Euthyroid Group Research Articles

The relationship between thyroid hormone levels, insulin resistance and body mass index, in patients with subclinical hypothyroidism andeuthyroid patients

Background. Hypothyroidism is a common thyroid disorder with female predominance. In general population its prevalance is 2–5% while 10 times higher in female than in men. Insulin resistance, one of the most discussed issues recently, is an inadequate response to insulin in peripheral tissues despite the normal secretory function of pancreatic islet cells. In this study, we analyzed relationship between thyroid hormone levels, body mass index and insulin resistance calculated with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI) and Atherogenic Index of Plasma (AIP) in SCH and euthyroid patients under levothyroxine treatment. Materials and methods. The clinical and laboratory data of approximately 14000 patients between the ages of 18–60 were retrospectively evaluated. After these exclusion criteria were applied, 371 eligible individuals were included in the study. All 371 individuals divided into three groups according to TSH levels. Group 1 is eutyhroid patients under levothyroxine treatment with TSH levels between 0.27–4.2μIU/mL. Group 2 is subclinical hypothyroid patients with TSH levels between 4.2–10 μIU/mL. Group 3 is healthy control group with TSH levels between 0.27–4.2 μIU/mL. Results. The euthyroid patient group has the highest (25.66±3.36 kg/m2) mean BMI. On the other hand the mean BMI was higher in SCH (24.0400±3.8436kg/m2) group than in control group (22.48±2.74 kg/m2) (p<0.05). Fasting plasma glucose (FPG), serum triglyserid, low density lipoprotein (LDL), anti-thyroid peroxidase (TPO) and insulin levels were significantly higher in euthyroid patient and SCH groups (p<0.05). Notably, total cholesterol, LDL and TPO levels were higher in euthyroid patient group (p<0.05). On the other hand, there were no difference between euthyroid patients and SCH group. Conclusions. This study found significantly elevated insulin resistance and cholesterol levels in SCH patients, so we hypothesized that SCH is also a risk factor for insulin resistance disorders such as cardiovascular diseases and metabolic syndrome. As a consequence, lipid metabolism defects and insulin resistance should be screened and treated in SCH patients. Thanks to the strong and significant correlation between HOMA and QUICKI in our study, we suggest the combined use of HOMA and QUICKI in these patients. Further and large-scale studies are needed to evaluate the relationship of HOMA, QUICKI, AIP, and BMI in detecting insulin resistance in SCH patients.

Dyslipidemia In Thyroid Disorders

Background: Thyroid hormones play an important role in regulating lipid metabolism; and thyroid dysfunctions can result in lipid abnormalities which increase the risk of endothelial dysfunction, hypertension and cardiovascular disease.
 Methods: A cross-sectional study was conducted on 50 patients with suspicion of thyroid disorders were taken as cases. 50 patients with normal thyroid profile and no history of other chronic diseases were taken as control group.
 Results: The serum TC, TG and LDL levels in hypothyroid individuals (both overt and subclinical) were significantly higher than euthyroid subjects but the levels were comparable between hyperthyroid and euthyroid group.
 Conclusion: We conclude that, dyslipidemias are associated with thyroid disorders, so biochemical screening for thyroid dysfunction in all dyslipidemic patients. Therefore, patients presenting with dyslipidemia are recommended for investigation to explore thyroid dysfunction.
 Keywords: Total cholesterol, Triglycerides and LDL.

Untreated thyroid autoantibody-negative SCH increases the risk of spontaneous abortions

BackgroundNumerous studies have found that subclinical hypothyroidism (SCH) may increase adverse pregnancy outcomes; however, the benefit of levothyroxine (LT4) treatment remains controversial. The 2017 guidelines of the American Thyroid Association weakly recommended LT4 therapy for serum antithyroid peroxidase antibody (TPOAb)-negative women with thyroid-stimulating hormone (TSH) concentrations greater than the pregnancy-specific reference range and below 10.0 mU/L. Therefore, the primary goal of this study was to investigate the correlation between thyroid autoantibody-negative SCH with or without LT4 treatment and adverse pregnancy outcomes.MethodsWe prospectively enrolled 1868 consecutive pregnant women. Finally, 1344 women were involved in the study according to the inclusion and exclusion criteria. Assays for TSH, free thyroxine (FT4), TPOAb, anti-thyroglobulin antibody, and laboratory indicators were performed. The participants were divided into the euthyroid (ET) group (n = 1250) and the SCH group(n = 94). The SCH group was further divided into LT4 group (n = 40) and non-LT4 group(n = 54). The laboratory indicators and pregnancy outcomes were evaluated during follow-ups.ResultsMaternal age, BMI, parity, and the history of spontaneous abortion did not differ significantly between the ET group and the different SCH groups. There were no significant differences in lipid profile and homocysteine levels between ET and SCH group in the first and third trimester of pregnancy. After adjusting the confounding factors, the non-LT4 group was a risk factor for spontaneous abortion (odds ratio: 3.141, 95% CI: 1.060–9.302). Survival analysis showed that the time of abortion was different between the ET group and SCH group (log-rank P= 0.042). The spontaneous abortion in SCH, especially in non-LT4, group mainly occurred in the first trimester of pregnancy.ConclusionsThyroid autoantibody negative-SCH seems to be associated with increased risk of spontaneous abortions during the first trimester of pregnancy. LT4 therapy in this patient population might be beneficial to reduce adverse pregnancy outcomes.

Sex-specific Association of Subclinical Hypothyroidism With Incident Metabolic Syndrome: A Population-based Cohort Study.

Subclinical hypothyroidism is known to increase the risk of cardiovascular diseases and mortality. However, the longitudinal association between subclinical hypothyroidism and incident metabolic syndrome remains unclear. A total of 3615 participants from Beijing Health Management Cohort were enrolled from 2012 to 2014 and followed through 2019. People were placed into subclinical hypothyroidism and euthyroidism groups according to serum-free thyroxine and TSH concentrations. We used Cox proportional hazards regression models to investigate the relationship between TSH level and incident metabolic syndrome considering the modification effect of sex and age. Of 3615 participants, 1929 were men (53.4%); mean (SD) age was 43.51 (11.73) years. Throughout the follow-up (median [interquartile range], 3.0 [2.8-3.2] years), 738 individuals developed metabolic syndrome. Subclinical hypothyroidism was significantly associated with metabolic syndrome development only in men, and the adjusted hazard ratio was 1.87 (95% CI, 1.21-2.90) compared with euthyroidism group. Of note, there was no increased risk of metabolic syndrome in people aged 50 years or older with subclinical hypothyroidism. Subclinical hypothyroidism is associated with incident metabolic syndrome in young men. Further studies are needed to evaluate the targeted threshold and benefit of thyroid hormone replacement therapy for metabolic health.

Aging-related Characteristics of Subclinical Hypothyroidism Detected in General Practice.

Subclinical hypothyroidism (SCH) is diagnosed when serum thyrotropin (TSH) is elevated despite a normal thyroxine level and is known to increase the risk of metabolic disorders. This study was conducted to identify potential laboratory markers suspicious for latent SCH. We retrospectively reviewed 958 outpatients in whom thyroid functions had been examined. Eighty-five (9.1%) of the 939 analyzed subjects had SCH (73% females). In the SCH group, median serum TSH and FT4 levels were 5.04 μU/ml and 1.19 ng/dl, respectively, and auto-thyroid antibodies were detected in 53.8% of patients. SCH group patients were significantly older than patients in the euthyroid group, while there was no intergroup difference in BMI. However, 56.5% of the SCH patients were asymptomatic. In the SCH group, serum aspartate aminotransferase and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher, and the estimated glomerular filtration rate (eGFR) was significantly lower than in the euthyroid group. Among patients less than 65 years of age, SCH patients tended to have lower eGFR and higher LDL-C than euthyroid patients. Age-dependent reductions of red blood cells and serum albumin were more prominent in the SCH than the euthyroid group. Biochemical changes with aging are useful as potential clues for suspecting latent SCH.

Determining the Association Between Helicobacter pylori Infection and Treatment-Refractory Hypothyroidism.

IntroductionRefractory hypothyroidism, despite weight-based thyroxine dosing, is a common endocrinology consultation in outpatients. Chronic Helicobacter (H.) pylori infection has been reported to be responsible for the poor absorption of thyroxine from the small gut leading to suboptimal response with contradictory evidence. This study was carried out to determine the association of chronic Helicobacter pylori infection with refractory hypothyroidism in outpatients presenting to a tertiary care hospital.MethodsOne hundred thirty patients with the diagnosis of hypothyroidism, visiting Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE) Jinnah Hospital Lahore, Pakistan, from January 2020 to February 2021, were included in the study after informed consent following the non-probability consecutive sampling technique. All of these patients were 15-70 years of age, non-pregnant, and receiving thyroxine treatment for at least six weeks. Patients with a history of gastric surgery, malabsorption syndrome, or poor compliance were excluded from the study. Patients’ age, sex, and body mass index (BMI) were recorded in a structured proforma. Patients were categorized into two groups, i.e. controls (biochemically euthyroid on thyroxine treatment with TSH < 4.5mU/L) and cases (refractory hypothyroidism despite 1.6 mcg/kg thyroxine treatment with TSH > 4.5 mU/L). The presence of chronic H. pylori infection was checked with serum immunoglobulin G (IgG) testing by enzyme-linked immunoassay (ELISA) from the hospital laboratory and data analysis was done by SPSS version 21.0 (IBM Corp., Armonk, NY).ResultsOne hundred thirty patients were included in this study, with an age range from 15 to 70 years. Of these, 65/130 (50%) were euthyroid on treatment and 65/130 (50%) had treatment-refractory hypothyroidism. The mean age of patients in our study was 45.81 ± 11 years, with 118 (90.8%) female patients. The prevalence of positive H. pylori IgG antibody was 47/130 (36.2%) overall, with 23 patients (35.4%) in the control (euthyroid) group and 24 patients (36.9%) in the cases (refractory hypothyroidism) group. The difference between the two groups was not statistically significant with an odds ratio of 1.069 (CI 0.523 - 2.187) and a p-value of 0.855. Moreover, age, gender, and BMI had no effect on chronic H. pylori association with refractory hypothyroidism.ConclusionThis study does not suggest any significant association between chronic H. pylori infection and treatment-refractory hypothyroidism. Other factors like poor compliance, drug-drug interactions, and malabsorption disorders should be preferably sought in case of refractory hypothyroidism.

Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves' Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients.

BackgroundGraves’ disease (GD) is the most common cause of hyperthyroidism and can cause cardiac changes, such as pulmonary hypertension.MethodsThis is a prospective study in which we obtained demographic, clinical, laboratory data and characteristics of the GD, in addition to investigating cardiorespiratory function, focusing on the detection of pulmonary hypertension. Patients were separated into two groups: thyrotoxicosis and euthyroidism. Ninety patients with GD of both sexes, over 18 years of age, were included. The cardiorespiratory assessment included an echocardiographic evaluation, a questionnaire of specific symptoms, spirometry and a six-minute walk test.ResultsThe hyperthyroid group included 42 patients (47.73%) and the euthyroid group 46 patients (52.27%); 78 were women (86.67%). The prevalence of pulmonary hypertension between the hyperthyroidism (48.57%) and the euthyroidism (29.41%) groups was not different. Free thyroxine levels (FT4) (OR 1.266), higher left atrium volume (OR 1.113) and right ventricle diameter were associated with pulmonary hypertension. A direct correlation between FT4 with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as also an inverse correlation between initial oxygen saturation (SpO2) with diagnostic time and drop SpO2 with the ratio between the diastolic velocity E of the mitral flow and the diastolic velocity of the mitral ring (E/e’) were observed in the euthyroid group. An inverse correlation between FT4 levels with walked distance as % of predicted value, and a direct correlation between E/e’ ratio and walked distance as % of predicted value were observed in the hyperthyroid group.ConclusionWe emphasize the importance of a cardiorespiratory reassessment in GD, even after a long-term control of the thyrotoxic state, as we demonstrate that about 30% of these patients remain with PH and are subject to specific treatment.

Higher serum thyroid autoantibody value is a risk factor of hypothyroidism in children and young adults with chronic thyroiditis.

.Thyroid function in patients with chronic thyroiditis (CT) varies depending on the clinical course. Serum antithyroglobulin antibody (TgAb) and antithyroid peroxidase antibody (TPOAb) levels may be used to predict hypothyroidism in CT. In this retrospective cohort study, patients with CT, defined as having a high TgAb or TPOAb value, were divided into a hypothyroid group (HG) and euthyroid group (EG), after a mean follow-up of 2.5 years. The definitions of the two groups was based on the maximum TSH value from the initial measurement to the most recent follow-up: HG was defined as TSH 10.0 μIU/mL or higher, and EG was defined as TSH < 10.0 μIU/mL. There were 20 and 113 patients in the HG and EG, respectively. There were no significant differences in age, sex, underlying diseases, or TgAb and TPOAb levels between the groups. Receiver operating characteristic curve analyses of TgAb and TPOAb values for predicting thyroid function showed areas under the curve of 0.714 and 0.757, respectively. The value with the highest diagnostic accuracy was 106 IU/mL for TgAb and 16 IU/mL for TPOAb. Thus, TgAb > 106 IU/mL and TPOAb > 16 IU/mL may predict hypothyroidism in children and young adults with CT.

SERUM CARBOXYMETHYL-LYSINE AND SOLUBLE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS IN HYPERTHYROID AND HYPOTHYROID PATIENTS.

The formation and accumulation of advanced glycation end products (AGEs) are enhanced with increased oxidative stress and inflammatory conditions. A hyperthyroid and hypothyroid state is associated with oxidative stress. This study aimed to evaluate skin AGE deposition, serum carboxymethyl-lysine (CML), and serum soluble receptor for AGEs (sRAGE) levels in hypothyroid and hyperthyroid patients. A total of 203 subjects were included in this cross-sectional study. After excluding diabetes mellitus, 103 newly diagnosed hypothyroid patients, 50 newly diagnosed hyperthyroid patients, and 50 control (euthyroid) subjects were enrolled. All tests were done before beginning the appropriate treatment. Accumulated AGEs in the skin collagen were measured by skin autofluorescence (SAF) using an AGE Reader. SAF measurements were 1.82 ± 0.04, 1.80 ± 0.40, and 1.63 ± 0.30 arbitrary units for the hypothyroid, hyperthyroid, and euthyroid groups, respectively (p = 0.04). Serum CML levels were 8.2 ± 2.8, 10.2 ± 2.0, and 8.0 ± 3.3 ng/mL for the hypothyroid, hyperthyroid, and euthyroid groups, respectively (p = 0.01). sRAGE levels were similar between the groups. Serum thyroid-stimulating hormone and SAF measurements were positively correlated (r = 0.25, p = 0.02) in the hypothyroid group and negatively correlated in the hyperthyroid group (r = -0.36, p = 0.04). There was no correlation between CML and sRAGE levels. SAF measurements are increased in both hypo- and hyperthyroid normoglycemic patients. Serum CML levels are increased in hyperthyroid patients. Hypo and hyperthyroid states might be associated with acceleration of AGE accumulation and may have a long term effect on metabolic memory.

Relationship between subclinical hypothyroidism and distal-symmetric diabetic polyneuropathy in type 2 diabetes mellitus referred to Kosar Hospital in Semnan and related indicators in 2019-2020.

Introduction:Diabetes is one of the most common metabolic diseases and one of its important complications is diabetic neuropathy. Due to the relationship between diabetes and thyroid disorders, the present study was performed to determine the association between subclinical hypothyroidism and end-stage diabetic polyneuropathy in patients with type 2 diabetes.Materials and Methods:In this descriptive, analytical study, 154 patients with type 2 diabetes referred to Kosar Hospital in Semnan were evaluated. After recording their demographic information, samples were received for biochemical testing. The patients’ neuropathy was then evaluated based on the United Kingdom screening test (UKST). The results were recorded in the data collection form and then analyzed using SPSS Statistics 22 software.Results:In this study, 154 patients were studied, including 49 with subclinical hypothyroidism and 105 with euthyroid. The results of the present study showed that the mean age of patients in the subclinical hypothyroid group was 60.08 years and in the euthyroid group was 60.77 years. Mean ± standard deviation (SD) of the patients’ age, blood pressure, duration of diabetes, body mass index, fasting blood sugar (FBS) and Glucose, and 2-hour post prandial (2HPP) were not statistically significant between the two groups. The frequency of neuropathy severity based on clinical signs during examination and symptoms mentioned by the patients in the two groups was statistically significant (P = 0.005 and P = 0.001, respectively). The severity of neuropathy was not significantly associated with thyroid-stimulating hormone (TSH) levels (P > 0.05).Conclusion:From the results of the present study, it can be concluded that the severity of neuropathy based on the clinical signs during examination and the symptoms mentioned by the patient in diabetic patients is related to subclinical hypothyroidism. Further studies are recommended.

Thyroid Dysfunction and its Effect on Red Blood Cell Parameters

Background: Thyroid hormones are necessary for the growth and development, cellular differentiation, physiological function and metabolic regulation of almost all tissues in our body. Thyroid disorders are accompanied by alteration in hematological profile. This study aims to evaluate the effect of thyroid dysfunction on red blood cell parameters.&#x0D; Materials and Methods: This case-control observational study was conducted in the Department of Clinical Biochemistry, KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from January 2021 to June 2021.Total number of recruited subjects was 248, out of which 67 were labeled as hypothyroid, 7 were hyperthyroid and 174 were euthyroid as control. Subjects for all three groups were between 16-93 years old. Thyroid hormone profile of patients was determined by Siemens ADVIA Centaur CP immunoassay analyzer and hematological parameters by automated hematology analyzer Sysmex XN-550. Results were analyzed by SPSS 21 software and a chi-square test was applied to see significant differences among the groups.&#x0D; Results: The mean age of all study participants was 42.08±17.27 years and female constituted 74.6% of total subjects. Analysis of the data obtained a statistically significant difference in the mean hemoglobin (p&lt;0.001) between hypothyroid and euthyroid groups. The difference was not significant for hemoglobin (p=0.252) among hyperthyroid and euthyroid groups. There was no statistical significant difference between thyroid cases and control for MCV, MCH and MCHC.&#x0D; Conclusion: The current study concluded that thyroid dysfunction have a significant effect on red blood cell parameters. Hematological parameters should be evaluated in patient with thyroid dysfunction.

Oxidative stress correlates well with markers of metabolic syndrome in clinically hypothyroid cases: a hospital based study in a remote tribal district

Relevance. Dislipidemia is one of the major manifestation of thyroid disease process due to alteration of metabolic parameters which are also seen in metabolic syndrome. Though oxidative stress has been implicated in both processes, controversial results have been obtained. Objective. To determine the status of lipid peroxidation product (Lpx) in the study group and identify the association of different components of metabolic syndrome. Material and Methods: 102 patients comprising of 60 healthy euthyroid controls and 42 hypothyroid patients served as the study group. Blood samples were collected for fasting blood sugar, renal parameters, lipid profile, tri-iodothyronin (T3), thyroxine (T4) and thyroid stimulating hormone (TSH). Level of lipid peroxidation in the samples was determined by monitoring the level of thiobarbituric acid like substances (TBARS) like substances. Results. The demographic parameters were significantly altered in hypothyroid patients. Systolic and diastolic blood pressure amongst both the groups was observed to have higher mean value in hypothyroid patients. The fasting blood sugar (FBS), total cholesterol, triacylglycerol, low density lipoprotein (LDL) and high density lipoprotein (HDL) in the hypothyroid was significantly higher than euthyroid control groups. The most frequent alteration in the hypothyroid patients was rise in SBP (95 %), Hypertriglyceridemia (50 %) and raised waist circumference (48 %) and DBP (42 %). A fourfold rise in Lpx was observed in hypothyroid subjects (p0.001). Robust positive association was observed between TSH and Lpx. Multiple linear regressions revealed strongest and statistically significant association between serum serum thyroid stimulating hormone and waist circumference. Conclusion. The hypothyroid patients have significant higher degree of oxidative stress and the components of metabolic syndrome. They are the candidates for preventive health intervention.

Effect of hypothyroidism and thyroid autoimmunity on the ovarian reserve: A systematic review and meta-analysis.

BackgroundEvidence suggests that hypothyroidism and thyroid autoimmunity (TAI) are possibly associated with ovarian dysfunction. This meta‐analysis aimed to investigate whether hypothyroidism and/or TAI affect the ovarian reserve and evaluated using the anti‐Mullerian hormone (AMH).MethodsPubMed, EMBASE, Web of Science, and Cochrane Controlled Trials Register databases from inception to October 2020 were searched to identify relevant studies. Studies comparing the AMH levels between the control and the affected groups were included in the data synthesis. The primary endpoint in the meta‐analysis was AMH levels compared with the controls.Main findingsNine trials were included in the analysis. The AMH levels were significantly lower in the adults with euthyroid TAI (mean difference −0.12, [95% CI: −0.18 to −0.06]). The AMH levels tended to be lower in subclinical hypothyroidism and overt hypothyroidism than in the control group, although the differences were not significant. The AMH levels were significantly higher in the euthyroid TAI group in the adolescents (mean difference 2.51, [95% CI 1.82 to 3.21]).ConclusionTAI and hypothyroidism may affect the ovarian reserve. The opposite effects on AMH levels depending on age suggest that TAI may be implicated in the depletion of follicles in adults following extensive activation of primordial follicles in adolescence.

Comparison of Enzyme-Linked Immunosorbent Assay and Chemiluminescence Immunoassay for Thyroid Stimulating Hormone Analysis in Tertiary Care Hospital Lahore

Objective: To compare enzyme-linked immunosorbent assay and Chemiluminescence immunoassay for thyroid stimulating hormone analysis in human serum. &#x0D; Methodology: This cross-sectional study conducted from 17th March till 13th June. In Punjab Rangers Teaching Hospital, Lahore after approval from Institutional Review Board. Random samples from both genders, between 18-70 years of age were included. Haemolysed, lipemic or icteric specimens were excluded. The sera were assayed for thyroid stimulating hormone (TSH) by enzyme-linked immunosorbent assay (ELISA) and Chemiluminescence immunoassay (CLIA). Data was analyzed by SPSS 24.&#x0D; Results: A total of one hundred and ninety-eight serum samples were processed by ELISA and CLIA in all the samples, with more females as compared to males (1:1.3). ELISA technique identified 134 subjects as Euthyroid, 40 Hypothyroid and 24 Hyperthyroid, while 122 Euthyroid, 48 hypothyroid and 28 hyperthyroid subjects by CLIA. Thyroid stimulating hormone (TSH) levels reference range was taken 0.4-4.5mU/L according to American Thyroid Association. Mean ± SD of TSH was 1.45 ± 0.79; 12.27 ± 11.03 and 0.23 ± 0.17 mU/L respectively by ELISA whereas CLIA indicated Mean ± SD to be 1.93 ± 0.936, 16.04 ± 14.68 and 0.393 ± 0.375 mU/L respectively for Euthyroid, hypothyroid and hyperthyroid. Correlation of coefficient (R2 =0.89) was found significantly positive between both methods. There was a significant difference in hypothyroid and Euthyroid groups.&#x0D; Conclusion: TSH assay by CLIA has shown a wider range of functionality, throughout and borderline cases were identified better as compared to ELISA. Turn-around-time (TAT) decreased, physician satisfaction increased and indirectly benefitting patient treatment and prognosis.

Hematological changes in hypothyroidism and hyperthyroidism in adults

Thyroid function disorders are among the most common endocrine diseases. Thyroid disorders can cause certain forms of anemia, more commonly in hypothyroidism. Slightly decreased TLC, relative neutropenia, relative lymphocytosis or relative eosinophilia may be found in thyroid disorders. These observations confirmed the association between thyroid gland dysfunction and hemopoiesis.1) To study the pattern of hematological changes in thyroid dysfunction 2) To correlate thyroid function tests with complete blood count &amp; red cell indices findings 3) To correlate complete blood count investigations and peripheral blood smear findings with serum TSH levels.It was an Observational study conducted during 18 months of period from March 2018 to October 2019 with 100 subjects of hypothyroidism, 80 subjects of hyperthyroidism and 100 euthyroid subjects as control group. CBC was done on automated cell counter. PBS was stained with Leishman stain and observed under microscope. TFTwas done by immunoassay method.It was done with SPSS Software.: Predominance of female was seen in hypothyroidism and hyperthyroidism. Significant decrease was seen in RBC, Hb, HCT, MCV and MCH in hypothyroid group, while in hyperthyroid group RBC, Hb and HCT were significantly decreased as compared with euthyroid control group. Both groups showed significant increase in RDW as compared with control group.It is important to carefully evaluate the thyroid hormones in cases of unexplained anemias. So, periodic evaluation for probable hematological changes should be done in all the patients with hypothyroidism and hyperthyroidism.

Association of subtle alterations in thyroid function with presarcopenia in patients with type 2 diabetes mellitus.

ABSTRACTAims/IntroductionTo investigate the association of subtle alterations in thyroid function with presarcopenia among patients with type 2 diabetes mellitus.Materials and MethodsA total of 1,865 adult patients with type 2 diabetes mellitus were enrolled in this cross‐sectional study, excluding patients with overt thyroid dysfunction. Skeletal muscle mass measured by dual energy X‐ray absorptiometry was used to assess presarcopenia. Logistic regression models were used to estimate the effects of thyroid hormones on presarcopenia, and subgroup analyses were carried out in different strata of age, sex and body mass index, respectively.ResultsCompared with the euthyroid group (Euthy), the subclinical hyperthyroidism group had an increased odds of presarcopenia (multivariate‐adjusted odds ratio 1.99, 95% confidence interval 1.09–3.63), but the subclinical hypothyroidism group did not (P > 0.05). In the subclinical hyperthyroidism group, age and body mass index <24 kg/m2 were independent risk factors for presarcopenia. In the overall Euthy group, an increased odds of presarcopenia was correlated with the elevated free thyroxine : free triiodothyronine ratio (all P for trend <0.05), whereas not with increment in free triiodothyronine level (P for trend >0.05). Additionally, in Euthy subgroup analyses stratified by middle‐age, sex and body mass index, a similar association was noted (all P for trend <0.05), but not in the older‐aged patients (P for trend >0.05).ConclusionsSubclinical hyperthyroidism was an independent risk factor for presarcopenia in patients with type 2 diabetes mellitus, but subclinical hypothyroidism was not. In the Euthy group with type 2 diabetes mellitus, a high free thyroxine : free triiodothyronine ratio was a good index of presarcopenia in addition to older age.

Relationship between Subclinical Hypothyroidism and Chronic Kidney Disease in Type Two Diabetes Mellitus in Al-Nasria City South of Iraq.

The association between subclinical hypothyroidism (SCH) and chronic kidney disease(CKD)in type2 diabetes mellitus is unclear. We examined whether SCH is associated with CKD in type2 diabetic patients in AL-Nasria city. Data from 207 patients who visited Al-Nasria diabetic clinic and Al-Hussain teaching hospital between July 2013-october 2014 were analyzed in cross-section study.&#x0D; All patients with type2 diabetes mellitus were evaluated for glycaemic control, thyroid function and chronic kidney disease (CKD).CKD estimated by calculation of GFR from serum creatinine levels according to National Kidney Foundation.GFR levels were classified into five stages. CKD was define as eGFR 60 mL/min/1073 m2. The prevalence of SCH was 9.6%(n=20) among patients with type2 diabetes mellitus. The SCH group had a higher prevalence of dyslipidemia (p=0.009)and CKD (decline in GFR) (p=0.034) than the euthyroid group.&#x0D; After adjustment for potential risk factors of diabetes mellitus by multivariate logistic regression analysis, SCH remained significantly associated with CKD (odds ratio 2.086 (95% CI1.10-4.307, p=0.047),duration of diabetes(odds ratio 2.89 (95% CI 0.0-1.00 P=0.032),Dyslipidemia (odds ratio 4.849(95% CI 0.0-0.1.20 p=0.009). These results suggest that SCH was independently associated with CKD in type 2 diabetes mellitus.&#x0D;

Evaluation of vitamin D levels in patients with primary hypothyroidism: A cross-sectional study

Vitamin D deficiency (VDD) and hypothyroidism have been linked in research with inconsistent outcomes. Because of the controversy surrounding these two disorders and their relatively high incidence, we undertook a case-control research comparing the prevalence of VDD in hypothyroid patients (both TPO-Ab positive and negative) to euthyroid controls. This is a cross-sectional study with a single centre. Adults (aged 18 and above) of both sexes with primary hypothyroidism (TSH &amp;#62;5.1 mIU/L) were included (n = 165), as were age and sex matched euthyroid (TSH 5 mIU/ml) controls (n = 165) from the outpatients' department. Biochemical parameters like Thyroid stimulating hormone (TSH), free T4 (fT4), 25 hydroxy vitamin D (Vit D) and thyroid peroxidase antibody (TPO-Ab) were tested in both the groups.The study involved 330 patients, with 165 (mean age 46± 15 years) having primary hypothyroidism (3 having subclinical hypothyroidism) and 165 (mean age 45± 17 years) being euthyroid controls. VDD was seen in 96 percent of hypothyroid patients compared to 90 percent in the control group. The hypothyroid group had a significantly lower mean Vitamin D level than the euthyroid group (12.03± 8.6 SD vs. 17.49± 11.89 SD [ng/ml]; P= 0.001). TPO-Ab was found in two-thirds of the hypothyroid group (110/165). The mean Vitamin D level in the TPO-Ab positive hypothyroid group was 10.4± 7.2 ng/ml, compared to 15.3± 10.3 ng/ml in the TPO-Ab negative group (P = 0.004). With increased TPO-Ab titers, there was a downward trend in Vitamin D levels. A direct association between Vitamin D levels and TPO-Ab, on the other hand, did not reveal any relevance. Patients with hypothyroidism had considerably lower vitamin D levels than euthyroid controls. TPO-Ab positive individuals had lower vitamin D levels than TPO-Ab negative patients.

TSH Variations in Chronic Heart Failure Outpatients: Clinical Correlates and Outcomes.

Hypothyroidism is a frequently observed comorbidity in patients with chronic heart failure (CHF), possibly giving rise to unfavorable outcomes. The aim of the study was to evaluate the impact of TSH changes over time on cardiac function and prognosis of outpatients with CHF. Patients underwent clinical, electrocardiographic, and echocardiographic evaluations at baseline and after 12 months. Moreover, blood chemistry tests were performed to evaluate renal function, cardiac biomarkers, fT3, fT4, and TSH levels. Based on TSH serum levels, patients were retrospectively classified into four categories: Group 1, patients with improved thyroid function at one-year follow up vs. baseline; Group 2, patients with stable and mildly high TSH values (3.74 - 10 mUI/L); Group 3, patients with worsening thyroid function; Euthyroid patients Group, TSH levels within the normal range of reference at baseline as well as at 12 months follow-up. We considered as end-points: one-year changes of laboratory and echocardiographic parameters; hospitalizations due to worsening of HF (acute decompensated heart failure - ADHF); death for all causes. Among 257 patients, 174 (67.7%) were euthyroid at baseline and after 12 months. Group 1 patients (n. 22, 8.6%) showed a significant improvement in systolic and diastolic function, filling pressures, NT-proBNP and Galectin-3. Group 2 patients (n. 34, 13.2%) did not exhibit significant modifications in studied parameters. Group 3 patients (n. 27, 10.5%) showed worsening of diastolic function and NT-proBNP and a greater risk of ADHF (HR: 2.12; 95%CI: 1.20-3.74; p: 0.009) and death (HR: 4.05; 95%CI: 2.01-8.15; p<0.001). In patients with CHF, changes in thyroid function over time influenced echocardiographic parameters and biomarkers reflecting modifications of cardiac function and prognosis, thus suggesting the clinical relevance of thyroid deficiency screening and correction.

Effects of isolated maternal hypothyroxinemia on adverse pregnancy outcomes.

There are conflicting results about the effects of maternal hypothyroidism (IMH) on adverse pregnancy outcomes. This study aimed to investigate the relationship between IMH identified in the first trimester of gestation and adverse pregnancy outcomes. In this prospective cohort study, we used data from the Tehran Thyroid and Pregnancy study (TTPs). To diagnose IMH, we considered a threshold of 2.04 for FTI, which was based on the 10th percentile of this marker identified in the 1st trimesters. A generalized linear regression (GLM) model adjusted for the gravidity, urine iodine, and TPOAb status was applied to assess the effects of IMH on adverse pregnancy outcomes, compared to the controls group. Penalized logistic regression analysis indicated that the adjusted odds ratio (aOR) of Preterm premature rupture of the membranes (PPROM) in women with IMH was 5.43-folder higher than euthyroid group [aOR 5.43, 95% CI (1.40, 21.1), p = 0.01]. Besides, the adjusted odds ratio of low birth weight (LBW) in the IMH group was 2.53-folder higher than the healthy group [aOR 2.53, 95% CI (1.01, 6.33), p = 0.047]. Furthermore, the results of the GLM adjusted model revealed that the mean of neonatal head circumference and weight in the IMH group was around 0.43cm (95% CI - 0.80, - 0.07, p = 0.02) and 145.4g (95% CI - 242.6, - 48.1, p = 0.003) lower than euthyroid group, respectively. This study demonstrated that women with IMH identified in early pregnancy have a higher odds ratio for developing some adverse pregnancy outcomes, including PPROM and LBW compared to their euthyroid counterparts. Also, the neonatal head circumference and weight in the IMH group were lower than in the euthyroid group.