A novel melanoma therapy stirs up a storm: ipilimumab-induced thyrotoxicosis.

Unlabelled: Ipilimumab, a novel therapy for metastatic melanoma, inhibits cytotoxic T-lymphocyte apoptosis, causing both antitumor activity and significant autoimmunity, including autoimmune thyroiditis. Steroids are frequently used in treatment of immune-related adverse events; however, a concern regarding the property of steroids to reduce therapeutic antitumor response exists. This study describes the first reported case of ipilimumab-associated thyroid storm and implicates iopanoic acid as an alternative therapy for immune-mediated adverse effects.

Radioiodine treatment of differentiated thyroid cancer despite history of 'iodine allergy'.

Unlabelled: Radioiodine ((131)I) is a critical component in the treatment of differentiated thyroid cancer. We recently saw a patient with thyroid cancer who was hesitant to take (131)I treatment because he had previously encountered an allergic reaction to administration of iodine-containing radiocontrast agent for computed tomography (CT) scanning. We were able to administer (131)I treatment after discussion that his anaphylactic reaction was not due to iodine and that radioiodine ((131)I) treatment is unlikely to cause a reaction in the patient.

Targeted treatment of differentiated and medullary thyroid cancer.

The incidence of thyroid cancer is increasing, with a concomitant increase in the number of patients with advanced and metastatic disease. Discoveries regarding the pathogenesis of thyroid cancer have led to the recent development of new therapeutic agents that are beginning to appear on the market. Many of these new agents are targeted kinase inhibitors primarily affecting oncogenic kinases (BRAF V600E, RET/PTC) or signaling kinases (VEGFR, PDGFR).

Falsely elevated thyroid hormone levels due to anti-sheep antibody interference in an automated electrochemiluminescent immunoassay.

We describe a 43-year-old woman with falsely increased thyroxine (T(4)) and triiodothyronine (T(3)) concentrations (total and index values) using a competitive electrochemiluminescent immunoassay, due to human anti-sheep antibodies. The thyrotropin (TSH) concentration was within normal limits. When specimens were re-tested by an immunoassay utilizing mouse antibodies, the total T(4) and T(3) concentrations were within normal limits.

Alternate pathways of thyroid hormone metabolism.

The major thyroid hormone (TH) secreted by the thyroid gland is thyroxine (T(4)). Triiodothyronine (T(3)), formed chiefly by deiodination of T(4), is the active hormone at the nuclear receptor, and it is generally accepted that deiodination is the major pathway regulating T(3) bioavailability in mammalian tissues. The alternate pathways, sulfation and glucuronidation of the phenolic hydroxyl group of iodothyronines, the oxidative deamination and decarboxylation of the alanine side chain to form iodothyroacetic acids, and ether link cleavage provide additional mechanisms for regulating the supply of active hormone.

Current controversies in endocrinology: screening of asymptomatic elderly for subclinical hypothyroidism.

Thyroid disorders are common in elderly patients. In fact, the most common form of thyroid dysfunction in the elderly is subclinical hypothyroidism. Subclinical hypothyroidism is a biochemical state characterized by an increased serum thyroid-stimulating hormone and normal levels of serum-free T4 and free T3.

Elevated serum parathyroid hormone concentration in eucalcemic patients after parathyroidectomy for primary hyperparathyroidism and its relationship to vitamin D profile.

Elevation of serum parathyroid hormone (PTH) level in eucalcemic patients after parathyroidectomy for primary hyperparathyroidism has been described in up to 40% of patients, but little is known about its etiology or clinical significance. To better understand the cause of this phenomenon, we studied 49 patients without renal dysfunction or osteomalacia who underwent parathyroidectomy for primary hyperparathyroidism. Patients were categorized into 2 groups based on their serum PTH and calcium levels after parathyroidectomy: (1) elevated PTH with eucalcemia (n = 21), (2) normal PTH with eucalcemia (n = 28).

A radioimmunoassay for measurement of 3,3'-diiodothyronine sulfate: Studies in thyroidal and nonthyroidal diseases, pregnancy, and fetal/neonatal life.

Data suggesting that (1) sulfation of the phenolic hydroxyl of iodothyronines plays an important role in thyroid hormone metabolism and (2) maternal serum 3,3'-diiodothyronone sulfate (3,3'-T(2)S) may reflect on the status of fetal thyroid function stimulated us to develop a radioimmunoassay (RIA) for measurement of T(2)S. Our T(2)S RIA is highly sensitive, practical, and reproducible. T(4)S, T(3)S, and T(1)S crossreacted 3.

Treatment of hyperthyroidism associated with thyrotropin-secreting pituitary adenomas with iopanoic acid.

TSH-secreting tumors comprise less than 2% of all pituitary adenomas. All patients present with hyperthyroidism with a detectable TSH level, and a majority have macroadenomas. Oral cholecystographic agents (e.

Role for inner ring deiodination preventing transcutaneous passage of thyroxine.

Creams containing thyroid hormone are commonly employed for cosmetic purposes. To verify whether T(4) applied to the skin surface can enter the bloodstream either directly or as a metabolite, a cream containing L-T(4) [3,5,3',5'-tetraiodothyronine (T(4))] was self-applied by volunteers for 2 wk. No significant variations in urinary iodide, TSH, and serum (total and free) T(4) and T(3) concentrations were observed at any time relative to pretreatment values, whereas rT(3) concentrations increased significantly 6 and 12 h after cream application.

Treatment of primary hypothyroidism during pregnancy: is there an increase in thyroxine dose requirement in pregnancy?

We studied the dose requirements of thyroxine (T(4)) and serum concentrations of thyrotropin-stimulating hormone (TSH) and free T(4) in 16 pregnant women with primary hypothyroidism due to autoimmune thyroid disease (ATD, n = 11) or thyroidectomy (n = 5). All patients had been advised by their obstetricians to take prenatal vitamins enriched with iron ( approximately 90mg/tablet) and calcium ( approximately 200 mg/tablet), known to inhibit absorption of T(4). We asked patients to take their vitamins 4 hours after ingesting T(4) in the morning.