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1. Oral Corticosteroids for Teprotumumab-Related Hearing Loss: A Case Report.

Author

Inserra, Michelle, Dosiou, Chrysoula, Kossler, Andrea, Lu, Tracy, Amarikwa, Linus, and Winn, Bryan

Subjects
Hearing loss, Prednisone, Steroids, Teprotumumab, Thyroid eye disease
Abstract

Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.

Published
2023

4. Risk Factors for Thyroid Dysfunction in Pregnancy:An Individual Participant Data Meta-Analysis

Author

Osinga, Joris A. J., Liu, Yindi, Männistö, Tuija, Vafeiadi, Marina, Tao, Fang-Biao, Vaidya, Bijay, Vrijkotte, Tanja G. M., Mosso, Lorena, Bassols, Judit, López-Bermejo, Abel, Boucai, Laura, Aminorroaya, Ashraf, Feldt-Rasmussen, Ulla, Hisada, Aya, Yoshinaga, Jun, Broeren, Maarten A. C., Itoh, Sachiko, Kishi, Reiko, Ashoor, Ghalia, Chen, Liangmiao, Veltri, Flora, Lu, Xuemian, Taylor, Peter N., Brown, Suzanne J., Chatzi, Leda, Popova, Polina V., Grineva, Elena N., Ghafoor, Farkhanda, Pirzada, Amna, Kianpour, Maryam, Oken, Emily, Suvanto, Eila, Hattersley, Andrew, Rebagliato, Marisa, Riaño-Galán, Isolina, Irizar, Amaia, Vrijheid, Martine, Delgado-Saborit, Juana Maria, Fernández-Somoano, Ana, Santa-Marina, Loreto, Boelaert, Kristien, Brenta, Gabriela, Dhillon-Smith, Rima, Dosiou, Chrysoula, Eaton, Jennifer L., Guan, Haixia, Lee, Sun Y., Maraka, Spyridoula, Morris-Wiseman, Lilah F., Nguyen, Caroline T., Shan, Zhongyan, Guxens, Mònica, Pop, Victor J. M., Walsh, John P., Nicolaides, Kypros H., D'Alton, Mary E., Visser, W. Edward, Carty, David M., Delles, Christian, Nelson, Scott M., Alexander, Erik K., Chaker, Layal, Palomaki, Glenn E., Peeters, Robin P., Bliddal, Sofie, Huang, Kun, Poppe, Kris G., Pearce, Elizabeth N., Derakhshan, Arash, Korevaar, Tim I. M., Osinga, Joris A. J., Liu, Yindi, Männistö, Tuija, Vafeiadi, Marina, Tao, Fang-Biao, Vaidya, Bijay, Vrijkotte, Tanja G. M., Mosso, Lorena, Bassols, Judit, López-Bermejo, Abel, Boucai, Laura, Aminorroaya, Ashraf, Feldt-Rasmussen, Ulla, Hisada, Aya, Yoshinaga, Jun, Broeren, Maarten A. C., Itoh, Sachiko, Kishi, Reiko, Ashoor, Ghalia, Chen, Liangmiao, Veltri, Flora, Lu, Xuemian, Taylor, Peter N., Brown, Suzanne J., Chatzi, Leda, Popova, Polina V., Grineva, Elena N., Ghafoor, Farkhanda, Pirzada, Amna, Kianpour, Maryam, Oken, Emily, Suvanto, Eila, Hattersley, Andrew, Rebagliato, Marisa, Riaño-Galán, Isolina, Irizar, Amaia, Vrijheid, Martine, Delgado-Saborit, Juana Maria, Fernández-Somoano, Ana, Santa-Marina, Loreto, Boelaert, Kristien, Brenta, Gabriela, Dhillon-Smith, Rima, Dosiou, Chrysoula, Eaton, Jennifer L., Guan, Haixia, Lee, Sun Y., Maraka, Spyridoula, Morris-Wiseman, Lilah F., Nguyen, Caroline T., Shan, Zhongyan, Guxens, Mònica, Pop, Victor J. M., Walsh, John P., Nicolaides, Kypros H., D'Alton, Mary E., Visser, W. Edward, Carty, David M., Delles, Christian, Nelson, Scott M., Alexander, Erik K., Chaker, Layal, Palomaki, Glenn E., Peeters, Robin P., Bliddal, Sofie, Huang, Kun, Poppe, Kris G., Pearce, Elizabeth N., Derakhshan, Arash, and Korevaar, Tim I. M.

Abstract

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (r, Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk f

Published
2024

5. Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis

Author

Osinga, Joris A.J., primary, Liu, Yindi, additional, Männistö, Tuija, additional, Vafeiadi, Marina, additional, Tao, Fang-Biao, additional, Vaidya, Bijay, additional, Vrijkotte, Tanja G.M., additional, Mosso, Lorena, additional, Bassols, Judit, additional, López-Bermejo, Abel, additional, Boucai, Laura, additional, Aminorroaya, Ashraf, additional, Feldt-Rasmussen, Ulla, additional, Hisada, Aya, additional, Yoshinaga, Jun, additional, Broeren, Maarten A.C., additional, Itoh, Sachiko, additional, Kishi, Reiko, additional, Ashoor, Ghalia, additional, Chen, Liangmiao, additional, Veltri, Flora, additional, Lu, Xuemian, additional, Taylor, Peter N., additional, Brown, Suzanne J., additional, Chatzi, Leda, additional, Popova, Polina V., additional, Grineva, Elena N., additional, Ghafoor, Farkhanda, additional, Pirzada, Amna, additional, Kianpour, Maryam, additional, Oken, Emily, additional, Suvanto, Eila, additional, Hattersley, Andrew, additional, Rebagliato, Marisa, additional, Riaño-Galán, Isolina, additional, Irizar, Amaia, additional, Vrijheid, Martine, additional, Delgado-Saborit, Juana Maria, additional, Fernández-Somoano, Ana, additional, Santa-Marina, Loreto, additional, Boelaert, Kristien, additional, Brenta, Gabriela, additional, Dhillon-Smith, Rima, additional, Dosiou, Chrysoula, additional, Eaton, Jennifer L., additional, Guan, Haixia, additional, Lee, Sun Y., additional, Maraka, Spyridoula, additional, Morris-Wiseman, Lilah F., additional, Nguyen, Caroline T., additional, Shan, Zhongyan, additional, Guxens, Mònica, additional, Pop, Victor J.M., additional, Walsh, John P., additional, Nicolaides, Kypros H., additional, D'Alton, Mary E., additional, Visser, W. Edward, additional, Carty, David M., additional, Delles, Christian, additional, Nelson, Scott M., additional, Alexander, Erik K., additional, Chaker, Layal, additional, Palomaki, Glenn E., additional, Peeters, Robin P., additional, Bliddal, Sofie, additional, Huang, Kun, additional, Poppe, Kris G., additional, Pearce, Elizabeth N., additional, Derakhshan, Arash, additional, and Korevaar, Tim I.M., additional

Published
2024
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7. Teprotumumab-Related Adverse Events in Thyroid Eye Disease: A Multi-Center Study

Author

Shah, Shreya A., primary, Amarikwa, Linus, additional, Sears, Connie M., additional, Clauss, Kevin D., additional, Rajjoub, Raneem D., additional, Kang, Julia Y., additional, Tamhankar, Madhura A., additional, Briceño, César A., additional, Harrison, Andrew R., additional, Dosiou, Chrysoula C., additional, Cockerham, Kimberly P., additional, Wester, Sara T., additional, Douglas, Raymond S., additional, and Kossler, Andrea L., additional

Published
2023
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10. Use of the Community of Inquiry Framework to Measure Student and Facilitator Perceptions of Online Flipped Classroom Compared with Online Lecture Learning in Undergraduate Medical Education

Author

Chang,Julia, Hain,Adam, Dosiou,Chrysoula, Gesundheit,Neil, Chang,Julia, Hain,Adam, Dosiou,Chrysoula, and Gesundheit,Neil

Abstract

Julia J Chang,1 Adam Hain,2 Chrysoula Dosiou,1,&ast; Neil Gesundheit1,&ast; 1Division of Endocrinology, Metabolism, and Gerontology, Department of Medicine, Stanford School of Medicine, Stanford, California; 2Office of Medical Education, Stanford School of Medicine, Stanford, California&ast;These authors contributed equally to this workCorrespondence: Julia J Chang, Stanford School of Medicine, 300 Pasteur Dr., Room S025, Stanford, CA, 94305, Tel +1 650-724-2474, Fax +1 (248) 720-4461, Email jchang89@stanford.eduBackground: The COVID-19 pandemic and a movement away from traditional lecture-based learning have increased the use of online flipped classroom (FC) and active learning models in medical education. The Community of Inquiry (CoI) framework for online learning may be used to evaluate the effectiveness and strengths of the online FC model compared with other learning formats.Methods: An observational survey study was conducted to measure medical student and facilitator perceptions of an online FC endocrinology tutorial compared with online lecture experiences. For the tutorial, students were instructed to watch short, pre-recorded lecture videos on thyroid pathophysiology prior to class. During class, small groups of students were paired with a faculty facilitator in online Zoom rooms for case discussion. Students were surveyed using the CoI framework to assess elements of cognitive, social, and teaching presence between the two online learning modalities. Facilitators were also surveyed. Survey questions were rated on a 5-point Likert scale.Results: Fifty-three out of 92 students (58% response rate) and seven out of eight facilitators (88% response rate) completed surveys. In general, students felt that online FC learning improved cognitive, teaching, and social presence compared with online lecture. Areas of cognitive presence (mean score 3.9 ± 1.0 SD), such as stimulating curiosity and applying concepts, were highly rated. Certain elements of s

Published
2023

19. Teprotumumab for Inactive Thyroid Eye Disease? The Jury Is Still Out.

Author

Dosiou, Chrysoula

Subjects
THYROID eye disease, TERMINATION of treatment, VISION, DISEASE duration, EXOPHTHALMOS, DIABETIC acidosis
Abstract

This article discusses the use of teprotumumab, a monoclonal antibody, as a potential treatment for inactive thyroid eye disease (TED). TED is a condition that can cause visual dysfunction and has traditionally been classified into inflammatory and fibrotic phases. Teprotumumab has shown promise in reducing inflammation, improving quality of life, and decreasing proptosis (bulging of the eyes) in patients with active TED. However, the efficacy of teprotumumab in patients with inactive TED is still uncertain. The article highlights the results of a recent randomized controlled trial that investigated the use of teprotumumab in patients with low activity TED, and discusses the need for further research to determine the role of teprotumumab in treating inactive TED. [Extracted from the article]

Published
2024
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21. Hearing Dysfunction After Treatment With Teprotumumab for Thyroid Eye Disease

Author

Sears, Connie M., primary, Azad, Amee D., additional, Amarikwa, Linus, additional, Pham, Brandon H., additional, Men, Clara J., additional, Kaplan, Daniel N., additional, Liu, Jocelyn, additional, Hoffman, Andrew R., additional, Swanson, Austin, additional, Alyono, Jennifer, additional, Lee, Jennifer Y., additional, Dosiou, Chrysoula, additional, and Kossler, Andrea L., additional

Published
2022
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22. Teprotumumab-Related Hyperglycemia.

Author

Amarikwa, Linus, Mohamed, Abubakr, Kim, Sun H., Kossler, Andrea Lora, and Dosiou, Chrysoula

Subjects
HYPERGLYCEMIA, THYROID eye disease, SOMATOMEDIN C
Abstract

Context: Graves orbitopathy (GO) or thyroid eye disease is a potentially sight-threatening and disfiguring autoimmune disease. Teprotumumab is a monoclonal antibody against the insulin-like growth factor-I receptor that was recently approved for GO treatment. Hyperglycemia is a recognized adverse event of teprotumumab, occurring in 10% of patients in 2 recent randomized controlled trials. Objective: Our study aimed to report the incidence, severity, management, and longitudinal glycemic changes in patients treated with teprotumumab in an academic practice cohort. Methods: This longitudinal, observational study included all consecutive patients treated with teprotumumab between March 2020 and May 2022 at 1 institution. Hemoglobin A1c (HbA1c) was measured every 3 months. Results: Forty-two patients with baseline normoglycemia (n=22), prediabetes (n= 10), and diabetes (n =10) were followed for a mean of 47.5 weeks. Overall, HbA1c increased by 0.5% at 3 months. Least-squares mean changes in HbA1c at 3 months were 1.3 (P<.001), 0.7 (P=.01), and 0.1 (P= .41) in patients with diabetes, prediabetes, and normoglycemia, respectively. Twenty-two patients (52%) had hyperglycemia, which was graded as mild, moderate, and life-threatening in 55% (12/22), 41% (9/22), and 5% (1/22) of cases, respectively. Age, pre-existing diabetes, and Hispanic and Asian race/ethnicity were significant risk factors for hyperglycemia. Among patients with hyperglycemia, 36.4% (8/22) returned to baseline glycemic status at last follow-up. Conclusion: While effective, teprotumumab carries a significant risk of hyperglycemia, especially in patients with diabetes. Hyperglycemia may persist after stopping teprotumumab. These findings underscore the importance of guidelines for screening and management of teprotumumabrelated hyperglycemia. [ABSTRACT FROM AUTHOR]

Published
2023
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23. New Onset or Deterioration of Thyroid Eye Disease After mRNA SARS-CoV-2 Vaccines: Report of 2 Cases and Literature Review.

Author

Mohamed, Abubakr, Tzoulis, Ploutarchos, Kossler, Andrea Lora, and Dosiou, Chrysoula

Subjects
THYROID eye disease, COVID-19 vaccines, GRAVES' disease
Abstract

Context: Occurrence of Graves' disease (GD) has been reported following SARS-CoV-2 vaccine administration, but little is known about thyroid eye disease (TED) after SARS-CoV-2 vaccination. Objective: We describe 2 cases of TED activation following mRNA SARS-CoV-2 vaccination and review additional cases reported in the literature. Methods: We report 2 cases of TED activation following SARS-CoV-2 vaccination: 1 case of TED worsening in a patient with GD, and 1 of de novo active TED progressing to dysthyroid optic neuropathy in a patient with a history of Hashimoto hypothyroidism. Our literature search revealed 8 additional reported TED cases associated with SARS-CoV-2 vaccination until June 2022. We review the characteristics, duration, and management of TED following SARS-CoV-2 vaccination in these cases. Results: Of all 10 reported TED cases following SARS-CoV-2 vaccination, 4 developed new-onset TED and 6 previously stable TED cases experienced significant deterioration. Six patients had known GD and 2 patients had Hashimoto thyroiditis. Two cases progressed to dysthyroid optic neuropathy, 6 had moderate/severe active disease, and 2 had mild disease that did not require treatment. Seven TED cases received teprotumumab and had a favorable response, 2 of whom had prior limited response to initial prednisone or methylprednisolone and tocilizumab therapy. Conclusion: New diagnosis or deterioration of TED after mRNA SARS-CoV-2 vaccination can occur, with most cases described in patients with underlying autoimmune thyroid disease. Our report raises awareness to this potential complication to promote early recognition and prompt management of TED associated with mRNA SARS-CoV-2 vaccines. Further studies are needed to explore the mechanism, risk factors, prevention, and treatment of TED following mRNA SARS-CoV-2 vaccination. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Reply

Author

Shah, Shreya A., Amarikwa, Linus, Sears, Connie M., Clauss, Kevin D., Rajjoub, Raneem D., Kang, Julia Y., Tamhankar, Madhura A., Briceño, César A., Harrison, Andrew R., Cockerham, Kimberly P., Wester, Sara T., Douglas, Raymond S., Dosiou, Chrysoula, and Kossler, Andrea L.

Published
2024
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27. Hu et al. Supplemental Tables.docx

Author

Hu, Mimi I., Waguespack, Steven G., Dosiou, Chrysoula, Ladenson, Paul W., Livhits, Masha, Wirth, Lori J., Sadow, Peter M., Krane, Jeffrey F., Stack, Brendan C., Zafereo, Mark E., Ali, Syed Z., Weitzman, Steven P., Yangyang Hao, Babiarz, Joshua E., Kennedy, Giulia C., and Kloos, Richard

Abstract

Supplemental Tables

Published
2021
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28. NTRK, RET, BRAF, and ALK fusions in thyroid fine-needle aspirates (FNAs).

Author

Wirth, Lori J., primary, Hu, Mimi I-Nan, additional, Waguespack, Steven G., additional, Dosiou, Chrysoula, additional, Ladenson, Paul, additional, Livhits, Masha J., additional, Sadow, Peter M., additional, Krane, Jeffrey, additional, Stack, Brendan C., additional, Zafereo, Mark, additional, Ali, Syed Z., additional, Weitzman, Steven P, additional, Hao, Yangyang, additional, Babiarz, Joshua, additional, Kennedy, Giulia, additional, and Kloos, Richard, additional

Published
2021
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29. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Findings in Consecutive Bethesda III-VI Thyroid Nodules

Author

Hu, Mimi I, primary, Waguespack, Steven G, additional, Dosiou, Chrysoula, additional, Ladenson, Paul W, additional, Livhits, Masha J, additional, Wirth, Lori J, additional, Sadow, Peter M, additional, Krane, Jeffrey F, additional, Stack, Brendan C, additional, Zafereo, Mark E, additional, Ali, Syed Z, additional, Weitzman, Steven P, additional, Hao, Yangyang, additional, Babiarz, Joshua E, additional, Kennedy, Giulia C, additional, and Kloos, Richard T, additional

Published
2021
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44. Additional file 2: Figure S1. of Development of prognostic signatures for intermediate-risk papillary thyroid cancer

Author

Brennan, Kevin, Holsinger, Christopher, Dosiou, Chrysoula, Sunwoo, John, Akatsu, Haruko, Haile, Robert, and Gevaert, Olivier

Abstract

MACIS score in extreme prognsos and intermediate prognosis patient groups: MACIS score (based on the presence of distant Metastases, patient Age, Completeness of tumor resection, presence of local Invasion, and tumor Size) was higher in poor prognosis patients (n = 77) than good prognosis patients (n = 50) within the Extreme prognosis patient (training set) patient group (p = 4.28e-07). However, there was no difference in MACIS score between patients predicted as poor (n = 189) and good prognosis (n = 146) witin the medium prognosis (test set) patient group (p = 0.2). This indicates that the MACIS score, indicating that the MACIS score does not have ability to predict patient prognosis as determined by our gene expression classifier. Figure S2. Checking the robustness of the PAM model gene signature: Leaving out one of 7 extreme prognosis patient groups in each round, and using the remaining 6 patient groups to train a Prediction Analysis of Microarrays (PAM) model, the performance of the PAM model in correctly classifying patients within the left-out group to either the good or poor prognosis groups, was tested. ROC curves illustrate the performances of the models for each left out group. Left out groups represent extreme poor prognosis patients, each group associated with a specific poor prognostic clinical factor. Figure S3. Negative correlation between NR1D1 and the overlapping thyroid hormone receptor gene THRA. There was a significant Pearson correlation of expression of NR1D1 and THRA (measured using RNA-Seq) in tumor (cor = −0.09, p = 0.04, n = 501), but not within a smaller set of normal adjacent tissue samples (cor = −0.16, p = 0.24, n = 58). NR1D1 was the gene most strongly upregulated in poor prognosis PTC patients relative to good prognosis patients, and may influence thyroid cancer through downregulation of THRA. (PPTX 1109 kb)

Published
2016
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45. Additional file 1: Table S1. of Development of prognostic signatures for intermediate-risk papillary thyroid cancer

Author

Brennan, Kevin, Holsinger, Christopher, Dosiou, Chrysoula, Sunwoo, John, Akatsu, Haruko, Haile, Robert, and Gevaert, Olivier

Abstract

Demographic factors in extreme good and extreme poor prognosis patient groups (in samples for which data was available). Table S2. Genes deregulated in extreme poor prognosis PTC patients relative to extreme good prognosis patients. Table S3. Differential expression of prognostic genes in normal tissue, extreme good prognosis cancers and extreme poor prognosis cancers. Table S4. Genes consistently upregulated or downregulated [1] in extreme poor prognosis patients in leave-one-out cross validation. Table S5. Genes downregulated in poor-prognosis PTC & overlapping with published (referenced) gene-sets. Table S6. Distribution of clinicopathologic and demographic factors in intermediate risk patients classified as good or poor prognosis by PAM model (All samples). Table S7. Distribution of clinical characteristics of intermediate good and intermediate poor prognosis groups in leave-one-out cross validation. Table S8. Genes used within the PAM classifier, and presence [1] or absence (0) of each gene within classifier, when patients representing each of 6 poor prognostic factors are left out. (PDF 1097Â kb)

Published
2016
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46. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Author

Alexander, Erik K., primary, Pearce, Elizabeth N., additional, Brent, Gregory A., additional, Brown, Rosalind S., additional, Chen, Herbert, additional, Dosiou, Chrysoula, additional, Grobman, William A., additional, Laurberg, Peter, additional, Lazarus, John H., additional, Mandel, Susan J., additional, Peeters, Robin P., additional, and Sullivan, Scott, additional

Published
2017
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49. Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns.

Author

Dosiou, Chrysoula and Medici, Marco

Subjects
*THYROID diseases, *THYROXINE, *NEURAL development
Abstract

Isolated maternal hypothyroxinemia (IMH) during pregnancy is defined as a low maternal T4 in the absence of TSH elevation. As IMH is common, with a prevalence of 1-2% in iodine-sufficient populations, and early research has suggested adverse effects on fetal neurodevelopment, it has been the focus of many studies in the last decade. In the current review, we first discuss the significance of IMH based on data from animal models and recent discoveries regarding the role of thyroid hormone on neurodevelopment. We address issues surrounding the definition and prevalence of this entity and discuss new insights into the etiologies, clinical consequences and management of IMH. A number of large cohort studies have investigated the effects of IMH on the risk of various pregnancy complications and child neurodevelopment. We review these studies in detail and describe their limitations. We discuss the available research on management of IMH, including two recent randomized controlled trials (RCTs). Finally, we delineate the remaining uncertainties in this field and emphasize the need for a sufficiently powered, placebo-controlled RCT on the treatment of IMH early in the first trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Published
2017
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