Decreased Thyroid Function Research Articles

Thyroid autoimmunity in euthyroid pregnant women is associated with slower productive language acquisition: the Odense child cohort study.

Maternal thyroid autoimmunity and thyroid function in early pregnancy may impact fetal neurodevelopment. We aimed to investigate how thyroid autoimmunity and thyroid function in early pregnancy were associated with language acquisition in offspring at 12-36 months of age. This study was embedded in the prospective Odense child cohort. Mother-child dyads were excluded in case of maternal intake of thyroid medication during pregnancy. The parents completed MacArthur-Bates Communicative Development Inventories (MB-CDI) every third month to assess their offspring's productive vocabulary. All completed reports for each child were included in the analyses. Logistic growth curve models evaluated associations between MB-CDI scores and levels of maternal thyroid peroxidase antibodies (TPOAb), free thyroxine (FT4), and thyrotropin, respectively, measured in early pregnancy (median gestational week 12). All models were stratified by offspring sex and adjusted for maternal age, education, pre-pregnancy body mass index, parity, breastfeeding, and offspring age. The study included 735 mother-child dyads. Children born to mothers with TPOAb ≥11 kIU/L, opposed to TPOAb <11 kIU/L, had a lower probability of producing words at age 18-36 months for girls (OR = 0.78, P < 0.001) and 33-36 months for boys (OR = 0.83, P < 0.001). The probability of producing words was higher in girls at 30-36 months of age with low-normal maternal FT4 vs high-normal FT4 (OR = 0.60, P < 0.001), and a similar trend was seen in boys. Results were ambiguous for thyrotropin. In women without known thyroid disease, TPOAb positivity in early pregnancy was negatively associated with productive vocabulary acquisition in girls and boys. This association was not mediated by a decreased thyroid function, as low-normal maternal FT4, unexpectedly, indicated better vocabulary acquisition. Our results support that maternal thyroid autoimmunity per se may affect fetal neurodevelopment.

Thyroid paradox in older age

BACKGROUND: The thyroid gland plays an important role in our body, influencing almost all metabolic processes in the body throughout life. However, literature data on the effect of decreased thyroid function on mortality in older people is contradictory.&#x0D; AIM: To evaluate the impact of thyroid-stimulating hormone levels on 5-year survival in older adults.&#x0D; MATERIALS AND METHODS: This work was carried out on the basis of the second screening of the Crystal study of community-dwelling individuals 65+ (n = 383). Main study parameters: thyroid-stimulating hormone level, blood test, lipid profile, albumin, total protein, comprehensive geriatric assessment, 5 years of follow-up.&#x0D; RESULTS: A thyroid-stimulating hormone level of 3.3–10.0 mIU/L was associated with a 44.6% reduced risk of all-cause mortality (hazard ratio 0.554; 95% confidence interval 0.307–0.999) at 5 years of follow-up, regardless of the presence of non-communicable diseases and geriatric status. A thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of mortality. The lower risk of mortality in patients with high thyroid-stimulating hormone levels may be due to a larger thigh muscle circumference. After adjustment for all covariates used and thyroid-stimulating hormone level, a 1 cm increase in thigh muscle circumference was associated with a 4.5% reduction in the risk of all-cause mortality (hazard ratio 0.955; 95% confidence interval 0.932–0.979).&#x0D; CONCLUSIONS: The lowest risk of all cause-mortality mortality in persons aged 65 years and older is observed with a thyroid-stimulating hormone level of 3.3–10.0 mIU/L. Thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of all cause-mortality.

Selenium bioactive compounds produced by beneficial microbes.

Selenium (Se) is an essential trace element present as selenocysteine (SeCys) in selenoproteins, which have an important role in thyroid metabolism and the redox system in humans. Se deficiency affects between 500 and 1000 million people worldwide. Increasing Se intake can prevent from bacterial and viral infections. Se deficiency has been associated with cancer, Alzheimer, Parkinson, decreased thyroid function, and male infertility. Se intake depends on the food consumed which is directly related to the amount of Se in the soil as well as on its availability. Se is unevenly distributed on the earth's crust, being scarce in some regions and in excess in others. The easiest way to counteract the symptoms of Se deficiency is to enhance the Se status of the human diet. Se salts are the most toxic form of Se, while Se amino acids and Se-nanoparticles (SeNPs) are the least toxic and most bio-available forms. Some bacteria transform Se salts into these Se species. Generally accepted as safe selenized microorganisms can be directly used in the manufacture of selenized fermented and/or probiotic foods. On the other hand, plant growth-promoting bacteria and/or the SeNPs produced by them can be used to promote plant growth and produce crops enriched with Se. In this chapter we discuss bacterial Se metabolism, the effect of Se on human health, the applications of SeNPs and Se-enriched bacteria, as well as their effect on food fortification. Different strategies to counteract Se deficiency by enriching foods using sustainable strategies and their possible implications for improving human health are discussed.

Prevalence of Hypoteriosis Prognosis and Prevention

The purpose of the study is to study the prevalence of hypothyroidism among the population, its course, to study the frequency of occurrence of hypothyroidism, prognosis, prevention and the impact of the thyroid gland on the functioning of other systems and organs. Diagnosis of hypothyroidism is based on an assessment of the clinical picture and data from laboratory and instrumental research methods. Laboratory testing of serum TSH and thyroid hormone levels is fundamental in diagnosing decreased thyroid function. The main role is given to the determination of thyriotropic hormone by highly sensitive methods

Complex relationship between gut microbiota and thyroid dysfunction: a bidirectional two-sample Mendelian randomization study.

Many studies have reported the link between gut microbiota and thyroid dysfunction. However, the causal effect of gut microbiota on thyroid dysfunction and the changes in gut microbiota after the onset of thyroid dysfunction are not clear. A two-sample Mendelian randomization (MR) study was used to explore the complex relationship between gut microbiota and thyroid dysfunction. Data on 211 bacterial taxa were obtained from the MiBioGen consortium, and data on thyroid dysfunction, including hypothyroidism, thyroid-stimulating hormone alteration, thyroxine deficiency, and thyroid peroxidase antibodies positivity, were derived from several databases. Inverse variance weighting (IVW), weighted median, MR-Egger, weighted mode, and simple mode were applied to assess the causal effects of gut microbiota on thyroid dysfunction. Comprehensive sensitivity analyses were followed to validate the robustness of the results. Finally, a reverse MR study was conducted to explore the alteration of gut microbiota after hypothyroidism onset. Our bidirectional two-sample MR study revealed that the genera Intestinimonas, Eubacterium brachy group, Ruminiclostridium5, and Ruminococcaceae UCG004 were the risk factors for decreased thyroid function, whereas the genera Bifidobacterium and Lachnospiraceae UCG008 and phyla Actinobacteria and Verrucomicrobia were protective. The abundance of eight bacterial taxa varied after the onset of hypothyroidism. Sensitivity analysis showed that no heterogeneity or pleiotropy existed in the results of this study. This novel MR study systematically demonstrated the complex relationship between gut microbiota and thyroid dysfunction, which supports the selection of more targeted probiotics to maintain thyroid-gut axis homeostasis and thus to prevent, control, and reverse the development of thyroid dysfunction.

Changes in thyroid function in prostate cancer patients receiving docetaxel chemotherapy at Haji Adam Malik Hospital, Indonesia.

Prostate cancer treatment is determined based on several factors, namely tumor grading, staging, co-morbidity, patient preferences, life expectancy at diagnosis. Today, taxanes are commonly prescribed to treat several types of cancer and have been shown to have antitumor effects in many cancers. This research has never been done in prostate cancer patients but similar studies have been done before in breast cancer patients. The research design was observational analytic where this type of research was a prospective cohort where data was collected to record prostate cancer patients who received docetaxel chemotherapy which were then examined for thyroid function in cancer patients at the Adam Malik Hospital, Medan, Indonesia. In this study, data were collected regarding the thyroid function of the study sample in the form of free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels before chemotherapy with the docetaxel regimen. The mean of fT4 in all research subjects was 1.05 with a standard deviation of 0.26. The mean TSH in all study subjects was 1.52 with a standard deviation of 1.21. Thyroid function was examined after 3 cycles of docetaxel chemotherapy. The mean of fT4 in all research subjects was 0.91 with a standard deviation of 0.23. The mean TSH in all study subjects was 1.69 with a standard deviation of 1.09. There are traces of the use of docetaxel chemotherapy in prostate cancer patients on decreased thyroid function at the Adam Malik Hospital in the form of decreased fT4 levels and increased TSH.

Endothelial dysfunction correction in patients with hypertension, dyslipidaemia, and decreased thyroid function

Endothelial dysfunction is considered a universal predictor of numerous diseases, development of the complications and their adverse course. The study aimed to investigate the endothelium-dependent vasodilation among patients with arterial hypertension, dyslipidemia and different functional state of the thyroid gland and feasibilities of its correction by means of hypolipidaemic and metabolic therapy. 99 patients with arterial hypertension and dyslipidemia were examined, among them were 65 hypothyroid persons (group 1) and 34 individuals with normal thyroid function (group 2). The effects of lipid-lowering combination therapy with ezetimibe and rosuvastatin or monotherapy with statins, and metabolic therapy with L-arginine aspartate during 3 months on endothelium-dependent vasodilation were studied. At the beginning of the study, the values of endothelial-dependent vasodilation in group 1 compared to those in group 2 were reliably smaller by 9.38%. After 3 months of treatment, this indicator in group 1 reliably increased by 11.11%, while 19 (29.23%) patients showed its normalization. The best values of the endothelium-dependent vasodilation was demonstrated by examinees in group 2 – the indicator reliably increased by 15.76 %, while 17 (50%) patients showed its normalization. Together, the greater increase in the percentage of endothelium – dependent vasodilation was observed among subgroups of patients that in complex treatment received combination hypolipidaemic therapy with ezetimibe and rosuvastatin, and metabolic therapy with L-arginine. The best indicators of endothelium-dependent vasodilation were demonstrated by examinees of both groups who, in addition to combination hypolipidaemic therapy, received metabolic therapy. Decreased thyroid gland function negatively affected the values of endothelium-dependent vasodilation and overweighted the possibilities of endothelial dysfunction correction in this cohort of patients. The results of the study can be applied in internal medicine clinic for complex treatment of comorbid hypertensive and hypothyroid patients

Decreased Thyroid Function in Nasopharyngeal Carcinoma Patients Who Received Chemoradiotherapy in DR Sardjito Public Hospital, Yogyakarta, Indonesia

Background: Radiotherapy has long been recognized as the mainstay for the treatment of nasopharyngeal carcinoma with or without chemotherapy. Chemoradiotherapy can induce a transformation of thyroid gland causing thyroid disorder. Objective: This study has evaluated a decrease in thyroid function in patients with nasopharyngeal carcinoma who received chemoradiotherapy. Methods: This is a pre-post study design. The subject includes patients with nasopharyngeal carcinoma that underwent chemoradiotherapy. Patient's thyroid functions were measured twice; before and 3 months after chemoradiotherapy. Results: We observed the result of 30 patients that underwent chemoradiotherapy. The results of pre and post treatment for FT3, FT4 and TSH show p-value of 0,001, 0,0043 and 0,015 respectively showing statistically significant difference between two measurement period. Conclusion: We found an alteration in thyroid function in patients with nasopharyngeal carcinoma who received chemoradiotherapy.

Thyroid status in pregnant women with pregnancy induced hypertension – A case control study

Introduction: Pregnancy induced hypertension (PIH) is an important cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. PIH is more frequently associated with elevated TSH (Thyroid-stimulating hormone). Thyroid dysfunction plays an important role in the development of gestational hypertension. However, this relationship remains unclear. The study was performed to evaluate the thyroid status in pregnant women with PIH and normal pregnant women. Methodology: This was a hospital based observational case control study done in Dr M K Shah Medical College, Ahmedabad. Total 100 pregnant women were included, out of them 50 PIH women were included in the case study group and 50 normotensive healthy pregnant women were included in the control group. After taking written consent, thyroid profile (TSH, free T3 and free T4) were measured in all 100 subjects. Results: Women with PIH had higher TSH levels and lower free T3 and free T4 as compared to normotensive pregnant women. There was a significant association between hypothyroidism and PIH cases. There was a significant positive correlation between TSH and systolic BP (r=0.42) and diastolic BP (r=0.52). Conclusion: PIH women are at greater risk of decreased thyroid function. Therefore, PIH women should be monitored for thyroid levels regularly.

Головная боль и гипотиреоз

Hypothyroidism is usually manifested by a wide range of symptoms from various body systems, including the nervous system. It was found that approximately 30% of patients with decreased thyroid function suffer from cephalgia, which is associated with a thyroid hormone deficiency. Both primary and secondary hypothyroidism can not only lead to secondary cephalgia but also aggravate pre-existing primary cephalgia, most commonly migraine. It is known that cephalgia is more common in women, especially if there is a history of migraine. In everyday clinical practice, cephalgia associated with hypothyroidism is rarely diagnosed as an independent form of secondary cephalgia. More commonly, primary cephalgia, such as migraine and tension headache, are regarded as concomitant diseases in patients with decreased thyroid function. To date, data on the association between hypothyroidism and migraine, as well as hypothyroidism and tension headache are contradictory and it is not always possible to determine which process is primary or secondary. The pathophysiological basis explaining the association between hypothyroidism and cephalgia/migraine has not yet been studied. KEYWORDS: hypothyroidism, cephalgia, migraine, tension headache, thyroid-stimulating hormone, hypothalamus, levothyroxine, Hashimoto's thyroiditis, Hashimoto's encephalopathy, preventive migraine treatment. FOR CITATION: Parkhomenko E.V., Ekusheva E.V., Kulikova S.I. Сephalgia and hypothyroidism. Russian Medical Inquiry. 2023;7(10):630–634 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-4.

Diagnosis and Treatment of Primary Hypothyroidism in Primary Care

Decreased thyroid function occurs among 0,2–1% of men and 1,4–5% of women in the general population, and among people over 60 years among 2,5% of men and 6% of women. Hypothyroidism in 95% of cases is caused by thyroid disfunction (primary hypothyroidism), only 5% of cases are central hypothyroidism, associated with dysfunction of the pituitary gland (insufficient production of thyroid-stimulating hormone) and hypothalamus (impaired thyroliberin synthesis). Nonspecific clinical manifestations of hypothyroidism are the reason for examining the patient for thyroid hormone levels in primary care. Primary hypothyroidism screening is a common clinical situation in the general practitioner`s practice. According to Guideline 00514. Hypothyroidism of the Finnish Medical Research Society Duodecim Medical Publications Ltd, the use of which is approved by the Order of the Ministry of Health of Ukraine № 1422 of December 29, 2016, diagnosis of hypothyroidism and treatment of primary hypothyroidism are the tasks of primary care professionals. Decreased thyroid function may have subclinical and manifest forms, which are detected in the analysis of the results of thyroid hormones and clinical signs of the disease, require different treatment approaches. There are the differences in the use of levothyroxine replacement therapy in patients of different ages and depending on the causes of hypothyroidism. Patients under 55 years old are prescribed levothyroxine sodium in a daily dose of 1,6–1,8 μg/kg body weight. In patients over 55 years old, the daily requirement of levothyroxine sodium is calculated at 0,9 μg/kg body weight, taking into account existing cardiovascular disease. If patients are obese, the calculation is made on the «ideal» weight. The calculation of the dose and rules of levothyroxine sodium prescription in primary care are presented on the example of four clinical cases. The algorithm for control levothyroxine replacement therapy in patients with primary hypothyroidism is also presented.

Non-thyroidal illness syndrome predicts outcome in adult critically ill patients: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of non-thyroidal illness syndrome (NTIS) in critically ill patients. We included studies that assessed thyroid function by measuring the serum thyroid hormone (TH) level and in-hospital mortality in adult septic patients. Reviews, case reports, editorials, letters, animal studies, duplicate studies, and studies with irrelevant populations and inappropriate controls were excluded. A total of 6869 patients from 25 studies were included. The median prevalence rate of NTIS was 58% (IQR 33.2–63.7). In univariate analysis, triiodothyronine (T3) and free T3 (FT3) levels in non-survivors were relatively lower than that of survivors (8 studies for T3; standardized mean difference (SMD) 1.16; 95% CI, 0.41–1.92; I2 = 97%; P < 0.01). Free thyroxine (FT4) levels in non-survivors were also lower than that of survivors (12 studies; SMD 0.54; 95% CI, 0.31–0.78; I2 = 83%; P < 0.01). There were no statistically significant differences in thyrotropin levels between non-survivors and survivors. NTIS was independently associated with increased risk of mortality in critically ill patients (odds ratio (OR) = 2.21, 95% CI, 1.64–2.97, I2 = 65% P < 0.01). The results favor the concept that decreased thyroid function might be associated with a worse outcome in critically ill patients. Hence, the measurement of TH could provide prognostic information on mortality in adult patients admitted to ICU.

Relationship Of Zonulin Levels With Thyroid Function And Metabolic Parameters In Hashimoto’s Thyroiditis

Aim: Intestinal permeability is one of the factors responsible for the pathogenesis of many immune-related diseases, one of which is Hashimoto's-thyroid (HT). We used zonulin as a biomarker of intestinal permeability in this cross-sectional study. We aimed to determine serum zonulin levels in individuals diagnosed with HT and to investigate the relationship between zonulin and autoimmunity biomarkers, thyroid function and metabolic parameters. Materials and Methods: The study was conducted with 43 women newly diagnosed with HT and a control group of 30 matched with them. The evaluated parameters were thyroperoxidase-antibody (TPO-AB), thyroglobulin-antibody (Tg-AB), thyroid hormone profile, metabolic parameters and zonulin levels. Results: Higher levels of TSH, TPO-AB, Tg-AB, TG and TC were measured in the HT group compared to controls (P&lt;0.005). The means of zonulin in HT.patients were significantly higher than in the control group (P&lt;0.005). Conclusion: The correlations between zonulin levels and TSH and TPO-AB among all subjects in this study support the idea that intestinal permeability is a distinguishing feature in the conditions causing the formation of immunological hypersensitivity in HT. More studies are needed to prove that impaired intestinal permeability is among the causes of decreased thyroid function.

Subclinical hypothyroidism has no association with insulin resistance indices in adult females: A case-control study.

Longitudinal studies have indicated an association between thyroid function and insulin resistance (IR) or a neutral relationship. Both the lowest tertile of free thyroxine (fT4) and the highest tertile of free triiodothyronine (fT3) were found to be associated with IR in cross-sectional studies. The aim of the present study was to analyze the association between IR and subclinical hypothyroidism in a female adult population from Bucharest, Romania. This is a retrospective pilot case-control study that included female patients examined by two endocrinologists and a diabetologist in an outpatient clinic. The retrospective follow-up had a one-year duration and included the evaluation of thyroid function tests and IR indices based on fasting insulinemia and C-peptide. The study included 176 women, 91 with subclinical hypothyroidism, with a median age of 60±17 years and a mean body mass index (BMI) of 27.79±4.76 kg/m2. The majority of the population (50%) was diagnosed with autoimmune thyroiditis, and 17.05% with goitre. The univariate logistic regression using hypothyroidism as the explaining variable found no evidence of a significant relationship between a decreased thyroid function and IR (OR 1.32; P=0.36). Metabolic syndrome was probably the most important determinant of IR in the population group studied. Thus, it was not the thyroid function per se, but the coexistence of other elements of this syndrome that prevailed in determining IR. Advantages to the study are the design that permitted evaluation of IR and the thyroid function at different moments in time as well as the uniformity of the blood tests. The multivariate analyses were adjusted for age, lipid profile and treatment; however, one limiting factor was the absence of other hormonal blood tests. In summary, there was no association between the thyroid function tests (TSH, fT4) and IR indices in adult Romanian women in a case-control study with one-year retrospective follow-up.

Hypokalemic Periodic Paralysis and Renal Tubular Acidosis in Patient withHypothyroidism

Hypokalemiaperiodic paralysis (HPP) is a rare disorder characterized by acute muscle paralysis. Basedon its etiology, HPP can be classified as primary and secondary types. One of the most common causes ofsecondary HPP is renal tubular acidosis (RTA) which may be also present in thyroid disease. We observed acase of a 48-year-old female, with complaints of weakness in both lower extremities for two days. Difficultiesin walking and weakness in both arms were also present. Patient also experienced nausea, vomiting, anddiarrhea 4 days before coming to the hospital. She had a history of thyroidectomy in 2009 and in 2019 wasadmitted for similar symptoms. Medication consumed by the patient were Euthyrox 100 mg one time dailyand KSR 600 mg three times daily. In the last week, Euthyrox was discontinued by the patient due to herdiarrhea. The patient’s general condition was weak and vital signs were BP 120/80 mmHg, pulse 84 bpm, RR18 times per minute and temperature was 36.6°C. Motoric strength was 4/4 in both arms and 3/3 in both legs.No pathological neurological reflexes were found during examination. Inverted T wave and prominent Uwave were seen on electrocardiogram (ECG) results.Laboratory results showed hypokalemia (2.0 mmol/L),Blood Gas Analysis: Metabolic Acidosis (pH 7.42, pCO2 32 mmHg, HCO3 20.8 mmol/L, BE -3.7 mmol/L)with anion gap of 14.2 meq/L. Urinalysis results were pH 8, urinary anion gap 18.29 mmol/h. Decreasedthyroid function was also shown in the endocrine laboratory panel FT4 0.57 ng/dl and TSH 32.097 IU/mL.HPP is a disorder characterized by muscle weakness and may be present in distal type RTA. Clinicalsymptoms of distal type RTA are hypokalemia, hyperchloremic metabolic acidosis, urinary pH &lt;5.5. Distaltype RTA can be caused by endocrine disorder i.e., hypothyroidism. Observation of patient condition andlaboratory results lead to the conclusion that the patient is diagnosed with hypokalemic periodic paralysisand renal tubular acidosis based on hypokalemia, metabolic acidosis with normal anion gap, and alkalineurine with positive urinary anion gap.

The "vicious circle" of thyroid metabolism in patients with chronic kidney disease

Background. Decreased thyroid function is common in patients with chronic kidney disease. Under conditions of hypothyroidism, there is significant changes in lipid metabolism, nitrogen excretion function of the kidneys. THE AIM. To study the parameters of the functional state of the thyroid gland in patients with various stages of chronic kidney disease. Patients and methods . A one-stage cross-sectional study of patients with glomerulopathies without clinically significant diseases of the cardiovascular system with preserved EF (&gt; 55 % according to Simpson) from April 2019 to March 2020 was carried out. The study included 270 patients. To identify subclinical hypothyroidism (SH), the TSH level was determined. Patients were divided into groups according to TSH level: low TSH, normal TSH, and subclinical hypothyroidism. In patients, the indicators of biochemical blood analysis, data from a complex laboratory functional examination of the kidneys were assessed. Results. The detection rate of SH in patients with different stages of CKD was 17.56 %. Patients with SH were significantly older than the group of patients with normal TSH levels (p=0.002). In the group of patients with subclinical hypothyroidism, anti-TPO antibodies were detected only in 9.6 % of patients. A correlation was found between GFR and free T3 in patients with 3B and 4 stages of CKD (r=0.3, p&lt;0.05). In the group of patients with subclinical hypothyroidism, there was a decrease in total protein and albumin, an increase in daily proteinuria, a decrease in total calcium, increased inorganic phosphorus, chlorine, decreased renal transport of uric acid. Conclusion. Increased TSH levels are associated with advanced stages of CKD. The increase in TSH levels in patients with CKD is not associated with female sex and older age. In most patients with glomerulopathies, an increase in TSH levels is not an outcome of autoimmune thyroiditis. SH in CKD patients is associated with severe impairment of renal nitrogen excretion function, protein, and electrolyte metabolism.

Thyroid Dysfunction and Thyroid Cancer in Childhood Cancer Survivors: Prevalence, Surveillance and Management.

Childhood cancer survivors (CCS) are at increased risk of developing thyroid disorders during follow-up. Radiation therapy to a field that includes the thyroid gland and 131I-meta-iodobenzylguanidine (131I-MIBG) treatment are the main risk factors for thyroid sequelae, which include decreased thyroid function, hyperthyroidism, thyroid nodules, and differentiated thyroid cancer, specifically papillary thyroid carcinoma. In addition, treatment with anti-neoplastic drugs or immunotherapy may result in thyroid dysfunction. Central hypothyroidism may be seen in CCS after cranial radiotherapy, after immunotherapy, or secondary to a brain tumor that involves the hypothalamic-pituitary region and will be discussed elsewhere in this series. In this chapter, the prevalence, risk factors, surveillance, and management of primary hypothyroidism, hyperthyroidism, thyroid nodules, and differentiated thyroid carcinoma in CCS are discussed.

Ultrasound Findings of Thyroiditis

Thyroiditis is a general term that refers to the inflammation of the thyroid gland. It can be classified as acute, subacute (painful and painless), or chronic. Clinical symptoms may include pain and tenderness when caused by infection, but it may be painless when caused by autoimmune conditions. It can be associated with normal, increased, or decreased thyroid function, often with changing from one condition to another. Several parameters evaluated by the ultrasound (US) contribute to the diagnosis. This article reviews the types of thyroiditis and their US findings. Keywords: Thyroidtis; Ultrasound 중심 단어: ê°‘ìƒì„ ì—¼; 초음파

Thyroid Function Changes in a Rat Model of Vitamin D Deficiency and Effect of Vitamin D and Metformin Treatment

Abstract Background: Previous studies showed controversies about the association of vitamin D deficiency and thyroid dysfunction and up to our knowledge there was no study that were con-ducted to study the effect of vitamin D deficiency on thyroid function. Metformin is an antidiabetic drug that is widely used and also there was contradictory data about its effect on thyroid function. Aim of Study: To identify whether vitamin D deficiency is considered a cause for hypothyroidism or not. Also, to investigate the effect of metformin treatment on thyroid function in a rat model of vitamin D deficiency. Material and Methods: 40 Adult male albino rats of local strains were divided randomly into 5 equal groups; control, control metformin treated (control + metformin), vitamin D deficient, vitamin D deficient metformin treated (vitamin D deficient + metformin) and vitamin D deficient vitamin D treated (vitamin D deficient + vitamin D). Results: Vitamin D deficiency model significantly in-creased final Body Mass Index (BMI), relative thyroid weight, serum Thyroid Stimulating Hormone (TSH), serum reverse triiodothyronine (rT3) and hepatic deiodinase 3 activity but significantly declined serum levels of each of triiodothyronine (T3), thyroxin (T4), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) when compared to control group. Metformin treatment of vitamin D deficient rats significantly reduced relative thyroid weight with a significant decreased in TSH level when compared with vitamin D deficient group. A significant negative correlation was reported between serum 25(OH)D and each of final BMI, serum TSH, relative thyroid weight, hepatic deiodinase activity and serum rT3 but it was positively correlated to serum level of both T3 and T4. Histopathology and histomorphometric studies of the thyroid gland in vitamin D deficient rats showed a large number of follicles with increased dimensions, the follicular colloid showed no vacuolation, the amount of colloid increased and the follicles were found to be lined by simple cuboidal epithelial cells with basal nuclei. Conclusion: As vitamin D deficiency decreased thyroid function through affecting hepatic deiodinase 3 activity and this change was deteriorated with vitamin D supplementation, thus, monitoring of vitamin D levels and its supplementation may play a role in management of hypothyroidism. Also, metformin exerted an anti-proliferative activity, improved thyroid structure and lowered TSH without affecting serum levels of T4 or T3, thus it could provide a rationale for an innovative therapy of thyroid proliferative diseases.

The impact of selective serotonin reuptake inhibitors on the thyroid function among patients with major depressive disorder: A systematic review and meta-analysis

Selective serotonin reuptake inhibitors (SSRI) have been claimed to negatively affect the thyroid function, albeit the evidence is controversial. We searched for studies that measured parameters of thyroid function (TSH, T4, Free T4, or T3) before and after a course of SSRI treatment in euthyroid patients with major depressive disorder. Electronic searches were conducted on MEDLINE, Embase and Web of Science databases from inception through April 4th, 2018. We performed random-effects meta-analyses to estimate the effect of SSRIs on each hormone. A total 1791 records were identified in the electronic search, and 14 observational clinical studies were included in the analyses. All studies had at least moderate risk of bias and were considered of low quality. A course of SSRI treatment was associated with a decrease in T4 of –6.58 nmol/L (95% Confidence Interval [CI], –12.17 to –.99, p = .005, I2=97%; Cohen's d = .50), a decrease in Free T4 of –.91 pmol/L (95% CI, –1.65 to –.16, p = .017, I2=96%; Cohen's d = .66), and a decrease in T3 of –.10 nmol/L (95% CI, –.18 to –.03, p = .007, I2=96%; Cohen's d = .45), and no effect on TSH (0.06 microIU/L, 95% CI, –.05 to .17, p = .285, I2=98%; Cohen's d = .17). We did not detect publication bias in any of the four meta-analyses. We conclude that there is preliminary evidence that SSRIs slightly decrease thyroid function, but quality of evidence is low. Clinical magnitude of such effect is yet unclear.