High Thyroid Peroxidase Antibody Research Articles

Correlation of thyroid function and sensitivity to thyroid hormone with spinal bone mineral content, bone mineral density, and osteoporotic vertebral fracture: A cross-sectional study based on NHANES.

Previous studies have demonstrated that thyroid hormone plays an important role in normal bone development, bone metabolism, and establishment of peak bone mass. However, the correlation of thyroid status with bone mineral content (BMC), bone mineral density (BMD), and osteoporotic vertebral fracture (OVF) is rarely discussed. The current study probes into the potential association between thyroid status and spinal BMC, BMD, and OVF from a novel perspective of thyroid function (TF) and sensitivity to thyroid hormone based on the National Health and Nutrition Examination Survey database. A total of 1844 participants were included in this study. The association of thyroid status with outcome variables, like spinal BMC, BMD, and OVF, was analyzed using thyroid function indices and sensitivity to thyroid hormone indices as influence factors. The correlation of them were assessed using univariate and multivariable weighted linear regression, weighted logistic regression models, restricted cubic spline model, and subgroup analyses. The results of this study showed that the association of free triiodothyronine (FT3)/free thyroxine (FT4) with BMC remained negatively associated after adjustment for all covariates. Higher thyroid peroxidase antibody (TPOAb) was significantly associated with an increased risk of developing OVF in both unadjusted and adjusted models. In addition, the results of the restricted cubic spline model were consistent with the weighted multivariate regression analysis after adjustment. The results of this cross-sectional study showed that higher FT3/FT4 and TPOAb were associated with decreased spinal BMC and the increased risk of OVF, indicating a complex link between thyroid status and bone health. Therefore, patients with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, or abnormal peripheral thyroid sensitivity, especially who with elevated TPOAb or FT3/FT4, should focus on the prevention of vertebral osteopenia, osteoporosis, and OVF.

Sex-specific effect of maternal thyroid peroxidase antibody exposure during pregnancy on 5- to 6-year-old children's cardiometabolic risk score: the Ma'anshan birth cohort study.

To explore the association between maternal thyroid peroxidase antibody (TPOAb) exposure and 5- to 6-year-old children's cardiometabolic risk (CMR). A total of 2129 mother-child pairs were recruited from the Ma'anshan Birth Cohort (MABC) study. Serum TPOAb was retrospectively measured in pregnant women using an electrochemiluminescence immunoassay. CMR score was evaluated by the serum glycolipids, blood pressure, and waist circumference for children aged 5-6 years. Growth mixture modelling was used to fit trajectories of TPOAb levels throughout pregnancy. Multiple linear regression models and logistic regression models were used for statistical analyses. Two thousand one hundred twenty-nine mother-child pairs (mean [SD] age, 26.6 [3.6] years) were enrolled for the final study. Maternal TPOAb exposure in the first trimester increased children's overall CMR, glucose level, HOMA-IR, triglyceride level, boys' overall CMR, boys' glucose level, and girls' glucose level. TPOAb exposure in the first trimester was also associated with lower boys' high-density lipoprotein cholesterol (HDL-C) level. In the second trimester, maternal TPOAb exposure was positively associated with children's triglyceride level. Compared with low TPOAb trajectory, children with high maternal TPOAb trajectory had an increased risk of developing high CMR (OR = 3.40; 95% CI, 1.30-8.90), hyperglycemia (OR = 5.20; 95% CI, 2.20-12.28), insulin-resistance (adjusted OR = 2.12; 95% CI, 1.10-4.07), and hypertriglyceridemia (OR = 2.55; 95% CI, 1.06-6.14). The first trimester of pregnancy is a critical period for maternal TPOAb exposure to affect CMR in children, with some sex specificity, mainly to the detriment of boys.

Association between Thyroid Function indices and Thyroid Autoantibodies with Thyroid Ultrasonography Outcomes in Children and Adolescents

Objectives: Thyroid Ultrasonography (US) is recommended as a valuable tool for evaluating the status and function of the thyroid gland. The objective of this study was to compare and analyze the thyroid ultrasonography outcomes in children and adolescents who have normal thyroid function and thyroid antibodies.
 Methods: A cross-sectional study was conducted on a group of 233 selected females aged 9 to 14 years old. Blood samples were obtained from the subjects and analyzed for thyroid hormones and thyroid autoantibodies. Additionally, a thyroid ultrasound was performed to provide an in-depth evaluation.
 Results: Of all the participants, 25% displayed hypoechogenicity. Individuals with reduced echogenicity had higher median levels of thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPO-Ab), and thyroglobulin antibody (Tg-Ab) compared to those with normal echogenicity. Moreover, those with hypoechogenicity had significantly higher thyroid volume (TVol), iodine status, and thyroglobulin levels than their counterparts with normal echogenicity. Hypoechogenicity was also significantly associated with higher levels of TPO-Ab, Tg-Ab, and TSH. Logistic regression analysis revealed that high TSH and TPO-Ab levels were associated with a higher risk of irregular echo patterns and thyroid autoantibodies.
 Conclusion: The results revealed that irregular thyroid patterns in the ultrasonography were useful for assessing thyroid structure and dysfunction. Moreover, elevated TPOAb, Tg-Ab, and TSH concentrations in the serum may indicate thyroid malfunction. Ultrasound can help to identify early thyroid dysfunction along with the standard thyroid assessment biomarkers.

Are Mental Health Problems and Mindfulness Awareness Related to Levothyroxine Replacement in Adolescent Patients With Hashimoto's Thyroiditis?

Considering the possible adverse effects of thyroid autoantibodies on the brain, the present study aimed to investigate whether there was a difference in mental health difficulties and mindfulness awareness levels between subclinical Hashimoto's thyroiditis patients with and without levothyroxine (LT4) use. A case-control study was conducted. The Strengths and Difficulties Questionnaire (SDQ) and the Mindful Attention Awareness Scale (MAAS) were used to screen mental health difficulties and mindfulness awareness. Scale scores were compared by performing correlation analysis between the groups with respect to LT4 use and thyroid autoantibodies. Levothyroxine alone does not affect scale results. Higher thyroid peroxidase antibody (TPOAb) titers were positively correlated with the behavioral problems subscale of the SDQ, while awareness level in patients was inversely correlated with higher thyroglobulin antibody (TgAb) levels.

Exposure to persistent organic pollutants in Danish pregnant women: Hormone levels and fetal growth indices

This study examines possible associations of maternal Persistent Organic Pollutants (POP) exposure during pregnancy, maternal hormone levels and fetal growth indices (FGI). During 1st trimester, we measured maternal thyroids, androgens and estrogens, lipophilic POP and perfluorinated-alkyl-acid (PFAA) levels in serum from nulliparous women. Adjusted multivariate-linear regression models assessed associations between exposure and outcomes. Maternal characteristics and POP exposures associated with maternal hormone levels. Lipophilic POP elicited inverse association with androgen and estrogen levels but no strong association with thyroids. Higher level of PFAA was associated with higher thyroid and androgen levels. The PFAA did not associate with estrogens. Higher thyroid-peroxidase-antibody (TPO-Ab) and estradiol level associated with higher birth weight and length in sons. For daughters, the TPO-Ab associations were the opposite being inversely associated with birth weight and length, and higher TPO-Ab and estradiol associated with lower gestational age. Mediation analyses suggested that TPO-Ab mediates the association of PFAA with FGI.

Association Between Vitamin D, Zinc, and Thyroid Biomarker Levels With Vitiligo Disease: A Retrospective Cohort Study in a Tertiary Care Center.

Objectives Vitiligo is a dermatological autoimmune disease that has been linked with numerous risk factors. There is an elevated level of evidence suggesting a linkage between vitiligo disease and zinc, vitamin D (Vit-D), thyroid hormones, and thyroid antibody levels. Methods This retrospective cohort studyincluded patients of all age groups of both sexes. Patients were investigated for demographics, vitiligo characteristics, and laboratory tests, including zinc, Vit-D, T3 (triiodothyronine), T4 (thyroxine), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb). Results Two hundred and ninety-seven patients were retrospectively assessed; they averaged 29 years for segmental vitiligo (SV) and 31 years for nonsegmental vitiligo (NSV). Gender-wise, our study included more females (57.5%) than males (42.5%). Females comprised approximately 51.8% of NSV patients, while males constituted 36.7%. Patients'T3, T4, and TPOAb levelscorrelated significantly with age (p=0.001, p <0.01, p=0.14), and elevated BMI recorded high TPOAb levels (p<0.001). An increase in TGAb was associated with extensive involvement in the depigmentation of body surface area (BSA). The segmental type had the lowest TGAb and TPOAb titers. The universal subtype of vitiligo recorded the highest TSH, T3, and TGAb levels. However, differences in laboratory test levels were insignificant for the sex, the type of vitiligo, or the subtype of vitiligo. Conclusion In conclusion, neither Vit-D nor zinc had a significant linkage with any of vitiligo's characteristics or treatments. Nonetheless, TGAb had a significant correlation to the BSA involved with vitiligowhile T4 and TPOAb had a significant association with age, BMI, and BSA overall. Statistically, T3 waslinked with age and BSA overall only. More studies with a higher level of evidence are required to establish the association of Vit-D, zinc, thyroid biomarkers, and thyroidantibodies.

Correlation between thyroid autoantibodies and cardiovascular disease in patients with stages 3-5 chronic kidney disease.

BackgroundChronic kidney disease (CKD) is associated with thyroid disease and cardiovascular disease (CVD). To date, little is known about the association of thyroid autoantibodies with renal function or cardiac function in patients with CKD.MethodsThis is a descriptive cross-sectional study. Patients diagnosed with stages 3–5 CKD from January 2015 to May 2019 at our department were recruited. Routine medical history, general clinical data, and laboratory test indexes were collected for all patients. Echocardiography was performed by a trained echocardiographer to measure E in early diastole and A, E/A ratio, E’ in early diastole, A’ in end-diastole, E/E’ ratio, and E’/A’ ratio.ResultsA total of 1,164 patients with stages 3–5 CKD were included. Thyrotropin receptor antibody (TRAb) was significantly positively correlated with C-reactive protein (r=0.206, P<0.001). Thyroid peroxidase antibody (TPOAb) and TGAb titers in male diabetic patients were higher (r=0.137, P=0.023; r=0.159, P=0.011). In female patients, both TPOAb and TGAb were significantly negatively correlated with hemoglobin (r=–0.213, P=0.018; r=–0.188, P=0.019). The E/E’ of patients who were TPOAb positive was higher than that in patients with TPOAb negative (r=0.181, P<0.001). LVEF in patients who were TPOAb positive was higher than that in patients with TPOAb negative (r=0.159, P=0.007). In addition, LVEF was significantly negatively correlated with TRAb (r=–0.112, P=0.026).ConclusionsIn patients with stages 3–5 CKD, AITD may increase the risk of CVD in CKD patients by affecting triglycerides levels, increasing the risk of anemia, and promoting micro-inflammation. Attention should be paid to female patients with high TPOAb and TGAb titers. The mean of E/E’ in patients with stage 5 CKD was 16.89 in the present study. Women with TPOAb positive may be more likely to develop diastolic heart failure.

Thyroid Autoimmunity and Dysfunction in Sri Lankan Children and Adolescents After 22 Years of Sustained Universal Salt Iodization.

Background: Sri Lanka introduced universal salt iodization (USI) in 1995 after which we demonstrated a high thyroglobulin antibody (TgAb) prevalence in 1998. However, it is unclear whether thyroid autoimmunity persists in the long term in populations exposed to sustained USI and whether such populations have an excess of thyroid dysfunction. We evaluated the prevalence of thyroid autoantibodies and dysfunction in Sri Lankan children and adolescents after more than two decades of sustained USI. Methods: We selected 10- to 18-year-old subjects of both sexes (randomized cluster sampling) from all 9 provinces of Sri Lanka in this cross-sectional study. Blood, urine, and anthropometric data were collected and thyroid ultrasound scans were performed. Validated statistical methods were used to derive local population-specific reference ranges for all thyroid parameters. We also measured urine iodine concentration (UIC), salt, and water iodine concentrations. Results: Blood and urine samples from 2507 and 2473 subjects respectively, and ultrasound scans from 882 subjects were analyzed. Population-derived upper limits for thyroid peroxidase antibody (TPOAb) and TgAb, and reference ranges for triiodothyronine, thyroxine, and thyrotropin (total and age-year-related groups) were significantly different from manufacturer's reference ranges. Using these derived ranges, the prevalence of TPOAb was 10.3% and TgAb was 6.4%. Of the TPOAb-positive subjects, TPOAb were of low concentration in 66.2% (1-3 times the upper limit of the reference range [ULRR]) and showed the strongest association with subclinical hypothyroidism (SCH) at the highest concentrations (>4 ULRR). The prevalence of SCH was 3%. Median UIC (interquartile range) was 138.5 μg/L (79.4-219.0) with regional variability, and median thyroglobulin was 8.3 ng/mL (4.1-13.5). Goiter prevalence was 0.6% and 1.93% (thyroid volume compared to age and body surface area, respectively). Salt and water iodine concentrations were satisfactory. Conclusions: Sri Lanka has safely and effectively implemented USI with good sources of iodine, leading to sustained iodine sufficiency over more than two decades. The early postiodization TgAb surge (42.1%) has settled (6.4%), and despite a persistently high TPOAb prevalence (10.3%), SCH prevalence remains low (3%). Further studies should be undertaken to monitor thyroid autoimmune dysfunction in Sri Lankan children, using age-specific, population-derived reference ranges.

Positive Thyroid Peroxidase Antibody and Thyroglobulin Antibody are Associated With Better Clinicopathologic Features of Papillary Thyroid Cancer

ObjectiveTo compare the thyroid autoantibody status of patients with papillary thyroid cancer (PTC) and benign nodular goiter as well as possible associations between thyroid autoantibodies and clinicopathologic features of PTC. MethodsA total of 3934 participants who underwent thyroidectomy were enrolled in this retrospective study. Patients were divided into PTC and benign nodule groups according to pathological diagnosis. Based on the preoperative serum antibody results, PTC patients were divided into thyroid peroxidase antibody (TPOAb)-positive, thyroglobulin antibody (TgAb)-positive, dual TPOAb- and TgAb-positive, or antibody-negative groups. ResultsOf the 3934 enrolled patients, 2926 (74.4%) were diagnosed with PTC. Multivariate regression analyses suggested that high thyroid-stimulating hormone levels (adjusted odds ratio [OR] = 1.732, 95% CI [1.485-2.021], P < .001), positive TgAb (adjusted OR = 1.768, 95% CI [1.436-2.178], P < .001), and positive TPOAb (adjusted OR = 1.452, 95% CI [1.148-1.836], P = .002) were independent risk factors for predicting malignancy of thyroid nodules. Multinomial multiple logistic regression analyses indicated that positive TPOAb alone was an independent predictor of less central lymph node metastasis in PTC patients (adjusted OR = 0.643, 95% CI [0.448-0.923], P = .017), whereas positive TgAb alone was significantly associated with less extrathyroidal extension (adjusted OR = 0.778, 95% CI [0.622-0.974], P = .028). PTC patients with dual-positive TPOAb and TgAb displayed a decreased incidence of extrathyroidal extension (adjusted OR = 0.767, 95% CI [0.623-0.944], P = .012) and central lymph node metastasis (adjusted OR = 0.784, 95% CI [0.624-0.986], P = .037). ConclusionAlthough preoperative positive TPOAb and TgAb are independent predictive markers for PTC, they are also associated with better clinicopathologic features of PTC.

Thyroid antibody status exerts insignificant effect on lymph node metastasis of thyroid cancer.

BackgroundTo investigate whether high thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels are associated with increased risk of lymph node metastasis (LNM) of thyroid cancer.MethodsData of 2,352 patients who committed thyroidectomy from January 2018 to December 2018 at our institution were retrospectively reviewed. Of which, 806 patients diagnosed with thyroid cancer with available data of both TPOAb and TgAb were finally included, and were divided into four groups: (I) TPOAb−/TgAb− (control, n=493), (II) TPOAb+/TgAb− (n=96), (III) TPOAb−/TgAb+ (n=104), and (IV) TPOAb+/TgAb+ (n=113). The demographic and clinicopathological data were analyzed.ResultsCompared to control, significantly less extrathyroidal invasions were identified in TPOAb+ and/or TgAb+ patients (P<0.05), while no significant differences for tumor size, multifocality, or central/lateral neck LNM rate were found for TPOAb+ and/or TgAb+ groups (all P>0.05). Compared to control, significantly more lymph nodes were removed during neck dissection (P<0.05), but there were no significant differences for the number or size of lymph nodes involved (all P>0.05) for TPOAb+ and/or TgAb+ patients. TPOAb+ and/or TgAb+ were not identified as risk factors or protect factors of LNM of thyroid cancer in Logistic regression analyses.ConclusionsIn the present study, we demonstrated that anti-thyroid peroxidase and thyroglobulin antibodies are not associated with increased risk of lymph node metastasis of thyroid cancer.

Prevalence, predictors and outcomes of thyroid dysfunction in patients with acute myocardial infarction: the ThyrAMI-1 study

PurposeThyroid dysfunction in patients with cardiac disease is associated with worse outcomes. This study aimed to evaluate the prevalence and analyse predictors and outcomes of thyroid dysfunction in patients presenting with an acute myocardial infarction (AMI).MethodsA prospective multicentre observational study of patients recruited from six acute hospitals within the North of England. Consecutive patients without previous thyroid disease presenting with both ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) were recruited to the Thyroxine in Acute Myocardial Infarction 1 (ThyrAMI-1) cohort study between December 2014 and 2016. Thyroid profile, standard biochemistry measurements and demographic information were obtained within 12 h of admission to hospital. Multivariable logistic regression analyses were performed to assess the predictors of thyroid dysfunction and Cox proportional hazards analyses were utilised to compare all-cause mortality by categories of thyroid dysfunction up to June 2019.ResultsOf the 1802 participants analysed, 1440 (79.9%) were euthyroid, 312 (17.3%) had subclinical hypothyroidism (SCH), 22 (1.2%) had subclinical hyperthyroidism (SHyper) and 25 (1.3%) had low T3 syndrome (LT3S). Predictors for SCH were increasing age, female sex, higher thyroid peroxidase antibody (TPOAb) levels, higher serum creatinine levels and early morning sampling time (between 00:01–06:00 h). The predictors of SHyper were lower body mass index and afternoon sampling time (between 12:01 and 18:00 h). Predictors of LT3S were increasing age, higher creatinine levels and presence of previous ischaemic heart disease. Compared to the euthyroid group, patients with LT3S had higher all-cause mortality; adjusted hazard ratio (95% CI) of 2.02 (1.03–3.95), p = 0.04, whereas those with SCH and SHyper did not exhibit significantly increased mortality; adjusted hazard ratios (95% CI) of 1.05 (0.74–1.49), p = 0.79 and 0.27 (0.04–1.95), p = 0.19, respectively.ConclusionsThyroid dysfunction is common in AMI patients on admission to hospital and our data provide an understanding regarding which factors might influence thyroid dysfunction in these patients. Furthermore, the negative association between LT3S and increased mortality post-AMI has once again been highlighted by this study. More research is required to assess if treatment of thyroid dysfunction improves clinical outcomes.

Risk factors and outcomes of conversion to open surgery in endoscopic thyroidectomy via bilateral areola approach: a retrospective Chinese population study.

Although endoscopic thyroidectomy via the bilateral areola approach (ETBAA) has shown cosmetic advantage over open surgery, the risk factors of conversion to open surgery and its impact on patients remain unknown. The objective of this study is to analyze the predictors for conversion to open procedure in patients who underwent ETBAA and its related outcomes. The clinical data of patients who underwent ETBAA from May 2010 to May 2019 were analyzed retrospectively. The patients were divided into two groups according to operation notes: the conversion group and the non-conversion group. Univariate and multivariate logistic regression analyses were performed to investigate the risk factors for conversion to open surgery. Altogether, 140 patients were included in this study. Sixteen (11.4%) patients underwent conversion during ETBAA. Four factors demonstrated significant difference between the two groups: sex (P = 0.001), body mass index (BMI) (P = 0.021), thyroid peroxidase antibody (TPOAb) level (P = 0), and antithyroglobulin antibody (ATG) level (P = 0). Further univariate and multivariate logistic regression analysis revealed that male sex (P = 0.006), TPOAb level>7.8IU/ml (P = 0.005), and ATG level>79IU/ml (P = 0.003) had a significant correlation with conversion to open surgery in ETBAA. Prolonged operative time, increased surgical cost, and less patient cosmetic satisfaction were demonstrated in the conversion group (P < 0.05). Male sex, high TPOAb level, and high ATG level were independent risk factors for conversion. Conversion to open surgery in ETBAA is associated with prolonged operative time, increased surgical cost and less patient cosmetic satisfaction.

SAT-433 The Influence of Thyroid Autoimmunity on Pregnancy Outcome in Infertile Women

Background: Women with subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) reportedly have high risks of miscarriage and preterm birth. Infertile women undergoing assisted reproductive technology (ART) are recommended for levothyroxine (L-T4) supplementation to maintain TSH levels below 2.5 mIU/mL according to ATA guideline; however, insufficient evidence exists to determine whether L-T4 treatment for infertile women with TSH levels between 2.5 and 5.0 mIU/mL. Objective: To clarify the influence of TAI on pregnancy in infertile women under L-T4 treatment to maintain TSH levels below 2.5 mIU/mL, and to compare its influence depending on fertility treatments. Methods: A total of 595 infertile women who visited a fertility clinic between January 2013 and December 2015 were prospectively recruited to this study. Five patients with Graves’ disease were excluded and remained 590 women were included in the analysis. Infertile women with TSH levels above 2.5 mIU/mL were treated with L-T4 followed by evaluation of fertility status and pregnancy outcomes. Factors affecting pregnancy were analyzed statistically depending on fertility treatments. Written informed consent was obtained from all patients, and the study protocol was approved by the Ethics Committee. Results: The proportion of SCH and thyroid peroxidase antibodies (TPOAb).positivity was 19.6% and 10.4%, respectively. Women who did not become pregnant were older than those who became pregnant (p=0.003), but no influence of thyroid-associated factors on pregnancy was confirmed. Pregnancy outcome contrarily showed that women who had a miscarriage were older (p<0.001) and higher TPOAb titers (p=0.038) than those who had a live birth. In addition, higher age (OR 26.4, p<0.001) and high TPOAb titer (OR 11.8, p=0.043) were decided as risk factors for miscarriage through multiple logistic regression analysis. Among women who treated with intrauterine insemination, TPOAb titers were higher in women who had a miscarriage than in those who had a live birth (p=0.040). We further focused on the difference between ART methods including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Women undergoing IVF had higher TPOAb titers in women who had miscarriage than those who had a live birth (p=0.023), but in women undergoing ICSI there was no association between TPOAb titers and pregnancy outcome. Conclusion: Infertile women with high TPOAb titers are susceptible to miscarriage despite appropriate L-T4 treatment. The influence of TPOAb titers as well as TPOAb positivity on pregnancy should be considered, when undergoing fertility treatments.

109 Hyperthyroidism-induced Psychosis

To describe the presence of psychotic symptomatology in a patient with hyperthyroidism. Psychiatric-spectrum symptoms associated with thyrotoxicosis has been well reported in the past. However, psychosis in a patient with a thyroid nodule is a rare find. Here, the case of twenty four-year-old, single, unemployed, Albanian American male with self-reported history of Attention Deficit Disorder (ADD) and Cannabis use disorder was brought in to the Comprehensive Psychiatric Emergency Program (CPEP) due to new onset psychosis. Patient was paranoid, disorganized with labile mood. He had poor insight, judgement and impulse control. The event coincided with a period of unemployment in his life and new onset of hallucinations from past few days. He was brought in to the hospital after he was found pacing and having lack of sleep. Patient was treated with antipsychotic for acute psychosis. He was started on Risperidone initially to which he did not respond to. Blood work showed low TSH and elevated T4. Physical exam was noted for palpable thyroid nodule. Further labs resulted in high thyroid peroxidase antibody. Ultrasound of thyroid with color flow showed single nodule in the left lobe and iodine uptake activity localized to the left lobe. Patient was started on Methimazole 5 mg along with Haldol 5mg orally twice a day which improved his symptoms tremendously. Patient was stabilized and after 1 week was discharged on Haldol 5 mg by mouth two times a day for Psychosis, Cogentin 1 mg by mouth two times a day for extrapyramidal system (EPS), and Methimazole 5 mg by mouth daily for overactive thyroid nodule. Psychosis associated with thyroid nodule is rare but possible. The onset of psychotic syndrome is an important clinical element whose underlying medical cause must be promptly clarified. Psychosis can present in a number of ways and can have different causes. Apart from psychiatric causes, underlying medical causes should always be considered. In this case it was important to get a full clinical history of the patient as well as complete physical examination. The differential diagnosis of a psychotic disorder in light of a medical disease should always be considered in order to promptly diagnose and treat the underlying cause to reduce the morbidity and possibly the mortality associated with it.

Maternal serum perfluoroalkyl substance mixtures and thyroid hormone concentrations in maternal and cord sera: The HOME Study

BackgroundPer- and polyfluoroalkyl substances (PFAS) are ubiquitous. Previous studies have found associations between PFAS and thyroid hormones in maternal and cord sera, but the results are inconsistent. To further address this research question, we used mixture modeling to assess the associations with individual PFAS, interactions among PFAS chemicals, and the overall mixture. MethodsWe collected data through the Health Outcomes and Measures of the Environment (HOME) Study, a prospective cohort study that between 2003 and 2006 enrolled 468 pregnant women and their children in the greater Cincinnati, Ohio region. We assessed the associations of maternal serum PFAS concentrations measured during pregnancy with maternal (n = 185) and cord (n = 256) sera thyroid stimulating hormone (TSH), total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), and free triiodothyronine (FT3) using two mixture modeling approaches (Bayesian kernel machine regression (BKMR) and quantile g-computation) and multivariable linear regression. Additional models considered thyroid autoantibodies, other non-PFAS chemicals, and iodine deficiency as potential confounders or effect measure modifiers. ResultsPFAS, considered individually or as mixtures, were generally not associated with any thyroid hormones. A doubling of perfluorooctanesulfonic acid (PFOS) had a positive association with cord serum TSH in BKMR models but the 95% Credible Interval included the null (β = 0.09; 95% CrI: −0.08, 0.27). Using BKMR and multivariable models, we found that among children born to mothers with higher thyroid peroxidase antibody (TPOAb), perfluorooctanoic acid (PFOA), PFOS, and perfluorohexanesulfonic acid (PFHxS) were associated with decreased cord FT4 suggesting modification by maternal TPOAb status. ConclusionsThese findings suggest that maternal serum PFAS concentrations measured in the second trimester of pregnancy are not strongly associated with thyroid hormones in maternal and cord sera. Further analyses using robust mixture models in other cohorts are required to corroborate these findings.

Idiopathic spontaneous filtering bleb: Is there an autoimmune etiology?

A 45-year-old male presented with complaints of defective vision for near. There was no prior history of trauma, recurrent redness, or surgery. He is a known patient of hypothyroidism and vitiligo. His best-corrected visual acuity was 6/6, N6 in both the eyes (BE). Slit-lamp examination revealed a diffuse, elevated, avascular thin bleb near the limbus in the superonasal quadrant with underlying scleral thinning in BE. Right eye (RE) showed clear cornea, quiet and deep anterior chamber, normal iris pattern, and clear lens. Left eye (LE) showed peripheral corneal vascularisation with lipid deposits at 10'o clock anterior to the area of scleral thinning and bleb formation, the rest of the anterior segment was normal [Fig. 1a and b]. Schirmer's test was normal and Seidel's test did not reveal any leak in BE. His intraocular pressure was 9 and 10 mm Hg in the RE and LE, respectively. Gonioscopy revealed open angles in BE with an area of hyperpigmentation around fistula at 2 o'clock in the RE and increased pigmentation with prominent iris processes in the nasal quadrant in LE [Fig. 1c and d]. The fundus examination revealed an average size disc with a cup to disc ratio of 0.4:1, healthy neuroretinal rim and attached retina in BE.Figure 1: Right eye showing superonasal diffuse avascular thin bleb (a). Left eye showing superonasal diffuse avascular thin bleb with scleral thinning, corneal vascularisation, and lipid deposits (b). Gonioscopy showing fistula with hyperpigmentation anterior to schwalbe's line at 2'0 clock (arrowhead) in the right eye (c) and increased pigmentation with prominent iris processes in the nasal quadrant in left eye (d). Ultrasound biomicroscopy image of the right (e) and left (f) eye showing communicating fistula between the anterior chamber and subconjunctival space, indicated by the arrowheadsCorneal topography was suggestive of oblique astigmatism with flattening along the meridian of the bleb without evidence of corneal ectasia in BE. Ultrasound biomicroscopy revealed a communicating fistula between the anterior chamber and subconjunctival space in BE [Fig. 1e and f]. Physical examination was unremarkable, except for depigmented patches in the skin. Blood investigations revealed high thyroid peroxidase antibody titer (157 IU/mL), whereas C-reactive protein, rheumatoid factor, and antinuclear antibody were within normal limits. Discussion Spontaneous filtering bleb is a rare condition, which can develop if a communicating fistula between the anterior chamber and subconjunctival space is established. Spontaneous filtering bleb has been reported in patients with Axenfeld syndrome,[1] Terrien marginal degeneration,[2] Traboulsi syndrome,[34] connective tissue diseases,[56] and without any ocular or systemic association.[27] Our patient with hypothyroidism and vitiligo, has scleral thinning and subconjunctival bleb in both the eyes. There were no signs of anterior segment abnormalities or facial dysmorphism. Considering the fact that our patient has 2 autoimmune systemic conditions, we postulate that the scleral thinning and spontaneous bleb formation could be due to autoimmune etiology. 2.1 Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. 2.2 Financial support and sponsorship Nil. 2.3 Conflicts of interest There are no conflicts of interest.

Association between iodine intake and thyroid autoantibodies: a cross-sectional study of 7073 early pregnant women in an iodine-adequate region.

The association between iodine intake and thyroid autoimmunity has been debated, especially in pregnant women. This study aimed to investigate thyroid autoantibodies and their association with iodine intake and hypothyroidism in early pregnancy. 7073 early pregnant women from an iodine-sufficient region participated in this study. Urinary iodine concentrations (UICs) were measured using an ammonium persulfate method. Serum thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and Tg were determined using an electrochemiluminescence immunoassay. Iodine deficiency (UIC < 100μg/L) was associated with higher risks of TPOAb positivity [adjusted odds ratio (aOR) = 1.64, 95% confidence interval [CI] (1.29-2.08)] and TgAb positivity [aOR = 1.44, 95% CI (1.16-1.80)]. Women with isolated TPOAb positivity, isolated TgAb positivity, or both TPOAb and TgAb positivity had a 14.64-fold, 7.83-fold, and 44.69-fold increased risk of overt hypothyroidism, and a 4.36-fold, 2.86-fold, and 6.26-fold increased risk of subclinical hypothyroidism, respectively. Moreover, the risks of overt and subclinical hypothyroidism in women with a high TPOAb titer were 16.99 and 4.80 times that in TPOAb-negative women, respectively. The risk of overt hypothyroidism in women with a high TgAb titer was 6.97 times that in TgAb-negative women. Our work demonstrates that iodine deficiency during early pregnancy is an independent risk factor for both TPOAb positivity and TgAb positivity. Furthermore, positivity for both autoantibodies and a high thyroid autoantibody titer are associated with significantly higher risks of overt and subclinical hypothyroidism.

CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S

Event Abstract Back to Event CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S David J. Clark1* 1 Carrick Institute, United States Background: A 45 year old woman presented with severe fatigue, poor appetite, mental fog and nausea. She also suffered sleep disturbances characterized by waking after 4 to 5 hours of sleep, and alternately, difficulty falling asleep until 2:00 AM. Her history was significant for previous diagnosis of alopecia universalis and hypothyroidism. She was taking Concerta®, Zoloft® and levothyroxine. Her diet was unrestricted and notable for appearing hypocaloric. Methods: Ingestion of Th1 cytokine boosters provoked her symptoms. Blood chemistry revealed low vitamin D (21.7 ng/mL), vitamin B12 (226 pg/mL) and high thyroid peroxidase antibodies (220 IU/mL), eosinophil percentage (17%), absolute eosinophils (0.9), cholesterol (236 mg/dL), HDL (105 mg/dL), homocysteine (16.8 umol/L) as well as clinically significantly low folate (7.6 ng/mL), T3 (87 ng/dL), and ferritin (47 ng/mL). She was placed on an anti-inflammatory diet and supplement protocol utilizing turmeric, resveratrol, sublingual vitamin D, sublingual glutathione, folinic acid, hydroxocobalamin, and a multi-nutrient formula to support glucose utilization. Results: After 30 days, she reported 80% improvement in sleep, 60% improvement in fatigue, 90% improvement in appetite (reduction in nausea). She continued on the same protocol for an additional 30 days, and reported complete resolution of fatigue, mental fog and poor appetite. She began running for exercise. Blood chemistry retest showed normal levels of vitamin B12, folate, ferretin and vitamin D. Conclusion: The author recommends further investigation into the use of diet and supplementation in the treatment of patients with chronic fatigue and sleep problems. Keywords: Hashimoto's autoimmune thyroiditis, chronic fatigue, Anti-inflammatory diet, supplementation, Sleep disturbance Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINICAL NUTRITION IMPROVES CHRONIC FATIGUE, SLEEP DISTURBANCE, MENTAL FOG AND NAUSEA IN 45 YEAR OLD WOMAN WITH HASHIMOTO’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00037 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Алгоритм прогнозування невиношування вагітності в умовах природного йодного дефіциту

The article presents a logistic model for prediction of miscarriage in the second trimester in conditions of iodine deficiency, which is based on the accounting of clinical and laboratory evidence, in particular, the altered parameters of iodine-thyroid homeostasis. The objective: development and practical application of the algorithm, which, based on the analysis of quantitative and qualitative parameters with high reliability, makes it possible to draw clinical conclusions and on their basis predict the risk of miscarriage in the second trimester of pregnancy. Materials and methods. We examined 80 pregnant women living in conditions of natural iodine deficiency (50 women with spontaneous abortion in the second trimester of pregnancy and 30 women with in-time deliveries). The parameters of iodine-thyroid homeostasis were assessed by iodine, free thyroxine and antibodies to thyreperoxidase levels. The algorithm is based on a pathometric recognition procedure with subsequent calculation of informative parameters, prognostic coefficients. Results. The result of the correct operation of the algorithm was a substantiated conclusion about the necessity for integrated accounting of the iodine-thyroid parameters in assessing the risk of miscarriage. It has also been established that the independent prognostic value of these indicators for a relatively high risk of miscarriage is realized only in conditions of the totality of their deviations and the level of iodine excretion &lt; 49 μg/l. Accordingly, at an iodine excretion level &gt;50 μg/l, corresponding to mild iodine deficiency, or lack of such (&gt;100 μg/l), the independent prognostic value of hypothyroxinemia and high thyroid peroxidase antibodies level is not statistically significant. Conclusion. The presented logistic model allows to predict the risk of miscarriage in the second trimester with a high level of sensitivity and specificity. The high prognostic significance of the deviations of iodine-thyroid parameters, which is realized fully in the conditions of middle-severe iodine deficiency, is shown. Key words: logistic model for prediction of miscarriage, iodine deficiency.

Thyroid-associated genetic polymorphisms in relation to breast cancer risk in the Malmö Diet and Cancer Study.

Previous studies have suggested that thyroid function is associated with breast cancer risk, which could have an important clinical impact, as one in eight women will develop a thyroid disorder during her lifetime. However, the underlying pathomechanism behind the association is still unknown. We used the Malmö Diet and Cancer Study (a population-based prospective study consisting of 17,035 women) to examine 17 single nucleotide polymorphisms (SNPs) previously related to levels of free thyroxine (free T4) and thyroid peroxidase antibodies (TPO-Ab) as potential genetic risk factors for breast cancer. A baseline examination including free T4 and TPO-Ab levels was conducted at the time of inclusion. Genotyping was performed on 901 breast cancer patients and 3335 controls. Odds ratios (95% confidence intervals) for high free T4, TPO-Ab positivity, and breast cancer were calculated by logistic regression and adjusted for confounders. We identified one free T4-related SNP (rs2235544, D101 gene) that was significantly associated with both free T4 level and breast cancer risk. There was a suggested association between rs11675434 (TPO gene) and TPO-Ab level, and TPO-Ab-related rs11675434 (TPO), rs3094228 (HCP5), rs1033662 (no registered gene), and rs301806 (RERE) were associated with breast cancer risk. There was an indicated interaction between rs6485050 (no registered gene) and free T4 level in regards to breast cancer risk. This is the first study to suggest an association between thyroid-related SNPs and breast cancer risk. All SNPs have a biological plausibility of being associated with breast cancer risk, and may contribute to the genetic predisposition to breast cancer.