Euthyroid Group Research Articles

Evaluating the Progression to Hypothyroidism in Preconception Euthyroid Thyroid Peroxidase Antibody-Positive Women.

Thyroid peroxidase antibody (TPOAb) positivity is prevalent in women of reproductive age and predisposes to thyroid dysfunction, particularly hypothyroidism, which has adverse effects on pregnancy. This study aimed to report the rate of development of abnormal thyroid function among initially euthyroid TPOAb-positive women recruited into the TABLET trial, to identify factors associated with the development of hypothyroidism, and to compare outcomes between euthyroid and treated hypothyroid individuals. This observational cohort study, conducted at 49 UK hospitals between 2011 and 2016, included euthyroid TPOAb-positive women 16 to 40 years of age with a history of miscarriage or subfertility, planning pregnancy, randomized to levothyroxine 50 mcg daily or placebo. Abnormal thyroid function, conception rate, and live birth rate (LBR) ≥34 weeks were analyzed. Among the women, 70/940 (7.4%) developed subclinical (SCH) or overt (OH) hypothyroidism: 27/470 taking levothyroxine and 43/470 placebo (relative risk [RR] 0.63; 95% CI, 0.39-1.00; P = 0.05); 83% of cases emerged prepregnancy. Baseline median serum TSH concentrations and TPOAb titers were significantly higher in those who developed hypothyroidism vs those who did not (P < 0.001). Treated SCH/OH demonstrated a higher failure-to-conceive rate compared with euthyroid women (adjusted RR 2.02 [1.56-2.62]; P < 0.001). The LBR ≥ 34 weeks was similar in the treated SCH/OH and euthyroid groups (adjusted RR 1.09 [0.77-1.55]; P = 0.6). Approximately 7% of euthyroid TPOAb-positive women will develop hypothyroidism within 1 year preconception or in pregnancy. Conception rates are lower in women with treated SCH/OH compared with euthyroid women, but LBR are comparable. Thyroid function in TPOAb-positive women should be monitored regularly, when trying to conceive, to ensure prompt diagnosis and appropriate treatment initiation.

Maternal subclinical hyperthyroidism and adverse pregnancy outcomes considering the iodine status: Tehran thyroid and pregnancy study

BackgroundUnlike overt thyroid diseases, the impacts of subclinical thyroid dysfunction, especially subclinical hyperthyroidism (SH), on adverse pregnancy outcomes are inconclusive. ObjectiveWe aimed to investigate the effect of maternal SH on adverse maternal and neonatal outcomes based on urinary iodine concentration (UIC). MethodsA secondary analysis was run on data collected in the Tehran Thyroid and Pregnancy study (TTPs). We used the data of 131 women with SH and 1650 cases of euthyroid. Serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine index (FT4I), and thyroid peroxidase antibody (TPOAb) were assessed at the first prenatal visit. A generalized linear regression model was applied to identify the effect of SH on the pregnancy outcomes based on UIC, and the effects were estimated with a 95% confidence interval. ResultsPreterm delivery was observed in 12.3% of women with SH and 6.7% of those with euthyroid (P = 0.03). Women with TSH< 0.3 mIU/L had a higher odds of preterm delivery than those with TSH≥ 0.3 regardless of urine iodine cut-off [OR= 2.27; 95% CI: (1.15, 4.48), p = 0.02]. Among those with UIC levels≥ 150 μg/L, the odds ratio of preterm delivery was 4.61 folds higher in the SH group compared to those with euthyroid [95%CI: (1.36, 15.71), p = 0.01)]. No significant difference between these two study groups was found in Neonatal Intensive Care Unit admission. Moreover, the results revealed no statistically significant difference in the means of neonatal anthropometric parameters in the SH and euthyroid groups in none of the subgroups of UIC (<150 or ≥150 µg/l). ConclusionsAccording to our results, maternal SH appears to be a risk factor for preterm delivery. This effect is more pronounced in women with higher UIC than those with lower UIC.

Gender effect on anti TPO antibodies and hypothyroidism in patients presenting to a teaching hospital, Bahawalpur, Pakistan.

Objective: To know the gender difference in the autoimmune profile that is anti TPO antibodies and thyroid profile in patients with hypothyroidism and in euthyroid controls. Study Design: Case Control study. Settings: Medical Out Door Department of Bahawal Victoria Hospital, Bahawalpur. Period: 01/09/2018 to 31/08/2019. Material &amp; Methods: Case control study that was conducted after taking ethical approval from hospital ethical committee. After taking informed consent data was entered on a predesigned questionnaire and 5 ml of venous blood was taken for thyroid profile and anti TPO antibodies. Study population was selected by nonprobability sampling. A total 128 patients in which 69 in the hypothyroid group A and 69 in euthyroid control group were added. Results: Most of the anti TPO positive hypothyroid participants were females but TSH value was more in males. All euthyroid anti TPO participants were females. Female hypothyroid patients were young compared to males. Conclusion: Autoimmune thyroid disorders are more common in females, autoimmunity appears before biochemical failure of thyroid.

Influence of Mild Thyroid Dysfunction on Outcomes after Off-Pump Coronary Artery Bypass Surgery.

We retrospectively evaluated the association between preoperative mild thyroid dysfunction (subclinical hypothyroidism [SCH] or low triiodothyronine [T3] syndrome) and outcomes in patients who underwent off-pump coronary surgery (OPCAB). Further, 800 patients (2015–2020) were divided into euthyroid, low T3, and SCH groups. The primary outcome assessed the association with composite endpoints (myocardial infarction, prolonged mechanical ventilation [>24 h], acute kidney injury, and 30-day/in-hospital mortality). The secondary outcome assessed the association with long-term mortality and 10% and 8% of the patients exhibited low T3 and SCH, respectively. Incidences of composite endpoints were significantly higher in the low T3 and SCH groups versus the euthyroid group (50.6%, 45.2%, 17.4%, respectively, p < 0.001). Multivariable regression analysis revealed chronic kidney disease, anemia, EuroSCORE, low T3, and SCH as independent risk factors of composite endpoints. The long-term mortality rate (median follow-up, 30 months) was higher in the low T3 and SCH groups than in the euthyroid group (9.6%, 11.3%, 2.4%, respectively, p < 0.001). In the absence of overt thyroid dysfunction, low T3 and SCH were associated with increased risk of adverse outcomes after OPCAB. Moreover, the adverse influences of low T3 and SCH seem to extend to long-term mortality, implying that routine thyroid function tests may enhance accurate risk stratification.

Comparison of reproductive outcomes in subclinical hypothyroidism women with high-normal versus low-normal thyroid-stimulating hormone levels after treatment with levothyroxine.

Reproductive outcomes in euthyroid women with high-normal thyroid-stimulating hormone (TSH) levels are comparable to those in euthyroid women with low TSH levels; however, few studies have investigated whether strictly controlled TSH levels after levothyroxine (LT4) treatment impair reproductive outcomes in infertile women with subclinical hypothyroidism (SCH). This study aimed to investigate the impact of high-normal versus low-normal TSH levels on reproductive outcomes in women undergoing their first in vitro fertilisation and embryo transfer (IVF-ET) cycle. This was a retrospective cohort study. Patients were divided into low-normal (TSH < 2.5 mIU/L, and ≥0.27 mIU/L) and high-normal (TSH ≥ 2.5 mIU/L, and <4.2 mIU/L) groups based on TSH levels after LT4 treatment. TSH levels after LT4 treatment and before ovarian stimulation were recorded. Reproductive outcomes were compared between the low-normal and high-normal TSH groups and between the euthyroid and LT4-treated groups. A total of 6002 women, 548 of whom were LT4-treated women, were finally included in this study. Among the LT4-treated women, 129 women had low-normal TSH levels, and 167 women had high-normal TSH levels. The clinical pregnancy rate, miscarriage rate, and live birth rate were comparable between the low-normal and high-normal groups (all p > .05). When adjusted by age, anti-Mullerian hormone (AMH) levels, infertility duration, transferred embryos, and dose and duration of LT4 treatment, high-normal TSH levels neither significantly decreased miscarriage (adjusted odds ratio [aOR] = 2.27, 95% confidence interval [CI] = 0.77-6.69, p = .14) nor increased clinical pregnancy (aOR = 1.15, 95% CI = 0.70-1.89, p = .57 or live birth (aOR = 0.97, 95% CI = 0.60-1.59, p = .92). Similar obstetric outcomes were observed between the low-normal and high-normal TSH groups after LT4 treatment and between the euthyroid and LT4-treated groups (all p ≥ .05). High-normal TSH levels did not have adverse effects on clinical and obstetric outcomes when compared with low-normal TSH levels after LT4 treatment. However, whether it is appropriate to set 2.5 mIU/L as the goal of treatment before IVF/ICSI remains to be determined in further well-designed studies.

Study of ECG changes in different thyrotoxic states and their correlation with thyroid hormone levels

: Thyroid hormone has many recognized effects on the cardiovascular system that results in significant comorbidity and may also affect the quality of life of diseased person. : To assess the ECG changes in thyrotoxicosis with thyroid hormone level and secondary objectives are to compare different ECG pattern in thyrotoxicosis patients (Graves’ disease, Toxic multinodular goiter, Thyroid adenoma) with healthy individual taken as controls after exclusion of cardiovascular disorder, Hypertension.: Observational prospective case-controlled study include minimum 50 thyrotoxicosis patients and 50 control, done at Department of General Medicine MGM Medical college and MY Hospital Indore (MP). : In the present study peak incidence of thyrotoxicosis was observed in the age group of 35-50 years (50%), followed by in the age group of 20-34 years (36%). The female: male ratio in thyrotoxic group is 5.25:1. In this study Graves’ disease accounts most of the cases of thyrotoxic patients i.e., 84%. Sinus tachycardia was observed in 88.09% of Graves’ disease, 40% of toxic multinodular goiter, and 100% of thyroiditis. Atrial fibrillation was observed in 7.1% of Graves’ disease and 60 % of toxic multinodular goiter. Also, sinus tachycardia was observed in 63% of thyrotoxic patients who had free T3 level &amp;#62;2.4 ng/ml, in 100% of thyrotoxic patients who had free T3 level from 1.39-2.4 ng/ml, and in 81.8% of thyrotoxic patients who had free T3 level from 0.486-1.38 ng/ml. Atrial fibrillation was observed in 31.5% of thyrotoxic patients who had free T3 level &amp;#62;2.4 ng/ml. The patients having free T3 level from 1.39-2.4 ng/ml and 0.486-1.38 ng/ml does not show atrial fibrillation in ECG. The peak incidence of the thyrotoxicosis was found in the age group of 35-50 years (50%), younger patients age group of 20-50 years accounts 86% of total thyrotoxic patients and females were more affected than male. Graves’ disease accounts 84% cases of thyrotoxicosis. Thyrotoxic group and euthyroid group shows statistically significant ECG changes in terms of sinus tachycardia (&amp;#60;0.0001) and atrial fibrillation (0.0256). In the thyrotoxic group 82% of patient shows sinus tachycardia and 12% of patient shows atrial fibrillation. The association between sinus tachycardia, atrial fibrillation and total T3 level and free T3 level was found statistically significant (P=0.007).

Study regarding the interrelation between subclinical hypothyroidism &amp; insulin resistance among PCOS women

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder (5-10%) in women of reproductive age. It is characterized by clinical and biochemical hyperandrogenism, menstrual irregularities, infertility and metabolic syndrome. Hypothyroidism is more common in PCOS. Subclinical hypothyroidism may aggravate insulin resistance. Objective: To find any relationship between subclinical hypothyroidism and Insulin resistance in PCOS patients. Materials and Methods: Study Design: A hospital based cross sectional study, Study Subjects: PCOS cases fulfilling the inclusion and exclusion criteria, SAMPLE SIZE: 100 PCOS cases attending to Gynaecology OPD, Study Setting: Gynaecology OPD of a Medical College hospital, Study Duration: January 2015 to August 2016. This included all PCOS patients, who had the criteria of Rotterdam for PCOS. Clinical examination, height, weight, BMI and lab data were measured including thyroid hormone and biochemical profile. Data were analysed by SPSS software version 21. Results: Out of 100 study subjects 52 were Euthyroid (TSH &lt; 5) and 48 were SCH (TSH ≥ 5). Fasting serum Insulin, and HOMA IR were significantly elevated in SCH group compared to Euthyroid group (p = &lt; 0.05.).

Effects of Levothyroxine Therapy on Pregnancy and Neonatal Outcomes in Subclinical Hypothyroidism.

PurposeTo assess the effects of levothyroxine (LT4) therapy on pregnancy and neonatal outcomes in pregnant women with subclinical hypothyroidism (SCH) who had different thyroid peroxidase antibody (TPOAb) status.MethodsThe data of pregnant women from the Chengdu Hospital of Integrated Traditional Chinese and Western Medicine between January 2017 and August 2019 were collected. SCH was defined as 11.88 < free thyroxine (FT4) < 20.06pmol/L in conjunction with thyroid-stimulating hormone (TSH) >4.00 mU/L. Some clinical characteristics have been collected, including body mass index (BMI) before pregnancy, number of pregnancies, number of miscarriages (spontaneous abortion), parity, family history of diabetes, history of smoking, history of drinking, TSH, FT4, and TPOAb levels. The prevalence of pregnancy and neonatal outcomes in the LT4 and non-LT4 groups, and in the LT4 and euthyroid control groups were compared, respectively. Univariate and multivariate logistic regression analyses were used to assess the effects of LT4 therapy on pregnancy and neonatal outcomes in SCH pregnant women with TPOAb.ResultsA total of 985 subjects were enrolled and divided into LT4 group with 478 patients, non-LT4 group with 156 patients and euthyroid control group with 351 patients. The prevalence of amniotic fluid abnormalities and premature delivery in the LT4 group was lower than that in the non-LT4 group in participants with TPOAb-positive (TPOAb+). After adjusting age, BMI prior to pregnancy, number of pregnancies, number of miscarriages, parity, TSH and FT4 level, the SCH pregnant women with TPOAb+ in the LT4 group had a lower risk of amniotic fluid abnormalities and premature delivery than that in the non-LT4 group.ConclusionLT4 therapy could reduce the risk of premature delivery and amniotic fluid abnormalities in the SCH pregnant women with TPOAb+. However, more randomized trials are required to confirm this association before the unequivocal advocacy of LT4 therapy in pregnant women with SCH.

Impact of thyroid dysfunction on red cell indices in a Sahiwal Teaching Hospital, Sahiwal.

Objective: To see the impact of abnormal secretion of thyroid hormones on red cell indices in patients of thyroid disorders. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology, Sahiwal Teaching Hospital, Sahiwal. Period: September 2020 to March 2021. Material &amp; Methods: Two hundred and thirty four (234) patients of thyroid disorders were enrolled in total, out of which 44 were hyperthyroid, 102 were euthyroid and 88 were hypothyroid. Patients of both genders with age limit of 20-60 years were included. Blood samples for CBC and serum TSH were analysed. SPSS 20 was used to analyse data. To analyze significance among various groups of thyroid dysfunction, we applied an independent t-test. Results: The comparison of hyperthyroid and euthyroid groups, showed a statistically significant difference in the RBC count (p=0.043) and hematocrit (p=0.032). Between hyperthyroid and hypothyroid groups a statistically significant difference was also noted in the mean hemoglobin (p=0.036) and hematocrit (p=0.022). Comparison of hypothyroid and euthyroid groups remained statistically non-significant for any of the hematological parameters. Conclusion: A fluctuation in hematological indices is seen due to interrelation between erythropoiesis and thyroid dysfunction, therefore in patients with thyroid disorders, monitoring of hematological parameters should be done.

Subclinical Hypothyroidism and Sperm DNA Fragmentation: A Cross-sectional Study of 5401 Men Seeking Infertility Care.

Our previous study showed that paternal subclinical hypothyroidism (SCH) had a detrimental effect on the clinical outcomes of assisted reproductive technologies. However, it remains to be determined whether paternal SCH affects sperm DNA integrity. To investigate the association between SCH and sperm DNA fragmentation in men seeking infertility care. This cross-sectional study included 4983 men with euthyroidism and 418 men with SCH seeking infertility treatment in a tertiary care academic medical center between January 2017 and December 2021. The outcome measures were the absolute DNA fragmentation index (DFI) and the risk of abnormal DFI (defined as DFI ≥ 25% or ≥ 30%). The mean (SD) age of men with euthyroidism and men with SCH was 34.20 (5.97) and 35.35 (6.48) years, respectively (P < 0.001). The difference in DFI was not statistically significant (adjusted mean: 19.7% vs 18.9% in the SCH and euthyroidism groups, respectively; P = 0.07) after confounder adjustment. A DFI ≥25% was significantly more frequent in men with SCH (20.57%) than in men with euthyroidism (14.49%) after confounder adjustment [odds ratio (OR) 1.43 (95% CI 1.09-1.88)]. DFI ≥ 30% was also significantly more common in men with SCH (11.72%) than in men with euthyroidism [6.74%; OR 1.84 (95% CI 1.34-2.52)]. In addition, thyroid-stimulating hormone concentration was significantly associated with an increased risk of having a DFI ≥25% (P < 0.001) or ≥30% (P = 0.011). SCH was significantly associated with an increased risk of an abnormal DFI.

Dyslipidaemia and inflammatory markers as the risk predictors for cardiovascular disease in newly diagnosed premenopausal hypothyroid women.

Hypothyroidism can predispose systolic and diastolic cardiac dysfunction, increased peripheral vascular resistance, endothelial dysfunction, altered coagulopathy, and dyslipidemia resulting in atherosclerosis. Thyroid hormones can influence homocysteine metabolism by regulating the methylenetetrahydrofolate reductase (M THR). So, this study aimed to compare the markers homocysteine, high sensitive C-reactive protein (hs-CRP), and Atherogenic Indices (AI) between newly diagnosed hypothyroid and euthyroid premenopausal women. 80 Female patients between 20 and 45 years were enrolled in this study and were equally divided into cases and controls group. Laboratory tests included: i) Serum T3, T4, TSH was measured using electrochemiluminescence, ii) lipid profile, homocysteine, and hs-CRP were measured for all the participants. Atherogenic indices: Castelli risk indices I&II, Atherogenic coefficient (AEC), and Atherogenic Index of Plasma (AIP) were calculated using formulas. A comparison between the study groups was made by using the Independent t-test and Mann-Whitney U test. p-value < 0.05 was considered significant. The hypothyroid group had significantly higher levels of homocysteine (p= 0.014), and hs-CRP (hs-CRP> 3.0 mg/L, 70% of participants have intermediate to high risk for a cardiovascular event) and elevated BMI compared to participants in the euthyroid group. Atherogenic indices (p< 0.001) was significantly increased in the hypothyroid participants' group. TC, TG , and LDL were significantly elevated in the hypothyroid group but did not show any association with systolic and diastolic blood pressure. Premenopausal women with hypothyroidism have a greater predisposition for cardiovascular disease compared to euthyroid.

Maternal Subclinical Hyperthyroidism and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis of Observational Studies.

Findings from studies evaluating adverse pregnancy outcomes in pregnant women with subclinical hyperthyroidism are conflicting and inconclusive. In this systematic review and meta-analysis, our aim was to evaluate the pooled odds ratio (OR) of adverse pregnancy outcomes in women with subclinical hyperthyroidism, compared to euthyroid women. Scopus, PubMed (including Medline), and Web of Science databases were systemically searched for regaining published studies to January 2022 examining adverse pregnancy outcomes in women with subclinical hyperthyroidism. Outcomes of interest were classified into seven composite outcomes, including hypertensive disorders, preterm delivery, macrosomia/large for gestational age (LGA), pregnancy loss, adverse maternal outcomes, adverse neonatal outcomes, and adverse fetal outcomes. In this meta-analysis, both fixed and random effect models were used. Publication bias was also evaluated by Egger test and the funnel plot, and the trim and fill method was conducted in case of a significant result, to adjust the bias. Of 202 records retrieved through searching databases, 11 studies were selected for the final analyses. There were no significant differences in pooled ORs of hypertensive disorders, preterm delivery, macrosomia/LGA, and pregnancy loss in pregnant women with subclinical hyperthyroidism, compared to the euthyroid controls. The pooled OR of adverse maternal, neonatal, and fetal outcomes in pregnant women with subclinical hyperthyroidism was not statistically significantly different from that of the euthyroid control group. The current meta-analysis demonstrated that subclinical hyperthyroidism in pregnancy is not related with adverse maternal and fetal outcomes. Therefore, clinicians should be avoided unnecessary treatments for pregnant women with subclinical hyperthyroidism.

P-659 Does Preconception thyroid-stimulating hormone (TSH) levels affect the clinical outcomes of Infertile Women Undergoing Fresh Embryo Transfer Cycle?

Abstract Study question Does Preconception TSH levels affect the clinical outcomes of Infertile Women Undergoing Fresh Embryo Transfer Cycle? Summary answer Among euthyroid patients, preconceptional TSH values in the high-normal range (between 2.5 and 4.0 mIU/L) are associated with adverse clinical outcomes. What is known already Serum thyroid-stimulating hormone (TSH) levels are routinely screened in women with infertility given the negative impact of thyroid disease on ovarian function and pregnancy is associated with poor outcomes.In fact, an underlying thyroid abnormality was found in 46% for women experiencing IVF failure and TSH levels were inversely proportional to the fertilization rate at IVF. While it is clear that pregnancies complicated by subclinical hypothyroidism in the fertile population have poor outcomes, the relevance of preconception subclinical hypothyroidism in infertile patients undergoing ART has not been thoroughly examined. Study design, size, duration Outcomes of all fresh IVF patients with an embryo transfer from from January 2019 to August 2021 within 1 yr of TSH screening at a our center were studied. IVF cycles using donor oocyte, TESE sperm, PGT, or those lacking follow-up were excluded. For patients with more than one Preconception TSH measurement prior IVF, the most recent measurement before the IVF cycle was used. Participants/materials, setting, methods Cycles were categorized into two groups based on preconceptional TSH values: Euthyroid (0.4–2.5 μIU/mL), subclinical hypothyroidism (&amp;gt;2.5-4.0 μIU/mL). All women underwent standard IVF protocols following usual individualized practice in our IVF clinic. Chi-square test was used to evaluate the differences between the patient cohorts. Main results and the role of chance A total of 2,669 fresh-ET cycles were reviewed retrospectively by dividing them into a euthyroid group (0.4-2.5 uIU/mL, n = 2397) and subclinical hypothyroidism group (2.5-4.0 uIU/mL, n=272). The overall biochemical pregnancy rate and clinical pregnancy rate was significantly lower in women with subclinical hypothyroidism (50.0% vs 43.4%, 40.0% vs 30.9%, p &amp;lt; 0.05). However, biochemical preganacy loss rate and the miscarriage rate was higher in women with subclinical hypothyroidism. (19.6% vs. 28.8%, 17.3% vs. 25.0%, p = 0.079) Limitations, reasons for caution This is a retrospective study and results must be confirmed on a well-designed randomized controlled study. Correlations must be considered with caution since the role of TSH is under study, especially when considering LBR outcome. Wider implications of the findings Among euthyroid patients, preconceptional TSH values in the high-normal range (between 2.5 and 4.0 mIU/L) are associated with adverse clinical outcomes. Our findings suggest that subclinical hypothyroidism may affect clinical outcomes. Trial registration number not applicable

Effect of Hyperthyroidism Control During Pregnancy on Maternal and Fetal Outcome: A Systematic Review and Meta-Analysis.

ContextAlthough the overt hyperthyroidism treatment during pregnancy is mandatory, unfortunately, few studies have evaluated the impact of treatment on reducing maternal and fetal outcomes.ObjectiveThis study aimed to demonstrate whether treatment to control hyperthyroidism manifested during pregnancy can potentially reduce maternal-fetal effects compared with euthyroid pregnancies through a systematic review with meta-analysis.Data SourceMEDLINE (PubMed), Embase, Cochrane Library Central, LILACS/BIREME until May 2021.Study SelectionStudies that compared, during the gestational period, treated women with hyperthyroidism versus euthyroid women. The following outcomes of this comparison were: pre-eclampsia, abruptio placentae, fetal growth retardation, gestational diabetes, postpartum hemorrhage, low birth weight, stillbirth, spontaneous abortions, premature birth.Data ExtractionTwo independent reviewers extracted data and performed quality assessments. Dichotomous data were analyzed by calculating risk differences (DR) with fixed and random effect models according to the level of heterogeneity.Data SynthesisSeven cohort studies were included. The results of the meta-analysis indicated that there was a lower incidence of preeclampsia (p=0.01), low birth weight (p=0.03), spontaneous abortion (p<0.00001) and preterm birth (p=0.001) favouring the euthyroid pregnant group when compared to those who treated hyperthyroidism during pregnancy. However, no statistically significant differences were observed in the outcomes: abruptio placentae, fetal growth retardation, gestational diabetes mellitus, postpartum hemorrhage, and stillbirth.ConclusionsOur findings demonstrated that treating overt hyperthyroidism in pregnancy is mandatory and appears to reduce some potential maternal-fetal complications, despite there still being a residual risk of negative outcomes.

Effect of Maternal Subclinical Hypothyroidism on Congenital Hypothyroidism Screening Results: A Retrospective Cohort Study.

This study aimed to evaluate the results of congenital hypothyroidism screening (CHS) in neonates born to women with subclinical hypothyroidism (SHT) during pregnancy and to identify maternal and neonatal characteristics associated with recall rate in CHS. This retrospective cohort study included nonrefugee pregnant women and newborn pairs who underwent thyroid function tests during prenatal follow-up between 2014 and 2017 and had neonatal CHS records. The women were evaluated overall and divided into euthyroidism (ET) and SHT groups according to their thyroid function tests. The groups were compared in terms of CHS results. Neonates with thyroid-stimulating hormone (TSH) levels <5.5 mIU/L were considered "normal," while those with values ≥5.5 mIU/L were "recall." The antenatal thyroid function data of a total of 22,383 pregnant women were analyzed. Of these, 71.6% were ET and 16.3% were diagnosed as SHT. Overall, the recall rate accounted for 5.34% of all CHS results and the recall rate was higher in the SHT group (7.10%) compared with the ET group (5.54%; p = 0.001). Being low birth weight (LBW) or large for gestation age (LGA), maternal TSH above the 97.5th percentile, and cesarean delivery increased the risk of recall in CHS (p ˂ 0.05). The recall rate was higher among the neonates of mothers with SHT. Being LBW or LGA, maternal TSH above the 97.5th percentile and cesarean delivery increased the risk of recall in CHS. · SHT is the most common form of hypothyroidism in pregnancy.. · TSH elevation is higher among the neonates of mothers with SHT.. · Being LBW or LGA, and cesarean delivery also increase the risk of TSH elevation in infants..

Anxiety in patients with hyperthyroidism

IntroductionMental symptoms are the first manifestations of hyperthyroidism. They include anxiety, dysphoria, irritability, emotional lability, sleep disorders, intellectual dysfunction, mania or depression. Anxiety is the main symptom and requires more detailed study.ObjectivesThe objective was to determine symptomatology of anxiety in patients with hyperthyroidism and compare with euthyroid patients.MethodsThe study included 56 patients with hyperthyroidism (high free T3 and free T4, suppressed TSH) and 32 euthyroid patients (normal free T3, free T4 and TSH) of the control group. For psychiatric assessment State-Trait Anxiety Inventory [STAI], Hamilton Depression Rating Scale [HAM-D], and Hamilton Anxiety Rating Scale [HAM-A] were used.ResultsTotal scores obtained from STAI, HAM-D and HAM-A were significantly greater in the hyperthyroidism group than that of the euthyroid group (p&lt;0.05). The level of state anxiety in patients with hyperthyroidism was 51.39 ± 0.95 (high level) compared with 41.59 ± 2.41 (moderate level) in the control group. The level of trait anxiety in patients with hyperthyroidism was 46.86 ± 0.69 (high level), and 44.16 ± 2.17 (moderate level) in the control group. Psychomotor agitation (HAM-D # 9), psychic anxiety (HAM-D # 10), insomnia (HAM-A # 4) and weight loss (HAM-D # 16) were typical for patients with hyperthyroidism, while in the control group predominate the feelings of fatigue, weakness and loss of interest in working (HAM-D # 7).ConclusionsThe prevalence of anxiety in patients with hyperthyroidism is significantly more frequent compared to euthyroid patients. Anxiety and other psychiatric symptoms should be considered by both endocrinologists and psychiatrists.DisclosureNo significant relationships.

Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction.

AimsThyroid hormones widely affect the cardiovascular system, but the effects of mild thyroid dysfunction on the clinical prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. Our aims were to analyze the relations between mild thyroid dysfunction at admission and clinical outcomes in Chinese patients with STEMI.MethodsA total of 1,176 STEMI patients with the available data of thyroid function and follow-up were analyzed, including 348 patients with mild thyroid dysfunction [subclinical hypothyroidism (n=81), hyperthyroidism (SHyper) (n=51), and low triiodothyronine syndrome (LT3S) (n=216)] and 828 patients with euthyroid function. During a median 4.4-year follow-up, in-hospital mortality, cardiac and all-cause mortalities were subsequently compared among the four groups.ResultsCompared with the euthyroid group, STEMI patients in the SHyper and LT3S groups faced obviously increased risks of in-hospital death [odds ratio (OR): 5.007, 95% confidence interval (CI): 1.246–20.124, p = 0.023 and OR: 2.491, 95% CI: 1.054–5.887, p = 0.037, respectively) even after adjustment for various confounding factors. During a median 4.4-year follow-up, STEMI patients with LT3S at baseline had higher cardiovascular mortality [hazard ratio (HR): 1.880, 95% CI: 1.178–2.998, p = 0.008] and all-cause mortality HR: 1.647, 95% CI: 1.072–2.531, p = 0.023] than those with euthyroid at baseline, whereas no significantly increased mortality was found for STEMI patients with SCH and SHyper at baseline.ConclusionsSTEMI patients with SHyper at admission had increased risk of in-hospital mortality, and STEMI patients with LT3S at baseline had worse prognosis and higher incidences of in-hospital mortality and cardiovascular and all-cause deaths compared with euthyroid patients.

Dynamic follow-up of the effects of programmed death 1 inhibitor treatment on thyroid function and sonographic features in patients with hepatocellular carcinoma.

ObjectiveProgrammed cell death protein-1 (PD-1) inhibitors are widely used for the treatment of hepatocellular carcinoma (HCC). Thyroid dysfunction is common in patients treated with this therapy, although the dynamic changes in thyroid function and sonographic features remain unclear.MethodsWe analyzed 38 patients with HCC who received anti-PD-1 therapy at our hospital. Demographic, clinical, laboratory, and ultrasound data were extracted from electronic medical records. The grading of thyroid nodules was based on the American College of Radiology Thyroid Imaging Reporting and Data System classification. Statistical analyses were performed using GraphPad Prism 5.0.ResultsFifteen patients (40%) had hypothyroidism, among which six had hypothyroidism at baseline, three had overt hypothyroidism, and six had subclinical hypothyroidism after anti-PD1 therapy. The proportion of patients with euthyroid function and thyroid antibody positivity was significantly lower than that of patients with thyroid dysfunction (10% vs 39%, P < 0.05). Nine patients (24%) had irregular echo patterns on sonographic imaging, six of whom had irregular echo patterns present during the treatment, but only one had them persist until the end of treatment. At baseline, the classification of most thyroid nodules was grade 3, with a significant increase in grade 4A and 4B classifications during treatment, though most nodules remained grade 3 at the end of treatment. There were no significant differences in survival rates between the euthyroid and thyroid dysfunction groups.ConclusionAnti-PD-1 therapy-induced thyroid dysfunction was accompanied by changes in thyroid function, antibodies, and ultrasonography. Therefore, in patients receiving anti-PD-1 therapy, close, dynamic monitoring of thyroid function, antibodies, and ultrasonographic characteristics is necessary.

Developmental Hypothyroidism Influences the Development of the Entorhinal-Dentate Gyrus Pathway of Rat Offspring.

BackgroundDevelopmental hypothyroidism impairs learning and memory in offspring, which depend on extensive neuronal circuits in the entorhinal cortex, together with the hippocampus and neocortex. The entorhinal-dentate gyrus pathway is the main entrance of memory circuits. We investigated whether developmental hypothyroidism impaired the morphological development of the entorhinal-dentate gyrus pathway.MethodsWe examined the structure and function of the entorhinal-dentate gyrus pathway in response to developmental hypothyroidism induced using 2-mercapto-1-methylimidazole.Results1,1´-Dioctadecyl-3,3,3´,3´-tetramethylindocarbocyanine perchlorate tract tracing indicated that entorhinal axons showed delayed growth in reaching the outer molecular layer of the dentate gyrus at postnatal days 2 and 4 in hypothyroid conditions. The proportion of fibers in the outer molecular layer was significantly smaller in the hypothyroid group than in the euthyroid group at postnatal day 4. At postnatal day 10, the pathway showed a layer-specific distribution in the outer molecular layer, similar to the euthyroid group. However, the projected area of entorhinal axons was smaller in the hypothyroid group than in the euthyroid group. An electrophysiological examination showed that hypothyroidism impaired the long-term potentiation of the perforant and the cornu ammonis 3–cornu ammonis 1 pathways. Many repulsive axon guidance molecules were involved in the formation of the entorhinaldentate gyrus pathway. The hypothyroid group had higher levels of erythropoietin-producing hepatocyte ligand A3 and semaphorin 3A than the euthyroid group.ConclusionWe demonstrated that developmental hypothyroidism might influence the development of the entorhinal-dentate gyrus pathway, contributing to impaired long-term potentiation. These findings improve our understanding of neural mechanisms for memory function.

The Relationship Between Thyroid Diseases and Irisin Hormone

Introduction: The aim of this study is to investigate the relationship between irisin, a new test with similar effects on energy metabolism and thermogenesis, and thyroid hormones. Material and Methods: 86 subjects included in the study. The subjects were divided into three groups as euthyroid, hypothyroid and hyperthyroid group by evaluating their TSH and fT4 levels. For all subjects, gender, age, medical history and blood test results were examined. Irisin levels of all groups were measured. Statistical analysis was performed with the obtained data. Results: A total of 86 people; 30 patients with newly diagnosed hypothyroidism, 28 patients with newly diagnosed hyperthyroidism and 28 euthyroid individuals as the control group were included in the study.The mean irisin level was highest in the hyperthyroid group and lowest in the hypothyroid group. The mean irisin level was found to be significantly higher in the hyperthyroid group than in the hypothyroid and control group (p˂0.01).The irisin level was found to be significantly higher in the control group than in the hypothyroid group (p˂0.01). A statistically significant negative correlation was found between the irisin levels and TSH levels (p˂0.01). A statistically significant positive correlation was found between the irisin levels and fT4,fT3 levels (p˂0.01). Conclusion: A significant correlation has been found between the TSH,fT3,fT4 and irisin.It was found that as TSH levels increase, irisin levels decreased and that as fT3, fT4 levels increase, irisin levels increased.We believe that irisin can be used as a new test in the follow-up and diagnosis of thyroid diseases, with studies with larger sample size and long-term follow-up in future.