Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2...

https://www.thyca.org/download/document/486/PregnancyandPostpartum.pdf

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Context: Altered vitamin D and calcium homeostasis may play a role in the development of type 2 diabetes mellitus (type 2 DM). Evidence Acquisition and Analyses: MEDLINE review was conducted through January 2007 for observational studies and clinical trials in adults with outcomes related to glucose homeostasis. When data were available to combine, meta-analyses were performed, and summary odds ratios (OR) are presented. Evidence Synthesis: Observational studies show a relatively consistent association between low vitamin D status, calcium or dairy intake, and prevalent type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM prevalence, 0.36 (0.16–0.80) among nonblacks for highest vs. lowest 25-hydroxyvitamin D; metabolic syndrome prevalence, 0.71 (0.57–0.89) for highest vs. lowest dairy intake]. There are also inverse associations with incident type 2 DM or metabolic syndrome [OR (95% confidence interval): type 2 DM incidence, 0.82 (0.72–0.93) for highest vs. lowest combined vitamin D an...

/pdf/the-role-of-vitamin-d-and-calcium-in-type-2-diabetes-a-2zpmm7zote.pdf

The Role of Vitamin D and Calcium in Type 2 Diabetes. A Systematic Review and Meta-Analysis

The vitamin D endocrine system is essential for calcium and bone homeostasis. The precise mode of action and the full spectrum of activities of the vitamin D hormone, 1,25-dihydroxyvitamin D [1,25-(OH)2D], can now be better evaluated by critical analysis of mice with engineered deletion of the vitamin D receptor (VDR). Absence of a functional VDR or the key activating enzyme, 25-OHD-1α-hydroxylase (CYP27B1), in mice creates a bone and growth plate phenotype that mimics humans with the same congenital disease or severe vitamin D deficiency. The intestine is the key target for the VDR because high calcium intake, or selective VDR rescue in the intestine, restores a normal bone and growth plate phenotype.

The VDR is nearly ubiquitously expressed, and almost all cells respond to 1,25-(OH)2D exposure; about 3% of the mouse or human genome is regulated, directly and/or indirectly, by the vitamin D endocrine system, suggesting a more widespread function. VDR-deficient mice, but not vitamin D- or 1α-hydroxylase-deficient mice, and man develop total alopecia, indicating that the function of the VDR and its ligand is not fully overlapping. The immune system of VDR- or vitamin D-deficient mice is grossly normal but shows increased sensitivity to autoimmune diseases such as inflammatory bowel disease or type 1 diabetes after exposure to predisposing factors. VDR-deficient mice do not have a spontaneous increase in cancer but are more prone to oncogene- or chemocarcinogen-induced tumors. They also develop high renin hypertension, cardiac hypertrophy, and increased thrombogenicity. Vitamin D deficiency in humans is associated with increased prevalence of diseases, as predicted by the VDR null phenotype. Prospective vitamin D supplementation studies with multiple noncalcemic endpoints are needed to define the benefits of an optimal vitamin D status.

Vitamin D and Human Health: Lessons from Vitamin D Receptor Null Mice

Hypovitaminosis D is associated with insulin resistance and β cell dysfunction

Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%– 40% in areas of iodine deficiency. Production of thyroxine (T4) and triiodothyronine (T3) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%–50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto’s disease who were euthyroid prior to conception. Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and

/pdf/guidelines-of-the-american-thyroid-association-for-the-1oqnx3mmj9.pdf

Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum

Vitamin D-binding protein (Gc-globulin) binds actin.

Using standard single damascene type techniques on bulk-Si, combined on one hand with extreme wafer thinning and on the other with Cu-Cu thermo-compression bonding technology, the paper demonstrate yielding 10k through-wafer 3D-via chains with a via pitch of 10μm for a via diameter of 5μm. The bonded contacts exhibit shear strengths exceeding 40MPa. Measurements indicate there is no significant contact resistance at the Cu-Cu bonded interface: within measurement accuracy, the 4-point via chain resistance is consistent with bulk Cu resistivity

3D integration by Cu-Cu thermo-compression bonding of extremely thinned bulk-Si die containing 10 μm pitch through-Si vias

Study of steroid-protein binding by means of competitive adsorption: Application to cortisol binding in plasma

The serum concentrations of parathyroid hormone, 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 were measured in patients with untreated thyroid disorders. The serum concentration of parathyroid hormone was decreased in hyperthyroidism [20 +/- 10 mU/liter, (mean +/- SD); n =23; P < 0.01] and increased in hypothyroidism (53 +/- 17 mU/liter; n = 12; P < 0.001) compared to that in normal subjects (26 +/- 9 mU/liter; n = 81). The concentration of 25-hydroxyvitamin D3 was not altered, but the concentration of 1,25-dihydroxyvitamin D3 was significantly lower in the serum of hyperthyroid patients (28 +/- 11 ng/liter) than in the serum of normal subjects (42 +/- 13 ng/liter). On the contrary, an increased concentration of 1,25-dihydroxyvitamin D3 was observed in the serum of hypothyroid patients (73 +/- 28 ng/liter; P < 0.001 vs. normal subjects). The abnormal serum concentrations of 1,25-dihydroxyvitamin D3 in thyroid disorders cannot be explained by differences in serum binding because the serum vitamin D-binding protein was unaltered in hyperthyroid subjects and only slightly increased (+17%) in hypothyroid subjects. These changes in the serum concentration of 1,25-dihydroxyvitamin D3 are compatible with previous data on altered intestinal calcium absorption in thyroid disorders.

P. De Moor

Papers

Vitamin D-binding protein (Gc-globulin) binds actin.

3D integration by Cu-Cu thermo-compression bonding of extremely thinned bulk-Si die containing 10 μm pitch through-Si vias

Study of steroid-protein binding by means of competitive adsorption: Application to cortisol binding in plasma

Influence of Thyroid Function on the Serum Concentration of 1,25-Dihydroxyvitamin D3

Thyroid function in patients with hyperemesis gravidarum