High Prevalence Of Hypothyroidism Research Articles

Thyroid Hormone and Diabetes Mellitus Interplay: Making Management of Comorbid Disorders Complicated.

Insulin and thyroid hormones play important roles in our body. Insulin helps regulate the glucose level while the thyroid hormones affect various cells and tissues, metabolizing protein, lipids, and glucose. Hyperthyroidism and thyrotoxicosis are potential hazards for type 2 diabetes mellitus. There is a high prevalence of hypothyroidism being more common compared to hyperthyroidism coexisting with diabetes mellitus. Thyroid hormones affect glucose metabolism through its action on peripheral tissues (gastrointestinal tract, liver, skeletal muscles, adipose tissue, and pancreas). High-level thyroid hormone causes hyperglycemia, upregulation of glucose transport, and reduction in glycogen storage. The reverse is observed during low levels of thyroid hormone along with insulin clearance. The net result of thyroid disorder is insulin resistance. Type 2 diabetes mellitus can downsize the regulation of thyroid stimulating hormones and impair the conversion of thyroxine to triiodothyronine in peripheral tissues. Furthermore, poorly managed type 2 diabetes mellitus may result in insulin resistance and hyperinsulinemia, contributing to the proliferation of thyroid tissue and an increase in nodule formation and goiter size. Although metformin proves advantageous for both type 2 diabetes mellitus and thyroid disorder patients, other antidiabetics like sulfonylureas, pioglitazone, and thiazolidinediones may have adverse effects on thyroid disorders. Moreover, antithyroid drugs such as methimazole can weaken glycemic control in individuals with diabetes. Thus, an interplay between both endocrinopathies is observed and individualized care and management of the disorder needs to be facilitated.

Significant Association of Epidemiological Factors with Hypothyroid Patients in Khulna Region: A Cross Sectional Study

Background and Objectives: Thyroid disorder is one of the most common endocrine disorders worldwide. A community‑based investigations showed that; overall occurrence of thyroid disease was 20.43%, highest incidence of diffuse goiter (7.35%), followed by sub-clinical hypothyroidism (6.59%), hypothyroidism (4.97%), hyperthyroidism (0.86%) and sub-clinical hyperthyroidism (0.65%) in Khulna, Bangladesh. High prevalence of hypothyroidism with autoimmunity are also observed in Khulna Region. The aim of this study was to conduct epidemiological survey of hypothyroid patients in Khulna region. Methods: This cross‑sectional study was done on Hypothyroid patients of Khulna Medical College Hospital and Institute of Nuclear Medicine and Allied Science (INMAS), Khulna, from July 2023 to December 2023. After having informed written consent of adult sixty hypothyroid patients, was interviewed and examined the blood sample for relevant information; data recorded in a preformed, semi-structured data collection sheet (Patient particulars form) and analyzed. Results: Out of the sixty hypothyroid patients about fifty percent was obese, eighty percent was female of 30-60 years age group. Ninety percent of them belongs to poor socioeconomic conditions and came from rural area of Khulna district. About 20 percent had positive family history of hypothyroidism, 27 percent patient was associated with other autoimmune diseases and about 80 percent was associated with anti-thyroid antibody. Conclusions: Most of the patients were rural female of low socioeconomic back ground of reproductive age groups. They also associated with other autoimmune diseases. Chronic autoimmune diseases, poverty, anti-thyroid antibody and salinity of environment may play an important role for the causation of hypothyroidism in Khulna region. Keywords: Thyroid disorder, hypothyroidism, dyslipidemia, thyroiditis.

The frequency of clinical and subclinical hypothyroidism in transfusion dependent thalassemia patients in Slemani city /Iraq

Background and objective: Thyroid disorders caused by blood transfusion in thalassemia patients could affect human health and growth, this study was conducted to determine the frequency of clinical and subclinical hypothyroidism in blood transfusion-dependent thalassemia patients in the city of Slemani, Kurdistan Region, Iraq. Methods: The current study is a retrospective cross-sectional study (comparative analysis) conducted in Slemani center for thalassemia patients and congenital blood, between December 2021 and July 2022. Participants included l07 thalassemia patients with medical records the sampling method was a convenience method. The data was collected through the review of patients' files and blood tests, including( thyroid hormones, hemoglobin level, serum ferritin level), with a questionnaire that was completed through an interview with the patients. Results: The results of thyroid function tests have shown that 21/107 pateints (19.6%) have hypothyroidism, 6 patients have overt hypothyroidism, and 15 patients have subclinical showed that 23/107 patients and 4/107 patients had hight and low levels,respectively, and there was statistically a significant difference in the average Thyroid stimulating hormone and serum thyroxin levels in two groups of hypothyroid and euthyroid patients and mean ferritine serum level between these two groups was 2166.7±2174.8 and 2068.37±1919.97 respictively ,which was not a statistically significant difference . Conclusion: Considering the high prevalence of hypothyroidism in thalassemia patients, measuring Thyroid stimulating hormone and thyroxin can be very important and vital in the initial screenings,effective treatment and follow-up of patients.

Comparative Effectiveness of Varunadi Ghan Vati and Kanchnar Guggulu in Management of Subclinical Hypothyroidism- Study Protocol for a Randomized Controlled Trial

Abstract: Background: Hypothyroidism is an emerging disease nowadays. India has a high prevalence of Hypothyroidism, which is about 10%. Hormone replacement therapy is advised in the treatment of hypothyroidism. However, in subclinical hypothyroidism, no treatment is advised. Ayurveda describes a number of treatment modalities for the treatment of disease on the basis of their dosha-dushya. The aim of this study is to evaluate the effectiveness of Varunadi Ghan Vati in comparison with Kanchnar Guggulu in the management of subclinical hypothyroidism. Methods and Design: This study will be a prospective, single-centered, randomized controlled trial. A total of 60 patients of age between 19 and 60 years, diagnosed with subclinical hypothyroidism, and presented with cardinal features of the disease will be randomized into two groups. In Group A, patients will be given Varunadi Ghan Vati and in Group B patients will be given Kanchnar Guggulu. Pathya-Apathya regarding the disease will be guided to both groups. Both groups will receive treatment for 45 days. Outcomes will be evaluated on the 15th, 30th and 45th days (during treatment) and 75 th day(post-treatment). The primary outcome will be evaluated on the basis of cardinal symptoms of subclinical hypothyroidism. Improvement in laboratory investigations will be evaluated for secondary outcomes. Conclusion: This trial is the first to compare the effectiveness of Varunadi Ghan Vati with Kanchnar Guggulu in the management of subclinical hypothyroidism. Varunadi Ghan Vati is expected to improve the symptoms of subclinical hypothyroidism, thus proving to be effective in the management of patients with subclinical hypothyroidism. Trial registration: CTRI/2023/07/055295

FRI412 A Case of 46,XX Gonadal Dysgenesis With Mayer-Rokitansky-Küster-Hauser Syndrome And Primary Hypothyroidism

Abstract Disclosure: S. Al Allawi: None. R. Osman: None. Introduction: The association between Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and gonadal dysgenesis is rarely reported in the literature. Coexistence of hypothyroidism with this condition is scarce and clinical correlation remains unclear. We describe a case of this rare clinical entity in conjunction with primary hypothyroidism. Clinical case: A 27-year-old Female with a medical history of primary hypothyroidism was referred to our clinic for evaluation of primary amenorrhea. She was born with a female phenotype. Growth was appropriate, but puberty was delayed with self-reported late pubarche at age 19. She never had a menstrual cycle, and had received hormonal replacement therapy (HRT) for a few months but failed to trigger menarche. However due to financial constraints, treatment was not continued. She was diagnosed with hypothyroidism since birth, for which she is currently maintained on levothyroxine 225 mcg daily. On physical exam, blood pressure was 126/72 mmHg, pulse rate 83 BPM, height 5’9”, BMI 34 kg/m2. No facial dysmorphisms or skeletal deformity were apparent. She had normal pubic and axillary hair distribution, breast budding consistent with Tanner Stage II. Genital examination revealed normal external genitalia and a blind vaginal pouch. Hormonal workup revealed hypergonadotrophic hypogonadism with estradiol < 0.5 pg/mL and post-menopausal range follicle-stimulating hormone (FSH) 36.7 mIU/mL. Thyroid stimulating hormone (TSH) 2.19 uIU/ml (nl 0.45-4.5 uIU/mL) and anti-TPO antibodies 10 IU/mL (nl 0-34 IU/mL). Prior thyroid ultrasound reported a small thyroid gland. Fluorescence in situ hybridization (FISH) analysis revealed 46XX karyotype. Abdominal and pelvic ultrasound showed normal kidneys with a non-visualized uterus and ovaries. Pelvic MRI confirmed the absence of both and showed a blind end vaginal pouch, leading to the conclusion of the coexistence of gonadal dysgenesis with MRKH. She was then placed on transdermal estradioltherapy. Conclusion: The association between gonadal dysgenesis (the most common cause of primary amenorrhea) and MRKH syndrome (the second most common cause) is infrequent. HRT remains the only therapeutic option. It aims to trigger the development of secondary sexual characteristics and prevent osteoporosis by allowing appropriate bone mineral accrual. Unfortunately, infertility remains the most significant consequential issue; hence the availability of good caring and psychological counseling should not be underestimated. The co-existence of likely non-immune primary hypothyroidism is even less frequent. To our knowledge, our case is the second reported case of this trilogy. Given the paucity of data, the association of this condition with primary hypothyroidism cannot be well established and can be coincidental. More studies are needed to determine if this condition has a higher prevalence of hypothyroidism. Presentation: Friday, June 16, 2023

Abstract #1406850: Prevalence of Primary and Sub-clinical Hypothyroidism and Impact of Metformin on Thyroid Hormones in Patients with Type 2 Diabetes Mellitus in a Tertiary Care Hospital in Kashmir

Diabetes mellitus and hypothyroidism are the commonest endocrine disorders worldwide and tend to coexist and mutually influence each other. We aim to determine the prevalence of overt (OH) and subclinical hypothyroidism (SCH) and impact of metformin on thyroid hormones in patients with type 2 diabetes mellitus (T2DM). In this cross-sectional observational study, 257 adult patients of T2DM enrolled were evaluated for thyroid dysfunctions by testing thyroid profile. The levels of fT3, fT4, serum TSH, and anti-TPO antibody were estimated by chemiluminescent micro-particle immunoassay (CMIA). The correlation analysis of prevalence of thyroid disorder with age distribution, gender distribution, BMI, duration of diabetes and glycated hemoglobin (HbA1C) was done. The mean age in our study was 56.3±7.82 (28-74) years with female to male ratio of 1.62:1(159 females vs. 98 Males). The mean (± SD) duration of diabetes HbA1c of the study cohort was 6.7±2.19years and 8.1±2.53% respectively. The prevalence of OH and SCH was 7.4% (Female vs. Male; 10.7% vs. 2%; p=0.013) and 12.1 % (Female vs. Male; 15.7% vs. 6.1%; p=0.021) respectively. The prevalence of anti-TPO positivity was 94.7%, 51.6%and 10.6% in OH, SCH and euthyroid patients respectively. The prevalence of hypothyroidism and subclinical hypothyroidism was higher in patients of female gender, age >60 years, long duration and uncontrolled diabetes. Among 257 patients, 63% (n=163) patients were on metformin. The mean TSH of patients who were on metformin was significantly lower (1.34±0.95 vs. 3.19±1.41; p < 0.001). However, the mean free T4 and free T3 levels were not significantly different between the two groups. There is high prevalence of hypothyroidism especially subclinical hypothyroidism in diabetic patients. Patients on metformin therapy had significantly lower TSH levels. Screening for thyroid dysfunction among patients with diabetes mellitus should be routinely considered for early diagnosis and effective management.

THYROID FUNCTION IN POSTMENOPAUSAL WOMEN IN WESTERN INDIA AND ITS IMPACT ON MENOPAUSAL SYMPTOMS, BMI, GLYCEMIC, LIPID AND CARDIAC PROFILE

Background Menopause is characterized by estrogen deciency and appearance of variety of menopausal symptoms like lethargy, hotushes, anxiety, sexual problems, tiredness, insomnia, weight gain and mood swings. Many of these symptoms are similar to symptoms of thyroid dysfunction and hence there is likelihood of symptoms of thyroid dysfunction in this age group being misinterpreted as menopausal symptoms and thyroid dysfunction remaining undetected. If thyroid dysfunction remains undetected and untreated, it can lead to health hazards like hyperlipidemia, atherosclerosis and heart disease.2Presently there are no clear cut guidelines about screening menopausal patients for thyroid function and existing studies on screening of menopausal women for thyroid disorders are not conclusive. Therefore this study was undertaken to look at thyroid functions in postmenopausal women and impact of thyroid dysfunction on their cardiovacular health through its action on their glycemic status, BMI and lipid prole. Aims And Objectives 1. To assess the basic thyroid functions in postmenopausal women. 2. To evaluate the effect of abnormal thyroid function on glycemic status, lipid prole, body weight and BMI in postmenopausal women. 3. To look for association of severity of menopause symptoms with the degree of thyroid dysfunction in postmenopausal women. Materials And Methods A cross-sectional observational study was carried out in the indoor and outdoor sections of Department of Medicine at SSG Hospital Vadodara for a period of one year from March 2015 to Feb 2016 in which 130 patients were enrolled. All patients were subjected to a standardized interview in which their symptoms were graded on the basis of the Simplied Menopausal Index , their BMI was calculated from their height and weight and investigations (Fasting thyroid prole, fasting blood sugar, fasting lipid prole, ECG) were carried out. Association between abnormalities in thyroid prole and severity of menopausal symptoms as well as abnormalities in BMI , fasting blood sugar, lipid prole and ECG were analyzed using appropriate statistical tests (Odd's ratio). A P value&lt;0.05 was considered statistically signicant. Thyroid dysfunction is Conclusion common in postmenopausal females and the symptoms of the two entities overlap but with a higher intensity in the former and the simplied menopausal index score can be used as an efcient tool to further increase the index of suspicion for thyroid dysfunction in postmenopausal women. Abnormal thyroid function is statistically associated with BMI with higher prevalence of hypothyroidism in overweight, preobese and obese postmenopausal subjects and hyperthyroidism in underweight postmenopausal subjects. Abnormal thyroid function is statistically associated with abnormal glucose metabolism with higher prevalence of fasting hyperglycemia at either end of the spectrum of thyroid disorders. Abnormal thyroid function is statistically associated with Dyslipidemia in the form of raised total cholesterol, LDL cholesterol and serum triglycerides with no signicant association with HDL cholesterol in postmenopausal women. There is no statistically signicant association between thyroid dysfunction and ischemic heart disease

Association between different metabolic phenotypes and the development of hypothyroidism: 9 years follow-up of Tehran thyroid study.

The association between metabolic phenotypes and thyroid function has not yet been established; therefore, this study examined whether different metabolic phenotypes are associated with the development of hypothyroidism. Study participants were selected from the Tehran Thyroid Study (TTS). A total of 3338 euthyroid adults were included and categorized into four obesity phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). The participants were assessed at baseline and during three follow-up studies at three-year intervals. Multiple logistic regression analysis was used to examine the relationship between metabolic phenotypes and the development of hypothyroidism. In the total population, the chi-square test was only significant (P=0.008) in 3rd year with a higher prevalence of hypothyroidism in the MUNW phenotype, followed by MHO, MUO, and MHNW. Moreover, in the 3rd and 9th years of follow-up, hypothyroidism was more prevalent in MUO only in male subjects (P=0.002 and 0.035, respectively). In the unadjusted model, the MHO phenotype increased the odds of hypothyroidism compared with the MHNW phenotype (OR=1.51; 95% CI=1.04, 2.18; P-value=0.031). After adjusting for confounding factors, the odds of hypothyroidism were higher in the MUNW (OR=1.86; 95% CI=1.17, 2.96; P-value=0.008), MHO (OR=1.71; 95% CI=1.09, 2.67; P-value=0.018), and MUO (OR=1.64; 95% CI=1.03, 2.62; P-value=0.036) phenotypes than in the MHNW group. The MUNW phenotype increased the risk of hypothyroidism compared to MHNW, only in males. However, in females, the MHO phenotype increased the risk of hypothyroidism compared to MHNW. Both obesity and metabolic abnormalities are associated with hyperthyroidism. Healthy metabolic and weight maintenance were associated with a lower risk of hypothyroidism in males and females.

Abstract P465: Impact of Smoking Among Medicare Beneficiaries With HIV Admitted for Acute Myocardial Infarction in the United States; a Perspective Using the 2019 National Inpatient Sample

Introduction: While smoking has shown to influence health negatively, there is a lack of data of its impact among HIV patients hospitalized for Acute Myocardial Infarction (AMI) under Medicare. Hypothesis: We assessed the hypothesis that the characteristics of smokers vs. non-smokers differ among Medicare beneficiaries with a diagnosis of HIV admitted for AMI in the US, and that worse hospitalization outcomes may be seen with smokers. Method: The 2019 National Inpatient Sample was used for our study. We first found patients with a principal admission for AMI, covered by Medicare and with a diagnosis of HIV. The presence of smoking(nicotine) was compared between various patient characteristics and an adjusted odds ratio (aOR) for the mortality risk among smokers with HIV admitted for AMI was also estimated. Results: Our study found 1315 cases of AMI among HIV patients covered by Medicare with 800 (60.8%) smokers. Various differences were seen in patient characteristics. Smokers were younger than non-smokers (mean age 61.13 years vs. 62.74 years) and a higher proportion were males (88.1%). Furthermore, smokers also had a higher prevalence of depression (16.9% vs. 10.7%), drug abuse (14.4% vs. 3.9%), chronic pulmonary disease (40.0% vs. 15.5%), and peripheral vascular disease (13.6% vs 10.0%). However, non-smokers had a higher prevalence of hypothyroidism (6.9% vs. 10.7%), cirrhosis (1.9 vs. 8.7%), diabetes mellitus (33.1% vs. 47.6%), hypertension (78.8% vs. 86.4%), anemia (25.0% vs 38.8%) and chronic kidney disease (35.0% vs 50.5%). After adjusting for variables, smokers in our sample had a higher inpatient mortality risk (aOR 2.203, 95% CI 1.027-4.728, p= 0.043). Conclusion: Inpatient mortality risk for HIV Medicare beneficiaries admitted with AMI was higher among smokers. Several differences in patient characteristics were also observed. More strict educational and sensitization campaigns among this population may be helpful.

A study of foetomaternal outcome among pregnant hypothyroid women

During pregnancy one of the most common endocrinological disorder which are very often overlooked during pregnancy because of their nonspecific symptoms and the hypermetabloic state of pregnancy is Thyroid disorder. Optimal maternal thyroid function during pregnancy is important for both the mother and fetus.The study was planned to determine the prevalence of hypothyroidism using the classical reference range of normal serum TSH as 0.4-6.2μIU/L. It also aimed to study the foetomaternal outcome among pregnant hypothyroid women, using the classical reference range and a lower cut off (&amp;#60;3μIU/L) of TSH for diagnosing hypothyroidism in pregnancy.This was a longitudinal prospective study conducted in the Department of Obstetrics &amp; Gynaecology, Suryanagari Hospital, in collaboration with the Departments of Endocrinology, Laboratory Medicine &amp; Paediatrics. Before starting the study, clearance was taken from ethical committee of the hospital. A total of 522 pregnant women attending the antenatal OPD were recruited to determine the prevalence of hypothyroidism on the basis of TSH evaluation. With our study we concluded that these very high prevalence of hypothyroidism in India and routine maternal thyroid function testing must be done as soon as pregnancy is confirmed thus saving lives of many infants who could lead rest of their lives happily and prosperously.

Analysis of diagnostic tests in patients with dry eye and hypothyroidism: an observational study

PurposeColombia is a country with a high prevalence of hypothyroidism, approximately 18.5% compared to the rest of Latin American countries, which is estimated at 10%. That is why in the ophthalmology consultation we find a large proportion of patients with this disease and who also present symptoms of dry eye. When conducting a search in the medical literature, most publications refer to the clinical presentation of dry eye in hyperthyroidism, which is why the main objective of this study is to evaluate tear function tests in the diagnosis of dry eye in patients with hypothyroidism. MethodsThis is an observational, cross-sectional study carried out in the period between May and December 2019 in the ocular surface unit of the Ophthalmic Technology Center (CTO) in Bogotá. The tests of: OSDI test (Ocular Surface Disease Index), Schirmer type I, tear meniscus height, NiBUT, Osmolarity, Ferning test, Lisamine Green test of 59 patients with Dry Eye Disease (DED) and history of hypothyroidism. ResultsSchirmer type I and NiBUT tests were the parameters that presented the highest percentage of severity, while lissamine green staining and meniscometry showed a tendency to normality. ConclusionsThe population of this study presents a mixed type dry eye without epithelial cell damage.

Análisis de pruebas diagnósticas de pacientes con ojo seco e hipotiroidismo: un estudio observacional

PurposeColombia is a country with a high prevalence of hypothyroidism, approximately 18.5% compared to the rest of Latin American countries, which is estimated at 10%. That is why in the ophthalmology consultation we find a large proportion of patients with this disease and who also present symptoms of dry eye. When conducting a search in the medical literature, most publications refer to the clinical presentation of dry eye in hyperthyroidism, which is why the main objective of this study is to evaluate tear function tests in the diagnosis of dry eye in patients with hypothyroidism. MethodsThis is an observational, cross-sectional study carried out in the period between May and December 2019 in the ocular surface unit of the Ophthalmic Technology Center (CTO) in Bogotá. The tests of: OSDI test (Ocular Surface Disease Index), Schirmer type I, tear meniscus height, NiBUT, Osmolarity, Ferning test, Lisamine Green test of 59 patients with Dry Eye Disease and history of hypothyroidism. ResultsSchirmer type I and NiBUT tests were the parameters that presented the highest percentage of severity, while lissamine green staining and meniscometry showed a tendency to normality. ConclusionsThe population of this study presents a mixed type dry eye without epithelial cell damage.

Cancer-specific mortality in breast cancer patients with hypothyroidism: a UK population-based study

PurposeEpidemiological studies have indicated a higher prevalence of hypothyroidism in breast cancer patients, possibly related to shared risk factors and breast cancer treatments. However, few studies have evaluated how hypothyroidism impacts survival outcomes in breast cancer patients. We aimed to determine the association between hypothyroidism and breast cancer-specific and all-cause mortality.MethodsWe conducted a population-based study using the Scottish Cancer Registry to identify women diagnosed with breast cancer between 2010 and 2017. A matched comparison cohort of breast cancer-free women was also identified. Using hospital diagnoses and dispensed prescriptions for levothyroxine, we identified hypothyroidism diagnosed before and after breast cancer diagnosis and determined associations with breast cancer-specific and all-cause mortality. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for potential confounders.ResultsA total of 33,500 breast cancer patients were identified, of which 3,802 had hypothyroidism before breast cancer diagnosis and 565 patients went on to develop hypothyroidism after. Breast cancer patients had higher rates of hypothyroidism compared with cancer-free controls (HR 1.14, 95% CI 1.01–1.30). Among breast cancer patients, we found no association between hypothyroidism (diagnosed before or after) and cancer-specific mortality (before: HR 0.99, 95% CI 0.88–1.12, after: HR 0.97, 95% CI 0.63–1.49). Similar associations were seen for all-cause mortality.ConclusionIn a large contemporary breast cancer cohort, there was little evidence that hypothyroidism, either at diagnosis or diagnosed after breast cancer, was associated with cancer-specific or all-cause mortality.

Cardiometabolic Comorbidity Risk in Pediatric Patients With Psychiatric Illnesses: A Case-Control Inpatient Study

ObjectivesTo delineate the differences in the cardiometabolic comorbidities in pediatric patients with medical versus psychiatric illnesses and to determine the risk of association between the spectrum of cardiometabolic comorbidities in pediatric patients with a broad range of psychiatric illnesses.MethodsWe conducted a case-control study using the nationwide inpatient sample (NIS), the largest hospital database in the United States (US) and included 179,550 pediatric patients (age 10-18 years) that were hospitalized with a primary diagnosis of psychiatric illness (N = 89,775) and pediatric patients that were hospitalized with a primary diagnosis of medical illness (N = 89,775). We used descriptive statistics and Pearson’s chi-square test to delineate the differences between pediatric inpatients with medical versus psychiatric illnesses.ResultsThe majority of pediatric patients with psychiatric illnesses were females (58%) and white (62%), with a mean age of 15 years. Cardiometabolic comorbidities were higher in patients admitted for psychiatric illness, with a higher prevalence of hypothyroidism (1.6%) and obesity (7.1%) than in those hospitalized for medical illnesses. Among all cardiometabolic comorbidities, obesity had the highest prevalence across all psychiatric illnesses, measuring eight percent in patients with disruptive behavior disorders, followed by seven percent each in anxiety, mood, and psychotic disorders. Diabetes had the lowest prevalence hovering between one and two percent for a spectrum of psychiatric illnesses.ConclusionThe prevalence of cardiometabolic comorbidities is higher in pediatric inpatients with psychiatric illnesses. This calls for timely monitoring of the routine labs and early diagnosis and management of the cardiometabolic comorbidities in this at-risk population.

THE PREVALENCE OF THYROID HORMONES DISORDER IN TERTIARY CARE CENTRE, GWALIOR WITH SPECIAL REFERENCE TO ANTENATAL CASES

Multiple studies had been conducted world wide on the prevalence of thyroid hormone disorder in past and recent years.Hypothyroidism during pregnancy is also very common affecting both mother and foetus. A prospective study is conducted in department of pathology,GRMC Gwalior including 1554 patient with symptoms and previous history and analysed by SNIBE MAGLUMI series fully automated ChemiluminescenceImmunoassay analyzer (Clia) for the quantitative determination of thyroid hormone profile. Out of 1554 patients, prevalence of thyroid hormone disorders discussed separately in 1271 cases and 283 antenatal cases. Among 1271 patients, prevalence of thyroid hormone disorder is 32.9% where as 67.1% were euthyroid with higher prevalence of hypothyroidism (26.3%) than hyperthyroidism (6.6%). Females are affected more than male (7:1) and most commonly affected age group is 20 to 39 years. Prevalence of primary, secondary and subclinical hypothyroidism were 4.16%, 2.04% and 20.06% respectively where as in case of hyperthyroidism were 0.94%. 5.43% and 0.23% respectively. Antenatal cases shows 33.6% prevalence of hypothyroidism and 0.4% prevalence of hyperthyroidism. Women in first trimester shows maximum prevalence of 15.9% including 15.55% hypothyroidism and 0.35% hyperthyroidism followed by 9.9% and 8.13% prevalence of hypothyroidism in second and third trimester respectively. Our study conclude that prevalence of thyroid hormone disorders are increasing with recent advances and time and further evaluation is needed to rule out the cause behind increasing trends.

Association between early-onset affective disorders and hypothyroidism in a larger number of psychiatric drug-free patients

AimsWe aimed to assess the association between early onset of affective disorders and hypothyroidism in a larger number of psychiatric drug-free patients with bipolar disorder (BD) or major depressive disorder (MDD). MethodsEarly onset of affective disorders was defined as BD and MDD developed before the age of 22 years. The hypothyroidism hierarchy were diagnosed biochemically and included subclinical and overt hypothyroidism in this study. Demographic and clinical data including diagnosis, illness duration and thyroid function parameters (TSH, T4, FT4, T3 and FT3) at admission were collected from patients' records. Adjusted odds ratio (OR) and 95% confidence interval (CI), which were estimated by logistic regression model, were used to assess the association between early-onset affective disorder and hypothyroidism. ResultsThe prevalence of hypothyroidism in early-onset affective disorders was higher than that in late-onset patients (in BD, 9.4% vs. 6.2%, χ2 = 6.020, P = 0.014; and in MDD 12.7% vs. 6.6%, χ2 = 13.295, P < 0.001). Early-onset affective disorders were 2.097 times (95% CI: 1.409–3.123) more likely to have hypothyroidism compared with late-onset patients, after adjustment for age, gender, duration of illness and mood episode (adjusted OR: 1.965, 95% CI: 1.198–3.221 in BD, and adjusted OR: 2.831, 95% CI: 1.378–5.817 in MDD, respectively). LimitationBecause of the cross-sectional design of this study, we were unable to sort out causality between early-onset affective disorders and hypothyroidism. ConclusionEarly-onset affective disorder may be associated with higher prevalence of hypothyroidism.

Evaluation of the Thyroid Status and Types of Thyroid Dysfunction in Beta-Thalassemia Major Patients More Than 9 Years of Age in Wassit, Iraq 2020

Background: Hypothyroidism is one of the commonest endocrine complications that can happen in patients with Beta-Thalassemia Major (BTM) above nine years old which may pass hidden and untreated for years. Aim: To evaluate the thyroid status and types of thyroid dysfunction in Beta-Thalassemia Major Patients above 9 years of age. Method: A Cross-Sectional study was performed on sixty-six randomly selected patients above 12 years of age with BTM in Al-Kut Heriditory Blood Disease Center at Wassit province from March to August 2020. Thyroid function tests were done (TSH, T3, and T4) to detect the thyroid status and identify patients with thyroid dysfunction and determine the type of hypothyroidism (Primary, central, Subclinical). Data collected include Age, Sex, weight, height, Serum ferritin and mean hemoglobin level, Type of chelation therapy, dose, compliance, and frequency of blood transfusion, other diseases such as Diabetes Mellitus, HCV, HBV, HIV, and Heart Failure were evaluated statistically. Results: In the studied patients, Thirty-one patients (46.96%) were found to have hypothyroidism;( Seven of them (10.6%) had primary hypothyroidism, Sixteen(24.2%) had subclinical hypothyroidism and eight (12.1%) had central hypothyroidism). Twenty-one (67.74 %) patients with Hypothyroidism were found to have stunted height or short stature (with significant p.value 0.03) from the 13 (41.9%) who had subclinical hypothyroidism. By Pearson correlation, increasing serum ferritin levels significantly affect decreasing thyroxin (T4) levels with inverse correlation (P value 0.0001), (r)= -0.45. Conclusion: in this study, there was a high prevalence of hypothyroidism in BTM and subclinical hypothyroidism is the most common type, which signifies the importance of regular screening and close supervision especially when high ferritin and or short stature are present.

Birth control pills and risk of hypothyroidism: a cross-sectional study of the National Health and Nutrition Examination Survey, 2007–2012

ObjectiveThe association between use of birth control pills and thyroid function in women has not ever been well studied, but potential risk has been implicated by small sample-sized studies. We...

Postpartum Thyroid Abnormalities and Systemic Lupus Erythematosus: Is There a Link?

Abstract Introduction: Postpartum Thyroiditis (PPT) is an autoimmune disorder characterized by destruction of the thyroid gland within the first year after delivery. Systemic Lupus Erythematosus (SLE), another autoimmune disease, has been associated with a spectrum of thyroid disorders. While the prevalence of thyroid diseases in patients with SLE is increased, the association between SLE and PPT is not well known. The infrequency of encountering SLE and PPT makes abnormal thyroid tests in the postpartum period a diagnostic challenge. Clinical Case: A 27-year-old G1P1001 who was five months postpartum and not breast feeding was referred to Endocrinology clinic for evaluation of abnormal thyroid function tests. Past medical history was significant for SLE with renal and pericardial involvement. SLE was well controlled, treated with hydroxychloroquine. Family history was significant for hypothyroidism in her mother. She was asymptomatic and appeared clinically euthyroid. Vitals were stable and physical exam was negative for goiter, nodule or orbitopathy. Lab results at two months postpartum showed an elevated TSH of 3.87 UIU/mL (Normal 0.40-3.8 UIU/mL) and at four months postpartum TSH was low at 0.012 UIU/mL. Repeat labs at five months postpartum continued to show a low TSH at 0.007 UIU/mL with mildly elevated Free T4 at 1.7 ng/dL (Normal 0.6-1.6 ng/dL) and elevated Free T3 of 6.0 pg/mL (Normal 2.1-3.8 pg/mL). Anti-thyroid peroxidase antibodies (TPO), thyroid stimulating antibodies (TSI) and TSH receptor antibodies (TRAb) were negative. Thyroid Ultrasound with Doppler was within normal limits. Radioactive Iodine Uptake and Scan, obtained at 6 months postpartum, showed high normal uptake (17% and 32% at 4 hours and 24 hours respectively), suggestive of recovery phase of PPT. The most recent TSH was elevated at 8.5 UIU/mL and Free T4 was low at 0.7 ng/dL. Disease course was consistent with PPT. Conclusion: The Th1 (T-helper) lymphocyte immune predominance in autoimmune thyroid disease and SLE is the immune-pathogenetic base of the association between both diseases. Postpartum thyroiditis is a variant of chronic autoimmune thyroiditis. Serum anti-TPO antibodies vary during pregnancy and tend to increase early and may decline later. Immunologic tolerance increases during pregnancy, fades in the postpartum period and makes interpretation of thyroid function tests and disease process challenging. Pregnant and postpartum patients who have SLE have increased prevalence of thyroid disease. Causes are multifactorial with a higher prevalence of hypothyroidism and thyroid autoantibodies. Hyperthyroidism is much less likely. One comparable study found 6 of 43 (14%) women with SLE developed PPT and only one of these patients had positive thyroid antibodies. These reports and our patient illustrate the variability of thyroid function tests in patients with SLE.

A Comparative Study on the Association of Hypothyroidism with Adhesive Capsulitis of Shoulder

Objective: Adhesive capsulitis (AC) is a pathologic condition characterized by pain and limitation of shoulder movements. Thyroid dysfunction often accompanies musculoskeletal disorders, and undiagnosed hypothyroidism can delay response to treatment outcomes. Early diagnosis and treatment of hypothyroidism in patients with AC of shoulder could help to improve pain and disability. This study was done to assess the association of hypothyroidism with AC of shoulder and to find the correlation of severity of pain and disability in AC with hypothyroidism. MATERIALS AND METHODS: In this case–control study, patients who attended PMR OPD during a period of 2 years with pain and limitation of shoulder movements satisfying the inclusion and exclusion criteria were included as cases and patients without AC as controls. Fifty-seven patients were selected as cases and 114 patients as controls. Serum thyroid-stimulating hormone (TSH) level and free tetraiodothyronine level were estimated. Shoulder range of motion (ROM) measurement and radiographs were performed in cases, and the TSH values obtained were compared with the severity of ROM restriction, Visual Analog Scale score, and Shoulder Pain and Disability Index Scale (SPADI) score. Statistical analysis was done using IBM SPSS 20 (SPSS Inc., Chicago, IL, USA). RESULTS: Among cases, 8 (14%) patients had hypothyroidism and 16 (28.1%) had subclinical hypothyroidism, and among controls, 4 (3.5%) had hypothyroidism and 9 (7.9%) had subclinical hypothyroidism. Among the 24 patients with elevated TSH, 16 (66.6%) had mild-to-moderate pain and 8 (33.3%) had severe pain. Mean TSH was elevated in patients with severe pain compared with those with mild-to-moderate pain (5.43 ± 2.31 vs. 3.35 ± 2.48 µIU/mL, P = 0.031). TSH levels showed a positive correlation with SPADI pain score (r =0.335, P = 0.011) and SPADI disability score (r = 0.375, P = 0.004), respectively. There was significant restriction in ROM in patients with higher TSH levels (P &lt; 0.001). CONCLUSION: Patients with AC have higher prevalence of hypothyroidism and subclinical hypothyroidism compared with those who did not. Patients with higher TSH levels had more severe pain, restriction of movement, and overall disability when compared with euthyroid patients. Proper management of hypothyroidism along with the standard measures of management may result in more speedy relief from symptoms and recovery of function in these patients.