Hypothyroidism and type d personality:Results from E-MPATHY, a cross-sectional international online patient survey

ContextBetween 10% and 15% of people with hypothyroidism experience persistent symptoms, despite achieving biochemical euthyroidism.The underlying causes are unclear. Type D personality (a vulnerability factor for general psychological distress) is associated with poor healthstatus and symptom burden but has not been studied in people with hypothyroidism.ObjectiveTo investigate type D personality in hypothyroidism and explore associations with other characteristics and patient-reported outcomes.DesignMultinational, cross-sectional survey.SettingOnline.ParticipantsIndividuals with self-reported, treated hypothyroidism.InterventionQuestionnaire.Main Outcome MeasuresType D personality and associations with baseline characteristics, control of the symptoms of hypothyroidism bymedication, satisfaction with care and treatment of hypothyroidism, impact of hypothyroidism on everyday living.ResultsA total of 3915 responses were received, 3523 of which were valid. The prevalence of type D personality was 54.2%. Statisticallysignificant associations were found between type D personality and several respondent characteristics (age, marital status, ethnicity,household income, comorbidities, type of treatment for hypothyroidism, most recent TSH level), anxiety, depression, somatization, poorcontrol of the symptoms of hypothyroidism by medication, dissatisfaction with care and treatment of hypothyroidism, and a negative impactof hypothyroidism on everyday living).DiscussionOur study found a high prevalence of type D personality among people with hypothyroidism who responded to the survey. Type Dpersonality may be an important determinant of dissatisfaction with treatment and care among people with hypothyroidism. Our findings requireindependent confirmation. Close collaboration between the disciplines of thyroidology and psychology is likely to be key in progressing ourunderstanding in this area

Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia

\ua9 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.Objective: Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Design and Participants: Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. Measurements: We analysed questionnaires that had complete demographic data. Results: Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Conclusions: Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires

The thromboxane receptor antagonist NTP42 promotes beneficial adaptation and preserves cardiac function in experimental models of right heart overload

BackgroundPulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary artery pressure leading to right ventricular (RV) failure. While current PAH therapies improve patient outlook, they show limited benefit in attenuating RV dysfunction. Recent investigations demonstrated that the thromboxane (TX) A2 receptor (TP) antagonist NTP42 attenuates experimental PAH across key hemodynamic parameters in the lungs and heart. This study aimed to validate the efficacy of NTP42:KVA4, a novel oral formulation of NTP42 in clinical development, in preclinical models of PAH while also, critically, investigating its direct effects on RV dysfunction.MethodsThe effects of NTP42:KVA4 were evaluated in the monocrotaline (MCT) and pulmonary artery banding (PAB) models of PAH and RV dysfunction, respectively, and when compared with leading standard-of-care (SOC) PAH drugs. In addition, the expression of the TP, the target for NTP42, was investigated in cardiac tissue from several other related disease models, and from subjects with PAH and dilated cardiomyopathy (DCM).ResultsIn the MCT-PAH model, NTP42:KVA4 alleviated disease-induced changes in cardiopulmonary hemodynamics, pulmonary vascular remodeling, inflammation, and fibrosis, to a similar or greater extent than the PAH SOCs tested. In the PAB model, NTP42:KVA4 improved RV geometries and contractility, normalized RV stiffness, and significantly increased RV ejection fraction. In both models, NTP42:KVA4 promoted beneficial RV adaptation, decreasing cellular hypertrophy, and increasing vascularization. Notably, elevated expression of the TP target was observed both in RV tissue from these and related disease models, and in clinical RV specimens of PAH and DCM.ConclusionThis study shows that, through antagonism of TP signaling, NTP42:KVA4 attenuates experimental PAH pathophysiology, not only alleviating pulmonary pathologies but also reducing RV remodeling, promoting beneficial hypertrophy, and improving cardiac function. The findings suggest a direct cardioprotective effect for NTP42:KVA4, and its potential to be a disease-modifying therapy in PAH and other cardiac conditions

Remodeling of extra-bronchial lung vasculature following allergic airway inflammation

<p>Abstract</p> <p>Background</p> <p>We previously observed that allergen-exposed mice exhibit remodeling of large bronchial-associated blood vessels. The aim of the study was to examine whether vascular remodeling occurs also in vessels where a spill-over effect of bronchial remodeling molecules is less likely.</p> <p>Methods</p> <p>We used an established mouse model of allergic airway inflammation, where an allergic airway inflammation is triggered by inhalations of OVA. Remodeling of bronchial un-associated vessels was determined histologically by staining for α-smooth muscle actin, procollagen I, Ki67 and von Willebrand-factor. Myofibroblasts were defined as and visualized by double staining for α-smooth muscle actin and procollagen I. For quantification the blood vessels were divided, based on length of basement membrane, into groups; small (≤250 μm) and mid-sized (250–500 μm).</p> <p>Results</p> <p>We discovered marked remodeling in solitary small and mid-sized blood vessels. Smooth muscle mass increased significantly as did the number of proliferating smooth muscle and endothelial cells. The changes were similar to those previously seen in large bronchial-associated vessels. Additionally, normally poorly muscularized blood vessels changed phenotype to a more muscularized type and the number of myofibroblasts around the small and mid-sized vessels increased following allergen challenge.</p> <p>Conclusion</p> <p>We demonstrate that allergic airway inflammation in mice is accompanied by remodeling of small and mid-sized pulmonary blood vessels some distance away (at least 150 μm) from the allergen-exposed bronchi. The present findings suggest the possibility that allergic airway inflammation may cause such vascular remodeling as previously associated with lung inflammatory conditions involving a risk for development of pulmonary hypertension.</p

Treatment of Obesity with Thyroid hormones in Europe. Data from the THESIS* Collaboration

\ua9 The Author(s) 2024.Purpose: The use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists. Methods: Specialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether “Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions”. Results: Of 17,232 invitations 5695 responses were received (33% valid response rate; 65% women; 90% endocrinologists). Of these, 290 (5.1%) stated that TH may be indicated as treatment for obesity in euthyroid patients. This view was commoner among non-endocrinologists (8.7% vs. 4.7%, p &lt; 0.01), private practice (6.5% vs. 4.5%, p &lt; 0.01), and varied geographically (Eastern Europe, 7.3%; Southern Europe, 4.8%; Western Europe, 2.7%; and Northern Europe, 2.5%). Respondents from Northern and Western Europe were less likely to use TH than those from Eastern Europe (p &lt; 0.01). Gross national income (GNI) correlated inversely with this view (OR 0.97, CI: 0.96–0.97; p &lt; 0.001). Having national guidelines on hypothyroidism correlated negatively with treating obesity with TH (OR 0.71, CI: 0.55–0.91). Conclusions: Despite the lack of evidence, and contrary to guidelines’ recommendations, about 5% of respondents stated that TH may be indicated as a treatment for obesity in euthyroid patients resistant to life-style interventions. This opinion was associated with (i) respondent characteristics: being non-endocrinologist, working in private practice, treating a small number of hypothyroid patients annually and (ii) national characteristics: prevalence of obesity, Eastern Europe, low GNI and lack of national hypothyroidism guidelines

Characteristics of specialists treating hypothyroid patients: the “THESIS” collaborative

Copyright \ua9 2023 Žarković, Attanasio, Nagy, Negro, Papini, Perros, Cohen, Akarsu, Alevizaki, Ayvaz, Bednarczuk, Berta, Bodor, Borissova, Boyanov, Buffet, Burlacu, Ćirić, D\uedez, Dobnig, Fadeyev, Field, Fliers, Fr\uf8lich, F\ufchrer, Galofr\ue9, Hakala, Jiskra, Kopp, Krebs, Kršek, Kužma, Lantz, Laz\ufarov\ue1, Leenhardt, Luchytskiy, McGowan, Melo, Metso, Moran, Morgunova, Mykola, Beleslin, Niculescu, Perić, Planck, Poiana, Puga, Robenshtok, Rosselet, Ruchala, Riis, Shepelkevich, Unuane, Vardarli, Visser, Vrionidou, Younes, Yurenya and Heged\ufcs.Introduction: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors. Methods: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita). Results: 5,695 valid responses were received (response rate 33\ub70%). The mean age was 49 years, and 65\ub70% were female. The proportion of female respondents was lowest in Northern (45\ub76%) and highest in Eastern Europe (77\ub72%) (p &lt;0\ub7001). Respondent work volume, university affiliation and private practice differed significantly between countries (p&lt;0\ub7001). Age and GNI per capita were correlated inversely with the proportion of female respondents (p&lt;0\ub701). GNI per capita was inversely related to the proportion of respondents working exclusively in private practice (p&lt;0\ub7011) and the proportion of respondents who treated &gt;100 patients annually (p&lt;0\ub701). Discussion: THESIS has demonstrated differences in characteristics of thyroid specialists at national and regional levels, strongly associated with GNI per capita. Hypothyroid patients in middle-income countries are more likely to encounter female thyroid specialists working in private practice, with a high workload, compared to high-income countries. Whether these differences influence the quality of care and patient satisfaction is unknown, but merits further study