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Innsbruck, Austria
Innsbruck, Austria
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Moncayo R.,Innsbruck Medical University | Zanon B.,Kreisklinik Ebersberg | Heim K.,LKH Kirchdorf | Ortner K.,Innsbruck Medical University | Moncayo H.,WOMED
BBA Clinical | Year: 2015

The aim of this retrospective observational study was to describe thyroid function parameters (fT3, fT4 and TSH) in the course of normal pregnancies. Methods: Data were obtained between 2006 and 2007 at the University Hospital in Innsbruck, Austria. The starting point was the identification of women who had had a normal birth as recorded in the birth registry of Tyrol. Thyroid function parameters were determined using methods implemented at the Department of Nuclear Medicine in Innsbruck. Results: The fT3 and fT4 values were normally distributed. Grouping the results by trimester revealed the following values: 4.93 ± 0.59, 4.54 ± 0.48, and 4.27 ± 0.45. pmol/l for fT3; and 15.23 ± 2.43, 13.79 ± 1.99, and 13.32 ± 0.2.01. pmol/l for fT4, respectively. The values corresponding to the 10th-percentile were 3.9. pmol/l for fT3 and 11.3. pmol/l for fT4, respectively. TSH values showed a typical left skewed distribution, thus the mean values were calculated after log transformation of the data. The corresponding mean trimestral values for TSH were 1.46 ± 1.29, 1.68 ± 1.23, and 1.70 ± 2.22. mIU/l, respectively. Conclusion: In an iodine sufficient population, thyroid function parameters in normal pregnancies do not differ from those in non-pregnant women. Our previously defined reference range for TSH of 0.3 to 3.5. mIU/l is equally valid for normal pregnancies. General significance: The question of cognition and IQ development of children has been proposed to be associated with thyroid function. The addition of data regarding normal thyroid function during pregnancy will contribute to this research. © 2015.


Classical thinking in endocrine physiology squeezes our diagnostic handling into a simple negative feedback mechanism with a controller and a controlled variable. In the case of the thyroid this is reduced to TSH and fT3 and fT4, respectively. The setting of this tight notion has no free space for any additions. In this paper we want to challenge this model of limited application by proposing a construct based on a systems approach departing from two basic considerations. In first place since the majority of cases of thyroid disease develop and appear during life it has to be considered as an acquired condition. In the second place, our experience with the reversibility of morphological changes makes the autoimmune theory inconsistent. While medical complexity can expand into the era of OMICS as well as into one where manipulations with the use of knock-outs and -ins are common in science, we have preferred to maintain a simple and practical approach. We will describe the interactions of iron, magnesium, zinc, selenium and coenzyme Q10 with the thyroid axis. The discourse will be then brought into the context of ovarian function, i.e. steroid hormone production. Finally the same elemental players will be presented in relation to the basic mitochondrial machinery that supports the endocrine. We propose that an intact mitochondrial function can guard the normal endocrine function of both the thyroid as well as of the ovarian axis. The basic elements required for this function appear to be magnesium and iron. In the case of the thyroid, magnesium-ATP acts in iodine uptake and the heme protein peroxidase in thyroid hormone synthesis. A similar biochemical process is found in steroid synthesis with cholesterol uptake being the initial energy-dependent step and later the heme protein ferredoxin 1 which is required for steroid synthesis. Magnesium plays a central role in determining the clinical picture associated with thyroid disease and is also involved in maintaining fertility. With the aid of 3D sonography patients needing selenium and/or coenzyme Q10 can be easily identified. By this we firmly believe that physicians should know more about basic biochemistry and the way it fits into mitochondrial function in order to understand metabolism. Contemplating only TSH is highly reductionistic. Outline • Author's profiles and motivation for this analysis• The philosophical alternatives in science and medicine• Reductionism vs. systems approach in clinical thyroid disease guidelines• The entry into complexity: the involvement of the musculoskeletal system• Integrating East and West: teachings from Chinese Medicine and from evidence based medicine (EBM)• Can a mathematical model represent complexity in the daily thyroid practice?• How effective is thyroxine treatment?• Resolving the situation of residual symptoms in treated patients with thyroid disease• Importance of iron, zinc and magnesium in relation to thyroid function• Putting together new concepts related to thyroid function for a systems approach• Expanding our model into general aspects of medicine © 2017 The Authors


Background: The aim of this study was to discern whether a relation between biochemical parameters, sonography and musculoskeletal data exists in cases of hyperthyroidism and whether they are modifiable through supplementation with selenomethionine and magnesium citrate as well as by acupuncture and manual medicine methods. Results: A direct correlation between whole blood selenium and serum magnesium was found in subjects without thyroid disease and in menopausal women while it was reversed in cases of thyroid diseases as well as in patients with depression, infection, and in infertile women. Vascularization indices were elevated in cases of newly diagnosed benign thyroid diseases. Musculoskeletal changes i.e. lateral tension and idiopathic moving toes, as well as situations of physical and psychological stress and minor trauma and infection led to an increase of vascularization. Magnesium levels correlated negatively with these two conditions. The supplementation brought a reduction of the vascularization indices and reduced the incidence of idiopathic moving toes. Treatment of lateral tension required manual medicine methods and acupuncture (gastrocnemius). A small subgroup of patients showed a further reduction of hyper-vascularization after receiving coenzyme Q10. Conclusions: We interpret the elevated thyroid vascularization and low magnesium levels as signs of an inflammatory process related to the musculoskeletal changes. Improvement of thyroid function and morphology can be achieved after correcting the influence of stressors together with the supplementation regime. We hypothesize that the central biochemical event in thyroid disease is that of an acquired, altered mitochondrial function due to deficiency of magnesium, selenium, and coenzyme Q10. © 2014.


Background: The aim of this study was to investigate the influence of a combined supplementation with magnesium, selenium and coenzyme Q10 on the morphology of the thyroid in patients with benign diseases. The clinical examination and treatment approach aims additionally at treating musculoskeletal and psychological stress. Methods: A group of 8 patients (5 with hyperthyroidism, 3 with hypothyroidism) who initially attended a public institution received additional treatment at our private institution. The basic pharmacological treatment, i.e. substitution or thyreostatic, was kept unchanged. The inclusion of patients required good quality ultrasound images to be available. Results: Initially the changes of the musculoskeletal system were corrected. Following this, stress components were also treated. After a period of 2-4. years of supplementation we observed a normalization of thyroid morphology as evidenced on ultrasound while at the same time there was a reduction of perfusion intensity. Thyroid antibody titers decreased in the majority of cases. Failure of the treatment was seen in 2 cases of chronic thyroiditis that was present for more than 10. years. The ultrasound images of these patients suggest a possible fibrosis. Conclusions: In spite of the limitation due to the small number of cases, our observational study has delivered proof of concept for our examination and treatment model for benign thyroid disease. General significance: Our results challenge validity of the prevailing dogma of a destructive unstoppable "autoimmune" destructive process of the gland. At the same time it shows new therapeutic options for patients with thyroid disease. © 2014 The Authors.


Background: The initiation of a pregnancy is a process that requires adequate energetic support. Recent observations at our Institution suggest a central role of magnesium in this situation. The aim of this study was to evaluate magnesium, zinc, selenium and thyroid function as well as anti-Müllerian hormone in early pregnancy following in-vitro fertilization as compared to spontaneous successful pregnancies. Results: A successful outcome of pregnancy after IVF treatment was associated with 2 parameters: higher levels of anti-Müllerian hormone as well as higher levels of magnesium in the pre-stimulation blood sample. These two parameters, however, showed no correlation. Spontaneous pregnancies as well as pregnancies after IVF show a fall of magnesium levels at 2-3 weeks of gestation. This drop of magnesium concentration is larger following IVF as compared to spontaneous pregnancies. Parallel to these changes TSH levels showed an increase in early IVF-pregnancy. At this time point we also observed a positive correlation between fT4 and TSH. This was not observed in spontaneous pregnancies. Thyroid antibodies showed no correlation to outcomes. Conclusions: In connection with the initiation of pregnancy following ovarian stimulation dynamic changes of magnesium and TSH levels can be observed. A positive correlation was found between fT4 and TSH in IVF pregnancies. In spontaneous pregnancies smaller increases of TSH levels are related to higher magnesium levels. General significance: We propose that magnesium plays a role in early pregnancy as well as in pregnancy success independently from anti-Müllerian hormone. Neither thyroid hormones nor thyroid antibodies were related to outcome. © 2015 .


Patients with hypothyroidism can present a series of so-called residual symptoms which are said to be without physical pathology. These symptoms, however, affect negatively the well-being state of these patients. Currently there are no explanations for this situation.Based on previous investigations done with thyroid disease patients we have carried out a clinical examination which is centered on musculoskeletal features together with a simple evaluation of psychological stressors (scaled 1-3). Laboratory diagnosis was focused on serum magnesium. This report includes the data from 166 women including 58 euthyroid controls (six males) and 108 patients with hypothyroidism (eight males).The most common complaints seen in our patients included fatigue, being easily tired, concentration deficit, ankle instability, and gait insecurity, giving way of the ankle, muscle cramps in the shanks, visual disturbances, irritability, and vertigo sensation. Besides this symptomatology a great majority of the patients (89.5%) presented musculoskeletal alterations. The main finding was that of lateral tension which entails an eccentric muscle action of the affected lower extremity. Lateral tension was always accompanied by (forward) rotation of the hemi-pelvis of the affected side. Idiopathic moving toes were found to be independent of lateral tension. Stress scores in patients were higher in patients than in the control group. Serum magnesium levels were significantly lower in patients (0.87 ± 0.1 mmol/l vs. 0.92 ± 0.07 mmol/l, p = 0.041) and showed a trend toward an inverse correlation to the intensity of lateral tension as well as to the stress score. Patients having magnesium levels below 0.9. mmol/l received 3× 1.4. mmol daily of elemental magnesium in the form of 400. mg of magnesium citrate. In cases presenting stress scores of 2 or 3 a relaxation treatment procedure was included in the treatment. This treatment was extended to the use of acupuncture on points of the Triple Burner meridian. Treatment success was observed in 90% of cases, i.e. residual symptoms were no longer present and patients reported an improved feeling of well-being.We hypothesize that magnesium deficit is facilitated by the presence of physical and psychological stressors. This condition has the potential to negatively influence the function of Complex V of oxidative phosphorylation which relies on magnesium-ATP. Reproductive processes, which have high energetic requirements in women, could thus be affected. The disappearance of the so-called psychosomatic symptoms after our therapeutic scheme brings a new light into this field of medicine and it stresses the importance of holistic handling. Understanding of body-mind interactions is explained by discussing thermodynamics, noesis, Salutogenesis and Resilience, and shamanism. © 2014 Elsevier GmbH.

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