History Of Thyroid Dysfunction Research Articles

Cystatin C- and Creatinine-based Estimated GFR Differences: Prevalence and Predictors in the UK Biobank

Rationale & ObjectiveLarge differences between estimated glomerular filtration rate (eGFR) based on cystatin C (eGFRcys) and creatinine (eGFRcr) occur commonly. A comprehensive evaluation of factors that contribute to these differences is needed to guide the interpretation of discrepant eGFR values. Study DesignCohort study Setting& Participants: 468,969 participants in the UK Biobank ExposureCandidate sociodemographic, lifestyle factors, comorbidities, medication usage, and physical and laboratory predictors OutcomesEGFRdiff, defined as eGFRcys minus eGFRcr, categorized into three levels: lower eGFRcys (eGFRdiff < -15 mL/min/1.73 m2), concordant eGFRcys and eGFRcr (eGFRdiff -15 to <15 mL/min/1.73 m2), and lower eGFRcr (eGFRdiff ≥15 mL/min/1.73 m2) Analytical ApproachMultinomial logistic regression models were constructed to identify predictors of lower eGFRcys or lower eGFRcr. We developed two prediction models comprising 375,175 participants: 1) a clinical model using clinically available variables; and 2) an enriched model additionally including lifestyle variables. The models were internally validated in an additional 93,794 participants. ResultsMean ± SD of eGFRcys was 88±16 and eGFRcr was 95±13 mL/min/1.73 m2; 25% and 5% of participants were in the lower eGFRcys and lower eGFRcr groups, respectively. In the multivariable enriched model, strong predictors of lower eGFRcys were older age, male sex, South Asian ethnicity, current smoker (vs. never smoker); history of thyroid dysfunction, chronic inflammatory disease, steroid use, higher waist circumference and body fat, and UACR >300 mg/g. Odds ratio estimates for these predictors were largely inverse of those in the lower eGFRcr group. The model’s AUC was 0.75 in the validation set, with good calibration (1.00). LimitationsLimited generalizability ConclusionsThis study highlights the multitude of demographic, lifestyle, and health characteristics that are associated with large eGFRdiff. The clinical model may identify individuals who are likely to have discrepant eGFR values and thus should be prioritized for cystatin C testing.

FRI464 Subacute Thyroiditis Related To COVID-19 Vaccines- A Case Series

Abstract Disclosure: H. Mejia: None. S.A. Gillis Funderburk: None. S.R. Thomas: None. Background: Subacute thyroiditis (SAT) has been reported following SARS-COV-2 viral infection, as well as in recipients of the mRNA vaccines for SARS-COV-2. Patients present with palpitations, tremors and weight loss as well as low grade fevers and a tender thyroid. It is a self-limited condition that typically follows a triphasic course that may include thyrotoxicosis, hypothyroidism and return to normal thyroid function. Clinical features and sonographic findings can provide a specific diagnosis, and a radioactive iodine uptake study is often not required. Report: In 2021, 123 patients were referred to our outpatient service for evaluation of thyrotoxicosis. Among them, we identified 9 women without history of thyroid disease who presented with clinical findings of SAT with thyrotoxicosis. Patients with history of thyroid dysfunction and thyroid nodules were excluded. The symptoms began between 4-27 days after the first or second dose of either the Pfizer Bio-NTech or the Moderna COVID-19 mRNA vaccine. All tested negative for TSI and had no nodules on ultrasound. 2 patients had thyroid uptake scans which confirmed thyroiditis. All 9 patients improved with symptomatic treatment and thyroid functions normalized with time. Discussion: Since the mRNA vaccines for SARS-COV-2 became nationally available, several adverse reactions have been reported including SAT. The mechanism for post-vaccination SAT or thyroid dysfunction remains unknown. Transmembrane protease serine-2 (TMPRSS-2) and ACE-2 receptors allow the SARS-CoV-2 to enter human cells. ACE-2 and TMPRSS-2 are expressed in thyroid follicular cells, and their expression is higher than in lung cells, especially in women. These situations may explain why SARS-CoV-2 causes SAT in women more frequently. Inactive virus vaccines contain many proteins belonging to the pathogen virus and similar antigenic parts. The increased affinity of the SARS-CoV-2 towards the thyroid suggests that inactive vaccine may also affect the thyroid tissue. In the past, SAT has been reported after an inactive virus vaccine- seasonal influenza vaccine, H1N1 vaccine and hepatitis B vaccine. In addition, the COVID-19 vaccine contains aluminum hydroxide as an adjuvant. Autoimmune inflammatory syndrome induced by adjuvants (ASIA syndrome) was previously reported following various vaccines. A recent article describes a patient with COVID-19 vaccine related ASIA syndrome and SAT. In some cases, elevated proinflammatory markers and cytokines after receiving the vaccine may play a major role, as it can stimulate a significant response from our immune system. Hence, SAT should be included as a possible side effect of receiving these vaccines. Conclusion: Our case series highlights a possible relationship between the COVID-19 mRNA vaccines and subacute thyroiditis which has been previously underreported or not recognized by healthcare providers. Presentation: Friday, June 16, 2023

Association of Melasma in Patients with Thyroid Dysfunction and their Clinical Profile: A Cross-sectional Observational Study

Introduction: Melasma may occur in thyroid diseases, and its manifestations may be the first presenting sign or even precede the diagnosis by many years. Melasma is difficult to treat. An initial screening of thyroid dysfunction will help in better management of both thyroid disorders and melasma. Aim: To detect the proportion of thyroid dysfunction in patients with melasma and describe the clinical profile of such patients. Materials and Methods: This was a cross-sectional, observational study carried out in the Department of Dermatology, Venereology and Leprosy, of a tertiary care teaching hospital of Karnataka, India from September 2020 to February 2022. Patient above or equal to 18 years of age with newly diagnosed melasma alone and no history of thyroid dysfunction were included in the study. A detailed history, using a preformed questionnaire, was taken. Wood’s lamp examination, to know the depth of pigmentation, along with thyroid dysfunction test, and antiThyroid Peroxidase (TPO) antibody was evaluated. Descriptive statistics data were analysed using a Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: There were 100 patients with a mean age of 35.9 years, with a predominance of female (86%) and the majority (48%) of population were housewives. The distribution of lesion was either dermal (55%) or epidermal (44%). There were 65 patients with positive antiTPO; with men (85.7%) being significantly more than women (61.6%). The distribution of pigmentations was higher for the dermal pattern (55%), among females (46) and males (9), while only one mixed pattern was seen in males. Conclusion: Male melasma patients had higher positivity of antiTPO positivity than females, with significant antiTPO positivity. These patients showed more dermal pigmentations on Wood’s lamp examination.

Incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without heart failure: a nationwide cohort study

Abstract Background Although thyroid dysfunction is a well-known complication of amiodarone treatment, population-based estimates of the short- and long-term incidence of this complication are lacking. In addition, it is not clear whether heart failure (HF) exacerbates this risk. Purpose To examine the short- and long-term incidence of thyroid dysfunction following initiation of amiodarone treatment in patients with and without HF. Methods All Danish residents who initiated amiodarone treatment between 2000–2018 without a history of thyroid dysfunction was identified using nationwide registries. Thyroid dysfunction, defined as a composite of levothyroxine, anti-thyroid medication, or a diagnosis of hypothyroidism, hyperthyroidism, or thyroiditis, was assessed at 1-year follow-up. In a landmark analysis, we estimated the 5-year outcomes with patients grouped according to the cumulated dose (CD) of amiodarone within the first year (regardless of whether treatment duration was shorter than 1 year). The Aalen-Johansen estimator and a cause-specific Cox regression model were applied to compare risk across groups. Results In total, 43,724 patients were identified of whom 16,939 (38%) had a history of HF. Compared to patients without HF, those with HF were at a similar age (71 vs 70 years), more likely men (74% vs 65%), and more often had a history of ventricular tachycardia (19% vs 6%), ischemic heart disease (60% vs 43%), aborted cardiac arrest (8.0% vs. 3.0%), ICD or CRT (30% vs 19%), all p-value &amp;lt;0.01 and less atrial fibrillation (72% vs 73%, p-value 0.02). At 1-year follow-up, the cumulative incidence of thyroid dysfunction was 5.3% in patients with a history of HF vs. 4.2% in patients without HF, adjusted hazard ratio (HR) 1.55 (95% CI, 1.47–1.62), Figure 1. In the landmark analysis, the 5-year cumulative incidences and adjusted HRs of thyroid dysfunction were 5.3% (HR 0.66 [95% CI 0.62–0.70]) in patients with 1-year CD of amiodarone &amp;lt;27.38 g (average daily dose [ADD] &amp;lt;75 mg), 14.0% (reference) for patients with CD 27.38–45.63 g (ADD 75–125 mg), 20.0% (HR 1.28 [95% CI 1.21–1.36]) for patients with CD 45.64–63.88 g (ADD 126–175 mg), and 24.5% (HR 1.39 [95% CI 1.31–1.47]), for patients with CD&amp;gt;63.88 g (ADD &amp;gt;175 mg), (Figure 2). Conclusions In patients who initiated amiodarone treatment, around 5% had evidence of thyroid dysfunction at 1-year follow-up with a slightly higher incidence in those with a history of HF. A dose-response relationship was observed between the 1-year amiodarone cumulative dose and the subsequent 5-year cumulative incidence of thyroid dysfunction. Funding Acknowledgement Type of funding sources: None.

Menstrual Pattern of Reproductive Age Group Women and Their Association with Thyroid Dysfunction

Background and Aim: Thyroid hormones play a significant role in physiology of normal reproductive system. Thyroid dysfunction is extremely common in women and effect certain metabolic process and menstrual irregularities. The present study aimed to assess the menstrual pattern of reproductive age group women and their association with thyroid dysfunction. Methodology: This cross-sectional study was carried out on 140 women with menstrual irregularities who were assessed for thyroid dysfunction in the Department of Obstetrics and Gynecology outpatient Department of Sindh Government Hospital Karachi, January 2021 to December 2021. All the reproductive age group women between (15-45 years) with menstrual irregularities were enrolled. Women with a history of thyroid dysfunction and taking anti-thyroid drugs were excluded from the study. Individual age, thyroid hormones level, and type of menstrual irregularities were recorded. ELISA technique was used for the determination of thyroid hormones. Thyroid stimulating hormone (TSH) levels, serum free triiodothyronine (T3), and free thyroxine (T4) were used for the assessment of thyroid dysfunction. SPSS version 25 was used for data analysis. Results: The overall mean age of the study population was 27.8 ± 5.3 years with an age range from 15 years to 45 years. The age-wise distribution of patients were as follows; 15-25 years n=67, (47.8%), 26-35 years n=46 (32.9%), and 36-45 years n=27 (19.3%). The prevalence of thyroid dysfunction was 22% (n=31). The clinical presentations of menstrual patterns were as follows; Irregular menstruation 66.4% (n=93), Oligomenorrhea 4.3% (n=6), Menorrhagia 15.7% (n=22), Polymenorrhea 7.9% (n=11), and Metropathia 6.4% (n=9). Of the total 31 thyroid dysfunction women, the incidence of normal, hypothyroidism and hyperthyroidism was 82 (58.6%), 12 (38.7%) and 1 (1.4%) respectively. The median TSH level was 2 mIU/L IQR (1.0-4.0). The mean level of T3 and T4 was 2.83±1.13 pg/ml and 1.38±1.1 ng/dl respectively. Conclusion: The present study found that hypothyroidism is the most prevalent thyroid dysfunction among women of reproductive age with different menstrual irregularities. The most common clinical presentation was menorrhagia, polymenorrhea, and oligomenorrhea.. Hence the thyroid function evaluation should be mandatory in cases of DUB to detect thyroid dysfunction so the cases have to evaluated for further medical help Keywords: Menstrual Pattern, Reproductive age group women, Thyroid dysfunction

Effect of Misoprostol in Third Trimester of Pregnancy- A Multi-Center Study in Bangladesh

Background: Misoprostol is an analogue of prostaglandin (PGE1) and the first registered PGN used for the treatment of peptic ulcer disease. Misoprostol should not be used in pregnant women but it can be used in termination of intrauterine fetal death (IUFD). It has been used for the induction of abortion in the first and second trimester of pregnancy. Misoprostol has already been proved to be effective and efficient for second trimester since 1987. There is insufficient information available from clinical trials to support their use to induce labor in third trimester of pregnancy. Aim of the study: The aim of this study was to describe the effect of misoprostol in third trimester of pregnancy. Methods: This retrospective study was carried out in two large hospitals in Dhaka city, which is the capital of a South Asian country, Bangladesh. The record of the studied subject was taken from the Department of Obstetrics and Gynecology of Alpha Hospital and the maternity ward of Beta Hospital from June 2018 to August 2019. The actual names of the two hospitals are pseudonym for privacy. A detailed history of each patient was taken and physical and obstetric examination were done. In total 52 patients were investigated and data were analyzed by SPSS version 23.0. Results: In this study, the primi gravida response time was found as the highest. On an average 20.34 hours was needed for the primi gravida category. In single, 2 and multi-parity cases the average pain response times were found as 16.3125, 10.3375 and 14 hours respectively. In Primi, 2nd, 3rd and 5th gravida cases the average delivery times were found 13.0714, 12.5938, 9.0769 and 3 hours respectively. Against single, two and three doses of misoprostol, the average pain response times were found 7.6875, 11.5375 and 19.25 hours respectively. Conclusion: In this study, it had been found that, most of the patient of IUFD was ‘primigravid’ (30.8%) of total respondents having complication with medical and endocrinal disease. Pre- eclampsia is more common in prim gravid than multi. There is history of thyroid dysfunction. In some cases, now a day, GDM is the cause behind IUFD.

Comorbidities of alopecia areata in infancy and childhood. A small descriptive study in a tertiary hospital in Greece

Sir, A small descriptive study in a tertiary hospital in Greece was conducted on the comorbidities of alopecia areata in infancy and childhood. Alopecia areata is a non-scarring alopecia of autoimmune origin linked also to genetic and environmental factors [1], affecting 2% of the general population and is considered a disease of young adults. Attempts have been made to detect the comorbidities in infants and children suffering from alopecia areata. Sorell Jennifer et al. established a strong association of alopecia areata with atopy, psoriasis thyroid disease, and juvenile idiopathic arthritis [2]. More recently, Comiz et al. [3] added anemia, obesity, vitamin D deficiency, hypothyroidism, vitiligo, psoriasis, hyperlipidemia, and depression to the list of the comorbidities detected in the pediatric population with alopecia areata. The purpose of the study was to detect the comorbidities in infants and children with alopecia areata in an outpatient dermatology clinic during a period of six years from 2013 through 2019. All those examined as outpatients and those hospitalized for several reasons in the pediatric ward who were diagnosed with alopecia areata were included in the study. Laboratory tests, a full blood count, and vitamin D, IgE, and thyroid tests were performed in the laboratories of our hospital. During these seven years, 71 patients were diagnosed with alopecia areata and 7 (approx. 10%) were children. Four (57.1%) were males, and the rest three were females. The males were aged 23 months, and 6-, 7-, and 11-years. The females were 2-, 7-, and 11-year-old. Clinical atopy confirmed by high levels of IgE in the serum was detected in two males and in all three females. Thyroid dysfunction, hypothyroidism, was only detected in one infant associated with atopy; this was in a 23-month-old who at the time of the diagnosis of alopecia areata was hospitalized with severe asthma. Vitamin D deficiency was found in one male patient. A family history of alopecia areata was found in only one male patient. A family history of atopy was reported in only one boy, aged 7 years. A family history of thyroid dysfunction was detected in two males 28%: The 23-month-old infant whose father suffered from hyperthyroidism and the 12-year-old male whose both parents suffered from hypothyroidism. A family history of rheumatoid arthritis was found in one female patient. All patients presented with a mild disease limited to the scalp at the time of diagnosis. No nail pitting was observed, and neither clinical signs of psoriasis, nor of vitiligo. Folliculitis of the scalp preceded the onset of alopecia areata in one of the females (Table 1). Although males comprised 57.1% of our cases, most studies have found a preponderance of females in the pediatric population with AA. Atopy was the most frequent comorbidity (5/7; 70%) and was more frequent in females; all three girls were atopic. The second most frequently found comorbidity was thyroid dysfunction, hypothyroidism., detected in one patient (14%). Vitamin D deficiency was noted in one (14%) patient. A family history of AA was found in one patient as well as a family history of atopy. A family history of thyroid dysfunction was found in two patients (28%). The precipitating factor in our case was staphylococcal infection of the scalp. Staphylococcus, probably acting as a super antigen, was observed in only one patient (14%). Both atopy and thyroid dysfunction should be sought for in pediatric patients with AA in this order.

Frequency and factors associated with thyroid dysfunctions: An analytical cross-sectional study from a tertiary care center in Kabul, Afghanistan

Abstract Introduction/Objective Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland, however there is lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. This is the first study aimed to describe the frequency of occurrence and factor associated with thyroid dysfunction in Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods/Case Report A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) Hypothyroidism 2) Hyperthyroidism 3) normal. Results (if a Case Study enter NA) A total of 127 individuals were included in the final analysis. Majority study participants (77%) were females. A large number of the participants (92%) did not have family history of thyroid dysfunction. (74%) participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels and (12%) higher TSH levels (Table 1) classified as hyper and hypothyroid respectively. Conclusion The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Особливості взаємозв’язків між вмістом тиреотропного гормону і деякими маркерами серцево-судинного ризику при субклінічному гіпотиреозі

Вступ. Гіпотиреоз, у тому числі субклінічний, асоціюється з підвищенням ризику розвитку хронічної серцевої недостатності. Згідно з даними дослідження Cardiovascular Health Study, підвищений рівень тиреотропного гормона (ТТГ) можна розглядати як фактор ризику розвитку серцевої недостатності. Мета дослідження — вивчення взаємозв’язків між рівнем ТТГ і наявністю серцево-судинних порушень у пацієнток із субклінічним гіпотиреозом. Матеріали та методи. В одномоментне поперечне дослідження були включені 26 жінок репродуктивного віку (від 32 до 47 років) із субклінічним гіпотиреозом (група 1) і 25 жінок без порушення функціонального стану щитоподібної залози (ЩЗ) і кардіальної патології в анамнезі (група 2). У всіх жінок оцінювали наявність факторів і маркерів серцево-судинного ризику, ранніх ознак ураження міокарда. Для порівняння груп пацієнток із нормальною функцією ЩЗ та із субклінічним гіпотиреозом (групи 1 і 2) був застосований ROC-аналіз для ідентифікації рівнів ТТГ, асоційованих із найбільшою ймовірністю виявлення досліджуваних порушень. Результати. За даними ROC-аналізу, рівень ТТГ ≥ 4,67 мМО/л прогнозував розвиток діастолічної дисфункції лівого та/або правого шлуночків із чутливістю 70,6 (49,8; 89,1) % і специфічністю 69,3 (53,2; 80,6) % (AUC 0,672 (0,561; 0,787), p = 0,032). Аналогічно значення ТТГ ≥ 4,8 мМО/л вказувало на можливість виявлення сегментарних порушень релаксації з чутливістю 61,9 (46,2; 77,7) % і специфічністю 73,1 (42,9; 91,0) % (AUC 0,680 (0,543; 0,831), p = 0,042). Висновки. Початкові прояви серцево-судинних порушень частіше виникають при значеннях ТТГ у діапазоні 4,6–5,9 мМО/л. Рівень ТТГ понад 5,45 мМО/л може розглядатися як предиктор розвитку асоційованих із субклінічним гіпотиреозом кардіоваскулярних розладів.

Overt Hypothyroidism Induced by Prolonged Therapy With Imatinib

Abstract Background: Imatinib, a tyrosine kinase inhibitor (TKI), is commonly used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. TKI-induced thyroid dysfunction is recognized as an adverse class effect with most cases occurring between six to twelve months after treatment initiation. Clinical Case: 76-year-old man with hypertension and CML on Imatinib that had been started twenty months prior was admitted for confusion. The patient also reported constipation, cold intolerance, and weight gain despite no change in diet, appetite, or physical activity. On evaluation, his responses to questioning were noticeably delayed, however he was not lethargic. His vital signs were normal and he was otherwise euthyroid on physical exam. He had no known history of thyroid dysfunction. Labs showed a TSH of 94.7 (0.4 - 4.2 uIU/mL), Free T4 0.4 (0.8 - 1.5 ng/dL), and Total T3 30 (87 - 178 ng/dL). Thyroglobulin antibody was 1016 (0.0 - 4.1 U/mL) and TPO antibody was &amp;gt;2000 (0.0 - 5.6 IU/mL). A TSH checked two months before admission was 1.1. Antibody levels had not been checked previously. Thyroid ultrasound demonstrated a hyperemic and heterogeneous thyroid, consistent with thyroiditis. Levothyroxine at a dose of 50 mcg daily was advised, due to patient’s advanced age as well as history of arrhythmia. The patient’s confusion resolved on hospital day three. Repeat thyroid function tests will be checked four to six weeks after Levothyroxine initiation. Discussion: As a class, tyrosine kinase inhibitors are known to cause thyroid dysfunction with the most common medication being Sunitinib. Data related to the effects of thyroid function during Imatinib treatment are limited. Previous cases of Imatinib-induced thyroid dysfunction report only hypothyroidism in thyroidectomized patients and no clinically significant change in thyroid function among patients who were euthyroid prior to therapy initiation. Our case reports a patient with no prior thyroidectomy who developed overt hypothyroidism while on Imatinib for nearly two years. The mechanism for TKI-induced thyroid dysfunction has not been elucidated. Due to relatively acute onset and markedly positive TPO and thyroglobulin antibodies, we suspect that TKI may alter HLA recognition on thyroid follicular cells, thereby inducing autoimmunity. Our case showcases the need to maintain awareness and continuous surveillance for thyroid dysfunction when patients are on long term TKI as overt hypothyroidism may be induced by prolonged treatment.

The role of routine thyroid assay in the management of gallstones

Cholelithiasis is a type of biliary stone disease, with a high prevalence. Along with classic risk factors like obesity, weight loss, female sex hormones, age, an association with thyroid dysfunction has been established.To evaluate the importance of thyroid profile as a diagnostic/therapeutic workup of gallstones.The study included 200 subjects, above 18 years. 100 subjects (50 males+50 females) had cholelithiasis confirmed by ultrasonography and remaining as 100 subjects(50males+50females) control group without gallstones. After a detailed history and clinical examination, blood samples were analyzed for TSH, T3 and T4, using Chemiluminescence-Immunoassay. Subjects with history of thyroid dysfunction or on thyroid replacement therapy, diabetes mellitus, pregnancy, drugs affecting thyroid hormone levels were excluded.Computing descriptive statistics was used. Any significant difference were tested using the unpaired sample student t-test.The case group had a mean age of 45.70 ± 13.76 and the controls, a mean age of 38.78 ± 15.63. There was a significant increase in the prevalence of gallstones after the age of 40years, especially in females. 20% of cases were hypothyroid and 12% were hyperthyroid when compared to the controls which were 10% hypothyroid and 6% hyperthyroid. The higher prevalence of hypothyroid among cases was statistically significant. Among the hypothyroid cases, 80% had subclinical hypothyroidism.Our study concludes by saying that thyroid assay could be made a part of the diagnostic work up of gallstone management thus providing early detection for thyroid dysfunction and thus reducing the surgical/anesthetic complications.

No Longterm Severe Thyroid Dysfunction Seen In Patients With Preexisting Reduced Serum Tt3 Concentrations After A Single Large Dose Of Iodinated Contrast

After an intravenous bolus injection of 100 mL of iodinated contrast agent (370 mgI/mL), the amount of iodine atoms entering the blood is tens of thousands of times the daily dose of iodine recommended by the World Health Organization. However, the effect of iodinated contrast in patients with nonthyroidal illness, manifested as reduced serum total triiodothyronine (TT3) concentrations, is unclear. We studied the effect of iodinated contrast on thyroid function and auto-antibodies in patients with reduced TT3 after diagnosis and treatment of coronary heart disease. This was a prospective cohort study. One hundred and fifty-four stable angina pectoris patients with reduced TT3 and normal thyroid-stimulating hormone (TSH), free thyroxine (FT4), and reverse triiodothyronine (rT3) were enrolled from January, 2017, to June, 2018. All subjects had no history of thyroid dysfunction and had no recent infections, tumors, trauma, or other critical illnesses. Fourty-one patients underwent coronary angiography and 113 patients underwent coronary intervention. There were 6 patients (3.9%) with hypothyroidism and 30 patients (19.5%) developed subclinical hypothyroidism (SCHypo) on the first day after surgery. There were 6 patients (3.9%) with hypothyroidism, 6 patients (3.9%) with SCHypo, and 18 patients (11.7%) with subclinical hyperthyroidism (SCHyper) at the first month postsurgery. There were 23 patients (14.9%) with SCHyper and 6 patients (3.9%) with SCHypo at the sixth month after surgery. No patient with longterm severe thyroid dysfunction occurred during follow-up. The levels of free triiodothyronine, FT4, TT3, total thyroxine, and TSH showed statistically significant changes at 1 day, and 1, 3, and 6 months postoperative (P<.005). The level of rT3 showed no statistically significant change at 1, 3, and 6 months postoperative (P>.05). The levels of thyroglobulin antibody and thyroid peroxidase antibody decreased at 6 months postoperative (P<.001). The risk of subclinical thyroid dysfunction and transient hypothyroidism occurred with a single large dose of iodinated contrast in the diagnosis and treatment of coronary heart disease, but no longterm severe thyroid dysfunction occurred. Patients with preoperative thyroid antibody elevation were more likely to have subclinical thyroid dysfunction after surgery. FT3 = free triiodothyronine; FT4 = free thyroxine; PCI = percutaneous coronary intervention; rT3 = reverse triiodothyronine; SCHyper = subclinical hyperthyroidism; SCHypo = subclinical hypothyroidism; TGAB = thyroglobulin antibody; TPOAB = thyroid peroxidase antibody; TT3 = total triiodothyronine; TT4 = total thyroxine; TSH = thyroid-stimulating hormone; WHO = World Health Organization.

COMPARISON OF THYROID HORMONES LEVEL IN NORMAL AND PREECLAMPTIC PREGNANCY

To find a relationship between preeclampsia and thyroid dysfunction by comparing serum levels of Free T3 (fT3), Free T4 (fT4) and TSH in preeclampsia and normal pregnancy. The study was conducted within 6 months from May 2018 to November 2018, on the patients who attended OB/GYN department of Sohag Faculty of Medicine, Institutional review board approval was obtained April 2017. 30 of them were diagnosed as preeclamptic [blood pressure after 20 weeks of gestation is raised to 140/90 mm of Hg or more or have mean Blood Pressure. (diastolic+1/3rd pulse pressure) of more than 110 mm of Hg] with presence of proteinuria and/or edema. 30 age-matched normotensive pregnant women. Blood pressure was measured (auscultatory and palpatory) in semi sitting position using sphygmomanometer. Both groups had no history of thyroid dysfunction. According to the International Society for the Study of Hypertension Pre-eclampsia is defined as blood pressure ≥140/90 mmHg on two separate occasions 6 hours apart or a single recording of a diastolic blood pressure of 110 mmHg, in association with proteinuria ≥1+ on dipstick urine testing (Dawn C. Scantlebury, et al., 2013)

The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

Thyroid profile and autoantibodies in Type 1 diabetes subjects: A perspective from Eastern India.

Context:There has been a rise in the incidence of type 1 diabetes mellitus (T1DM) in India. The prevalence of thyroid autoantibodies and thyroid dysfunction is common in T1DM.Aims:The aim of this study is to determine the incidence of thyroid dysfunction and thyroid autoantibodies in T1DM subjects, without any history of thyroid disease, and the prevalence of glutamic acid decarboxylase (GAD) antibody, Islet antigen-2 antibody (IA2), thyroid peroxidase (TPO), and thyroglobulin autoantibodies (Tg-AB) in T1DM subjects.Settings and Design:This was a cross-sectional clinical-based study.Subjects and Methods:Fifty subjects (29 males, 31 females) with T1DM and without any history of thyroid dysfunction were included in the study. All subjects were tested for GAD antibody, IA2 antibody, TPO antibody, thyroglobulin antibody, free thyroxine, and thyroid-stimulating hormone.Statistical Analysis Used:A Chi-square/pooled Chi-square test was used to assess the trends in the prevalence of hypothyroidism. A two-tailed P < 0.05 was considered statistically significant.Results:The mean age of the subjects was 23.50 years. 9.8% of subjects were below the age of 12 years, 27.45% of subjects were of age 12–18 years, 37.25% of subjects were of age 19–30 years, and 25.49% of subjects were above 30 years. 78% were positive autoantibody for GAD, 30% for IA-2, 24% for TPO, and 16% were positive for Tg-AB. A total of 6.0% of T1DM subjects had evidence of clinical hypothyroidism, but the prevalence of subclinical hyperthyroidism (SCH) varied from 32% to 68.0% for we considered different definitions of SCH as advocated by different guidelines. All subjects with overt hypothyroidism had positive GAD and thyroid autoantibodies. One (2%) subject had clinical hyperthyroidism with strongly positive GAD, TPO, and Tg-AB.Conclusions:We found a high prevalence of GAD, IA2, TPO, and Tg-AB in our T1DM subjects. A substantial proportion of our subjects had undiagnosed thyroid dysfunction with a preponderance of subclinical hypothyroidism. All T1DM subjects with overt hypothyroidism or hyperthyroidism had positive GAD and thyroid autoantibodies. The high prevalence of undiagnosed thyroid dysfunction highlights the importance of regular thyroid screening in T1DM subjects.

Positivity Rates of Tests Used at Immune Thrombocytopenia Diagnosis to Detect Associated Diseases. a Prospective Multicenter Cohort Study of 218 Patients

Introduction:The frequency ofimmune thrombocytopenia (ITP)-associated diseases detected at ITP onset is not well known. The positivity rates of tests performed at ITP onset in order to detect these diseases are discussed or unknown, leading to discrepancies among recommendations. The aim of this study was to compare the positivity rates of tests used at ITP diagnosis to detect ITP-associated diseases in the overall ITP population, in the presence of signs evocative of these diseases and in the absence of these signs.Methods:We studied all patients included between June 2013 and May 2016 in the CARMEN (Cytopénies Auto-immunes : Registre Midi-PyréneEN) registry. This multicenter registry is aimed at the prospective follow-up of all incident ITP adults in the French Midi-Pyrénées region (South of France, 3 million inhabitants). Each investigator prospectively follows every patient newly diagnosed for ITP in routine visit or hospital stay. ITP is defined in accordance with French guidelines: platelet count <150 x 109/L and exclusion of other causes of thrombocytopenia. Investigations performed at ITP diagnosis are recorded with their results. We assessed their positivity rates in the entire cohort and depending on the clinical and biological context. Patients with a cause of secondary ITP already known at ITP diagnosis were excluded for these calculations.Results:We included 218patients. Median age was 66 years (range: 18-96), 47.3% were female, 34 (15.8%) had a secondary ITP, 104 (48.2%) had bleeding signs, median platelet count was 18 x109/L (range: 1-135) and 144 (66.1%) were treated for ITP within the month following the diagnosis.Bone marrow examination was performed in 167patients. Fivemyelodysplastic syndromes (MDS) were found (3 refractory cytopenia with unilineage dysplasia and 2 with multilineage dysplasia). These 5 ITP patients had platelet count <15x 109/L and responded to corticosteroids. The positivity rate among patients with anemia or neutropenia was 6.6% (4/61 patients) and 0.9% in case of isolated thrombocytopenia (1/106). Among patients aged >60 years, these rates were 8.3% and 1.5%, respectively.Antinuclear antibodies (ANAs) were tested in 170 patients without known connective tissue disease and were positive (titer³1/160) in 73 (42.9%). The positivity rates were 40.0% incase of clinical signs of connective tissue disease and 41.8% otherwise.Antiphospholipid antibodies were positive in 7 patients (73 tested). The positivity rates were 11.1%in case of history of thrombosis or fetal loss and 9.4% in the absence of evocative context.The positivity rates ofdirectantiglobulintest (tested in 64 patients) were 30.4% in case of anemia or lowhaptoglobinlevel, and 7.3% otherwise.Serum protein electrophoresis was performed in 158 patients. None had a history of repeated or severe infections.Hypogammaglobulinemia(<5g/L) was detected in 1 patient over 76 with lymphopenia and in1 patient without lymphopenia.HCV, HBV and HIV were tested in respectively 143, 140 and 159 patients. No new infection was detected.Nine patients were tested for Helicobacter pylori infection and 3 were positive. One patient had symptoms evocative of gastritis and was positive for Helicobacter. Among the 7 patients without symptoms of gastritis, 2 were positive (28.6%).Thyroid stimulating hormone (TSH) was tested in 112 patients without history of thyroid dysfunction. The positivity rates were 50.0% in case of symptoms evocative of thyroid dysfunction and 7.3% otherwise.Conclusions: Except for ANAs (whose presence may lead to hydroxychloroquine prescription) andhypogammaglobulinemia, the positivity rates were at least three-fold higher in case of evocative context, discussing the systematic use of these tests. HIV, HCV and HBV infections revealed by ITP seem very rare in France. DisclosuresBeyne-Rauzy:Celgene, Novartis: Honoraria.

IgG4-Related Hashimoto's Thyroiditis of the Thyroid Gland

Immunoglobulin (Ig) G4-related Hashimoto's thyroiditis is a newly discovered subtype of Hashimoto's thyroiditis and characterized by thyroid inflammation and marked fibrosis. IgG4-related Hashimoto's thyroiditis is very rare and there has been relatively little information available to date. A 46-year-old woman with a past history of thyroid dysfunction visited our outpatient clinic for severe anterior neck swelling. She complained of swallowing discomfort and pain due to severe goiter and was successfully treated with total thyroidectomy. Immunohistochemistry showed thyroid invasion by IgG4-positive cells and an IgG4/IgG ratio over 40%. The patient was diagnosed with IgG4-related Hashimoto's thyroiditis. We report a very rare case of IgG4-related Hashimoto's thyroiditis with severe goiter. A more comprehensive understanding of the IgG4-related Hashimoto's thyroiditis may help physicians to allow proper diagnosis and treatment of patients with severe goiter.

High rates of same-sex attraction/gender nonconformity in the offspring of mothers with thyroid dysfunction during pregnancy: proposal of prenatal thyroid model

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. Despite mounting efforts to determine the biological background, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to 17 years. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction. Twelve overlapping cases with both same-sex attraction and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (P&lt;0.0001, by Fisher's exact test). The association was also significant for each sex (P&lt;0.0001, by Fisher's exact test). There is evidence that thyroid gland plays a crucial and decisive role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the off-spring.

High Rates of Same-Sex Attraction/Gender Nonconformity in the Offspring of Mothers with Thyroid Dysfunction During Pregnancy: Proposal of Prenatal Thyroid Model.

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. Despite mounting efforts to determine the biological background, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to 17 years. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction. Twelve overlapping cases with both same-sex attraction and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (P<0.0001, by Fisher’s exact test). The association was also significant for each sex (P<0.0001, by Fisher’s exact test). There is evidence that thyroid gland plays a crucial and decisive role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the offspring.

Maternal Thyroid Dysfunction During Pregnancy May Lead to Same-sex Attraction/gender Nonconformity in the Offspring: Proposal of Prenatal Thyroid Model

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. It is argued that early biological events generated by genes and prenatal sex hormones determine an individual's sexual orientation. However, despite mounting efforts, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. This study was conducted to explore the relationship between maternal thyroid dysfunction in pregnancy and same-sex attraction/gender nonconformity in the offspring. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to17 years. Children who were victims of sexual and physical abuse and who had mental retardation, autism and psychosis were not included. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction/gender nonconformity. Twelve overlapping cases with both same-sex attraction/gender nonconformity and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (p < 0.0001, by Fisher's exact test). The association was also significant for each sex (p < 0.0001, by Fisher's exact test). There is evidence that thyroid gland and its hormones play a crucial role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the offspring.