Euthyroid Patients Research Articles

Efficacy of a levothyroxine dosage regimen based on serum thyrotropin level, for primary hypothyroidism. An open label dose finding study.

There are no guidelines on individualized initial levothyroxine dosage in primary hypothyroidism. This prospective observational study was done to assess whether a predetermined dose of levothyroxine based on Thyroid Stimulating Hormone (TSH) levels would be able to make the patient euthyroid during a period of six weeks and to find other factors which influence the levothyroxine requirement. Newly diagnosed patients with primary hypothyroidism or those patients who were not on levothyroxine therapy were divided into TSH-based groups-Group 1, 5-9.99, Group 2, 10-29.99, Group 3, 30-99.99 and Group 4, >100 μIU/ml and treated with an initial levothyroxine dose of 25,50,75 and100 μg/day for next six weeks. Factors correlating with levothyroxine requirement were determined. Of the 171 patients who were included 142 completed the study, 34,46,28 and 34 patients were included in groups 1 to 4, respectively. Normalization of TSH with the above criteria was achieved in 111 (78.7%) out of 141 patients, and 91%, 67%, 75%, and 82% respectively in the 4 groups. Among adequately replaced patients pre-treatment TSH level (r = 0.81), T4 level (r = 0.61), and body weight (r = 0.19) correlated with the levothyroxine requirement. Based on these factors predicted initial dose (μg/day) was found to be 0.54 (Body Weight [Kg]) +0.47 (TSH [μIU/m]) - 1.4 (Total T4 [μg/dl]) +17.79 or 0.27 (Body Weight) +0.553 (TSH) +21. Serum thyrotropin-based categorization for initial levothyroxine dose leads to euthyroidism in nearly four of five patients with primary hypothyroidism. The dose required for adequate replacement of levothyroxine has correlation with pre-treatment serum TSH levels serum thyroxine levels and body weight.

Association of Hypervitaminosis D with Thyroid Function in Euthyroid Adult Patients

Aim: No study has investigated the effect of hypervitaminosis D on thyroid function. We aimed to analyze
 possible associations of hypervitaminosis D with thyroid function in levothyroxine-naive euthyroid
 patients.
 Material and Methods: Levothyroxine-naive euthyroid patients (>18-year-old) with 25(OH) vitamin D
 level of ≥88 ng/mL after supplementation were analyzed retrospectively. We grouped them as: Group 1,
 TSH increased above the range; Group 2, TSH increased but in normal range; Group 3, TSH decreased
 but in normal range; Group 4, TSH decreased below the range; Group A, TSH increased; and Group
 B, TSH decreased. Before/after levels of TSH, fT4, Ca, P, creatinine, and TSH-change, fT4-change,
 25(OH) vitamin D (basal/post-treatment and change), basal AntiTPO levels, and vitamin D dose were
 analyzed.
 Results: TSH-change -0.19±1.03 mIU/L and fT4-change 0.015±0.17 ng/dL were insignificant in
 total(n=64). Post-treatment 25(OH) vitamin D, TSH-after, and TSH-change were higher in group 1(n=3)
 than in group 2(n=22), group 3(n=33), or group 4(n=6) (p

Cholescintigraphic evaluation of gallbladder contraction in correlation with serum thyrotropin and serum cholesterol

Background and aims: To study the effect of serum thyrotropin (Sr.TSH) and serum cholesterol on gallbladder contraction by cholescintigraphy. Methods: This is a prospective cross-sectional study comprising 77 patients for evaluation of gallbladder function in patients with biliary pain. All of them underwent 99mTc- Mebrofenin fatty meal cholescintigraphy following a standard institutional protocol apart from regular investigations. Dynamic images were acquired for 90 minutes with a standardised fatty meal given at the 60th minute. Gallbladder emptying kinetics was determined with Gallbladder Ejection Fraction (GBEF) calculated at 30 minutes post-meal. Relevant statistical methods were applied for interpretation. Results: The mean of GBEF was 60.82% ± 16.65% and the mean of Sr.TSH was 3.72 ± 3.88 mIU/ml, there was a negative correlation between GBEF and Sr.TSH (Pearson correlation coefficient r = -0.535, p < 0.05). The mean serum cholesterol was 180.61 ± 46.34 mg/dl, there was a negative correlation between GBEF and serum cholesterol (Pearson’s correlation coefficient r = -0.685, p < 0.05). The mean GBEF in euthyroid and hypothyroid patients were 65.04% ± 15.04% and 47.27% ± 15.93% respectively (P < 0.05). Conclusion: Hypothyroidism is one of the key factors affecting gallbladder contractility and should not be overlooked in the management of functional gallbladder disorders. Cholescintigraphy can accurately assess gallbladder function qualitatively and quantitatively, and it can help (aid) physicians in diagnosing and decision-making on the management of biliary pain in hypothyroidism.

CHARACTERISTICS OF CIRCADIAN BLOOD PRESSURE PROFILE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND THEIR ASSOCIATION WITH THYROID FUNCTION

The paper presents the results of a study of circadian arterial blood pressure (ABP) profile in patients with Acute Coronary Syndrome (ACS) and their association with thyroid-stimulating hormone (TSH) levels.
 Aim. To conduct a comparative analysis of circadian BP monitoring (CBPM) indicators in patients with ACS and their association with the TSH level.
 Materials and Methods. The study includes 125 patients with ACS aged 36 to 81 (mean age - 60.98± 0.81 years old). The patients were divided into two groups according to thyroid function. Group one (I) included 51 individuals (40.8%) - hypothyroid patients (TSH level>4mIU/ml), mean age - 62.51±1.18 years old; Group II included 74 individuals (59.2%) - euthyroid patients (TSH level 0.4-4mIU/ml), mean age - 59.93±1.08 years old. The serum-free thyroxine (FT4) levels were within the normal range in both groups. In the general group, the proportion of individuals with unstable angina (UA) was 28.8%, and with myocardial infarction (MI) - 71.2%. In particular, in Group I, the proportion of individuals with UA was 23.53%, and with MI - 76.47%; in Group II, the proportion of individuals with UA was 32.43%, and with MI - 67.57%, p>0,05 between Groups I and II. The circadian BP monitoring was carried out using the Biomed ВАТ41-2 device after stabilization of the patient's condition (on the second day of hospital admission). The following indicators have been determined: systolic BP (SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic BP (DBPd, DBPn, and DBPav); pulse BP (PBPd, PBPn, and PBPav); time index (TI) for SBPd, SBPn, and SBPav (SBPd TI, SBPn TI, and SBPav TI) and DBP (DBPd TI, DBPn TI, and DBPav TI); variability of SBPd, SBPn, and SBPav (SBPd var, SBPn var, and SBPav var) and DBP (DBPd var, DBPn var, and DBPav var); average daily index for SBP (SBP AvDI) and DBP (DBP AvDI); average daily heart rate (HRav). To study thyroid function in patients enrolled, TSH and FT4 levels were determined by chemiluminescent immunoassay method on the ARCHITECT iSystem analyzer using reagent kits for the quantitative determination of TSH (ARCHITECT TSH) and FT4 (ARCHITECT Free T4).
 Results and Discussion. The comparison of the CBPM results in both groups of patients with ACS shows significantly higher mean nighttime (SBPn and DBPn) levels in Group I patients compared to Group II patients: SBPn - by 6.27% (125.44±2.98 mm Hg (I) versus 117.58±2.26 (II), p<0,05), DBPn - by 6.15% (73.65±1.91 mm Hg (I) versus 69.12±1.62 (II), p<0,05), in the absence of a significant between-group difference between the mean levels of respective daytime and average daily indicators. Mean DBPn TI value also turned out to be significantly higher in Group I patients compared to Group II patients - by 33.69% (42.47±4.60% (I) versus 28.16±3.60% (II), p<0.01). Significant difference was detected between mean SBP AvDI and DBP AvDI indicators in hypothyroid patients (I) versus respective indicators in euthyroid patients (II): SBP AvDI (I) 2.52±1.25% versus SBP AvDI (II) 5.99±0.98, p<0.05; and DBP AvDI (I) 4.69±1.38% versus DBP AvDI (II) 8.88±1.32, p<0.05.
 Conclusions. 1. Mean nighttime BP indicator (SBPn, DBPn, and DBPn TI) levels were significantly higher in the Group of hypothyroid patients with ACS, compared to euthyroid patients. In addition, the proportion of patients whose mean nighttime SBP and DBP levels exceeded the permissible values (SBPn<120, DBPn<70 mm Hg) was significantly higher in the Group of hypothyroid patients (I) compared to the Group of euthyroid patients (II). 2. Every third hypothyroid patient (I) (SBP AvDI: 37.25% and DBP AvDI: 31.37%) had a night-peaker circadian BP profile, characterized by nighttime BP increase instead of reduction, which suggests an extremely unfavorable prognosis. The findings may signal an additional adverse effect of thyroid dysfunction on arterial tone and, accordingly, BP regulation, which brings about a high risk of complications of ACS.

Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review.

The literature on the connection between obesity, metabolic syndrome, and subclinical hypothyroidism is critically analyzed in this narrative review. These conditions are frequently observed among adult populations and various studies and meta-analyses have assessed their association. The prevalence of subclinical hypothyroidism in obese individuals is higher than in non-obese subjects and this trend is more pronounced in unhealthy obesity phenotypes. However, the diagnosis and treatment of subclinical hypothyroidism can be difficult in obese patients. Exaggerated body fat is linked to thyroid hypoechogenicity as evident through ultrasonography and euthyroid obese people have greater TSH, FT3, and FT3/FT4 ratios than non-obese individuals in a euthyroid condition. Moreover, a reduced expression of the TSH receptor and altered function of deiodinases has been found in the adipose tissue of obese patients. Current data do not support the necessity of a pharmacological correction of the isolated hyperthyrotropinemia in euthyroid obese patients because treatment with thyroid hormone does not significantly improve weight loss and the increase in serum TSH can be reversible after hypocaloric diet or bariatric surgery. On the other hand, obesity is linked to elevated leptin levels. Inflammation can raise the risk of Hashimoto thyroiditis, which increases the likelihood that obese patients will experience overt or subclinical hypothyroidism. Both metabolic syndrome and subclinical hypothyroidism are associated with atherosclerosis, liver and kidney disease. Hence, the association of these two illnesses may potentiate the adverse effects noted in each of them. Subclinical hypothyroidism should be identified in patients with obesity and treated with appropriate doses of L-thyroxine according to the lean body mass and body weight. Randomized controlled trials are necessary to verify whether treatment of thyroid deficiency could counteract the expected risks.

Effects of short- and long-term TSH suppression on lumbar bone mineral density in both genders using PET/CT

Iatrogenic subclinical hyperthyroidism is induced intentionally in patients with differentiated thyroid cancer to reduce the risk of tumor recurrence. This retrospective study aimed to investigate the effect of thyroid-stimulating hormone (TSH) suppressive therapy on bone mineral density in men and women. Two cohorts of endocrine cancer patients were compared. In cohort A, 42 patients with long-lasting suppressed serum TSH were assessed. Cohort B consisted of 41 euthyroid patients. Bone density was measured in the L1-L4 lumbar vertebrae of all patients using PET/CT scans performed for cancer staging. In 17 patients of cohort A who received a second PET/CT scan, bone density was measured again to provide longitudinal analysis. A non-significant difference in age (p = .572) and equal distribution of sex (p = .916) was determined when comparing both cohorts. A significant difference (p = .011) with a moderate effect (η2 = .08; 20.4%) was observed regarding higher bone mineral density (BMD^HU) in cohort B with normal TSH levels (M 160.63 ± 54.7 HU) versus cohort A under TSH suppression therapy (M 127.9 ± 59.5 HU) for a mean duration of 4.45 ± 2.64 years. Furthermore, no significant change in BMD^HU (p = .786) was found in those patients who received a second PET/CT scan after a mean observation time of 2.3 ± 1.2 years. In conclusion, long-lasting TSH suppression therapy caused a statistically significant decrease in BMD^HU while short-lasting therapy didn't. Therefore, we can assume a higher likelihood of osteoporosis in those patients under prolonged TSH suppression.

Evaluation of macular choroidal and microvascular network changes by activity scores and serum antibodies in thyroid eye patients and healthy subjects.

To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease (TED) patients at different stages and the relationship of those changes with risk factors, serum antibodies and the severity of TED. A total of 85 participants were enrolled. All participants underwent ophthalmology and endocrinology examinations. Subfoveal choroidal thickness (SFCT), superficial (s) and deep (d) foveal avascular zone (FAZ) area, mean (m) and central (c) superficial vascular density (SVD), deep vascular density (DVD) measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography (OCT)/OCT angiography (OCTA) DRI OCT Triton. Multiple linear regression analysis was used to explore the associations between SFCT, FAZ area, SVD, DVD and the relevant factors of TED. Those with active TED patients had higher c-DVD and m-DVD levels (P<0.05), however there is no statistically significant difference in SFCT between active and stable TED patients. Among the serum antibodies, it was observed that s-FAZ and d-FAZ increased, c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies (TRAB) level, whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin (hTG). There was no significant difference in SFCT, FAZ, SVD and DVD measurement at gender, between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma. The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density. It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.

A Review on Hashimoto’s Thyroiditis

Hashimoto's thyroiditis (HT) is an autoimmune thyroid disorder first described by Japanese physician Haraku Hashimoto in 1912 characterized by lymphocytic infiltration of the thyroid parenchyma and is influenced by immune system instability. The onset of autoimmunity may be influenced by innate and acquired immune responses. Thyroid autoantibodies (TAbs) are the primary biochemical feature. Epidemiological studies show AITD (autoimmune thyroid disease) risk is higher in women and is age-related. Risk factors include high iodine consumption, selenium insufficiency, infectious disorders, and specific medications. Genetic predisposition and environmental factors also contribute to HT. Pregnancy and sex steroids play a role in the development of autoimmune thyroiditis, with older women being more susceptible. The immune system is modified during pregnancy, with progesterone playing a significant role. About 20% of postpartum thyroiditis patients eventually develop HT. The symptoms include dysphonia, dyspnea, and dysphagia, with primary hypothyroidism causing greater systemic symptoms. Diagnosis involves circulating thyroid-specific antibodies, ultrasound examination, increased thyroid stimulating hormone, and normal serum thyroid hormone levels. Ultrasonography is crucial for diagnosing Hashimoto's thyroiditis, distinguishing it from other thyroid disorders like Graves' disease (GD). The treatment comprises levothyroxine, which effectively lowers thyroid volume, as well as vitamin D deficiency and replacement. Autoimmune thyroiditis (AIT) surgery has traditionally been reserved for people who have discomfort or compressive symptoms from goitre or co-existing malignant thyroid nodules. Thyroidectomy has lately been advocated as a treatment option for decreasing TPOAbs, as the presence of such antibodies is linked to a worse quality of life even in euthyroid patients.&#x0D; Keywords: Hashimoto’s thyroiditis (HT), Autoimmune thyroid disease (AITD), Autoimmune thyroiditis (AIT) Vitamin D , Levothyroxine

A study on the clinical profile of patients with thyroid-related orbitopathy presenting to a tertiary eye care institute

Thyroid-associated orbitopathy is an autoimmune disorder that is the most frequent extrathyroidal involvement of Graves’ disease but sometimes occurs in euthyroid or hypothyroid patients. Patients with Thyroid associated disease present with chemosis, superior limbic keratoconjunctivitis, proptosis, lid retraction and oedema, restricted extraocular muscle, and dysthyroid optic neuropathy. This study was an observational cross-sectional study which included all the patients with all age groups who attended the Outpatient Department of a Tertiary Care Hospital, Ajmer, with signs and symptoms of thyroid-associated orbitopathy or diagnosed with thyroid-associated orbitopathy with no history of multiple endocrine disorder. 95 subjects satisfying the inclusion and exclusion criteria were enrolled in the study.The mean age of study participants was 43.93± 12.25 years. Age ranges from 21 years to 80 years. 59 (62.1%) were female. Among all patients 69 (72.6%) were hyperthyroid, 19 (20.0%) were euthyroid and 7 (7.4%) were euthyroid. 5 (5.2%) presented with dysthyroid optic neuropathy. 40(42.10%) cases were of active thyroid eye disease (TED) and the remaining 55 (57.8%) were inactive cases. Out of all active presenters, 30% were having Clinical Active Scoring (CAS) ≥4.Middleage group and female sex were the common clinical profile of the patients of TED. When active and Inactive TED groups were compared, findings such as Average CAS, dysthyroid optic neuropathy, average Hertel’s value, and presenting signs were significantly higher in the active group.

The negative impact of levothyroxine treatment on urinary luteinizing hormone measurements in pediatric patients with thyroid disease.

Previous studies suggest urinary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) measurements by immunofluorometric assays (IFMA) as noninvasive alternatives to serum assays for puberty assessment. However, these studies excluded patients with other endocrine disorders and those taking medications. Besides, the recent discontinuation of IFMA manufacturing is a concern. We explored the utility of luminometric assays (LIA) for urinary gonadotropins and thyroid-stimulating hormone (TSH) determinations in euthyroid patients with thyroid pathologies. We used LIA and IFMA assays to measure serum and first-morning-voided (FMV) urine LH, FSH, and TSH concentrations in euthyroid patients with various thyroid disorders. Of the 47 euthyroid patients with normal serum TSH (S-TSH) levels, 14 were receiving levothyroxine therapy. FMV total urinary LH (U-LH) concentrations correlated significantly with those measured in serum using either LIA (r=0.67, P<.001) or IFMA (r=0.83, P=.003) in patients not receiving levothyroxine treatment; however, no significant correlation could be detected in patients receiving levothyroxine regardless of the assay method (for LIA: r=0.50, P=.08 and IFMA r=0.44, P=.15). Urinary TSH (U-TSH) concentrations correlated poorly with those in serum in both the untreated and the treated groups (r=-0.13, P=.49, and r=-0.45, P=.11, respectively). FMV total U-LH determinations by LIA can be used to assess pubertal development in patients with thyroid pathology, provided the euthyroid patient is not on levothyroxine treatment. U-TSH measurements by LIA cannot replace invasive S-TSH measurements at least in patients with normal S-TSH levels. Further research may reveal the utility of U-TSH determinations in patients with elevated S-TSH levels.

Twice or thrice weekly levothyroxine provides similar rates of adherence and post-Ramadan euthyroidism compared to daily levothyroxine during Ramadan fasting

BackgroundHaving to take levothyroxine (L-T4) on a daily basis, on an empty stomach is burdensome and may impair adherence, especially during Ramadan fasting. A long half-life and autoregulation of thyroid hormone levels allows for twice or thrice weekly administration of L-T4. This study aims to establish twice or thrice weekly L-T4 dosing as a convenient and effective practice during Ramadan fasting.MethodsThe study included 2 groups; twice or thrice weekly (TTW) group included patients assigned to take L-T4 twice or thrice a week, and standard daily dosing (SDT) group included patients assigned to take L-T4 daily. Patients freely chose between three L-T4 regimens: before Iftar, before Suhor, or before the next fast. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included.ResultsTTW group included 57 patients, while SDT group included 91 patients. Pre-Ramadan TSH in TTW group (1.80 ± 0.88 µIU/L) was higher compared to SDT group (1.39 ± 0.72 µIU/L) [P = 0.003]. Similar adherence rates were observed in both groups, 96.5% in TTW group versus 89% in SDT group, [P = 0.13]. similar rates of post-Ramadan euthyroidism were also found in both groups, 91.2% in TTW group versus 94.5% in SDT group, [P = 0.509]. TTW group preferred regimen 1 (64.9%) significantly more than SDT group (35.2%) [P = 0.001].ConclusionTwice or thrice weekly levothyroxine results in similarly high rates of adherence (96.5%) and post-Ramadan euthyroidism (91.2%) compared to daily levothyroxine during Ramadan fasting.

Evaluation of Dyspepsia with Optimal and Suboptimal Gastric Emptying Tests in Patients with Euthyroid Goiter.

The presence of gastroparesis in patients with dyspepsia can be evaluated by gastric emptying scintigraphy. We aimed to evaluate gastroparesis with optimal solid gastric emptying scintigraphy and suboptimal liquid gastric emptying scintigraphy in euthyroid goiter patients with dyspepsia. We included 67 patients diagnosed with euthyroid goiter with dyspepsia complaints. The patients did not use any medication and did not have any other chronic diseases. Solid and liquid gastric emptying scintigraphy was performed on all patients. In our retrospective study; the images were reevaluated. The region of interest was plotted on the area compatible with the stomach and timeactivity curves were obtained. The correlation of solid and liquid gastric emptying test results was evaluated. Twelve (18%) of the patients were male and the mean age of the patients was 64 (49-75). There is a correlation between solid and liquid gastric emptying scintigraphy (p< 0.0005, r: 0.0880). Solid gastric emptying time was prolonged in 27 patients (40%). Liquid gastric emptying was prolonged in 23 patients (34%). Solid gastric emptying was also prolonged in all patients with prolonged liquid gastric emptying. According to the results of the optimal gastric emptying test performed with radio-labeled solid food. The rate of gastroparesis was low in our patient group with dyspepsia complaints. However, there is a correlation between the optimal test and suboptimal gastric emptying test results in our patient group. Liquid gastric emptying scintigraphy may be preferred in specific patient groups in case of suspected gastroparesis because of its easy application and short duration.

АССОЦИАЦИЯ СОСУДИСТЫХ КАЛЬЦИНАТОВ МОЛОЧНОЙ ЖЕЛЕЗЫ И ГИПОТИРЕОЗА: описание серии клинических наблюдений и обзор литературы

Abstract. Introduction. Currently, mammography is widely used in the routine clinical practice and, along with detecting the changes that may be indicative of breast carcinoma, allows assessing the unaltered breast parenchyma and its feeding vessels with the diameter of at least 0.5 mm, particularly regarding calcifications. Hypothyroidism represents the deficiency of thyroid hormones, which is relatively frequently seen in the clinical routine and associated with multiple unfavorable outcomes. Aim: To present a series of clinical cases where we found typical breast vascular calcifications in female patients at mammography. Materials and Methods. This paper describes 3 patients of this type with long- standing uncompensated hypothyroidism, all having pronounced vascular breast calcifications. Results and Discussion. All the patients had no significant cardiovascular pathologies both at the first detection of vascular calcifications and during their 5-year follow-up. Hypothyroidism is associated with the decreased overall survival as compared to the euthyroid patients, particularly because it also increases the risk of chronic kidney insufficiency, adhesive shoulder capsulitis, senile macular degeneration, myocardial infarction, and chronic cardiac insufficiency. This makes timely identifying such patients very important. Conclusion. Pronounced vascular calcifications at mammography may be the marker of the chronic thyroid insufficiency. Moreover, this phenomenon and the link between such changes and adverse cardiovascular outcomes needs to be clarified in future clarification.

Association between Alopecia Areata and Thyroid Disorders

Background &amp; Objective: Alopecia areata (AA) is an autoimmune disorder characterized by patches ofnon-scarring alopecia affecting the scalp and body hair. Previous epidemiological studies suggest a potentialpositive association between alopecia areata (AA) and several autoimmune diseases, including autoimmunethyroid disorders. The present study was therefore undertaken to determine the association between AA andthyroid disorder. Methods: This cross-sectional case-control study was carried out in the Department of Physiology, Dhaka Medical College, Dhaka over a period of 1 year from July 2021 to June 2022. A total of 40 clinically diagnosed patients of AA (case) of both sexes with age ≥18 years were taken from the Outpatient Department of Dermatology and Venereology, Dhaka Medical College Hospital (DMCH), Dhaka. An equal number (n = 40) of age-matched (withcases) apparently healthy subjects were taken as controls for comparison. In order to assess thyroid functionstatus, five variables were measured. These were free tri-iodothyronine (FT3), free thyroxine (FT4), thyroidstimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb or TmAb).Thyroid disorders were evaluated in terms of hypothyroidism, subclinical hypothyroidism, hyperthyroidism, subclinical hyperthyroidism, etc. Result: In the present study, the baseline demographic and clinical characteristics were almost similar between cases and controls. The male-to-female ratio of AA patients was 1:1. The mean age was 29.9 ± 10.5 years for thecase group and 29.9 ± 10.4 years for the control group. Most of the patients with AA had mild disease (45%)followed by moderate (42.5%) and severe (12.5%) diseases. The study demonstrated the prevalence of thyroiddys function to be significantly higher in the case group (20%) than that in the control group (5%) with a risk of developing thyroid disorder in patients with AA being 4.7(95% CI = 0.9 – 23.9) times higher than that in the control group (p = 0.043). There were significant differences between cases and controls in terms of levels of TSH,FT3 and FT4. The present study demonstrated a significant difference between cases (AA patients) and controlswith respect to thyroid auto-antibodies (Tg-Ab, TPO-Ab) as well. Tg-Ab and TPO-Ab were also found positive in 12euthyroid alopecia areata patients. Conclusion: The prevalence of thyroid disorders is comparatively high in alopecia areata patients as opposed to healthy individuals of similar age and sex. The serum levels of TSH, TPO-Ab and Tg-Ab are significantly elevated, and the levels of free T3 and free T4 are significantly dropped in patients of alopecia areata compared to theirhealthy counterparts. However, Tg-Ab and TPO-Ab may be present in euthyroid alopecia areata patients. Ibrahim Card Med J 2022;12(2):15-20

Prognostic impact of thyroid dysfunction in patients with incident heart failure: a nationwide study

Abstract Background Thyroid hormones directly affect the cardiovascular system. Thyroid dysfunction can cause a variety of haemodynamic alterations and has been associated with an increased risk of atrial fibrillation (AF), heart failure (HF), and all-cause mortality. However, a paucity remains regarding knowledge on the prognostic impact of thyroid dysfunction in patients with HF. Purpose To examine the impact of the whole spectrum of thyroid dysfunction in patients with HF on the associated risk of AF, HF admissions, and all-cause mortality. Methods This Danish cohort study included patients with a first-time HF diagnosis from 2000–2021. According to blood samples within 6 months prior to the HF diagnosis, the study population was categorized based on thyroid function in 1) overt hypothyroidism, 2) subclinical hypothyroidism, 3) euthyroidism, 4) subclinical hyperthyroidism, and 5) overt hyperthyroidism. With up to one year of follow-up from the date of HF diagnosis, we used Aalen-Johansen estimator to examine the cumulative incidence frequency (CIF) of AF and HF admissions and Kaplan-Meier estimates to assess all-cause mortality. Multivariable Cox proportional hazard analysis was performed to investigate differences in outcomes among groups. Results Of the 7,380 individuals included in this study (56.6% female, median age 76.5 years [p25-p75: 67.9-84.1]), 102 (1.4%) had overt hypothyroidism, 1,706 (23.1%) had subclinical hypothyroidism, 4,374 (59.3%) were euthyroid, 691 (9.4%) had subclinical hyperthyroidism, and 507 (6.9%) had overt hyperthyroidism. Compared with euthyroid patients, the adjusted one-year hazard ratio (HR) for AF was 0.77 (95% CI, 0.49-1.20) for overt hypothyroidism, 1.01 (95% CI, 0.90-1.13) for subclinical hypothyroidism, 1.18 (95% CI, 1.01-1.38) for subclinical hyperthyroidism, and 1.19 (95% CI, 1.01-1.39) for overt hyperthyroidism (Figure). The adjusted one-year HR for HF hospitalizations was 1.51 (95% CI, 1.06-2.14) in patients with overt hypothyroidism, 1.07 (95% CI, 0.96-1.20) in patients with subclinical hypothyroidism, 0.99 (95% CI, 0.84-1.16) in patients with subclinical hyperthyroidism, and 1.26 (95% CI, 1.06-1.50) in patients with overt hyperthyroidism. The adjusted one-year HR for mortality was 1.81 (95% CI, 1.25-2.63) in patients with overt hypothyroidism, 1.25 (95% CI, 1.10-1.42) in patients with subclinical hypothyroidism, 1.15 (95% CI, 0.96-1.37) in patients with subclinical hyperthyroidism, and 1.46 (95% CI, 1.20-1.78) in patients with overt hyperthyroidism. Conclusion In patients with HF, overt and subclinical hyperthyroidism was associated with an increased rate of AF. Both hypo and hyperthyroid states were associated with increased risk of HF admission and mortality. Increased awareness regarding thyroid status in patients with HF is warranted.

Effect of extra-low dose levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism undergoing in vitro fertilization and embryo transfer

ObjectiveThis study was undertaken to test the therapeutic effect of extra-low dose of levothyroxine (LT4; 25 mcg/day) to preconception and pregnant women with subclinical hypothyroidism (SCH). Materials and methodsThis is a retrospective study, SCH women who succeeded in their first in vitro fertilization (IVF) cycle between January 1, 2018, to December 31, 2020 were included. SCH is defined as normal serum free thyroxine (T4) level and an elevated serum thyroid stimulating hormone (TSH) level >4 mIU/L. Extra-low dose of levothyroxine (LT4; 25 mcg/day) was prescribed to the SCH women from the establish of diagnosis of SCH to the end of pregnancy. The pregnancy outcomes (miscarriage, live birth, preterm birth, and small for gestational age baby) were compared to the euthyroid pregnant women. ResultsTotally, 589 women were screened, and 317 cases received their first time IVF treatment. 167 women were clinically pregnant after IVF treatment, 155 of them were euthyroid and 12 of these women were diagnosed to have SCH. The average age of the participants was 35 years old. There were no significant differences in age, body mass index (BMI), anti-müllerian hormone (AMH), types of embryo transfer, number of embryos to transfer, or embryo stage during transfer between two groups. The live birth rate, miscarriage rate, and preterm birth rate in women with SCH supplemented with extra-low dose of LT4 were non-inferior to euthyroid patients (miscarriage rate: P = 0.7112; live birth rate: P = 0.7028; preterm delivery: P = 0.2419; small for gestational age: P = 0.2419). ConclusionOur result demonstrated that supplementation with extra-low dose of levothyroxine at 25 mcg/day to SCH women can produce the comparable obstetrical and neonatal outcome as that in euthyroid pregnant women. Accordingly, we suggest extra-low-dose of levothyroxine may be considered as a safe and effective alternative for those SCH pregnant women who were not tolerated to the standard dose of levothyroxine.

The effect of metformin therapy on serum thyrotropin and free thyroxine concentrations in patients with type 2 diabetes: a meta-analysis

Type 2 diabetes and thyroid function disorders are two common chronic endocrine disorders with the high prevalence in various populations. Metformin is well established as the first-line drug therapy for managing diabetes mellitus. In this meta-analysis, we aimed to determine the effect of metformin on serum TSH and FT4 concentrations in patients with type 2 diabetes. We searched PubMed, Scopus, web of science, Cochrane library, and google scholar to collect information on the effect of metformin on serum TSH and FT4 levels. Demographic and clinical information and serum TSH and FT4 concentrations before and after metformin treatment were extracted. Studies on patients over 18 years of age were included. A total of 11 studies including 1147 patients were selected for the final analysis. In hypothyroid patients, the TSH level decreased significantly after treatment with metformin (Hedges’s g:1.55, 95%CI 0.93–2.16, p-value < 0.001); FT4 level increased slightly after taking metformin, but the increase was not significant (Heddges’s g: − 0.30, 95%CI − 0.90,0.31, p-value = 0.34). In euthyroid subjects, the slight decrease found in TSH and FT4 concentrations was not statistically significant. Metformin reduces TSH levels in hypothyroid patients; however, it has no effect on TSH levels in euthyroid patients. Metformin does not affect serum FT4 levels in euthyroid and hypothyroid patients.

Case study of thyroid dysfunction associated with polycystic ovarian syndrome (PCOS)

Background: In recent times, there's a noticeable rise in endocrine dysfunctions, with increasing clinical resemblance between PCOS and autoimmune thyroid disease. The exact cause of this association remains uncertain, but these conditions share a reciprocal relationship. While they exhibit common clinical features, risk factors, and pathophysiological abnormalities, the root causes differ. Polycystic ovaries can be a manifestation of hypothyroidism, making it necessary to rule out hypothyroidism before diagnosing PCOS. Common factors like increased adipose tissue, insulin resistance, high leptin, and abnormal autoimmunity play a vital role in linking these conditions. These shared signs and symptoms emphasize the association between PCOS and hypothyroidism, though the etiopathological basis of this complex relationship is not fully established. Methodology: Cross-Sectional study of 200 patients involved after history, examination. Statistical analysis by SPSS v.22. Result: In this study, we aimed to evaluate thyroid function in PCOS patients using serum TSH levels and estimate the prevalence of hypothyroidism. We also examined prolactin levels in diagnosed PCOS patients, considering criteria like age distribution, BMI, clinical manifestations, fertility status, and thyroid status. Conclusion: Our findings suggest that PCOS is more prevalent in patients with thyroid disorders such as autoimmune thyroiditis and subclinical hypothyroidism compared to the general population. Additionally, PCOS increases the risk of cardiovascular diseases like hypertension and dyslipidemia. Subclinical hypothyroidism with PCOS further elevates the risk of hypertension compared to euthyroid PCOS patients. The study reveals that thyroid dysfunction occurs in 29.0% of PCOS patients, emphasizing importance of screening for thyroid abnormalities in PCOS patients.

Laparoscopic Sleeve Gastrectomy: Impact on Body Mass Index and Thyroid Hormones in Euthyroid Obese Patients.

BACKGROUND Obesity is still a major global public health problem and its incidence is increasing. Obesity leads to deterioration in thyroid functions. Even when they are within normal ranges, high normal levels of thyroid-stimulating hormone (TSH) increase morbidity and mortality. This study aimed to evaluate the body mass index (BMI) and TSH levels in 300 euthyroid patients with obesity before and after laparoscopic sleeve gastrectomy (LSG). MATERIAL AND METHODS A total of 300 euthyroid patients who underwent LSG between 2019 and 2021 were included in the study. Body mass index (BMI), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT) 3 and tetraiodothyronine (FT4) levels were recorded before surgery and at 6 and 12 months after surgery and subsequently analyzed. RESULTS Mean BMI values were significantly lower at 6 and 12 months after surgery (P<0.001). There was a significant difference between mean TSH and FT4 levels before surgery and those at 6 and 12 months after surgery (P<0.001). However, mean FT3 levels remained unchanged 1 year after surgery (P=0.005). CONCLUSIONS LSG is not only effective in terms of weight loss, but also exhibits improving effects on thyroid hormone homeostasis in obese patients and provides protection against further adverse effects of TSH.

Serum Lipoprotein(a) Is Not Associated with Graves' Ophthalmopathy.

Aim: To investigate the relationship of serum lipoprotein(a) [Lp(a)] and other serum lipids with presence of Graves' ophthalmopathy (GO). Methods: A total of 99 consecutive patients diagnosed with Graves' disease (GD), aged 18-65 years, who had not received prior treatment for GO, thyroid surgery, or radioactive iodine therapy, were recruited between June 2020 and July 2022. In addition, 56 healthy controls (HCs) were included as the control group. All patients underwent an ophthalmological examination, and were classified based on the presence of GO into the GO group (n = 45) and no GO group (n = 54). Fasting blood samples were collected from all participants to analyze serum lipid parameters, including Lp(a), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Results: The median serum levels of Lp(a) were 5.7 [4.3-9.2] in the GO group, 6.7 [3.7-9.9] in the no GO group, and 4.7 [3-7.6] in the HC group. The intergroup comparisons of serum Lp(a) levels showed no significant result. The serum levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were also similar between the groups (P > 0.05 for all). However, when analyzing only euthyroid GD patients and the control group, the serum LDL cholesterol levels were found to be significantly higher in the euthyroid GO group [median: 132 interquartile range (IQR) (110-148) mg/dL] than in the HCs [median: 96 IQR (94-118) mg/dL] (P = 0.002). Conclusion: The findings of our study did not support the association between serum Lp(a) levels and GO.