Higher Thyroid-stimulating Hormone Levels Research Articles

Sodium selenite enhances thyroid uptake of iodine-131 and regulates thyroid function in rats.

The aim of the present study was to evaluate the role of selenium (Se) on the thyroid uptake and retention of radioiodine ((131)I) and on the serum levels of thyroid hormones. Experimental rats were divided into four groups with 10 animals in each group viz: untreated controls, (131)II-treated, Se-treated and (131)I+Se-treated. Group II and Group IV animals were injected intraperitoneally with 3.7MBq of (131)I. Group III and Group IV animals received Se in the form of sodium selenite, everyday at a dose of 1ppm in drinking water. Thyroidal (131)II uptake measurements, determination of biological half life of (131)I and estimation of serum of tri-iodothyronine (T3) and tetra-iodothyronine (T4) and thyroid stimulating hormone (TSH) were carried out at two time intervals after 2 and 4 weeks. The statistical significance of the data was determined by using one-way analysis of variance (ANOVA) followed by Newman-Keuls test. The results showed lower serum levels of T3 and T4 and higher TSH levels in rats treated with (131)I when compared to untreated rats. Furthermore, the biological half life (Tbiol) of (131)I in thyroid and thyroidal (131)I uptake values at 2h and 24h were significantly lower in rats treated with (131)I compared with untrated control. Selenium treatment of (131)I treated rats resulted in a significant increase in the thyroid uptake as well as Tbiol of (131)I which indicated its increased retention. Moreover, normalization of the elevated serum TSH levels and a significant increase in the T3 and T4 levels was evident when Se was administered to the (131)I treated rats. In conclusion, this study indicates that Se when given to rats in the form of sodium selenite, at a dose of 1ppm in drinking water enhances the uptake and retention of (131)I in the thyroid as well as regulates thyroid hormone levels.

Relationship between hypothyroidism and cholesterol out of the records of 1756 patients

Subclinical hypothyroidism (SH) is settled whenever high levels of serum thyroid-stimulating hormone (TSH) are detected, whereas free thyroid hormone levels are within the normal range. Benefits and risks of therapy for SH have been debated for 2 decades. However, consensus has not yet been achieved. Besides preventing the progression to overt hypothyroidism, the decision of undertaking replacement therapy in SH is made mainly by basing on the risk of metabolic (dyslypidemia) and subsequent cardiovascular complications. A series, made up of 1756 patients (mean age 42,8±16,8, range 0,5-94) and filed from 1984 to 2013, was studied retrospectively. 169 patients were affected by clinical (overt) hypothyroidism (IC: TSH >40). 1587 patients were affected by SH, out of whom 1121 were mild (TSH <10) and 466 medium (TSH ≥ 10 ≤40). The series of patients was properly followed-up. The mean follow-up time was 6 years. In all patients TSH, Ft4, and total cholesterol were evaluated basally and after appropriate (TSH normalized) medical therapy. By medical replacement treatment, clinical hypothyroidism (CI) related hypercholesterolemia decreased significantly in 28%. In SH, the baseline serum cholesterol levels were wide. However, replacement treatment did not reduce such levels. No major cardiovascular accident occurred to any patient over the follow-up period. Hypercholesterolemia is certainly due to CI, therapy reduces cholesterol levels that not always fall below 200 mg/dl and this condition persists over time. SH is not characterized by hypercholesterolemia. Cholesterol levels in these patients are variable equal to the normal people and can not be reduced with thyroxine.

Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone.

Thyroid hormones are important regulators of fetal neurodevelopment. Among preterm infants, thyroid stimulating hormone (TSH) is highly variable. Understanding this variability will further improvements in screening for thyroid disorders in preterm infants. We examined 61 maternal and infant clinical and demographic factors for associations with neonatal TSH levels in 698 preterm neonates. TSH was measured as part of routine State-mandated newborn screening in Iowa. Of the maternal characteristics, nulliparous women (p=8×10-4), women with preeclampsia (p=2×10-3), and those with induced labor (p=3×10-3) had infants with higher TSH levels. TSH levels at the time of newborn screening were associated with respiratory distress syndrome (RDS) (p<0.0001) and sepsis (p=3×10-3). We replicated findings between parity and preeclampsia previously observed in primarily term infants. We also observed strong relationships between neonatal TSH and complications of prematurity including RDS and sepsis, which have implications for future studies examining this relationship both prenatally and longitudinally after birth.

Letter: the biochemical prognostic factors of subclinical hypothyroidism (endocrinol metab 2014;29:154-62, myung won lee et Al.).

Subclinical hypothyroidism is defined as a serum thyroid stimulating hormone (TSH) concentration above the upper limit of its reference range plus a serum free thyroxine (FT4) concentration within its reference range. There are several controversies regarding the effect of subclinical hypothyroidism on the risk of heart failure, cardiovascular disease risk, cholesterol metabolism and mortality, due to the lack of randomized prospective clinical trials [1]. Several studies have evaluated the natural course of overt hypothyroidism and risk factors for its development. In one previous United States study of elderly subjects (≥65 years old) [2], subclinical hypothyroidism remained in 56% of patients at a 2-year follow-up, while 35% showed euthyroidism and 2% overt hypothyroidism. In that study, higher TSH level and thyroid peroxidase (TPO) antibody (Ab) positivity were independently associated with persistent subclinical hypothyroidism, and a TSH level of 10 mU/L or higher was an independent risk factor for overt hypothyroidism. In another study, 36.4% of patients showed persistent subclinical hypothyroidism, 37.4% euthyroidism and 26.2% overt hypothyroidism after 6 to 72 months of follow-up (mean 31.7 months) [3]. TSH level was the only significant predictor of progression to overt hypothyroidism. Recently, Lee et al. [4] reported that the initial TSH level was the only definite prognostic factor for persistent subclinical hypothyroidism. Also, TPO Ab titer was a helpful prognostic factor for maintenance of subclinical hypothyroidism in patients with mildly elevated TSH levels (5 to 10 mU/L). This result is consistent with those reported previously. However, the authors needed to perform a multivariate Cox regression analysis to identify prognostic or risk factors for persistent subclinical hypothyroidism. Simple comparison of baseline characteristics seems insufficient to conclude that TSH is a risk factor. In addition, it might be helpful to perform a survival analysis according to TSH range using Kaplan-Meier curves. Determining the natural course and long-term clinical effects of subclinical hypothyroidism and identifying risk factors for persistent subclinical hypothyroidism would have implications for the follow-up and treatment of patients with subclinical hypothyroidism. Therefore, a long-term prospective study is needed.

The Relationships between Thyroid Hormones and Thyroid-stimulating Hormone with Lipid Profile in Euthyroid Men

Background and Aim: Alteration in lipid profile is a common observation in patients with thyroid dysfunction, but the current knowledge on the relationship between lipids and thyroid hormone levels in euthyroid state is insufficient. The current study aimed to determine the association between thyroid hormones and thyroid-stimulating hormone (TSH) with lipid profile in a euthyroid male population.Methods: A total of 708 Chinese and Malay men aged 20 years and above were recruited in this cross-sectional study. Their blood was collected for the determination of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), free thyroxine (FT4), free triiodothyronine (FT3) and TSH levels. The association was analyzed using multiple regression and logistic regression models with adjustment for age, ethnicity, body mass index and FT4/FT3/TSH levels.Results: In multiple regression models, TSH was positively and significantly associated with TG (p<0.05). Free T4 was positively and significantly associated with TC, LDL-C and HDL-C (p<0.05). Free T3 was negatively and significantly associated with HDL-C (p<0.05). In binary logistic models, an increase in TSH was significantly associated with higher prevalence of elevated TG in the subjects (p<0.05), while an increase in FT4 was significantly associated with higher prevalence of elevated TC but a lower prevalence of subnormal HDL in the subjects (p<0.05). Free T3 was not associated with any lipid variables in the logistic regression (p>0.05).Conclusions: In euthyroid Malaysian men, there are positive and significant relationships between TSH level and TG level, and between FT4 level and cholesterol levels.

Impact of Adipocytokines-Leptin and Adiponectin on Thyroid Stimulating Hormone among Hypothyroid Patients

Background: Adipocytokines, secreted from the adipose tissues have profound effect on complex metabolic and endocrine functions. Among them, leptin and adiponectin are the most recognized molecules which influence body homeostasis and metabolism. Moreover, patients with thyroid disease usually exhibit disturbances of these metabolic activities. Thus adipocytokines and thyroid hormones may influence similar aspects of metabolic functions. Objective: The main objective of current study was to evaluate the association and impact of leptin and adiponectin on thyroid stimulating hormone (TSH) among hypothyroid patients. Materials and Methods: For the present study a total 350 individuals were enlisted, out of which 200 were hypothyroid patients and 150 age and sex matched healthy controls aged ≥ 12 years. The serum TSH, leptin and adiponectin concentration were measured by CLIA method and results were computed by statistical methods such as mean, standard deviation, standard error and correlation using MS-Excel 2007. Result: Our data showed that hypothyroidism was more prevalent in the age group 30-50(62%) and an elevated TSH level was observed with advancing age among the patients as compared to controls. The inverse relation of leptin and adiponectin has been seen among the patients. When patients were compared with controls, they were with normal values which were in the range of standardized lab values leptin (3.7-13ng/dl) and adiponectin (5-10μg/ml). Conclusion: In conclusion, our data interpreted variations in the level of leptin and adiponectin among the hypothyroid individuals with high TSH level. As abnormal levels of these adipocytokines indicates the risk for other metabolic diseases like cardiovascular disease, obesity etc. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8789 Asian Journal of Medical Science, Volume-5(2) 2014: 67-72

Supraphysiologic Doses of Levothyroxine as Adjunctive Therapy in Bipolar Depression

Suboptimal availability of circulating thyroid hormones may contribute to the high rate of treatment failures in bipolar disorder. This study tested the efficacy of adjunctive treatment with supraphysiologic doses of levothyroxine in patients with bipolar depression and the hypothesis that women would display a better outcome compared to men. The aims of this multicenter, 6-week, double-blind, randomized, placebo-controlled fixed-dose (300 μg/d) trial conducted from 2004 to 2009 were to assess efficacy and tolerability of levothyroxine adjunctive to continuing treatment with mood stabilizer and/or antidepressant medication for patients with bipolar I or II disorder, currently depressed (DSM-IV), and to investigate gender differences in treatment response. The primary efficacy variable was mean change in Hamilton Depression Rating Scale (HDRS) score. Of 74 patients enrolled in the study, 62 (35 with bipolar I; mean age = 44.9 years) were randomized. Mean change in HDRS score from randomization to week 6 was larger in the levothyroxine group compared to the placebo group, with a 2.7-point difference (decline of -7.8 [38.3%] vs -5.1 [25.5%]; last-observation-carried-forward analysis). The course of HDRS scores over time from randomization to week 6 was significantly different between groups at week 4 (P = .046) but not at the end of the placebo-controlled phase (P = .198). The secondary analysis of women (n = 32) revealed a significant difference between groups in mean change in HDRS score (-16.6% placebo vs -42.4% levothyroxine, P = .018). A mixed-effects model for repeated-measures analysis showed a significant between-group difference in HDRS score (6.8, P = .012) for women. High thyroid-stimulating hormone levels, indicating suboptimal levels of circulating thyroid hormones, were predictive for positive treatment outcome in women treated with levothyroxine in a linear regression model (F3 = 3.47; P = .05). This trial demonstrated that patients treated with levothyroxine did numerically better than those treated with placebo; however, the study failed to detect a statistically significant difference between the 2 groups in the primary outcome measure due to a high placebo response rate. Previous findings that women show better improvement in depression scores with levothyroxine compared to men were confirmed. ClinicalTrials.gov identifier: NCT01528839.

Van Wyk and Grumbach syndrome: Two case reports and review of the published work

Van Wyk and Grumbach syndrome is characterized by a long-standing history of hypothyroidism, high levels of thyroid-stimulating hormone, uni- or bilateral ovarian cysts, isosexual precocity and a delayed bone age. All of the features can be reversed with treatment of the underlying hypothyroidism. Here, we describe two cases of Van Wyk and Grumbach syndrome presenting with bilateral multicystic ovaries and enlargement of the pituitary gland. One patient suffered from ovarian cyst and hypophysoma resection, the other patient promptly responded to L-thyroxine with complete regression of the ovarian cyst and other symptoms.

Postpartum thyroid measures and depressive symptomology: a pilot study.

While correlations have been demonstrated between postpartum depression and psychosocial and circumstantial risk factors, some evidence exists for a similar relationship between postpartum depression and thyroid measures. To search at 4 weeks postpartum for correlations of numerical scores on a postnatal depression screening tool and thyroid measures. Subjects took the Edinburgh Postnatal Depression Scale (EPDS) prenatally and at 4 weeks postpartum. Participants were also given blood tests for thyroid-stimulating hormone (TSH), free thyroxine4, thyroid peroxidase, and thyroglobulin at the same testing intervals. Fifty-one subjects aged 18 years or older were recruited. Subjects with higher serum TSH at 4 weeks postpartum tended to have higher EPDS scores. Similarly, the 7 subjects (13.7%) with positive postnatal thyroid antibody tests were more likely than their counterparts to have higher EPDS scores. Presence of thyroid autoantibodies or higher TSH levels during the postpartum period may be related to depressive symptoms or dysphoric mood, even when clinical depression is not present. Either or both of these associations may contribute, along with other physiologic and psychosocial risk factors, to postpartum depression. (ClinicalTrials.gov number NCT00565032).

Association between thyroid profile and perfluoroalkyl acids: Data from NHNAES 2007–2008

The effect of six perfluoroalkyl acids (PFAAs), namely, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorodecanoic acid (PFDE), perfluorohexane sulfonic acid (PFHxS), 2-(N-methyl-perfluorooctane sulfonamide) acetic acid (MPAH), and perfluorononanoic acid (PFNA) on the levels of six thyroid function variables, namely, thyroid stimulating hormone (TSH), free and total thyroxine (FT4, TT4), free and total triiodothyronine (FT3, TT3), and thyroglobulin (TGN) was evaluated. Data from National Health and Nutrition Examination Survey for the years 2007–2008 were used for this evaluation. TSH levels increased with increase in levels of PFOA (p<0.01). There were no statistically significant associations between the levels of FT3, and FT4 with the levels of any of the six PFAAs. Levels of TT3 were found to increase with the levels of PFOA (p=0.01) and TT4 levels were found to increase with increase in PFHxS levels (p<0.01). Males had statistically significantly higher levels of FT3 than females and females had statistically significantly higher levels of TT4 than males. As compared to non-Hispanics whites and Hispanics, non-Hispanic blacks had lower levels of TSH, FT3, TT3, and TT4 but Hispanics had the lowest levels of TGN. Age was negatively associated with FT3 and TT3 but positively associated with FT4 and TT4. Non-smokers had higher levels of TSH and TT4 than smokers and smokers had higher levels of FT3 and TGN than non-smokers. Iodine deficiency was associated with increased levels of TSH, TT3, TT4, and TGN.

Association between Perfluoroalkyl substances and thyroid stimulating hormone among pregnant women: a cross-sectional study

BackgroundPerfluoroalkyl substances (PFASs) are a group of highly persistent chemicals that are widespread contaminants in wildlife and humans. Exposure to PFAS affects thyroid homeostasis in experimental animals and possibly in humans. The objective of this study was to examine the association between plasma concentrations of PFASs and thyroid stimulating hormone (TSH) among pregnant women.MethodsA total of 903 pregnant women who enrolled in the Norwegian Mother and Child Cohort Study from 2003 to 2004 were studied. Concentrations of thirteen PFASs and TSH were measured in plasma samples collected around the 18th week of gestation. Linear regression models were used to evaluate associations between PFASs and TSH.ResultsAmong the thirteen PFASs, seven were detected in more than 60% of samples and perfluorooctane sulfonate (PFOS) had the highest concentrations (median, 12.8 ng/mL; inter-quartile range [IQR], 10.1 -16.5 ng/mL). The median TSH concentration was 3.5 (IQR, 2.4 - 4.8) μIU/mL. Pregnant women with higher PFOS had higher TSH levels. After adjustment, with each 1 ng/mL increase in PFOS concentration, there was a 0.8% (95% confidence interval: 0.1%, 1.6%) rise in TSH. The odds ratio of having an abnormally high TSH, however, was not increased, and other PFASs were unrelated to TSH.ConclusionsOur results suggest an association between PFOS and TSH in pregnant women that is small and may be of no clinical significance.

Receptors of thyroid hormones.

The important physiological actions of the thyroid hormones are mediated by binding to nuclear thyroid hormone receptors (TRs), encoded by two genes TRalpha and TRbeta. These receptors act as hormone-dependent transcription factors by binding to DNA motifs located in the regulatory regions of target genes and recruiting coregulators (coactivators and corepresors), which alter chromatin structure. Novel thyromimetics have been developed that bind preferentially TRbeta could be used for treatment of hyperlipidemia and obesity. TRbeta gene mutations cause resistance to thyroid hormones (RTH), characterized by inappropriately high thyroid-stimulating hormone (TSH) levels due to lack of feedback inhibition of thyroid hormones on the hypothalamus and pituitary gland, and to reduced sensitivity of other TRbeta target tissues to thyroid hormones. Very recently, patients heterozygous for TRalpha mutations have been identified. These patients exhibit clinical symptoms of hypothyroidism in TRalpha target tissues such as intestine or hearth and near normal circulating TSH and thyroid hormone levels.

Association between thyroid function and selected organochlorine pesticides: Data from NHANES 2001–2002

Exposure to organochlorine pesticides (OCP) has been shown to be associated with adverse thyroid function. The impact of exposure to selected OCPs on total serum thyroxine (TT4) and thyroid stimulating hormone (TSH) was evaluated by analyzing data from the 2001–2002 National Health and Nutrition Examination Survey. Oxychlordane, p,p′-DDE, trans-nonachlor, and heptachlor epoxide were selected for analysis. Regression models with logs of TSH and TT4 as dependent variables and OCP exposure, race/ethnicity, iodine and smoking status, total lipids and others as independent variables were fitted. TSH levels increased (p<0.05) with increase in trans-nonachlor exposure for 20–39year old iodine deficient males. TSH levels were higher when oxychlordane exposure was low than when the exposure was medium or high for 20–39year old iodine deficient females (p<0.05). For iodine deficient females, TT4 levels were lower when p,p′-DDE exposure was low than when it was medium (p<0.05). For non-Hispanic blacks (NHB), TT4 levels decreased with increase in exposure to heptachlor epoxide (p<0.05). For iodine replete males, TSH levels increased with increase in trans-nonachlor exposure (p<0.05). For iodine replete females, (i) Mexican Americans (MA) had higher TSH levels when the exposure to oxychlordane was medium than when the exposure was low; (ii) for 60+years old, there was a positive association between TSH and heptachlor epoxide levels; and (iii) TT4 levels had an inverse association with trans-nonachlor and oxychlordane. In general though not always, (i) TSH and TT4 levels were lowest for the 20–39years old and highest for the 60+years old (p<=0.05), (ii) TSH and TT4 levels for iodine deficient males and females were lowest for NHB, highest for MA, and in-between for non-Hispanic white, and (iii) non-smokers had higher TSH and TT4 levels than smokers and in general, statistically significantly so.

Factors Associated with Hypothyroidism following Hemithyroidectomy: A Prospective Study

Objectives: Analyze factors associated with hypothyroidism following hemithyroidectomy. Methods: Prospective study at Chiang Mai University Hospital, Thailand. Patients who were scheduled for a hemithyroidectomy between September 2010 and April 2012 were recruited for the study. Demographic data, pre- and post-operative thyroid function tests, resected side, weight and pathological diagnosis of resected thyroids between the euthyroid and hypothyroid groups were analyzed. Results: Of 50 cases, 11 cases with documented malignancy, or who required a total thyroidectomy, or who were lost to follow up were excluded. Thirty-nine cases included seven males and 32 females, age ranged from 19 to 71 years (46.9±13.8 years). The resected thyroids were from the left (25) and the right (14). The pathology reports were as follows: adenomatous goiter (67%), follicular adenoma (20%), colloid cyst (5%), chronic lymphocytic thyroiditis (3%), and others (5%). Eight cases (20.5%) had hypothyroidism postoperatively at eight to ten weeks. The pre-operative thyroid-stimulating hormone (TSH) level of the hypothyroid group was normal but significantly less than in the euthyroid group (P = 0.009). Age, gender, pre-operative free T4 and free T3, weight and resected side showed no difference between the two groups. Conclusions: One-fifth of the hemithyroidectomy patients developed hypothyroidism within eight to ten weeks post-operatively. Clinicians should be aware of post-operative hypothyroidism and provide prompt treatment, particularly in patients with a pre-operative high normal TSH level.

Effects of phytate on thyroid gland of rats intoxicated with cadmium

Cadmium (Cd) is one of the most dangerous occupational and environmental toxins. The objective of the present study is to examine the potential prophylactic effects of phytic acid (PA) on thyroid hormones of male rats intoxicated with Cd. The male albino rats were divided into five groups: group I (control) was fed with the basal diet, group II was intoxicated with Cd in drinking water, groups III, IV, and V were intoxicated with Cd in drinking water and fed with the diet containing 3.5, 7, and 10 g of PA/kg, respectively. The results indicated that the serum calcium, iron (Fe), and total Fe binding capacity levels and serum T3 and T4 in Cd-treated rats of group II were decreased when compared with the control group, while PA-administered groups with Cd showed a significant improvement when compared with the Cd-treated rats only. Serum thyroid stimulating hormone (TSH) level was significantly increased in Cd-treated rats compared with the control group, while the addition of PA in diet decreased the high levels of TSH. These results indicated a prophylactic effect of PA against Cd-induced toxicity in rats.

Maternal and Neonatal Urinary Iodine Status and its Effect on Neonatal TSH Levels in a Mildly Iodine-Deficient Area

Objective: Iodine deficiency and excess are the most important factors that affect screening and recall rates of congenital hypothyroidism. The purpose of this study was to investigate the urinary iodine status in newborns and their mothers and its effects on neonatal thyroid-stimulating hormone (TSH) levels in a mildly iodine-deficient area.Methods: A total of 116 newborns and their mothers were included in the study. Urinary iodine levels were measured from healthy mothers and their babies on the 5th day following birth. Neonatal TSH levels were screened, and TSH and free thyroxine (fT4) levels were measured on the15th day in the recall cases. T4 treatment was started in infants with high TSH and low fT4 levels. These measurements were repeated on the 30th day in these newborns.Results: Ninety-nine percent of the mothers included in the study were using iodized salt. The median urinary iodine level in the newborns was 279 µg/L, while it was 84 µg/L in their mothers. The rate of iodine deficiency among the mothers was 56.8%, and the rate of iodine excess was 8.6%. This rate was 10.3% for iodine deficiency and 61.2% for iodine excess in the newborns. The recall rate at the screening was 9.5% (n=11). The urinary iodine levels were above 200 µg/L in three newborns who had transient hyperthyrotropinemia.Conclusions: Iodine deficiency was more frequently observed in nursing mothers, and iodine excess was more frequently seen in their newborns. The iodine excess noted in the newborns was attributed to the use of antiseptics containing iodine. The iodine excess leads to increases in recall rates, screening costs, and frequency of transient hyperthyrotropinemia.Conflict of interest:None declared.

Association of thyroid stimulating hormone levels with subclinical carotid atherosclerosis in a Mediterranean female population

Objective To determine whether thyroid stimulating hormone (TSH) levels, an index of thyroid function, are associated with signs of carotid atherosclerosis. Participants and methods We examined 310 women from Southern Italy, aged 30–69 years, recruited for a prospective study, currently ongoing, on the etiology of cardiovascular disease and cancer in the female population (Progetto ATENA). All participants underwent cardiovascular risk factor assessment and high-resolution B-mode ultrasound to measure intima-media thickness (IMT) of carotid arteries. The occurrence and the number of atherosclerotic plaques (intima-media thickness>1.2 mm) were also evaluated. Results Women in the upper TSH decile (n=30; TSH>3.13 mU/l) had a significantly higher prevalence of diabetes mellitus and hypertriglyceridemia compared with women in the other TSH deciles. In a multivariate analysis, women in the upper TSH decile had a thicker carotid intima-media complex than those in the other deciles (0.92±0.02 vs. 0.86±0.01 mm; P=0.037) after adjustment for covariates. Furthermore, the number of carotid plaques was significantly associated with higher TSH levels (2.3±0.3 vs. 1.7±0.1; P=0.025). Conclusion In a cohort of women, higher TSH levels were associated with subclinical atherosclerotic changes of the carotid artery wall.

Consumptive hypothyroidism in an Egyptian baby with benign neonatal hemangiomatosis: a case report

IntroductionBenign neonatal hemangiomatosis is a condition in which multiple cutaneous hemangiomas appear at birth or shortly thereafter; visceral complications are absent. Here, we report a case of a consumption hypothyroidism in an Egyptian baby with benign neonatal hemangiomatosis.Case presentationAn 8-month-old Egyptian boy with benign neonatal hemangiomatosis was referred to our institution for evaluation of developmental delay. Initial examination revealed a quiet baby who was able to sit only with support. He had hypotonia, a large anterior fontanelle, puffy eyes, cold extremities, hypothermia, bradycardia, and abdominal distension. An examination of his skin revealed more than 100 dome-shaped red-purple cutaneous hemangiomas that varied in size from 5 to 10mm on the back, the abdomen and the extremities without mucus membrane involvement. He had low serum free thyroxine concentration and triiodothyronine levels and high thyroid-stimulating hormone and reverse-triiodothyronine levels. A work-up that involved appropriate imaging ruled out visceral involvement. Based on the above mentioned data, a diagnosis of consumptive hypothyroidism due to benign neonatal hemangiomatosis was made. He was started on oral thyroid medication which was gradually increased to 90μg L-thyroxine daily (15μg/kg/day). After three months of treatment, he was able to sit alone without support and he had normal levels of thyroid-stimulating hormone and serum free thyroxine.ConclusionThyroid function should be assessed periodically in babies with benign neonatal hemangiomatosis, especially if symptoms of hypothyroidism appear or the size and number of hemangiomatosis increase rapidly. Moreover, high doses of L-thyroxine may be needed to achieve euthyroidism during the infancy.

Higher TSH level is a risk factor for differentiated thyroid cancer

Higher thyroid-stimulating hormone (TSH) levels are associated with differentiated thyroid cancers (DTC). To validate this association, we compared TSH levels obtained from euthyroid patients with DTC with TSH levels from controls in the general population. The case group included 1759 patients with DTC, who underwent thyroid surgery at Chonnam National University Hwasun Hospital. The control group (n = 1548), who had participated in the Thyroid Disease Prevalence Study were used as a healthy control group. The subjects were divided into four groups of similar size according to their TSH levels, with the first quartile used as a reference group. The mean TSH level of the case group was significantly higher than the mean TSH level of the control group (1.95 ± 0.9 mIU/l vs 1.62 ± 0.8 mIU/l, P < 0.001), and was associated with DTC risk. Multiple logistic regression, after controlling for age, gender and the presence of a family history of thyroid cancer, showed that the odds ratios and 95% confidence intervals for the second, third and fourth quartiles of TSH levels were 1.27 (1.03-1.57), 1.55 (1.25-1.92) and 2.21 (1.78-2.74) respectively. No significant differences were observed in mean TSH levels in patients with different tumour stages and tumour sizes. Having a high TSH level within the normal range is an independent risk factor for DTC, and may contribute to the initiation of thyroid carcinogenesis. TSH levels in patients with thyroid nodules may be used as diagnostic adjuncts for the identification of high-risk patients, who require further investigation and/or surgical intervention.

Relationship between subclinical hypothyroidism and serum homocysteine concentration in premenopausal women

Objective: In our study we aimed to examine serum homocysteine levels of patients without thyroid dysfunctions who have high serum anti thyroid peroxidase (anti-TPO) levels and patients with subclinical hypothyroidism who have high serum thyroid stimulating hormone (TSH) and anti-TPO levels. Methods: One hundred and seven premenopause female outpatients who referred to endocrine clinic of our hospital were included in our study. We generated 3 groups. First group (Control) consists of 53 (50%) patients between the ages of 30-40 years. Second group (Euthyroid) consists of 31 (29%) patients between the ages of 26-49. Third group (Subclinical Hypothyroidism) consists of 23 (21%) patients between the ages of 33-53 years. Serum total cholesterol, triglycerides, high density lipoprotein (HDL) levels were measured by Olympus 2700 autoanalyzer. Serum TSH, free T4, anti-TPO and homocysteine levels were measured by Siemens Immulite 2000 autoanalyzer. Results: In our study, total cholesterol, triglycerides, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) levels were not statistically significantly different among the groups. Although serum homocysteine levels of the third group were higher than the other groups it was not statistically significantly different among the groups. Conclusion: Serum homocysteine and lipid levels of patients with euthyroidism and subclinical hypothyroidism who have positive anti-TPO levels may be inadequate in assessing the risk of cardiovascular diseases.