Hypothyroidism Causes and Treatments
This chapter describes four murine models of autoimmune diseases two related to autoimmune myocarditis and two related to autoimmune thyroiditis. The first model, Coxsackie virus B3 (CB3)-induced myocarditis, results in the development of acute myocarditis in susceptible as well as resistant mouse strains, whereas chronic myocarditis develops only in genetically susceptible mice. CB3-induced myocarditis closely resembles the course of human myocarditis, which is believed to be initiated by viral infection. Mouse cardiac myosin heavy chain has been identified as the major antigen associated with the late chronic phase of viral myocarditis. The second model is cardiac myosin-induced experimental autoimmune myocarditis (EAM) and, in a modification, cardiac a-myosin heavy chain peptide-induced myocarditis. In the EAM model, cardiac myosin or the relevant peptide in Freund's complete adjuvant (FCA)is injected subcutaneously into mice. The immune response, the histological changes, and the...
This chapter explores the interactions of anemia and aging that are of interest for at least three reasons. First, incidence and prevalence of anemia increase with aging (6-8). Second anemia may represent the early sign of an underlying serious disease such as cancer, hypothyroidism or malabsorption (6). Third, anemia itself is associated with increased mortality and disability (7). It is reasonable to expect that prompt and effective management of anemia may help compress the aging-related morbidity.
Often restrict themselves to a liquid diet, which is tolerated better than solids. Bezoars are common and are seen in up to 12 of postgastrectomy patients (14). Gastric atony (Fig. 9) is a major complication of gastric surgery. This may be further exacerbated by diabetes, hypothyroidism, and neurologic disorders. It is important to determine whether the impedence to gastric outflow is mechanical or functional. Endoscopy, contrast radiography, and scintigraphy usually allow differentiation.
Depletion of CD52 positive cells CD52 is expressed on the vast majority of differentiated lymphocytes, monocytes, and macrophages. Alemtuzumab, a humanized antibody against CD52 based on CAM-PATH-1 (Hale et al., 1988), and utilized for lymphoma therapy, leads to a transient but profound depletion of CD52 expressing cells. Interestingly, the analysis of effects on different lymphocyte populations revealed a profound depletion of CD4+ and CD8+ T cells, whereas B cell counts increased. One clinical trial initially showed a positive effect on MRI activity in treated MS patients (Moreau et al., 1994), but one-third of patients developed antibody-mediated autoimmune thyroid disease (Coles et al., 1999). Further monitoring of patients treated with this antibody revealed progressive brain and spinal cord atrophy associated with clinical deterioration, though reduction of inflammatory activity in MRI was sustained (Paolillo et al., 1999). In keeping with these findings, patients in...
In a subsequent study, this same group stratified the patients by age and found a strong and progressive effect on all laboratory parameters. In other words, as the patients became older, there was an increased incidence of cobalamin deficiency, as shown in Table 3.8. Patients with autoimmune gastritis-associated IDA had many features overlapping with classic pernicious anemia (e.g., coincident thyroiditis, diabetes mellitus, Sjogren's syndrome, etc.). This raises the question of whether H. pylori gastritis represents an early phase of a progressive disease in which an infectious disease is
Chemokines in allergic inflammation. J Allergy Clin Immunol 1997 99 273-277. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med 1996 335 99-107. Finn A, Kaplan AP, Fretwell R, Qu R, Long J. A double-blind, placebo-controlled trial of fexofenadine HCl in the treatment of chronic idiopathic urticaria (CIU). J Allergy Clin Immunol 1999 103 1071-1078. Greaves MW. Chronic urticaria. N Engl J Med 1995 332(26) 1767-1772.
Numerous studies have demonstrated that FTY720 synergizes with classical immunosuppressants (e.g. cyclosporine A, FK506, RAD001, steroids) in rodent and non-human primate models of solid organ and islet transplantation 24,25,37,42 . The most profound activity of FTY720 monotherapy has been seen in experimental autoimmune encephalomyelitis (EAE) 24,31,43 . Efficacy has also been reported in models of systemic lupus erythematosus, graft versus host disease, type-1 diabetic mice, adjuvant- and collagen-induced arthritis, experimental autoimmune myocarditis, colitis, experimental autoimmune thyroiditis and uveoretinitis 24,25,44-51 .
HYPOTHYROID OR HYPERTHYROID STATES Primary hypothyroidism Secondary hypothyroidism 4. List common signs, symptoms, and causes of hypothyroidism. The most common cause of hypothyroidism is surgical or radioiodine ablation of thyroid tissue in the treatment of hyperthyroidism, most commonly Graves' disease. Other causes of hypothyroidism include chronic thyroiditis (Hashimoto's thyroiditis), drug effects, iodine deficiency, and pituitary or hypothalamic dysfunction. The signs and symptoms observed in patients with mild hypothyroidism are nonspecific, and clinical detection is extremely difficult. Patients with severe long-term untreated hypothyroidism may progress to myxedema coma, which is frequently fatal. Factors that may lead to myxedema coma in hypothyroid patients include cold exposure, infection, trauma, and administration of central nervous system depressants. Myxedema coma is characterized by hypoventilation, hypothermia, hypotension, hyponatremia, hypoglycemia, obtundation,...
A very small percentage of women (1 ) experience natural menopause before the age of 40. It is not known why these people stop having their periods. Idiopathic ovarian insufficiency or premature ovarian failure is a condition that usually occurs in women under the age of 40 and causes menopause. Idiopathic ovarian insufficiency is usually caused by autoimmune and genetic disorders, Addison's disease (disorder of the adrenal glands, which manufacture steroid hormones), or hypothyroidism (an underactive thyroid gland).
Anaerobes belonging to the indigenous flora of the oral cavity can be recovered from various infections adjacent to that area such as cervical lymphadenitis (7,8) subcutaneous abscesses (9) and burns (10) in proximity to the oral cavity human and animal bites (11) paronychia (12) tonsillar and retropharyngeal abscesses (13) chronic sinusitis (14) chronic otitis media (15) periodontal abscess (16) thyroiditis (17) aspiration pneumonia (18) empyema (19), and bacteremia associated with one of the above infections (20). The predominant anaerobes recovered in these infections are species of anaerobic gram-negative bacilli including pigmented Prevotella and Porphyromonas, Prevotella oralis, Fusobacterium, and gram-positive anaerobic cocci (Peptostreptococcus spp.) which are all part of the normal flora, the mucous surfaces of the oral, pharyngeal, and sinus flora (Table 3). 17. Brook I. Microbiology and management of acute suppurative thyroiditis in children. Int J Pediatr Otorhinolaryngol...
In such cases of gland ablation or removal, there is likely to be a severe hyposecretion (HIGH-poh-see-KREE-shun) of the gland's hormones. Hyposecretion is a ''deficient or below normal'' (hypo-) ''secretion'' of some substance. After thyroidectomy (ablation or removal of the thyroid), for example, the patient may suffer from a hyposecretion of thyroxine. The resulting disease state is often called hypothyroidism (high-poh-THIGH-royd-izm). The patient with hypothyroidism will tend to have an extremely low BMR (basal metabolic rate), an abnormally low body temperature, sleep frequently, and be mentally unresponsive and sluggish. The major cause of these symptoms, of course, is hyposecretion (or nearly absent) secretion of thyroxine into the bloodstream.
Important metabolic causes of parkinsonism include hypothyroidism and parathyroid dysfunction. Patients with hyperparathyroidism have clinical presentation identical to that of idiopathic PD, but the syndrome is levodopa resistant. The symptoms, however, may be relieved after resolution of the parathyroid dysfunction by surgical removal of the parathyroid adenoma. Hypoparathyroidism may also cause levodopa unresponsive parkinsonism (69,70).
Diabetes is probably one of the best investigated endocrine diseases concerning olfactory disorders 121, 166-168 . Most studies reveal slight olfactory deficiencies in diabetic patients especially at threshold levels indicating a peripheral patho-mechanism compatible with a possible diabetic micro-angiopathy or peripheral polyneuropathy. However, olfactory impairment in diabetes is relatively mild. Two recent studies conducted with identification tests in large study samples did not find that diabetic patients exhibit a decreased ability to identify odors compared to healthy controls 121, 122 . Several other endocrine diseases such as hypothyroidism 169, 170 , adrenocortical insufficiency (Addison's disease) 171 or pseudohypoparathyroidism 172 , have been reported to cause olfactory disorders. Many endocrine diseases have been reported to cause hyposmia but rarely lead to anosmia.
This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration. Figure 1.4. This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration.
Once absorbed, GCs bind to serum proteins with prednisolone binding to transcortin, albumin, and a1-acid glycoprotein, while methylprednisolone binds primarily to albumin. GCs are metabolized in the liver into inactive compounds. The rate of metabolism or clearance of GCs can be altered by drug interactions and disease states. Hyperthyroid patients require higher GC doses because of enhanced clearance and metabolism. With hypothyroid patients, slowed elimination is a concern however, this has not been well studied. Cystic fibrosis results in enhanced clearance of prednisolone.
Many asthmatics will only respond once their concomitant sinusitis, GERD, thyroiditis, emotional stress, or pregnancy is under control. Moreover, the treatment of asthma requires close attention to concomitant colds, flu, bronchitis, environmental irritant or pollutant inhalation, recreational drug use, and emotional changes. Compliance is a significant problem, both with medication use and allergen avoidance and inhaler techniques. Thus, the physician who treats asthma needs to keep the whole patient in focus, as well as his work and family environment. On the other hand, proper treatment is nearly always effective and can be extraordinarily gratifying. It is common to convert pulmonary cripples into totally functioning humans in a matter of weeks.
Dopamine, in addition to not achieving the preset goal of organ protection, may also be deleterious because it can induce renal failure in normovolemic and hypovolemic patients. Dopamine also suppresses the secretion and function of anterior pituitary hormones, thereby aggravating catabolism and cellular immune dysfunction and inducing central hypothyroidism. In addition, it blunts the ventilatory drive, increasing the risk of respiratory failure in patients who are being weaned from mechanical ventilation. There have also been recent observational trials that seem to indicate an increased mortality in septic patients treated with dopamine, whereas similar patients treated with norepinephrine did not demonstrate this mortality risk. Based on current metaanalysis (which is lacking good, prospective randomized data), dopamine is now considered a fourth-line agent for cardiogenic, septic, or vasodilatory shock.
The mechanisms responsible for nasal symptoms associated with medications or hormones are variable. Antihypertensive therapies with p-blockers and a-adrenergic antagonists probably affect regulation of nasal blood flow. Oral a-adrenergic antagonists are also commonly utilized for symptom relief of prostate enlargement. Topical ophthalmic p-blocker therapy may also result in nasal congestion by the same mechanism. Nasal congestion and or rhinorrhea may also result from changes in estrogen, and possibly progesterone, either from exogenous administration, pregnancy, or menstrual cycle variations. Hypothyroidism is associated with nasal congestion, rhinorrhea, and a pale, allergic-like nasal mucosa. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may result in congestion and rhinorrhea, primarily in subjects with aspirin triad. Subjects with intermittent symptoms associated with aspirin or NSAIDs may be part of the evolving spectrum of chronic, eosinophilic rhinosinusitis...
Described elsewhere 17 , Metabolites of ATC, i.e., alpha-tocopheryl quinone and hydroquinone, are able to exert potent anti-oxidant activity, albeit in the presence of ATC 80 , Due to the practical difficulties involved in directly obtaining organ biopsies, plasma levels of ATC are frequently used to indirectly reflect tissue levels. It is important to note that with regards body distribution, the most abundant reservoir source of alpha-tocopherol is skeletal muscle by virtue of the fact that this organ is a major component of the body (i.e., contributing to 40 ofbody weight 81 ). Highest concentrations are in adipose and adrenal tissue. ATC circulates in plasma bound to beta-lipoprotein and in red cells (20 of plasma level). Levels increase in hypothyroidism, diabetes mellitus and hypercholestero-laemia, and are reduced in liver disorders and malnutrition. Dietary requirements are in the order of 15-30 IU day.
The alteration of cardiac gene expression in cocaine-induced cardiomyopathy has recently been investigated using a rat model 88 , Specifically, the effects of acute as well as prolonged administration of cocaine were studied with respect to the transcription of atrial natriuretic factor (ANF) mRNAs as a marker of acute mechanical overload 89-91 , Acute and prolonged dosing with cocaine was also investigated with respect to the encoding of myosin heavy chain mRNAs as markers of prolonged mechanical overload 90,92-94 , Additionally, the study also sought to determine the effect of acute and prolonged administration of cocaine in terms of the transcription of type I and III procollagens as markers of active fibrosis 91,95 , The study found that acute injection of cocaine induced ANF gene expression. Cocaine treatment during 28 days resulted in left ventricular hypertrophy (+20 after 24 days) with normal blood pressure, associated with an accumulation of mRNAs encoding ANF and type I and...
A high fever or severe infection can produce hair loss, as can an overactive or underactive thyroid gland. Other causes of hair loss include an inadequate amount of protein in your diet, iron deficiency, or cancer treatment. Certain prescription medications such as those for gout, arthritis, depression, heart disease, or high blood pressure can cause hair loss in some people. Large doses of vitamin A also can cause hair loss. If you notice that your hair is falling out in large amounts after you brush or comb your hair, see your doctor as soon as possible to determine the cause.
Thyroid hormones exert an effect on sebum secretion since thyroidectomy decreases the rate of sebum secretion in rats and administration of thyroxine reverses this effect (140). Increases in sebum secretion rate were observed when thyroxine was given to hypothyroid patients (141), and immunohistochem-ical localization of thyroid hormone nuclear receptors has been demonstrated in human scalp follicles in the nuclei of the outer root sheath cells, dermal papilla cells, sheath cells, and sebaceous gland cells (142). Other than this, little attention has been paid to the effect of thyroid hormones on sebum secretion.
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