Higher Free Thyroxine Levels Research Articles

Hyperthyroidism induced by paraneoplastic human chorionic gonadotropin production from testicular tumours: a retrospective clinical and histopathological study.

Human chorionic gonadotropin (hCG) has structural similarities with TSH and may stimulate TSH receptors at higher concentrations. During pregnancy, placental hCG causes TSH suppression, contributing to hyperemesis. However, in males, clinical manifestations caused by excess hCG are rare. Herein, we describe complications of life-threatening thyroid storm caused by paraneoplastic hCG secretion from testicular germ cell tumours (GCT) and aim to identify high-risk groups through retrospective analysis in n=20 males (aged 17-55 years) with testicular hCG-positive GCTs. Seven hCG-positive testicular GCTs were classified as seminoma, and 13 as non-seminomatous GCTs (NSGCT). In 3/7 males with seminomas (43%), serum β-hCG concentrations were mildly elevated (median: 0.3 U/L, range 0.3-82.1 U/L). In contrast, β-hCG was increased in 12/13 (92%) males with an NSCGT (median 71.1 U/L; range: 0.3-1,600,000 U/L). In 10/13 males with NSGCT (77%), we detected components of embryonal cell carcinoma (EC), and in 7/13 (54%) components of a choriocarcinoma (ChC). TSH was suppressed with high free thyroxine levels in two cases with NSCGT and excessively elevated β-hCG concentrations, but there was no TSH suppression in a further case with high β-hCG. One patient with NSGCT and high β-hCG levels presented with thyroid storm and imminent decompensation refractory to anti-thyroid treatment, requiring a total thyroidectomy. In the second patient, anti-thyroid treatment was initiated shortly after the diagnosis, successfully normalizing hyperthyroxinemia. In conclusion, paraneoplastic β-hCG production, occurring in NSGCT with components of ECs or ChCs, is a rare cause of thyrotoxicosis. Early recognition and treatment are critical to prevent a life-threatening thyroid storm.

Clinical efficacy of multigene panels in the management of congenital hypothyroidism with gland in situ.

Congenital hypothyroidism (CHT) is a diverse condition with various genetic etiologies. This study aimed to investigate the utility of next-generation sequencing (NGS) analysis in guiding treatment decisions and predicting prognosis for CHT patients with gland in situ (GIS). A retrospective analysis was conducted on 33 CHT patients with GIS who underwent NGS analysis at a single institution between 2018 and 2023. Patients were classified as having permanent (PCH), transient congenital hypothyroidism, or ambiguous congenital hypothyroidism (ACH) CHT based on their response to levothyroxine discontinuation at 3 years of age. Among the 33 patients, genetic variants were identified in 26, with the most prevalent variants found in DUOX2 (26.92%), TSHR (30.77%), TG (19.35%), and DUOXA2 (19.23%). Patients with high initial thyroid-stimulating hormone levels (>50 mIU/L) and low free thyroxine levels (<0.89 ng/dL) at diagnosis tended to have compound heterozygous or homozygous variants in DUOX2, DUOXA2, and TG, and were more likely to develop PCH. In contrast, patients with heterozygous variants in these genes often exhibited ACH. TSHR variants were associated with diverse clinical manifestations, ranging from PCH to ACH, and were more common in patients with initial thyroid-stimulating hormone levels <50 mIU/L. The study highlights the potential utility of NGS analysis in predicting the clinical course and guiding treatment decisions for CHT patients with GIS. Genetic analysis may aid in determining the appropriate duration of levothyroxine therapy and monitoring strategies, particularly in cases where traditional clinical indicators are inconclusive.

Impending thyroid storm caused by hydatidiform mole

Introduction: Thyroid storm is a rare but life-threatening endocrine emergency. It is an acute exaggerated clinical manifestation of thyrotoxic state. We report an impending thyroid storm caused by a hydatidiform mole in a 14-year-old girl. This paper intends to describe hyperthyroidism secondary to molar pregnancy highlighting the rare but essential evaluation of hyperthyroidism. Case: A 14-year-old girl was consulted by the obstetric division to evaluate and manage hydatidiform mole with suspected hyperthyroidism. She had frequent palpitations and tremors for 1 week ago. She also complained of nausea and vomiting 1 week before admission to the hospital. We found a Burch-Wartofsky score of 25, which was categorized as an impending thyroid storm. Laboratory results showed mild anemia, low thyroid stimulating hormone (TSH) levels, high free thyroxine (T4) levels, and markedly elevated beta-human chorionic gonadotropin (beta-hCG) levels, normal Thyroid-stimulating hormone receptor antibodies (TRAb). Other laboratory parameters are mediocre. The ECG results showed sinus tachycardia. A mole tissue biopsy of the uterus confirms the morphology of the hydatidiform mole. These findings established the diagnosis of Impending Thyroid Storm caused by a hydatidiform mole. Conclusion: A hydatidiform mole can cause thyroid storm because the hormone hCG has similar structure to TSH. Doctors should always estimate the possibility of hyperthyroidism in a molar pregnancy.

Exploring the Association between Thyroid Function and Frailty: Insights from Representative Korean Data.

This study investigates the association between thyroid function and frailty in the old patients using representative data. The study was conducted using data from the Korea National Health and Nutrition Examination Survey conducted from 2013 to 2015. The study population included 2,416 participants aged 50 years and older with available thyroid function test data. Frailty assessment was performed using the Fried frailty phenotype. The prevalence of frailty was analyzed across different thyroid diseases and thyroid function parameters. The significant association between thyroid dysfunction and frailty was observed in overt hyperthyroidism and subclinical hyperthyroidism. After adjusting for various factors, the association between thyroid dysfunction and frailty remained significant. On the other hand, overt hypothyroidism did not show a significant association with frailty in the adjusted analysis. For individuals with overt hyperthyroidism and subclinical hyperthyroidism, higher levels of free thyroxine (FT4) were significantly associated with an increased risk of frailty (aOR >999; 95% CI, >999 to 999). Among individuals with overt hypothyroidism, lower level of FT4 levels and high thyrotropin (TSH) levels showed a significant association with frailty risk (FT4: aOR, <0.01; TSH: aOR, 999). In participants with subclinical hypothyroidism, there were no significant associations between parameters for thyroid and frailty risk. These findings suggest that thyroid dysfunction, particularly overt hyperthyroidism and subclinical hyperthyroidism, may be associated with an increased risk of frailty in the old patients.

SAT498 A Challenging Case of Hypothyroidism Requiring Frequent Primary Care Visits to Achieve Euthyroidism

Abstract Disclosure: S. Kaul: None. A. Gupta: None. Introduction: We report a patient with persistent primary hypothyroidism despite multiple adjustments in thyroid medication. Clinical Case: A 67-year-old white man with multinodular goiter underwent total thyroidectomy in 2016 for abnormal thyroid nodule biopsy. Surgical pathology revealed papillary thyroid cancer with lymph node metastasis. He subsequently received radioactive iodine ablation treatment. His plasma thyroid stimulating hormone (TSH) level was noted to be 0.275 uIU/mL (normal range 0.35-4.00 uIU/mL) in January 2017 on levothyroxine 224 micrograms daily. Subsequently, his plasma TSH level continued to remain elevated with variable levels despite multiple titrations of his levothyroxine dosage, counseling, and multiple follow-up visits. Plasma TSH level went up as high as 108.140 uIU/mL (normal range changed to 0.55-4.78 uIU/mL). In January 2022, plasma TSH level normalized to 3.125 uIU/mL with high plasma free thyroxine level of 2.45 ng/dL (normal range 0.89-1.76 ng/dL), but plasma TSH level increased again to 5.190 uIU/mL in April 2022. Home care nurse was involved in monitoring of the patient taking thyroid medication daily and correctly but was unsuccessful. The patient and his son reported taking thyroid medicine daily and correctly. There was no concern for malabsorption or interference with any of his medications. The patient was subsequently asked to come to primary care clinic every week for six weeks with all his medications. He was unable to come to endocrinology clinic due to travel time being more than one hour. His repeat plasma TSH normalized to 1.010 uIU/mL. The etiology of previously high plasma TSH level was suspected due to non-compliance with taking his thyroid medication. Non-compliance was discussed in detail with the patient and his son, including life-threatening consequences of hypothyroidism. The patient verbalized understanding and was willing to comply with the recommendations. The patient was then asked to stop coming weekly to primary care clinic. Repeat plasma TSH level in October 2022 was again noted to be high at 80.723 uIU/mL. He again claimed compliance, but weekly visits to primary care clinic were resumed. In December 2022, he was noted to have low plasma TSH level of 0.232 uIU/mL. Conclusion: Once weekly visits seem impractical but might be required in a certain group of patients with persistent abnormal thyroid hormone levels where no etiology can be found. Presentation Date: Saturday, June 17, 2023

Neuropsychiatric Manifestations of Thyroid Diseases.

Thyroid disorders are known to cause neuropsychiatric manifestations. Variousneuropsychiatric manifestations are depression, dementia, mania, and autoimmune Hashimoto encephalopathy. Numerous investigations carried out in the previous 50-60 years have been evaluated critically.The pathophysiology of neuropsychiatric symptoms of thyroid diseases is described in the current studyand its link with autoimmune Hashimoto encephalopathy is also discussed. Furthermore, this paper also describes the association between thyroid-stimulating hormones and cognitive impairment. Hypothyroidism is associated with depression and mania, and hyperthyroidism is linked with dementia and mania. The association between Graves' disease and various mental disorders such as depressive and anxiety disorders is also discussed. The aim of this study is to review the relationship between various neuropsychiatric disorders and thyroid diseases. A literature search from the PubMed database to find various neuropsychiatric manifestations of thyroid disorders in the adult population was conducted. According to the review of the studies, cognitive impairment can result from thyroid disease. It has not been possible to demonstrate how hyperthyroidism can hasten the process of developing dementia. However, subclinical hyperthyroidism, thyroid-stimulating hormone (TSH) levels below the normal range, and high free thyroxine (T4) levels all raise the risk of dementia in the elderly. Additionally, the potential mechanisms underlying this associationhave been examined. A quick summary of the research on mania as a clinical symptom of hypothyroidism and its likely causes and pathogenesis is also reviewed. There is no dearth of evidence that describes variousneuropsychiatric manifestation in thyroid disorders.

PSAT350 Autoimmune Polyglandular Syndrome Type II Presenting with Hashimoto's Thyroiditis, Diabetes Mellitus Type I and Addison's Disease: A Case Report

Abstract A. BACKGROUND/SIGNIFICANCE Autoimmune polyglandular syndrome Type II (APS-II) is a rare polyendocrinopathy with a prevalence of 1 to 2 in 100,000, instigated by immune-mediated destruction of several organs. Knowledge of APS-II is crucial, especially in the early detection of polyglandular disorder among patients with endocrine autoimmunity. B. CASE This case is of a 40-year-old male who initially presented with Grave's disease after showing signs and symptoms of hyperthyroidism, as supported by low thyrotropin (&amp;lt;0.05 uIU/mL; nv: 0.35-4.94) and high free thyroxine levels (2.05 ng/dL, nv: 0.71-1.85). He was maintained on methimazole. Five months following diagnosis, he developed symptoms of Diabetes Mellitus Type 1 (T1DM) as confirmed by high capillary blood glucose, undetectable C-peptide, and positive anti-Glutamic acid decarboxylase. Insulin and rosuvastatin were added on his maintenance medications. Ten months later, he discontinued methimazole and became lost to follow-up. One month after discontinuation, he sought consult again after experiencing symptoms of fatigue, muscle cramps, cold intolerance, forgetfulness, abdominal pain, diarrhea, and episodes of hypoglycemia at home. On examination, he was noted to have hypotension of 80/60 mmHg and skin hyperpigmentation. His random blood sugar was 408 mg/dL. High thyrotropin (57.8777 uIU/Ml, nv: 0.35-4.94), low free thyroxine (0.57 ng/dL, nv: 0.71-1.85), and positive antithyroid peroxidase antibody levels revealed Hashimoto's thyroiditis. Low fasting 8 am serum cortisol (81 nmol/L, nv: 138-635) and low serum cortisol 30 mins (403.85 nmol/L) and 1 hour (542.31 nmol/L, normal response: &amp;gt;550 nmol/L) after adrenocorticotropic hormone stimulation test in addition to the clinical manifestations, supported the diagnosis of Addison's disease. With the combination of Addison's disease, Autoimmune thyroid disease, and T1DM, a diagnosis of APS Type II was made. Management included insulin, prednisone, and levothyroxine. These resulted in significant improvement in the patient's symptoms. He is now clinically well and compliant to regular follow-up. C. LEARNING POINTS/CONCLUSION It is crucial in APS-II management to identify and manage the associated autoimmune disorders to prevent significant morbidity and mortality. Therefore, in the presence of any autoimmune disorder, a high index of suspicion for APS-II is essential. There should be regular follow-up and observation of patients with autoimmune endocrine disorders to ensure early detection of APS-II. Patient health education must include identifying symptoms of the disorders for which they are at high risk. Keywords: APS Type 2, Addison's Disease, DM Type 1, Hashimoto's Thyroiditis Sources of Support: None Conflicts of Interest: None Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study

Embryos with higher morphologic quality grading may have a greater potential to achieve clinical pregnancy that leads to a live birth regardless of the type of cleavage-stage embryos or blastocysts. Few studies have investigated the impacts of embryo grading on the long-term health of the offspring. This pilot study aimed to examine the associations between embryo morphologic quality and the physical, metabolic, and cognitive development of singletons conceived by invitro fertilization and intracytoplasmic sperm injection at preschool age. This matched cohort study included singletons born to infertile couples who underwent fresh cleavage-stage embryo transfer cycles with good- or poor-quality embryos from 2014 to 2016 at the reproductive center of the Women's Hospital, School of Medicine, Zhejiang University. A total of 144 children, aged 4 to 6 years, participated in the follow-up assessment from 2020 to 2021, and the response rate of poor-quality embryo offspring was 39%. Singletons in the good-quality embryo group were matched with singletons in the poor-quality embryo group at a 2:1 ratio according to the fertilization method and the children's age (±1 year). We measured the offspring's height, weight, body mass index, blood pressure, thyroid hormone levels, and metabolic indicators. Neurodevelopmental assessments were performed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Adaptive Behavior Assessment System, Second Edition. We also collected data from the medical records. A linear regression model was used to analyze the association between embryo morphologic quality and offspring health outcomes. A total of 48 singletons conceived with poor-quality embryo transfer and 96 matched singletons conceived with good-quality embryo transfer were included in the final analysis. Age, sex, height, weight, body mass index, blood pressure, thyroid function, and metabolic indicators were comparable between the 2 groups. After adjustment for potential risk factors by linear regression model 1 and model 2, poor-quality embryo offspring exhibited a tendency toward higher free thyroxine levels than offspring of good-quality embryo transfers (beta, 0.22; 95% confidence interval, 0.09-0.90; beta, 0.22; 95% confidence interval, 0.09-0.91, respectively), but this difference was not clinically significant. Regarding neurodevelopmental assessments, there was no difference in the full-scale intelligence quotient based on the Wechsler Preschool and Primary Scale of Intelligence (109.96±12.42 vs 109.60±14.46; P=.88) or the general adaptive index based on the Adaptive Behavior Assessment System (108.26±11.70 vs 108.08±13.44; P=.94) between the 2 groups. The subindices of the 2 tests were also comparable. These findings remained after linear regression analysis. At 4 to 6 years of age, singletons born from poor-quality embryo transfers have comparable metabolic and cognitive development as those born from good-quality embryo transfers using fresh cleavage-stage embryos. The results of this pilot study indicate that poor-quality embryos that can survive implantation and end in live birth are likely to have a developmental potential comparable to that of good-quality embryos.

Pregnancy Outcomes in Thyroid Cancer Survivors: A Propensity Score-Matched Cohort Study.

BackgroundSome female thyroid cancer survivors wish to become pregnant following their cancer treatment. Current studies have shown inconsistent results on pregnancy outcomes in these survivors; however, detailed information on the pathological type, treatment, and gestational thyroid function of these patients are not yet well documented, making the refined assessment of the influence of a history of thyroid cancer and related treatments on pregnancy outcomes challenging.ObjectiveTo investigate the risk of adverse pregnancy outcomes in thyroid cancer survivors.MethodsThis was a retrospective cohort study. We included all women aged between 19 and 45 years old who delivered between January 2019 and June 2020 in West China Second University Hospital of Sichuan University. Women with tumors other than thyroid cancer or other thyroid diseases were excluded. The included women were divided into survivors of thyroid cancer (survivors) and women without any history of thyroid disease (controls). Propensity score matching and logistic regression were used to control confounding variables.ResultsAll 18,332 women who met the inclusion criteria were included in the study (96 survivors of papillary thyroid cancer and 18,236 controls). After propensity score matching, 96 survivors and 192 controls were included. The survivors had higher levels of free thyroxine (15.47 [13.61–17.67] vs. 14.38 [13.20–15.81] pmol/mL; P<0.001) and higher levels of thyroid peroxidase antibodies (TPOAb) (43.55 [31.43–71.43] vs. 35.95 [28.00–48.03] U/mL; P=0.008) but similar levels of thyroid stimulating hormone (1.46 [0.56–3.15] vs. 1.36 [0.81–1.92] mIU/mL; P=0.142) than the controls. There were no significant differences in adverse pregnancy outcomes between survivors and controls. Fetal macrosomia was lower among survivors (OR: 0.077, 95% CI: 0.009–0.668. P=0.020) than controls. Additionally, survivors had reduced weight gain during pregnancy (13.0 [10.0–15.0] vs. 14.00 [11.00–16.00] kg, P=0.005) and reduced placental weight (563.0 [514.5–620.0] vs. 572.0 [520.0–650.0] g, P=0.019), albeit with small absolute differences. Thyroidectomy or radioiodine therapy did not adversely affect pregnancy outcomes.ConclusionA history of treated papillary thyroid cancer was not associated with adverse pregnancy outcomes.

Tissue sensitivity to thyroid hormones may change over time.

IntroductionPatients with congenital hypothyroidism (CH) may transiently show a certain degree of pituitary resistance to levothyroxine (LT4) which, however, normalizes subsequently. However, in some individuals, thyroid-stimulating hormone (TSH) fails to normalize despite adequate LT4 treatment.MethodsNine patients with CH followed in three Academic Centre who developed over time resistance to thyroid hormones underwent extensive biochemical and genetic analyses. These latter were performed by Sanger sequence or targeted next-generation sequencing technique including a panel of candidate genes involved in thyroid hormone actions and congenital hypothyroidism (CH): THRA, THRB, DIO1, DIO2, SLC16A2, SECISBP2, DUOX2, DUOXA2, FOXE1, GLIS3, IYD, JAG1, NKX2-1, NKX2- 5, PAX8, SLC26A4, SLC5A5, TG, TPO, TSHR.ResultsAll patients displayed a normal sensitivity to thyroid hormone (TH) in the first years of life but developed variable degrees of resistance to LT4 treatment at later stages. In all cases, TSH normalized only in the presence of high free thyroxine levels. Tri-iodothyronine suppression test followed by thyrotrophin-releasing hormone stimulation was performed in two cases and was compatible with central resistance to THs. This biochemical feature was present independently on the cause of CH, being observed either in patients with an ectopic (n = 2) or eutopic gland (n = 3) or in case of athyreosis (n = 1). None of the patients had genetic variants in genes involved in the regulation of TH actions, while in two cases, we found two double heterozygous missense variants in TSHR and GLIS3 or in DUOX2 and SLC26A4 genes, respectively.ConclusionsWe report CH patients who showed an acquired and unexplainable pituitary refractoriness to TH action.

Subacute Thyroiditis During the SARS-CoV-2 Pandemic.

ContextAcute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been related to subacute thyroiditis (SAT).ObjectiveWe compared SAT cases during the SARS-CoV-2 pandemic to those observed in the previous years.MethodsA cross-sectional, retrospective study was conducted at the Endocrinology Unit of University Hospital of Pisa, Italy. We included all patients observed from January 2016 to December 2020 because of an untreated SAT, who had developed the disease within 15 days prior to the visit. SAT cases from 2016 to 2019 (N = 152) are referred to as pre-SARS-CoV-2, while 2020 SAT patients are classified as pos-SARS-CoV-2 (N = 18) or neg-SARS-CoV-2 (N = 28), according to positive or negative SARS-CoV-2 testing performed up to 45 days from SAT onset.ResultsWhile during 2016-2019, most SAT cases were observed in the third quarter, in 2020, 2 peaks were seen, superimposable to the SARS-CoV-2 outbreaks in the second and the fourth quarters. In the second and fourth quarters of 2020, we observed higher levels of free thyroxine (FT4), C-reactive protein (CRP), and thyroglobulin (Tg) compared with the same quarters of the years 2016-2019. Pos-SARS-CoV-2 patients had higher FT4 (28.4 vs 24.1 nmol/L), CRP (8.5 vs 3.6 mg/L), and Tg (155 vs 60 µg/L) (P < 0.05 for all) and more frequently had hypothyroidism (13/15 vs 30/152 at 3 months) (P < 0.001) than pre-SARS-CoV-2 patients. Neg-SARS-CoV-2 patients showed a clinical picture intermediate between the other 2 groups.ConclusionThe SARS-CoV-2 pandemic has caused a shift in the annual timing and severity of SAT cases.

Risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in papillary thyroid carcinoma.

Thyroid lobectomy is now preferred over total thyroidectomy to preserve thyroid function and reduce complications in patients with low-risk papillary thyroid carcinoma (PTC). One inevitable consequence of thyroidectomy includes hypothyroidism. This study aimed to evaluate the risk factors for hypothyroidism and thyroid hormone replacement after hemithyroidectomy in patients with PTC. We retrospectively studied 353 patients with PTC who underwent hemithyroidectomy with or without central neck dissection from January 2012 to January 2019. We excluded patients who had hypo- or hyperthyroidism preoperatively and those who underwent total or subtotal thyroidectomy. We analyzed various risk factors related to postoperative hypothyroidism and thyroid hormone supplementation. Of the patients, 54.7% showed hypothyroidism after hemithyroidectomy (n=193 with n=157, subclinical hypothyroidism; n=36, overt hypothyroidism). Ninety-one percent of postoperative hypothyroidism cases developed within 7 months postoperatively. Eventually, 43.1% (n=152) of patients received levothyroxine after hemithyroidectomy. Preoperative high thyroid-stimulating hormone (TSH) level and low free thyroxine (fT4) level were significantly associated with postoperative hypothyroidism and the need for thyroid hormone supplementation postoperatively. Preoperative TSH and fT4 levels are predictive risk factors of hypothyroidism and need for supplementation of levothyroxine after hemithyroidectomy in patients with PTC. Finally, approximately 43% of patients need levothyroxine supplementation after hemithyroidectomy, and individual preoperative counseling is necessary for these patients.

Correlation of Dietary Zinc Intake and Serum Zinc with Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4) Levels in Adult Hyperthyroid Patients

Background: Hyperthyroidism is a thyroid disorder caused by increased synthesis and secretion of thyroid hormone by the thyroid gland. Hyperthyroidism is characterized by low thyroid stimulating hormone (TSH) and high free thyroxine (FT4) levels. The prevalence of hyperthyroidism in Indonesia was 0.6% in female and 0.2% in male. Zinc acts as an enzyme cofactor that converts thyroxine into triiodothyronine and it affects TSH synthesis. Adequacy of dietary zinc intake and serum zinc levels in hyperthyroid patients indirectly affects TSH and FT4 hormones.Objective: to analyze the correlation of dietary zinc intake and serum zinc with TSH and FT4 levels in adult hyperthyroid patients.Materials and Methods: This cross sectional study sampling based on inclusion and exclusion criteria which obtained 50 adult hyperthyroid patients at the Clinic of the Magelang Health Research and Development Center. Data of TSH and FT4 levels were measured by the ELISA method, serum zinc was measured with the ICP-MS method, dietary zinc intake’s data was collected using the 24 hour dietary recall and it was analyzed based on the table of Indonesian food composition 2017. Statistical analysis used in this study were spearman correlation and multivariate linear regression with 95% confidence level.Results : Dietary zinc intake did not correlate with both TSH and FT4 levels (p&gt;0.05). Serum zinc had no correlation with TSH level (p&gt;0.05), while serum zinc had a positive correlation with FT4 level (r=0.327; β=0.054; p&lt;0.05).Conclusion: Serum zinc concentrations in adult hyperthyroid patients must be maintained because abnormal zinc status in the body’s metabolism will affect FT4 level.International Journal of Human and Health Sciences Vol. 05 No. 03 July’21 Page: 341-346

COVID-19 Infection May Cause Thyroid Dysfunction

Background: Coronavirus disease 2019 (COVID-19) is sweeping the globe and may infect various organs aside from the lungs. We explored the serum thyroid function of the patients with COVID-19.Methods: This retrospective cohort study involved 652 patients including 334 COVID-19 patients and 318 age- and sex- matched controls without COVID-19. COVID-19 patients were divided into three groups based on their condition: 142 moderate, 107 severe, and 85 critical. Patient data were collected through electronic records containing patients’ general information and the first test results of laboratory tests including thyroid hormone (TH) and thyrotropin (TSH) levels after admission.Findings: Relative to the control group, the COVID-19 group had lower serum levels of free triiodothyronine (FT3) and TSH and higher levels of free thyroxine (FT4) (all p Interpretation: Serum thyroid dysfunction appear at the early stage of COVID-19 and are mainly manifested as NTIS. The incidence of NTIS and a low FT3/FT4 ratio could be predicators of poor prognosis of COVID-19. Early detection of TH levels may help predict the prognosis of COVID-19 patients.Funding Statement: Central Hospital of Wuhan (Hubei Province, China)Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: This study was approved by the Ethics Commission of the Central Hospital of Wuhan under the criteria of emerging infection diseases and the requirement for informed consent was waived because of the retrospective nature of the study.

Is Hyperthyroidism a Possible Etiology of Early Onset Dementia?

Dementia, a disabling syndrome of the elderly characterized by the decline in memory and cognition, is increasing in incidence and affects not only the individual but also their family and close ones. Hyperthyroidism can mimic many other diseases and untreated hyperthyroidism can lead to adverse problems of various systems including the heart, bones, muscles, menstrual cycle, and fertility. In this article, we have tried to evaluate the association between hyperthyroidism and dementia, as well as the impact of hyperthyroidism management in the treatment and prevention of dementia. Studies available in the PubMed database have been used, excluding animal studies and including studies of adults above the age of 50. The analysis of studies reveals that thyroid dysfunction can lead to cognitive impairment. It has not been able to prove that hyperthyroidism can lead to an earlier onset of dementia. But subclinical hyperthyroidism, thyroid-stimulating hormone (TSH) levels below the normal range, and high free thyroxine (T4) levels increase the risk of dementia among the elderly. The possible mechanisms involved in this association have also been discussed. Thus, we concluded that it is essential to detect and manage hyperthyroidism at an earlier stage since hyperthyroidism increases the risk of dementia. The possibility of using antithyroid treatment in euthyroid dementia is yet to be studied extensively.

Subacute thyroiditis – A rare cause of pyrexia of unknown origin

Pyrexia of unknown origin is a challenging problem to the physicians and rarely endocrine causes such as subacute thyroiditis can present as a pyrexia of unknown origin. It is usually a self-limiting condition and following post viral inflammatory process. It is common in young adults to middle age and does not involve in any autoimmune pathology. It has a self-limiting nature and symptomatic treatment is adequate. We report a 34 year old presented with a one month history of fever found to have high ESR and CRP with high free thyroxine level and treated as subacute thyroiditis with NSAID and she recovered completely from the acute illness.

Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center

Thyrotropin (TSH)-secreting pituitary tumors are rare and typically present with hyperthyroidism. Here we report the diagnosis, treatment, and surgical outcomes in a series of patients with TSH-secreting pituitary tumors in a tertiary referral center. Descriptive retrospective study that included all patients with TSH-secreting pituitary tumors who underwent transsphenoidal surgery in the endocrinology and nutrition unit of the Virgen del Rocío University Hospital (Seville, Spain) between 2004 and2016. The mean age at diagnosis was 42.8 ± 17 years. The mean time from onset of symptoms to diagnosis was 13 ± 10 months. Four patients displayed symptoms indicating hyperthyroidism (1 suffered from tachycardia); 3 patients showed symptoms because of mass effect (visual impairment and headache) and 3 patients were diagnosed based on incidental findings after routine blood tests (high free thyroxine levels). Eight patients had macroadenomas, and 2 patients had microadenomas. Five patients underwent conventional pituitary surgery, and 5 patients underwent expanded endoscopic transsphenoidal surgery. Six patients achieved cure after surgery. The other patients received radiotherapy and/or treatment with somatostatin analogs. Analysis of somatostatin receptor (SSTR) expression by immunohistochemistry could be performed in 6 tumors. Our results confirm the clinical and hormonal heterogeneity caused by TSH-secreting pituitary adenomas. Surgery is considered the first choice of treatment for these tumors. We observed surgical cure rates similar to those reported in recent published series. SSTR2 and SSTR3 are highly expressed in TSH-secreting pituitary adenomas. Our results suggest that somatostatin analog treatment may be also helpful in the treatment of TSH-secreting pituitary adenomas.

Thyrotoxic periodic paralysis with ventricular tachycardia

A 47-year-old man presented to our emergency department (ED) with limbs weakness for 2 h. His heart rate was 127 beats per minute and blood pressure was 95/49 mm Hg. He found weakness of limbs after 4-h sleep. Physical examinations revealed that the muscle strength of upper limbs is 3/5, and lower limbs are 2/5.Electrocardiogram (ECG) revealed wide QRS complex, monomorphic ventricular tachycardia (VT) with ST-segment depression and long QT interval. Serum potassium level was extremely low as 1.0 mEq/L. This led to periodic hypokalemic paralysis. Due to severe hypokalemia with possible atrioventricular block, the patient was admitted to the intensive care unit. During hospitalization, his potassium level returned to 5.1 mEq/L on the first day. He had a low level of thyroid stimulating hormone (TSH) of <0.03 micro-IU/mL (normal range: 0.25–4.00) and a high free thyroxine (T4) level of 2.43 ng/dL (normal range: 0.89–1.79 ng/dL). Therefore, hyperthyroidism was diagnosed, and 5 mg of methimazole was administered twice a day. The patient was discharged on the seventh day after admission. The final diagnosis is thyrotoxic periodic paralysis (TPP), also as known as nocturnal paralysis or night palsy.

Thyroid Disorders and Hemostasis

Lower levels of free thyroxine (whether this is endogenous or exogenous) lead to a hypocoagulable state, and higher levels of free thyroxine lead to a hypercoagulable state. In this narrative review, the effects of different levels of thyroid hormones on clinical end points are described. Hypothyroidism is associated with an increased bleeding risk, whereas hyperthyroidism leads to an increased risk of venous thrombosis. Besides, effects of thyroid hormone on the heart may indirectly influence hemostasis. Hyperthyroidism leads to a higher incidence of atrial fibrillation and atrial flutter, and, at least partly by that mechanism, a higher risk of cerebral arterial thrombosis. In addition, compression effects of goiter on developing venous thrombosis are described. This is caused by local stasis of blood due to tumor expansion.

Association between thyroid hormones and the components of metabolic syndrome

BackgroundThyroid hormones are known to have direct and indirect effects on metabolism. Individuals with metabolic syndrome, a disease that is growing in incidence at a rapid rate, are at higher risk for cardiovascular disease, diabetes, and cancer. The aim of this study was to identify whether significant correlations exist between thyroid hormone levels and components of the metabolic syndrome in the general population of Korea.MethodsThe data were collected from the sixth Korea National Health and Nutrition Examination Surveys from 2013 to 2015. A total of 1423 participants were tested for thyroid function. The analysis of variance and multiple linear regression were performed to analyze the relationship between thyroid hormone level and components of the metabolic syndrome.ResultsA positive association between free thyroxine and fasting glucose level was observed in patients with high free thyroxine levels (≥1.70 ng/dL, β = 15.992, p = < 0.0001), when compared with patients with normal-middle free thyroxine levels. Moreover, a negative association was observed between free thyroxine and triglyceride levels in patients with normal-high free thyroxine levels (β = − 21.145, p = 0.0054) and those with high free thyroxine levels (β = − 49.713, p = 0.0404).ConclusionFree thyroxine shows a partially positive association with fasting glucose and a partially negative association with triglycerides in the Korean population. In patients with abnormal thyroid function, follow up tests for glucose levels and lipid profiling during treatment for thyroid dysfunction would be beneficial in terms of overlooking metabolic syndrome and to prevent related diseases.