Patterns of thyroid disorders among patients attending an endocrine clinic in Dhaka city

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Background: Thyroid disorders are common in pregnancy and are associated with adverse pregnancy outcomes. The objective of the present study was to assess thyroid status and its association with adverse maternal and neonatal outcomes in pregnant women in Bangladesh.Methods: This cross-sectional study was conducted on 252 women with term pregnancy included from the Department of Gynecology and Obstetrics of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital from September 2019 to October 2020. Their baseline information was collected by face-to-face interviews using a semi-structured questionnaire and approximately 3 ml of blood was drawn after maintaining all aseptic precautions for FT4, TSH, and anti-thyroid antibody (anti-TPO-Ab and anti-TG-Ab) estimation. All laboratory procedures were performed using an autoanalyzer (ADVIA Centaur CP, manufactured by Siemens Healthcare Diagnostic Inc., USA). To assess the thyroid function status of the newborn, blood was drawn by the heel-prick technique, and TSH was analyzed using the same autoanalyzer.Results: The mean gestational age of the pregnant women was 38.3 (SD 1.3) weeks. Their mean FT4 and TSH levels were 0.96 (SD 0.1) ng/dL (reference range 0.87–1.54 ng/dL for pregnant women) and 1.8 (SD 1.6) mIU/ml (reference range 0.3-3 mIU/L for pregnant women), respectively. The prevalence of overt hypothyroidism was 3.2%, and subclinical hypothyroidism was 5.2%. None of the pregnant women were diagnosed with overt or subclinical hyperthyroidism. All the women with overt hypothyroidism and almost half of the patients with subclinical hypothyroidism had a positive anti-thyroid antibody status (overall prevalence of positive anti-thyroid antibody was 13%). Adverse maternal and fetal outcomes, such as postpartum hemorrhage, low birth weight, intrauterine growth retardation and neonatal hypothyroidism, were more prevalent among women with overt or subclinical hypothyroidism (p value <0.001).Conclusion: A substantial number of pregnant women in Bangladesh suffer from subclinical or overt hypothyroidism, which increases their risk of adverse pregnancy outcomes.

Despite improved hematologic care, multiendocrine dysfunction is a common complication of homozygous transfusion-dependent beta-thalassemia. In this study our goal was to estimate the prevalence of thyroid dysfunction in a large homogenous group of thalassemic patients. Two hundred patients with beta-thalassemia major (100 males and 100 females; mean age, 23.2 +/- 6.7 years; age range 11-43 years), regularly transfused and desferioxamine chelated, were randomly selected from a pool of approximately 800 patients with beta-thalassemia followed in our department. Thyroid function and iron-load status were evaluated by measurements of free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH), and serum ferritin levels. Of the subgroup of patients who proved to have normal thyroid hormone values, 26 (12 males, 14 females; mean age, 23.6 +/- 6.8 years; age range, 15-36 years) were randomly selected and underwent a standard TRH stimulation test. Thyroid dysfunction was defined as follows: overt hypothyroidism: low FT4 and/or FT3, increased TSH levels; subclinical hypothyroidism: normal FT4, FT3, increased TSH levels; exaggerated TSH response: normal FT4, FT3, normal basal TSH, deltaTSH > or = 21 microIU/mL (TSH levels measured prior and 30 minutes after intravenous TRH administration). Normal thyroid hormone values were found in 167 (83.5%) of the 200 patients studied. Eight (4%) of the remaining patients had overt hypothyroidisim, and 25 (12.5%) had subclinical hypothyroidism. Exaggerated TSH response to TRH was revealed in 7 of the 26 patients with normal hormone values tested (26.9%). Antithyroglobulin and anti-thyroid peroxidase (TPO) antibody titers were negative in 191 patients (95.5%). Mean ferritin levels in hypothyroid and euthyroid patients were 2707.66 +/- 1990.5 mg/L and 2902.9 +/- 1997.3 mg/L, respectively, (p = 0.61), indicating no correlation between ferritin levels and thyroid functional status. Mean ferritin levels in the patients who responded normally to TRH stimulation and in those who overresponded, were 2,586 +/- 1791 mg/L and 3,228 +/- 2473 mg/L, respectively (p = 0.46; NS). Thyroid failure is a rather rare endocrine complication in patients with beta-thalassemic from Greece. In our series, no case of central hypothyroidism was observed. No correlation was found between thyroid functional status and ferritin plasma levels. Approximately 1 of 5 beta-thalassemic patients with normal thyroid hormone values showed an exaggerated TSH response to TRH test. It is to be investigated how many of these patients will establish overt or subclinical hypothyroidism in the future.

Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.

This study was conducted on postmenopausal women who went to internal medicine and gynaecological outpatient clinics for various purposes during the period from 1/3/2021 to 1/2/2022. The aim of this work was to study possible relationship between thyroid disorders and menopause. Our study included 80 women who were postmenopausal. Patient with history of thyroid disorders, autoimmune diseases, liver disease, renal disease and patient on amiodarone or other drugs that affect thyroid function were excluded from the study.All cases were subjected to the following: History , examination , Routine investigations and Thyroid gland hormones (TSH, free T3 and free T4) and thyroid autoantibodies (TPO and TG).The result of this study showed that: Among our post-menopausal women there was 17.5% of them had thyroid disorders. The frequency of different thyroid disorders in our post-menopausal women was as follow: 10 women out of 80 (representing 12.5%) were overt hypothyroid, 4 women (5%) had subclinical hypothyroidism and 22 women (27.5%) classified as non-thyroidal illness syndrome. While 44 women (55%) were euthyroid. Thyroid auto antibodies were detected in 15% in cases of the study distributed as follow: 5% were overt hypothyroid, 2.5% had subclinical hypothyroidism and 7.5% were euthyroid women. Conclusion: Thyroid disorders are common in women in postmenopausal age. Overt hypothyroidism is the most common thyroid disorder in them, followed by subclinical hypothyroidism and thyroid autoantibodies are present in high percentage of women whether they have thyroid disorders or are euthyroid.

Background: The association between autoimmune thyroid diseases and autoimmune diabetes is well established. However, the association between type 2 Diabetes and thyroid disease is unclear. Studies conducted on this topic worldwide have revealed varying results. The aims of this study were to assess the prevalence of diabetes and impaired fasting glucose in a group of hypothyroid patients in Sri Lanka and to assess the relationship between severity and etiology of hypothyroidism with diabetes and impaired fasting glucose. Method: This descriptive (prospective) study was conducted at the Endocrine clinic, Teaching Hospital, Ragama over a period of 12 months, where all the new and follow up patients with hypothyroidism (both overt and subclinical hypothyroid patients) attending the clinic during this study period were included until the sample size is achieved. Interviewer-administered questionnaire was used to obtain relevant data from the patient and from the clinic book. Fasting blood sugar was done for all patients. When FBS ≥ 100mg/dl, the test was repeated. For patients who had repeatedly elevated FBS ≥ 100mg/dl, Urine for micro albumin and serum creatinine were also checked. If the urine micro albumin was elevated, the test was repeated after 3 months. The presence of retinopathy was assessed by the ophthalmology team. Results: Majority of the study population consisted of females (91%). Mean age of the study population was 44.7 (SD – 12.1). 85.6% of the patients had overt hypothyroidism and 14.4% had subclinical hypothyroidism. The overall prevalence of diabetes mellitus among the study population was 15.6%. Prevalence of impaired fasting glucose was 31%. The prevalence of diabetes, impaired fasting glucose as well as dysglycaemia among patients with overt hypothyroidism and the subclinical hypothyroidism not significantly different (p-0.905, p-0.931, p-0.982). There was no significance difference between the etiology of hypothyroidism and in the prevalence of diabetes and impaired fasting glucose (p- 0.079, p- 0.182 respectively). None of the newly diagnosed patients with diabetes had microvascular complications. Conclusion: Overall prevalence of both overt and subclinical hypothyroidism was not associated with type 2 diabetes mellitus and the severity of hypothyroidism did not have an effect on the development of any form of hyperglycemia. There was no significant association between the etiology of hypothyroidism and in the prevalence of diabetes as well as impaired fasting glucose. Even though the age, the body mass index, the presence of hypertension and the family history were significantly associated with the development of diabetes mellitus, the gender and the sedentary lifestyle did not show a significant association with the development of diabetes in our study population.

Introduction : Thyroid dysfunction has profound effect on both the mother and the fetus. This study was conducted in order to evaluate the thyroid function in pregnancy and its association with adverse maternal and fetal outcome. Method: This was a cross sectional epidemiological study. 162 patients were recruited for the study and patients with chronic illnesses were excluded via a detailed history, examination and investigations. Thyroid function tests including anti thyroid peroxidase antibody levels were done to assess the thyroid status. Patients were categorized into subclinical hypothyroidism, overt hypothyroidism or hyperthyroid based on thyroid function test results. Maternal and fetal outcomes were ascertained and the association of outcomes with the thyroid dysfunction was assessed. Results : 162 pregnant females irrespective of their gestational age were selected for the study. However, fetal and perinatal outcomes could be obtained in 138 cases. Prevalence of thyroid dysfunction among pregnant mothers was found to be 24.07% and subclinical hypothyroidism (18.9%) was the commonest thyroid disorder. There was a clear relationship between thyroid dysfunction and history of abortion, pre-term delivery and stillbirths. Prevalence of low birth weight is significantly higher in mothers with thyroid dysfunction. Conclusions : Thyroid dysfunction is common during pregnancy and sub clinical hypothyroidism is the commonest thyroid disorder. Thyroid dysfunction has a clear association with poor fetal outcome with regards to abortions, pre-term delivery, still births and low birth weight.

Background: Thyroid Disorders are often underdiagnosed. This is probably due to the fact that most of the clinicians are unaware of that fact that clinical entities like Subclinical Hypothyroidism & Subclinical Hyperthyroidism do exist. Overt Hypothyroidism & Hyperthyroidism form only the tip of the iceberg of Thyroid Disorders. It has been shown in previous studies that unchecked subclinical hypothyroidism (SCH) in young individuals poses a risk for cardiovascular events in the future. This study attempts to assess the extent of Subclinical Hypothyroidism & Autoimmune Sub Clinical Hypothyroidism in the male members of the Indian Armed Forces. Through this study, the authors endeavour to bring to the notice that Subclinical Thyroid Disorders are an emerging health problem among the young individuals. It is also evident that clinical parameters alone are insufficient in establishing a diagnosis of hypothyroidism and are often misleading, thus biochemical confirmation is a must. Aims & Objectives: 1) To assess the thyroid function among asymptomatic male members of the Indian Armed Forces. 2) To study the distribution of non neoplastic thyroid disorders, if any, among the asymptomatic male members of the Armed Forces. 3) To detect the levels of Anti TPO antibodies among the members of the Armed Forces. 4) To correlate the variation in the T3, T4, TSH levels with the presence of Anti TPO antibodies. 5) To ascertain correlation, if any, between age of the subjects & presence of Anti thyroid antibodies. Materials & Methods: This is an Observation Crossectional Study performed at a Tertiary Care Naval Hospital over a period of 15 months.100 Male volunteers meeting the Inclusion & Exclusion criteria were enrolled using simple random sampling. The samples were tested for Serum T3, T4, TSH & Anti TPO Antibody levels using the STRATEC SR 300 Analyser on the day of collection. The data was analysed using the SPSS software & depicted in figures. Results: The prevalent non neoplastic Thyroid Disorders in the study population were Subclincal Hypothyroidism, Autoimmune Subclinical Hypothyroidism, Overt Hypothyroidism & High Anti TPO Antibody levels with normal Thyroid Function.The Mean Age of Presentation of Subclinical Hypothyroidism, Positive Anti TPO Antibodies & Autoimmune Subclinical Hypothyroidism were 27 ± 8.36 years (p>0.05), 26.12 ± 9.0 years (p>0.05) & 26.5 ± 7.0 years (p>0.05) respectively .The prevalence of Autoimmune Subclinical Hypothyroidism (p=0.0004), Overt Hypothyroidism (p value 0.042) & Anti TPO Antibody positivity (p=0.017) in the study population was significantly lower compared to the results of the prevalence of these disorders in General Population Based Studies. The Serum T4 levels and Age in the study population were found to have a statistically significant inverse correlation (p=0.041) Conclusion: Subclinical Autoimmune Hypothyroidism & Overt Hypothyroidism are the most prevalent non neoplastic thyroid disorders in the Male members of the Indian Armed with their prevalence in the study population being significantly less than the General population. Anti TPO antibody positivity precedes thyroid symptoms & deranged Thyroid Profile. Serum T4 has a significant inverse correlation with age & serum TSH levels. However, the correlation serum Anti TPO Antibody levels & age of the individuals is insignificant.

AB0541 Thyroid Dysfunction in Patients with Systemic Lupus Erythematosus, Correlation with Disease Activity

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthritis involving 0.5-1% of the global population. Coexistence of RA and thyroid dysfunction is now increasingly being recognized. This is due to the shared factors involved in the pathogenesis of RA and autoimmune thyroid disease. Thyroid disorder is an important amplifier of disease activity, thereby impairing the quality of life. To study the prevalence and pattern of thyroid dysfunction in RA patients, to compare the disease activity among RA patients with thyroid dysfunction and those without thyroid dysfunction, and to study the possible association between severe RA and thyroid dysfunction. A hospital-based analytical cross-sectional study was done in 165 RA patients attending the General Medicine and Rheumatology outpatient facilities of the Department of General Medicine, Government Medical College, Kozhikode, from January to December 2019. Study subjects were selected based on the inclusion and exclusion criteria. Relevant investigations were done, which included serum thyroid stimulating hormone (TSH), free thyroxine (free T4), free triiodothyronine (free T3), and anti-thyroid peroxidase antibody (anti-TPO) antibody levels. Data were analyzed using MS Excel and Statistical Package for the Social Sciences (SPSS) software. The prevalence and pattern of thyroid disorders in RA patients were assessed. The association of thyroid dysfunction with disease activity was tested. The prevalence of thyroid dysfunction among RA patients was 38.2%. The most common thyroid disorder observed was subclinical hypothyroidism, which was seen in 33.3% (55) of the study population, followed by overt hypothyroidism in 3.6% (6) of patients. Both subclinical hyperthyroidism and clinical hyperthyroidism were found in only 0.6% of RA patients. There was a significant difference in mean age between RA patients with thyroid dysfunction and euthyroid patients (p-value = 0.001). No significant association was found between the duration of RA and thyroid dysfunction (p-value = 0.253). RA patients with thyroid dysfunction had elevated inflammatory markers compared to those with normal thyroid function. The prevalence of autoimmune thyroid disorder in RA patients is 24.8%. There was a significant association between disease activity and thyroid dysfunction (p-value = 0.001). Patients with thyroid disorders had severe disease compared to euthyroid patients. A significant positive correlation was noted between serum TSH and Disease Activity Score-28 (DAS-28) (Pearson coefficient = 0.768, p-value = 0.000), and between anti-TPO antibody and DAS-28 (Pearson coefficient = 0.794, p-value = 0.000). Thyroid dysfunction is prevalent in 38.2% of RA patients, with subclinical hypothyroidism being the most common thyroid disorder encountered. RA patients with thyroid dysfunction had higher disease activity than euthyroid patients. Hence, thyroid function tests should be a routine investigation in all RA patients, and if found abnormal, they should be treated appropriately.

Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome. We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted. Overt hypothyroidism was significantly (p < 0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p < 0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P = 0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p < 0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

Background: Thyroid disorders constitute the second most common endocrine disorders worldwide, but they are less commonly researched in this environment due to low cost-effectiveness. Objective: To study the spectrum of thyroid disorders at the Endocrinology Clinic of a tertiary health facility in Sagamu, South-west, Nigeria, over two years. Method: This retrospective study was conducted on all new clinic attendees with thyroid disorders between January 2016 and December 2017. The data retrieved included clinical data, results of thyroid function tests and thyroid ultrasonographic scan. The patients were grouped clinically into euthyroid, hypothyroid and thyrotoxic states. Results: A total of 93 thyroid cases were seen, and this constituted 13.64% of all new endocrine consultations (682 patients). The mean age (±SD; range) of the patients was 37.6 (13.6; 15-78) years. Majority of the patients were females with a female-to-male ratio of 4.5:1. Out of these, 77.4% had Goitrous enlargement. Thyrotoxicosis was the most common form of thyroid dysfunction, (72; 77.40%), mainly due to hyperthyroidism from Graves’ disease (50; 69.44%), followed by toxic multinodular goitre (12; 16.67%), toxic solitary nodular goiter (5; 6.94%) and others (5; 6.95 %). Hypothyroidism constituted 10.75% while euthyroid goitre constituted 11.85% of all thyroid cases. Conclusion: Auto-immune thyroid disease remains the most common thyroid disorder among endocrine clinic attendees. There is a need for further studies to elucidate the likely aetiologies.

ObjectiveThe present study examined the relationship between thyroid function status and the prevalence of metabolic syndrome in a Chinese population.MethodsCross-sectional data were obtained from the Thyroid Disease, Iodine Nutrition and Diabetes Epidemiology (TIDE) Survey. A total of 62,408 subjects aged ≥18 years were enrolled. Differences in metabolic indicators and the prevalence of metabolic syndrome according to sex and thyroid function status were compared. Logistic regression was used to analyze the influence of thyroid function on metabolic syndrome and its components.ResultsThe prevalence of metabolic syndrome was generally higher in men than women. Overt hyperthyroidism and subclinical hypothyroidism had a significant effect on metabolism in men. Body mass index (BMI), waist circumference, and triglycerides (TGs) were significantly lower in men in the overt hyperthyroidism group, and BMI, waist circumference, systolic blood pressure (SBP) and TGs were higher in men in the subclinical hypothyroidism group than men in the normal group. Overt and subclinical hypothyroidism had significant impacts on metabolic components in women. BMI, waist circumference, TGs, SBP and DBP in the subclinical and overt hypothyroidism groups were significantly higher than the euthyroid group in women. The relative risk of abdominal obesity and hypertriglyceridemia was increased in women with hypothyroidism. Thyroid dysfunction had different effects on metabolic syndrome and its components before and after menopause.ConclusionThyroid function had important effects on the prevalence of metabolic syndrome. Women with hypothyroidism, especially post-menopausal women, had a higher risk of metabolic syndrome than men.

Thyroid hormone (TH) affects many metabolic processes such as promoting oxidation of sugar, fat, and protein in many tissues. Thyroid dysfunction is associated with metabolic disorders. The newly discovered adipocyte- and hepatocyte-derived cytokine, betatrophin, has been reported to be involved in metabolic diseases, but its influence on thyroid dysfunction is uncertain. Therefore, the present study aims to evaluate circulating betatrophin levels in subjects with different thyroid function status and to predict the factors associated with betatrophin levels, especially whether thyroid stimulating hormone (TSH), TH, or thyroid autoantibodies are associated with betatrophin levels. In the study, serum betatrophin was measured in the subjects grouped as overt hypothyroidism (OH), subclinical hypothyroidism (SCH), euthyroid with isolated thyroid peroxidase antibody positivity (isolated Ab), and healthy control (HC), according to their thyroid functions. From our results, we found that betatrophin may be associated with thyroid insufficiency but not thyroid autoimmunity. Thus, when interpreting the results of betatrophin, thyroid functions should also be taken into consideration.

The objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77-1.88), 0.76 (0.33-1.69), 0.81 (0.46-1.41) and 1.48 (0.70-3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.