High TSH Levels Research Articles

A screening study of high-risk groups for liver fibrosis in patients with metabolic dysfunction-associated fatty liver disease

The purpose of this study was to explore the correlation between Hashimoto’s thyroiditis and Metabolic dysfunction-associated fatty liver disease (MAFLD), and at the same time to screen high-risk groups for liver fibrosis in MAFLD, find out the high-risk related indicators. The physical examination population was included as the study subjects and was grouped according to the diagnostic criteria for MAFLD. APRI > 1 or NFS > 0.676 or FIB-4 > 2.67were used to assess people at high risk of liver fibrosis, and logistic regression analysis was used to identify risk factors associated with high risk of liver fibrosis in MAFLD. ROC curves are used to look for indicators of diagnostic value. The proportion of people with Hashimoto’s thyroiditis was lower in the MAFLD group. The MAFLD high-risk group for liver fibrosis had higher TSH levels, lower FT3 and FT4 levels, higher TGAB levels, and differences in biochemical markers. Age, BMI, FBG, and AST are risk factors for the high risk of liver fibrosis in MAFLD patients. ROC curve analysis showed that the AUC of age was 0.741 (0.721–0.761), and the optimal stage value was 57.5 years, while the AUC of AST was 0.729 (0.707–0.751), and the optimal cut-off value was 39.5 U/L. Age, BMI, FBG, and AST are risk factors for the high risk of liver fibrosis in MAFLD patients.The age is greater than or equal to 57.5 years, or the AST is greater than or equal to 39.5 U/L, indicating that the MAFLD patients are at high risk of liver fibrosis.

7982 Is there a Connection between Alpha Thalassemia and Thyroid Disorders

Abstract Disclosure: W. Akhter: None. V. Taqi: None. J.L. Gilden: None. IntroductionA number of case reports suggest an association between thalassemia and autoimmune diseases through specific mutations and molecular pathways. An example is thyroid disease in thalassemia patients. Due to factors such as age, ethnicity and treatment protocol differences, the frequency of hypothyroidism in thalassemia patients is a wide range of 4 to 29% based on free T4 and TSH levels. Subclinical hypothyroidism is more common in thalassemia patients as compared to overt hypothyroidism. 90% of morbidity and mortality in B-Thalassemia patients is attributed to iron overload, anemia and hypoxia. Understanding this possible mechanism helps guide treatment and monitoring. Case PresentationWe present the case of a 26-year-old African American with Haitian ethnicity female, who upon routine testing was found to have a very high TSH level of 79.084 uIU/ml (nl=0.550-4.780 uIU/ml) for which 125 mcg of Levothyroxine was started, and then she was referred to the endocrine clinic. Past history was notable for sickle cell trait and alpha thalassemia trait. Patient stated that at age 12, she developed fatigue and low energy and was found to have hyperthyroidism which was treated with RAI ablation. After that, no follow up or lab tests were done until recently. The patient denied symptoms of hypo or hyperthyroidism or enlargement of the thyroid gland. She denied any family history of thyroid disorders. After presenting to the endocrine clinic a few days later, she was diagnosed with postprocedural hypothyroidism and the same dose of levothyroxine was continued. Physical exam was unremarkable and no thyromegaly was appreciated on exam. Labs were notable for decreased Hemoglobin of 11.4 g/dL (nl=12-16 g/dL) and CMP was unremarkable except low glucose of 65 mg/dL (nl=70-99 mg/dL). The patient’s most recent labs after 8 weeks of taking Levothyroxine were notable for TSH of 14.65 uIU/ml (nl=0.550-4.780 uIU/ml) and free T4 of 1 ng/dL (nl= 0.89-1.76 ng/dL) and the patient admitted to having still no thyroid symptoms and a little more energy. ConclusionEndocrinopathies are common complications of thalassemia with hypothyroidism being the second most common endocrine disorder in thalassemia patients after hypogonadism, reported in 5.6-17% of patients. In thalassemia patients, endocrine disorders have to be managed as early as possible. Therefore, it is recommended that an endocrine evaluation be carried out in thalassemia patients at a young age.Monitoring for glucose homeostasis, hypothyroidism and hypoparathyroidism is also warranted. Physicians caring for thalassemia patients should perform routine screening for and treat thyroid dysfunction appropriately. Reference: De Sanctis V, Soliman AT, Canatan, et al.. Thyroid Disorders in Homozygous β-Thalassemia: Mediterr J Hematol Infect Dis. 2019 May 1;11(1):e2019029. doi: 10.4084/MJHID.2019.029. PMID: 31205633; PMCID: PMC6548211. Presentation: 6/2/2024

Prevalence of high neonatal thyroid stimulating hormone levels as an indicator of iodine deficiency in the province of La Pampa: An epidemiological analysis.

Introduction. Iodine plays a key role in human metabolism, growth, and development. During pregnancy and childhood, the demand for this micronutrient increases notably. Increased neonatal thyroid stimulating hormone (nTSH) levels, defined as nTSH ≥ 5 mIU/L, are a marker of iodine deficiency in a population if its prevalence is higher than 3%. Objective. To establish the prevalence of nTSH ≥ 5 in La Pampa in the 2021-2022 period, analyze its correlation with different variables, and compare it with data from a historical cohort. Population and methods. Cross-sectional, descriptive-analytical study in a population of newborn infants born in the 5 health regions of the province of La Pampa in 2021 and 2022. Results. Of the 5778 assessed newborn infants, 9.6% had nTSH levels ≥ 5 mIU/L. It was reported that 70.4% of these measurements were done after the third day of life. No significant differences were observed in the frequency of high nTSH levels by year of birth, birth weight, or days until sample collection. A higher prevalence was observed among male infants (10.6% versus 8.5%; p = 0.007) and term infants (9.8% versus 6.6%; p = 0.02). The prevalence of high TSH levels was superior to that observed in the 2001-2002 cohort. Conclusions. The prevalence of high nTSH levels in La Pampa during 2021 and 2022 was 9.6%, suggesting the presence of mild iodine deficiency in the population of this province, higher that what had been reported 2 decades ago.

Evaluation of Thyroid Dysfunction among Libyan Patients with Type-2 Diabetes Mellitus

Thyroid disorders are more common in people with diabetes compared to the general population. This study aimed to evaluate the prevalence of thyroid disorders in Libyan patients with type 2 diabetes mellitus (T2DM) and the association between thyroid dysfunction and T2DM parameters. The current study included a total of 50 participants: 40 with T2DM, and 10 healthy volunteers. They were divided into three groups: G1 (10 healthy controls), G2 (30 patients with T2DM [DM]), and group 3 [10 patients with T2DM and thyroid dysfunction (DM+TD)]. The average age of control and patients was 33.1±10.9 years and 55.3±12.8 years, respectively. The diabetes profile (FBS, RBS, and HbA1c), and thyroid profile (TSH, FT3, and FT4) of each participant were assessed. The levels of FBG, RBS, and HbA1c showed a highly significant (P=0.000) increase in the DM and DM+TD groups compared to the healthy control group. Additionally, the findings indicated that the majority of the participants with diabetes (75%) had normal thyroid function, while 25% had thyroid disorders., Among the patients with thyroid disorders, 10% had subclinical hypothyroidism, 7.5% nonthyroidal illness syndrome (NITS), and 7.5% exhibited high levels of TSH, FT4, and FT3.,. The prevalence of thyroid disorders was higher in women (22.5%) than in men (2.5%). None of the diabetic patients showed hyperthyroidism in this study. The study concluded that 25% of patients with type 2 diabetes mellitus had a thyroid disorder, and subclinical hypothyroidism was more prevalent. Also, the current study showed that female gender and family history of thyroid disorders are important risk factors.

Generalized edema on a hypothyroid patient with incorrect use of levothyroxine

Hypothyroidism is manifested when thyroid hormone isn’t enough for body's requirement and is usually diagnosed by high levels of TSH and low levels of fT4. Generalized edema is commonly associated with cardiovascular, hepatic, or renal diseases and is quite uncommon to see in hypothyroidism; the edema is usually generalized when the disease is severe. Generalized edema in hypothyroidism is traditionally accompanied with more serious hypothyroid symptoms, which is not the case here. It is discussed why the other common causes of generalized edema such as heart failure, advanced kidney disease, nephrotic syndrome, and cirrhosis do not fit here. And we emphasize the importance of thyroid hormone and drug use evaluation. In our case, a 60-year-old man comes with chief complaint of generalized swelling of his body and weakness that slowly worsening. He presents with extremely high blood pressure and generalized edema but with otherwise normal findings. From the labs there is high TSH and low ft4. He was then admitted and given supportive treatment. His levothyroxine was adjusted and he was reeducated for his wrong levothyroxine use, which he took after meal. He was then slowly improving and was discharged.

Testing for a causal role of thyroid hormone measurements within the normal range on human metabolism and diseases: a systematic Mendelian randomization

Variation in thyroid function parameters within the normal range has been observationally associated with adverse health outcomes. Whether those associations reflect causal effects is largely unknown. We systematically tested associations between genetic differences in thyrotropin (TSH) and free thyroxine (FT4) within the normal range and more than 1100 diseases and more than 6000 molecular traits (metabolites and proteins) in three large population-based cohorts. This was performed by combining individual and summary level genetic data and using polygenic scores and Mendelian randomization (MR) methods. We performed a phenome-wide MR study in the OpenGWAS database covering thousands of complex phenotypes and diseases. Genetically predicted TSH or FT4 levels within the normal range were predominately associated with thyroid-related outcomes, like goitre. The few extra-thyroidal outcomes that were found to be associated with genetic liability towards high but normal TSH levels included atrial fibrillation (odds ratio=0.92, p-value=2.13×10-3), thyroid cancer (odds ratio=0.57, p-value=2.97×10-4), and specific biomarkers, such as sex hormone binding globulin (β=-0.046, p-value=1.33×10-6) and total cholesterol (β=0.027, p-value=5.80×10-3). In contrast to previous studies that have described the association with thyroid hormone levels and disease outcomes, our genetic approach finds little evidence of an association between genetic differences in thyroid function within the normal range and non-thyroidal phenotypes. The association described in previous studies may be explained by reverse causation and confounding. This research was funded by the Swiss National Science Foundation (P1BEP3_200041). The Fenland study (DOI 10.22025/2017.10.101.00001) is funded by the Medical Research Council (MC_UU_12015/1, MC_PC_13046 and MC_UU_00006/1). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1, MC-UU_12015/1, MC_PC_13048 and MC_UU_00006/1).

Electrocardiographic, Ultrasonographic, and Echocardiographic Findings in Hypothyroidism: A Cross-Sectional Study

Background: Hypothyroidism, a common endocrine disorder, significantly impacts cardiovascular health and thyroid gland structure. Electrocardiography (ECG), ultrasonography (USG) of the neck, and echocardiography (2D Echo) are essential tools for evaluating these complications. Despite the well-known risks, comprehensive assessments combining these modalities are often underutilized in clinical practice. The study evaluated electrocardiographic, ultrasonographic, and echocardiographic findings in hypothyroid patients to identify prevalent abnormalities and associated risk factors. Methods: A total of 260 hypothyroid patients were included. Data collection involved clinical history, blood tests, ECG, USG neck, and 2D Echo. Statistical analysis was done using SPSS version 20, with qualitative variables analyzed using Chi-square tests and quantitative variables using multivariate analysis and logistic regression. Results: The study revealed that 65% of patients had abnormal ECG findings, with sinus bradycardia (20%) and prolonged QT interval (17%) being most common. USG neck showed thyromegaly in 48.1% and nodules in 40% of patients. Echocardiographic assessment indicated systolic dysfunction in 30% and diastolic dysfunction in 40% of patients. Higher TSH levels were significantly associated with increased prevalence of cardiac dysfunction (p < 0.01). Conclusion: Hypothyroidism significantly affects both cardiac function and thyroid gland structure. The study underscores the necessity for comprehensive diagnostic assessments, including ECG, USG, and echocardiography, to detect and manage complications early. Effective control of thyroid function is crucial in mitigating cardiovascular risks. Recommendations: Regular monitoring of thyroid and cardiac health in hypothyroid patients is recommended. Future research should focus on long-term outcomes of integrated diagnostic assessments and the effectiveness of early interventions. Keywords: Hypothyroidism, Electrocardiography, Ultrasonography, Echocardiography, Cardiac Dysfunction

Un association of Anti-Mullerian Hormone gene (rs4807216) polymorphism in Polycystic Ovary Syndrome (PCOS) Among Iraqi Women

The current work aimed to assess the hormonal profile of women with PCOS, including the AMH hormone and the AMH gene (rs4807216) polymorphism. The blood samples were obtained from 60 patients with PCOs who visited Reproductive Medicine Centre of General Hospital of Kirkuk and 30 healthy women. The serum level of LH, FSH, TSH, Estrogen and AMH determined by Enzyme linked immunosorbent assay (ELISA), while Polymerase chain reaction (PCR) was used to genotype the AMH gene (rs4807216). The current results showed a significant increase in LH, TSH, Estrogen, and AMH serum levels in PCOS females as compared to the control female group at P value= 0.05. In contrast, the serum level of FSH was not significantly increased at p value = 0.05. Polymorphism rs4807216was not significantly associated with serum AMH levels in the population study. In conclusion, Women with PCOS have high levels of LH, TSH, Estrogen, and AMH. Therefore, these hormones consider biomarkers for detecting PCOS in Iraqi females.

Association between thyroid function and nonalcoholic fatty liver disease: a dose-response meta-analysis.

Thyroid hormones (THs) have been found that it is closely associated with the onset and progression of non-alcoholic fatty liver disease (NAFLD). However, the current study could not verify the intrinsic relationship between thyroid hormones and NAFLD, which requires further research. The searches of studies reported both TH level in serum and NAFLD were performed in PubMed, Web of Science, Cochrane Library, and Embase databases. We combined an overall meta-analysis with a dose-response meta-analysis to assess the correlation and dose-response relationship between thyroid function levels and the risk of NAFLD. Overall, 10 studies were included with a total of 38,425 individuals. We found that the non-linear dose-response model showed that for every 1 ng/dL increase in FT4, the risk of NAFLD was reduced by 10.56% (p=0.003). The odds ratios (ORs) for NAFLD with high free triiodothyronine (FT3) exposure compared to those with low FT3 were 1.580 (95% CI 1.370 to 1.830, I2=0.0%, p<0.001) in the overall meta-analysis. The continuous variable meta-analysis indicated that individuals with high levels of TSH (SMD=1.32, 95% CI 0.660 to 1.970, p<0.001) had significantly higher levels of liver fibrosis than those with low levels. Our findings only validate that there is a correlation between the occurrence of NAFLD and abnormal levels of THs, and it is expected that more observational studies will still be conducted in the future to further demonstrate the relationship between thyroid hormones and NAFLD. Registered number in PROSPERO: CRD42023405052.

Hypothyroidism and 25-Hydroxyvitamin D Correlation Study

Background: Thyroid disease is one of the most common illnesses in the UAE, which could be linked to vast numbers of people suffering from vitamin D deficiency. This study aimed to explore the association between serum 25(OH)D levels and thyroid function parameters in men and women with diagnosed hypothyroidism. Methods and Results: This cross-sectional observational study included 86 patients (78[90.7%] women and 8[9.3%] men) with diagnosed hypothyroidism. The patients were divided into two groups, male and female. These two groups were compared in terms of age, TSH, free-T4 (FT4), vitamin D, free-T3 (FT3), and body mass index (BMI). In addition, the correlation between levels of vitamin D and TSH was also examined in these two groups. The mean age of the patients was 27.5 years, and BMI was 28.00 kg/m2, indicating overweight. Vitamin D deficiency was found in 61(70.9%) patients and severe vitamin D deficiency in 10(11.6%) patients with hypothyroidism. 25(OH)D levels were significantly low in patients with high TSH levels, showing a weak negative correlation (r=-0.132, P=0.043). A negligible positive correlation was identified between 25(OH)D levels and FT4 r=0.089, P&gt;0.05) and FT3 (r=0.071, P&gt;0.05), and a negligible negative correlation with BMI (r=-0.059, P&gt;0.05). Conclusion: There is a clear indication that vitamin D deficiency is prevalent in hypothyroid patients and that these subjects have lower levels of serum 25(OH)D. Suggesting that lower serum 25(OH)D is related to hypothyroidism and the deficiency in vitamin D plays a role in the development of the disease.

Long-term hypothyroidism in patients started on levothyroxine during pregnancy.

Current guidelines recommend different postpartum approaches for patients started on levothyroxine (LT4) during pregnancy. We studied the postpartum management of these patients and determined factors associated with long-term hypothyroidism. A retrospective study was conducted at a tertiary center between 2014 and 2020, with LT4 initiation according to 2014 ETA recommendations. We performed multivariate logistic regression (MVR) and a receiver operating characteristic curve analysis to determine variables associated with long-term hypothyroidism and their optimal cutoffs. LT4 was initiated in 177 pregnant women, and 106/177 (60%) were followed at long-term (at least 6 months post partum) (28.5 (9.0-81.9) months). LT4 could have been stopped in 45% of patients who continued it immediately after delivery. Thirty-six out of 106 (34%) patients were long-term hypothyroid. In them, LT4 was initiated earlier during pregnancy than in euthyroid women (11.7 ± 4.7 vs 13.7 ± 6.5 weeks, P = 0.077), at a higher thyroid-stimulating hormone (TSH) level (4.1 (2.2-10.1) vs 3.5 (0.9-6.9) mU/L, P = 0.005), and reached a higher dose during pregnancy (62.8 ± 22.2 vs 50.7 ± 13.9 µg/day, P = 0.005). In the MVR, only the maximal LT4 dose during pregnancy was associated with long-term hypothyroidism (odds ratio (OR) = 1.03, 95% CI: 1.00-1.05, P = 0.003). The optimal cutoffs for predicting long-term hypothyroidism were an LT4 dose of 68.75 µg/day (87% specificity, 42% sensitivity; P = 0.013) and a TSH level ≥ 3.8 mU/L (68.5% specificity, 77% sensitivity; P = 0.019). One-third of the patients who started on LT4 during pregnancy had long-term hypothyroidism. The TSH level at treatment initiation and the LT4 dose during pregnancy could guide the decision for continuing long-term LT4.

#1080 Low-T3 syndrome: “endemic” in hemodialysis patients?

Abstract Background and Aims In hemodialysis patients, low-T3 syndrome is more prevalent than in the general population and was found to be associated with malnutrition and inflammation. Although evidence suggest that low free T3 (fT3) levels predict cardiovascular and all-cause mortality, low-T3 syndrome is usually not treated. The aim of this single-center retrospective observational study was to determine the prevalence of thyroid axis derangements and examine the relationship between thyroid hormones and biochemical and clinical variables in our hemodialysis (HD) patients cohort. Method Patients on thrice-weekly maintenance HD for at least 6 months were enrolled. Patients taking amiodarone, levothyroxine or methimazole were excluded. Data about age, sex, ethnicity, hemodialysis vintage, type of dialysis (bicarbonate dialysis/online hemodiafiltration/acetate-free-biofiltration/hemofiltration with endogenous reinfusion/expanded hemodialysis) were obtained from medical records and values of fT3, fT4, TSH, albumin, LDL, hemoglobin—routinely checked for every patient during hemodialysis sessions—were acquired. Continuous variables are expressed as median and IQR or mean ± SD and categorical variables as absolute value or percentage. The normality of data distribution was tested by Sapiro-Wilk test. Correlations were studied with Pearson and Spearman. T-test and Mann-Whitney U test were performed to compare continuous and categorical variables. Statistical significance was reached with p &amp;lt; 0.05. Results A total of 57 patients on thrice-weekly maintenance HD were enrolled. Most of them were male (70.2%), Caucasians (89.5%), with a mean age of 69 ± 14 years and with a median dialytic vintage of 63 [29; 113] months. Hypertension was the most frequent comorbidity and more than half of the patients was either affected by ischemic, hypertensive or dilatative cardiomyopathy. Most of the patients underwent bicarbonate hemodialysis (42.1%) and overall 57.9% of the study population was treated by convective techniques. Hemoglobin, albumin, LDL cholesterol, fT3 and fT4 values was normally distributed, while those of TSH and PCR were not. A very high prevalence of low-T3 syndrome (75%) was found, 5 patients showed subclinical hypothyroidism and only in a minority of patients thyroid function tests were normal (12%) (Fig. 1). A significant negative correlation between fT3 and age (p = 0.041) and a positive one between TSH and dialytic vintage (p = 0.017) were found (Table 1). In addition, a significant positive correlation between albumin and fT3 was detected, supporting the known association between low T3 and malnutrition. Interestingly, PCR negatively correlated with fT3 and positively with fT4. Patients treated by diffusive techniques showed no statistically significant difference of thyroid hormone levels compared to convective therapies (Table 1). Conclusion Low-T3 syndrome affects the great majority of patients in our hemodialysis population, with a prevalence even higher than that provided by literature. Our investigations confirm that older patients seem to show lower fT3 levels and a longer hemodialysis vintage may correlate with higher TSH levels. The association with inflammation was also confirmed. Considering the known impact on cardiovascular and all-cause mortality already demonstrated, it is important to routinely check thyroid hormones in HD. In addition, further studies should be performed in order to establish the possible impact of the therapeutic correction of this hormonal derangement on hemodialysis patients’ mortality and cardiovascular outcomes.

Myxoedema coma secondary to severe hypothyroidis

Introduction: Myxoedema is a medical emergency associated with a highmortality rate. It is a rare presentation of severe hypothyroidism andsalient features usually seen include Decreased Mental Status,Hypothermia. Other features like Bradycardia, hypotension, hypoglycaemia,hypoventilation, signs of cognitive impairment like confusion, agitation,disorientation, and even psychotic features could be seen.Precipitants like alcohol, sedative drugs, MI, sepsis, exposure to cold mayalso result in severe hypothyroidism; hence effort should be made toreverse precipitating factors rapidly.The incidence of Myxoedema Coma is very low in developed countriesas there is improved diagnosis and treatment; early, aggressive treatmentis necessary due to the high mortality rate (30–60%). Groups of patientsat risk include elderly patients, those with a compromise cardiovascularsystem, reduced consciousness, sepsis etc. usually have a poorer outcome.Mainstay of treatment is thyroid hormone therapy, supportive-reversalof precipitating factors. Adrenal insufficiency should be excluded; glucocorticoidsare given to the patient.Case report-discussion &amp; results: I present an 89-year-old woman who presentedwith Back Pain, Confusion following opioid medications prescribedby the GP. However on admission, there was hypothermia,hypotension with cold peripheries, pedal discolouration and ulceration,pitting oedema. The patient was initially managed for pneumonia, acutekidney injury secondary to poor intake. Patient was rehydrated andplaced on antibiotics. ECG, Transthoracic Echocardiography, ChestX-Ray, Blood tests, Brain CT showed nil tumour or acute changes. CTTAP showed nil malignancy or bony changes.Few days following admission to the ward, patient tested positivefor COVID and was isolated. Following COVID Stepdown, the patientdeveloped altered sensorium, hypotension, and seizures. Lactate washigh, EEG showed nil evidence of encephalitis. A confusion screen whichincluded Thyroid Function Test (TFT) was requested. The lab called ina few hours later due to a very high level of TSH (63) and low T4 (5.1)and Levothyroxine was commenced. Referral was made to the endocrinologist.Gentle rewarming using blankets with the room heater at roomtemperature was done and the patient was also placed on antibiotics.Relatives were updated as events evolved, and diagnosis changed withtime. Repeat TFT showed that the TSH level increased and there was clinicalworsening of the patient’s mental state. A diagnosis of Myxoedemacoma was made.Conclusion: A low threshold for requesting investigations like TFT, especiallyin at-risk patients and a high index of suspicion is required clinically.Could Covid have contributed to the precipitating factors? Areferral was made to the Palliative Care Team. There was good multidisciplinaryteam input with relatives updated from time to time with mentionof limited prognosis.

The effect of preoperative TSH levels on perioperative complications in patients undergoing pituitary surgery

IntroductionPituitary surgery involves special conditions for the anaesthetist due to the anatomical localisation and the role of the pituitary gland in hormonal balance. The aim of this study was to retrospectively investigate the effect of TSH levels on perioperative complication rates in patients undergoing pituitary surgery.MethodsIn this study, patients who underwent pituitary surgery at Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2017 and November 2022 were retrospectively screened. Two patients out of the 137 were excluded from the study as they underwent simultaneous aneurysm surgery along with pituitary tumor surgery. A total of 135 patients meeting the criteria were analyzed. Patients were divided into three groups according to TSH levels. Perioperative complication rates and mortality rates were compared between the three groups.FindingsThe study included a total of 135 patients, with an age range of 16–76 years. Among the groups with low–normal–high TSH levels, there were no statistically significant difference observed, in postoperative complications, such as epistaxis, rhinorrhea, postoperative nausea/vomiting, seizures, hypertension, and hypotension. When looking at the incidence of postoperative diabetes insipidus, a significant difference was found between the groups. When examining the mortality rates on the 28th day, a significant difference was found between the groups, with a mortality rate of 25% in the high TSH group (p < 0.5).ConclusionsThe risk of perioperative mortality is higher in patients with TSH levels above normal.

Cytomorphological Profile of Graves' Disease and its Co-relation with anti-TPO Antibody

Objective: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland. FNAC plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost and with a diagnostic accuracy rate of 92%. This study was designed to cytomorphological profile of Graves’ disease and its co relation with anti TPO antibody. Materials and Methods: This is a prospective analytical study of fifty patients with clinically enlarged thyroid gland presenting at STG Hospital, Haldwani, Nainital during Oct 2019 to Oct 2022. FNAC smears of these patients were studied and correlated with cytomorphological findings of different types, grades of thyroiditis and hormone level of T4, T3 and T.S.H. Results: Females were mostly affected by thyroid diseases than males. Female patients were 39 (78%) and male patients were 11 (22%). In the present study, patients were in the age group of 13 to 74 years of age. High T3 levels were noted in 80% high T4 levels were found in 90%. Low TSH level was found in only 64%, normal TSH level found in 34% and 2% presented with high TSH level. 34 patients (68%) found high anti-thyroid peroxidase antibody titre &gt;34 U/ml. Cytomorphology revealed moderate to high cellularity in 88% cases, mild to moderate nuclear atypia in 86% and presence of marginal vacuoles in 82%. Lymphocytic infiltrate found in 24% cases and epithelioid cell granuloma in 14% cases. Conclusion: Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. We recommend further studies with a larger population to validate our study. Keywords: Thyroiditis, Graves' Disease, Malignancy Goiter, Histopathology

Correlation Between Thyroid-Related Hormones and Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients with Normal Thyroid Function: A Retrospective Study.

To investigate the correlation between thyroid-related hormones and diabetic retinopathy (DR) in euthyroid patients with type 2 diabetes mellitus (T2DM). Patients with T2DM admitted to our hospital between January 2023 and June 2023 were retrospectively analyzed. The patients were divided into DR and non-diabetic retinopathy (NDR) groups according to whether DR occurred. Thyroid function-related hormones (TSH, FT3, and FT4), blood glucose indices (FBG and HbA1c), and blood lipid indices (HDL-C, LDL-C, TC, and TG) of the two groups were analyzed by univariate and multivariate logistic regression to explore the risk factors for DR. Pearson correlation analysis and multiple stepwise regression analysis were used to investigate the correlation of TSH or FT3 with FBG, HbA1c, and TG in DR patients. Of the 286 patients with T2DM included in this study, 101 (35.31%) developed DR and 185 (64.69%) did not. High TG, FBG, HbA1c, and TSH and low FT3 levels were independent risk factors for DR in T2DM patients. TSH positively correlated with TG, whereas FT3 negatively correlated with TG and HbA1c in T2DM patients with DR. Higher TSH and lower FT3 in T2DM patients with normal thyroid function may affect glucose and lipid metabolism, thereby increasing the risk of DR.

Impact of Subclinical Hypothyroidism on Pregnancy and Newborn

Objective: The normal free T4 level together with a high TSH level is called subclinical hypothyroidism. In this study, we investigated cases of subclinical hypothyroidism diagnosed in the first trimester for possible adverse effects. The study aims to show the pregnancy outcomes and neonatal effects. Material and Methods: The study we planned was conducted retrospectively as a record study based on diagnoses. Three hospitals; one city and two state hospitals, were included in our study. Pregnant women treated at these centers between 2019 and 2021 were included the screening of newborns was similarly performed by our pediatric colleagues, based on the diagnosis in the form of scanning the files. Results: It became statistically significant when prematurity (p: 0.005), fetal weight, and week of birth were evaluated. The T4 values of the pregnant women who taken part in the study were normal, and their TSH values were ≥ 2.5-4 mIU/L. The evaluation showed that preterm birth was statistically higher and fetal weight and week of birth were significantly lower. Conclusions: In the study of pregnant women diagnosed with subclinical hypothyroidism, it was found that the preterm delivery rate was higher than in the control group, and the delivery week was also lower than in the control group.

Multi-trait analysis characterizes the genetics of thyroid function and identifies causal associations with clinical implications

To date only a fraction of the genetic footprint of thyroid function has been clarified. We report a genome-wide association study meta-analysis of thyroid function in up to 271,040 individuals of European ancestry, including reference range thyrotropin (TSH), free thyroxine (FT4), free and total triiodothyronine (T3), proxies for metabolism (T3/FT4 ratio) as well as dichotomized high and low TSH levels. We revealed 259 independent significant associations for TSH (61% novel), 85 for FT4 (67% novel), and 62 novel signals for the T3 related traits. The loci explained 14.1%, 6.0%, 9.5% and 1.1% of the total variation in TSH, FT4, total T3 and free T3 concentrations, respectively. Genetic correlations indicate that TSH associated loci reflect the thyroid function determined by free T3, whereas the FT4 associations represent the thyroid hormone metabolism. Polygenic risk score and Mendelian randomization analyses showed the effects of genetically determined variation in thyroid function on various clinical outcomes, including cardiovascular risk factors and diseases, autoimmune diseases, and cancer. In conclusion, our results improve the understanding of thyroid hormone physiology and highlight the pleiotropic effects of thyroid function on various diseases.

Prevalence and Related Factors of Thyroid Nodules in Physical Examination Population in a Level-A Hospital in Jinan.

To investigate the prevalence of thyroid nodules among medical staff and health check-up population in a Level-A hospital (Primary-level hospital) in Jinan City and analyze its influencing factors. A total of 5812 cases from the two groups were screened. t-test and χ2 tests were used to analyze the differences in the prevalence of thyroid nodules. Multivariate Logistic regression analysis was used to explore the influencing factors. The average age of medical staff was (36.20±9.11) years old, and the total prevalence was 48.5%. The average age of the healthcare population was (57.89±12.51) years old, and the total prevalence rate was 63.9%, with statistical significance between the two groups (P<0.001 for all). A stratified analysis of the two groups showed that the prevalence increased with age, and the prevalence among medical workers of all ages was higher than that of the health population younger than 50 years of age. Multivariate Logistic regression analysis showed that female sex (OR=1.646,95% CI: 1.315-2.060), older age (OR=1.384,95% CI: 1.265-1.514), and high BMI (OR = 1.199, 95% CI: 1.065-1.350) were risk factors for the disease among medical staff. In the health population, female sex (OR=0.799,95% CI: 0.644-0.992) and high TSH levels (OR = 0.918, 95% CI: 0.874-0.964) were protective factors, while older age (OR=1.634,95% CI: 1.525-1.751) was a risk factor. There are certain differences in the prevalence of thyroid nodules between the two groups. Age and occupation are important influencing factors. While age is uncontrollable, active regulation of emotional status caused by occupational factors has important clinical guiding significance for reducing the prevalence of thyroid nodules and reducing the social medical burden.

A meta-analysis of the value of serum TSH concentration in the diagnosis of differentiated thyroid cancer in patients with thyroid nodules

BackgroundIn recent years, most studies believe that high TSH level is positively correlated with the incidence of thyroid cancer, but it is still controversial. For this reason, the purpose of this study is to analyze the correlation between preoperative TSH level and thyroid malignant nodules using pathological diagnosis as the gold standard. To evaluate the role of serum TSH in predicting malignancy of thyroid nodules with uncertain cytology.As an important member of the hypothalamus–pituitary–thyroid axis in the endocrine system, TSH plays a crucial role in regulating the growth, differentiation, and function of thyroid cells (Zhang et al., 2023) [1]. Therefore, it has always been considered closely related to TC. Currently, most studies have compared the TSH levels of TC patients and individuals with benign thyroid disease or healthy controls. These findings from various studies indicated that TC patients often demonstrate elevated TSH levels, even when their TSH falls within the normal range. However, it is important to highlight that the current evidence primarily relies on cross-sectional studies, which mainly describe a phenomenon without establishing causal relationships. The involvement of TSH in the early onset or late progression of TC remains unknown, the interaction between TSH and other factors and how it affects TC is not well understood (Gubbi et al., 2020) [2].Symptoms of thyroid cancer are usually insidious, and early thyroid cancer often has no obvious clinical symptoms. Therefore, early detection and early treatment are particularly important, and how to improve the preoperative diagnosis rate of thyroid nodules is also a problem that clinicians pay close attention to. ObjectiveTo evaluate the value of serum TSH concentration in the diagnosis of differentiated thyroid carcinoma in patients with thyroid nodules. MethodsOur study searched databases in both Chinese and English.China Academic Journals FULL-text Database (CNKI), China Online Journals, Chinese Scientific Journals database and Chinese Biomedical Literature Database (CBM) were searched by computer. The English literature was established by PubMed, Embase, Cochrane Library, Web of Science and other databases until June 2022 to search for relevant literatures on the diagnostic test of serum TSH concentration in patients with thyroid nodule. The literatures that met the criteria were screened, the data were extracted, and the literature quality was evaluated. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the method for the diagnosis of differentiated thyroid carcinoma were calculated and summarized. The receiver operating characteristic (SROC) curve was drawn and the area under the curve was obtained. ResultsA total of 23 diagnostic tests were included (5348 lesions). Meta-analysis showed that the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of serum TSH concentration in the diagnosis of differentiated thyroid carcinoma were 0.64, 0.72, 2.511, 0.386 and 7.14, respectively. The area under SROC curve (AUC) was 0.79, and the Q index was 0.7283, indicating no statistically significant difference. ConclusionBased on current evidence, detection of serum TSH concentration in thyroid nodule patients has high sensitivity and specificity for the diagnosis of differentiated thyroid cancer, which has good clinical application value. However, other auxiliary examinations are still needed to improve the diagnosis rate.