PHILADELPHIA (October 12, 2020)— Christian A. Koch, MD, PhD, FACP, MACE, director of endocrinology and researcher in the Department of Medicine at Fox Chase Cancer Center, recently assisted in the publication of a special edition of The Journal of Clinical and Translational Endocrinology that highlighted methods of managing patients with hyperthyroidism.
Koch, who has served as an associate editor for the journal for several years, helped edit the special edition, which covers several topics related to the diagnosis and treatment of patients with hyperthyroidism.
“We chose this topic because in terms of cases of hyperthyroidism, they are increasing. Potential explanations for that can be the rising incidence of thyroid cancer patients, with many requiring exogenous thyroid hormone to suppress thyroid stimulating hormone, also known as TSH,” Koch said.
“Another reason for seeing more cases of hyperthyroidism can be that we increasingly use medications called immunotherapy to treat cancers. Immunotherapy has been shown to cause, in some cases, an inflammation of the thyroid gland,” he added.
“Over time this might turn into hypothyroidism, with the need to replace thyroid hormone, and then there’s even potential that the patient, after completing immunotherapy, might not need the thyroid hormone anymore,” he said.
In the issue, researchers highlight cases of thyroid dysfunction in relation to cancer. They note that while cancer is an unusual cause of thyroid dysfunction, tumors can metastasize to the thyroid gland. Determining if that is the case is pivotal to effective treatment.
“This is an extremely important topic. In the case of referrals, specifically at Fox Chase, we will get a patient that has a thyroid nodule and at the same time will have renal cancer or another cancer. The question is ‘What is the prevalence of metastases in the thyroid gland,’” said Koch. “It’s important to determine whether a nodule within the thyroid gland has metastasized or not because treatment of the cancer can completely change.”
In one of the articles, the authors call for a stronger emphasis on etiological and clinical features rather than focusing solely on measuring TSH, which can determine whether an individual has an underactive or overactive thyroid.
A higher level of TSH typically indicates an underactive thyroid, or hypothyroidism, and a lower level typically indicates an overactive thyroid, or hyperthyroidism. However, this needs to be interpreted in the context of free thyroid hormones, Koch said.
“One other interesting feature that we cover is that TSH really can vary in patients with autoimmune thyroid disease. The key is the TSH receptor, which can be stimulated or blocked by antibodies. If you stimulate the TSH receptor, you might get an overactive phase. If you block it, you might get an underactive phase, which explains in part why there’s a wax and wane in thyroid function for some patients with autoimmune thyroid disease, and people are confused about what to do,” he said.
In another article, researchers discuss mental disease in connection to thyroid function, noting that bipolar disorder with mania or manic-depressive psychosis can be related to hyperthyroidism. Conversely, a decline in the thyroid hormone triiodothyronine can cause depressive and anxiety disorders.
In additional articles in the issue, researchers reviewed practices for managing hyperthyroidism during pregnancy as well as the use of color Doppler sonography in diagnosing hyperthyroidism.
“When reading again the papers of this JCTE issue as average readers, we felt that most colleagues would find them useful in their daily clinical practice,” the editors wrote.
The highlights were featured in “The Various Faces of Hyperthyroidism,” the latest issue of The Journal of Clinical and Translational Endocrinology.