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Fulltext Understanding issues in preparing patients for radioactive iodine treatment of thyroid disorders

Zanial AZ, Hamzah F

The Malaysian Journal of Nursing, 2015;7(1):3-6.
MyJurnal

Thyroid disorders could be broadly categorised into benign and malignant diseases. Approaches for the
management of benign and malignant thyroid disorders have been well documented including the treatment
using radioactive iodine (RAI). RAI has long been used to treat hyperthyroidism and well differentiated
thyroid cancer. Nevertheless, there are various factors that may influence the outcome of RAI treatment
including matters related to patient preparations. Thus, healthcare personnel play an important role in
assisting patients to make the necessary preparations. This article aims to give nurses and clinicians of
various specialities an insight into the overview of RAI treatment for thyroid disorders particularly in
Malaysia and further discusses the issues related to preparations of patients.

Matched MeSH terms: Thyroid Diseases
Hyperthyroidism in pregnancy

Zainurrashid Z, Shaker AaRH

Family Physician, 2005;13:2-4.

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects. Keywords: Hyperthyroidism, pregnancy

Matched MeSH terms: Thyroid Diseases
Hyperthyroidism in pregnancy

Zainuddin Z, Shaker AAH

Family Physician, 2005;13(3):2-4.
MyJurnal

Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects

Matched MeSH terms: Thyroid Diseases
Fulltext Salmonella Thyroid Abscess Treated by Serial Aspiration: Case Report and Literature Review

Vengathajalam S, Retinasekharan S, Mat Lazim N, Abdullah B

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):823-826.
PMID: 31742073 DOI: 10.1007/s12070-019-01654-6

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58 year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics.

Matched MeSH terms: Thyroid Diseases
Fulltext Solitary thyroid nodule--experience in a district hospital

Thambi Dorai CR

Med J Malaysia, 1988 Mar;43(1):55-8.
PMID: 3244321
Matched MeSH terms: Thyroid Diseases/diagnosis*
Fulltext Prevalence of growth and endocrine disorders in Malaysian children with transfusion-dependent thalassaemia

Tan KA, Lum SH, Yahya A, Krishnan S, Jalaludin MY, Lee WS

Singapore Med J, 2019 Jun;60(6):303-308.
PMID: 30556093 DOI: 10.11622/smedj.2018155

INTRODUCTION: Endocrine dysfunction due to iron overload secondary to frequent blood transfusions is a common complication in children with transfusion-dependent thalassaemia (TDT). We ascertained the prevalence of endocrine dysfunction in children with TDT seen in a hospital setting in Malaysia.
METHODS: We reviewed all patients with TDT who had ≥ 8 blood transfusions per year. Patients who had a history of stem cell transplantation, concurrent autoimmune diseases or were newly diagnosed to have TDT were excluded. Standard diagnostic criteria were used in the diagnosis of various endocrine dysfunctions.
RESULTS: Of the 82 patients with TDT, 65% had at least one endocrine dysfunction. Short stature was the commonest (40.2%), followed by pubertal disorders (14.6%), hypoparathyroidism (12.3%), vitamin D deficiency (10.1%), hypocortisolism (7.3%), diabetes mellitus (5.2%) and overt hypothyroidism (4.9%). Subclinical hypothyroidism and pre-diabetes mellitus were seen in 13.4% and 8.6% of the patients, respectively. For children aged < 10 years, the prevalence of both thyroid dysfunction and hypoparathyroidism was 9.1%.
CONCLUSION: Two-thirds of children with TDT experienced at least one endocrine dysfunction. Thyroid dysfunction and hypoparathyroidism may be missed if endocrine screening is only performed in children with TDT > 10 years of age. Close monitoring for endocrine dysfunction and hormonal therapy is essential to prevent long-term adverse outcomes.

Matched MeSH terms: Thyroid Diseases/etiology; Thyroid Diseases/epidemiology
Fulltext Depression symptoms level among thyroid disorders patients at Central region of Peninsular Malaysia

Siti Nur Illiani, J., Azlina, D., Sanisah, S., Ramli, M., Nik Noor Fatnoon, N.A.

Malaysian Journal of Psychiatry, 2017;26(1):0-0.
MyJurnal

Background of Study: Patients with thyroid disorders were found to have
continued to experience symptoms of depression despite the great of treatment has
been given to the patient to balance the thyroid hormones. Objective: The aim of
this study is to determine the level of depression symptoms among various types
of thyroid disorders patients.

Methods: A cross sectional study was carried out at
one of the government hospital at central region of Peninsular Malaysia from
August to October 2016. Patients were diagnosed as thyroid disorders, Malaysian
citizen, above 18 years old and did not have any psychiatric disorders were
included in this study.Depression Anxiety Stress Scale-42 (DASS-42) was
selected to determine the severity of depression symptoms and interpreted as
follow: less than 9-no depression, between 10 and 13-mild depression, between
14-20-moderate depression, between 21 and 27- severe depression and more than
28-extreme severe depression. Descriptive statistic was analysed by IBM
Statistical Package for the Social Sciences (SPSS) version 21.0.

Results: About
15% (23) out of 153 thyroid patients had varies degree of depression symptoms
from mild to severe extremely depression. Patients who had hyperthyroid were
found to have more depressed, followed by hypothyroid and thyroid cancer group.

Conclusion: These findings would suggest that the depression score was higher in
the patients who have hyperthyroid. A more detail and thorough study is
recommended to be done, in order to confirm these findings.

Matched MeSH terms: Thyroid Diseases
Spectral sensitivity in patients with dysthyroid eye disease

Sharanjeet-Kaur, Dickinson CM, O'Donoghue E, Murray IJ

Ophthalmic Physiol Opt, 1997 May;17(3):232-8.
PMID: 9196665 DOI: 10.1111/j.1475-1313.1997.0_749.x

The majority of patients with dysthyroid eye disease have an acquired colour vision defect. However, no psychophysical investigation of selective damage to colour or flicker pathways has been carried out. In order to clarify the nature of the visual pathology, we have used a psychophysical technique (spectral sensitivity) to selectively stimulate the chromatic and achromatic mechanisms. Spectral spots of size 1 degree presented at a rate of 1 Hz on a bright 1000 td white background are detected by the chromatic mechanism but a rate of 25 Hz reveals the achromatic mechanism. Fifteen patients (28 eyes) between the ages of 50-70 years were tested. The study showed that all patients had reduced spectral sensitivity, either 1 Hz, 25 Hz or both. The patients with reduced 1 Hz or 25 Hz spectral sensitivity only had a shorter systemic and ocular duration of the condition, had no proptosis, normal intraocular pressures in primary gaze, slightly higher intraocular pressures on upgaze, normal visual field plots and FM 100-Hue error scores higher than the normal age-matched values. The patients with reduced both 1 Hz and 25 Hz spectral sensitivities had a longer systemic and ocular duration of the condition, had proptosis, normal intraocular pressures in primary position, higher intraocular pressures on upgaze and higher FM 100-Hue error scores than the age-matched normals and those in Groups 1 and 2. A total of 50% of patients in Group 3 had defective visual field plots. These data suggest that there is a damage of the large achromatic fibres and small chromatic fibres in dysthyroid eye disease. The mechanism of the damage could be one of ischaemic or mechanical or both.

Matched MeSH terms: Thyroid Diseases/complications; Thyroid Diseases/physiopathology*
Fulltext Thyroid disorders and psychiatric morbidities

Sapini Y, Rokiah P, Nor Zuraida Z

Malaysian Journal of Psychiatry, 2009;18(2):1-9.
MyJurnal

The functional behavior of the thyroid is fundamental in most diseases and represents the basis for diagnosis and therapy. The status can be euthyroidism, hypothyroidism or hyperthyroidism. The psychiatric manifestation varies in different thyroid status. Those with hypothyroidism were described to have depression, psychosis and cognitive dysfunction. Meanwhile, those with hyperthyroidism were found to have psychosis, aggression, anxiety as well as cognitive impairment.

Matched MeSH terms: Thyroid Diseases*
Fulltext Optic neuropathy in thyroid eye disease: A case series

Salleh NA, Wong HS, Mohd Isa HD

Korean J Fam Med, 2016 May;37(3):197-201.
PMID: 27274392 DOI: 10.4082/kjfm.2016.37.3.197

In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of their thyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze (Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatment may lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis, who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One of the patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient's vision progressively deteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serum thyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TED among general practitioners and physicians.

Matched MeSH terms: Thyroid Diseases
Racial disparity in the prevalence of thyroid disorder during pregnancy

Sakinah SO, Khalid BA, Aishah AB

Ann Acad Med Singap, 1993 Jul;22(4):563-6.
PMID: 8257059

A study to determine the prevalence of goitre and abnormal thyroid status during pregnancy in Malaysian women was conducted. Two hundred and three women (Malay = 85, Chinese = 47 and Indian = 71) in the third trimester and with no known thyroid disease were studied. There was a marked racial disparity in the prevalence of goitre: Indian 61%, Malay 28% and Chinese 29% (p = 0.001). The serum thyrotropic hormone (TSH) was significantly higher in Indians (median: 1.36 uIU/ml) compared to Malays (1.14 uIU/ml, p = 0.009). The serum albumin was also significantly lower in Indians (mean +/- sd; 36.12 +/- 3.9 mmol/l) compared to Malays (39.3 +/- 4.8 mmol/l) or Chinese (39.1 +/- 5.2) (p < 0.001). Thyroid antibody was detected in 14.6% of these women with no significant racial difference in its prevalence. Three women were found to be thyrotoxic but none were hypothyroid. This study found a high prevalence of goitre among the pregnant Indian women, probably related to the protein malnutrition state. The high prevalence of positive thyroid antibody in our population indicates that a high percentage of women are at risk of developing postpartum thyroiditis.

Matched MeSH terms: Thyroid Diseases/blood; Thyroid Diseases/diagnosis; Thyroid Diseases/epidemiology*
Relationship between levels of thyroid stimulating hormone, age, and gender, with symptoms of depression among patients with thyroid disorders as measured by the Depression Anxiety Stress Scale 21 (DASS-21)

Saidi S, Iliani Jaafar SN, Daud A, Musa R, Nik Ahmad NNF

Enferm Clin, 2018 Feb;28 Suppl 1:180-183.
PMID: 29650181 DOI: 10.1016/S1130-8621(18)30063-9

OBJECTIVE: The aim of this study was to investigate the correlation between levels of depression symptoms and age, thyroid-stimulating hormone levels, and stressful life events of the participants.
METHOD: Patients above 18 years old, with any thyroid disorders, and without psychiatric disorders were included in this study. All participants completed the Depression Anxiety Stress Scale 21 (DASS-21). The depression symptom score was calculated and interpreted as follows: less than 9: no depression; between 10 and 13: mild depression; between 14 and 20: moderate depression; between 21 and 27: severe depression, and more than 28: extremely severe depression.
RESULTS: The total number of participants in this study was 199. There was no correlation between age, thyroid stimulating hormone, and the DASS score. There was also no significant difference in the DASS-21 score between genders. However, there was a positive correlation between depression symptoms and stressful life events (r=0.201, n=199, p < 0.05).
CONCLUSIONS: These findings would suggest that increased depression symptom scores correlate with increased stressful life events. A larger study should be undertaken to confirm these findings.

Matched MeSH terms: Thyroid Diseases/blood*; Thyroid Diseases/complications
Autoimmune antithyroid antibodies with special reference to their presence in human patients in Singapore

STEIN J, STEIN B, YU M, CHEE M, CHEW BK

Med J Malaysia, 1963 Dec;18:116-21.
PMID: 14117279
Matched MeSH terms: Thyroid Diseases*
Fulltext A case of tuberculosis of the thyroid gland

Puri MM, Dougall P, Arora VK

Med J Malaysia, 2002 Jun;57(2):237-9.
PMID: 24326661

We report a case of tuberculosis of the thyroid gland associated with mediastinal lymphadenitis in a 30 years-old male, who presented with dysphagia and a mid line anterior neck swelling. Fine needle aspiration was positive for acid fast bacilli. He made an uneventful recovery with antituberculous drugs. Although seldom observed, tuberculosis should be kept in mind in te differential diagnisis of nodular lesions of the thyroid.

Matched MeSH terms: Thyroid Diseases*
Endemic goitre in Malaya

Polunin I

Med J Malaya, 1951;5.

1. Observations have been quoted which mention the existence of goiter in remote inland areas of Malaya. 2. 39.5% of 618 Malays and 40.8% of 710 aborigines from inland areas were found on examination to have visible thyroid glands. A high incidence of thyroid enlargement was found in almost all areas where these observations were made, on a wide range of Geological Formations. 3. In the seaside populations studied, the low incidence of ‘visible’ thyroid glands (2/184) is typical of that of other ‘goiter free’ areas. 4. Iodine estimations have been carried out on seven water samples from rivers draining inland areas where thyroid data have been collected, and gave values of 0.2 to 0.6 parts of iodine per thousand million. The development of goiter is to be expected when the iodine content is so low. 5. High calcium content of waters cannot be important in causing goiter in Malaya. 6. The availability of dried seafoods is thought to be an important factor in goiter prevention in Malaya. Four dried marine foods contained 360 to 1,340 parts of iodine per thousand million.

Matched MeSH terms: Thyroid Diseases
Fulltext Thyroid disorders in the aged

Peter Michael Barling

International e-Journal of Science, Medicine & Education, 2013;7(2):4-7.
MyJurnal

A review of current information related to the likely incidences of thyroid diseases in the aged population of Malaysia, raising issues such as the need for further epidemiological studies of iodine intake in relation to thyroid diseases within different geographical regions and population subtypes, the need for general country-wide iodization of salt, and the screening of elderly Malaysians for so-called “occult” thyroid diseases.

Matched MeSH terms: Thyroid Diseases
Effectiveness of Zinc Supplementation on Lithium-Induced Alterations in Thyroid Functions

Pathak R, Pathak A

Biol Trace Elem Res, 2020 Aug 26.
PMID: 32851540 DOI: 10.1007/s12011-020-02356-9

Lithium is an integral drug used in the management of acute mania, unipolar and bipolar depression, and prophylaxis of bipolar disorders. Thyroid abnormalities have been associated with treatment with lithium. Zinc is an essential trace element that plays a role in several biological activities. Therefore, the present study was aimed at investigating the potential role of zinc in the thyroid gland following lithium administration to explore the role of zinc under such conditions. To achieve this goal, male Wistar rats (150-195 g) were divided into four groups: Group 1 animals were fed standard pellet feed and tap water ad lib; Group 2 rats were fed lithium in the form of lithium carbonate through diet at a concentration of 1.1 g/kg body weight; Group 3 animals received zinc treatment in the form of zinc sulfate (ZnSO4·7H2O) at a dose level of 227 mg/L mixed with drinking water of the animals; and Group 4 animals were given lithium and zinc in a similar manner as was given to the animals belonging to groups 2 and 4 respectively. The role of zinc on thyroid functions in lithium-treated rats was studied after 2, 4, and 8 weeks of different treatments. Zinc has been observed to have the capability to nearly normalize the altered 2-h uptake of 131I, biological and effective half-lives of 131I, and circulating T4 levels that were altered after lithium treatment. The present study concludes that zinc may be an effective agent in normalizing the adverse effects caused by lithium on thyroid functions.

Matched MeSH terms: Thyroid Diseases
Fulltext Thyroid-Modulating Activities of Olive and Its Polyphenols: A Systematic Review

Pang KL, Lumintang JN, Chin KY

Nutrients, 2021 Feb 06;13(2).
PMID: 33561976 DOI: 10.3390/nu13020529

Olive oil, which is commonly used in the Mediterranean diet, is known for its health benefits related to the reduction of the risks of cancer, coronary heart disease, hypertension, and neurodegenerative disease. These unique properties are attributed to the phytochemicals with potent antioxidant activities in olive oil. Olive leaf also harbours similar bioactive compounds. Several studies have reported the effects of olive phenolics, olive oil, and leaf extract in the modulation of thyroid activities. A systematic review of the literature was conducted to identify relevant studies on the effects of olive derivatives on thyroid function. A comprehensive search was conducted in October 2020 using the PubMed, Scopus, and Web of Science databases. Cellular, animal, and human studies reporting the effects of olive derivatives, including olive phenolics, olive oil, and leaf extracts on thyroid function were considered. The literature search found 445 articles on this topic, but only nine articles were included based on the inclusion and exclusion criteria. All included articles were animal studies involving the administration of olive oil, olive leaf extract, or olive pomace residues orally. These olive derivatives were consistently demonstrated to have thyroid-stimulating activities in euthyroid or hypothyroid animals, but their mechanisms of action are unknown. Despite the positive results, validation of the beneficial health effects of olive derivatives in the human population is lacking. In conclusion, olive derivatives, especially olive oil and leaf extract, could stimulate thyroid function. Olive pomace residue is not suitable for pharmaceutical or health supplementation purposes. Therapeutic applications of olive oil and leaf extract, especially in individuals with hypothyroidism, require further validation through human studies.

Matched MeSH terms: Thyroid Diseases/diet therapy*
High prevalence of thyroid function test abnormalities in chronic schizophrenia

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N

Aust N Z J Psychiatry, 1994 Dec;28(4):620-4.
PMID: 7794205

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n = 152, p = 0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n = 449, p = 0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT41 and FT31 were significantly lower in those with low or high TSH (p < 0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.

Matched MeSH terms: Thyroid Diseases/diagnosis; Thyroid Diseases/physiopathology*; Thyroid Diseases/psychology
Fulltext Spectrum of thyroid lesions in hospital Universiti Sains Malaysia over 11years and a review of thyroid cancers in Malaysia

Othman NH, Omar E, Naing NN

Asian Pac J Cancer Prev, 2009;10(1):87-90.
PMID: 19469631

INTRODUCTION: Endemic goitre is a major concern in many nations including Malaysia. Seven states in the country have been identified by Ministry of Health of Malaysia to have high incidence of goitre and one of these is Kelantan.

METHODS: This is a retrospective study over an 11-year period from 1994 to 2004 on all thyroid specimens submitted to the Pathology Department, Hospital Universiti Sains Malaysia (HUSM), in Kelantan. Epidemiological data were retrieved from the patients' records and pathology findings from the pathology reports.

RESULTS: During this period, Department of Pathology HUSM received a total of 1,486 thyroid specimens. The female to male ratio was 6:1 and the median age was 40.0 years. The duration of goitre ranged from one to 15 years. Histopathological examination showed 71.9 percent were non-neoplastic and 28.1 percent neoplastic lesions. The hospital-based incidence of nodular hyperplasia was 9.9 per 100,000 admitted patients per year. The hospital-based incidence of all types of malignant thyroid cancers was 3.5 per 100,000. The most common malignancy was papillary carcinoma 76.6 percent. The majority of the cancers (59.5 percent) occurred in a background of nodular hyperplasia. Thyroid cancers made up 4.9 percent of all cancers seen in HUSM.

CONCLUSION: This study suggests that malignant thyroid lesions arising from multi-nodular goitre are high in a population living in an iodine-deficiency area.

Matched MeSH terms: Thyroid Diseases/epidemiology*

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