Cases Of Thyroid Dysfunction Research Articles

SAT453 Endocrine Related Adverse Events Of Immune Checkpoint Inhibitors In Cancer Patients Visiting Tertiary Care Center In Saudi Arabia

Abstract Disclosure: A.M. Alqahtani: None. A.S. Alghassab: None. L.A. Alghamdi: None. M. Almalki: None. Introduction: Immune checkpoint inhibitors (ICIs) have been approved for the treatment of a different types of cancers. Those agents may result in exaggerated immune response leading to numerous toxicities referred to as immune-related adverse events particularly endocrinopathies affecting most commonly the thyroid and pituitary glands. Methods: We carried out a retrospective analysis of endocrine dysfunction in cancer patients receiving immune checkpoint inhibitors therapy namely pembrolizumab, nivolumab and ipilimumab between July 2018 and July 2022. A total of 123 patients were included in this analysis. We reviewed pituitary-, thyroid-, and adrenal-related hormone test results, as well as the clinical perspective of patients, to identify and characterize cases of hypophysitis, hypothyroidism, thyroiditis, and adrenal dysfunction. Results: A total of 123 patients were included in our study. Among them, Female participants were 67 (54.5%) and males were 56 (45.5%) with mean age of 53.7 years. Majority of the included patients (91.1%) received single agent and only 8.9% received combination therapy. The most used ICI in our cohort was pembrolizumab 73.9% followed by nivolumab 17.8% and the combination of either one of them (beside ipilimumab) was used in 8.9% of the time. The most frequent indication for ICIs was breast cancer (27.6%) followed by lung cancer (19.5%) and metastatic renal cell carcinoma (8.9%). The average number of cycles was 12 cycles, and the average duration of treatment was 12 months. The total incidence of all endocrinopathies was 22.7%. Out of 123 patients, 24 patients developed thyroid dysfunction in term of thyroiditis (1), subclinical hypothyroidism (7) or overt hypothyroidism (16). Hypophysitis occurred in one patient only. There was no occurrence of new onset diabetes mellitus in all groups. Pembrolizumab is thought to be the culprit in 18 patients of thyroid dysfunction and the patient who developed hypophysitis. Nivolumab was responsible about 4 cases of thyroid dysfunction. The rest of the cases were attributed to the combination therapy. The mean TSH level at the time of hypothyroidism diagnosis (overt hypothyroidism and subclinical hypothyroidism) was 95.8 mIU/L. And the mean free thyroxine level in overt hypothyroidism group was 6.3 pmol/L. Conclusion: Our cohort demonstrated an increased risk of thyroid dysfunction among cancer patients who receive immune checkpoint inhibitors. Pituitary dysfunction is infrequent adverse effect of these agents. Endocrine assessment is recommended prior to initiation of therapy and periodically afterward. Special attention should be given to pituitary dysfunction as it might be overlooked due to non-specific symptoms. Presentation: Saturday, June 17, 2023

PSAT319 A 34-year-old Male with Subacute Thyroiditis Following COVID-19 Vaccination: A Case Report

Abstract Background Few cases of subacute thyroiditis (SAT) have been reported after exposure to SARS-CoV-2 vaccines, which may stimulate immunogenic cross-reactivity in genetically susceptible individuals. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) should be considered as post-vaccination phenomenon, which may cause an underrecognized cause of autoimmune endocrine disease. Clinical Case A 34-year-old, Filipino male, presented with neck pain and throat discomfort, which started 5 days after his first dose of COVID-19 vaccine (Pfizer Bio-NTech mRNA vaccine). He reported sore throat, palpitations, easy fatigability, weight loss, diarrhea and mood changes. He had no recent history of any viral or respiratory illness. Premorbid, he was clinically and biochemically euthyroid. He had maternal history of thyroid carcinoma. Initial examination showed enlarged left thyroid nodule, tender on palpation. Laboratory work-up showed elevated C-reactive protein (8.16 mg/dL, n: 0.50 mg/dL), suppressed TSH (<0.005 uIU/mL, n: 0.27-4.20 uIU/mL) and elevated FT4 (89.15 pmol/L, n: 12-22 pmol/L), consistent with thyrotoxic phase of SAT. Thyroid peroxidase antibody, TSH receptor antibody and thyroglobulin were within reference range, while the thyroglobulin antibody was elevated (33.73, n: 4.11). SARS-CoV-2 RT-PCR was negative. Thyroid ultrasonography showed enlarged left thyroid lobe, with diffuse parenchymal disease and increased thyroid vascularity. Thyroid scintigraphy with 99mTc-pertechnetate demonstrated no tracer accumulation in thyroid beds and low thyroid uptake, consistent with thyroiditis. He was initially treated with nonsteroidal anti-inflammatory drug (Celecoxib) to relieve the neck discomfort and beta-blocker (Propranolol) to control his palpitations. Celecoxib was shifted to prednisone after 1 week due to further increase in FT4 (>100 pmol/L, n: 12-22 pmol/L), and persistence of neck pain. Prednisone was eventually tapered to discontinue when symptoms improved. Repeat thyroid function test after 4 weeks demonstrated results transitioning to the hypothyroid phase of SAT, elevated TSH (3.910 uIU/mL) and low-normal FT4 (15.71 pmol/mL). Levothyroxine was initiated at 25 g daily. After 4 weeks, repeat TSH was 3.75 uIU/mL. His levothyroxine dose was maintained and he remained well. Second dose of Pfizer Bio-NTech vaccine was administered when his thyroid status was stable, and he had no adverse effects thereafter. Conclusion Thyroid dysfunction occurring after COVID-19 vaccination is probably an underreported adverse effect. To our knowledge, no case of thyroid dysfunction after COVID-19 vaccination had been reported yet in the Philippines. SAT should be considered in patients presenting with neck pain, fever and thyroid dysfunction. Awareness of potential thyroid dysfunction after administration of COVID-19 vaccine, in the context of safety monitoring, is important. References (1) Saygılı ES, Karakilic E. Subacute thyroiditis after inactive SARS-CoV-2 vaccine. BMJ Case Rep 2021;14: e244711. doi: 10.1136/bcr-2021-244711 Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Association between rheumatoid arthritis and thyroid dysfunction: A meta-analysis and systematic review.

ObjectiveRheumatoid arthritis (RA) is an autoimmune disorder. Multiple studies have investigated the risk of thyroid dysfunction in patients with RA but have reached conflicting conclusions. This systematic review aimed to determine whether patients with RA are at higher risk of thyroid dysfunction.MethodsWe comprehensively reviewed online literature databases, including PubMed, Scopus, Embase, and the Cochrane Library, from their respective inception dates to March 25, 2022. Studies that provided data on at least one case of thyroid dysfunction in RA patients and their controls were included. Based on these data, we calculated pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for thyroid dysfunction in RA and non-RA patients.ResultsTwenty-nine studies met the inclusion criteria, involving a total of 35,708 patients with RA. The meta-analysis showed that, compared with non-RA patients, RA patients had an increased risk of developing thyroid dysfunction, particularly hypothyroidism (OR 2.25, 95% CI 1.78–2.84). Subgroup analysis suggested that study type and sample source of control group were the source of heterogeneity.ConclusionsPatients with RA are at increased risk of developing thyroid dysfunction, especially hypothyroidism. Routine biochemical examination of thyroid function in RA patients should be strengthened. Larger prospective studies are needed to explore the causal relationship between RA and thyroid dysfunction, and to investigate the impact of thyroid dysfunction on RA disease activity, drug efficacy, and medication safety.Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022331142.

Thyroid Dysfunction under Amiodarone in Patients with and without Congenital Heart Disease: Results of a Nationwide Analysis.

Background: Amiodarone has a profound adverse toxicity profile. Large population-based analyses quantifying the risk of thyroid dysfunction (TD) in adults with and without congenital heart disease (ACHD) are lacking. Methods: All adults registered with a major German health insurer (≈9.2 million members) with amiodarone prescriptions were analyzed. Occurrence of amiodarone-associated TD was assessed. Results: Overall, 48,891 non-ACHD (37% female; median 73 years) and 886 ACHD (34% female; median 66 years) received amiodarone. Over 184,787 patient-years, 10,875 cases of TD occurred. The 10-year risk for TD was 38% in non-ACHD (35% ACHD). Within ACHD, compared to amiodarone-naïve patients, the hazard ratio (HR) for TD was 3.9 at 4 years after any amiodarone exposure. TD was associated with female gender (HR 1.42, p < 0.001) and younger age (HR 0.97 per 10 years, p = 0.009). Patients with congenital heart disease were not at increased risk (HR 0.98, p = 0.80). Diagnosis of complex congenital heart disease, however, was a predictor for TD (HR 1.56, p = 0.02). Amiodarone was continued in 47% of non-ACHD (38% ACHD), and 2.3% of non-ACHD (3.5% ACHD) underwent thyroid surgery/radiotherapy. Conclusions: Amiodarone-associated TD is common and comparable in non-ACHD and ACHD. While female gender and younger age are predictors for TD, congenital heart disease is not necessarily associated with an elevated risk.

Thyroid check-up of people over 18 living with Human Immunodeficiency Virus (HIV), malnourished followed at Notre Dame des Apôtres Hospital in Sarh / Chad

Malnutrition and Human Immunodeficiency Virus/Acquire Immunodeciency Syndrome (HIV/AIDS) are public health problems. HIV/AIDS continues to have severe consequences for the nutrition, food security, and other socioeconomic aspects of HIV-infected individuals. The objective of our study is to evaluate the correlation between HIV infection, malnutrition, and thyroid disorders in malnourished people living with HIV/AIDS followed at Notre Dame des Apôtres Hospital in Sarh/Chad. The study included 36 malnourished people living with HIV/AIDS over 18 years of age, followed at the People Living with Human Immunodeficiency Virus (PLWHIV) ward. Our study population consisted of females with 75 percent of cases with a sex ratio (M/F) of 0.33. The most represented age group was between 32 and 59 years. We performed a thyroid assessment of each patient by measuring biochemical parameters such as Thyroid Stimulating Hormone (TSH), Tri-iodothyronin (T3) and Tetra-iodothyronin (T4). The results obtained showed 61.76 percent of thyroid dysfunction prevalence with 11.76 percent primary hypothyroidism, 2.94 percent subclinical hypothyroidism, 5.88 percent TSH-mediated hyperthyroidism, and 41.18 percent central hypothyroidism. As a result, the cases of thyroid dysfunction were high noticed in the age group between 32 and 45 years. Furthermore, the assessment showed that 67 percent of the cases were women. From these results, we can conclude that the combination of the two conditions, malnutrition and HIV infection, weakens the immune system, thus giving way to other opportunistic diseases.

Hypothyroidism and Hypothyroxinemia in Pregnancy: An Overview in the Time of Coronavirus Disease 2019

In normal pregnancy, the maternal thyroid gland undergoes alterations to maintain the necessary levels of thyroid hormones (THs) in each gestational period. However, various factors may reduce TH levels, potentially impacting the onset and development of pregnancy. Such cases of thyroid dysfunction are divided into overt (clinical) hypothyroidism, subclinical hypothyroidism, or isolated hypothyroxinemia, depending on the severity of deficiency. The reported incidence of overt hypothyroidism in p

TO STUDY CORRELATION OF CRITERIA LIKE OBESITY, DM, HYPERTENSION, DYSLIPIDEMIA IN RELATION WITH THYROID DISORDER

Background: In this study 100 cases of thyroid dysfunction were studied for the cardiovascular manifestations. Out of these, 60 cases were of hypothyroidism and 40 cases were of hyperthyroidism.&#x0D; There was no age bar for inclusion in the study. All of these cases were selected from those attending the Endocrinology OPD in IMCHRC hospital, Indore.&#x0D; Result: 78.3% cases of hypothyroidism in our study were suffering from obesity. Relationship between age group and obesity was not significant in these patients. In our study out of 40 patients suffering from hypothyroidism 10 (25%) patients have DM. In our study out of 60 patients suffering from hypothyroidism 28(46.7%) patients were have DM. In our study out of 40 patients of hyperthyroidism, 12 had dyslipidemia. In our study out of 60 patients of hypothyroidism, 41 had dyslipidemia.&#x0D; Conclusion: In our study out of 60 patients suffering from hypothyroidism 28(46.7%) patients were found to have diabetes mellitus. All were females. Out of 60 patients of hypothyroidism, 33 had diastolic hypertension. Out of these 6.1% were male and 93.9% were female. Out of 60 patients of hypothyroidism, 41 had dyslipidemia, of these 97.6% were females only 2.4% were male.&#x0D; Keywords: Cardiac, Manifestation, Thyroid, Hyperthyroidism &amp; Hypothyroidism.

TO STUDY THE INCIDENCES OF CARDIAC MANIFESTATION IN THYROID DISORDER (HYPO &amp; HYPER) BOTH IN RURAL AREA OF MALWA REGION

Background: In this study 100 cases of thyroid dysfunction were studied for the cardiovascular manifestations. Out of these, 60 cases were of hypothyroidism and 40 cases were of hyperthyroidism.&#x0D; There was no age bar for inclusion in the study. All of these cases were selected from those attending the Endocrinology OPD in IMCHRC hospital, Indore.&#x0D; Result: Low pulse pressure is the commonest cardiovascular finding in hypothyroidism (68.33%) followed by diastolic hypertension (55%), soft heart murmur (31.66%), sinus bradycardia (30%) and pericardial effusion (20%) Pulse pressure &gt;40 mm of Hg is the commonest finding in hyperthyroidism. Almost all patients of hyperthyroidism have sinus tachycardia.&#x0D; Conclusion: Study of cardiac signs and symptoms in patient with hyperthyroidism revealed 87.5% prevalence of pulse pressure &gt; 40 mm hg, 85% prevalence of loud heart sound, 82.5% cases of sinus tachycardia, 52.5% cases of hyperdynamic precordium, 47.5% cases of ejection systolic murmur, 42.5% cases of prolonged Qt interval, 25% cases of precordial thrill, 47.5% patients with systolic BP&gt;160 mm Hg, 20 5 cases with mid systolic click, 27.5% patients with LVH , 15% cases with ST-T changes, 5% cases with S3 and 10% patients with atrial fibrillation.&#x0D; Keywords: Cardiac, Manifestation, Thyroid, Hyperthyroidism &amp; Hypothyroidism.

The prevalence and incidence of thyroid dysfunction in patients with diabetes - a longitudinal follow-up study

Thyroid dysfunction (TD) occurs in 13.4% of diabetic patients, which has prompted recommendations for annual thyroid screening in patients with diabetes. However, recommendations for annual screening should be based on disease incidence rather than prevalence. In 1997-1998, seven hundred and thirty patients (618 type 2 diabetes, 55% male; 112 type 1 diabetes, 47% male) were sequentially screened for TD. The 639 patients with normal thyroid function were followed from 1999 to 2006, with annual thyroid function tests. A total of 21/112 (19%) with type 1 diabetes (T1DM) and 70/618 (11%) with type 2 diabetes (T2DM) had TD. TD was more frequent in females (p < 0.05) and T1DM (p = 0.04). The mean annual rate of conversion to abnormal tests was 2.1%. At 8years, there were 100 new cases of TD representing 15.6% of the cohort (17 T1DM and 83 T2DM). TD was more frequent in females (p < 0.05), but there was no difference in the incidence of new TD between T1DM and T2DM (p = 0.39). Our data confirms the high prevalence of TD in diabetic patients, in concordance with the results from other series. We found only 25 treatable cases of new thyroid disease from 639 patients in the 8-year follow-up, less than 0.5% per year. The low incidence of treatable thyroid disease challenges the need for annual screening for thyroid abnormalities in patients with type 2 diabetes.

The Presence of Thyroid Peroxidase Antibody Is Associated with Lower Placental Weight in Maternal Thyroid Dysfunction.

Thyroid dysfunction (TD) is caused by thyroid peroxidase (TPO) antibody, as seen in Hashimoto's disease. TD is a common problem of reproductive age and may impair fetal development. Here, we determined the effect of TPO antibody on perinatal outcomes in Japanese women with TD before conception. A retrospective study involving cases of maternal TD with term singleton birth was conducted. The subjects with TD were divided into two groups according to the presence (n = 22) or absence (n = 20) of TPO antibody. The control groups matched for age, parity, and gestational weeks were selected for TPO antibody-positive (n = 44) and -negative TD subjects (n = 40), respectively. Using the standard curve of Japanese placental weight, the frequency of placental weight less than the 50th percentile (small placenta) was examined. Placental weight was lower among TPO antibody-positive TD subjects, compared with TPO antibody-negative TD subjects (p < 0.01). However, other outcomes were similar between the groups. Importantly, compared with control mothers, placental weight was significantly lower (p < 0.01), birth weight tended to be lower (p = 0.07), and the incidence of gestational diabetes mellitus was higher (p = 0.02) among TPO antibody-positive subjects. There was no significant difference in placental weight between TPO antibody-negative subjects and controls. The frequency of small placenta was significantly higher in TPO antibody-positive subjects (odds ratio: 16.7) even when considering diabetes and pregnancy induced hypertension. Thus, the presence of TPO antibody is associated with lower placental weight among Japanese women having TD.

Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years.

Thyroid autoimmunity, especially Graves' disease or hypothyroidism with positive autoantibodies (TRAb) to the thyrotropin receptor (TSHR), occurs in 30-40% of patients with relapsing multiple sclerosis following treatment with alemtuzumab (ALTZ). ALTZ therapy therefore provides a unique opportunity to study the evolution of TRAb prior to clinical presentation. TRAb can stimulate (TSAb), block (TBAb), or not affect ("neutral") the TSHR function, causing hyperthyroidism, hypothyroidism, or euthyroidism, respectively. A longitudinal retrospective analysis was conducted of TRAb bioactivity over a period of nine years in 45 multiple sclerosis patients receiving ALTZ using available stored serum. Of these 45 patients, 31 developed thyroid dysfunction (TD) and 14 remained euthyroid despite being followed for a minimum of five years (NO-TD). The presence of TRAb was evaluated at standardized time points: (i) before ALTZ, (ii) latest time available following ALTZ and before TD onset, and (iii) following ALTZ during/after TD onset. Serum TRAb were detected by published in-house assays (ihTRAb): flow cytometry detecting any TSHR-binding TRAb, and luciferase bioassays detecting TSAb/TBAb bioactivity. Purified immunoglobulin G was used to verify TSAb/TBAb in selected hypothyroid cases. Standard clinical automated measurements of TRAb, antithyroid peroxidase autoantibodies (TPOAb), thyrotropin, free thyroxine, and free triiodothyronine were also collected. Before ALTZ, combined ihTRAb (positive with flow cytometry and/or luciferase bioassay) but not automated TRAb were present in 5/16 (31.2%) TD versus 0/14 (0%) NO-TD (p = 0.017). Detectable ihTRAb preceded TD development in 9/28 (32.1%) and by a median of 1.2 years (range 28 days-7.3 years). Combination testing of ihTRAb and TPOAb at baseline predicted 20% of subsequent cases of hyperthyroidism and 83% of hypothyroidism. Evidence is presented that TRAb measured with custom-made assays can be detected prior to any change in thyroid function in up to a third of cases of ALTZ-related TD. Furthermore, the presence of ihTRAb prior to ALTZ treatment was strongly predictive of subsequent TD. The findings suggest that a period of affinity maturation of TRAb may precede clinical disease onset in some cases. Combined testing of TPOAb and ihTRAb may increase the ability to predict those who will develop TD following ALTZ.

Rapid Evolution of Thyroid Dysfunction in Patients Treated with Nivolumab

To describe the evolution of thyroid dysfunction in a series of patients with cancer treated with the immune checkpoint inhibitor anti-programmed cell death protein-1 (PD-1) monoclonal antibody, nivolumab. Cases of thyroid dysfunction after initiation of checkpoint inhibitor treatment were identified from the Division of Endocrinology clinical practice at Mount Sinai Hospital, New York from April 2016 to February 2017. Charts were reviewed to identify patients treated with nivolumab with new onset of thyroid dysfunction. Nine cases of thyroid function in patients who were treated with nivolumab were identified. There were 4 male and 5 female patients, with a mean age of 66 years (range 50-76 years). Seven patients ultimately developed hypothyroidism. Five of the 7 patients developed abnormal thyroid function tests within the first 90 days of starting therapy (range 21-84 days), 3 of whom had transient hyperthyroidism. Transient hyperthyroidism evolved rapidly to hypothyroidism; elevated thyroid-stimulating hormone (TSH) levels were detected within 16 to 32 days of the last documented low TSH. In the 2 patients without a hyperthyroid phase, TSH levels >50 were found 18 to 28 days after the last normal TSH value. As the use of immune checkpoint inhibitor therapy increases, the need for prompt diagnosis and treatment of drug-induced thyroid disease will become more important. As illustrated in this case series, in contrast to other causes of auto-immune thyroiditis, hypothyroidism can develop rapidly within 3 months of treatment. Close monitoring is necessary to detect the development of thyroid dysfunction and avoid preventable morbidity. Anti-TPO Abs = anti-thyroglobulin antibodies; CT = computed tomography; CTLA-4 = cytotoxic T-lymphocyte-associated protein 4; FDA = U.S. Food & Drug Administration; FDG-PET = fluorodeoxyglucose-positron emission tomography; PD-1 = programmed cell death protein-1; PD-L1 = programmed death-ligand 1; T3 = triiodothyronine; T4 = thyroxine; TG = thyroglobulin; TPO = thyroperoxidase; TSH = thyroid-stimulating hormone.

EVALUATION OF SERUM IRISIN AND CREATINE KINASE LEVELS IN HYPO- AND HYPERTHYROID RATS

Background: Thyroid dysfunction is one of the most common metabolic disorders that has not been dependent yet in its diagnosis on evaluation of serum levels of thyroid stimulating hormone (TSH), tri-iodothyronine (T3), thyroxine (T4). Other markers like serum irisin which is an adipo-myokine secreted by muscles during exercise, and serum creatine kinase (CK) which is a marker of muscle damage, show changes in their levels with hypo and hyperthyroidism in different species. Objective: To evaluate the levels of both serum irisin and serum creatine kinase in hypo- and hyperthyroid rats, and to illustrate the relationship between their levels and thyroid function tests. Methods: This study was performed on 30 adult healthy male local strain albino rats that were divided into three equal groups: Group I (Control Euthyroid group): Fed on commercial rat laboratory chow, Group II (Hypothyroid group): Hypothyroidism was induced by administration of propylthiouracil, and Group III ( Hyperthyroid group): Hyperthyroidism was induced by administration of T4. BMI in each group was calculated at the end of the experiment. Hormonal assay was performed to measure serum levels of TSH, FT3, FT4, insulin, glucose, irisin and CK. Results: Serum irisin was negatively correlated with TSH levels, and positively correlated with FT3 and FT4 levels in both hypo-and hyperthyroid groups. However, serum CK was positively correlated with TSH levels and negatively correlated with FT3 and FT4 levels in both hypo-and hyperthyroid groups. Also, a negative correlation between serum irisin and serum CK was recorded in both cases of thyroid dysfunction. Conclusions: Serum irisin level decreased in hypothyroid and increased in hyperthyroid rats. At the same time, serum CK level increased in hypothyroid and decreased in hyperthyroid rats. Both serum irisin and CK levels may be considered as parameters for diagnosis of both hypo-and hyperthyroidism in rats.

Ocular Manifestations in Thyroid Eye Disorder: A Cross-Sectional Study from Nepal

Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye disease. Aim: This study was conducted for the profile of ocular manifestation in Thyroid Eye Disease (TED). Methodology: A cross-sectional study of 117 cases of thyroid dysfunction was carried out at BP Koirala Institute of Health System, out of which 84 (71.79%) cases had ocular manifestation. They were evaluated and analyzed in detail and the characteristics documented included patient’s demography, ocular and systemic history and as well as ocular examination and some of the systemic and laboratory findings. Results: In this study, mean age of presentation of TED was 39.7 years. 59 patients were female and 25 were male. The maximum patients of both sexes were in the fourth decade of their lives. The common lid signs were lid retraction and lid lag. Proptosis was seen in 33.3% of cases out of which 68% had bilateral proptosis. Corneal ulcer was seen in 7.1% and optic neuropathy in 1.2% of cases. In 27.3% of cases there was elevation of IOP. Dry eye was seen in 61.9% of cases and POAG seen in 8.3% of cases. In the study population 75% were hyperthyroiditic, 16.7% were hypothyroiditic and 8.3% were in euthyroid state. Conclusion: Female was more commonly affected. The maximum number of patients of both sexes was in the fourth decade of their lives. Hyperthyroidism patient had greater chance of ocular manifestation.

Analysis of thyroid function change before 20 weeks of pregnancy

Objective To investigate the development of thyroid function before 20 weeks of pregnancy refer-ence range and prevalence of thyroid dysfunction.Methods 1 706 healthy routine check early single births over the same period of non-pregnant women and maternal health check were chosen for the study.Thyroid function were meas-ured,characteristics of thyroid function changes were analyzed.Results TSH median values minimum and maximum eight weeks of pregnancy,respectively,19^＋6 weeks of gestation,respectively 0.90mU/L,2.74mU/L,FT4 median value minimum and maximum respectively nine weeks pregnant, pregnant 19^＋6 week, respectively 11.34mpmol/L, 8.75pmol/L,TSH with the extension of time to pregnancy gradually increase, while FT4 decreased.Compared with non-pregnant women,pregnant 8 to 12^＋6 weeks pregnant median TSH decreased 28.48%,FSH level in 34 cases of pregnant women during pregnancy was lower than the reference range,accounting for 5.54%.FT4 than non-pregnant women the median increased 7.98%,39 cases of pregnant women during pregnancy than non-FT4 reference range,ac-counting for 6.35%.In section 2.5% and 97.5% of euthyroid reference range, non-pregnant females, 8 to 12^＋6 weeks of pregnancy,13 to 16^＋6 weeks of pregnancy,17 to 19^＋6 weeks of gestation TSH reference range was 0.16-5.90mU/L, 0.03-3.66mU/L, 0.06-3.75mU/L, 0.32-4.32mU/L, FT4 respectively 6.70-14.04pmol/L, 7.99-18.67pmol/L,6.19-16.23pmol/L,6.43-13.50pmol/L.In 1 706 cases of pregnant women before 20 weeks of pregnancy,41 cases of thyroid dysfunction exists,the total prevalence of 2.40%,including one case of hyperthyroid-ism,1 case of hypothyroidism,subclinical hypothyroidism in 33 cases,6 cases of low FT4 hyperlipidemia,most common subclinical hypothyroidism.Thyroid peroxidase autoantibodies （ TPOAb ） positive rate was 18.70%.Conclusion Pregnancy 20 weeks pregnant TSH and FT4 before presenting specific changes,TSH at 8 to 12^＋6 weeks of pregnancy decreased gradually,gradually increased,while the FT4 in 8 to 12^＋6 weeks of pregnancy increased gradually,gradually reduce;thyroid dysfunction prevalence is higher,to subclinical hypothyroidism is most common in early pregnancy,so we recommend routine thyroid function tests. Key words: Pregnancy; Hypothyroidism; Reference value; Thyroxine; Thyrotropin; Prevalence rate

Thyroid dysfunction and cardiovascular risk factors in Bulgarian adults

Abstract The aim of this study was to determine the prevalence of thyroid dysfunction and its association with cardiovascular risk factors in an adult Bulgarian population. 2402 subjects were studied, 1347 female, 20–94y (median: 48.0y) and 1055 male, 20–91y (median: 45.5y). Body weight, height, waist circumference, arterial blood pressure, TSH, FT4 and lipids were measured. Known hypothyroidism was reported by 53 subjects (2.2%) and hyperthyroidism by 20 (0.8%). New hypothyroidism was found in 98 (4.1%), [subclinical (3.2%), overt (0.9%)]. New hyperthyroidism was found in 68 (2.9%), [subclinical (2.5%), overt (0.4%)]. New diagnosis of hypothyroidism and hyperthyroidism was entered in 84% and 87% in male subjects and 60% and 65% in the females respectively. Arterial hypertension was present in 40% of the women and in 47% of the men (p&lt;0.001) and was more prevalent in hypothyroidism. Abdominal obesity and dyslipidemia were more prevalent in males and hypothyroid subjects. Arterial hypertension depended on age, gender and lipid status but not on thyroid function. CHD history depended on thyroid function and age. Conclusion: Most cases of thyroid dysfunction were undiagnosed, especially in the males. CV risk factors were more prevalent in the males with thyroid dysfunction a major determinant of CHD, but not hypertension.

Incidence and Pattern of Thyroid Dysfunction in Patients on Chronic Amiodarone Therapy: Experience at a Tertiary Care Centre in Oman

Objective: To determine the incidence and pattern of thyroid dysfunction (TD) in patients on chronic amiodarone therapy. Methods: A retrospective study which evaluated 59 patients who had received amiodarone therapy regularly for at least 12 months from a period of 3 years from October 2007 to October 2010. The patients were followed-up at the cardiac clinic at Sultan Qaboos University Hospital, Muscat, Oman. Results: The mean age of the cohort was 63 ± 13 years ranging from 27 to 98 years. Fifty-one percent (n = 30) of the patients were female. There were 11 (19%) cases of thyroid dysfunction (TD). Seven (12%) patients were hypothyroid, 3 (5%) had hyperthyroidism and 1 (2%) patient had sub-clinical hypothyroidism; no cases of sub-clinical hyperthyroidism were noted. Female gender and presence of anti-thyroid peroxidase antibodies were significantly associated with amiodarone-induced hypothyroidism (p = 0.001) while age, amiodarone dose and duration of therapy were not correlated with the development of TD (all p-values > 0.05). Conclusion: Amiodarone-induced thyroid dysfunction is prevalent. Hypothyroidism was more frequent and seen more in female patients and those who had positive anti-thyroid peroxidase antibodies. Initial screening and periodic monitoring of thyroid function is mandatory for all patients on amiodarone therapy.

Prevalence of thyroid dysfunction in patients with diabetes mellitus

BackgroundDiabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. The unrecognized TD may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to investigate the prevalence of TD in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM).MethodsThis is an observational cross-sectional study. Three hundred eighty-six (386) patients with T1DM or T2DM that regularly attended the outpatient clinic of the Diabetes unit, Hospital Universitário Pedro Ernesto, participated in the study. All patients underwent a clinical and laboratory evaluation. Thyroid dysfunction was classified as clinical hypothyroidism (C-Hypo) if TSH > 4.20 μUI/mL and FT4 < 0.93 ng/dL; Subclinical hypothyroidism (SC-Hypo) if TSH > 4.20 μUI/ml and FT4 ranged from 0.93 to 1.7 ng/dL; Subclinical hyperthyroidism (SC-Hyper) if TSH < 0.27 μUI/ml and FT4 in the normal range (0.93 and 1.7 ng/dL) and Clinical hyperthyroidism (C-Hyper) if TSH < 0.27 μUI/ml and FT4 > 1.7 μUI/mL. Autoimmunity were diagnosed when anti-TPO levels were greater than 34 IU/mL. The positive autoimmunity was not considered as a criterion of thyroid dysfunction.ResultsThe prevalence of TD in all diabetic patients was 14,7%. In patients who had not or denied prior TD the frequency of TD was 13%. The most frequently TD was subclinical hypothyroidism, in 13% of patients with T1DM and in 12% of patients with T2DM. The prevalence of anti-TPO antibodies was 10.8%. Forty-four (11.2%) new cases of TD were diagnosed during the clinical evaluation. The forty-nine patients with prior TD, 50% with T1DM and 76% with T2DM were with normal TSH levels.ConclusionsWe conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the possible aggravation the classical risk factors such as hypertension and dyslipidemia, arising from an undiagnosed thyroid dysfunction.

Prevalence of Thyroid Dysfunction in Patients with Type 2 Diabetes

Assess the prevalence of thyroid dysfunction in patients with type 2 diabetes (T2D) in Segovia (Spain). A screening program for thyroid dysfunction including all patients with T2D attending the diabetes clinic at the Hospital General de Segovia was performed from 2003 to 2005. 318 patients (191 women, aged 29-89 yr, median duration of diabetes 8 yr) attended the diabetes clinic. The number of patients with thyroid dysfunction and their respective prevalences were: overt hyperthyroidism, 11 (3.5%); subclinical hyperthyroidism, 10 (3.1%); overt hypothyroidism, 48 (15.1%), and subclinical hypothyroidism, 34 patients (10.7%). The screening program detected the following cases of newly diagnosed thyroid dysfunction: subclinical hyperthyroidism, 5 (1.6%); overt hypothyroidism, 6 (1.9%), and subclinical hypothyroidism, 20 patients (6.3%). Therefore, total thyroid dysfunction was present in 32.4% (95% CI, 27.3-37.5%), and newly diagnosed thyroid dysfunction was present 9.7% (95% CI, 6.5-13.0%) of the patients. Logistic regression analysis showed that there were no significant relationships between the presence of thyroid dysfunction and duration of diabetes, hemoglobin A1c levels, and the presence of diabetic complications. This screening program detected new cases of thyroid dysfunction in ∼10% of diabetic subjects. However, we could not identify any diabetes-related clinical parameter with predictive value on the presence of thyroid dysfunction.

5. Nonmalignant Diseases after the Chernobyl Catastrophe

This section describes the spectrum and the scale of the nonmalignant diseases that have been found among exposed populations. Adverse effects as a result of Chernobyl irradiation have been found in every group that has been studied. Brain damage has been found in individuals directly exposed--liquidators and those living in the contaminated territories, as well as in their offspring. Premature cataracts; tooth and mouth abnormalities; and blood, lymphatic, heart, lung, gastrointestinal, urologic, bone, and skin diseases afflict and impair people, young and old alike. Endocrine dysfunction, particularly thyroid disease, is far more common than might be expected, with some 1,000 cases of thyroid dysfunction for every case of thyroid cancer, a marked increase after the catastrophe. There are genetic damage and birth defects especially in children of liquidators and in children born in areas with high levels of radioisotope contamination. Immunological abnormalities and increases in viral, bacterial, and parasitic diseases are rife among individuals in the heavily contaminated areas. For more than 20 years, overall morbidity has remained high in those exposed to the irradiation released by Chernobyl. One cannot give credence to the explanation that these numbers are due solely to socioeconomic factors. The negative health consequences of the catastrophe are amply documented in this chapter and concern millions of people.