Higher TSH Values Research Articles

9303 Evaluation of The Consistency of Thyroid Indicators Tests in Minimally Invasive Peripheral Blood and Venous Blood

Abstract Disclosure: Z. Zhu: None. Y. Huang: None. Z. Cao: None. L. Zhang: None. D. Wang: None. S. Wang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background The detection of thyroid indicators is of high demand in clinical and epidemiological screenings. Compared with existing venous blood tests, peripheral fingertip blood tests are less invasive and have a lower blood collection volume, which is the basis for point-of-care tests of thyroid indicators. Objective To explore the feasibility of minimally invasive and micro blood collection tests for thyroid disease (TD) patients by evaluating the consistency of thyroid indicators and TD diagnostic efficiency between fingertip blood tests and venous blood tests. Method 63 subjects with or without thyroid dysfunction were consecutively recruited. All subjects underwent serum, plasma and fingertip blood (same day collection) measurements for TSH and TT4 detection via the chemiluminescence method and for TPOAb detection via the electrochemiluminescence immunoassay method. The fingertip blood was centrifuged and diluted after EDTA anticoagulation. Bland–Altman plot, Passing–Bablok regression, and weighted kappa test were used for consistency test; AUC of ROC curve, sensitivity and specificity were used for authenticity evaluation among the three collection and testing methods. Results 43 subjects with euthyroidism and 20 subjects with thyroid dysfunction were included; including 29 (46.03%) females, the average age was 50.98±14.76 years. Bland-Altman plots showed more than 90% of the subjects had TSH and TT4 differences within the 95% limits of agreement between peripheral blood (PB) and venous blood (including serum and plasma). Passing–Bablok regression analyses revealed strong correlations between TSH levels in PB and serum (r=0.888) and plasma (r=0.894) (p<0.05); for TT4, there was a strong correlation between PB and serum (r=0.746), and there was also a moderate correlation between PB and plasma (r=0.664) (p<0.05 for both). Weighted kappa tests were performed for low, normal and high TSH values, indicating strong consistency between PB and serum and between PB and plasma, with coefficients of 0.901 and 0.881, respectively (P<0.001); for TT4, the coefficients between PB and serum, PB and plasma were 0.541 and 0.585 (P<0.001), indicating moderate consistency. Regardless of TPOAb positivity or negativity, the consistency among three blood sample sources was 100%. For euthyroidism (n=43), hyperthyroidism (n=6), subclinical hyperthyroidism (n=9), hypothyroidism (n=1), and subclinical hypothyroidism (n=4), the diagnostic sensitivities of PB were 97.06%, 83.33%, 87.50%, 100%, and 75.00%, respectively; the specificities were 94.74%, 97.87%, 95.74%, 98.11%, and 100.00%, respectively. The AUC of PB ROC curve for determining thyroid dysfunction was 0.944 (95% CI 0.867-1.000). Conclusion PB tests of thyroid indicators has high consistency with venous blood tests, offers sufficient diagnostic efficiency for TD, and is a feasible minimally invasive detection method. Presentation: 6/1/2024

7583 Evaluation of The Consistency of Thyroid Indicators Tests in Minimally Invasive Peripheral Blood and Venous Blood

Abstract Disclosure: Z. Zhu: None. Y. Huang: None. Z. Cao: None. L. Zhang: None. D. Wang: None. S. Wang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background: The detection of thyroid indicators is of high demand in clinical and epidemiological screenings. Compared with existing venous blood tests, peripheral fingertip blood tests are less invasive and have a lower blood collection volume, which is the basis for point-of-care tests of thyroid indicators. Objective To explore the feasibility of minimally invasive and micro blood collection tests for thyroid disease (TD) patients by evaluating the consistency of thyroid indicators and TD diagnostic efficiency between fingertip blood tests and venous blood tests. Method 63 subjects with or without thyroid dysfunction were consecutively recruited. All subjects underwent serum, plasma and fingertip blood (same day collection) measurements for TSH and TT4 detection via the chemiluminescence method and for TPOAb detection via the electrochemiluminescence immunoassay method. The fingertip blood was centrifuged and diluted after EDTA anticoagulation. Bland–Altman plot, Passing–Bablok regression, and weighted kappa test were used for consistency test; AUC of ROC curve, sensitivity and specificity were used for authenticity evaluation among the three collection and testing methods. Results 43 subjects with euthyroidism and 20 subjects with thyroid dysfunction were included; including 29 (46.03%) females, the average age was 50.98±14.76 years. Bland-Altman plots showed more than 90% of the subjects had TSH and TT4 differences within the 95% limits of agreement between peripheral blood (PB) and venous blood (including serum and plasma). Passing–Bablok regression analyses revealed strong correlations between TSH levels in PB and serum (r=0.888) and plasma (r=0.894) (p<0.05); for TT4, there was a strong correlation between PB and serum (r=0.746), and there was also a moderate correlation between PB and plasma (r=0.664) (p<0.05 for both). Weighted kappa tests were performed for low, normal and high TSH values, indicating strong consistency between PB and serum and between PB and plasma, with coefficients of 0.901 and 0.881, respectively (P<0.001); for TT4, the coefficients between PB and serum, PB and plasma were 0.541 and 0.585 (P<0.001), indicating moderate consistency. Regardless of TPOAb positivity or negativity, the consistency among three blood sample sources was 100%. For euthyroidism (n=43), hyperthyroidism (n=6), subclinical hyperthyroidism (n=9), hypothyroidism (n=1), and subclinical hypothyroidism (n=4), the diagnostic sensitivities of PB were 97.06%, 83.33%, 87.50%, 100%, and 75.00%, respectively; the specificities were 94.74%, 97.87%, 95.74%, 98.11%, and 100.00%, respectively. The AUC of PB ROC curve for determining thyroid dysfunction was 0.944 (95% CI 0.867-1.000). Conclusion PB tests of thyroid indicators has high consistency with venous blood tests, offers sufficient diagnostic efficiency for TD, and is a feasible minimally invasive detection method. Presentation: 6/1/2024

Anemia in non-celiac wheat sensitivity: Prevalence and associated clinical and laboratory features.

Patients suffering from non-celiac wheat sensitivity (NCWS) frequently report extra-intestinal symptoms, such as anemia. We investigated the prevalence and associated clinical features of anemia in NCWS patients. Data from 244 NCWS patients, diagnosed by double-blind placebo-controlled wheat challenge, were retrospectively reviewed and compared with 2 control groups (celiac disease (CD) and irritable bowel syndrome (IBS)). Furthermore, 31 NCWS anemic patients were prospectively re-evaluated after at least 12 months on the "strict" wheat-free diet (WFD). Anemia prevalence in NCWS patients was 34.8% (mean hemoglobin 10.4±1.4g/dl), significantly higher than in IBS (17.4%, P=0.03), but not in CD ones. The NCWS group, on the whole, had sideropenic-like features with low serum iron and altered iron deposits. Both anemia prevalence and sideropenic-like features were more evident in CD than in NCWS patients, whereas only a few IBS subjects showed such features. Significant differences were found in anemic vs non-anemic NCWS patients as regards to female sex, diagnostic delay, poly/hypermenorrhea, iron deficiency, and higher TSH values. A long-term WFD significantly reduced anemia and improved iron metabolism. Microcytic/hypochromic anemia and altered iron metabolism occur frequently in NCWS and can be treated with a long-term strict WFD. NCWS should be included in differential diagnosis of anemic patients with "functional gastrointestinal troubles".

TO STUDY SMALL FOR GESTATIONAL AGE AS A RISK FACTOR FOR THYROID DYSFUNCTION

Introduction: Babies with a birth weight and/or length below the 10th percentile of a population of the same gestational age are dened small-forgestational-age (SGA). Children born prematurely or small for gestational age are at a higher risk of thyroid dysfunction. Intrauterine growth retardation and the delivery of SGA infants may have a variety of reasons. This illness is characterised by several endocrine-metabolic changes and pathophysiological processes. It has been shown that there are greater rates of diseases including cardiovascular events, metabolic syndrome, hypertension, and obesity. These changes may also have an impact on future health in infancy and adulthood. There aren't many research that compare the thyroid function of SGA and AGA neonates. For newborn plasma concentrations of T4 and TSH, contradictory ndings have been reported. The study was conducted to observe the relationship that the weight and/ Objective: or the gestational age plays on the thyroid function of the babies. This retrospective study was conducted in a tertiary care cent Materials And Methods: re. This study focused on the day 3 TSH, Ft4 value of the SGA babies compared with the AGA babies. Preterm and term Results: SGA babies had considerably lower blood T4 concentrations and higher TSH values as compared to AGA neonates (P=0.0001). SGA babies had a hi Conclusion: gher incidence of transient hypothyroidism and required accurate follow-up and close monitoring of thyroid function.

Dyslipidemia Is a Risk Factor for Hypothyroidism in Women: A Longitudinal Cohort Study from South Korea.

Background: Hypothyroidism is a risk factor for dyslipidemia. We explored whether dyslipidemia is a risk factor for hypothyroidism. Methods: We performed a retrospective analysis of data from a longitudinal cohort study of South Korean adults who underwent medical examination and ≥4 biochemical assessments of thyroid function. The primary outcome was hypothyroidism (thyrotropin [TSH] >4.2 mU/L), and the secondary outcome was severe subclinical hypothyroidism (SCH; TSH ≥10.0 mU/L and normal free thyroxine [fT4] level) or overt hypothyroidism (OH; total triiodothyronine <80 ng/dL and/or fT4 < 0.93 ng/dL and high TSH values). The association of baseline dyslipidemia status with subsequent hypothyroidism was evaluated using Kaplan-Meier curves with the log-rank test and Cox proportional hazards regression models (for the entire population and respective genders). Subgroup analyses according to age (<40 and ≥40 years) and body-mass index (BMI; <23, 23-25, and ≥25 kg/m2) were performed according to gender. Results: We included 1665 participants. During a median follow-up period of 61.0 months, 24.3% (404/1665) individuals developed hypothyroidism. Among these, 36 participants (2.1%) had severe SCH or OH. Excluding patients with a first abnormal TSH level at last follow-up, 44.5% (126/283) of the patients with hypothyroidism had spontaneous TSH normalization. In respective multivariate analyses, dyslipidemia at baseline was independently associated with development of hypothyroidism in women (adjusted hazard ratio [HR] = 2.05 [1.31-3.19], p = 0.002), but not in men (adjusted HR = 1.00 [0.77-1.30], p = 0.991). In women, the presence of dyslipidemia at baseline was associated with development of severe SCH or OH (adjusted HR = 5.33 [1.41-20.12], p = 0.014). In women, respective associations according to age and BMI were as follows: age <40 years, adjusted HR = 2.90 (1.34-6.26, p = 0.007); age ≥40 years, adjusted HR = 1.85 (1.08-3.14, p = 0.023); BMI <23 kg/m2, adjusted HR = 1.68 (0.82-3.43, p = 0.151); BMI = 23-25 kg/m2, adjusted HR = 2.17 (0.93-5.07, p = 0.071); and BMI ≥25 kg/m2, adjusted HR = 2.82 (1.16-6.86, p = 0.022). Conclusions: In Korean adults, dyslipidemia was associated with development of hypothyroidism in women. Our findings require confirmation.

Evaluation of Anemia Frequency and Types in Patients with Subclinical and Clinical Hypothyroidism in the Endemic Goiter Region

ABSTRACT&#x0D; Objective: Hypothyroidism is a disease that occurs as a result of thyroid hormone deficiency or rarely, due to ineffectiveness at the tissue level. While the prevalence of clinical hypothyroidism is reported to be 2-5% worldwide, of subclinical hypothyroidism it is 4-8.5%, with the prevalence of subclinical hypothyroidism in women over 60 years of age being 14-20%. Hypothyroidism affects many organs and systems in the body, one of which is the hematopoietic system. Thyroid hormone deficiency plays a role in the development of microcytic, normocytic and macrocytic anemia. The frequency of anemia in patients with hypothyroidism varies between 20-60%. In this study, our aim was to determine the regional prevalence of subclinical and clinical hypothyroidism in adult patients in our region and to evaluate the frequency and types of anemia in patients with hypothyroidism.&#x0D; &#x0D; Method and Material: This study was prospectively conducted between 01.12.2012 and 01.05.2013 at the outpatient clinic of Recep Tayyip Erdogan University Faculty of Medicine Endocrinology. Included in the study were 96 patients who had subclinical hypothyroidism, 30 patients who had clinical hypothyroidism, and 100 healthy controls. Normal fT4 and fT3, high TSH values were used for the diagnosis of subclinical hypothyroidism, and low fT4 and/or fT3, high TSH values were used for the diagnosis of clinical hypothyroidism. The diagnosis of anemia was based on subclinical hypothyroidism, clinical hypothyroidism, and control group Hb value

PREVALENCE OF DYSLIPIDEMIA AND ASSESSMENT OF BLOOD PRESSURE IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM IN A TERTIARY CARE HOSPITAL - A CASE CONTROL STUDY

Introduction: The THYROID gland has been incriminated to cause a spectrum of diseases that involve almost every system of the human body. Subclinical thyroid disorders can be rightly said to be the forerunners of these clinical scenarios. One pole constitutes subclinical hypothyroidism, the other end being subclinical hyperthyroidism. 'Subclinical hypothyroidism' is dened as a condition with elevated serum TSH and normal serum T3 and T4 in the absence of overt clinical signs and symptoms. It is quite common in the community. Estimation of the prevalence ofAims: dyslipidemia among cases of subclinical hypothyroidism and Estimation of the prevalence of hypertension among cases of subclinical hypothyroidism. The present study was Observational study. This Study was conducted from January 2012 to JuneMaterials And Methods: 2014(18 months) at N.R.S Medical College and Hospital, Kolkata. 100 patients were included in this study. In this study, SH has beenResult: found to be more prevalent among elderly female.81% of total SH cases were female and 61% of the cases were aged above 50 years. Most (70%) of the SH cases had TSH value &gt; 10 micro IU/ml. These ndings correlate with the results of the Wickham survey, although the prevalence of cases with higher TSH value was more than that of the Colorado Thyroid Disease Prevalence Study. Hypertension was more prevalentConclusion: among SH cases than control population. Systolic and diastolic both blood pressure means were higher among SH cases although diastolic blood pressure was more affected. Mean arterial blood pressure was also higher among SH cases than euthyroid control.

Thyroid dsyfunctions in down’s syndrome

Down’s syndrome is one of the common chromosomal abnormalities seen. Also means yes having thyroid dysfunctions would be better than neonatal having thyroid dysfunction. The patients having Down’s syndrome are having thyroid dysfunction and the children having down’s syndrome are at higher risk to have thyroid dysfunction and these children are having both the hypothyroidism and hyperthyroidism. The present study aims at identifying the thyroid dysfunctions among the patients having Down’s syndrome. : The present study is an observational study which is being conducted in tertiary care hospital from March 2018 to June 2019. In this study 80 neonatal having Down’s syndrome were being examined and the thyroid function tests are being performed on the patients for identifying the prevalence of thyroid dysfunction in patients with Down’s syndrome. The patients are being selected on the basis of inclusion and exclusion criteria. In the present study it is being found that 56% of the patients were having normal thyroid function and 44% were having abnormal thyroid function. TSH value of the patients having abnormal thyroid function is significantly higher as compared to the patients having normal thyroid function. The mean of FT3 (pg/ml) among the patients having normal and abnormal thyroid function was found to be 2.9±0.4 and 2.5±0.9 respectively and the mean of FT4 (pg/ml) among the patients having normal and abnormal thyroid function was found to be 14.9±8.4 and 2.5±0.9 respectively 13.5±7.9. The study concluded that there is a significant impact of down syndrome on the thyroid function and the patients having down syndrome are at higher risk of thyroid diseases as it is found that the patients having down syndrome are having abnormal thyroid function and higher TSH value.

THE EFFECTS OF THYROID-STIMULATING HORMONE, FREE THYROXINE LEVELS, AND THYROID ANTIBODIES ON MEAN PLATELET VOLUME: ORIGINAL RESEARCH

Background: Coagulation abnormalities has been reported in patients with impaired metabolism of thyroid hormones. Platelets play an important role in coagulation and Mean Platelet Volume has been considered as an inflammatory biomarker in multiple diseases. &#x0D; Objectives: The aim of this study was to investigate whether any relationship exists between the values of thyroid-stimulating hormone, free thyroxine, anti-thyroid peroxidase, anti-thyroglobulin and those of the MPV.&#x0D; Methods: Patients who were admitted to the Endocrinology outpatient clinic between October 2013 and July 2019 with a pre-diagnosis of thyroid disease were included in the study. The data were analyzed with IBM SPSS V23. Compatibility with normal distribution was examined with the Shapiro Wilk test. The relation between the variables was evaluated with Spearman rank correlation. &#x0D; Results: Records of 1098 patients were examined. There is a very weak positive relationship between TSH and MPV (r: 0,075), there is no significant relationship between ST4, Anti TPO, Anti TG and MPV.&#x0D; Conclusion: Patients have high TSH values display a increased MPV should hence be acknowledged in risk prediction of thrombotic events.

TSH Variations in Chronic Heart Failure Outpatients: Clinical Correlates and Outcomes.

Hypothyroidism is a frequently observed comorbidity in patients with chronic heart failure (CHF), possibly giving rise to unfavorable outcomes. The aim of the study was to evaluate the impact of TSH changes over time on cardiac function and prognosis of outpatients with CHF. Patients underwent clinical, electrocardiographic, and echocardiographic evaluations at baseline and after 12 months. Moreover, blood chemistry tests were performed to evaluate renal function, cardiac biomarkers, fT3, fT4, and TSH levels. Based on TSH serum levels, patients were retrospectively classified into four categories: Group 1, patients with improved thyroid function at one-year follow up vs. baseline; Group 2, patients with stable and mildly high TSH values (3.74 - 10 mUI/L); Group 3, patients with worsening thyroid function; Euthyroid patients Group, TSH levels within the normal range of reference at baseline as well as at 12 months follow-up. We considered as end-points: one-year changes of laboratory and echocardiographic parameters; hospitalizations due to worsening of HF (acute decompensated heart failure - ADHF); death for all causes. Among 257 patients, 174 (67.7%) were euthyroid at baseline and after 12 months. Group 1 patients (n. 22, 8.6%) showed a significant improvement in systolic and diastolic function, filling pressures, NT-proBNP and Galectin-3. Group 2 patients (n. 34, 13.2%) did not exhibit significant modifications in studied parameters. Group 3 patients (n. 27, 10.5%) showed worsening of diastolic function and NT-proBNP and a greater risk of ADHF (HR: 2.12; 95%CI: 1.20-3.74; p: 0.009) and death (HR: 4.05; 95%CI: 2.01-8.15; p<0.001). In patients with CHF, changes in thyroid function over time influenced echocardiographic parameters and biomarkers reflecting modifications of cardiac function and prognosis, thus suggesting the clinical relevance of thyroid deficiency screening and correction.

English

BACKGROUND Thyroid hormone is known to regulate metabolisms which are an integral part of normal growth and development. It affects key metabolisms involved in energy storage and expenditure. We wanted to study the correlation of thyroid function test with metabolic markers. METHODS After appropriate clearance from Human Institutional Ethics Committee and proper permission from author of article by Dr Sindhu et al, the secondary, blinded data was adopted for this study. This is an observational, cross-sectional retrospective study. Anthropometric measurements were taken, and lipid and thyroid profile were analysed in overnight fasting sample. As per our inclusion and exclusion criteria 120 of 253 subjects included in primary study were recruited in our study. Statistical analysis was done in Microsoft Excel 2007 and SPSS software version 16.0. ATP III criteria were used as a benchmark for metabolic syndrome markers. RESULTS Our study suggests that prevalence of subclinical hypothyroidism was higher in young South Indian women and it significantly correlated with the markers of metabolic syndrome like BMI, waist circumference, Low Density Lipoprotein (LDL) and systolic blood pressure. TSH values strongly correlated with BMI and LDL values. FT4 values correlated well with LDL. CONCLUSIONS High TSH and lower thyroxine values in blood can be a marker associated with metabolic syndrome. Our study suggests routine screening for thyroid status and lipid profile in young females to categorize them as high risk for cardiovascular mortality and morbidity along with anthropometric measurements. The study can be continued by long term follow up of the study subjects and correlation of these study subjects into mid or old age can give significant information of their cardiac status at that age. Counseling on appropriate diet and lifestyle modification may be beneficial for young people categorized as high risk to reduce the cardiovascular mortality later in life. KEYWORDS Thyroid Stimulating Hormone, Free Thyroxine, BMI, Lipid Profile

Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism.

It has been suggested that increasing levothyroxine dose to lower TSH levels within the normal laboratory range might be a therapeutic option for patients with apparently well-controlled primary hypothyroidism who are dissatisfied with their treatment and complain of physical or psychological symptoms. This study assessed whether there is a relationship between TSH levels and health-related quality of life (HRQoL) among subjects with adequately treated hypothyroidism. HRQoL was measured with the specific thyroid disease ThyPRO-39 questionnaire in 218 consecutive patients with primary hypothyroidism of any cause attending an Endocrinology Department in a single center. Patients had TSH values within the normal laboratory range on a blood test performed not before than 6 weeks prior to study participation, but they were not aware of their lab results. The association between TSH values and the different ThyPRO-39 scales was analyzed by means of multiple regression models, both linear and additive, in which, in addition to TSH, a wide set of clinical and sociodemographic variables potentially related to HRQoL were also considered. TSH levels and the use of anxiolytic and antidepressant drugs were the only variables that showed a positive linear correlation with the ThyPRO-39 composite scale in the multivariate regression analysis, indicating greater impairment in HRQoL with increasing TSH values. TSH was also independently correlated to scores of scales dealing on tiredness and emotional susceptibility. In patients with primary hypothyroidism, higher TSH values, even within the normal reference range, are associated with greater deterioration of HRQoL.

Valores de referencia de hormonas tiroideas en la población de gestantes en Lugo

Background and objectiveThe complex physiology of thyroid function during pregnancy requires a hormonal evaluation according to reference values for each trimester, each area, and with the techniques of each laboratory. The objectives of this study were to analyse thyroid function in the three trimesters of pregnancy and to establish the reference values of hormones in pregnant women in this health area (Lugo). MethodsA total of 831 pregnant women were included in the study (median age: 33years, age range: 16-47years). Once the exclusion criteria were applied, the sample consisted of 641 pregnant women, a size that can be considered representative of the reference population. ResultsThe reference intervals were as follows: TSH first trimester, 0.10-3.74mIU/L; second trimester, 0.45-3.77mIU/L; and third trimester, 0.36-4.15mIU/L. For Free T4 in the first trimester, 0.87-1.34ng/dL; second trimester, 0.78-1.20ng/dL; and third trimester, 0.78-1.23ng/dL. For Free T3 in the first trimester, 2.52-3.78pg/mL; second trimester, 2.22-3.21pg/mL; and third trimester, 2.17-3.14pg/mL. The presence of thyroid autoimmunity was confirmed in 109 women (13.1%), who presented with higher TSH values than pregnant women without thyroid autoimmunity. ConclusionThe reference intervals for TSH, Free T4, and Free T3 obtained in this study are below those used in the non-pregnant adult population in this laboratory. This should help to identify more accurately a possible thyroid dysfunction in pregnant women in the study area, avoiding an underdiagnosis of subclinical hypothyroidism and reducing the possible associated perinatal complications.

A study of serum thyroid stimulating hormone levels, and its correlation with clinical features and delayed diagnosis of hypothyroidism in central India

Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value &gt;100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician’s level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.

Neonatal Screening for Congenital Hypothyroidism: What Can We Learn From Discordant Twins?

Newborn screening program for congenital hypothyroidism (CH) adopting rescreening in at-risk neonates. To estimate the concordance rate for CH in twin pairs discordant at the first screening; to verify whether long-term follow-up of healthy cotwins belonging to CH discordant pairs may be useful to diagnose thyroid hypofunction during development; to evaluate the importance of genetic and environmental influences on liability to permanent and transient CH. Forty-seven screening discordant twin pairs were investigated. Proband was defined as the twin in the pair with a positive test at the first screening and a confirmed diagnosis of CH. Seven screening discordant twin pairs became concordant for CH within the first month of life (pairwise concordance of 14.9%) because seven screening negative cotwins showed high TSH values when retested. During long-term follow-up (range, 3 to 21 years), hypothyroidism was diagnosed in two monozygotic screening negative cotwins at the age of 9 months and 12 years, respectively. Furthermore, the twin analysis showed that 95% of liability to transient CH was explained by genetic factors and 5% by environmental (unshared) factors, whereas 64% of phenotypic variance of permanent CH was explained by common environmental factors (shared during the fetal life) and 36% by unshared environmental factors. This study showed that the introduction of rescreening permits the diagnosis of CH in a greater number of twins. It also showed the importance of long-term follow-up in both twins in the pair, and the role of nongenetic factors in the etiology of permanent CH.

Prevalence of a Iodothyronine Deiodinase 2 gene single nucleotide polymorphism in children with congenital hypothyroidism from Western Romania and impact on TSH levels

Abstract The aim of this study was to evaluate the prevalence of the Iodothyronine Deiodinase 2 gene Thr92Ala polymorphism in children from West of Romania with congenital hypothyroidism (CH) and association with TSH levels in response to levothyroxine monotherapy. Genotyping in 50 children with CH and 52 healthy controls was done using real time PCR. The results showed that there was no statistical difference between the frequencies of genotypes in patients vs. controls. Patients were treated with L-thyroxine and most had normal values for fT3 and fT4. However, high TSH values were found in 21 patients (42%) after treatment. Among patients with high TSH values, AA genotypes were significantly more prevalent (p = 0.044) than TT and AT genotypes. Our results suggest that for the D2 gene Ala92Thr polymorphism, the AA genotype may be detrimental for achieving euthyroidism in patients with CH and levothyroxine monotherapy, therefore polytherapy could be considered as a better approach in these patients.

Assessing Diastolic Hypertension in Patients of Primary Hypothyroidism among Adults Visiting a Tertiary Care Hospital in North India

Background: Elevation of diastolic BP has been shown in few studies among patients with hypothyroidism. However, the evidence is still obsolete when it comes to Indian settings. This study intends to evaluate association between hypertension and primary hypothyroidism in North Indian population. Methodology: One hundred primary hypothyroid patients (TSH level >5.5) were subjected to a cross-sectional comparative study in a tertiary care hospital in North India from August 2015 to June 2017. Patients had no thyroid complications and were unknown of their blood pressure status. Sociodemographic profile and clinical and laboratory status was evaluated which included blood pressure measurements; lipid profile, kidney function tests, and other vitals were recorded. Results: Individuals with diastolic and overall hypertension had significantly less serum T3 values and high TSH and serum creatinine values as compared to non-hypertensive individuals. Pearson test showed a significant correlation between serum TSH levels with both systolic and diastolic BP. Conclusion: This study showed that both systolic and diastolic blood pressure increased linearly with increasing TSH. Despite the differing estimated prevalence of hypertension in hypothyroidism, there seems to be a positive association of thyroid with BP.

Impact of Autoimmune Thyroiditis on Reproductive and Metabolic Parameters in Patients with Polycystic Ovary Syndrome.

Autoimmune thyroiditis (AIT) has been found to be associated with polycystic ovary syndrome (PCOS). The aim of this retrospective cohort study using data from a fertility clinic, with patients recruited from 2009 to 2010, was to confirm the higher prevalence of AIT in PCOS and to evaluate the impact of AIT on reproductive and metabolic parameters of PCOS patients. Patients comprised 827 PCOS subjects seen for reproductive or metabolic complaints. Patients presenting primarily for thyroid problems were excluded. All patients were tested for the presence of AIT by laboratory testing and thyroid ultrasound. The impact of AIT on PCOS was evaluated by determination of reproductive and metabolic parameters. Patients with PCOS and AIT as compared to those only with PCOS, had a lower prevalence of elevated testosterone (45 vs. 61%; p=0,0001), free androgen index (5,96±5,41 vs. 7,02±7,6; p<0,001) and hyperandrogenemia (66 vs. 78%; p<0,001). Also testosterone levels were lower in PCOS patients with AIT (0,50±0,30 vs. 0,63±0,71; p=0,0006). Consequently, in these patients, hirsutism was less frequent (51 vs. 66%; p=0,0021). There was no difference in the prevalence of acne, alopecia, a-/ or oligomenorrhea or PCO-morphology in the two patient groups. Patients with PCOS and AIT were more obese by 2 kg/m² BMI on average. A higher BMI correlated with a higher TSH value, although all patients were euthyroid. AIT is more prevalent in PCOS than in controls. PCOS patients with AIT have less severe hyperandrogenemia and hyperandrogenism but are likely to suffer from an elevated metabolic risk.

Is cathelicidin a novel marker of diabetic microangiopathy in patients with type 1 diabetes?

AimThe aim was to evaluate the relationship between higher serum cathelicidin levels with the occurrence of chronic microangiopathic complications in patients with diabetes mellitus type 1 (DM1). MethodsThe study group consisted of 62 patients with DM1 (35 men), aged 30 (24–38) years and with duration of DM1 12 (9–17) years. Patients were divided into two groups depending on the level of cathelicidin, with cut-off point 24.5ng/ml (median value for the whole group) and according to the presence or absence of any microangiopathy. ResultsThe group with higher serum level of cathelicidin (n=31) in comparison with patients with lower levels (n=31) had higher serum level of total cholesterol [5.0(4.5–5.6) vs 4.5(3.9–5.0) mmol/l; p=0.04], HDL cholesterol [1.9(1.5–2.1) vs 1.4(1.3–1.8) mmol/l; p=0.009], LDL cholesterol [2.6(2.2–3.1) vs 2.3(1.9–2.8) mmol/l; p=0.03] and higher TSH value [1.8(1.5–2.6) vs 1.4(0.9–2.1) mIU/L; p=0.01]. Moreover, higher serum levels of cathelicidin were in women than men (58% vs 29%, p=0.02) and in patients with vs without microangiopathy (45% vs 19%, p=0.03). In the multiple regression model higher serum level of cathelicidin was related to the presence of microangiopathy, independently from sex, waist to hip ratio, serum total cholesterol level and TSH. ConclusionsPatients with type 1 diabetes and presence of microangiopathy characterize higher level of serum cathelicidin. This observation may have important clinical implication and needs further investigations.

Pediatric TSH Reference Intervals and Prevalence of High Thyroid Antibodies in the Lebanese Population.

The aims of this study are to establish reference values for TSH in Lebanese schoolchildren; to look at the relationship between TSH and age, gender, BMI, socioeconomic status (SES), and thyroid antibodies (TAb); and to investigate the prevalence of abnormal TAb in this population. 974 Lebanese schoolchildren aged 8–18 years were recruited from 10 schools of different SES. Third-generation TSH, TPO-Ab, and Tg-Ab measurements were performed using the IMMULITE chemiluminescent immunoassay. The mean TSH is 2.06 ± 1.05 μUI/ml. TSH values are inversely correlated with age (p < 0.0001), are higher in boys than in girls (resp., 2.14 ± 1.10 and 1.98 ± 0.99 μUI/ml, p = 0.017), and are positively correlated with BMI (p < 0.0001). They are also significantly higher in subjects from low-SES schools (p = 0.03) and in girls with positive TAb (p = 0.026). In boys, TSH is independently associated with age, BMI, and schools' SES (p = 0.01, p = 0.03, and p = 0.026, resp.) while in girls, the association is only significant for age and TAb (p = 0.0001 and p = 0.015, resp.). The prevalence of TAb is 4.3% (3% for TPO-Ab and 2.1% for Tg-Ab). Our results showed higher TSH values in the pediatric Lebanese population compared to western populations. TSH varies according to age, gender, BMI, and SES and is associated in girls with TAb.