Elevated Thyroid-stimulating Hormone Research Articles

Female and male C57BL/6J offspring exposed to maternal obesogenic diet develop altered hypothalamic energy metabolism in adulthood.

Maternal obesity is exceedingly common and strongly linked to offspring obesity and metabolic disease. Hypothalamic function is critical to obesity development. Hypothalamic mechanisms causing obesity following exposure to maternal obesity have not been elucidated. Therefore, we studied a cohort of C57BL/6J dams, treated with a control or high-fat-high-sugar diet, and their adult offspring to explore potential hypothalamic mechanisms to explain the link between maternal and offspring obesity. Dams treated with obesogenic diet were heavier with mild insulin resistance, which is reflective of the most common metabolic disease in pregnancy. Adult offspring exposed to maternal obesogenic diet had no change in body weight but significant increase in fat mass, decreased glucose tolerance, decreased insulin sensitivity, elevated plasma leptin, and elevated plasma thyroid-stimulating hormone. In addition, offspring exposed to maternal obesity had decreased energy intake and activity without change in basal metabolic rate. Hypothalamic neurochemical profile and transcriptome demonstrated decreased neuronal activity and inhibition of oxidative phosphorylation. Collectively, these results indicate that maternal obesity without diabetes is associated with adiposity and decreased hypothalamic energy production in offspring. We hypothesize that altered hypothalamic function significantly contributes to obesity development. Future studies focused on neuroprotective strategies aimed to improve hypothalamic function may decrease obesity development.NEW & NOTEWORTHY Offspring exposed to maternal diet-induced obesity demonstrate a phenotype consistent with energy excess. Contrary to previous studies, the observed energy phenotype was not associated with hyperphagia or decreased basal metabolic rate but rather decreased hypothalamic neuronal activity and energy production. This was supported by neurochemical changes in the hypothalamus as well as inhibition of hypothalamic oxidative phosphorylation pathway. These results highlight the potential for neuroprotective interventions in the prevention of obesity with fetal origins.

Effects of Secretoneurin and Gonadotropin-Releasing Hormone Agonist on the Spawning of Captive Greater Amberjack (Seriola dumerili).

The greater amberjack (Seriola dumerili), a pelagic marine species with a global distribution, has considerable worldwide potential as an aquaculture species. However, difficulties have been encountered in inducing spontaneous spawning in cultured fish stocks. In this study, we analysed the key regulatory factors, secretoneurin (SN) and gonadotropin-releasing hormone (GnRH), in greater amberjack. Active peptides of SN and GnRH, SdSNa, and SdGnRH, respectively, were obtained by comparative analysis of homologous proteins from different species. Amino acid substitutions of the SdGnRH decapeptide at position 6 with a dextrorotatory (D) amino acid and at position 10 with an ethylamide group yielded a super-active agonist (SdGnRHa). The injection of SdSNa and SdGnRHa elevated luteinizing hormone, thyroid-stimulating hormone, and oxytocin levels in the sera of sexually mature fish, whereas it reduced the level of follicle-stimulating hormone. Furthermore, in response to the SdSNa and SdGnRHa injections, we detected an increase in the expression of genes associated with oocyte development and spermatogenesis. We established that the greater amberjack cultured along the southern coast of China reached sexual maturity at three years of age, and its reproductive season extended from February to April. Spawning of the cultured greater amberjack was successfully induced with a single injection of SdGnRHa/SdSN/DOM/HCG. Our findings indicate that similar to GnRHa, SNa is a potential stimulator of reproduction that can be used to artificially induce spawning in marine fish.

Expression patterns of serum MicroRNAs related to endothelial dysfunction in patients with subclinical hypothyroidism.

BackgroundIncreasing evidence has shown that elevated Thyroid stimulating hormone (TSH) levels are positively correlated with atherosclerosis (ATH) in patients with subclinical hypothyroidism (SCH). Some researchers found that the dysfunction of Endothelial Cells (ECs) in SCH plays an important role in the pathogenesis of ATH in SCH, but the association remains controversial.ObjectivesTo determine the expression profiles of serum microRNAs critical to the function of Endothelial cells (ECs) may help reanalyze the possible mechanism underlying ATH in SCH and the association between ATH and SCH.MethodsWe used qRT-PCR to perform microRNA profiling and analysis in normal control subjects (NC), patients with SCH alone (SCH), patients with SCH and ATH (SCH+ATH), and patients with ATH without SCH (ATH).ResultsBoth miR-221-3p and miR-222-3p showed a decreasing expression trend between the SCH and SCH+ATH groups. In addition, miR-126-3p and miR-150-5p showed a stepwise decrease from the NC to SCH groups and then to the SCH+ATH or ATH group. miR-21-5p was unregulated in the SCH, SCH+ATH, and ATH groups. Furthermore, elevated levels of miR-21-5p in SCH+ATH group were higher than SCH and ATH group. No differences were found in the levels of miR-150, miR-126, miR-221 and miR-222 between the ATH and the SCH+ATH subjects.ConclusionsmiR-21-5p may be involved in the atherosclerosis process in patients with SCH (SCH and SCH+ATH groups). miR-150-5p may be sensitive risk markers for predicting endothelial dysfunction in patients with ATH (ATH and SCH+ATH groups).

Screening for thyroid dysfunction with free T4 instead of thyroid stimulating hormone (TSH) improves efficiency in older adults in primary care.

Subclinical hypothyroidism (SCHT) is defined as a consistently elevated thyroid stimulating hormone (TSH) with a free T4 (fT4) within the reference range. This diagnosis may lead to additional monitoring, levothyroxine therapy and increased patient concerns, despite lack of evidence of treatment benefit in older adults. In order to avoid this diagnosis, we evaluated the efficiency of fT4-based screening for thyroid dysfunction, in older adults in primary care and compared it with TSH-based screening.Individuals aged >65years in primary care were selected for this retrospective study when both TSH and fT4 were individually requested irrespective of the TSH value. Exclusion criteria were C-reactive protein > 10 mg/l or a history of thyroid hormone monitoring in the previous year.Screening based on fT4 instead of TSH decreased reflex testing from 23.8% to 11.2%. The positive predictive value (PPV) for clinical hypothyroidism increased from 17.3% to 52.2%. The negative predictive value was 96.1% with TSH-based screening versus 97.8% with fT4-based screening. Elevation of the TSH cutoff value from 4.2 to 6.5 mU/l resulted in a reflex test percentage of 12.5% and a PPV of 31.0%.Our results suggest that screening for thyroid dysfunction in older individuals in primary care can be improved by screening based on fT4 instead of TSH or by adjusting the TSH cutoff value. Adjustment of the screening strategy may be of interest to health policy makers because of potential cost reduction. From a patient perspective, medical concerns and unnecessary biochemical follow-up might be reduced by circumventing the diagnosis SCHT.

AN UPDATE ON SUBCLINICAL HYPOTHYROIDISM, COMPLICATIONS, AND ITS MANAGEMENT BY AYURVEDIC MEDICINES: A REVIEW

Subclinical hypothyroidism (SCH) is characterized by an average level of tetraiodothyronine (T4) and triiodothyronine (T3) and an uncharacteristic rise of serum thyroid-stimulating hormone (TSH). The occurrence of hypothyroidism is about 4-5% in the developed world and about 4- 15% worldwide, which is increasing at an alarming rate. Mostly, Subclinical hypothyroidism (SCH) has been considered in two main categories based on the elevation in serum thyroid-stimulating hormone (TSH) level. The first category included a mild increase in TSH levels, i.e., 4.0–10.0 mU/l, while the second category involved a more critically increased TSH value, i.e., >10 mU/l. For overt hypothyroidism, treatment is based on symptoms, while subclinical hypothyroidism didn’t follow the same due to the asymptomatic behaviour of the disease. Additionally, subclinical hypothyroidism is associated with cardiovascular diseases, complications during pregnancy and diabetes, etc. In the current review, we mainly discussed the diagnosis of subclinical hypothyroidism, possible complications, management of SCH with ayurvedic remedies, and some Yogasanas preferred in managing the disease.

Longitudinal population-based study of progression rates for borderline thyroid-stimulating hormone abnormalities.

Current guidelines recommend thyroid-stimulating hormone (TSH) for initial biochemical evaluation of thyroid function, with borderline TSH abnormalities a common finding. The likelihood of a borderline TSH progressing to overt abnormality is not well characterised at the population level. To determine risk factors and likelihood for progression of borderline TSH to overt abnormality. Population-based retrospective longitudinal data-linkage study for TSH tests performed in Tasmania (1996-2013). Kaplan-Meier methodology was used to summarise conversion time for overt TSH elevation (≥10 mU/L) and overt suppression (≤0.1 mU/L) in patients whose initial TSH was borderline elevated (BeTSH; 4.0-9.99 mU/L) and borderline suppressed (BsTSH; 0.10-0.39 mU/L) respectively. Main outcome measures are the progression from borderline to overt TSH abnormality. A total of 1 296 060 TSH tests was performed on 367 917 patients. Of these, 14 507 (3.9%) patients had BeTSH on initial assessment; mean age 51.4 ± 21.8 years and median TSH of 5.0 mU/L (interquartile range (IQR) 4.4, 5.2). Patients aged ≥80 years were most likely to progress (hazard ratio (HR) = 2.09 compared with age <20 years reference group (95% confidence interval (CI): 1.64, 2.68)). Patients aged 20-39 years had the second-highest rate of progression (HR=1.49 (95% CI: 1.18, 1.88)). Seven thousand, eight hundred and eighty-three (2.14%) patients had BsTSH; mean age 50.7 ± 22.1 years and median TSH 0.30 mU/L (IQR 0.22, 0.35). Patients aged 60-79 years had the highest rate of progression to overt TSH suppression (HR=2.47 compared with age <20 years reference group (95% CI: 1.88, 3.22)). Follow-up intervals for patients with borderline TSH abnormalities should take into account patient age as a progression risk factor.

DIAGNOSING A PROBABLE CASE OF THYROID HORMONE RESISTANCE IN A RESOURCE-POOR SETTING

Resistance to Thyroid Hormone (RTH) is a rare inherited condition usually caused by mutations of the thyroid hormone receptor beta (THRB), thyroid hormone cell membrane transporters, or thyroid hormone metabolism which can present as asymptomatic, hypothyroidism, or hyperthyroidism. The objective is to report a probable case of RTH presenting with hypothyroidism and to demonstrate the resilience in the diagnosis of endocrine disorders in resource-poor settings. A 23-year old University undergraduate presented with clinical features of hypothyroidism but elevated thyroid hormones and thyroid stimulating hormone (TSH): free T4=38 [normal range 10-24] pmol/L, free T3=11 [normal range 3-8] pmol/L, TSH=3.8 [normal range 0.5-5.0] mU/L; and normal brain MRI. A working diagnosis of RTH was made. Though there was no facility to test for THRB gene mutation, the positive family history of a similar pattern of thyroid function tests, made for a probable diagnosis of RTH, and she was empirically placed on a gradually increased dose of levothyroxine from 50 µg till resolution of symptoms was achieved and maintained 6 months later at 600 µg daily. At 10 months follow-up, the patient felt well with the resolution of symptoms and improved academic performance despite elevated thyroid hormones and unsuppressed TSH. The diagnosis of RTH requires a high index of suspicion, to enable early diagnosis, and prevent unnecessary invasive treatments. The treatment target should be the resolution of symptoms and signs and not normalization of thyroid hormone levels. This report also underscores the resilience that can be adopted in diagnosing and treating endocrine cases in resource-poor settings.

Survivorship Care Plans Improve the Identification of Post-radiation Hypothyroidism After Head and Neck Cancer Treatment.

Survivorship care programs (SCPs) educate patients on post-treatment side-effects, which may lead to earlier identification and mitigation of their impact. This study assessed the impact of SCP on identification and management of post-treatment hypothyroidism in a head and neck cancer population and evaluated socio-demographic factors in the effectiveness of SCPs. A retrospective analysis was performed of sociodemographic and clinical characteristics of patients with head and neck cancer treated with radiation therapy between January 2011 and January 2019 at a large community cancer institution. Development of hypothyroidism was defined as elevated thyroid-stimulating hormone (TSH) or initiation of supplementation post-treatment. Cumulative incidence of hypothyroidism was analyzed with Gray's method. Of 608 patients, 483 (79%) had post-treatment TSH surveillance. A total of 203 (42%) of those patients developed hypothyroidism; 53 (11%) patients completed SCPs. The median follow-up was 1.4 (interquartile range=0.7-2.6) years with a median time until diagnosis of hypothyroidism of 1.2 (interquartile range=0.7-2.1) years. The median time to diagnosis was 12.0 months with SCP versus 14.2 months without. Race and insurance status were not associated with differences in thyroid surveillance. Patients with laryngeal cancer were at greatest risk of developing hypothyroidism (hazard ratio=1.92, confidence interval=1.44-2.56; p<0.077). Cumulative incidence of post-treatment hypothyroidism was higher in patients managed with SCP, 65.4% at 4 years, compared to those without (49.0%). Receipt of SCP was independently associated with an increased incidence of hypothyroidism detection (hazard ratio=1.51, confidence interval=1.04-2.20; p=0.030). In our experience, SCP utilization was independently associated with a diagnosis of hypothyroidism. This study supports implementation of a survivorship program for identification and management of post-treatment sequelae.

Hypothyroidism and Depression: A Narrative Review.

There has been an established relationship between hypothyroidism and depression. Studies have demonstrated that somatostatin and serotonin influence the hypothalamus-pituitary-thyroid axis, which links hypothyroidism to depression. Multiple studies concluded that undiagnosed, untreated, undertreated patients with hypothyroidism are at increased risk of developing depression. Autoimmune thyroiditis is also associated with an increased risk of depression. Elevated thyroid-stimulating hormone (TSH), antithyroglobulin (TgAb), and thyroid peroxidase antibodies (TPOAb) levels have all been linked to depression and an increased risk of suicide. Moreover, hypothyroidism is known to be one of the leading causes of treatment-resistant depression. Treating underlying hypothyroidism with thyroid replacement therapy could significantly improve mood disorders such as depression. Levothyroxine therapy is also used as adjunctive therapy to antidepressants in the management of depression, and it is known to improve the symptoms of depression rapidly when compared to antidepressants alone. This review strengthens the link between hypothyroidism and depression, and it also demonstrates how treating the underlying hypothyroidism in people who have been diagnosed with depression will be very beneficial.

Elevated TSH Level, TgAb, and Prior Use of Ramucirumab or TKIs as Risk Factors for Thyroid Dysfunction in PD-L1 Blockade.

Thyroid dysfunction is frequently caused by treatment with antiprogrammed cell death-1 ligand 1 antibodies (PD-L1-Abs) and anticancer drugs, including ramucirumab (RAM) and multitargeted tyrosine kinase inhibitors (multi-TKIs), which are often used prior to PD-L1-Ab treatment in cancer patients. A total of 148 patients treated with PD-L1-Abs were evaluated for antithyroid antibodies at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then were observed until the visits stopped. Of the 148 patients, 15 (10.1%) developed thyroid dysfunction after PD-L1-Ab treatment (destructive thyroiditis in 8 and hypothyroidism without preceding thyrotoxicosis in 7). The prevalence of an elevated thyroid-stimulating hormone (TSH) level at baseline (3/15 [20.0%] vs 4/133 [3.0%], P < .05), positive antithyroglobulin antibodies (TgAbs) at baseline (4/15 [26.7%] vs 5/133 [3.8%], P < .05) and prior treatment with RAM or multi-TKIs (3/15 [20.0%] vs 5/133 [3.8%], P < .05) were significantly higher in patients with vs without thyroid dysfunction. In a multivariate analysis, elevated TSH level at baseline, TgAb positivity at baseline, and prior treatment with RAM or multi-TKIs were significantly associated with the development of thyroid dysfunction, with ORs of 7.098 (95% CI 1.154-43.638), 11.927 (95% CI 2.526-56.316), and 8.476 (95% CI 1.592-45.115), respectively. The results of this real-world study suggest that the risk of thyroid dysfunction induced by PD-L1-Abs can be predicted by the TSH level at baseline, TgAb positivity at baseline, and prior treatment with RAM or multi-TKIs.

Association of Elevated Thyroid Stimulating Hormone with Atherosclerotic Cardiovascular Disease and Its Mortality in Elderly Community-Dwelling Chinese

PurposeWith increase of population aging, the prevalence of atherosclerotic cardiovascular disease (ASCVD) and elevated serum thyroid stimulating hormone (TSH) in elderly is increasing. High TSH level was reported to be associated with ASCVD and CVD mortality; however, few are studied in Chinese population, especially in the elderly. This study aimed to investigate the prevalence of elevated serum TSH and ASCVD in an elderly population of Chinese community and to explore the association between high serum TSH and ASCVD or CVD mortality.Patients and MethodsWe conducted a study involving 3814 adults who were at least 60 years of age. Questionnaires, physical examinations, and laboratory blood samples were collected in 2014, and a 78-months follow-up for cardiovascular and all-cause mortality was performed till December of 2020. Logistics regression was used to analyze the association between TSH and ASCVD. We used Cox models to assess the hazard ratios (HRs) for all-cause and CVD mortality across changes in serum TSH.ResultsIn this study, the prevalence of the elevated serum TSH was 19.8%, and significantly higher in women than in men (24.5% vs 13.9%, p < 0.001). The prevalence of ASCVD was 21.7%. In logistics regression models, elevated TSH was associated with ASCVD after adjusting for the risk factors of ASCVD in people over the age of 70 years (adjusted OR 1.054, P = 0.014). After a follow-up of 6.5 years, total 441 (11.6%) all-cause death and 174 (4.6%) death of CVD were observed. In Cox regression model, no significant correlation was found between TSH and all-cause mortality or CVD mortality in the elderly population.ConclusionIn the elderly population, there is high prevalence of elevated serum TSH and ASCVD. Elevated TSH seemed to be not associated with risk of all-cause or CVD mortality.

Low-grade systemic inflammation in subclinical hypothyroidism

Background: Hypothyroidism is the deficiency in the production of thyroid hormones to meet the requirements of peripheral tissues. Subclinical hypothyroidism (SCH) is defined biochemically as normal serum free thyroxin concentration in the presence of an elevated serum thyroid-stimulating hormone (TSH) concentration. SCH may be associated with low-grade systemic inflammation (increased high sensitivity-C reactive protein (hs-CRP), one possible explanation may be that TSH in adipocytes promotes the release of interleukin-6 (IL-6). Studies have confirmed inflammatory biomarkers like hs-CRP and IL-6 to be a predictor of cardiovascular (CV) events. However, the treatment of SCH remains subject to debate. Conclusions: It is increasingly evident that SCH has prognostic values and crucial clinical effects, which leads to the view of SCH not being a compensated biochemical change sensu strictu. Even a modest but consistent fluctuation in the circulating thyroid hormone levels can create a response from the human heart. Well-timed treatment should be considered as a precaution to avoid the unfavourable CV diseases. The inflammatory biomarkers, namely CRP and IL-6 are exceptionally robust markers of cardiovascular risk. Thus, using these biomarkers may be helpful in assessing the cardiovascular risk in patients with subclinical hypothyroidism.

Novel TSHB variant (c.217A>C) causing severe central hypothyroidism and pituitary hyperplasia.

SummaryBiallelic pathological variants in the thyroid stimulating hormone (TSH) subunit β gene (TSHB) result in isolated TSH deficiency and secondary hypothyroidism, a rare form of central congenital hypothyroidism (CCH), with an estimated incidence of 1 in 65 000 births. It is characterised by low levels of free thyroxine and inappropriately low serum TSH and may therefore be missed on routine neonatal screening for hypothyroidism, which relies on elevated TSH. We describe a patient with CCH who developed recurrence of pituitary hyperplasia and symptomatic hypothyroidism due to poor compliance with thyroxine replacement. She was diagnosed with CCH as a neonate and had previously required trans-sphenoidal hypophysectomy surgery for pituitary hyperplasia associated with threatened chiasmal compression at 17 years of age due to variable adherence to thyroxine replacement. Genetic testing of TSHB identified compound heterozygosity with novel variant c.217A>C, p.(Thr73Pro), and a previously reported variant c.373delT, p.(Cys125Valfs*10). Continued variable adherence to treatment as an adult resulted in recurrence of significant pituitary hyperplasia, which subsequently resolved with improved compliance without the need for additional medications or repeat surgery. This case describes a novel TSHB variant associated with CCH and demonstrates the importance of consistent compliance with thyroxine replacement to treat hypothyroidism and prevent pituitary hyperplasia in central hypothyroidism.Learning pointsPathogenic variants in the TSH subunit β gene (TSHB) are rare causes of central congenital hypothyroidism (CCH).c.217A>C, p.(Thr73Pro), is a novel TSHB variant, presented in association with CCH in this case report.Thyroxine replacement is critical to prevent clinical hypothyroidism and pituitary hyperplasia.Pituitary hyperplasia can recur post-surgery if adherence to thyroxine replacement is not maintained.Pituitary hyperplasia can dramatically reverse if compliance with thyroxine replacement is improved to maintain free thyroxine (FT4) levels in the middle-to-upper normal range, without the need for additional medications or surgeries.

Relationships between the serum TPOAb and TGAb antibody distributions and water iodine concentrations, thyroid hormones and thyroid diseases: a cross-sectional study of 2503 adults in China.

The aim of this study was to explore the status of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in three areas with differing water iodine concentrations; and to discuss the relationships between these two thyroid antibodies and thyroid diseases in the three areas. We investigated 2503 adults from three areas. Urinary iodine concentrations, thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), TPOAb, TGAb and thyroid volume (TV) were measured, and thyroid ultrasonography was performed. The positivity rates of TGAb(+), TPOAb(+) and TGAb(+) and TPOAb(+) or TGAb(+) were significantly higher in iodine fortification (IF) areas than iodine adequate (IA) areas (all P < 0·05). In IF and iodine excess areas, the positivity rates of TPOAb(+), TGAb(+) and TPOAb(+) or TGAb(+) significantly increased with age (all P for trend < 0·05). The levels of TSH, TV and the prevalence of overt hypothyroidism, subclinical hypothyroidism and goitre were significantly elevated in the thyroid antibody-positive groups in the three areas, but the FT3 was diminished (all P < 0·010). Positivity for TPOAb and TGAb was associated with an increased risk of subclinical hypothyroidism in the three areas. In areas with different median water iodine, positivity for both TPOAb and TGAb was associated with elevated TSH values. Notably, with the increased levels of TPOAb, the frequency of abnormally elevated TSH increased dramatically in the three areas.

Association between thyroid function and comorbid anxiety in first-episode and drug naïve patients with major depressive disorder.

Existing studies have shown that thyroid dysfunction is associated with depression. However, its role in major depressive disorder (MDD) with comorbid anxiety remains unclear. The main purpose of this study was to compare thyroid function in a large sample of first episode drug naïve (FEDN) MDD patients with and without anxiety. This cross-sectional study examined 1718 outpatients who were drug-naïve and diagnosed as MDD at first episode. Socio-demographic and clinical data, as well as thyroid function-related parameters, including free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin (TGAb), were evaluated. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to evaluate depressive, anxiety and psychotic symptoms, respectively. Compared to MDD patients without anxiety, MDD patients with anxiety were more likely to have more suicide attempts and psychotic symptoms, as well as higher serum levels of TSH, TPOAb and TGAb (all p < 0.001). Among patients with abnormally elevated serum TSH, TPOAb, and TGAb, 83.5% (872/1044), 89.3% (391/438) and 89.6% (266/297) had comorbid anxiety disorders, respectively. The odds ratio between patients with comorbid and without comorbid anxiety was 1.657 (95% CI 1.304-2.105) for elevated TSH levels, 1.943 (95% CI 1.444-2.613) for elevated TGAb levels, and 2.448 (95% CI 1.760-3.403) for elevated TPOAb levels. Furthermore, multivariable linear analysis showed that elevated TSH and TGAb were significant predictors of anxiety in MDD patients. Our results suggest that comorbid anxiety in FEDN MDD patients is positively associated with elevated TSH and TGAb levels, which may be promising biomarkers of comorbid anxiety in MDD patients. Clinical treatment of impaired thyroid function may be useful for comorbid anxiety in MDD patients.

Benefits of rescreening newborns of mothers affected by autoimmune hypothyroidism.

IntroductionInfants of mothers with autoimmune hypothyroidism (AH) are at risk of developing late-onset hypothyroidism, often escaping at newborn screening. This condition might be caused both by the action of maternal antibodies and/or by maternal treatment.ObjectivesThe aim of this study is to evaluate the prevalence of AH in the mothers of children born in Veneto region, Italy, and to define what is the most appropriate management for these newborns.MethodsNewborns of six different hospitals with a mother suffering from AH and with negative neonatal screening for congenital hypothyroidism (CH) were included in the study. Between 15 and 20 days of life, we collected a serum sample for the evaluation of thyroid function (thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3)) and anti-thyroid antibodies. On the same occasion, a capillary blood sampling was performed for a second screening test.ResultsMaternal AH has a prevalence of 3.5%. A total of 291 newborns were enrolled from November 2019 to May 2021. Whereas the 11.4% of infants had a slight elevated serum TSH (>6 mU/L) and required a follow-up, only 2 children presented an elevated TSH level at the second screening test. One of these, with the gland in situ, showed persistently elevated serum TSH levels and required treatment with levothyroxine.ConclusionsMaternal AH rarely caused neonatal thyroid dysfunction. We suggest to reassess newborns from mothers with AH 15 days after birth by means of a second neonatal screening test. This procedure avoids false negatives due to maternal thyroid status, is less invasive and cheaper than the serum TSH evaluation, and prevents a long follow-up.

Ecotoxicological impacts of industrial effluents on irrigation water quality, animal health and the role of calcium alginate in effluents treatment

The effluents discharged from Mansoura Company for Resins and Chemicals Industry were evaluated for drinking and irrigation purposes. Calcium-alginate beads were used for effluents treatment in this study. Young male rats were also allowed to drink effluents at different concentrations (10%, 50%, 100%) and treated 100% effluents with calcium-alginate for 11 weeks. Results indicated high concentrations of some physicochemical parameters and Cd, Co, Fe, Mn, Ni, Pb, and Zn in effluents that exceeded the permissible limits for drinking and irrigation purposes. Treatment by calcium-alginate alleviate heavy metals concentration but did not affect the physicochemical parameters. Depending on effluents concentration, the liver of young male rats showed high accumulation of Fe, Mn, Zn, Pb, Cd, Co, Cu, Cr, and Ni compared to the control group. Serum levels of liver enzymes, total bilirubin significantly increased while total protein, and albumin contents decreased in effluent groups. Liver concentrations of malondialdehyde and protein carbonyl significantly elevated along with significant decrease in superoxide dismutase, catalase, glutathione-S-transferase activities, and glutathione content. Moreover, growth and thyroid hormones were significantly reduced along with significant elevation in thyroid stimulating hormone. This was accompanied by significant decrease in the body weight, especially with 100% effluents concentration compared to control group. Also, histological investigations of both liver and thyroid gland using hematoxylin and eosin showed distortion in the structure of both organs especially with 50% and 100% effluent groups. However, treatment of effluents by calcium-alginate improved these changes. The study revealed that calcium-alginate are effective biosorbents for heavy metals and consequently decrease animal and human health hazards, but further studies are needed to alleviate physicochemical characteristics.

Can Thyroid Screening in the First Trimester Improve the Prediction of Gestational Diabetes Mellitus?

This study aimed to evaluate the clinical utility of the subclinical hypothyroidism (SCH) marker, elevated thyroid-stimulating hormone (TSH) and thyroid antibodies in their ability to predict subsequent gestational diabetes mellitus (GDM). In a prospective clinical trial, 230 pregnant women were screened for thyroid function during the first trimester of pregnancy. Increased TSH levels with normal free thyroxine (fT4) were considered SCH. The titers of thyroid peroxidase antibody (anti TPO Ab) at >35 IU/mL and thyroglobulin antibody (anti Tg Ab) at >115 IU/mL were considered as antibodies present. According to the OGTT results, the number of pregnant women with GDM showed the expected growth trend, which was 19%. Two groups of pregnant women were compared, one with GDM and the other without. Increased TSH levels and the presence of thyroid antibodies showed a positive correlation with the risk of GDM. TSH levels were significantly higher in pregnant women with GDM, p = 0.027. In this study, 25.6% of pregnant women met the diagnostic criteria for autoimmune thyroiditis. Hashimoto’s thyroiditis was significantly more common in GDM patients, p < 0.001. Through multivariate logistic regression, it was demonstrated that patient age, TSH 4 IU/mL, and anti TPO Ab > 35 IU/mL are significant predictors of gestational diabetes mellitus that may improve first-trimester pregnancy screening performance, AUC: 0.711; 95% CI: 0.629–0.793.

Increased Incidence of Hashimoto Thyroiditis in Selenium Deficiency: A Prospective 6-Year Cohort Study.

In 2015, we reported an increased prevalence of thyroid disease in a county of low habitual selenium (Se) intake in comparison to a neighboring county with higher intake in a cross-sectional survey in Shaanxi Province, China. To explore longitudinal effects of low Se status, a prospective cohort study was conducted in the same area from 2013 to 2019, and thyroid peroxidase autoantibodies (TPO-Abs) and disease incidence were compared. A total 1254 individuals from 1500 reinvited participants were successfully enrolled. Venous blood, fingernails, and urine samples were collected and analyzed to evaluate thyroid status, TPO-Abs, serum Se, and urinary iodine. Diagnosis of Hashimoto thyroiditis (HT) was based on elevated thyrotropin, presence of TPO-Abs, and ultrasound characteristics. Se deficiency was categorized using a serum concentration of 80 µg/L as a threshold, and tested by logistic regression for a relationship to TPO-Abs and HT. Se deficiency was observed in 46.2% of participants from the adequate-Se county (Ziyang) and in 89.7% from the low-Se county (Ningshan). Se concentrations in fingernails differed strongly by residency (Ziyang vs Ningshan; 678.7 vs 364.3 μg/kg; Z = -9.552; P < .001). Newly diagnosed HT in Ziyang was less frequent than in Ningshan (0.09% vs 0.31%; χ 2 = 4.350; P = .037). The conversion rate to seropositive TPO-Abs was 10.2% in Ningshan vs 5.6% in Ziyang. Excluding iodine as confounding factor, low-Se was confirmed as a risk factor for HT (relative risk [95% CI]; 3.65 [1.03-12.90]; P < .05). The data indicate an increased incidence of TPO-Ab seroconversion with low Se supply and support the hypothesis that Se deficiency contributes to HT as a modifiable risk factor.

Development of delayed thyroid stimulating hormone elevation in small-for-gestational-age infants: is a second screening needed?

Recent reports indicate that small for gestational age (SGA) could be a risk factor for delayed thyroid stimulating hormone (dTSH) elevation in preterm infants. The development of dTSH elevation in SGA late-preterm infants with a gestational age of 34-36 weeks has been investigated in only a few studies. In the present retrospective study, 70 SGA infants and 86 sex- and gestational age-matched controls who presented with normal results on initial thyroid function testing were included. SGA infants had a significantly higher prevalence of dTSH elevation (15.7% vs. 3.5%, P=0.009) compared with appropriate-for-gestational age infants. In SGA infants, the mean age at the time of dTSH was 24 days. Development of dTSH was associated with SGA and medical treatment with dopamine or furosemide. After adjusting for confounding factors, multiple logistic regression analysis showed SGA was a significant risk factor for the development of dTSH elevation (odds ratio, 23.2; 95% confidence interval, 2.27-236.91; P=0.008). SGA infants may be at risk for dTSH and clinicians could consider a second thyroid screening test around the age of 1 month.