Evaluation Of Thyroid Function Research Articles

Optimizing Care for Primary Glomerulonephritis: The Role of Thyroid Evaluation.

The coexistence of primary glomerulonephritis and autoimmune thyroid disease has not been investigated. This study aimed to assess thyroid morphology using sonography, determine the prevalence of autoimmune thyroid disorders, and evaluate thyroid function status in patients diagnosed with primary glomerulonephritis. This single-center cross-sectional and observational study included 58 consecutive patients with primary glomerulonephritis and 58 healthy controls (HC). All participants underwent thyroid examination through laboratory tests and thyroid ultrasonography. The findings were subsequently compared between the two groups. Among the patients, 17.2% (n = 10) exhibited subclinical hypothyroidism, while 8.6% (n = 5) had overt hypothyroidism. None of the HCs showed overt hypothyroidism, whereas 3.4% (n = 2) of them exhibited subclinical hypothyroidism. Patients displayed significantly lower free triiodothyronine (FT3) levels than HCs (p < 0.001). A linear correlation was observed between patients' thyroid-stimulating hormone (TSH) levels and the degree of proteinuria (p = 0.044). Furthermore, thyroid volume (p < 0.001), hypoechogenicity (p < 0.001), heterogeneous structure (p < 0.001), pseudonodular hypoechoic infiltration (p = 0.05), and the presence of nodules (p < 0.001) were notably higher in patients compared to HCs. The prevalence of both overt and subclinical hypothyroidism, along with the frequency of nodular goiter, was found to be elevated in patients with primary glomerulonephritis. Considering that primary glomerulonephritis predominantly afflicts young individuals, and these patients bear the lifelong burden of chronic kidney disease, we underscore the significance of routine thyroid function tests and sonographic examinations for the early detection of thyroid disorders.

Ardiovascular risk factors associated with hypothyroidism in children and adolescents with Down Syndrome

Objective: To evaluate the association between cardiometabolic risk factors and treated hypothyroidism in children and adolescents with Down Syndrome. Methods: Of 51 patients with Down Syndrome, 20 met the eligibility criteria and participated in a cross-sectional study, underwent clinical examination, laboratory tests aimed at evaluating thyroid function, insulin resistance and lipids. Results: Age ranged from 4.0 to 19 years (mean:11.6), 14 were pubertal, 8(40%) had acanthosis nigricans, 7(35%) were overweight/obese and 3(15%) had increased abdominal circumference, Z-BMI was higher in males (p=0.034). Elevations of insulin were observed in 7(35%) patients of the HOMA-IR index in 5(25%), of triglycerides in 12(60%), ferritin in 6(30%), reduction of HDL-cholesterol in 10(50%). Triglycerides and non-HDL-cholesterol were significantly higher in males. Free T4 concentrations were higher in females (p=0.043). The variables Z-BMI and waist circumference showed an inverse correlation with Free T4 and Total T3 and a direct correlation with insulin, ferritin and triglycerides concentrations. Conclusion: The data from the present study indicate the need to optimize the treatment of hypothyroidism, prevention and reduction of cardiometabolic risk factors, especially in males.

Serologic predictors of thyroid immune-related adverse events during immune checkpoint inhibitors therapy: a retrospective cohort study

Rationale: Immune-related adverse events (irAEs) are a specific type of drug toxicity that can occur in cancer patients undergoing immunotherapy with immune checkpoint inhibitors (ICIs). Endocrine irAEs rank the 3rd after the skin and gastrointestinal ones. Clinical course of endocrine irAEs usually results in irreversible damage of the glands function. Prevailing thyroid disorders among endocrine irAEs, their reactivity compared to that of autoimmune thyroiditis, the risk of potential temporary or complete withdrawal of the immunotherapy would make it necessary to search for markers able to identify the most susceptible patient groups. Aim: To evaluate an association between baseline laboratory parameters (hormonal, biochemical, and serological) in patients with malignant solid neoplasms before the first course of anti-tumor immunotherapy with ICIs in monotherapy and the subsequent development of thyroid irAEs. Methods: In this retrospective cohort we analyzed medical files from 102 adult patients (50 (49%) men, median age 60 years) with confirmed solid malignant tumors who were treated in two specialized in-patient departments from January 2020 to February 2022. Their baseline blood samples for subsequent evaluation of thyroid function, carbohydrate and calcium metabolism, as well as to exclude adrenal insufficiency were taken before the initiation of the first course of specific immunotherapy with ICIs. Thereafter, the patients were monitored for any registered irAE for up to 34 months from the beginning of the antitumor immunotherapy with ICIs. Results: Thyroid irAEs were registered in 13/102 (12.7%) patients. Only two markers were significantly associated with the development of thyroid disorders under immunotherapy with ICIs: baseline levels of anti-thyroperoxidase antibodies (TPOAb) ≥ 7.54 IU/mL (reference range (RR) 0–5.6) and anti-thyroglobulin antibodies (TgAb) ≥ 16.45 IU/mL (RR 0–115) (p 0.001). For TPOAb ≥ 7.54 IU/mL and TgAb ≥ 16.45 IU/mL, the areas under the ROC curve (AUC) were 0.828 [95% confidence interval (CI) 0.678–0.979] and 0.875 [95% CI 0.742–1.000], diagnostic sensitivity was 75% [95% CI 48–92] and 92% [95% CI 64–100], diagnostic specificity 92% [95% CI 85–96] and 84% [95% CI 77–86], prognostic values of the positive result 69% [95% CI 44–85] and 58% [95% CI 40–63], and prognostic values of the negative results 94% [95% CI 87–98] and 98% [95% CI 90–100], respectively. Conclusion: Baseline levels of TPOAb and TgAb may serve as markers for the risk of thyroid irAEs in cancer patients with solid malignancies who are planned to receive anti-tumor immunotherapy with ICIs.

Thyroid Function and Morphology in Gaucher Disease: Exploring the Endocrine Implications.

Gaucher disease (GD), the most common ultra-rare metabolic disorder, results from lipid accumulation. Systemic inflammation, cellular stress, and metabolic dysfunction may influence endocrine function, including the thyroid. This study evaluated thyroid function and morphology in 60 GD patients, alongside carbohydrate and lipid metabolism. Anthropometric, biochemical, and hormonal tests were conducted, including thyroid ultrasound and shear-wave elastography (SWE). Clinical data, bone mineral density (BMD), and body composition (BOD POD) analyses were correlated. Healthy controls, matched for age, sex, and body mass index (BMI), were included. GD patients had higher thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels within normal limits. Hypothyroidism occurred in 7%, elevated anti-thyroid antibodies in 8%, and nodular goiter in 23%. Patients with nodular goiter showed lower platelet counts and higher chitotriosidase and glucosylsphingosine (lysoGb-1) levels. Patients with type 3 GD had larger thyroid volumes and greater stiffness on SWE than patients with type 1 GD. GD patients also exhibited increased metabolic risk, including central obesity and elevated glucose levels. GD patients, despite normal thyroid hormone levels, exhibit subtle alterations in thyroid function indicators. Their increased risk of central obesity and glucose metabolism disorders, alongside higher TSH and FT4 levels, underscores the need for closer monitoring and further investigation.

Turner Syndrome and the Thyroid Function-A Systematic and Critical Review.

Turner syndrome (TS) is associated with thyroid disorders. Since the rate of thyroid disease among patients with this syndrome is significantly higher as compared to the general population, it seems vital to explore this particular area. This systematic and critical review was performed to evaluate thyroid function and autoimmunity in patients with Turner syndrome. Four databases were searched: PubMed, Scopus, Google Scholar, and Cochrane Library from the onset of the study to July 2024. Two independent researchers manually searched databases for the following keywords: "Turner syndrome", "anti-TPO", "anti-Tg", "autoimmune thyroid disorders", "TSH", and "hypothyroidism", which were entered into the search engine in isolation, as well as in combinations. Criteria incorporating information on thyroid-stimulating hormone (TSH), triiodothyronine (total-TT3), and thyroxine (free and total-fT4, TT4) concentrations among patients and control groups were also included. Thyroid diseases are common in patients with Turner syndrome. Women with TS present both higher TSH levels and positive thyroid antibodies concentrations. Typical thyroid ultrasound heterogeneity with a hypogenic or mixed echopattern was also observed. As a result, it is essential to monitor thyroid hormone levels in this group, in order to detect hypothyroidism earlier and initiate appropriate replacement therapy. Thyroid diseases in women with TS may remain underdiagnosed for a number of years, due to the lack of screening. Therefore, the authors suggest a thyroid screening regimen for TS patients, which allows for early detection of the disease and implementation of treatment.

To Study the Thyroid Hormone Levels in Neonates of Rural and Urban Vidarbha Region

ABSTRACT Background: This study aimed to evaluate thyroid hormone levels in neonates from the rural and urban Vidarbha region. Over the past decade, neonatal hypothyroidism screening has been conducted using filter paper techniques to identify congenital hypothyroidism (CH). In some screening programs, only T4 is measured initially, with TSH assessed if the T4 levels fall below normal. Conversely, some programs exclusively measure TSH to screen for CH. Currently, initial TSH screening can identify subclinical hypothyroidism in cases where T4 levels are normal, while preliminary T4 testing can reveal congenital hypothyroidism when TSH is elevated. If either T4 or TSH is found to be abnormal during preliminary screening, the other parameter should be monitored. Early diagnosis and prompt treatment are crucial in preventing intellectual disabilities in newborns. Material and Method: The present cross-sectional research will be conducted in collaboration with the Departments of Biochemistry, Obstetrics and Gynecology, Community Medicine, and Pediatrics at Jawaharlal-Nehru Medical College Sawangi (Meghe) Wardha, along with the Datta-Meghe Institute of Medical Science (Deemed University) in Maharashtra, India, and Datta-Meghe Medical College, Shalinitai Meghe Hospital and Research Centre, Nagpur. Results: A total of 272 neonates were tested for Congenital Hypothyroidism (CH) from the study area of the Vidarba region in which 138 neonates were from the rural area and 134 neonates were from the urban area. A total of 144 (53%) males and 128 (47%) females were born in rural and urban areas. In the neonates, it was observed that the Mean ± SD for free T4 and TSH was 0.84 ± 0.15 and 3.83 ± 2.12, respectively. If the free T4 value was less than the lower limit, the TSH value CB ≥25 μIU/ml and plasma ≥10 μIU/ml was considered as screen positive in the present study. Conclusion: Newborn screening programs were established to assess neonates at birth by measuring (TSH) levels. In many screening programs, TSH is the primary marker for evaluating thyroid function and is the preferred test for clinicians diagnosing various thyroid disorders. However, TSH levels can vary significantly and exhibit a broad reference range within the general population, which presents challenges in interpreting the results during newborn screening and in using it later as a clinical diagnostic tool for thyroid function.

Thyroid Functions and Cognitive Decline in the Elderly.

Background The maintenance of cognitive health depends on thyroid hormones, and it is becoming more widely acknowledged that thyroid hormoneissues may be a factor in cognitive decline in the aged. Objective This study aimed to investigate the association between thyroid hormone levels and cognitive decline among elderly individuals, considering the influence of age-related factors and comorbidities. Methodology Over the course of two years, 218 adults 60 years of age and older with clinically diagnosed hypothyroidism or subclinical thyroid disease were included in a prospective observational research. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (T4), and free triiodothyronine (T3) were measured at baseline and at 6, 12, 18, and 24-month intervals to evaluate thyroid function. The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used to assess cognitive function at the same intervals. Factors linked to cognitive deterioration were identified using multivariate regression analysis. Results The study found that TSH levels decreased from 3.20 ± 1.82 µIU/mL at baseline to 2.80 ± 1.51 by 24 months (p < 0.001), while free T4 levels increased from 13.50 ± 2.53 pmol/L to 14.20 ± 2.52 pmol/L (p = 0.020). Cognitive scores declined significantly, with MMSE scores dropping from 23.27 ± 4.64 to 21.80 ± 4.89 (p = 0.005) and MoCA scores from 21.20 ± 5.11 to 20.03 ± 5.51 (p = 0.012). Conclusion The results show a strong correlation between thyroid malfunction and cognitive loss in the elderly, emphasizing the need to closely monitor thyroid function to maintain cognitive function in this population.

Thyroid storm in a patient with unknown hyperthyroidism during nonthyroidal surgery—a case report and literature review

BackgroundThyroid storm (TS) is a critical manifestation of hyperthyroidism. In recent years, the risk of perioperative TS is significantly decreased in patients with hyperthyroidism undergoing thyroid surgeries with adequate preoperative preparations. However, those who undergo non-thyroidal operations have higher risk of TS due to easily ignoring the evaluation of thyroid function. The purpose of this case report is to present a patient with TS during nonthyroidal surgery and review similar cases in the literature.Case presentationA middle-aged female who received unilateral total knee arthroplasty under general anesthesia developed refractory tachycardia during the operation and was diagnosed with hyperthyroidism via laboratory tests after surgery. She was suggestive of TS based on the Burch and Wartofsky scoring system and relieved after etiological treatments. She was discharged 10 days after surgery and continued to take antithyroid medication.ConclusionWe recommend that a comprehensive history collection is warranted. The clinical manifestations of TS during operation could be versatile and atypical. Any abnormalities during an operation like abnormal heart rate, blood pressure, body temperature, or even the unusual anesthetics needed, should not be ignored. In surgeries with general anesthesia, it is necessary to be cautious about TS with an atypical manifestation of tachycardia. Once suspected, supportive and resuscitative treatment along with antithyroid medication should be promptly initiated.

Longitudinal assessment of thyroid function in dogs with hypoadrenocorticism: Clinical outcomes and prevalence of autoantibodies.

Knowledge about primary hypoadrenocorticism coexisting with immune-mediated thyroiditis (Schmidt's syndrome) in dogs is limited. To evaluate thyroid function in dogs with naturally occurring hypoadrenocorticism before and during treatment. Sixty-six client-owned dogs. Measurement of canine thyroid stimulating hormone (cTSH), total thyroxine (T4), free thyroxine, and autoantibodies against thyroglobulin, T4, and total triiodothyronine. Thirty-eight dogs were assessed before and 28 during treatment. Follow-up data were available for 24/38 and 17/28 dogs, with median follow-up duration of 3.8 years (range, <1.0-8.8 years) and 4 years (range, 1.1 weeks to 10.5 years), respectively. Canine thyroid stimulating hormone was above the reference range at the time of diagnosis of hypoadrenocorticism in 10 of 38 dogs but decreased into the reference range in 7 for which follow-up data was available. Hypothyroidism was confirmed in 5 dogs at a median age of 11 years (range, 7-15 years). In 4 dogs, the condition was diagnosed after a median treatment duration of 5.75 years (range, 2.6-10 years), while in 1 dog, the diagnosis was made concurrently. One dog had detectable thyroid autoantibodies. Hypothyroidism occurs as a rare concurrent condition in dogs with hypoadrenocorticism, potentially at any phase of treatment. Close monitoring of cTSH levels in these dogs could be beneficial, as early changes might indicate the onset of hypothyroidism. The low prevalence of detectable thyroid autoantibodies suggests that nonimmune mechanisms might contribute to thyroid dysfunction.

Evaluation of the thyroid and hypothyroid function after postoperative radiation therapy among breast cancer patients.

The current advances in radiotherapy (RT) have improved the outcome of breast cancer (BC) patients. Despite its therapeutic benefits, the iatrogenic toxicities of RT and its impact on BC survivors are still debated, and further evaluations should be considered. This study aims to assess the rate of subclinical hypothyroidism and hypoparathyroidism among BC patients who were exposed to therapeutic radiation. Seventy females undergoing RT for BC were enrolled in this cross-sectional study. Laboratory assessment of thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels was obtained to evaluate thyroid function. The parathyroid function was evaluated by measuring serum levels of Calcium (Ca), Phosphorus (P), and parathyroid hormone (PTH) at baseline, six and 12 months after RT. The mean age of patients was 54.3±6.4 years. We found no cases of hypothyroidism before radiotherapy. However, nine patients developed hypothyroidism in the six months after radiotherapy (one clinical and eight subclinical, 13% in total), and six patients were identified with hypothyroidism in the 12 months after radiotherapy (one clinical and five subclinical, 8.7% in total). Significant relationships were observed in the hypothyroidism rate at both six months (p = 0.003) and 12 months (p = 0.028) after RT compared with the baseline. There was no case of hypoparathyroidism before and after RT. In summary, we found that thyroid and parathyroid dysfunction after RT are relatively common findings among women with BC. It is a treatable source of morbidity in patients undergoing RT. Therefore, routine thyroid function monitoring should be recommended to improve the quality of life in BC survivors.

Evaluation of Thyroid Function and Its Relation to Glycemic Status in Pregnant Women With Gestational Diabetes Mellitus.

Background Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy that can lead to adverse outcomes for both the mother and the fetus. It also increases the likelihood of developing type 2 diabetes mellitus (T2DM) later in life. Thyroid hormones play an essential role in regulating growth and metabolism and often coexist with diabetes mellitus (DM), affecting glucose metabolism. Pregnant women with GDM frequently exhibit thyroid issues, impacting insulin secretion and beta-cell function. Aim This study aims to assess thyroid function and glycemic status in pregnant women with and without GDM and to evaluate the correlation between thyroid function and glycemic status in pregnant women with GDM. Methods This prospective case-control study was conducted over two months at a tertiary care hospital in Puducherry, India. It included 60 cases (pregnant women with GDM, blood glucose > 140 mg/dL per DIPSI guidelines) and 60 age- and parity-matched controls. Blood samples were collected, centrifuged, and analyzed for blood glucose and serum thyroid levels (FT3, FT4, thyroid-stimulating hormone (TSH)) using the Cobas e-411 autoanalyzer through an electrochemiluminescence assay. Results Serum plasma glucose levels were significantly higher in cases (159.25 ± 16.22 mg/dL) compared to controls (101.6 ± 17.30 mg/dL) (p < 0.05). FT3 levels were higher in cases (3.98 ± 4.18) compared to controls (2.87 ± 0.54) (p = 0.04). The FT3/FT4 ratio was also higher in cases (3.99 ± 4.927) than in controls (2.70 ± 0.58) (p = 0.04). No significant differences were found in FT4 or TSH levels between the groups. Correlation analysis revealed no significant correlations between plasma glucose levels and thyroid function parameters. Conclusion Pregnant women with GDM showed significantly higher plasma glucose levels, FT3 levels, and FT3/FT4 ratio compared to normal pregnant women. These findings suggest an association between altered thyroid function, particularly higher FT3 levels and the FT3/FT4 ratio, and GDM.

Sustainable dairy farming and fipronil risk in circular feeds: insights from an Italian case study

Circular feeds, such as grain dry distillers, citrus pulp, cane molasses, and potatoes peels, are co-products of biomass processes. They are currently proposed in animal nutrition to improve the environmental and economic sustainability of the food production chain. In this paper, we report a case study involving fipronil, a pesticide currently not authorized for agriculture within the EU, but used in the Americas, Eastern Europe, and Asia. Fipronil was found at a mean level of 0.49 mg/kg, in a grain dry distiller batch administered to dairy cows. This finding, along with other evidence of potential fipronil presence in feed materials, prompted us to evaluate the risk to food safety and food security from 12 different conventional and sustainable feeding regimens. To this purpose, we considered a fipronil feed-to-milk carry-over rate of 0.52, the tolerance levels in fodders and food from The EU, Codex Alimentarius, and US-EPA, and the Acceptable Daily Intake (ADI) of 0.0002 mg/kg body weight for adverse effects on thyroid function in dairy cows. Under a conservative scenario, fipronil-contaminated potato peels and grain distillers in the feeding regimens may play a pivotal role in exceeding the EU Maximum Residue Level (MRL) in bovine milk and fat (0.005 and 0.030 mg/kg, respectively). Hay-based diets with soybean hulls and cane molasses show negligible risks (Hazard Index ∼ 1). In all cases, the ADI exceedance suggests the need to evaluate thyroid function in dairy cows exposed to fipronil as a food security factor.

New onset of Graves' disease after controlled ovarian stimulation: A case report and brief literature review.

De novo onset of Graves' disease (GD) after controlled ovarian stimulation (OS) is exceptional. Only one case of progression to GD after OS in a patient with pre-existing subclinical hyperthyroidism has been reported. We describe the case of a patient with neither previous thyroid disorders nor autoimmunity who developed GD after OS for primary infertility. A 40-year-old woman with primary infertility underwent four cycles of OS. Her thyroid function performed before the last cycle was unremarkable (thyroid stimulating hormone [TSH] 1.9 mU/L, fT4 1.3 ng/dL, fT3 2.4 pg/mL), and thyroid autoimmunity was negative (anti-thyroperoxidase antibodies and anti-thyroglobuline antibodies). Six weeks after the last cycle she developed overt thyrotoxicosis (TSH < 0.005 mU/L, fT4 4.79 ng/dL, fT3 15.6 pg/mL) with anti-thyrotropin receptor antibodies (TRAb) positivity (9.2 IU/L). She was diagnosed with GD and anti-thyroid therapy was instituted. After 1 year of treatment, thyroid function was still suboptimal (TSH 0.2 mU/L, fT4 1.04 ng/dL, fT3 2.2 pg/mL), and TRAb titer still elevated (8.75 IU/L). Despite her desire to achieve pregnancy, a further cycle of OS was postponed until complete remission of thyroid dysfunction and withdrawal of anti-thyroid therapy. Although TSH assay after OS is not recommended in euthyroid women without autoimmunity, in the presence of hyperthyroid symptoms throughout OS it is advisable to evaluate thyroid function and TRAb. It is advisable to carefully evaluate the course of GD before proceeding with further courses of OS that could lead to its exacerbation or recurrence. In cases where a strong desire for pregnancy persists, thyroidectomy may be proposed.

12217 Exploring Thyroid-stimulating Hormone As A Potential Cardiovascular Disease Risk Marker In Euthyroid Individuals

Abstract Disclosure: A.P. Neto: None. H. Lucchesi: None. C.C. Silva Janovsky: None. I. Bensenor: None. L.S. Ward: None. L.L. Cunha: None. Previous studies have suggested that TSH levels may predict longevity primarily in elderly individuals. Aging is associated with a high prevalence of cardiovascular and metabolic diseases that reduce survival. However, the relationship between serum TSH levels and these conditions, especially traditional cardiovascular risk markers, remains poorly explored. We employed data from the longitudinal multicenter cohort study ELSA-Brasil, which includes workers from five Brazilian Universities, to evaluate thyroid function in 8,452 participants aged between 34 and 75 years, classified as euthyroid and followed for 8.9 ± 0.6 years. The participants were evaluated for the presence of diabetes, hypertension, angina, peripheral arterial disease, and cardiovascular mortality. Additionally, we measured cardiovascular markers, including global cardiovascular risk score, HbA1c, microalbuminuria (mg/dl), LDL levels, and triglyceride levels. Statistical analysis was used to compare TSH levels with clinically relevant outcomes and classical cardiovascular risk markers. We observed that higher TSH levels correlated negatively with global cardiovascular risk (Spearman rank -0.023, p-value=0.038), microalbuminuria (Spearman rank -0.055, p&amp;lt;0.000), and HbA1c (Spearman rank -0.041, p&amp;lt;0.000). However, TSH levels were positively correlated with hypertriglyceridemia (Spearman rank +0.125, p&amp;lt;0.000) but had no relationship with LDL (p &amp;gt;0.05). The appraisal of cardio-metabolic diseases showed that individuals without diabetes had higher TSH levels (1.79 mIU/L, IQR 1.07) than individuals with diabetes (1.71 mIU/L, IQR 1.07). Patients with arteriosclerosis diseases, such as coronary and peripheral arterial disease, had lower TSH levels (1.66, IQR 0.98 and 1.67, IQR 0.94, respectively) than those who did not have these comorbidities (1.79, IQR 1.07, and 1.79, IQR 1.07). Furthermore, TSH levels did not correlate with the incidence of hypertension (p &amp;gt;0.05). Finally, we divided the population into two groups: higher and lower TSH levels based on the median TSH levels (1.78 mIU/L, IQR 1.06). The Kaplan-Meier curve did not show a difference between these groups (p=0.758) in survival after cardiovascular events (08 events in total) during follow-up. In conclusion, our results suggest that higher serum TSH levels in euthyroid individuals are associated with a lower prevalence of metabolic and cardiovascular disease. However, the relatively short observation duration and low frequency of cardiovascular events in our cohort made it difficult to statistically analyze several endpoints, such as survival. Further investigation is necessary to completely understand whether TSH is a cardiovascular risk indicator. Presentation: 6/2/2024

7593 Early re-evaluation using levothyroxine dose requirements in infancy in patients with congenital hypothyroidism

Abstract Disclosure: M. Yoo: None. E. Joo: None. S. Kim: None. J. Lee: None. Background: Congenital hypothyroidism (CH) is the most common endocrine disorder in the neonatal period. CH can lead to permanent mental retardation if left untreated. The prevalence of CH has recently increased due to neonatal screening programs for CH. Congenital Hypothyroidism: The 2020-2021 Consensus Guidelines Update, recently published in the Endo-European Reference Network (Endo-ERN), suggested that a reevaluation of early treatment withdrawal after 6 months could be performed in patients with CH. In Korea, there has been no study on early reevaluation after 6 months, so we conducted this study. Methods: As a retrospective study, patients diagnosed with CH from January 2013 to December 2022 at the Department of Pediatrics, Inha University evaluated thyroid function tests (TFT) at the time of diagnosis and LT4 dose and body weight during treatment. Results: A total of 105 patients were diagnosed with CH, 64 were classified as transient CH (TCH) and 41 as permanent CH (PCH). Patients younger than 2 years who did not complete the reevaluation were excluded. At diagnosis, thyroid stimulating hormone (TSH) levels were higher in the PCH group than in the TCH group (47.8 ± 58.0 mIU/L vs 69.2 ± 94.1 mIU/L, respectively). At 6 months, 1 and 2 years, the mean dose of levothyroxine (μg/kg/day) was significantly lower in the TCH group than in the PCH group. (3.34 ± 0.94 vs 3.63 ± 1.03 μg/kg/day, p&amp;lt;0.05, 2.56 ± 0.95 vs 3.16 ± 1.14 μg/kg/day, p&amp;lt;0.01 and 2.07 ± 0.57 vs 3.01 ± 1.14 μg/kg/day, p&amp;lt;0.01). Based on the Receiver Operating Characteristic (ROC) curve, the optimal cutoff doses of LT4 for prediction of TCH at 6 month was 3.24 µg/kg/day (area under the curve=0.643; 95% CI, 0.529-0.757; sensitivity, 58.6%; specificity, 70.3%) Conclusion: Early re-evaluation after 6 month for withdrawal of LT4 treatment is possible in patients with CH if the patient has gland in situ, no family history, and low LT4 dose requirements. Presentation: 6/1/2024

Evaluation of thyroid function in advanced Chronic Renal Disease

Evaluation of thyroid function in advanced Chronic Renal Disease

Effect of IGF-1 on Thyroid Nodules and its Relation to Insulin Resistance

Abstract Background The insulin/IGF-1 signaling pathway modulates the regulation of thyroid gene expression and it is an important factor in the proliferation and differentiation of thyroid cells. Numerous growth factors are identified in thyroid tissue: like epidermal growth factor (EGF), transforming growth factor- alpha (TGF-alpha), IGF receptor (IGF-R), insulin-like growth factor-1 (IGF-1), IGF1-receptor (IGF-R) and IGF binding proteins (IGFBPs) Overexpression of these growth factors and/or their receptors may play a role in the growth of the thyroid nodules. in addition to TSH, insulin is also a thyroid growth factor that stimulates the growth of thyroid cells. Aim of Work The aim of this study is to investigate the possible association between IGF-1 and thyroid nodules by determining the effect of serum IGF-1 on thyroid nodules and its u/s findings and to investigate IGF-1 relation with insulin resistance (IR) and whether IR also plays a role in the thyroid nodular formation and its ultrasonography(u/s) findings. Patients and Methods A total of 80 medically free euthyroid patients with thyroid nodules detected by clinical examination (palpation) and radiologically by neck u/s screening were selected from out patient endocrine clinic at Ain Shams University hospitals. for all participants the following was done: Glycemic profile (fasting plasma glucose (mg/dl), 2hours post prandial plasma glucose (mg/dl) and HBA1C(%)), Lipid profile (total cholesterol (mg/dl), LDL (mg/dl), HDL (mg/dl), triglycerides (mg/dl)),The thyroid function evaluation (free tetra iodothyronine (FT4)(ng/dl), (free tri iodothyronine (FT3)(pg./ml) and serum thyroid stimulating hormone (TSH)(uIU/ml), IGF-1 determined by enzyme linked immunosorbent assay (ELISA), Fasting serum insulin determined by (ELISA), HOMA-IR was determined for all patients as a quantitative method for insulin resistance. Neck u/s was done for all patients with TIRADS score of the nodule. Results The study conducted on 80 medically free euthyroid patients with thyroid nodules and revealed that IGF-1 was high in patients with thyroid nodules. but there was no statistical association with nodular number, size or volume, p value (0.184,0.75,0.25), respectively. there was a statistically significant association between IGF-1 and TIRADS score of the nodule, p value = (0.039). There was an association between HOMA-IR, volume and size of the nodules, p value (0.023,0.013), respectively. but no statistical significance with number of the nodules, p value (0.279). by logistic regression analysis HOMA-IR can’t be used as a predictor of nodular size and volume p value (0.384). there was a statistical significance between presence of metabolic syndrome and number of nodules, p value (0.048). also, there was no association between serum IGF-1 and HOMA-IR, p value (0.077). Conclusion IGF complex is involved in thyroid development and seems to play an important role in thyroid nodules formation. There is an association between IGF-1 and thyroid nodules but it may exert its effect through autocrine and paracrine pathways; therefore, the use of circulating IGF-1 levels in predicting and diagnosing thyroid nodules is not advisable. There is an association between metabolic syndrome and number of thyroid nodules, also a significant relationship was found between nodule formation and insulin resistance. Presence of Insulin resistance leads to higher nodular volume and size in non-diabetic euthyroid patients but HOMA-IR can’t be used as a predictor of nodular size or volume. However, these data must be confirmed by further studies in the future.

Hyperthyroidism in thyroid carcinoma originating in struma ovarii.

Thyroid carcinoma originating in Struma Ovarii (SO) is a rare thyroid ectopic cancer that accounts for 0.01% of all ovarian malignancies and is associated with hyperthyroidism in less than 15% of cases. In a 44-year-old patient with pelvic pain, the CT scan revealed a solid-cystic formation in the ovarium. A left oophorectomy was performed and showed a borderline serous tumor and papillary thyroid carcinoma ('thyroid carcinoma originating in Struma Ovarii') measuring 10 cm. Thyroid function was assessed, and hyperthyroidism was diagnosed. Surgical complementation and a pelvic re-approach were performed. The histological findings showed a papillary thyroid carcinoma in the uterine serosa and the right adnexa. Thyroid function was re-evaluated, and despite normal thyroid function, the TRAb test remained positive. The patient underwent total thyroidectomy and radioiodine therapy (RIT), after which the TRAb test became negative. During 3 years of follow-up, no evidence of tumor was observed. In our case of thyroid carcinoma originating in SO, hyperthyroidism was treated with ovarian surgery, total thyroidectomy, and RIT. It is worth noting that thyroid function was normalized after ovarian surgery, but the TRAb test only became negative after total thyroidectomy. We hope to draw attention to the importance of evaluating thyroid function in patients with SO and treating high-risk SO patients with RIT after total thyroidectomy to achieve disease remission. Struma ovarii can cause hyperthyroidism. Thyroid carcinoma can originate in Struma Ovarii. Differentiated thyroid carcinoma and hyperthyroidism originating in Struma Ovarii are rare conditions.

Thyroid function evaluation in pediatric nephrotic syndrome: a study in a developing country

BackgroundIn steroid-resistant nephrotic syndrome (SRNS), protracted proteinuria leads to the loss of thyroxine-binding proteins resulting in low thyroid hormones and in damage renal tubules and exhausts the thyroid reserve. This study aimed to assess thyroid function in those patients with SRNS and steroid-sensitive nephrotic syndrome (SSNS). A comparative cross-sectional study evaluated the thyroid status of 50 children with an equal age- and sex-matched SSNS, and controls were enrolled in this study. Demographic data, clinical examination, renal profile, and thyroid function tests were conducted for them.ResultsSubclinical non-autoimmune hypothyroidism was significantly prevalent in 54% of SRNS patients and 12% of SSNS patients (p < 0.001). No cases of overt hypothyroidism were detected. Albumin and protein/creatinine ratio emerged as significant independent factors influencing subclinical hypothyroidism with odds ratio (OR) 0.624, 95% CI (0.425–0.916), and 1.315 OR (1.315) and 95% CI (1.035–1.672), respectively.ConclusionSubclinical non-autoimmune hypothyroidism among patients with SRNS might occur, especially with protracted proteinuria necessitating regular screening of thyroid function in this cohort.

Alteration of Thyroid Function Tests and Evaluation of Serum Zinc, IgG and IgM Levels in non-hospitalized Iraqi Patients with Corona Virus

Background:SARS-CoV-2 is a novel corona virus that would be responsible for COVID-19 infection and has provoked a worldwide epidemic. Objective: To investigate alteration of thyroid function tests and evaluation of serum zinc, IgG and IgM levels in Iraqi patients with corona virus.Methods:A total of 166 sera, 83 from non-hospitalized asymptomatic patientsdiagnosed with COVID-19 (aged 17–78 years) and 83(aged 18–70 years) from negative healthy individuals, were evaluated for thyroid hormones T 3 ,T 4 and TSH, trace element of zinc, IgM and IgG antibodies.Results: recent study described non-hospitalized COVID-19 patients who developed argumentative results related to thyroid function test, signs of hypozincemia,disturbances in IgG, and IgM levels were started in some of them as compared with healthy group. Conclusion:current study discovered that non-hospitalized patients diagnosed with COVID-19 can develop a non-critical state of thyroid function.