Disorders of Thyroid Function Presentations at American Thyroid Association: 88th Annual Meeting

October 2, 2018—The American Thyroid Association (ATA) will hold its 88^th Annual Meeting on October 3‒7, 2018, at the Marriott Marquis in Washington, DC. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these concerns disorders of thyroid function.

1. Dr. Maia Banige will give a presentation titled "Prediction of fetal and neonatal dysthyroidism," showing how imperfect development and function of the thyroid in fetuses (FD) and newborns (ND) can be predicted from perinatal variables. Dr. Banige is from the Department of Pediatrics-Neonatology and Pediatric Emergency of the French-British Hospital Institute, Levallois-Perret, Ile-de-France.
     
   She and her colleagues conducted a retrospective, multicenter study using data from the medical records of all patients monitored for pregnancy from 2007 to 2014 in 10 obstetric centers of the Assistance Publique des Hôpitaux de Paris. Women with Graves' disease who were positive for thyrotropin receptor antibodies (TRAb) at least once during pregnancy were included. Among 280,000 births, 2,288 medical records of women with thyroid dysfunction were selected and screened, and 417 women with Graves' disease who were positive for TRAb during pregnancy (0.15%) were finally included in the study.
     
   Analysis revealed that the TRAb level in the mother and child was the strongest independent predictor of thyroid dysfunction. The risk of FD and ND increases with maternal hormonal imbalance and is also greater in the patients receiving antithyroid drugs (ATDs) during pregnancy. In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction.

  

A presentation titled "Pre-conception thyroid stimulating hormone level and risk of preterm birth in over 4.3 million rural Chinese women aged 20-49 years: a population-based cohort study" will be given by Dr. Ying Yang of the National Research Institute for Health and Family Planning and the National Human Genetic Resources Center. Dr. Ying and his colleagues studied the association between the pre-conception thyroid stimulating hormone (TSH) levels of women planning for pregnancy and the risk of preterm births (PTB).
  
Researchers conducted a historical cohort study of 4,320,584 rural reproductive-age women who had participated in free National Free Pre-pregnancy Checkups (NFPC) in 2013-2016 in China. Data on preconception TSH, history of pregnancy and diseases, and other variables were obtained from the physical examination record in NFPC. Successful conception and pregnancy outcomes were documented during the follow-up period, June 2013 to December 2017. PTB is defined as any birth within 28 to 37 weeks of gestational age. Participants who failed to become pregnant within 6 months, suffered from fetal death or stillbirth, or had multiple gestations during the period of study were excluded from the analysis. The data documented 283,854 PTB events (6.57%).
  
The study identified a V-shaped relationship between maternal pre-conception TSH levels and PTB risk. Either decreasing or increasing pre-conception TSH levels can significantly increase the risk of preterm birth.

  

Dr. George Kahaly of the Department of Medicine at Johannes Gutenberg University Medical Center in Mainz, Germany, and colleagues have undertaken a three-phase clinical trial of the drug teprotumumab. Results from the first phase—a 24-week randomized, double-masked, placebo-controlled treatment trial of the drug, which is an insulin-like growth-factor-1 receptor inhibitory antibody—were reported in the New England Journal of Medicine (NEJM 2017; 376:1748). Compared with a placebo (69% versus 20%), teprotumumab reduced protopsis (protrusion of the eyeballs) significantly beginning at week 6 and continuing over the 24 weeks of the trial. This second-phase report is an assessment of clinical status at weeks 28 and 72.
  
At week 28 (4 weeks after the treatment period), proptosis response was 73.8% in the teprotumumab group versus 13.3% in controls. At week 72 (48 weeks after treatment), 53% of week 24 teprotumumab proptosis responders maintained ≧ 2 mm improvement relative to baseline. Compared to baseline and placebo, clinical activity also decreased at week 28 and was relatively unchanged in the teprotumumab group at week 72. These results indicate no acute rebound of disease following the 24-week treatment.
  
Dr. Kahaly's group conclude that teprotumumab may represent a disease-modifying therapy in TAO by reducing proptosis and clinical activity, with sustained effects seen in most patients 48 weeks after treatment. In phase 3 of the trial, the research group will investigate whether patients would benefit from longer treatment or retreatment with teprotumumab.

  

Dr. Mats Holmberg of Institute of Medicine, Sahlgrenska Academy, and the Karolinska University Hospital, ANOVA, both in Stockholm, Sweden, will present a study titled "Structural brain changes in Graves' hyperthyroidism may be of autoimmune origin."  During the hyperthyroid state of Graves' disease (GD), the volumes of medial temporal lobe (MTL) structures, e.g., the hippocampi, are reduced. This has been attributed to high thyroid hormone levels, but Dr. Holmberg and his colleagues hypothesized that the structural changes and mental symptoms may be due to autoimmunity per se. The aim of their study was to determine the relationship between nonthyroid autoimmunity and MTL volumes during hyperthyroidism in GD.
  
Dr. Holmberg's project is a longitudinal, observational, prospective case-controlled study in which 65 premenopausal women were evaluated within 2 weeks after a diagnosis of GD and again after 15 months of antithyroid treatment. Thyroid-stimulating hormone receptor antibodies, thyroid-stimulating immunoglobulins, and several additional antibodies were measured in the hyperthyroid state. MTL structures were scanned to determine hippocampal and amygdala volumes. This presentation reports preliminary data on the nonthyroid antibodies at baseline. Data on the thyroid antibodies will be reported separately.
  
The data so far support the hypothesis that autoimmunity that is not directly connected to the thyroid may be involved in the impairment of brain function in GD, introducing a new concept that needs further study.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

• The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

 

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