losartan-potassium and Hypothyroidism

We aimed to determine the effects of thyroid hormone on A1C and glycated albumin (GA) in nondiabetic patients with overt hypothyroidism.. A1C levels were measured in 45 nondiabetic patients with overt hypothyroidism and 180 euthyroid control subjects. A1C, GA, fasting blood glucose (FBG), 1,5-anhydroglucitol, and erythrocyte indexes were determined in 30 nondiabetic patients with overt hypothyroidism before and after thyroid hormone replacement.. A1C levels were higher in patients with hypothyroidism compared with control subjects. A1C levels were decreased by thyroid hormone replacement. Thyroid hormone replacement increased serum erythropoietin, reticulocyte count, and mean corpuscular hemoglobin (MCH). The change in A1C level was significantly correlated with the change in reticulocyte count or MCH. Thyroid hormone replacement decreased serum levels of albumin and GA. However, FBG and 1,5-anhydroglucitol levels were not altered.. Levels of A1C and GA are spuriously high in nondiabetic patients with overt hypothyroidism.

Topics: Adult; Cross-Sectional Studies; Erythrocyte Indices; Erythropoietin; Female; Glycated Hemoglobin; Humans; Hypothyroidism; Iodine Radioisotopes; Male; Middle Aged; Reticulocyte Count; Serum Albumin; Thyroid Hormones

Hypoxia-inducible factor prolyl-hydroxylase inhibitor (HIF-PHI) is a novel agent for the treatment of renal anemia. HIF-PHI increases endogenous erythropoietin production by inhibiting the degradation of an erythropoietin transcription factor. Although beneficial effects are expected from HIF-PHI, its novel mechanism raises concerns regarding the risk of potential adverse events. The cases of hypothyroidism, which had not been reported in clinical trials, were reported after the administration of roxadustat in a real-world setting. However, the effects of HIF-PHIs on thyroid function have not yet been fully evaluated. This study aimed to assess the clinical impact of HIF-PHIs on thyroid function using the Japanese Adverse Drug Event Report database, a spontaneous reporting system in Japan, because HIF-PHIs were made available in Japan before they were available in other countries. Although a disproportionality signal for hypothyroidism was detected with roxadustat (reporting odds ratio [ROR]:22.1, 95% confidence interval [CI]:18.3-26.7, no signals were detected with another HIF-PHI, daprodustat (ROR:1.3, 95%CI:0.3-5.4), and epoetin beta pegol (ROR:1.2, 95%CI:0.5-2.7). Signals of hypothyroidism due to roxadustat were also detected regardless of age or sex. Approximately 50% of hypothyroidism cases were reported within 50 days of starting roxadustat use. These results indicate that roxadustat use may be related to the development of hypothyroidism. The need for monitoring of thyroid function should be alerted during roxadustat administration regardless of age or sex.

Topics: Drug-Related Side Effects and Adverse Reactions; East Asian People; Erythropoietin; Humans; Hypothyroidism; Hypoxia-Inducible Factor-Proline Dioxygenases; Isoquinolines; Renal Insufficiency, Chronic

Although thyroid diseases exist in patients with renal failure, thyroid function tests are not routine tests in patients on chronic hemodialysis (HD). Therefore, the impact of thyroid diseases on erythropoietin (EPO) dosage in HD patients is not well defined. This study evaluated the relationship between the dose of EPO and the presence or absence of thyroid dysfunction in HD patients.. This study included 1013 adult patients on HD who did not have a malignancy, liver cirrhosis, thalassemia, iron deficiency, gastrointestinal bleeding, or a major operation within 6 months. Patients were characterized as being euthyroid, or having the sick euthyroid syndrome, primary hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or subclinical hyperthyroidism based on thyroid function tests. Routine biochemistry profiles including an index of the efficiency of HD, along with clinical data over the previous 6-month period, were collected and analyzed. Multiple regression models were employed to assess the relationship between the dose of EPO and the presence or absence of thyroid status.. The mean monthly EPO dosages were 77.7±37.0, 70.2±40.6, 90.8±68.4, 78.5±46.7, and 82.3±41.2 μg, respectively, in the sick euthyroid syndrome, euthyroid patients, hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism groups (p<0.05). After adjustment of all other variables in multiple regression, the mean monthly EPO dosage was 19.00±8.59 μg more in hypothyroid patients compared with euthyroid patients (p=0.027). Further, considering an interaction with the presence of diabetes, the mean monthly EPO dosage in patients with either hypothyroidism or subclinical hypothyroidism and diabetes was 54.66±17.12 μg (p=0.001) and 31.51±10.38 μg more than that of euthyroid patients, respectively (p=0.002).. In HD patients, the EPO dosage required to maintain the target hemoglobin level is significantly higher in patients having both hypothyroidism or subclinical hypothyroidism and diabetes than in euthyroid patients.

Topics: Aged; Anemia, Hemolytic; Cross-Sectional Studies; Diabetic Nephropathies; Drug Monitoring; Erythropoietin; Euthyroid Sick Syndromes; Female; Hematinics; Humans; Hyperthyroidism; Hypothyroidism; Kidney Failure, Chronic; Male; Middle Aged; Prevalence; Recombinant Proteins; Renal Dialysis; Severity of Illness Index; Taiwan; Thyroid Diseases; Thyroid Gland

The overall incidence of amiodarone-induced thyroid dysfunction ranges from 2% to 24%. One third to half of patients with hypothyroidism have anemia due to some decrease in normal red blood cell mass and erythropoietin (EPO) resistance. Therefore, for patients with chronic renal disease under medication with amiodarone, early regular thyroid function test should be checked in order to avoid amiodarone-induced hypothyroidism and EPO-resistant anemia. If amiodarone-induced hypothyroidism and EPO-resistant anemia occur in patients with chronic renal failure, early thyroxine should be given instead of waiting for spontaneous recovery by amiodarone discontinuation only. Here, we report a patient with chronic renal failure who developed EPO-resistant anemia after amiodarone treatment for arrhythmia. The hemoglobin level responded to EPO therapy rapidly after thyroxine administration and amiodarone discontinuation.

Topics: Aged, 80 and over; Amiodarone; Anemia; Anti-Arrhythmia Agents; Drug Resistance; Erythropoietin; Humans; Hypothyroidism; Kidney Failure, Chronic; Male

Topics: Anemia; Drug Resistance; Erythropoietin; Female; Humans; Hypothyroidism; Middle Aged; Recombinant Proteins; Renal Dialysis

Topics: Anemia; Drug Resistance; Erythropoietin; Female; Humans; Hypothyroidism; Middle Aged; Polycystic Kidney Diseases

beta-adrenergic agonists are able to increase erythropoiesis in the polycythemic mouse model by possibly increasing erythropoietin secretion. Since a great deal of evidence indicates that the actions of thyroid hormones and catecholamines are intimately interrelated, the present study was designed to estimate the erythropoietic response to isoproterenol, a very well-known beta-adrenergic agonist, in hypothyroid mice. Adult male CF-1 mice, maintained on a standard rodent chow and water (euthyroid) or 0.1% propylthiouracil (PTU) solution (hypothyroid) ad libitum during 37 days. Plasma T4 concentration was 1.75 +/- 0.25 micrograms/ml in euthyroid and < 1.0 microgram/ml in hypothyroid mice at this time. Mice were transfused with 1.0 ml of packed homologous red cells and the erythropoietic effect of graded doses (50, 500 and 5000 micrograms/kg) were tested by the RBC-59Fe incorporation method. No statistically significant differences (unpaired t test) were found between euthyroid and hypothyroid mice. Hypothyroidism, therefore, does not affect beta-adrenergic agonist-induced erythropoietin secretion in the present experimental conditions.

Topics: Adrenergic beta-Agonists; Animals; Erythropoiesis; Erythropoietin; Hypothyroidism; Isoproterenol; Male; Mice

Laboratory experiments have demonstrated that tetra- and triiodothyronine (T4, T3) enhance hypoxia-induced erythropoietin (Epo) production. In the present study serum immunoreactive Epo was measured in 29 patients with hyperthyroidism and in 10 patients with hypothyroidism. Epo levels were inversely correlated to the blood haemoglobin concentration [Hb] in both groups of patients. However, Epo levels at given [Hb] were significantly higher in the hyperthyroid state. In vitro studies confirmed that T4 and T3 stimulate Epo synthesis in the human liver cell line HepG2. This stimulating effect persisted for at least 1 day after the removal of T4 and T3 from the cultures. Thus, while thyroidal disorders affect steady-state levels of circulating Epo, it seems unlikely that thyroid hormones play a major role in abrupt adjustments of Epo production, such as the diurnal changes.

Topics: Carcinoma, Hepatocellular; Erythropoietin; Hemoglobins; Humans; Hyperthyroidism; Hypothyroidism; Liver; Liver Neoplasms; Thyroxine; Triiodothyronine; Tumor Cells, Cultured

Topics: Adult; Anemia; Drug Resistance; Erythropoietin; Female; Humans; Hypothyroidism; Renal Dialysis

Topics: Anemia; Animals; Blood Proteins; Dose-Response Relationship, Drug; Erythrocyte Volume; Erythropoiesis; Erythropoietin; Humans; Hyperthyroidism; Hypothyroidism; In Vitro Techniques; Oxygen Consumption; Thyroid Hormones

Qualitative and quantitative studies of erythropoiesis in 23 patients with hypothyroidism and 21 patients with hyperthryoidism included routine hematologic evaluation, bone marrow morphology, status of serum iron, B12 and folate red blood cell mass and plasma volume by radioisotope methods, erythrokinetics and radiobioassay of plasma erythropoietin. A majority of patients with the hypothyroid state had significant reduction in red blood cell mas per kg of body weight. The presence of anemia in many of these patients was not evident from hemoglobin and hematocrit values due to concomitant reduction of plasma volume. The erythrokinetic data in hypothyroid patients provided evidence of significant decline of the erythropoietic activity of the bone marrow. Erythroid cells in the marrow were depleted and also showed reduced proliferative activity as indicated by lower 3H-thymidine labeling index. Plasma erythropoietin levels were reduced, often being immeasurable by the polycythemic mouse bioassay technique. These changes in erythropoiesis in the hypothyroid state appear to be a part of physiological adjustment to the reduced oxygen requirement of the tissues due to diminished basal metabolic rate. Similar investigations revealed mild erythrocytosis in a significant proportion of patients with hyperthyroidism. Failure of erythrocytosis to occur in other patients of this group was associated with impaired erythropoiesis due to a deficiency of hemopoietic nutrients such as iron, vitamin B12 and folate. The mean plasma erythropoietin level of these patients was significantly elevated; in 4 patients the levels were in the upper normal range whereas in the rest, the values were above the normal range. The bone marrow showed erythyroid hyperplasia in all patients with hyperthyroidism. The mean 3H-thymidine labeling index of the erythroblasts was also significantly higher than normal in hyperthyroidism; in 8 patients the index was within the normal range whereas in the remaining 13 it was above the normal range. Erythrokinetic studies also provided evidences of increased erythropoietic activity in the bone marrow. It is postulated that thyroid hormones stimulate erythropoiesis, sometimes leading to erythrocytosis provided there is no deficiency of hemopoietic nutrients. Stimulation of erythropoiesis by thryoid hormones appears to be mediated through erythropoietin.

Topics: Biological Assay; Bone Marrow Examination; Cell Division; Erythrocytes; Erythropoiesis; Erythropoietin; Folic Acid; Hematocrit; Hemoglobinometry; Humans; Hyperthyroidism; Hypothyroidism; Iron; Isoenzymes; L-Lactate Dehydrogenase; Plasma Volume; Polycythemia; Thymidine; Vitamin B 12

Topics: Animals; Biological Assay; Digestive System; Erythrocytes; Erythropoiesis; Erythropoietin; Female; Hematocrit; Hypothyroidism; Hypoxia; Iron; Iron Radioisotopes; Mice; Oxygen Consumption; Rats; Thyroidectomy; Triiodothyronine

Topics: Adult; Aged; Anemia; Basal Metabolism; Bone Marrow; Erythropoietin; Female; Humans; Hypothyroidism; Middle Aged; Tyrosine

Topics: Androgens; Anemia; Blood Cells; Epinephrine; Erythropoiesis; Erythropoietin; Female; Glucocorticoids; Growth Hormone; Hematologic Diseases; Hormones; Humans; Hyperthyroidism; Hypothyroidism; Lymphocytosis; Middle Aged; Thyroid Hormones

Topics: Adolescent; Anemia, Hypochromic; Anemia, Macrocytic; Animals; Blood; Blood Cell Count; Blood Chemical Analysis; Erythropoietin; Female; Humans; Hypothyroidism; Iodine Isotopes; Male; Middle Aged; Rabbits; Rats; Thyroid Hormones; Thyroidectomy