Average Thyroid-stimulating Hormone Research Articles

A Study of Non-alcoholic Fatty Liver Disease in Patients With Hypothyroidism: A Cross-Sectional Study in a Tertiary Care Hospital.

Background Hypothyroidism occurs when the thyroid gland is underactive and fails to produce sufficient thyroid hormones. It can affect multiple organs including the heart, brain, liver, kidneys, and reproductive system, leading to symptoms such as fatigue, cognitive impairment, elevated cholesterol, fluid retention, fatty liver, and menstrual irregularities. Given the higher prevalence of fatty liver disease in patients with hypothyroidism, it is important to evaluate the need for routine screening for fatty liver in these patients. Materials and methods This observational, cross-sectional study was conducted at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from October 2022 to June 2024. The study included 60 patients aged over 12 years who were known or recently diagnosed with hypothyroidism. Patients with type 2 diabetes mellitus, pregnant women, or those with chronic liver disease were excluded. Data collected included physical examination findings and laboratory test results. Fatty liver was diagnosed using magnetic resonance elastography. Statistical analysis was performed using IBM SPSS statistics for Windows, version 20 (IBM Corp., Armonk, New York). The statistical significance of parametric data was evaluated using the Chi-square test. A p-value less than 0.05 and a confidence interval of 95% were considered statistically significant. Result The study population had an average age of about 45 years, with most participants aged between 40 and 49 years. The majority of the participants were female, making up over 83% of the group, while males constituted about 17%. The most commonly reported symptom was weight gain, followed by constipation and fatigue. For individuals with fatty liver, the average thyroid-stimulating hormone (TSH) level was notably higher compared to those without fatty liver.Additionally, low-density lipoprotein (LDL) levels were higher in individuals with non-alcoholic fatty liver disease (NAFLD) compared to those without. Both TSHand LDL levels showed a statistically significant association with the occurrence of NAFLD. Conclusion Hypothyroidism was more prevalent in females and in the age group 40-49 years. There was a statistical significance between TSHand the occurrence of NAFLD. In this study,statistical significance was also found between LDLand the occurrence of NAFLD.

The frequency of clinical and subclinical hypothyroidism in transfusion dependent thalassemia patients in Slemani city /Iraq

Background and objective: Thyroid disorders caused by blood transfusion in thalassemia patients could affect human health and growth, this study was conducted to determine the frequency of clinical and subclinical hypothyroidism in blood transfusion-dependent thalassemia patients in the city of Slemani, Kurdistan Region, Iraq. Methods: The current study is a retrospective cross-sectional study (comparative analysis) conducted in Slemani center for thalassemia patients and congenital blood, between December 2021 and July 2022. Participants included l07 thalassemia patients with medical records the sampling method was a convenience method. The data was collected through the review of patients' files and blood tests, including( thyroid hormones, hemoglobin level, serum ferritin level), with a questionnaire that was completed through an interview with the patients. Results: The results of thyroid function tests have shown that 21/107 pateints (19.6%) have hypothyroidism, 6 patients have overt hypothyroidism, and 15 patients have subclinical showed that 23/107 patients and 4/107 patients had hight and low levels,respectively, and there was statistically a significant difference in the average Thyroid stimulating hormone and serum thyroxin levels in two groups of hypothyroid and euthyroid patients and mean ferritine serum level between these two groups was 2166.7±2174.8 and 2068.37±1919.97 respictively ,which was not a statistically significant difference . Conclusion: Considering the high prevalence of hypothyroidism in thalassemia patients, measuring Thyroid stimulating hormone and thyroxin can be very important and vital in the initial screenings,effective treatment and follow-up of patients.

Comparison between transient and permanent congenital hypothyroidism on a thyroid function test after re-evaluation.

Congenital hypothyroidism (CH) is diagnosed with neonatal screening and is treated early in the neonatal period. Among these patients, transient CH (TCH) is included and requires re-evaluation. The purpose of this study was to find the best way to discontinue levothyroxine and to find trends in thyroid function tests (TFTs) after re-evaluation. We retrospectively reviewed 388 patients diagnosed with CH. They were classified as permanent CH (PCH) and TCH. The total number of the PCH and TCH groups was 83 (51 boys and 32 girls). We compared clinical parameters to predict TCH and to identify the trends of TFT. The first thyroid-stimulating hormone (TSH) value after discontinuation and the average TSH value for 1, 2, and 3 years were all significantly higher in the PCH group (P<0.01). The first fT4 value after discontinuation and the average fT4 value for 1, 2, and 3 years were all significantly higher in the TCH group (P<0.01). The optimal cutoff value on the receiver operating characteristic curve for PCH prediction with an average of 3 years of TSH was greater than 9.05 μIU/mL, which was predicted with a sensitivity of 100% and a specificity of 100%. When the TSH value ranges from 10 μIU/mL to 20 μIU/mL, clinicians can discontinue levothyroxine if the next result is around 10 μIU/mL or shows a decreasing trend.

Comparative analysis of the levels of thyroid-stimulating hormone, glycated hemoglobin and indicators of lipid metabolism in women of Lviv and Kyiv regions

Background. The prevalence of thyroid diseases, including endemic goiter and autoimmune disorders, has been consi­dered by scientists for more than a century as a cause for reducing the working capacity of the population and also affects the cognitive ability of future generations. Geographically, Lviv region is in an endemic iodine deficiency zone, while Kyiv region suffered negative radiation exposure as a result of the accident at the Chernobyl Nuclear Power Plant. Since both factors affect the state of the thyroid system, the study on the levels of thyroid hormones among women in the specified areas makes it possible to identify the risks of thyroid pathologies and to develop a strategy for their prevention. The purpose of the study: to find out and analyze the levels of thyroid-stimulating hormone (TSH), glycated hemoglobin and indicators of lipid metabolism in women of Lviv and Kyiv regions. Materials and methods. One hundred and fifty women were examined, their average age was 48 ± 7 years. The criterion for inclusion in the study were: absence of diabetes or treatment for thyroid pathologies, as well as other serious diseases. The survey was conducted once, in July-August 2022. The level of pituitary TSH, antibodies to thyroid peroxidase (TPO-Ab), glycated hemoglobin, total cholesterol, low-density lipoprotein was evaluated. Results. In examined women of the Kyiv region, the average TSH was 2.21 ± 0.30 mIU/l, while in those from the Lviv region it was within 2.42 ± 0.17 mIU/l (p &gt; 0.05). A significant difference was found between the average values of TPO-Ab, some women had high levels of antibodies without manifestations of hypothyroidism and clinical complaints. The average value of TPO-Ab in patients from the Kyiv region was 81.21 ± 19.41 IU/ml and in women from the Lviv region it was 38.41 ± 5.97 IU/ml (р &lt; 0,05). When analyzing carbohydrate metabolism, no significant changes were found between the levels of glycated hemoglobin in the examined women of Kyiv and Lviv regions, 5.81 ± 0.09 % and 5.66 ± 0.04 %, respectively (р &gt; 0.05). Some women showed a slight increase in glycated hemoglobin over 5.6 %, which did not reach the level of 6.5 %. This group of examinees were at risk of developing type 2 diabetes and is characterized by the term “prediabetes”. Regarding lipid metabolism, we found no significant changes in the level of total cholesterol and low-density lipoprotein. Conclusions. The conducted observation revealed differences in TSH, TPO-Ab indicators in healthy women living in Lviv and Kyiv regions. We can assume that the obtained results of Lviv region reflect the problems of the endemic zone of the Western regions of Ukraine. In turn, significantly higher levels of TPO-Ab among residents of Kyiv region are most likely a consequence of the accident at the Chernobyl Nuclear Power Plant, which can still affect the health of the population of this region.

B-159 Data Mining With the Bhattacharya Method as a Tool for Reference Interval Determination in Populations With Thyroid Disorders

Abstract Background Establishing a precise reference interval (RI) is crucial for laboratory diagnosis, population studies, and aiding physicians in patient follow-up treatment. Data mining and Bhattacharya analysis can be an efficient and cost-effective way to determine RIs for thyroid disorders based on large datasets. Bhattacharya analysis is a simple resolution method that detects distributions into Gaussian components. Unlike traditional reference interval studies using parametric or non-parametric statistics, Bhattacharya analysis does not exclude results from an “unhealthy” population before analysis. This study aimed to define the RI for thyroid-stimulating hormone (TSH) and free thyroxine (fT4) from three distinct regions in São Paulo, Brazil, using the Bhattacharya method. Methods The study was a 20-month retrospective analysis of a large laboratory database in São Paulo from February/2021 to September/2022. Individuals aged 21 or older with available TSH or fT4 results were selected, including only outpatient results. Three groups from different regions (R1, R2, R3) were studied and the indirect Bhattacharya method was used to determine each region’s RI values. The midpoint, upper and lower reference limits (URL and LRL), were calculated, and a data plot was created using Microsoft Excel. One-way ANOVA was used for multiple group comparisons and results with *P &amp;lt; 0.01 were considered statistically significant. Results A total of 234 903 TSH and fT4 records were obtained. The three groups showed significant differences in their mean age and TSH and fT4 results (P &amp;lt; 0.001). The mean age was 49.41 ± 16.9 for R1, 46.9 ± 9.6 for R2, and 53 ± 16 years old for R3. The average TSH value for all three regions was 2.44 µIU/mL (SD 0.18, CV 7.2%), and the average fT4 value was 1.17 ng/dL (SD 0.06, CV 4.7%). The central bin was selected for the best data distribution and close to the average or median for each group. The derived RIs for R1, R2, and R3 were compared for consideration of a common RI. Other criteria, such as the best bin size and at least four bins for the graph curve, were also applied. Altogether, Bhattacharya’s analysis identified the following estimates from all collection points for TSH and fT4: TSH Average LRL 0.43 µIU/mL (SD 0.07, CV 16.6%)/TSH Average URL 6.45 µIU/mL (SD 0.85, CV 13.1%)/TSH Average Range 6.03 µIU/mL (SD 0.88, CV 14.6%)/fT4 Average LRL 0.82 ng/dL (SD 0.07, CV 8.1%)/fT4 Average URL 1.47 ng/dL (SD 0.07, CV 4.4%)/fT4 Average Range 0.65 ng/dL (SD 0.02, CV 3.5%). 9.7% of individuals in R3 had results outside the accepted RIs for TSH and fT4, compared to R2 as a standard population with the lowest possibility of relevant thyroid disorders. Conclusion Bhattacharya’s non-parametric method could be useful to determine reference values and laboratory analysis of populations with distinct characteristics. The study highlights the importance of choosing the correct control group in comparison studies, and the potential bias in unifying distinct regions to determine RIs. The low cost of data mining makes it possible for nearby laboratories to perform similar studies using the Bhattacharya method to establish RI results suitable for specific patient populations.

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.

Vitamin D, Testosterone, and Thyroid Status in Young Men at Different Seasons

There are evidences that seasonal fluctuations in vitamin D levels coincide with annual rhythms of testosterone levels, and hypothyroidism may be a predictor of hypoandrogenism.&#x0D; The aim of the study was to establish the levels of vitamin D (vit. D), testosterone (T), thyroid stimulating hormone (TSH) and free thyroxine (T4f) in young people with pathospermia and normospermia in the spring-summer and autumn-winter periods.&#x0D; Materials and methods. The data of 58 men aged 23-44 years, who are in a sterile marriage, were analyzed: 24 were examined in the spring-summer period, 34 - in the autumn-winter period. BMI, levels of T, TSH, T4fandvit. Dwere investigated.&#x0D; Results. In the general group of men, the frequency of D - hypovitaminosis was higher in those examined in the autumn-winter period. Vit D levels were significantly lower with pathospermia than with normospermia. BMI did not significantly affect the level of vit.D in the blood.A direct correlation between vit. D and T in men with patho- and normospermiahas not been established, although such a correlation took place in the general group of the surveyed.&#x0D; The average TSH values ​​in the group examined in the spring-summer period did not significantly differ in the group with patho- and normospermia, and in those examined in the autumn-winter period, against the background of pathospermia, there was a decrease in T4f values ​​and an increase in TSH. 13.6% of this subgroup had laboratory signs of subclinical hypothyroidism.&#x0D; Conclusions:&#x0D; &#x0D; In men of the general group, without taking into account the state of the spermatogenic function of the testicles, examined in the autumn-winter period, there is a significant increase in the frequency of D-hypovitaminosis compared with a similar group of men in whom the level of vitamin D blood was determined in the spring-summer period.&#x0D; Regardless of the examination period, patients with pathospermia show a decrease in the average levels of vitamin D and testosterone compared to men with normal semen parameters.&#x0D; The frequency of vitamin D deficiency in patients with pathospermia significantly increases in the autumn-winter period.&#x0D; &#x0D; Disorders of spermatogenesis in men can be associated with the hypofunctional state of the thyroid gland against the background of the existing deficiency of vitamin D in the autumn-winter period.

Evidence of a Causal Relationship between Serum Thyroid-Stimulating Hormone and Osteoporotic Bone Fractures

Objective: We aimed to validate the association of genome-wide association study (GWAS)-identified loci and polygenic risk score with serum thyroid-stimulating hormone (TSH) concentrations and the diagnosis of hypothyroidism. Then, the causal relationship between serum TSH and osteoporotic bone fracture risk was tested. Methods: A cross-sectional study was done among patients of European Caucasian ethnicity recruited in Tayside (Scotland, UK). Electronic medical records (EMRs) were used to identify patients and average serum TSH concentration and linked to genetic biobank data. Genetic associations were performed by linear and logistic regression models. One-sample Mendelian randomization (MR) was used to test causality of serum TSH on bone fracture risk. Results: Replication in 9,452 euthyroid individuals confirmed known loci previously reported. The 58 polymorphisms accounted for 11.08% of the TSH variation (p < 1e−04). TSH-GRS was directly associated with the risk of hypothyroidism with an odds ratio (OR) of 1.98 for the highest quartile compared to the first quartile (p = 2.2e−12). MR analysis of 5,599 individuals showed that compared with those in the lowest tertile of the TSH-GRS, men in the highest tertile had a decreased risk of osteoporotic bone fracture (OR = 0.59, p = 2.4e−03), while no difference in a similar comparison was observed in women (OR = 0.93, p = 0.61). Sensitivity analysis yielded similar results. Conclusions: EMRs linked to genomic data in large populations allow replication of GWAS discoveries without additional genotyping costs. This study suggests that genetically raised serum TSH concentrations are causally associated with decreased bone fracture risk in men.

Patterns of Bodyweight Changes in Patients With Hypothyroidism, a Retrospective Study From Basrah, Southern Iraq.

BackgroundWeight gain is one of the most important hypothyroidism-related concerns in patients with hypothyroidism. However, unexpectedly, levothyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism.MethodIn a retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center, a total of 346 adult patients with hypothyroidism (192 newly diagnosed and 154 known hypothyroidism patients) who had one visit every three months, five visits in one year were included. Of these, 116 new and 69 known hypothyroidism patients had completed nine visits in two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH ≤ 4.2 μIU/ml) and uncontrolled (TSH > 4.2 μIU/ml). Repeated measures analysis of variance (ANOVA) with a Greenhouse-Geisser correction and post hoc tests using the Bonferroni correction were used to evaluate TSH and BWT changes through the study.ResultsBoth in newly diagnosed and known hypothyroidism patients with an average TSH > 4.2 μIU/mL, BWT increased significantly through visits over one and two years. For newly diagnosed patients assessed over one year (F(2.41, 321.60) = 3.28, p = 0.03), the mean BWT increase was 1.4 ± 0.38 kg from 3rd to 12th month visits (p = 0.004). For newly diagnosed patients assessed over two years (F(3.10, 263.89) = 9.08, P < 0.0005), the mean BWT increase was 3.02 ± 0.77 kg from 3rd to 24th month visits (p = 0.007). For patients with known hypothyroidism assessed over one year (F(2.56, 187.47) = 7.11, p = 0.0003), the mean BWT increase was 1.97 ± 0.64 kg at 12th month visit, and over two years (F(2.35, 77.56) = 4.67, P = 0.009), the mean BWT increase was 3.78 ± 1.26 kg at 24th month visit. While in all other patients with an average TSH ≤ 4.2 μIU/mL, the BWT changed non-significantly through the visits for newly diagnosed patients over one year and two years (p = 0.10, 0.34, respectively), and known patients over one year and two years (p = 0.47, 0.34, respectively).ConclusionContrary to what is believed, adequate treatment with levothyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.

Patterns of Body Weight Changes in Patients With Hypothyroidism, a Retrospective Study From Basrah, Southern Iraq

Background: Weight gain is one of the most important hypothyroidism-related concerns among patients with hypothyroidism. However, not as expected, thyroxine replacement does not necessarily result in body weight (BWT) reduction among those patients. The study aimed to assess the patterns of BWT changes through time in patients with hypothyroidism. Method: A retrospective database study from Faiha Specialized Diabetes, Endocrine, and Metabolism Center. A total of 346 adult patients with hypothyroidism, 192 newly diagnosed and 154 known, who had 1 visit every 3 months, 5 visits per one year. From those patients, 116 new and 69 known had completd 9 visits per two years. Each visit involved thyroid-stimulating hormone (TSH) and BWT measurements. Patients with chronic liver or renal disease, diabetes mellitus, thyroid cancer, or other malignancies, pregnancy, and on steroid or hormonal therapies were excluded. The patients were further subdivided based on average TSH levels into controlled (TSH≤4.2 μIU/mL) and uncontrolled TSH>4.2 μIU/mL. Repeated measures ANOVA with a Greenhouse-Geisser correction and Post hoc tests using the Bonferroni correction were used to evaluate BWT changes through the study. Results: Both newly diagnosed and known hypothyroidism, over one and two years, in patients with average TSH>4.2 μIU/mL, BWT increased significantly through visits. For newly diagnosed over one year, (F(2.41, 321.60) = 3.28, p = 0.03), and mean BWT increase = 1.4 ± 0.38 kg from 3rd to 12th month visits, (p = 0.004). For newly diagnosed over two years, (F(3.10, 263.89) = 9.08, P < 0.0005), mean BWT increase = 3.02 ± 0.77 kg from 3rd to 24th month visits, (p = 0.007). And for known hypothyroidism over one year, (F(2.56, 187.47) = 7.11, p = 0.0003), mean BWT increase = 1.97 ± 0.64 kg at 12th month visit, and over two years, (F(2.35, 77.56) = 4.67, P = 0.009), mean BWT increase = 3.78 ± 1.26 kg at 24th month visit. While in all other patients with average TSH≤4.2 μIU/mL, the BWT changed non-significantly through visits. For newly diagnosed patients over one year and two years (p = 0.10, 0.34 respectively), and known patients over one year and two years (p = 0.47, 0.34 respectively). Conclusion: In contrary to what is believed, adequate treatment with thyroxine does not associate with weight reduction. Instead, either the patient kept on the same weight or continued to gain more weight.

Prognosis of papillary thyroid carcinoma in relation to preoperative subclinical hypothyroidism.

It has been established that thyroid-stimulating hormone (TSH) stimulates the growth and development of thyroid malignancy, and a higher serum TSH level is associated with the incidence of thyroid cancer and an advanced tumour stage. This study aimed to evaluate the association of preoperative subclinical hypothyroidism with the prognosis of papillary thyroid cancer (PTC). A total of 466 patients who underwent surgery for PTC between December 2006 and June 2009 were enrolled. Among them, 44 patients had subclinical hypothyroidism, while 422 did not have subclinical hypothyroidism, as diagnosed using the preoperative thyroid function test. We compared the recurrence rate and association with clinicopathological features in the two groups. The median patient age was 46.9 years (17-74 years). There were 420 female and 46 male patients. The median follow-up duration was 81.4 months. There were no statistical differences between the two groups with respect to age, sex, tumour size, extrathyroidal extension, multifocality, lymph node metastasis, TNM stages, recurrence and disease-free survival, despite a significant difference in the average TSH concentrations of the two groups. Our results suggest that preoperative subclinical hypothyroidism was not associated with tumour aggressiveness and recurrence in PTC.

Assessment of thyroid function among children with epilepsy receiving anticonvulsant monotherapy: a hospital based prospective study

Background: Data on influence of antiepileptic drugs (AED) on thyroid profile in children is limited and is still controversial. This study aimed to investigate the effects of valproate, levetiracetam, phenobarbitone and oxcarbazepine monotherapy on thyroid function in children after one year of therapy.Method: A total of 106 children (39 girls and 67 boys) with new onset and controlled epilepsy treated with valproate (n=52), phenobarbitone (n=12), oxcarbazepine (n=14) and levetiracetam (n=28) were enrolled in the study. Serum thyroxine (T4, T3) and thyroid-stimulating hormone (TSH) level were measured before and at one year of therapy.Results: At baseline average T4, T3 and TSH concentrations were not different between the drug groups. Except levetiracetam all antiepileptics increased TSH after one year of therapy and there was significant difference in TSH increment in valproate treated patients compared to other anticonvulsants. All anti-epileptics except levetiracetam was found to decrease T4 and T3 after one year of therapy but there was no significant difference among the groups, unlike TSH. Sodium valproate was the most frequently used antiepileptic drug. None of children had any symptoms of hypothyroidism, only 3% had signs of hypothyroidism which included goitre on examination. Out of various seizure disorders generalised tonic clonic type was most common (47.5%) followed by atypical febrile seizure (23%).Conclusions: All antiepileptic drugs studied except levetiracetam had varying degrees of deleterious effects on thyroid function.

Perfluoroalkyl Substances and Maternal Thyroid Hormones in Early Pregnancy; Findings in the Danish National Birth Cohort.

Background:Maternal thyroid hormones are essential for fetal brain development in early gestation. Perfluoroalkyl substances (PFASs)—widespread and persistent pollutants—have been suggested to interfere with maternal thyroid hormones in the second or third trimesters, but evidence for an association in the early pregnancy period is sparse.Objectives:Our goal was to evaluate the gestational-week specific associations of maternal thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels with plasma concentrations of six PFAS chemicals in the first and second pregnancy trimester.Methods:A cross-sectional analysis was conducted using 1,366 maternal blood samples collected between gestational weeks (GWs) 5 and 19 (median, 8 gestational weeks) in the Danish National Birth Cohort (DNBC) during 1996–2002. We estimated the percentage changes of serum TSH and fT4 levels according to concentrations (in nanograms per milliliter) of six PFAS chemicals modeled as per interquartile range (IQR) increase or by exposure quartiles. Moreover, we contrasted the estimated week-specific TSH or fT4 levels by PFAS quartile and estimated ORs for binary high or low TSH and fT4 status based on the week-specific distribution according to IQR increase of PFAS.Results:TSH levels followed a U-curve trend in early pregnancy with a nadir at GW10, whereas fT4 levels were less fluctuated in the samples. There were no apparent associations between any of the PFASs and changes of average TSH or fT4 levels in total samples. In gestational-week–specific analyses, we found that the estimated TSH values were higher among the highest perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), and perfluoroheptane sulfonate (PFHpS) quartiles compared with the lower quartiles from GW5 to GW10, but the difference became null or even reversed after GW10. For binary outcomes, perfluorodecanoic acid (PFDA) was associated with high fT4 status before GW10 [ (95% CI: 1.04, 2.05)].Conclusions:We observed some gestational-week–specific associations between high exposure to several PFAS and TSH level in early gestations. Further research of the biology and the potential clinical impact regarding thyroid hormones disruptions in early pregnancy is needed. https://doi.org/10.1289/EHP5482

Congenital hypothyroidism in preterm infants: a 3- to 8-year longitudinal study in southern Thailand.

Background Preterm infants are at high risk of developing congenital hypothyroidism (CH) due to the immaturity of the hypothalamic-pituitary-thyroid (HPT) axis, loss of iodine supply from the mother and preterm health problems. Objectives To study the incidence and etiologies of CH in preterm infants who were born or admitted in our institute during 2010-2015. Methods The medical records of preterm infants diagnosed with CH as defined by the thyroid-stimulating hormone (TSH) level at the time of the first or second screening >10 mU/L and/or free T4 < 1.00 ng/dL were reviewed. Results Of 2777 preterm infants, 73 cases (2.6%) were diagnosed as CH. The average TSH levels at the first and second screenings were 20.85 and 15.42 mU/L, respectively. The patients were treated with thyroxine at an average initial dosage of 15 μg/kg/day. At 2-3 years of age, after thyroxine discontinuation for 6-10 weeks and regular thyroid function tests for 2 years, 58 patients (79.5%) were diagnosed as having transient CH and 15 patients (20.5%) were diagnosed as having permanent CH. We found no clinical or laboratory parameters in the neonatal period that could differentiate permanent from transient CH. Thyroid scintigraphy (99 m pertechnetate) revealed two patients (13.3%) with ectopic thyroid, one with thyroid hypoplasia (6.7%), eight with normal thyroid (53.3%) and four with enlarged thyroid (26.7%). Conclusions CH was common in preterm infants with an estimated incidence of 2.6%. Thyroxine should be given to preterm infants with higher initial values of TSH >10 mU/L in order to prevent delayed treatment of permanent CH that could be confirmed later.

Inverse Relationship of BMI to TSH and Risk of Papillary Thyroid Cancer in Surgical Patients

BackgroundObesity and thyroid cancer has increased in recent decades. Thyroid malignancy is linked with elevated thyroid-stimulating hormone (TSH) levels, which may have a positive association with body mass index (BMI). This study examines obesity and TSH level effect on papillary thyroid cancer (PTC) risk in a surgical population. MethodsA retrospective review of prospectively collected data for 991 patients who underwent thyroidectomy at a single institution was performed. Patients were stratified according to BMI into three groups: nonobese (18.5-29.9 kg/m2), obese (30-39.9 kg/m2), and morbidly obese (≥40 kg/m2). Further subdivisions into benign and malignant outcomes based on final pathology were compared with preoperative TSH levels. Subanalyses according to sex were also performed. ResultsOf 517 patients with PTC, rate of malignancy (ROM) decreased (55% versus 48% versus 41%, P < 0.05) as BMI increased with a concomitant decrease in average TSH levels (1.75 versus 1.69 versus 1.41 mU/L), respectively. According to sex, decreased ROM (53% versus 44% versus 42%, P < 0.05) and TSH (1.79 versus 1.70 versus 1.33 mU/L), respectively, with increased BMI was identified in women. However, decrease of ROM was not significant in men with increasing TSH levels as BMI increased. Male sex was associated with increased PTC risk (OR, 1.916; 95% CI, 1.331-2.759), whereas obesity with reduced PTC risk (OR, 0.736; 95% CI, 0.555-0.976). ConclusionsHigher BMI correlates with decreased PTC rates and lower TSH levels and suggests other factors may be involved in thyroid tumorigenesis. Obese patients with thyroid cancer should not be managed differently compared with nonobese patients.

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

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

Higher levels of thyrotropin in pregnancy and adverse pregnancy outcomes

Objective: To determine the frequency of subclinical hypothyroidism in women with pathological pregnancies and the association between elevated thyroid-stimulating hormone (TSH) and pregnancy outcome.Subjects and methods: A cross-sectional prospective study investigated value of TSH and free thyroxine (FT4) in (1) pregnant women with hypertension (HTA) (N = 62) or preeclampsia (PE) (N = 50), (2) women with gestational diabetes mellitus (GDM) (N = 92) in pregnancy, and (3) women with normal pregnancies (control) (N = 201). The level of statistical significance was set at p < .05.Results: Of the total 404 respondents, the highest incidence of subclinical hypothyroidism was in the group with preeclampsia 22%, followed HTA group 9.6%; GDM group 10.9% and in the control group 9% (p < .001). Higher levels of TSH were in the preeclampsia (2.5 ± 1.54 mIU/L) and in the HTA (2.03 ± 0.97 mIU/L) compared with the control group (1.95 ± 0.86 mIU/L); (p < .001). Weight gain in pregnancy was significantly higher in women with TSH >3 mIU/L (p = .003). There were no differences in the average TSH value between GDM (1.93 ± 1.03 mIU/L) and control group (p = .962).Conclusions: Early detection and optimal treatment of thyroid dysfunction before and in the first trimester of pregnancy reduces the risk of adverse pregnancy outcomes.

A retrospective cohort study: do patients with graves\u2019 disease need to be euthyroid prior to surgery?

BackgroundThe 2016 American Thyroid Association guidelines indicate that patients with Graves’ disease who undergo a thyroidectomy should be rendered euthyroid through the use of antithyroid drugs (ATD) prior to surgery to avoid complications such as a thyroid storm. At times, the use of ATDs can have limited efficacy and therefore some patients will inevitably remain biochemically hyperthyroid at the time of surgery.The aim of this study is to assess if hyperthyroid patients undergoing a thyroidectomy are at an increased risk of developing a thyroid storm in comparison to euthyroid patients. Furthermore, this study seeks to establish a correlation between thyroid storm identified by the levels of thyroid hormones (T3 and T4) and the level of thyroid stimulating hormone (TSH).MethodsA retrospective cohort study was conducted at two Canadian centers, one in Montreal and the other in Nova Scotia. Sixty-seven patients undergoing thyroidectomy for Graves’ disease from January 2006 to December 2016 were evaluated.ResultsThe study comprised 67 participants with a mean age of 46 years (range16–78 years). A total of 78% of patients were on methimazole, 34% on beta-blockers, 27% on potassium iodine solution, 10% on propylthiouracil and 7% on steroids. At the time of surgery 21% were in an overt hyperthyroid state and 33% were in a subclinical hyperthyroid state. The average TSH level of 0.03 mIUL/L (range 0.01–0.23 mIUL/L). Sixteen percent of patients had a TSH level less than 0.01 mIUL/L. The average free T4 level was 29.58 pmol/L (range 11.5–95.2 pmol/L). The average total T3 level was 11.52 nmol/L (range 4.5–29.1 nmol/L) and free T3 level was 6.35 pmol/L (range 6.1–6.6 pmol/L). No patient developed thyroid storm.ConclusionsIn our study, biochemically hyperthyroid patients undergoing thyroidectomy did not develop thyroid storm. Additional studies with larger sample sizes are needed to better understand the risk of thyroid storm in hyperthyroid patients.

Replication confirms the association of loci in FOXE1, PDE8B, CAPZB and PDE10A with thyroid traits: a Genetics of Diabetes Audit and Research Tayside study (GoDARTS).

Replication of associations in genome-wide association studies is desirable to ensure that such signals are potentially clinically meaningful. This study aimed to replicate associations of selected single-nucleotide polymorphisms (SNPs) with hypothyroidism and serum thyroid-stimulating hormone (TSH) using electronic medical records (EMRs). A cross-sectional study was carried out among patients of European Caucasian ethnicity from the Genetics of Diabetes Audit and Research Tayside recruited in Tayside (Scotland, UK). EMRs (biochemistry, prescribing, hospital admissions and demographics) were used to ascertain patients with hypothyroidism and their controls as well as average serum TSH concentration, and linked to genetic biobank data. Genetic tests of association were performed using logistic and linear regression models. We analysed 1703 cases of hypothyroidism and 9457 controls. All four SNPs located on chromosome 9 at FOXE1 were associated with hypothyroidism with similar effect estimates (odds ratio=0.75-0.76, P<5e-08). Also, loci on chromosomes 1 (PTPN22), six (HLA-E/HLA-C) and 12 (SH2B3) were replicated. For serum TSH, we confirmed 12 SNPs previously reported at PDE8B, CAPZB, PDE10A, LOC105371356, NR3C2, VEGFA, IGFBP5, INSR, PRDM11, NFIA, ITPK1 and ABO. Overall, these SNPs accounted for 6.8% of the serum TSH variation (P<1e-04). EMRs linked to genomic data in large populations enable validation of genome-wide association studies discoveries without additional genotyping costs. Our replication confirmed at genome-wide significance the association of loci at FOXE1 with hypothyroidism, and PDE8B, CAPZB and PDE10A with serum TSH. A total of 12 SNPs seemed to explain nearly 7% of the serum TSH variation.

High levels of Nesfatin-1 in relation to the dysfunction of the hypothalamic-pituitary-adrenal and hypothalamus-pituitary-thyroid axes in depressed patients with subclinical hypothyroidism.

Despite the increasing amount of evidence suggesting a relationship between depression and subclinical hypothyroidism (SCH), the exact mechanism underlying this relationship remains unclear. The main purpose of this study was to investigate the roles of plasma Nesfatin-1 levels and dysfunction of the hypothalamic–pituitary–adrenal (HPA) and hypothalamus–pituitary–thyroid (HPT) axes in the comorbidity of depression and SCH. Dysfunctions of the HPA and HPT axes were detected by measuring plasma corticosterone and thyroid-stimulating hormone (TSH) concentrations, respectively. Subjects in the patient group were selected from patients hospitalized at the Anhui Mental Health Center, and subjects in the control group were recruited from healthy volunteers. Healthy control subjects were matched to the patients in terms of weight and body mass index. The Hamilton Depression Rating Scale was administered to both the groups. The enzyme-linked immunosorbent assay method was used to measure plasma Nesfatin-1, corticosterone, and TSH levels. A radioimmunoassay kit was used for the measurement of the plasma-free triiodothyronine and plasma-free thyroxine. The results showed that the Hamilton Depression Rating Scale scores and average Nesfatin-1, corticosterone, and TSH levels were significantly higher in depressed patients with SCH than in the control group. Moreover, positive relationships were observed between Nesfatin-1 levels and the concentrations of corticosterone (r=0.626, P<0.001) and TSH (r=0.229, P=0.036) in depressed patients with SCH. These findings indicate that Nesfatin-1 is involved in the comorbidity of depression and SCH, and the mechanism underlying this involvement might be related to the dysfunction of the HPA and HPT axes.