Problems in the Management of Hypothyroidism

  • Enrico L. Ocampo
  • Martin I. Surks
Part of the Contemporary Endocrinology book series (COE, volume 2)

Abstract

Overt hypothyroidism occurs in 1.5–2% of women and in 0.2% of men; its incidence increases with age. Most hypothyroid patients have disease of the thyroid gland. Presenting complaints and physical findings vary widely from patient to patient and depend on the severity of the illness. Patients may present with weakness, fatigue, arthralgias, myalgias, muscle cramps, cold intolerance, constipation, lethargy, dryness of the skin, headache, menorrhagia, hoarseness, edema, and unexplained weight gain. Physical findings include varying degrees of brittle nails and hair, pallor, delayed relaxation time of the deep tendon reflexes, keratinic skin color, macroglossia, mental status changes, diastolic hypertension, bradycardia, and, often, a palpable goiter (1) Laboratory investigation may show increased serum cholesterol, abnormal liver enzymes and creatinine kinase, increased serum prolactin, hyponatremia, normochromic, normocytic or macrocytic anemia, and, in those with Hashimoto’s disease, the presence of antithyroid microsomal (antithyroid peroxidase) antibodies (1).

Keywords

Bone Mineral Density Subclinical Hypothyroidism Hypothyroid Patient Primary Hypothyroidism Overt Hypothyroidism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Singer PA, Cooper DS, Levy EG, Ladenson PW, Braverman LE, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. J Am Med Assoc 1995; 273: 808–812.Google Scholar
  2. 2.
    Surks MI, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH. American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. J Am Med Assoc 1990; 263 (11): 1529–1532.Google Scholar
  3. 3.
    Shapiro LE, Surks MI. Hypothyroidism. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism 2nd ed. JB Lippincott, Philadelphia, 1995, pp. 404–411.Google Scholar
  4. 4.
    Shapiro LE, Surks MI. Managing hypothyroidism. Endocrinologist 1991; 1 (5): 343–347.Google Scholar
  5. 5.
    Toft AD. Thyroxine therapy. N Engl J Med 1994; 331 (4): 174–180.PubMedGoogle Scholar
  6. 6.
    Mokshagundam S, Barzel US. Thyroid disease in the elderly. J Am Geriatric Soc 1993; 41: 1361–1369.Google Scholar
  7. 7.
    Bearcroft CP, Toms GC, Williams SJ, Noonan K, Monson JP. Thyroxine replacement in postradioiodine hypothyroidism. Clin Endocrinol 1991; 34: 115–118.Google Scholar
  8. 8.
    Kasagi K, Konishi J, Iida Y, Mori T, Torizuka K. Changes in thyroid-stimulating and TSHbinding inhibitory activities in a patient who developed hyperthyroidism due to Graves’ following primary hypothyroidism. Clin Endocrinol 1986; 25: 519–525.Google Scholar
  9. 9.
    Hardisty GA, Fowles A, Munro DS. The effect of radioiodine and antithyroid drugs on serum long acting thyroid stimulator protector (LATS-P): a three year prospective study. Clin Endocrinol 1984; 20: 597–605.Google Scholar
  10. 10.
    Surks MI, Sievert R. Drugs and thyroid function. N Engl J Med 1995; 33 (25): 1688–1694.Google Scholar
  11. 11.
    Shakir KMMM, Michaels RD, Hays JH, Potter BB. The use of bile acid sequestrants to lower serum thyroid hormones in iatrogenic hyperthyroidism. Ann Intern Med 1993; 218: 112, 113.Google Scholar
  12. 12.
    Liel Y, Sperber AD, Shany S. Nonspecific intestinal adsorption of levothyroxine by aluminum hydroxide. Am J Med 1994; 97: 363–365.PubMedGoogle Scholar
  13. 13.
    Campbell NRC, Hasinoff BB, Stalts H, Rao B, Wong NC. Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern Med 1992; 117: 1010–1013.PubMedGoogle Scholar
  14. 14.
    Havrankova J, Lahaie R. Levothyroxine binding by sucralfate. Ann Intern Med 1992; 117: 445, 446.Google Scholar
  15. 15.
    Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patient with thyroid disease. Ann Intern Med 1993; 119 (6): 492–502.PubMedGoogle Scholar
  16. 16.
    Oppenheimer JH, Bernstein G, Surks MI. Increase thyroxine turnover and thyroidal function after stimulation of hepatocellular binding of thyroxine by phenobarbital. J Clin Invest 1968; 47: 1399–1406.PubMedGoogle Scholar
  17. 17.
    Isley WL. Effect of rifampin therapy on thyroid function tests in a hypothyroid patient on replacement L-thyroxine. Ann Intern Med 1987; 107: 517, 518.Google Scholar
  18. 18.
    Faber J, Lumholtz IB, Kirkegaard C, Poulsen S, Jorgensum PH, Siersbaek-Nielsen K, et al. The effects of phenytoin on the extrathyroidal turnover of thyroxine, 3,5,3 ’-triiodothyronine, 3,3 ’,5 ’-triiodothyronine, and 3 ’,5 ’-diiodothyronine in man. J Clin Endocrinol Metab 1985; 61: 1093–1099.PubMedGoogle Scholar
  19. 19.
    De Luca F, Arrigo T, Pandullo E, Siracusano MF, Benvenga S, Trimarchi F. Changes in thyroid function tests induced by 2 month carbamazepine treatment in L-thyroxine-substituted hypothyroid children. Eur J Pediatr 1986; 145: 77–79.PubMedGoogle Scholar
  20. 20.
    Arafah BM. Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Ann Intern Med 1994; 121: 247–251.PubMedGoogle Scholar
  21. 21.
    Klein I, Ojamaa K. Cardiovascular manifestations of endocrine disease. J Clin Endocrinol Metab 1992; 75 (2): 339–342.PubMedGoogle Scholar
  22. 22.
    Klein I. Thyroid hormone and the cardiovascular system. Am J Med 1990; 88: 631–637.PubMedGoogle Scholar
  23. 23.
    Althaus BU, Staub JJ, Ryff-De Leche A, Stahelin B. LDL/HDL changes in subclinical hypothyroidism Clin Endocrinol 1988; 28: 157.Google Scholar
  24. 24.
    Levine HD. Compromise therapy in the patient with angina pectoris and hypothyroidism. A clinical assessment. Am J Med 1980; 69: 411–418.Google Scholar
  25. 25.
    Hiasa Y, Ishida T, Aihara T, Bando M, Nakai Y, Kataoka Y. Acute myocardial infarction due to coronary spasm associated with L-thyroxine therapy. Clin Cardiology 1989; 12: 161–163.Google Scholar
  26. 26.
    Polikar R, Feld GK, Dittrich HC, Smith J, Nicod P. Effect of thyroid replacement therapy on the frequency of benign atrial and ventricular arrhythmias. J Am Coll Cardiol 1989; 14 (4): 999–1002.PubMedGoogle Scholar
  27. 27.
    Ellyin F, Fuh C-Y, Singh SP, Kumar Y. Hypothyroidism with angina pectoris. A clinical dilemma. Postgraduate Medicine 1986; 79 (7): 93–98.PubMedGoogle Scholar
  28. 28.
    Ellyin FM, Kumar Y, Somberg JC. Hypothyroidism complicated by angina pectoris: therapeutic approaches. J Clin Pharmacol 1992; 32: 843–847.PubMedGoogle Scholar
  29. 29.
    Ladenson PW. Recognition and management of cardiovascular disease related to thyroid dysfunction. Am J Med 1990; 88: 638–641.PubMedGoogle Scholar
  30. 30.
    Keating FR, Parkin TW, Selby JB, Dickinson LS. Treatment of Heart Disease Associated with Myxedema. Prog Cardiovasc Dis 1961; 3: 364–381.PubMedGoogle Scholar
  31. 31.
    Toft AD. Thyroxine replacement therapy. Ann Academy Med 1993; 22 (4): 583–586.Google Scholar
  32. 32.
    Drucker DJ, et al. Cardiovascular surgery in the hypothyroid patient. Arch Intern Med 1985; 145: 85–87.Google Scholar
  33. 33.
    Stall GM, Harris S, Sokoll LJ, Dawson-Hughes B. Accelerated bone loss in hypothyroid patients overtreated with L-thyroxine. Ann Intern Med 1990; 113: 265–269.PubMedGoogle Scholar
  34. 34.
    Ross DS, Neer RM, Ridgway EC, Daniels GH. Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with 1-thyroxine. Am J Med 1987; 82: 1167–1170.PubMedGoogle Scholar
  35. 35.
    Coindre JM, David J-P, Riviere L, Goussot J-F, Roger P, et al. Bone loss in hypothyroidism with hormone replacement. Arch Intern Med 1986; 146: 48–53.PubMedGoogle Scholar
  36. 36.
    Leese GP, Jung RT, Guthrie C, Waught N, Browning MCK. Morbidity in patients on L-thyroxine: a comparison of those with a normal TSH to those with a suppressed TSH. Clin Endocrinol 1992; 37: 500–503.Google Scholar
  37. 37.
    Ross DS. Bone density is not reduced during the short-term administration of levothyroxine to postmenopausal women with subclinical hypothyroidism: a randomized, prospective study. Am J Med 1993; 95: 385–388.PubMedGoogle Scholar
  38. 38.
    Grant DJ, McMurdo ET, Mole PA, Paterson CR, Davies RR. Suppressed TSH levels secondary to thyroxine replacement therapy are not associated with osteoporosis. Clin Endocrinol 1993; 39: 529–533.Google Scholar
  39. 39.
    Burman KD. How serious are the risks of thyroid hormone over-replacement? Thyroid Today 1995; 18 (4): 1–9.Google Scholar
  40. 40.
    Duncan WE, Chang A, Solomon B, Wartofsky L. Influence of clinical characteristics and parameters associated with thyroid hormone therapy on the bone mineral density of women treated with thyroid hormone. Thyroid 1994; 4 (2): 183–190.PubMedGoogle Scholar
  41. 41.
    Ross DS. Hyperthyroidism, thyroid hormone therapy, and bone. Thyroid 1994; 4 (3): 319–326.PubMedGoogle Scholar
  42. 42.
    Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J of Endocrinol 1994; 130: 350–356.Google Scholar
  43. 43.
    Garton M, Reid I, Loveridge N, Robins S, Murchison L, Beckett G, Reid D. Bone mineral density and metabolism in premenopausal women taking L-thyroxine replacement therapy. Clin Endocrinol 1994; 41 (6): 747–755.Google Scholar
  44. 44.
    Kung AWC, Lorentz T, Tam SCF. Thyroxine suppressive therapy decreases bone mineral density in post-menopausal women. Clin Endocrinol 1993; 39: 535–540.Google Scholar
  45. 45.
    Lehmke J, Bogner U, Felsenberg D, Peters H, Schleusener H. Determination of bone mineral density by quantitative computed tomography and single photon absorptiometry in subclincial hyperthyroidism: a risk of early osteopaenia in post-menopausal women. Clin Endocrinol 1992; 36: 511–517.Google Scholar
  46. 46.
    Pioli G, Pedrazzone M, Palummeri E, Sianesi M, Del Frate R, et al. Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premenopausal women. Acta Endocrinol 1992; 126: 238–242.PubMedGoogle Scholar
  47. 47.
    Adlin EV, Maurer AH, Marks AD, Channick BJ. Bone mineral density in postmenopausal women treated with L-thyroxine. Am J Med 1991; 90: 360–366.PubMedGoogle Scholar
  48. 48.
    Greenspan SL, Greenspan FS, Resnick NM, Block JE, Friedlander AL, Genant HK. Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-thyroxine therapy. Am J Med 1991; 91: 5–14.PubMedGoogle Scholar
  49. 49.
    Diamond T, Nery L, Hales I. A therapeutic dilemma: suppressive doses of thyroxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab 1991; 72 (5): 1184–1188.PubMedGoogle Scholar
  50. 50.
    Paul TL, Keerigan J, Kelly AM, Braverman LE, Baran DT. Long-term 1-thyroxine therapy is associated with decreased hip bone density in premenopausal women. J Am Med Assoc 1988; 259: 3137–3141.Google Scholar
  51. 51.
    Franklyn JA, Betteridge J, Daykin J, Holder R, Oates GD, Parle JV, et al. Long-term thyroxine treatment and bone mineral density. Lancet 1992; 340: 9–13.PubMedGoogle Scholar
  52. 52.
    Franklyn JA, Betteridge J, Holder R, Daykin J, Lilley I, Sheppard M. Bone mineral density in thyroxine treated females with or without a previous history of thyrotoxicosis. Clin Endocrinol 1994; 41 (4): 425–432.Google Scholar
  53. 53.
    Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol 1988; 72: 108–112.PubMedGoogle Scholar
  54. 54.
    Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med 1994; 331 (16): 1072–1078.PubMedGoogle Scholar
  55. 55.
    Mandel SJ, Larsen PR, Seely EW, Brent GA. Increased need for thyroxine during pregnancy in women with primary hypothyroidism. N Engl J Med 1990; 323 (2): 91–96.PubMedGoogle Scholar
  56. 56.
    Sawin CT, et al. The aging thyroid. Use of thyroid hormone in older persons. J Am Med Assoc 1989; 261 (18): 2653–2655.Google Scholar
  57. 57.
    Felicetta JV. Thyroid disease in the elderly. Special features, changes in management. Postgrad Med 1988; 83: 145–166.PubMedGoogle Scholar
  58. 58.
    Robuschi G, Safran M, Braverman LE, Gnudi A, Roti E. Hypothyroidism in the elderly (Review). Endocrine Reviews 1987; 8: 142–153.PubMedGoogle Scholar
  59. 59.
    Felicetta JV. Thyroid changes with aging: significance and management. Geriatrics 1987; 42: 86–92.PubMedGoogle Scholar
  60. 60.
    Surks MI, Ocampo E. Subclinical thyroid disease. Am J Med 1996; 100: 217–233.PubMedGoogle Scholar
  61. 61.
    Campbell AJ, Reinken J, Allan BC. Thyroid disease in the elderly in the community. Age and Aging 1981; 10: 47–52.Google Scholar
  62. 62.
    Tunbridge WMG, Evered D, Hall R, et al. Spectrum of thyroid disease in a community. The Whickham Study. Clin Endocrinol 1977; 7: 481–493.Google Scholar
  63. 63.
    Davis PJ, Davis FB. Hypothyroidism in the elderly. Comprehensive Therapy 1984; 10 (4): 17–23.PubMedGoogle Scholar
  64. 64.
    Young RE, Jones SJ, Bewsher PD, Hedley AJ. Age and the daily dose of thyroxine replacement therapy for hypothyroidism. Age and Aging 1984; 13 (5): 293–303.Google Scholar
  65. 65.
    Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid: thyroid deficiency in the Framingham Study. Arch Intern Med 1985; 145: 1386–1388.PubMedGoogle Scholar
  66. 66.
    Caron PH, Calazel C, Parra HJ, Hoff M, Louvet JP. Decreased HDL cholesterol in subclinial hypothyroidism• the effect of L-thyroxine therapy. Clin Endocrinol 1990; 33: 519–523.Google Scholar
  67. 67.
    Ridgway EC, Cooper DS, Walker H, Rodbard D, Maloof F. Peripheral responses to thyroid hormone before and after L-thyroxine therapy in patients with subclinical hypothyroidism. J Clin Endocrinol Metab 1981; 53: 1238–1242.PubMedGoogle Scholar
  68. 68.
    Cooper DS, Halpern R, Wood LC, Levin AA, Ridgeway EC. L-thyroxine therapy in sub-clinical hypothyroidism: a double-blind, placebo-controlled trial. Ann Intern Med 1984; 101: 18–24.PubMedGoogle Scholar
  69. 69.
    Nystrom E, Caidahl K, Fager G, Wikkelso C, Lundberg P-A, Lindstedt G. A double-blind cross-over 12-month study of L-thyroxine treatment of women with “subclinical” hypothyroidism. Clin Endocrinol 1988; 29: 63–75.Google Scholar
  70. 70.
    Tibaldi J, Barzel US. Thyroxine supplementation: method for the prevention of clinical hypothyroidism. Am J Med 1985; 79: 241–244.PubMedGoogle Scholar
  71. 71.
    Bell GM, Forfar JC, Martyn C, Wathen CG, Gow S, Riemersma, X, Toft AD. End-organ responses to thyroxine therapy in subclinical hypothyroidism. Clin Endocrinol 1985; 22: 83–89.Google Scholar
  72. 72.
    Fung HYM, Kologlu M, Collison K, et al. Postpartum thyroid dysfunction in Mid Glamorgan. Brit Med J 1988; 296: 241–244.Google Scholar
  73. 73.
    Sakiyama R, et al. Thyroiditis: a clinical review. Am Family Physician 1993; 48 (4): 615–621.Google Scholar
  74. 74.
    Jackson HJ, Sutherland RM. Effect of povidone-iodine on neonatal thyroid function. Lancet 1981; 2: 992PubMedGoogle Scholar
  75. 75.
    Iseki M, Shimizu M, Oikawa T, et al. Sequential serum measurement of thyrotropin binding inhibitor immunoglobulin G in transient familial neonatal hypothyroidism. J Endocrinol Metab 1983; 57: 384–387.Google Scholar
  76. 76.
    Hamblin PS, Dyer SA, Mohr VS, LeGrand BA, Lim C-F, Tuxen DV, Topliss DJ, Stockigt JR. Relationship between thyrotropin and thyroxine changes during recovery from severe hypothyroxinemia of critical illness. J Clin Endocrinol Metab 1986; 62: 717–722.PubMedGoogle Scholar
  77. 77.
    Bacci V, Schussler GC, Kaplan TB. The relationship between serum triiodothyronine and thyrotropin during systemic illness. J Clin Endocrinol Metab 1982; 54: 1229–1235.PubMedGoogle Scholar
  78. 78.
    Martinez M, et al. Making sense of hypothyroidism. Postgrad Med 1993; 93: 135–145.PubMedGoogle Scholar
  79. 79.
    Nicoloff JT, LoPresti JS. Myxedema coma: a form of decompensated hypothyroidism. Endocrinol Metab Clin North Am 1993; 22: 279.PubMedGoogle Scholar
  80. 80.
    Jordan RM. Myxedema coma: pathophysiology, therapy, and factors affecting prognosis. Med Clin North America 1995; 79 (1): 185–194.Google Scholar
  81. 81.
    Myers L, Hays J. Myxedema coma. Crit Care Clin 1991; 7 (1): 43–56.Google Scholar
  82. 82.
    Senior RM, Birge SJ, Wessler S, et al. The recognition and management of myxedema coma. J Am Med Assoc 1971; 271: 261.Google Scholar
  83. 83.
    Holvey DN, Goodner CJ, Nicoloff JT, et al. Treatment of myxedema coma with intravenous thyroxine. Arch Intern Med 1964; 113: 139.Google Scholar
  84. 84.
    Jordan RM. Endocrine emergencies. Med Clin North Am 1983; 67: 1193.PubMedGoogle Scholar
  85. 85.
    Gavin LA. Thyroid crisis. Med Clin North Am 1991; 75: 179.PubMedGoogle Scholar
  86. 86.
    Smallridge RC. Metabolic and anatomic thyroid emergencies: a review. Crit Care Med 1992; 20 (2): 276–291.PubMedGoogle Scholar
  87. 87.
    Gharib H, Hodgson SF, Gastineau CF, Scholz DA, Smith LA. Reversible hypothyroidism in Addison’s disease. Lancet 1972;ii:734–736.Google Scholar
  88. 88.
    Topliss DJ, White E, Stockigt JR. Significance of thyrotropin excess in untreated primary adrenal insufficiency. J Clin Endocrinol Metab 1980; 50: 52–56.PubMedGoogle Scholar
  89. 89.
    Jeffcoate WJ, Davis JRE. Reversible hypothyroidism in adrenal insufficiency. Brit Med J 1982; 285: 651–652.Google Scholar
  90. 90.
    Ladenson PW, Levin AA, Ridgway EC, Daniels GH. Complications of surgery in hypothyroid patients. Am J Med 1984; 77 (2): 261–266.PubMedGoogle Scholar
  91. 91.
    Weinberg AD, Brennan MD, Gorman CA, Marsh HM, O’Fallon M. Outcome of anesthesia and surgery in hypothyroid patients. Arch Intern Med 1983; 143: 893–897.PubMedGoogle Scholar
  92. 92.
    Paine TD, Rogers WJ, Baxley WA, et al. Coronary arterial surgery in patients with incapacitating angina pectoris and myxedema. Am J Cardiol 1977; 40: 226–231.PubMedGoogle Scholar
  93. 93.
    Bogardus GM, Finley JW. Breast cancer and thyroid disease. Surgery 1961; 49: 461–468.Google Scholar
  94. 94.
    Itoh K, Maruchi N. Breast cancer in patients with Hashimoto’s thyroiditis. Lancet 1975; 2: 1119–1121.Google Scholar
  95. 95.
    Brinton LA, et al. Relationship of thyroid disease and use of thyroid supplements to breast cancer risk. J Chron Dis 1984; 37 (12): 877–883.PubMedGoogle Scholar
  96. 96.
    Smyth PP. Thyroid disease and breast cancer. J Endocrinol Invest 1993; 16 (5): 396–401.PubMedGoogle Scholar
  97. 97.
    Goldman MB, Monson RR, Maloof F. Cancer mortality in women with thyroid disease. Cancer Res 1990; 50: 2283–2289.PubMedGoogle Scholar
  98. 98.
    Hoffman DA, McConahey WM, Brinton LA, Fraumeni JF. Breast cancer in hypothyroid women using thyroid supplements. J Am Med Assoc 1984; 251 (5): 616–669.Google Scholar
  99. 99.
    Shapiro S, Slone D, Kaufman DW, Rosenberg L, Miettinen OS, Knapp RC, et al. Use of thyroid supplements in relation to the risk of breast cancer. J Am Med Assoc 1980; 224 (15): 1685–1687.Google Scholar
  100. 100.
    Kurland LT, Annegers JF. Breast Cancer and Hashimoto’s disease. Lancet 1976; I: 808.Google Scholar
  101. 101.
    Kapdi CC, Wolfe N. Breast Cancer. Relationship to thyroid supplements for hypothyroidism. J Am Med Assoc 1976; 236 (10): 1124–1127.Google Scholar
  102. 102.
    Lin C, Tsan K-W, Chen P-J. The relationship between sleep apnea syndrome and hypothyroidism. Chest 1992; 102: 1663–1667.PubMedGoogle Scholar
  103. 103.
    Rajagopal KR et al. Obstructive sleep apnea in hypothyroidism. Ann Intern Med 1984; 101: 491–494.PubMedGoogle Scholar
  104. 104.
    Vandyck P, Chadband R, Chaudhary B, Stachura ME. Case report: sleep apnea, sleep disorders, and hypothyroidism. Am J Med Sci 1989; 298 (2): 119–122.PubMedGoogle Scholar
  105. 105.
    Kittle WM, Chaudhary BA. Sleep apnea and hypothyroidism. South Med J 1988; 81: 1421–1425.PubMedGoogle Scholar
  106. 106.
    Grunstein RR, Sullivan CE. Sleep apnea and hypothyroidism: mechanisms and management. Am J Med 1988; 85: 775–779.PubMedGoogle Scholar
  107. 107.
    Bush RK, Ehrlich EN, Reed CE. Thyroid disease and asthma. J Allergy Clin Immunol 1977; 59: 398–401.PubMedGoogle Scholar
  108. 108.
    Murray JF, Kelly JJ. The relationship of thyroidal hormone level to epinephrine response: a diagnostic test for hyperthyroidism. Ann Intern Med 1959; 51; 309–321.PubMedGoogle Scholar
  109. 109.
    Rowe MS, MacKechnie HLN. Hypothyroidism with coexisting asthma: problems in management. South Med J 1984;77(3):401,402.Google Scholar
  110. 110.
    Granet RB, Kalman TP. Hypothyroidism and psychosis: a case illustration of the disgnostic dilemma in psychiatry. J Clin Psychiatry 1978; 39 (3): 260–263.PubMedGoogle Scholar
  111. 111.
    Morley JE, Shafer RB. Thyroid function screening in new psychiatric admissions. Archives of Intern Med 1982; 142 (3): 591–593.Google Scholar
  112. 112.
    Howland RH. Thyroid dysfunction in refractory depression: implications for pathophysiology and treatment. J Clin Psychiatry 1993; 54 (2): 47–54.PubMedGoogle Scholar
  113. 113.
    Jellinek EH, Oxon DM. Fits, faints, coma and dementia in myxoedema. Lancet 1962;ii:1010.Google Scholar
  114. 114.
    Staubb JJ, Noelpp B, Grani R, et al. The relationship of serum thyrotropin (TSH) to the thyroid hormones after oral TSH-releasing hormone in patients with preclinical hypothyroidism. J Clin Endocrinol Metab 1983; 56: 449.Google Scholar
  115. 115.
    Larson EB, Reifler BV, Featherstone HJ, English DR. Dementia in elderly outpatients: a prospective study. Ann Intern Med 1984; 100: 417–423.PubMedGoogle Scholar
  116. 116.
    Tappy L, Randin JP, Schwed P, Wertheimer J, Lemarchand-Beraud Th. Prevalence of thyroid disorders in psychogeriatric inpatients. A possible relationship of hypothyroidism with neurotic depression but not with dementia. JAGS 1987; 35: 526–531.Google Scholar
  117. 117.
    Reed K, Bland RC. Masked “myxedema madness”. Acta Psych Scand 1977; 56 (5): 421–426.Google Scholar
  118. 118.
    Reiser MF, Whisnat L. Endocrine Disorders. In: Kaplan NI, Freedman AM, Sadock BJ, eds. Comprehensive Textbook of Psychiatry/III. Williams * Wilkin, Baltimore/London, 1980, 1920.Google Scholar
  119. 119.
    Nemeroff CB. Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal. J Clin Psychiatry 1989;50 Supp1:13–22.Google Scholar
  120. 120.
    Fava M, Labbate LA, Abraham ME, Rosenbaum JF. Hypothyroidism and hyperthyroidism in major depression revisited. J Clin Psychiatry 1995; 56 (5): 186–192.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Enrico L. Ocampo
  • Martin I. Surks

There are no affiliations available

Personalised recommendations