High Prevalence Of Thyroid Dysfunction Research Articles

Pattern of Thyroid Dysfunction in Type II Diabetes Mellitus Patients in a Tertiary Care Center: A Cross-Sectional Study

Background: Early identification and intervention of thyroid dysfunction which occurs in association with type-II diabetes mellitus may significantly reduce the risk of adverse cerebrovascular and cardiovascular events in such patients. Hence, this study analyzed the pattern of thyroid dysfunction in T2DM (Type 2 Diabetes mellitus) patients. Methods: The present cross-sectional study was done on 250 T2DM patients, who visited the department of General Medicine in a tertiary care teaching center. Medical history was recorded and venous blood samples were collected for investigations (HbA1C (Hemoglobin A1C), FBS (Fasting blood sugar), PPBS (Postprandial blood sugar), TSH (Thyroid stimulating hormone), T4 (Tetraiodothyronine), anti-TPO (Thyroid peroxidase), and fasting lipid profile). Thyroid dysfunction in patients with T2DM was considered as the primary outcome variable. P value <0.05 was considered statistically significant. Data were analyzed using coGuide software, V.1.03. Results: Females (55.6%) outnumbered males (44.4%) in this study. The prevalence of thyroid dysfunction in our study was 23.6% (95%CI 0.184 to 0.293). Subclinical hypothyroidism was found in 67.79% (95%CI 0.543 to 0.793) participants, overt hypothyroidism in 27.11% (95%CI 0.163 to 0.402), and hyperthyroidism in 5.10% (95%CI 0.010 to 0.141). Females (84.6%) had significantly higher prevalence of anti-TPO positivity compared to males (15.4%)(p=0.013). Conclusions: Findings of this study showed that T2DM patients have higher prevalence of thyroid dysfunction with predominance of subclinical hypothyroidism. Hence, this study emphasizes the importance of annual investigation of TSH levels in all the patients with T2DM. Keywords: Autoimmune Diseases, Hyperthyroidism, Hypothyroidism, Thyroid­Stimulating Hormone, Type II Diabetes Mellitus

An Assessment of Thyroid Dysfunction and Related Parameters in Patients With Systemic Autoimmune Disorders.

Background and objective Systemic autoimmune disorders involve abnormal immune responses leading to tissue damage. Dysfunction of the thyroid gland due to autoimmune mechanisms is commonin such disorders, which can cause either hypofunctioning or hyperfunctioning of the gland. This study aimed to investigate the prevalence of thyroid dysfunction among patients with various systemic autoimmune disorders. Material and methods This cross-sectional observational study included 110 adult patients either diagnosed with or having clinical/biological features of systemic autoimmune diseases. The patients underwent a detailed clinical history assessment, physical examination, and necessary investigations. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0. (IBM Corp., Armonk, NY). Results Among the 110 autoimmune disorder patients, 22.7% had thyroid dysfunction, specifically hypothyroidism, while 77.3% were euthyroid. Hypothyroidism was prevalent among patients with rheumatoid arthritis (RA, 20.3%), systemic sclerosis (SSc, 20%), ankylosing spondylitis (AS, 15.8%), and systemic lupus erythematosus (SLE, 54.5%). Moreover, 60% of patients were anemic, and the prevalence of anemia was higher among female patients and younger individuals. Conclusions This study showed a higher prevalence of thyroid dysfunction, particularly hypothyroidism, in patients with systemic autoimmune disorders. Female patients and younger individuals were more susceptible to autoimmune disorders, thyroid dysfunction, and anemia. These findings highlight the need for simultaneous screening and evaluation for thyroid dysfunction and anemia in systemic autoimmune disease patients, particularly in female patients and those of younger age groups.

Thyroid Dysfunction at Different Stages of Chronic Kidney Disease: A Cross-Sectional Study at a Rural Teaching College in Central India.

Background The high prevalence of thyroid dysfunction in patients with chronic kidney disease (CKD) indicates a major correlation between the progression of CKD and thyroid dysfunction. In this study, we highlighted thyroid dysfunction and its relation to the severity and different stages of CKDs. Materials and methods From October 2018 to September 2020, 200 cases with CKD, admitted under the Department of Medicine at a rural teaching hospital in central India, were selected for the study. The collected data was analyzed and correlated using the Chi-square test, and the parameters suggested the presence or absence of low T3 syndrome, low T4 syndrome, and primary hypothyroidism. Results Out of 200 patients enrolled, 181 (91.5%) had thyroid abnormalities. Among these patients, the presence of low T3 syndrome was 57%, low T4 syndrome was 23%, and primary hypothyroidism was 10.5%. It was reported that as the CKD stages advanced, TSH levels increased with a statistically significant difference (p=0.04). Conclusions As kidney function progressively deteriorated, specifically in stage five, the chances of occurrence of hypothyroidism increased.

Thyroid function, glycemic control, and diabetic nephropathy in patients with type 2 diabetes over 24 months: prospective observational study

BackgroundThe higher prevalence of thyroid dysfunction in type 1 diabetes patients has been well established, whereas it is a matter of debate whether that is also observed in type 2 diabetes patients. This study was conducted to reveal whether higher prevalence of thyroid dysfunction is observed in patients with type 2 diabetes.MethodsWe examined thyroid functions and thyroid autoantibodies in 200 patients with type 2 diabetes and 225 controls, with 24 months follow up for those with type 2 diabetes.ResultsSerum free triiodothyronine (fT3) levels and fT3/free thyroxine (fT4) ratio were significantly lower, while fT4 levels were significantly higher in patients with type 2 diabetes. The number of patients with thyroid dysfunction or patients positive for thyroid autoantibodies were not different between the two groups. The fT3/fT4 ratio was positively and negatively correlated with serum c-peptide and HbA1c levels, respectively, suggesting that the difference can be attributable to insulin resistance and diabetic control. In the follow-up observation, we found no significant correlation between basal thyrotropin (TSH), fT3, fT4 or fT3/fT4 ratio with the amounts of changes of HbA1c levels at 12 or 24 months after the basal measurements. There was a negative relationship between TSH levels and eGFR at baseline measurements, but TSH levels did not seem to predict future decline of eGFR levels. No relationship was observed between urine albumin/ g‧cre levels and thyroid function.ConclusionThyroid dysfunction and thyroid autoantibodies were not different in prevalence between patients with type 2 diabetes and controls, although in patients with type 2 diabetes, the fT3/fT4 ratio was decreased. Basal thyroid function did not predict future diabetes control or renal function within 24 months of follow-up.

P-589 How Does Hypothyroidism Alter Perinatal Outcomes in Patients with Polycystic Ovary Syndrome? - An Evaluation of a Population Database

Abstract Study question Does concomitant hypothyroidism in polycystic ovary syndrome (PCOS) patients have an additive effect on the risk for adverse pregnancy, delivery and neonatal outcomes? Summary answer In patients with PCOS, hypothyroidism significantly increases the risk for preeclampsia, however risks of other adverse perinatal outcomes are unaltered. What is known already PCOS and hypothyroidism are common endocrinopathies during reproductive age, and each has been shown to be associated with pregnancy complications. While PCOS has been associated with gestational diabetes, gestational hypertension, and preeclampsia, overt hypothyroidism has been associated with pregnancy loss, intrauterine growth restriction, preeclampsia, and preterm birth. Furthermore, PCOS and thyroid abnormalities are known to be linked, with a higher prevalence of thyroid dysfunction in pregnant PCOS patients compared to controls. However, information on obstetric and neonatal outcomes in women with both PCOS and hypothyroidism is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. This population-based cohort study included 14,882 women with an International Classification of Diseases (ICD)-9 diagnosis of PCOS in the United States. IN 2015 data was converted to ICD-10 codes which are not comparable to ICD-9 codes. Participants/materials, setting, methods All pregnancy admissions that resulted in delivery or maternal death were included so that patients were counted only once per pregnancy. We compared PCOS women with a concurrent diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Multivariate logistic regression analysis was used to adjust for confounding effects. Main results and the role of chance Overall, 14,882 women met the inclusion criteria. Amongst them, 1,882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥35 years vs. 18%, p < 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery, and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033), when not accounting for confounding effects. In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). Of note when controlling for confounding effects, all other pregnancy, delivery, and neonatal outcomes were comparable between the groups, including pregnancy-induced hypertension; eclampsia; gestational diabetes mellitus; preterm premature rupture of membranes; preterm delivery; placental abruption; cesarean delivery; hysterectomy; post-partum hemorrhage; wound complications; maternal death; blood transfusions; maternal infection; venous thromboembolism; disseminated intravascular coagulation; SGA; intrauterine fetal death; and congenital anomalies. Limitations, reasons for caution Due to our study’s retrospective nature, some data is missing such as TSH levels, TPO antibody status, the time period in which hypothyroidism was diagnosed (pre-gestationally or during the 1st, 2nd or 3rd trimesters), and Levothyroxine treatment dose and compliance. Wider implications of the findings Patients with PCOS and hypothyroidism during pregnancy should be managed with consideration of instituting both preventive measures for preeclampsia development and heightened blood pressure, proteinuria, and symptom monitoring. Interestingly, hypothyroidism did little to affect the already increased rates of pregnancy complications in PCOS. This should be further studied. Trial registration number not applicable

Prevalence and risk factors of thyroid dysfunction in outpatients with overweight or obese first-episode and drug-naïve major depressive disorder

BackgroundThyroid dysfunction is common in patients with major depressive disorder (MDD). However, few studies have examined risk factors for thyroid dysfunction in overweight or obese first-episode and drug-naïve (FEDN) MDD patients. This study aimed to investigate the prevalence and risk factors of thyroid dysfunction in FEDN MDD patients with comorbid high body mass index (BMI). MethodsA total of 1718 FEDN MDD patients were included. Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale were used to assess the clinical symptoms of the patients. In addition, metabolic parameters and thyroid hormone levels were measured. ResultsThe prevalence of thyroid dysfunction was approximately 1.75 times higher in MDD patients with comorbid overweight or obesity (72.3 %) than in patients without high BMI (58.8 %). The HAMD score, HAMA score, systolic blood pressure (BP), fasting blood glucose (FBG), thyroid peroxidase antibody (TPOAb), total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C), were risk factors for thyroid dysfunction in MDD patients with high BMI. The combination of HAMD, FBG, TC, LDL-C, and systolic BP had a high AUC value of 0.76 differentiating patients with and without thyroid dysfunction. LimitationCausality cannot be drawn due to cross-sectional design. ConclusionsThis study demonstrated a high prevalence of thyroid dysfunction in FEDN MDD patients with high BMI. Severity of depression and anxiety, levels of systolic BP, FBG, TPOAb, TC, HDL-C and LDL-C appear to be associated with thyroid dysfunction in FEDN MDD patients with high BMI.

Study of Thyroid Autoantibodies in Infertile Women Visiting Chittagong Medical College Hospital, Chattogram, Bangladesh

Background: Thyroid hormones are essential for normal growth, sexual development and reproductive function. Thyroid dysfunction can lead to a variety of gynaecological disorders ranging from menstrual irregularities to infertility. Autoimmune thyroid disease (AITD) is now one of the most important causes of female infertility. Thus, this study was designed to study possible relationship between thyroid disorders, as well as thyroid autoimmunity and unexplained infertility.
 Methodology: This was a hospital based cross-sectional observational study comprising hundred (100) infertile women aging 18-35 years in Outpatient Department of Obstetrics & Gynaecology and Endocrinology in Chittagong Medical College Hospital and Department of Biochemistry, Chittagong Medical College, Chattogram. Samples were taken by non-probability consecutive sampling. Important variables in this study were serum FT3, FT4, TSH and thyroid antibodies (anti TPO and anti TG).
 Results: The majority of the infertile women were 21-30 years. Primary and subclinical hypothyroidism were 5% and 17% cases in this study. On the other hand, 22% cases of this study had anti-TG antibody positive and 26% cases had anti-TPO antibody positive.
 Conclusions: The results of the present study suggest that, increased anti thyroid antibody were associated with a higher prevalence of thyroid dysfunction and mainly hypothyroidism. So, we propose that a systematic screening of TSH, FT3, FT4 and the presence of thyroid antibodies could be considered in all women with a female cause of infertility.
 EMCJ. July 2022; 7(2): 6-9

A community based prospective study on thyroid dysfunction among pregnant females and its effect on maternal and neonatal outcome

Background: Thyroid disorders are often overlooked in pregnancy because of their non-specific symptoms and the hypermetabolic state of pregnancy. The laboratory measurements of thyroid function play an important role in the assessment of maternal thyroid health. Thyroid disorders can have grievous effect on mother and new-borne which can be prevented. The study was aimed to find the prevalence of thyroid dysfunction among pregnant females and its effect on maternal and neonatal outcome.Methods: A prospective study was conducted from August 2019 to October 2020 among 360 pregnant females in the rural fields practice area of a medical college. Thyroid function test was done in all pregnant females and the maternal and neonatal outcome was noted.Results: 20.31% of the pregnant females were found to be suffering from thyroid dysfunction which is approximately 1/5th of the total sample. Out the total females with thyroid dysfunction maximum females suffered from subclinical hypothyroidism that is 10.94% while 1.56% had overt hypothyroidism. 1.88% and 5.94% had subclinical and overt hyperthyroidism respectively. Postpartum haemorrhage, pre term delivery, abortion and neonatal deaths were more common in females with thyroid dysfunction as compared to euthyroid females although not statistically significant.Conclusions: Though pregnancy outcome was not found to be significantly adverse among females with thyroid dysfunction, very high prevalence of thyroid dysfunction among pregnant warrants its detection during antenatal care to be uniformly included in peripheral health care centres.

Association of thyroid dysfunction and COVID-19: A systematic review and meta-analysis.

This systematic review and meta-analysis was conducted to evaluate the effect of COVID-19 on thyroid function and the role of thyroid hormones alterations in predicting the severity of COVID-19. Online databases, including Scopus, Medline/PubMed, EMBASE, Google Scholar, and Cochrane were searched up to August 2, 2022. After screening titles, abstracts, and full manuscripts, respectively, 30 reports were enrolled. The risk of bias (ROB) was evaluated using the QUADAS-2 tool. In addition, odds ratio (OR) and hazard ratio (HR) analysis for assessing the OR of abnormal thyroid function tests (TFT) in predicting the COVID-19 severity and poor outcomes. Among 30 enrolled studies, ROB of the current study is estimated low to moderate. The average number of patients in each study was 325 (range: 40-3,703), with an overall mean age of 57.6, and the female proportion of 40.4%. Overall, the pooled analysis showed that the prevalence of thyroid dysfunction among 9,707 COVID-19 cases was 15%. Among mild to moderate COVID-19 patients, 6.2% had abnormal TFT, and among patients who experienced severe to critical COVID-19, 20.8% had abnormal TFT. The pooled OR for abnormal TFT and the severity of COVID-19 obtained from 3,865 COVID-19 patients was 3.77 (2.03, 6.99). The pooled HR of TSH level of COVID-19 mortality was 1.57 (0.91, 2.72). Our results demonstrate a high prevalence of thyroid dysfunction in COVID-19, and that among patients severe cases had a 3.77-fold higher risk of abnormal TFT compared to mild to moderate COVID-19. Further studies are required to evaluate the longer-term prognostic role of thyroid dysfunction in severe COVID-19, and investigate potential therapeutic strategies.

Clinicoepidemiological Features of Childhood and Adult Vitiligo - A Cross- Sectional Observational Study

BACKGROUND
 Vitiligo is an acquired primary, usually progressive, melanocytopenia of unknown aetiology clinically manifested by circumscribed achromic macules and histologically by degeneration and disappearance of melanocytes in involved skin. Childhood vitiligo deserves special attention as it has unique epidemiological features. We wanted to determine, compare and analyze the clinical and epidemiological features and autoimmune disease associations in childhood vitiligo and adult vitiligo.
 METHODS
 It was a prospective cross-sectional observational hospital-based clinical study conducted in a suburban medical college hospital over 20 months which involved 120 patients with vitiligo who were assessed using detailed history and clinical examination for demographic and clinical data. Relevant history and family history were noted. Investigations including complete hemogram, serum biochemistry profile, thyroid profile and fasting plasma glucose examination were performed in all patients. Data were collected, tabulated, and all statistical analysis was done by using SPSS trial version 25 and in MS Excel 2007.
 RESULTS
 The majority of patients were in the age group of 16-30 years. Among 60 patients, female preponderance was noted in the study with a percentage of 53.3 % followed by 46 % males in the childhood group. The prevalence of segmental vitiligo was more in children (30 %) than in adults (5 %) which was statistically significant (P= 0.000). In adults, there was a statistically significant higher prevalence (P=0.000) of mucosal vitiligo (30 %) than in children (3.35 %). On performing statistical analysis, thyroid dysfunction (P=0.00) and diabetes mellitus (P=0.01) were found to be significantly more prevalent in adults than in children.
 CONCLUSIONS
 This study provides clinical evidence that vitiligo at different ages has different characteristics mainly regarding an increased incidence of segmental vitiligo and a more common positive family history among children than adults. A higher prevalence of thyroid dysfunction and diabetes mellitus in adult vitiligo patients compared to children warrants prompt treatment in all detected cases to prevent long-term morbidity and complications.

Impact of Thyroid Function on Pregnancy and Neonatal Outcome in Women with and without PCOS.

Background: Women with polycystic ovary syndrome (PCOS) are more prone to autoimmune thyroiditis, and both disorders lead to subfertility and pregnancy-related complications. The aim of this study was to investigate whether mothers with and without PCOS and their offspring have comparable thyroid parameters at term and how thyroid parameters are associated with perinatal outcome in this population. Methods: This cross-sectional observational study was performed in a single academic tertiary hospital in Austria. Seventy-nine pregnant women with PCOS and 354 pregnant women without PCOS were included. Blood samples were taken from the mother and cord blood at birth. Primary outcome parameters were maternal and neonatal thyroid parameters at delivery. Secondary outcome parameters were the composite complication rate per woman and per neonate. Results: Thyroid dysfunction was more prevalent among PCOS women (p < 0.001). At time of birth, free triiodothyronine (fT3) levels were significantly lower in PCOS than in non-PCOS women (p = 0.005). PCOS women and their neonates had significantly higher thyreoperoxidase antibody (TPO-AB) levels (p = 0.001). Women with elevated TPO-AB had a significantly higher prevalence of hypothyroidism (p < 0.001). There was a significant positive correlation between maternal and neonatal free thyroxine, fT3 and TPO-AB levels. There were no significant differences in thyroid parameters between women or neonates with or without complications. Conclusions: Our results demonstrate a higher prevalence of thyroid dysfunction and autoimmunity in PCOS women, supporting a common etiology of both disorders. We were not able to show an association between complication rate and thyroid parameters.

Establishment of an iodine model for prevention of iodine-excess-induced thyroid dysfunction in pregnant women.

This study aims to explore the relationship between the iodine status and thyroid dysfunction (TD) in pregnant women and establish a model to guide them to prevent excessive iodine intake. A total of 515 pregnant women were enrolled in the study. Urinary iodine concentration (UIC), thyroid hormones, and thyroid autoantibodies were measured, and then a logistic regression model was established. The median UIC of pregnant women was 174 ± 120 μg/L. Multivariate logistic regression analysis indicated that multivitamin supplements containing iodine and frequent seafood consumption were risk factors for excessive iodine (UIC ≥500 μg/L). Besides, excessive iodine was a risk factor for TD. Iodine excess was associated with a high prevalence of TD in pregnant women, especially TPOAb-positive women (P < 0.05). A logistic regression model based on potential risk factors was established to predict the risk of excessive iodine intake among pregnant women and provide guidance to minimize the risk of excessive iodine intake, thus reducing the risk of TD.

Thyroid dysfunction in cerebral venous thrombosis: a retrospective cohort study

BackgroundCerebral venous thrombosis (CVT) is a multifactorial disease with a variety of related conditions and risk factors. Thyroid dysfunction—especially hyperthyroidism—has been linked to CVT, but this is mainly based on case reports ranging back to 1913, while systematic investigations addressing this issue are lacking. Therefore, we investigated the frequency and clinical characteristics of thyroid dysfunction in a large single-center cohort of CVT patients.MethodsWe retrospectively identified all consecutive patients with aseptic CVT treated at our center between 2006 and 2020. Clinical information was extracted from our electronic medical documentation system. Thyroid-stimulating hormone (TSH) had been routinely measured at admission, free thyroid hormones and thyroid autoantibodies were analyzed whenever available.ResultsOf 120 patients with imaging-confirmed CVT, our main analysis included 107 patients (mean age 42 ± 16 years, 74% female) in whom TSH measurements were available. Nineteen patients (17.8%, 95% confidence interval 10–25%) had thyroid dysfunction. Two had newly diagnosed hyperthyroidism (1.9%, 95% confidence interval 0–4%) caused by Graves’ disease, but without typical symptoms for this condition. Seventeen patients (15.9%, 95% confidence interval 9–23%) had hypothyroidism (12 previously diagnosed with ongoing thyroid hormone replacement therapy; 5 with newly diagnosed subclinical hypothyroidism). Clinical CVT characteristics were similar comparing patients with versus without thyroid dysfunction.ConclusionWe observed a remarkably high prevalence of thyroid dysfunction in CVT patients. Whether this finding reflects a causal relationship warrants further studies. Despite that, the frequent coexistence of both diseases argues for TSH screening in CVT patients.

Thyroid Disorders in Type 2 Diabetics in India: A Real-world Evidence-based Study

Background: In Type 2 diabetes mellitus (T2DM), both hypothyroidism and hyperthyroidism are commonly seen. The circulating thyroid hormones have a significant effect on the metabolism of glucose, lipid, and protein. In the case of T2DM, glycaemic control can worsen due to this effect. In T2DM patients, hyperglycemia can occur due to worsening diabetes mellitus because of hyperthyroidism and thyrotoxicosis and can increase the risk of complications of diabetes. T2DM also affects the levels of thyroid stimulating hormone by reducing it. It also impairs triiodothyronine (T3) conversion from thyroxine (T4) in the peripheral tissues. If T2DM is poorly managed, it can lead to insulin resistance and hyperinsulinemia. It is important to carry out more studies to clarify the relationship between thyroid disorders and T2DM. Objective: To understand the interdependent relationship between TD, T2DM, and hypertension. Material and methods: Retrospective, single-center, observational study conducted on anonymized patient data captured from electronic medical records (EMR). The demographic and clinical profile of T2DM patients were noted along with the thyroid test lab values available for the diabetic patients in the records. Results: A high prevalence of thyroid dysfunction was found in T2DM diabetics than found in the normal population. In the present study, hypothyroidism was found to be more in T2DM patients as compared to hypothyroidism. Conclusion: An increased prevalence of TD is being seen in T2DM patients and can worsen each other's function. A more systematic approach is needed for thyroid testing considering the clinical implications of the coexistence of TD and T2DM.

Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status.

Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. Mother-infant pairs (n=87) were recruited at three months postpartum and followed up at six months postpartum (n=78). Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p=.001). There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.

Is climacterium by the mid-40s associated with thyroid dysfunction or autoimmunity? A population-based study.

We investigated whether more advanced climacteric stage in the mid-40s is associated with thyroid autoimmunity and dysfunction. This cross-sectional cohort study included 2,569 46-year-old women. Thyroid hormone, thyroid peroxidase antibodies, and follicle-stimulating hormone levels were determined. Using menstrual history and follicle-stimulating hormone levels, the participants were divided into climacteric (n = 340) and preclimacteric (n = 2,229) groups. Women diagnosed with premature ovarian insufficiency (menopause by 40 y of age) were excluded. The use of thyroid medication was evaluated from the medication reimbursement register. The prevalence of thyroid medication use, laboratory-based thyroid dysfunction, and thyroid peroxidase antibody positivity was compared between the two groups. The association between climacteric status and thyroid disorders was investigated using a logistic regression model including smoking and thyroid antibody status. At 46 years old, climacteric women used thyroid medication more often than preclimacteric women (9.1% vs 6.1%; P = 0.04). There was no difference in the prevalence of subclinical or clinical hypothyroidism and hyperthyroidism in nonmedicated participants (5.5% vs 5.0%; P = 0.7) or thyroid peroxidase antibody positivity (14.0% vs 15.0%, P = 0.7). In the regression model, being climacteric (OR = 1.6; 95% CI 1.1-2.3; P = 0.02) and antibody positivity (OR 4.9; 95% CI 3.6-6.6; P < 0.001) were associated with a higher prevalence of thyroid dysfunction. More advanced climacteric stage in the mid-40s was slightly associated with thyroid dysfunction but not thyroid autoimmunity.

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies.

Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

Prevalence of thyroid dysfunction and anti–thyroid peroxidase antibody in gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) and thyroid dysfunction are the two common endocrine disorders affecting pregnancy. Some association was hypothesized between GDM and thyroid dysfunction in the literature. The main aim of this study was to unveil this metabolic interplay as better understanding may facilitate early diagnosis and intervention thereby limiting major fetal and maternal adverse events. Here we estimated the prevalence of abnormal thyroid function and anti–thyroid peroxidase (anti-TPO) antibody and also studied the risk factors for thyroid disorders in patients with GDM. Materials and Methods: This cross-sectional study was conducted between February 2014 and January 2015. A total of 100 consecutive pregnant women diagnosed to have GDM as per the American Diabetes Association 2013 recommendations were recruited and thyroid stimulating hormone, free triiodothyronine (T3), free thyroxine (T4), and anti-TPO antibody assays were done. Details regarding pregnancy outcome and any complications if present were also obtained and analyzed. The prevalence is expressed as proportions, and the statistical significance of risk factors was assessed using the chi-square test and independent t-test. Results: Abnormal thyroid function was detected in 31 (31%) patients, which includes 17 cases of subclinical hypothyroidism (54%), 10 hypothyroidism (32%), 2 (6%) subclinical hyperthyroidism, and one case each of isolated low T3 and isolated low T4. Anti-TPO antibody was positive in 35 patients (35%). History of GDM in previous pregnancy, family history of diabetes mellitus, presence of clinically detectable thyroid gland enlargement, and presence of anti-TPO antibody in serum were found to increase the risk of thyroid dysfunction. Majority of the subjects had uneventful delivery, and no significant increase in maternal or fetal complications was reported. Conclusions: This study showed a high prevalence of thyroid dysfunction and anti-TPO antibody in GDM patients. The significant thyroid abnormalities detected were subclinical hypothyroidism and hypothyroidism. The risk of thyroid dysfunction is elevated in patients with the presence of anti-TPO antibody. This scenario provides a strong ground to recommend meticulous assessment of thyroid function in GDM patients.

Prevalence of Thyroid Dysfunction and its Relationship with Severity of Depression among Patients of Depression attending Tertiary Hospital

Background: Thyroid dysfunction is common feature among patients presenting with depression. The aim of this study was to estimate the prevalence of thyroid dysfunction in patients with depression attending Psychiatry outpatient department of College of Medical Sciences and Teaching Hospital, Chitwan, Nepal and to investigate its relationship with the severity of depression.&#x0D; Methods: A total of 259 who attended the Psychiatry OPD of College of Medical Sciences and Teaching Hospital were enrolled over a period of 6 months after taking informed written consent. These patients were diagnosed as depression as per the ICD-10/ DCR criteria. The severity of illness was determined by using HAM-D. Thyroid profiling was done against common thyroid hormones TSH, FT3 and FT4 by standard method. Data was analyzed using SPSS.&#x0D; Results: Among 259 patients, thirty patients (18.40%) were found to have thyroid dysfunction, sub-clinical hypothyroidism was seen in 23 (14.1%) followed by 3.1% with overt hypothyroidism and 1.2% with overt hyperthyroidism. However, there was no significant association found between severity of depression and thyroid dysfunction.&#x0D; Conclusions: This study concluded that there was high prevalence of thyroid dysfunction in patients with major depression. Thus screening of thyroid test among depressive patients may be helpful in proper management of cases.

13624 Thyroid dysfunction in psoriasis: Higher prevalence of thyroid dysfunction in patients with generalized pustular psoriasis

13624 Thyroid dysfunction in psoriasis: Higher prevalence of thyroid dysfunction in patients with generalized pustular psoriasis