Hypothyroidism Disease Research Articles

Knowledge and perception on expanded newborn screening in Sri Lanka among pregnant women attending antenatal clinics in Teaching Hospital Mahamodara

Introduction: Unlike in developed countries, there is no established expanded newborn screening (eNBS) in resource-limited settings. In Sri Lanka, the Ministry of Health has adopted screening only for congenital hypothyroidism, critical congenital heart diseases and congenital deafness as a policy in all newborns. Hence, there is a requirement to assess the need for eNBS in Sri Lanka. This requires epidemiological studies of the inherited metabolic disorders (IMDs) before investment to ensure costeffectiveness of the programme and reflections on acceptance by beneficiaries.Objectives: To evaluate the pregnant women's knowledge, attitudes and willingness towards eNBS.Method: A descriptive cross-sectional study was conducted at the Mahamodara Maternity Hospital antenatal clinics, Galle, Southern Province, Sri Lanka. A convenient sample was obtained from the antenatal clinics. A pre-tested intervieweradministered questionnaire was used to assess basic socio-demographic details, knowledge and perception of eNBSResults: A total of 602 pregnant women took part in the study. The mean age was 29±5.7 years; 67% were in the 25-40-year age group; 37.2% were primigravida and 60% were in the third trimester. More than 50% of the study participants knew about the heel prick test done at birth. However, only 34.8% and 28% were aware of the screening for congenital hypothyroidism and congenital heart disease, respectively; 93.6% of mothers had not heard of the term IMD, and only seven were aware of the term eNBS. Nevertheless, more than 80% of participants were willing to screen their babies at birth for underlying IMDs, even if it is available on payment, as the current programme was free of charge to the family. Similarly, 96.2% were willing to screen their babies for incurable diseases.Conclusions: Though most women were aware of the heel prick test done at birth, only a suboptimal proportion of them was aware of the disease/s checked using the test. In addition, there was poor knowledge about the IMDs and eNBS. However, there were positive attitudes towards eNBS.

Assessment of the Impact of Nutritional Intervention with the Probiotic Lactiplantibacillus plantarum 299v on Nutritional Status and Quality of Life of Hashimoto's Thyroiditis Patients-A Randomized Double-Blind Study Protocol.

The current treatment for the autoimmune disease of hypothyroidism (AIDH) is based on pharmacotherapy with levothyroxine. A non-pharmacological supplementary element of therapy could be the implementation of an individualized balanced diet and probiotics. Lactiplantibacillus plantarum 299v (Lp299v), with its anti-inflammatory effects, may also support the therapy. However, the number of studies on personalized dietary interventions with probiotics in AIDH is limited, and no clear conclusions can be drawn from the results so far. Therefore, this trial will analyze the effect of Lp299v supplementation in conjunction with nutrition education on the quality of life and nutritional status of patients with Hashimoto's. Methods: This double-blind, 12-week intervention study will include 100 female patients with AIDH. They will be divided into two groups: (1) individual personalized nutrition education + Lp299v and (2) individual personalized nutrition education + placebo. Before and after the education intervention, selected elements in the diet, eating behavior, quality of life, nutritional status (anthropometric parameters, body composition), blood pressure, and anti-TPO (antibodies against thyroid peroxidase) titer will be assessed. Hypothesis: It is expected that this study will provide deeper knowledge on the validity of using proper nutritional principles and Lp299v in AIDH. Specifically, the impact on the subjective assessment of the quality of life, selected elements in the diet, and the state of nutrition and health will be assessed.

Abstract 16440: Gender Differences of In-Hospital Outcomes in Acute Myocardial Infarction and Cardiogenic Shock Patients Using Impella: From the Nation Inpatient Sample 2016-2019

Background: There is a lack of independent studies on gender differences in hospital outcomes with Impella in patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS). Our study aims to provide evidence on the impact of gender differences on AMI-CS patients receiving Impella with a nationally representative sample. Methods: Data were obtained from the National Inpatient Sample (NIS) from 2016 to 2019. Patients with AMI and CS were searched in the NIS using ICD-10 CM codes, and those with Impella were screened using ICD-10PCS codes. Patients treated with Impella were then stratified by gender. We used multivariate regression analysis with inverse probability weighting(IPTW) based on propensity scores to compare the risk of in-hospital death after Impella among patients of different genders. Results: From 2016-2019, a total of 2,953 inpatients with AMI combined with CS using Impella were identified. Of these, 28.5% were women. Women treated with Impella were older (mean age 68.42 versus 64.68 years, P<0.0001). Male inpatients on Impella had a higher proportion of NSTEMI, and were more likely to have smoking, congestive heart failure, cardiac arrhythmias, and acute renal failure. Female inpatients were more likely to have STEMI and were more likely to have Chronic pulmonary disease, uncomplicated hypertension, hypothyroidism, and valvular disease. After IPTW-adjusted baseline clinical covariates, women using Impella had a higher risk of in-hospital death than men, while length of stay and total hospital cost did not differ significantly between genders (OR, 1.33 [95%CI, 1.10-1.60]; Beta, -0.05 [95%CI, -0.80-0.71]; and Beta, 8105.24 [95%CI, -25376.84-9166.35]; respectively). Conclusions: Impella use was lower in women. However, in-hospital mortality was significantly higher in women among AMI-CS patients using Impella. Further studies are needed to explore the reasons for higher mortality in female patients using Impella.

Genetic polymorphism of CTLA4 with functional thyroid tests in hypothyroid disease patients

Objective: To recognize the role of Cytotoxic T-Lymphocyte Antigen 4 CTLA4 gene polymorphism (rs231775A/G) in Hashimoto's thyroiditis (HT) patients and a study its correlation with other clinical data.Design and MethodsCase-control research was conducted on 200 females, with 100 patients with Hashimoto's thyroiditis aged 18-68 years and 100 age and gender-matched healthy volunteers. Patients were drawn from Al-Sadder Medical City in Al-Najaf Governorate. All participants underwent to medical examinations to ensure they were suffering from Hashimoto's thyroiditis. The Real-time-PCR method was used to analyze the genotyping of the CTLA4 gene, and the levels of T3, T4, TSH, Anti-TPO, and Anti-TG were assessed using an ELISA kit in all study groups

Low-density lipoprotein triglycerides: A marker for metabolic diseases.

Dyslipidemia plays an essential role in the occurrence and development of cardiovascular diseases, and the regulation of cholesterol and triglyceride metabolism has been applied in the diagnosis, treatment and prognosis of clinical cardiovascular diseases. Following advances in methodology in recent years, low-density lipoprotein triglycerides (LDL-TG) has been identified as a potential risk factor for the development of cardiovascular disease and has some clinical significance in its diagnosis and treatment. Meanwhile, LDL-TG metabolism regulation may also be involved in the development of type 2 diabetes, chronic kidney disease, hypothyroidism and other diseases, which may improve our understanding of the prevention, control and risk assessment of clinically relevant diseases.

Genome-wide association study of thyroid-stimulating hormone highlights new genes, pathways and associations with thyroid disease

Thyroid hormones play a critical role in regulation of multiple physiological functions and thyroid dysfunction is associated with substantial morbidity. Here, we use electronic health records to undertake a genome-wide association study of thyroid-stimulating hormone (TSH) levels, with a total sample size of 247,107. We identify 158 novel genetic associations, more than doubling the number of known associations with TSH, and implicate 112 putative causal genes, of which 76 are not previously implicated. A polygenic score for TSH is associated with TSH levels in African, South Asian, East Asian, Middle Eastern and admixed American ancestries, and associated with hypothyroidism and other thyroid disease in South Asians. In Europeans, the TSH polygenic score is associated with thyroid disease, including thyroid cancer and age-of-onset of hypothyroidism and hyperthyroidism. We develop pathway-specific genetic risk scores for TSH levels and use these in phenome-wide association studies to identify potential consequences of pathway perturbation. Together, these findings demonstrate the potential utility of genetic associations to inform future therapeutics and risk prediction for thyroid diseases.

FRI469 Natural History Of de Quervain’s Thyroiditis In The Era Of COVID -19: The Greek Experience Of 226 Cases

Abstract Disclosure: N. Angelopoulos: None. D.P. Askitis: None. I. Androulakis: None. N. Valvis: None. R. Paparodis: None. V. Petkova: None. A. Boniakos: None. D. Zianni: None. I. Perogamvros: None. K.A. Toulis: None. S. Livadas: None. Background: Subacute thyroiditis (SAT) is a usually self-limiting disease however,patients with pronounced tenderness normally receive nonsteroidal anti-inflammatorydrugs (NSAIDs) or systemic steroids. Disease recurrence is unfortunately common, while approximately 0.5-15% of patients require permanent thyroxine substitution. Among the thyroid SARS-CoV-2 complications, SAT was reported early and the question whether SAT might be underestimated was raised. Aims and Scope: The aims of this retrospective study were: (1) to determine predictive factors for SAT recurrence and the development of hypothyroidism and (2) to identify potential clinical and laboratory characteristics in patients with SAT due to SARS-CoV-2 infection. Methods: We retrospectively reviewed the records of 226 patients with confirmed subacute thyroiditis between January 2020 and November 2022 in eleven outpatient endocrine clinics with geographical representativeness of Greek territory. Results: Mean age was 48.01 years and F/M 158/68. Baseline hypothyroidism was present in 11 patients (4.86%), 36 had Hashimoto, 30 had nodular disease, 4 had both Hashimoto and nodules, 1 was hyperthyroid and the remaining 144 patients had no thyroid disease. At the end of follow up (16.77±0.8 months) 68 patients (34.5%) had hypothyroidism (P <0.001, 15 of them with nodules), 17 Hashimoto, 4 Hashimoto and nodular disease, 1 developed hyperthyroidism and 1 was thyroidectomized due to multiple recurrences. Regarding treatment protocols, significant differences were detected for treatment duration (shorter with ibuprofen, p<0.001), time-to-symptoms relief (shorter with methylprednisolone, p<0.05) and the initial equivalent dose of cortisone (lower in combined treatment with cortisone and ibuprofen, p<0.001). Demographical (age, gender, BMI), serological (ESR,CRP) and treatment parameters (type of therapy, duration of therapy, initial dose of treatment, time to treat, time to symptoms relief) were not related with the development of hypothyroidism. Recurrence was observed in 28 patients (14.1%) all treated with glucocotricoids. 34 patients had covid-19 related SAT with no specific clinical manifestation of the disease. Compared to the non-covid group, BMI was higher (27.58±4.05 vs 25.69±5.44, respectively, p=0.026) and a shorter time-to-symptoms relief was observed (3.56±1.94 vs 5.46±6.93 days, respectively, p=0.044). Conclusion: In a large cohort of patients, corticosteroid therapy was found to promptly alleviate the acute symptoms during the onset of SAT, duration of treatment was longer and the incidence of recurrence greater than that observed with nonsteroidal anti-inflammatory drugs. Both regimens could not prevent the development of delayed hypothyroidism. Clinical characteristics of SAT after COVID-19 were similar to those of typical SAT. Presentation: Friday, June 16, 2023

THU323 Extreme Insulin Resistance In Type 1 Diabetic After Covid 19 Infection

Abstract Disclosure: A.A. Zakkar: None. M. Fadanelli: None. M. Al Mushref: None. Patient is a 46-year-old African American female with a medical history of Diabetes Mellitus Type 1 for 20 years, hypothyroidism, rheumatoid arthritis and celiac disease who presented with a complaint of dizziness and heavy menstrual periods. When she presented, labs were significant for a glucose of 513 mg/dL, anion gap of 22 with a bicarbonate of 8, HbA1c of 10%, Hemoglobin of 8.1 and UA revealed ketones and she was thus started on an insulin drip for diabetic ketoacidosis. Patient was also complaining of a cough and weakness and thus a sputum sample was obtained which was positive for Streptococcus pneumoniae and she was started on antibiotics. At the time of arrival the patient was A&Ox4 and stated that her glucose has been really difficult to control over the last 6 months after she had been infected with COVID-19 and over that time she has also lost approximately 50 lbs. She stated that one month prior to the patient having COVID-19 infection, she was taking aspart 20 units per/meal and detemir 32 units qAM and 62 units qHS, and had an HbA1c of 8.5%. Just prior to presentation, the patient was taking 70 units of the U-100 aspart insulin per meal and 60 units of glargine U300 twice daily with persistent hyperglycemia. Insulin antibodies were tested and returned remarkably high. GAD-65 antibody was also high. The patient's glucose remained in the 500-600 mg/dL range and the acidosis worsened to a pH of 6.9 despite receiving continuous intravenous insulin aspart at 30units/hr with the addition of detemir 100 units q12-hours. The patient's acidosis resolved after two days and she was transitioned to Humulin R-U-500 at 80 units TID and aspart 40 units every 4-hours for tube feeding coverage but was still hyperglycemic in the 200-300 mg/dl range. Due to autoimmunity and extreme insulin requirements the patient was started on methylprednisolone 20 mg q8hr with improvement of glucose to the 150 to 200 mg/dl range and a decrease in her daily insulin requirements and thus she was transitioned to 60mg of prednisone daily with a 10mg taper weekly. By the time she was discharged 2 weeks later, her glucose was more controlled and her insulin requirements were decreased to aspart 14 units per/meal and detemir 40 units BID. Conclusion: In patients with diabetes mellitus who develop extreme insulin resistance following COVID -19 infection, consider autoimmune etiology in the differential diagnosis, such as insulin inactivating antibodies or insulin receptor blocking antibodies. In our experience laboratory testing of the specific antibodies was not available. Management of autoimmune mediated hyperglycemia will require immunosuppressivetherapy. Presentation: Thursday, June 15, 2023

Relationship between infant hypothyroidism and maternal thyroid disease

Background: Due to the very high complications of neonatal hypothyroidism in the country, neonatal screening program is performed for timely diagnosis and treatment of neonates. The aim of this study to investigate the relationship between infant hypothyroidism and maternal thyroid disease. Methods: This cross-sectional study was done on 195 neonates with a diagnosis of hypothyroidism. Necessary data were collected by a checklist and then analyzed by statistical methods in statistical package for the social sciences (SPSS) version 21 by statistical methods. Results: Of all mothers, 21.0% had a history of thyroid disease. There was no statistically significant relationship between maternal age and infant thyroid stimulating hormone (TSH). There was no significant relationship between the history of maternal hypothyroidism and maternal hypothyroidism (during experiments) with the amount of TSH in the newborn. There was a direct and significant relationship between maternal TSH level and maternal free T4. But there was no statistically significant relationship between infant TSH level and maternal TSH level and free T4. There was no significant difference in neonatal TSH levels with maternal anti-TPO status. There was no significant relationship between the history of maternal diabetes and the history of maternal hypertension with neonatal TSH. There was no significant difference in neonatal TSH levels by maternal thyroid status. Conclusions: In the present study, no significant relationship was found between the incidence of neonatal hypothyroidism and the presence of thyroid disease in mothers. The existence of different genetic and environmental factors and the significant impact of each of these factors can justify this result.

Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy.

Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. A retrospective follow-up was conducted of GD patients that participated in a randomized trial from 1997 to 2001. Demographic and clinical data were obtained from medical records and questionnaires. Biobank samples were analyzed for inflammatory biomarkers and compared with age- and sex-matched healthy individuals. We included 83% (182/218) of the patients from the original study. At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36). At the end of treatment, CD40 was lower in patients who maintained normal thyroid function (P = .04). At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). GD patients who developed hypothyroidism had reduced quality of life. Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED.

Do Dietary Supplements Affect Inflammation, Oxidative Stress, and Antioxidant Status in Adults with Hypothyroidism or Hashimoto's Disease?-A Systematic Review of Controlled Trials.

This systematic review aims to summarise the results of controlled trials on dietary supplements (DS) usage and inflammation, oxidative stress, antioxidant status, and thyroid parameter improvement in hypothyroidism (HT)/Hashimoto's thyroiditis (AIT) patients. The study protocol was registered with PROSPERO (no. CRD42022365149). A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of nineteen randomised controlled trials and three non-randomised studies for the review; three studies examined the effect of supplementation with vitamin D, twelve studies-with selenium, and seven studies-with other DS. Based on very limited evidence, the lack of influence of vitamin D supplementation on inflammatory parameters was found, while no studies have examined oxidative stress and antioxidant status parameters, and only one provided results for a single thyroid parameter after an intervention. Some evidence was found proving that selenium supplementation may decrease inflammation and improve thyroid parameters, but reaching a conclusion about its influence on oxidative stress and antioxidant status is not possible because of the insufficient number of studies. Additionally, due to examining other DS (e.g., multicomponent, Nigella sativa, and genistein) only in single studies, conclusions cannot be drawn. Further long-term, high-quality randomised controlled trials are necessary to better understand the influence of DS on inflammation, oxidative stress, and antioxidant status, as well as their potential to improve thyroid gland function in HT/AIT patients.

Collagenous Colitis associated with Celiac Disease

Introduction: Microscopic colitis is an inflammatory GI condition whereby patients present predominantly with chronic watery diarrhea associated with other non-specific symptoms such as abdominal pain, urgency, fecal incontinence, weight loss, arthralgia, myalgia, anxiety, depression, and fatigue, which negatively impact their quality of life. Case Presentation: We present a case of a 44 -year old female with a history of hypothyroidism and celiac disease who presented to the GI clinic with a history of more than ten diarrhea episodes per day along with mild abdominal pain and bloating. Conclusion: A colonoscopy was performed, and a random colon biopsy revealed collagenous/microscopic colitis.

Primary Hypothyroidism and Alzheimer's Disease: A Tale of Two.

Hypothyroidism (HPT) HPT could be a risk factor for the development and progression of Alzheimer's disease (AD). In addition, progressive neurodegeneration in AD may affect the metabolism of thyroid hormones (THs) in the brain causing local brain HPT. Hence, the present review aimed to clarify the potential association between HPT and AD. HPT promotes the progression of AD by inducing the production of amyloid beta (Aβ) and tau protein phosphorylation with the development of synaptic plasticity and memory dysfunction. Besides, the metabolism of THs is dysregulated in AD due to the accumulation of Aβ and tau protein phosphorylation leading to local brain HPT. Additionally, HPT can affect AD neuropathology through various mechanistic pathways including dysregulation of transthyretin, oxidative stress, ER stress, autophagy dysfunction mitochondrial dysfunction, and inhibition of brain-derived neurotrophic factor. Taken together there is a potential link between HPT and AD, as HPT adversely impacts AD neuropathology and the reverse is also true.

The need for neonatal jaundice screening awareness in the Pakistani population: short communication.

Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.

A rare case of SCHMID metaphyseal chondrodysplasia associated with hypothyroidism,growth hormone deficiency and celiac disease: case report.

The authors present a rare case of 4-year-2-month-old boy referred to our Unit for harmonious short stature, he had a waddling gait, subtle micromelia, and hyperlordosis, no special facies. The skeletal scan made the diagnosis of SCHMID metaphyseal chondrodysplasia. The first laboratory workup showed elevated thyroid stimulating hormone and anti-tissue transglutaminase immunoglobulin A. The duodenal biopsies confirmed the diagnosis of coeliac disease. Treatment of levothyroxine was initiated with a gluten-free diet .6 years later, his re-evaluation showed a low insulin-like growth factor 1 and low growth hormone peaks confirming the diagnosis of growth hormone deficiency, Growth hormone therapy was initiated with an adjusted dose of levothyroxine. Other causes of short stature should not be missed when diagnosing chondrodysplasia, and further investigations should be carried out to detect other concomitant disorders since metaphyseal chondrodysplasia is a rare cause for short stature while hypothyroidism and coeliac disease are relatively common.

A retrospective study of lipid profile during the various phases of timing in renal failure and hypothyroid patients

: As there are very few studies in our region about the metabolic changes in hypothyroid and renal failure patients in collection of sample during various phases of time, where these organs were involved in regulating this metabolism.To evaluate the trends of lipid profiles in hypothyroidism and chronic kidney disease throughout various phases of time. This was a retrospective control study conducted on 50 CKD patients, 50 hypothyroidism patients and 50 controls in the tertiary care hospital attending to OPD. Collected samples are analyzed for Total cholesterol, Triglycerides, and HDL cholesterol whereas LDL and VLDL are measured by calculated method taken at various phases of time. The data was entered into the master chart and analyzed statistically.: It was found that random lipid profile values in CKD and hypothyroidism were higher and are statistically significant compared to fasting and postprandial states. Particularly there is an elevation in Total cholesterol, Triglycerides, LDL cholesterol whereas HDL levels are decreased.: This research work is done by analyzing the fasting, postprandial and random states because it includes an explanation of why a random blood sample is preferred to analyze lipid profile values. Thyroid disease and renal failure patients are more prone to development of atherosclerosis which were primary cause for development of cardiovascular and cerebrovascular complications. So collection of the sample also plays key role in management.

Frequency of Celiac Disease among Children with Type I Diabetes Mellitus

Background: Type 1 diabetes mellitus (T1DM) is a metabolic condition of chronic hyperglycemia due to a lack of insulin resulting from the autoimmune destruction of pancreatic beta cells. T1DM is associated with many autoimmune conditions, especially hypothyroidism and celiac disease (CD). Objective: To determine the frequency of celiac disease among children and adolescents with type 1 diabetes mellitus. Study Design: Prospective cross-sectional study. Settings: Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Child Health Sciences, The Children’s Hospital, Lahore Pakistan. Duration: October 2019 to January 2022. Methods: A total of 150 children and adolescents with T1DM were included in this study. Patients already diagnosed with CD, patients with concomitant autoimmune disease, patients with Down syndrome, and patients who refused to participate and who lost follow-up were excluded from the study. All patients underwent a celiac screen, and those with positive or borderline serology had an endoscopic biopsy of the distal duodenum. Biopsy reporting was done as per Modified Marsh Classification. The patient's data and laboratory findings were recorded through a predesigned proforma and analyzed using SPSS version 20. Results: The mean age of participants was 8.08 ± 2.95 years, including 79 (52.7%) male and 71 (47.3%) female patients. A total of 19 (12.7%) had positive serology for celiac disease, and 8 (5.3%) had biopsy findings confirming celiac disease. Conclusion: Children and adolescents with T1DM have an increased tendency for CD, warranting earlier screening for timely detection and management.

Evaluation of salivary Tumor Necrosis Factor-Alpha in patients with hypothyroidism and periodontitis: A Case- Control Study

Introduction: The immune system has served as a bridge among periodontitis and the endocrine system, particularly in the case of thyroid disorders. After non-surgical periodontal therapy for hypothyroid patients, serum thyroid stimulating hormone levels fall within the normal limits, which reduces the inflammatory markers linked to both periodontal and hypothyroid diseases. The pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α), released by macrophages, plays a significant role in bone loss caused by periodontitis. TNF-α will increase the production of collagenases, prostaglandin E2, chemokines and cytokines, cell adhesion molecules, and factors that are related to bone resorption. The aim of our study is to evaluate the salivary level of TNF-α in hypothyroidism patients with periodontitis in comparison to healthy controls.
 Material and subject: Saliva were collected from 90 subjects with age ranged between (22-65) years, 50 of them hypothyroid patients (25 patients with hypothyroidism and healthy periodontium, 25 patients with hypothyroidism and periodontitis) and 25 patients with periodontitis and systemically healthy compare with 15 subject as control (systemically healthy with healthy periodontium). Detection of TNF-α in saliva was done by using Enzyme Linked Immunosorbent Assay.
 
 Result: The current results revealed that salivary TNF-α levels are significantly high (p<0.001) in diseases group (periodontitis group (132.8 ng/L), hypothyroid patients groups without periodontitis (128.4 ng/L) and with periodontitis (117.0 ng/L) as compared to control group (73.4 ng/L), while there are no significant difference between diseases group.
 Conclusion: Salivary TNF-α level increased significantly in all diseased groups (periodontitis group, hypothyroidism groups with and without periodontitis) in comparison to healthy subject.

Common non-cardiovascular multimorbidity groupings and clinical outcomes in older adults with major cardiovascular disease.

Among older adults, non-cardiovascular multimorbidity often coexists with cardiovascular disease (CVD) but their clinical significance is uncertain. We identified common non-cardiovascular comorbidity patterns and their association with clinical outcomes in Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), or atrial fibrillation (AF). Using 2015-2016 Medicare data, we took 1% random sample to create 3 cohorts of beneficiaries diagnosed with AMI (n = 24,808), CHF (n = 57,285), and AF (n = 36,277) prior to 1/1/2016. Within each cohort, we applied latent class analysis to classify beneficiaries based on 9 non-cardiovascular comorbidities (anemia, cancer, chronic kidney disease, chronic lung disease, dementia, depression, diabetes, hypothyroidism, and musculoskeletal disease). Mortality, cardiovascular and non-cardiovascular hospitalizations, and home time lost over a 1-year follow-up period were compared across non-cardiovascular multimorbidity classes. Similar non-cardiovascular multimorbidity classes emerged from the 3 CVD cohorts: (1) minimal, (2) depression-lung, (3) chronic kidney disease (CKD)-diabetes, and (4) multi-system class. Across CVD cohorts, multi-system class had the highest risk of mortality (hazard ratio [HR], 2.7-3.9), cardiovascular hospitalization (HR, 1.6-3.3), non-cardiovascular hospitalization (HR, 3.1-7.2), and home time lost (rate ratio, 2.7-5.4). Among those with AMI, the CKD-diabetes class was more strongly associated with all the adverse outcomes than the depression-lung class. In CHF and AF, differences in risk between the depression-lung and CKD-diabetes classes varied per outcome; and the depression-lung and multi-system classes had double the rates of non-cardiovascular hospitalizations than cardiovascular hospitalizations. Four non-cardiovascular multimorbidity patterns were found among Medicare beneficiaries with CHF, AMI, or AF. Compared to the minimal class, the multi-system, CKD-diabetes, and depression-lung classes were associated with worse outcomes. Identification of these classes offers insight into specific segments of the population that may benefit from more than the usual cardiovascular care.

1457-P: Analysis of Type 1 Diabetes Trends in Israel

Background and Aim: With increased awareness of late-onset type 1 diabetes and the importance of accurate diabetes classification, there is a need to reassess the epidemiological and clinical characteristics of people with T1D (PwT1D). We report analyses of a novel population based cohort of PwT1D in Israel. Methods: Using database of Clalit HMO in Israel, insuring 4.8M people (51.5% of the population) we established a registry of all PwT1D. Prevalence, annual incidence, assessment of anthropometric, metabolic parameters, complications, and comorbidities were analyzed. Results: We recorded data of 13,167 PwT1D (0.27% of the population, 51.3% men), with an annual incidence of 1.05/10,000 people representing a 13% increase over the past decade. Median age at diagnosis is 22 years with 25% diagnosed at age ≥40 years. Median age of current PwT1D is 36 years with 25% are ≥55. Of note, 50% are either overweight or obese, with over 50% having metabolic abnormalities, traditionally associated with type 2 diabetes. Hypothyroidism (16.1%) and Celiac disease (4.5%) are the most prevalent autoimmune diseases in this cohort. Additional characteristics are depicted in table 1. Conclusion: Currently, a significant proportion of PwT1D are middle aged or older, half are overweight or obese with the majority having additional characteristics of the metabolic syndrome. Efforts for accurate classification of PwT1D and addressing associated comorbidities are of key importance. Disclosure H.Duskin-bitan: None. A.Tirosh: Advisory Panel; Medtronic, Novo Nordisk, Sanofi, Eli Lilly and Company, Research Support; Medtronic, Sanofi, Speaker's Bureau; Medtronic, Novo Nordisk, Sanofi, Eli Lilly and Company. T.Beckenstein: None. D.Netzer: None. R.Arbel: None. A.Peretz: None.