Hyperthyroid Women Research Articles

Subclinical Hyperthyroidism Enhances Gonadotropin-Lowering Effects of Metformin in Postmenopausal Women.

Metformin treatment decreases elevated concentrations of anterior pituitary hormones. The aim of this prospective, cohort study was to investigate whether hyperthyroidism modulates the impact of metformin on gonadotroph secretory function. The study population included 48 postmenopausal women with untreated type 2 diabetes or prediabetes, 24 of whom had coexisting grade 1 subclinical hyperthyroidism. Both groups were matched for age, insulin sensitivity, and gonadotropin levels. Over the entire study period, all participants were treated with metformin (2.55-3 g daily). Plasma glucose, insulin, thyroid-stimulating hormone (TSH), total and free thyroid hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, adrenocorticotropic hormone (ACTH), and insulin-like growth factor-1 (IGF-1) were assayed at entry and 6 months later. At baseline, the study groups differed in levels of TSH and thyroid hormones but not in body mass index, blood pressure, glucose homeostasis markers (fasting glucose, homeostatic model assessment 1 of insulin resistance ratio [HOMA1-IR], and glycated hemoglobin [HbA1c]), and the remaining hormones. There were no differences between both groups in the degree of reduction in plasma glucose and HbA1c in response to metformin treatment. Although metformin decreased HOMA1-IR in both groups, this effect was stronger in women with hyperthyroidism than with normal thyroid function (-50 ± 20% vs -30 ± 15%). Similar relationships were observed for FSH (-43 ± 21% vs -21 ± 12%). Only in hyperthyroid women did the drug reduce LH concentration (by 35 ± 17%). Metformin did not affect circulating levels of TSH, total and free thyroxine, total and free triiodothyronine, estradiol, prolactin, ACTH, and IGF-1. The obtained results indicate that hyperthyroidism enhances the gonadotropin-lowering effects of metformin, as well as the fact that this agent has a neutral effect on the hypothalamic-pituitary-thyroid axis in case of its overactivity.

Prevalence of Hypothyroidism and Hyperthyroidism in Women of Reproductive Ages in Kabul

Introduction: The association of sex steroids with cancer cell proliferation has been reported in recent studies; however, the findings are still controversial. The present study aimed to determine the cytotoxic effects of progesterone and testosterone on colon cancer (SW480) cells and to evaluate the expression levels of Bcl-2 and Bax genes in SW480 cells. Materials and Methods: The SW480 cell line was divided into a control group (untreated) and groups treated with 125, 250, 500, and 1000 μg/mL of testosterone and progesterone. Cell viability was quantified by the MTT assay. qRT-PCR was performed to evaluate gene expression levels. Flow cytometry was used to assess the apoptosis in cancer cells. Data were analyzed using the student's t-test and ANOVA. Results: The expression level of the Bax gene significantly decreased in SW480 cells exposed to a cytotoxic dose of progesterone. Moreover, the expression level of the Bax gene significantly increased in the SW480 cells exposed to a cytotoxic dose of testosterone. Conclusion: The results of the present study showed that testosterone might affect the apoptosis of colon cancer cells at low concentrations. Studies have shown that progesterone can induce tumor cell death in cancer cells. Accordingly, the clinical use of testosterone and progesterone therapy for cancer treatment is highly controversial.

Hypothyroidism and hyperthyroidism related to gynecologic cancers: a nationwide population-based cohort study

The purpose of this study was to assess the risks of hyperthyroidism and hypothyroidism related to gynecological cancers. Population-based retrospective cohort study. We conducted a cohort study using the Taiwan National Health Insurance Research Database to explore hyperthyroidism and hypothyroidism associated with site-specific gynecologic cancers in women from January 1, 2000 to December 31, 2018. The examined gynecologic cancers included endometrial (EC), uterine corpus cancer (UC), and ovarian cancer (OC). The incidence and hazard ratios were quantified using Cox proportional hazards models. The incidence of developing gynecological (Gyn) cancers in the hyperthyroid and hypothyroid women was 0.29 and 0.44 per 1000 person-years, which was 0.86 fold lower and 1.13 fold higher than that in the comparison cohort (p < 0.001). Compared with patients aged 20–40 years, patients in older age groups had a lower and higher risk of developing Gyn cancers (for hyperthyroid, 40–65 years: adjusted hazard ratio (aHR) = 0.82; > 65 years: aHR = 0.94; for hypothyroid, adjusted hazard ratio (aHR) = 1.26; > 65 years: aHR = 1.38). Compared with the non-hypothyroid women and non-hyperthyroid women beyond 6 years of follow-up, hypothyroid and hyperthyroid women showed decreased risk of Gyn cancers. Medication treatment for hyperthyroid and hypothyroid disease did not showed significant association in subgroup analyses (aHR = 0.99 and 0.80, respectively). Our results show that women with hyperthyroidism have a significantly reduced risk of gynecological cancers, whereas women with hypothyroidism have a slightly increased risk of gynecological cancers suggesting an association between thyroid function level and risk of gynecological cancers.

TPO Gene Expression in Relation with Promoter SNPs in Iraqi Patients with Hyperthyroidism

Background: Thyroid peroxidase (TPO) gene mutations are one of the most common causes of thyroid disorders. Objective: To investigate the effect of genetic polymorphisms in the TPO promoter region on gene expression in early-diagnosed hyperthyroid patients. Methods: Genomic DNA was extracted from 100 blood samples (75 hyperthyroid patients and 25 healthy controls), then the TPO promoter region was amplified and sequenced for genotyping rs2071399, rs2071400, and rs2071403 SNPs. Total RNA was also isolated, and cDNA synthesis was performed to determine quantitatively the expression of TPO by using qPCR. The level of TPO antibodies in serum was determined by using an enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of hyperthyroidism in women was significantly higher than in men, as were serum levels of TPO-Abs. There was a significant increase in serum TPO-Abs in hyperthyroid patients (235.29 IU/ml) compared with healthy controls. Genotypes of three SNPs (rs2071399 G/A, rs2071400 C/T, and rs2071403 A/G) in the TPO promoter region were TPO rs2071399 AG and GG, and rs2071400 CT and TT genotypes were more frequent in hyperthyroid patients. There are no significant differences between rs2071403 polymorphic and non-polymorphic genotypes among hyperthyroid patients and healthy controls. The rs2071399 G/A and rs2071400 C/T gene promoter polymorphism significantly down-regulated constitutive TPO gene expression in hyperthyroid patients, but rs2071403 A/G has no major effect on gene expression. Conclusion: There was an association between the mutation in the promoter region of TPO and the incidence of hyperthyroidism.

The Influence of Thyroid Hormones on Levels of Lipid Profile and Adipokine in Iraqi Women with Thyroid Disorders

Hypothyroidism and hyperthyroidism are prevalent endocrine diseases.These have significant implications for lipid synthesis, mobilization, and metabolism. Retinol-binding protein 4 is a new adipokine implicated in some physiological and pathological processes, such as metabolic and endocrine disorders. Its elevation aids in the diagnosis of thyroid problems. The present study includes 60 women with thyroid diseases; 30 of them have hypothyroidism and 30 have hyperthyroidism. This study includes 20 healthy women as a control group. For each participant anthropometric, biochemical Thyroid-stimulating hormone, triiodothyronine, Thyroxine, lipid profile, and retinol binding protein-4 are measured. The results show that hypothyroid women have significantly higher levels of total cholesterol, triglycerides, and lowdensity lipoprotein cholesterol as compared to the hyperthyroid or control group. The serum of total cholesterol, triglycerides, and low-density lipoprotein cholesterol are significantly lower in hyperthyroid women compared to the hypothyroid or control group. In addition, there are no significant differences in blood high-density lipoprotein cholesterol concentrations among the three groups. Furthermore, serum retinolbinding protein-4 levels were higher in the hyperthyroid group compared to the hypothyroid or control groups. According to the findings of this study, hypothyroidism causes dyslipidemia, which raises the risk of cardiovascular disease while hyperthyroidism causes abnormalities in lipid profiles. Additionally, hyperthyroidism causes an increase in serum retinol-binding protein-4 levels in the blood.

HYPERTHYROIDISM SECONDARY TO GESTATIONAL TROPHOBLASTIC DISEASE : A LITERATURE REVIEW

Gestational trophoblastic disease (GTD) is a rare form of pregnancy-related cancer that is effectively treatable. GTD is accompanied by the potentially fatal complication of hyperthyroidism. We created a review consisting of five case reports. This case report was conducted on women who became pregnant when they were &gt;35 years old. They showed consistent laboratory results, in which there was an increase in hCG levels. TSH and thyroid stimulating antibodies cannot account for the hyperthyroidism associated with GTD. The source of the thyroid stimulating agent is trophoblastic tissue. The thyrotropic effects of ?-hCG mediate GTD hyperthyroidism. Other research examined the prevalence of hyperthyroidism in women with normal pregnancy, hydatidiform mole, and choriocarcinoma who had ?-hCG serum levels below 100,000 IU/ml. Early prenatal screening may significantly reduce hyperthyroidism rates. Thyroid hormone synthesis inhibitors treat hyperthyroidism in pregnancy. Thioamides, propylthiouracil (PTU), and methimazole (MMI) are the most prevalent U.S. antithyroid medications (ATD). Plasmaphoresis may be an option for people who are resistant to therapy or need emergency surgery. GTD can cause fatal hyperthyroidism. Anti-thyroid medicines can handle most GTD hyperthyroidism. Surgery may be a possibility for patients refractory to medical treatment.

Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study.

Optimal thyroid status in pregnancy is essential in reducing the risk of adverse outcomes. The management of hyperthyroidism in women of reproductive age poses unique challenges and it is unclear how preconception treatment strategies impact on thyroid status in subsequent pregnancy. We aimed to determine trends in the management of hyperthyroidism before and during pregnancy and to assess the impact of different preconception treatment strategies on maternal thyroid status. We utilized the Clinical Practice Research Datalink database to evaluate all females aged 15-45 years with a clinical diagnosis of hyperthyroidism and a subsequent pregnancy (January 2000 to December 2017). We compared thyroid status in pregnancy according to preconception treatment, namely, (1) antithyroid drugs up to or beyond pregnancy onset, (2) definitive treatment with thyroidectomy or radioiodine before pregnancy, and (3) no treatment at pregnancy onset. Our study cohort comprised 4712 pregnancies. Thyrotropin (TSH) was measured in only 53.1% of pregnancies, of which 28.1% showed suboptimal thyroid status (TSH >4.0 mU/L or TSH <0.1 mU/L plus FT4 >reference range). Pregnancies with prior definitive treatment were more likely to have suboptimal thyroid status compared with pregnancies starting during antithyroid drug treatment (odds ratio 4.72, 95% CI 3.50-6.36). A steady decline in the use of definitive treatment before pregnancy was observed from 2000 to 2017. One-third (32.6%) of first trimester carbimazole-exposed pregnancies were switched to propylthiouracil while 6.0% of propylthiouracil-exposed pregnancies switched to carbimazole. The management of women with hyperthyroidism who become pregnant is suboptimal, particularly in those with preconception definitive treatment, and needs urgent improvement. Better thyroid monitoring and prenatal counseling are needed to optimize thyroid status, reduce teratogenic drug exposure, and ultimately reduce the risk of adverse pregnancy outcomes.

Hyperthyroidism in pregnancy: design and methodology of a Danish multicenter study

BackgroundGraves’ disease (GD) is the main cause of hyperthyroidism in women of the fertile age. In pregnant women, the disease should be carefully managed and controlled to prevent maternal and fetal complications. Observational studies provide evidence of the adverse effects of untreated hyperthyroidism in pregnancy and have in more recent years substantiated a risk of teratogenic side effects with the use of antithyroid drugs (ATDs). These findings have challenged the clinical recommendations regarding the choice of treatment when patients become pregnant. To extend observational findings and support future clinical practice, a systematic collection of detailed clinical data in and around pregnancy is needed.MethodsWith the aim of collecting clinical and biochemical data, a Danish multicenter study entitled ‘Pregnancy Investigations on Thyroid Disease’ (PRETHYR) was initiated in 2021. We here describe the design and methodology of the first study part of PRETHYR. This part focuses on maternal hyperthyroidism and recruits female patients in Denmark with a past or present diagnosis of GD, who become pregnant, as well as women who are treated with ATDs in the pregnancy, irrespective of the underlying etiology. The women are included during clinical management from endocrine hospital departments in Denmark, and study participation includes patient questionnaires in pregnancy and postpartum as well as review of medical records from the mother and the child.ResultsData collection was initiated on November 1, 2021 and covered all five Danish Regions from March 1, 2022. Consecutive study inclusion will continue, and we here report the first status of inclusion. As of November 1, 2022, a total of 62 women have been included in median pregnancy week 19 (interquartile range (IQR): 10–27) with a median maternal age of 31.4 years (IQR: 28.5–35.1). At inclusion, 26 women (41.9%) reported current use of thyroid medication; ATDs (n = 14), Levothyroxine (n = 12).ConclusionThis report describes a newly established systematic and nationwide collection of detailed clinical data on pregnant women with hyperthyroidism and their offspring. Considering the course and relatively low prevalence of GD in pregnant women, such nationwide design is essential to establish a sufficiently large cohort.

Helicobacter pylori infection increase the risk of subclinical hyperthyroidism in middle-aged and elderly women independent of dietary factors: Results from the Tianjin chronic low-grade systemic inflammation and health cohort study in China.

Prospective studies on the association between Helicobacter pylori (H. pylori) infection and subclinical hyperthyroidism are limited. We, therefore, designed a large-scale cohort study to explore the association between H. pylori infection and the risk of subclinical hyperthyroidism in women. This prospective cohort study investigated 2,713 participants. H. pylori infection was diagnosed with the carbon 13 breath test. Subclinical hyperthyroidism was defined as serum thyroid-stimulating hormone levels are low or undetectable but free thyroxine and tri-iodothyronine concentrations are normal. Propensity score matching (PSM) analyses and Cox proportional hazards regression models were used to estimate the association between H. pylori infection and subclinical hyperthyroidism. A total of 1,025 PS-matched pairs of H. pylori infection women were generated after PSM. During 6 years of follow-up, the incidence rate of subclinical hyperthyroidism was 7.35/1,000 person-years. After adjusting potential confounding factors (including iodine intake in food and three main dietary patterns score), the multivariable hazard ratio (HR; 95% confidence intervals) of subclinical hyperthyroidism by H. pylori infection was 2.49 (1.36, 4.56). Stratified analyses suggested a potential effect modification by age, the multivariable HR (95% confidence intervals) was 2.85 (1.45, 5.61) in participants aged ≥ 40 years and 0.70 (0.08, 6.00) in participants aged < 40 years (P for interaction = 0.048). Our prospective study first indicates that H. pylori infection is significantly associated with the risk of subclinical hyperthyroidism independent of dietary factors among Chinese women, especially in middle-aged and older individuals.Clinical Trial Registration:https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000031137, identifier UMIN000027174.

W-Compound can be used as a Biomarker for Fetal Thyroid Function and a Potential Tool for Screening Congenital Hypothyroidism

Sulfoconjugation is the major pathway for thyroid hormone (TH) metabolism, converting T4 to inactive metabolites, T4S, rT3S, and T3S in fetus, via sulfotransferases (SULT) and type 3 deiodinase in gestation. Consistent with high production rate of T4S and rT3S, there are high serum sulfated iodothyronine analogs, including T4S, T3S, rT3S, and 3,3’-T2S (T2S), in ovine and human fetal and preterm infants. Fetal TH metabolic pathways predict T2S as the major TH metabolite in the fetus. Since maternal T2S appears to be quantitatively derived from fetal T3 (the active TH), the amount of T2S in the maternal compartment correlates with fetal thyroid function in sheep. In humans, maternal serum contains high levels of radioimmunoassayable T2S; however, it displays as a peak adjacent to but unidentical to synthetic T2S on HLPC and we named it the W-Compound. Levels of W-Compound increase during pregnancy and peak as high as 20-fold to that of nonpregnant women. Maternal serum levels of W-Compound significantly correlate with fetal T4 and W-compound concentrations but not maternal serum T4 in euthyroid or hyperthyroid women, showing a distinct difference between fetal and maternal in TH metabolism. Fetal T2S is actively transferred to the mother via placenta and the quantity of T2S or its metabolite (W-Compound) in maternal compartment reflects fetal thyroid function. Thus, maternal serum W-Compound may be a biomarker for monitoring fetal thyroid function in utero, although more investigations are needed to determine if it can be used as an alternative strategy for screening/managing congenital hypothyroidism due to dysregulated thyroid hormone metabolism.

TSH Receptor Antibody Testing in Early Pregnancy.

Graves disease (GD) is the leading cause of hyperthyroidism in women of childbearing age, and thus, low serum thyrotropin (TSH) during pregnancy might be expected to be largely secondary to GD. This is not the case for 2 reasons. First, autoimmunity frequently abates during pregnancy, including thyroid-specific autoimmunity (1), so that even those with previously diagnosed GD may go into remission during pregnancy. Second, the physiology of thyroid hormone regulation is altered as a result of the agonist activity of β-human chorionic gonadotropin (βhCG) at the TSH receptor (2). Under normal conditions this leads to a slight increase in thyroid hormone production, which is independent of pituitary TSH secretion. Serum TSH levels fall, resulting in a left shift of the TSH reference range in pregnancy, and a lower limit of 0.1 mU/L in most assays (3). In early pregnancy especially, elevations of serum βhCG above those typically seen can cause a further rise in serum free thyroxine and more dramatic suppression of the serum TSH, resulting in “gestational transient thyrotoxicosis” (GTT) (3). This is typically mild and resolves after the first trimester, and is not associated with adverse pregnancy outcomes (4). The very high levels of βhCG found in hyperemesis gravidarum are associated with more severe biochemical thyrotoxicosis, and extremely high levels seen with molar pregnancy and choriocarcinoma can require antithyroid drug therapy and other measures to mitigate thyrotoxicosis. Indeed, persistent thyrotoxicosis during pregnancy from any cause, especially GD, has been associated with poor outcomes including fetal loss, maternal heart failure, and preeclampsia (5).

Congenital Hypothyroidism and Hyperthyroidism Alters Adrenal Gene Expression, Development, and Function.

Background: The human adrenal cortex undergoes several rapid remodeling steps during its lifetime. In rodents, similar remodeling occurs postnatally in the "X-zone" layer through unknown mechanisms. Furthermore, little is known regarding the impact of thyroid hormone (TH) on adrenal glands in humans. Methods: To investigate the impact of TH on adrenal pathophysiology, we created two genetic murine models mimicking human nonautoimmune hypothyroidism and hyperthyroidism. Moreover, we analyzed serum thyrotropin (TSH) and steroid hormone concentrations in patients diagnosed with congenital hypothyroidism and premature adrenarche (PA). Results: We found that TH receptor beta-mediated hypertrophy of the X-zone significantly elevated the adrenal weights of hyperthyroid women. In the hypothyroid model, the X-zone was poorly developed in both sexes. Moreover, large reciprocal changes in the expression levels of genes that regulate adrenal cortical function were observed with both models. Unexpectedly, up- and downregulation of several genes involved in catecholamine synthesis were detected in the adrenal glands of the hypothyroid and hyperthyroid models, respectively. Furthermore, TSH and adrenal steroid concentrations correlated positively in pediatric patients with congenital hypothyroidism and PA. Conclusions: Our results revealed that congenital hypothyroidism and hyperthyroidism functionally affect adrenal gland development and related steroidogenic activity, as well as the adrenal medulla.

MANAGEMENT OF THYROTOXICOSIS IN PREGNANCY

Background: Autoimmune GD (Graves' Disease) is the most common cause of hyperthyroidism in women of childbearing age. To prevent maternal and fetal complications, thyrotoxicosis during pregnancy should be adequately managed and controlled. The physiological adaptations associated with pregnancy challenge the assessment of thyroid function in pregnant women, and the treatment with antithyroid drugs (ATD) raises concerns for the pregnant woman and the fetus. Our aim of this study was to discuss the effect of hyperthyroidism on pregnancy, different methods of diagnosis of hyperthyroidism and treatment of hyperthyroidism during pregnancy for a favorable maternal health and fetal outcome. Objective: To discuss thyrotoxicosis this affects the pregnant woman and the effect of hyperthyroidism on pregnancy. It is to discuss different methods of diagnosis of hyperthyroidism during pregnancy. Also it is to study the treatment of hyperthyroidism and thyrotoxicosis during pregnancy for a favorable maternal health and fetal outcome. Patients and Methods: A prospective randomized clinical study that was conducted on 20 pregnant female patients with thyrotoxicosis in different stages of pregnancy attending Bab-El Shaaria and El-Hussein University Hospitals through the period from April (2020) to December (2020). The selected patients received one of the two main medications which are propyl-thiouracil (PTU) and methimazole (MMI). Propylthiouracil was given in the 1st trimester and Methimazole was given in 2nd and 3rd trimester. Results: There was statistically significant difference found between pretreatment and post treatment groups regarding Heat Intolerance, Palpitations, Tremors, and Irritability, while there was no statistically significant difference found between Pretreatment and Post treatment regarding Exophthalmos. Methimazole (MMI) is preferred to propyl-thiouracil (PTU) after the first trimester because PTU has an association with hepatotoxicity. However, PTU is recommended for the first trimester of pregnancy because its teratogenic effects are considered less severe than those of MMI. Conclusion: Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be meticulously implemented to provide best care to pregnant woman and prevent any adverse effects. Thyrotoxicosis of pregnancy can present unique diagnostic challenges and, if untreated, is associated with increased risks of adverse maternal, fetal, and neonatal complications. The clinical presentation, serum thyroid function test results, and serum TRAb titers can help differentiate the etiology of thyrotoxicosis. However, assessment and monitoring with serum thyroid function tests can be difficult, as there is significant overlap between test results arising from normal pregnancy physiology and intrinsic hyperthyroidism.

Показатель качества трабекулярной костной ткани и оценка вертебральных переломов у португальских пременопаузальных женщин с гипертиреозом

Гипертиреоз является фактором риска снижения минеральной плотности костной ткани (МПКТ) и возникновения остеопоротических переломов. Оценка вертебральных переломов (ОВП) помогает диагностировать вертебральный перелом, а показатель качества трабекулярной костной ткани (ТКТ) — оценить костную микроархитектуру. Мы поставили себе цель оценить влияние гипертиреоза на МПКТ, состав мягких тканей тела, частоту «немых» (невыявленных) вертебральных переломов и ТКТ. 80 пременопаузальных португальских женщин были распределены в группу пациентов с подтвержденным гипертиреозом (n = 40) и контрольную группу (n = 40). МПКТ (г/см2) поясничного отдела позвоночника, бедренной кости, 33 % лучевой кости, всего скелета исследовали с помощью двухэнергетической рентгеновской абсорбциометрии (ДРА) с учетом массы тела (кг) пациентов. ОВП применялась для диагностики переломов, которые впоследствии классифицировали с применением полуколичественного метода Женанта и подтверждали с помощью рентгенографии. Показатель ТКТ получали с помощью ДРА поясничного отдела позвоночника. Ни один пациент ранее не получал лечения по поводу гипертиреоза, остеопороза или пониженной костной массы (остеопении). Полученные результаты подтверждались статистическими подсчетами. В группе пациентов с гипертиреозом средняя МПКТ (МПКТ бедренной кости, шейки бедренной кости, всего скелета), общая обезжиренная масса и ТКТ были достоверно ниже, чем в контрольной группе; согласно классификации Международной ассоциации клинической денситометрии (ISCD), отмечалась тенденция к большей частоте снижения МПКТ; количество вертебральных переломов также достоверно возрастало. Эти результаты свидетельствуют о том, что в группе пременопаузальных женщин с гипертиреозом показатели МПКТ, обезжиренной массы и ТКТ являются достоверно более низкими. Частота «немых» вертебральных переломов также достоверно выше.

Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug.

Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (<6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%); 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in T3; (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively; FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3; (d) no fetal birth defects were recorded; one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy.

Polymorphism of Thyroid Hormones Receptor, Angiotensin-Converting Enzyme, and High Blood Pressure in Childbearing Age Women with Hyperthyroidism

AIM: This study aimed to investigate the association between two polymorphisms of thyroid hormone receptor and renin-angiotensin system (THRA C/T and angiotensin-converting enzyme (ACE) I/D) genes with hypertension in childbearing age women with hypertension. METHODS: This was a case–control study including 35 cases and 40 matched control subjects. The case group was hyperthyroid women with hypertension while the control group was hyperthyroid women with normotension. The polymorphisms were identified by a classical polymerase chain reaction. RESULTS: The THRA C/T gene and ACE I/D polymorphisms were not associated with the hypertension while the genotype frequencies in hyperthyroid women with hypertension were as follows: CC genotype was 25.71%, CT genotype was 54.29%, and TT genotype was 20.00%. The ACE I/D genotype frequencies in hyperthyroid women with hypertension were as follows: II genotype was 23.53%, whereas in hyperthyroid women without hypertension, the I/D genotype frequencies were CC: 7.50%, CT: 72.50%, and TT: 20.00%. There were no differences in age, thyroid-stimulating hormone, FT4, systolic blood pressure (SBP), diastolic BP between subgroups in ACE I/D, and at THRA rs-939348. There was a significant difference in the levels of FT4 concentrations in THRA rs-939348. Hypertension groups have higher SBP than controls. Genotype II had higher SBP but it was not statistically significant, while individuals with allele I had SBP higher than D allele. CONCLUSIONS: The I allele of the ACE gene is involved in susceptibility to hypertension and polymorphism in THRA increasing concentration of FT4. There was no statistically significant difference in blood pressure between hyperthyroid women with or without hypertension.

Abstract #1004259: An Unusual Case Of Severe Hypokalemic Periodic Paralysis

Thyrotoxic Periodic Paralysis (TPP) is a disorder characterized by abrupt onset of hypokalemia and typically lower extremity paralysis secondary to thyrotoxicosis. Despite a higher incidence of hyperthyroidism in women, over 95 percent of TPP cases occur in men, with onset between 20-40 years of age. TPP has been most widely reported in Asian populations, in which the incidence among patients with hyperthyroidism is 2 percent. In non-Asian populations, this incidence is 0.1-0.2 percent.

Bone Microarchitectural Changes in Hyperthyroid Women Compared to a Normal Canadian Cohort

Thyroid hormones play a critical role in bone physiology during childhood, but also impacts adult bone metabolism. Hyperthyroidism promotes accelerated bone turnover and bone remodelling which is associated with net loss of bone mineral density over time (BMD) and these changes have been quantitated using the gold standard of measuring BMD, Dual Energy X-ray Absorptiometry (DEXA). Ordinarily, biochemical thyroid hormone normalization restores BMD towards normal, yet an increased risk of fractures remains lifelong. DEXA, therefore, cannot explain the underlying etiology for fracture risk which may be due to undetected changes in bone microarchitecture. Our primary objective was to utilize an investigational 3-dimensional bone imaging technology, High Resolution peripheral Quantitative Tomography (HR-pQCT), to study bone microarchitecture in actively hyperthyroid women to determine if there are changes in cortical and trabecular bone microarchitecture from that of age-matched controls. A subset of women were rescanned using HR-pCT after thyroid hormones had been normalized for at least 6 months to determine if there were cortical/trabecular architectural changes that reversed towards normal in these individual cases.We enrolled 20 hyperthyroid women (age 20–76) for this pilot study who had persistent TSH suppression for >3 months (TSH< 0.5, normal range: 0.5–4.49 mU/L) without secondary causes for bone loss. Their etiology was divided amongst TSH suppression for thyroid carcinoma, Grave’s disease and iatrogenic hyperthyroidism. HR-pQCT scans of the radius were compared to age-matched scans of normal females, available from the robust Canadian Multicentre Osteoporosis Study (CaMOS) control cohort. Four participants were re-scanned after 6 months of TSH normalization to assess reversibility. The observed data showed statistically significant differences in key parameters of bone microarchitecture in hyperthyroidism, independent of etiology. We observed decreased cortical thickness and increased failure load as statistically different from age-matched controls. Increases in cortical bone porosity and decreases in volumetric bone density (cortical, trabecular and total) were notable but did not reach significance in this small study. Repeat scans following normalization of thyroid hormone levels revealed consistent (partial, nonsignificant) normalization of multiple bone microarchitecture elements including increased trabecular number/thickness, and decreased cortical porosity. These findings suggest that there are changes in both cortical and trabecular bone during active hyperthyroidism that may contribute to increased lifelong fracture risk.

Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa

The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) wer...

Prevalence of Suspected Cases of Hyperthyroidism in Jeddah by Using Wayne's Scoring Index.

IntroductionHyperthyroidism is one of the primary dysfunctional thyroid diseases that results from abnormally high thyroid hormone secretion. It leads to metabolic derangement that manifests as heightened vital functions and metabolism and hyperdynamic blood circulation. Hyperthyroidism jeopardizes one’s quality of life and hampers the patient’s job performance. The disease is chronic but diagnosable and treatable and can be kept under control medically. We aimed to estimate the prevalence of suspected hyperthyroidism cases among a population sample in Jeddah city by using Wayne’s scoring and delineation of factors associated with the disease.Materials and methodsA cross-sectional study design was used. A total of 346 participants were conveniently selected from two shopping malls in Jeddah city during a five-day health awareness campaign. The data were collected by certified physicians, according to Wayne’s score inventory.ResultsThe study included 194 women (56.1%) and 152 men (43.9%). The participants’ ages ranged from 16 to 56 years. The Wayne’s scores showed 80.6% were euthyroid, 18.2% equivocal, and 1.2% have hyperthyroidism. Bronchial asthma was significantly associated with hyperthyroidism in men, while obesity was significantly associated with hyperthyroidism in women. Age, gender, level of education, and family history of chronic diseases, including thyroid disorders, were not significantly associated with hyperthyroidism.ConclusionsWayne’s scoring for hyperthyroidism, which is a noninvasive tool, in addition to its detection of hyperthyroidism cases, can predict patients with equivocal results or those that might be subclinical for further medical assessment and follow-up. A Wayne’s score can give the results of hyperthyroidism comparable to the results obtained by biochemical investigations. This tool is not in common use, but it is quite useful and should be put into broader usage.