Cases Of Overt Hypothyroidism Research Articles

6301733 The impact of mental health problems on medical comorbidity in pregnancy: a case of overt hypothyroidism

6301733 The impact of mental health problems on medical comorbidity in pregnancy: a case of overt hypothyroidism

Thyroid dysfunction after immune checkpoint inhibitors in a single-centre UK pan-cancer cohort: A retrospective study

PurposeThis study investigated thyroid dysfunction with immune checkpoint inhibitors (ICIs) in terms of proportions affected, risk factors, thyroid sequelae, and overall survival (OS). MethodsAmong patients with normal baseline free T4 (fT4) and thyroid stimulating hormone (TSH) receiving ICIs at a large cancer centre, proportions of hyperthyroidism/hypothyroidism were determined (any, subclinical [normal fT4, abnormal TSH], overt [abnormal fT4, abnormal TSH], isolated hyperthyroxinaemia/hypothyroxinaemia and secondary) with onset times and subsequent thyroid statuses. Associations of overt dysfunction with OS were estimated using Cox regression and methods robust to immortal time bias (time-dependent Cox regression and 3- and 6-month landmark analyses). Associations of baseline variables with overt hyperthyroidism and hypothyroidism were estimated using Fine and Gray regression. ResultsOf 1349 patients, 34.2% developed hyperthyroidism (10.3% overt), including 54.9% receiving combination ICIs, while 28.2% developed hypothyroidism (overt 9.3%, secondary 0.5%). A third of overt hypothyroidism cases occurred without preceding hyperthyroidism. Subclinical thyroid dysfunction returned directly to normal in up to half. Overt hyperthyroidism progressed to overt hypothyroidism in 55.4% (median 1.6 months). Melanoma treatment in the adjuvant vs. advanced setting caused more overt hyperthyroidism (12.1% vs. 7.5%) and overt hypothyroidism (14.5% vs. 9.7%). Baseline eGFR < 60 mL/min/1.73 m2 (HR=1.68, 1.07–2.63) was associated with overt hyperthyroidism and sex (HR=0.60, 0.42–0.87) and TSH (4th vs. 1st quartile HR=1.87, 1.10–3.19) with overt hypothyroidism. Overt dysfunction was associated with OS in the Cox analysis (HR=0.65, 0.50–0.85, median follow-up 22.2 months) but not in the time-dependent Cox (HR=0.79, 0.60–1.03) or landmark analyses (3-month HR=0.74, 0.51–1.07; 6-month HR=0.91, 0.66–1.24). ConclusionThyroid dysfunction affects up to half of patients receiving ICIs. The association with OS is unclear after considering immortal time bias. The clinical courses include recovery, thyrotoxicosis and de novo overt hypothyroidism. Adjuvant treatment for melanoma, where longer-term harms are of concern, causes more frequent/aggressive dysfunction.

Prevalence of Hypothyroidism in Pregnancy in a Tertiary Care Hospital

Introduction: Thyroid disorders are the most common endocrine disorders affecting women of reproductive age. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. During early pregnancy, the fetus is totally dependent on maternal thyroid hormone supply. Thyroid hormone is critical for fetal brain and intellectual development. Thyroid hormone is also important for some preventable pregnancy complications like anaemia, low birth weight, abruptio placenta, preeclampsia, etc., which pose special risks for the mother and developing fetus. Aim of the study: To assess the prevalence of hypothyroidism in pregnant women and thus ensure appropriate treatment for the wellbeing of the mother and baby. Methods: This prospective obsessional study was conducted on 113 pregnant women at US Bangla Medical College Hospital, Dhaka, Bangladesh, who attended obstetrics outdoors. Women were randomly chosen irrespective of age, parity, residence, and socioeconomic status. Women with multiple pregnancies or having any pre-existing medical disorder were excluded. All women were investigated for TSH along with routine pregnancy tests. All were divided into two groups: normal/euthyroid and abnormal/thyroid disorders, considering their thyroid status. Result: We found the prevalence of thyroid dysfunction in pregnancy was 17.7%, with hypothyroidism being 15.93%, of which 10.62% were subclinical hypothyroidism, 5.31% were cases of overt hypothyroidism, and 1.77% were cases of hyperthyroidism. Conclusion: This study showed an increased prevalence of hypothyroidism in pregnancy, recommending a need for universal screening for all pregnant women in the early weeks of pregnancy. This study aims at validating the efficacy of the above-mentioned screening for a better pregnancy outcome.

Thyroid Disorders in Pregnancy and Their Maternal and Foetal Outcome in Tertiary Care Centre

BACKGROUND&#x0D; In pregnant women, thyroid disorders are common endocrine problems and due to non-specific symptoms and hyper-metabolic state of pregnancy they are often neglected. To know the prevalence of thyroid disorders in pregnant women and their maternal and foetal outcome was the purpose of this study.&#x0D; METHODS&#x0D; This was an observational study which was conducted from 15th November 2021 to 15th May 2022 in the Department of Obstetrics and Gynaecology, Srinivas Medical College, Mukka, (Mangalore). Registration of one fifty pregnant women attending antenatal clinic in first trimester was done. Detailed history and examination was done. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) level evaluation was done apart from routine antenatal investigations.&#x0D; RESULTS&#x0D; Among 150 pregnant women, the prevalence of thyroid disorders is 14 (9.31 %). Subclinical hypothyroidism 9 (6 %) was the most common thyroid disorder observed. Maternal anaemia and eclampsia was most common complication 3 each (33.33 %). 1 (11 %) was antepartum haemorrhage. Thyroid disorder occurred during the 2nd trimester 58.33 %; 25 % and 16.66 % in 1st and 3rd trimester. Most commonly observed foetal birth weight in this study were between 2 - 2.5 kgs 7 (77.77 %). Most common foetal complication observed were foetal growth restriction (five) with spontaneous abortion and intra uterine foetal demise (IUFD) (one each) was noted. Out of all thyroid disorders associated with pregnancy, subclinical hypothyroidism is the most frequently noted. Patients with subclinical hypothyroidism remain asymptomatic when not treated, but had bad obstetric and neonatal outcome, although less severe than overt hypothyroidism cases.&#x0D; CONCLUSIONS&#x0D; Timely screening of pregnant women is required during pregnancy for the prevention of pregnancy which helps in the early diagnosis and management of complications related to maternal and foetus due to thyroid disorders.

A study of serum uric acid levels and serum creatinine levels in hypothyroidism

This study was undertaken to estimate the serum creatinine and uric acid levels in subclinical, overt hypothyroid cases and healthy controls and correlate these parameters with TSH in hypothyroid cases. Study included 60 patients of newly diagnosed hypothyroidism, of which 30 were subclinical and 30 were overt cases. 80 age sex matched healthy controls were taken. Venous blood was used for estimation of serum fT3, fT4, TSH, uric acid and creatinine levels. Statistical analysis was done using unpaired t' test. Correlation between creatinine, thyroid parameters and uric acid was done.There was significant elevation in serum levels of creatinine and uric acid in subclinical and overt hypothyroidism cases when compared to controls. Overt cases had significantly higher creatinine and uric acid levels in comparison to subclinical hypothyroid cases. Significant positive correlation with TSH was shown by both creatinine and uric acid. Both subclinical and overt hypothyroidism cases are associated with elevated serum creatinine and uric acid levels.

Prevalence of overt and subclinical hypothyroidism during pregnancy in antenatal care - cross-sectional study, Jeddah, Saudi Arabia

Objective • To estimate the prevalence of subclinical and overt hypothyroidism in antenatal care clinics • To evaluate the performance of targeted screening approach based on the risk stratification as recommended by the U.S. Preventive Service Task Force (USPSTF) and adopted by the American Thyroid Association (ATA) Method: This was a multicenter, cross-sectional study conducted in 386 pregnant women attending routine antenatal visits at 4 antenatal clinics from September 2019 to August 2020. All participants underwent clinical and thyroid function test (TFT) including TSH and T4 levels. Based on risk factor assessment, participants were categorized into low-risk versus high-risk patients. The performance of targeted screening was assessed by comparing the two categories regarding the prevalence of subclinical and overt hypothyroidism and calculating the associated sensitivity, specificity and accuracy. Result: Overall, the prevalence of dysthyroidism was 11.7% (95% CI=8.6-15.3%) with 10.4% subclinical hypothyroidism and 1.3% overt hypothyroidism cases. No difference in the prevalence of dysthyroidism was found between low-risk and high-risk patients. The performance of the risk stratification-based screening approach in detecting subclinical or overt hypothyroidism showed sensitivity (73.3% and 86.7%), specificity (30.2% and 13.2%), and accuracy (35.2% and 21.8%), using the USPSTF alone and combined with the ATA criteria, respectively. Conclusion: The application of the targeted screening for subclinical and overt hypothyroidism using the USPSTF and ATA criteria performed poorly in the studied population. Thus, universal screening appears to be a better option. Key words: Hypothyroidism, Overt, Pregnancy, Screening, Subclinical, Targeted, Universal, U.S. Preventive Service Task Force;

Study of Serum Magnesium, Calcium and Phosphorus Levels in Subclinical and Overt Hypothyroidism

Background: Hypothyroidism is one of the most common forms of hormonal dysfunction resulting from deficiency of thyroid hormone or its impaired activity. Various electrolyte and mineral disturbances have been observed in many studies. The role of thyroid hormones on mineral metabolism and its complications have not been established. This study was undertaken to assess the alterations in the levels of serum magnesium, calcium and phosphorous levels in subclinical hypothyroidism. Also to assess the alterations in the levels of serum magnesium, calcium and phosphorous levels in overt hypothyroidism. Method: A descriptive case control study was done with a total 100 subjects in the department of Medicine, Adichunchanagiri hospital and research center, B G Nagara during October 2018 to June 2020. 25 subclinical hypothyroidism cases, 25 overt hypothyroidism cases and 50 controls were taken. Blood sample for analyzing serum free T3, free T4, TSH, calcium, magnesium and phosphorus was taken and estimated in all subjects. Results: In this study the mean age of hypothyroidism (subclinical and overt) cases was 35.46 ± 7.26. A significant hypocalcaemia (P = 0.002) was observed in cases with overt hypothyroidism and a significant (P = 0.01) hyperphosphatemia was observed in cases with subclinical hypothyroidism. Conclusion: The present study showed a significant hypocalcaemia in overt hypothyroidism cases than controls and showed significant hyperphosphatemia in subclinical hypothyroidism. It can be concluded that there are various electrolyte disturbances in both subclinical and overt hypothyroidism, hence such disturbances need to be monitored prospectively to avoid further complications and needs to be treated accordingly.

Lipid Profile Abnormalities in Newly Diagnosed Primary Hypothyroidism in a Tertiary Care Centre of Western Nepal: A Descriptive Cross-sectional Study.

Thyroid hormones have a major influence on synthesis, mobilization and metabolism of lipids. Hypothyroidism accounts for a notable cause of secondary dyslipidemia. This can increase the risk for cardiovascular morbidity and mortality. This study was performed to find out the prevalence of lipid profile abnormalities in newly diagnosed primary hypothyroid states. This descriptive cross-sectional study was conducted among 71 patients in the context of newly diagnosed primary hypothyroidism patients visiting outpatient department of internal medicine from 9th December 2018 to 30th June 2020 after taking ethical clearance from Institutional Review Committee. Case screening for lipid profile changes was performed at the time of diagnosis of primary hypothyroidism. A convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. In this study including 71 cases of newly diagnosed primary hypothyroidism, 49 (69.0%) (95% Confidence Interval= 58.24-79.76) had abnormal lipid profiles. Among them, 5 (38.5%) out of 13 (18.3%) cases of subclinical hypothyroidism and 44 (75.9%) out of 58 (81.7%) cases of overt hypothyroidism had abnormal lipid profiles. The prevalence of abnormal lipid profile parameters was similar to the study done in various studies in similar settings except for high-density lipid which showed both similarity and dissimilarity with other studies. Our study suggested that all newly diagnosed cases of primary hypothyroidism are to be investigated for dyslipidemia thus ensuring early treatment and prevention of complications.

Patterns of clinical management of hypothyroidism in adults: An electronic survey of physicians from the Middle East and Africa

Background: Hypothyroidism is a common endocrine disorder that is managed by a wide range of physicians. There are no data on the pattern of clinical management of hypothyroidism in the Middle East and Africa (MEA) region. Objectives: We sought to document current practices in the management of primary hypothyroidism in the MEA region and compare these with international recommendations and practices elsewhere. Materials and Methods: A convenience sample of physicians practicing in the MEA in relevant disciplines were invited to take a web-based survey consisting of previously validated multiple-choice questions dealing with investigation and treatment of an index case of overt primary hypothyroidism in general and in three special situations. Results: Out of complete 397 responses, 368 were eligible for inclusion in the analysis. The majority were endocrinologists and internal medicine specialists; 82.2% of them have been in clinical practice for 10 years or more. Overt hypothyroidism would be treated using L-T4 alone by 97.2% of respondents; 1.7% would use a combination of L-T4 and liothyronine (L-T3) therapy. The rate of replacement would be gradual (66.5%), an empiric dose, adjusted to achieve target levels (14.7%); or a calculated full replacement dose (18.5%). A target thyroid-stimulating hormone (TSH) of 2.0–2.9 mU/L was favored in the index case of overt hypothyroidism (by 34.4%) followed by a target of 3.0–3.9 mU/L (by 26.0%) of respondents. However, a target of 4.0–4.9 mU/L was the most commonly selected TSH target for an octogenarian (by 33.5% of respondents). Persistent hypothyroid symptoms despite achieving a target TSH would prompt testing for other causes by 86.9% of respondents, a change to L-T4 plus L-T3 therapy by 5.8%, and an increase in the thyroid hormone dose by 4.6%. Evaluation of persistent symptoms would include measurements of complete blood count (82.4%), complete metabolic panel (68.7%), morning cortisol (65.3%), Vitamin B12 levels (54.5%), and serum T3 levels (27.9%). Subclinical disease with a TSH 7.8 mU/L would be treated without further justification by 9.0% of respondents, or in the presence of positive thyroid peroxidase antibodies (65.3%), hypothyroid symptoms (65.0%), high low-density lipoprotein (51.7%), or a goiter (36.7%). The TSH target for a newly pregnant patient was 2.0–2.4 mU/L for 28.5% of respondents, with 15.8% preferring a TSH target of 1.5–1.9 mU/L. Thyroid hormone levels would be checked every 4 weeks during pregnancy by 62.9% and every 8 weeks by an additional 17.6%. A hypothyroid patient with a TSH of 0.5 mU/L who becomes pregnant would receive an immediate L-T4 dose increase by only 28.5% of respondents. Conclusions: The survey revealed that (1) nearly exclusive preference for L-T4 alone for therapy, (2) use of age-specific TSH targets for replacement therapy, (3) a low threshold for treating mild thyroid failure, (4) complacent and variable attention to TSH targets in the pregnant and prepregnant woman, and (5) a highly variable approach to both the rate and means of restoring euthyroid status for overt disease. Both alignments with and divergence from guidelines were detected. The results should help in directing focused educational activities in the region, providing a baseline for future monitoring of practices.

Thyroid Function During Pregnancy in A Multiethnic Population in Norway.

ContextEthnic differences in thyroid function during pregnancy have been reported. However, it is unclear if this is equally valid across ethnic groups within multiethnic populations.ObjectiveWe aimed to assess ethnic differences in thyrotropin (TSH) and free thyroxine (FT4), and the prevalence of thyroid dysfunction and thyroid autoimmunity during pregnancy.MethodsIn a population-based cohort of 785 pregnant women in Oslo, Norway, TSH, FT4, and thyroid peroxidase antibodies (TPO Abs) were measured twice: at gestational week (GW) 15 and 28, and urine iodine concentration at GW 15. Associations were assessed using multivariate linear regression.ResultsWe found ethnic differences in TSH levels at both time points, but not for fT4. South Asians had 0.42 mU/L (95% CI, 0.20-0.64) higher TSH than Europeans in GW 15. This difference persisted after adjusting for covariates (including TPO Ab positivity and iodine status), and increased further as pregnancy progressed. In contrast, East Asians had the lowest TSH. No new cases of overt hypothyroidism were detected in early pregnancy, but subclinical hypothyroidism was found in 6.6% among all, highest in South Asians (14.2%). Hyperthyroidism early in pregnancy was observed in 3.7% (almost all subclinical), highest in East Asians (11.9%). The prevalence of TPO Ab positivity was 4%, highest in South Asians (8%).ConclusionIn a multiethnic population of presumably healthy women, we found ethnic variations in TSH but not FT4 levels throughout pregnancy. South Asians had higher TSH and more subclinical hypothyroidism, not explained by their higher prevalence of TPO Ab positivity. Larger studies are needed to define ethnic- and trimester-specific reference ranges in pregnancy.

Study of serum zinc level in overt and subclinical hypothyroidism – A case control study

Introduction: Hypothyroidism is a clinical condition which is characterized by low thyroid hormone synthesis. It results in slowdown of metabolic processes and also presents with biochemical abnormalities including reduced serum zinc level. Objectives: This study was done to estimate the serum zinc level in subclinical and overt hypothyroidism cases.| Materials and Methods: Study included 90 patients of hypothyroidism, of which 60 subclinical and 30 overt cases and 91 age sex matched healthy controls. Venous blood was used for testing serum fT3, fT4, TSH, and zinc levels. Statistical analysis was done using student ‘t’ test. Pearson’s correlation between serum zinc and thyroid parameters was used to establish the relationship. Results: The serum zinc levels were significantly decreased in subclinical and overt hypothyroidism cases compared to controls and it showed significant negative correlation with TSH. Conclusion: Serum zinc level is decreased in both subclinical and overt hypothyroidism. Keywords: fT3 (free triiodothyronine), fT4 (free tetraiodothyronine), TSH (thyroid stimulating hormone), Subclinical hypothyroidism, Overt.

OVERT HYPOTHYROIDISM;

Objective: To assess the frequency of common presentations of the overthypothyroidism. Study design: Cross sectional study. Setting: This study was conducted at allOPD’s of peoples’ medical college hospital nawab shah, a tertiary care hospital, from 01-10-2012to 31-03-2013. Material and methods: This study was conducted at all OPDs of Peoples’medical college hospital Nawabshah, a tertiary care hospital, from 01-10-2012 to 31-03-2013.Patients visiting outpatient department (OPD) meeting the inclusion criteria were involved instudy. Inclusive criteria were diagnosed cases of overt hypothyroidism, age 18-60 years and bothgender. Exclusion criteria were age less than 18 years and more than 60 years and pregnantwomen. The collected data was entered and analyzed by using Statistical Package for SocialSciences (SPSS) software, Version 17. Results: Among 126 patients that had hypothyroidism,there were 46 males(36.5%) and 80 females(63.5%). Mean age of patients was 37.60 ± 7.54years. Most of the patients presented with symptoms of cold intolerance (62.7%) dry skin(61.9%), pedal edema (57.1%), weight gain(56.3%) while rest presented with hair loss (20.6%),bradycardia (29.4%) &amp; delayed tendon reflexes (27.8%). Overt hypothyroidism was presented inonly 21 (16.7%) patients. Conclusions: The frequency of Hypothyroidism vary in different areas,and is affected by Socio-demographic, nutritional status, illiteracy level and personal self-care.

Comparative study of lipid profile between clinical and subclinical hypothyroidism

Background: Subclinical hypothyroidism (SH) is characterized by elevated levels of serum thyroid stimulating hormone in the presence of normal thyroxin levels. Subclinical hypothyroidism is often associated with elevated total cholesterol and other lipid profile parameters. This study was done to evaluate the lipid metabolism in subclinical hypothyroidism.Methods: This case control study was done to compare the lipid profile parameters between subclinical and overt hypothyroidism cases attending the outpatient facility of our tertiary care hospital of our medical college in Puducherry. Newly diagnosed cases of hypothyroidism were selected by convenient sampling. A total of 37 SH cases and 31 overt hypothyroidism cases were included. Blood samples were drawn to measure lipid profile. A 2D echocardiogram was done to evaluate cardiac function. Ultrasonogram was done to evaluate fatty liver.Results: The mean age of the participants in the subclinical hypothyroidism group was 34.2±12.2 years while in the clinical hypothyroidism group was 35.7±9.8 years. About 13.5% of the participants in subclinical hypothyroidism group and 12.9% of the participants in clinical hypothyroidism had fatty liver in ultrasound. A significant difference was observed in the mean values of total cholesterol, triglycerides and LDL levels between clinical and subclinical hypothyroidism.Conclusions: This study highlights the need for screening of subclinical hypothyroidism in order to prevent the incidences of cardiovascular complications and other diseases like metabolic syndrome.

Iodine Status among Subclinical and Overt Hypothyroid Patients by Urinary Iodine Assay: A Case-Control Study.

Objectives:The objective of the study was to assess the differences of iodine status as measured by urinary iodine excretion (UIE) between cases of hypothyroidism and healthy controls.Materials and Methods:The study was conducted in cases with subclinical hypothyroidism (n = 58) and overt hypothyroidism (n = 41) and compared with age- and sex-matched healthy euthyroid controls (n = 52) attending Universal College of Medical Sciences Teaching Hospital, Bhairahawa, Nepal. Serum free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were estimated by competitive ELISA and sandwich ELISA, respectively (Diametra, Italy). The urinary iodine concentration (UIC) in urine samples was estimated by ammonium persulfate digestion method recommended by the WHO.Results:A significantly higher median UIC was observed among cases of subclinical hypothyroidism (224.90 μg/l) and overt hypothyroidism (281.0 μg/l) as compared to the controls (189.90 μg/l) (P = 0.0001, P = 0.001). Serum TSH in the cases of subclinical hypothyroid was higher, whereas fT3 was lower as compared to controls (P = 0.028, P = 0.0001), respectively. Similarly, serum TSH in the cases of overt hypothyroid was higher and fT3 and fT4 were lower as compared to controls (P = 0.0001, P = 0.0001, P = 0.015), respectively. There was positive correlation of UIC with TSH (r = 0.269, P = 0.0001), whereas negative correlation was seen with fT3 (r = −0.328, P = 0.0001) and fT4 (r = −0.145, P = 0.076). The test of multiple regression has shown that fT3 (β = −0.262, P = 0.012) as an independent predictor in association with UIE in cases.Conclusion:Excessive iodine intake was found in hypothyroid patients as assessed by UIE concluding that it may trigger the thyroid hypofunction. Cohort studies to generate further evidence should be done to explore potential mechanism of hypothyroidism in excess iodine intake.

Prevalence of hypothyroidism in Assam: A clinic-based observational study

Introduction: Hypothyroidism is a common functional disorder of the thyroid gland. Despite extensive research, data on this subject are lacking from the northeastern part of India, which falls in the Sub-Himalayan goitrogenic belt. Therefore, we decided to study the profile of hypothyroidism in Assam, a northeastern state with the following objectives: to determine the prevalence of hypothyroidism and to describe the various modes of clinical presentation. Materials and Methods: The study was conducted at a clinic-cum-radioimmunoassay laboratory in Guwahati, Assam, from January to November 2011. Two thousand and four hundred fifty-six patients referred to our center from different parts of Assam were evaluated clinically and their thyroid profile was estimated. Antithyroid peroxidase (TPO) antibody was estimated in 1950 patients. Results: The prevalence of overt hypothyroidism was 10.9% (n = 267) and that of subclinical hypothyroidism was 13.1% (n = 321). Male:female ratio was 1:3. Among the cases of overt hypothyroidism, 247 (92.51%) were adult hypothyroids, 15 (5.62%) juvenile hypothyroids, and 5 (1.87%) cretins. The common presenting features of hypothyroidism were weakness (98%), lethargy (95%), dry and coarse skin (87%), and body ache (85%). Uncommon modes of presentation were pleural and pericardial effusion, low body weight, frequent motions, and palpitations. Postthyroidectomy and drug-induced hypothyroidism accounted for 2.38% cases each and postpartum hypothyroidism for 3.74% cases. Thirteen percent cases presented with goiter. The prevalence of anti-TPO antibody in the study population was 8.41%. Conclusion: Hypothyroidsm is no longer a rarity, and Assam is no exception to this phenomenon. A population-based epidemiological study of thyroid disorders in Northeast India is an urgent need.

Study of serum electrolytes and minerals in hypothyroidism

Background of the study: Hypothyroidism is known to affect electrolyte, fat, protein and carbohydrate metabolism. Though the effects of thyroid hormones on lipid profile has been well established, the effects on electrolytes and certain minerals like calcium, magnesium and phosphorus is not clear and the underlying mechanisms responsible for these changes are not well understood. Aim and objectives: The objective was to find out the effects of hypothyroidism on certain electrolytes and minerals levels. Materials and methods: The study was carried out in Dept. of Physiology in collaboration with Medicine, Endocrinology and Biochemistry.100 cases of overt hypothyroidism of both genders aged 25-60 years were chosen,100 age and sex matched healthy controls were chosen. Blood samples were collected from them and serum TSH, total T3, T4, sodium, potassium, calcium, magnesium and phosphorus levels were measured. The values of the above parameters of cases and controls were compared and statistical analysis was made. Results: It was found that the levels of serum sodium, potassium and calcium were significantly decreased in cases than the controls. Serum magnesium and phosphorus were significantly elevated in cases than controls. Conclusion: From this study we were able to conclude that higher the TSH levels, higher will be serum magnesium and phosphorus in the blood and lower will be serum sodium, potassium and calcium levels.

Evaluation of thyroid antibodies and benign disease prevalence among young adults exposed to (131)I more than 25 years after the accident at the Chernobyl Nuclear Power Plant.

Background. The Chernobyl Nuclear Power Plant (CNPP) accident exposed a large number of inhabitants to internal 131I radiation. The associations between internal 131I exposure and thyroid autoimmunity and benign thyroid diseases remain controversial in the population living in the contaminated area around the CNNP. In this study, we evaluate the association of 131I with benign thyroid diseases. Methods. We compared the prevalence of Anti-Thyroid Autoantibodies (ATAs), thyroid function, and prevalence of thyroid ultrasound finding outcomes in 300 residents of the contaminated area of Ukraine who were 0–5 years of age at the time of the CNPP accident (group 1) and 300 sex-matched residents who were born after the accident (group 2). Results. We did not find any differences of the prevalence of Antithyroglobulin Antibodies (TGAb) positive, Antithyroid Peroxidase Antibodies (TPOAb) positive, and TGAb and/or TPOAb positive between the study groups. (11.7% vs 10.3%; p = 0.602, 17.3% vs 13.0%; p = 0.136, 21.0% vs 17.3%; p = 0.254, respectively); after adjusting for age and sex, the prevalence was not associated with the 131I exposure status in the study groups. The prevalence of subclinical and overt hypothyroidism cases was not significantly different (p = 0.093 and p = 0.320) in the two groups, nor was the prevalence of goiter (p = 0.482). On the other hand, the prevalence of nodules was significantly higher in group 1 (p = 0.003), though not significantly so after adjustment for age and sex. Discussion. Working 26–27 years after the CNNP accident, we found no increased prevalence of ATAs or benign thyroid diseases in young adults exposed to 131I fallout during early childhood in the contaminated area of Ukraine. Long-term follow-up is needed to clarify the effects of radiation exposure on autoimmunity reaction in the thyroid.

Prevalence and risk factors for hypothyroidism in Jordanian women: comparison between different reference ranges

The aim of this cross-sectional study in Jordan was to estimate the prevalence of hypothyroidism among women during early pregnancy and to assess the association of risk factors with hypothyroidism. According to internationally adopted thyroid stimulating hormone (TSH) and thyroxine (T4) pregnancy reference ranges (TSH > or = 2.6 mlU/L and T4 10.6-20.4 pmol/L), 67 of 322 (20.8%) women were diagnosed with sub-clinical hypothyroidism. When the general laboratory criteria were applied (TSH > or = 4.6 mlU/L and T4 < 10.6 pmol/L) the prevalence dropped to 4.3%. No cases of overt hypothyroidism were diagnosed using either diagnostic criterion. Younger age and being in gestational weeks 1-8 were significant risk factors for hypothyroidism. It is suggested that the reference criteria need revision, and that pathology laboratories should adopt appropriate pregnancy-specific reference intervals.

Reassessment of elicitation of myoedema in evaluation of overt hypothyroidism: A pilot study

Introduction:There is a need to reassess the significance of myoedema in evaluation of overt hypothyroidism in the current day clinical practice. It is commonly checked for by flicking across the biceps belly expecting a transient mound at the points of tactile stimuli with mild pressure.Aim and Objective:To assess elicitation of myoedema in overt hypothyroidism (defined arbitrarily as TSH >50 mIU/L in primary hypothyroidism and fT4 <0.6 ng/dl in secondary hypothyroidism).Results:The 28 primary overt hypothyroid (OH) patients were divided into three groups as mild, moderate, and severe depending on TSH levels as those with 50-100, 100-150, and >150 mIU/L. Myoedema was elicited in 8 of 13 in the severe OH group, in 2 of 7 in moderate OH group and in 1 of 8 in the mild OH group. In the group of secondary hypothyroidism, myoedema was elicitable in one of two patients. The odds ratio for presence of both myoedema and clinical features of myopathy in a group of overt hypothyroid patients with TSH >150 mIU/L as compared to <150 mIU/L was 17.5. Similarly, the odds ratio for the presence of only myoedema was 6.4 while the odds ratio for presence of only clinical features of myopathy was 3.67. While the odds ratios involving presence of myoedema neared statistical significance, that with the presence of clinical features of myopathy alone did not.Conclusion:Examination for eliciting myoedema is useful when evaluating a case of overt hypothyroidism.

Thyroid function and morphology in subjects with microdeletion of chromosome 22q11 (del(22)(q11))

Monoallelic microdeletion of chromosome 22q11 (22q11DS) is considered to be the commonest human microdeletion syndrome. Abnormalities of thyroid function are sporadically reported in this syndrome, but very few studies have specifically assessed this issue, and thyroid morphology has not been systematically studied. To evaluate the prevalence of abnormalities of thyroid function and morphology in a cohort of paediatric and adult patients with 22q11DS. Thirty patients with 22q11DS (median age 9.7, range 1.5-43.9 years) were studied. In all subjects, serum free-T(3), free-T(4), TSH, thyroperoxidase, thyroglobulin, and TSHr auto-antibodies, as well as thyroid ultrasonographic data, were evaluated and compared with age- and sex-matched healthy control groups, for paediatric and adult patients. Fourteen (46.6%) patients showed thyroid hypoplasia involving the entire gland. In all the patients, the volume of the left lobe of the thyroid was significantly reduced (P < 0.01). Among the subjects with thyroid hypoplasia, 10 out of 14 (71%) showed a concomitant heart malformation, a condition that was present in five (31%) of the subjects with a normal thyroid volume (P < 0.05). Seven (23.3%) cases of subclinical hypothyroidism and one (3.3%) case of overt hypothyroidism were identified. Three (10%) patients were positive for thyroid auto-antibodies. Of the patients with overt and subclinical hypothyroidism, five out of eight (62.5%) patients showed thyroid hypoplasia. This study confirms the presence of alterations of thyroid function in 22q11DS, and also suggests a frequent occurrence of abnormalities in thyroid morphology in these subjects. Patients with 22q11DS should be monitored for thyroid function, and thyroid ultrasound screening should be considered, especially in those patients with changes in thyroid function or congenital heart malformations. The possible relationship between developmental abnormalities in the heart and the thyroid gland should be confirmed.