Cases Of Hypothyroidism Research Articles

Evaluation of Thyroid functions in Patients with End Stage Renal Disease in a Sample of Egyptian Populations

Abstract Background In most cases, hypothyroidism is not linked to kidney disease. However, hypothyroidism has been shown to hasten the development of chronic kidney disease (CKD). Aim of the Work to evaluate thyroid abnormalities in patients with end stage renal disease in a sample of Egyptian populations. Patients and Methods This study was conducted with 70 Egyptian Patients selected from Nephrology department in Theodor Bilharz Research Institute, in a case control study, they were categorized into 2 groups Group 1: Stage V renal disease group (n = 40): patients with eGFR <15 mL/min with no history of thyroid disease or receiving any thyroid medications. Group 2: Age and sex matched health population group (n = 30): with normal renal function with no history of thyroid disease or receiving any thyroid medications. All subjects underwent full thyroid profile, and estimated GFR. Results Symptoms of thyroid dysfunction were more frequent in end stage group, the difference statistically were significant only in muscle weakness. TSH was statistically significantly higher in cases with hypothyroidism. TGABs were statistically significantly higher in cases with hypothyroidism. Antimicrosomal antibodies recorded only in hypothyroid cases, the differences were statistically significant. FT3, TSH, TGABs and thyroid volume statistically had perfect diagnostic performance in diagnosing hypothyroidism among end stage renal disease group. Conclusion Frequency of hypothyroidism was higher in end stage renal disease patients compared to control group. So, it is important to keep monitoring thyroid functions in patients with advanced renal impairment that may enhance quality of life.

P-617 The investigation of the shared genetic architecture between hypothyroidism and age at menopause

Abstract Study question Is there a shared genetic architecture and a putative causal association between hypothyroidism and age at menopause (AM)? Summary answer There is a genetic correlation and a causal relationship between Hypothyroidism and AM. What is known already Thyroid disease is more common in women. The interplay between thyroid function and the gonadal axes remains interconnected throughout a woman’s reproductive cycle. Notably, the menopausal phase represents a critical period for metabolic alterations, wherein thyroid hormones and metabolic status are intricately intertwined. Study design, size, duration Data from publicly available genome-wide association study (GWAS) summary statistics of hypothyroidism (European-based: 51,194 hypothyroidism cases and 443,383 controls) and AM (European-based: N = 141,926) were used to investigate shared genetic assosiation. Participants/materials, setting, methods Shared genetics between hypothyroidism and AM were explored using linkage disequilibrium score regression, ρ-HESS, cross-trait meta-analysis, colocalization analysis and summary data-based Mendelian randomization, and investigated causal associations using Mendelian randomization. Main results and the role of chance The estimated liability scale of the single nucleotide polymorphisms (SNPs) heritability for AM and hypothyroidism was 13.0% and 5.1%, respectively. A substantial negative genetic association (rg = -0.081, P = 0.0055) was found by bivariate LDSC between hypothyroidism and AM. Local Genetic Correlations identified a strong local signal at 6p21.32-21.33 (chromosome 6: 31571218-32682664) (P = 1.39E-5). Ten important common SNPs were found. Hypothyroidism had a causal effect on AM, but not vice versa. Genetic association between hypothyroidism and AM in blood were enriched in Genotype-Tissue Expression (GTEx) data. In addition, two potentially functional genes, PPM1F and RPL23AP1, were identified to be associated with both hypothyroidism and AM. Limitations, reasons for caution Hypothyroidism encompasses primary and secondary forms, and due to limited data availability, our study could not perform phenotype-specific analyses. Second, even though our research identified genes associated with hypothyroidism and AM, more experimental research and long-term studies are required to fully understand the biological mechanisms underlying the observed genetic relationships. Wider implications of the findings Our study, thorough genome-wide cross-trait analysis, reveals a shared genetic architecture and causal relationship between hypothyroidism and AM. These may open up a new avenue for future research between hypothyroidism and AM. Trial registration number Not applicable

Posterior Reversible Encephalopathy Syndrome After Inadvertent Dural Puncture Vs Bupivacaine-Induced Adverse Drug Reaction: A Case Report

A case involving a 29-year-old female patient with a known case of hypothyroidism at 38 weeks gestation. She developed a fronto-occipital, postural type of headache. This ensued on the second postoperative day after undergoing an unintended dural puncture with the introducer needle during spinal anesthesia for an elective cesarean section. It was initially treated as a post-dural puncture headache until she developed generalized tonic–clonic seizures the next day. Magnetic resonance imaging (MRI) of the brain exhibited features of posterior reversible encephalopathy syndrome (PRES). With anticonvulsants and antibiotics, the neurological symptoms subsided, and the patient was discharged home symptom-free. We call attention to the importance of suspecting PRES in obstetric cases with an inadvertent dural puncture in a normotensive patient. Neuroimaging plays a crucial role in making a diagnosis of headaches, especially during the peripartum period. Lastly, keeping in view, the potential medicolegal implications in such cases, further research seems vital, especially in the Asian population.

A study of the association of lipid ratios with thyroid dysfunction in a tertiary medical college in Eastern India

Background: Thyroid hormones play a crucial role in major metabolic pathways in the body and dyslipidemia is a major metabolic abnormality seen in thyroid disorders. Cardiovascular diseases (CVDs) are now emerging as the leading cause of morbidity and mortality worldwide and the most important risk factor for CVDs is dyslipidemia. The lipid ratios that have a positive association with CVD risk are atherogenic index of plasma (AIP), Castelli’s risk index (CRI)-I and II, and atherogenic coefficient (AC). Clinically, both an excess and deficiency of thyroid hormones can exacerbate or induce CVDs and lipid ratio can be used as an inexpensive marker for predicting CVD risk. Aims and Objectives: This study aims to evaluate the lipid ratios (AIP, CRI-I, CRI-II, AC) in patients with thyroid dysfunction and compare the results with lipid ratios in euthyroid individuals. This study also aims to find any correlation, if exists, between lipid ratios and serum thyroid-stimulating hormone (TSH) levels in thyroid dysfunction. Materials and Methods: The serum TSH and lipid profile were evaluated in fifty euthyroid, fifty hypothyroid, fifty subclinical hypothyroid, and fifty hyperthyroid patients. The lipid ratios (AIP, CRI-I, CRI-II, AC) were calculated from the lipid profile. Results: The mean lipid ratios were higher in hypothyroid, followed by subclinical hypothyroid cases when compared to euthyroid controls and hyperthyroid patients. A positive correlation was observed between the TSH and lipid ratios in euthyroid, hypothyroid, and subclinical hypothyroid subjects. There was no significant correlation between TSH and lipid ratios in hyperthyroid patients. Conclusion: This study demonstrates that the evaluation of lipid ratios along with TSH can provide an effective screening tool to assess the cardiovascular risk in patients with subclinical and overt hypothyroidism, especially in the absence of imaging techniques in resource-limited centers.

Correlations between rheumatoid arthritis severity and thyroid dysfunction: insights from a cohort study on treatment patterns and hypothyroidism prevalence

Thyroid dysfunction may exacerbate the systemic inflammatory condition known as rheumatoid arthritis (RA). In this cross-sectional study, 53 patients' thyroid function tests (Thyroid-Stimulating Hormone (TSH), Free T4, Free T3) and RA activity scores (including the Health Assessment Questionnaire (HAQ) and Disease Activity Score-28 (DAS28)) were correlated with lifestyle variables including smoking, alcohol consumption, and physical activity. Results indicate that TSH levels and RA severity are strongly positively correlated (correlation coefficients: 0.85 for HAQ and 0.89 for DAS28); on the other hand, levels of Free T4 and Free T3 were negatively correlated with RA severity. With just one case of overt hypothyroidism, the bulk of the sample (87%) received a diagnosis of hypothyroidism, most of it subclinical. These results emphasize the need of include thyroid function monitoring into RA treatment plans and imply that lifestyle variables as well as thyroid hormone levels should be taken into account in the all-encompassing care of RA patients.

Identification of southern Taiwan genetic variants in thyroid dyshormonogenesis through whole-exome sequencing.

Thyroid dyshormonogenesis (TDH) is responsible for 15%-25% of congenital hypothyroidism (CH) cases. Pathogenetic variants of this common inherited endocrine disorders vary geographically. Unraveling the genetic underpinnings of TDH is essential for genetic counseling and precise therapeutic strategies. This study aims to identify genetic variants associated with TDH in Southern Taiwan using whole exome sequencing (WES). We included CH patients diagnosed through newborn screening at a tertiary medical center from 2011 to 2022. Permanent TDH was determined based on imaging evidence of bilateral thyroid structure and the requirement for continuous medication beyond 3 years of age. Genomic DNA extracted from blood was used for exome library construction, and pathogenic variants were detected using an in-house algorithm. Of the 876 CH patients reviewed, 121 were classified as permanent, with 47 (40%) confirmed as TDH. WES was conducted for 45 patients, and causative variants were identified in 32 patients (71.1%), including DUOX2 (15 cases), TG (8 cases), TSHR (7 cases), TPO (5 cases), and DUOXA2 (1 case). Recurrent variants included DUOX2 c.3329G>A, TSHR c.1349G>A, TG c.1348delT, and TPO c.2268dupT. We identified four novel variants based on genotype, including TSHR c.1135C>T, TSHR c.1349G>C, TG c.2461delA, and TG c.2459T>A. This study underscores the efficacy of WES in providing definitive molecular diagnoses for TDH. Molecular diagnoses are instrumental in genetic counseling, formulating treatment, and developing management strategies. Future research integrating larger population cohorts is vital to further elucidate the genetic landscape of TDH.

Role of Thyroidinum (sarcode) as an intercurrent remedy in treating various cases of Hypothyroidism

As we all know that Hypothyroidism is going to be increased in 21st century. Homoeopathic sarcode like Thyroidinum can play an important role in treating cases of Hypothyroidism. An observational retrospective study was undertaken to study the impact of Thyroidinum as an intercurrent remedy. I have taken 40 cases for study & evaluated all cases with evidence of laboratory report at the interval of 3 months up to 1 year. In my clinical study I have seen that in various hypothyroid cases it worked very well as an intercurrent remedy with constitutional remedy from lower to higher potency. I got significant result in 31 cases, no result in 9 cases. So, I have found that we can increase our efficacy of result with use of ‘Thyroidinum’ as an intercurrent remedy.

A child with congenital hypothyroidism posted for emergency surgery- anaesthesia challenges

Paediatric cases pose considerable anaesthetic challenges and are more challenging if they are posted for emergency surgeries with associated comorbidities like congenital hypothyroidism. Few reported cases of anaesthesia management of congenital hypothyroid cases are there in the literature. Challenges are due to the difficult airway, associated congenital anomalies and increased sensitivity to anaesthetic drugs. Knowledge of pathophysiology, preoperative optimization and proper selection and planning of anaesthesia techniques are essential for successful anaesthesia management of children with congenital hypothyroidism for emergency surgeries. Congenital hypothyroidism in a child poses significant challenges for anaesthesiologists because of altered physiology, airway anatomy and difficult airway and drug metabolism.

A Study of the Outcomes of a Yoga Prana Vidya (YPV) 7-Day Healing Camp for Health &Wellness Conducted at the YPV Ashram, Sri Ramana Trust in December 2023

Introduction: The integrated and holistic healing protocols of the Yoga Prana vidya (YPV) system have been making significant contributions to people as complementary and alternative therapies to the various mainstream healthcare systems. YPV healing camps are conducted by Competent YPV healers to raise the awareness of people on the need to learn and practice healthy lifestyles for the cure and prevention of diseases. This paper presents the outcomes of one such Health & Wellness camp conducted by a team of 8 YPV healers for a week in December 2023. Method: This is an interventional study with data collected from 27 patients who participated in the camp. Data was collected on selected health parameters before and after the camp ended to know the improvements the patients experienced in this one-week camp. Results: The mean body weight and BMI (Body mass Index) reduced by 1.88 % and 1.66% respectively. Those with diabetes and BP became normal. Patients who had physical pain, mobility, and flexibility issues were greatly relieved and were able to walk normally. Cases of constipation, hypothyroidism, psoriasis, varicose veins, and acne were resolved to return to normal condition. An alcoholic case was successfully de-addicted after 3 days of healing treatment. Improvements were noticed in patients with eye/vision problems. Those who had mental and emotional issues were also found to be calm and peaceful by the end of the camp. Conclusions: It is observed that the patients in this YPV healing camp experienced satisfactory improvements in their health and wellness issues. The team of healers did a dedicated service helping and treating the patients holistically with a combination of exercises, rhythmic breathing protocols, the right diet, and meditations. The patients appreciated and practiced the lifestyle changes needed based on the principles of YPV energy healing system protocols. There is great scope to conduct more such camps in rural and semi-urban areas to disseminate this knowledge to the general population.

Thyroid Function Test: A Screening Tool for Diagnosis of Thyroid Diseases: A One-Year Study Conducted at a District Hospital

Objective: To evaluate the prevalence of abnormalities in thyroid function tests among individuals from Gujrat district seeking evaluation at Aziz Bhatti Shaheed Teaching Hospital in Gujrat. Methodology: All specimens tested for Thyroid Function Tests (TFTs) in the hospital laboratory between January 2023 and December 2023 were included in the study. The results of the thyroid function tests were classified into categories of hypothyroidism and hyperthyroidism based on established criteria. Hypothyroidism was defined as a TSH level above the reference range, typically greater than 4.0 milli-international units per liter (mIU/L). A typical cut-off value for diagnosing hyperthyroidism was a TSH level below the reference range, usually less than 0.4 mIU/L, in conjunction with elevated FT4 and/or T3 levels. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: The mean age of the participants was 35.39 years, The majority of participants were female, accounting for 82.3%, while males constituted 17.7% of the total sample. The most of the cases 62.0% had normal values of thyroid profile, while hypothyroidism cases were found 15.20% and 21.90% cases had hyperthyroidism. Furthermore, the analysis suggests that there is no significant association between types thyroid disorders and age groups (p = 0.156) or gender (p = 0.973). Conclusion: In conclusion, our analysis of thyroid profiles revealed a higher prevalence of thyroid disorder (Hypothyroidism 15.20% and 21.90% hyperthyroidism) according to a one-year data. Moreover, thyroid is not significantly influenced by age and gender. These results underscore the importance of routine thyroid screening to identify and manage thyroid disorders effectively, irrespective of age or gender.

Revealing the genetic complexity of hypothyroidism: integrating complementary association methods.

Hypothyroidism is a common endocrine disorder whose prevalence increases with age. The disease manifests itself when the thyroid gland fails to produce sufficient thyroid hormones. The disorder includes cases of congenital hypothyroidism (CH), but most cases exhibit hormonal feedback dysregulation and destruction of the thyroid gland by autoantibodies. In this study, we sought to identify causal genes for hypothyroidism in large populations. The study used the UK-Biobank (UKB) database, reporting on 13,687 cases of European ancestry. We used GWAS compilation from Open Targets (OT) and tuned protocols focusing on genes and coding regions, along with complementary association methods of PWAS (proteome-based) and TWAS (transcriptome-based). Comparing summary statistics from numerous GWAS revealed a limited number of variants associated with thyroid development. The proteome-wide association study method identified 77 statistically significant genes, half of which are located within the Chr6-MHC locus and are enriched with autoimmunity-related genes. While coding GWAS and PWAS highlighted the centrality of immune-related genes, OT and transcriptome-wide association study mostly identified genes involved in thyroid developmental programs. We used independent populations from Finland (FinnGen) and the Taiwan cohort to validate the PWAS results. The higher prevalence in females relative to males is substantiated as the polygenic risk score prediction of hypothyroidism relied mostly from the female group genetics. Comparing results from OT, TWAS, and PWAS revealed the complementary facets of hypothyroidism's etiology. This study underscores the significance of synthesizing gene-phenotype association methods for this common, intricate disease. We propose that the integration of established association methods enhances interpretability and clinical utility.

An interesting case of hypothyroidism: hypothyroidism with bilateral foot drop

An interesting case of hypothyroidism: hypothyroidism with bilateral foot drop

Efficacy and safety of the combination of tisleizumab with chemoradiotherapy in oligorecurrence esophageal squamous cell carcinoma: A prospective phase II study.

4057 Background: The postoperative recurrence and metastasis rate of esophageal squamous cell carcinoma (ESCC) remains high and prognosis is poor. PD-1 immune checkpoint inhibitors have shown efficacy in targeting advanced esophageal cancer. This phase II study aims to explore the efficacy and safety of concurrent chemoradiotherapy and immunotherapy for ESCC patients with oligometastatic recurrence after radical surgery. Methods: This phase II study enrolled ESCC patients from 3 hospitals in China, diagnosed oligometastatic recurrence after radical surgery. The 1st stage, with 10 patients enrolled, was designed to explore the safety level and the 2nd stage was to explore efficacy. The oligorecurrence is defined as progression occurring three months after the operation with no more than three metastatic regions. The local recurrence was defined as tumor bed or anastomotic recurrence. The regional lymph node recurrences were regarded as mediastinal region and celiac lymph, respectively. The distal recurrences were considered as supraclavicular, retroperitoneal region and other distal organs. All of the positive regional lymph nodes were collectively counted as one lesion if regional lymph node recurrences existed. Tisleizumab was delivered on D1,22. Nab-paclitaxel 150mg/m2 (starting on D2,23) and cisplatin, 75mg/m2(starting on D2-4,22-24) were administered for two cycles. The radiotherapy was delivered with 50.4-60Gy, 1.8-2Gy per fraction. After CRT, patients received Tisleizumab every 3 weeks for 3-6 months and 2-4 cycle consolidation chemotherapy. The primary endpoint was 1-year OS, the second endpoints were 1-year PFS, ORR and toxicities. Results: Between Jan 2021 and May 2023,50 patients were screened for enrolment and 44 patients met the eligibility criteria. The metastatic regions were made up by the local (15.9%),regional (47.7%), distal (13.6%) and mixed recurrence (22.7%). In the 1st stage, one patient had a grade-3 Immune-related erythra out of ten patients. All patients were delivered chemoradiotherapy, 36(81.8%) patients had completed two cycles of immunotherapy. The ORR rate was 84.1%. During concurrent chemoradiotherapy, the incidence of grade≥3 treatment-related adverse events was nausea (9.1%), vomit (4.5%), anorexia (4.5%), leukopenia (13.6%), hepatitis (2.3%), radiation esophagitis (1.4%), erythra (4.5%). There were 5 cases of Immune-related adverse, including 2 cases of erythra, 1 case of hypothyroidism, hepatitis, gastroenteritis, respectively. With the median follow-up time of 19 months (range:4-30 months), 1-year OS and PFS was 83.2% and 79.2%. The median OS and the median PFS were not reached. Conclusions: Concurrent chemoradiotherapy and immunotherapy yielded satisfactory 1-year OS rate and manageable toxicities in oligometastatic recurrence patients with ESCC after radical surgery. Clinical trial information: NCT04821765 .

Association between immunotherapy and hypothyroidism in a Latin American population: An analytical study of cases and controls from 2019 to 2023.

e24135 Background: In different clinical studies worldwide, the use of immunotherapy has been related to the development of hypothyroidism; However, there is no data on this association in Latin American population. Methods: An analytical observational case-control study conducted in a 3-year follow-up cohort at an oncology institute of cancer patients treated with immunotherapy who developed hypothyroidism in Colombia. The aim of the study was to evaluate the development of new hypothyroidism cases after immunotherapy. Cases and controls were randomized in a ratio of 1:3. A multivariate analysis was performed to identify risk factors for developing hypothyroidism and an inferential analysis was performed over time between levothyroxine dose vs TSH levels. Results: 112 patients were included, 57% men and 42% women with a mean age of 63 years. 21% developed hypothyroidism after immunotherapy, while 12% presented with thyrotoxicosis as first alteration and 9% with central hypothyroidism. During the first semester 54% of patients developed hypothyroidism, 84% in the first year and 100% at 2 years . Pembrolizumab and nivolumab were used most frequently with 58% and 29% respectively developing hypothyroidism. The most common underlying pathology was lung cancer with 33% and kidney at 38%. In the multivariate analysis, female were found as a protective factor compared to men (OR:0.10 CI: 0.05-0.63 95% p = 0.02), and the use of pembrolizumab was associated with a higher risk trend, but this result was not statistically significant (OR:2.49 CI: 0.5-2.7 p = 0.2). The average initial dose of levothyroxine was 1.4 mcg/kg, at 3 months of 1.2 mcg/kg and 6 months of 0.82 mcg/kg. Average TSH levels at diagnosis were 23.3, uUI/ml, achieving target values for 100% of patients after 9 months of substitution. After two years of follow-up, patients continued with an average dose of levothyroxine of 0.8 mcg/kg. Conclusions: The incidence of hypothyroidism in our population is similar to that reported worldwide. Male patients who start immunotherapy should have their thyroid profile monitored strictly given that they present a higher risk. Additionally, monthly monitoring of the thyroid profile should be done within the first year. In Latin American population, more conservative initial doses of levothyroxine (1.0 - 1.1 mcg/kg) could be used and titrated.

Management of Hypothyroidism with Ayurveda - A Case Study

Thyroid problems are the most common endocrine disorders seen worldwide. Thyroid gland secretes two hormones, Thyroxine (T4) and Triiodothyronine (T3). TSH plays a major role in controlling the thyroid axis and serves as the most useful physiological marker of Thyroid gland function. Sedentary lifestyle and unhealthy food habits may be considered as a primary reason behind increasing Endocrinological disorders including that of Thyroid gland. Increasing levels of stress and anxiety is also contributing to thyroid disorders as the gland is highly sensitive to stimuli. Many of the Kaphaja Nanatmaja Vikaras are seen as the clinical features of Hypothyroidism viz. Gurugatrata (feeling of heaviness), Alashya (lethargy), Tandra (drowsiness), Atisthoulya (obesity/weight gain), Atinidra (excessive sleep) etc. Hypothyroidism is a clinico-pathological condition affecting multiple systems and require multimodal treatment. The treatment protocol was adopted to counteract the pathophysiology by Shodhana and Shamana Chikitsa. Patient was cured completely with no reoccurrence of symptoms even after 6 months. During subsequent treatments and routine follow-ups, laboratory investigations were done. A case of hypothyroidism was successfully treated with multimodal Ayurvedic medicine, resulting in a rapid and significant recovery.

A rare case of transient central hypothyroidism

A rare case of transient central hypothyroidism

Model-Informed Precision Dosing Using Machine Learning for Levothyroxine in General Practice: Development, Validation and Clinical Simulation Trial.

Levothyroxine is one of the most prescribed drugs in the western world. Dosing is challenging due to high-interindividual differences in effective dosage and the narrow therapeutic window. Model-informed precision dosing (MIPD) using machine learning could assist general practitioners (GPs), but no such models exist for primary care. Furthermore, introduction of decision-support algorithms in healthcare is limited due to the substantial gap between developers and clinicians' perspectives. We report the development, validation, and a clinical simulation trial of the first MIPD application for primary care. Stable maintenance dosage of levothyroxine was the model target. The multiclass model generates predictions for individual patients, for different dosing classes. Random forest was trained and tested on a national primary care database (n = 19,004) with a final weighted AUC across dosing options of 0.71, even in subclinical hypothyroidism. TSH, fT4, weight, and age were most predictive. To assess the safety, feasibility, and clinical impact of MIPD for levothyroxine, we performed clinical simulation studies in GPs and compared MIPD to traditional prescription. Fifty-one GPs selected starting dosages for 20 primary hypothyroidism cases without and then with MIPD 2 weeks later. Overdosage and underdosage were defined as higher and lower than 12.5 μg relative to stable maintenance dosage. MIPD decreased overdosage in number (30.5 to 23.9%, P < 0.01) and magnitude (median 50 to 37.5 μg, P < 0.01) and increased optimal starting dosages (18.3 to 30.2%, P < 0.01). GPs considered lab results more often with MIPD and most would use the model frequently. This study demonstrates the clinical relevance, safety, and effectiveness of MIPD for levothyroxine in primary care.

Current utility of first-line FT4 and TSH in screening for central hypothyroidism.

Thyroid testing strategies vary across laboratories. First-line combined thyroid stimulating hormone (TSH) and freeT4 (FT4) have historically been preferred by many laboratories as this detects individuals with undiagnosed central hypothyroidism who can be missed with a first-line TSH-only strategy. However, an up-to-date evaluation of the utility of this approach is lacking. We investigated the clinical utility of first-line TSH and FT4 in the detection of central hypothyroidism in current day practice. The All-Wales laboratory information system was queried to identify thyroid function tests in patients aged ≥16 years with decreased FT4 and inappropriate TSH (low-FT4). The 1-year incidence of low-FT4 was determined using mid-year population data. Clinical information of patients with low-FT4 was reviewed to determine causes of low-FT4 and the incidence of central hypothyroidism. The incidence of low-FT4 varied according to FT4 assay method (range: 98-301 cases/100,000 population/year). Fifteen new cases of central hypothyroidism were detected in two health boards, equivalent to 2 cases/100,000 population/year. Positive predictive value of low-FT4 for central hypothyroidism was 2%-4%. In a cross-section of primary care patients, low-FT4 was detected in 0.5% of all thyroid tests with assay-related differences in detection rates. Although low-FT4 is a common laboratory finding, the incidence of central hypothyroidism remains rare. With the currently increased rates of thyroid testing and increased use of medications that decrease FT4, low-FT4 has a much lower predictive value for central hypothyroidism than previously reported. Thyroid screening strategies will need to balance the yield from first line TSH and FT4 testing with the cost of investigating individuals with non-pathological laboratory abnormalities.

6301733 The impact of mental health problems on medical comorbidity in pregnancy: a case of overt hypothyroidism

6301733 The impact of mental health problems on medical comorbidity in pregnancy: a case of overt hypothyroidism

Immune Checkpoint Inhibitor Use During Pregnancy and Outcomes in Pregnant Individuals and Newborns

With the widespread use of immune checkpoint inhibitors (ICIs), concerns about their pregnancy outcomes through maternal exposure have emerged, and clinical comparative data are lacking. To assess the risk of pregnancy-, fetal-, and/or newborn-related adverse outcomes associated with exposure to ICIs compared with exposure to other anticancer agents. In this cohort study, all reports mentioning a pregnancy-related condition and an antineoplastic agent (Anatomical Therapeutic Chemical classification group L01) used for a cancer indication registered in the World Health Organization international pharmacovigilance database VigiBase up to June 26, 2022, were extracted. Anticancer agents, including ICIs, used during pregnancy for a cancer indication. Immune checkpoint inhibitors included blockers of programmed cell death 1 (PD1) or its ligand (PD-L1) or cytotoxic T-lymphocyte-associated protein 4 (CTLA4). The main outcome was the reporting odds ratio (ROR) for maternal, fetal, or newborn complications in patients treated with ICIs vs any other anticancer drug. Adverse events, categorized into 45 individual maternofetal adverse outcomes, were directly mapped to Medical Dictionary for Regulatory Activities preferred terms in VigiBase. A total of 3558 reports (ICI: 91 [2.6%]; other anticancer drugs: 3467 [97.4%]) were included in the analysis. In the ICI group, most reports were from the US (60 [65.9%]), and the mean (SD) patient age was 28.9 (10.2) years; in 24 of 55 reports with data on cancer type (43.6%), patients were treated for melanoma. The molecules involved in the ICI group were anti-PD1 (58 reports [63.7%]), anti-PD1 plus anti-CTLA4 (15 [16.5%]), anti-CTLA4 (13 [14.3%]), anti-PD-L1 (4 [4.4%]), and anti-PD1 plus anti-lymphocyte activation gene 3 (1 [1.1%]). An ICI was used in combination with a non-ICI anticancer agent in 10 participants (11.0%). Compared with other anticancer drugs, none of the 45 adverse outcomes identified were overreported in the group exposed to ICIs. However, preterm birth was significantly overreported for the anti-PD1 plus anti-CTLA4 combination compared with other anticancer drugs (12 of 15 [80.0%] vs 793 of 3452 [23.0%]; ROR, 13.87; 95% CI, 3.90-49.28; P < .001) but not for anti-PD-L1 or anti-CTLA4 monotherapy. Three reports of possibly immune-related maternofetal events were identified: 1 case of maternal antiphospholipid syndrome leading to spontaneous abortion, 1 case of pneumonitis leading to neonatal respiratory distress syndrome and death, and 1 case of transient congenital hypothyroidism. In this cohort study of 91 individuals exposed to ICIs during pregnancy, ICI exposure was not associated with overreporting of specific adverse pregnancy, fetal, and/or newborn outcomes compared with other anticancer treatments. However, due to possible rare immune-related neonatal adverse events, ICI use in pregnant women should be avoided when possible, especially the anti-PD1 plus anti-CTLA4 combination.