Thyroid disease represents a significant medical and public health challenge in the United States affecting over 19 million Americans. Hypothyroidism (HT) found in 4.6% of the US population, is increasingly common in the elderly affecting more than 20% of women and 11% of men. Hypothyroidism is defined by an elevated serum thyroid stimulating hormone (TSH) concentration with low serum thyroxine (T4) and tri- iodothyronine (T3) concentrations. Population studies demonstrate an age-related elevation in TSH concentrations, but at present, there is no consensus regarding the TSH concentration at which replacement therapy should be initiated. Another significant gap in knowledge is a lack of pharmacokinetic data of levothyroxine specifically in aging. The presence of endogenous thyroxine makes it impossible to differentiate between internally and externally-derived thyroxine using conventional laboratory tests.
In Aims 1 we will conduct pharmacokinetic studies of 13C-LT4 in the elderly. We have designed and validated this method, using state-of- the-art technology, which permit the measurement of exogenous LT4 and conduct pharmacokinetic studies of single dose oral LT4 replacement. A secondary aim (Aim 2) will examine the bioactivity of TSH, assuming the age-related elevation in TSH concentrations consists of relatively more inactive TSH.
Aim 3 will examine age-related thyroid hormone activity in peripheral tissues reflecting drug effectiveness. Our experience in patient recruitment and conducting PK studies using state-of-the- art liquid chromatography tandem mass spectrometry (LC/MS/MS) at Georgetown University Medical Center (GUMC), as well as our preliminary data, assure the success of this proposal. If the goals of this research are achieved it will advance the knowledge in the field and have a major impact on the aging population;with the aging of America's baby boomers the need to fully understand the progression thyroid disease, to improve diagnosis and treatment is vitally important to our nation and to our healthcare systems. We believe that these unique and innovative studies will provide a wealth of information that will translate to improved diagnosis, evaluation and management of therapeutic interventions.

Public Health Relevance

Thyroid disease represents a significant medical and public health challenge in the United States affecting over 19 million Americans. In order to diagnose, treat and manage hypothyroid disease appropriately we need elucidate and characterize the age- associated differences in thyroid hormone metabolism, especially in women. This will help in setting therapeutic goals and help millions in diagnosis, treatment and management of thyroid disease in aging.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
1R01AG033867-01A2
Application #
7987882
Study Section
Integrative and Clinical Endocrinology and Reproduction Study Section (ICER)
Program Officer
Eldadah, Basil A
Project Start
2010-09-01
Project End
2015-08-31
Budget Start
2010-09-01
Budget End
2011-08-31
Support Year
1
Fiscal Year
2010
Total Cost
$383,750
Indirect Cost
Name
Georgetown University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
049515844
City
Washington
State
DC
Country
United States
Zip Code
20057
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Jonklaas, Jacqueline (2017) Persistent hypothyroid symptoms in a patient with a normal thyroid stimulating hormone level. Curr Opin Endocrinol Diabetes Obes 24:356-363
Goede, Simon L; Latham, Keith R; Leow, Melvin Khee-Shing et al. (2017) High Resolution Free Triiodothyronine-Thyrotropin (FT3-TSH) Responses to a Single Oral Dose of Liothyronine in Humans: Evidence of Distinct Inter-Individual Differences Unraveled Using an Electrical Network Model. J Biol Syst 25:119-143
Jonklaas, Jacqueline (2016) Update on the treatment of hypothyroidism. Curr Opin Oncol 28:18-25
Jonklaas, Jacqueline; Burman, Kenneth D (2016) Daily Administration of Short-Acting Liothyronine Is Associated with Significant Triiodothyronine Excursions and Fails to Alter Thyroid-Responsive Parameters. Thyroid 26:770-8
Jonklaas, Jacqueline; Sathasivam, Anpalakan; Wang, Hong et al. (2014) 3,3'-diiodothyronine concentrations in hospitalized or thyroidectomized patients: results from a pilot study. Endocr Pract 20:797-807
Estrada, Joshua M; Soldin, Danielle; Buckey, Timothy M et al. (2014) Thyrotropin isoforms: implications for thyrotropin analysis and clinical practice. Thyroid 24:411-23
Jonklaas, Jacqueline; Sathasivam, Anpalakan; Wang, Hong et al. (2014) Total and free thyroxine and triiodothyronine: measurement discrepancies, particularly in inpatients. Clin Biochem 47:1272-8
Klubo-Gwiezdzinska, Joanna; Burman, Kenneth D; Van Nostrand, Douglas et al. (2013) Potential use of recombinant human thyrotropin in the treatment of distant metastases in patients with differentiated thyroid cancer. Endocr Pract 19:139-48
Mehran, L; Tohidi, M; Sarvghadi, F et al. (2013) Management of thyroid peroxidase antibody euthyroid women in pregnancy: comparison of the american thyroid association and the endocrine society guidelines. J Thyroid Res 2013:542692

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