Euthyroid Group Research Articles

Oral Microbiota Signatures in the Pathogenesis of Euthyroid Hashimoto's Thyroiditis.

One of the most prevalent autoimmune illnesses in the world is Hashimoto's thyroiditis, whose pathogenesis is still unknown. The gut-thyroid axis is frequently examined, and although oral health affects thyroid functions, there are limited data on how oral microbiota is linked to Hashimoto's thyroiditis. The study aims to identify the oral microbiota from saliva samples taken from treated (with levothyroxine) and untreated female euthyroid Hashimoto's thyroiditis patients as well as healthy controls who were age- and sex-matched to compare the oral microbiota across the groups and to contribute preliminary data to the literature. This study was designed as a single-center cross-sectional observational study. Sixty (60) female patients with euthyroid Hashimoto's thyroiditis (HT) and eighteen (18) age- and gender-matched healthy controls were included in this study. Unstimulated saliva samples were collected. After DNA isolation, sequencing was performed by targeting the V3-V4 gene regions of the 16S rRNA on the MiSeq instrument. R scripts and SPSS were used for bioinformatic and statistical analysis. No significant differences were found in the diversity indices. However, Patescibacteria phylum showed a significantly higher abundance (3.59 vs. 1.12; p = 0.022) in the oral microbiota of HT patients compared to HC. In the oral microbiota, the euthyroid HT group had approximately 7, 9, and 10-fold higher levels of the Gemella, Enterococcus, and Bacillus genera levels than healthy controls, respectively. In conclusion, the results of our study demonstrated that Hashimoto's thyroiditis causes changes in the oral microbiota, whereas the medicine used to treat the condition had no such effects. Therefore, revealing the core oral microbiota and long-term follow-up of the HT process by conducting extensive and multicenter studies might provide some important data for understanding the pathogenesis of the disease.

The prevalence of subclinical hypothyroidism in a pre-diabetes population and an analysis of related factors

Background To investigate the prevalence and related influencing factors of subclinical hypothyroidism (SCH) in a pre-diabetes (PreDM) population. Patients and methods A multi-stage stratified cluster random sampling method was used to select the adult Han population in Gansu Province for investigation. General data and related biochemical indices were recorded and SPSS software was used for statistical analyses. Results This study selected 2876 patients, including 548 with SCH and 433 with PreDM. In the PreDM population, the levels of thyroid stimulating hormone (TSH), serum phosphorus, TPOAb and TgAb in the SCH group were higher than those in the euthyroid group (P < 0.05). The level of TPOAb in females of SCH group was higher than that in males (P < 0.05). The positive rates of TPOAb and TgAb in females were higher than those in males in the total population and SCH population. The prevalence of SCH in the PreDM group under 60 was significantly higher than that in the normal glucose tolerance (NGT) group (26.02% vs. 20.40%, χ 2 = 5.150, P < 0.05). We defined SCH as a TSH level of >4.20 mIU/L. Using this criterion, the prevalence of SCH in the total population of PreDM was higher than that in the NGT population (χ 2 = 8.611, P < 0.05), the prevalence of SCH in the PreDM population generally showed an upward trend. However, we performed a separate analysis considering the accepted impact of age on TSH redefining SCH as TSH >8.86 mIU/L (for individuals over age 65). However, allowing for the expected rise in TSH levels in individuals over age 65, the prevalence of SCH in the elderly over 65 years of age decreased significantly (NGT population from 27.48% to 9.16%, PreDM population from 34.18% to 6.33%, P < 0.05). Logistic regression analysis showed that the risk factors for SCH in the PreDM population were female gender, fasting plasma glucose and TSH (all P < 0.05). Risk factors for SCH in the impaired fasting glucose (IFG) population were female gender, OGTT 2 h, TSH and TPOAb (all P < 0.05). Conclusion The prevalence of SCH in the PreDM population not considering the known physiological increase in age related TSH was relatively high and was significant in female and the IFG population. However, the effect of age on these findings needs to attract more attention.

Levels of Liver Enzymes and Some Changes in Renal Functions in Iraqi Hypothyroid Patients Women

The present study aimed to investigate physiological disorders in some liver and kidney functions in hypothyroid Iraqi women .The study was carried on 120 subjects in the Specialist Center of Endocrine and Diabetic diseases at Rusafa region, near AL-Kindey Hospital . That study began on 20/10/2013 to 25/1/2014&#x0D; The subjects were divided into 4 groups (control, euthyroid ,subclinical and overt hypothyroid).Each group included 30 females ,their ages ranged (39.45 ±1.79) years.&#x0D; The results showed a significant(P˂ 0.05) increase in the level of TSH in subclinical (18.23 ± 2.34mu/l) and overt hypothyroid patients (41.37 ± 3.75 mu/l) in comparison with control (2.09 ± 0.23mu/l) and euthyroid groups (2.89 ± 0.20mu/l). The levels of T4 and T3 were within the normal limits in control (79.73 ± 2.11 nmol/L);(1.70 ± 0.07nmol/L),euthyroid (87.10 ± 2.16 nmol/L) ; (1.58 ± 0.05nmol/L) and subclinical (77.76 ± 2.31nmol/L) ; (1.52 ± 0.08 nmol/L)respectively. While overt hypothyroid group showed a significant (P˂0.05) decrease in T4 level (46.36 ± 2.32 nmol/L) with normal T3(1.30 ± 0.11 nmol/L).&#x0D; The changes in liver function tests in overt hypothyroid group showed a significant (P˂0.05) increase in the levels of SGOT (23.05 ± 2.67U/L),SGPT(21.89 ± 2.35 U/L) and ALP(99.98 ± 7.47 U/L) in comparison with SGOT in control (8.80 ± 0.88 U/L) , euthyroid (11.36 ± 0.85 U/L) and subclinical (11.88 ± 1.42 U/L) and SGPT in control (13.46 ± 0.75 U/L) euthyroid (10.93 ± 1.03 U/L), and subclinical (14.08 ± 1.87 U/L) and in the level of ALP in control(50.27 ± 2.65 U/L),euthyroid (65.27 ± 2.87 U/L) and subclinical(71.58 ± 4.90 U/L) respectively.&#x0D; Total serum protein(7.49 ± 0.16 g/dl) and bilirubin (1.23 ± 0.11 mg/dl) were increased significantly (P˂ 0.05) in overt hypothyroid patients in comparable with control (6.82 ± 0.04 gm/dl) ; (0.613 ± 0.04 mg/dl),euthyroid(6.93 ± 0.07gm/dl) ;(0.653 ±0.04 mg/dl), and subclinical (6.91 ± 0.08 gm/dl);(0.883 ± 0.08 mg/dl) respectively.&#x0D; Creatinine level was increased significantly (P˂0.05) in subclinical and overt hypothyroid groups (1.07 ± 0.07mg/dl);(1.26 ± 0.06mg/dl), in comparable with control and euthyroid groups (0.846 ± 0.03),(0.836 ± 0.02) respectively.The level of uric acid was increased significantly (P˂0.05) in the overt group(7.11 ± 0.11mg/dl) in comparable with control,euthyroid and subclinical (3.78 ± 0.18mg/dl),(3.66 ± 0.16mg/dl),(4.42 ± 0.28mg/dl) respectively.&#x0D; We concluded from this study that the overt hypothyroidism had effected the liver function tests by increasing liver enzymes SGOT,SGPT,and ALP . Also we found that total plasma protein and bilirubin levels were increased in overt hypothyroid group.The renal function test showed an increase in the levels of creatinine in subclinical and overt hypothyroid groups while uric acid increased in overt hypothyroid .&#x0D; Euthyroid group showed normal levels for the above studied parameters which means that the levels of these parameters returned to the normal values in treated hypothyroid group (euthyroid patients) with Levothroxine –L at a dose 50mg or 100 mg orally.

Type 2 Diabetes Mellitus Coincident with Clinical and Subclinical Thyroid Dysfunctions Results in Dysregulation of Circulating Chemerin, Resistin and Visfatin

The alterations of circulating adipocytokines have been reported in thyroid diseases or type 2 diabetes mellitus (T2DM), but such data in T2DM coincident with clinical and subclinical thyroid-dysfunctions are limited, and remain to be investigated. We studied the changes in serum chemerin, resisitin and visfatin in T2DM patients with thyroid dysfunctions, and their association with inflammatory and insulin resistance-markers. A total of 272 female and male Iranian participants were selected and divided into six groups: the euthyroid group, T2DM, T2DM coincident with clinical and sub clinical hypothyroidism (SC-HO, and C-HO), and T2DM coincident with clinical and sub clinical hyperthyroidism (SC-HR, C-HR).Demographic characteristics, serum levels of adipocytokines, thyroid hormones, inflammatory factors (IL1-β, IL-6 and CRP) and insulin resistance-markers were determined in all participants. T2DM patients with clinical thyroid dysfunctions showed higher levels of circulating resistin, visfatin, chemerin and inflammatory factors, compared with the T2DM group and T2DM coexisted with subclinical thyroid diseases. No significant differences were observed in circulating adipocytokines and inflammatory markers between T2DM coexisting with subclinical thyroid diseases and those without thyroid dysfunctions. Our results revealed that clinical thyroid dysfunction in T2DM patients was associated with elevated levels of circulating resistin, chemerin, visfatin and inflammatory factors, while no such alteration was detected in T2DM coincident with subclinical thyroid dysfunction.

A Novel Inflammatory Marker for the Diagnosis of Hashimoto's Thyroiditis: Platelet-Count-to-Lymphocyte-Count Ratio.

Hashimoto's thyroiditis (HT) is a chronic autoimmune thyroiditis that causes systemic inflammation in the body, leading to hypothyroidism and an enlargement of the thyroid gland. This study aims to reveal whether there is a relationship between Hashimoto's thyroiditis and the platelet-count-to-lymphocyte-count ratio (PLR), which is used as a new inflammatory marker. In this retrospective study, we compared the PLR of the euthyroid HT group and the hypothyroid-thyrotoxic HT group to the controls. We also evaluated the values of thyroid-stimulating hormone (TSH), free T4 (fT4), C-reactive protein (CRP), aspartate transaminase (AST), alanine transaminase (ALT), white blood cell count, lymphocyte count, hemoglobin, hematocrit, and platelet count in each group. The PLR of the subjects with Hashimoto's thyroiditis was found to be significantly different from the control group (p < 0.001), with the rankings as follows: hypothyroid-thyrotoxic HT 177% (72-417) > euthyroid HT 137% (69-272) > control group 103% (44-243). In addition to the increased PLR values, an increase in CRP values was also observed, revealing a strong positive correlation between the PLR and CRP in the HT patients. In this study, we found out that the PLR was higher in the hypothyroid-thyrotoxic HT and euthyroid HT patients than in a healthy control group.

Evaluation of an Association of Thyroid Disorder and Dyslipidemia in Patients with Cardiovascular Disease: A Cross-sectional Study

Background: Subclinical Hypothyroidism (SCH) is defined as normal serum free thyroid hormone levels coexisting with elevated serum Thyroid-Stimulating Hormone (TSH) levels. SCH is a common condition observed in clinical practice with several unique features. The present study was conducted to find prevalence of subclinical hypothyroidism in patients with myocardial infarction and demographic differences between patients with and without SCH. Materials and Methods: A total of 100 patients with Myocardial Infarction of Adult (age &gt; 18 years) males and females were selected from the patients attending Medicine OPD, IPD or Intensive Care Unit (ICU) in GMC, Azamgarh. Clinical examination, laboratory investigations for myocardial infarction, thyroid status and lipid profile was done in all patients in our study. All Patients with TSH values &gt; 10mU/L or &lt; 0.04mU/L or Known cases of Thyroid abnormalities were excluded from the study. Statistical analysis was done using excel and SPSS software. Results: Out of 100 patients 44 patients of MI had subclinical hypothyroid were as rest 56 patients were euthyroid. In both the groups no statistical difference was seen in the type of Myocardial infarction. There was significant difference in lipid profile (p&lt;0.05) in SCH group as compared to euthyroid group. Conclusion: Patients with Subclinical hypothyroid and MI had more lipid abnormalities as compared to Euthyroid group although the type of myocardial infarction was similar in both the groups. Males had more myocardial infarction as compared to females in both the subclinical hypothyroid and euthyroid groups.

Association between circulating resistin levels and thyroid dysfunction: A systematic review and meta-analysis.

As a product of adipose tissue, resistin exceeds other adipokines in its role in regulating appetite, energy expenditure, insulin sensitivity, inflammation, and immunity, similar to thyroid hormones. This study aimed to evaluate the association between resistin levels and thyroid dysfunction and to explore variations in circulating resistin levels before and after treatment for thyroid dysfunction. This study was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. A comprehensive search of PubMed, Embase, and Cochrane databases was conducted until June 15, 2022, with no start date restriction, according to the preregistered protocol (PROSPERO-CRD42022336617). RevMan version 5.4 and R software package version 4.2.0 were used for statistical analyses. Fourteen studies with 1716 participants were included in this study. The findings of the meta-analysis confirmed that the resistin levels of patients with thyroid dysfunction were significantly higher than those of the euthyroid function control group (mean difference [MD] = 2.11, 95% confidence interval [CI] = 1.11-3.11, P < 0.00001). Furthermore, the resistin levels of patients with hyperthyroidism (MD = 3.23, 95% CI = 0.68-5.79, P = 0.01) and subclinical hypoidism (MD = 1.37, 95% CI = 0.31-2.42, P = 0.01) were significantly higher than those of euthyroid controls. The resistin levels of patients with thyroid dysfunction after treatment were significantly lower than those before treatment (MD = 1.00, 95% CI = 0.34-1.65, P = 0.003), especially in patients with hyperthyroidism (MD = 2.16, 95% CI = 1.00-3.32, P = 0.0003). Correlation analysis confirmed a positive correlation between resistin levels and free triiodothyronine (FT3) levels in patients with thyroid dysfunction (r = 0.27578, P = 0.001). Our meta-analysis demonstrates that resistin levels are significantly higher in patients with thyroid dysfunction, and the resistin levels after treatment in patients with thyroid dysfunction are significantly lower than those before treatment. Correlation analysis shows a positive correlation between resistin levels and FT3 levels in patients with thyroid dysfunction. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022336617.

ANALYSIS OF RENAL FUNCTION IN A STUDY TO DETERMINE THE PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM IN TYPE 2 DIABETES MELLITUS

Background and Objectives - Diabetes and hypothyroidism are common endocrine diseases that impact health and mortality. Glycaemic status affects thyroid hormone levels immensely. There is a paucity of studies from India that have investigated the prevalence of subclinical hypothyroidism in patients with type 2 diabetes mellitus. In this study, we determined the prevalence of subclinical hypothyroidism in type two diabetes mellitus patients. Renal function is affected both by thyroid hormones and glycemic status, hence we have analysed renal function in the study subjects. Our study was conducted in the Department of Medicine of North D Methods - elhi Medical College &amp; Hindu Rao Hospital, Delhi. A total of 150 patients with type 2 diabetes were screened for thyroid dysfunction, a group of 126 patients with normal thyroid function, 13 patients with subclinical hypothyroidism, and 11 patients with overt hypothyroidism were subjected to the renal function tests. 126 (84%) Results – patients out of 150 were classied as euthyroid. 11(7.3%) and 13 (8.7%) patients had overt hypothyroidism and subclinical hypothyroidism respectively. Serum creatinine value was within the normal range in 90.4% of the euthyroid diabetics. However, only 69.2% of patients with SCHT had normal serum creatinine levels. There was a signicant difference between the eGFR in euthyroid and the SCHT group, with mean eGFR in the euthyroid group being 78.26± 17.9mL/min/1.73m2 and 57.92± 27.4mL/min/1.73m2 in the SCHT group. The i Conclusion - ncidence of subclinical hypothyroidism in patients with type 2 diabetes mellitus was signicantly increased with increasing age and in female patients. Type 2 diabetic patients with subclinical hypothyroidism have increased incedence of renal dysfunction

Does altered thyroid hormone status affect resting systolic blood pressure significantly in premenopausal women? - A cross-sectional comparative study

Background: Hypothyroid or hyperthyroid state affects all the physiological systems including cardiovascular system, central nervous system, digestive system, and blood. Among all adverse changes, systolic blood pressure (SBP) can also be affected in patients with thyroid disorders. Aims and Objectives: The present study was carried out to compare SBP in newly diagnosed patients of hypothyroidism, hyperthyroidism and age and gender matched euthyroid subjects and to assess correlation between Tri-iodothyronine (T3) level and resting SBP. Materials and Methods: The present study was carried out in 90 female subjects in the age group of 30 to 45 years. Diagnosis of hypothyroidism and hyperthyroidism was based on both clinical and biochemical criteria. Subjects were divided in euthyroid, hypothyroid and hyperthyroid groups with each group containing 30 subjects. Resting SBP was measured in all the groups. Results: Hyperthyroid group had significantly higher SBP as compared to euthyroid group and hypothyroid group. The difference in SBP between euthyroid and hypothyroid group was statistically non-significant. There was a significant correlation between Total T3 level and resting SBP. Conclusion: Elevated levels of thyroid hormone increases the cardiac output by increasing heart rate and increasing force of contraction. This elevated cardiac output in hyperthyroid subject is reflected as increase in resting SBP. Hence, thyroid hormone concentration should be kept within normal limits by appropriate therapeutic measures so as to prevent ill effects of resultant elevated SBP.

Calcium and Magnesium Levels in Subclinical and Overt Hypothyroidism: A Cross-sectional Study

Introduction: Hypothyroidism, one of the most common thyroid gland disorders, can cause electrolyte disturbances in the body. Hypothyroidism can alter mineral metabolism by changing the levels of serum calcium and magnesium. Therefore, it is essential to study any abnormalities in calcium and magnesium metabolism in patients with hypothyroidism. Aim: The aim of this study was to assess the levels of calcium and magnesium in patients with hypothyroidism and to study the correlation between Thyroid Stimulating Hormone (TSH), fT3, and fT4 with calcium and magnesium in subclinical and Overt Hypothyroidism (OH). Materials and Methods: This cross-sectional study was held from August 2019 to January 2020 in the Department of Biochemistry, BS Medical College, Bankura. A total of 150 subjects were included in the study, distributed equally among three groups: euthyroidism, subclinical hypothyroidism, and OH. Serum TSH, fT3, fT4, calcium, and magnesium levels were determined in the laboratory, and the data obtained were statistically analysed using ANOVA test and Pearson’s correlation test. Results: Out of a total of 150 subjects, 61 were female, among whom 23 had subclinical hypothyroidism and 21 had OH. There were significant differences in the mean levels of TSH, fT3, fT4, calcium, and magnesium between the SCH, OH, and euthyroid groups. The study showed that the mean serum calcium level was significantly lower in SCH and OH compared to euthyroids, while the level of serum magnesium was significantly increased in SCH and OH compared to euthyroid. There was a statistically significant negative correlation between TSH and serum calcium in both OH and SCH, while a statistically significant positive correlation was observed between TSH and serum magnesium levels in both groups. Conclusion: The present study revealed that serum magnesium levels were high while serum calcium levels were low in both subclinical hypothyroidism and OH when compared to euthyroid subjects. Additionally, calcium levels negatively correlated with TSH, while magnesium levels positively correlated with TSH levels.

Effect of Low T3 Syndrome on Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function by influencing the Nitric Oxide (NO) production. In Acute Coronary Syndrome (ACS) inflammation disrupts plaque which stimulates thrombosis, coagulation, activation of sympathetic system and release of cytokines mainly Interleukin 6 (IL-6), which is a pleotropic and pro-inflammatory cytokine, which exerts inhibitory effect on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU)under the Department of Cardiology, Karnataka institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients were taken for the study and all underwent Coronary Angiography (CAG). Severity of CAD was assessed with the help of Gensini risk scoring system. The patients were divided based on thyroid function status. Low T3 syndrome was defined as &lt;0.846 ng/ mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinominal logistic regression analysis demonstrated LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of euthyroid group (n=71, 59.1%), with all the groups’ (p-value=0.047). Multinominal logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of CAD for moderate (Odds ratio=2.34, 95%CI: 0.47-11.39, p&lt;0.02) and severe (Odds ratio=8.56, 95%CI: 1.52-47.9, p&lt;0.015) lesions. Conclusion: The patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.

Platelet abnormalities in autoimmune thyroid diseases: A systematic review and meta-analysis.

Some degree of platelet index abnormality has been found clinically in the autoimmune thyroid disease (AITD), but the findings are not uniform. The PubMed, Web of Science, Cochrane Library, and Embase databases were searched for relevant articles published up to August 16th, 2022, with no restrictions on the language of the articles. Reference lists of eligible articles were also searched. A random effect model was used to pool the standardized mean difference (SMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) between AITD patients and healthy controls, and subgroup analyses were performed. A total of 19 articles with 6173 people (3824 AITD patients and 2349 healthy people) were included in the meta-analysis. The results showed that PLT and MPV values were significantly increased in AITD patients when compared with healthy people (SMD: 0.164, 95% CI: 0.044 to 0.285; SMD: 0.256, 95% CI: 0.013 to 0.500), while no significant difference was found in PDW between the AITD group and the control group (SMD: 0.060, 95% CI: -0.164 to 0.284). Subgroup analysis according to disease type and thyroid function revealed that for PLT, this difference was only found in the Hashimoto's thyroiditis (HT) and hypothyroid groups, but not in the Graves' disease (GD) and hyperthyroid groups. For MPV, the results were the opposite of those for PLT: MPV was significantly higher in the GD, hyperthyroid, and euthyroid groups than in the control group, but not in the HT and hypothyroid groups. Sensitivity analysis showed that the stability of the pooled MPV was not good. No publication bias was found. PLT and MPV are significantly elevated in patients with AITD, with PLT being more significantly elevated in HT and hypothyroidism, and MPV being more significantly increased in GD and hyperthyroidism. Appropriate clinical attention can be paid to the thyroid function of patients when abnormal platelet indices are found, and conversely, the consequences of abnormal platelet parameters such as elevated MPV lead to an increased occurrence of cardiovascular events, which should also be addressed in the AITD population. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022341823.

Prevalence of thyroid dysfunction in pregnancy and its association with feto-maternal outcomes: A prospective observational study from a tertiary care institute in Northern India

BackgroundThyroid dysfunction in pregnancy is one of the most prominent endocrinological disorders. Physiological changes in thyroid status and non-adaptation to these changes during pregnancy lead to thyroid dysfunction resulting in feto-maternal complications. In this context, we undertook this study to estimate the prevalence of thyroid disorders in pregnant women and their association with feto-maternal outcomes. MethodsThis prospective observational study was carried out in a tertiary care institute in Punjab, North India. We recruited 347 pregnant women who visited the OPD (Out Patient Department) through consecutive sampling, out of which 300 were included in our final analysis. A detailed history and clinical examination were made. Apart from routine ante-natal investigations, we estimated the TSH levels. In case of abnormal TSH values, free T4 and T3 levels were assessed. Study participants were followed till 12 weeks post-delivery to observe their obstetrical and perinatal outcomes. ResultsOverall prevalence of thyroid disorders in pregnancy was 33.9%, with hypothyroidism (31.6%) being more common than hyperthyroidism (2.3%). A significant association was found between thyroid disorders and feto-maternal complications (p value < 0.001). Adverse maternal effects observed in the hypothyroid group as compared to the euthyroid group were preeclampsia (14.7% vs. 5.6%), anemia (7.4% vs. 6.1%), abortion (7.4% vs. 0.5%) and meconium-stained liquor (5.3% vs. 2.5%). Abortion (71.4%) was the main complication in the hyperthyroid group. Adverse neonatal outcomes were low and very low birth weight, low Apgar scores, respiratory distress syndrome, and meconium aspiration syndrome. ConclusionWe observed a high prevalence of thyroid disorders and their relative adverse effects. Universal screening of all women in the pre-conception period or as early as pregnancy is diagnosed, is recommended to reduce subsequent feto-maternal morbidity and mortality.

The effect of hyperthyroidism at thyroidectomy on complication rates in children with Graves' disease.

Graves' disease (GD) is the most common cause of childhood hyperthyroidism. Surgery is often chosen as a treatment modality given the high relapse rates and side effects of antithyroid drugs and has shown to be safe and efficacious. The goal of our study was to evaluate whether hyperthyroidism at time of thyroidectomy is associated with higher intra and postoperative complication rates. A retrospective cohort study of children who underwent thyroidectomy for GD by high-volume pediatric otolaryngologists between 2014 and 2021. 64 patients met inclusion criteria. Patients with hyperthyroidism (defined as free T4≥1.63ng/dL) were more likely to be treated with beta-blocker preoperatively compared to the euthyroid group (20/24 patients (83%) vs 23/40 patients (58%) respectively, p=0.035). Twenty (83%) patients with hyperthyroidism and 39 euthyroid patients (98%) were treated with methimazole prior to surgery. Intraoperative tachycardia was noted in 5% of euthyroid patients and 20.8% of patients with hyperthyroidism. The mean peak heart rate intra-operatively and the number of patients with heart rate ≥120bmp were significantly higher for patients with hyperthyroidism (96.5±16.2 vs 87.6±22.1bpm, p=0.02). Two patients required administration of esmolol during surgery for heart rate control, both with hyperthyroidism. Intra-operative peak systolic blood pressure, operative time, estimated blood loss, persistent hypocalcemia, length of admission and recurrent laryngeal nerve paralysis rates were similar among groups. Hyperthyroidism at surgery is associated with increased heart rate intraoperatively, with no increased risk for other complications. While optimizing thyroid hormone levels before surgery should be pursued in all children, our data suggest that hyperthyroidism should not delay the surgery.

Does presence of subclinical hypothyroidism and thyroid auto antibodies affect pregnancy outcomes in pregnancy? A record-based cross-sectional study

ObjectiveOur aim in this study is to determine the relationship between TPOAb positivity and pregnancy outcomes in the subclinical hypothyroid patient group. Materials and methodsThis study was started with 21,321 pregnant women, but after the exclusion criteria, 11,387 pregnant women were included int his study. Demographic characteristics of each patient group included in the study, such as age, bodymass index (BMI), and laboratory parameters such as complete blood count (hemogram), liver and kidney function tests, type of delivery, birth weight, neonatal intensive care admission, 1st and 5th minute APGAR scores, glucose tolerance test results, whether there was high blood pressure during pregnancy, whether there was premature rupture of membranes were recorded from the hospital information system and patient files. ResultsPregnant women with subclinical hypothyroidism were divided into groups according to their TPOAb status. When maternal and neonatal outcomes were evaluated between groups; Among these four groups there was a statistically significant difference only in impaired glucose tolerance (IGT) antibody groups with and without subclinical hypothyroidism according to their positivity (p < 0.01). When the euthyroid TPOAb negative group was taken as reference, the risk of impaired and TPOAb positive groups (OR: 1.210; 95% CI: 0.936–1.563; P = 0.145), impaired in the group with subclinical hypothyroidism but TPOAb positivity glucose tolerance 1.358(OR: 1.358); 95% CI: 1.042–1.770; P = 0.023) fold increased by 3.556 (OR: 3.556) in the group with subclinical hypothyroidism and TPOAb positivity; (95% CI: 2.37–5.343; p < 0,001). ConclusionIn ourstudy, there was a significant difference only in terms of IGT between the Groups with and without subclinical hypothyroidism, depending on whether they were positive for TPOAb or not. Therefore, studies in volving larger patient groups are needed.

Language and Neurocognitive Impairments Associated with Hypothyroidism

Introduction: Accumulating clinical evidence has indicated that hypothyroidism was associated with neurocognitive and linguistic impairments; however, these impairments were not reported in Arabic individuals. The aims of the present study were (1) to investigate the patterns of linguistic and neurocognitive impairments associated with hypothyroidism in native speakers of Jordanian Arabic and (2) to examine the accuracy of TFT in confirming a clinical diagnosis of hypothyroidism. Methods: A cross-sectional design with random recruitment of participants from targeted hypothyroid (HT) and euthyroid (ET) groups was conducted. Clinical evaluation of hypothyroidism was obtained via a structured questionnaire followed by TFT. Evaluation measures included digit span, confrontation naming, color naming, auditory and visual memory, and visual recognition tasks. The HT group comprised 36 participants including 8 males and 28 females with a ratio of 1:3.5. Their age ranged between 5.11 and 10.7 years (M = 7.7, SD = ±1.4). The ET group included an equal number of participants in terms of age and gender, their age ranged between 5.9 and 10.8 years (M = 7.6, SD = ±1.5). Results: Results revealed significant differences between the two experimental groups in all of the linguistic and neurocognitive tasks. The HT showed 10- and 26-s delayed responses on a timed color naming and visual recognition tasks compared to the ET group, whereas the ET group showed larger scores compared to the HT on the digit span, confrontation naming, auditory memory, and visual memory tasks. Differences were 2.2, 4, 1.7, and 3 points, respectively. Conclusion: Hypothyroidism influences linguistic and neurocognitive functions mainly naming ability, working memory, and auditory and visual processes needed for learning. Clinicians ought to be attentive to these impacts when designing screening and therapy protocols for children with hypothyroidism. Furthermore, TSH showed higher prediction of hypothyroidism and may be used in favor of FT3 and FT4.

Interpretation of TSH and T4 for diagnosing minor alterations in thyroid function: a comparative analysis of two separate longitudinal cohorts

BackgroundMinor alterations in thyroid function are frequent, and interpretation of thyroid function tests in the individual patient can be challenging. Furthermore, the choice of thyroid function test is debatable. To inform the debate, we performed a comparative evaluation of the variation in thyrotropin (TSH) and thyroxine (T4) in two different cohorts to illustrate the precision of TSH and T4 in the diagnosis and monitoring of thyroid dysfunction.MethodsA comparative analysis of two separate longitudinal studies previously surveyed with monthly blood sampling for one year among 35 subjects. Participants were included based on T4 within the reference range and TSH either within (euthyroid; n = 15) or above (subclinical hypothyroidism; n = 20) the laboratory reference range on two independent blood samplings before inclusion. Exclusion criteria were known thyroid disease or use of thyroid interfering medication. TSH and T4 in individual samples were measured in a single batch to prevent between-batch variation. The distributions TSH and T4 were compared among euthyroid and subclinical hypothyroid individuals, and bootstrap estimates were used to calculate area under the curve (AUC).ResultsCollection of twelve, monthly blood samples in the 35 participants provided 420 samples, and data completeness was 100%. The mean TSH was 1.27/7.19 mIU/L and the mean total T4 was 106/85 nmol/L in euthyroid/subclinical hypothyroid participants. The subclinical hypothyroidism state deviated from the euthyroid by 20% for total T4 and by 466% for TSH. The overlap between the euthyroid and subclinical hypothyroid groups was 92.6% (389/420) for total T4 and 9.0% (38/420) of test results for TSH. The estimated AUC was 0.999 (95%-CI: 0.995; 1.00) for TSH and 0.853 (0.736; 0.935) for total T4. There was no confidence interval overlap between participant groups for TSH while there was a considerable overlap for total T4 (p < 0.001).ConclusionThe distributions of thyroid function tests illustrated how TSH outperforms T4 for detecting delicate differences in thyroid function in an individual. Thus, TSH was markedly better than T4 to discriminate between the subtle differences in thyroid function corroborating that TSH is the more sensitive and accurate index of thyroid function status in the individual patient.

Thyroid dysfunction in acute coronary syndrome and its prognostic implications

Background: Thyroid disorders impact the cardiovascular system associated with a significantly increased risk of vascular morbidity and mortality. We undertook this study to evaluate the prevalence of thyroid dysfunction in patients with acute coronary syndrome (ACS) and to study the impact of thyroid dysfunction on morbidity and mortality among those patients during 1 year follow up. Methods: We studied consecutive 303 hospitalized patients between March 2018-February 2021 with ACS to determine features of thyroid dysfunction both clinical and sub-clinical and their effect on MACE at 1 year follow up. All patients were subjected to clinical examination and routine investigations. Results: Nineteen (19%) patients had thyroid dysfunction. Majority had subclinical hypothyroidism 34 (11%), followed by overt hypothyroidism 20 (7%). Hyperthyroidism was uncommon (1.3%). There was a predilection for females and elderly. Majority 136 (45%) patients had STEMI. MACE rates were higher in thyroid dysfunction group 14 (30.5%) vs 36 (19.6%) euthyroid group. Likewise incidence of rehospitalization due to CV cause was significantly higher in thyroid dysfunction group 32.2% vs 19.7% in euthyroid group (p=0.0374). Conclusions: Hypothyroidism is an important risk factor in ACS patients especially in elderly female population. A clear trend towards higher MACE is seen in thyroid dysfunction patients.

Hypothyroid Symptoms Throughout Pregnancy Are Predominantly Associated with Thyroxine and Not with Thyrotropin Concentrations.

Background: It is unclear whether levels of hypothyroid symptoms in pregnant women with (sub)clinical thyroid dysfunction differ from euthyroid controls and whether free thyroxine (fT4)/thyrotropin (TSH) changes throughout pregnancy affect hypothyroid symptom levels. The objective was twofold: (1) To compare hypothyroid symptom levels between thyroid dysfunction subgroups and a carefully defined reference group; (2) to assess the association between fT4/TSH changes throughout pregnancy and hypothyroid symptom levels adjusted for depressive symptoms. Methods: The current study was a longitudinal prospective cohort study in 1800 healthy pregnant women. At each trimester of pregnancy, hypothyroid symptoms were assessed with a 12-item symptom hypothyroidism checklist and depressive symptoms with the Edinburgh Depression Scale. Thyroid dysfunction was defined using the 2.5-97.5th fT4/TSH percentile of thyroid peroxidase antibodies-negative women. Euthyroid controls consisted of women with appropriate fT4 levels within the 10-90th percentile and with a normal TSH level. Hypothyroid symptom mean scores were compared between controls and several thyroid dysfunction subgroups. Growth mixture modeling was performed to evaluate possible longitudinal trajectories of hypothyroid and depressive symptoms. The association between hypothyroid symptom trajectories (adjusted for depression) and fT4/TSH changes was assessed with multivariate logistic regression analysis. Results: Women with overt hypothyroidism (fT4 < 2.5th, TSH >97.5th) and hypothyroxinemia (fT4 < 2.5th, TSH: 2.5-97.5th) showed higher hypothyroid symptom levels compared with the euthyroid controls and women with subclinical hypothyroidism (SCH, fT4: 2.5-97.5th, TSH >97.5th), because 82% of these SCH women had fT4 levels in the euthyroid range. Two groups of hypothyroid and depressive symptoms were defined: a persistently low and persistently high symptom group. fT4 decreased in 98% of the women from the first to third trimester and per unit pmol/L fT4 decrease (not TSH increase), the likelihood to present persistently high hypothyroid symptoms increased with 46%, adjusted for depression. Conclusions: A properly defined euthyroid control group distinguishes women with hypothyroid symptoms. An fT4 decrease toward end term is associated with persistently high hypothyroid symptom levels. Clinicians should be aware of the importance of fT4 stratification in SCH women.

A comparative study of serum ferritin and thyroid stimulating hormone (TSH) levels in hypothyroid and euthyroid subjects

Thyroid hormones synthesized and released by the thyroid gland, have a vital role in regulating the metabolism of body. Synthesis of these thyroid hormones requires an iron containing enzyme Thyroid Peroxidase (TPO). Thus, iron inadequacy can affect the proper functioning of the TPO enzyme that further affect the thyroid hormone production. Serum ferritin, an index of iron store is present in almost all cells; however, it has been reported that an alteration in ferritin levels occurs in patients with thyroid disease. This study was conducted to determine serum ferritin and Thyroid Stimulating Hormone (TSH) levels in hypothyroid and euthyroid subjects and to compare the same.The retrospective study was carried out in Amrita Institute of Medical Sciences (AIMS), Kochi, which included 30 hypothyroid subjects as cases and 30 age and gender matched healthy controls. TSH, Thyroxine (T4) and serum ferritin levels of the study groups were collected and recorded.The mean TSH of hypothyroid patients was found to be higher (16.12±17.00) than that of euthyroid group (2.35± 1.08) whereas the mean value of T4 (1.01± 0.25) and ferritin (43.80 ± 75.44) were found to be reduced in patients with hypothyroidism compared to normal subjects. All the parameters were statistically significant with p value &amp;#60;0.05.The present study showed that hypothyroid subjects had significantly lower serum ferritin concentration than euthyroid subjects. Thus, serum ferritin measurement could be useful for the evaluation of thyroid diseases.