High TSH Levels Research Articles

ANALYTICAL STUDY OF CAUSES OF INFERTILITY IN COUPLES ATTENDING TERTIARY CARE CENTRE OF RURAL BIHAR

Background:Infertility is a life crisis affecting patients from all around the world. It is a disease of the reproductive system dened by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, its prevalence is approximately 8-12%. Aim:To determine the causes and clinical pattern of infertility in couples based on clinical and laboratory nding Methods: It was hospital based observational study carried out in the department of Obstetrics and Gynaecology of Katihar Medical College and Hospital, from Feb 2019 to Jan 2020. 300 women were selected for the study with the diagnosis of infertility and 36 of them were lost to follow up so 264 women were enrolled in the study Result: Out of 300 women, 264 had all the data and they participated in the study. Maximum women (50%) were in age group 20-29 yrs. The median duration of marriage was 5 yrs. Primary infertility was in 70% women and 30% women presented with secondary infertility. Female factor was found in 48.1% cases, 15.2% cases had only male factor, 28% having both male and female factor whereas 8.7% cases were with unexplained infertility. Features of polycystic ovaries and ovulatory dysfunction were found in 14.4% women. Adnexal pathology was seen in 10% cases, uterine broid detected in 10.6% cases and uterine anomalies were found in 1.5% cases. High level of TSH (TSH≥4) were found in 32 (12.1%) women and 14 women (5.3%) diagnosed with hyperprolactinemia (≥25ng/ml). Approx. 3.4% women were found to have high level of FSH≥10, whereas LH was raised in 2.3% cases. 14.4% male had abnormal semen parameters. Common abnormalities were azoospermia 6% and oligozoospermia in 3.8% and asthenospermia in 4.5% cases. Conclusion: Primary infertility cases are more common with female factor predominance over male factor. Ovulatory dysfunction, tubal pathology, hormonal imbalance and abnormal semen parameters were main contributing factor for infertility. Male and female both factors are responsible for infertility. So, both partners should be counselled and investigated properly.

Neonatal thyroid screening a tertiary care experience at VSS Medical College and Hospital, Burla

Background: Congenital hypothyroidism is one of the most common preventable etiologies of mental retardation. The worldwide incidence of CH ranges from 1 in 3000 to 1 in 4000 live newborn. Objective of the study was to know the incidence of congenital hypothyroidism in this part of the country, which is necessary to understand the burden of congenital hypothyroidism to the society.Methods: Primary serum TSH measurement in screening neonates with backup thyroxine (T4) determination in infants with high TSH levels (>20 mIU/l). TSH and FT4 were estimated by chemi luminescence immunoassay (CLIA) method using reagent monobind, INC.Results: Serum TSH of screened neonates ranged between 0.16 mIU/l and 80.32 mIU/l, Mean±SD of sTSH being 5.80±3.96 mIU/l. Out of 2212 screened newborns, 9 newborns had sTSH value >20 mIU/l, who were recalled for confirmatory test, giving a recall rate of 0.4%. Out of 9 recalled newborns, 3 had persistently elevated sTSH >20 mIU/l making incidence of congenital hypothyroidism of 1:737 in our study.Conclusions: We found a higher incidence of 1:737 neonatal hypothyroidism in this region as compared to estimated national incidence. CH being preventable cause of mental retardation and other harmful effects on a growing newborn, neonatal screening programme for congenital hypothyroidism is highly recommended.

The Association between Subclinical Hypothyroidism and Diabetic Retinopathy in the Patient with Type 2 Diabetic

The present study aimed to determine the relationship between subclinical hypothyroidism and diabeticretinopathy in patients with type 2 diabetes mellitus. In this cross-sectional analytical study, 150 patientswith type 2 diabetes mellitus were assessed. The eye fundus examination was performed using fundoscopyto confirm or rule out retinopathy. Thyroid hormones were also measured by special kits to diagnosesubclinical hypothyroidism. The criteria for diagnosis of this disorder include the high serum thyrotropinconcentration (? 4mIU/L) plus normal serum free thyroxin levels. Statistical analyses were done using IBMSPSS. In the study, 34.66% suffered retinopathy. A total of 24.0% suffered subclinical hypothyroidism withhigher prevalence rate in those with retinopathy as compared with the group without retinopathy (p = 0.001).Those with diabetic retinopathy also experienced longer duration of diabetes than those without this event.(p = 0.006). Analysis show a significant role for type 2 diabetes mellitus (OR = 1.121, P = 0.003), and highTSH level (OR = 1.342, P = 0.006) to predict diabetic retinopathy.This study showed an association betweenhypothyroidism, diabetes and increased TSH with retinopathy. Retinopathy is significantly predicable withthe presence of subclinical hypothyroidism and longer duration of diabetes.

Artava Kshaya with Hypothyroidism: A case study

Artava Kshaya is the condition in which the menstruation does not occur in its appropriate time, which can be correlated with oligomenorrhoea with Scanty Menstrual flow. Hypothyroidism is one of the causative factors of oligomenorrhoea, i.e. Artava Kshaya. The prevalence of hypothyroidism in the reproductive age group ranges from 2% to 4%. It affects female fertility in the form of menstrual irregularities, infertility and spontaneous first trimester miscarriages. In modern science, thyroxine is used for the management of hypothyroidism which is useful but with specific side effects. A 27 years old married female with the complaints of delayed and scanty menstrual flow for four years with an obstetric history of G1P1L1 & on 12.5 thyroxine tablet, visited the OPD. A urine pregnancy test was negative. Thyroid profile showed high TSH level, i.e. 9.23 uIU/ml and USG report showed small-sized Uterus with thin endometrium and very small-sized both ovaries without detectable follicles. Based on the symptoms and investigations, the patient was diagnosed as a case of Artava Kshaya with hypothyroidism. The principle of treatment was focused on Agnideepana, Strotoshodhana, Artava Pravartana and Vata Kapha Shamana. A treatment scenario was selected for the management, and follow up was done after every month.

A Cross Sectional Study to Assess the Association of Thyroid Autoantibodies with Thyroid Malignancies in a Tertiary Care Hospital in Bangladesh

Thyroid cancer is the most common endocrine malignant lesion and its incidence continues to rise. The aim of this study was to assess association between thyroid antibodies and thyroid malignancies. This was a cross sectional study of 120 patients with thyroid nodules undergoing thyroidectomy with recorded preoperative thyroid antibodies [autoantibodies to thyroglobulin (TgAb) and/or thyroid peroxidase (TPOAb)] levels from 2017 to 2018 admitted at the ENT Department of Chittagong Medical College Hospital, Chittagong. Analysis was done to assess the association between preoperative thyroid antibody levels, fine needle aspiration cytology (FNAC) results, type of thyroid surgery and final histopathology. Mean age of the study population was 35.58 years (SD:±11.36). According to the final histopathological diagnosis of the 120 patients 80% were benign and other 20% were malignant. Men are more likely to suffer from thyroid malignancy than women (33.3% versus 18.9%). Multinodules are predominant group than solitary nodule (55% versus 45%). Though the prevalence of thyroid malignancies is more in solitary group than multinodules group (22.2% versus 18.2%) the difference is not statistically significant. Among the benign nodules most of them (88.5%) were nodular goiter and among the malignancies most of them were (80.3%) were papillary thyroid carcinoma. There is moderate agreement between FNA and histopathological diagnosis (kappa is .405). The patients with high TSH level in comparison to low TSH level were significantly associated with thyroid malignancy. The patients with preoperative elevated TgAb (≥ 40IU/mL) has 2.55 times of more chance to have malignant lesion than the patients who has normal TgAb level. The study revealed that elevated level of TgAb may act as an independent prediction factor for thyroid malignancy.

Prevalence, severity and associated factors of restless leg syndrome in inflammatory bowel disease patients

Background:The association between restless leg syndrome (RLS) and inflammatory bowel disease (IBD) has often been an under-investigated and clinically misdiagnosed entity. An emphasis should be made on the severity and associated factors, as the prevalence of both entities is on the rise globally. In this study we aimed to investigate the prevalence, severity and associated risk factors of RLS in patients with IBD.Methods:A multi-center, prospective cross-sectional study was conducted with age and gender matched controls in the ratio of 1:3. Cases of IBD were confirmed according to European Crohns and Colitis Organization guidelines. The study recruited 377 cases and 1131 age and gender-matched controls. RLS severity and prevalence was determined using a validated International Restless Legs Syndrome Study Group questionnaire. The anthropometric and blood biochemical measurements were retrieved from the patient's medical records. Associated factors were analyzed by regression analysis.Results:The prevalence of RLS in patients with IBD and non-IBD control groups was 21.5% and 9.7%, respectively (P = 0.001). The severity index of RLS symptoms in all the three categories of mild, moderate and severe RLS was higher in the IBD group (P = 0.001). Obesity (BMI >30 Kg/m2) was more prevalent in patients with IBD with RLS than without RLS (21.9%: 10.3%, P = 0.009). Ages between 46 and 59 years (OR = 18.7 [2.6–29.4], P = 0.008), obesity (OR = 22 [2.6–29.4], P = 0.005), higher TSH levels (OR = 1.7 [1.0–3.0], P = 0.033), and lower hemoglobin levels (P = 0.028) showed a greater risk associated with RLS.Conclusion:Prevalence and severity of RLS was higher in patients with IBD. The risk factors for RLS in IBD include increasing age, obesity, higher TSH, and lower hemoglobin.

Exposure to the Chinese Great Famine in Early Life and Thyroid Function and Disorders in Adulthood: A Cross-Sectional Study.

Background: Malnutrition in early life may permanently change the structure and function of the body, which lead to a number of diseases in adulthood. The effect of famine exposure during the early life on thyroid function and disorders remains unclear. This study investigated the association between exposure to the Great Chinese Famine (1959-1961) in early life and thyroid function and disorders in adulthood. Methods: Nine thousand eight hundred eighty-one subjects with appropriate birth dates derived from the Thyroid disorders, Iodine status, and Diabetes Epidemiological survey were included. Thyroid function and disorders were defined by the test results of blood sample and ultrasonography of all participants. Associations between famine exposure in early life and thyroid function and disorders in adulthood were assessed with binary logistic regression and linear regression. Results: Participants exposed to the Great Chinese Famine during the fetal stage was associated with a higher thyrotropin (TSH) level in adulthood (β = 0.024; p = 0.038), compared with the nonexposed participants. The association was significant among rural participants (β = 0.039; p = 0.02) but not in urban participants (β = 0.005; p = 0.77). Fetal-exposed group did not show a higher risk of thyroid disorders than the age-matched balanced control group, including overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism, subclinical hypothyroidism, autoimmune thyroiditis, and thyroid nodules (p > 0.05). Conclusions: Famine exposure during the fetal stage was associated with a higher TSH level in adulthood. The fetal stage could be the critical period for programming the pituitary-thyroid axis.

Study of pulmonary function test in hypothyroidism

Introduction: thyroid disorders are very common worldwide and there is steep rise in thyroid disorders in India as well.1 There are very few studies done in past to evaluate effect of thyroid disorder on pulmonary function. This study is focused on estimating effects of hypothyroidism on pulmonary function of affected individual. Aim: To study pulmonary function test in hypothyroid patients and to assess correlation of compromised pulmonary function with Thyroid stimulating hormone levels, duration of hypothyroidism, age of patient and body mass index values. Materials and Methods: A total of 67 hypothyroid patients were selected. This study was approved by the Ethical Committee. The present study was carried out in accordance with the Helsinki declaration all participants participated voluntarily after being given a detailed explanation of the purpose of the study. All hypothyroid patients visiting medicine OPD and those hospitalised were included in study. Smokers, former smokers, patients suffering from lifestyle disease and all patients suffering from pulmonary diseases were excluded from study. Pulmonary function tests were evaluated by computerised spirometer HELIOS 702 of recorders and medicare systems private limited (RMS). Data so obtained was analysed with the help of SPSS. Results: both FVC and FEV1 means were decreased. 44% of patients were having restrictive type of lung disease. Forced vital capacity (FVC) and forced expiratory volume in one sec (FEV1) showed strong negative correlation with Thyroid stimulating hormone levels (TSH), duration of hypothyroidism and Body mass Index (BMI). Conclusion: Findings of this study were consistent with restrictive type of lung disease in hypothyroid patients. Hypothyroidism compromises the pulmonary function of affected individual to variable degree depending upon duration of disease and higher levels of TSH and BMI. All hypothyroid patients must be screened for abnormalities of pulmonary function and all patients

Determination of age and sex specific TSH and FT4 reference limits in overweight and obese individuals in an iodine-replete region: Tehran Thyroid Study (TTS)

ABSTRACT Introduction: To determine age and sex-specific thyrotropin (TSH) and free thyroxine (FT4) reference ranges according to body mass index (BMI) categories. Methods: With regards to the National Academy of Clinical Biochemistry (NACB) criteria, a total of 2818 individuals from the Tehran Thyroid Study population was selected and categorized in three BMI groups. Results: TSH levels did not differ significantly between BMI groups (p = .054). Females had statistically higher TSH levels than males in all BMI categories (p < .001). According to age-specific analyses, the youngest category (20–29 years) had the highest median values of serum TSH in all BMI groups. With increasing BMI, the 2.5th percentile of TSH remained approximately unchanged and the 97.5th percentile showed an increasing pattern. FT4 level was significantly higher in the normal weight group compared to obese individuals (p < .001); females had significantly lower FT4 levels than males in normal weight and obese groups (p < .001). According to age categories, the youngest group (20–29 years) had higher levels of FT4 than the elderly group in all BMI categories. A decreasing pattern in both 2.5th and 97.5th percentiles of FT4 was observed along with increasing BMI. Conclusions: Compared to the normal weight population, obese individuals have slightly lower FT4 concentrations accompanied by similar TSH levels. With increasing BMI, upper limits of TSH and FT4 show increasing and decreasing patterns, respectively.

The impact of TSH levels on clinical outcomes 14 days after frozen-thawed embryo transfer

BackgroundThe aim of this study was to investigate the impact of TSH levels on clinical outcomes 14 days after frozen-thawed embryo transfer.MethodsBlood samples were collected on the first visit to our department and 14 days after embryo transfer. Women were divided into three groups based on D14 TSH levels, which were compared to basal TSH levels in groups with different clinical outcomes. TSH levels between pregnant and nonpregnant women were also compared.ResultsThe clinical pregnancy rate in women with lower TSH levels 14 days after transfer was slightly but significantly lower (56%, P = 0.05) compared to those with higher TSH levels. Furthermore, TSH levels were significantly elevated 14 days after transfer compared to basal TSH levels in pregnant women and in women who successfully became pregnant (P < 0.001, respectively).ConclusionsElevated TSH levels 14 days after embryo transfer compared to basal TSH levels seem to play a protective role and predict favorable clinical outcomes under specific conditions.

Elevated TPOAb is a Strong Predictor of Autoimmune Development in Patients of Type 2 Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease: A Case-Control Study.

ObjectiveThe aim of this study was to assess the prevalence of thyroid autoimmunity in T2DM with NAFLD, furthermore explore the relationship between elevated TPOAb titer and the severity of NAFLD.MethodsA total of 400 patients with T2DM were divided into two groups according to NAFLD. Thyroid function and other metabolic indicators were measured.ResultsThere were more TPOAb-positive patients in both groups, and the prevalence of TPOAb positive was significantly different in two groups (17% vs 6.9%, p< 0.01). FT4 was significantly lower in patients with T2DM with NAFLD (median FT4 0.89 vs 1.08, p < 0.001), while TSH was increased (median TSH 2.85 vs 2.28, p < 0.05). In patients with T2DM with NAFLD, the proportion of women in the thyroid autoimmune-positive group was significantly higher than the negative (71.1% vs 46%, p < 0.01). Similarly, thyroid autoimmune-positive T2DM and NAFLD patients had lower FT4 levels (median FT4 0.59 vs 0.92, p < 0.001), higher TSH levels (median TSH 3.65 vs 2.67, p < 0.001), and much higher TPOAb/TGAb (median TPOAb/TGAb 6.8 vs 1.46, p < 0.001). The increase of TPOAb was significantly correlated with the severity of fatty liver. HbA1c, TC, TG, TSH, TPOAb/TGAb and severity of fatty liver were risk factors of thyroid autoimmunity.ConclusionAutoimmune thyroid disease is more common in patients with T2DM complicated with NAFLD. Elevated TPOAb titer is closely related to fatty liver, suggesting that elevated TPOAb titer is a predictor of autoimmune development in T2DM with NAFLD.

EFFECTIVENESS OF KANCHANARA KWATHA IN THE MANAGEMENT OF PRIMARY HYPOTHYROIDISM: CASE SERIES

Primary hypothyroidism is a condition that results due to the decreased ability of thyroid gland to produce its hormones Tri-iodothyronine (T3) and Thyroxin (T4) and results in increased TSH production from the Pituitary gland. This decreased hormone secretion may result in reduced metabolism and in Ayurveda, this metabolism may be explained in terms of Dhatu Parinama Siddhanta and this reduced metabolism with Dhatva agnimandya condition. Ten subjects having high TSH levels and one or multiplicity of the symptoms like Lethargy, hairfall, dryness of skin, less appetite, cold intolerance, puffiness of face, hoarseness of voice, muscle aches, menstrual disturbances were selected for the study. They were gradually developing these symptoms since 1 year. They all were given Kanchanara Kwatha 24 ml with 1.5 g Shunthi Choorna as Prakshepaka Dravya twice daily before food for 60 days. Follow up was done on 30th day after the intervention. Assessment of subjects was done by using TSH levels and Zulewski’s clinical score for on 0th, 61th and 90th day. The results were analysed statistically. Statistically highly significant result (i.e. p-value = 0.003) were obtained for TSH. When the subjective criteria is analysed, statistically highly significant result (p-value &lt; 0.001) were obtained for the criteria slow movement and statistically significant results (p value &lt; 0.05) were obtained for the criteria’s hoarseness of voice, constipation, weight increase, periorbital puffiness. The change obtained for symptoms after the treatment was maintained in the follow-up period too. Above results showed that the drug Kanchanara Kwathais effective in primary hypothyroidism.

Study of Thyroid Function Tests in Cirrhosis of Liver And Correlation of Thyroid Function Tests Levels With Severity of Liver Dysfunction

Background: One of the leading causes of morbidity and mortality in the world is chronic liver diseases. Thyroid hormones regulate the basal metabolic rate of all cells, including hepatocytes, and thereby modulate hepatic function. The liver in turn metabolizes the thyroid hormones and regulates their systemic endocrine effects. Thyroid dysfunction may perturb liver function, liver disease modulates thyroid hormone metabolism, and a variety of systemic diseases affect both organs. Keeping in mind the above view we have done this study by highlighting the association between thyroid function tests with severity of liver dysfunction in cirrhosis of liver by using child Pugh scoring Methods: All patients aged 30-80 years with cirrhosis of liver who are attending Rajarajeshwari Medical College and Hospital. Detailed history, physical examination and drug history was taken as per pre-designed performa. Relevant investigations were done for assessing thyroid function and liver cirrhosis. Severity of liver dysfunction was graded by using Child Pugh Scoring Results: The prevalence of hypothyroidism among patients with liver cirrhosis was 64%. Majority of the cases had a high TSH and TSH levels were directly correlated severity of liver disease. Total T3 levels were low in majority of the cases and it was inversely correlated with severity of liver disease. FT3 was low in most of the cases with child B and child C score; it was inversely correlated with severity of liver disease. FT3 was found to be a more sensitive marker than total T3 for assessing severity of liver disease. Conclusion: Thyroid dysfunction is common in cirrhosis of liver hence thyroid function tests should be carried out in all cirrhotic patients to assess the severity and prognostication of such patients.

Effect of thyroxine treatment on pregnancy outcomes in infertile Japanese women with TSH levels between 2.5 μIU/mL and the upper reference limit: a retrospective study.

Recent randomized controlled studies have revealed that levothyroxine (LT4) treatment improves pregnancy outcomes only in infertile women with subclinical hypothyroidism who have thyroid autoantibodies (TAs), but not for those with high TSH levels within the normal range who have TAs. Here, we retrospectively investigated pregnancy outcomes in infertile Japanese women with 2.5 μIU/mL ≤ TSH < upper reference limit (URL). Between 2012 and 2018, 286 patients diagnosed with infertility were followed for more than 1 year at our institution. Among them, we included 106 patients with 2.5 μIU/mL ≤ TSH < URL. We divided these patients into four groups based on the combination of TA positivity and LT4 treatment status to assess the effects of LT4 treatment considering TA positivity on the incidence of pregnancy or miscarriage. In this study, we did not find any significant differences in the rates of pregnancy or miscarriage among the four groups (p = 0.81 and 0.52, respectively). In addition, logistic regression analysis showed that age and history of miscarriage were associated with the incidence of pregnancy, but presence of TAs and LT4 treatment status were not and that no variables examined were associated with the incidence of miscarriage. In summary, we were not able to demonstrate the benefit of LT4 treatment for pregnancy outcomes in Japanese euthyroid infertile women with 2.5 μIU/mL ≤ TSH < URL regardless of TA status in this study.

Influence of General Mineral Condition on Collagen-Guided Alveolar Crest Augmentation.

The local regeneration of bone defects is regulated by general hormone, enzyme, ion, and vitamin levels. General diseases and dysregulation of the human mineral system can impact this process, even in alveolar crest. The aim of this study is to investigate a relation between bone density, measured in two-dimensional X-rays, and general mineral condition of patients. The study included 42 patients on whom tooth extractions were performed. Data were divided into two groups: the region where collagen scaffold (BRM) was used and the reference region of intact normal bone (REF). Two-dimensional intraoral radiographs were taken in all cases just after the surgery (00 M) and 12 months later (12 M). Thyrotropin (TSH), parathormone (PTH), Ca2+ in serum, HbA1c, vitamin 25(OH)D3, and spine densitometry were checked. Digital texture analysis in MaZda 4.6 software was done. Texture Index (TI: BRM 1.66 ± 0.34 in 00 M, 1.51 ± 0.41 in 12 M, and REF 1.72 ± 0.28) and Bone Index (BI: BRM 0.73 ± 0.17 in 00 M, 0.65 ± 0.22 41 in 12 M, and REF 0.80 ± 0.14) were calculated to evaluate bone regeneration process after 12 months of healing (TI (p < 0.05) and BI (p < 0.01) are lower in BRM 12 M than in REF). This showed a relation between BI and TSH (R2 = 26%, p < 0.05), as well as a between BI and patient age (R2 = 65%, p < 0.001), and a weak relation between TI and TSH level (R2 = 10%, p < 0.05). This study proved that a collagen scaffold can be successfully used in alveolar crest regeneration, especially in patients with a high normal level of TSH in the middle-aged population.

Evaluation of Thyroid Dysfunction in Women with Gestational Diabetes Mellitus Compared to Healthy Pregnant Women Referred to Kowsar Hospital in Qazvin from 2017 to 2018

Background & Objective: In this study, thyroid dysfunction in women with gestational diabetes mellitus was examined and compared to that in healthy pregnant women referred to Kowsar Hospital in Qazvin in 2017 and 2018.Methods: In this case-control study, 100 women with gestational diabetes mellitus and 100 non diabetic healthy pregnant women who referred to Kowsar Hospital in Qazvin from 2017 to 2018 were selected using the convenience sampling method, and their serum thyroxine, anti-TPO, and TSH levels were determined and compared. Moreover, Apgar scores and anthropometric variables were compared between the two groups.Results: In the present study, there were statistically significant differences between the groups in terms of the TSH level (P < /em>=0.012), assessed by the independent t-test, the thyroxine (P < /em>=0.0001) and anti-TPO (P < /em>=0.008) levels, both examined by the Mann-Whitney test, which associated with high levels of TSH and anti-TPO and low levels of thyroxine in the diabetic group. No differences were found regarding the Apgar scores and anthropometric variables between the groups (P < /em>>0.05).Conclusion: Overall, according to the obtained results, it can be inferred that thyroid dysfunction, realized as hypothyroid with high anti-TPO levels, was more prevalent in women with gestational diabetes mellitus compared to healthy pregnant women.

In patients with hypothyroidism, high TSH levels are associated with increased mortality

Evidence-Based Practice: August 2020 - Volume 23 - Issue 8 - p 8-9 doi: 10.1097/EBP.0000000000000978

Massive Ovarian Enlargement with Multiple Cysts Mimicking Ovarian Neoplasm and Primary Hypothyroidism

Background: Cystic enlargement of ovaries may develop due a large number of causesand may need surgical intervention. Moreover, some ovarian cysts arise due to endocrinedisorders &amp; do not require surgery. We report an unusual case of massive enlargement ofovaries with multiple cysts in a girl with severe hypothyroidism. Morphologic features ofcysts on ultrasonography and clinical features of hypothyroidism with elevated TSH levelfacilitates diagnosis of multiple ovarian cysts and hypothyroidism.&#x0D; Case presentation: A 23-year-old unmarried woman presented with abdominal enlargement,pain and moderate anemia. Abdominal ultra sonogram revealed huge enlargement of theovaries with multiple large cysts. She was admitted in a hospital, treated with blood transfusionand laparotomy was decided. She was referred to us in a private clinic. On further evaluation, she had features of hypothyroidism with high TSH level and abdomino-pelvic ultrasoundrevealed enlarged ovaries with multiple large thin-walled cysts and mild ascitis. Conservativemanagement with thyroxin replacement therapy was given and after 3 weeks of thyroxine(T4) therapy, follow-up abdominal ultrasound showed significant reduction in ovarian size.After 4 months of thyroxine therapy, ovarian size normalized, cysts disappeared completelyand there was significant improvement of patient’s condition and she became euthyroid.&#x0D; Conclusion: This case report highlights the rare association between hypothyroidism andmulticystic ovarian enlargement. It is necessary to keep in mind the possibility ofhypothyroidism in the differential diagnosis of adult patients with ovarian enlargement andmultiple cyst formation in order to prevent unnecessary ovarian surgery.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 78-81

Incidence of congenital hypothyroidism and associated congenital anomalies at VSS Medical College &amp;amp; Hospital, Burla

Background: The worldwide incidence of CH ranges from 1 in 3000 to 1 in 4000 live newborn. However, varied incidence has been found from state, regional, and national screening programs.Objective: to know the incidence of Congenital Hypothyroidism and associated congenital anomalies in this part of the country, which is necessary to understand the burden of congenital hypothyroidism to the society.Setting: Primary serum TSH measurement in screening neonates with backup thyroxine (T4) determination in infants with high TSH levels (>20mIU/L). TSH and FT4 were estimated by Chemi Luminescence Immuno Assay (CLIA) method using reagent moonblind, INC.Result: Serum TSH of screened neonates ranged between 0.16mIU/L and 80.32mIU/L, Mean ± SD of sTSH being 5.80±3.96mIU/L. Out of 2212 screened newborns, 9 newborns had sTSH value >20mIU/L. out of 9 recalled newborns, 3 had persistently elevated sTSH >20mIU/L. Making incidence of Congenital hypothyroidism of 1:737 in our study. In a study carried out at Israel found 15.6% cases of Congenital Hypothyroidism were associated with congenital anomalies majority being cardiac anomalies.Conclusion: In our study we found a higher incidence of 1 in 737, when compared to estimated national incidence of congenital hypothyroidism. Our study reported significant number of neonates with sTSH value >10mIU/L indicating iodine deficiency prevalent in this part of country.

Study of Carcinoma Embryonic Antigen (CEA) and its Relationship to TSH Polymorphisms in Patients with Thyroid Gland Dysfunction.

In this study, 145 patients with different thyroid dysfunctions were included. All the patients have undergone for measuring thyroid hormone (T3, T4 & TSH). These patients are put in five groups, in the first group, which include 38 patients who have hyperthyroidism, the second group includes 58 patients who have hypothyroidism, the third group includes 31 patients who have Euthyroid with normal thyroid hormones levels, the fourth group includes 5 patients only who have low levels of thyroid hormones, and the last group includes 13 patients who have a high levels of TSH with normal level of T3 & T4. All samples are obtained before treatment. All serum samples are subjected to estimate the levels of CEA. The results of this study showed that CEA is increased at high levels in patients of group 2 & group 5 who have high levels of TSH. However, some patients when the treatment is given, CEA levels return to the normal. This will give an indicator that CEA is not biomarker for malignancy but it is a biomarker for the high TSH levels associated with two groups (two and five). Single nucleotide polymorphism was studied for D1a gene to show the variation between TSH & CEA levels in patients with thyroid dysfunction .The study was found that the genotype is C/C allele which gives absolute relationship between TSH concentration and CEA levels in both patients and control groups and to the less extent in heterozygous allele C/T.