Dr. John C.
Lowe
Editor-in-Chief
February 16, 2010
Today, Thyroid Science, our open-access journal published three
new papers. Two of the papers are reports of clinical studies,
and another is a case report.
I am confident that many of our subscribers will find especially
interesting the case report. It concerns a woman who became
hyperthyroid due to Graves’ disease in each of her two
pregnancies. She and her physicians faced treatment dilemmas
from the complications that developed. We know that many of our
readers are intently interested in autoimmune thyroid disease,
and many are also concerned about respiratory problems related
to hypothyroidism. One of the reports directly deals with the
association of thyroid autoimmunity, asthma, and allergic
rhinitis.
Treatment Dilemma in the Care of a
Pregnant Woman with Graves’ Disease
The report of the pregnant hyperthyroid woman is from Dr. Rimpy
Tandon and his colleagues in Northern India. One of the authors
is from the Department of Obstetrics & Gynecology, Guru Gobind
Singh Medical College in Punjab; the other four authors are from
the Department of Obstetrics & Gynecology of the Government
Medical College and Hospital in Chandigarh.
Five-weeks into her first pregnancy, the woman became
hyperthyroid from Graves’ disease. She was treated with PTU and
propranolol. However, the PTU induced hepatitis, so the
physicians had the woman stop the drug. The treatment with
propranolol was not effective enough for her, and she lost the
baby late in her pregnancy. Her hyperthyroidism was subsequently
relieved by radioablative therapy. She then became pregnant
again and developed hyperthyroidism once more. This time the
physicians treated her with a drug that is metabolized to
methimazole, which effectively relieved her hyperthyroidism. The
second time the pregnancy was successful, and the woman
delivered a healthy baby.
This report is interesting for at least two reasons. First, the
authors describe well what a woman can go through when she
develops Graves’ as an autoimmune thyroid disease during
pregnancy.
Second, the authors describe the difficult treatment decisions
physicians may face when they work with some women who are both
pregnant and hyperthyroid.
Thyroid Antibodies in Patients with
Bronchial Asthma and Allergic Rhinitis
In their report, Dr. Mohamed Sabry and his colleagues give the
results of their study of the association of thyroid peroxidase
and thyroglobulin antibodies in patients with two allergic
disorders, bronchial asthma and allergic rhinitis. The five
coauthors are with Ain Shams University and the Misr University
for Technology and Science in Cairo, Egypt. They are from three
different departments: the Endocrine and Diabetes Unit of
Internal Medicine, the Allergy Unit of Internal Medicine, and
Clinical Pathology.
The purpose of their study was to assess the coexistence of the
two anti-thyroid antibodies and immunoglobulin-E (IgE) in
patients with bronchial asthma and allergic rhinitis. As I noted
in the immune chapter of The Metabolic Treatment of
Fibromyalgia,[p.640] “IgE is known as the skin-sensitizing or
anaphylactic antibody. It is found mainly in mucous secretions
of the respiratory and gastrointestinal tracts . . . . IgE has a
locus termed the “Fc region” that binds to the surface of mast
cells and basophils, which secrete histamine that mediates
allergic reactions. The IgE level is elevated in allergic
asthma, hay fever, atopic dermatitis, and parasitic diseases.”
The researchers compared the asthma and allergic rhinitis
patients to healthy controls. The two types of thyroid
antibodies and the IgE were significantly higher in the two
patients groups. However, the thyroid antibody and IgE levels
did not significantly differ between the two groups of allergic
patients. The researches found that the mean TSH, free T3, and
free T4 level of the patients did not significantly differ from
that of the healthy controls. The investigators concluded that
in their two patients groups, bronchial asthma and allergic
rhinitis were significantly associated with thyroid
auto-immunity, but the auto-immunity was not reflected in
out-of-range TSH, free T3, and free T4 levels.
This study is of particular interest to me because breathing
problems are common among hypothyroid and thyroid hormone
resistance patients. Five-years ago, I wrote a review of the
evidence for different mechanisms by which too little thyroid
hormone regulation impairs some patients’ breathing. (See the
webpage listing below Dr. Sabry's antibody study,
or click here.)
I must revise the review now to include allergies of the
respiratory system as another possible mechanism.
Assessment of a
Postsurgical Radiation Therapy
for Thyroid Cancer Patients
The other clinical study reported in Thyroid Science today was
conducted by researchers at the Fox Chase Cancer Center in
Philadelphia and the University of Maryland in Baltimore. The
researchers are from several different departments: Radiation
Oncology, Biostatistics, Medical Oncology, Surgical Oncology,
and Nuclear Medicine.
In their paper, they report the cancer outcome and toxicity of a
particular method for treating thyroid cancer patients. The
method is called “intensity modulated radiation therapy.” Our
subscribers who have had thyroid cancer and readers who are
clinicians interested in the treatment of thyroid cancer should
find the report interesting. Although the report is highly
technical, it is obviously of considerable importance. We are
grateful to Dr. Aruna Turaka, Dr. Steven J. Feigenberg, and
their colleagues for adding to the publications in Thyroid
Science on thyroid cancer.