Abnormal Thyroid-stimulating Hormone Research Articles

Single-Center Analysis of Essential Laboratory Testing in Patients with Newly Diagnosed Celiac Disease

To analyze laboratory testing results from pediatric patients newly diagnosed with celiac disease to determine the usefulness of each test derived from recommended guidelines. Serological testing at the time of diagnosis from patients enrolled in our celiac disease registry from January 2018 through December 2021 was reviewed. The incidence of abnormal laboratory results, routinely obtained as per the recommendations of Snyder etal and our institution's Celiac Care Index, was assessed. Rates of abnormal laboratory values and estimated costs associated with these screening measures were analyzed. Our data demonstrated abnormalities in all serological testing obtained at celiac diagnosis. Hemoglobin, alanine aminotransferase, ferritin, iron, and vitamin D screening were found to be abnormal with notable frequency. Only 7% of patients had an abnormal thyroid-stimulating hormone and <0.1% had an abnormal free T4. Nonresponse to hepatitis B vaccination was prominent, with 69% of patients considered nonimmune. Screening protocols as currently outlined in our Celiac Care Index resulted in an estimated cost of approximately $320000 during our study. Review of screening laboratory results at our center reveals that abnormal values for several recommended measures are uncommon. Thyroid screening was infrequently abnormal and the usefulness of screening for hepatitis B at diagnosis is uncertain. Similarly, our data suggest that iron deficiency screening may be condensed effectively into hemoglobin and ferritin testing, eliminating the need for initial iron studies. Decreasing baseline screening measures could safely decrease the burden of testing on patients and overall healthcare expenditures.

A Causality between Thyroid Function and Bone Mineral Density in Childhood: Abnormal Thyrotropin May Be Another Pediatric Predictor of Bone Fragility.

Low bone mass can occur in children and adolescents with numerous chronic conditions; however, the influence of abnormal thyroid hormone and thyroid-stimulating hormone (TSH) levels on low bone mineral density (BMD) in children and adolescents remains controversial. Investigating the effects of excessive or deficient thyroid hormone and TSH levels on the risk of childhood bone fragility may provide a better understanding of the role of thyroid function on bone density in the pediatric population. The triiodothyronine (T3), thyroxine (T4), and TSH levels and BMD of 619 children diagnosed with various underlying conditions and whose treatment was completed were simultaneously assessed. The T3, free thyroxine (FT4), and TSH levels were subcategorized based on the age-matched reference range, and the lumbar spine BMD (LSBMD) data were compared. The mean LSBMD z-score was 0.49 ± 1.28, while T3, FT4, and TSH levels were 1.25 ± 0.29 ng/mL, 1.28 ± 0.19 ng/dL, and 2.76 ± 1.87 µU/mL, respectively. Both lumbar and femoral BMD z-scores were lower in children with abnormal TSH levels. TSH abnormality was the strongest risk factor for decreased LSBMD z-scores, and thus could be an early indicator of low BMD in children and adolescents with various underlying conditions.

Anterior pituitary hormones in first-episode psychosis: a systematic review and meta-analysis

IntroductionAlthough the role of pituitary gland in schizophrenia and psychotic disorders has been studied for decades, evidence on anterior pituitary hormones in the early phases of psychoses – without the influence of chronicity, comorbidities, and pharmacological treatment – is mostly unclear and inconsistent.ObjectivesOur systematic review and meta-analysis was aimed at comparing the blood concentrations of adrenocorticotropic hormone (ACTH), follicle stimulating and luteinizing hormones (FSH and LH), growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) between people with drug-naïve first-episode psychosis (FEP) and healthy controls.MethodsWe searched main electronic databases for articles indexed up to September 2022. We appraised the quality of data. We carried out random-effects meta-analyses, generating pooled standardized mean differences (SMDs) and estimating between-study heterogeneity. Moreover, we performed sensitivity and meta-regression analyses.ResultsTwenty-six studies were included. People with drug-naïve FEP had higher ACTH (p&lt;0.001; moderate-to-high heterogeneity) and PRL (p&lt;0.001; high heterogeneity) concentrations, as well as lower TSH concentrations (p=0.001; low heterogeneity), than healthy subjects. Sensitivity analyses confirmed these findings. Data were not sufficient to perform meta-analyses on other hormones (FSH, LH, and GH).ConclusionsPeople with drug-naïve FEP have abnormal ACTH, PRL, and TSH blood concentrations, supporting the hypothesis that anterior pituitary hormone secretion is altered in the first stages of schizophrenia and psychoses. Additional research is needed to clarify the complex interconnections between vulnerability, environmental factors, and pituitary hormones in FEP.Disclosure of InterestNone Declared

Evaluation of thyroid function monitoring in people treated with lithium: Advice based on real-world data.

Blood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance recommends 6-monthly serum testing of thyroid function. We examined conformity to these guidelines and the impact of monitoring outside these intervals. We extracted serum lithium and thyroid hormone results at one centre between January 2009 and December 2020. We identified 266 patients who started lithium during this period with no history of thyroid abnormality within the previous 2 years and were at risk of developing thyroid abnormalities. We examined the interval between tests, time between onset of lithium testing and first thyroid-stimulating hormone (TSH) outside the laboratory reference range and assessed impact of testing outside recommended 6-monthly intervals. The most common testing frequency was 3 months (±1month), accounting for 17.3% of test intervals. Kaplan-Meier analysis showed that most thyroid dysfunction manifests within 3 years (proportion with abnormal TSH at 3 years=91.4%, 19.9% of total patients). In the first 3 months after commencing lithium therapy, eight patients developed subclinical hypothyroidism and had clinical follow-up data available. Of these, half spontaneously normalized without clinical intervention. In the remaining patients, thyroxine replacement was only initiated after multiple occasions of subclinical hypothyroidism (median=2 years after initiating lithium, range: 6months to 3 years). The peak interval at 3months suggests that thyroid function is frequently checked at the same time as serum lithium, indicating too frequent testing. Our data support the recommended 6-monthly testing interval and highlight poor adherence to it.

Gestational TSH Levels and Their Association with Obstetric and Neonatal Outcomes in Lebanon: A National Observational Retrospective Study

Objectives: Gestational hypothyroidism is associated with obstetric complications and disturbances in the offspring development; however, it remains easy to treat. The objective of the study was to describe thyroid-stimulating hormone (TSH) levels in pregnant women and analyze their association with pregnancy course and outcome. Design: This national, observational, retrospective study analyzed data on Lebanese pregnant women visiting their obstetrician as part of their routine follow up. Participants, Setting and Methods: Enrolled subjects were all pregnant women who visited the obstetrics clinic from 01 September 2017 until 31 August 2018, as part of their routine follow up and have a TSH level record. In 2020, during their routine follow-up visit, the participants signed an informed consent to allow the investigator to access the data retrospectively and enter them into his database. Relevant participant characteristics and outcome data were collected from clinic files of the private clinic of Dr Abi Tayeh, at the Department of Obstetrics and Gynecology, H?tel-Dieu de France University Hospital, Beirut, Lebanon. Results: A total of 419 women were enrolled, 11.5% of them reported at least one comorbidity prior to pregnancy, most often the antiphospholipid syndrome, followed by thrombophilia and hypothyroidism. At least one complication was reported for 18.4% of participants. Around 87.6% of participants delivered a full-term baby with normal birth weight for most. The average TSH value for all participants was within the normal range at all time-points. Highest TSH values were recorded during the first trimester. As treatment was immediately initiated in women with abnormal TSH levels, no correlation was observed between TSH levels and pregnancy outcomes or pregnancy complications at any time-point. Conclusions: This study highlights satisfactory routine practice in the management of thyroid disorders in pregnancy and underscores the need for routine TSH screening for all pregnant women.

ODP445 If You Can't Beat Them, Join Them: A Therapeutic Strategy for Maintaining Euthyroidism in Non-Compliant Patients

Abstract Levothyroxine (LT4) has been the mainstay therapy for hypothyroidism since synthesized in 1949, and it was depicted to be a daily, usually lifelong, therapy. LT4 may have many interactions with other medications, food, and supplements, for which it should also be taken on an empty stomach, at least thirty minutes before consuming any other product, to achieve adequate absorption. These two characteristics of LT4 therapy are two of the main reasons for patient non-compliance, leading to uncontrolled hypothyroid state shown by abnormal thyroid stimulating hormone (TSH) levels, and associated symptoms. LT4 properties, such as seven-day half-life, as well as increased peripheral conversion to metabolically active T3 by local deiodinase enzyme when there are low T4 levels, provide a scenario where it can be used at longer dosing intervals than the traditional daily dosing. This is the case of a 27-year-old female with past medical history of hypothyroidism on daily replacement therapy with 50mcg of branded LT4, presenting to the endocrinologist for continuation of care. Over the course of visits, patient showed uncontrolled thyroid disease with altered levels of TSH, ranging from 5.4 uIU/mL up to 46.8 uIU/mL (N: 0.45-5. 0 uIU/mL), despite appropriate dose adjustments and frequent TSH and free T4 (FT4) monitoring. Due to persistent clinical and biochemical hypothyroidism requiring dosage increases up to 300mcg, patient was referred for a thyroxine absorption test to rule out LT4 malabsorption versus medication non-compliance. A supervised dose of 812mcg of the same branded LT4 was provided, based on body weight, and TSH, free T3, and free T4 levels were measured before administration and sequentially at 30, 45, 60, 90, 120, 240, and 360 minutes after dose, yielding TSH values ranging from 0.11 uIU/mL to 0.18 uIU/mL, consistent with adequate TSH suppression. Patient admitted to erratic medication ingestion for which a dose of 150 mcg LT4 orally daily was started. TSH levels remained above 9. 0 uIU/mL, for which a trial of complete weekly dosage was offered and accepted by patient. Two months after therapeutic adjustment, patient became both clinically and biochemically euthyroid, with TSH level of 1.35 uIU/mL without any adverse effects from excess hormone intake. Medication non-compliance is an issue every physician must battle with. This case serves as an example of the great impact of individualized modification of LT4 administration to establish a therapeutic regimen that adjusts to each patient's lifestyle while allowing them to remain clinically stable, which is a great benefit for both the patient and the clinician. Although studies already exist in proving the benefits of weekly versus daily therapy in such patients without major risks, further investigation should be conducted, as therapeutic guidelines could potentially change altogether in the future to avoid, or at least reduce, non-compliance consequences. Presentation: No date and time listed

ODP598 Liquid levothyroxine (L-T4) maintains more stable TSH levels in hypothyroid patients, than tablet L-T4

Abstract Hypothyroidism affects approximately 5% of the population, mostly women and people over 60 years of age. The standard therapy used for the treatment of hypothyroidism is tablet levothyroxine (L-T4). Thyroid-stimulating hormone (TSH) is monitored, and L-T4 is adjusted as necessary to reach euthyroidism. Upon the stabilization of TSH levels in the normal range, it is recommended to perform an annual testing in treated patients to warrant suitable replacement. Large population studies showed an increased mortality in people with TSH in the hypothyroid range, demonstrating the importance of maintaining a stable TSH level in the normal range. We evaluated the stability of circulating TSH in hypothyroid patients treated with liquid L-T4, with respect to those treated with tablet L-T4. We enrolled patients with normal circulating TSH levels at the basal evaluation, not reporting any malabsorption or drug interference issues, who were in treatment with liquid or tablet L-T4.Six hundred and fifty six hypothyroid patients treated with liquid L-T4 were compared to 328 hypothyroid subjects receiving tablet L-T4 (both groups were matched by age and gender).Patients were followed for two years, and serum TSH, FT3, FT4 levels were assessed after one and two years. At the first abnormal TSH value, the evaluated parameters were: age, gender, body mass index, history of chronic autoimmune thyroiditis, initial TSH, and L-T4 dosage. At the time of initial normal TSH, these parameters were not associated significantly with time to abnormal TSH values. After 1 year, normal TSH values were registered in 86% of the patients who received L-T4 liquid formulation, but only in 81% of patients treated with tablet L-T4. After 2 years, normal TSH values were registered in 84% of patients receiving L-T4 liquid formulation, while only in 74% of those with tablet L-T4 (p&amp;lt;0.05). To sum up, the obtained data suggest that liquid L-T4 maintains more efficiently (than tablet L-T4) normal TSH levels in hypothyroid patients in the long term follow-up. Presentation: No date and time listed

Free the T3: Implementation of Best Practice Advisory to Reduce Unnecessary Orders

Thyroid function tests (TFTs) are commonly overused and amount to 1.6 billion dollars annually in health care spending in the United States.1,2 Although national guidelines recommend a thyroid-stimulating hormone (TSH)-centered approach, clinicians often inappropriately order triiodothyronine (T3) and thyroxine (T4).2 This may be due to lack of knowledge or ease of ordering all 3 tests at once in premature anticipation of an abnormal TSH.3 Additionally, clinicians order free T3 rather than total T3, despite the American Thyroid Association's recommendations to avoid free T3 due to its high rate of variability.

Association of the thyroid Function disorder with recurrent pregnancy loss in women

Thyroid function disorder is a very common disorder among the general population. Almost 3% of the people around the globe are receiving thyroid replacement therapy around the globe. Objectives: The study aimed to screen the thyroid function disorder among the women with recurrent pregnancy loss. The treatment effects of thyroid disorder on the pregnancy outcomes were also assessed. Methods: This longitudinal study was conducted at Allama Iqbal Memorial Teaching Hospital Sialkot and Islamic International Medical College, Rawalpindi for duration of six months from October 2021 to March 2022. The 110 patients were included in the study to screen abnormal thyroid function and its association with recurrent pregnancy loss. All patients were fully aware of the study and informed consent was taken. Different screening test such as free thyroxin (FT4), Thyroid stimulating hormone (TSH), free tri-iodothyronin (FT3) and thyroperoxidase antibodies test were performed and data was collected. The thyroxin was given to the patients with abnormal TSH levels. Results: The free thyroxin (FT4), (TSH), free tri-iodothyronin (FT3) and anti thyroperoxidase level were measured. Out of 110 patients that participated there were 36% in which elevated levels of thyroid stimulating hormone was observed. Among these 36%, there were 22% that had the level of TSH more than 10 mU/L and there were 14% patients that had their TSH levels in the range of 7-10 mU/L. These patients were given thyroxin approximately 26-75 μg per day and the amount of thyroxin was adjusted according to the level of Thyroid stimulating hormone. Out of these 36% women that had high levels of TSH, there were 21 women that conceived within 1 year of treatment. Among the 33% women with high level of TSH, there were 39 that underwent the anti TPO test. Conclusion: Women who face recurrent pregnancy loss should be checked for thyroid abnormality as it was detected that there is significant number of women who face hypothyroidism and recurrent pregnancy loss.

Effect of Inactivated SARS-CoV-2 Vaccine on Thyroid Function and Autoimmunity Within 28 Days After the Second Dose.

Background: The safety of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines is widely appreciated. However, there is limited knowledge regarding the potential impact of SARS-CoV-2 vaccines on the thyroid. Methods: We performed two prospective clinical trials between April and June, 2021, enrolling recipients of the inactivated SARS-CoV-2 vaccine (BBIBP-CorV and CoronaVac). Thyroid function, antithyroid antibody levels, and SARS-CoV-2 neutralizing antibody levels were detected for each participant before receiving the first vaccine dose and 28 days after receiving the second vaccine dose. Results: A total of 657 recipients participated in the study. The overall median thyroid function and levels of antithyroid antibodies before and after SARS-CoV-2 vaccination were within the normal range. Among the 564 participants with normal thyroid function at baseline, 36 (6.38% [confidence interval; CI 4.51-8.73]) developed thyroid dysfunction. Of the 545 recipients with negative antithyroid antibodies at baseline, none developed abnormal antibodies after vaccination. Notably, 75.27% (70/93 [CI 65.24-83.63]) of the 93 recipients with thyroid dysfunction returned to normal function after vaccination. The levels of antithyroid peroxidase antibody (96.20% [CI 89.30-99.21]) and antithyroglobulin antibody (TgAb; 88.31% [CI 78.97-94.51]) remained positive after vaccination in most patients with abnormal values at baseline. However, the TgAb levels in more than half of the patients (48/77) decreased. All of 11 abnormal thyrotropin receptor antibody levels at baseline decreased postvaccination. Conclusions: Vaccination with an inactivated SARS-CoV-2 vaccine had no significant adverse impact on thyroid function or antithyroid antibodies within the first 28 days after the second dose. Clinical Trial Registration: ChiCTR2100045109 and ChiCTR2100042222.

Pharmacist-Mediated Thyroid-Stimulating Hormone (TSH) Test Guideline Monitoring Program- Outcomes of a Retrospective Study In Patients On Levothyroxine

Thirty to sixty percent of individuals taking levothyroxine were either under or overtreated, which leads to organ damage and excess mortality. This study aims to assess the gaps in the “thyroid-stimulating hormone (TSH) test guideline compliance rate” and validate the scope of ambulatory care pharmacist-mediated practice in patients on levothyroxine. At the study site, pharmacists offered patient-centered telephonic counseling to patients on levothyroxine who had been non-compliant with TSH tests for more than a year. A two-month quantitative retrospective analysis of this practice was conducted to assess its impact on TSH lab test adherence and dose modification outcomes. 415 patients met the study’s inclusion criteria who received pharmacist counseling with documented intervention. Pharmacists bridged the significant gap in practice by creating new TSH lab requests with counseling in 81.2% (n = 337) of the study population who did not have TSH lab requests prior to the program. The non-compliance rate population dropped from 79.27% (n = 329) to 17.59% (n = 73) in the study population who had been non-compliant with the TSH test for 13 and 24 months. 74.5% (n = 309) were found to have performed their TSH test after the pharmacist’s intervention. Among 100, 66% (n = 66) patients with abnormal TSH values consulted their physician for advice, of which 60.6% (n=40) had their levothyroxine dose adjusted (χ2=82.702, P < 0.01. The study suggests that pharmacists can significantly mediate between patients and physicians to enhance TSH test compliance and essential dose adjustment in patients prescribed levothyroxine.

Maternal exposure to atmospheric PM2.5 and fetal brain development: Associations with BAI1 methylation and thyroid hormones

Maternal exposure to atmospheric fine particulate matter (PM2.5) during pregnancy is associated with adverse fetal development, including abnormal brain development. However, the underlying mechanisms and influencing factors remain uncertain. This study investigated the roles of DNA methylation in genes involving neurodevelopment and thyroid hormones (THs) in fetal brain development after maternal exposure to PM2.5 from e-waste. Among 939 healthy pregnant women recruited from June 2011 to September 2012, 101 e-waste-exposed and 103 reference mother-infant pairs (204 pairs totally) were included. Annual ground-level PM2.5 concentrations over e-waste-exposed area (116.38°E, 23.29°N) and reference area (116.67°E, 23.34°N) in 2011, 2012 were obtained by estimates and maternal exposure was evaluated by calculating individual chronic daily intakes (CDIs) of PM2.5. Methylation and THs including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) level were measured in umbilical cord blood collected shortly after delivery. We found higher ground-level PM2.5 concentrations led to greater individual CDI of PM2.5 in e-waste-exposed pregnant women. After adjustment for gender and birth BMI, significant mediation effects on the adverse associations of maternal PM2.5 exposure with birth head circumference were observed for methylations at positions +13 and + 32 (respectively mediated proportion of 9.8% and 5.3%, P < 0.05 and P < 0.01) in the brain-specific angiogenesis inhibitor 1 (BAI1) gene, but not for methylations in the catenin cadherin-associated protein, alpha 2 (CTNNA2) gene. BAI1 (position +13) methylation was also significantly correlated with FT3 levels (rs = −0.156, P = 0.032), although maternal CDI of PM2.5 was positively associated with higher odds of abnormal TSH levels (OR = 5.03, 95% CI: 1.00, 25.20, P = 0.05) rather than FT3 levels. Our findings suggest that methylation (likely linked to THs) in neonates may play mediation roles associated with abnormal brain development risk due to maternal exposure to atmospheric PM2.5 from e-waste.

Thyroid Function in Neonates with Hypoxic Ischemic Encephalopathy.

We aimed to examine heel prick (capillary) and serum thyroid function test (TFT) results in neonates with hypoxic ischemic encephalopathy (HIE) to evaluate the effect of asphyxia and therapeutic hypothermia (TH) on thyroid functions. This retrospective chart review included infants who were born after 34 weeks of gestation, were diagnosed and treated for HIE. The patients were divided into those who did and did not undergo TH and the groups were compared in terms of demographic characteristics, laboratory results, capillary thyroid-stimulating hormone (cTSH) levels, and serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels. A total of 111 neonates were included in the study. There was no difference between the TH group (n = 90) and the nonhypothermia group (n = 21) in terms of median gestational age (38.3 ± 2.1 weeks vs. 38.6 ± 1.8 weeks, p = 0.42) or birth weight (3182 ± 509 g vs. 3174 ± 573 g, p = 0.72). Serum TFT was performed at a median of 10 days (range, 2-43) and capillary TSH analyzed at a median of 6 days (range, 1-26). Capillary TSH at 96 hours was analyzed in 36 patients in the TH group and 19 patients in the nonhypothermia group. Serum TSH and fT4 levels were similar in both groups (p = 0.29, p = 0.1). Overall cTSH and cTSH obtained in the first 4 days were 2.2 (0.5-10) and 4.3 (0.5-94), p = 0.059; 2 (0.5-22) and 5 (0.5-94), p = 0.04, respectively, whereas cTSH obtained after day 4 was similar in both groups (p = 0.058). Abnormal serum TSH (>5.5 mU/mL) was more frequent in the hypothermia group (44.4% vs. 19%, p = 0.026). Our results suggest that TH may cause some alterations on TFTs. Therefore, it may be reasonable to repeat TSH screening after TH.

Indications for ordering thyroid-stimulating hormone in noncritically ill adult inpatients-A Delphi consensus recommendation.

Thyroid-stimulating hormone (TSH) is ordered commonly among inpatients, but the possibility of nonthyroidal illness syndrome challenges interpretation. Our objective was to obtain Canadian consensus on appropriate indications for ordering TSH in the first 48 hfollowing presentation of a noncritically ill internal medicine patient. Canadian endocrinologists with inpatient expertise were invited via snowball sampling to an online 3-round Delphi study. Main Outcome and Measures using a 6-point Likert scale, they rated 58 indications on appropriateness for measuring TSH in medical inpatients. These indications included clinical presentations, signs, and symptoms. Items that reached consensus and agreement (≥80% of participants selecting a rating of 5 or 6 on the Likert scale) were tabulated and dropped after each round. Qualitative analysis of comments identified additional contextual considerations as themes. There were 45 participants (academic setting: 84%) representing 8 provinces (Ontario: 64%). Rounds 2 and 3 were completed by 42 and 33 participants, respectively. Nine indications reached consensus and agreement: presumed myxedema coma, presumed thyroid storm, atrial fibrillation/flutter, euvolemic hyponatremia, proptosis, adrenal insufficiency, hypothermia, thyroid medication noncompliance, and goiter. There was also agreement that two contextual considerations identified in thematic analysis, including a recent abnormal outpatient TSH, and the presence of other findings of thyroid dysfunction, would significantly change some mid-range responses. Canadian experts agreed upon nine specific indications for ordering an inpatient TSH, with others requiring consideration of previous TSH measurement and clinical context.

Association between fasting blood glucose and thyroid stimulating hormones and suicidal tendency and disease severity in patients with major depressive disorder

Thyroid dysfunction and diabetes are reported to be associated with depression. However, their role in the suicide risk in patients with major depressive disorder (MDD) is unclear. The purpose of this study was to investigate and compare thyroid dysfunction and diabetes between suicide attempters and non-suicide attempters in a large sample of first-episode drug-naïve MDD patients. A descriptive study was conducted on 1279 Chinese outpatients with a diagnosis of first-episode MDD. Their socio-demographic information, blood levels of thyroid hormones, glucose, lipids and body mass index (BMI) parameters were collected. The positive subscales of the positive and negative syndrome scale (PANSS), Hamilton anxiety rating scale (HAMA), Hamilton depression rating scale (HAMD) were measured for psychotic, anxiety and depressive symptoms. Our results showed that compared with non-suicide attempters (p < 0.01), suicide attempters had statistically higher scores on HAMD, HAMA and PANSS psychotic symptoms, as well as higher thyroid stimulating hormone (TSH) serum levels, glucose, anti-thyroglobulin (A-TG), anti-thyroid peroxidase (A-TPO), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), systolic blood pressure, and diastolic blood pressure (all with p < 0.001). These results revealed that TSH, A-TG, A-TPO, TC, TG, and LDL-C may be promising biomarkers of suicide risk in MDD, implying the importance of regular assessment of blood glucose level and thyroid function parameters for suicide prevention, along with possible treatment for impaired thyroid function and diabetes for the suicide intervention in MDD patients. Such patients with abnormal blood sugar and TSH must undergo thorough screening for suicidal ideation.

Divergent prognostic effects of pre-existing and treatment-emergent thyroid dysfunction in patients treated with immune checkpoint inhibitors

BackgroundThyroid dysfunction is among the most common autoimmune diseases and immune checkpoint inhibitor (ICI)-induced immune-related adverse events (irAE). We determined the association between longitudinal thyroid function and clinical outcomes in patients treated with ICI.MethodsWe identified all patients treated with ICI at UT Southwestern Medical Center from January 1, 2011, through December 31, 2020. We defined normal thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels according to institutional reference range. We defined clinical thyroid dysfunction using established criteria incorporating labs and treatment. We determined the association between thyroid function and overall survival (OS) using Kaplan–Meier curves, log-rank tests, and multivariate Cox proportional hazards model.ResultsA total of 1781 patients were included in analyses, of whom 381 (21%) had abnormal baseline TSH. Patients with abnormal baseline TSH were more likely to be female, have kidney cancer, and initiate levothyroxine after ICI initiation (all P < 0.001). Patients with abnormal baseline TSH had inferior OS (median 16 vs 27 months; P < 0.001). Among patients with normal baseline TSH, those who had abnormal TSH after ICI initiation had improved OS (median 41 vs 22 months; P < 0.001). In a multivariate Cox model, abnormal baseline TSH was associated with worse OS (HR 1.62; 95% CI, 1.30–2.02; P < 0.001), while initiation of levothyroxine after ICI initiation was associated with improved OS (HR 0.62; 95% CI, 0.44–0.88; P = 0.008).ConclusionsICI-induced thyroid dysfunction is associated with improved survival, although abnormal TSH prior to ICI initiation is associated with inferior survival.PrecisThyroid abnormalities occur commonly in the general population and as immunotherapy toxicities. We found that immunotherapy-induced thyroid dysfunction is associated with better survival, but pre-existing thyroid abnormalities convey worse outcomes.

Association between levels of thyroid-stimulating hormone and prognosis of patients admitted to intensive care units: an analysis using the MIMIC-III

To explore the association between levels of thyroid-stimulating hormone (TSH) on admission and prognosis of patients admitted to intensive care unit (ICU). The data were collected from patients who were admitted to the ICU of the Beth Israel Deaconess Medical Center in the United States from 2001 to 2012 with available TSH test records within 24 hours after the ICU admission via the Medical Information Mart for Intensive Care-III v1.4 (MIMIC-III v1.4). Information including gender, age, ethnicity, type of admission, mechanical ventilation (MV) or renal replacement therapy (RRT) received on admission, comorbidities, and TSH test records within 24 hours after the ICU admission were collected. The sequential organ failure assessment (SOFA) score, simplified acute physiology score II (SAPS II) and the comorbidities index Elixhauser (SID30) score were calculated according to the parameters. The primary outcome was hospital mortality. Differences in baseline characteristics and prognosis were examined between patients with normal TSH levels and abnormal TSH levels which was determined according to a dichotomous variable provided by the data. Multivariable Logistic regression was used to analyze the association between TSH levels and prognosis after adjusting for confounding factors. A sensitivity analysis was conducted which categorized the study population as three groups (i.e., decreased, normal, and elevated TSH levels) using the range of 0.30-3.00 mU/L as the normal range of TSH. A total of 3 425 ICU patients were enrolled in the study, of which 2 692 (78.60%) were with normal TSH and 733 (21.40%) were with abnormal TSH. There was no statistically significant difference in gender, age, ethnicity, type of admission and the ratio of MV between the normal TSH and abnormal TSH groups. Compared with normal TSH group, the patients in abnormal TSH had a higher SOFA, SAPS II and SID30 scores as well as the ratio of RRT [SOFA score: 4 (2, 7) vs. 4 (2, 6), SAPS II score: 38.02±13.76 vs. 36.53±13.75, SID30 score: 11 (4, 22) vs. 11 (0, 20), RRT ratio: 5.32% (39/733) vs. 3.49% (94/2 692), all P < 0.05]. The hospital mortality of patients in normal TSH was significantly higher than that of those in abnormal TSH [9.82% (72/733) vs. 5.94% (160/2 692), P < 0.01]. After adjusting for confounding factors, abnormal TSH was significantly associated with hospital mortality [odds ratio (OR) = 1.71, 95% confidence interval (95%CI) was 1.24-2.35, P = 0.001]. In the sensitivity analysis in which the range of 0.30-3.00 mU/L was used as the normal range of TSH, compared with normal TSH, decreased TSH (OR = 2.36, 95%CI was 1.40-3.97, P = 0.001) and elevated TSH (OR = 1.44, 95%CI was 1.05-1.98, P = 0.023) were both significantly associated with increased hospital mortality. An abnormal level of TSH within 24 hours after admitted to ICU is an independent risk factor for hospital mortality among ICU patients.

Serum vitamin D, ferritin, and TSH in patients with telogen effluvium: a retrospective epidemiological study

Background: Telogen effluvium (TE) is one of the most common causes of alopecia. It is a non-scarring type of hair loss. TE is mainly diagnosed clinically; however, it can be associated with laboratory abnormalities such as serum ferritin, vitamin D, and thyroid-stimulating hormone (TSH); thus, screening them in TE patients could potentially improve the treatment outcome. The present study is aimed at assessing serum vitamin D, ferritin, and TSH in patients with TE in the Saudi population. Methods: A retrospective chart review study was carried out at Qassim University&amp;apos;s dermatology clinics. The inclusion criteria included all female patients above the age of 18 years who were diagnosed with TE by one of the consultant dermatologists at Qassim University&amp;apos;s clinics and who had at least one of the three laboratory tests: serum ferritin, vitamin D, and TSH level. Results: Our results indicated that among patients who were diagnosed with TE, the percentage of TE patients with ferritin deficiency was found to be 35.4%. Besides, the percentage of TE patients with vitamin D deficiency was 34.2%, and 8.5% had an abnormal TSH, with 1.5% having a low TSH and 7.0% having high TSH. Conclusion: Based on the findings of our study, we suggest that serum ferritin and vitamin D should be added to the screening panel of TE patients. The prevalence of hypothyroidism in our study was 7%, which is somewhat similar to the prevalence of hypothyroidism in the general population of about 5%-10%. Thus, we suggest that adding TSH to the TE screening panel is better to be individualized according to the patient&amp;apos;s clinical presentation rather than a routine test in all TE patients.

Comparative sonographic assessment of thyroid volume in adult diabetics and nondiabetics in the university of uyo teaching hospital, Uyo

Background: Diabetes mellitus and Thyroid disorders are known to mutually influence each other. Thyroid dysfunction especially when undiagnosed has a negative impact on metabolic control, likewise, increased levels of insulin in insulin resistance has a proliferative effect on thyroid tissue. Aims: The study aimed to sonographically measure and compare Thyroid gland volume (TV) in adults with diabetes and apparently healthy subjects, as well as determine the effect of thyroid stimulating hormone (TSH), glycosylated haemoglobin (HbA1c) and anthropometry on TV. Patients, Materials and Methods: This was a case-controlled study carried out over 6 months in the University of Uyo Teaching Hospital, from April to September 2019, among 70 adult diabetics and an equal number of non-diabetics. The thyroid volume was correlated with gender, age, height, weight, BMI, waist circumference, duration of diabetes, TSH and HbA1c. Results: The overall mean TV was higher in diabetics (6.8 ± 3.5cm3 versus 6.3 ± 2.9cm3). Among those with diabetes, TV was significantly higher in those with poor glycemic control (p=0.020). A positive correlation was found between TV and duration of diabetes and height. The mean thyroid volume was higher among the male population of both groups. An equal number of subjects had abnormal (high) TSH levels in both study arms. There was no correlation between TV and most of the anthropometric indices. Conclusion: Sonographic thyroid volume is higher among diabetics and it has a positive correlation with gender, height, duration of diabetes and HbA1c.

Non-Toxic Multinodular Goiter: From Etiopathogenesis to Treatment.

Goiter term is generally used for defining the enlargement of thyroid gland. Thyroid nodules are very common and some of these nodules may harbor malignancy. Multinodular goiter (MNG) disease without thyroid dysfunction is defined as non-toxic MNG.There are many factors in etiology for development of MNG. They can be classified as iodine dependent and non-iodine dependent factors basically. Beyond this basic classification, the effect of many environmental and acquired factors is also effective on the development of goiter.Many methods have described for diagnosis and treatment for non-toxic MNG. Biochemical tests, imagining methods, invasive and non-invasive methods have been used for diagnosis for many years. Each method has advantages and disadvantages, separately. Although the best method for diagnosis is still debatable, distinguishing malignant nodules from benign nodules is the first and most important step for MNG.Biochemical tests such as serum thyroid stimulating hormone (TSH) measurement, thyroid hormone measurement; and thyroid ultrasonography are used for diagnosis of MNG, traditionally. Nowadays, there are some new techniques were developed like ultrasound-elastography. Furthermore, thyroid scintigraphy may be used if there is abnormal TSH measurement. Fine-needle aspiration biopsy and some cross-sectional imaging methods (computed tomography, magnetic resonance imaging, and positron emission tomography) could be used, too.After a certain diagnosis is made, treatment options should be evaluated. Many treatment methods have been used for goiter from ancient times upon today. From non-invasive methods such as medical follow-up to invasive methods such as lobectomy or thyroidectomy are options for treatment. Patients with compression symptoms due to an enlarged thyroid gland are usually candidates for surgery. In this study, it is aimed to determine the most appropriate treatment for the patient by discussing the advantages and disadvantages of all these methods.The present review discusses definition of goiter term, etiology, epidemiology, pathogenesis, diagnostic methods, and treatment methods for nontoxic MNG.