Low FT4 Research Articles

Depleted uranium induces thyroid damage through activation of ER stress via the thrombospondin 1-PERK pathway

Depleted uranium (DU) can cause damage to the body, but its effects on the thyroid are unclear. The purpose of this study was to investigate the DU-induced thyroid damage and its potential mechanism in order to find new targets for detoxification after DU poisoning. A model of acute exposure to DU was constructed in rats. It was observed that DU accumulated in the thyroid, induced thyroid structure disorder and cell apoptosis, and decreased the serum T4 and FT4 levels. Gene screening showed that thrombospondin 1 (TSP-1) was a sensitive gene of DU, and the expression of TSP-1 decreased with the increase of DU exposure dose and time. TSP-1 knockout mice exposed to DU had more severe thyroid damage and lower serum FT4 and T4 levels than wild-type mice. Inhibiting the expression of TSP-1 in FRTL-5 cells aggravated DU-induced apoptosis, while exogenous TSP-1 protein alleviated the decreased viability in FRTL-5 cells caused by DU. It was suggested that DU may caused thyroid damage by down-regulating TSP-1. It was also found that DU increased the expressions of PERK, CHOP, and Caspase-3, and 4-Phenylbutyric (4-PBA) alleviated the DU-induced FRTL-5 cell viability decline and the decrease levels of rat serum FT4 and T4 caused by DU. After DU exposure, the PERK expression was further up-regulated in TSP-1 knockout mice, and the increased expression of PERK was alleviated in TSP-1 over-expressed cells, as well as the increased expression of CHOP and Caspase-3. Further verification showed that inhibition of PERK expression could reduce the DU-induced increased expression of CHOP and Caspase-3. These findings shed light on the mechanism that DU may activate ER stress via the TSP 1-PERK pathway, thereby leading to thyroid damage, and suggest that TSP-1 may be a potential therapeutic target for DU-induced thyroid damage.

HEMATOLOGICAL AND THYROID DISTURBANCE IN AN ALGERIAN POPULATION OF CHRONIC HEMODIALYSIS PATIENTS

Objective: Hemodialysis patients suffer in the majority of cases from normocytic normochromic anemia, due to the decrease of erythropoietin production. Thyroid abnormalities are also observed in these patients. They are represented by hypothyroidism which is characterized by low levels of FT3, normal levels of free thyroxine, and often high levels of TSH The objective is to estimate the prevalence of hypothyroidism and anemia in an Algerian population with end-stage chronic renal failure on hemodialysis. Design and method: This is a descriptive cross-sectional study carried out in the Biochemistry laboratory in collaboration with the Hematology laboratory of CPMC. 94 patients with end-stage chronic renal failure . Results and discussion Results: The mean age of our hemodialysis patients was 59.62 years, with a sex ratio of 0.69. Most of our patients (47%) had arterial hypertension (AH) and 20% of patients had diabetes. Our results show a prevalence of normocytic normochromic anemia in 88.30% of hemodialysis patients. The TSH and FT3 hormone assays in our patients revealed a prevalence of hypothyroidism of 38%, with a female predominance. FT3 was low in 24 patients, 12 patients had high TSH levels. The hypothyroid profile was characterized by normal TSH levels associated with low FT3 levels (25% of patients), 12 patients had high TSH levels associated with normal FT3 concentrations. Thyroid abnormalities in chronic hemodialysis patients (CDH) are secondary to hormonal disorders. They are often represented by hypothyroidism. (Captein, 1996). The results of the comparison of the distribution of hypothyroid and anemic patients show an independence of the distribution of the number of cases according to the symptoms of hypothyroidism. Conclusions: The similarity of symptoms between anemic and hypothyroid hemodialysis patients can mislead the clinician if he does not think to measure thyroid hormones, knowing that the therapeutic conduct is different in the two situations, and the impact on the health economy is very important.

Association between thyroid function and obesity phenotypes in healthy euthyroid individuals: an investigation based on Tehran Thyroid Study

AimsWe investigated whether thyroid function could be associated with obesity phenotypes amongst euthyroid individuals.Materials and methodsA cross-sectional analysis was conducted among healthy, euthyroid subjects. The study participants were chosen from the Tehran Thyroid Study (TTS). We analyzed 2988 euthyroid adults and classified them into four obesity phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). The statistical differences between thyroid hormones between various obesity phenotypes according to age and sex was compared using analysis of covariance (ANCOVA).ResultsIt was found that MHNW participants had higher levels of FT4 when compared with metabolically healthy or unhealthy obese subjects (P < 0.001), even after adjustment for the confounding variables. No difference was observed in the levels of TSH (P = 0.260) among obesity phenotypes. In the subgroup analysis according to the age, a significant difference was observed in the level of FT4 only in subjects with age < 55 years (P = 0.001). However, analyzing men and women separately did not show a significant difference in the FT4 level among obesity phenotypes (P > 0.05).Conclusion“Metabolically abnormality” was independently related to low normal FT4 levels in overweight/obese euthyroid individuals. There is a need for further research to understand how low FT4 levels are linked to metabolically unhealthy states in euthyroid individuals.

The determinants of thyroid function among vegetable farmers with primary exposure to chlorpyrifos: A cross-sectional study in Central Java, Indonesia

ObjectivesOccupational pesticide exposure, chlorpyrifos (CPF) in particular, may adversely affect the thyroid. The purpose of this study was to evaluate the determinants of thyroid function as indicated by the serum concentration of thyroid-stimulating hormone (TSH) among Indonesian vegetable farmers with primary exposure to CPF. MethodsA total of 151 vegetable farmers participated in this study. The sociodemographic and occupational characteristics of the participants were obtained using a structured interviewer-administered questionnaire. A validated quantitative method was used to estimate the cumulative exposure level (CEL). Serum TSH, thyroglobulin (Tg), free thyroxine (FT4), and urinary iodine excretion (UIE) were measured in the laboratory. The difference in TSH concentrations according to CEL and other characteristics were analysed using the Mann-Whitney U test. A multiple linear regression model was used to evaluate the potential determinants of TSH. ResultsThe mean age was 50 (SD 9.4) years. The median concentrations of TSH, FT4, and Tg/FT4 ratio were 1.46 mIU/L, 1.17 ng/dL, and 6.23 × 102, respectively. We observed that higher TSH concentrations were found among those with a higher Tg/FT4 ratio, were classified as high CEL, and had lower UIE or FT4. ConclusionsOur findings show that Tg/FT4 ratio, CEL, FT4, UIE concentrations, and post-spraying days were determinants of TSH concentrations among farmers with primary exposure to CPF. These results indicate that farmers are exposed to agents with thyroid-disrupting properties, thus supporting previous evidence showing the potential for thyroid disorders in agricultural populations exposed to pesticides.

(168) Financial Toxicity of Erectile Dysfunction: The First Assessment of the Economic Stress Associated With the Treatment of Erectile Dysfunction

Abstract Introduction Financial toxicity (FT) describes the direct and indirect financial burden associated with disease treatment. FT has been associated with adverse outcomes, including medication-rationing, psychological distress, and bankruptcy. Despite the well-described psychosocial impact of erectile dysfunction (ED), limited work has been performed to characterize its financial impact on patients. Objective We present the first study to directly report on the FT associated with ED management. Methods We performed a cross-sectional study of patients treated for ED in a diverse, urban academic medical center. Patients were surveyed with the validated COST tool (COmprehensive Score for financial Toxicity), the IIEF-5 (International Index of Erectile Function), and a 10-item social needs screener. The maximum score for the COST tool is 44, with lower scores indicating increased FT. Patients were stratified into “Moderate-to-Severe FT” (COST 25-0 points) and “Low FT” (COST &amp;gt;26 points). Lower IIEF-5 scores similarly indicate more severe ED. FT score distributions were analyzed by patient characteristics and ED severity. Descriptive statistics, chi-square, linear regression, and Mann-Whitney U tests were performed using SPSS v28. Results 48 patients were surveyed. 46% of patients identified as Hispanic, and 90% identified as non-white including 31% Black and 40% Latinx. Average age was 62.6 ± 9.0 years. Median ED severity was mild-moderate (IIEF5 Score = 13) and 73% of patients used oral ED medications. In the last year, 34% of respondents spent &amp;lt;$100 on these medications, 23% spent $100-$499, 26% spent $500-$1000, and 9% spent &amp;gt;$1000. Indirect costs of ED care were defined as cost of transportation to visits, copays, lab tests, or imaging. 40% of respondents spent nothing on indirect costs, 27% spent $100-$499, and 19% spent &amp;gt;$500. Mean COST score was 26.7 ± 9.2 and “Moderate-to-Severe FT” was found in 48% of patients. Compared to those with "Low FT", the “Moderate-to-Severe FT” cohort had lower income (OR for annual income &amp;lt;50,000 = 6.4, 95% CI 1.8 - 23.1, p=0.003), were less likely to have English as their first language (OR 0.25, 95% CI 0.07 - 0.8, p=0.02), were less likely to self-drive (OR 0.25, 95% CI 0.07 - 0.84, p=0.02), screened positively for more unmet social needs (mean difference 1.3, 95% CI 2.0 - 0.6, p&amp;lt;0.001) and had more severe ED (mean IIEF score difference of 3.1, 95% CI 0.2 - 6.0, p=0.035). IIEF score was significantly correlated with COST Score (Spearmans rho correlation coefficient = -0.302, p=0.039). Conclusions Our findings suggest FT and unmet social needs may be related to ED severity. In addition to medical interventions, these patients may benefit from financial social services. 48% of our patients reported moderate or severe FT. As even moderate FT has been associated with cost-coping behaviors, like medication rationing, the clinical implications of these findings are potentially significant. We recommend that urologists inquire and investigate the financial burden incurred on their patients. Disclosure No

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population.

The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated. We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH. We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint. Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH. Prophylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.

Thyroid Function in Newly Diagnosed HIV-positive Patients.

As of 2019, the highest prevalence of human immunodeficiency virus (HIV) in India is seen in the Northeastern states. Endocrine and metabolic disturbances can occur in HIV infection. Thyroid dysfunction is one of the common endocrinopathies. In HIV infection, thyroid function abnormalities are seen in about 4-35% of adult patients. Thyroid function abnormalities range from overt hypothyroidism, subclinical hypothyroidism, and sick euthyroid syndrome to overt hyperthyroidism. Among them, subclinical hypothyroidism is the commonest abnormality. To our knowledge, there have been no studies from Northeastern India done in this regard. To study the thyroid function in newly diagnosed cases of HIV infection attending anti-retroviral therapy (ART) center, Assam Medical College. To estimate the prevalence and types of thyroid dysfunction in newly diagnosed HIV-infected individuals. To study thyroid dysfunctions with respect to age, sex, and cluster of differentiation (CD) 4 count. Hospital-based observational study was done at a tertiary care centre of upper Assam on newly diagnosed HIV-positive patients who were not started on antiretroviral therapy and who attended the ART centre, Assam Medical College during the period of our study. History, examinations and laboratory investigations, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and CD4 count, are done in all such patients, and only those who fulfilled the inclusion and exclusion criteria of our study are taken as study participants, and their findings tabulated. A total of 95 newly diagnosed HIV-positive patients fulfilling the inclusion and exclusion criteria of our study were taken. In our study, a total of 36.84% of the patients had thyroid dysfunction. We got subclinical hypothyroidism, overt hypothyroidism, sick euthyroid syndrome, and overt hyperthyroidism as the types of thyroid dysfunction. Among all the types of thyroid dysfunction, subclinical hypothyroidism was the commonest abnormality in our study. Under sick euthyroid syndrome, we got only low FT3 as the biochemical abnormality. Thyroid dysfunctions were more common in females (42.3%) than males (35.8%) and were more common in the age group of 30-39 years. In the present study, among patients with thyroid dysfunction, it was seen that 51.43% of the patients had a CD4 cell count in the range 101-200 cells/mm3, whereas only 11.43% of patients had a CD4 cell count in the range &lt;50 cells/mm3 and no patient had a CD4 cell count &gt;500 cells/mm3 . In our study, we found that thyroid dysfunctions were common in newly diagnosed HIV-positive patients, the prevalence of which was much higher in the general population. Thyroid dysfunction was present in all the stages of the HIV disease.

Thyroid Function in Obese Patients without Thyroid Disorders

Background: Thyroid status influences weight and thyroid function is altered in obese individuals. Objective: This study aimed to see the levels of free thyroxine (FT4) and thyroid-stimulating hormone (TSH) and their relationship with the parameters of obesity in obese children and adults with primary exogenous obesity without thyroid disorders. Materials and Methods: This retrospective cross-sectional study was done in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, from May 2019 to March 2020 in 238 children and adults with primary exogenous obesity. Individuals with thyroid disorders were excluded from the study. Data were taken from hospital records to assess the thyroid function (FT4 and TSH) in obesity. Results: Two hundred and thirty-eight individuals with a mean age of 16.42 ± 9.72 years (range 3–62 years) and mean body mass index of 31.09 ± 7.64 kg/m2 were included in the study. The distribution of FT4 was normal and that of TSH was skewed to the right. Ninety-five percent confidence interval (CI) of FT4 and TSH was within the normal reference range. Ninety-five percent CI of FT4 was in the upper end of normal (1.176–1.251 mIU/L in ≤20 years and 1.094–1.306 mIU/L in &gt;20 years) and that of TSH was in the lower end of normal (2.619–3.207 mIU/L in ≤20 years and 2.616–4.141 mIU/L in &gt;20 years). About 13.4% had low FT4 and 15.4% had raised TSH. Waist circumference (WC) had a negative linear association with FT4 (r = −0.229, P = 0.003, R 2 = 5.24%), which was not present in the multivariate analysis. WC was significantly higher in the first versus third quartile of FT4 (103.974 ± 17.211 vs. 94.818 ± 14.544 cm). Conclusion: FT4 and TSH levels were in the lower and upper end of normal, respectively, in obese patients without thyroid disorders. Central obesity was negatively associated with FT4 in obese individuals.

Abstract #1400968: A Case of Co-Existing Alemtuzumab-Induced Thyroid Disorders

Alemtuzumab (ALZ) is an anti-CD52 monoclonal antibody effective in treating relapsing-remitting Multiple Sclerosis (MS). ALZ is hypothesized to augment immune function due to mature lymphocyte depletion; it may also predispose patients to secondary autoimmune disorders during the immune system recovery phase, with thyroid dysfunction occurring in up to 33%. We a case of a woman with MS who developed Hashimoto’s thyroiditis followed by Graves’ disease after ALZ use. A 43-year-old woman with MS was referred for management of hyperthyroidism after experiencing 1 year of palpitations, insomnia, and tremors. She completed two doses of ALZ nineteen months apart. Nine months after her 2nd ALZ dose, she developed hypothyroidism (TSH 38 mIU/L, TPO 856 IU/L, and low FT4 0.2ng/dL); she was treated to euthyroidism with levothyroxine. Sixteen months after her 2nd dose, she developed hyperthyroidism, persisting after levothyroxine cessation: TSH 0.02 mIU/L, FT4 1.9ng/dL, FT3 7.4pg/mL, TRAb 9.6, TSI 385, and TPO 83 IU/L. Her Graves’ disease course was complicated by the development of mild unilateral proptosis and diplopia. Past medical history included neurogenic bladder and anxiety, treated with mirabegron and alprazolam. Family history was notable for thyroidectomy in her mother for unknown indication. Physical exam showed stable vitals, mild active thyroid eye disease, goiter, and fine bilateral hand tremor. She was initially treated with methimazole, but unfortunately developed significant hepatotoxicity. She was recommended for total thyroidectomy, which she underwent without complication following preparation with potassium iodide. This case highlights an interesting presentation of co-existing autoimmune thyroid disorders in an ALZ-treated patient. ALZ has a rapid and long-lasting effect on the immune system, leading to qualitative and quantitative lymphocyte changes. ALZ induced Graves’ disease (AIGD) is the most common thyroid disorder, followed by Hashimoto’s thyroiditis & silent thyroiditis at 63%, 15%, & 9%, respectively. Most of those with AIGD had overt symptoms, and 10% reported ophthalmopathy. They peak around 28 months after the last dose, concurring with the B cell slow recovery phase. Over half of patients with AIGD required anti-thyroid medications (56%), 22% underwent radioactive iodine, and 11% underwent thyroidectomy. Interestingly, MS patients who developed AIGD had better overall MS disease prognosis. The frequency of ALZ-associated thyroid disease underscores the importance of routine thyroid function monitoring every 3 months following ALZ, and a provision of thyroid education materials for earlier identification of thyroid disorders.

Triglycerides Mediate the Relationship Between Maternal Free Thyroxine and Birth Weight: A Prospective Cohort Study from China.

Fetal overgrowth (large for gestational age, LGA), is associated with an increased risk of maternal and fetal morbidity and adverse health outcomes. Thyroid hormones are key regulators of metabolism during pregnancy and fetal development. Lower maternal free thyroxine (FT4) and higher maternal triglyceride (TG) levels during early pregnancy are associated with higher birth weight. We aimed to examine the mediating role of maternal TG in the association between maternal FT4 and birth weight. We performed a large prospective cohort study including pregnant Chinese women who were treated at a tertiary obstetric center during the period of January 2016 to December 2018. We included 35,914 participants with complete medical records. We performed causal mediation analysis to decompose the overall effect of FT4 on birth weight and LGA with maternal TG as the mediator. We observed statistically significant associations between maternal FT4, TG levels and birth weight (all p<0.0001). Using a four-way decomposition model, we identified a controlled direct effect (coefficient [95% confidence interval, CI], -0.038 [-0.047 to -0.029], p<0.0001) that accounted for 63.9% of the total effect, in addition to the other three estimated effects (reference interaction, coefficient [95% CI]= -0.006 [-0.009 to -0.001], p=0.008; mediated interaction, coefficient [95% CI]= 0.0004 [0.000 to 0.001], p=0.008; and pure indirect effect, coefficient [95% CI]= -0.009 [-0.013 to -0.005], p<0.0001) of TG on the association between FT4 and birth weight z-score. Moreover, maternal TG accounted for 21.6% and 20.7% (via mediation) and 13.6% and 41.6% (via maternal FT4 and TG interaction) of the total effect of maternal FT4 on fetal birth weight and LGA, respectively. The proportions of the total associations that could be reduced by "eliminating" the effect of maternal TG were 36.1% for birth weight and 65.1% for LGA, respectively. High maternal TG levels may play substantial mediating roles in the relationship between low FT4 levels in early pregnancy and increased birth weight and a higher risk of LGA. Furthermore, the occurrence of fetal overgrowth may also be influenced by possible synergistic effects between FT4 and TG.

Thyroid function analysis after roxadustat or erythropoietin treatment in patients with renal anemia: a cohort study

Purpose This cohort study was designed to explore whether roxadustat or erythropoietin could affect thyroid function in patients with renal anemia. Methods The study involved 110 patients with renal anemia. Thyroid profile and baseline investigations were carried out for each patient. The patients were divided into two groups: 60 patients taking erythropoietin served as the control group (rHuEPO group) and 50 patients using roxadustat served as the experimental group (roxadustat group). Results The results indicated that there were no significant differences in serum total thyroxine (TT4), total triiodothyronine (TT3), free triiodothyronine (FT3), free thyroxine (FT4) or thyroid stimulating hormone (TSH) between the two groups at baseline. After treatment, TSH, FT3, and FT4 were significantly lower in the roxadustat group than in the rHuEPO group (p < 0.05). After adjusting for age, sex, dialysis modality, thyroid nodules and causes of kidney disease, Cox regression showed that roxadustat was an independent influencing factor on thyroid dysfunction (HR 3.37; 95% CI 1.94–5.87; p < 0.001). After 12 months of follow-up, the incidence of thyroid dysfunction was higher in the roxadustat group than in the rHuEPO group (log-rank p < 0.001). Conclusion Roxadustat may lead to a higher risk of thyroid dysfunction, including low TSH, FT3 and FT4, than rHuEPO in patients with renal anemia.

MAFLD in Patients with Cushing's Disease Is Negatively Associated with Low Free Thyroxine Levels Rather than with Cortisol or TSH Levels.

This study aims to analyze the clinical characteristic of metabolic associated fatty liver disease (MAFLD) in patients with active Cushing's disease (CD) and determine associations of thyroid hormones with MAFLD. Patients with active CD were included in this cross-sectional study. All subjects were assessed for hepatic steatosis by abdominal ultrasonography and thyroid functions. Demographic and clinical characteristic parameters were collected for correlation analysis and logistic analysis. 290 individuals with active CD were included in Huashan hospital from January 2014 to February 2022. We found that the prevalence of CD with MAFLD was 33.79%. The MAFLD group had a lower level of FT4 and a higher level of FT3/FT4 but no difference in levels of cortisol, 24 h UFC, TSH, TT4, TT3, and FT3. Correlation analysis showed positive associations of TSH, TT4, TT3, FT3, and FT3/FT4 with BMI. In age-, BMI-, sex-, cortisol-, and 24 h UFC-adjusted analysis, FT4 was independently associated with MAFLD in patients with CD. This association remained similar even after adjusting for the presence of metabolic syndrome components. Lower FT4 levels were associated with higher risk of MAFLD in patients with CD. FT4 may be used as a helpful indicator to predict MAFLD and provide novel ideas for the treatment of MAFLD in patients with CD in the future.

Construction and validation of nomograms to reduce completion thyroidectomy by predicting lymph node metastasis in low-risk papillary thyroid carcinoma

ContextMore than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy. ObjectiveTo screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status. MethodsA retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009–2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort. ResultsMore than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy. ConclusionsModels based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.

Thyroid Abnormalities in Children with Sepsis

Introduction: Sepsis is the most common cause of mortality in infants and children. A hormonal disorder that often affected in sepsis is thyroid hormones which occur in the form of euthyroid sick syndrome (ESS) or nonthyroidal illness syndrome (NTIS). The aim of study was to evaluate thyroid hormones changes and the outcome in children with sepsis. Materials and Methods: Present study is hospital based observational cohort study.70 children with diagnosed sepsis were required in sample size. Serum free T3, free T4 and TSH was measured on day one and also on follow up (7th day). Result: on day one Serum FT3 level was low in 40 (57.2%) subjects and Serum FT4 level was low in 12 (17.2%) subjects. TSH was normal in most 66 (94.2%) of subjects. Mortality was more in children with low serum FT3 (22.5%) as compared to those with normal FT3 (3.4%). Mortality was also more in children with low serum FT4 level (41.6%) as compared to those with normal FT4 level (8.7%), (p=0.002). Mortality was more in children with low serum FT3 (29%) on follow up as compared to those with normal FT3 (2.5%) (p=0.001). Conclusion: Thyroid hormones dysfunctions are common in children with sepsis. Mortality is significantly associated with low levels of serum FT3 &amp; FT4. So Thyroid hormones dysfunctions could be an indicator of disease severity with possible need for hormone supplementation. Keywords: Thyroid hormones, Serum free T3, free T4, TSH, sepsis, children

Thyroid evaluation in suspicious hypothyroid adult dogs before and after treatment.

The purpose of this study was to measure circulating TSH, T4 and fT4 concentrations in dogs submitted to a clinical visit for general symptoms (weight gain, polyuria and polydipsia, changes in hair coat). Twenty-eight dogs, 14 cross-breed and 14 purebreds (Golden Retriever, Labrador, Doberman), of both sexes (14 males and 14 females), aged 8 to 14 years, were assessed. No significant differences of circulating TSH, T4 , fT4 concentrations between the baseline and after therapeutic treatment nor between intact and neutered females were observed. Compared to baseline values, intact males showed higher TSH concentrations (p⟨0.01), and castrated males lower TSH concentrations (p⟨0.01) after therapeutic treatment. Compared to intact males, castrated males showed baseline TSH concentrations higher (p⟨0.01), but lower (p⟨0.01) after therapeutic treatment. No significant differences of T4 and fT4 concentrations between baseline conditions and after therapeutic treatment, nor between intact and castrated males, were observed. The experimental sample considered in this study falls within that casuistry involving elevated TSH concentrations but low serum T4 and fT4 concentrations or close to the minimum physiological cut-off, in which the common clinical signs suggestive of hypothyroidism was, essentially, overweight and neglected appearance of the hair.

THYROID DYSFUNCTION IN HIV INFECTED PATIENTS - A CROSS SECTIONAL PREVALENCE STUDY IN TERTIARY CARE HOSPITAL

Background: Thyroid dysfunction is becoming more common in HIV infected patients. However, there is no enough data to suggest routine thyroid monitoring for those who are asymptomatic. Therefore, this study was conducted in an effort to nd a solution to these problems. Methods: A cross sectional observational study was conducted on 50 adult HIV positive patients with no comorbidities. A detailed history taking and examination was done and necessary investigations were done to make diagnosis. FT3, FT4, TSH and CD4 were done in all the patients. Results: Overt Hypothyroidism was noted in 2%(1), subclinical hypothyroidism in 10% (6), isolated low FT4 noted in 2%(1) and sick euthyroidism in 22%(14) patients. FT3, FT4 levels found decreasing, as the stage of HIV advanced whereas TSH levels did not correlate with stage of infection. A direct correlation was found FT3 and CD4 counts and an inverse correlation between TSH and CD4 counts. TSH levels in patients on HAARTwere signicantly higher when compared to those not on HAART. Conclusion: Majotiy of HIV infected patients with thyroid dysfunction did not have any symptoms. Serum FT3 and FT4 were directly correlated with WHO clinical infection stage. As CD4 counts dropped, TSH level was rising. Subclinical hypothyroidism was prevalent among HAART patients. Due to short sample size, no association could be shown between opportunistic infections and thyroid dysfunction

Congenital hypothyroidism in children with eutopic gland or thyroid hemiagenesis: prognostic factors for transient vs. permanent hypothyroidism.

More than one third of children with congenital hypothyroidism (CH) and thyroid gland in situ(or eutopic gland) have transient hypothyroidism. It remains difficult to determine early on whether hypothyroidism will be transient which may cause overtreatment and its complications in these children. Our primary aim was to determine prognostic factors for transient hypothyroidism in children with congenital hypothyroidism and eutopic gland or thyroid hemiagenesis. We retrospectively reviewed medical records of111 children, born between 1996 and 2017, diagnosed withcongenital hypothyroidism and eutopic gland or hemiagenesis and treated at the Nancy Regional and University Hospital. Fifty four infants (48.6%) had permanent congenital hypothyroidism (PCH) and 57 (51.4%) transient congenital hypothyroidism (TCH). Prognostic factors for TCH included prematurity, twin pregnancy, low birth weight and Apgar score <7, while low FT3 at diagnosis, maternal levothyroxine treatment, a family history of thyroid dysfunction and TSH≥10mUI/L while receiving treatment were associated with PCH. Knee epiphyses on X-ray at diagnosis were absent only in children with PCH. The median levothyroxine dose during follow-up was significantly lower in the TCH group compared to the PCH group. A levothyroxine dose of≤3.95,≤2.56,≤2.19 and≤2.12μg/kg/day at 6months, 1, 2 and 3years of follow-up, respectively, had the best sensitivity-to-specificity ratio for predicting TCH. Even though it remains difficult to predict thecourse of hypothyroidism at diagnosis, we were able to identify several prognostic factors for TCH including perinatal problems and lower levothyroxine requirements that can guide the physician on the evolution of hypothyroidism. Clinical Trial Registration Number: NCT04712760.

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.

Lower serum FT3 within the reference range is associated with mortality for older adults over 80 years of age with sarcopenia

ObjectiveThyroid hormones stimulate myogenesis and muscle contraction and regulate skeletal muscle cell metabolism. However, the association between thyroid hormone levels and mortality in sarcopenic older adults remains elusive. The aim of this study was to investigate the relationship between thyroid hormones and all-cause mortality in people over 80 years of age with sarcopenia.MethodsThis study was performed on 264 sarcopenic patients aged 80 years and older. Serum levels of thyroid hormone, including free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were tested to evaluate thyroid status. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People. Mortality data were available for up to 38 months of follow-up. The correlation between FT3 and calf circumference (CC) or handgrip strength (HGS) was determined by Pearson correlation analysis. Kaplan-Meier analysis was used to compare the differences between FT3 tertile groups. Cox regression was used to analyze the mortality risk ratio of patients with different FT3 tertiles.ResultsDuring the follow-up period, 88 older adults died. Non-Survivors had lower serum FT3 levels (3.7 ± 0.5 vs. 3.9 ± 0.7, P = 0.001) than the Survivor. Serum FT3 was positively associated with CC and HGS (r = 0.29, P < 0.001, r = 0.21, P = 0.002, respectively). The Kaplan-Meier curve analysis demonstrated a difference in mortality among the FT3 tertile groups (log-rank test, χ2 = 11.83, P = 0.003). The high FT3 group had lower mortality compared with the low FT3 group (the adjusted HRs were 0.63 (95%CI: 0.41–0.96 P = 0.031).ConclusionLower FT3 within the reference range is associated with higher mortality in adults over 80 years with sarcopenia and euthyroid. Routine assessment of FT3 may be an easy way to identify high-risk older adults with sarcopenia.

Effect of SARS-CoV-2 BNT162b2 mRNA vaccine on thyroid autoimmunity: A twelve-month follow-up study.

Graves' disease (GD) has been highlighted as a possible adverse effect of the respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine. However, it is unknown if the SARS-CoV-2 vaccine disrupts thyroid autoimmunity. We aimed to present long-term follow-up of thyroid autoimmunity after the SARS-CoV-2 BNT162b2 mRNA vaccine. Serum samples collected from seventy Japanese healthcare workers at baseline, 32 weeks after the second dose (pre-third dose), and 4 weeks after the third dose of the vaccine were analyzed. The time courses of anti-SARS-CoV-2 spike immunoglobulin G (IgG) antibody, thyroid-stimulating hormone receptor antibody (TRAb), and thyroid function were evaluated. Anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) were additionally evaluated in thirty-three participants. The median age was 50 (IQR, 38-54) years and 69% were female. The median anti-spike IgG antibody titer was 17627 (IQR, 10898-24175) U/mL 4 weeks after the third dose. The mean TRAb was significantly increased from 0.81 (SD, 0.05) IU/L at baseline to 0.97 (SD, 0.30) IU/L 4 weeks after the third dose without functional changes. An increase in TRAb was positively associated with female sex (β = 0.32, P = 0.008) and low basal FT4 (β = -0.29, P = 0.02) and FT3 (β = -0.33, P = 0.004). TgAb was increased by the third dose. Increase in TgAb was associated with history of the thyroid diseases (β = 0.55, P <0.001). SARS-CoV-2 BNT162b2 mRNA vaccine can disrupt thyroid autoimmunity. Clinicians should consider the possibility that the SARS-CoV-2 vaccine may disrupt thyroid autoimmunity.