Thyroid function tests in patients taking thyroid medication in Germany: Results from the population-based Study of Health in Pomerania (SHIP)

<p>Abstract</p> <p>Background</p> <p>Studies from iodine-sufficient areas have shown that a high proportion of patients taking medication for thyroid diseases have thyroid stimulating hormone (TSH) levels outside the reference range. Next to patient compliance, inadequate dosing adjustment resulting in under- and over-treatment of thyroid disease is a major cause of poor therapy outcomes. Using thyroid function tests, we aim to measure the proportions of subjects, who are under- or over-treated with thyroid medication in a previously iodine-deficient area.</p> <p>Findings</p> <p>Data from 266 subjects participating in the population-based Study of Health in Pomerania (SHIP) were analysed. All subjects were taking thyroid medication. Serum TSH levels were measured using immunochemiluminescent procedures. TSH levels of < 0.27 or > 2.15 mIU/L in subjects younger than 50 years and < 0.19 or > 2.09 mIU/L in subjects 50 years and older, were defined as decreased or elevated, according to the established reference range for the specific study area. Our analysis revealed that 56 of 190 (29.5%) subjects treated with thyroxine had TSH levels outside the reference range (10.0% elevated, 19.5% decreased). Of the 31 subjects taking antithyroid drugs, 12 (38.7%) had TSH levels outside the reference range (9.7% elevated, 29.0% decreased). These proportions were lower in the 45 subjects receiving iodine supplementation (2.2% elevated, 8.9% decreased). Among the 3,974 SHIP participants not taking thyroid medication, TSH levels outside the reference range (2.8% elevated, 5.9% decreased) were less frequent.</p> <p>Conclusion</p> <p>In concordance with previous studies in iodine-sufficient areas, our results indicate that a considerable number of patients taking thyroid medication are either under- or over-treated. Improved monitoring of these patients' TSH levels, compared to the local reference range, is recommended.</p

A Genome-Wide Association Meta-Analysis of Circulating Sex Hormone-Binding Globulin Reveals Multiple Loci Implicated in Sex Steroid Hormone Regulation

WOS:000306840400020Peer reviewe

The Relation between Migratory Activity of Pipistrellus Bats at Sea and Weather Conditions Offers Possibilities to Reduce Offshore Wind Farm Effects

Bats undertaking seasonal migration between summer roosts and wintering areas can cross large areas of open sea. Given the known impact of onshore wind turbines on bats, concerns were raised on whether offshore wind farms pose risks to bats. Better comprehension of the phenology and weather conditions of offshore bat migration are considered as research priorities for bat conservation and provide a scientific basis for mitigating the impact of offshore wind turbines on bats. This study investigated the weather conditions linked to the migratory activity of Pipistrellus bats at multiple near- and offshore locations in the Belgian part of the North Sea. We found a positive relationship between migratory activity and ambient temperature and atmospheric pressure and a negative relationship with wind speed. The activity was highest with a wind direction between NE and SE, which may favor offshore migration towards the UK. Further, we found a clear negative relationship between the number of detections and the distance from the coast. At the nearshore survey location, the number of detections was up to 24 times higher compared to the offshore locations. Our results can support mitigation strategies to reduce offshore wind farm effects on bats and offer guidance in the siting process of new offshore wind farms

Setting the context for offshore wind development effects on fish and fisheries

Changes to fisheries that result from offshore wind farm (OWF) installations may be considered good or bad depending on various stakeholders’ perspectives. OWFs can act as artificial reefs that may benefit secondary fish production, but such effects may also have ecological consequences. The fisheries exclusion effect that turns some OWFs into no-go areas, hence effectively no-take zones, could provide resource enhancements or redistribution. However, the displacement of fishing effort may have consequences to fisheries elsewhere. Changes in the sensory environment related to sound, as well as electromagnetic fields and physical alterations of current and wind wakes, may have as yet unknown impacts on fisheries resources. Understanding the interactions among effect type, OWF development phase, and spatiotemporal population dynamics of commercial and recreational species remains chal-lenging, exemplified by the commercial fishery lobster genus Homarus in European and North American waters. While knowledge of the interactions between resource species and OWFs is improving, there remain questions on the wider interaction between and consequences of OWFs and fisheries. Studies of this wider relevance should aim to improve understanding of the economic and societal impacts of OWFs linked to ecosystem services that support fisheries. Furthermore, assisting fisheries management and providing advice requires monitoring and survey data collection at appropriate spatiotemporal scales. This information will help to determine whether OWFs have any meaningful impact on regional fisheries, and increased investments will be needed to target scientifically appropriate monitoring of OWFs and fisheries, which is supported by better integrated policy and regulation.</p

ETA Guideline: Management of Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT(4) within reference range, should be investigated with a repeat measurement of both serum TSH and FT(4), along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (<65-70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L-thyroxine replacement therapy should be considered. For such patients who have been started on L-thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L-thyroxine therapy should generally be stopped. Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people. The oldest old subjects (>80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter