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Article ; Online: Thyroid Function across the Lifespan: Do Age-Related Changes Matter?

Walsh, John P

Endocrinology and metabolism (Seoul, Korea)

2022 Volume 37, Issue 2, Page(s) 208–219

Abstract: Circulating concentrations of thyrotropin (TSH) and thyroxine (T4) are tightly regulated. Each individual has setpoints for TSH and free T4 which are genetically determined, and subject to environmental and epigenetic influence. Pituitary-thyroid axis ... ...

Abstract	Circulating concentrations of thyrotropin (TSH) and thyroxine (T4) are tightly regulated. Each individual has setpoints for TSH and free T4 which are genetically determined, and subject to environmental and epigenetic influence. Pituitary-thyroid axis setpoints are probably established in utero, with maturation of thyroid function continuing until late gestation. From neonatal life (characterized by a surge of TSH and T4 secretion) through childhood and adolescence (when free triiodothyronine levels are higher than in adults), thyroid function tests display complex, dynamic patterns which are sexually dimorphic. In later life, TSH increases with age in healthy older adults without an accompanying fall in free T4, indicating alteration in TSH setpoint. In view of this, and evidence that mild subclinical hypothyroidism in older people has no health impact, a strong case can be made for implementation of age-related TSH reference ranges in adults, as is routine in children.
MeSH term(s)	Adolescent ; Aged ; Child ; Female ; Humans ; Hypothyroidism ; Infant, Newborn ; Longevity ; Pregnancy ; Thyrotropin ; Thyroxine ; Triiodothyronine
Chemical Substances	Triiodothyronine (06LU7C9H1V) ; Thyrotropin (9002-71-5) ; Thyroxine (Q51BO43MG4)
Language	English
Publishing date	2022-04-14
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2802452-7
ISSN	2093-5978 ; 2093-5978
ISSN (online)	2093-5978
ISSN	2093-5978
DOI	10.3803/EnM.2022.1463
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Article: Mitigating Spinal Cord Stimulator Lead Migration Complications in Minimally Invasive Spine Surgery: Technical Note.

Walsh, John P / Jimenez, Juan

Cureus

2022 Volume 14, Issue 3, Page(s) e23343

Abstract: Spinal Cord Stimulators (SCS) are a nonpharmacologic chronic pain management treatment modality that is well-validated and cost-effective within the surgeon's armamentarium. The reported complication rates are between 5.3% to 40%, most commonly secondary ...

Abstract	Spinal Cord Stimulators (SCS) are a nonpharmacologic chronic pain management treatment modality that is well-validated and cost-effective within the surgeon's armamentarium. The reported complication rates are between 5.3% to 40%, most commonly secondary to mechanical hardware failure. The most common mechanical complication is lead migration, which necessitates second surgery. The purpose of this technical note is to describe a minimally invasive spine surgery (MISS) implantation technique we believe to be more resilient to lead migration. We present a stepwise technique for SCS implantation with a maxillofacial screw and washer failsafe.
Language	English
Publishing date	2022-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.23343
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Article ; Online: Hyperthyroidism.

Chaker, Layal / Cooper, David S / Walsh, John P / Peeters, Robin P

Lancet (London, England)

2024 Volume 403, Issue 10428, Page(s) 768–780

Abstract: Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, ... ...

Abstract	Thyrotoxicosis causes a variety of symptoms and adverse health outcomes. Hyperthyroidism refers to increased thyroid hormone synthesis and secretion, most commonly from Graves' disease or toxic nodular goitre, whereas thyroiditis (typically autoimmune, viral, or drug induced) causes thyrotoxicosis without hyperthyroidism. The diagnosis is based on suppressed serum concentrations of thyroid-stimulating hormone (TSH), accompanied by free thyroxine and total or free tri-iodothyronine concentrations, which are raised (overt hyperthyroidism) or within range (subclinical hyperthyroidism). The underlying cause is determined by clinical assessment, detection of TSH-receptor antibodies and, if necessary, radionuclide thyroid scintigraphy. Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and thyroidectomy, whereas thyroiditis is managed symptomatically or with glucocorticoid therapy. In Graves' disease, first-line treatment is a 12-18-month course of antithyroid drugs, whereas for goitre, radioactive iodine or surgery are preferred for toxic nodules or goitres. Evidence also supports long-term treatment with antithyroid drugs as an option for patients with Graves' disease and toxic nodular goitre.
MeSH term(s)	Humans ; Antithyroid Agents/therapeutic use ; Antithyroid Agents/adverse effects ; Goiter, Nodular/diagnosis ; Goiter, Nodular/therapy ; Goiter, Nodular/chemically induced ; Iodine Radioisotopes/therapeutic use ; Thyroid Neoplasms/drug therapy ; Hyperthyroidism/therapy ; Hyperthyroidism/drug therapy ; Graves Disease/diagnosis ; Graves Disease/therapy ; Thyrotoxicosis/diagnosis ; Thyrotoxicosis/therapy ; Thyrotoxicosis/chemically induced ; Thyroiditis/chemically induced ; Thyroiditis/drug therapy
Chemical Substances	Antithyroid Agents ; Iodine Radioisotopes
Language	English
Publishing date	2024-01-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(23)02016-0
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Article: A case of catamenial erythema multiforme major successfully treated with goserelin.

Tyack, Lauren T / Stuckey, Bronwyn G A / Walsh, John P

Endocrinology, diabetes & metabolism case reports

2023 Volume 2023, Issue 4

Abstract: Summary: We report a case of catamenial erythema multiforme major in a 46-year-old female. She was treated successfully with goserelin, a GnRH agonist, until the expected age of menopause; however, its therapeutic effects persisted for longer than ... ...

Abstract	Summary: We report a case of catamenial erythema multiforme major in a 46-year-old female. She was treated successfully with goserelin, a GnRH agonist, until the expected age of menopause; however, its therapeutic effects persisted for longer than expected, possibly due to accumulation in adipose tissue. Learning points: A group of menstrual cycle-related dermatoses and hypersensitivity syndromes exist but are rarely reported in the literature. A history of recurrent cutaneous eruptions in premenopausal females should be considered in the context of the menstrual cycle. The diagnosis of menstrual cycle-related dermatoses is largely clinical, although provocation testing can assist. Treatment options are broad and are aimed at reducing the immune response and/or suppressing ovulation. Goserelin may accumulate and have a gonadotrophin-suppressing effect for longer than expected.
Language	English
Publishing date	2023-11-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-23-0030
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Article: Decompression and collagen wrapping of a fibrolipomatous hamartoma of the median nerve: a new approach for a rare and difficult problem.

Meter, Joseph / Anthony, Taylor / Walsh, John P / Amesur, Ajit / Williams, Carl N

Case reports in plastic surgery & hand surgery

2024 Volume 11, Issue 1, Page(s) 2344262

Abstract: Fibrolipomatous hamartoma is a rare benign slow growing fibrofatty tumor of peripheral nerves of unknown etiology. Clinical presentation may mimic carpal tunnel syndrome when involving the median nerve. We present a case of FLH of the median nerve in a ... ...

Abstract	Fibrolipomatous hamartoma is a rare benign slow growing fibrofatty tumor of peripheral nerves of unknown etiology. Clinical presentation may mimic carpal tunnel syndrome when involving the median nerve. We present a case of FLH of the median nerve in a 59-year-old female treated with decompression and collagen nerve wrapping.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Case Reports
ISSN	2332-0885
ISSN	2332-0885
DOI	10.1080/23320885.2024.2344262
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Article ; Online: Three Cases of Non-islet Cell Tumor Hypoglycemia Highlighting Efficacy of Glucocorticoid Treatment.

Voon, Kimberly / Simpson, Aaron / Fegan, Peter Gerard / Walsh, John P

JCEM case reports

2023 Volume 1, Issue 4, Page(s) luad045

Abstract: Non-islet cell tumor hypoglycemia (NICTH) is a rarely encountered cause of hypoglycemia. It is most often caused by tumor secretion of precursor insulin-like growth factor-2 (IGF-2) which, in high concentrations, binds to insulin receptors exerting ... ...

Abstract	Non-islet cell tumor hypoglycemia (NICTH) is a rarely encountered cause of hypoglycemia. It is most often caused by tumor secretion of precursor insulin-like growth factor-2 (IGF-2) which, in high concentrations, binds to insulin receptors exerting insulin-like metabolic effects. It is often associated with mesenchymal and hepatic tumors. We describe 3 cases of NICTH: a 60-year-old man with an unresectable pelvic sarcoma and two women ages 43 and 57 with metastatic hemangiopericytoma. Biochemical assessment identified hypoglycemia associated with suppressed insulin, c-peptide, and beta-hydroxybutyrate levels. Each patient was treated with oral glucocorticoids, which effectively prevented recurrence of hypoglycemia and this effect was sustained long-term. These cases highlight a rarely encountered but important cause of hypoglycemia and demonstrate the long-term efficacy of glucocorticoid treatment in preventing hypoglycemia in cases of NICTH related to surgically unresectable tumors.
Language	English
Publishing date	2023-07-13
Publishing country	England
Document type	Case Reports
ISSN	2755-1520
ISSN (online)	2755-1520
DOI	10.1210/jcemcr/luad045
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Article ; Online: Shared genetics and causal relationships between migraine and thyroid function traits.

Tasnim, Sana / Wilson, Scott G / Walsh, John P / Nyholt, Dale R

Cephalalgia : an international journal of headache

2023 Volume 43, Issue 2, Page(s) 3331024221139253

Abstract: Background: Epidemiological studies have reported a comorbid relationship between migraine and thyroid dysfunction.: Methods: We investigated the genetic relationship between migraine and thyroid function traits using genome-wide association study ( ... ...

Abstract	Background: Epidemiological studies have reported a comorbid relationship between migraine and thyroid dysfunction. Methods: We investigated the genetic relationship between migraine and thyroid function traits using genome-wide association study (GWAS) data. Results: We found a significant genetic correlation ( Conclusion: These findings provide strong evidence for genetic correlation and suggest complex causal relationships between migraine and thyroid traits.
MeSH term(s)	Humans ; Thyroxine ; Genome-Wide Association Study ; Hypothyroidism/complications ; Hypothyroidism/genetics ; Hyperthyroidism/complications ; Hyperthyroidism/genetics ; Thyrotropin ; Migraine Disorders/genetics ; Migraine Disorders/complications
Chemical Substances	Thyroxine (Q51BO43MG4) ; Thyrotropin (9002-71-5)
Language	English
Publishing date	2023-02-04
Publishing country	England
Document type	Meta-Analysis ; Journal Article
ZDB-ID	604567-4
ISSN	1468-2982 ; 0333-1024
ISSN (online)	1468-2982
ISSN	0333-1024
DOI	10.1177/03331024221139253
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Article ; Online: DNA Methylation in Autoimmune Thyroid Disease.

Lafontaine, Nicole / Wilson, Scott G / Walsh, John P

The Journal of clinical endocrinology and metabolism

2022 Volume 108, Issue 3, Page(s) 604–613

Abstract: Graves disease and Hashimoto disease form part of the spectrum of autoimmune thyroid disease (AITD), to which genetic and environmental factors are recognized contributors. Epigenetics provides a potential link between environmental influences, gene ... ...

Abstract	Graves disease and Hashimoto disease form part of the spectrum of autoimmune thyroid disease (AITD), to which genetic and environmental factors are recognized contributors. Epigenetics provides a potential link between environmental influences, gene expression, and thyroid autoimmunity. DNA methylation (DNAm) is the best studied epigenetic process, and global hypomethylation of leukocyte DNA is reported in several autoimmune disorders. This review summarizes the current understanding of DNAm in AITD. Targeted DNAm studies of blood samples from AITD patients have reported differential DNAm in the promoter regions of several genes implicated in AITD, including TNF, IFNG, IL2RA, IL6, ICAM1, and PTPN22. In many cases, however, the findings await replication and are unsupported by functional studies to support causal roles in AITD pathogenesis. Furthermore, thyroid hormones affect DNAm, and in many studies confounding by reverse causation has not been considered. Recent studies have shown that DNAm patterns in candidate genes including ITGA6, PRKAA2, and DAPK1 differ between AITD patients from regions with different iodine status, providing a potential mechanism for associations between iodine and AITD. Research focus in the field is moving from candidate gene studies to an epigenome-wide approach. Genome-wide methylation studies of AITD patients have demonstrated multiple differentially methylated positions, including some in immunoregulatory genes such as NOTCH1, HLA-DRB1, TNF, and ICAM1. Large, epigenome-wide studies are required to elucidate the pathophysiological role of DNAm in AITD, with the potential to provide novel diagnostic and prognostic biomarkers as well as therapeutic targets.
MeSH term(s)	Humans ; Hashimoto Disease/genetics ; DNA Methylation ; Autoimmune Diseases/genetics ; Graves Disease ; Iodine ; Genetic Predisposition to Disease ; Protein Tyrosine Phosphatase, Non-Receptor Type 22/genetics
Chemical Substances	Iodine (9679TC07X4) ; PTPN22 protein, human (EC 3.1.3.48) ; Protein Tyrosine Phosphatase, Non-Receptor Type 22 (EC 3.1.3.48)
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgac664
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Uh III Zs.134: Show issues

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Article ; Online: Managing thyroid disease in general practice.

Walsh, John P

The Medical journal of Australia

2016 Volume 205, Issue 4, Page(s) 179–184

Abstract: Serum thyroid-stimulating hormone (TSH) testing is the best screening tool for thyroid dysfunction. When TSH levels are in the reference range, additional tests such as free thyroxine, free triiodothyronine or thyroid antibodies rarely add value, except ... ...

Abstract	Serum thyroid-stimulating hormone (TSH) testing is the best screening tool for thyroid dysfunction. When TSH levels are in the reference range, additional tests such as free thyroxine, free triiodothyronine or thyroid antibodies rarely add value, except in patients with pituitary disease, when TSH is unreliable. Overt hypothyroidism and subclinical hypothyroidism with TSH levels > 10 mU/L can be treated without further investigation. The health impact of subclinical hypothyroidism with mildly elevated levels of TSH (4-10 mU/L) remains uncertain, particularly in older people; treatment or observation are reasonable options. Thyroxine remains standard treatment for hypothyroidism, with optimal dosage determined by clinical response and serum TSH. Hyperthyroidism is commonly caused by Graves' disease, thyroiditis or toxic nodular goitre. The cause should be established before offering treatment. Radionuclide scanning is the imaging modality of choice. Positive TSH-receptor antibodies indicate Graves' disease. Thyroid ultrasound is indicated for assessment of palpable goitre and thyroid nodules. It is not part of routine assessment of hyperthyroidism or hypothyroidism. Overzealous use of ultrasound identifies clinically unimportant thyroid nodules and can lead to overdiagnosis of thyroid cancer. For thyroid nodules, the key investigation is ultrasound-guided fine needle aspiration biopsy, depending on size and sonographic appearance. Biopsy should not be performed routinely on small nodules < 1 cm. It remains controversial whether pregnant women should be screened for thyroid disease. Reference intervals for thyroid function tests during pregnancy are not well established, and it is uncertain whether thyroxine treatment for pregnant women with serum TSH levels between 2.5 and 4.0 mU/L is beneficial. Iodine supplementation is recommended during pregnancy.
MeSH term(s)	Adult ; Aged ; Female ; General Practice ; Humans ; Hyperthyroidism/blood ; Hyperthyroidism/diagnosis ; Hyperthyroidism/therapy ; Hypothyroidism/blood ; Hypothyroidism/diagnosis ; Hypothyroidism/therapy ; Male ; Mass Screening ; Middle Aged ; Pregnancy ; Reference Values ; Thyroid Diseases/blood ; Thyroid Diseases/diagnosis ; Thyroid Diseases/therapy ; Thyroid Function Tests ; Thyrotropin/blood
Chemical Substances	Thyrotropin (9002-71-5)
Language	English
Publishing date	2016-06-02
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	186082-3
ISSN	1326-5377 ; 0025-729X
ISSN (online)	1326-5377
ISSN	0025-729X
DOI	10.5694/mja16.00545
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Ua VI Zs.398: Show issues

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Article ; Online: Cross-Trait Genetic Analyses Indicate Pleiotropy and Complex Causal Relationships between Headache and Thyroid Function Traits.

Tasnim, Sana / Wilson, Scott G / Walsh, John P / Nyholt, Dale R

Genes

2022 Volume 14, Issue 1

Abstract: Epidemiological studies have reported a comorbid relationship between headache and thyroid traits; however, little is known about the shared genetics and causality that contributes to this association. We investigated the genetic overlap and associations ...

Abstract	Epidemiological studies have reported a comorbid relationship between headache and thyroid traits; however, little is known about the shared genetics and causality that contributes to this association. We investigated the genetic overlap and associations between headache and thyroid function traits using genome-wide association study (GWAS) data. We found a significant genetic correlation (rg) with headache and hypothyroidism (rg = 0.09, p = 2.00 × 10−4), free thyroxine (fT4) (rg = 0.08, p = 5.50 × 10−3), and hyperthyroidism (rg = −0.14, p = 1.80 × 10−3), a near significant genetic correlation with secondary hypothyroidism (rg = 0.20, p = 5.24 × 10−2), but not with thyroid stimulating hormone (TSH). Pairwise-GWAS analysis revealed six, 14, four and five shared (pleiotropic) loci with headache and hypothyroidism, hyperthyroidism, secondary hypothyroidism, and fT4, respectively. Cross-trait GWAS meta-analysis identified novel genome-wide significant loci for headache: five with hypothyroidism, three with secondary hypothyroidism, 12 with TSH, and nine with fT4. Of the genes at these loci, six (FAF1, TMX2-CTNND1, AARSD1, PLCD3, ZNF652, and C20orf203; headache-TSH) and six (HMGB1P45, RPL30P1, ZNF462, TMX2-CTNND1, ITPK1, SECISBP2L; headache-fT4) were significant in our gene-based analysis (pFisher’s combined p-value < 2.09 × 10−6). Our causal analysis suggested a positive causal relationship between headache and secondary hypothyroidism (p = 3.64 × 10−4). The results also suggest a positive causal relationship between hypothyroidism and headache (p = 2.45 × 10−3) and a negative causal relationship between hyperthyroidism and headache (p = 1.16 × 10−13). These findings suggest a strong evidence base for a genetic correlation and complex causal relationships between headache and thyroid traits.
MeSH term(s)	Humans ; Thyroxine ; Genome-Wide Association Study ; Hypothyroidism/complications ; Hypothyroidism/genetics ; Hyperthyroidism/complications ; Hyperthyroidism/genetics ; Thyrotropin/genetics ; Headache/genetics ; Headache/complications ; Adaptor Proteins, Signal Transducing/genetics ; Apoptosis Regulatory Proteins/genetics ; DNA-Binding Proteins/genetics ; Nerve Tissue Proteins/genetics ; Transcription Factors/genetics
Chemical Substances	Thyroxine (Q51BO43MG4) ; Thyrotropin (9002-71-5) ; FAF1 protein, human ; Adaptor Proteins, Signal Transducing ; Apoptosis Regulatory Proteins ; ZNF462 protein, human ; DNA-Binding Proteins ; Nerve Tissue Proteins ; Transcription Factors
Language	English
Publishing date	2022-12-21
Publishing country	Switzerland
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2527218-4
ISSN	2073-4425 ; 2073-4425
ISSN (online)	2073-4425
ISSN	2073-4425
DOI	10.3390/genes14010016
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