Free Triiodothyronine Levels Research Articles

Association between clinical activity score and serum sPD-1 and sPD-L1 levels during systemic glucocorticoid treatment for active moderate-to-severe thyroid eye disease.

CD4+ T lymphocytes are key immune cells involved in orbital inflammation in thyroid eye disease (TED). Inhibition of their activity is important in treatment of TED, but effective drugs targeting these cells are lacking. The programmed cell death-1/programmed cell death ligand-1 pathway has been implicated in several T-cell-mediated diseases. Manipulation of this pathway with antagonists or agonists is an attractive therapeutic option. The role of soluble programmed cell death-1 (sPD-1) and soluble programmed cell death ligand-1 (sPD-L1) in regulation of this pathway is debated. This study aimed to investigate the involvement of sPD-1 and sPD-L1 in the pathogenesis of TED, focusing on their utility as novel biomarkers to evaluate disease severity and treatment response. Thirty patients diagnosed with moderate-to-severe TED associated with Graves' disease were included. Blood samples were collected from patients before and 12weeks after initiation of intravenous glucocorticosteroid (IVGC) treatment. Disease severity was assessed using the Clinical Activity Score (CAS) before and after IVGC treatment. Thyroid-stimulating hormone, free thyroxine, free triiodothyronine, thyroid-stimulating immunoglobulin, interleukin-6, sPD-1, and sPD-L1 levels were measured. Correlations between sPD-1, sPD-L1, and CAS before and after IVGC treatment were investigated. Serum concentrations of sPD-1 and sPD-L1 before and after IVGC treatment in patients with TED were compared with those in healthy controls (HCs). The changes in the tested protein concentrations upon IVGC treatment and their associations with clinical characteristics were investigated. Enzyme-linked immunosorbent assays were used to measure sPD-1 and sPD-L1 concentrations in peripheral blood serum. There was a positive correlation of moderate Spearman's rank strength between sPD-L1 and CAS before and after treatment, and a positive correlation between sPD-1 and sPD-L1. However, no correlation was observed between sPD-1 and CAS. Baseline serum levels of sPD-1 and sPD-L1 did not significantly differ between patients with TED and HCs. There were no correlations between changes in the levels of the tested molecules upon IVGC treatment and the analyzed clinical features. The decreases of sPD-1 and sPD-L1 levels after 12weeks of IVGC treatment were not significant. The positive correlation of moderate Spearman's rank strength between sPD-L1 and CAS before and after 12weeks of treatment indicates that sPD-L1 is involved in the pathogenesis of TED. sPD-L1 may become an additional immunological biomarker to assess the disease activity and monitor the respond to treatment. Although sPD-1 is reported in the literature to have an activating effect on lymphocytes, our study shows that sPD-1 may not play a significant role in the pathogenesis of TED, as its level does not differ significantly between the TED and HC groups and does not correlate with disease activity. Understanding the clinical value of sPD-1 and sPD-L1 is of great practical importance.

A beneficial levels of 25-hydroxyvitamin D for a decrease in thyrotropin receptor antibody (TRAB) in patients with Graves’ disease: a real-world study

ObjectiveThis study aimed to determine whether a relationship exist between pre-therapy 25-hydroxyvitamin D levels and the remission/negative conversion rates of thyrotropin receptor antibody (TRAB) during treatment in patients with newly diagnosed Graves’ disease (GD).Methods171 patients were included from the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University in March 2013 to April 2016. Ninety-five patients of them were diagnosed at our hospital but transferred to local hospitals for treatment. Seventy-six patients were followed and treated at our hospital with a median follow-up time of 11.03 (range 6–27) months. Patients were divided into 3 groups according to baseline 25-hydroxyvitamin D levels; <20 ng/mL (31,43.05%), 20–29 ng /mL (20,27.78%), and ≥ 30 ng/mL (20,29.17%). The TRAB remission rate and negative conversion rate was assessed among each group.ResultsThere was a higher TSH and lower TRAB titer in the 20–29 ng/mL group at initial diagnosis. Cox regression analysis suggested that 20–29 ng/mL group had significantly higher remission rates [RR; 95% CI: 7.505 (1.401–40.201), 8.975 (2.759–29.196),6.853(2.206–21.285), respectively] and negative conversion rates [RR; 95% CI: 7.835 (1.468–41.804),7.189(1.393–37.092), 8.122(1.621–40.688)] at the 6-, 12-, and 24-month follow-up, respectively . The level of 25-hydroxyvitamin D at the time of initial diagnosis was not associated with the re-normal of free Triiodothyronine(FT3), free thyroxineIndex(FT4) or TSH levels during the follow-up.ConclusionNewly diagnosed GD patients with appropriate baseline 25-hydroxyvitamin D levels (20–29 ng/mL) are beneficial for the reduction of TRAB during antithyroid therapy.

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

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

Associations of reverse triiodothyronine serum levels with anxiety, depression, and health related quality of life after experiencing acute ischemic stroke.

This study intended to explore associations of reverse triiodothyronine (rT3) with emotional disturbances and health-related quality of life (HRQoL) after experiencing acute ischemic stroke (AIS). Serum samples from individuals with AIS were collected on admission to three Lithuania stroke centers and investigated for free tetraiodothyronine, free triiodothyronine (fT3), rT3, and thyroid stimulating hormone levels. At discharge, emotional disturbance was evaluated using the Hospital Depression and Anxiety Scale (HADS), and HRQoL using the EQ-5D-5L scale. Analyses included 159 individuals (59.7% male and 40.3% female; mean (SD) aged 66.4 [10.3] years), 52.83% of which showed increased rT3 levels upon admission. After adjustment for age, sex, National Institutes of Health Stroke Scale scores, previous stroke, modified Rankin Scale before AIS ≤ 2, and diabetes mellitus, multivariable linear regression revealed negative associations of rT3 with HADS total score (β = -0.163; p = 0.046) and HADS-D subscale score (β = -0.187; p = 0.019). Analyses supported a positive relationship between the fT3 ratio to rT3 with HADS-D score (β = 0.157; p = 0.046) and rT3, rT3 × fT3 product with EQ-5D index score (β = 0.157; p = 0.044 and β = 0.179; p = 0.023, respectively). We found that individuals who experienced AIS and had higher levels of rT3 at hospital admission had less emotional disturbance and better HRQoL when discharged.

Effect of Vitamin B12 Deficiency on Thyroid Function Tests Among Adults Visiting Tertiary Health Care Centre in Eastern Nepal

Background Vitamin B12 deficiency is commonly observed in hypothyroidism and autoimmune thyroiditis. Low vitamin B12 can disrupt thyroid function. Though the prevalence of this deficiency has been documented in various regions of Nepal, studies in Eastern Nepal are limited. The objective of this study was to assess the percentage distribution of vitamin B12 deficiency among adults visiting the tertiary health care centre in Eastern Nepal and to find out the effect of vitamin B12 deficiency on thyroid function test. Methods This study, conducted at Nobel Medical College from January 2022 to December 2023, was cross-sectional in design and included 379 patients. Subjects underwent general health check-ups, including Vitamin B12 and thyroid function tests. Descriptive analysis was performed, and Pearson’s correlation assessed the relationship between vitamin B12 levels and thyroid hormones. Independent t-tests compared hormone levels between groups. P value &lt; 0.05 was considered as statistically significant. Results The vitamin B12 status distribution was as follows: 62.5% normal (&gt;300pg/ml), 18.2% borderline deficient (200-300pg/ml), and 19.3% deficient (&lt;200pg/ml). Prevalence was higher among females. Group II subjects (vitamin B12 &lt;300pg/dl) had significantly lower mean free triiodothyronine (FT3) levels (2.82±0.742 vs. 3.14±0.49 pg/mL, p=0.003) and higher mean thyroid stimulating hormone (TSH) levels (4.69±3.56 vs. 2.55±1.47 mIU/L, p&lt;0.001) compared to group I (B12 &gt;300pg/ml). Vitamin B12 showed a negative correlation with TSH (p=0.013). Conclusion The study indicates a decrease in FT3 levels and an increase in TSH levels among those with vitamin B12 deficiency or borderline cases

Does Epstein-Barr virus and intracellular Toll-like receptors affect the course of Hashimoto disease? Findings from studies on newly-diagnosed patients.

Epstein‑Barr virus (EBV) reactivation is increasingly recognized as a potential exacerbator of autoimmune diseases, including Hashimoto thyroiditis (HT). This study examined the association between EBV reactivation and intracellular Toll‑like receptor (TLR) expression in newly‑diagnosed, untreated HT patients. Its aim was to determine whether EBV reactivation and expression of specific TLRs (TLR3, TLR7, TLR8, and TLR9) contribute to the pathogenesis and progression of HT. The study involved a cohort was 54 newly‑diagnosed, untreated patients with HT and 20 healthy volunteers (HVs) matched for age and sex. Blood samples were collected to assess EBV viral load and intracellular expression levels of TLR3, TLR7, TLR8, and TLR9 using flow cytometry. The levels of specific anti‑EBV antibodies (eg, viral capsid A [VCA] immunoglobulin [Ig] M, VCA IgG, Epstein‑Barr nuclear antigen 1 [EBNA‑1] IgM, EBNA‑1 IgG) were measured to identify signs of EBV reactivation, while soluble TLRs (sTLR3, sTLR7, sTLR8, and sTLR9) were quantified in serum using enzyme‑linked immunosorbent assay. Notably, our HT patients were not euthyroid, as they exhibited significantly lower thyroid‑stimulating hormone levels and elevated free triiodothyronine and free thyroxine levels in comparison with the HVs. The study showed a significant increase in EBV reactivation among the HT patients, with 26 of 54 (48.1%) testing positive for EBV DNA, as compared with none of the HVs. The HT patients with reactivated EBV showed significantly higher intracellular expression of TLR3, TLR7, and TLR9, with TLR3+ cells constituting an average of 4.72% of CD4+ lymphocytes (vs 0.69% in the HVs), suggesting a potential synergistic effect. In addition, sTLR levels increased in the HT patients with reactivated EBV, suggesting a possible role of these receptors in potentiating autoimmune responses. These findings highlight the importance of considering both viral reactivation and TLR activity in the treatment of HT. Understanding the interplay between EBV and intracellular TLRs may lead to development of new therapeutic approaches to mitigate the impact of these factors on the disease progression. Further research is warranted to investigate the mechanisms underlying this interaction and its implications for treatment strategies.

Prognostic significance of free triiodothyronine levels in alpine region patients undergoing drug-coated balloon therapy for coronary heart disease

ObjectiveThis study retrospectively analyzed the relationship between serum-free triiodothyronine (FT3) levels and the prognosis of coronary atherosclerotic cardiopathy (CHD) in patients from alpine regions treated with drug-coated balloons (DCB).MethodsData from 201 CHD patients with DCB at Hulunbuir People’s Hospital between September 2019 and August 2023 were included. Patients were divided into two groups based on the occurrence of major adverse cardiovascular events (MACE) after surgery. Univariate and multivariate logistic regression analyses were conducted to identify risk factors. The predictive efficiency of these risk factors for MACE was evaluated using the ROC curve.ResultsThe poor prognosis group had significantly higher ages, a greater proportion of patients with a history of previous coronary interventions, and elevated levels of N-terminal pro-B-type natriuretic peptide compared to the good prognosis group. In contrast, FT3 levels were significantly lower (P < 0.05). No significant differences were observed in surgical parameters such as DCB target lesion site, lesion length, or puncture approach between the groups (P > 0.05). Multivariate binary logistic regression analysis identified FT3 level as an independent predictor factor of MACE in CHD patients treated with DCB. The optimal cut-off value for FT3 in predicting adverse prognosis following DCB surgery was 3.30 pmol/L, with a sensitivity of 72.5%, specificity of 62.8%, and an area under the curve (AUC) of 0.741 (P < 0.05).ConclusionDecreased FT3 levels serve as a biomarker for predicting the occurrence of MACE in patients from alpine regions undergoing DCB treatment for CHD. There is a significant correlation between reduced FT3 levels and the incidence of MACE in these patients.

Management of perioperative thyrotoxicosis - what to do when standard therapy is contraindicated or fails?

Current guidelines recommend that hyperthyroid patients should be rendered euthyroid prior to surgical procedures. These guidelines rely heavily on the use of ATDs as the primary medication, and do not give recommendations for patients who have contraindications to ATDs, or for whom standalone ATD treatment is inadequate. To evaluate the efficacy and safety of adjunctive pharmacological therapy and/or therapeutic plasma exchange (TPE) in the perioperative management of patients with thyrotoxicosis who were intolerant to ATD or for whom standalone ATD therapy was inadequate to achieve euthyroidism prior to surgery. A comprehensive search of MEDLINE, Google Scholar, Embase and CENTRAL up to 31 December 2023 retrieved 12,876 records. After screening titles, abstracts and full manuscripts, 16 reports were enrolled. The study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Patients were primarily female (78.5%), aged between 35 and 52 years. The predominant thyroid condition was Graves' disease (89.7%). Majority underwent thyroidectomy (99.3%). Patients treated pre-operatively with 2nd line pharmacotherapy with/without therapeutic plasma exchange (TPE) underwent surgery safely with no reports of perioperative thyroid storm. Pre-operative treatment achieved mean percentage reduction of free thyroxine and free triiodothyronine levels of 52.6 ± 8.2% and 68.1 ± 9.3% respectively. One study reported a patient who suffered from myocardial infarction and tachyarrhythmia and subsequently demised. Preoperative management of hyperthyroidism with second line pharmacotherapy and/or TPE can be effectively and safely implemented in patients with intolerance to or ineffective treatment with ATDs. The treatment modalities were generally safe, though some complications were observed.

Gender differences in the prevalence and clinical correlates of suicide attempts in young first-episode drug-naïve major depressive disorder patients with thyroid dysfunction

Thyroid dysfunction is commonly seen in major depressive disorder (MDD), and is particularly prevalent in female patients. Moreover, gender differences occur in many aspects of MDD, including suicide attempts (SAs). We aimed to explore gender differences in the prevalence and clinical correlates of SAs in young first-episode drug-naïve MDD patients with thyroid dysfunction, which have not yet been reported. We recruited 509 patients in this study. Demographic and clinical characteristics were collected. We used HAMD-17, HAMA-14, the positive subscale of PANSS, and CGI-S to assess every participant. We found no significant difference in the prevalence of SAs between male and female subgroup. Gender differences in factors associated with SAs were found with anxiety, body mass index, serum anti-thyroid antibodies (A-TPO), and free triiodothyronine levels in male patients and anxiety, CGI-S score, and A-TPO in female patients. We found no gender differences in the prevalence of SAs; however, there were gender differences in several clinical correlates of SAs, highlighting specific strategies to avoid SAs in male and female MDD patients.

Thyroid Functions and Cognitive Decline in the Elderly.

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

Impact of Hypothyroidism in Pregnancy on Feto-Maternal Outcomes: A Prospective Observational Study.

Introduction Hypothyroidism represents an endocrine disorder marked by the insufficient production of hormones by the thyroid gland, with significant effects on bodily functions. Its occurrence during pregnancy is of particular concern due to its profound effects on both maternal and fetal health outcomes. Aim To study the impact of hypothyroidism in pregnancy and its correlation with feto-maternal outcomes. Methodology The present study is a two-year prospective observational study carried out at a tertiary care hospital from July 2022 to June 2024. A total of 350 antenatal women withsingleton pregnancies and without any pre-existing medical disorder were screened. Serum thyroid stimulating hormone (TSH) was evaluatedwith a cut-off value of 4.0 mIU/L. If serum TSH was abnormal, free thyroxine (FT4) and free triiodothyronine (FT3) levels were assessed. The participants were categorized into three groups designated as euthyroid, overt hypothyroidism, and subclinical hypothyroidism. TSH was periodically re-evaluated at 16 weeks, 20 weeks, and 32 weeks. All patients were monitored up to the point of delivery, allowing for comparison of outcomes across the three groups. Results The prevalence of hypothyroidism in the present study was 11.14% (n=39). Eight percent(n=28) of the cases had subclinical hypothyroidism whereas 3.14% (n=11) of cases had overt hypothyroidism. Hypothyroidism was more common in the 26-30 years age group. There was a higher incidence of hypothyroidism in multigravida patients. Lower segment caesarean section (LSCS) was the most common mode of delivery in the women with hypothyroidism. Maternal outcomes included preeclampsia, eclampsia, anemia, gestational hypertension, gestational diabetes mellitus (GDM), spontaneous miscarriage, preterm labor, oligohydramnios, etc. The fetal outcomes included intrauterine growth restriction (IUGR), low birth weight (LBW) and fetal distress. Conclusion Early diagnosis and adequate treatment of maternal hypothyroidism leads to successful pregnancy outcomes. Therefore, universal thyroid screening in pregnancy is recommended in order to preventmaternal and fetal complications.

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.

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

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

Prevalence and Clinical Correlates of Autistic Features in Patients with Initial-Treatment and Drug-Naive Schizophrenia.

A distinct subtype of schizophrenia (SCZ) is the one accompanied with autistic features (AF). This study aimed to determine the prevalence of AF in initial-treatment and drug-naive (ITDN) patients with SCZ and investigate its influencing factors. The study recruited 710 ITDN patients with SCZ. Their sociodemographic data and general clinical information were collected, and a clinical psychological assessment was performed to quantify their psychopathology and disease severity. The severity of AF was calculated based on psychopathology scores. Overall, 19.01% (135/710) patients with SCZ showed AF. Patients with AF exhibited higher levels of thyroid-stimulating hormone (TSH) (t = -4.54, P < .001) and lower levels of free triiodothyronine (FT3) and free tetraiodothyronine (FT4) (t = 2.38, P = .018; t = 3.19, P = .002) than those with AF. Binary logistic regression analysis revealed waist circumference (B = 0.03, P = .022, odds ratio (OR) = 1.03) and TSH level (B = 0.54, P < .001, OR = 1.71) as risk factors for AF, and deemed low-density lipoprotein cholesterol (B = -0.43, P = .025, OR = 0.65), fasting blood glucose (B = -0.72, P = .013, OR = 0.49), FT3 (B = -0.32, P = .034, OR = 0.73), and FT4 (B = -0.08, P = .025, OR = 0.93) levels as protective factors. Multiple linear regression analysis identified FT3 level (B = -0.85, t = -2.22, P = .028, 95%, Confidence Intervals (CI): -1.61- -0.09) as a protective factor influencing AF severity. This study reports the prevalence of AF in the target SCZ population and identifies factors associated with its development and severity. The discernment of these distinctive clinical features may facilitate formulation of tailored prevention strategies and interventions for this precise subset of SCZ patients.

Effect of electronic smoking (Vaping) on thyroid hormones level and lipid profile in men

In the last period, the market quickly became saturated with vaping devices available in many flavors and forms appealing to youth. Both traditional cigarette and e-cigarette smoking are known to potentially alter metabolic processes, including hormone production and to increase the risk of lung, heart and kidney diseases. The aim of the study was to estimate the level of thyroid hormones and lipids in the blood of young men who smoked traditional or e-cigarettes. A case-control study involved 200 men aged 24-25 years who smoked 5-7 h per day, divided into two groups (100 e-cigarette smokers and 100 cigarette smokers) and 50 healthy men who did not smoke. The levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured using COBAS E411. The levels of total cholesterol, TG, LDL and HDL were estimated spectrophotometrically. No significant changes were found in thyroid hormone levels or lipid profiles, except for an increased TG content in the group of traditional cigarette smokers compared to the control group. Whereas in the blood of e-smokers, the increase in the level of FT3 and FT4 and a significant decrease in that of TSH, as well as the elevated content of total cholesterol, TG, and LDL, were detected compared to the control group. The results obtained indicate that e-smoking affects the function of the thyroid gland and lipid metabolism. Keywords: blood samples, lipid profile, thyroid hormones, vaping

What is the impact of acute endocrine and metabolic alterations on long-term ischemic stroke prognosis: a prospective study

BackgroundPost-stroke stress can trigger instant survival but its influence on long-term ischemic stroke outcomes remains controversial. Thus, we sought to explore the associations of acute post-stroke stress evidenced by endocrine and metabolic changes, with long-term ischemic stroke outcomes.MethodsAdmissions for acute ischemic stroke within seven days of onset were prospectively recruited to determine acute endocrine and metabolic variations measured by thyroid parameters and the stress hyperglycemia ratio (SHR). Long-term ischemic stroke prognoses were followed up for one year, with the primary outcome being a modified Rankin Scale score of 3 to 6.ResultsA total of 887 patients were enrolled, of which 535 reached the final one-year followed up at a poor prognosis rate of 29.3%. Patients with poor outcomes were observed to have lower levels of free triiodothyronine (fT3) and higher levels of SHR on admission. Medium values (fT3, 4.4 mmol/L; SHR, 8 nmol/L) were used to divide patients into four gradient stress degrees. Larger acute endocrine and metabolic variations (fT3 < 4.4 mmol/L and SHR ≥ 8 nmol/L) were independently associated with a poor one-year prognosis (adjusted OR = 4.231, P = 0.001).ConclusionsHigh degrees of acute post-stroke stress may aggravate long-term ischemic stroke prognosis and timely stress-reduced interventions may help promote post-stroke living quality is equally important as survival.

Lower Free Thyroxine Levels Are Associated with Diabetic Kidney Disease in Males with Type 2 Diabetes Mellitus: An Observational Cross-Sectional Study.

Objectives: We aimed to explore the correlation between thyroid function and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 7516 T2DM patients were enrolled and grouped according to DKD status. Clinical parameters, including blood glucose parameters, thyroid function, and indicators of renal impairment, were collected and compared between the DKD and Non-DKD groups. Correlation analysis and univariate/multivariate logistic regression analyses were performed. Results: Age, T2DM duration, the use of insulin and lipid-lowering drugs, systolic and diastolic blood pressure, body mass index, and fasting blood glucose levels were greater in the DKD group than in the Non-DKD group (p < 0.001). Notably, compared with those in the Non-DKD group, patients in the DKD group had lower triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4) levels and higher thyrotropin levels (p < 0.001). Univariate logistic regression analysis revealed that T3, T4, FT3, and FT4 levels were negatively correlated with the risk of DKD. Spearman correlation analysis confirmed that T3, T4, FT3, and FT4 levels were negatively correlated with blood urea nitrogen levels, blood creatinine levels, and the urinary albumin-to-creatinine ratio (p < 0.05). Multivariate logistic regression analysis revealed that a greater FT4 level was a protective factor against DKD in T2DM patients, especially in males, with a cut-off value of 13.35 pmol/L (area under the curve = 0.604). Conclusions: Thyroid hormone levels, especially FT4 levels, were significantly negatively correlated with DKD in T2DM patients.

Effects of repetitive transcranial magnetic stimulation on cognitive function and hormone levels in early stroke patients with low thyroid hormone levels.

This study aimed to observe the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function and thyroid hormone levels in early older stroke patients with low thyroid hormone levels, and to investigate the correlation between the changes in thyroid hormone levels and the improvements in cognitive function after stroke. Forty older stroke patients who met the inclusion criteria were recruited and randomized into a magnetic-stimulation group (rTMS group) and a sham-stimulation group (Sham group). The rTMS group received low-frequency true stimulation and the Sham group received low-frequency sham stimulation. Patients' cognitive scores, activity of daily living(ADL) scores, and their levels of triiodothyronine (T3), free triiodothyronine (FT3), thyroxin (T4), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were assessed before the intervention, after the 4-week intervention, and after an additional 4 weeks of follow-up; Repeated measurement analysis of variance was used to compare the changes of each index in the two groups at different times and the correlations between patiens' cognitive function scores and their changing hormone levels were subsequently investigated. Thirty-one patients were included in this study: 16 patients in rTMS group and 15 patients in the Sham group. Repeated-measures ANOVA showed that patients' T3,FT3 and TSH levels tended to increase at 4-week intervention and at the follow up (p < 0.05), and that the rTMS group had a better effect on improving T3 than the Sham group (Fgroup = 5.319, p = 0.028); The cognitive scale at different time points in both groups showed an upward trend (p < 0.05), and the MoCA, DSF, DSB scores in the rTMS group were statistically higher than those in the Sham group at the end of the 4-week intervention and at the follow-up (p < 0.05); The changes in the levels of T3 before and after 4-week intervention were positively correlated with the changes in the MoCA scores (r = 0.638, p < 0.05). And the difference in T3 level change was positively correlated with the difference in delayed recall, attention and naming score change (r = 0.562, p < 0.05; r = 0.562, p < 0.05; r = 0.531, p < 0.05); and the difference in FT3 level change was positively correlated with the visuospatial and executive function (r = 0.514, p < 0.05). Repetitive transcranial magnetic stimulation improved cognitive function and elevated T3 levels in older patients with post-stroke cognitive dysfunction who had low thyroid hormone levels. Within the normal range, increases in T3 levels are positively correlated with changes in cognitive function.

Blood levels of zearalenone, thyroid-stimulating hormone, and thyroid hormones in patients with colorectal cancer

Mycotoxins are secondary metabolites produced by various species of mold fungi commonly found in plant materials. Zearalenone (ZEN) adversely affects the endocrine system. This study aimed to determine whether thyroid-stimulating hormone (TSH), procalcitonin (PCT), free triiodothyronine (fT3), and free thyroxine (fT4) levels are altered during natural zearalenone mycotoxicosis in patients diagnosed with sigmoid colon cancer (SCC) or colorectal cancer (CRC). A study was conducted on women and men diagnosed with SCC or CRC accompanied by the presence or absence (Patients Without ZEN – PWZ group) of ZEN in the blood. The PWZ group consisted of 17 patients with symptoms of SCC and CRC in whom ZEN and its metabolites were not detected in peripheral blood. The experimental (empirical) groups included a total of 16 SCC and CRC patients who tested positive for ZEN, but not its metabolites. TSH values in both sexes were within the upper limit of the reference range (0.27–4.2 μIU/mL) adopted by the hospital laboratory and corresponded to the upper second tertile and the lower third tertile. PCT values demonstrated that SCC and CRC were accompanied by a systemic or local bacterial infection. All mean values of fT3 were in the middle of the reference range, and the mean values of fT4 were within the upper reference limit. The fT3/fT4 prognostic marker was somewhat above the cut-off point of 0.22. These results indicate that in postmenopausal women and andropausal men who were diagnosed with SCC and CRC and were exposed to food-borne ZEN, higher values of the prognostic marker (fT3/fT4) were associated with an unfavorable prognosis. The study also revealed that the more distal the neoplastic lesions in the colon, the higher the percentage of both thyroid hormones, regardless of the patient's sex. The presence of ZEN in the diet alters thyroid activity in patients diagnosed with SCC and CRC.

Roxadustat has risks of reversible central hypothyroidism in patients undergoing hemodialysis: a single-center retrospective cohort study

Roxadustat, a hypoxia-inducible factor-prolyl hydroxylase inhibitor, has proven efficacy in the treatment of renal anemia; however, evidence indicates that it may cause central hypothyroidism. The prevalence and reversibility of roxadustat-induced central hypothyroidism in patients undergoing hemodialysis remain unclear. Here, we retrospectively analyzed thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels in 51 patients (mean age: 72.3 ± 10.7 years; 58.8% male) undergoing hemodialysis before, during, and after halting roxadustat treatment. TSH levels were significantly decreased from a median of 2.46 (interquartile range:1.60–4.51) mU/L before roxadustat treatment to 1.36 (0.72–2.41) mU/L during treatment (p < 0.001), and improved to 2.56 (1.78–4.63) mU/L after halting roxadustat (p < 0.001). Similarly, FT4 levels decreased from 1.11 (0.97–1.24) ng/dL before roxadustat treatment to 0.92 (0.71–1.03) ng/dL during treatment (p < 0.001) and improved to 1.05 (0.93–1.17) ng/dL after halting roxadustat (p < 0.001). FT3 levels were 2.04 (1.78–2.31) pg/mL before starting roxadustat, 1.97 (1.69–2.27) pg/mL during treatment, and 1.90 (1.63–2.18) pg/mL after halting roxadustat, with no significant difference between each group. Moreover, 2.0% of patients exhibited extremely low TSH levels (≤0.1 mU/L) and low TSH levels (>0.1 mU/L to <0.4 mU/L) before starting roxadustat and that percentage increased to 5.9% and 7.8%, respectively, during treatment. After roxadustat cessation, extremely low or low TSH levels recovered in all patients. Taken together, the results indicate that roxadustat can cause reversible central hypothyroidism in patients undergoing hemodialysis.