Clinical Hyperthyroidism Research Articles

The association of TSH-receptor antibody with the clinical and laboratory parameters in patients with newly diagnosed Graves' hyperthyroidism: experience from a tertiary referral center including a large number of patients with TSH-receptor antibody-negative patients with Graves' hyperthyroidism.

Although the TSH-receptor antibody (TRAb) plays a central role in the pathogenesis of Graves' disease (GD), the association between TRAb at first diagnosis and clinical and laboratory parameters is not well known. On the other hand, a minority of patients with GD may be TRAb negative, and there is a lack of adequate evidence to demonstrate the clinical and laboratory characteristics of these patients. Therefore, we aimed to investigate the association of TRAb at the initial diagnosis of GD with the clinical and laboratory parameters in a large number of patients with GD and to compare the clinical and laboratory parameters between patients with high TRAb levels and TRAb-negative patients. This study included 440 patients [326 (74%) female, 114 (26%) male]. All patients were classified according to gender, age, smoking habit, and TRAb levels. TRAb levels were significantly higher in male compared to female patients and in smokers compared to non-smokers. Smoking male patients had the highest TRAb levels. In regression analysis, goiter size, male gender, cigarette smoking, Graves' orbitopathy, fT3, and anti-TPO antibody levels were independently associated with high TRAb levels, while age at diagnosis and fT4 levels were not independently associated with high TRAb levels. TRAb-negative GD was diagnosed in 80 (18%) patients. TRA-negative patients had markedly less severe clinical and laboratory hyperthyroidism compared to patients with high TRAb levels. Moreover, the smoking habit was significantly lower in patients with TRAb-negative GD. According to our study results, TRAb levels at the initial diagnosis of GD are differently associated with clinical and laboratory parameters. Male patients and smoking patients with GD tended to have markedly higher TRAb levels and more severe clinical hyperthyroidism. Therefore, besides other contributing factors, male gender and smoking may affect TRAb levels and consequently the severity of hyperthyroidism in patients with GD. Furthermore, male gender and smoking may have a synergistic effect on TRAb levels and consequently on the severity of hyperthyroidism in patients with GD.

Frequency and characteristics of thyroid dysfunction in pregnant women – screening of 547 women in Bulgaria

The Recommendations of the European Thyroid Association’2014 have been widespread among the medical community for many years. In them as well as in the latest Recommendations of the American Thyroid Association’2017 the first recommendation is related to the development of population-based reference limits based on data from the local population. The aim is to study the current functional thyroid status in pregnant Bulgarian women and to carefully assess in the light of modern understandings the specific diagnostic and therapeutic approach for our population. Material and Methods: The study was conducted as a cross-sectional multicenter population-based study, which included 547 pregnant women, mean age 30 ± 5 years. Fasting morning venous blood (TSH, FT4, TPOAb - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration) was taken, ultrasound examination of the thyroid gland was performed. Results: Based on the accepted cut-off for TSH according to the Recommendations of ETA’2014, the studied pregnant women were divided into six groups: Subclinical and Clinical hypothyroidism; Subclinical and Clinical hyperthyroidism; Euthyroid; Low T4 syndrome. Almost 2/3 of pregnant women have TSH < 2.5 mIU / L. Undiagnosed hypothyroidism is present in 121 pregnant women (22%), which is a bad feature of our health system. The data were analyzed in two TSH cut-offs (ETA’2014 and ATA’2017) and it was found that the increase in TSH cut-off for the first trimester did not change the absolute number of undiagnosed and untreated pregnant women with Clinical hypothyroidism, increasing 2.5 times its relative share, from 25.6% reaching 63.3% of all undiagnosed cases of hypothyroidism. Conclusion: Increasing the cut-off of TSH would unrealistically calm and neglect the follow-up of the pregnant women which is very dangerous. Efforts should focus on early screening for verbally identified risk factors. Of course, it is necessary to develop a national standard for TSH, which would serve more accurately to assess the thyroid status of pregnant women in the Bulgarian population.

Opposing effects of thyroid hormones on cancer risk: a population-based study.

The association between dysregulated thyroid hormone function and cancer risk is inconclusive, especially among different age groups and uncommon malignancies. We sought to determine the relation of TSH and free T4 levels with overall cancer risk as well as risk of specific cancer types. Data on thyroid hormone profile was collected from 375 635 Israeli patients with no prior history of cancer. Cancer cases were identified via the Israel National Cancer Registry. Cox proportional hazards model was used to assess hazard ratios for overall cancer as well as 20 cancer subgroups. In this study, 23 808 cases of cancer were detected over median follow up of 10.9 years. Among patients younger than 50 at inclusion, TSH in the hyperthyroid range, elevated free T4 and subclinical hyperthyroidism were associated with increased cancer risk (HR: 1.3, 1.28 and 1.31, respectively). In contrast, patients 50 or older with clinical hyperthyroidism were at lower cancer risk (HR: 0.64). Elevated TSH was associated with decreased risk of prostate cancer (HR: 0.67). Log-TSH elevation was associated with decreased risk of thyroid cancer (HR: 0.82) and increased risk of melanoma (HR: 1.11) and uterine cancer (HR: 1.27). Elevated free T4 was associated with increased lung cancer risk (HR: 1.54), while free T4 levels above the normal range and clinical hyperthyroidism were related to lower colorectal cancer risk (HR: 0.59 and 0.08, respectively). Thyroid hormones display opposing effects on cancer risk, based on patient age and cancer type.

Visual and dual-fluorescence homogeneous sensor for the detection of pyrophosphatase in clinical hyperthyroidism samples based on selective recognition of CdTe QDs and coordination polymerization of Ce3+

A visual / dual fluorescent strategy based on selective recognition of QDs and coordination polymerization of Ce3+ was developed for pyrophosphatase detection.

The Association of Thyroid Hormones With β-HCG in Patients With Hydatidiform Mole

Background: A hydatidiform mole or molar pregnancy is the most prevalent gestational trophoblastic disease (GTD). About 55%-60% of women with trophoblastic diseases have overt hyperthyroidism at the time of diagnosis, which may have severe manifestations. This study examined the relationship between gestational hypertension and the level of thyroid hormones with beta human chorionic gonadotropin (β-HCG) in patients with a hydatidiform mole. Materials and Methods: This cross-sectional study enrolled 65 patients with a hydatidiform mole admitted to Khalij-e Fars hospital, Bandar Abbas, Iran. Patients were divided into three groups of clinical hyperthyroidism, subclinical hyperthyroidism, and healthy. The serum levels of thyroid-stimulating hormone (TSH), T4, T3, and β-HCG were checked in all subjects, and the relationship between gestational hypertension and the level of thyroid hormones with β-HCG in patients with a hydatidiform mole was examined. Results: The mean age of patients was 29.93 ± 9.04 years, and their mean gestational age was 11.09 ± 4.2 weeks. In this study, 12.3% of the patients had subclinical hyperthyroidism, 41.5% had clinical hyperthyroidism, and 46.2% were healthy. A significant relationship was found between the serum level of β-HCG and thyroid function in patients with clinical and subclinical hyperthyroidism compared to the healthy group (P= 0.001). No significant relationship was found between systolic/ diastolic blood pressure and the serum level of β-HCG. Conclusion: A significant relationship was observed between the serum levels of β-HCG and TSH, free T3, and free T4 in patients with a hydatidiform mole and thyrotoxicosis. Thus, early diagnosis of hyperthyroidism can help treat these patients more quickly.

English

BACKGROUND Diabetes mellitus is one of the leading endocrine disorders worldwide. Thyroid dysfunction is a common endocrine disorder affecting the general population next to diabetes. The objective of this study was to determine the prevalence of thyroid dysfunction among patients with Type 2 diabetes. METHODS This analytical cross sectional study was conducted from June 2019 to Dec 2019. One hundred and fifty type–2 diabetes patients who attended the outpatient clinic of General Medicine Department, ACS Medical College and Hospital were included in the study. A detailed history and examination was done after getting informed consent. Blood samples were collected and sent to the laboratory for the evaluation of thyroid profile. RESULTS Thyroid dysfunction was found in 27 % of the patients with diabetes. Subclinical hypothyroidism was the most common thyroid dysfunction reported (14.7 %) followed by clinical hypothyroidism (10 %), subclinical hyperthyroidism (2 %) and clinical hyperthyroidism (0.6 %). CONCLUSIONS Thyroid dysfunction is common in patients with type-2 diabetes. A substantial proportion of the diabetic patients with thyroid dysfunction have subclinical hypothyroidism. Unidentified thyroid dysfunction could negatively impact diabetes and its complications. Therefore, early and routine screening of thyroid is recommended in all patients with diabetes to reduce the burden of the disease. KEYWORDS Type-2 Diabetes Mellitus, Thyroid Dysfunction, Hypothyroidism

HOSPITAL-BASED CLINICAL STUDY ON PREVALENCE OF TPO ANTIBODIES IN ASSOCIATION TO AUTOIMMUNE THYROID DISEASES IN TERTIARY CARE HOSPITAL

Objective: Autoimmune thyroid disease is one of the organs specific autoimmune disorders. The onset is much more common in women than in men. Worldwide, 2–4% of women and only 1% of men have affected and the rate increases with age. Thyroperoxidase (TPO) antibodies (Abs) level helps to diagnose autoimmune thyroid disease along with levels of thyroid stimulating hormone (TSH), Free Tri-iodotyrosine (Free T3), and Free Thyroxin(Free T4) and it helps in differentiation between subclinical and overt thyroidism. The core objective of clinical study was to evaluate prevalence of anti-TPO Abs in association to autoimmune thyroid disease in a tertiary care hospital – Punjab.
 Methods: A cross-sectional study of random patient (n=200 patients) at a tertiary care hospital, Mohall – Punjab was carried out. All the patients fall in the age group 12–89 years. The parameters, which were used for the diagnosis of autoimmune thyroid disease, were anti-TPO level, Free T3 level, and Free T4 level. The patients were divided in different group on the basis of their age, gender, and their clinical conditions. The level of TPO Abs, TSH, Free T3, and Free T4 was noted for each patient. Electrochemiluminescence immunoassay method was used for determination of TPO Abs and other thyroid parameters. After a period of 16 weeks, subjects from different groups had great difference in their anti-TPO values in the autoimmune thyroid disease.
 Results: TPO Abs positive is one of the most common associated with hypothyroidism which was 36.5%, among them 20.5% suffered from subclinical hypothyroidism, whereas other remaining suffered from clinical hypothyroidism, clinical hyperthyroidism, and other autoimmune disease.
 Conclusion: TPO Abs level helps to diagnose autoimmune thyroid disease, along with this the level of TSH, Free T3, and Free T4 helps in differentiation between subclinical and overt thyroidism.

An evaluation of urine and serum iodine status in the population of Tibet, China: No longer an iodine-deficient region.

Iodine is a critical trace element for the synthesis of thyroid-related hormones, and either low or high iodine status can lead to thyroid dysfunction. This study aimed to evaluate the iodine status of the Tibetan population. From September 2016 to August 2018, we enrolled 1499 healthy adults from three areas of varying altitudes in Tibet. Urine iodine concentrations (UICs), adjusted UICs, and serum iodine concentrations (SICs) were measured using inductively coupled plasma mass spectrometry. The median UIC, adjusted UIC, and SIC was 137.9 μg/L, 118.4 µg/gCr, and 58.3 μg/L, respectively. Of the participants, 30.4% had UICs <100 µg/L, 63.0% had UICs ranging from 100 to 300 µg/L, and 9.6% had UICs >300 µg/L. The correlation between UIC, adjusted UIC, and SIC was good (r > 0.65, P < 0.01). The SICs were more stable than the UICs, and were not associated with age or sex. The prevalence of clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, positive thyroid peroxide antibody, positive thyroglobulin antibody, either positive and both positive was 0.5%, 1.3%, 1.7% and 17.9%, 9.3%, 6.5%, 12.5%, and 2.5%, respectively. The prevalence of almost all thyroid disorders was higher in women than in men. This multicenter cross-sectional study found that the human iodine status of adults in Tibet was considered adequate, based on the World Health Organization's criteria.

Higher thyroid hormone levels and cancer.

This narrative review aims to summarize the relationship between hyperthyroidism, upper reference range thyroid hormone (TH) levels, and cancer, and to address the clinical management of hyperthyroidism in cancer patients. A comprehensive search was performed by an independent reviewer through Google Scholar and PubMed Electronic databases. All searches were restricted to English language manuscripts published between 2000 and 2020. Numerous in vitro, in vivo, and population-based studies suggest cancer-stimulating effect of triiodothyronine and thyroxin. THs are presented as mediators for tumor growth, proliferation, and progression. Many population and case-control studies suggest an increased risk of several solid but also hematologic malignancies in relation to hyperthyroidism and upper normal range TH levels. However, results are not unambiguous. In this review, we will summarize population and case-control studies that investigated the relationship between hyperthyroidism, upper reference range TH levels, lower thyrotropin (TSH) levels, lower reference range TSH levels with cancer risk, cancer prognosis, and cancer outcome. The vast majority of evidence suggests an association between clinical and subclinical hyperthyroidism with the risk of developing several types of cancer. Furthermore, hyperthyroidism is also linked with a poorer cancer prognosis. In this review, we will also discuss the diagnosis of hyperthyroidism in patients with pre-existing cancer and cover the management of hyperthyroidism in cancer patients, with special attention on the role of nuclear medicine. It is crucial to emphasize the importance of the rapid establishment of euthyroidism, and consequently, the importance of radioiodine therapy, as the therapy of choice in most cancer patients. We want to show that in this day and age there still is a high relevance for I-131 to achieve a permanent solution and thus likely reduce the risk of adverse influence of hyperthyroidism on the occurrence of new and course of existing cancer cases.

Association Between Overt Hyperthyroidism and Risk of Sexual Dysfunction in Both Sexes: A Systematic Review and Meta-Analysis

BackgroundNumerous studies have shown the detrimental effects of overt hyperthyroidism on sexual functioning but a quantitative result has not yet been synthesized. AimTo conduct a systematic review and meta-analysis that quantifies the association between overt hyperthyroidism and the risk of sexual dysfunction (SD). MethodsA meta-analysis of studies in the literature published prior to February 1, 2020, from 4 electronic databases (MEDLINE, Embase, Cochrane Library databases, and PsychINFO) was conducted. All analyses were performed using the random-effects model comparing individuals with and without overt hyperthyroidism. OutcomesThe strength of the association between overt hyperthyroidism and risk of SD was quantified by calculating the relative risk (RR) and the standard mean difierences with 95% CI. The quality of evidence for the reported outcome was based on the Grading of Recommendations Assessment, Development, and Evaluation approach. ResultsOf 571 publications, a total of 7 studies involving 323,257 individuals were included. Synthetic results from 7 eligible studies indicated that overt hyperthyroidism led to significant SD in both sexes (pooled RR = 2.59, 95% CI: 1.3–5.17, P = .007; heterogeneity: I2 = 98.8%, P < .001). When we analyzed the data of men and women independently, the pooled results consistently showed that men and women with overt hyperthyroidism were at over 2-fold higher risk of SD than the general populations (RR for males = 2.59, 95% CI: 1.03–6.52, P = .044; RR for females = 2.51, 95% CI: 1.47–4.28, P = .001). Combined standard mean diffierences from those studies providing the Female Sexual Function Index (FSFI) suggested that women with overt hyperthyroidism were associated with a significantly lower FSFI value in FSFI total scores, subscale sexual arousal, lubrication, orgasm, and satisfaction domain (all P < .05). The overall quality of evidence in our study was considered to be moderate. Clinical ImplicationsClinicians should know the detrimental effects of overt hyperthyroidism on sexual functioning in clinical practice. Measurement of thyroid hormones should be included in the assessment of patients presenting with SD when they show symptoms of clinical hyperthyroidism. Strengths & LimitationsThis is the first meta-analysis quantifying the relationship between overt hyperthyroidism and the risks of SD. However, the combined results were derived from limited retrospective studies along with substantial heterogeneities. ConclusionOur study has confirmed the potentially devastating sexual health consequences caused by overt hyperthyroidism. However, additional rigorous studies with sizable samples are still needed to better elucidate this evidence.Pan Y, Xie Q, Zhang Z, et al. Association Between Overt Hyperthyroidism and Risk of Sexual Dysfunction in Both Sexes: A Systematic Review and Meta-Analysis. J Sex Med 2020;17:2198–2207.

Thyroid dysfunction in Iranian pregnant women: a systematic review and meta-analysis

BackgroundThyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and fetus. The present meta-analysis was conducted to evaluate thyroid dysfunction in Iranian pregnant women.MethodsWe registered this review at PROSPERO (registration number: CRD42020166655). The research steps in this systematic review and meta-analysis were performed according to the MOOSE protocol, and finally, reports were provided based on the PRISMA guidelines. The literature search was performed in October 2019 using the international online databases, including Web of Science, Ovid, Science Direct, Scopus, EMBASE, PubMed/Medline, Cochrane Library, EBSCO, CINAHL, Google Scholar as well as national databases were reviewed. Data were extracted after applying the inclusion and exclusion criteria and qualitative evaluation of the studies. I2 index and Q test were used to assess differences in studies. All analyses were performed using Comprehensive Meta-Analysis Software. P-value less than 0.05 was considered statistically significant. We identified 1261 potential articles from the databases, and 426 articles remained after removing the duplicate and unrelated studies. After evaluating the full text, 52 articles were removed.ResultsFinally, 19 eligible studies including 17,670 pregnant women included for meta-analysis. The prevalence of thyroid dysfunction in Iranian pregnant women was 18.10% (95%CI: 13.89–23.25). The prevalence of hypothyroidism, clinical hypothyroidism, and subclinical hypothyroidism in Iranian pregnant women was respectively estimated to be 13.01% (95%CI: 9.15–18.17), 1.35% (95%CI: 0.97–1.86) and 11.90% (95%CI: 7.40–18.57). The prevalence of hyperthyroidism, clinical hyperthyroidism, and subclinical hyperthyroidism in Iranian pregnant women was respectively estimated to be 3.31% (95%CI: 1.62–6.61), 1.06% (95%CI: 0.61–1.84) and 2.56% (95%CI: 0.90–7.05). The prevalence of anti-thyroperoxidase antibody was estimated to be 11.68% (95%CI: 7.92–16.89).ConclusionThe results of this meta-analysis showed a high prevalence of thyroid disorders, especially hypothyroidism. The decision to recommend thyroid screening during pregnancy for all women is still under debate, because the positive effects of treatment on pregnancy outcomes must be ensured. On the other hand, evidence about the effect of thyroid screening and treatment of thyroid disorders on pregnancy outcomes is still insufficient. Nevertheless, a large percentage of general practitioners, obstetricians and gynecologists perform screening procedures in Iran.

1745-P: High Prevalence of Thyroid Abnormalities in Patients with Congenital Generalized Lipodystrophy

Background: It is related that thyroid appears can be affected by insulin resistance (IR). Early and severe IR is a characteristic of Congenital Generalized Lipodystrophy (CGL), characterized by near to total absence of subcutaneous adipose tissue. There are few studies about thyroid abnormalities in CGL. Aim: To describe thyroid structure and function in patients with CGL and correlate with HOMA-IR. Methods: The patients were submitted to a medical interview, physical examination, thyroid ultrasonography and biochemical, lipid profile and thyroid hormones evaluation. Results: Twenty-three patients with a CGL were included, median age was 13.3 years (3.6 to 38.7), 15 (65%) were younger than 19 years, 14/23 (60.8%) were women and 14 (60.8%) patients had diabetes. All patients had low leptin levels, low HDL cholesterol and 18/23 (78,2%) had hypertriglyceridemia (316.55-1052mg/dL). The prevalence of thyroid hormonal dysfunction was 17.4% (4/23): subclinical (1/23) and clinical hypothyroidism (1/23), subclinical (1/23) and clinical hyperthyroidism (1/23). TSH level was 1.27 uUI/mL (0.48 - 6.71), fT4, 1.06 ng/dL (0.82 - 1.92) and T3, 1.27 ng/dL (0, 69 - 1.76). Antithyroperoxidase (ATPO) and anti-titreoglobulin (ATG) antibodies were positive in 4% (1/23) and in 17.3% (4/23). There was a negative correlation between HOMA-IR and fT4 (r= 0.036). The thyroid volume was 4.3 cm³ (1.04 - 60.4), it was altered in 19% of the patients: 33% had nodules and another 33%, parenchyma heterogenicity. There was a positive correlation between HOMA-IR and volume (r= 0.035). A case of thyroid carcinoma was diagnosed in an 8 years-old girl. Conclusion: The prevalence of thyroid abnormalities was higher than in population data, especially in a young population. IR correlated positively with thyroid volume and negatively with T4l levels. This study did not show correlation between IR and autoimmunity. These data support that thyroid may be directly influenced by the high levels of insulin present in CGL. Disclosure V.O. Fernandes: None. G.D. Lima: None. A.D. Montenegro: None. A.B. Carvalho: None. G.M. Rodrigues: None. I.P. Melo: None. L.V. Martins: None. L.A. Batista: None. L. Aguiar: None. R.M. Montenegro: None.

SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG >100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period.A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (< 5mlU/mL), TSH <0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued.The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm.1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

A CROSS-SECTIONAL STUDY OF THE ACUTE EFFECTS OF HEAD AND NECK RADIOTHERAPY ON THE THYROID VOLUME AND FUNCTION

Objective: To evaluate the acute effects of radiotherapy on the volume and function of the thyroid gland.Material and Methods: Thirty-one patients with head and neck cancer were included in the study. Patients with thyroid cancer or thyroidectomy were excluded. There was no patient for whom radiotherapy was the only tretment modality. Thyroid function tests, thyroglobulin and thyroid volume imaging were evaluated before and immediately after radiotherapy, Results: After radiotherapy 13 patients had dysfunction. Among 13, 8 had subclinical hyperthyroidism, 1 had clinical hyperthyroidism, 1 had subclinical hypothyroidism and 3 developed clinical hypothyroidism. After chemoradiotherapy all patients had significantly decreased FT3 (p&amp;lt;0.001). FT4 slightly increased in all of the patients other than operated patients (p&amp;gt;0.05). After treatment, the TSH decreased in patients who were not operated but given chemotherapy whereas it was increased in patients who were operated but not given chemotherapy (p&amp;gt;0.05). The thyroid volume was unchanged in 2 patients, decreased in 17 patients and increased in 12 patients (p&amp;gt;0.05). There was no correlation between chemotherapy or surgery, and the volume of the thyroid gland. No thyroiditis was seen in the acute phase.Conclusion: Hyperthyroidism appeared immediately after radiotherapy. The volume of the gland starts to be slightly affected in the acute phase. Due to possible clinical thyroid dysfunction, after completion of the radiotherapy patients should not be discharged without thyroid function tests.

Study of thyroid dysfunction in metabolic syndrome in patients of Amalapuram, Andhra Pradesh, India

Background: Both metabolic syndrome and thyroid dysfunction are associated with increased risk of atherosclerotic heart disease. The present study was conducted to study the Association of thyroid dysfunction and Metabolic syndrome and to find out the type of thyroid dysfunction in metabolic syndrome patients.Methods: Sixty cases were defined according to the IDF Criteria. Detailed history and necessary investigations like fasting blood sample was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid-stimulating hormone (TSH), lipid profile, and blood glucose were undertaken.Results: In this study population of metabolic syndrome cases, the thyroid dysfunction is present in 16.7% patients. Among the thyroid dysfunction, sub clinical hypothyroidism is highly prevalent - 11.7%, The hypothyroidism is 3.3% prevalent in metabolic syndrome patients (one patient had TSH levels of more than 150 mU/L) and sub clinical hyperthyroidism is 1.7% prevalent. There were no overt hyperthyroidism patients in the study.Conclusions: This study clearly shows that, one sixth of metabolic syndrome patients or every sixth metabolic syndrome had hypothyroidism either overt or subclinical. This finding indicates a need for investigating the presence of Thyroid dysfunction during managing metabolic syndrome patients

THYROID HORMONES AS A THIRD LINE OF AUGMENTATION MEDICATION IN TREATMENT-RESISTANT DEPRESSION.

Clinical or subclinical hypothyroidism dictates the severity of depressive episodes and more frequently overlaps psychotic phenomenology. There are also major depressive episodes resistant to treatment in patients with euthyroidism, in which supplementation of antidepressant medication with thyroid hormones is beneficial. Systematization of meta-analyses from perspectives: hypothyroidism and depression, autoimmune and depression pathology, gestational and puerperal pathology in association with hormonal and dispositional changes, presentation of therapeutic schemes. Hypothyroidism is more commonly comorbid with major depression in women. It associates the need for hospitalizations, psychotic phenomenology, resistance to treatment, somatic comorbidities. Autoimmune pathology is associated with depression and requires thorough investigation. A possible genetic candidate for thyroid dysfunction is the DIO1 gene. FT4 may be a predictor, but the combination of FT4 + TBG measured during the prenatal period has a higher prognostic power for a future depressive episode. The article presents psychiatric medication schemes that combine antidepressants and antipsychotics of various classes with other enhancers, an important role going back to step three, which includes thyroid hormones, mainly T3. The doses used are smaller than the amount of endogenous production of T3 daily, with a small risk of inducing clinical hyperthyroidism.

The association of serologically documented maternal thyroid conditions during pregnancy with bipolar disorder in offspring.

Higher rates of thyroid conditions are reported in individuals with bipolar disorder. However, no study to date has considered whether maternal thyroid conditions during pregnancy are associated with offspring risk of bipolar disorder, even though the fetus exclusively relies on maternal thyroid hormones through the early second trimester. We therefore examined the association between offspring bipolar disorder and serologically documented maternal thyroid conditions. The study was based on a nested case-control design that utilized data from the Child Health and Development Study, a birth cohort that enrolled pregnant women from 1959 to 1966. Eighty-five cases with DSM-IV-TR were ascertained and matched to controls (1:2) by date of birth, sex, gestational timing of the serum draws, and residence in Alameda County the first year receiving treatment. Archived prenatal maternal serum drawn during early to mid-gestation was used to measure two thyroid hormones, free thyroxine (fT4) and thyroid stimulating hormone (TSH). Subclinical and clinical hypothyroxinemia, hypothyroidism, and hyperthyroidism were determined based on standard methods. Exposure to maternal hypothyroxinemia was associated with a five-fold increased risk of offspring bipolar disorder with psychotic features, but not without psychotic features. In stratified analysis, female offspring demonstrated increased risk for bipolar disorder with exposure to maternal hypothyroxinemia. No significant association was found between maternal hypothyroidism and offspring bipolar disorder. These findings suggest that prenatal thyroid hormone deficiency, particularly a thyroid condition marked by low levels of thyroxine, may be an important developmental mechanism related to the risk of bipolar disorder with psychotic features.

Prevalence, risks, and comorbidity of thyroid dysfunction: a cross-sectional epidemiological study

BackgroundWorldwide, the incidence of individuals with thyroid dysfunction is increasing and represents approximately 30–40% of the patients seen in an endocrine clinic. The undiagnosed thyroid dysfunction may adversely affect the metabolic control and add more risk to already predisposing cardiovascular risk factors. Thus, the objective of the present study was to assess the prevalence of undiagnosed thyroid dysfunction and its association with other comorbidities.Patients and methodsA cross-sectional study was conducted on 430 patients who attended the outpatient clinic of Diabetes and Endocrinology, the Internal Medicine Department, Zagazig University Hospitals. All patients underwent clinical and laboratory evaluations. A total of 304 patients had normal thyroid function (euthyroid) and 126 patients had thyroid dysfunction, who were stratified into one of the following groups based on the reference of the normal thyroid function test result: hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism. Thyroid-stimulating hormone and free thyroxine were used as the screening tests to diagnose thyroid dysfunction.ResultsOur results show the prevalence of thyroid dysfunction was 29.3%. Among thyroid dysfunction groups, the prevalence of subclinical hypothyroidism was 44.4%, hypothyroidism was 20.6%, hyperthyroidism was 19.2%, and subclinical hyperthyroidism was 15.8%. The prevalence of overall thyroid dysfunction among studied patients with type 2 diabetes mellitus was 27.6%, whereas in type 1 diabetes mellitus, the prevalence of overall thyroid dysfunction was 38.7%. Patients with subclinical hypothyroidism and hypothyroidism had a high prevalence of hypertension compared with those with subclinical hyperthyroidism and clinical hyperthyroidism. Approximately 8% of studied pregnant female patients had subclinical hypothyroidism. Among the 15% of female patients in the postpartum period who had thyroid dysfunction, 10% had clinical hypothyroidism and 5% had clinical hyperthyroidism. Among postmenopausal women, 20% had thyroid dysfunction (12% had subclinical hypothyroidism and 8% had clinical hypothyroidism).ConclusionThe most frequently undiagnosed thyroid dysfunction was subclinical hypothyroidism. Thyroid dysfunction was common in certain age groups: reproductive age and postmenopausal as well as in patients with diabetes mellitus and hypertension; thus, screening for thyroid disease among those groups of patients should be routinely performed.

Thyroid profile in type 2 diabetes mellitus

Background: Diabetes mellitus is an endocrine disorder which involves multiple organ systems and leads to significant morbidity and mortality. Diabetes mellitus has been defined as “A metabolic syndrome characterized by chronic hyperglycemia and disturbance of carbohydrate, fat and protein metabolism associated with absolute or relative deficiency in insulin secretion and or insulin action”. Thyroid diseases are also a common endocrinopathy seen in the adult population. Thyroid hormones are intimately involved in cellular metabolism. The present work is a modest attempt to study the prevalence of thyroid disorders in patients with type 2 diabetes mellitus.Methods: The study was carried out in total 108 diabetic patients without known thyroid disorder admitted in various Medical wards of R.N.T. Medical college and attached group of hospitals, Udaipur. It was a cross Sectional study done over a period of 10 months. Results: In the present study, 13% of patients with type 2 diabetes mellitus had abnormal thyroid profile. Out of which the most common presentation was sub clinical hypothyroidism found in 9.25% followed by1.9% had overt hypothyroidism and 1.9% had sub clinical hyperthyroidism. In persons with abnormal thyroid profile 85.7% were females and 14.3% were males which was statistically significant.Conclusions: Prevalence of thyroid dysfunction is common among T2DM patients and is higher in females than in males. There is no significant correlation between thyroid dysfunction and age, diabetes control, family history, type of treatment and HbA1c level in diabetic patients.

THE ASSOCIATION OF SUBCLINICAL HYPERTHYROIDISM WITH FRAILTY

The relevance of subclinical hyperthyroidism in the elderly has not been clearly defined. We studied whether the reported association of low TSH with frailty is an indicator of subclinical hyperthyroidism as assessed by free T3 levels. In a retrospective chart review of patients seen between January 2017 and December 2018 at the Phoenix VA Medical Center, we identified 100 patients aged ≥60 years with at least 2 low TSH measurements (<0.5 µIU/ml) and a free T3 measurement within 6 months of the measured TSH and 50 sex- and age-matched controls (TSH 0.5-5.0 µIU/ml). Patients with exogenous or clinical hyperthyroidism were excluded. We used a deficit accumulation approach evaluating 31 factors, to create a frailty index between 0 and 1 for each patient. The higher the FI, the more likely (p<0.001) it was that patients had expired in the interim. Patients with low (0.31±0.11 µIU/mL) vs. normal (1.84±0.84 µIU/mL) TSH had higher mean FI compared to controls (0.25±0.12 vs. 0.15±0.07, p<0.001). TSH significantly predicted frailty score (p<0.0001) independent of age. However, lower TSH was not associated with higher free T3 or free T4 levels. There was a nonsignificant inverse association of free T3 levels with FI (P = 0.09), which disappeared when adjusted for age. Similar to prior studies, low TSH predicted frailty. However, neither free T3 nor free T4 predicted low TSH or frailty index, suggesting that the association of low TSH with frailty is not due to subclinical hyperthyroidism, but perhaps to effects of comorbidities on TSH secretion.