Abnormal Thyroid Function Research Articles

Photodynamic therapy as resource to control exfoliative cheilitis associated with abnormal thyroid function

Photodynamic therapy as resource to control exfoliative cheilitis associated with abnormal thyroid function

Retrospective Analysis of the Effects of Maternal Thyroid Dysfunction on Obstetrical Complications and Outcomes in a Cohort of 17,219 Pregnant Women

Background: Abnormal concentrations of maternal thyroid hormones are risk factors for certain obstetrical complications. However, the influence induced by different types of maternal thyroid dysfunction on obstetrical complications and outcomes remains controversial. This study aimed to systematically evaluate the prevalence of distinct thyroid dysfunction subtypes in pregnant women and their specific associations with adverse obstetric outcomes, thereby clarifying clinical management priorities. Methods: In a retrospective cohort study, a total of 17,219 pregnant women underwent a thyroid function test, including thyroid stimulating hormone (TSH) and free tetraiodothyronine (fT4). All participants were divided into seven groups based on their blood test results, and their pregnancy outcomes were followed up. The isolated hypothyroxinemia group was divided into two cohorts, depending on whether the patients received levothyroxine. Complications during pregnancy and the outcomes were observed and analyzed in both cohorts. Results: A total of 2621 (15.22%) women were identified with an abnormal thyroid function, including 1150 with subclinical hypothyroidism, 562 with gestational transient thyrotoxicosis, 419 with subclinical hyperthyroidism, 336 with isolated hypothyroxinemia, 78 with hyperthyroidism, and 76 with hypothyroidism. After adjusting for maternal characteristics, no significant associations were found between specific hyperthyroidism groups and the risk of pregnancy complications. However, mothers with overt hypothyroidism had nearly a 3-fold increased risk of developing postpartum hemorrhage (odds ratio (OR): 2.76; 95% confidence interval (95% CI): 1.19–6.38; p = 0.018). Subclinical hypothyroidism was associated with an increased risk of premature membrane rupture (OR: 1.44; 95% CI: 1.25–1.64; p < 0.001) and therapeutic abortion related to fetal anomalies (OR: 2.05; 95% CI: 1.13–3.74; p = 0.019). Additionally, both subclinical hypothyroidism, overt hypothyroidism, and isolated hypothyroxinemia were linked to more than a 2-fold increase in the risk of preeclampsia. Mothers with subclinical hypothyroidism exhibited a lower risk for gestational diabetes mellitus (OR: 0.67; 95% CI: 0.57–0.79; p < 0.001), while those with isolated hypothyroxinemia had approximately a 1.5-fold increased risk for gestational diabetes mellitus (OR: 1.41; 95% CI: 1.11–1.80; p = 0.005). There were no significant differences in outcomes between those receiving levothyroxine treatment in the isolated hypothyroxinemia group and those who did not. Conclusions: Our results showed a high incidence of thyroid dysfunction in pregnant women, with subclinical hypothyroidism being the most common, followed by gestational transient thyrotoxicosis. In general, pregnant women with hypothyroidism presented with a high risk of complications during pregnancy. Isolated hypothyroxinemia in pregnant women is concerning, and levothyroxine treatment did not improve pregnancy outcomes and obstetrical complications.

Can chimeric antigen receptors – based therapy bring a gleam of hope for thyroid-associated ophthalmopathy and other autoimmune diseases?

Abstract Thyroid-associated ophthalmopathy (TAO), also known as Graves’ ophthalmopathy (GO) is an autoimmune disease (AD) with abnormal thyroid function typically. Currently, intravenous glucocorticoid therapy remains the first-line treatment for moderate-to-severe active TAO. Second-line treatments, including immunosuppressants and biological agents, are being explored in depth. However, like other ADs, the adverse effects of these therapies, little impact on long-term sequelae, and the irreversible progression of the disease remain significant limitations. As a result, the development of new therapeutic strategies for TAO is essential. Chimeric antigen receptors (CAR)-based adoptive cell therapy has emerged as an innovative approach for ADs treatment, capitalizing on its principles of genetically modifying immune cells to specifically target pathogenic cells. This approach aims to reduce autoimmune response or eliminate effective cells, CAR-based therapies of both T-cell-mediated and B-cell-mediated ADs have shown promising results in wide clinical trial. CAR-based therapy obviously become a rising star on refractory and relapsed ADs. TAO is no exception in terms of the potential for improvement through CAR-based therapy. However, the success of CAR-based therapy in TAO depends critically on identifying appropriate targets. Selected targets need to be coverage to ensure the therapeutic efficiency while specificity to preserve safety. Furthermore, the target cells must be relevant to the pathogenesis of TAO. Except target selection, adopting advanced and effective strategies for CAR design is also crucial. For example, dual-target approaches involving thyroid-stimulating hormone receptor (TSHR) or insulin-like growth factor-1 receptor (lGF-1R), off-the-shelf CAR-based cells, or leveraging artificial intelligence (Al) to predict optimal targets could enhance the specificity and effectiveness of CAR-based, therapies in TAO treatment.

Allan-Herndon-Dudley Syndrome.

X-linked MCT 8 mutations cause Allan-Herndon-Dudley syndrome (AHDS), characterized by severe developmental delay and specific thyroid function abnormality. The report describes a 2-y-old boy who presented with severe developmental delay, generalized hypotonia and thyroid function abnormality (high FT3, low FT4 and normal TSH) suggesting a form of impaired thyroid hormone sensitivity. Whole exome sequencing (WES) analysis revealed mutation in exon 3 of MCT 8 gene. Improvement of neurodevelopmental delay and clinical and biochemical features of thyrotoxicosis occurs with use of tri iodoacetic acid.

Investigating glucose metabolism in children with Williams-Beuren syndrome: A case study on WBS and DKA

Objective: More attention should be paid to glucose metabolism in children with Williams-Beuren syndrome (WBS). Methods: The clinical data of a child diagnosed with WBS due to diabetic ketoacidosis (DKA) were retrospectively analyzed, and the related literature was reviewed. Results: An 8-year-old boy presented with thickened upper lip, low palatal arch, strong heart sound, rumbling murmur in the apex area, a little pigmentation in the webbed margin of fingers and toes, and atypical elfin features. Blood gas analysis showed severe ketoacidosis with significantly elevated amylase, significantly increased amylase, elevated blood lipids, abnormal thyroid function, negative C-peptide, diabetic. Echocardiography showed supravalvular aortic stenosis and abnormal continental valve. The large copy number variation of the nuclear genome revealed a heterozygous variation in the 7q11.23 region, with a 1.4 Mb deletion in the 7q11.23 region, and the related gene in the region was elastin gene. Conclusion: DKA was reported for the first time as the first symptom of WBS diabetes. The mechanism of concurrent DKA in WBS is not well understood.

An interesting case of abnormal thyroid function tests due to THR-beta receptor mutation

An interesting case of abnormal thyroid function tests due to THR-beta receptor mutation

Thyroid function during COVID-19 and post-COVID complications in adults: a systematic review.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has presented multifaceted health challenges. COVID-19 primarily targets the respiratory system but also affects multiple organ systems, including the endocrine system. Emerging evidence suggests interactions between thyroid function, the acute phase of COVID-19, and the prolonged symptoms known as post-COVID sequalae or long COVID. Several studies have reported that COVID-19 can induce thyroid dysfunction, leading to conditions such as thyroiditis and alterations in thyroid hormone levels. The mechanisms through which SARS-CoV-2 affects the thyroid include direct viral infection of thyroid cells, leading to viral thyroiditis, which causes inflammation and transient or sustained thyroid dysfunction, as well as an excessive systemic immune response (cytokine storm). This is associated with elevated levels of cytokines, such as IL-6, that disrupt thyroid function and lead to nonthyroidal illness syndrome (NTIS). Medications administered during the acute illness phase, such as corticosteroids and antiviral drugs, can also impact thyroid hormone actions. The involvement of the thyroid gland in long COVID, or postacute sequelae of SARS-CoV-2 infection, is an area not well defined, with potential implications for understanding and managing this condition. Persistent low-grade inflammation affecting thyroid function over time can lead to ongoing thyroiditis or exacerbate pre-existing thyroid conditions. Viral infections, including SARS-CoV-2, can trigger or worsen autoimmune thyroid diseases, such as Hashimoto's thyroiditis and Graves' disease. Long COVID may disrupt the hypothalamic-pituitary-adrenal (HPA) axis, which can, in turn, affect the hypothalamic-pituitary-thyroid (HPT) axis, leading to abnormal thyroid function. This review was designed to systematically capture recent literature on COVID-19-related thyroid dysfunction in the adult population, the prognostic consequences of thyroid dysfunction during COVID-19, and the effects of thyroid dysfunction on patients with long COVID. A comprehensive search of PubMed and EMBASE databases was conducted. The systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Study quality was assessed using the Critical Appraisal Skills Programme (CASP). A total of 53 studies met the inclusion criteria. The review summarises recent findings and provides an update of the current understanding of thyroid dysfunction in COVID-19-related spectrum of disorders, underscoring the complex nature of SARS-CoV-2 infection and its far-reaching impacts on human health.

Abstract TP332: Assessing the Role of Thyroid Function in Ischemic Stroke: A Retrospective Analysis Across TOAST Classification

Introduction: Subclinical hyperthyroidism has been linked to an increased risk of atrial fibrillation, which elevates the likelihood of cardioembolism, cryptogenic stroke (CS), and embolic stroke of undetermined source (ESUS). However, the broader relationship between thyroid function abnormalities and acute ischemic stroke remains uncertain. This study aims to investigate whether patients with acute ischemic stroke due to cardioembolism, CS, or ESUS are more likely to have abnormal thyroid-stimulating hormone (TSH) levels compared to those with ischemic strokes from other etiologies, as classified by the TOAST criteria. Methods: Utilizing data from the Get With The Guidelines Database, we conducted a retrospective chart review of patients admitted to our single comprehensive stroke center, diagnosed with an acute ischemic stroke between August 2022 and January 2023. The Kruskal-Wallis rank sum test was employed to assess differences in TSH, Free T4, and, if available, one year follow-up TSH levels among patients with ischemic stroke etiologies of small vessel disease, large artery atherosclerosis, cardioembolism, CS, and ESUS. Results: A total of 211 patients were included in the analysis, the distribution of stroke etiologies included 33 (16%) with small vessel disease, 51 (24%) with large artery atherosclerosis, 77 (36%) with cardioembolism, 13 (6.2%) with an undetermined/cryptogenic etiology, and 25 (12%) with ESUS. The majority of patients had normal TSH levels, accounting for 82% of the total cohort, the overall mean TSH level was 2.52 (reference range 0.27-4.2uIU/mL). No significant differences were observed in the mean TSH (p = 0.066), Free T4 (p = 0.13), or follow-up TSH (p = 0.79) levels across each stroke subtype. Conclusions: Our findings suggest that thyroid function does not significantly differ across the various etiologies of acute ischemic stroke, as classified by TOAST criteria. While further large-scale studies are warranted, our results indicate that routine evaluation of thyroid function may not be essential in the determination of stroke etiology.

The lymphocyte levels of Hashimoto thyroiditis patients were significantly lower than that of healthy population.

Hashimoto thyroiditis (HT) is an autoimmune disease without infectivity. We compared the differences of blood lymphocytes levels between HT patients and healthy people. This study included a total of 84 HT patients whose thyroid function was normal and 60 HT patients with abnormal thyroid function. A corresponding number of medical examination population in our hospital were randomly selected as the control groups. White blood cell count, neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage were compared between HT patients and healthy population. The correlations between TSH, FT4 and above parameters were further tested. We found significant differences between HT with normal thyroid function group and control group in lymphocyte count (P<0.001), lymphocyte percentage (P<0.001) and neutrophil percentage (P<0.001), but no differences in sex (P=0.134), age (P=0.200), white blood cell count (P=0.315) and neutrophil count (P=0.790). Significant differences were observed in neutrophil count (P=0.032), neutrophil percentage (P=0.010), lymphocyte count (P=0.010) and lymphocyte percentage (P<0.001) between HT with abnormal thyroid function group and control group, but not in sex (P=0.769), age (P=0.060) and white blood cell count (P=0.156) between the two groups. There were significant differences in white blood cell count (P=0.009) and neutrophil count (P=0.032) between HT patients in the normal thyroid function group and HT patients in the abnormal thyroid function group. Neither FT4 nor TSH was associated with lymphocyte levels or neutrophil levels. The lymphocyte levels in HT patients were significantly lower than healthy population. The neutrophil count in HT patients with regular thyroid function was lower than those in abnormal thyroid function HT patients.

P-67 TWO RARE GENETIC DISORDERS IN ONE CASE ‘’ALLAN-HERNDON-DUDLEY-SYNDROME’’ AND’ “TREACHER COLLINS SYNDROME’’:A CASE REPORT

Abstract Introduction Resistance to thyroid hormone syndrome (RTH), also named Refetoff Syndrome is an autosomal dominant or recessive rare genetic disease. It’s incidence is approximately 1:50.000 in newborns. Increasing awareness and knowledge about RTH will increase the diagnosis rate. So that other genetic diseases that accompany can be detected with early genetic consultation. Clinical Case A 45-year-old female patient was consulted to the endocrinology department for abnormal thyroid function tests. In her medical history, she had no known disease and no medication she used regularly. Her TSH level was 1,26 mıU/L(0,45-4,31), fT4:1,94ng/dl(0,85-1,70 ng/dl), fT3:5,73 ng/L(2-4,4). Thyroid autoantibodies were negative. In pituitary MRI, nodular formations that were hypointense compared to normal tissue were observed on the right and left sides of the pituitary (microadenoma?). Anterior pituitary hormones within the normal range. Heterophile antibody was negative. RTH or TSHoma was considered. She was admitted to the service for further examinations. Alpha subunit level could not measured. Basal TSH was found to be 1,49mU/L (0,54-4,31). A TRH stimulation test was performed on the patient and end of the test TSH was found to be 14.6 mıU/L. T3 supression test was performed. End of the test TSH was &amp;lt;0,1 mıU/L. Thyroid hormone resistance was considered. During the patient’s medical history there were no signs of hyperthyroidism other than fatigue. In patient's genetic analysis heterozygous c.401A&amp;gt;C:p variant detected in the THRB gene. NM_006517.5:C.401A&amp;gt;C:p.(Glu134Ala) missense variant heterozygous was detected in SLC16A2 gene and was associated with the ‘’Allan-Herndon-Dudley Syndrome’’ phenotype. The NM__001371623.1;C.2998G&amp;gt;A:p(Glu1000Lys)rs755763024 missense variant was observed heterozygous in the TCOF1 gene and was associated with the ‘’Treacher Collins Syndrome 1’’phenotype. Thyroid function tests were performed to the daughter and sons of the patient (table2). Genetic counseling was recommended to the patient and her family. There in no phenotypic features of ‘’Allan-Herndon-Dudley Syndrome ‘’ and Treacher Collins Syndrome ‘’ detected in the patient. Ophthalmology, otorhinolaryngology and cardiology examination was normal. The patient was diagnosed as RTH. She was clinically asymptomatic and discharged with plans to remain under medication-free monitoring. Conclusion As far as the literature is examined there is no previous case of the coexistence of TCS with RTH and other thyroid function test abnormalities. More case reports are needed to determine whether the coexistence of these two rare diseases is coincidental or related. According to previous literature information AHDS is usually clinically asymptomatic in women. But it is with RTH in the female patient in this case. As in the case, it is important to perform genetic screening and provide genetic counseling to the patients and family members.Table 1:Thyroid Function Tests of the Patient Table 2:Family Members Thyroid Function Test Results (1 daughter and 3 son of the patient)

Epidemiology of Thyroid Diseases in Patients of Heart Failure in a Tertiary Care Hospital of Eastern India: A Cross-sectional Study

Background Thyroid diseases are common in India. Both insufficient and excess thyroid hormones cause adverse cardiovascular events. Subclinical hypothyroidism and hyperthyroidism while undiagnosed can lead to derangement of cardiac functions. This study aimed to explore thyroid function abnormalities among heart failure patients of different severity (NYHA class). Methodology A descriptive, cross-sectional study was undertaken on 492 heart failure patients (246 males and 246 females) of age greater than 18 years. Patients were classified according to NYHA. Serum TSH and FT4 were investigated. Data were analyzed by standard statistical software. Results The mean age of participants was 54.2 ± 13.1 years. Mean FT4 and TSH were 1.36 ± 0.39 ng/dL and 2.89 ± 1.15 mIU/L, respectively. Patients belonged to NYHA class II (35.4%), III (52.4%) and IV (12.2%). Comorbidities included Hypertension (38%), Diabetes Mellitus (29%) and Dyslipidemia (52%). Hypothyroidism and hyperthyroidism were present in 27% and 5% patients respectively in overt or subclinical forms. The prevalence of thyroid disorders among NYHA class II, III and IV patients were 17%, 37%, and 50%, respectively. Conclusion Thyroid disorders were present in about one-third of the patients with heart failure. The prevalence of hypothyroidism was almost five times that of hyperthyroidism. The prevalence of thyroid disorders increased with the severity of heart failure.

Spectrum of thyroid disorders among patients with type 2 diabetes mellitus

Background and objectives: Thyroid disorders (TD) are common among patients with type 2 diabetes mellitus (T2DM). Information on types of functional and structural TDs among Bangladeshi patients with T2DM is scarce in the literature. The present study aimed to determine the magnitude and characteristics of different TDs among Bangladeshi diabetic patients attending an urban healthcare center in Dhaka. Material and methods: The study included patients with T2DM who attended an urban Endocrinology Outpatient consultation center in Dhaka over a period of two years. Diagnosis of TDs was based either on previous medical records or on investigational results of thyroid functions/gland during the first visit. Standard criteria were used to diagnose TDs. Results: Total 1424 patients with T2DM were enrolled in the study. The mean age of the study population was 48.8 ± 12.9 years and 45.2% and 54.8% were male and female respectively. Among 1424 participants 217 (15.2%) had functional and/or structural abnormalities of thyroid gland. For those with abnormal thyroid function (14.3%), the most common was clinical hypothyroidism (10.5%), followed by subclinical hypothyroidism (2.6%), and clinical thyrotoxicosis (1.3%). Except for one, all patients with overt hypothyroidism had primary hypothyroidism. Among patients with overt thyrotoxicosis, Graves’ disease was the most common entity (50%). Multinodular goiter was the most frequent diagnosis among structural abnormalities (7 out of 13). Female sex (OR: 3.0, 95%CI: 1.5, 6.1, p=0.003) and obesity (OR: 2.3, 95%CI: 1.1, 5.0, p=0.039) had higher odds of having a diagnosis of overt hypothyroidism among patients with T2DM. Hypertension, dyslipidemia and obesity were significantly (p &lt; 0.05) higher in diabetic patients with overt hypothyroidism. Conclusion: TDs especially hypothyroidism are common among female Bangladeshi patients with T2DM. Dyslipidemia and obesity are significantly more in overt hypothyroidism among patients with T2DM. January 2025; Vol. 19(1):008. DOI: https://doi.org/10.55010/imcjms.19.008 *Correspondence: Md Rakibul Hasan, Department of Endocrinology, Medical College for Women and Hospital, Uttara, Dhaka 1230, Bangladesh. Email: dr.mrh46@gmail.com; © 2025 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).

The impact of COVID-19 infection on thyroid function.

Extensive research on COVID-19 has revealed a notable link between the disease and thyroid disorders, highlighting complex interactions between thyroid hormones, immunomodulatory signaling molecules within the thyroid gland, and viral infections. This study evaluated the relationship between thyroid function and COVID-19 in Iraqi patients at Adiwaniyah Teaching Hospital. The cohort for this investigation comprised all patients who were admitted to the isolation center at the Teaching Hospital during the timeframe extending from January 2024 to June 2024. Each participant included in this research underwent comprehensive evaluations of their thyroid function, which is composed of the measurement of thyroid-stimulating hormone (TSH), total triiodothyronine (T3), and serum total thyroxine (T4) levels. Results showed that the serum T4 levels in all participants included in the study were observed to range from 20 to 182 (ng/dl), with the average concentration recorded at 87.26 ± 38.29 (ng/dl); no statistically significant disparity was noted in the mean serum T4 levels relative to the severity of the disease (p = 0.291). The serum TSH levels across all enrolled individuals spanned from 0.03 to 82 (mU/L), with a mean concentration of 5.55 ± 12.36 (mU/L); similarly, there was no statistically significant difference in the mean serum TSH levels when assessed against the disease severity (p = 0.926). According to the serum thyroid hormone concentrations, the cohort was stratified into 17 (24.6%) individuals classified as hypothyroid, 34 (49.3%) categorized as euthyroid, and 18 (26.1%) identified as hyperthyroid. Furthermore, no significant correlation was identified between the disease's severity and the participants' thyroid status (p = 0.556). In conclusion, patients with COVID-19 are liable to develop thyroid function abnormalities that may explain several of the long-term symptoms associated with the disease.

Changes in thyroid function after thermal ablation of thyroid nodules.

To evaluate changes in thyroid function post-thermal ablation (TA) of thyroid nodules and to identify risk factors associated with post-ablation thyroid function abnormalities. A retrospective analysis of 2,264 cases treated with TA between June 2015 and July 2024 was conducted, including 1,169 benign thyroid nodules (BTNs) and 1,095 papillary thyroid carcinoma (PTC) cases. Thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured before treatment and at 1, 3, 6, 9, and 12 months post-ablation. FT3 levels remained significantly reduced at 12 months post-ablation (3.04 ± 0.42 vs. 3.15 ± 0.36 pg/mL; p < 0.001). In contrast, FT4 levels showed a persistent increase at 12 months (1.36 ± 0.69 vs. 1.27 ± 0.15 ng/dL; p < 0.001). Although TSH levels decreased slightly over time, they remained elevated at 12 months compared to baseline (1.80 ± 1.17 vs. 1.73 ± 0.84 μIU/mL; p = 0.029). At the end of the follow-up period, the incidence of thyroid function abnormalities was 5.07% (18/355), with only one patient requiring Thiamazole for antithyroid therapy. The cumulative incidence of thyroid function abnormalities was notably higher in the PTC group compared to the BTN group (17.80% vs. 10.94%; p < 0.001). Pre-ablation TSH levels (OR= 2.06; 95% CI, 1.77-2.39; p < 0.001), Hashimoto's thyroiditis (OR = 2.66; 95% CI, 1.88-3.77; p < 0.001), and multiple nodules were positively correlated with the occurrence of thyroid function abnormalities. The cutoff value of TSH was 2.015 μIU/mL with a sensitivity of 0.527 and a specificity of 0.246 (AUC = 0.625). Thermal ablation had a minimal impact on thyroid function. Pre-ablation TSH levels, Hashimoto's thyroiditis, and multiple nodules were risk factors for post-ablation thyroid function abnormalities.

Oxidative stress pattern of patients with abnormal thyroid function in Southern Nigeria

Oxidative stress pattern of patients with abnormal thyroid function in Southern Nigeria

Correlation of Fibroblast Growth Factor-23 with Thyroid Disorder in Patients with Chronic Kidney Disease

Abstract Background: Various thyroid functional test abnormalities are commonly observed in chronic kidney disease (CKD) due to alterations in thyroid hormone synthesis, metabolism, and regulation. Objectives: The objectives of this study were to detect the levels of thyroid hormones at various stage of CKD and find a correlation of thyroid hormones with fibroblast growth factor-23 (FGF23). Materials and Methods: A cross-sectional study was conducted at an outpatient clinic (patient with chronic renal failure). Eighty patients reported chronic renal failure in an outpatient clinic from June 2020 to February 2021. Experimental work was carried out at private laboratories in Kirkuk, Iraq. Results: According to the findings of this study, the age group with the highest risk of renal failure was 61–70 years, with a rate of 25%. The highest age group of patients with renal failure was 51–60 years with 23.8%, whereas the lowest age group of patients with renal failure was 31–40 years with 6.3%. FGF23 levels in the end stage increased significantly (P ≤ 0.05) as compared with other CKD stages. About thyroid hormones, T3 and T4 levels in the end stage were significantly lower (P &lt; 0.05) than in other CKD stages. However, thyroid-stimulating hormone (TSH) levels in the end stage increased significantly (P &lt; 0.05) compared with other CKD stages. The findings of this study revealed an inverse association between FGF23 and T3, with increased levels of FGF23 resulting in lower levels of T3, and the levels of correlation were R 2 = 0.5931, also increased levels of FGF23 resulting in lower levels of T4, and the levels of correlation were R 2 = 0.6356. Finally, the increase in levels of FGF23 lead to an increase in levels of TSH and the levels of correlation were R 2 = 0.7106. Conclusions: Based on the results of this study, the study showed that there is a strong association between thyroid hormones and chronic renal failure. There is a decrease in thyroid hormone levels with an increase in fibroblast growth factor 23 levels.

A diagnostic conundrum: a patient with only complaints of palpitations and dyspnea was diagnosed with thyroid storm: a rare case report

Introduction and background: The life-threatening side effect of hyperthyroidism, the thyrotoxic storm, can be difficult to diagnose because of its wide range of vague clinical symptoms. Patient survival depends on early diagnosis and treatment. Case presentation: This report presents the case of a male patient, age 58, who had no previous history of hyperthyroidism and initially complained of palpitations and dyspnea. He had supraventricular tachycardia (SVT) and thyrotoxicosis upon evaluation. His Burch-Wartofsky Point Scale (BWPS) score of 50 indicated a high probability of thyroid storm. Propranolol and propylthiouracil were started on time, stabilizing the patient’s vital signs and converting SVT to atrial fibrillation. With further care, the thyrotoxicosis resolved. Clinical discussion: This example emphasizes how critical it is to identify thyroid storm and treat it quickly in order to maximize patient outcomes, especially when it is exacerbated by SVT. It also emphasizes how helpful the BWPS is in helping diagnose and treat patients in such cases. Conclusion: It is important for clinicians to evaluate each patient presented with cardiac symptoms of thyroid function abnormality. In order to manage thyroid storm, early intervention with beta-blockers and antithyroid drugs is essential. Better patient outcomes result from early diagnosis and treatment, which is made possible by the BWPS, particularly in cases with unexplained new-onset atrial fibrillation.

Assessment of the Thyroid Disorder During Pregnancy in Tertiary Level Hospital, Nepal

Background: Thyroid dysfunctions are most prevalent in women during their most fertile years (15 - 35) and thyroid dysfunction during pregnancy is associated with higher risk of pregnancy and neonatal complications. Routine screening of thyroid dysfunction during pregnancy can help to identify and treat the disorder early and prevent its complication. Methods: A hospital based observational study on 400 pregnant women was conducted in tertiary level hospital in Nepal. Participants with abnormal thyroid functions were regularly followed up till the pregnancy outcome. Results: Among 400 cases, 45.3% of the respondents were of age group 21-25 years with mean age 23.84 ±3.5 years. This study had 14.7 % (n 59) women with abnormal thyroid functions. Of these 12.7 % were hypothyroid and 2 % were hyperthyroid. Among 51 cases of hypothyroid 10.5 % were subclinical hypothyroid and 2.2 % were overt hypothyroid. Majority of the pregnant women with thyroid dysfunction had one or more adverse events during pregnancy course. Conclusion: Thyroid dysfunction is common during pregnancy. High prevalence of thyroid dysfunction necessitates the standardized screening protocol to pregnant women based on risk categories and early initiation of treatment if significant abnormality is identified and regular follow up for every pregnant woman with abnormal thyroid function.

Prevalence of Thyroid Disorders in Type 2 Diabetes Mellitus Patients in Nepalgunj Medical College

Introduction: Thyroid dysfunction is defined as the altered serum thyroid stimulation hormone level with normal or altered th roid hormones. It is a common endocrine disorder affecting around 300 million people worldwide. Hypothyroidism is a common thyroid disorder in diabetic patients, impacting diabetes control. Both thyroid dysfunction and diabetes are significant pub- lic health concerns in Nepal. Addressing thyroid dysfunction in diabetic patients is crucial for optimal disease management as untreated thyroid dysfunction can invariably affect glycemic control and contributes to cardiovascular complications. Aims: To assess the prevalence of thyroid disorders amongst Type 2 diabetic patients in Nepalgunj Medical College. Methods: This is a cross-sectional, hospital-based study conducted at the Diabetes Endocrine Outpatient Department, department of Medicine, and among indoor patients of these units at Nepalgunj Medical College. The study utilized a non-probability consecutive sampling technique. Results: Among the 100 participants, 37% had abnormal thyroid function whereas 63% of the participants had normal thyroid function. Among participants with diabetes over 13 years of duration 36.2% had thyroid dysfunction and with duration of diabetes 10-12 years 50% had thyroid dysfunction. The most common thyroid disorder present was subclinical hypothyroidism noted in 17% of the total participants. Conclusion: A high prevalence of thyroid dysfunction was seen in Type 2 Diabetes Mellitus patients. Screening for hypothyroidism, appropriate management and control of diabetes may lower the risk of thyroid dysfunction.

Assessment of Immunological, Skeletal, and Thyroid Function Abnormalities in Paediatric Morphoea.

Morphoea is a sclerosing disorder of skin and subcutaneous tissue. Paediatric morphoea shows increased prevalence of various auto-immune diseases, bone deformities, and systemic abnormalities. There is paucity of studies on various immunological, skeletal, and thyroid function abnormalities in paediatric morphoea. To describe immunological, skeletal, and thyroid function abnormalities present in paediatric morphoea patients. This cross-sectional study was conducted from January 2021 to March 2023 in the Dermatology outpatient department in a tertiary care hospital. All paediatric morphoea patients were included in this study. All were subjected to detailed history, clinical examination, and investigations including complete blood count, serum IgE, anti-nuclear antibody, thyroid function tests, anti-thyroid peroxidase antibodies, and radiological investigations. A total of 42 children were recruited, out of which 61.90% were females and 38.09% were males. The majority were in the age group of 4-8 years. The most common type of morphoea was encoup de sabre. Anaemia was present in 14.28% patients. Serum IgE levels were raised in 33.33% patients. Thyroid stimulating hormone was raised in 11.9% patients. 33.33% had raised anti-thyroid peroxidase levels. Anti-nuclear antibody titres and rheumatoid factor were raised in 7.14% and 4.76% patients, respectively. Magnetic resonance imaging brain revealed abnormalities in three patients as hyper-intensities in subcortical white matter. Morphoea in children can be associated with varied immunological, osteoarticular, and neurological abnormalities. This study highlights the multi-system involvement in morphoea and the need for larger data and well-designed therapeutic trials for generating evidence-based treatment of this potentially disfiguring disease.