Higher FT4 Research Articles

Association of Maternal Thyroid Function with Gestational Hypercholanemia.

Background: High bile acid concentration is associated with adverse perinatal outcomes (i.e., stillbirth and preterm birth) and experimental studies indicate that thyroid hormone regulates bile acid metabolism, but this has not yet been translated to clinical data in pregnant women. We aim to explore the association of thyroid function with bile acid concentrations and the risk of gestational hypercholanemia. Methods: This study comprised 68,016 singleton pregnancies without known thyroid or hepatobiliary diseases before pregnancy and thyroid medication based on a prospective cohort. Thyroid function and serum total bile acid (TBA) were routinely screened in both early (9-13 weeks) and late pregnancy (32-36 weeks). Hypercholanemia was defined as serum TBA concentration ≥10 μmol/L. Multiple linear regression models and multiple logistic regression models were performed. Results: A higher free thyroxine (fT4) during both early or late pregnancy was associated with a higher TBA concentration and a higher risk of hypercholanemia (all p < 0.01). A higher thyrotropin (TSH) in early pregnancy was associated with a higher TBA concentration in early pregnancy (p = 0.0155), but with a lower TBA concentration during later pregnancy (p < 0.0001), and there was no association of TSH with hypercholanemia. Overt hyperthyroidism in late pregnancy was associated with a 2.12-fold higher risk of hypercholanemia ([confidence interval; CI 1.12-4.03], p = 0.021) and subclinical hyperthyroidism during later pregnancy was associated with a 1.5-fold higher risk of hypercholanemia ([CI 1.14-1.97], p = 0.0034). Sensitivity analyses indicated that a high fT4 throughout pregnancy was associated with a higher risk of hypercholanemia rather than only in early or late pregnancy. Conclusions: A higher fT4 concentration during either early or late pregnancy, but not the TSH concentration, is associated with higher TBA and a higher risk of gestational hypercholanemia. Furthermore, hyperthyroidism during pregnancy could be a novel risk factor for hypercholanemia.

Diabetic Ketoacidosis in Pregnancy: A Case Report

A 31-year-old pregnant woman complained of vomiting, shortness of breath, fever, general weakness,painful and frequent urination with sign of hypertension, tachycardia, Kussmaul breathing. Laboratorystudies showed neutrophilia, leukocytosis, hyperglycemia, hypokalemia, ketonuria, metabolic acidosis,low C-peptide, low Thyroid Stimulating Hormone, high FT4 and Staphylococcus in blood culturewas diagnosed with Diabetic Ketoacidosis, pregestational Type 1 Diabetes Mellitus, hyperemesisgravidarum, 14 weeks of pregnancy, suspect Urinary Tract Infection, hypokalemia, hypertension, andsubclinical hyperthyroidism. Besides, the patient blamed the fetus on causing the disease and financialproblem so that the patient also was diagnosed with episode of moderate depression. The patient receivedKVT1 diet therapy, fluid replacement therapy, insulin therapy, correction of hypokalemia, correctionof acidosis metabolic antibiotic and anti-hypertension. The therapies aimed to prevent maternal andfetal morbidity. Supportive psychotherapy therapy, relaxation therapy, and family psychoeducationwere also needed to improve patient’s compliant. The patient was also suggested to consult for familyplanning and glucose control before conception.

Abnormal Cardiac Repolarization in Thyroid Diseases: Results of an Observational Study.

Background: The relationship between thyroid function and cardiac disease is complex. Both hypothyroidism and thyrotoxicosis can predispose to ventricular arrhythmia and other major adverse cardiovascular events (MACE), so that a U-shaped relationship between thyroid signaling and the incidence of MACE has been postulated. Moreover, recently published data suggest an association between thyroid hormone concentration and the risk of sudden cardiac death (SCD) even in euthyroid populations with high-normal FT4 levels. In this study, we investigated markers of repolarization in ECGs, as predictors of cardiovascular events, in patients with a spectrum of subclinical and overt thyroid dysfunction.Methods: Resting ECGs of 100 subjects, 90 patients (LV-EF > 45%) with thyroid disease (60 overt hyperthyroid, 11 overt hypothyroid and 19 L-T4-treated and biochemically euthyroid patients after thyroidectomy or with autoimmune thyroiditis) and 10 healthy volunteers were analyzed for Tp-e interval. The Tp-e interval was measured manually and was correlated to serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and thyroxine (FT4).Results: The Tp-e interval significantly correlated to log-transformed concentrations of TSH (Spearman's rho = 0.30, p < 0.01), FT4 (rho = −0.26, p < 0.05), and FT3 (rho = −0.23, p < 0.05) as well as log-transformed thyroid's secretory capacity (SPINA-GT, rho = −0.33, p < 0.01). Spearman's rho of correlations of JT interval to log-transformed TSH, FT4, FT3, and SPINA-GT were 0.51 (p < 1e−7), −0.45 (p < 1e−5), −0.55 (p < 1e−8), and −0.43 (p < 1e−4), respectively. In minimal multivariable regression models, markers of thyroid homeostasis correlated to heart rate, QT, Tp-e, and JT intervals. Group-wise evaluation in hypothyroid, euthyroid and hyperthyroid subjects revealed similar correlations in all three groups.Conclusion: We observed significant inverse correlations of Tp-e and JT intervals with FT4 and FT3 over the whole spectrum of thyroid function. Our data suggest a possible mechanism of SCD in hypothyroid state by prolongation of repolarization. We do not observe a U-shaped relationship, so that the mechanism of SCD in patients with high FT4 or hyperthyroidism seems not to be driven by abnormalities in repolarization.

Abstract 13044: Hemodynamic Changes In Neonates Born To Mothers With Graves’ Disease

Purpose: Cardiac insufficiency is a major morbidity in neonatal hyperthyroidism. It is therefore important to assess the hemodynamics in neonates born to mothers with Graves’ disease (GD). This study prospectively evaluated the hemodynamic changes in neonates born to mothers with GD. Methods: The subjects of this study were neonates born to mothers with GD who became pregnant between April 2006 and May 2018 and visited Hamamatsu University Hospital. This study included two groups: neonates born to mothers consistently negative for thyroid-stimulating hormone (TSH) receptor antibody (TRAb) in the third trimester of pregnancy, and neonates born to mothers with at least one positive TRAb assay in the third trimester of pregnancy. The serum levels of TSH, free triiodothyronine (FT3), free thyroxine (FT4), and N-terminal-pro-B-type natriuretic peptide (NT-proBNP), the cardiac output, and cardiac index (CI) evaluated by echocardiography were compared between the two groups at several postnatal points (day of delivery and 5, 10, and 30 days of life). Results: Overall, 80 newborns were enrolled. Thirty-six neonates were born to mothers with GD who were positive for TRAb, and 44 were born to mother negative for TRAb. During the study period, four newborns (11.1%) in the TRAb-positive group required treatment with ATD for overt neonatal hyperthyroidism. Eight newborns (22.2%) in the TRAb-positive group were diagnosed with subclinical hyperthyroidism based on findings of laboratory tests in the absence of any clinical symptoms. One neonate in the TRAb-positive group had subclinical hypothyroidism at birth, but there were no symptoms, so no treatment was required. The TRAb-positive newborns had higher FT4 levels and CI on Day 5 (both p &lt; 0.05) and higher FT3 (p &lt; 0.05) and FT4 levels (p &lt; 0.01) and CI (p &lt; 0.01) but lower TSH levels (p &lt; 0.05) on Day 10 than the TRAb-negative newborns. The TRAb-positive newborns had significantly higher NT-proBNP levels on Days 5 (median 752 vs. 563 pg/mL, p = 0.034) and 10 (median 789 vs. 552 pg/mL, p = 0.002) than the TRAb-negative newborns. Conclusions: Hemodynamic changes in neonates born to TRAb-positive mothers with GD resulted in a higher CI and NT-proBNP levels than in those with TRAb-negative mothers from postnatal days 5 to 10.

The ratio of HDL-C to apoA-I interacts with free triiodothyronine to modulate coronary artery disease risk

ObjectiveIn the present work, research was carried out to explore the correlation between the high-density lipoprotein cholesterol (HDL-C)/apolipoprotein A-I (apoA-I) ratio and serum free triiodothyronine (FT3) and their interaction on the risk of coronary artery disease (CAD).MethodsA total of 1686 patients who underwent selective coronary angiography were enrolled in the present study, including 1279 patients with CAD and 407 controls. The subjects were divided into three groups according to tertiles of the HDL-C/apoA-I ratio. Binary logistic regression analysis was used to evaluate the interaction of the HDL-C/apoA-I ratio and FT3 level with the risk of CAD.ResultsThe group with the highest HDL-C/apoA-I ratio had the lowest levels of FT3. Multiple linear regression analysis showed that the HDL-C/apoA-I ratio was negatively associated with FT3 after adjusting for age, sex, body mass index (BMI), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apoB), FT4 and TSH. A logistic regression model showed that a high HDL-C/apoA-I ratio (> 0.89 mmol/g) and high FT3 levels (> 4.5 pmol/l) were protective factors for CAD. Patients with a lower HDL-C/apoA-I ratio (≤ 0.89 mmol/g) and lower FT3 level (≤ 4.5 pmol/l) had an increased risk of CAD (OR = 2.441, P = 0.000, S = 1.13, AP = 0.068, AP* = 0.116, RERI = 0.168).ConclusionsThe HDL-C/apoA-I ratio was negatively associated with FT3, and there was a significant interaction between the HDL-C/apoA-I ratio and FT3 with the risk of CAD.

Low FT3 is an independent marker of disease severity in patients hospitalized for COVID-19.

AimTo study the prevalence of thyroid dysfunction and its association with disease severity in hospitalized patients of coronavirus disease-19 (COVID-19).MethodsIn this retrospective cohort study, thyroid function tests (TFT) of 236 hospitalized patients of COVID-19 along with demographic, comorbid, clinical, biochemical and disease severity records were analysed. Patients were divided into previous euthyroid or hypothyroid status to observe the effect of prior hypothyroidism on the severity of COVID-19.ResultsTFT abnormalities were common. Low free T3 (FT3), high thyroid-stimulating hormone (TSH) and low TSH were seen in 56 (23.7%), 15 (6.4%) and 9 (3.8%) patients, respectively. The median levels of TSH (2.06 vs 1.26 mIU/mL, P = 0.001) and FT3 (2.94 vs 2.47 pg/mL, P < 0.001) were significantly lower in severe disease. Previous hypothyroid status (n = 43) was associated with older age, higher frequency of comorbidities, higher FT4 and lower FT3. TFT did not correlate with markers of inflammation (except lactate dehydrogenase); however, FT3 and TSH negatively correlated with outcome severity score and duration of hospital stay. Cox regression analysis showed that low FT3 was associated with severe COVID-19 (P = 0.032, HR 0.302; CI 0.101–0.904), irrespective of prior hypothyroidism.ConclusionsFunctional thyroid abnormalities (low FT3 and low TSH) are frequently seen in hospitalized patients of COVID-19. Although these abnormalities did not correlate with markers of inflammation, this study shows that low FT3 at admission independently predicts the severity of COVID-19.

Thyroid Status and Brain Circulation: The Rotterdam Study.

ContextWhether thyroid dysfunction is related to altered brain circulation in the general population remains unknown.ObjectiveWe determined the association of thyroid hormones with different markers of brain circulation within community-dwelling elderly people.MethodsThis was a population-based study of 3 subcohorts of the Rotterdam Study, starting in 1989, 2000, and 2006. A total of 5142 participants (mean age, 63.8 years; 55.4% women), underwent venipuncture to measure serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4). Between 2005 and 2015, all participants underwent phase-contrast brain magnetic resonance imaging to assess global brain perfusion (mL of blood flow/100 mL of brain/minute). Arteriolar retinal calibers were assessed using digitized images of stereoscopic fundus color transparencies in 3105 participants as markers of microcirculation. We investigated associations of TSH, FT4 with brain circulation measures using (non)linear regression models.ResultsFT4 (in pmol/L) levels had an inverse U-shaped association with global brain perfusion, such that high and low levels of FT4 were associated with lower global brain perfusion than middle levels of FT4. The difference in global brain perfusion between high FT4 levels (25 pmol/L) and middle FT4 levels (FT4 = 15 pmol/L; P nonlinearity = .002) was up to –2.44 mL (95% CI –4.31; –0.56). Higher and lower levels of FT4, compared with middle FT4 levels, were associated with arteriolar retinal vessels (mean difference up to –2.46 µm, 95% CI –4.98; 0.05 for lower FT4).ConclusionThese results suggest that thyroid dysfunction could lead to brain diseases such as stroke or dementia through suboptimal brain circulation that is potentially modifiable.

Iodine Nutrition and Iodine Supplement Initiation in Association with Thyroid Function in Mildly-to-Moderately Iodine-Deficient Pregnant and Postpartum Women

BackgroundWhereas the adverse effects of severe iodine deficiency during pregnancy are well documented, the effects of mild-to-moderate deficiency are not well established. ObjectivesWe aimed to explore whether iodine nutrition and timing of iodine supplement initiation are associated with thyroid function in pregnant and postpartum women. MethodsIn this cohort study, 137 pregnant women were enrolled and followed up at gestational weeks (GWs) 18 and 36, and 3 and 6 mo postpartum. Thyroid function tests [thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4)], urinary iodine and creatinine concentration (UIC:Cr), and iodine intake (including iodine supplement use) were measured at each time point. The associations between thyroid hormone concentrations and UIC:Cr, iodine intakes, and iodine supplement use were estimated using multiple generalized estimating equation models. ResultsThe median UIC at GW18 was 94 μg/L, indicating mild-to-moderate iodine deficiency. UIC:Cr (β; 95% CI) per 100 μg/g was negatively associated with fT3 (−0.191; −0.331, −0.051) and fT4 (−0.756; −1.372, −0.141) concentrations. Iodine intake (β; 95% CI) per 100 μg/d was positively associated with TSH (0.099; 0.022, 0.177), and negatively associated with fT3 (−0.084; −0.0141, −0.027) and fT4 (−0.390; −0.599, −0.182) concentrations. Compared with no use of supplement, those initiating an iodine-containing supplement prepregnancy and continuing through pregnancy had lower TSH (estimated means) (1.35 compared with 1.68 mIU/L, P = 0.021), and higher fT3 (4.48 compared with 4.28 pmol/L, P = 0.035) and fT4 (15.2 compared with 14.4 pmol/L, P = 0.024) concentrations. ConclusionsLower iodine availability during pregnancy and postpartum was associated with lower TSH, and higher fT3 and fT4 concentrations. The use of an iodine-containing supplement that was initiated prepregnancy and continuing through pregnancy was associated with lower TSH, and higher fT3 and fT4 concentrations, which may suggest improved thyroid function. These findings support the notion that optimization of iodine intake should start before pregnancy.This trial was registered at clinicaltrials.gov as NCT02610959.

The Association of Thyroid Hormones With Cardiogenic Shock and Prognosis in Patients with ST Segment Elevation Myocardial Infarction (STEMI) Treated with Primary PCI

BackgroundCardiogenic shock (CS) is the leading cause of the death in patients with ST elevation myocardial infarction (STEMI). Thyroid dysfunction is related to prognosis of patients with myocardial infarction. Hence, the aim of this study is to explore the relationship between thyroid hormones (free triiodothyronine [FT3] and free thyroxine [FT4]) and CS. MethodsA total of 1270 patients with STEMI treated with percutaneous coronary intervention (PCI) were consecutively enrolled in our study. Patients were classified into two groups according to with or without CS during hospitalization. Stepwise multivariate logistic analysis was conducted to investigate the association of thyroid hormones and CS. Restricted cubic spline method was employed to further explore the relationship between CS and thyroid hormones. ResultsPatients who developed CS (n=103) had lower FT3 and higher FT4 upon admission. The stepwise logistic analysis showed both FT3 (P=0.038) and FT4 (P=0.024) were independently related to CS. Restricted cubic splines indicated that lower FT3 (<2.25 pg/ml) or higher FT4 (>1.25 ng/dl) were correlated with higher prevalence of CS. Over 2.5 years’ follow-up, patients (n=294) with low FT3 (<2.85 pg/ml) and high FT4 (>=0.88 ng/dl) had the highest all-cause mortality (18.2%), whereas patients (n=293) with high FT3 and low FT4 had the lowest all-cause mortality (3.8%) (P for trend <0.0001). ConclusionsBoth FT3 and FT4 were independently associated with in-hospital CS development in patients with STEMI treated with PCI. Patients with lower range of FT3 and upper range of FT4 had the worst outcomes in long-term follow-up.

Correlation between inflammatory parameters and pituitary-thyroid axis in patients with COVID-19.

PurposeInflammation plays a critical role in the progression of COVID-19. Nonthyroidal illness syndrome (NTIS) has been increasingly recognized in affected patients. We aim to evaluate the correlation of thyroid hormones with markers of inflammation and association with disease outcome in hospitalized patients with COVID-19, and in two profiles of NTIS (low T3-normal/low FT4 vs. low T3-high FT4).Methodsconsecutive patients admitted to a nonintensive care unit for COVID-19 were recruited. Infection was mild in 22%, moderate in 27.1% and severe in 50.8%; 7.41% died. T4, T3, FT4, FT3, and their ratios (T3/T4, FT3/FT4) were correlated with albumin, ferritin, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-dimer.ResultsFifty five patients (50.9% men, median age 56 years) were included. Albumin correlated positively with T3 and hormones ratios, but negatively with FT4. T3, FT3, T3/T4, and FT3/FT4 correlated inversely with ferritin, fibrinogen, ESR, CRP, LDH, and D-dimer. FT4 showed direct correlation with fibrinogen and ESR. T3/T4 was lower in severe compared to mild/moderate disease [7.5 (4.5–15.5) vs. 9.2 (5.8–18.1); p = 0.04], and lower in patients who died than in those discharged [5 (4.53–5.6) vs. 8.1 (4.7–18.1); p = 0.03]. A low T3/high FT4 profile was associated with lower albumin, higher ferritin, and severity.ConclusionIn this cohort, thyroid hormones correlated with inflammation and outcome. T3 and T3/T4 correlated inversely with inflammatory markers; a low T3/T4 ratio was associated with severity and poor prognosis. Patients with low T3 but high FT4 had higher ferritin, lower albumin, and more severe disease at presentation.

The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder

The relationship between thyroid function and depression has long been recognized, but little is known about the effect of thyroid function on the risk of readmission after hospitalization for major depressive disorder (MDD). This retrospective cohort study was aimed to explore the effect of thyroid function on psychiatric readmission after hospitalization for MDD. Data was derived from electronic medical records (EMR) of the Shanghai Mental Health Center (SMHC), Shanghai, China. Univariate and multivariate logistic regression analyses were conducted in subjects aged ≥ 18 years who had been hospitalized for MDD between January 1, 2007, and May 31, 2019. Of the 1803 eligible patients, 85 and 132 patients experienced psychiatric readmission within 90 days and 180 days after discharge respectively. Multivariate analyses showed that serum FT3 level (aOR=1.271; 95%CI=1.051-1.537) and comorbidity of thyroid disease (aOR=2,179; 95%CI=1.136-4.179) was independently associated with the risk of 90-day and 180-day readmission respectively. These findings indicated that high serum FT3 levels and comorbidity of thyroid disease could increase the risk of readmission after hospitalization for MDD. It is warranted to provide routine assessment and intervention of the thyroid function during the treatment of depression so as to prevent re-hospitalization.

Thyroid testing paradigm switch from thyrotropin to thyroid hormones\u2014Future directions and opportunities in clinical medicine and research

PurposeRecently published papers have demonstrated that particularly in untreated individuals, clinical parameters more often associate with thyroid hormone, particularly free thyroxine (FT4), levels than with thyrotropin (TSH) levels. Clinical and research assessments of the thyroid state of peripheral tissues would therefore be more precise if they were based on FT4 levels rather than on TSH levels. In this paper we describe implications of, and opportunities provided by, this discovery.ConclusionsThe FT4 level may be the best single test of thyroid function. The addition of free triiodothyronine (FT3) and TSH levels would further enhance test sensitivity and distinguish primary from secondary thyroid dysfunction respectively. There are opportunities to reconsider testing algorithms. Additional potential thyroidology research subjects include the peripheral differences between circulating FT4 and FT3 action, and outcomes in patients on thyroid replacement therapy in terms of thyroid hormone levels. Previously performed negative studies of therapy for subclinical thyroid dysfunction could be repeated using thyroid hormone levels rather than TSH levels for subject selection and the monitoring of treatment. Studies of outcomes in older individuals with treatment of high normal FT4 levels, and pregnant women with borderline high or low FT4 levels would appear to be the most likely to show positive results. There are fresh indications to critically re-analyse the physiological rationale for the current preference for TSH levels in the assessment of the thyroid state of the peripheral tissues. There may be opportunities to apply these research principles to analogous parameters in other endocrine systems.

Associations of exposure to cadmium, antimony, lead and their mixture with gestational thyroid homeostasis

Maintaining thyroid homeostasis during pregnancy is vital for fetal development. The few studies that have investigated associations between metal exposure and gestational thyroid function have yielded mixed findings. To evaluate the association of exposure to a mixture of toxic metals with thyroid parameters in 824 pregnant women from the Rhea birth cohort in Crete, Greece. Concentrations of three toxic metals [cadmium (Cd), antimony (Sb), lead (Pb)] and iodine were measured in urine using inductively coupled plasma mass spectrometry and thyroid hormones [Thyroid Stimulating Hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3)] were measured in serum in early pregnancy. Associations of individual metals with thyroid parameters were assessed using adjusted regression models, while associations of the metal mixture with thyroid parameters were assessed using Bayesian Kernel Machine Regression (BKMR).Women with high (3rd tertile) concentrations of urinary Cd, Sb and Pb, respectively, had 13.3 % (95%CI: 2.0 %, 23.2 %), 12.5 % (95%CI: 1.8 %, 22.0 %) and 16.0 % (95%CI: 5.7 %, 25.2 %) lower TSH compared to women with low concentrations (2nd and 1st tertile). In addition, women with high urinary Cd had 2.2 % (95%CI: 0.0 %, 4.4 %) higher fT4 and 4.0 % (95%CI: −0.1 %, 8.1 %) higher fT3 levels, and women with high urinary Pb had 4 % (95%CI: 0.2 %, 8.0 %) higher fT3 levels compared to women with low exposure. The negative association of Cd with TSH persisted only when iodine sufficiency was unfavorable. BKMR attested that simultaneous exposure to toxic metals was associated with decreased TSH and increased fT3 and revealed a potential synergistic interaction of Cd and Pb in association with TSH. The present results suggest that exposure to toxic metals even at low levels can alter gestational thyroid homeostasis.

Management in Mitral Valve Replacement with Pulmonary Hypertension and Thyroid Storm: A Case Report

Introduction: We reported a case of patient after mitral valve replacement (MVR) with pulmonary hypertension (PH) and thyroid storm that is rare, but life-threatening condition. Case Illustration: A 57-year-old-male with a subclinical hyperthyroidism underwent MVR due to severe mitral regurgitation (MR) and high possibility for PH. He showed atrial fibrillation with normal left ventricular ejection fraction (LVEF). In the intensive care unit (ICU), four hours postoperatively, he developed thyroid storm with heart rate of 226 times/min, temperature 39oC, and thyroid function showed low TSH (&lt;0.05 uIU/mL), high fT4 (25.4 pmol/L), and high T3 (3.3 nmol/L). He was administered with propranolol, propylthiouracil, hydrocortisone, and lugol. Discussion: Trauma of cardiac surgery might trigger thyroid storm in this patient. The post-operative period represented a high-risk time for PH patients, moreover with thyroid storm. Therapy for thyroid storm was multimodal, including anti-thyroid, beta blockers, iodine, and glucocorticoid. Hemodynamic goals were avoidance of elevation in pulmonary vascular resistance (PVR), avoidance of myocardial depressants and maintenance of systemic vascular resistance (SVR), myocardial contractility and preload. Conclusion: Thyroid storm and PH complicating MVR was rare, but life-threatening. Comprehensive management could decrease morbidity and mortality of thyroid storm. Keywords: mitral valve replacement surgery; pulmonary hypertension; thyroid storm

Subacute Thyroiditis During the SARS-CoV-2 Pandemic.

ContextAcute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been related to subacute thyroiditis (SAT).ObjectiveWe compared SAT cases during the SARS-CoV-2 pandemic to those observed in the previous years.MethodsA cross-sectional, retrospective study was conducted at the Endocrinology Unit of University Hospital of Pisa, Italy. We included all patients observed from January 2016 to December 2020 because of an untreated SAT, who had developed the disease within 15 days prior to the visit. SAT cases from 2016 to 2019 (N = 152) are referred to as pre-SARS-CoV-2, while 2020 SAT patients are classified as pos-SARS-CoV-2 (N = 18) or neg-SARS-CoV-2 (N = 28), according to positive or negative SARS-CoV-2 testing performed up to 45 days from SAT onset.ResultsWhile during 2016-2019, most SAT cases were observed in the third quarter, in 2020, 2 peaks were seen, superimposable to the SARS-CoV-2 outbreaks in the second and the fourth quarters. In the second and fourth quarters of 2020, we observed higher levels of free thyroxine (FT4), C-reactive protein (CRP), and thyroglobulin (Tg) compared with the same quarters of the years 2016-2019. Pos-SARS-CoV-2 patients had higher FT4 (28.4 vs 24.1 nmol/L), CRP (8.5 vs 3.6 mg/L), and Tg (155 vs 60 µg/L) (P < 0.05 for all) and more frequently had hypothyroidism (13/15 vs 30/152 at 3 months) (P < 0.001) than pre-SARS-CoV-2 patients. Neg-SARS-CoV-2 patients showed a clinical picture intermediate between the other 2 groups.ConclusionThe SARS-CoV-2 pandemic has caused a shift in the annual timing and severity of SAT cases.

The Increased Prevalence of Thyroid Dysfunction in First Trimester Pregnancy in a Tertiary Care Centre and the Significance of Universal Screening

Introduction: Thyroid disorder is the second most common endocrine disorder in pregnancy, after diabetes. The present study was designed to assess the prevalence of thyroid disorder in first trimester in pregnant women in a tertiary care centre. Materials and Methods: This was a descriptive cross sectional study in which thyroid hormone levels and Anti- TPO antibodies levels were measured in one hundred and forty two pregnant women. The analytes were measured using Cobas e 411 autoanalyzer which is based on ECLIA principle. Results: From our study we found that 51.4% of the pregnant women had thyroid dysfunction. 40.9% of the pregnant women were found to have subclinical hypothyroidism with high TSH levels but normal FT4 levels. Hypothyroidism is diagnosed to be much more common that hyperthyroidism in pregnant women. In addition, 10.5% of our study population was found to have autoantibodies to thyroid peroxidase enzyme. Conclusion: The increased prevalence of thyroid disorders makes it necessary to start universal screening of pregnant women for thyroid disorders which would help in the early identification and rectification of thyroid disorders in pregnant women. Further, early screening and treatment of thyroid disorders would prevent to a large extent the incidence of thyroid disorders in the newborns, which is one of the leading causes of mental retardation.

Predictive factors for recurrence in patients with Graves’ Disease following treatment with methimazole

Graves’ disease (GD) contributes for 60–80% of all hyperthyroidism. Methimazole is the first line drug and most commonly used as antithyroid drug (ATD). However, the relapse rate following ATD therapy is 40–50%. The aimed of this study was to evaluate long-term ATD treatments and to identify prognostic factors that contribute to GD recurrence. A total of 46 GD patients who referred to the Endocrinology Clinic, Dr. Sardjito General Hospital, Yogyakarta between January 2016 and December 2018 with thyrotropin receptor antibody (TRAb) tested and treated with methimazole were included in this study. Size of goiter was measured based on WHO grading system and eye syndrome based on NOSPEC score system. Patients were classified into recurrence and remission groups based on TRAb evaluation at 12 month following treatment. Result of thyroid hormone level (FT4) and subject characteristic as predictive factors observed at 3-, 6- and 12-month post- treatment were compared and analyzed. Among 46 patient involved in this study, 23 patients demonstrated remission of hyperthyroidism based on TRAb evaluation at 12-month. The size of thyroid at onset of disease in 30 (65%) patients was grade 2 or above (p<0.05). Free FT4 levels at the end of observation (12 month) was 1.9±0.6 ng/ dL in recurrent and 1.4±0.5 ng/dL in remission group (p<0.05). TRAb levels at early of study was higher in the recurrent group (p<0.05). Logistic regression analysis demonstrated that thyroid size, FT4 level, and TRAb at diagnosis were associated with recurrencies. In conclusion, GD patients with large thyroids size, high TRAb levels, and high FT4 level at the onset of disease tended to fail to respond to ATD and were associated with recurrence incidence.

The relationship between thyroid dysfunction during pregnancy and gestational diabetes mellitus.

Thyroid dysfunction and gestational diabetes (GDM) are the two most common endocrine disorders that can be observed during pregnancy. Thyroid function abnormalities can be associated with insulin resistance (IR) and changes in carbohydrate metabolism. In patients with type 1 diabetes, thyroid function is usually evaluated to rule out abnormalities within a second autoimmune disease. Patients with type 2 diabetes are tested for thyroid function in view of the associated weight gain, IR, and changes in metabolism. The question arises: Should we also look for thyroid dysfunction in patients with gestational diabetes? The aim of the study was to determine whether there are abnormalities in thyroid hormone levels in pregnant women with gestational diabetes. A monocentric, retrospective study of the Dr Shterev Hospital electronic database was performed. We analysed the medical records of 662 pregnant women, divided in two groups - 412 with GDM and 250 with normal glucose tolerance, who gave birth in the period 2017-2019. Gestational diabetes mellitus in the study group was diagnosed with a 2-h, 75-g oral glucose tolerance test (OGTT) using the International Federation of Gynaecology and Obstetrics (FIGO) and American Diabetes Association (ADA) criteria. We analysed the mean serum concentrations of thyroid-stimulating hormone (TSH); free thyroxine (FT4), free triiodothyronine (FT3), FT3:FT4 ratio, fasting plasma glucose, age and body mass index in both groups. The groups were compared using the Mann-Whitney U-test. In patients who developed GDM, significantly higher concentrations of TSH (p < 0.0001) and FT3 (p < 0.0001), lower concentrations of FT4 (p < 0.0001), and higher FT3:FT4 ratios (p < 0.0001) were found. The results of this pilot retrospective series reveal that high-normal to high concentration of TSH and low-normal to low concentration of FT4 as well as high FT3:Ft4 ratio could indicate increased risk of development of GDM.

Correlation of dietary iron intake and serum iron with thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels in adult hyperthyroid patients.

National Baseline Health Research 2013 showed that there were 706,757 (0.4%) hyperthyroid patients in Indonesia. Hyperthyroidism is characterized by abnormal thyroid stimulating immunoglobulin (TSI) which causes low TSH and high FT4 levels. Hyperthyroid patients have a decrease of serum iron levels due to acute phase reactions of hyperthyroidism. This study aimed to analyze the correlation between dietary iron intake and serum iron with TSH and FT4 levels in adult hyperthyroid patients. This study was conducted in February-July 2020 at the Clinic of Magelang Health Research and Development Center. Sampling of this cross sectional study was based on inclusion criteria in order to obtain 50 adult hyperthyroid patients. Dietary iron intake was collected with 2×24h dietary recall, serum iron was measured with colorimetric analysis, the levels of TSH and FT4 were measured by ELISA. The collected data were analyzed using Spearman correlation and multivariate linear regression with 95% confidence level. Deficiencies of dietary iron intake was found in 20 hyperthyroid patients (40%). Low serum iron levels were found in 10 hyperthyroid patients (20%). Spearman correlation analysis showed that dietary iron intake had a negative correlation with TSH (r=-0.294; p<0.05) but did not correlate with FT4 (r=-0.142; p>0.05), while serum iron didn't associated with both TSH (r=0.110; p>0.05) and FT4 (r=0.142; p>0.05). Furthermore, regression analysis showed that dietary iron intake, serum iron, phytate, and thyrozol intake correlate with TSH levels (R square=0.193; p<0.05) and FT4 levels (R square=0.341; p<0.05), but there were no independent association between dietary iron intake and serum iron with TSH and FT4 levels (p>0.05). Intake and serum of iron didn't correlate with TSH and FT4 levels in adult hyperthyroid patients.

Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries.

BackgroundLow free triiodothyronine (fT3) level is strongly associated with poor prognosis in various patient populations. However, the role of fT3 in the risk of clinical outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been studied. Our study aimed to evaluate the association between low fT3 levels and the clinical outcomes of MINOCA patients.MethodsA total of 218 MINOCA patients without a history of thyroid disease were enrolled in the study. Demographic, baseline clinical data, thyroid hormones, and other biochemical parameters were assessed in all patients. According to the fT3 levels, the present study was classified into two groups: the low fT3 group (fT3<3.5 pmol/L) and the normal fT3 group (fT3 3.5-6.5 pmol/L). The endpoint of the study was major adverse cardiac events (MACE).ResultsFifty-nine patients were in the low fT3 group and 159 patients were in the normal fT3 group. Over the two years of follow-up, 36 MACE have occurred. The occurrence of MACE was higher in the low fT3 group compared with normal fT3 group (25.4% vs 13.2%; P=0.031). Kaplan-Meier survival curves showed a significantly increased risk of MACE in patients with low fT3 (log-rank P=0.027). Multivariable logistic regression analysis stated that high fT3 was independently associated with lower risk of MACE after two years of follow up (OR, 0.623; 95% CI, 0.399- 0.972; P=0.037).ConclusionLow fT3 levels were significantly associated with increased risk of MACE in patients with MINOCA. This finding suggests that the fT3 levels may serve as a potential biomarker in risk stratification of MINOCA patients.