Family History Of Thyroid Disorders Research Articles

Frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital.

Objective: To determine the frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Outpatients Obstetrics & Gynaecology, Ward 8, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: July 30, 2021 to January 29, 2022. Methods: All patients who met the inclusion criteria and visited JPMC, Karachi were enrolled in the study. After providing a thorough explanation of the procedure, risks, and benefits of the study, informed consent was obtained. The study involved conducting detailed history and examination, as well as recommending relevant laboratory investigations such as thyroid and ultrasound pelvic/TVS profiles. Results: 150 women of thyroid disorders in patients with menstrual irregularities were included with mean age was 33.72±7.62 years, mean height was 1.69±0.07 meter, mean weight was 76.60±12.70 kg, mean BMI was 26.78±4.13 kg/m2, mean parity was 2.84±2.05 and mean duration of menstrual irregularity was 0.82±0.07 days. Positive family history of thyroid disorder was found to be in 15 (10.0%). Positive history of thyroid surgery was noted in 26 (17.3%) patients. Thyroid disorder was noted in 57 (38.0%) cases. In distribution for type of thyroid disorder, subclinical hypothyroidism was noted in 37 (64.9%), 9 (15.8%) overt hypothyroidism, 11 (19.3%) subclinical hyperthyroidism while overt hyperthyroidism was noted in 0 (0.0%). In distribution of menstrual complain, amenorrhea was noted in 3 (5.3%), 3 (5.3%) oligomenorrhea, 7 (12.3%) metrorrhagia, 32 (56.1%) menorrhagia while polymenorrhea were noted in 12 (21.1%) cases. Conclusion: It is to be concluded that thyroid disorder is frequently observed in patients experiencing menstrual irregularities, as indicated by the study. However, further research is required to validate these finding.

Hashimoto's Thyroiditis among Patients with Thyroid Diseases in Sulaimani City: A Cross-Sectional Study

This study aimed to measure the prevalence of Hashimoto's Thyroiditis among patients with thyroid diseases in Sulaimani city and to observe some features of this autoimmune disorder. Hashimoto's Thyroiditis, also known as Hashimoto's disease, is an essential cause of Hypothyroidism. Blood samples ‎were collected from 203 patients suffering from thyroid disease in Sulaimani endocrine center and Bakshin Private Hospital in Sulaimani city from December 2018 to March 2019. Serum levels of thyroid hormones, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and anti-‎thyroid-stimulating hormone ‎receptor antibodies were determined using Cobas e411 Immuno‎analyzer; moreover, data about ‎gender, age, and family history of thyroid disease were recorded. The prevalence of Hashimoto's Thyroiditis among all thyroid patients was 62% (n=126/203), while Graves' disease was 15.3% (n=31/203); thus, autoimmune diseases represent 77.3% (157/203) of thyroid diseases. Hypothyroidism is diagnosed in 155/203 (76.4%) thyroid diseases, while the remaining 23.6% were patients with hyperthyroidism. The demographic data revealed that 88.9% (n=112/126) of Hashimoto's Thyroiditis are females, while 11.1 % (n=14/126) are males. The peak incidence of Hashimoto's Thyroiditis is in the age group 36-45 years; a family history of thyroid diseases was recorded in 64.3% of Hashimoto's patients. The correlation coefficient between anti-thyroid peroxidase antibodies and the ages of Hashimoto's Thyroiditis patients is 0.21938. Hashimoto's Thyroiditis is the main thyroid disorder in Sulaimani city among patients with thyroid diseases, Hypothyroidism, and autoimmune thyroid disorders; both seropositive and seronegative anti-thyroid peroxidase antibodies are recorded among Hashimoto's Thyroiditis patients. Family history of thyroid disorders and females of childbearing age are possible risk factors for developing Hashimoto's Thyroiditis. There is no significant correlation between anti-thyroid peroxidase antibodies concentrations and ages of Hashimoto's Thyroiditis patients, but these antibodies are much higher in Hashimoto's females than in Hashimoto's Thyroiditis males

THU540 Cribriform Morular Thyroid Carcinoma In A Young Female With Prior Exposure To Whole-Body Radiation For Metastatic Wilms’ Tumor

Abstract Disclosure: D. Caesario: None. M.S. Richardson: None. D. Carneiro-Pla: None. J.K. Fernandes: None. Introduction: Cribriform morular thyroid carcinoma (CMTC) is a rare thyroid cancer that is classically associated with familial adenomatous polyposis (FAP), but can also occur sporadically. We report a case of CMTC in a young female with history of whole-body radiation therapy (WBRT). Case Report: A 19-year-old female with past medical history of Wilms’ tumor (WT) with lung metastasis status post left nephrectomy and WBRT at the age of 6 was seen for newly diagnosed thyroid nodules. Physical exam was remarkable for thyromegaly. Thyroid function tests were normal. Thyroid ultrasound revealed 2 dominant TI-RADS 4 nodules measuring 1.9 x 1.7 x 2.1 cm on the left lobe and 0.9 x 0.8 x 0.8 cm on the right lobe. No suspicious lymphadenopathy. Fine needle aspiration biopsy on both nodules showed findings consistent with papillary thyroid carcinoma (PTC). No family history of thyroid disorders, malignancies, or FAP. She underwent total thyroidectomy with central neck node sampling. Thyroid gland surgical pathology result revealed CMTC positive for thyroid transcription factor-1 (TTF-1), β-catenin, and cytokeratins 5 and 6. It was negative for calcitonin. There was no evidence of invasion, extension, or lymph node metastasis. Genetic tests are currently pending. Discussion: CMTC was previously considered a variant of PTC, accounting for 0.2 to 6% of PTC cases. However, recent observations have challenged this view, and latest WHO update reclassified it as a distinct form of thyroid cancer. It is associated with an indolent clinical course and good prognosis. It almost exclusively affects young women. Both familial and sporadic cases are associated with mutations in the adenomatous polyposis coli (APC) gene. The APC protein is a negative regulator that controls β-catenin concentrations, which is involved in cell adhesion. Mutations in the APC gene may result in FAP and colorectal cancers. In cases associated with FAP, the tumors are usually multifocal and/or bilateral, while sporadic cases usually appear as single nodule. Tumor cells are always positive for TTF-1 and negative for calcitonin. They can also be positive for multiple cytokeratins, but strong nuclear and cytoplasmic staining for β-catenin is the hallmark of this tumor type. The case above occurred in a young female with no significant family history, but who underwent WBRT for WT as a child. Radiation is a known predisposing factor for thyroid cancer, and limited studies on early exposure to radiation revealed higher incidence of sporadic CMTC. However, even among FAP associated cases, CMTC diagnosis preceded that of FAP in up to 40% of the cases. Additionally, up to 20% of WT cases have mutations of the WT1 gene, and among these, at least half also carry acquired somatic mutations in CTNNB1, the gene encoding β-catenin. So far, there has been no reported case of CMTC in the background of WT. It will be interesting to see if she has these underlying mutations. Presentation: Thursday, June 15, 2023

FRI480 Uncovering The Mystery Of Macro TSH

Abstract Disclosure: F. Anwar: None. Z.I. Saeed: None. Introduction: An isolated elevation in TSH level, while uncommon, may result in incorrect diagnosis and improper treatment. We present a case of suspected hypothyroidism that was later found to be caused by macroTSH in the blood. Clinical Case: A 21-year-old asymptomatic female was diagnosed with hypothyroidism and started on levothyroxine at age 16 when routine lab work revealed TSH of 34.2 MCU (0.550-4.780 MCU) and free T4 of 1.1 ng/dl (0.89-1.76 ng/dl). She denied any personal or family history of thyroid disorders in the past. Patient later reported symptoms including palpitations and weight loss leading to discontinuation of levothyroxine. Repeat lab work showed TSH of 0.112 MCU and free T4 of 1.71 ng/dl. After discontinuing levothyroxine, TSH levels were found in range of 89.26 MCU to 106 MCU (0.550-4.780 MCU). Free T4 levels remained normal, even when tested using dialysis method. Total T3 level also remained normal at 87 ng/dl (80-200 ng/dl). TPO antibodies were slightly elevated at 9.3 IU/mL (0.0-9.0 IU/ml), TSI and TSH receptor antibodies were negative. Patient's high TSH level, lack of symptoms, and normal free T4 levels prompted the use of different assays to test TSH. We contacted Mayo Clinic Lab for further testing. One assay (Roche Elecsys) showed TSH level of 90.8 mIU/L, but this result was not significantly changed when sample was incubated with a commercial heterophile antibody blocking reagent. Another assay (Beckman Coulter Access TSH) produced a significantly different but still elevated result of 43.1 mIU/L. For research purposes, the sample was further tested for macroTSH using polyethylene glycol (PEG) precipitation, which resulted in TSH level of 5.8 mIU/L which was reduced from 90.8 mIU/L (94% reduction). These results were higher than the mean +/- 2 standard deviations of the control group (range 0% to 65% reduction in TSH with PEG in controls). This suggested presence of macroTSH, although the assay's performance characteristics and reference ranges had not been established at the time of testing for this patient. Patient's TSH levels remain high and she was advised not to begin the medication unless circulating thyroid hormone levels are abnormal. Conclusion: Macro TSH is a combination of monomeric TSH and anti-TSH antibodies, similar to macro-prolactin. It is considered inactive and has an estimated prevalence of 0.6-1.6%. In a review of over 150 patients, more than 50% of documented thyroid interferences, including macro TSH, led to incorrect diagnosis and improper treatment. This case demonstrates the significance of identifying macro TSH to avoid misdiagnosis and inappropriate management of euthyroid patients with isolated TSH elevation. Presentation: Friday, June 16, 2023

FRI292 Asymptomatic TSH Secreting Pituitary Macroadenoma

Abstract Disclosure: B. Gautam: None. M.S. Hossain: None. H. liao: None. K. Mandal: None. D.S. Rosenthal: None. S.C. Kumar: None. Introduction: TSH-producing adenoma is a rare disorder accounting for 0.5-2% of all pituitary adenomas with prevalence of 1-2 cases/million, often diagnosed at the stage of invasive macroadenoma hence challenging to manage. Case Presentation: A 36 years old male with no PMH referred to endocrine clinic for the evaluation of insomnia with abnormal thyroid panel for last 4 years. He denied skin or hair changes, diaphoresis, tremor, change in appetite, weight or bowel habits, cold/heat intolerance, palpitations, recent use of biotin or x-ray contrast exposure. Patient denied headache, visual or hearing impairment, galactorrhea, sexual dysfunction, change in facial appearance or size of gloves & shoes. Patient also denied childhood history of developmental delay, learning disability and family history of thyroid disorder. Unremarkable physical exam with normal vitals. Thyroid was normal without palpable nodule. No thyroid bruit. Normal visual field by confrontation. No tremors, gynecomastia or galactorrhea noted. Laboratory results showed normal CBC, CMP, TSH 5.2 (0.55-4.78 uIU/ml) with FT4 2.1 (0.8-1.8 ng/dl), FT3 5.4 (2.3-4.2 pg/ml), FT4 by dialysis 3.1 (0.9-2.2 ng/dl), FT3 by dialysis 433 pg/dl, Thyroglobulin ab <1 (<1 IU/ml), TPO ab 3 (<9 IU/ml), TSI <89 (<140%), TBII <1 (<2 IU/L), HAMA <6 (<74 ng/ml). Normal ACTH 17 (6-50 pg/ml), serum cortisol level 10.5 (5.2-22.4 ug/dl), prolactin 9.2 (2-18 ng/dl), GH 0.1 (<7.1 ng/ml), IGF-1 183 (53-331 ng/ml), LH 4.7 (1.5-9.3 mIU/ml), FSH 5.9 (1.6-8 mIU/ml), free testosterone 120 (35-155 pg/ml) and total testosterone 1100 (250-1100 ng/dl), SHBG 82 (10-50 nmol/L), alpha-subunit 0.8 (0.1-0.5 ng/ml) & alpha/TSH molar ratio 1.5. MRI brain with pituitary protocol showed an expansile round enhancing soft tissue mass filling the sellar cavity measuring 1.5 x 1.5 x 1.3 cm tenting the optic chiasm without cavernous sinus involvement. Patient was diagnosed with TSH secreting pituitary adenoma and referred to Neurosurgery. Patient had successful trans-sphenoidal adenectomy. Post-surgery TFTs: TSH 2.18 (0.55-4.78 uIU/ml), FT4 1.2 (0.8-1.8 ng/dl). Pathology report showed pituitary adenoma, IM stains positive for FSH, GH patchy and TSH (patchy and weak), negative for prolactin and ACTH. Rare tumor cells positive for LH Discussion: Our case highlights the importance of early diagnosis and appropriate treatment of TSH secreting adenoma to prevent complications such as hyperthyroidism, visual field defect and pan-hypopituitarism. Diagnosis in our case was particularly challenging as the patient was completely asymptomatic, therefore emphasize the importance of correlating TSH level with FT4 and early evaluation of central cause in the presence of biochemical evidence suggesting central thyroid disorder. Presentation: Friday, June 16, 2023

SAT533 The Case of an Ectopic Thyroid Twin

Abstract Disclosure: A. Abu Limon: None. S.A. Aldasouqi: Consulting Fee; Self; Abbott Laboratories. P. Kachhadia: None. S. Khan: None. Introduction: Ectopic thyroid tissue is a rare but known developmental abnormality during the descent of the thyroid tissue from the floor of the foregut to its final location Infront of the trachea. The most frequent ectopic locations are the base of the tongue and anywhere along the course of the thyroglossal duct. It is very rare to have an ectopic thyroid tissue located in the mediastinum. It’s even more rare when the patient still has an almost normal thyroid gland in its usual location in the neck, and both are sizable and functional. Case Presentation: We are reporting the case of a 38-Year-old African American Female, who was involved in a car accident with non-critical injuries to her neck and chest area. She underwent a contrasted CT scan of her neck and chest that showed an anterior mediastinal mass towards the right at the level of the great vessels and arch, right paratracheal location overall measuring 6.0 x 4.6 x 4.5 cm. She was seen by Cardiothoracic surgery group and underwent Mediastinoscopy that confirmed a large firm to hard mass just inferior to the innominate artery was firmly adherent to the trachea as well as surrounding structures. Multiple biopsies showed thyroid tissue with focal mild chronic inflammation, benign. No atypia or malignancy is noted. Then, she was referred to our clinic for further evaluation. When interviewed, the patient denies any compressive symptoms (Shortness of breath, palpitations, chest pain or dysphagia). The patient has no personal or family history of thyroid disorders, including no thyroid cancer history. She has no Goiter on exam and no Pemberton sign is elicited. Laboratory work up was unremarkable including normal thyroid functions. Neck Ultrasound confirmed presence of a thyroid gland in its expected location, with Right Lobe Measurement: 5.04 x 1.70 x 1.47 cm Vol: 6.02 ml and Left Lobe Measurement: 3.94 x 1.25 x 1.21 cm Vol: 2.87 ml. We were keen to explore this matter further and ordered a thyroid uptake scan with 0.97 uCi iodine-123, that showed a 24-hour normal uptake of 27.4% at the thyroid bed and a separate substernal and RT paratracheal location uptake. Discussion: This patient has supplementary ectopic thyroid tissue in her mediastinum along with a normal thyroid gland in her neck. From the literature review and search, This is a very rare occurrence. The discussion with the patient is about the specific concern of the malignant potential of this ectopic thyroid and if surgical intervention is needed. The probability of cancer on ectopic thyroid tissue is less than 1% and when it occurs papillary carcinoma is the most common histology. Our patient has benign biopsy results and no signs nor symptoms related to this ectopic thyroid gland. The final decision is to not undergo surgery, but rather, a follow up with CT scan in 6 months. Presentation Date: Saturday, June 17, 2023

Abstract #1403045: Thyroiditis Post COVID-19 mRNA Booster Dose Vaccination

SARS-CoV-2 vaccines have been associated with thyroid dysfunction including thyroiditis and Graves' disease. We report a patient who developed thyrotoxicosis secondary to thyroiditis after COVID-19 mRNA booster dose vaccination. A 74-year-old man with no known personal or family history of thyroid disorders went to his primary care physician with symptoms of palpitations. Of note, he had the first booster (third dose) of the Pfizer/BioNTech vaccine about 1 week before. He did not recall any similar symptoms after the first two doses of the same vaccine. There were no other symptoms of thyrotoxicosis such as hand tremors, weight loss or mood change. There was no family history of thyroid disorders. He was not on any medications such as amiodarone and was not taking any herbal supplements. He did not have any symptoms of upper respiratory tract infection. There was no neck pain. Physical examination was unremarkable with no goiter or thyroid eye manifestations. Thyroid function: free T4 elevated at 46.7 pmol/L (11.5-22.7) and TSH suppressed at 0.01 mIU/L (0.5-4.5). Thyroid stimulating immunoglobulin was positive at 200% (50-179). He was initially started on carbimazole 15mg daily. However, the patient became rapidly hypothyroid despite dose reduction and subsequent discontinuation of carbimazole with free T4 of 8 pmol/L and TSH of 36.4 mIU/L. An ultrasound of the thyroid gland showed vascularity with no discrete nodules. No thyroid uptake scan was done. The diagnosis was revised to thyroiditis post vaccination. Hypothyroidism persisted despite discontinuation of carbimazole before recovery 8 months later. Patient was well and did not require any thyroxine supplementation. It is postulated that COVID-19 vaccines triggered thyroiditis via an autoimmune inflammatory syndrome caused by the vaccine adjuvants. A high index of suspicion is necessary and a thyroid uptake scan may be useful in making the diagnosis. Thyroiditis is a self-limiting condition and recognising it is important as no specific thyroid treatment is necessary in most patients. Patients should not be deterred from subsequent vaccination as COVID-19 infection has higher mortality risk than thyroiditis.

Abstract #1373163: A Rare Case of Ectopic Parathyroid Adenoma in the Left Axillary Region

A parathyroid adenoma is a benign neoplasm that arises from parathyroid parenchymal cells. Parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHPT). Ectopic parathyroid adenomas arise within the parathyroid glands located at the four poles of the thyroid [2]. Ectopic parathyroid adenomas result from aberrant migration of the gland during the early stages of development and can be identified in up to 16% of cases of PHPT [3]. They are commonly found in the mediastinum, within the thyroid, and along the path of the vagus or recurrent laryngeal nerves [4]. 45% of ectopic parathyroid adenomas are found in the paraesophageal region, 25% in the cervical thymus, 20% in the cervical mediastinum, 5% in the anterior portion of the mediastinum, and 5% at the level of the thymus [5]. A 64-year-old man with a past medical history of over 20-year history of recurrent nephrolithiasis, type II diabetes mellitus, dyslipidemia, hypertension, and pancreatic cancer presented to our outpatient endocrine clinic for evaluation of hyperparathyroidism. Further investigation of his history revealed that he had struggled with several bouts of urinary calculi throughout his life. These episodes required multiple surgical interventions to treat, including left nephrectomy and ureteral stenting. He had been evaluated for high serum calcium in the past and was diagnosed with PHPT by his urologist, who referred him to our clinic. Also complicating his health was a recent diagnosis of prostate cancer for which, he was undergoing radiation treatment. He had a family history of thyroid disorder in his mother but no family history of parathyroid disorders. Physical examination was unremarkable. Laboratory investigations revealed high serum calcium and high serum parathyroid hormone. Parathyroid scintigraphy with 99mTc-sestamibi revealed a subtle persistent focal region of increased uptake in the left axilla with no other areas of increased uptake, raising the suspicion for parathyroid adenoma in the left axilla. As discussed earlier, ectopic parathyroid adenomas result from aberrant migration of parathyroid tissue during embryological development. Additionally, ectopic parathyroid adenomas are a cause of failed surgery for hyperparathyroidism as well as persistent and recurrent hyperparathyroidism [3, 7-9]. Ectopic parathyroid tissue has a prevalence of 2-43% in anatomic series and has been detected in up to 16% of patients undergoing evaluation for hyperparathyroidism [3, 7, 10]. Ectopic parathyroid adenomas arising within the axilla may present with hypercalcemia and associated skeletal and renal involvement [11, 12]. The case that has been reported had a presentation of PHPT with recurrent nephrolithiasis. As mentioned earlier, 45% of ectopic parathyroid lesions are found in the paraesophageal region with 38% arising within the thymus [7, 10]. However, in this case, the patient presented with a possible ectopic parathyroid adenoma localized to the left axilla and no other areas of increased uptake on tc99m-sestamibi parathyroid scintigraphy.

Increasing Prevalence of Congenital Hypothyroidism in children with Down Syndrome who have a family history of Thyroid disease

Introduction: The family history of thyroid disease (FHTD), which is either hyper or hypothyroidism, and its effect and the association with other diseases such as autoimmune disease or genetic diseases such as Down syndrome are not well understood, especially in countries in the middle east such as Iraq, which makes studies of this type get some interest recently and the correlation should be understood. Objective: To find out if there is an association between down syndrome and a family history of thyroid disorder. Methods: 451 New born babies have been enrolled in the studies. However, 4 of them has been excluded due to inadequate information; the result is about 396 collected in two hospital public (free serves) and privet hospital here in Iraq. The thyroid test and its family history information were collected in 67 new borns with down syndrome with a family history of thyroid dysfunction and the second group of 329 new borns with down syndrome without a family history of thyroid dysfunction, using the SPSS program to study the correlation confidence interval, and other logical analysis were performed in studies. Results: about sixteen neonates suffered from thyroid percent of about 4.1%, 9-Newborn's with down syndrome in this study had congenital hypothyroidism (4.1%). However, our research shows a correlation between a patient suffering from thyroid dysfunction with Down syndrome (Adjusted odds ratios= 8.3, 95% CI 2.0-34.3), moreover, the result slightly changes in males (Adjusted odds ratios= 9.0, 95% CI: 1.6-49.6). However, all the neonates with down syndrome had a low incidence of thyroid dysfunction if they have no family history of thyroid dysfunction (Adjusted odds ratios= 0.4, 95% CI: 0.1-0.8). In conclusion, we confirm the association between congenital hypothyroidism and FHTD in babies with DS. Babies with DS with FHTD have an eight-time higher risk of congenital hypothyroidism, particularly those of the male sex.

Thyroid hormone status during pregnancy in Bangladesh

ABSTRACT Background: Pregnancy is a physiological condition where early detection of any pathological change of thyroid hormone is very important to prevent complications. Population-specific thyroid hormone reference intervals are a key to this. Since Bangladesh is yet to develop such reference intervals, the aim of this study was to establish trimester-specific reference intervals addressing the physiological changes of thyroid hormone during pregnancy for Bangladeshi women. Materials and Methods: One thousand nine hundred and thirty-seven women with singleton pregnancy consuming iodinated salt were selected for this cross-sectional study. Participants having a history of thyroid disorder (TD), any illness influencing thyroid function, presence of goiter, recent history of consumption of thyroid status-altering medications, family history of TDs, and presence of thyroid antibodies were excluded from the study. 1038 pregnant women with thyroid-stimulating hormone (TSH) level within normal (nonpregnant) laboratory reference value (0.35–5.5 μIU/mL) were considered eligible for the study. Results: The mean age of the eligible cases was 28.06 ± 4.633 years ranging from 18 years to 42 years. The mean gestational ages of the study population while checking thyroid function were 8.83 ± 2.344 weeks, 19.99 ± 4.824 weeks, and 31.77 ± 2.123 weeks during 1st, 2nd, and 3rd trimesters, respectively. TSH level raised significantly from 1st trimester to 2nd trimester (1.85 ± 1.00 vs. 2.03 ± 1.02; P = 0.018) but the decline in 3rd trimester comparing to 2nd trimester (2.03 ± 1.02 vs. 1.90 ± 0.90; P = 0.071) was not statistically significant. The 2.5th–97.5th percentiles of TSH level of the study population were 0.440–4.050 μIU/mL, 0.531–4.570 μIU/mL, and 0.622–3.917 μIU/mL in 1st, 2nd, and 3rd trimesters, respectively. Conclusion: Reliance on nonpregnant reference intervals or any generalized gestational reference interval can hinder the desired progression of pregnancy influencing diagnosis and management for TDs in case of certain populations. Establishment of individual reference intervals for thyroid hormone in pregnancy bears great clinical importance for every population.

ODP462 Amiodarone Induced Thyrotoxicosis-Treatment Challenges

Abstract Amiodarone induced thyrotoxicosis (AIT) presents a diagnostic and treatment challenge. Importantly, uncontrolled thyrotoxicosis can be associated with significant morbidity and mortality. The following presentation depicts a case of AIT with persistent thyrotoxicosis despite optimal and prolonged medical therapy. The case was complicated by patient's high-risk cardiovascular profile postponing definitive therapy with thyroidectomy. Patient was a 58-year-old female with past medical history of coronary artery disease, severe systolic heart failure, atrial fibrillation, and ventricular tachycardia maintained on amiodarone therapy since 2019, who was noted to have abnormal thyroid function labs in 2021 with TSH of 0. 04 uIU/mL (0.45-5.3), free T3 of 4.6 pg/mL (2.2-4.1) and free T4 of 2.7 ng/dL (0.58-1.64) indicative of hyperthyroidism. Her evaluation included negative family history of thyroid disorder, negative thyroid antibody profile, as well as a thyroid ultrasound that demonstrated no thyroid enlargement, no nodules and normal vascularity. At the time of initial evaluation, patient was suffering from episodes of atrial fibrillation with rapid ventricular response. Patient was diagnosed with AIT (presumably type 1). Amiodarone was discontinued and patient was initiated on methimazole 10 mg twice daily. Unfortunately, three weeks after initiation of methimazole treatment, patient's clinical status deteriorated and she was hospitalized for multifactorial shock requiring multidisciplinary approach and vasopressor/ionotropic support. At that time her free T4 had risen to >5.6 ng/dL and free T3 peaked at 6.17 pg/mL. The most probable diagnosis was AIT type 2 and her medical therapy was augmented to methimazole 20 mg three times daily and prednisone 50 mg daily. After clinical stabilization, she was discharged home on this regimen. Unfortunately, her thyroid function tests remained persistently elevated for almost three months despite maximum medical therapy. At that point, patient was referred for thyroidectomy despite severe cardiomyopathy and high-risk surgical profile. Fortunately, her thyroid function tests began to improve prior to planned surgery and medical therapy was successfully de-escalated, precluding the need for surgical intervention. While most cases of AIT can be successfully treated with medical therapy, refractory cases can present a clinical challenge, especially in patients at high risk for thyroidectomy. Weighing the risks and benefits of each treatment plan requires a multi-disciplinary approach and close communication with all parties involved. Presentation: No date and time listed

Association between thyroid autoimmunity and antidepressant treatment-emergent mania in pediatric mood disorders

Risk factors associated with antidepressant treatment-emergent mania(ATEM) are poorly characterized in child and adolescent populations. To identify better biomarkers, we aimed to explore whether thyroid autoimmunity is associated with ATEM in pediatric mood disorders. We enrolled two groups of pediatric mood disorders, those with ATEM+ (n = 29) and those with ATEM- controls (n = 31). All diagnoses were made according to structured interviews by the clinicians. Autoimmune thyroiditis (anti-thyroid peroxidase antibodies [TPO-abs] and thyroid function (thyroid-stimulating hormone [TSH] and free thyroxin [FT4]) were assessed. Logistic regression was used to explore the relationship between TPO-abs seroprevalence and ATEM+ while controlling for covariates. Group comparisons showed that the patient with ATEM+ had significantly higher seroprevalence and titer of TPO-abs compared to ATEM- controls. In logistic regression analysis adjusting for age, gender, Tanner stage, body mass index, antipsychotic treatments, smoking status and family history of thyroid disorder, the seroprevalence of TPO-abs (>60 U/mL) was significantly associated with ATEM+ (OR = 3.67, 95% confidence interval [CI] = 1.2-11.1, p = 0.022). Our findings demonstrated that seroprevalence and titer of TPO-abs in pediatric mood disorders are associated with ATEM+ status. TPO-abs could potentially serve as a biomarker when assessing the risk of ATEM in the child and adolescent population.

Clinical, Laboratory, and Ultrasound Related Diagnoses of Thyroid Disorders: Using a Family Medicine Center Data to Assess Thyroiditis and Thyroid Nodules in the Eastern Province of Saudi Arabia.

Introduction/Objectives:The prevalence of thyroid disorders is high in Saudi Arabia. Among the disorders, goiter and thyroiditis are the most common and have unique ultrasound (US) features, underscoring the need for US screening for thyroid pathologies. This study aimed to determine the prevalence of thyroiditis and thyroid nodules in patients attending the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University.Methods:This registry-based cross-sectional study analyzed laboratory and US data from 240 patients who attended the Family and Community Medicine Center of Imam Abdulrahman Bin Faisal University from January 2020 to December 2021. Abnormalities of the thyroid gland were categorized according to laboratory and US data. Associations between different types of thyroid pathology and clinical and laboratory findings were assessed using appropriate statistical methods.Results:The majority of participants were Saudi women. The prevalence of thyroiditis in the study population was 43%. Approximately 25% of these patients had more than 1 nodule, and fine-needle aspiration biopsy showed that most nodules were benign. Most nodules were found in clinically euthyroid patients. Thyroiditis might be associated with abnormal thyroid function.Conclusions:Thyroiditis and thyroid nodules were common in our cohort. Vitamin D deficiency, other autoimmune diseases, and a family history of thyroid disorders were associated with thyroiditis and thyroid nodules. US is useful for identifying the type of thyroid disease.

COVID INDUCED THYROIDITIS: A CASE REPORT

INTRODUCTION: Thyroiditis is one of the manifestations of novel Covid-19 virus. Thyroid function test (TFTs) shows typical features of hyperthyroidism. Inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and serum ferritin] and thyroid scan give clue to the diagnosis. Up till now very few cases of subacute thyroiditis (SAT) due to Covid-19 have been reported CASE DESCRIPTION: We present a case of 39-year-old female with no personal or family history of thyroid disorder presented with features suggestive of thyrotoxicosis along with pain in the neck, odynophagia and intermittent fever after recovering from covid-19 recently i.e. 2 weeks before the onset of symptoms. TFTs revealed high triiodothyronine-T3 (1.8 ηg/ml) and thyroxine-T4 (2.66 ηg/dl) and low TSH (<0.04 uIU/ml). Thyroid scan revealed decrease uptake, ESR was 115 mm/hour, CRP was 48 mg/L and serum ferritin was 740ηg/ml. She was started on non-steroidal anti-inflammatory drugs, steroids and beta blocker. Four weeks later she reverted back with the resolution of symptoms and normal TFTs. CONCLUSION: Early recognition and timely management of SAT with anti-inflammatory therapy can help in successful management of the disease.

English

BACKGROUND It has been noted of the interdependence and impact of diabetes mellitus and thyroid dysfunction on each other. Prevalence of thyroid dysfunction was found to be higher in individuals with diabetes mellitus. Most commonly associated thyroid dysfunction in diabetes was hypothyroidism. Hyperthyroidism can precipitate complications in diabetes mellitus. The purpose of this study was to assess the prevalence of thyroid dysfunction and dyslipidaemia in type 2 diabetes mellitus patients. METHODS This cross-sectional study included a total number of 100 type-2 diabetic patients aged >15 years. All the patients were evaluated for thyroid dysfunction and dyslipidaemia by estimating triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) and lipid profile [total cholesterol (TC), triglycerides (TGA-c), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C)].The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, family history of thyroid disorder, body mass index (BMI), usage of oral hypoglycaemic agents (OHA’s) and insulin and dyslipidaemia was carried out. The observations and interpretations were recorded and results obtained were statistically analysed. This study was conducted from December 2018 to November 2019 at Government Medical College, Kottayam, Kerala. RESULTS The study revealed a high prevalence (26 %) of thyroid disorders in patients with type 2 diabetes mellitus (T2DM), most common being hypothyroidism (20 %) which was further found to be more in females, patients with uncontrolled diabetes i.e. HbA1C values ≥ 8.7 or patients on OHA and patients with BMI > 25. High prevalence of dyslipidaemia in diabetics (62 %) was observed; of which 51 % had hypertriglyceridaemia, 49 % had decreased HDL-C, 47 % had hyper cholesterolaemia and 43 % had increased LDL-C. Only 30.6 % diabetics with dyslipidaemia had thyroid dysfunction. CONCLUSIONS Screening of thyroid dysfunction should be done in all diabetic patients especially in patients with poor glycaemic control as micro vascular complications were commonly observed in this group of patients with dual endocrine disorders. There is a high prevalence of dyslipidaemia in diabetics. KEYWORDS Diabetes Mellitus, Thyroid Dysfunction, Dyslipidemia

Cognitive and White Matter Microstructure Development in Congenital Hypothyroidism and Familial Thyroid Disorders.

Children with congenital hypothyroidism (CH) are at risk for suboptimal neurodevelopment. To evaluate neurocognitive function and white matter microstructure in children with permanent or transient CH and to correlate these findings with disease severity. A retrospective and prospective observational study was conducted in 39 children with permanent or transient CH, and in 39 healthy children. Cognitive function was assessed by Wechsler Intelligence Scale, Fourth Edition, and by other tests; the white matter microstructure was investigated by 3 Tesla magnetic resonance imaging. Children with permanent CH have lower cognitive scores at a median age of 9.5 years than those with transient CH and controls. An IQ score between 71 and 84 was found in 28.6% of permanent CH and of <70 (P = 0.06) in 10.7%. The Processing Speed Index (PSI; P = 0.004), sustained visual attention (P = 0.02), reading speed (P = 0.0001), written calculations (P = 0.002), and numerical knowledge (P = 0.0001) were significantly lower than controls. Children born to mothers with Hashimoto's thyroiditis have significantly lower IQ values (P = 0.02), Working Memory Index (P = 0.03), and PSI (P = 0.02). Significantly lower IQ and Verbal Comprehension Index values were found in children with a family history of thyroid disorders (P = 0.004 and P = 0.009, respectively). In children with permanent CH, significant correlations between abnormalities in white matter microstructural, clinical, and cognitive measures were documented. These findings indicate that children with CH are at risk of neurocognitive impairment and white matter abnormalities despite timely and adequate treatment. The association between offspring cognitive vulnerability and maternal thyroid disorders requires careful consideration.

A Study of Clinical Profile of Thyroid Disorders in Children in A Tertiary Care Hospital, Kurnool

Background: Thyroid hormone abnormalities are the commonest endocrine disorder in India and also the commonest preventable cause of mental retardation, so we want to determine the prevalence of thyroid dysfunction in children at kurnool district. Materials and Methods: A hospital based prospective observational study performed in new born and children below 18 years fulfilling the inclusion criteria visiting the pediatric OPD and IPD in Viswabharathi medical college, Kurnool if they had clinical suspicion of thyroid dysfunction. If suspicion of hypothyroidism, Free T4, Total T4, TSH levels and if suspicion of hyperthyroidism Free T3 and TSH were done. Results: Out of 70 case 3 cases (4.3%) are hyperthyroidism and 67 cases (95.7%) are hypothyroidism in these 3 (4.3%) cases had family history of thyroid disorders, male to female ratio was 1.3:6 and prevalence rate was high in the age group of 10 - 12 years 32.9% (23 cases). 13 (18.6%) cases had thyroid enlargement and 48 (68.57%) cases had anaemia. Treatment was started according to standard guidelines. Conclusion: The higher prevalence rate of thyroid disorders in childhood that to in female children and age group of 10 - 12 years in and around kurnool. Hence, screening of all new-borns and children should be mandatory as early diagnosis and treatment helps in prevention of complications of thyroid disorders. KEY WORDS: Free T3, Free T4, Goiter, Hyperthyroidism, Hypothyroidism, and Thyroid stimulating hormone.

The Iodine Status and Prevalence of Thyroid Disorders Among Women of Childbearing Age in China: National Cross-sectional Study

ObjectiveMandatory universal salt iodization in China was implemented 20 years ago. However, the current iodine status and prevalence of thyroid disorders among childbearing-age women are unknown. MethodsA nationally representative cross-sectional study with 26 166 enrolled participants aged 18 to 49 years from all 31 provincial regions of mainland China was performed. The participants were given a questionnaire and underwent B-mode ultrasonography of the thyroid. The serum concentrations of thyroid hormones and thyroid antibodies and the urinary iodine concentration (UIC) were measured. ResultsThe median UIC was 178.7 μg/L, indicative of adequate iodine status. pHowever, 19.04% and 19.87% of the participants were classified as having iodine deficiency and excessive iodine, respectively. The weighted prevalence of thyroid disorders was as follows: 1.08% had overt hyperthyroidism, 0.58% had subclinical hyperthyroidism, 0.76% had Graves disease, 1.28% had overt hypothyroidism, 14.28% had subclinical hypothyroidism, 13.53% were positive for thyroid peroxidase antibodies, and 14.55% were positive for thyroglobulin antibodies. Excessive iodine and overweight were associated with higher odds of subclinical hypothyroidism. A family history of thyroid disorders and an age between 40 and 49 years were significantly associated with higher odds of positivity for thyroid peroxidase antibodies and thyroglobulin antibodies. ConclusionIodine deficiency, excessive iodine, subclinical hypothyroidism, and positivity for thyroid autoantibodies remain prevalent among women of childbearing age in China. Women of childbearing age who are relatively older, are overweight, or have a family history of thyroid disorders are encouraged to undergo active screening of their UIC and thyroid function when planning a pregnancy.

Serum thyroglobulin level in newly detected thyrotoxicosis and its role in differential diagnosis of thyrotoxicosis

Background: Elevated serum thyroglobulin (Tg) level is commonly observed in various forms of thyrotoxicosis; the levels vary according to different etiologies. This study aimed at identifying the value of serum Tg level in the differential diagnosis of common etiologies of thyrotoxicosis. Methods: This cross-sectional study was conducted at the endocrine outpatient department of a tertiary hospital in Bangladesh from March 2015 to May 2017. In this study, 200 subjects with newly detected untreated thyrotoxicosis were evaluated. Serum Tg was assayed by chemiluminescent immunometric assay. Results: Serum Tg level was raised in 48% of subjects. Subjects aged ≥40 years, and those having a family history of thyroid disorders had relatively higher thyroglobulin levels. The frequency of subjects with an elevated Tg was highest in subacute thyroiditis (89.5%) followed by toxic nodular goiter (77.3%) and Graves’ disease (32.9%); the difference in the frequencies was statistically significant (p&lt;0.001). Median Tg was highest in the subjects with subacute thyroiditis (132.6 ng/ml) followed by toxic nodular goiter (99.55 ng/ml); those with Graves’ disease had the lowest Tg level (12.5 ng/ml); the differences in median Tg levels across the three groups were also statistically significant (p&lt;0.001). Conclusions: Serum thyroglobulin level may be useful for the etiological diagnosis of thyrotoxicosis.

High Prevalences of Subclinical Hypothyroidism and Positive Thyroid Autoantibodies Recorded Among Women of Childbearing Age in China: National Cross-Sectional Study

Background: Iodine deficiency and thyroid disorders are associated with several obstetric and neonatal adverse outcomes. Mandatory universal salt iodization in China was implemented 20 years ago; however, the current iodine status and prevalence of thyroid disorders among women of childbearing age are unknown. Methods: A nationally representative cross-sectional study with 26166 enrolled participants aged 18 to 49 years from all 31 provincial regions of mainland China was performed. The participants were given a questionnaire and underwent B-mode ultrasonography of the thyroid. The serum concentrations of thyroid hormones and thyroid antibodies and the urine iodine concentration (UIC) were measured. Findings: The median UIC was 178.7 μg/L, which is indicative of adequate iodine status; however, 19.04% and 19.87% of the participants were classified as having iodine deficiency and excessive iodine, respectively. The weighted prevalences of thyroid disorders were as follows: 1.08% had overt hyperthyroidism, 0.58% had subclinical hyperthyroidism, 0.76% had Graves’ disease, 1.28% had overt hypothyroidism, 14.28% had subclinical hypothyroidism, 13.53% were positive for TPOAb, and 14.55% were positive for TgAb. Excessive iodine and overweight were associated with higher odds of subclinical hypothyroidism. A family history of thyroid disorders and an age between 40 and 49 years were significantly associated with higher odds of positivity for TPOAb and positive TgAb. At the provincial level, the prevalences of iodine deficiency, excessive iodine, subnormal TSH levels, and supranormal TSH levels varied widely. Gansu was identified as a region with high prevalences of both excessive iodine and supranormal TSH levels. Interpretation: Iodine deficiency, excessive iodine, subclinical hypothyroidism, and positivity for thyroid autoantibodies are still prevalent among women of childbearing age in China. Women of childbearing age who are relatively older, have excessive iodine, are overweight, or have a family history of thyroid disorders are encouraged to undergo active screening of their UIC and thyroid function when planning a pregnancy. Strategies for addressing iodine status and thyroid disorders require geographic targeting of this subpopulation. Funding Statement: National Health Commission of the People’s Republic of China and National Natural Science Foundation of China. Declaration of Interests: The authors declare no conflict of interests. Ethics Approval Statement: The research protocols were approved by the Medical Ethics Committee of China Medical University.