High TSH Research Articles

Hyperprolactinemia in patients with high TSH levels with both clinical and subclinical hypothyroidism

Hyperprolactinemia is the most common endocrine disorder involving hypothalamic–pituitary axis. This results from multiple causes such as medications, hypothyroidism, and pituitary disorders. Hyperprolactinemia and hypothyroidism are closely interrelated conditions. The present study aimed to estimate serum prolactin levels and determine the prevalence of hyperprolactinemia in newly diagnosed subclinical and clinical hypothyroid patients and correlation between TSH and prolactin levels in subclinical and clinical hypothyroid patients.This study was conducted in the Department of Biochemistry, in collaboration with Department of Medicine, Department of Obstetrics and Gynecology, LATE BRKM Government Medical College, Jagdalpur, Chhattisgarh, India. Total of 138 patients presenting to Department of Medicine for various thyroid related problems were involved in this study. The newly diagnosed cases of primary hypothyroidism were included in this study. The demographic, physical and clinical history was taken from all the study subjects. In the present study, serum prolactin levels were significantly increased in subclinical (28.7 ± 6.4 ng/mL) and clinical hypothyroidism (15.02 ± 4.2ng/mL) compared to controls. Hyperprolactinemia was observed in 11 (22.9%) patients in subclinical hypothyroidism and 4 (8.3%) in clinical hypothyroid patients. In the subclinical hypothyroidism and clinical hypothyroidism, the serum TSH levels were (17.01 ± 8.2 μU/l, 7.3 ± 2.0 μU/l respectively) significantly increased than the controls. In the clinical hypothyroidism and subclinical hypothyroidism, the serum free T3 (fT3) levels were (5.6 ± 0.68 pmol/l, 2.54 ± 0.43 pmol/l respectively) significantly increased than the controls. In the clinical hypothyroidism and subclinical hypothyroidism, the serum total T3 (T3) levels were (1.27± 0.24 nmol/l, 0.59±0.12 nmol/l respectively) significantly increased than the controls. The study results may conclude that, prolactin regulation is altered, in patients with clinical and subclinical hypothyroidism. Thyroid functions tests ought to be conducted in patients with hyperprolactinemia prior to performing further tests.

Assessment of the Relation of Anti-TPO and TSH, T3 and T4 Levels between Some Subclinical Diabetes Patients in Iran

Background: As we know, around 28% of ills who had benign fibrocystic mastopathy mostly have shown antibodies of anti-TPO as well as around 80% of them that have shown the thyroid hypertrophy issue. The Assessment of thyroid peroxidase (TPO) as the main antigen agent of the thyroid microsomal fraction has enabled the progress of a sensitive and specific assay for the detection of the corresponding autoantibodies and other digestive fractions.
 Aim: Effect of gender, climate, and age on the ATPO, TSH, T3 and T4 rates were assessed as a goal.
 Materials and Methods: We evaluated the diagnostic validity of the anti-TPO, TSH, T3, and T4 assays and their relationships in 500 laboratory cases from Isfahan province with various types of thyroid and diabetes diseases and in controls. Age factor in the various levels of T3, T4, ATPO and TSH items is studied in the following research, which demonstrates a reduced rate in T4 factor of the 1st decade.
 Results: In the present study, patients with high TSH levels had high TPO tests. Patients with high levels of ATPO usually had high TSH, and in patients with low thyroid status, high TSH and high ATPO, TSH levels were normalized with levothyroxine tablets. Those with a high ATP content and normal TSH levels may have hypothyroidism in the future.
 Conclusion: We concluded that you should check the thyroid test every 6 months. This could be concluded from the following research that gender, age, race, and area all demonstrate some remarkable impacts on the levels of T4, T3, TSH, and ATPO.

Lack of association between gestational age adjusted TSH percentiles and neurodevelopmental outcomes among preterm infants

Limited evidence exists on whether subclinical hypothyroidism suggested by mildly elevated TSH levels affect neurodevelopment and growth in preterm infants. The objective of this study was to determine the association between gestational age adjusted TSH percentiles and neurodevelopmental outcomes among preterm infants. Univariate linear regression analysis was conducted to determine, in infants born less than thirty-two weeks gestational age, the correlation between the TSH percentile on the last newborn screen and neurodevelopmental assessment scores and growth outcomes at eighteen to twenty-two months of corrected age. Seventy-four patients were enrolled in the study with a mean gestational age of 28.8 weeks. There was no correlation between the last TSH percentile value and Bayley-III cognitive composite score or other neurodevelopmental or growth outcomes. In a cohort of preterm infants, higher TSH percentiles suggesting potential subclinical hypothyroidism did not predict any adverse effect on neurodevelopmental or growth outcomes.

Thyrotropinoma - the case report about one of the rarest type of pituitary adenomas

Pituitary tumours are a significant diagnostic problem in clinical practice. Considering all the rarity of thyrotropic hormone secreting adenoma it is a diagnostic and therapeutic challenge in part due to the lack of the preoperative standards. TSH-oma, besides hyperthyroidism symptoms, might be a cause of other endocrine disorders, most often dysfunction of other tropic axes and may cause neurological symptoms associated with sella expansion. We report a case of a 49-year-old male patient with macroadenoma, overt clinical hyperthyroidism, secondary adrenal insufficiency and hypogonadotropic hypogonadism. The diagnosis of thyrotropinoma was confirmed by blood tests that revealed elevated FT3 and FT4 levels together with high TSH. Thyrotropin-releasing hormone (TRH) test was performed and magnetic resonance imaging (MRI) imaging revealed the presence of macroadenoma. Histopathology examination confirmed the diagnosis of thyrotropic cell pituitary adenoma. The appropriate therapy for thyrotropin pituitary adenoma has not been elaborated in reports of this domain. Preoperatively the patient was prepared by long-acting somatostatin analogue (Sandostatin LAR) injections to reduce tumor size with good therapeutic effect afterwards underwent surgical transsphenoidal treatment successfully. However, specific treatment guidelines for pituitary thyrotropic tumors need to be elaborated more in details.

Seronegative phenotype in a pediatric population with Hashimoto's thyroiditis.

The aim was to verify in a pediatric population with Hashimoto's thyroiditis whether there is a relationship between antithyroid antibodies and inflammatory status on thyroid ultrasound and thyroid function. A total of 154 children and adolescents, aged 4 to 18years, diagnosed with Hashimoto's thyroiditis with normal body weight were followed up for 1year. Patients with only antiperoxidase antibodies presented with higher TSH levels than subjects with only antithyroglobulin antibodies (p 0.027) but with similar FT4 levels and thyroid score. Prevalence of seronegative Hashimoto's thyroiditis in this cohort was 12.3% (19/154). At diagnosis, the seronegative group presented with lower prevalence of overt hypothyroidism, symptoms of hypothyroidism, and thyroid score, meaning less severe thyroid involvement. In contrast, similar TSH and FT4 values were found at diagnosis and during follow-up in both the seronegative and seropositive groups. A comparison between patients with seronegative Hashimoto's thyroiditis and an overweight/obese antibody-negative population, who presented superimposable altered parenchymal pattern on thyroid ultrasound without circulating antithyroid antibodies, presented similar clinical data. We report for the first time in the literature that seronegative Hashimoto's thyroiditis in the pediatric age group has a less severe pattern. The seronegative group presents similar characteristics to those of overweight/obese children and adolescents with ultrasound changes, but, according to the established knowledge, the latter condition is reversible and does not need follow-up examinations.

Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes

Background and Aim: Hypertension, placental abruption, low birth weight, fetal death, and preterm birth are different pregnancy complications associated with clinical thyroid dysfunction. Thyroid dysfunction is common among pregnant women. The aim of the present study was to assess the prevalence of hypothyroidism in pregnancies and its obstetric outcomes. Methodology: This cross sectional study was conducted 164 antenatal women with singleton pregnancy in third trimester at the department of Gynecology and Obstetrics, Hayatabad Medical Complex, Peshawar for the duration of six months from January 2021 to October 2021. All the pregnant women irrespective of parity, socio-economics, and age were enrolled after taking informed consent. All cases of thyroid disorders and having multiple pregnancy were left out. Routinely hematological factors and estimation of TSH, fT3, and fT4 was performed. Fetal and maternal complications were assessed subsequently in patients for thyroid deranged profile. Thyroid disease family and infertility history, level of hemoglobin, menstrual pattern, fetal outcome, and recurrent abortion were the main parameters. SPSS version 21 was used for data analysis. Results: Out of 164 women screened, prevalence of thyroid dysfunction was 41 (25%). The incidence of subclinical hyperthyroidism, subclinical hypothyroidism, and overt hypothyroidism was 13 (7.8%), 6 (3.7%), and 9 (5.4%) respectively. Higher TSH and abnormal fT4 was found in one sample. About 28.5% patients had anemia among over and subclinical hypothyroidism. Hypothyroidism was significantly associated with NICU admission 39.2% (p=0.001), LBW 28.7% (p=0.001), and low APGAR score 23.6% (p=0.039). Comparing hypothyroidism women to euthyroid women, risk of NICU admission, low birth weight, lower APGAR score, and anemia was found 1.3, 5.8, 3.7, and 4.9 times higher. Conclusion: Our study revealed that pregnant women are more susceptible to subclinical hypothyroidism. In the third trimester of pregnancy, the occurrence of subclinical hypothyroidism is 3.7%. Hypothyroidism is associated with pre-eclampsia, anemia, neonatal morbidities, and high caesarean rates. Keywords: Pregnancy, Hypothyroidism, Thyroid dysfunction, obstetric outcomes

Analysis of correlation factors influencing the outcome of initial 131I remnant ablative therapy in intermediate- to high-risk patients with papillary thyroid microcarcinoma.

To investigate the factors influencing the outcome of initial 131I remnant ablative therapy in intermediate- to high-risk patients with papillary thyroid microcarcinoma (PTMC). We divided 99 patients with PTMC who underwent total thyroidectomy into two groups according to their response to initial 131I remnant ablative therapy: excellent response (ER) and non-ER groups. Clinical and laboratory characteristics were collected and retrospectively analyzed using univariate and multivariate binary logistic regression. Receiver operator characteristic (ROC) curves and diagnostic cutoff values were analyzed to evaluate the predictive value of significant quantitative influencing factors for 131I treatment outcomes. A prognostic nomogram model based on the above independent risk factors was established. Of the 99 eligible patients who accepted the initial 131I treatment following total thyroidectomy, 76 (76.7%) were classified into the ER group and 23 (23.3%) into the non-ER group. The univariate and multivariate analyses showed that extrathyroidal extension [ETE; odds ratio (OR) = 4.769; P = 0.041], preablative thyrotropin (TSH; OR = 0.972; P = 0.017), and stimulated thyroglobulin (sTg; OR = 1.614; P = 0.040) were independent predictors for the therapeutic effect of 131I treatment. Patients with higher sTg (>1.37 ng/ml) and lower TSH (<67.97 mU/l) and ETE tended to have a poor response to initial 131I treatment. The quantification of the therapeutic effect of initial 131I therapy in patients with PTMC using our newly constructed nomogram showed that ETE, preablative sTg, and TSH were contributors to non-ER. Intermediate- to high-risk patients with PTMC after total thyroidectomy who had low pretreatment sTg and high preablative TSH levels and negative ETE were more likely to achieve satisfactory response to initial 131I remnant ablative therapy. Our prognostic nomogram is a valuable tool to enable patients and clinical professionals to be better informed about patients' therapeutic response to initial 131I remnant ablative therapy.

Relationship of Vitamin A and Thyroid Function in Individuals With Obesity and After Laparoscopic Sleeve Gastrectomy.

Vitamin A deficiency (VAD) occurs in obesity and may be associated with thyroid dysfunction. We aimed to investigate the association of VA with thyroid function in obesity and after laparoscopic sleeve gastrectomy (LSG). Nine hundred and seventy-six obese subjects were enrolled for this study and were divided into VAD, marginal vitamin A deficiency (MVAD), and vitamin A normal (NVA) groups. VAD was defined as VA ≤ 200 ng/ml, MVAD was defined as VA > 200 but <300 ng/ml, and NVA was defined as VA ≥ 300 ng/ml. Thyroid function was compared among groups and the relationship of VA and thyroid function was analyzed. Two hundred and forty-four of the 976 obese subjects underwent LSG, and the change in thyroid function and VA at 3, 6, and 12 months after surgery was measured. Results showed that 37% of all the subjects had subclinical hypothyroidism (SH), and the SH group had lower VA levels than the non-SH group (P = 0.008). Forty-nine percent of all the subjects had MVAD, 9% had VAD, while the MVAD or VAD group had lower FT4 than the NVA group (P = 0.005 and P = 0.001). The VAD group also had higher TSH than NVA group (P = 0.037). VA was significantly negatively associated with TSH (r = −0.151, P = 0.006) and positively associated with FT4 (r = 0.228, P < 0.001). TSH was significantly decreased at 3, 6, and 12 months (3M: from 4.43 ± 2.70 to 2.63 ± 1.46 mU/l, P < 0.001; 6M: from 4.43 ± 2.70 to 3.84 ± 2.34 mU/l, P = 0.041; 12M: from 4.43 ± 2.70 to 2.85 ± 1.68 mU/l, P = 0.024). After LSG surgery, VA levels were slightly increased, when compared to pre-surgery levels, at 3, 6, and 12 months (3M: from 262.57 ± 68.19 to 410.33 ± 76.55 ng/ml, P = 0.065; 6M: from 262.57 ± 68.19 to 281.36 ± 93.23 ng/ml, P = 0.343; 12M: from 262.57 ± 68.19 to 300.37 ± 86.03 ng/ml, P = 0.083). SH group also had lower TSH and higher VA than the non-SH group at 3 months post-surgery [TSH: −1.4(−2.3, −0.3) vs. −0.2(−0.8, −0.2) mU/l, P < 0.001; VA: 163.99 ± 32.58 vs. 121.69 ± 27.59 ng/ml, P = 0.044]. In conclusion VA, which is related to thyroid hormone production, protects against thyroid dysfunction in obese subjects. The improvement of thyroid function in subjects with SH after LSG may be related to the increased VA levels observed post-surgery.Clinical Trial RegistrationClinicalTrial.gov ID: NCT04548232.

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.

The role of thyroid hormones in carotid arterial wall remodeling in women.

Introduction: Thyroid hormones affect the cardiovascular system, but the precise mechanisms of their effects on the development of atherosclerosis are not entirely clear. The relationship between subclinical hypothyroidism, dyslipidemia and carotid atherosclerosis has been widely investigated, but the findings were controversial. The aim of the present study was to determine whether female subjects with subclinical hypothyroidism (SHypo) have increased carotid intima-media thickness (IMT) compared with euthyroid subjects, as well as to examine the association of SHypo, carotid atherosclerosis and dyslipidemia.Methods: This research included 100 women aged 30 to 70 years who were divided into two groups: the SHypo group including subjects with signs of subclinical hypothyroidism and the control group of euthyroid subjects. Carotid IMT thickness using B mode ultrasound was determined and its correlation with serum concentrations of fT4, TSH, CRP, and lipid profile including small dense LDL (sdLDL) was analysed.Results: Subjects with SHypo had significantly increased carotid IMT (IMT ≥ 75th centile) in all three measured segments of the right (p <0.001) and the left (p = 0.001) carotid artery compared to the control group, with a significantly more frequent appearance of plaque (25% vs. 9%; p = 0.05). Significant positive correlations were found between higher TSH and higher IMT values. Increased age, LDL cholesterol, and TSH predicted thickening of the carotid artery IMT.Conclusions: It is important to screen people showing early, subclinical signs of thyroid gland dysfunction due to its impact on carotid atherosclerosis development.

Hypothyroidism with too Many Associations Case Report

Hypothyroidism is one of the common endocrine disorders. Amongst other causes, autoimmune hypothyroidism is clinically more important. It has got many adverse effects on metabolism, cardiovascular, musculoskeletal, fetomaternal and mental health. It's associated with obesity, dyslipidemia, IHD, inflammatory myopathy, depression etc. It is responsible for menorrhagia, subfertility, recurrent abortion, prematurity, fetomaternal morbidity and mortality. It may be associated with other organ specific or multisystem autoimmune diseases like SLE, vitiligo, alopecia, type-I DM, pernicious anemia and others. We have diagnosed a case of autoimmune hypothyroidism who had all the classic features of hypothyroidism. He had low FT4 and very high TSH. Autoimmunity was confirmed by high titer of anti TG and anti TPO antibody. In addition he had dimorphic anaemia, alopecia, diastolic hypertension, dyslipidemia, IHD, Vit D deficiency, myopathy, peripheral neuropathy, depression and dementia. His condition has been improved with Thyroxin replacement, lipid lowring drugs, anti anginal drugs, iron, calcium, folic acid, Vit-D supplementations, exercise, physiotherapy and other symptomatic and supportive measures. He was advised for consultation with dermatologist and periodic follow up. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 42-45

HAEMATOLOGICAL PARAMETERS AND THYROID PROFILE IN SEVERELY MALNOURISHED CHILDREN: A CROSS SECTIONAL STUDY

INTRODUCTION: ). SAM and India has the highest prevalence of severe acute malnutrition (SAM) anaemia have an interplay association, the latter being the commonest comorbid medical problem. But now literature suggests that SAM is also associated with marked changes in secretion and metabolism of thyroid hormone as well as in the structure. METHOD AND MATERIAL: A cross-sectional study was conducted in 60 children between the age group of 6 months to 5 years fullling the criteria of SAM over a period of 2 months admitted at NRC, ABVGMC and District Hospital Vidisha. Detailed history of the child was obtained; complications were noted and managed accordingly. Blood sample was collected and was subjected to complete blood count, peripheral smear examination and thyroid prole. RESULTS: Out of 60 children of SAM, 11.67% had leukocytopenia and the same percent of children had leukocytosis. Thrombocytopenia was reported in 13.34% of the children and thrombocytosis was seen in 15%. TSH levels in children of age 6 month to 1 year of study population were in the normal range. Children of age 1 year to 5 years had values above normal in 7.31% and below normal in 2.43%. CONCLUSION: Megaloblastic anemia and dimorphic anemia along with high TSH level are prevalent in children with SAM along with iron deciency anemia but more specic studies are required to associate hypothyroidism with malnutrition and low serum protein.

Redefining the Cut-Off Ranges for TSH Based on the Clinical Picture, Results of Neuroimaging and Laboratory Tests in Unsupervised Cluster Analysis as Individualized Diagnosis of Early Schizophrenia

Thyroid abnormalities, including mild forms of hypothyroidism and hyperthyroidism, are reported as risk factors for the development of a number of neuropsychiatric disorders, including schizophrenia. The diagnostic process still takes into account the extreme ranges of the accepted reference values for serum TSH since the concentration of free thyroxine in the serum does not change by definition. TSH mU/L cut-off values in psychiatric patients are currently clinically considered in the case of extremely high serum TSH levels (>4.0 mU/L). The results obtained in this study suggest that the clinically significant value has a lower TSH cut-off point with an upper limit of 2–2.5 mU/L. The criteria for the differential diagnosis of patients with schizophrenia, however, mainly take into account statutory reference ranges without a background related to the history of thyroid diseases in the family. The results indicate the need to lower the upper cut-off values for TSH among patients with early psychosis, which is related to the potential clinical significance of the obtained values both in the field of clinical evaluation and neuroimaging and laboratory evaluation parameters. The cut-off points obtained with the prior available knowledge coincided with the values established in the unsupervised clustering method, which further confirms the legitimacy of their use in the individualized diagnosis strategy of schizophrenia.

Selective Pituitary Resistance to Thyroid Hormone: Clinical Hyperthyroidism with High TSH on Levothyroxine Administration in I-131 Ablated “Graves Disease”

Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.

A Hidden Link between Subclinical Hypothyroidism and Depression: A literature Review

The association between Subclinical hypothyroidism and Depression is recognised. It is found that patients with Thyroid disorders are more prone to develop depressive symptoms and depression may be accompanied by various subtle thyroid abnormalities. The most commonly documented abnormalities are elevated T4 levels, Low T3, elevated rT3, a blunted TSH response to TSH, Positive anti thyroid autoantibodies and elevated CSF TRH concentrations. It is also found that thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressants. It is found out that Depression is associated with changes in Hypothalamic-pituitary axis as thyroid hormones act on the central nervous system. Mild thyroid dysfunction causes depression in younger patients (&lt;60 years old) diagnosed by depressive scale. It was found that differences in age group may cause depressive episodes. Depressive episodes such as anxiety and the risk of committing suicide are considerable factors that differ according to the age of the individuals.SCH was found to be associated with depression in the younger adults (&lt;60 years old). The only difference between SCH and normal thyroid function is TSH.In depressive disorder and subclinical hypothyroidism sex differences have also been recognised. Association between subclinical hypothyroidism and Depression is assessed by various depressive scores such as Beck Depression Inventory and Hamilton depression rating scale. As Subclinical hypothyroidism is associated with low mood, Serum levels of TSH, FT3, FT4 and Hamilton depression, treatment with Levothyroxine showed significant decrease is TSH levels and Hamilton scores were decreased. Since the prevalence of depressive symptoms in hypothyroidism is high TSH cut-off levels is used,TSH cut off value for hypothyroidism is based on associated symptoms,TSH cut-off value is 2.5 MIU/L is optima

A Hidden Link between Subclinical Hypothyroidism and Depression: A literature Review

The association between Subclinical hypothyroidism and Depression is recognised. It is found that patients with Thyroid disorders are more prone to develop depressive symptoms and depression may be accompanied by various subtle thyroid abnormalities. The most commonly documented abnormalities are elevated T4 levels, Low T3, elevated rT3, a blunted TSH response to TSH, Positive anti thyroid autoantibodies and elevated CSF TRH concentrations. It is also found that thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressants. It is found out that Depression is associated with changes in Hypothalamic-pituitary axis as thyroid hormones act on the central nervous system. Mild thyroid dysfunction causes depression in younger patients (&lt;60 years old) diagnosed by depressive scale. It was found that differences in age group may cause depressive episodes. Depressive episodes such as anxiety and the risk of committing suicide are considerable factors that differ according to the age of the individuals.SCH was found to be associated with depression in the younger adults (&lt;60 years old). The only difference between SCH and normal thyroid function is TSH.In depressive disorder and subclinical hypothyroidism sex differences have also been recognised. Association between subclinical hypothyroidism and Depression is assessed by various depressive scores such as Beck Depression Inventory and Hamilton depression rating scale. As Subclinical hypothyroidism is associated with low mood, Serum levels of TSH, FT3, FT4 and Hamilton depression, treatment with Levothyroxine showed significant decrease is TSH levels and Hamilton scores were decreased. Since the prevalence of depressive symptoms in hypothyroidism is high TSH cut-off levels is used,TSH cut off value for hypothyroidism is based on associated symptoms,TSH cut-off value is 2.5 MIU/L is optimal

Classification of maternal thyroid function in early pregnancy using repeated blood samples.

Objective The assessment of maternal thyroid function in early pregnancy is debated. It is well-established that pregnancy-specific reference ranges preferably should be used. We speculated if the use of repeated blood samples drawn in early pregnancy would influence the classification of maternal thyroid function.MethodsPregnant women with repeated early pregnancy blood samples were identified in the North Denmark Region Pregnancy Cohort. Each sample was used for the measurement of TSH, free T4 (fT4), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab) (ADVIA Centaur XPT, Siemens Healthineers). Method- and pregnancy week-specific reference ranges were used for the classification of maternal thyroid function.ResultsAmong 1466 pregnancies included, 89 women had TSH above the upper reference limit in the first sample (median pregnancy week 8) and 44 (49.4%) of these similarly had high TSH in the second sample (median week 10). A total of 47 women had TSH below the lower reference limit in the first sample and 19 (40.4%) of these similarly had low TSH in the second sample. Regarding women classified with isolated changes in fT4 in the first sample, less than 20% were similarly classified as such in the second sample. The percentage agreement between the samples was dependent on the level of TSH in the first sample and the presence of TPO- and Tg-Ab.ConclusionIn a large cohort of pregnant women, the classification of maternal thyroid function varied considerably with the use of repeated blood samples. Results emphasize a focus on the severity of thyroid function abnormalities in pregnant women.

Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction.

Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n=260). Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p=0.03) and 30-day readmission (p=0.04). Patients with FF compromise had higher TSH (p=0.04) and lower albumin levels (p=0.005). Prealbumin levels were lower in patients who required neck washouts (p=0.02) or a second FF (p=0.03). TSH levels were higher in patients undergoing postoperative debridement (p=0.03) or local flap procedures (p=0.04). Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.

The Detection of Thyroid Nodules in Prediabetes Population and Analysis of Related Factors.

PurposeTo explore the detection of thyroid nodules (TN) and related influencing factors in the population of prediabetes (PreDM) in northwest China’s Gansu Province.Materials and MethodsA multi-stage stratified cluster random sampling method was used to select adult Han residents in Gansu Province for investigation, and recorded the clinical data of the subjects. The χ2 test was used to analyze the difference in TN detection rate of the PreDM population. Logistic regression analyzed the risk factors of TN in the PreDM population.ResultsThis study included 2659 people with normal glucose tolerance (NGT) and PreDM, of which 440 people were detected with TN. Among the PreDM population, the TN detection rate was higher than in the NGT population (24.48% vs 15.00%; P<0.05). The detection rate of TN in the impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG+IGT group was also significantly higher than that in the NGT population (X2=4.117, X2=13.187, X2=13.016, all P<0.05), and of which, the IFG+IGT group was the highest (32.20%). The general trend of TN in the IFG, IGT and PreDM population all increased with age. General data showed that BMI, waist-to-height ratio, waist circumference, TG, TC, LDL-C, FPG, 2h PG, HbA1c and TSH indicators in the TN group were higher than those in the Non-TN group (P<0.05). The logistic regression suggested that the risk factors for TN in the PreDM population were female, age increase, high SP, high TSH, high FPG, high LDL-C, hypertension and family history of diabetes (all P<0.05).ConclusionThe detection rate of TN in the PreDM population is high, especially in the IFG+IGT population. Middle-aged and elderly people with hypertension and abnormal glucose and lipid metabolism should be treated reasonably and regularly, and their TN should be screened and followed up.

Frequency of subclinical hypothyroidism and mean serum TSH level in first trimester of pregnancy.

Objective: To find out the frequency of subclinical hypothyroidism (SCH) in our pregnant population during 1st Trimester and the mean TSH level in first trimester of pregnancy. Study Design: Cross Sectional Descriptive study. Setting: Dow University Hospital and Dr Ruth KM Pfau CHK. Period: June 2015 to May 2016. Material &amp; Methods: All Pregnant women with &lt;14 weeks gestation were screened for Serum TSH level. Data were recorded after informed consent and institutional ethical approval. Variables recorded were age, parity, gestational age and serum TSH level. Data were analyzed on SPSS version 16. Mean and SD were calculated for quantitative variables ie. Age, parity, gestational age, serum TSH level and serum free T4 level. Mean TSH level according to age group, parity and gestational age groups were determined by applying ANOVA test. Correlation of Serum TSH level with the maternal age, parity and gestational age groups were also assessed by Pearson Correlation test. Significant P-value was taken as &lt;0.05. Results: The frequency of SCH found was 19.35% by taking cut off limit of &lt;2.5 IU/L and 3.55% by taking cut off limit of &lt;4.5 IU/L among total of 310 pregnant women. Mean TSH level was 1.84±1.36 IU/L. The mean maternal age was 27.22 ± 4.43 yrs. while median parity was 1. Mean gestational age of these patients were 9.41 ± 2.748 weeks and out of these 160 (51.61%) were between 4-9 weeks and 150(48.38%) between 10-14 weeks. Majority (74%) of these women belonged to lower middle socioeconomic class. Mean TSH level coorelation between different age groups, parity groups and gestational age groups were found to be insignificant. Conclusion: The prevalence of SCH is not so high and mean TSH level in our population was 1.84 IU/L. But to establish reference range for Pakistani population, further studies in population of different backgrounds and geographical distribution needs to be evaluated.