Serum Free Triiodothyronine Research Articles

Clinical efficacy of Chinese herbal medicine formula for Graves’ hyperthyroidism: A multicentre, randomized, double-blind, placebo-controlled clinical trial

Ethnopharmacological relevanceAccording to the theory of traditional Chinese medicine, Graves' disease (GD) is called ‘Ying Bing’, which is a kind of goiter. Haizao Yuhu decoction, originated from the medical book of the Ming Dynasty ‘Waikezhengzong’, is a classic Chinese herbal formula for the treatment of ‘Ying Bing’ for more than 400 years. Pingkang granules, modified from the Chinese herbal formula Haizao Yuhu decoction specialized in GD, has shown effectiveness in several single-centre studies. However, high-quality clinical evidence for the management of GD using Pingkang granules remains insufficient. Aim of the studyTo obtain high-quality medical evidence for the treatment of GD with Pingkang granules through randomized controlled clinical trial. Materials and methodsA multicentre, randomized, double-blinded, placebo-controlled clinical trial was designed. A total of 186 patients with Graves’ hyperthyroidism from five medical centers were randomly assigned to receive methimazole [MMI] and Pingkang granules placebo (group A), MMI and Pingkang granules (group B), or MMI placebo and Pingkang granules (group C) in a 1:1:1 ratio for 12 weeks. The primary clinical outcomes were serum free triiodothyronine (FT3) and free thyroxine (FT4) levels from baseline until the end of the research. Secondary clinical outcomes included serum thyrotrophin receptor antibody (TRAb) levels at 4- and 12-weeks post-intervention, thyroid volume, peak systolic velocity of the superior thyroid artery (STA-PSV), 39-item version of Thyroid-Related Patient-Reported Outcome (ThyPRO39) scores, and safety assessment included blood routine, liver and kidney function tests from baseline to the endpoint. Results150 patients were included in the full analysis set for efficacy analysis, including 48, 50, and 52 in groups A, B, and C, respectively. At the endpoint, three regimens significantly reduced serum FT3 levels (group A, p=0.0027; group B, p < 0.0001; group C, p=0.0028) and FT4 levels (group A, p < 0.0001; group B, p < 0.0001; group C, p < 0.0001), and the combination of MMI and Pingkang granules markedly reduced serum TRAb levels (p = 0.0014). The thyroid volume in group A was significantly larger than that at baseline at week 12 (p=0.0370), and there were no statistically significant differences in the thyroid volume among groups at week 4 (p=0.7485) and 12 (p=0.1333). STA-PSV values in group B were significantly higher than those in group A at week 4 (p=0.0409). The STA-PSV levels in groups A (p < 0.0001) and C (p=0.0025) were significantly lower than those at baseline at week 4, and STA-PSV levels in all groups were significantly lower than those at baseline at week 12 (group A, p=0.0095; group B, p=0.0138; group C, p=0.0423). Pingkang granule monotherapy significantly ameliorated symptoms related to hyperthyroidism (p < 0.0001), eye (p=0.0490), tiredness (p < 0.0001), cognition (p < 0.0001), depression (p=0.0478), and susceptibility (p=0.0052). No severe adverse events were reported in either group or three regimens showed similar safety. ConclusionsPingkang granules significantly reduced serum FT3, FT4 and STA-PSV levels, improved ThyPRO39 scores, and lowered serum TRAb levels when combined with MMI in patients with Grave's hyperthyroidism.

Differentiating Graves’ Disease from Subacute Thyroiditis Using Ratio of Serum Free Triiodothyronine to Free Thyroxine

Background: Graves’ disease and subacute thyroiditis are common causes of hyperthyroidism that share overlapping clinical features, making differentiation challenging. Accurate diagnosis is crucial for appropriate management to prevent adverse outcomes.Objective: To differentiate Graves’ disease from subacute thyroiditis using the ratio of serum free triiodothyronine (FT3) to free thyroxine (FT4).Methods: This prospective observational study was conducted at the Department of Diabetes, Endocrinology, and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, from November 2023 to May 2024. A total of 248 patients diagnosed with Graves’ disease (n = 158) or subacute thyroiditis (n = 90) were included. Clinical, biochemical, and imaging data were collected, and the FT3/FT4 ratio was calculated. Data were analyzed using SPSS v25, with independent samples t-tests and ROC curve analysis performed.Results: The mean FT3/FT4 ratio was significantly higher in Graves’ disease (4.5 ± 0.8) compared to subacute thyroiditis (2.1 ± 0.5), p = 0.001. An FT3/FT4 ratio &gt;3.0 had a sensitivity of 87% and specificity of 85%, with an AUC of 0.92.Conclusion: The FT3/FT4 ratio is a reliable diagnostic tool for differentiating Graves’ disease from subacute thyroiditis, offering high sensitivity and specificity.

Association of Serum Uric Acid Level and Thyroid Function in Chronic Kidney Disease: A Hospital-Based Cross-Sectional Study From Northeast India.

Although the prevalence of thyroid dysfunction and hyperuricemia are independently high in patients with chronic kidney disease (CKD), there are limited data showing the association of serum uric acid and thyroid function in those with CKD. The aim of this study was to observe the alteration of both the serum uric acid level and thyroid function in CKD patients and to find the association between both. This observational cross-sectional study was conducted in a tertiary care hospital over a period of one year in Northeast India. A total of 50 CKD patients were enrolled. Their demographic profiles were studied. Serum urea, creatinine, thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), free triiodothyronine (FT3), total tetraiodothyronine (TT4), and free tetraiodothyronine (FT4) levels were measured to establish the correlation of serum uric acid along with each of the parameters separately. A p-value of <0.05 was considered statistically significant. In the CKD patients studied, serum uric acid exhibited positive correlations with serum creatinine (p = 0.001, r = 0.67), serum urea (p = 0.001, r = 0.69), and serum TSH levels (p = 0.001, r = 0.5). Conversely, serum uric acid showed negative correlations with serum TT4 (p = 0.001, r = -0.74), TT3 (p = 0.001, r = -0.6), FT4 (p = 0.001, r = -0.53), and FT3 (p = 0.001, r = -0.58) levels. There was a significant positive correlation between uric acid and TSH levels in CKD patients. Thus, early estimation of both parameters should be considered in CKD patients.

Thyroid-disrupting effects of bisphenol S in male Wistar albino rats: Histopathological lesions, follicle cell proliferation and apoptosis, and biochemical changes.

In this presented study, the aim was to investigate the toxic effects of bisphenol S (BPS), one of the bisphenol A analogues, on the thyroid glands of male Wistar albino rats. Toward this aim, the rats (n = 28) were given a vehicle (control) or BPS at 3 different doses, comprising 20, 100, and 500mg/kg of body weight (bw) via oral gavage for 28days. According to the results, BPS led to numerous histopathological changes in the thyroid tissue. The average proliferation index values among the thyroid follicular cells (TFCs) displayed increases in all of the BPS groups, and significant differences were observed in the BPS-20 and BPS-100 groups. The average apoptotic index values in the TFCs were increased significantly in the BPS-500 group. The serum thyroid-stimulating hormone and serum free thyroxine levels did not show significant changes after exposure to BPS; however, the serum free triiodothyronine levels displayed significant decreases in all 3 of the BPS groups. BPS was determined to cause significant increases in the antioxidant enzyme activities of catalase, superoxide dismutase, glutathione-S-transferase, glutathione peroxidase, as well as a significantly decreased content of reduced glutathione. The malondialdehyde level in the thyroid tissue was elevated significantly in the BPS-500 group. The data obtained herein revealed that BPS has thyroid-disrupting potential based on structural changes, follicle cell responses, and biochemical alterations including a decreased serum free triiodothyronine level and increased oxidative stress.

Relationship between preoperative FT3 levels and new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. While thyroid dysfunction can predict POAF, the association between preoperative serum free triiodothyronine (FT3) levels and POAF in patients undergoing off-pump coronary artery bypass (OPCAB) grafting remains unclear. This study aimed to investigate the relationship between preoperative FT3 levels and POAF in OPCAB patients. This prospective observational study included patients with sinus rhythm and no history of atrial fibrillation or thyroid disease who underwent OPCAB and FT3 testing at the Tianjin Chest Hospital from June 2021 to March 2023. The relationship between FT3 level and POAF was evaluated using restricted cubic spline. Cox proportional hazards regression models were used to analyze the associations between FT3 concentration categories [low T3 syndrome (LT3S) (FT3 below the normal range), low normal FT3 (3.10-4.59 pmol/L), high normal FT3 (4.60-6.80 pmol/L)] and POAF, adjusting for potential confounders. Stratified analyses were performed to assess effect modification by gender and age (<60 vs. ≥60 years old). Among 875 patients, 259 (29.6%) developed POAF within 2 days after surgery. Restricted cubic spline analysis showed an S-shaped association between FT3 concentration and POAF risk. Compared to the low normal FT3 group, LT3S was associated with an increased risk of POAF [hazard ratio (HR), 1.41; 95% confidence interval (CI): 1.90-2.19], while high normal FT3 was associated with a decreased risk (HR, 0.72; 95% CI: 0.51-0.99). The association between FT3 and increased POAF risk was more pronounced in patients aged ≥60 years (HR, 1.41; 95% CI: 1.89-2.22). Preoperative FT3 levels most likely could predict POAF risk after OPCAB, especially in patients aged 60 years and older. Measuring FT3 preoperatively may identify high-risk patients benefiting from close monitoring and prophylactic treatment. Further investigation of thyroid hormone replacement therapy for LT3S is warranted.

Correlation analysis between serum free triiodothyronine and C-peptide-based insulin resistance index in euthyroid adults

Objective: To explore the correlation between serum free triiodothyronine (FT3) and C-peptide-based insulin resistance index (HOMA2 IR-CP) in euthyroid adults. Methods: A cross-sectional study. The clinical data of euthyroid adult participants who underwent physical examination in the Second Medical Center of Chinese PLA General Hospital from January to December in 2019 were retrospectively analyzed. According to the HOMA2 IR-CP level, the participants were divided into HOMA2 IR-CP>2.18 group (n=3 463) and HOMA2 IR-CP≤2.18 group (n=8 204). Univariate Pearson correlation analysis and multivariate logistic regression analysis were used to analyze the correlation between FT3 and HOMA2 IR-CP. The interaction model was used to analyze the interaction between FT3 and related factors, and the dose-response relationship between continuity variable FT3 and HOMA2 IR-CP was explored by using restricted cubic spline plots. Results: A total of 11 667 euthyroid adult participants aged (50.7±10.0)years were recruited according to the inclusion and exclusion criteria, with 7 756 males and 3 911 females. The proportion of males, body mass index, systolic blood pressure, glycated hemoglobin A1c, fasting plasma glucose, triglyceride, hemoglobin, alanine aminotransferase and FT3 levels in HOMA2 IR-CP>2.18 group were significantly higher than those in HOMA2 IR-CP≤2.18 group (all P<0.05). The levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and free thyroxine in HOMA2 IR-CP>2.18 group were lower than those in HOMA2 IR-CP≤2.18 group (all P<0.001). Univariate Pearson correlation analysis showed that FT3 was associated with HOMA2 IR-CP (r=0.21, P<0.001). Multivariate logistic regression analysis suggested an association between FT3 and HOMA2 IR-CP after adjusting for confounding factors(Pfor trend<0.001). Subgroup analysis showed an association between FT3 and HOMA2 IR-CP in different subgroups of gender, age and glucose metabolism status (Pfor trend<0.05). Multiplication interaction analysis suggested that there was an interaction between FT3 and age (Pinteraction<0.001). Restricted cubic spline model analysis demonstrated that the correlation between FT3 and HOMA2 IR-CP was linear (Poverall<0.001, Pnonlinear=0.479). Conclusions: There is a correlation between serum FT3 and HOMA2 IR-CP in euthyroid adults. With the increase of FT3 level, insulin resistance increases gradually.

Moderation of thyroid hormones for the relationship between amyloid and tau pathology

BackgroundAltered thyroid hormone levels have been associated with increased risk of Alzheimer's disease (AD) dementia and related cognitive decline. However, the neuropathological substrates underlying the link between thyroid hormones and AD dementia are not yet fully understood. We first investigated the association between serum thyroid hormone levels and in vivo AD pathologies including both beta-amyloid (Aβ) and tau deposition measured by positron emission tomography (PET). Given the well-known relationship between Aβ and tau pathology in AD, we additionally examined the moderating effects of thyroid hormone levels on the association between Aβ and tau deposition.MethodsThis cross-sectional study was conducted as part of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) cohort. This study included a total of 291 cognitively normal adults aged 55 to 90. All participants received comprehensive clinical assessments, measurements for serum total triiodothyronine (T3), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH), and brain imaging evaluations including [11C]-Pittsburgh compound B (PiB)- PET and [18F] AV-1451 PET.ResultsNo associations were found between either thyroid hormones or TSH and Aβ and tau deposition on PET. However, fT4 (p = 0.002) and fT3 (p = 0.001) exhibited significant interactions with Aβ on tau deposition: The sensitivity analyses conducted after the removal of an outlier showed that the interaction effect between fT4 and Aβ deposition was not significant, whereas the interaction between fT3 and Aβ deposition remained significant. However, further subgroup analyses demonstrated a more pronounced positive relationship between Aβ and tau in both the higher fT4 and fT3 groups compared to the lower group, irrespective of outlier removal. Meanwhile, neither T3 nor TSH had any interaction with Aβ on tau deposition.ConclusionOur findings suggest that serum thyroid hormones may moderate the relationship between cerebral Aβ and tau pathology. Higher levels of serum thyroid hormones could potentially accelerate the Aβ-dependent tau deposition in the brain. Further replication studies in independent samples are needed to verify the current results.

A retrospective analysis thyroid function and ultrasonography in a group of subjects with lepramatous leprosy in Turkey.

There are several studies on thyroid functions and thyroid gland features in patients with leprosy in the literature. The relationship between them have not been clarified yet. These studies are time-expired and don't contain ultrasonography examination. The purpose of the study is to investigate thyroid functions and gland characteristics in leprosy patients by ultrasonography (US) and current laboratory techniques. This retrospective study was conducted by collecting the data of patients with lepramatous leprosy. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti-thyroid peroxidase, antithyroglobulin, and thyroglobulin values and thyroid ultrasonography reports were collected from previous records. The mean age is 75.12±9.89 years of total 17 subjects and 10 patients (58.8%) were male. Thyroid US was performed on 14 of the patients, nodules were detected in a total of 7 (50%) patients. The mean FT3, FT4, TSH, Anti-Tpo, Anti-TG, and TG values of the patients were found to be within normal limits. In the present study, no changes were detected in the thyroid functions and structures of the patients with Lepromatous Leprosy. We consider that prospective randomized studies that will include larger sample sizes are needed to determine whether there is a relationship between leprosy and thyroid disease.

Subclinical Hypothyroidism Following Imatinib Use in Nigerian BCR::ABL1-positive Chronic Myeloid Leukemia Patients: A Prospective Cohort Study

Abstract BACKGROUND: Thyroid toxicity has been reported with tyrosine kinase inhibitors (TKIs) such as sunitinib and sorafenib, targeting angiogenic tyrosine kinase receptors. However, the effect of imatinib, a first-line TKI for chronic myeloid leukemia (CML) patients on the thyroid, has been inconclusive. Of note, imatinib remains the mainstay of treatment for BCR::ABL1-positive Nigerian CML patients. AIM: We evaluated the effect of imatinib mesylate on the thyroid and its function in BCR::ABL1 positive CML patients and assessed the effect of the continuous imatinib use on thyroid features. PATIENTS AND METHODS: This prospective cohort study included 50 imatinib-naive patients with BCR::ABL1-positive CML and 50 age- and sex-matched apparently normal controls without any underlying thyroid disorder or on any thyroid medication. Serum free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were measured at baseline for both the CML patients and the controls and were repeated at 1, 3, and 6 months for the CML patients while on imatinib therapy. RESULTS: Subclinical hypothyroidism was observed in 7 of 50 (14%) of the patients with CML at 6 months on imatinib. Six of these patients were female, while 1 was male. The mean values for the serum fT3 (pmol/L), serum fT4 (pmol/L), and TSH (μIU/mL) for the CML subjects versus controls were 4.22 ± 0.79 versus 4.31 ± 0.31 (t = −0.27 P = 0.532), 17.13 ± 2.49 vs. 16.39 ± 2.16 (t = 1.605 P = 0.112), and 1.58 ± 0.74 versus 1.63 ± 0.64 (t = −0.399 P = 0.691), respectively. CONCLUSION: This study confirmed subclinical hypothyroidism as an adverse effect of continuous imatinib use with a prevalence of 14% in Nigerian CML patients.

Corneal topography findings among patients with thyroid dysfunction

Background Hormonal dysregulation impacts the metabolism of the cornea and could be linked to keratoconus. Previous research has suggested an association between keratoconus and autoimmune thyroid disorders. Aim The aim of this study was to compare the topographic corneal changes in patients with thyroid dysfunction. Patients and methods This is a cross-sectional study of 200 patients with thyroid dysfunction attending the Endocrinology Clinic at the Faculty of Medicine, Alexandria University. The corneal topography of patients was examined with TMS. Serum levels of thyroid-stimulating hormone, free thyroxine, and free triiodothyronine were measured. Results Two hundred patients with thyroid dysfunction were enrolled in the study. Of them, 129 were hypothyroid patients and 71 were hyperthyroid patients. The study included 137 females and 63 males with a mean age of 32.4 ± 8.2 years. Corneal keratometry readings, including K1, K2, and K max readings, were measured. The mean value of K1 was 45.86 ± 4.69 D, mean K2 was 47.89 ± 5.08 D and the mean corneal thickness was 475 ± 0.36 µm, no relation was found between any of these parameters and serum thyroid-stimulating hormone, free triiodothyronine, or free thyroxine levels. Conclusion In our study, more topographic changes in favor of a thin cornea and steep cornea rather than a true keratoconus were detected in patients with thyroid dysfunction, making cautious analysis of corneal topography important, especially before refractive surgery.

Comparison of the effectiveness of ultrasound-guided radiofrequency ablation and conventional open thyroidectomy in the treatment of benign thyroid nodules.

To compare the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) and conventional open thyroidectomy (OT) in the treatment of benign thyroid nodules (BTN). Medical records of 103 patients with BTN undergoing surgical treatment at The Affiliated Jiangning Hospital of Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Records show that 53 patients underwent US-guided RFA (observation group) and 50 patients underwent conventional OT (control group). Perioperative indicators (operation duration, intraoperative blood loss, postoperative hospital stay, incision length, and VAS score 12h and 24h after surgery), complications, thyroid function, and nodule recurrence in both groups were compared and analyzed. Perioperative indicators of patients in the observation group were better, and the visual analogue scale (VAS) scores at 12 and 24 hours after the surgery were lower than those of the control group (p<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). There was no statistically significant difference in the preoperative levels of thyroid-stimulating hormone (TSH), serum free thyroxine (FT4) and serum free triiodothyronine (FT3) between the two groups (p>0.05). The postoperative TSH levels in the observation group increased compared to the preoperative levels and were higher than those in the control group, while FT4 and FT3 levels decreased after surgery and were lower than those in the control group (p<0.05). Compared to conventional open thyroidectomy, US-guided RFA is associated with less trauma, faster recovery, fewer complications, and less impact on thyroid function in the treatment of patients with BTN.

Predictive Value of Serum Inflammatory Factors and FT3 for Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke

Objective: The ability of serum inflammatory factors and free triiodothyronine (FT3) in predicting the occurrence of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) was assessed in this study. Methods: A retrospective analysis was conducted on 285 consecutive patients with AIS initially diagnosed and admitted to our hospital from January to December 2022. Patients were categorized into SAP and non-SAP groups based on the presence of SAP. Both groups were compared in terms of baseline characteristics, including National Institute of Health Stroke Scale (NIHSS) score, SAP risk assessment (A2DS2), TOAST classification. Independent risk factors for SAP were identified using multivariate logistic regression analysis, and the predictive value of inflammatory markers was evaluated through ROC curves. Results: Among 285 patients with AIS, 40 (14.03%) were found to have developed SAP. Higher NIHSS and A2DS2 scores, elevated serum IL-1β, IL-8, and IL-33 levels, increased age, atrial fibrillation, swallowing difficulties, and a higher proportion of patients with low FT3 levels were observed in the SAP group compared with the non-SAP group (all P&lt;0.05). Significant risk factors for SAP in patients with AIS were identified through multivariate logistic regression analysis, including age, swallowing difficulties, NIHSS, A2DS2 , IL-1β , IL-8 , IL-33, and FT3 (P&lt;0.05). The highest predictive values were observed for A2DS2, FT3, and IL-8 with AUC values of 0.854, 0.844, and 0.823, respectively. Conclusion: SAP can be highly predicted by A2DS2, FT3, and IL-8, enabling the early identification of patients with high-risk SAP and facilitating timely intervention and treatment.

High prevalence of morphometric vertebral fractures opportunistically detected on thoracic radiograms in patients with non-functioning pituitary adenoma.

Vertebral fractures (VFs), the hallmark of skeletal fragility, have been reported as an emerging complication in patients with pituitary diseases associated with hormonal excess and/or deficiency, independently from bone mineral density. Non-functioning pituitary adenoma (NFPA) is amongst the most frequent pituitary adenomas; however, skeletal health in this context has never been investigated. We aimed at assessing the prevalence and the determinants of morphometric VFs in patients with NFPA. We enrolled 156 patients (79M/77F, mean age 55.75 ± 12.94years) at admission in Neurosurgery Unit before trans-sphenoidal surgery and compared them with an age and sex-matched control group of subjects with neither history/risk factors for secondary osteoporosis nor pituitary disorders. We performed a vertebral morphometric evaluation of the thoracic spine on pre-operative X-ray images (MTRx) and collected biochemical, demographic, and clinical data from the entire cohort. The prevalence of thoracic VFs in patients with NFPA was significantly higher than the control group (26.3% vs. 10.3%; p < 0.001). In the NFPA group, 20 patients (48.8% of the fractured patients) showed multiple VFs, 14 (34.1% of them) showed moderate/severe VFs. Patients with VFs were significantly older and had lower serum free triiodothyronine (fT3) levels than non-fractured ones (p = 0.002 and p = 0.004; respectively). The prevalence of secondary male hypogonadism was higher among men with VFs as compared to those with no VFs (72% vs. 48.1%; p = 0.047). Consistently, total testosterone levels in males were significantly lower in fractured patients than in non-fractured ones (p = 0.02). The prevalence of gonadotroph adenomas was significantly higher among patients with VFs (p = 0.02). In multiple logistic regression analysis, older age and lower serum fT3 levels were independent factors predicting the risk for VFs. For the first time, we reported a high prevalence of thoracic radiological VFs in patients with NFPAs. Our data should prompt clinicians to proceed with a clinical bone fragility evaluation already during the diagnostic work-up, particularly in those with concomitant hypogonadism, or in those with older age and/or with lower fT3.

The Perioperative Period of Heart Transplantation Is Affected by Thyroid Hormone Status.

Background: Orthotopic heart transplantation (HTx) is a long-term surgical therapeutic approach for patients with end-stage heart failure. The objective of the present study was to uncover associations between altered thyroid hormone (TH) status and adverse outcomes after HTx. Methods: In this prospective, single-center cohort study, 283 patients underwent HTx between 2013 and 2020 at the Heart and Vascular Center of Semmelweis University in Hungary. We measured serum free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) pre- and postoperatively. TaqMan qPCR was used to measure type 2 deiodinase and type 3 deiodinase mRNA (Dio2 and Dio3, respectively) levels from the diseased heart bioptates. To assess the local TH action of the heart, mRNA levels of Hcn2 and Myh7 were measured in a subgroup of patients receiving extracorporeal membrane oxygenation (ECMO) postoperatively. Groups were compared using nonparametric tests. Cox regression analysis and logistic regression test were used to investigate the outcomes. The connection between serum TH parameters and cardiac gene expressions was assessed using linear regression. Results: Serum TSH (p = 0.009), fT3 (p < 0.001), and fT4 (p < 0.001) levels were lower after HTx than preoperatively. Levothyroxine (LT4) administered to donors was associated with better survival after 30 days (p = 0.049). LT4 replacement given to recipients after HTx was associated with better survival after 30 days (p = 0.018), 1 year (p = 0.002), and 2 years (p = 0.001). Dio3 mRNA level was significantly increased in patients who were treated with ECMO (p = 0.026), left ventricular assist device (LVAD) (p = 0.008), and biventricular assist device (BiVAD) (p = 0.013) preoperatively, and ECMO (p = 0.042) postoperatively, compared with those who did not require any type of mechanical circulatory support (MCS). We found no significant difference in the expression of the Hcn2 and Myh7 marker genes between patients on postoperative ECMO and those without MCS, and neither did they correlate with serum hormone levels (p = 0.519 and p = 0.056, respectively). Conclusions: We conclude that TH status plays an important role in HTx patients, and monitoring of TH status in the perioperative period may contribute to improved treatment outcomes. Our findings require independent confirmation in a randomized controlled clinical trial.

Urinary haloacetic acid concentrations and thyroid function among women: Results from the TREE study

BackgroundDisinfection byproducts (DBPs) have been shown to impair thyroid function in experimental models. However, epidemiological evidence is scarce. MethodsThis study included 1190 women undergoing assisted reproductive technology (ART) treatment from the Tongji Reproductive and Environmental (TREE) cohort from December 2018 to August 2021. Serum thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured as indicators of thyroid function. FT4/FT3 and TSH/FT4 ratios were calculated as markers of thyroid hormone homeostasis. Dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA), the two most abundant HAAs, in urine were detected to assess individual DBP exposures. ResultsAfter adjusting for relevant covariates, positive associations were observed between urinary TCAA concentrations and serum TSH and TSH/FT4 levels (e.g., percent change = 5.82 %, 95 % CI: 0.70 %, 11.21 % for TSH), whereas inverse associations were found for serum FT3 and FT4 (e.g., percent change = −1.29 %, 95 % CI: −2.49 %, −0.07 % for FT3). There also was a negative association between urinary DCAA concentration and serum FT4/FT3 (percent change = −2.49 %, 95 % CI: −4.71 %, −0.23 %). These associations were further confirmed in the restricted cubic spline and generalized additive models with linear or U-shaped dose-response relationships. ConclusionUrinary HAAs were associated with altered thyroid hormone homeostasis among women undergoing ART treatment.

Thyroid dysfunction in Egyptian patients with liver cirrhosis: a cross-sectional study

Background Owing to the liver’s important role in thyroid hormone metabolism. Concerns were raised about the effect of the degree of liver cirrhosis on thyroid functions. This study aimed to assess the effect of liver cirrhosis on thyroid functions and the relation between thyroid dysfunctions and both the severity of liver disease and associated clinical presentations. Aim To assess the effect of liver cirrhosis on thyroid function and its relation to the severity of liver disease. Patients and methods This was a cross-sectional study conducted on 70 patients with liver cirrhosis (35 cirrhotic compensated patients and 35 decompensated patients) in addition to 20 healthy control subjects. Serum free triiodothyronine (FT3), free thyroxine, and thyroid stimulating hormone (TSH) levels were measured. The severity of liver cirrhosis was assessed by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores. Statistical analysis was done to compare groups and evaluate the association of thyroid function tests with CTP and MELD scores. Results FT3 and free thyroxine levels showed significant differences among studied groups (P=0.013 and &lt;0.001, respectively) as both were decreased in decompensated patients compared with control group, while only FT3 was significantly decreased in compensated patients than the control group. While TSH levels showed no significant difference (P=0.062). FT3 and TSH levels showed a significant negative correlation to CTP and MELD scores. Conclusion Liver cirrhosis was associated with abnormalities in thyroid function tests that may be an additive cause to complaints in those patients. Being inversely related to the severity of the liver condition both TSH and FT3 needed to be followed-up as the liver condition deteriorated.

Effect of acupuncture on Hashimoto thyroiditis: A systematic review and meta-analysis.

Hashimoto thyroiditis (HT) is a common autoimmune thyroid disease for which there is no specific treatment. Oral levothyroxine sodium tablets significantly improved thyroid function but did not promote a reduction in thyroid-related antibody concentrations. Acupuncture can improve clinical symptoms and thyroid function in HT patients, reduce serum TPOAb and TGAb levels in HT patients, and improve patients' quality of life. We conducted a systematic review and meta-analysis to evaluate the effect of acupuncture versus levothyroxine sodium tablets on Hashimoto thyroiditis. We searched Web of Science, Embase, China National Knowledge Infrastructure, WanFang, VIP, SinoMed and the Cochrane Central Registry of Controlled Trials to identify candidate randomized controlled trials (RCTs). A total of 1020 patients participated in 14 randomized controlled trials. The results of meta-analysis showed that acupuncture regulated TPOAb content (mean difference [MD] = -63.18, 95%CI = -91.73 to -34.62, P < .00001), TGAb content (MD = -68.56, 95%CI = -101.55 to -35.57, P < .00001), serum free triiodothyronine (FT3) content (MD = 0.74, 95%CI = 0.20 to 1.27, P < .00001), serum free thyroxine (FT4) content (MD = 1.10, 95%CI = 0.29 to 1.92, P < .00001), TSH content (MD = -2.16, 95%CI = -3.14 to -1.19, P < .00001) had a significant effect. Compared with levothyroxine sodium tablets alone, acupuncture can significantly regulate the contents of TPOAb, TGAb, FT3, FT4 and TSH.

Correlation between a low serum free triiodothyronine level and mortality of severe pulmonary tuberculosis patients

BackgroundThis study aimed to assess the relationship between a low serum free triiodothyronine (FT3) level and the mortality of severe pulmonary tuberculosis (TB) patients.MethodsWe performed a retrospective study and reviewed the medical records of patients with severe pulmonary TB between January 2016 and June 2022. The patient demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, survival or death at 28 and 90 days after hospital admission, and serum FT3 level were recorded. Bivariate regression analysis was performed to study the relationship between mortality and the FT3 level. The Kaplan–Meier method and the log-rank test were used to compare the survival rates between patients with different serum FT3 levels.ResultsOur study included 495 severe pulmonary TB patients, with 383 (77.4%) patients having a low serum FT3 level. The low-serum FT3 group had high 28-day and 90-day mortalities. The patients who had died by 28 or 90 days after hospital admission had a low FT3 level. Survival analysis showed that the patients with a low serum FT3 level had a low probability of survival at 28 days and at 90 days after hospital admission.ConclusionThe serum FT3 level was correlated with the 28-day and 90-day mortalities in patients with severe pulmonary TB. The serum FT3 level should be monitored in these patients to help manage their disease.

Relationship of Thyroid Function with Renal Hemodynamics and Cholesterol Metabolism in Proteinuric Kidney Disease: A Pilot Study.

Nephrotic syndrome and hypothyroidism are respectively reported to influence renal hemodynamics and hypercholesterolemia. However, the relationship of proteinuria-associated thyroid function with renal hemodynamics and cholesterol metabolism has yet to be determined in a simultaneous analysis of thyroid, renal, and cholesterol variables. We investigated the hypothesis that the changes in thyroid hormones by proteinuria may contribute to changes in cholesterol metabolism and renal hemodynamics by proteinuria. Twenty-nine patients (17 men and 12 women) with proteinuric kidney disease (mean age 46 years) were enrolled in a pilot study. Data for serum free triiodothyronine (FT3), free thyroxine (FT4), total cholesterol, and filtration fraction (FF; assessed by para-aminohippuric acid clearance) were used in variable-adjusted correlation analyses. The patients had the following data (mean ± standard deviation): urinary protein 5.18 ± 3.28 g/day, FT3 2.18 ± 0.44 pg/mL, FT4 1.03 ± 0.26 ng/dL, FF 0.27 ± 0.07, and total cholesterol 327 ± 127 mg/dL. There was a significant positive correlation of FT3 with FF (β = 0.58, p = 0.01) and a significant inverse correlation of FT4 with total cholesterol (β = -0.40, p = 0.01). A positive correlation of FT3 with FF and an inverse correlation of FT4 with total cholesterol were demonstrated in patients with proteinuric kidney disease. The proteinuria-associated reduction in serum thyroid hormone levels was correlated with hypercholesterolemia and the reduced glomerular FF. Further studies of these relationships are required.

CT semi-quantitative score used as risk factor for hyponatremia in patients with COVID-19: a cross-sectional study.

Chest computed tomography (CT) is used to determine the severity of COVID-19 pneumonia, and pneumonia is associated with hyponatremia. This study aims to explore the predictive value of the semi-quantitative CT visual score for hyponatremia in patients with COVID-19 to provide a reference for clinical practice. In this cross-sectional study, 343 patients with RT-PCR confirmed COVID-19, all patients underwent CT, and the severity of lung lesions was scored by radiologists using the semi-quantitative CT visual score. The risk factors of hyponatremia in COVID-19 patients were analyzed and combined with laboratory tests. The thyroid function changes caused by SARS-CoV-2 infection and their interaction with hyponatremia were also analyzed. In patients with SARS-CoV-2 infection, the total severity score (TSS) of hyponatremia was higher [M(range), 3.5(2.5-5.5) vs 3.0(2.0-4.5) scores, P=0.001], implying that patients with hyponatremia had more severe lung lesions. The risk factors of hyponatremia in the multivariate regression model included age, vomiting, neutrophils, platelet, and total severity score. SARS-CoV-2 infection impacted thyroid function, and patients with hyponatremia showed a lower free triiodothyronine (3.1 ± 0.9 vs 3.7 ± 0.9, P=0.001) and thyroid stimulating hormone level [1.4(0.8-2.4) vs 2.2(1.2-3.4), P=0.038]. Semi-quantitative CT score can be used as a risk factor for hyponatremia in patients with COVID-19. There is a weak positive correlation between serum sodium and free triiodothyronine in patients with SARS-CoV-2 infection.