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Chinese herbal medicines for hypothyroidism

Hypothyroidism, also known as underactive or low thyroid, is a condition in which the thyroid gland does not produce sufficient amounts of thyroid hormones which are important for many functions of the body (metabolism). In adults hypothyroidism may cause fatigue and sluggishness, increased sensitivity to cold, constipation, pale and dry skin, brittle fingernails and hair, a puffy face, hoarse voice, unexplained weight gain, muscle aches, tenderness, stiffness and weakness, pain, stiffness or swelling in the joints, heavier than normal menstrual periods, and depression. Hypothyroidism in infants and teenagers may result in poor growth and mental development as well as delayed development of permanent teeth and puberty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Thyroid hormone replacement for subclinical hypothyroidism

Subclinical hypothyroidism is a condition where some laboratory findings point at a thyroid gland not working properly. Patients with subclinical hypothyroidism may have vague, non‐specific symptoms of actual hypothyroidism (for example dry skin, cold skin or feeling colder, constipation, slower thinking, poor memory) but these thyroid‐related symptoms are not specific, that is why the diagnosis is based on test results. The fundamental question regarding people with subclinical hypothyroidism is whether they should be treated with thyroid hormones. To answer this question twelve studies of six to 14 months duration involving 350 people were analysed. Thyroid hormone therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity (for example less heart attacks or strokes). Data on health‐related quality of life and symptoms did not demonstrate significant differences between placebo and thyroid hormone therapy. Some evidence indicated that thyroid hormone had some effects on blood lipids and technical measurements of heart function. Adverse effects were inadequately addressed in most of the included studies and have to be urgently investigated in future studies, especially in older patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

High versus low dose of initial thyroid hormone replacement for congenital hypothyroidism

Congenital hypothyroidism is a condition that affects infants from birth and results from a missing or abnormally developed thyroid gland, abnormal production of thyroid hormones or a failure of the pituitary gland to stimulate thyroid hormone production. It affects approximately 1 in 3000 to 4000 newborn infants and early diagnosis and treatment is very important to achieve a good outcome.Treatment of congenital hypothyroidism consists of a daily dose of thyroid hormone (thyroxine). However, the initial dose of thyroxine required to improve outcomes for infants with this condition is unclear and has been the subject of several studies. Some studies have suggested that when infants with congenital hypothyroidism are treated with a higher dose of thyroxine compared with the standard dose, this results in earlier normalisation of the their thyroid hormones and leads to better developmental outcome and intelligence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Hyperthyroidism: What are the advantages and disadvantages of combined treatment with anti-thyroid drugs and radioiodine?

Using anti-thyroid drugs before, during or after radioiodine therapy reduces the adverse effects of the treatment, but the trade-off is a similar reduction in treatment effectiveness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 30, 2013

How does the thyroid gland work?

The thyroid gland (Latin: glandula thyreoidea) is a vitally important hormonal gland that plays an essential role in metabolism, growth and maturation of the human body. It helps to regulate many body functions. The thyroid gland constantly releases a certain amount of hormones into the blood. More hormones are produced when the body needs more energy in certain situations like growth, coldness or during pregnancy.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 6, 2011

Interventions to reduce harm to women and their children from untreated low levels of thyroid hormone in pregnancy

The thyroid is a butterfly‐shaped gland at the front of the oesophagus/throat that produces thyroid hormone. Thyroid hormone helps the body to make energy, keeps body temperature regulated and assists other organs in their functions. Hypothyroidism (a deficiency of thyroid hormone) is a relatively common illness that can cause fatigue, constipation, muscle cramps and weakness, hair loss, dry skin, intolerance to cold, depression and weight gain. Medication is with levothyroxine. Selenium is a trace element that changes the expression of selenoproteins. These act as antioxidants and appear to decrease thyroid inflammation in autoimmune thyroiditis. Pregnant women with subclinical hypothyroidism have abnormal thyroid hormone levels but no symptoms. They are at a increased risk of miscarriage, pre‐eclampsia and preterm birth with impaired neuropsychological development in the child.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Radioiodine treatment for pediatric Graves' disease

Graves' disease is a common cause of hyperthyroidism in children and adolescents which excessive amounts of thyroid hormones circulating in the blood. Affected children and adolescents suffer from increased heart beats, warm moist skin, fatigue, weight loss, raised body temperature, eye and other problems. Application of radioactive iodine (radioiodine), surgical removal of the thyroid gland or drugs that interfere with the production of thyroid hormones (antithyroid drugs) are used to treat this disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Octreotide for treatment of chylothorax in newborns

Collection of lymphatic fluid in the chest cavity is called chylothorax. Routine management of this condition involves treatment of the underlying condition, draining of fluid, putting a tube in the chest wall until all the fluid is drained and rarely surgery. Octreotide is a drug that may reduce the production and accumulation of fluid and allow babies to recover faster. No trials have evaluated the safety and efficacy of this drug in babies and only case reports are available. Future studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antithyroid drug regimen for treating Graves' hyperthyroidism

People who have Graves' hyperthyroidism have thyroid glands which are releasing too much thyroid hormone. This can cause goitres (swelling in the neck around the thyroid gland), sweating, bowel or menstrual problems, and other, especially eye symptoms (ophthalmopathy). Treatments include anti‐thyroid drugs, surgery or radiation to reduce thyroid tissue. There are several choices to be made when considering the drug treatment of Graves' hyperthyroidism including the choice of drug, dose, duration of therapy, addition of thyroid hormone (thyroxine) and when to discontinue therapy. The antithyroid drugs which were used in the included randomised controlled trials (RCTs) comprised carbimazole, propylthiouracil and methimazole.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

No evidence found from randomised trials for drugs to treat pregnant women with hyperthyroidism

Hyperthyroidism in pregnancy is a rare, serious condition which can increase the risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction. Pregnant women who are hyperthyroid may also develop severe pre‐eclampsia or placental abruption. Most of these women have Graves' disease, an autoimmune disease most common in women aged 20 to 40 years. Most pregnant women with hyperthyroidism are diagnosed with thyroid disease prior to conception and will have previously received treatment for the condition. Generally only drug therapy is considered for treating pregnant women with hyperthyroidism. Radioiodine treatment is not used in pregnancy because it destroys the fetal thyroid gland, resulting in permanent hypothyroidism in the newborn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Recombinant human thyrotropin (rhTSH) aided radioiodine treatment for residual or metastatic differentiated thyroid cancer

After the removal of the thyroid gland (thyroidectomy) thyroid hormones have to be substituted to attain a normal way of life. Thyroid hormone withdrawal for four to six weeks has been used for more than 50 years for the treatment of metastatic differentiated thyroid cancer after thyroidectomy because residual cancer cells may then be better destroyed by radiation therapy using radioiodine. Another therapeutic approach to prepare for radiation uses injections of technologically created (recombinant) human thyroid‐stimulating hormone (thyrotropin, TSH) to avoid the symptoms of a malfunctioning thyroid gland (hypothyroidism), which are caused by thyroid hormone withdrawal. This technique has been approved for use in the diagnosis of recurrent and metastatic differentiated thyroid cancer and in the preparation of patients for elimination of normal thyroid remnants after thyroid surgery, but not for treatment of known locally recurrent or metastatic disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Thyroid hormone supplementation for the prevention of morbidity and mortality in infants undergoing cardiac surgery

There is insufficient evidence to advocate the use of triiodothyronine supplementation for the prevention of postoperative morbidity and mortality in infants who undergo cardiopulmonary bypass.Thyroid hormones are integral in cellular metabolism and haemodynamic stability. A transient acquired hypothyroidism occurs after cardiopulmonary bypass and is thought to be associated with low cardiac output, left ventricular dysfunction, increased vascular resistance and impaired ventilatory drives. Thyroid hormone supplementation has been postulated as a possible therapeutic option to improve postoperative outcome measures. This review highlights the lack of evidence concerning the benefits and harms of triiodothyronine supplementation in infants who undergo cardiopulmonary bypass.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Iodine supplementation for preventing iodine deficiency disorders in children

Iodine deficiency causes mental retardation in children as well as an enlarged thyroid gland (goitre) and sometimes deficiencies in thyroid hormones in people of all ages. It still exists in large parts of the world. This review looked at studies with a comparison group of iodine supplementation in children. Twenty‐six studies were included, but these were generally of poor quality. Iodine was given as iodised oil, salt or water. Giving iodine generally decreased thyroid size and increased iodine in the urine. One study suggested a reduction in infant mortality. In some studies there was a trend towards better developmental outcomes after iodine prophylaxis. There was some concern in studies using iodised salt that small children may not eat enough salt to achieve adequate iodine status. Adverse effects were reported, and most of them were minor and did not last long. More high quality long term studies measuring outcomes related to child development, to deaths associated with iodine‐deficiency, and to intervention programmes relevant to children in developed countries, are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Iodised salt for preventing iodine deficiency disorders

Iodine deficiency causes mental retardation in children as well as enlarged thyroid glands (goitre) and deficiencies in thyroid hormones in people of all ages. It still exists in large parts of the world. This review looked at studies of iodised salt in the diet that included a comparison group. Six studies, most of them in children but some also in adults, were included. Iodine in the urine increased in all but one studies, but there was some concern that small children did not eat enough salt to achieve adequate iodine status. Some studies, but not all, also showed a reduction in the enlargement of the thyroid gland (goitre) that can accompany lack of iodine in the diet. Adverse effects were not reported, but these may not have been studied adequately. More high quality long term studies measuring outcomes related to child development, to deaths associated with iodine‐deficiency and to adverse effects are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Thyroid hormones for preventing neurodevelopmental impairment in preterm infants

No evidence from trials that thyroid hormone therapy is effective in preventing problems such as respiratory distress syndrome in preterm babies. Thyroid hormones are needed for the normal growth and maturity of the central nervous system, as well as the heart and lungs. Children born without sufficient thyroid hormones can develop serious mental retardation. It is believed that low levels of thyroid hormones in the first few weeks of life (transient hypothyroxinemia) in preterm babies born before 34 weeks may cause this abnormal development. The review of trials found no evidence that using thyroid hormones in preterm babies is effective in reducing the risk of problems caused by insufficient thyroid hormones.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants

A systematic review of the data from randomised controlled trials provides no evidence that routine thyroid hormone therapy is effective in preventing problems in preterm babies or improves their developmental outcomes. Thyroid hormones are needed for the normal growth and maturity of the central nervous system, as well as the heart and lungs. Children born without sufficient thyroid hormones can develop serious mental retardation. It is believed that low levels of thyroid hormones in the first few weeks after birth (transient hyperthyroxinaemia) in preterm babies born before 34 weeks may contribute to this abnormal development. The review of trials found no evidence that using thyroid hormones routinely in preterm babies is effective in reducing the risk of problems caused by transiently low levels of thyroid hormones.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Fact sheet: Understanding thyroid gland tests

The thyroid gland is a vitally important hormonal gland, which mainly works for body’s metabolism. It is located in the front part of the neck below the voice box and is butterfly-shaped. The functions of the thyroid gland include the production of the thyroid hormones triiodothyronine (T3) and tetraiodothyronine, also called thyroxine (T4).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 6, 2011

Selenium supplementation for Hashimoto's thyroiditis

Hashimoto's thyroiditis is a common disease in which a form of chronic inflammation of the thyroid gland results in reduced function of the gland. It is an auto‐immune disorder, which means that a person's own immune system attacks the thyroid gland, so that it no longer makes adequate quantities of thyroid hormones (hypothyroidism). Common clinical manifestations include feeling cold, depressive mood, dry skin, puffy eyes, constipation, weight gain, slowed heart rate, joint and muscle pain and fatigue. Some but not all people with Hashimoto's thyroiditis have an enlarged gland, also called a goitre. Hashimoto's thyroiditis is more common in women than in men and tends to run in families. Other auto‐immune diseases often occur simultaneously, such as vitiligo, rheumatoid arthritis and diabetes type 1. The disease does not always require treatment, but when it does, it is treated with synthetic thyroid hormone replacement (sometimes desiccated thyroid hormone is used, which is not synthetic). Selenium is an essential trace element that is required in small amounts for correct functioning of the immune system and the thyroid gland.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 7, 2014

Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood Langerhans Cell Histiocytosis.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 30, 2015

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