced Rat
Kijin Kim
The Korean Journal of Obesity.2012; 21(1): 65. CrossRef

Case Reports

A Case of Primary Hypothyroidism with Anti-Triiodothyronine Autoantibody.: Jae Ho Park, Ji Hoon Ahn, Mi Hee Kang, Jong Chul Won, Kyung Wook Lee, Yeo Joo Kim, Ji Oh Mok, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2006;21(5):428-432. Published online October 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.5.428

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Abstract PDF

Antithyroid hormone autoantibodies can be present in the sera of patients with thyroid and non-thyroid disorders. Antithyroid hormone autoantibodies in a patient's serum interfere with radioimmunoassay of thyroid hormones. Clinically, this interference can result in discordance between the serum thyroid hormone levels and the clinical features of the patient, which can lead to misdiagnosis or inappropriate treatment. We experienced a woman who had primary hypothyroidism with unexpectedly high concentrations of serum total triiodothyronine (T(3)) and free T(3), and she had been treated for Graves' disease in the past. Through the use of a polyethylene glycol precipitation method, we detected the anti-triiodothyronine autoantibodies in her serum. We report on this case along with a review of the related literature.

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Thyroxine (T4) Autoantibody Interference of Free T4 Concentration Measurement in a Patient With Hashimoto’s Thyroiditis
Mi-Na Lee, Soo-Youn Lee, Kyu Yeon Hur, Hyung-Doo Park
Annals of Laboratory Medicine.2017; 37(2): 169. CrossRef

A Case of Hashimoto's Thyroiditis Associated with Multiple Sclerosis.: Beom Ju Lee, Jong Chan Oh, Sang Yong Kim, Dong Hyun Choi, Jung In Kim, Gyung Nam Kim, Jin Hwa Kim, Hak Yeon Bae; J Korean Endocr Soc. 2004;19(4):426-432. Published online August 1, 2004

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Abstract PDF: Multiple sclerosis is an autoimmune disorder, which may be associated with other rheumatologic or endocrine diseases induced by autoantibodies. Hashimoto's thyroiditis is also an organ-specific autoimmune disorder, and its association with multiple sclerosis during interferon therapy has been reported. Cases of Hashimoto's thyroiditis with multiple sclerosis are very rare. Herein is reported our experience of a 27 year-old woman who presented with general weakness, cold intolerance and progressive muscle weakness. She had been treated with levothyroxine due to subclinical hypothyroidism, which rather aggravated the symptom. In a CSF analysis, the myelin basic protein level was above 10 ng/dL and that of the IgG and the IgG index were 135 mg/dL and 7.8, respectively. In a brain MRI, demyelinating lesions in the left middle pontocerebellar junction and right subcortex were shown. She was diagnosed with multiple sclerosis, and the symptom improved after glucocorticoid and levothyroxine therapy. Herein is reported the first Korean case of Hashimoto's thyroiditis associated with multiple sclerosis

A Case of Acute Rhabdomyolysis as a first Manifestation of Primary Hypothyroidism.: Jung Min Lee, Hyun Shik Son, Hye Jung Lee, Sook Hee Hong, Jong Min Lee, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2003;18(1):79-84. Published online February 1, 2003

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Abstract PDF: Various symptoms, such as bradycardia, hypotension, fatigue, constipation, myalgia, muscle weakness, delayed tendon reflex, and so forth, presented in hypothyroidism. Of these symptoms, muscle weakness, myalgia, and delayed tendon reflex are common features of hypothyroid myopathy. Acute rhabdomyolysis, a very severe form of myopathy, but is a rare manifestation of primary hypothyrodism. A 29-year-old man developed acute rhabdomyolysis, associated with primary hypothyroidism as a first manifestation. After thyroxine replacement therapy, he exhibited some improvement in muscle weakness and in non-pitting edema. We report a case of primary hypothyroidism presenting with spontaneous rhabdomyolysis as a first manifestation.

Original Articles

Changes in Plasma Leptin Levels Relating to Short-Term Thyroid Manipulation in Rats.: Min Seon Kim, Cho Ya Yoon, Young Min Cho, Hye Seung Jung, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Stephen R Bloom; J Korean Endocr Soc. 2002;17(2):197-205. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Leptin, an adipocyte derived hormone, and thyroid hormone have similar effects on energy homeostasis, such that a shortage of both hormones is associated with decreased energy expenditure and increased body weight. Therefore, for the maintenance of energy homeostasis may require a close interaction between leptin and thyroid hormone. This study was performed to investigate the change in plasma leptin levels relating to short-term thyroid manipulation causing no significant change in body weight. METHODS: Hypothyroidism was induced by surgical thyroidectomy and hyperthyroidism by subcutaneous injection of 50 g of L-T3/100 g body weight/day, for 5 days, in 6~8 weeks old male Wistar rats. Body weights and food intakes were monitored daily until sacrifice. Plasma samples were collected, and the thyroid stimulating hormone (TSH), free triiodothyronine (T3) and leptin levels measured. The plasma leptin levels in rats with hypothyroidism and hyperthyroidism were compared with those of body weights at death and food intakes during the study, atched controls. RESULTS: The rats treated with L-T3 consumed equal amount of food as freely fed, rats but their final body weights were significantly lower (L-T3 treated 220.0 +/- 1.8 vs. freely fed 226.0 +/- 2.0 g, p<0.05). There was no difference in food intake during study, and final body weight, between the thyroidectomised rats and their paired controls (thyroidectomised 220.4 +/- 1.7 vs. paired 223.9 +/- 4.7 g, P=NS). Plasma leptin levels in the L-T3 treated rats were significantly lower than those in freely fed rats (L-T3 treated 1.7 +/- 0.1 vs. freely fed 4.8 +/- 0.2 ng/ml, p<0.005). Conversely, the thyroidectomised rats had higher plasma leptin levels, compared to those of their paired controls (thyroidectomised 4.8 +/- 0.3 vs. paired 1.7 +/- 0.1 ng/ml, p<0.005). CONCLUSION: The Plasma leptin levels in the rats were decreased by short term hyperthyroidism, while they were increased by short term hypothyroidism. These findings suggest that thyroid hormones may affect the production or secretion of leptin

A Frequency of Hypothyroidism in a Population of Hypercholesterolemin Subjects.: Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yun Ho Choi, Myung Hee Shin; J Korean Endocr Soc. 1998;13(3):351-358. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Hypothyroidism is a treatable cause of secondary hyperlipidemia. The lipid profile usually seen is an increased total and low density lipoprotein(LDL) cholesterol, and the plasma triglyceride may also be increased. Hypercholesterolemia associated with hypothyroidism is an important factor in the pathogenesis of coronary artery disease(CAD). And the hyperchole-sterolemia caused by hypothyroidism is potentially reversible by thyroid hormone replacement therapy. Hypothyroidism should be ruled out by routine laboratory screening as a treatable cause of secondary hyperlipidemia and increased CAD risk. We carried out this study aimed at evaluating the frequency of hypothyroidism and its relationship with serum cholesterol concentration in Koreans. METHODS: We investigated 15028(men 8273, women 6755) Korean subjects who visited our hospital center for health promotion during an one year period(from January 1, 1996, to December 31, 1996). Among them, we analyzed 6756 hypercholesterolemic subjects whose serum cholesterol levels were greater than 200 mg/dL. They performed thyroid function tests(total T, T4, and TSH) and lipid profiles(total cholesterol, triglyceride and HDL-cholesterol) were measured by enzyme assay. We defined hypothyroidism by serum thyrotropin values greater than 5 U/mL. RESULTS: The observed prevalence of hypothyroidism was 2.4%(163/6756). Among those with high TSH levels, 17(10.4%) had overt hypothyroidism with a low T4 (below 6 g/dL) level. As we analyzed the frequency of hypothyroidism according to cholesterol range by 20 mg/dL, the frequency was significantly increased in the group whose serum cholesterol levels were greater than 300 mg/dL, especially in women over 50 years of age. Analysis of lipid parameters showed that hypertriglyceridemia was frequent and hyperHDLaemia was observed in hypothyroidic populations. CONCLUSION: Screening for hypothyroidism by measurement of thyrotropin values is of particular importance in patients with hypercholesterolemia. And the frequency of hypothyroidism was more significantly increased in whose serum cholesterol levels were greater than 300 mg/dL, especially in the group of women over 50 years of age.

Case Reports

A Case of Polygrandular Automune type II syndrome associated empty sella.: Jin Soo Kim, Mi Duk Lee, Hong Seung Kim, Choon Hee Chung; J Korean Endocr Soc. 1998;13(2):295-300. Published online January 1, 2001

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Abstract PDF: The polyglandular autoimmune(PGA) syndrome designate as the dysfimction of endocrine and nonendocrine systems involving two or more organs on the basis of an autoimmune mechanism. There are 3 types of PGA syndrome and their etiology or pathogenesis is still not complete by understood. Type I PGA is present in the patients who have at least two of the triad of Addison's disease, hypopacathyroidism, and chronic mucocutaneous candidiasis. Type II PGA is present in the those who have Addisons disease with autoimmune thyroid disease and/or insulin dependent diabetes mellitus, but who do not have hypoparathyroidism or candidiasis. Type III PGA is present in the one who have autoimmune thyroid disease, without Addisons disease, but with another autoimmune disease report a case of autoimmune polyglandular syndrome type II in a seventy-three years old female patient who had primary adrenal insufficiency, primary hypothyroidism, and empty sella, pulmonary tuberculosis.

A Case of Turner's Syndrome with Hypothyroidism and Pericardial Effusion.: Sung Kil Lim, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Jin Seok Kim, Yong Suk Yoon, Suk Ho Kwon, Jae Hyun Nam; J Korean Endocr Soc. 1997;12(4):661-666. Published online January 1, 2001

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Abstract PDF: Clinical manifestations of hypothyroidism are very various and these degree are related to the severity and duration of the disease. Pericardial effusions, one of the manifestations of hypothy-roidism, were relatively common in the past. However, recently they may not be so frequent representative of hypothyroid subjects. The higher frequency of Hashimotos thyroiditis in Turners syndrome, especially those with an X-isochromosome, compared with the general population is well known. The pathophysiological process of autoimmunity is thought to be linked with the presence of an abnormal X-chromosome. Recently we experienced a case of X-isochromosome Turners syndrome with hypothyroidism and pericardial effusion and report it with reviews of the literatures.

Four Cases of Newly Developing Goiter During Lithium Carbonate Therapy.: Kwan Woo Lee, Young Goo Shin, Sung Keun Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim; J Korean Endocr Soc. 1997;12(4):621-626. Published online January 1, 2001

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Abstract PDF: Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.

A Case of Piouitary Hyperplasia with Retardation due to Primary Hypothyroidism.: Hong Seung Kim, Choon Hee Chung, Young Goo Shin, Bong Ki Lee; J Korean Endocr Soc. 1997;12(4):589-595. Published online January 1, 2001

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Abstract PDF: Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. A 17-year-old girl came to the hospital due to short stature, general weakness and galac-torrhea. The magnetic resonance imaging (MRI) study showed pitutary enlargement. The hormone study showed hyperprolactinemia, decreased basal growth hormone level and primary hypothyroi-dism. By thyroid replacement therapy only, mass was successfully regressed on follow up MRI after 4 months, and growth acceleration could be achieved.

Original Article

Changes in Properties of Thyrotropin Receptor Antibodies Following Radioiodine Treatment in Patients with Graves' Disease.: Won Bae Kim, Hyun Kyung Chung, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Do Joon Park, Yeon Sahng Oh; J Korean Endocr Soc. 1997;12(2):194-206. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It has been suggested that thyroid stimulation blocking antibody (TSBAb) is involved in the development of early hypothyroidism after radioiodine treatment in patient with Graves disease. However, previous studies have reported the effect of radioiodine treatment on overall changes of TSH receptor antibodies without detailed observation of changes in properties of TSH receptor antibodies. The aim of this study is to evaluate the effect of radioiodine treatment on thyroid stimulation antibody (TSAb) or on thyroid stimulation blocking antibody (TSBAb) activities and to see whether the appearance of TSBAb after radioiodine treatment is involved in the development of early hypothyroidism in patients with Graves disease. METHODS: The activities of TSAb, TSBAb were measured serially with human TSH receptor transfected Chinese hamster ovary (CHO) cells in 36 patients with Graves disease who received 131I treatment. In addition to the wild type TSH receptor-expressing cells, we used a chimeric receptor that 90-165 amino acid residues were substituted by those of rat LH/CG receptor (Mc2) for measurement of TSBAb without interference by the presence of TSAb and for evaluation of TSAb epitope spreading. We evaluated the association of early hypothyroidism after 131I treatment with changes of various immunologic parameters. RESULTS: In 14 (39%) of 36 patients, TSBAb activities were present in their sera before or after 131I treatment. Four of them had TSBAb activities before 131 treatment, and 12 newly acquired TSBAb activities after 131I treatment. The existence of TSBAb was not associated with the development of early hypothyroidism after 131I treatment but with low TSAb activities before 131 treatment, high thyroidal uptake of 131I given and with old age. The phenomena of epitope spreading measured by TSAb with Mc2 mutant clone before and after 131I treatment was not infrequent, but it had no clinical relevance. CONCLUSION: These results suggest that the existence of TSBAb may be not a major factor in the development of early hypothyroidism after radioiodine treatment in Graves disease. Other factors such as TSAb activities before radioiodine treatment, the efficiency of thyroidal uptake of 131I or old age are associated with the development of early hypothyroidism.

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