Increased Thyroid-stimulating Hormone Levels Research Articles

Effect of Vitamin B12 Deficiency on Thyroid Function Tests Among Adults Visiting Tertiary Health Care Centre in Eastern Nepal

Background Vitamin B12 deficiency is commonly observed in hypothyroidism and autoimmune thyroiditis. Low vitamin B12 can disrupt thyroid function. Though the prevalence of this deficiency has been documented in various regions of Nepal, studies in Eastern Nepal are limited. The objective of this study was to assess the percentage distribution of vitamin B12 deficiency among adults visiting the tertiary health care centre in Eastern Nepal and to find out the effect of vitamin B12 deficiency on thyroid function test. Methods This study, conducted at Nobel Medical College from January 2022 to December 2023, was cross-sectional in design and included 379 patients. Subjects underwent general health check-ups, including Vitamin B12 and thyroid function tests. Descriptive analysis was performed, and Pearson’s correlation assessed the relationship between vitamin B12 levels and thyroid hormones. Independent t-tests compared hormone levels between groups. P value < 0.05 was considered as statistically significant. Results The vitamin B12 status distribution was as follows: 62.5% normal (>300pg/ml), 18.2% borderline deficient (200-300pg/ml), and 19.3% deficient (<200pg/ml). Prevalence was higher among females. Group II subjects (vitamin B12 <300pg/dl) had significantly lower mean free triiodothyronine (FT3) levels (2.82±0.742 vs. 3.14±0.49 pg/mL, p=0.003) and higher mean thyroid stimulating hormone (TSH) levels (4.69±3.56 vs. 2.55±1.47 mIU/L, p<0.001) compared to group I (B12 >300pg/ml). Vitamin B12 showed a negative correlation with TSH (p=0.013). Conclusion The study indicates a decrease in FT3 levels and an increase in TSH levels among those with vitamin B12 deficiency or borderline cases

Relationship between hypothyroidism and chronic kidney disease: Results from the National Health and Nutrition Examination Survey 2007 to 2012 and Mendelian randomization study.

Chronic kidney disease (CKD) and hypothyroidism are prevalent chronic conditions with a generally believed correlation between them. However, large-scale population studies and investigations into causation are lacking. This study analyzed CKD and thyroid function data from the National Health and Nutrition Examination Survey database spanning 2007 to 2012 using multiple regression analyses to examine the correlation between CKD and hypothyroidism. Bidirectional Mendelian randomization analysis was employed to investigate the causal association between the two conditions. As CKD stages deteriorated, there was a significant decrease in total triiodothyronine (TT3) and free triiodothyronine (P < .05). However, no significant decrease was observed in total thyroxine and free thyroxine. Notably, there was a significant increase in thyroid-stimulating hormone levels (P < .05). However, no significant changes were observed in thyroglobulin, thyroglobulin antibody, and thyroid peroxidase antibody levels. A causal relationship between CKD and reduced thyroid function was observed (odds ratio [OR] = 1.0041, 95% confidence interval [CI]: 1.0007-1.0075, P = .0186). Conversely, reverse causality was not statistically significant (OR = 2.540, 95%CI: 0.8680-4.8603, P = .1014). As CKD progressed, the risk of hypothyroidism increased. A causal correlation was observed between CKD and reduced thyroid function. Chronic kidney disease (CKD) and hypothyroidism are prevalent chronic conditions with a generally believed correlation between them. There is no large-scale population studies and the causation relationship between CKD and hypothyroidism are lacking. The finding of the causal relationship between CKD and hypothyroidism may be beneficial to the prevention of the disease and the prognosis of the patients.

Effects of Roxadustat on Thyroid Profiles in Patients and Animals with Chronic Kidney Disease

Introduction: Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor used in renal anemia treatment, has been associated with thyroid hormone suppression. This study investigated the patterns of thyroid profile changes following roxadustat administration and their clinical implications. Methods: In this retrospective study (2019–2023) at Shenzhen Second People’s Hospital, patients were categorized based on thyroid-stimulating hormone (TSH) reduction during follow-up (≥50% decrease vs. <50% decrease). Thyroid profiles, clinical symptoms, and laboratory indicators were analyzed. Quality of life was assessed using EQ-5D-3L and ThyPRO questionnaires. Complementary animal experiments were conducted to verify the effects of roxadustat on thyroid function. Results: A total of 118 patients were finally enrolled in our study. Among patients with initially normal thyroid function, 31 developed euthyroid sick syndrome post-roxadustat treatment. Treatment significantly decreased TT3, FT3, FT4, and TSH levels, with TSH showing marked reduction within the first 10 weeks. Contrastingly, animal models exhibited decreased T3 but increased TSH levels, regardless of renal status. Blood lipid levels decreased in all patients, particularly in those with substantial TSH reduction. Despite thyroid alterations, quality-of-life scores remained unchanged between roxadustat-treated and untreated patients, with no overt clinical symptoms in either humans or animals. Conclusion: While roxadustat induces significant thyroid hormone suppression in patients, these alterations rarely manifest as clinical symptoms. Euthyroid sick syndrome is the predominant thyroid dysfunction pattern observed. Regular thyroid function monitoring is recommended during roxadustat therapy, particularly during the initial treatment phase when TSH changes are most pronounced.

The effect of TSH on kidney function

Background: The thyroid gland plays a vital role in the regulation of many physiological processes, including kidney function. Aim: The purpose of this study was to investigate the relationship between thyroid-stimulating hormone (TSH) and kidney function in male and female patients with hyperthyroidism, as well as in healthy control subjects. Method: A total of 60 participants from Najaf city, Iraq, were included in the study. This included 10 male and 10 female control subjects, as well as 20 male and 20 female patients with hyperthyroidism. Blood samples were collected from all participants and analyzed for TSH, urea, and creatinine levels. Result: The results showed a significant increase in TSH levels in both male and female patients with hyperthyroidism compared to control subjects. Urea levels were also significantly higher in hyperthyroidism patients compared to controls, while creatinine levels were not significantly different. In addition, there was a significant difference in the effects of TSH on kidney function between male and female patients with hyperthyroidism. Female patients with hyperthyroidism had significantly higher levels of urea and lower levels of creatinine compared to male patients with hyperthyroidism. These findings suggest a direct effect of TSH on kidney function and highlight the need for regular monitoring of kidney function in individuals with hyperthyroidism, particularly women. Further research is needed to fully understand the mechanisms behind the gender differences observed in this study and to develop targeted interventions for both men and women with thyroid disorders. Conclusion: our study provides valuable insights into the relationship between TSH and kidney function and highlights the need for multidisciplinary care and targeted interventions for individuals with thyroid disorders to prevent or minimize the risk of kidney dysfunction.

Thyroxine Replacement Therapy during Ramadan Fasting: A Narrative Review

Abstract Introduction Ramadan fasting-induced changes in eating and sleeping patterns pose a risk of influencing thyroid hormone levels. There is a recognition of the potential impact of fasting and feasting on levothyroxine (L-T4) absorption. Materials and Methods A narrative, nonsystematic literature review from two major medical online databases (PubMed and Google Scholar) from their inception to the search day (February 22, 2024). A relevant combined search term was used. The retrieved literature is narrated in a concise account. Results There is a relationship between metabolism and thyroid-stimulating hormone (TSH). This relationship contributes to transient metabolic disturbances that influence the pharmacodynamics and pharmacokinetics of various drugs, adding complexity to the management of hypothyroidism during Ramadan fasting. Several observational studies have studied the changes in thyroid function levels during unmodified L-T4 regimens. Experimental trials explored the impact on body weight, well-being, and thyroid functions when the timing of L-T4 administration changes. Findings are far from homogeneous due to different study protocols. A recent meta-analysis demonstrated a significant post-Ramadan increase in TSH levels among euthyroid patients. L-T4 timing points, encompassing pre-Iftar, post-Iftar, and pre-Suhoor, are associated with elevated TSH levels after Ramadan fasting. The emphasis on individualized L-T4 regimens during Ramadan fasting is underscored, with recommendations for patients to refrain from food for at least 3 hours before and 30 minutes after L-T4 intake to ensure optimal compliance by most experts. The association between adherence to L-T4 during Ramadan fasting and maintaining euthyroid status is highlighted, encouraging patients to follow prescribed regimens diligently. Modified dosing frequencies, such as weekly regimens, exhibit promising results, especially in patients grappling with compliance issues. Proactive consultations with physicians before Ramadan are needed to review the latest thyroid function test and make possible dose adjustments. Conclusion Managing hypothyroidism during Ramadan necessitates an understanding of medication timing, food-drug interactions, and prior regimens. Adherence, facilitated by flexibility, plays a critical role in achieving euthyroid status.

Clinical signifi cance of various variants of euthyroid pathology syndrome in patients with end-stage chronic kidney disease on programmed hemodialysis

The number of patients with end-stage renal disease (ESRD) is growing every year. Due to the high comorbidity of such patients, the search for factors that influence the course of the disease and outcome is of particular importance. Indications for studying the functional state of the thyroid gland, as well as recommendations for the treatment of thyroid dysfunction in patients with ESRD have not been developed.THE AIM: to study indicators of thyroid status and identify clinically significant variants of the euthyroid pathology syndrome in patients with ESRD on program hemodialysis (PHD).PATIENTS AND METHODS. The study included 123 patients with ESRD undergoing PHD. A cross-sectional study was conducted to examine thyroid function parameters in patients with ESCKD undergoing PHD. All patients were assessed for the levels of thyroidstimulating hormone (TSH), free triiodothyronine (free T3) and free thyroxine (free T4), the comorbidity index, which was calculated using the Charlson scale, the effectiveness of program hemodialysis using Kt/V, and the urea reduction coefficient (URR).RESULTS. Increased TSH levels were associated with higher body mass index in the studied patients. “Low T3” syndrome is associated with older age and high comorbidity. The high level of T4 in the examined patients is also associated with old age, high comorbidity and a KT/V index below the target values.CONCLUSION. The TSH level in patients with endstage renal insufficiency on programmed hemodialysis does not reflect the true functional state of the thyroid gland.

Effect of Electromagnetic Radiation of Wi-Fi Router on Thyroid Gland and the Possible Protective Role of Combined Vitamin C and Zinc Administration in Adult Male Albino Rats.

Electromagnetic radiation (EMR) is widely used nowadays in various fields due to rapid expansion of technology and affects different organs such as endocrine glands. Antioxidants protect the cells and act as a free radical scavenger. The aim of the study was to clarify the effect of EMR emitted from Wi-Fi router on the thyroid gland of adult male albino rats and the possible protective role of combined Vitamin C and zinc. Thirty adult male albino rats were divided into three groups: Group I (control group), Group II (received combined Vitamin C and Zinc in one tablet called IMMUNO-MASH), and Group III (experimental groups). Group III was divided into two subgroups (A and B) according to the duration of exposure: 6 h and 24 h/day. Each of these groups was divided into two equal subgroups. One was exposed only to EMR while the other was exposed to EMR and received combined Vitamin C and zinc. All rats were weighed at the beginning and at the end of the experiment. The thyroid gland was prepared for general histological, anti-calcitonin immunostaining, and ultrastructural study. Furthermore, measurement of total serum T3, T4, and thyroid-stimulating hormone (TSH) hormone levels and quantitative analysis of immunoreactive C-cells were done. Then, statistical analysis was done on the number of immunoreactive C-cells, data of the body weight, and the hormonal levels. A highly significant increase in the body weight in subgroups exposed to EMR for 24 h/day was observed. Furthermore, they showed a highly significant decline in T3 and T4 levels together with a highly significant increase in TSH level. With increasing period of exposure, there was a variable degree of deterioration in the form of congestion and dilatation of blood vessels, cellular infiltration, follicular disintegration, vacuolar degeneration, and desquamated follicular cells in the colloid. The C-cells showed a significant increase in the mean number compared with the control group. Ultrastructural analysis of follicular cells revealed colloid droplets, deteriorations in rough endoplasmic reticulum, degenerating nuclei, and swollen mitochondria according to the dose of exposure. There was apparent improvement with the use of combined Vitamin C and zinc. Wi-Fi radiation has a very serious effect on thyroid gland morphology and activity. Moreover, experimentally induced hypothyroidism by radiation resulted in increased C-cell number. Combined Vitamin C and zinc could have a protective role against this tissue damage.

Relationship between maternal obesity and first-trimester TSH in women with negative anti-TPO antibodies.

Obesity is associated with increased thyroid-stimulating hormone (TSH) in non-pregnant subjects, but this phenomenon has not been fully characterized during pregnancy. Our aim was to evaluate the impact of BMI on first-trimester TSH in a wide cohort of pregnant women with negative anti-thyroperoxidase antibodies (AbTPO) and its implications on uterine artery pulsatility index (UtA-PI), a marker of early placentation. The study included 2268 AbTPO-negative pregnant women at their first antenatal visit. Anamnestic data, BMI, TSH, anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) positivity and mean UtA-PI were collected. A total of 1693 women had normal weight, 435 were overweight and 140 were obese. Maternal age, ANA/ENA positivity, history of autoimmune diseases and familiar history of thyroid diseases were similar in the three groups. TSH was significantly higher in obese women (1.8 (IQR: 1.4-2.4) mU/L) when compared to normal weight (1.6 (IQR: 1.2-2.2) mU/L) and overweight (median: 1.6 (IQR: 1.2-2.2) mU/L) ones (P < 0.001). BMI was significantly related with the risk of having a TSH level ≥4 mU/L at logistic regression, independently from non-thyroid autoimmunity, smoking or familiar predisposition for thyroid diseases (OR: 1.125, 95% CI: 1.080-1.172, P < 0.001). A restricted cubic splines regression showed a non-linear relationship between BMI and TSH. Women with a TSH ≥4 mU/L had a higher UtA-PI, independently from BMI. Overweight/obesity is significantly related with TSH serum levels in AbTPO-negative pregnant women, independently from the other risk factors for hypothyroidism during pregnancy. The increase of TSH levels could be clinically relevant, as suggested by its association with abnormal UtA-PI, a surrogate marker of abnormal placentation.

Temporary hypothyroidism in severe crush syndrome: a potential novel entity.

Thyroid hormone synthesis is a complex process in the human body. Although the thyroid gland is essential for thyroid hormone synthesis, skeletal muscles also have crucial roles in thyroid hormone metabolism due to the deiodinase activities of the muscle cells. Hypothyroidism-related myopathy is a well-known entity. However, systemic effects of acute myopathies, such as rhabdomyolysis, on thyroid hormone metabolism have not to date been fully clarified. Fifty-three earthquake victims were evaluated retrospectively. We investigated the thyroid function tests (TFTs) among patients with creatine kinase (CK) levels higher than 10.000 U/L at admission. Fifteen patients had CK levels higher than 10.000 U/L and 12 of them had data of TFTs, including thyroid stimulating hormone (TSH), free T4 (FT4), and free T3 (FT3) during hospitalization. These patients were evaluated. TSH levels were increased in all seven patients who required HD due to severe crush syndrome. Decreased FT4 levels were detected in 71.4% of them. None of the five non-HD patients had increased TSH levels or reduced FT4 levels. During follow-up, all patients survived. Renal and thyroid functions were normalized during follow-up without thyroxin replacement in patients with no prior history of hypothyroidism. Moreover, TFTs were normalized in two patients with history of hypothyroidism under thyroxine treatment without dose adjustments. In severe forms of crush syndrome, temporary hypothyroidism might be seen. The exact mechanism underlying this entity is not well-known. Further clinical and experimental trials should be conducted to illuminate the mechanism of disrupted thyroid hormonogenesis in crush syndrome victims.

Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis.

High thyroid stimulating hormone (TSH) levels may stimulate papillary thyroid cancer (PTC) cell proliferation; however, the relationship between TSH levels and PTC risk remains controversial. We aim to ascertain the association through a meta-analysis. Literature searches were conducted in PubMed, Embase, and Web of Science databases. After literature screening, the methodological quality was assessed using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality methods. Cochran's Q and I 2 tests were used to evaluate heterogeneity in the meta-analysis. Egger's test was applied to assess publication bias. A total of 12 eligible studies were included in this meta-analysis; all were of moderate and high methodological quality. The pooled results suggested that increased TSH levels were significantly associated with PTC risk; however, the included studies were significantly heterogeneous. Stratification analysis indicated that the heterogeneity might be from the area or type of control. Although significant publication bias existed among the studies, the trim-and-fill method and sensitivity analysis revealed that the combined results were stable and robust. TSH levels are significantly associated with the PTC risk; however, more high-quality studies in large sample sizes are recommended to verify the extrapolation of these findings.

The relationship between papillary thyroid carcinoma and preoperative TSH level: A cross-sectional study from Syria

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and thyroid stimulating hormone (TSH) is the major growth factor for thyroid cells. It is also an available, inexpensive test and performed routinely while evaluating thyroid nodules. Yet the relationship between TSH levels and PTC is still controversial. Understanding the relationship between preoperative TSH levels and thyroid cancer helps to break new ground of current prevention, diagnosis, and management approaches of thyroid cancer. A cross-sectional retrospective study of patients underwent total thyroidectomy during 2019 at Al-Assad University Hospital, which included 305 individuals. All patients underwent thyroid ultrasonography and laboratory assessment of serum TSH levels prior to surgery, in addition to recording histological features of resected thyroid samples. The malignancy rate was 21.3%, PTC patients had higher TSH values across the entire study even when gender, age and number of thyroid nodules differed. A statistically significant increase in TSH levels was noticed by moving from the benign thyroid nodular disease (BTND) group to papillary thyroid microcarcinoma (PTMC) group, then to thyroid cancer of larger size (TCLS) group (P = .001). A statistically significant relationship was also found between high TSH levels and lymph node metastases (LNM) (P = .008). TSH concentrations were significantly higher in patients with PTC, and higher TSH values were associated with TCLS and LNM.

Abstract #1405166: The Association of Thyroid Stimulating Hormone Among the Reference Range and its Change with the Incidence of Metabolic Syndrome in a 5-year Prospective Cohort Study

Although a number of studies have explored the association between thyroid stimulating hormone (TSH) among the normal range and the prevalence of metabolic syndrome (MetS), the conclusions are conflicting. We aimed to investigate the association of TSH among the reference range and its change (ΔTSH) with the incidence of MetS. In this prospective population-based cohort study, 1501 participants with baseline TSH among the reference range were divided into three groups by tertile cut-off values and 1386 participants with the normal TSH levels both in 2014 and 2019 were divided into three groups by ΔTSH in tertiles. Binary logistic regression models were used to estimate the associations of TSH and ΔTSH with MetS and its components. The reported association was measured using the odds ratios (ORs) and 95% confidence intervals (CIs). Compared with the lowest baseline TSH group, the highest group of TSH was associated with a higher incidence of MetS (OR 1.659; 95% CI 1.089, 2.525) in women after adjusting for important confounders. Among the individual components of MetS, the highest group of TSH was associated with central obesity (OR 1.746; 95% CI 1.135,2.685) in women. There was a lack of association between ΔTSH and MetS in both sexes. However, a significant relationship was found for the highest group of ΔTSH and central obesity (OR 1.887; 95% CI 1.144, 3.114) in men. Moreover, the middle (OR 2.526; 95% CI 1.374, 4.645) and high groups (OR 2.057; 95% CI 1.104, 3.833) of ΔTSH were associated with hypertriglyceride in women. Our results suggest that an increase in TSH levels even among the normal range is related to a higher risk of MetS and certain components. It is important to monitor basic TSH as well as the dynamic changes of TSH.

Correlation of Maternal Thyroid Stimulating Hormone Levels With Lipid Profile in Pregnant Women With Hypothyroidism.

Introduction Pregnancy leads to changes in hormonal levels and lipid profile. Thyroid hormones play a crucial role in embryonic growth and fetal development. Untreated thyroid disease during pregnancy can lead to a high risk of complications. Aim The aim of the study is to examine the correlation between thyroid stimulating hormone (TSH) and lipid profile in pregnant women with hypothyroidism. Materials and methods This cross-sectional case-control study was conducted at the Biochemistry Department, Alfalah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India.The study consisted of 500 patients (250 cases and 250 controls) who fulfilled the inclusion and exclusion criteria. Of the 250 cases recruited, 23 cases were in the 2nd trimester and 209 cases were in the 3rd trimester. Blood samples were collected from the participants to assess their lipid profile and TSH levels. Results The study showeda statistically significant difference between the mean TSH levels of hypothyroid pregnant females in the 2nd trimester (3.85 ± 0.59) and the 3rd trimester (4.71 ± 0.54). There was a significant positive correlation observed between TSH and Total Cholesterol, Triglycerides, and LDL-C in both the 2nd and 3rd trimesters.In the second trimester, there was a significant positive correlation observed between TSH & TC (r = 0.6634, p<0.0005), TSH & TG (r= 0.7346, p=0.00006), TSH & LDL (r= 0.5322, p= 0.008). In the third trimester, there was a significant positive correlation observed between TSH & TC (r = 0.8929, p<0.00001), TSH & TG (r= 0.430, p<0.00001), TSH & LDL (r= 0.168, p= 0.015). However, no significant correlation was found between TSH levels and HDL-C in either trimester. The correlation coefficient and p-value for TSH & HDL were r = 0.2083, p=0.340 in the second trimester, and r = 0.0189, p=0.2384 in the third trimester. Conclusion A significant increase in TSH levels in hypothyroid pregnant women was observed in the 3rd trimester compared to the second trimester. Moreover, a significant positive correlation was found between TSH and lipid profile (total cholesterol, triglycerides, and LDL) in both trimesters, but not with HDL. These findings highlight the importance of monitoring thyroid hormone levels in the later stages of pregnancy to avoid potential maternal & fetal complications.

Association of Thyroid Function and Severity of Illness in Liver Cirrhosis as Measured by Child-Pugh Score.

Objective The main aim of this study is to understand the existing knowledge gap between thyroid function tests and the severity of liver cirrhosisas measured by the Child-Pugh score. Materials and methods This is a cross-sectional study conducted on 100 patientsdiagnosed with cirrhosis of liver. Serum triiodothyronine (free T3), thyroxine (free T4), and thyroid stimulating hormone (TSH) levels were measured, and the severity of liver cirrhosis was measured by Child-Pugh score and statistical analysis were done to investigate the association of free T3, free T4 and TSH levels with Child-A, Child-B, and Child-C severity groups. Results The results revealed that there is a statistically significant positive correlation between TSH levels and Child-Pugh score, whereasa statistically significant negative correlation was associated between free T3 (fT3), free T4 (fT4) levels, and Child-Pugh Score.Further, we also observedthat the Child-C group has 7.5-foldrisk of increased TSH levels (odds ratio {OR} = 7.553, 95% CI = 2.869-19.883, p= 0.000), has 5-fold risk of decreased fT3 levels (OR = 5.023, 95% CI = 1.369-18.431, p = 0.009) and has 6.4-fold risk of decreased fT4 levels (OR = 6.402, 95% CI = 2.516-16.290, p = 0.000). Conclusion Our results demonstrated that there is a positive and direct correlation associated between increasing TSH with severity of liver cirrhosis as measured by Child-Pugh score, whereasa negative and inverse correlation was observed between decreasing fT3 and fT4 levels with the severity of liver cirrhosis as measured by Child-Pugh score. This suggests that the Child-Pugh score can be used as a prognostic indicator in cirrhotic patients.

The Incidence of Hypothyroidism Following Hemithyroidectomy in a Tertiary Academic Center in Saudi Arabia

Background Hemithyroidectomy is a common procedure used to treat various benign and malignant conditions. It is often associated with complications, of which hypothyroidism is an underappreciated sequel. We sought to comprehend the rate and associated risk factors for developing hypothyroidism following hemithyroidectomy at King Abdulaziz University Hospital (KAUH). Methods In this retrospective study, we reviewed the medical records of all patients who had hemithyroidectomies for benign and malignant conditions between January 2008 and August 2022. Patients were analyzed for age, gender, body mass index (BMI), comorbidities, family history of thyroid disease, thyroid antibodies, and pre- and postoperative thyroid-stimulating hormone (TSH). Pre- and postoperative TSH levels were compared using the Wilcoxon signed-rank test. Results From 153 cases, 39 patients met the inclusion criteria; 31 (79.5%) were females. Seventeen (43.59%) patients developed biochemical hypothyroidism within two years following hemithyroidectomy; the majority (64.71%) of those with hypothyroidism developed it within the first six months. There was a significant increase in TSH levels following surgery (p< 0.001). Conclusion The overall incidence of hypothyroidism within two years of hemithyroidectomy is 43.59%; among those who developed hypothyroidism, the majority (64.71%) did so within the first six months. Thus, we strongly recommend continuous monitoring of TSH levels in the first six months, as it may aid in the decision to begin treatment before symptoms develop.

Clinical symptoms, thyroid dysfunction, and metabolic disturbances in first-episode drug-naïve major depressive disorder patients with suicide attempts: A network perspective.

Co-occurrence of thyroid dysfunction, metabolic disturbances, and worsening clinical symptoms in major depressive disorder (MDD) patients with suicidal attempts (SA) are common. However, their relationship in SA patients remains unexplored. We aimed to (1) determine the independent association of thyroid dysfunction, clinical symptoms, and metabolic disturbances with SA; and (2) identify their interactions in SA patients via the network approach. 1718 FEDN MDD patients were recruited. Depressive, anxiety, and psychotic symptoms were assessed by the Hamilton Rating Scale for Depression (HAMD), the Hamilton Rating Scale for Anxiety (HAMA), and the Positive and Negative Syndrome Subscale positive subscale, respectively. The serum levels of thyroid hormones and other metabolic parameters were assessed. Logistic regression model was applied to determine the correlates of SA. Network analysis was applied to determine the interaction between thyroid dysfunction, clinical symptoms, and metabolic disturbances. SA patients had significant worse metabolic disturbances, thyroid dysfunction, and clinical symptoms than non-SA patients. Thyroid peroxidases antibody, thyroid stimulating hormone (TSH), HAMD scores, HAMA scores, and systolic blood pressure was independently associated with SA. Network analysis suggested that TSH was the hub of the network, exhibiting substantial associations with metabolic disturbances, anxiety, and psychotic symptoms in SA patients. Our work highlights the predominant role of serum TSH levels in the pathophysiology of SA. Regular thyroid function tests might help early detect SA. Targeting increased TSH levels may help reduce metabolic disturbances and clinical symptoms in SA patients.

Relationship of iodine excess with thyroid function in 6-year-old children living in an iodine-replete area.

Adequate iodine intake is essential for growing children, as both deficient and excessive iodine status can result in thyroid dysfunction. We investigated the iodine status and its association with thyroid function in 6-year-old children from South Korea. A total of 439 children aged 6 (231 boys and 208 girls) were investigated from the Environment and Development of Children cohort study. The thyroid function test included free thyroxine (FT4), total triiodothyronine (T3), and thyroid-stimulating hormone (TSH). Urine iodine status was evaluated using urine iodine concentration (UIC) in morning spot urine and categorized into iodine deficient (< 100 μg/L), adequate (100-199 μg/L), more than adequate (200-299 μg/L), mild excessive (300-999 μg/L), and severe excessive (≥ 1000 μg/L) groups. The estimated 24-hour urinary iodine excretion (24h-UIE) was also calculated. The median TSH level was 2.3 μIU/mL, with subclinical hypothyroidism detected in 4.3% of patients without sex differences. The median UIC was 606.2 μg/L, with higher levels in boys (684 μg/L vs. 545 μg/L, p = 0.021) than girls. Iodine status was categorized as deficient (n = 19, 4.3%), adequate (n = 42, 9.6%), more than adequate (n = 54, 12.3%), mild excessive (n = 170, 38.7%), or severe excessive (n = 154, 35.1%). After adjusting for age, sex, birth weight, gestational age, body mass index z-score, and family history, both the mild and severe excess groups showed lower FT4 (β = - 0.04, p = 0.032 for mild excess; β = - 0.04, p = 0.042 for severe excess) and T3 levels (β = - 8.12, p = 0.009 for mild excess; β = - 9.08, p = 0.004 for severe excess) compared to the adequate group. Log-transformed estimated 24h-UIE showed a positive association with log-transformed TSH levels (β = 0.04, p = 0.046). Excess iodine was prevalent (73.8%) in 6-year-old Korean children. Excess iodine was associated with a decrease in FT4 or T3 levels and an increase in TSH levels. The longitudinal effects of iodine excess on later thyroid function and health outcomes require further investigation.

Trends in Thyroid Nodules and Malignancy: A Two-Year Retrospective Study in a Tertiary Care Centre.

Thyroid nodules are one of the most common presentations faced by ENT clinicians, and the prevalence of differentiated thyroid cancer is increasing worldwide. We found no other study showing a clear occurence of cancer in thyroid nodules in the state of West Bengal. Hence, we undertook this study to determine the occurence of thyroid cancer among people with thyroid nodules. A retrospective review was performed for 96 patients with thyroid nodules who underwent USG and Fine Needle Aspiration Cytology (FNAC) and thyroid surgery at a tertiary hospital in Kolkata over a 2-year period from January 2020 to December 2021. The occurence of thyroid cancer in patients with thyroid nodules; association with age, sex, duration of thyroid swelling and thyroid stimulating hormone (TSH) levels of the patients; the sonographic findings (nodule size and number) and Bethesda classification on FNAC were reviewed. A total of 96 cases were reviewed. The highest malignancies were seen in swellings of 3-5years duration (50%), and in patients with increased TSH levels (60%). Patients with single vs. multinodular goitre had comparable rates (23.07 vs 22.22%). The highest risk was seen in nodules 1-2cm in size. A TIRADS score of 2 had a negative predictive value of 86.95% and a score of 5 had a positive predictive value of 100%. BETHESDA II lesions had a 3.44% rate of malignancy, while BETHESDA V and VI had rates of 100% and 75% respectively. While most of the thyroid swellings were benign, 22.91% were malignant, the most common being papillary carcinomas.

Very young children with Prader-Willi syndrome are refractory to growth hormone-associated decreases in free thyroxine levels.

The earlier initiation of growth hormone (GH) treatment for patients with Prader-Willi syndrome (PWS) who are younger than 2 years has become more prevalent. Because free thyroxine (FT4) levels are low during this period, GH may induce further reductions; however, limited information is currently available on this issue. Therefore, we herein performed age-dependent and time-course analyses of thyroid hormone levels in GH-treated PWS children. This retrospective analysis included genetically diagnosed PWS patients (N = 37, median age of 26 months). An age-dependent analysis was performed by subdividing subjects based on age [a younger group aged between 1 and 24 months (N = 16) and an older group between 25 and 84 months (N = 21)] and was followed by a multiple regression analysis with adjustments for sex and the cumulative GH dose per bodyweight. A time-course analysis of subjects who had not received levothyroxine during the first 18 months of GH treatment (N = 28) was conducted. A one-month treatment with GH decreased FT4 levels in the older group, but not in the younger group, and this was associated with increases in thyroid-stimulating hormone levels. A positive correlation was noted between age and decreases in FT4 levels independent of the cumulative GH dose per bodyweight. The time-course analysis revealed no changes in FT4 levels in the younger group, while transient decreases were observed in the older group. In conclusion, GH treatment causes age-dependent changes in FT4 levels. This result will help clinicians establish a therapeutic strategy to decide the necessity of levothyroxine supplementation in GH-treated children with PWS.

Challenges in Thyroid Function Testing: Interferences and Clinical Implications

In recent decades, significant advancements have been made in the methodologies used for evaluating thyroid dysfunctions. These advancements include the development of radioimmunoassays, immunometric assays, and liquid chromatography coupled with mass spectrometry. The main thyroid function tests include thyroid-stimulating hormone (TSH) and the measurement of triiodothyronine (T3) and thyroxine (T4), including their total and free fractions. Over time, different generations of TSH tests have been developed, starting from radioimmunoassays to immunometric assays, and more recently, tests utilizing fluorophores and chemiluminescent molecules. The third-generation tests are currently the most widely used due to their high sensitivity and specificity. Thyroid-stimulating hormone is preferred as the initial test for evaluating thyroid function since it has a log-linear relationship with free T4 levels, enabling the identification of subclinical hypothyroidism and subclinical hyperthyroidism. The reference range for normal TSH levels is typically between 0.45 and 4.5 mIU/L. However, there can be variations in TSH levels based on factors such as sex, age, and ethnicity. Specific reference values may be required for certain populations, such as the elderly, pregnancy, and neonates. In the elderly, an increase in TSH levels is expected. In the neonatal period, TSH levels are high after birth and take a few weeks to normalize. During pregnancy, various physiological changes occur, leading to alterations in thyroid hormones to meet fetal demands. Laboratory interferences in thyroid hormone assays must be considered to ensure accurate results. Biotin interference can lead to falsely low TSH and falsely high free T3 and T4 levels. Macro-thyrotropin can cause elevated TSH levels with normal thyroid hormone levels. Heterophilic antibodies can also cause false results. Additionally, the evaluation of autoantibodies and markers used in thyroid cancer follow-up needs special attention. Patients experiencing conditions like trauma, particularly in severe cases, may undergo changes in thyroid hormone levels, even without having a specific thyroid disease, which is called low triiodothyronine syndrome. In conclusion, it is essential to be aware of potential laboratory interferences and consider individual variations to ensure accurate interpretation and appropriate management of patients.