Effect Of Subclinical Hypothyroidism Research Articles

Effects of subclinical hypothyroidism in type II diabetes mellitus patients on biochemical, coagulation, and fibrinolysis status

Effects of subclinical hypothyroidism in type II diabetes mellitus patients on biochemical, coagulation, and fibrinolysis status

ASSESSMENT OF COGNITIVE FUNCTIONS AMONG SUBJECTS WITH SUBCLINICAL HYPOTHYROIDISM

Objective: The consequences of overt hypothyroidism on CNS are well known. In contrast, there is less evidence regarding the effects of subclinical hypothyroidism (SCH) on cognitive functions. Studies have shown a variable association between SCH and cognitive dysfunction. This study was done to assess the prevalence of cognitive impairment among subjects with SCH. Methods: The participants were 100 subjects (aged 40-60 years) with SCH and similar number of age-matched euthyroid controls. Subclinical hypothyroidism was defined as serum TSH level > 4.5 mIU/L with normal FT3 and FT4. Participants were interviewed by a single observer. Cognitive function was assessed by mini mental state examination (MMSE) and clock drawing test (CDT). MMSE scores ≤24 is indicative of cognitive impairment. For CDT a score of ≥3 represents a cognitive deficit, while a score of 1 or 2 was considered normal. Results: The mean age of patient group was 47.4 years, and BMI of 26.1kg/m2 which were comparable to controls who had a mean age of 46.1 years (P=0.16) and mean BMI of 25.9 kg/m2 (P=0.25). All other baseline variables including sex ratio, co-morbidities, family history of dementia, smoking, alcohol use, education and exercise were also comparable in both groups. The mean TSH was 7.8 mIU/L in patients and 2.7 mIU/L in controls (P< 0.05). The mean MMSE score was 26.1 in patient group and 27.7 in controls (P=0.31) The patients had mean CDT of 2.32 and controls 2.44 (P=0.61). Cognitive impairment by MMSE (score ≤24) was found in 22.0% of patients and in 16.0% of controls (P=0.14), also the cognitive impairment by CDT (score of ≥3) was present in 27.0% of patients and 25.0% of controls (P=0.29). Conclusion: In the present study we have found that the prevalence of cognitive impairment in subjects with SCH is similar to the age matched controls. Therefore the potential benefit of levothyroxine therapy if used with an aim of improving cognitive functions becomes doubtful.

Maternal and Neonatal Outcomes of Sub-clinical Hypothyroidism Treated With Levothyroxine in Pregnancy: A Retrospective Cohort Study.

The effect of sub-clinical hypothyroidism (SCH) in pregnancy has been controversial. Furthermore, the impact of levothyroxine replacement on improving outcomes in pregnant women with SCH is unknown. This study aimed to assess the maternal and neonatal outcomes of pregnant women with SCH who were treated with levothyroxine replacement. This retrospective chart review was conducted at a tertiary hospital in Iran between 2020 and 2022. All pregnant women who had given birth during the study period were recruited. Those who did not have thyroid function test results within 10-12 weeks, as well as those with SCH who did not have levothyroxine replacement, were excluded. The subjects were divided into two groups based on the 2017 American Thyroid Association (ATA) criteria: non-SCH (TSH values 0.27-2.5 mIU/L) and SCH (TSH values more than 4.0 mIU/L). The demographic, obstetric, maternal, and neonatal outcomes of both groups were compared. The Chi-square test was used to compare the categorical variables. Binary logistic regression was used to assess differences in categorical variables. With a frequency of 10.5%, 935 women out of 8888 were diagnosed with SCH. In terms of age, educational level, living residency, medical insurance, access to prenatal care, and smoking status, there were no differences between the two groups. In terms of gestational age, parity, onset of labor, history of infertility, hypertension, cardiovascular disease, anemia, and overt diabetes, there were no differences between the two groups; however, gestational diabetes was more common in those with SCH. Compared with the non-SCH group, the prevalence and risks of gestational diabetes [19.8 vs. 14.2, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.72-3.95] were significantly higher in the SCH group after controlling for confounding factors. There were no differences in neonatal outcomes between the two groups. Except for gestational diabetes, we found no significant adverse events in terms of maternal and neonatal outcomes among women with SCH who were treated with levothyroxine.

P-684 Subclinical hypothyroidism and ovarian reserve indices in women with normogonadotropic anovulation

Abstract Study question Does subclinical hypothyroidism (SCH) affect ovarian reserve indices in women with Polycystic Ovary syndrome (PCOS) or other forms of Hypothalamic-Pituitary-Ovarian Axis Dysfunction (HPOD)? Summary answer SCH increases Anti-Müllerian hormone (AMH) concentration, but has no influence on Follicle-stimulating hormone (FSH). What is known already In PCOS, anovulation is caused by the arrest of growing follicles due to increased frequency and amplitude of luteinizing hormone (LH) pulses, resulting in increased number of pre-antral and antral follicles, and concentration of AMH. In other cases of HPOD, the causes of anovulation are more diverse and have not yet been clearly identified. Thyroid hormones can modify the function of the HPO axis, affecting the maturation of follicles. While overt hypothyroidism is treated to improve ovulation and fertility, the effect of subclinical hypothyroidism (SCH) and the presence of circulating antithyroid antibodies (ATA) on ovarian function is uncertain. Study design, size, duration A prospective cohort tertiary single-center study (consent no. 1072.6120.172.2022) included women aged 18-45, examined due to menstrual disorders and/or infertility, from July to August 2022. Only women without previously diagnosed thyroid dysfunction were included. All enrolled women gave informed written consent to participate in the study. Participants/materials, setting, methods Women underwent routine gynecological examination and pelvic ultrasound. Blood sample was tested for AMH, FSH, Luteinizing hormone (LH), Thyroid-stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies concentrations. The Rotterdam-ESHRE-ASRM criteria were used to diagnose PCOS and its phenotypes. HPOD was diagnosed according to WHO classification. SCH was defined as TSH > 2.5 uIU/ml with normal thyroid function. The above parameters within subpopulations were calculated using regression analysis, Kruskal-Wallis and post-hoc tests. Main results and the role of chance The study included 51 euthyroid women aged 18-40. PCOS was diagnosed in 42/51 (82.35%) women, including PCOS-A phenotype in 31/51 (60.78%), PCOS-B in 5/51 (9.8%), PCOS-D in 6/51 (11.76%) women, and HPOD in 9/51 (17.65%) women. There was a significant positive correlation between the concentration of TSH and AMH in the studied population - with the increase of TSH value, the concentration of AMH increased (r = 0.4, p = 0.0035). The mean AMH concentration significantly differed between the groups and equaled to 55.4, 39.4, 31.1, 24.0 pmol/l in PCOS-A, PCOS-B, PCOS-D and HPOD (p = 0.05), respectively. The mean anti-TPO concentration was significantly different between the groups and was equal to 18.2, 19.0, 14.6, 10.9 U/ml in PCOS-A, PCOS-B, PCOS-D and HPOD (p = 0.05), respectively. There was no significant difference in FSH, LH, TSH, anti-TG concentrations between the groups. Limitations, reasons for caution The limitations of the study are small study group and single-center nature. Wider implications of the findings SCH increases the concentration of AMH, which in PCOS may exacerbate the symptoms of anovulation. Whether treatment of subclinical hypothyroidism affects ovarian reserve indices and improves ovarian function remain a subject of further research. Trial registration number 1072.6120.172.2022

Analysis of the relationship between subclinical hypothyroidism and anxiety and depression based on the theory of "Yi(liver) and Gui(kidney) from same source"

For a long time, the influence of subclinical thyroid dysfunction on anxiety and depression has been ignored, and the focus of research is on the influence of obvious thyroid dysfunction on mood. In recent years, the research on the effect of subclinical hypothyroidism on anxiety and depression has gradually increased, and the effect of subclinical hypothyroidism on mood has been re-emphasized. At present, the main measures for clinical diagnosis and treatment of subclinical hypothyroidism in China are clinical observation rather than drug intervention. In fact, patients do have negative emotional changes, which seriously affect people's sleep, study and work. Therefore, in this context, the advantages of traditional Chinese medicine are highlighted again. This paper aims to explore the essence of the relationship between subclinical hypothyroidism (SCH) and anxiety and depression based on the theory of "Yigui homology", so as to provide clinical diagnosis and treatment ideas.

The Frequency of Subclinical Hypothyroidism in Obese Children and Adolescents and Its Relationship with Metabolic Parameters and Atherogenic Index.

ObjectiveThe effect of subclinical hypothyroidism on glucose and lipid metabolism in obese children is controversial. This study aims to compare cardiovascular risk factors in obese patients with or without subclinical hypothyroidism and determine the frequency of subclinical hypothyroidism in obese children and adolescents.Materials and MethodsA total of 1130 obese children and adolescents aged 6–18 years were included in this single-center cross-sectional study. Metabolic parameters such as thyrotropin, free thyroxine, free triiodothyronine, homeostasis model assessment for insulin resistance, atherogenic index, and lipids were evaluated. The patients were divided into two groups—subclinical hypothyroidism group (free thyroxine normal, thyroid-stimulating hormone 5.5–10 mIU/L) (n = 59) and the control group (free thyroxine normal, thyroid-stimulating hormone < 5 mIU/L) (n = 1071).ResultsSubclinical hypothyroidism was detected in 59 (5.2%) of 1130 patients. The mean body mass index was similar in both groups. The mean serum insulin, homeostasis model assessment for insulin resistance, triglyceride, atherogenic index of plasma, aspartate aminotransferase, and alanine aminotransferase levels were higher in the subclinical hypothyroidism group, and the mean high-density lipoprotein cholesterol level was lower than the control group (P = .005, P < .001, P = .028, P < .001, P = .001, P < .001, and P = .018, respectively). While a positive correlation was observed between the thyroid-stimulating hormone levels and insulin, homeostasis model assessment for insulin resistance, alanine aminotransferase, triglyceride, and basal cortisol levels, a negative correlation was found between thyroid-stimulating hormone and high-density lipoprotein cholesterol.ConclusionSubclinical hypothyroidism can negatively affect the lipid and glucose profile.

The Effect of Subclinical Hypothyroidism on Coagulation and fibrinolysis: A Systematic Review and Meta-Analysis.

BackgroundDespite patients with thyroid dysfunction show obvious abnormal hemostatic indicators in the peripheral blood, the current research on whether and how subclinical hypothyroidism (SCH) influence hemostatic function (the coagulation and fibrinolytic system) still remains controversial.ObjectiveWe conducted this study to evaluate how SCH influence on the coagulation and fibrinolytic system in human body.MethodsPrior to March 2022, Web of Science, Embase, PubMed, WanFang, CNKI data and reference lists were searched to identify eligible researches. Two of us independently extracted the data and evaluated study quality. The effect size is represented by standard mean difference (SMD). Both fixed and random-effects models were used where appropriate. Review Manager 5.3 and STATA 16.0 were used to analyze the eligible data.Results1325 patients from twelve observational studies were involved in our research. Our study revealed that SCH changed the heamostatic balance towards hypercoagulable and hypofibrinolytic conditions accompanied by an increase in tissue fibrinogen, plasminogen activator and plasminogen activator inhibitor-1. By contrast, there was no statistically difference in acivated partial thromboplastin time (APTT) and D-Dimer in SCH group compared with that in control subjects.ConclusionsOur study confirmed that SCH is related with a prothrombotic state, as reflected by changes in both coagulation and fibrinolysis. It is highly recommended for screening cardiovascular risk factors in combination with an adequate evaluation of SCH state.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/#recordDetails] PROSPERO [CRD42021275313]

Effects of subclinical hypothyroidism on maternal and obstetric outcomes during pregnancy

Objectives: Subclinical hypothyroidism has been defined as normal free thyroxine (FT4) with elevated thyroid stimulating hormone (TSH) levels. The aim of this study is to examine the relationship between the first trimester subclinical hypothyroidism with adverse obstetric outcomes in pregnant women. Methods: This retrospective cohort study was conducted by examining the pregnant women who applied to the Gynecology Department of Okmeydani Training and Research Hospital at their 6th to 14th gestational weeks and had antenatal follow-ups between February 1, 2017 and December 31, 2020. Results: Fetal weight (OR: 1; 95% CI, 0.99-1.03, p = 0.023), gestational age at delivery (OR: 0.91; 95% CI, 0.83-0.99, p = 0.022), and preterm delivery (OR: 0.79; 95% CI, 0.48-1.06, p = 0.005) were found to be statistically significant parameters in univariate risk analyses performed in the group whith patients normal T4 levels and TSH levels ≥ 2.5-4 mIU/L. Lower gestational age at delivery (OR: 1; 95% CI, 0.93-1.88, p = 0.016), and higher preterm delivery rates (OR: 0.99; 95% CI, 0.96-1.01, p = 0.003) were found to be statistically significant in multivariate risk analysis. Conclusions: The rate of preterm delivery was statistically higher, and fetal weight and week of delivery were significantly lower in the group of pregnant women diagnosed with SCH having TSH values between 2.5 and 4 mIU/L.

Effect of Subclinical Hypothyroidism on the Association between Hemoglobin A1c and Reduced Renal Function: A Prospective Study.

Subclinical hypothyroidism (SCH) was reported to be associated with accelerating endothelial dysfunction, which is recognized as one of the upstream mechanisms that leads to glomerular injury (lower glomerular filtration rate (GFR)). SCH was also reported to be associated with hyperglycemia, which is associated with higher hemoglobin A1c (HbA1c) levels and induces endothelial dysfunction. Therefore, SCH status could influence the association between HbA1c and reduced eGFR. To clarify those associations, we conducted a prospective study of 1580 Japanese individuals who participated in an annual health check-up in 2014 with 2.8 years of follow-up. All participants had free triiodothyronine (T3) and free thyroxine (T4) levels in the normal range. Among study participants, 88 were diagnosed as having SCH. Even though no significant correlation was observed between HbA1c and annual change in estimated GFR among participants without SCH (multi-adjusted standardized parameter estimate (β) = 0.03, p = 0.250), a significant inverse association was observed among participants with SCH (β = −0.26, p = 0.014). When those analyses were performed among participants who were not taking glucose lowering medication, the observed associations were essentially the same: β = 0.03, p = 0.266 for participants without SCH and β = −0.32, p = 0.006 for participants with SCH, respectively. Therefore, SCH status could influence the association between HbA1c and renal function.

Вплив субклінічного гіпотиреозу на розвиток кардіоваскулярної патології

Актуальність. Ураження щитоподібної залози (ЩЗ) посідають провідне місце в структурі ендокринної захворюваності. Поширеність субклінічного гіпотиреозу (СГ) зростає з року в рік. Тому на даний час активно обговорюється роль СГ в розвитку кардіоваскулярної патології. Мета. Проаналізувати механізми впливу СГ на розвиток кардіоваскулярної патології. Матеріали та методи. Проведено аналітичний огляд наукових публікацій за останні 15 років з використанням пошукової системи JAMA, Scholar та PubMed. Результати. На сьогодні особливо важливо оцінити внесок так званої мінімальної тиреоїдної дисфункції у розвиток і прогресування патологічних процесів з боку серцево-судинної системи. За даними 20-річного Вікгемського дослідження, ризик розвитку гіпотиреозу в жінок за умови виявлення в них підвищеного рівня тиреотропного гормона (ТТГ) щорічно становить 2,6 %, при ізольованому підвищенні рівня антитіл до ЩЗ — 2,1 %. Цей показник може збільшуватись до 4,3 % при наявності двох факторів ризику: підвищення ТТГ і підвищення рівня антитіл. У дослідженні A.D. Toft і співавт. показано, що при тривалому спостереженні за пацієнтами з СГ у 20–50 % обстежуваних протягом наступних 4–8 років розвинувся явний гіпотиреоз. Серцево-судинні прояви посідають одне з провідних місць у симптоматиці гіпотиреозу. Багатогранні зміни з боку серцево-судинної системи визначаються різноманітними проявами: дисліпідемією, артеріальною гіпертензією, ішемічною хворобою серця, змінами серцевого ритму, кардіоміопатією та серцевою недостатністю. Висновки. У даній статті наведені сучасні дані механізму впливу гіпотиреозу на розвиток кардіоваскулярної патології. А от дані щодо впливу СГ є досить суперечливими, що свідчить про необхідність детального вивчення даного питання. Окрім того, постає питання щодо визначення необхідності скринінгу СГ, а саме: в якій віковій групі і з якою періодичністю його проводити з метою профілактики кардіоваскулярної захворюваності населення.

Effect of Levothyroxine Replacement on Cognitive Function Impairment in a Sample of Egyptian Population with Subclinical Hypothyroidism

Introduction: Subclinical hypothyroidism (SHT) is characterized by a normal range of free thyroxin concentrations together with increased serum TSH levels. SHT is defined as serum thyroid-stimulating hormone (TSH) concentration above the upper limit of the reference range in the face of normal free FT4 and FT3 levels. The effect of SHT on cognitive function has been investigated in several preclinical studies, and a growing body of evidence has suggested a relevant link between thyroid hormones and the central nervous system. Objectives: This study aimed to investigate the effect of levothyroxine replacement on cognitive impairment in a sample of Egyptian patients with SHT. Methods: A prospective cohort study conducted on 30 patients with cognitive impairment and SHT attending an endocrine outpatient clinic at the Ain Shams University Hospital to study the effect of levothyroxine supplementation on cognitive impairment in patients with SHT. The study was conducted on 30 patients. All participants were subjected to a full history taking; thorough clinical examination; laboratory investigations including thyroid profile (FT3, FT4, TSH), anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and lipid profile; imaging tests as neck ultrasound, echocardiography, and carotid duplex; and finally Addenbrooke’s questionnaire used to diagnose mild cognitive impairment. Results: A highly statistically significant difference was found before, 3 months and 6 months after treatment with levothyroxine regarding all clinical data, TSH, LDL, T. cholesterol, FT3, FT4 and HDL, carotid intima-media thickness, and Addenbrooke’s questionnaire. Our study showed a statistically significant inverse correlation between TSH level and mild cognitive impairment before and after treatment with levothyroxine at 3 and 6 months intervals as when TSH increased, results of Addenbrooke’s questionnaire decreased and, so, cognitive impairment increased, while when TSH decreased in response to thyroxine replacement, cognitive impairment improved as detected by an increase in the patient’s score. Conclusion: SHT has a great effect on cognitive impairment, as normalization in TSH level results in improvement in cognitive function. Also, there was a significant reduction in carotid intima-media thickness, which may contribute to improvement of cognitive function in addition to a great improvement in lipid profile, which in turn positively affects cardiac and cognitive function.

Abstract #973571: Assessment of Cognitive Functions Among The Elderly Indian Subjects with Subclinical Hypothyroidism

The consequences of overt hypothyroidism on CNS are well known. In contrast, there is less evidence regarding the effects of subclinical hypothyroidism (SCH) on cognitive functions particularly in the elderly subjects. Studies from various countries including India have shown a variable association between SCH and cognitive dysfunction. This study was done with an aim to assess the prevalence of cognitive impairment among elderly Indian subjects (Age >60 years) with subclinical hypothyroidism.

The effect of subclinical hypothyroidism on ovarian volume in prepubertal girls.

Enlargement and cystic changes in ovaries of patients with long-standing overt hypothyroidism have been described in numerous case reports. However, there are limited data about the effect of subclinical hypothyroidism (SH) on ovarian volume. The aim of the study is to evaluate the relationship between serum thyroid stimulating hormone (TSH) level and ovarian volume in prepubertal girls with SH. Patients who were aged between 6 and 10 years and diagnosed with SH and age-matched healthy euthyroid controls were enrolled in the study. All subjects were prepubertal. Thirty-five children with SH (mean age; 7.6±1.0 years) and 50 euthyroid healthy girls (mean age; 7.7±1.2 years) were enrolled in the study. TSH and LH levels and both ovarian volumes were significantly higher in SH group than controls (p<0.05). In addition, TSH was positively correlated with ovarian volumes and LH in patients with SH (p<0.05). The results of this study showed that ovarian volumes of prepubertal girls with SH were significantly greater than those with normal thyroid function. Although ovarian enlargement and cyst formation is well recognized in long-standing overt hypothyroidism, it has been shown for the 1st time in patients with SH.

亚临床甲状腺功能减退对助孕技术临床结局影响的分层分析

亚临床甲状腺功能减退对助孕技术临床结局影响的分层分析

The effect of subclinical hypothyroidism on body composition parameters in children.

It's known that overt hypothyroidism increases body fat content and weight. There's limited research about the effect of subclinical hypothyroidism (SH) on body composition in children and the effect of LT4 treatment. We aimed to evaluate body composition parameters in healthy subjects and in children with mild SH (MSH) and determine the effect of LT4 treatment. Sixty-four healthy children and 32 children with MSH were included. Anthropometric measurements and hormonal parameters were evaluated. Body composition was evaluated using bioelectric impedance analysis (BIA). Patients were put on LT4 treatment. BIA was performed again after 12months of therapy. There was no significant difference between the anthropometric parameters and basal metabolic rate of the healthy children and the MSH group. The percentage of trunk muscle mass (TMM) in the MSH group was lower than in the control group (P<.05). After 12months of LT4 treatment, the percentage of total fat-free mass (FFM), TMM and trunk fat-free mass (TFFM) were increased and percentage of total body fat mass and trunk fat mass were decreased (P<.05). The difference between the percentage of TMM in the MSH group and control group was insignificant after LT4 treatment (P>.05). The percentage of TMM in children with MSH was found lower than healthy control group. After LT4 treatment, the percentage of the FFM, TMM and TFFM were increased and the difference between percentage of TMM in children with MSH and healthy controls was insignificant. Our data indicated that MSH might be associated with early changes in body composition parameters.

Effect of subclinical hypothyroidism on indices of metabolic syndrome

Effect of subclinical hypothyroidism on indices of metabolic syndrome

Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States.

Evidence regarding the effects of subclinical hypothyroidism (SCH) on adverse pregnancy outcomes and the ability of levothyroxine (LT4) treatment to prevent them is unclear. Available recommendations for the management of SCH during pregnancy are inconsistent. We conducted a nationwide survey among physicians assessing their knowledge of and current practices in the care of SCH in pregnancy and compared these with the most recent American Thyroid Association (ATA) recommendations. In this cross-sectional study, an online survey was sent to active US members of the Endocrine Society. This survey included questions about current practices and clinical scenarios aimed at assessing diagnostic evaluation, initiation of therapy, and follow-up in pregnant women with SCH. In total, 162 physicians completed the survey. ATA guidelines were reviewed by 76%, of whom 53% indicated that these guidelines actually changed their practice. Universal screening was the preferred screening approach (54%), followed by targeted screening (30%). For SCH diagnosis, most respondents (52%) endorsed a TSH level >2.5 mIU/L as a cutoff, whereas 5% endorsed a population-based cutoff as recommended by the ATA. The decision to initiate treatment varied depending on the specific clinical scenario; however, when LT4 was initiated, respondents expected a small/very small reduction in maternofetal complications. In conclusion, despite recently updated guidelines, there is still wide variation in clinical practices regarding the care of women with SCH in pregnancy. Highly reliable randomized trials are required to evaluate the effectiveness of the most uncertain treatment practices on the care of pregnant women with SCH.

MON-610 Different Effects of Subclinical Hypothyroidism on Long-Term Outcomes of Patients Underwent CABG and Heart Valve Surgery

We performed this study to investigate whether subclinical hypothyroidism (SCH) is associated with long-term cardiovascular outcome after coronary artery bypass grafting (CABG) or heart valve surgery (HVS). All-cause mortality and cardiovascular (CV) mortality, and cardiovascular events were retrospectively reviewed in 395 euthyroid and 66 SCH patients who underwent CABG. We also analyzed cardiovascular outcomes in 87 euthyroid and 17 SCH patients who underwent HVS. During a mean follow-up period of 7.5 ± 3.9 years, there were 159 incidents of all-cause deaths, 26 CV deaths, 124 major cardiovascular adverse events (MACE), 11 myocardial infarctions, 1 unstable angina, 70 strokes, 23 hospitalizations due to heart failure, 101 atrial fibrillation events, and 33 coronary revascularizations. The incidence rate of all-cause mortality after CABG was significantly higher in patients with SCH (n=31, 47.0%) than in euthyroid patients (n=105, 26.6%), with a hazard ratio (HR) of 1.721 (95% confidence interval [CI] 1.068, 2.772; p=0.026) after adjustment with age, sex, underlying diseases, LV dysfunction and emergency operation. Interestingly, low T3 level in euthyroid patients (TSH 0.0-4.0mIU/L) who underwent CABG significantly increased all-cause, CV mortality and MACE in contrast to those of HVS. Moreover, both low T4 and high TSH level in euthyroid patients (TSH 0.0-4.0mIU/L) were not related to increased all-cause mortality, CV mortality and MACE in both CABG and HVS groups. In conclusion, insufficient thyroid status including low T3 in euthyroid and subclinical hypothyroid is associated with a long-term mortality in patients who underwent CABG, but the effects were not observed in HVS suggesting the importance of preoperative thyroid hormonal status in patients with ischemic heart disease. More RCTs should be needed to confirm whether normalization of thyroid function before CABG operation is helpful for the better postoperative outcome.

Study protocol: a randomised controlled trial on the clinical effects of levothyroxine treatment for subclinical hypothyroidism in people aged 80\xa0years and over

BackgroundSubclinical hypothyroidism is common in older people and its contribution to health and disease needs to be elucidated further. Observational and clinical trial data on the clinical effects of subclinical hypothyroidism in persons aged 80 years and over is inconclusive, with some studies suggesting harm and some suggesting benefits, translating into equipoise whether levothyroxine therapy provides clinical benefits. This manuscript describes the study protocol for the Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial to generate the necessary evidence base.MethodsThe IEMO 80-plus thyroid trial was explicitly designed as an ancillary experiment to the Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism randomised placebo controlled Trial (TRUST) with a near identical protocol and shared research infrastructure. Outcomes will be presented separately for the IEMO and TRUST 80-plus groups, as well as a pre-planned combined analysis of the 145 participants included in the IEMO trial and the 146 participants from the TRUST thyroid trial aged 80 years and over.The IEMO 80-plus thyroid trial is a multi-centre randomised double-blind placebo-controlled parallel group trial of levothyroxine treatment in community-dwelling participants aged 80 years and over with persistent subclinical hypothyroidism (TSH ≥4.6 and ≤ 19.9 mU/L and fT4 within laboratory reference ranges). Participants are randomised to levothyroxine 25 or 50 micrograms daily or matching placebo with dose titrations according to TSH levels, for a minimum follow-up of one and a maximum of three years.Primary study endpoints: hypothyroid physical symptoms and tiredness on the thyroid-related quality of life patient-reported outcome (ThyPRO) at one year. Secondary endpoints: generic quality of life, executive cognitive function, handgrip strength, functional ability, blood pressure, weight, body mass index, and mortality. Adverse events will be recorded with specific interest on cardiovascular endpoints such as atrial fibrillation and heart failure.DiscussionThe combined analysis of participants in the IEMO 80-plus thyroid trial with the participants aged over 80 in the TRUST trial will provide the largest experimental evidence base on multimodal effects of levothyroxine treatment in 80-plus persons to date.Trial registrationNederlands (Dutch) Trial Register: NTR3851 (12–02-2013), EudraCT: 2012–004160-22 (17–02-2013), ABR-41259.058.13 (12–02-2013).

Study of impact of subclinical hypothyroidism on iron status and hematological profile

Background: Thyroid hormones play an important physiological role to maintain balance of metabolism of entire human body. Erythrocyte abnormalities are frequently associated with thyroid disorder. Subclinical hypothyroidism, often a hidden entity, is associated with iron-deficiency anemia along with other hematological disorders. Thyroid hormones have a crucial role in metabolism and proliferation of blood cells. Thyroid dysfunction has profound effects on blood cells such as anemia, alters RBC indices including MCV, MCHC as well as iron stores. Present study was carried out to investigate and explore subclinical hypothyroid patients, to know the effect of subclinical hypothyroidism on hematological parameters and body iron store.Methods: This retrospective study included 200 newly diagnosed, untreated subclinical hypothyroid, and 200 healthy euthyroid individuals. The hematological parameters and thyroid profile of the subjects were assessed by the mean, standard deviation (SD). Student’s t-test was used to report our results, with p-value &lt;0.05 considered as statistically significant.Results: In this study we have compared hemoglobin level, red cell indices, serum Ferritin among study group and euthyroid healthy group and found that mean hemoglobin, serum ferritin and RBC indices were significantly depleted in subclinical hypothyroid patient in comparison to euthyroid group. 37 of total 200 [18.22%] newly diagnosed subclinical hypothyroid patients was suffering from Iron deficiency anemia with significant number of patients having hemoglobin level less than 10 gm%.Conclusions: Iron deficiency anemia is quite common in Subclinical hypothyroidism and is often associated with depleted body iron store and complication of getting converted into primary hypothyroidism. As there is no significant clinical manifestation of SCH at earlier stages with anemia it is advisable to routinely investigate it for early detection allowing its early management.