P-glycoprotein polymorphism in hypo- and hyper-thyroidism patients

P-glycoprotein (Pgp) is encoded by the multidrug resistance gene (MDR1) in humans and is the product of MDR1. It is expressed in various tissues and is related to drug distribution in intestinal erythrocytes, capillary endotel of brain, proximal tubules cells of kidneys and liver canalicular cells. Expression of Pgp is affected by Pgp polymorphism, and exon 26 C3435T polymorphism is the most common one. It has been thought that expression of Pgp is high in C-allele subjects and this situation is responsible for the resistance against some drugs and substances. Pgp may have a role in the distribution of thyroid hormones, drugs used for hypo- and hyperthyroidism and the resistance occurred. For this purpose possible relationship between T and C alleles and frequency of Pgp polymorphism as well as thyroid hormone distribution in patients with hypo- and hyperthyroidism was investigated. Thirty five hyperthyroidism patients diagnosed as Graves’ disease, 78 hypothyroidism patients diagnosed as Hashimoto’s thyroiditis and 100 healthy volunteers were included in the study. According to the results obtained no statistically significant difference was found in Pgp C3435T polymorphism between hypo- and hyperthyroidism patients. In addition, the serum free T3 levels of hyperthyroidism patients with C alleles was higher than those of subjects with T alleles. No statistically significant difference was seen in the CC, CT and TT genotype frequencies between the patients and control groups. In conclusion, it seems that Pgp polymorphism is not a predictor factor for the occurrence of hypo- and hyperthyroidism. There is a significant relationship between Pgp and the elevated serum free T3 levels of hyperthyroidism patients, and further research will help understand this situation.     

Scintigraphy has the potential to replace thyroid stimulating hormone and ultrasonography in hyperthyroidism diagnosis

The value of thyroid scintigraphy in hyperthyroidism diagnosis has long been the subject of debate. Unresolved issue is whether scintigraphy should be performed routinely, selectively, or for all hyperthyroidism patients. So, this study is concerned with the evaluation of thyroid scintigraphy for identifying hyperthyroidism in comparison with thyroid stimulating hormone (TSH) and ultrasound. This is cross sectional study including convenient patients sample (n = 50, 15 males and 35 females) aged (20–50 years) with primary hyperthyroidism and were attending endocrine clinics at King Faisal Specialist Hospital and Research Centre. All patients performed clinical investigations (TSH, ultrasound and thyroid scintigraphy). Among these patients, 96%, 48/50, had positive findings for hyperthyroidism with thyroid SC (95% CI; 96.0–99.5%); 84%, 42/50, had positive findings for hyperthyroidism by US (95% CI; 70.9–92.8%); and 56%, 28/50, had positive findings for hyperthyroidism by TSH measurement (95% CI; 41.3.0–70.0%). There was very good agreement between scintigraphy diagnosis and ultrasonography (kappa score = 0.812 (P < 0.0001), 95% CI (0.77–0.85). In many cases, scintigraphy provides considerably more functioning and anatomic details than ultrasound. In conclusion, these findings bring forth practical aspects of thyroid scintigraphy utilization for hyperthyroidism. By combining functional and anatomical information in one step, scintigraphy provides non-invasive, simple, fast and cost effective hyperthyroidism diagnostic method and has the potential to replace TSH and ultrasonography in hyperthyroidism investigation.     

Influence of Hyperthyroidism on the Activity of Liver Nitric Oxide Synthase in the Rat

Hyperthyroidism enhances the prooxidant activity of the liver by elevating superoxide radical and/or hydrogen peroxide generation in microsomal, mitochondrial, and peroxisomal fractions, with an increased respiratory burst of Kupffer cells. In this study, the influence of daily doses of 0.1 mg 3,3′,5-triiodothyronine (T₃)/kg for three consecutive days on liver nitric oxide (NO) synthase (NOS) was assessed, as a possible contributory mechanism to T₃-induced liver prooxidant activity. Thyroid calorigenesis was paralleled by a progressive increment in the rate of NO generation, with significant increases after 2 (47%) and 3 days (70%) of T₃treatment, and a net 45% (P< 0.05) enhancement in theN^G-methyl-l-arginine-sensitive NO production, compared to control values. These enhancement effects were reversed to control levels after 3 days of hormone withdrawal, concomitantly with the normalization of hepatic respiration. Enhancement of liver NOS activity in hyperthyroid animals was diminished by 27% (P< 0.05) by the selectivein vivoinactivation of Kupffer cells by gadolinium chloride (GdCl₃), without direct actions of GdCl₃on the enzyme. These data demonstrate that hyperthyroidism leads to a significant and reversible enhancement in rat liver NOS activity, an effect that is exerted at hepatocyte and Kupffer cell levels, thus representing an additional source of prooxidants to those of reactive oxygen species.     

Treatment of hyperthyroidism with radioiodine targeted activity: A comparison between two dosimetric methods

Radioiodine therapy is an effective and safe treatment of hyperthyroidism due to Graves’ disease, toxic adenoma, toxic multinodular goiter. We compared the outcomes of a traditional calculation method based on an analytical fit of the uptake curve and subsequent dose calculation with the MIRD approach, and an alternative computation approach based on a formulation implemented in a public-access website, searching for the best timing of radioiodine uptake measurements in pre-therapeutic dosimetry. We report about sixty-nine hyperthyroid patients that were treated after performing a pre-therapeutic dosimetry calculated by fitting a six-point uptake curve (3–168 h). In order to evaluate the results of the radioiodine treatment, patients were followed up to sixty-four months after treatment (mean 47.4 ± 16.9). Patient dosimetry was then retrospectively recalculated with the two above-mentioned methods. Several time schedules for uptake measurements were considered, with different timings and total number of points. Early time schedules, sampling uptake up to 48 h, do not allow to set-up an accurate treatment plan, while schedules including the measurement at one week give significantly better results. The analytical fit procedure applied to the three-point time schedule 3(6)–24–168 h gave results significantly more accurate than the website approach exploiting either the same schedule, or the single measurement at 168 h. Consequently, the best strategy among the ones considered is to sample the uptake at 3(6)–24–168 h, and carry out an analytical fit of the curve, while extra measurements at 48 and 72 h lead only marginal improvements in the accuracy of therapeutic activity determination.     

Increased calcium leak associated with reduced calsequestrin expression in hyperthyroid cardiomyocytes

IntroductionCalcium (Ca²⁺) leak during cardiac diastole is chiefly mediated by intracellular Ca²⁺ channel/Ryanodine Receptors. Increased diastolic Ca²⁺ leak has been proposed as the mechanism underlying the appearance of hereditary arrhythmias. However, little is known about alterations in diastolic Ca²⁺ leak and the specific roles played by key intracellular Ca²⁺-handling proteins in hyperthyroidism, a known arrhythmogenic condition.AimWe sought to determine whether there were modifications in diastolic Ca²⁺ leak, based on the recording of Ca²⁺ sparks and Ca²⁺ waves; we also investigated changes in the expression and activity of key Ca²⁺ handling proteins, including ryanodine receptors, Sarco-Endoplasmic Reticulum Ca²⁺ ATPase pump and calsequestrin in isolated left-ventricular cardiomyocytes isolated from hyperthyroid rats.Materials and methodsElectrocardiography (ECG) recordings were performed in control and hyperthyroid rats. Ca²⁺ sparks, Ca²⁺ waves, and electrically-stimulated Ca²⁺ transients were recorded in Fluo-3-loaded cardiomyocytes from both experimental groups using confocal microscopy. In addition, left-ventricular homogenates and Ryanodine Receptor-enriched membrane fractions were prepared for assessing [³H]-ryanodine binding, hydrolytic ATPase activity of SERCA pump and expression levels of key proteins by Western blot, and cDNA for real-time qPCR.Results and conclusionsExtrasystoles were observed in hearts of hyperthyroid rats by ECG recordings. Arrhythmogenic activity, high incidence of Ca²⁺ waves, and de novo Ca²⁺ wavelets −in the absence of sarcoplasmic reticulum Ca²⁺ overload- were recorded in these cardiomyocytes. The exacerbated diastolic Ca²⁺ leak and arrhythmogenic activities were related to a diminished expression of calsequestrin along with increased SERCA pump activity, which, in effect, promoted a gain-of-function in RyRs without alterations in SR Ca²⁺ load, RyR expression or its Ca²⁺ sensitivity.     

Melatonin prevents oxidant damage in various tissues of rats with hyperthyroidism

Impairment of thyroid functions brings about pathological changes in different organs of body. Findings of in vivo and in vitro studies indicate that thyroid hormones have a considerable impact on oxidative stress. Melatonin reduces oxidative damage through its free radical eliminating and direct anti-oxidant effects. The present study was undertaken to determine how a 3-week period of intraperitoneal melatonin administration affected oxidative damage caused in experimental hyperthyroidism in rat. The experimental animals were divided into 3 groups (control, hyperthyroidism, hyperthyroidism+melatonin). Malondialdehyde (MDA) and glutathione (GSH) levels were determined in different tissues. MDA levels in cerebral, liver and cardiac tissues in hyperthyroidism group were significantly higher than those in control and hyperthyroidism+melatonin supplemented groups (p<0.001). The highest GSH levels were observed in the group that was administered melatonin in addition to having hyperthyroidism (p<0.001). These results show that hyperthyroidism increased oxidative damage in cerebral, hepatic and cardiac tissues of rat. Melatonin supplementation may also suppress oxidative damage.     

Individual plasma ghrelin changes in the same patients in hyperthyroid,hypothyroid and euthyroid state

Ghrelin is a multifunctional peptide of widespread expression. Since it has been shown to influence energy homeostatis, its potential role in thyroid dysfunction may have clinical significance. In this study, plasma ghrelin changes have been analyzed in the same patients in three different thyroid states for the first time. The study group consisted of 16 patients who had been diagnosed with hyperthyroidism, were treated with radioiodine, developed hypothyroidism after treatment, and finally became euthyroid on l-thyroxine substitution. In the initial state of hyperthyroidism plasma ghrelin levels correlated negatively with fT₃ and fT₄. In hypothyroidism ghrelin concentration increased significantly (p < 0.05). Although the mean value of plasma ghrelin tended to decrease in the euthyroid state, the individual difference between hypothyroidism and euthyroidism was not significant. Plasma ghrelin in euthyroidism was still significantly higher than in hyperthyroidism (p < 0.05), and correlated positively with ghrelin levels in hyperthyroidism and hypothyroidism. In our opinion, plasma ghrelin fluctuations may reflect metabolic changes in patients with thyroid dysfunction. Moreover, it cannot be excluded that in thyroid disorders ghrelin acts as a compensatory factor, helping to balance metabolic disturbances.     

丙基硫氧嘧啶影响妊娠合并甲状腺功能亢进孕妇甲状腺功能及妊娠结局的研究

目的:探讨丙基硫氧嘧啶(PTU)影响妊娠合并甲状腺功能亢进(甲亢)孕妇甲状腺功能及妊娠结局的影响。方法:选择我院妇产科2010年3月至2013年1月收治的110例妊娠合并甲亢的患者作为观察对象,随机分为观察组58例,对照组52例。观察组予PTU每天300 mg口服,对照组确诊后未能定期检测甲状腺功能而自行停药,或拒绝PTU药物治疗。结果:观察组TT3、TT4、FT3、FT4、TSH水平均显著低于对照组,差异均具有统计学意义(均P0.05);观察组早产或流产、剖宫产、妊娠高血压、心力衰竭、重度子痫明显低于对照组,而足月产明显高于对照组,差异均具有统计学意义(均P0.05);观察组的围生儿发生胎儿窘迫、低体重儿、新生儿甲亢、转入NICU发生率均显著低于对照组,两组比较差异均具有统计学意义(均P0.05)。结论:规范的PTU治疗能很好地改善妊娠合并甲亢患者的孕期甲状腺功能,减低甲亢对孕妇及新生儿的危害,改善妊娠结局,且对新生儿畸形率无显著的影响,是一种相对安全和有效的治疗方法。     

肠道菌群与甲状腺疾病

肠道菌群被称为人类的第二基因组。近年研究发现许多内分泌及免疫相关疾病如糖尿病、非酒精性脂肪肝、炎症性肠炎、类风湿性关节炎等的发生发展与肠道菌群紊乱存在相关性。甲状腺是机体重要的内分泌腺体,常见的甲状腺疾病包括:甲状腺功能亢进症、甲状腺功能减退症和甲状腺炎等。甲状腺疾病的病因及发病机制尚不清楚,多数学者认为其与自身免疫异常有关。肠道菌群可以通过影响机体免疫状态等多种机制参与甲状腺稳态的维持,本文对肠道菌群与甲状腺疾病之间的关联性研究进展进行简要综述,以期为肠道菌群和甲状腺疾病领域的研究提供理论依据。     

Influence of hyperthyroidism on the superprecipitation response and Ca-sensitivity of natural actomyosin in cardiac and skeletal muscle

In cardiac natural actomyosin prepared from hyperthyroid rabbits, the time of onset of the superprecipitation response was shortened by 58% and the rate of response was increased 4-fold compared with euthyroid animals. However, Ca²⁺-sensitivity of cardiac natural actomyosin prepared from either euthyroid or hyperthyroid rabbits was not changed over the range of 10⁻⁷ to 6.6·10⁻⁵ mM free Ca²⁺ concentrations. Skeletal natural actomyosin prepared from either euthyroid or hyperthyroid rabbits showed a far higher Ca²⁺-sensitivity than cardiac natural actomyosin, but there was no difference in either time of onset or rate of superprecipitation response.