Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Steinberger, E.
Diagnostic characteristics and clinical course of thyroid dysfunction in various clinical settings
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2023. pp. 110
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pilz Stefan
- Theiler-Schwetz Verena
- Trummer Christian
- Altmetrics:
- Abstract:
- Thyroid disorders are among the most common diseases due to their high prevalence in the general population. In this thesis, we investigate the diagnosis and treatment of thyroid dysfunctions from various angles and focus on the clinical setting. We especially look into recent developments in the treatment of thyroid disorders, draw statistical conclusions with easily accessible measurements, and report about the clinical settings. We start with a general introduction on the pathophysiology of the thyroid gland and its diagnostic evaluation, forming the basis for more in-depth discussions. In the main part of the thesis, we evaluate at the association of thyroid hormones with resting heart rate (RHR), showing that there is a statistically significant association between free triiodothyronine (fT3) as well as free thyroxine (fT4) and RHR in patients referred to coronary angiography, where RHR is considered a risk factor for adverse clinical outcomes. We note that no such correlation could be found for thyrotropin (TSH). This finding is at large in line with other research. Based on these findings, multiple future research directions and potential treatment opportunities are revealed. For example, using RHR, which can nowadays easily be monitored with a smart watch, as first indication for the potential need for readjustment of a current treatment plan or the early detection of signs for the onset of thyroid disorders. Due to the ease of measurement of RHR and the ability to perform such measurements continuously and without the help of physicians, such an approach could easily be integrated into a tele-medicine setup. In the following chapter, we turn our attention to the clinical setting, providing a case report on an acute suppurative thyroiditis (AST) due to Streptococcus anginosus, which led to sepsis and acute respiratory distress syndrome. In this case report, we show how challenging the diagnosis of AST can be in practice, especially when the distinction from subacute thyroiditis (SAT) is not straight-forward. To fully bridge the gap between theoretical analysis to the clinical setting, we look at hypothyroidism as well as thyroid disorders with a focus on fertility, pregnancy and lactation from a broader perspective, covering guidelines, new evidence and the related clinical practice. The indication for treatment of subclinical hypothyroidism also within pregnancy has been increasingly questioned in recent years, suggesting that excessive diagnosis and therapy for subclinical hypothyroidism should be avoided. Thus, we observe trends away from aggressive therapies of subclinical hypothyroidism, while still putting emphasis on the importance of the diagnosis and treatment of overt thyroid dysfunctions. Overall, the thesis provides a string of scientific data that have a clear focus on clinical science. We also connect these scientific data with clinical practice through guidelines and a case study and thus hope the entirety of this thesis is useful for clinicians taking care of patients with thyroid disorders.