Hypothyroidism Disease Research Articles

Hypo vs. hyperthyroid eye disease: is there any difference?

BackgroundThyroid-eye disease (TED) is the most common extra-thyroidal presentation of graves’ disease. We performed this study to compare clinical characteristics of TED in hypothyroid vs. hyperthyroid patients.MethodsThis was a retrospective analytical cross-sectional study in which we compared demographics, severity (EUGOGO classification) and activity (clinical activity score) of TED, thyroid disease duration, TED duration and clinical signs between hypothyroid eye disease (Ho-TED) and hyperthyroid eye disease (Hr-TED). To minimize the effect of selection bias and potential confounders, 1:1 propensity score matching (PSM) was also performed.ResultsThree hundred and seventy-four patients (341 Hr-TED and 33 Ho-TED) with a female to male ratio of 1.4:1 were identified in our study. Female to male ratio was 1.3:1 in hyperthyroid and 4.5:1 in hypothyroid group (P = 0.005). The duration of thyroid disease was longer in Ho-TED (P = 0.002) while the duration of eye disease was not significantly different between the Hr-TED (mean = 24.33 ± 41.69, median = 8) and Ho-TED (mean = 19.06 ± 33.60, median = 12) (P = 0.923). Most of the patients in hypothyroid group developed eye involvement after thyroid disease (80.0% in hypo vs. 48.1% in hyper, P = 0.003). Severity (P = 0.13) and activity (P = 0.11) was not different between Hr-TED and Ho-TED patients. After PSM analysis, no clinical characteristics were significantly different between the two groups (P > 0.05).ConclusionThe results of our study showed several differences between the Hr/Ho TED patients including sex, duration of thyroid disease and pattern of eye involvement. After matching the two groups with statistical methods, no clinical characteristics were different between Hr-TED and Ho-TED patients.

Socio-economic coordinates and morbidity profile of the inhabitants of a peri-urban area of Srinagar district of Jammu and Kashmir India: a cross sectional study

Background: The present study was planned to find out socio-economic coordinates and morbidity profile of the inhabitants of a peri-urban area of Srinagar district- urban field practice area of Sher-i-Kashmir Institute of Medical Sciences (SKIMS). Methods: A cross-sectional community-based house to house study of Anchar area (peri-urban) was conducted for a period of six months. Out of six localities/mohallas of anchar, three localities/mohallas representing the core area and comprising the major chunk of population were purposively selected for the study. All the households of the selected localities were included in the study. Results: The inhabitants of area are moderately positioned on socio-economic scale. The area lacks an adequate liquid waste disposal system. The prevalence of tobacco use was found to be 30.61%. 10.94% of the total population was found to be morbid. Most common morbidities found were hypertension (5.15%) followed by diabetes (1.41%), hypothyroidism (1.23%) and cardiovascular disease (0.82%). Conclusions: Life style diseases are preponderate among the study population. Sustained and regular health check-ups ought to be carried out with a special focus on awareness and education.

LOSS OF EPITHELIAL DUOX2 SIGNALING IS ACCOMPANIED BY A REDUCTION IN AKKERMANSIACEAE AND PROMOTES THE DEVELOPMENT OF METABOLIC SYNDROME IN A MICROBIOME-DEPENDENT MANNER

Abstract BACKGROUND Dysbiosis, an imbalance in microbial composition or function, is a key player in the development of conditions associated with chronic inflammation. The gut epithelium regulates host-microbiome dynamics through a variety of mechanisms, including the release of reactive oxygen species by NADPH oxidases. Dual oxidase 2 (DUOX2) is an antimicrobial NADPH oxidase expressed in the thyroid gland and gut epithelium and its activity is associated with dysbiosis. Loss of function mutations in DUOX2 are linked to the development of metabolic and inflammatory conditions such as congenital hypothyroidism and inflammatory bowel disease. Metabolic syndrome (MetS) is a cluster of conditions characterized by dysbiosis, inflammation, obesity, glucose intolerance, and hepatic steatosis. Dysbiosis in MetS is associated with a reduction in Bacteroidaceae and Akkermansiaceae. Despite this association, the mechanism by which dysbiosis leads to chronic inflammation and MetS is poorly defined. Here, we investigate the relationship between impaired epithelial barrier function and the development of MetS by focusing for the first time on intestinal specific DUOX2 deficiency as a mechanistic link. METHODS Mice carrying an intestinal epithelial-specific deletion of DUOX2 (DA IEC-KO), and wild-type (WT) littermates were fed a standard diet and euthanized at 24 weeks. DUOX2 activity was determined by Amplex Red. Metabolic alterations were determined by glucose tolerance tests and body, adipose tissue, and liver weight measurements and histological and gene expression assessments. Intestinal permeability was determined by FITC-dextran and microbial translocation assessments. The role of the microbiome was assessed by RNA-sequencing of stool and in antibiotic-treated mice. RESULTS DA IEC-KO mice produced less epithelial H2O2 and exhibited increased body, liver, and adipose tissue weights that were accompanied by glucose intolerance and increased plasma triglycerides, lipid deposition in the liver, and lipid droplet size in adipocytes. Expression of macrophage and thermogenesis markers, F4/80, CD68, and UCP1 were altered in the liver and adipose tissue of these mice. DA IEC-KO mice showed altered gut permeability and increased bacterial translocation to the liver and adipocytes. Microbial sequencing revealed that loss of intestinal epithelial DUOX2 activity led to significant differences in alpha and beta diversity, and a marked reduction in the family Akkermansiaceae. Antibiotic depletion of the microbiota abrogated all MetS phenotypes observed. CONCLUSION Our findings suggest that loss of intestinal epithelial DUOX2 activity leads to increased intestinal permeability and MetS in a microbiome dependent manner. These findings are significant in that they elucidate a novel role for epithelial DUOX2 at the host-microbial interface with distant systemic effects.

A Novel Blunge Calibration Intelligent Feature Classification Model for the Prediction of Hypothyroid Disease.

According to the Indian health line report, 12% of the population suffer from abnormal thyroid functioning. The major challenge in this disease is that the existence of hypothyroid may not propagate any noticeable symptoms in its early stages. However, delayed treatment of this disease may lead to several other health problems, such as fertility issues and obesity. Therefore, early treatment is essential for patient survival. The proposed technology could be used for the prediction of hypothyroid disease and its severity during its early stages. Though several classification and regression algorithms are available for the prediction of hypothyroid using clinical information, there exists a gap in knowledge as to whether predicted outcomes may reach a higher accuracy or not. Therefore, the objective of this research is to predict the existence of hypothyroidism with higher accuracy by optimizing the estimator list of the pycaret classifier model. With this overview, a blunge calibration intelligent feature classification model that supports the assessment of the presence of hypothyroidism with high accuracy is proposed. A hypothyroidism dataset containing 3163 patient details with 23 independent and one dependent feature from the University of California Irvine (UCI) machine-learning repository was used for this work. We undertook dataset preprocessing and determined its incomplete values. Exploratory data analysis was performed to analyze all the clinical parameters and the extent to which each feature supports the prediction of hypothyroidism. ANOVA was used to verify the F-statistic values of all attributes that might highly influence the target. Then, hypothyroidism was predicted using various classifier algorithms, and the performance metrics were analyzed. The original dataset was subjected to dimensionality reduction by using regressor and classifier feature-selection algorithms to determine the best subset components for predicting hypothyroidism. The feature-selected subset of the clinical parameters was subjected to various classifier algorithms, and its performance was analyzed. The system was implemented with python in the Spyder editor of Anaconda Navigator IDE. Investigational results show that the Gaussian naive Bayes, AdaBoost classifier, and Ridge classifier maintained the accuracy of 89.5% for the regressor feature-selection methods. The blunge calibration regression model (BCRM) was designed with naive Bayes, AdaBoost, and Ridge as the estimators with accuracy optimization and with soft blending based on the sum of predicted probabilities of classifiers. The proposed BCRM showed 99.5% accuracy in predicting hypothyroidism. The implementation results show that the Kernel SVM, KNeighbor, and Ridge classifier maintained an accuracy of 87.5% for the classifier feature-selection methods. The blunge calibration classifier model (BCCM) was developed with Kernel SVM, KNeighbor, and Ridge as the estimators, with accuracy optimization and with soft blending based on the sum of predicted probabilities of classifiers. The proposed BCCM showed 99.7% accuracy in predicting hypothyroidism. The main contribution of this research is the design of BCCM and BCRM models that were built with accuracy optimization with soft blending based on the sum of predicted probabilities of classifiers. The BCRM and BCCM models uniqueness's are achieved by updating the estimators list with the effective classifiers and regressors that suit the application at runtime.

Burden of non-alcoholic fatty liver disease in subclinical hypothyroidism

Abstract Background: The objective of the study was to investigate the burden and predictors of non-alcoholic fatty liver disease (NAFLD) in subclinical hypothyroidism (SCH) patients. Methods: A cross-sectional study was undertaken from January 2017 to December 2017 in 69 patients with SCH, visiting our tertiary care centre. Data collected included the demographic features, physical examination findings, laboratory investigations (free triiodothyronine [T3], free thyroxine (T4), serum thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies, fasting plasma glucose, liver function test, fasting lipid profile and total serum cholesterol) and findings from the abdomen ultrasound and the electrocardiogram. Results: SCH was evident in 60.9% patients with SCH studied. Males showed a significantly high burden of NAFLD than females (52.4% Vs 47.61%; P = 0.005). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), body weight, waist circumference (WC) and waist–hip ratio (WHR) showed a positive association with NAFLD in subclinical hypothyroidism. Conclusions: Our study provides significant evidence of a positive association between subclinical hypothyroidism and NAFLD. AST, ALT, WC and WHR may be considered the predictors of NAFLD in SCH.

Are Severe Forms of Thyroid Eye Disease Common in the Indian Population? Clinical Characteristics of 136 Patients from a Tertiary Eye Care Centre.

Considerable evidence of gender, ethnicity, thyroid dysfunction, and environmental factors including smoking influencing the development and progression of thyroid eye disease (TED). Cross-sectional study of the clinical characteristics of 136 patients with TED who presented to the Orbit and Oculoplasty services at a tertiary eye care center in south India between October 2018 and June 2020. Among the 136 patients (M: 61, F: 75), the mean age was 47.04 (SD ± 13.24) years. Hyperthyroid disease was present in 53%, hypothyroid disease in 40%, and 7.3% were euthyroid. Active disease was noted in 25% and inactive disease in 75% of patients. Active disease was present in 25% of hyperthyroid, 18.5% of hypothyroid, and 15% of euthyroid patients. Active TED showed statistically significant association toward development of greater severity of proptosis (P = 0.001), optic neuropathy (P = 0.004), and extraocular movement restriction (P < 0.001) as compared to inactive disease. Mild, moderate to severe, and sight-threatening TED was noted in 34.6%, 59.6%, and 6% of patients, respectively. Nine eyes had dysthyroid optic neuropathy, of which eight had either mild or no proptosis while one had moderate to severe proptosis. Prevalence of active as well as severe thyroid eye disease is common in our population. Recommendation for ophthalmological examination of patients even with milder disease especially when associated with decreased vision and signs of inflammation. Active disease is less common in euthyroid patients, thus necessitating maintaining the euthyroid status toward reducing disease activity and progression.

The Association of Hypothyroidism and Periodontal Diseases in Tikrit City Patients

The Association of Hypothyroidism and Periodontal Diseases in Tikrit City Patients

Analysis of structure-activity and structure-mechanism relationships among thyroid stimulating hormone receptor binding chemicals by leveraging the ToxCast library.

The thyroid stimulating hormone receptor (TSHR) is crucial in thyroid hormone production in humans, and dysregulation in TSHR activation can lead to adverse health effects such as hypothyroidism and Graves' disease. Further, animal studies have shown that binding of endocrine disrupting chemicals (EDCs) with TSHR can lead to developmental toxicity. Hence, several such chemicals have been screened for their adverse physiological effects in human cell lines via high-throughput assays in the ToxCast project. The invaluable data generated by the ToxCast project has enabled the development of toxicity predictors, but they can be limited in their predictive ability due to the heterogeneity in structure-activity relationships among chemicals. Here, we systematically investigated the heterogeneity in structure-activity as well as structure-mechanism relationships among the TSHR binding chemicals from ToxCast. By employing a structure-activity similarity (SAS) map, we identified 79 activity cliffs among 509 chemicals in TSHR agonist dataset and 69 activity cliffs among 650 chemicals in the TSHR antagonist dataset. Further, by using the matched molecular pair (MMP) approach, we find that the resultant activity cliffs (MMP-cliffs) are a subset of activity cliffs identified via the SAS map approach. Subsequently, by leveraging ToxCast mechanism of action (MOA) annotations for chemicals common to both TSHR agonist and TSHR antagonist datasets, we identified 3 chemical pairs as strong MOA-cliffs and 19 chemical pairs as weak MOA-cliffs. In conclusion, the insights from this systematic investigation of the TSHR binding chemicals are likely to inform ongoing efforts towards development of better predictive toxicity models for characterization of the chemical exposome.

Prevalence of Thyroid Dysfunction in Patients with Gallstone Disease: A Cross-sectional Study

Introduction: Patients with gallstone disease have already been investigated for the prevalence of previously undetected thyroid dysfunction, and the findings point to a possible link between hypothyroidism and gallstone disease. This research was carried out to support the need for assessment of the thyroid status in patients presenting with gallstones. Aim: To determine the prevalence of thyroid disorders and to study the relationship between thyroid dysfunction and sociodemographic variables in patients with gallstone disease. Materials and Methods: A cross-sectional, observational, hospitalbased study was carried out at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, in 117 patients with gallstones from January 2021 to June 2022. The sampling method was consecutive sampling. Standard baseline investigations and thyroid profiles were conducted. Operative and perioperative factors such as age (ranging from 18-80 years), sex, co-morbidities, radiological findings (number and size of stones, presence of Common Bile Duct (CBD) stones), thyroid profile, surgeries performed, and significance (p-value) of these factors were assessed based on the Chi-square test. Results: The mean age of participants was 44 years. There were 37 (68%) males and 80 (32%) females. Of the 117 patients, 49 patients (41.9%) were found to have hypothyroidism, and the remaining 68 patients (58.1%) were euthyroid. Among these 49 patients, only 15 were known to have hypothyroidism, while the remaining 34 patients were newly diagnosed. Of the 49 patients, 30 were females and 19 were males. There was no significant association between hypothyroid state and gallstone formation in either males (p-value: 0.154) or females (p-value: 0.194). Conclusion: A low prevalence of hypothyroidism was observed in both sexes. Further large population studies are needed to compare these findings.

Present status of newborn screening in Bangladesh through the participation of health professionals

The idea of newborn screening is to discover potentially fatal or disabling problems in infants as early as possible, usually, before the baby shows any signs or symptoms of an illness or condition. As part of the government's newborn screening program, almost all infants in developed nations are checked at birth for uncommon, severe, and treatable disorders (NBS). As newborn screening remains a major difficulty in Bangladesh, there have lately been proposals for a wider voluntary strategy to aid in the early detection and treatment of a broader range of disorders. A self-administered online survey was carried out in collaboration with Bangladeshi health professionals. Using a mixed qualitative-quantitative statistical approach, the knowledge, engagement, intents, and preferences of healthcare professionals about testing methodologies, testing characteristics, hospital infrastructure, cost estimation, and parental attitudes toward newborn screening were investigated. The final analysis included 281 individuals, of which 59 percent were men and 41 percent were women. Males had a higher level of knowledge of newborn screening than females in relation to gender (79.1 percent for male participants and 77.7 percent for the female participants). Knowledge and the current occupation had a significant connection (p 0.05). Congenital Hypothyroidism disease was screened by NBS the most (18.7% of cases), numerous other diseases were also screened by NBS. The significance of this work to public health is the attribution of participants who want to reduce child mortality and improve child health in their community, as well as the potential to construct public discussion groups that recognize screening diseases, investigate hospital facilities for it, and provide information to families and health professionals about the importance of newborn screening.

Effect of nursing guidelines on quality of life, and treatment satisfaction among patients with hypothyroidism

Background Many patients with hypothyroidism still experience greater reduction in quality of life (QoL) and treatment satisfaction when on the recommended replacement dosage. Thus, nursing guidelines could improve patients’ knowledge, QoL, and treatment satisfaction among patients with hypothyroidism. Aim To evaluate the effect of nursing guidelines on knowledge, QoL, and treatment satisfaction among patients with hypothyroidism. Design A quasi-experimental pre–posttest control group design was used. Setting The study was conducted at endocrinology outpatient clinics in one of the teaching hospitals at Cairo University. Sample A convenient sample of 60 adult male and female patients diagnosed with primary hypothyroidism on a stable dose of levothyroxine was included. Tools Four tools were used to collect data pertinent to the study: (a) personal data form. It consists of two parts: (i) demographic data, including age, sex, education level, and place of residence, and (ii) medical data related to comorbid diseases and BMI; (b) Patients’ Hypothyroidism Knowledge Assessment Questionnaire; (c) Thyroid Patient-reported Quality-of-Life Questionnaire (ThyPRO39); and (d) Hypothyroid Treatment Satisfaction Questionnaire (ThyTSQ). Results There were no statistically significant differences between the study and control groups before application of nursing guidelines regarding demographic and medical variables as well as the total mean scores of patients’ knowledge about hypothyroidism, QoL, and treatment satisfaction. However, highly statistically significant differences were found between both groups at 1 and 2 months after implementation of nursing guidelines concerning patients’ knowledge about hypothyroidism, QoL, and treatment satisfaction (P=0.000 and 0.000, respectively). Conclusion Nursing guidelines could improve patients’ knowledge and QoL among patients with hypothyroidism by taking these nursing guidelines fully into account alongside the recommended treatment where nursing guidelines cover all suspected hypothyroid disease and thereby to improve knowledge, QoL, and treatment satisfaction. Recommendations: this study recommends that nurses provide verbal and written nursing guidelines for patients with hypothyroidism in both inpatient and outpatient clinics.

Congenital hypothyroidism in a child with Sickle cell anemia (a Case Report)

Sickle cell disease (SCD) is an autosomal recessive disease common in negros and Arab.1 The main pathological cause is the substitution of valine with glutamic acid in the β-chain of haemoglobin producing abnormal haemoglobin called haemoglobin S.1,2,3 The production of this abnormal haemoglobin is responsible for the sickling of red blood cells in deoxygenated conditions. The symptoms include chronic intravascular hemolysis, vaso-occlusion and painful crisis.1,3 Over time, multiple organ damage can develop.1,3,4 Patients with SCD display a defective activation of the alternate complement pathway, the combination of SCD and Autoimmune disease (AID) is rare, potentially underdiagnosed, and its prevalence is unknown.4However, the frequency of coexisting SCD and AID has not been evaluated and the data mainly demonstrated from case reports. Case presentation In this case, we report a rare combination of Sickle cell anaemia and congenital hypothyroidism in a 4 years old Libyan boy. This patient was referred to our Hematology department due to severe anaemia, the patient was diagnosed with Sickle cell anaemia and congenital Hypothyroidismwhen he was 32 days old. Genetic counselling for the family showed sickle cell anaemia, congenital hypothyroidism and celiac disease in the other family members. However, the association of SCD and congenital hypothyroidism were not reported before, this combination could be due to a new gene mutation since the high consanguinity and multiple affection in siblings with SCD, Celiac disease and Hypothyroidism separately or combined. Conclusion SCD and congenital hypothyroidism in toddlers are newly reported in this study. The combination of AID and SCD was detected in many members of this family. Genetic counselling and testing are important in developing countries to educate individuals on SCD and also offer those at risk. Further studies are needed to determine the frequency of congenital hypothyroidism in patients with SCD to look for a new cause of combination.

INVESTIGATING THE PHYSIOLOGICAL RELATIONSHIP BETWEEN ISCHEMIC HEART DISEASE AND HYPOTHYROIDISM

Both hypothyroidism and hyperthyroidism, which are thyroid conditions that are extremely prevalent throughout the world, predispose to CVD in general and CAD in particular. This is especially important for people who have hypothyroidism. Heart failure progression risk and the frequency of coronary events are both raised by overt and subclinical hypothyroidism. Thyroid hormone abnormalities are a common complication of heart disease, especially ischemic heart disease, and should be taken into consideration. In actuality, it is necessary to consider low thyroid hormone levels as a cardiovascular risk factor. Regarding ischemic heart disease, thyroid hormones impact left ventricular structure, function, and geometry in the late post-myocardial infarction stage. Cardio-protection is the new goal of therapies to reduce infarct size and stop the development of heart failure following an acute ischemic event in order to enhance cardiovascular outcomes. Through TR1 binding, TH replacement therapy administered soon after myocardial infarction (or even when delayed) may enhance cardiac function. In this review we will look at the relationship between hypothyroidism and ischemic heart disease.

Compound heterozygous variants in SPNS2 cause sensorineural hearing loss

Hearing Loss (HL) is one of the most prevalent congenital diseases in humans and is etiologically highly heterogeneous. To date, over 360 genes have been identified that are involved in mouse or human deafness. SPNS2 is one of these genes that has been attributed to deafness in recent years. In this study, we identified two novel damaging variants of c.906G>A; p.(Trp302*) and c.487G>A; p.(Asp163Asn) in the SPNS2 gene in an eight-year-old female with bilateral sensorineural hearing loss who also presents with congenital hypothyroidism and coronary heart disease. Sanger sequencing confirmed that the variants are compound heterozygote. In addition, in silico analysis by various tools predicted that these variants are damaging. To date, these detected variants have not been reported in any of the existing public databases. We hope that identification of more variants in SPNS2 provide new insights into its role in deafness.

Association between hypothyroidism and non-alcoholic fatty liver disease

Association between hypothyroidism and non-alcoholic fatty liver disease

Clinical Profile of Constipation in Children Under 5 Years of Age in Dr. Soetomo General Academic Hospital, Indonesia

Background: Childhood constipation is still common among children under 5 years of age. This study was conducted to determine the clinical profile of childhood constipation under 5 years of age at dr. Soetomo General Hospital, Indonesia. Methods: This retrospective cross-sectional study was performed by reviewing medical record of constipated children under 5 years of age at dr. Soetomo General Hospital Surabaya from January to December 2021. Data regarding age, gender, living place, body anthropometric (weight, height and nutritional status), sign and symptoms, and physical examination were collected for each patient. Nutritional status was determined by using WHO 2006 growth chart. We also assessed the presence of concomitant disease among those children and presented the data on the table. Results: A total of 35 subjects with constipation were included in this study. Mean (±SD) for age, body weight, length/height of these subjects were 27.09±17.71 months, 10.93±6.11 kg, 82.34±18.52 cm, respectively, with the male and female ratio of 1,67: 1. Around 18.2% of subjects presented with wasted, 18.2% with severely wasted, and 18.2% with severely stunted. Hardened stool (80%) was the most prevalent symptom, followed by straining (37.1%) and fecal impaction (22.9%). The most common concomitant diseases of childhood constipation were Hirschsprung’s disease (17.1%), congenital heart disease (11.4%), and hypothyroidism (11.4%). Conclusion: The results of this study showed that boys had a higher prevalence of constipation in children under 5 years of age, with the most prevalent clinical features being hardened stool, straining, and fecal impaction. Meanwhile, Hirschsprung’s disease, hypothyroidism, and congenital heart disease were the most concomitant disease.

Small intracranial aneurysms of the anterior circulation: A negligible risk?

According to the International Study of Unruptured Intracranial Aneurysms, small (<7 mm) unruptured intracranial aneurysms (IAs) of the anterior circulation (aC) carry a neglectable 5-year rupture risk. In contrast, some studies report frequencies of >20% of all ruptured IAs being small IAs of the aC. This contradiction was addressed in this study by analyzing the rates and risk factors for rupture of small IAs within the aC. Of the institutional observational cohort, 1676 small IAs of the aC were included. Different demographic, clinical, laboratory, and radiographic characteristics were collected. A rupture risk score was established using all independent prognostic factors. The score performance was checked using receiver operating characteristic curve analysis. Of all registered small IAs of the aC, 20.1% were ruptured. The developed small IAs of the aC (SIAAC) score (range = -4 to +13 points) contained five major risk factors: IA location and size, arterial hypertension, alcohol abuse, and chronic renal failure. In addition, three putative protective factors were also included in the score: hypothyroidism, dyslipidemia, and peripheral arterial disease. Increasing rates of ruptured IA with increasing SIAAC scores were observed, from 0% (≤-1 points) through >50% (≥8 points) and up to 100% in patients scoring ≥12 points. The SIAAC score achieved excellent discrimination (area under the curveSIAAC = 0.803) and performed better than the PHASES (Population,Hypertension, Age, Size of the aneurysm, Earlier SAH from another aneurysm, Site of aneurysm) score. Small IAs of the aC carry a considerable rupture risk. After external validation, the proposed rupture risk score might provide a basis for better decision-making regarding the treatment of small unruptured IAs of the aC.

Primary Hypothyroidism in a Adult Cat

A 10-year-old cross breed female cat was brought with the complaint of weight gain while only the same amount of food was given. As a result of the evaluation of clinical examination, anamnesis, laboratory results and thyroid panel parameters, a rare hypothyroid disease in cats was determined. Levotroxine was used in the treatment and after 1.5 months, the parameters were within normal ranges at the control. As a result, the opinion that primary hypothyroidism in cats has gained more importance in veterinary endocrinology in recent years compared to previous years.

HYPOTHYROID GRAVES DISEASE – REPORT OF CASE WITH REVIEW OF LITERATURE

Background: TAO is seen in about 80% of patients with Graves' disease; it may also occur in patients with thyroid cancers or autoimmune hypothyroid due to Hashimoto's thyroiditis in about 10% of TAO, while individuals with no thyroid disease were found to have orbital lesions in 10 percent of total cases. A 46-year- Case presentation: old male patient who is a known case of hypertension and hypothyroidism attended to medical OPD of SVS Hospital with foreign body sensation in both eyes, bulging of eyeballs and excessive watering in both eyes. He was on 40 mg of telmisartan and 50 micrograms of thyroxine daily for about 6 months. Pulse was 56 per minute and a blood pressure of 146/96 mmHg. The patient was treated with methyl prednisolone initially weekly intravenous doses followed by oral medication along with increased levothyroxine to 150 micrograms, selenium and statins. He was symptomatically better after 6 weeks of therapy. Summary and conclusion: Hypothyroid grave disease is very rare that too in a male patient. Treatment does not differ from Hyperthyroid Graves' disease except the supplementation of levothyroxine instead of anti-thyroid measures. The literature has been reviewed.

Abstract 14430: Sex Differences in Heart Transplantation - Analysis of the National Inpatient Sample 2012-2019

Introduction: Advanced heart failure therapies and heart transplantation (HTx) have been underutilized in women. Therefore, we aimed to explore the clinical characteristics and outcomes of HTx by sex. Methods: We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2012 and 2019. International Classification of Disease (ICD) procedure codes were used to identify those who underwent HTx. Results: A total of 20,180 HTx hospitalizations were identified from 2012-2019. Among them, 28% were female. Women undergoing HTx were younger (mean age 51 vs. 54.5 years, p&lt;0.001). HTx hospitalizations among men were more likely to have atrial fibrillation, diabetes, hypertension, renal failure, dyslipidemia, smoking, and ischemic heart disease. HTx hospitalizations among women were more likely to have hypothyroidism and valvular heart disease. HTx hospitalizations in women were associated with no significant difference in risk of in-hospital mortality (adjusted odds ratio [OR] 0.82; 95% confidence interval [CI] 0.58-1.16, p=0.271), no significant difference in length of stay or inflation-adjusted cost as shown in the Table. Men were more likely to develop acute kidney injury during HTx hospitalization (69.2% vs. 59.7%, adjusted OR 0.71, 95% CI 0.61-0.83, p&lt;0.001). Conclusions: HTx utilization is lower in women. However, most major in-hospital outcomes for HTx are similar between the sexes. Further studies are need to explore the causes of lower rates of HTx in women.