Johannes W. Dietrich @drjwdietrich@qoto.org
- Sektion DES / Klinik
- http://www.endokrinologie.org
apl. Prof. Dr. med. Johannes Dietrich, endocrinologist, head of the diabetes, endocrinology and metabolism section of #KKB @RUBMedizin. Views are my own.
Joined Nov 2022
#Syndrome_T, i.e. persistent symptoms and reduced #QoL despite normal #TSH concentration, affects 10% of #hypothyroid patients on #levothyroxine. Careful, multimodal and personalised treatment can result in significantly improved outcomes.
The interaction of three hormones, #TSH, #T4 and #T3, lays the foundation for #thyroid #homeostasis and its #allostatic responses.
It is necessary to forgo a univariable sight and to consider the evolution of the multihormonal working point to understand health and disease.
Multiple feedforward motifs and feedback loops maintain #thyroid #homeostasis and #allostasis. The mechanism of relational stability maintains T3 in a balanced and safe range, even in conditions of declining thyroid function.
Signalling via #thyroid hormones is more than T3 and T4. It involves 27 molecules based on the thyronine skeleton, 10 transmembrane transporters, 3 deiodinases, 6 receptors, and 4 types of action, unfolding a complex firework of possibilities, explaining health and disease.
Relational stability is a major motif of the intertwined feedback loops of #thyroid #homeostasis. The integrated systemic roles and interdependent homeostatically regulated equilibrium of TSH, FT4 and #deiodinases maintains appropriate FT3 concentrations.
Our eBook on #hypothyroidism has been published. The new cybernetic theory presented here summarises our scientific work of more than 20 years and lays the foundation for improved diagnosis and therapy of #thyroid disorders.
The book is available in EPUB and PDF formats.
#Thyroid hormones play a pivotal role in #thermoregulation and the attunement to hot and cold #climates. Recent research found global patterns of variants in the UCP1 and UCP3 genes and #SPINA-GD (step-up #deiodinase activity), suggesting integrated adaptation.
#Thyroid hormones profoundly impact the #cardiovascular system. They act at all levels, ranging from the tier of ion currents over cellular processes to the macroscopic levels of myocardial tissue and even the whole organism.
The #cardiovascular system is sensitive to #thyroid hormones. Even mild deviations of the free #thyroxine concentration from a (probably individual) optimum confer a significantly increased risk for #MACE (major adverse cardiovascular events).
Medical treatment of #hyperthyroidism, i.e. #thyrotoxicosis due to overproduction of #thyroid hormone, remains a challenge. We developed a new dosage methodology based on model predictive control (MPC), which is faster and more stable than the usual trial-and-error approach. https://doi.org/10.1016/j.ifacol.2025.03.041
Multiple studies have proven the impact of #endocrine #disruptors, e.g. #phthalates and #parabens, on #thyroid #homeostasis. It was unknown, however, that these effects depend on whether or not the included persons are fasting.
#Metformin is a useful antidiabetic substance, but also an endocrine disruptor. A recent study shows that it reduces the set point of #thyroid homeostasis, but this effect is mitigated by #vitamin_D deficiency.
https://pubmed.ncbi.nlm.nih.gov/39204438/
https://doi.org/10.3390/pharmaceutics16081093
Should we, therefore, classify #syndrome_T as a psychosomatic disease? This would be premature and probably wrong. We found signs of sensorimotor and autonomic #neuropathy that depend on autoimmunity and #thyroid's secretory capacity (#SPINA_GT).
Our newest paper provides new insights into the conundrum of #syndrome_T / #sorshot. #Anxiety and #depression are significantly more common in autoimmune #thyroiditis compared to healthy controls.
Sadly, John Midgley, a pioneer in #thyroid diagnostics and co-author of multiple papers by our group, passed away. Read Rudolf Hoermann's obituary at The Guardian:
https://www.theguardian.com/society/2024/apr/02/john-midgley-obituary
Our newest paper has been published. Based on machine learning with k-medoids #clustering we identified three different signatures of #thyroid #homeostasis that predict the prognosis of patients with #Takotsubo syndrome.
https://pubmed.ncbi.nlm.nih.gov/38502972/
https://doi.org/10.1016/j.ebiom.2024.105063
#Thyroid's secretory (#SPINA_GT) is higher in borderline personality disorder (#BPD) compared to controls. Is this a result of dynamical compensation or from sympathetic innervation of the thyroid gland? https://doi.org/10.3390/jcm12216702
#Thyroid hormones profoundly affect the heart. This also applies to chronic stress and type 2 allostatic load, where they relay signals from the brain to the heart. Our newest study observed an elevated thyroid output in borderline personality disorder. https://doi.org/10.3390/jcm12216702
Does impaired transport of #thyroid hormones into the central nervous system contribute to #syndrome_T / #SORSHOT? A recent study observed CSF/serum FT4 ratio to be associated with #QoL in treated #hypothyroidism. https://doi.org/10.1111/jne.13272
Recommended interview with Rudolf Hoermann on #thyroid #homeostasis and syndrome T: https://endocrinenews.endocrine.org/a-second-opinion/
- Sektion DES / Klinik
- http://www.endokrinologie.org
apl. Prof. Dr. med. Johannes Dietrich, endocrinologist, head of the diabetes, endocrinology and metabolism section of #KKB @RUBMedizin. Views are my own.
Joined Nov 2022
