Three New Papers
Published Today

Dr. John C. Lowe
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.


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