Binding activities of bisphenol analogues toward TTR and TBG and their potential to disrupt thyroid hormone homeostasis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic autoimmune inflammatory disorders in which TNF-α plays a key role. Anti-TNF agents are widely used in the management of these diseases. Since TNF-α is also involved in the pathogenesis of autoimmune thyroid disease (AITD), this study aimed to assess whether anti-TNF therapy influences thyroid function. This prospective study included 50 RA and 51 AS patients aged 18-85 years. Patients received either conventional treatment (DMARDs and NSAIDs/sulfasalazine) or anti-TNF agents. Serum TSH, free T4, and anti-TPO levels were measured at baseline and after 6 months. Thyroid dysfunction and AITD prevalence were compared between the two treatment groups. In the RA group, subclinical hyperthyroidism was observed in both arms; in the anti-TNF group, one patient had hypothyroidism, and another had subclinical hypothyroidism. Improvement in subclinical hyperthyroidism was observed in one patient in the DMARD arm, in one patient with hypothyroidism, and in one patient with subclinical hyperthyroidism in the anti-TNF arm (p>0.05). In the AS group, central hyperthyroidism developed in one patient receiving conventional treatment. In the anti-TNF group, one patient with subclinical hypothyroidism improved to normal values, while another developed central hypothyroidism. Anti-TPO positivity was 18% in the conventional group and 3.4% in the anti-TNF group (p>0.05). A significant TSH change was observed only in the RA-DMARD group (p < 0.05), while no significant changes in free T4 were detected in any group. Anti-TNF therapy showed no significant effect on thyroid function or autoimmune thyroid disease in patients with RA and AS during a six-month follow-up.

Hypothyroidism in dogs is a common endocrine disorder resulting from deficient thyroid hormone production, leading to a reduced metabolic rate. A four- year-old, neutered female Shih Tzu was presented with a history of progressive weight gain, lethargy, bilateral symmetrical alopecia, and cold intolerance over the preceding three months. Physical examination revealed a dull coat, seborrhoeic dermatitis, bradycardia and mild obesity. Routine haematology and serum biochemistry were within normal limits except for mild hypercholesterolaemia. Thyroid function testing demonstrated low total thyroxine (T4) and free T4 levels with elevated thyroid-stimulating hormone (TSH), confirming primary hypothyroidism. The dog was treated with oral levothyroxine sodium at 20 µg/kg twice daily, resulting in significant clinical improvement within six weeks.

Thyroid dysfunction is a frequently overlooked yet clinically significant comorbidity in human immunodeficiency virus (HIV)-infected individuals. The introduction of antiretroviral therapy (ART) has improved life expectancy but has also been associated with metabolic and endocrine disturbances, including thyroid abnormalities. Thyroid dysfunctions such as subclinical hypothyroidism, sick euthyroid syndrome, and overt hypothyroidism are increasingly recognized in both treatment-naïve and ART-experienced patients. However, limited data are available on thyroid function at the time of HIV diagnosis and its evolution following ART initiation, especially in the Indian population. This prospective observational study was conducted at Moti Lal Nehru Medical College, Prayagraj, including 100 newly diagnosed HIV patients aged ≥18 years. Baseline free T3, free T4, TSH, and CD4 were measured prior and 3 months after the start of ART. Statistical analysis was performed using SPSS version 27.0, with paired t-tests, analysis of variance (ANOVA), and Pearson correlation test to assess the changes and associations between thyroid parameters and ART, CD4 count, and demographic variables. The study focused on measuring serum free T3, free T4, and TSH levels at baseline and after ART initiation and analyzing their relationship with immunological status as indicated by CD4 count. The study population consisted of 100 individuals with a mean age of 37.29 ± 13.01 years, predominantly male (70%). At baseline, 62% of patients were euthyroid, while the remaining 38% showed thyroid dysfunction, primarily subclinical hypothyroidism and subclinical hyperthyroidism. Following 3 months of ART, the prevalence of thyroid dysfunction increased: euthyroid patients decreased to 41%, and cases of subclinical hypothyroidism, clinical hypothyroidism, and subclinical hyperthyroidism rose noticeably. This shift in thyroid status distribution was statistically significant (Chi-squared test, p = 0.028), suggesting a potential impact of ART on thyroid physiology. In terms of hormone levels, the study observed a statistically significant increase in mean TSH values (from 4.23 ± 4.13 µIU/mL to 7.50 ± 7.85 µIU/mL, p < 0.001) and a significant decrease in free T3 levels (from 2.92 ± 0.88 pg/mL to 2.45 ± 1.00 pg/mL, p = 0.005) post-ART. Free T4 levels did not show a significant change (p = 0.337). These results align with existing literature suggesting that ART may unmask or exacerbate subclinical thyroid dysfunction, possibly through immune reconstitution or direct effects on thyroid metabolism. Correlation analysis demonstrated a significant negative association between CD4 count and TSH levels both before and after ART (ρ = -0.28 and -0.34, respectively), and a positive correlation between CD4 and both free T3 and free T4. This study establishes that ART is associated with significant changes in thyroid hormone profiles, particularly an increase in TSH and a decline in free T3 levels, reflecting emerging thyroid dysfunction. The results underscore the importance of regular thyroid function monitoring in HIV patients, particularly after initiating ART, to facilitate early detection and management of evolving endocrine disturbances.

Evidence-based extension of reagent shelf-life beyond expiry using patient-based moving averages, westgard sigma rules, and CLSI EP25.

Association between free thyroxine and free triiodothyronine levels with inflammation markers in acute minor and severe ischemic stroke patients.

Background/Objectives: Euthyroid sick syndrome (ESS), and particularly low T3, have been associated with increased mortality in septic patients, yet the prognostic value of free thyroxine (fT4) remains controversial. This study aims to evaluate the association between fT4 on ICU admission and mortality in septic patients. Methods: We conducted a single-center, retrospective observational study including 149 adult patients with sepsis or septic shock admitted to the Anesthesia and Intensive Care I Department of the Cluj County Emergency Hospital, Cluj-Napoca, Romania, between January 2019 and September 2025. Free T4 and thyroid-stimulating hormone (TSH) levels were measured within 24 h of ICU admission. The primary outcome was 28-day mortality, and the secondary outcome was in-hospital mortality. Demographic data, comorbidities, severity scores (SOFA, APACHE II), laboratory parameters, and outcomes were analyzed. Univariate and multivariate logistic regression analyses were performed, and predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Results: A total of 149 patients were included. Twenty-eight-day mortality was 29.73%, and 53.57% in patients with sepsis and septic shock, respectively. Serum fT4 was significantly lower in non-survivors, for both primary and secondary outcome (p = 0.01 and p = 0.014, respectively), whereas TSH levels were similar between groups. In the univariate analysis, fT4 showed moderate predictive ability for mortality (AUROC 0.615 and 0.632). Multivariate models, including age, hemoglobin, SOFA score, and fT4, showed a greater discriminative performance (AUROC 0.805 and 0.799). Conclusions: Lower fT4 levels on ICU admission seem to be independently associated with increased mortality in septic patients. Incorporating fT4 into multiparametric prognostic models might improve early risk stratification in sepsis, particularly in settings where other thyroid parameters are not routinely available.

Background: Acne in adult women is increasingly recognized as a condition with systemic endocrine-metabolic correlates. Evidence linking acne to thyroid-related abnormalities and cardiometabolic risk markers remains mixed, and integrated real-world evaluations combining thyroid biochemistry, ultrasound metrics, inflammatory indices, and lipid profile are limited. Methods: We performed a cross-sectional observational analysis of 80 women with acne who underwent routine laboratory testing and thyroid ultrasound assessment. Thyroid status was defined using TSH (reference 0.4-4.5 mIU/L) and free T4 (0.8-1.8 ng/dL), with an additional TSH-only sensitivity definition (high TSH >4.5 mIU/L). Low HDL-cholesterol (HDL-C) was defined as <50 mg/dL. Group comparisons used Mann-Whitney U tests with Hodges-Lehmann shifts; associations were summarized using odds ratios (ORs) with Fisher's exact tests; correlations used Spearman's ρ (TSH log-transformed for correlation analyses) with confidence intervals. Multiple testing was controlled within panels using Benjamini-Hochberg FDR. Analyses were complete-case per comparison. Results: Thyroid dysfunction and metabolic-inflammatory abnormalities were common in this cohort. Low HDL-C was more frequent in thyroid dysfunction, and in the TSH-only sensitivity analysis, high TSH (>4.5 mIU/L) was strongly associated with low HDL-C (OR 13.13, 95% CI 1.48-116.04; p = 0.020). In a minimal adjusted model including NLR, high TSH remained associated with low HDL-C (adjusted OR 12.93, 95% CI 1.44-115.70; p = 0.022). HDL-C showed an inverse association with NLR (ρ = -0.28; p = 0.023). Endocrine profiling suggested a positive association between ACTH and log(TSH) (ρ = 0.62; p = 0.004), although this did not remain significant after FDR correction. Thyroid ultrasound metrics showed limited correspondence with thyroid biochemistry. Conclusions: In women with acne, elevated TSH is associated with substantially higher odds of low HDL-C, independent of inflammatory burden as proxied by NLR, while thyroid ultrasound morphology contributes limited functional information. These findings support integrated thyroid-metabolic assessment in adult female acne and motivate prospective studies incorporating acne severity measures and standardized testing to clarify clinical implications.

Introduction . Hyperthyroidism occurs in 35–50 cases per 100,000 women per year in women aged 20–29 years. Hyperthyroid mothers have pregnancy outcomes according to metabolic control. This case discusses a patient with Graves' disease without specific complaints of hyperthyroidism or thyrotoxicosis. Case report . A 31-year-old pregnant woman, with a history of two prior pregnancies and two deliveries with a current gestational age of 38 weeks was admitted to a tertiary care center for labor with a history of a previous visited the emergency room due to severe diarrhea, dehydration and hyperthyroidism. The patient had regular check-ups at the Endocrine Clinic and received propylthiouracil and propranolol until 7 months of pregnancy. Re-examination showed normal thyroxine (T4) and thyroid-stimulating hormone (TSH) so the treatment was concluded. The patient underwent a vaginal delivery without complications and was discharged. Discussion . The patient is a multiparous mother with no history of thyroid disorders. Initial complaints occurred at 2 months of pregnancy with vomiting, dehydration, tachycardia, and weight loss. Initial diagnosis of dehydration explained the tachycardia, but laboratory examinations showed low TSH and increased free T4 (fT4) in accordance with hyperthyroidism without typical physical symptoms. Thyroid disorder screening to prevent this is in accordance with similar programs conducted in Indonesia such as Congenital Hypothyroidism Screening. However, expert groups such as the American Thyroid Association and the Endocrine Society have not recommended universal thyroid screening without risk factors. Conclusion . Optimal outcomes are achieved with early diagnosis and adequate treatment. Tachycardia presenting during early pregnancy should be investigated for additional cause other than dehydration. Currently, universal screening of thyroid function in early pregnancy is not recommended without risk factors, but clinical suspicion is an indication for additional examination

Acromegaly is a chronic disease that can cause somatic disfigurement and hormonal changes. The aim of this study was to examine depression and anxiety levels, body image and sexual dysfunctions in patients with acromegaly and to compare them with those of controls. 52 patients with acromegaly who were being followed up at the Endocrinology Outpatient Clinic and 51 non-acromegalic individuals were included. The participants were evaluated cross-sectionally once and evaluated with the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Body Image Scale (BIS) and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). The GRISS total, infrequency, dissatisfaction, impotence and premature ejaculation subdimension scores of the acromegaly patients were found to be significantly higher than those of the controls. Sexual dysfunctions were associated with older age, female sex, unemployment, menopausal status, and the presence of concomitant diabetes mellitus. No meaningful differences were detected in depression or anxiety scores between patients and controls. Body image was significantly more impaired in patients with acromegaly and was associated with higher depression and anxiety scores. There was no difference between scale scores according to disease activity. Although inverse correlations were observed between GRISS total scores and IGF-1 and free T4 levels in univariate analyses, IGF-1 was not independently associated with sexual dysfunction after adjustment for relevant clinical covariates. In conclusion, considering that patients with acromegaly are a risky group in terms of mental disorders and sexual dysfunctions, we recommend that patients should be routinely questioned in terms of psychopathology and sexual functions during their follow-up.

Background: Thyroid hormone insufficiency is the hallmark of hypothyroidism, a common endocrine condition that profoundly affects cellular metabolism. According to recent research, hypothyroidism and increased cardiovascular risk are strongly correlated and may be mediated by hyperhomocysteinemia. The metabolism of homocysteine (Hcy) is closely associated with B vitamins, particularly folate and vitamin B12. Objective: This study's main goals were to assess serum homocysteine and vitamin B12 levels in patients with primary hypothyroidism in comparison to healthy controls and to examine the relationship between these metabolic markers and thyroid function parameters (TSH, fT3, and fT4) in an Eastern Indian population. Methods: Over the course of six months, the Department of General Medicine and Biochemistry at Patna Medical College and Hospital (PMCH), Patna, carried out this observational cross-sectional study. 115 patients with primary hypothyroidism and 115 healthy controls who were matched for age and sex made up the study population. Chemiluminescence immunoassay (CLIA) was used to evaluate the levels of serum free T3 (fT3), free T4 (T4), thyroid stimulating hormone (TSH), vitamin B12, and homocysteine. Using SPSS version 26.0, statistical analysis was carried out, utilizing Pearson's correlation coefficient to evaluate associations between variables and the student’s t-test for group comparisons. Results: In comparison to controls (2.3 ±1.1 µIU/mL), the mean serum TSH in the case group was considerably higher (14.2 ± 6.1 µIU/mL). The mean serum homocysteine levels of hypothyroid patients were substantially higher (19.8 ± 5.4 µmol/L) than those of the control group (10.2 ± 3.1 µIU/mL; p&lt;0.001). On the other hand, hypothyroid patients had considerably lower mean vitamin B12 levels (210 ± 85 pg/mL) than controls (450 ± 112 µIU/mL; p&lt;0.001). TSH and homocysteine showed a substantial positive association (r=0.68, p &lt; 0.01) whereas TSH and vitamin B12 levels showed a negative correlation. Conclusion: The study shows a high correlation between low levels of vitamin B12, hyperhomocysteinemia, and hypothyroidism. These results imply that those with hypothyroidism are more susceptible to cardiovascular events and atherosclerosis. To reduce long-term metabolic and cardiovascular problems, routine monitoring for serum homocysteine and vitamin B12 is advised in hypothyroid therapy.

Background: Gestational diabetes mellitus (GDM) and thyroid disorders are two common endocrine conditions in pregnancy; each associated with adverse maternal and neonatal outcomes. Emerging evidence suggests a bidirectional relationship between glucose intolerance and thyroid dysfunction, warranting focused evaluation in high‑risk obstetric populations. Methods: A hospital‑based case–control study was conducted on 120 pregnant women (60 GDM cases, 60 controls) between 24–28 weeks of gestation. Standard oral glucose tolerance testing was used to diagnose GDM. Thyroid function was assessed via serum TSH, free T4, and free T3, with classification into overt and subclinical hypo‑ or hyperthyroidism. Associations with maternal age, BMI, parity, and obstetric/neonatal outcomes were analyzed using chi‑square and logistic regression. Results: Women with GDM had significantly higher mean TSH (5.83 vs. 3.44 mIU/L, p&lt;0.0001) and lower T4 (8.80 vs. 11.73 μg/dl, p&lt;0.0001) and T3 (135.67 vs. 167.48 ng/dl, p&lt;0.0001) compared to controls. Thyroid dysfunction was more prevalent in cases (55%) than controls (38.3%), with subclinical hypothyroidism being the most frequent abnormality (31.7% vs. 23.3%). Descriptive trends indicated higher rates of thyroid dysfunction in women &gt;30 years, increased elective cesarean deliveries among hypothyroid cases, and poorer neonatal outcomes (low birth weight, low APGAR scores) among infants of hyperthyroid mothers, though these did not reach statistical significance. Conclusion: Pregnant women with GDM exhibit a significantly higher burden of thyroid dysfunction, particularly hypothyroidism. While associations with maternal age, delivery mode, and neonatal outcomes were not statistically significant, observed trends highlight potential compounded risks. Keywords: Gestational diabetes mellitus (GDM), Thyroid dysfunction, Hypothyroidism, Hyperthyroidism, Pregnancy outcomes

Background: Celiac disease is an immune-mediated disorder characterized by intestinal inflammation, malabsorption, and systemic manifestations. Coexisting Helicobacter pylori infection may further disrupt gastric and digestive function, contributing to nutrient deficiencies and persistent symptoms. Case Presentation: A 33-year-old underweight female presented with chronic fatigue, low energy, bloating, indigestion, constipation, disturbed sleep, and progressive weight loss. Investigations showed positive tissue transglutaminase IgA, H. pylori IgG seropositivity, anemia, elevated ESR, low vitamin D and B12 levels, high homocysteine, and low free T3. She followed a six-month functional nutrition program involving a strict gluten-free anti-inflammatory diet. Dairy, refined sugars, and seed oils were removed. Gut-supportive foods were emphasized. She received targeted micronutrient supplementation and herbal and probiotic support for H. pylori. Lifestyle measures focused on sleep, hydration, stress reduction, and strength training were also followed. Discussion: After six months, laboratory markers showed improvement. Vitamin D rose from 12.6 to 48 ng/mL. Homocysteine decreased from 23.75 to 14.56 µmol/L. ESR declined from 35 to 10 mm/hr. Hemoglobin and vitamin B12 increased. Thyroid markers and C-peptide improved. Tissue transglutaminase IgA moved toward the negative range, and H. pylori IgG levels declined. The patient reported better energy, improved digestion, more regular bowel movements, better sleep, and weight gain. Conclusion: This case illustrates that a structured functional nutrition protocol addressing dietary triggers, micronutrient repletion, microbial balance, and lifestyle factors was associated with meaningful clinical and biochemical improvement over six months. Keywords: Celiac disease, H. pylori, Functional nutrition, Gut inflammation, Micronutrient deficiency, Fatigue

The role of mast cells (MC) in the pathogenesis of autoimmune thyroid diseases has been discussed for decades. However, the exact role of MC in the pathogenesis of this autoimmune pathology remains largely unclear. Aim. In this study, we investigate the effect of thyroid hormones on the functional activity of mast cells using a continuous cell culture. Materials and methods. Mast cells of the human mast cells-1 line (HMC1) were cultured in two nutrient media. One series contained the T4 thyroid hormone, while the other – cultured simultaneously – served as a comparison group. 4',6-diamidino-2-phenylindole (DAPI) was used to stain necrotic cells; and 2’,7’-dichlorodihydrofluorescein diacetate (DCFH-DA) was used to stain cells with active mitochondria. The cultured mast cell media were analyzed for the cytokine content: INF-γ, TNF-α, IL-6, and free T4. Results. The conducted culturing of mast cells reliably demonstrated the stimulating role of thyroid hormones on mast cell functional activity. The TNF-α level in the mast cell medium, cultivated without the addition of T4, increased 9-fold by day 7, compared to the baseline values. However, in mast cells cultivated with the addition of T4, TNF-α increased 29-fold during the same period. Thyroxine exerted a significant stimulating effect on mast cell function, manifested in a significant increase in the synthesis/production of TNF-α de novo . The experiment can be considered representative due to the use of the established mast cell line. Conclusion. Mast cells respond to an increase in the thyroxine content in the environment with additional synthesis/production of TNF-α. The validity of the results obtained, determined by the use of the HMC1 line, allow us to assume that cell activation is also possible in vivo under changes in the synthesis or production of thyroxine by thyrocytes in the thyroid gland.

Hashimoto thyroiditis (HT) is an autoimmune disorder that may be associated with systemic inflammation. Adrenomedullin (ADM) is a peptide known to be elevated in inflammatory conditions, but its role in pediatric HT has not been extensively studied. To investigate serum ADM levels and their relationship with clinical and laboratory parameters in adolescents withHT. This cross-sectional study included 46 adolescents with HT and 41 age-, sex-, and BMI-matched healthy controls. Serum ADM, thyroid function tests, anti-thyroid antibodies, IL-6, and CRP levels were measured. Clinical features including goiter and symptom status were recorded. Correlation and multivariate logistic regression analyses were performed to evaluate associations and predictive factors. ADM levels were significantly higher in the HT group than in controls (p=0.016). TSH, anti-TPO, anti-TG, and IL-6 levels were also elevated, while free T4 and CRP did not differ significantly. ADM correlated with TSH and thyroid functional status but not with IL-6 or CRP. Goiter was present in 28 % of patients, with all patients with goiter showing elevated ADM. Multivariate analysis identified TSH, free T4, and ADM as significant predictors of HT. Receiver operating characteristic analysis showed moderate diagnostic performance for ADM (AUC=0.651). Serum adrenomedullin levels were elevated in adolescents with Hashimoto thyroiditis compared with matched controls and were associated with thyroid dysfunction and local inflammatory activity. Although ADM showed only moderate diagnostic performance, this exploratory first study in pediatric HT suggests a potential role in disease pathophysiology and warrants confirmation in larger prospective cohort studies.

Transfusion-Dependent Thalassemia (TDT) causes severe anemia requiring chronic transfusions, leading to iron overload and endocrine complications, including hypothyroidism. Iron chelation therapy (ICT) mitigates iron toxicity, but its effects on thyroid function remain understudied in resource-limited settings like Pakistan. This cross-sectional study compared 100 TDT patients receiving ICT (deferasirox, deferoxamine, or deferiprone) for ≥ 6 months with 100 Control group who have not taken ICT. Thyroid function tests (free T3, free T4, TSH), serum ferritin, and hepatic/renal biomarkers were analyzed. Statistical analyses included t-tests, ANOVA, Pearson correlation, and multivariate regression (SPSS v25). ICT-treated patients had significantly lower TSH (3.10 ± 0.62 vs. 9.95 ± 3.19 μIU/mL, p < 0.001) and higher free T3/T4 levels than controls (p < 0.001). Deferasirox users exhibited the lowest TSH (2.43 ± 0.06 μIU/mL) among chelators (p < 0.001). Ferritin strongly correlated with TSH (r = 0.94, p < 0.001) and independently predicted TSH levels (coefficient = 0.0010, p = 0.048). ICT also preserved hepatic (ALT: 50.55 ± 41.87 vs. 291.36 ± 161.99 U/L, p < 0.001) and renal function (creatinine: 0.97 ± 0.22 vs. 1.65 ± 0.34 mg/dL, p < 0.001). ICT, particularly deferasirox, protects against thyroid dysfunction in TDT, with ferritin as a key predictor. These findings support personalized chelation strategies and routine endocrine monitoring in thalassemia management.

Regular physical activity is associated with substantial health benefits, provided the body has sufficient energy sources. However, a long-term low-calorie intake can cause the syndrome of Relative Energy Deficiency in Sport (RED-S) with a significant health threat to athletes. Therefore, the objective of the current study was to evaluate markers of RED-S in a cohort of female athletes. The study was carried out in a cohort of female endurance athletes (n = 23) and healthy female control subjects (n = 21) recruited from a total of 42 athletes and 45 controls who underwent the Low Energy Availability in Females Questionnaire (LEAF-Q) survey. Anthropometric, nutritional, and laboratory analyses were performed on study subjects. A higher LEAF-Q score signifying low energy availability (LEA) was observed in athletes compared to controls (8 vs. 5, p < 0.005). Menstrual problems were significantly more common in athletes, with 33.3% of athletes having amenorrhea (p < 0.001). Compared to control women with LEAF-Q < 8, energy expenditure was higher (p < 0.001) in athletes with LEAF-Q ≥ 8, and athletes had a negative energy balance (90%) with a very low value of energy availability (24.3 kcal/kg FFM/day). Athletes with a LEAF-Q score ≥8 had lower serum concentrations of estradiol (p < 0.001), progesterone (p < 0.001), leptin (p < 0.001), white blood cells (p < 0.005) and phosphorus (p < 0.005). Furthermore, they had significantly higher concentrations of hepcidin (p < 0.05) and free T3 (p < 0.05). LEA is prevalent in female endurance athletes, and its diagnosis deserves a multifactorial approach with anthropometric and nutritional analyses, and the use of a wider range of laboratory markers.

The perioperative management of patients with uncontrolled hyperthyroidism requiring emergency surgery presents an acute clinical challenge, as surgical trauma and anesthesia can precipitate a life-threatening thyroid storm. This case report examines the strategic role of regional anesthesia in mitigating such risks through complete afferent blockade and sympathetic stabilization. A 28-year-old male presented with multiple right-hand fractures following a motorcycle accident. The patient had a history of untreated hyperthyroidism for one year and exhibited classic clinical thyrotoxicosis, including tachycardia of 104 bpm, hypertension of 164/90 mmHg, bilateral exophthalmos, and hyperkinesis. Laboratory investigations confirmed primary hyperthyroidism with a markedly elevated free T4 of 86.6 pmol/L and suppressed TSH. His Burch-Wartofsky Point Scale (BWPS) score was calculated at 30, indicating an impending thyroid storm. Following rapid medical optimization with propylthiouracil, propranolol, hydrocortisone, and amlodipine, surgical intervention was successfully performed under ultrasound-guided axillary brachial plexus block. The anesthetic mixture comprised 20 mL of 0.5 percent levobupivacaine and 8 mg of perineural dexamethasone. The patient demonstrated remarkable hemodynamic stability throughout the two-hour procedure, maintaining a systolic blood pressure between 115 and 135 mmHg and a heart rate between 82 and 94 bpm, without progressing to a thyroid crisis. In conclusion, ultrasound-guided regional anesthesia, specifically the axillary approach, offers a superior safety profile for thyrotoxic patients by avoiding airway instrumentation and preventing the sympathetic surges associated with general anesthesia. The synergistic use of levobupivacaine and dexamethasone provides a dual benefit of enhanced cardiac safety and peripheral endocrine stabilization.

Longitudinal PFAS exposure and thyroid function trajectories in Taiwanese youth: a 10-year prospective cohort study.

Proper hormonal signaling at the maternal-fetal interface and adequate placental steroidogenesis are crucial for a successful pregnancy. However, the effects of maternal diabetes (MD) and hypothyroidism (MH) on placental steroidogenic pathways remain poorly characterized. This study investigated the expression of sex hormone receptors and key steroidogenic enzymes at the maternal-fetal interface in rat models of MH and MD. At GD18, in both MH (6-propyl-2-thiouracil-induced) and MD (streptozotocin-induced) conditions, maternal hormonal dosage (free T4 or insulin, and E2, P4, and testosterone) were performed, along with placental RT-qPCR and/or immunohistochemistry analyses for steroidogenic pathway markers (ERα/Esr1, PR/Pgr, AR/Ar, Star, Cyp11a1, Hsd17b3, and Hsd3b1). Both MD and MH dams exhibited reduced fetal weight. These outcomes were associated with elevated plasma estradiol levels in MD rats and reduced testosterone levels in MH rats, while progesterone concentrations remained unchanged in both groups. Both MD and MH resulted in upregulated placental Esr1 expression, whereas MH additionally increased ERα protein levels in the metrial triangle. Regarding the progesterone receptor (PR), MH markedly increased its immunostaining throughout the maternal-fetal interface and both conditions elevated placental Pgr transcript levels. MH also upregulated androgen receptor (AR) protein expression in the decidua and increased placental expression of the steroidogenic enzyme Hsd3b1, while MD elevated placental Ar gene expression. These findings demonstrate that both MD and, more profoundly, MH disrupt sex steroid homeostasis and receptor expression at the rat maternal-fetal interface.