Disturbances Of Thyroid Function Research Articles

High Frequency of Cystic Fibrosis-Related Endocrinopathies in a Population of Colombian Children: A Cross-Sectional Study

Objective: The median length of survival for cystic fibrosis (CF) has significantly increased in recent years; however, this means that endocrine complications are more frequently observed in affected patients. This research was aimed at evaluating the frequency, clinical and paraclinical features, and the treatment of linear growth and pubertal disturbances, vitamin D insufficiency/deficiency, CF-related bone disease, and adrenal and thyroid function disturbances in patients with CF, as well as to explore their association with lung function and colonization. Method: A cross-sectional study with a retrospective collection of information from patients under 18 years of age with a confirmed diagnosis of CF, evaluated on an outpatient or in-hospital basis by a pediatric pulmonologist or endocrinologist, or in a multidisciplinary CF consultation, between January 2011–December 2020. Results: A total of 87 patients were included. A high frequency of endocrinopathies was found. Vitamin D insufficiency/deficiency was persistent despite cholecalciferol supplementation in 72%, short stature in 38%, pubertal delay in 26%, and thyroid axis disorders in 8% of cases. Bone disease involving densitometry and adrenal insufficiency secondary to chronic corticosteroid use were also frequent among the screened subjects (44% [n=16] and 12% [n=51], respectively). No significant differences were found for pulmonary function or bacterial lung colonization in the context of any endocrinopathies. Conclusion: Endocrine comorbidities are frequent in patients with CF, and early recognition improves the prognosis and quality of life in these patients. The findings for this cohort ratify the importance of multidisciplinary management of patients with CF.

Hiperhomocisteinemija kao faktor rizika za razvoj patoloških promena u kardiovaskularnom sistemu - mehanizmi i posledice

Hyperhomocysteinemia represents a pathological condition characterized by an increased concentration of homocysteine in the blood, exceeding the threshold of 15 µmol/L. Hyperhomocysteinemia can be caused by genetic defects in enzymes involved in the metabolism of homocysteine and inadequate intake of vitamin B6, folic acid, and/or vitamin B12, disturbances in kidney and thyroid function, malignant diseases, psoriasis, and diabetes, as well as the use of certain medications, alcohol, tobacco, and caffeine. Hyperhomocysteinemia leads to damage to blood vessels through the induction of the proliferation of vascular smooth muscle cells, disruption of physiological endothelial functions, accumulation of reactive oxygen and nitrogen species, i.e., induction of oxidative and nitrosative stress, increased production of collagen, and degradation of the elastic fibers of the arterial wall, disturbance in the production of nitric oxide, dysfunction in the H2S signaling pathway, cellular hypomethylation, homocysteinylation of proteins, and disturbances in lipid metabolism. These pathophysiological mechanisms lead to accelerated atherosclerosis, which ultimately results in diseases such as acute myocardial infarction, heart failure, stroke, and peripheral vascular disease. In patients with the aforementioned diseases, or with associated risk factors such as hypertension, diabetes, obesity, smoking, or a positive family history of coronary heart disease, it is of great importance to determine and monitor the concentration of homocysteine in the blood and to take measures in the form of lifestyle changes aimed at secondary prevention of the consequences that hyperhomocysteinemia brings with it.

Nickel as a potential disruptor of thyroid function: benchmark modelling of human data.

Nickel (Ni) is one of the well-known toxic metals found in the environment. However, its influence on thyroid function is not explored enough. Hence, the aim of this study was to analyse the potential of Ni to disrupt thyroid function by exploring the relationship between blood Ni concentration and serum hormone levels (TSH, T4, T3, fT4 and fT3), as well as the parameters of thyroid homeostasis (SPINA-GT and SPINA-GD) by using correlation analysis and Benchmark (BMD) concept. Ni concentration was measured by ICP-MS method, while CLIA was used for serum hormone determination. SPINA Thyr software was used to calculate SPINA-GT and SPINA-GD parameters. BMD analysis was performed by PROAST software (70.1). The limitations of this study are the small sample size and the uneven distribution of healthy and unhealthy subjects, limited confounding factors, as well as the age of the subjects that could have influenced the obtained results. The highest median value for blood Ni concentration was observed for the male population and amounted 8,278 µg/L. Accordingly, the statistically significant correlation was observed only in the male population, for Ni-fT4 and Ni-SPINA-GT pairs. The existence of a dose-response relationship was established between Ni and all the measured parameters of thyroid functions in entire population and in both sexes. However, the narrowest BMD intervals were obtained only in men, for Ni - SPINA-GT pair (1.36-60.9 µg/L) and Ni - fT3 pair (0.397-66.8 µg/L), indicating that even 78.68 and 83.25% of men in our study might be in 10% higher risk of Ni-induced SPINA-GT and fT3 alterations, respectively. Due to the relationship established between Ni and the SPINA-GT parameter, it can be concluded that Ni has an influence on the secretory function of the thyroid gland in men. Although the further research is required, these findings suggest possible role of Ni in thyroid function disturbances.

The impact of quetiapine monotherapy or in combination with lithium on the thyroid function in patients with bipolar depression: A retrospective study.

This study aims to investigate whether quetiapine monotherapy or in combination with lithium significantly disturbs thyroid function in depressed patients with bipolar disorder (BD), and whether difference exists in the post-treatment thyroid function between the two therapies. Based on the electric medical records, outpatients and inpatients with a current depressive episode of BD from January 2016 to December 2022 were screened. All patients were treated with quetiapine monotherapy or in combination with lithium. In addition to the demographic data and depression scale, thyroid profiles including total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and antithyroglobulin antibody (TGAb) were recorded, analyzed, and compared before and after the treatment. Totally, 73 eligible patients were enrolled, including 53 in the monotherapy group (MG) and 20 in the combined therapy group (CG). No significant differences in thyroid profiles were detected between the two groups at the baseline (p > 0.05). After one-month treatment, in the MG, serum levels of TT4, TT3, FT4, and FT3 reduced significantly (p < 0.05), while TSH, TPOAb, and TGAb increased significantly (p < 0.05). In the CG, serum levels of TT4, TT3, and FT4 reduced and TSH increased following one-month treatment (p < 0.05), with no significant change in FT3, TPOAb, or TGAb (p > 0.05). After one-month treatment, no difference of TT4, TT3, FT4, FT3, and TSH was found between the two groups (p > 0.05). Both quetiapine monotherapy and a combined therapy with lithium significantly disturbed thyroid function in patients with bipolar depression, while quetiapine monotherapy seems to be associated with immune dysregulation in the thyroid.

Long-term percutaneous triclosan exposure induces thyroid damage in mice: Interpretation of toxicity mechanism from metabolic and proteomic perspectives

Triclosan (TCS) is an antiseptic incorporated in consumer goods and personal care products that can be absorbed via the skin, raising public health concerns for its continuous detection in human biofluids and tissues. Epidemiology has associated TCS exposure with thyroid function disturbances and decreasing serum thyroid hormone (TH) levels, but the underlying mechanism remains unclear. In this study, we revealed hypothyroidism and histological alternation in the thyroid of mice with chronic percutaneous exposure to TCS, indicating a TCS-caused thyroid impairment. Subsequently, multi-omics approaches were performed to investigate the molecular mechanism of the thyroid in response to long-term dermal TCS exposure. We discovered that TCS interfered with the TH synthesis as indicated by the changes in the levels of the synthetic materials for TH (iodide, Tg, and H2O2) and affected TH release by the downregulation of lysosomal enzymes. The upregulation of glycolysis, tricarboxylic acid cycle, fatty acid, amino acid metabolism, and adenine salvage in the thyroid was also observed after TCS exposure. All these changes led to the elevation of ATP, serving as a rescue for the decreasing thyroid functions. Together, our study demonstrated TCS-induced thyroid damage and identified the interrupted pathways, providing meaningful insight into the molecular mechanisms underpinning the potential health influence of TCS in humans.

Association of Primary Subfertility in Polycystic Ovarian Syndrome with BMI and Waist Circumference

Background: To determine the association of primary subfertility in Polycystic Ovaries with BMI and waist circumference. Methods: This cross-sectional study was performed from 01-08-2018 to 01-08-2019 at the Department of Obstetrics &amp; Gynecology, Indus Medical College, Tando Muhammad Khan on (n=245) diagnosed with polycystic ovaries in the age group of 18 to 49 years. The study population, having diabetes mellitus, increased prolactin levels, disturbed thyroid function, congenital adrenal hyperplasia, and the couples with contraceptive measures were not included. Mean ± SD was computed for numerical data, frequencies and percentages were computed for qualitative data. Chi-square was used as a test of significance with a P-value &lt;0.05 as significant. Results: The mean ± SD age of these women was 33.46±6.71 years with a range from 18 to 45 years. The proportion of subfertility in PCOS was 40.41%. The frequency of subfertility in PCO increases from normal weight to obesity significantly. (P-value &lt;0.01) Additionally; women presenting with PCOS and increased waist circumference had a higher frequency of subfertility. (P-value &lt;0.01). Conclusion: A much higher proportion of women with PCOS who present with obesity, overweight, and higher waist circumference were subfertile. With early screening and treatment for PCOS, weight control also is necessary to prevent the big issue of subfertility. Keywords: Obesity, Polycystic Ovarian Syndrome. Subfertility.

Assessment of the Thyroid Functions among Female Flight Attendants.

Introduction: Epidemiological observations indicate that stewardesses are exposed to reproductive and endocrine system disturbances. The aim of the study was to assess of thyroid function disturbances as well as to identify factors affecting the thyroid function among stewardesses working both within one time zone and on long-distance flights. Material and methods: The cross-sectional study covered 103 women aged 23–46. The study group (I) was divided into two subgroups: group Ia comprising stewardesses flying within one flight zone and group Ib stewardesses working on long-distance flights. The control group (II) were women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, BMI, menstrual cycle regularity, length of work, frequency of flying, thyroid stimulating hormone (TSH) concentration, level of free thyroxine (fT4), antibodies to thyroglobulin (aTG) and to thyroperoxidase (aTPO), prolactin concentration, sex hormone binding globulin (SHGB) concentration, total cholesterol, and low density lipoprotein (LDL) fraction. Descriptive methods and inferential statistics methods were used to compile the data. Results: The difference between the concentrations of TSH in the study group (2.59 mcIU/mL) and the control group (1.52 mcIU/mL) was statistically significant (p < 0.01). An elevated titer of thyroid antibodies (aTPO and/or aTG) was revealed in 46.3% of stewardesses and in 15.1% of patients from the control group (p < 0.001). Groups Ia and Ib in individual concentrations were not statistically significant. The frequency of occurrence of an elevated titer of thyroid antibodies depended on the length of work in the study group (p > 0.05). No statistically significant difference was found in patients spending up to 60 h a month flying and in patients spending more than 60 h flying, the percentage of the occurrence of thyroid antibodies was 50% and 43.5, respectively. Conclusions: The occurrence in stewardesses of a higher TSH concentration than in the control group can signify that stewardesses are burdened with a higher risk of the development of hypothyroidism in the future. The character of the work of stewardesses (frequency of flying as well as length of work) does not affect the immunological profile of the thyroid.

The effect of levetiracetam and oxcarbazepine monotherapy on thyroid hormones and bone metabolism in children with epilepsy: A prospective study

BackgroundLong-term treatment with certain antiepileptic drugs may lead to thyroid function disturbances or alterations in bone metabolism; the data on the effects of new antiepileptic drugs on this are limited and conflicting, especially in children with epilepsy. Therefore, the aim of this study was to investigate the effects of levetiracetam and oxcarbazepine on thyroid hormone levels and bone metabolism in children with epilepsy. MethodsA total of 51 children with new-onset partial epilepsy were selected. They were randomly treated with either levetiracetam (n = 25), or oxcarbazepine (n = 26) monotherapy. Eight of the 51 patients were excluded for failing to take the drug continuously or failing to undergo a regular review. Thus, 43 patients were finally included (levetiracetam: 23 patients, oxcarbazepine: 20 patients). A control group consisting of age- and sex-matched healthy subjects (n = 20) was included for comparison. Serum triiodothyronine, tetraiodothyronine, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, calcium, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and 25-hydroxyvitamin D levels and bone mineral density values were measured before and at 6 and 12 months after therapy in all groups. ResultsAt baseline, thyroid hormone levels, bone metabolism index, and bone mineral density values did not differ between the control group and the drug-treated groups. Levetiracetam-treated patients showed no significant changes in thyroid hormone levels, bone metabolism, and bone mineral density during the 12-month follow-up period compared with baseline values. In the oxcarbazepine group, compared to baseline values, serum free thyroxine levels decreased after 12 months of treatment (Z = −3.115, p = 0.002), and after 6 and 12 months of treatment, calcium levels decreased (Z = −3.705, p < 0.001 and Z = −3.884, p < 0.001, respectively) and parathyroid hormone levels increased (Z = −3.698, p < 0.001 and Z = −3.921, p < 0.001, respectively); however, all other parameters did not differ from baseline values. ConclusionOur data show that levetiracetam treatment has no significant effect on thyroid function and bone metabolism in children with epilepsy. Long-term use of oxcarbazepine may reduce serum free thyroxine levels, resulting in impaired thyroid function, and may reduce serum calcium and increase parathyroid hormone levels, leading to bone metabolism disorders.

The significance of high thyroxine in hospitalized patients with low thyroid-stimulating hormone

There is scarce data about the interpretation of high thyroid hormone levels in hospitalized patients. We wished to investigate the significance of high thyroxine (T4) in hospitalized patients with low TSH. We conducted a retrospective study of data from patients in nonsurgical departments. Three groups of random patients with low TSH were defined and compared: 123 patients with only high FT4 levels (T4 group), 82 with high FT3 levels with or without high FT4 level (T3 group), and 119 with low FT3 and FT4 level in the lower half of the norm and below (NTIS group). The primary cause of admission in the T4 and NTIS groups was infectious disease, 20.3% and 40.3%, respectively; while in the T3 group it was cardiovascular disease (31.7%). The T4 group but not T3 group had epidemiological and clinical characteristics similar to the NTIS group. The T4 group had a significant correlation between increased CRP levels and decreased FT3 (r = 0.366, p < 0.001) similar to the NTIS group. The T3 group had a borderline correlation between increased FT3 and FT4 levels (r = 0.208, p = 0.061) but the T4 group did not. The combination of low TSH and high FT4 levels in hospitalized patient is usually caused by nonthyroidal illness combined with drug effects. This thyroid function disturbance is common in hospitalized patients and if the FT3 level is below the middle of the norm, treatment is probably unnecessary.

Relationship between maternal thyroid function disturbance and malpresentation in term fetus

Background: Malpresention is any presentation other than the vertex, breech presentation at term is the most common abnormal fetal presentation and is associated with neonatal and maternal morbidity and mortality. Many etiological factors associated with malpresention including prematurity, intrauterine growth restriction; uterine and pelvic abnormality and endocrine diseases as in hypo – or hyperthyroidism which impair obstetrical outcome. Objectives: To study and evaluate the relationship of disturbed maternal thyroid function during gestation and abnormal fetal presentation at term. Patients and methods: Prospective randomized study of pregnant women Over nine months period from October 2013 to July 2014 A hundred healthy pregnant women who living in Tikrit and Al-Fallujah cities with age ranging from 19 – 45 years old (mean age of 28.5) randomized selected undergone history and clinical examination, obstetrical ultrasonic examination done for them with blood sample taken at term(37 gestational week and more) for thyroid function assessment through free thyroxin T3, bound thyroxin T4, thyroid stimulating hormone TSH. Result: A fifty pregnant women were cephalic presentation (50%), thirty five were breech (35%) and other presentations such as shoulder, face, brow were 10%, 4% and 1% respectively. Normal thyroid function through thyroid parameters was shown in (83%) of the pregnant (class I), (8%) of cases were associated with hyperthyroxinaemia (class II) and (9%) were hypothyroxinaemia (class III); 2 cases of cephalic presentation (2%) of total cases; 6 cases of breech (6%) of total cases and one case of shoulder presentation (1%) of total cases were hypothyroxinaemia, 4 cases of cephalic presentation (4%), 3 cases of breech (3%) and one case (1%) face presentation were (class II) Hyper thyroxinaemia). Conclusion: Pregnant women with abnormal thyroid function during gestation are at risk of fetal malpresentation. Hypothyroxinaemic pregnant showing high incidence of breech presentation with more incidence of caesarean section and more fetal, maternal and obstetrical complications.

Age effect on thyroid hormone brain response in male mice

Thyroid hormones (TH) are important for brain development and central nervous system (CNS) function. Disturbances of thyroid function occur with higher prevalence in the ageing population and may negatively impact brain function. We investigated the age impact on behavior in young adult and old male mice (5 vs. 20 months) with chronic hypo- or hyper-thyroidism as well as in sham-treated controls. Expression of TH transporters and TH responsive genes was studied in CNS and pituitary by in situ hybridization and qRT-PCR, whereas TH serum concentrations were determined by immunoassay. Serum TH levels were lower in old compared with young hyperthyroid mice, suggesting a milder hyperthyroid phenotype in the aged group. Likewise, elevated plus maze activity was reduced in old hyperthyroid animals. Under hypothyroid conditions, thyroxine serum concentrations did not differ in young and old mice. Both groups showed a comparable decline in activity and elevated anxiety levels. However, an attenuated increase in hypothalamic thyrotropin releasing hormone and pituitary thyroid stimulating hormone transcript expression was found in old hypothyroid mice. Brain expression of monocarboxylate transporter 8 and organic anion transporting polypeptide 1c1 was not affected by age or TH status. In summary, ageing attenuates neurological phenotypes in hyperthyroid but not hypothyroid mice, which fits with age effects on TH serum levels in the animals. In contrast no changes in TH transporter expression were found in aged mouse brains with hyper- or hypo-thyroid state.

Association of Thyroid Function with Handgrip Strength: Data from the Study of Health in Pomerania and the Berlin Aging Study II.

Background: Untreated overt hypo- and hyperthyroidism can lead to detrimental effects on muscle tissue and physical performance, but it is still unclear whether subclinical hypo- or hyperthyroidism has clinically relevant effects on muscle function and physical performance. The objective of this study was to determine associations of thyrotropin (TSH) with grip strength and physical performance. Methods: A sample of 6196 participants from the Study of Health in Pomerania and the Berlin Aging Study II was included in this cross-sectional analysis. Handgrip strength was measured with a hand-held dynamometer and physical performance was assessed with the timed up and go (TUG) test. Results: Serum TSH levels were significantly inversely associated with handgrip strength (β -0.11; [95% confidence interval, CI, -0.18 to -0.03]; p < 0.05) in multivariable linear regression. Individuals with high (β -1.06; [95% CI -1.86 to -0.26]; p < 0.05) or low (β -0.99; [95% CI -1.70 to -0.28]; p < 0.05) serum TSH levels had a significantly lower handgrip strength than individuals with serum TSH levels within the reference range. There was no association between TSH and the TUG time. Age showed a significant influence on the association of TSH with grip strength and TUG time. Conclusions: Even mild disturbances of thyroid function might lead to a relevant decline in grip strength, particularly in young and middle-aged subjects. Mild subclinical hypothyroidism might not be that unfavorable with regard to physical function in terms of handgrip strength at older age. Further studies are needed to clarify causal relationships.

The effect of thyroid dysfunction and treatment on fat tissue adiponectin levels in rats

Adipose tissue is a hormonal active system that produces and releases leptin, adiponectin and resistin. Seen from this aspect, it may be thought that adiponectin may interact with the thyroid axis. Thyroid function disturbance led to changes on the body weight, muscle volume and adipose tissue. Experimental findings show that adiponectin and thyroid hormones have biological interactin with each other. However, various results have been reported a relationship between thyroid hormones and adiponection levels. The aim of the present study was to determine adipose tissue adiponectin levels in rats with thyroid dysfunction and after treatment. Study was performed on 40 Sprague-Dawley male rats. Groups were designed as 1-control, 2-hypothyroidism (Hypo), 3- hypothyroidism + Thyroxine, 4-hyperthyroidism (Hyper), 5-hyperthyroidism + PTU. At the end of 3 weeks experimental period, adipose tissues of rats were analyed for adiponection by Elisa. Experimental hypothyroidism reduced adipose tissue adiponectin levels, but hyperthyrodism increased. Treatment of hypothyroidism and hyperthyroidism corrected disrupted adiponectin levels to control. The results of the present study show that experimental thyroid dysfunction has affected adipose tissue adiponection levels in rats.

THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: THE STATE OF THE PROBLEM AND THE WAYS OF SOLVING

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney disease is the higher incidence of various thyroid function disturbances, especially hypothyroidism. It is known that in patients with chronic kidney disease (CKD) iodine excretion from the body is violated, since normally 90% of iodine is excreted in urine. Accumulation of high concentrations of inorganic iodine leads to the formation of the Wolf-Chaikoff effect: suppression of iodine organization in the thyroid gland and disruption of the thyroid hormones synthesis. Peripheral metabolism of thyroid hormones is also disturbed, namely, deiodinase type I activity is suppressed and peripheral conversion of T4 into T3 is inhibited (so-called low T3 syndrome). Therefore, patients with CKD are often diagnosed with hypothyroidism, and the origin of hypothyroidism is not always associated with the outcome of autoimmune thyroiditis. The article presents an overview of a large number of population studies of thyroid gland dysfunction in patients with CKD, as well as experimental data specifying the pathogenetic mechanisms of thyroid dysfunction in patients with CKD. Therapeutic tactics are still not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

Thyroid Function among Children with Iron Deficiency Anaemia: Pre and Post Iron Replacement Therapy

Introduction: Metabolism of thyroid hormones and iron is quite interdependent. Data indicates that Iron Deficiency (ID) could impair thyroid metabolism. Aim: To investigate the possible occurrence of thyroid dysfunction among children with isolated Iron Deficiency Anaemia (IDA) of various severities, and test if the oral iron replacement therapy alone can reverse the associated thyroid function disturbances, if present or additional therapies are required. Materials and Methods: This prospective study was carried out on 60 children selected from the attendants to the outpatient paediatric clinics of Al-Azhar University, Assiut and Qena university hospitals, Egypt, in addition to 60 controls. Complete blood count, thyroid profile, ferritin, iron, Total Iron Binding Capacity (TIBC), Transferrin Saturation% (TFS%), unsaturated iron binding capacity and Urinary Iodine Excretion (UIE) were assessed in the studied groups at baseline, then haemoglobin level and thyroid profile repeated among the studied patients after three months of oral iron supplementation therapy. Thyroid profile and ferritin were measured using commercially available Enzyme Linked Immunosorbent Assay (ELISA) kits; while, iron, TIBC and UIE were measured using colorimetric methods. Results: Significant higher serum Thyroid Stimulating Hormone (TSH) levels with significant lower serum levels of Free Triiodothyronine (FT3) and Free Thyroxine (FT4) among patients versus controls (p<0.001 for all). Significant positive correlation between serum iron and FT3 (r=0.284, p<0.05) with significant negative correlations between TSH versus both serum iron (r=-0.635, p<0.001) and ferritin (r=-0.342, p<0.01). Significant decrease in the serum levels of TSH, with significant increase in the serum levels of FT3 and FT4 (p<0.001 for all) to euthyroid status following oral iron replacement therapy. Conclusion: Subclinical or primary hypothyroidism can occur among children suffering from moderate to severe IDA, which is reversible following oral iron replacement therapy only, without need to add thyroid replacement therapy.

P265 Correlation of thyroid function disturbances and amyotrophic lateral sclerosis syndrome

Background Coexistence of Amyotrophic Lateral Sclerosis Syndrome (ALS-S) with thyroid disturbances is long ago noticed. Though, previous research did not confirm the role of thyroid hormones in ALS-S. Purpose to research the role of thyroid gland hormones and free radicals in patients with ALS-S. Methods Totally 52 patients aged 51–67 years with ALS-S investigated neurologically from endemic goiter area of Georgia. ALS was proved by Neuro-MEP-Micro (version 2009) 2-channel portable EMG. Serum levels of thyroxine (FT4), thyroid stimulating hormone (TSH) and antibodies against thyroid peroxidase (anti-TPO) were detected. The hormone levels analyzed by an electrochemiluminescence method on the apparatus Roche E411. Blood free radicals detected by Electron Paramagnetic Resonance Method (EPR). Statistics performed by SPSS-11.0. Results Neurologically was found spastic-atrophic changes of the limb muscles in each patient. EMG showed signs of motor neurons’ damage. From all ALS-S patients 38 (73%) found to have hypothyroidism (TSH = 14 ± 2.4 mIU/L, FT4 = 1.7 ± 0.8 ug/dL, anti-TPO = 35 ± 5.5 IU/ml); 14 patients (27%) diagnosed as Hashimoto’s thyroiditis (TSH = 11 ± 2.6 mIU/L, FT4 = 2.6 ± 0.7 ug/dL, anti-TPO = 300 ± 45.5 IU/ml). Blood lypoperoxiradical (LOO-) was detected in all ALS-S patients. Positive correlation was found between the blood data of anti-TPO and blood data of LOO-. All patients were given appropriate treatment for thyroid disturbances. After 6 months treatment patients’ health was clinically improved, increased volume of innervation by EMG. Conclusion According to the present study autoimmunity definitely assists to the promotion of free radical pathology in ALS-S and investigations in this direction should be continued.

Thyroid Functional Abnormalities in Newly Diagnosed AL Amyloidosis: Frequency and Influence By Type of Organ Involvement and Disease Burden

AL amyloidosis is a systemic disease with profound effects on organ function. However, despite the broad array of disease manifestations, the effect of AL amyloidosis on thyroid function is underreported. We explored the frequency of thyroid function abnormalities in 961 untreated AL amyloidosis patients seen in our clinic between 8/2005-8/2015, with emphasis on association with other organ involvement and tumor burden. Thyroid function was assessed using the thyroid stimulating hormone assay (TSH, normal range 0.3-5 mIU/L). If TSH was abnormal, measurement of free thyroxine (FT4) and thyroid peroxidase (TPO) antibodies was routinely performed. Patients’ median age was 62 [interquartile range (IQR) 56-69], 62% were male (Table). The median number of organs involved was 2 (IQR 1-3), 29% of patients had more than 2 involved organs. Seventy-seven percent of patients had cardiac involvement, 61% renal, 23% peripheral/autonomic neuropathy, 19% hepatic and 15% gastro-intestinal (GI) involvement. The median difference between involved and uninvolved light chains (dFLC) was 24.4 [interquartile range 10.6-65.2 mg/dL]. The median TSH was 3 mIU/L (range 0.1-50.1); 22% had levels above the normal range and 8% of patients had TSH greater than 7.5 mIU/L. Baseline characteristics by TSH ≤5 mIU/L and TSH >5 mIU/L subgroups can be viewed in Table. Patients with renal or hepatic involvement had higher TSH values compared to no renal or no hepatic involvement (3.2 vs 2.6 and 2.8 vs 3.8, respectively; P<0.001 for both comparisons). There was a borderline significance for higher TSH in patients with >2 organ involvement compared to 1-2 affected organs (3.3 vs 2.8; P=0.05), with a strong trend for higher TSH for dFLC ≥18 mg/dL compared to dFLC<18 mg/dL (P=0.07). In patients with renal involvement, presence of proteinuria > 2 grams/day was associated with a higher likelihood of TSH >7.5 mIU/L (13% vs 5%; P=0.003). Free thyroxine (FT4) measurements were performed in 214 (22%) of patients with a median value of 1.1 ng/dL(range 0.3-72), 6% had levels below the lower limit (0.8 ng/dL). One-hundred and sixty five patients (17%) were screened for TPO antibodies, of which 16% (n=27) had an elevated titer. L-thyroxine (median dose 100 mcg/d, range 25-350 mcg/d) was already prescribed to 157 of the patients (16%) at their first visit, but duration of treatment prior to AL amyloidosis diagnosis could not be determined. Seventeen patients (1.5%) were prescribed amiodarone (median dose 200mg/d, range 100-400 mg/d), and although numbers were low, patients with amiodarone treatment had a TSH twice as high as patients without this treatment (6 vs 2.9 mIU/L, P=0.006). In conclusion, thyroid function abnormalities are frequent at the time of AL amyloidosis diagnosis and are influenced by type of organ involvement as well as disease burden assessed by dFLC and/or number of affected organs. Amiodarone, although infrequently used in this disease, can cause a profound disturbance in thyroid function among these patients. [Display omitted] DisclosuresDispenzieri:Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; pfizer: Research Funding; Celgene: Research Funding; Alnylam: Research Funding; Prothena: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; Jannsen: Research Funding. Kumar:AbbVie: Research Funding; Array BioPharma: Consultancy, Research Funding; Glycomimetics: Consultancy; Celgene: Consultancy, Research Funding; Noxxon Pharma: Consultancy, Research Funding; Skyline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Research Funding; Onyx: Consultancy, Research Funding; Kesios: Consultancy; BMS: Consultancy; Sanofi: Consultancy, Research Funding; Janssen: Consultancy, Research Funding.

Does exposure to phthalates influence thyroid function and growth hormone homeostasis? The Taiwan Environmental Survey for Toxicants (TEST) 2013

BackgroundPrevious epidemiologic and toxicological studies provide some inconsistent evidence that exposure to phthalates may affect thyroid function and growth hormone homeostasis. ObjectiveTo assess the relations between exposure to phthalates and indicators of thyroid function and growth hormone homeostasis disturbances both among adults and minors. MethodsWe conducted a population-based cross-sectional study of 279 Taiwanese adults (≥18 years old) and 79 minors (<18 years old) in 2013. Exposure assessment was based on urinary biomarkers, 11 phthalate metabolites measured by using online liquid chromatography/tandem mass spectrometry. Indicators of thyroid function included serum levels of thyroxine (T4), free T4, triiodothyronine, thyroid-stimulating hormone, and thyroxine-binding globulin (TBG). Growth hormone homeostasis was measured as the serum levels of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3). We applied multivariate linear regression models to examine these associations after adjusting for covariates. ResultsAmong adults, serum T4 levels were negatively associated with urinary mono-(2-ethyl-5-hydroxyhexyl) phthalate (β=−0.028, P=0.043) and the sum of urinary di-(2-ethylhexyl) phthalate (DEHP) metabolite (β=−0.045, P=0.017) levels. Free T4 levels were negatively associated with urinary mono-ethylhexyl phthalate (MEHP) (β=−0.013, P=0.042) and mono-(2-ethyl-5-oxohexyl) phthalate (β=−0.030, P=0.003) levels, but positively associated with urinary monoethyl phthalate (β=0.014, P=0.037) after adjustment for age, BMI, gender, urinary creatinine levels, and TBG levels. Postive associations between urinary MEHP levels and IGF-1 levels (β=0.033, P=0.006) were observed. Among minors, free T4 was positively associated with urinary mono benzyl phthalate levels (β=0.044, P=0.001), and IGF-1 levels were negatively associated with the sum of urinary DEHP metabolite levels (β=−0.166, P=0.041) after adjustment for significant covariance and IGFBP3. ConclusionsOur results are consistent with the hypothesis that exposure to phthalates influences thyroid function and growth hormone homeostasis.

Cardiogenic Shock Secondary to Thyroid Goiter Case Report

1.1 Background: Thyroid goiter can appear in some developing countries, related with iodo deficiencies. The main complications associated with goiter is airway obstruction, but cardiogenic shocks have not been reported previously. 1.2 Case: We report the case of a 59 year-old woman who comes to general surgery consultation for an anterior cervical mass associated with weakness, fatigue, and relative incapacity to complete her activities. At physical exam a thyroid goiter was suspected and ultrasound confirms this. Symptomatology was attributed to thyroid function disturbance and hormonal levels of TSH, T3 and T4 were confirmed as normal. Preoperative evaluation by Internal Medicine service was requested. One week later patient come to this evaluation with increased symptomatology, pallor, bradycardia, tachypnea, and parents refers a syncope too. At physical exam she was diaphoretic, with Glasgow of 12 points, pallor, cardiac frequency of 40 beats per minute and arterial pressure of 80/40mmHg, yugular ingurgitation, dyspnea, tachypnea of 27 breaths per minute, diminished peripheral pulses and distal cyanosis. CT scan refers a compressive mass dependent of left thyroid hemisphere without occlusion of airway and we appreciate a compression of left carotid artery. Patient does not improve with medical management and a cardiogenic shock secondary to carotid sinus stimulation was suspected, reason why an emergency thyroidectomy was scheduled. Hemi-thyroidectomy was completed without complications and after 24 hours’ patient was recovered and asymptomatic, confirming our suspects. 1.3 Conclusion: This case is a very rare presentation of multinodular thyroid goiter, without previous similar reports, but with high relevance to consider it in a similar scenario because the delate in urgent surgical management could worsen outcomes.

Maternal High Estradiol Exposure is Associated with Elevated Thyroxine and Pax8 in Mouse Offspring.

Our previous studies have shown that maternal high estradiol (E2) environment increased the risk of thyroid dysfunction in offspring. However, the mechanism involved remains unexplored. To evaluate the thyroid function of offspring after high E2 exposure and to explore the underlying mechanism, we established a high E2 mouse model of early pregnancy, and detected thyroid hormones of their offspring. In thyroids of offspring, the expressions of Tg, Nis, Tpo, Pax8, and Titf1 and CpG island methylation status of Pax8 and genes involved in methylation were analyzed. We found that thyroxine (T4) and FT4 levels of offspring were obviously increased in the high-E2 group, especially in females. In both 3- and 8-week-old offspring of the high-E2 group, Pax8 was significantly up-regulated in thyroid glands, accompanied by the abnormal CpG island methylation status in the promoter region. Furthermore, Dnmt3a and Mbd1 were obviously down-regulated in thyroids of the high E2 group. Besides, the disturbance of thyroid function in females was more severe than that in males, implying that the effects were related to gender. In summary, our study indicated that maternal high E2 exposure disturbed the thyroid function of offspring through the dysregulation and abnormal DNA methylation of Pax8.