Low T3 Research Articles

To study thyroid profile in CKD patients in Eastern Uttar Pradesh

Chronic kidney disease (CKD) remains a universal pandemic that has evolved into a serious public health problem that imposes a significant socioeconomic burden. Thyroid profile is disrupted in CKD patients due to aberrant thyroid hormone metabolism. The purpose of our study was to assess thyroid function in people who had chronic renal disease (CKD).According to the inclusion-exclusion criteria, this cross-sectional observational research enrolled 150 chronic renal disease patients.All patients who met the above criteria underwent a detailed history as well as a general and systemic examination. Thyroid function tests, USG entire abdomen, chest X-ray, ECG, and 2D Echocardiogram, were performed. There were 84 men and 66 women among the 150 CKD patients. Thyroid hormone abnormalities were found in 93.3 % of the individuals. 14.7 % of the participants had hypothyroidism, 14.7 % had low T3 and T4 readings, 10% had low T4 values alone, 38 % had low T3 only, and 17% had subclinical hypothyroidism. Low T3 levels (58 %) were the most prevalent thyroid anomaly, with or without low T4 or elevated TSH levels. Low T3 levels were more common in patients with advanced CKD.Thyroid hormone abnormalities are linked to different stages of chronic renal disease.

Chronic Kidney Disease affects Thyroid Hormones

Kidney disease is one of the causes of death in many countries around the world. This study found that chronic kidney disease affects thyroid hormone formation, release, and storage. The results show a decrease in T3 and T4 thyroid hormones and an increase in TSH hormone in both sexes and people of different ages. The research aims to study the effect of chronic kidney disease on the thyroid gland’s activity and its deficiency’s effect on health ailments. Results showed a significant decrease in T3 concentration in patients at the probability level (p ≤ 0.05) (0.8±0.1) compared with the control group (1.0±0.1). Additionally, a significant decrease in T4 concentration at the probability level (p ≤ 0.05), (6.8±1.5) compared with the control group (8.7±0.9) and a significant increase in TSH concentration at the probability level (p ≤ 0.05), (4.8±0.6) compared with the control group (1.2±0.5). The CDK affects thyroid hormones; low T3 and T4 are the most common thyroid dysfunction. High TSH, enlarged thyroid gland, hypothyroidism, thyroid dysfunction. Keywords: CKD, Thyroid Hormones, Thyroid dysfunction.

Chronic Kidney Disease affects Thyroid Hormones

Kidney disease is one of the causes of death in many countries around the world. This study found that chronic kidney disease affects thyroid hormone formation, release, and storage. The results show a decrease in T3 and T4 thyroid hormones and an increase in TSH hormone in both sexes and people of different ages. The research aims to study the effect of chronic kidney disease on the thyroid gland’s activity and its deficiency’s effect on health ailments. Results showed a significant decrease in T3 concentration in patients at the probability level (p ≤ 0.05) (0.8±0.1) compared with the control group (1.0±0.1). Additionally, a significant decrease in T4 concentration at the probability level (p ≤ 0.05), (6.8±1.5) compared with the control group (8.7±0.9) and a significant increase in TSH concentration at the probability level (p ≤ 0.05), (4.8±0.6) compared with the control group (1.2±0.5). The CDK affects thyroid hormones; low T3 and T4 are the most common thyroid dysfunction. High TSH, enlarged thyroid gland, hypothyroidism, thyroid dysfunction. Keywords: CKD, Thyroid Hormones, Thyroid dysfunction.

An investigation of the effect of the pulse width and amplitude on sand bed scouring by a vertical submerged pulsed jet

This paper investigates the effects of the pulse width and amplitude on the scouring of sand beds by vertical submerged pulsed jets using a combination of experimental and numerical calculations. The reliability of the numerical calculations is verified through a comparison between the numerical simulations with the sedimentation scour model and the experimental data at a low pulse width T2 of 0, with the result that the various errors are within 5%. The results show that the scour hole depth |hmin| grows with the relative low pulse width T3 throughout three intervals: a slowly increasing zone I, a rapidly increasing zone II, and a decreasing zone III, producing a unique extreme value of |hmin|. The optimal scouring effect equation was obtained by analytically fitting the relationship curve between the pulse amplitude V and the relatively low pulse width T3. Including the optimal T3 and optimal duty cycle ƞ. The difference in the scour hole depth |hmin| under different pulse amplitudes is reflected in the initial period F of the jet. With an increasing pulse amplitude, |hmin| goes through three intervals: an increasing zone M, decreasing zone N, and rebound zone R. It is found that the scouring effect in the pulse jet is not necessarily always stronger with a larger amplitude. The results of the research in this paper can provide guidance for optimizing low-frequency pulsed jets for related engineering practices, such as dredging and rock-breaking projects.

Glycerol Phenylbutyrate Treatment of 2 Patients With Monocarboxylate Transporter 8 Deficiency.

Monocarboxylate transporter 8 (MCT8) deficiency is a rare genetic disease that leads to severe global developmental delay. MCT8 facilitates thyroid hormone (TH) transport across the cell membrane, and the serum TH profile is characterized by high T3 and low T4 levels. Recent studies have shown that the chemical chaperone sodium phenylbutyrate (NaPB) restored mutant MCT8 function and increased TH content in patient-derived induced pluripotent stem cells, making it a potential treatment for MCT8 deficiency. We aimed to assess the efficacy and safety of glycerol phenylbutyrate (GPB) in MCT8 deficiency. We treated 2 monozygotic twins aged 14.5 years with MCT8 deficiency due to P321L mutation with escalating doses of GPB over 13 months. We recorded TH, vital signs, anthropometric measurements, and neurocognitive functions. Resting metabolic rate (RMR) was measured by indirect calorimetry. Serum metabolites of GPB were monitored as a safety measure. In vitro effects of NaPB were evaluated in MDCK1 cells stably expressing the MCT8P321L mutation. The effects of GPB were compared to the effects of DITPA and TRIAC, thyromimetic medications that the patients had received in the past. NaPB restored mutant MCT8 expression in MDCK1 cells and increased T3 transport into cells carrying the P321L mutation. GPB treatment reduced high T3 and increased low T4 levels. The patients showed a significant weight gain simultaneously with a reduction in RMR. Only minor neurocognitive improvement was observed, in hyperreflexia score and in cognitive functions. Serum metabolites did not exceed the toxic range, but elevated liver transaminases were observed. In the first report of GPB treatment in MCT8 deficiency we found an improvement in TH profile and body mass index, with minor neurodevelopmental changes.

The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis to evaluate the prevalence of thyroid disorders in COVID-19 patients. Scopus, PubMed, ISI Web of Science, and Google Scholar databases were used in this review. We also consider the results of grey literature. Cohort, cross-sectional, and case-control studies were included. The required data were extracted by the first author of the article and reviewed by the second author. The Pooled prevalence of outcomes of interest was applied using the meta-prop method with a pooled estimate after Freeman-Tukey Double Arcsine Transformation to stabilize the variances. The different thyroid disorders were the main outcomes of this study. The diseases include non-thyroidal illness syndrome, thyrotoxicosis, hypothyroidism, isolated elevated free T4, and isolated low free T4. Eight articles were included in our meta-analysis(Total participants: 1654). The pooled prevalence of events hypothyroidism, isolated elevated FT4, isolated low FT4, NTIS, and thyrotoxicosis were estimated (Pooled P = 3%, 95% CI:2-5%, I2: 78%), (Pooled P = 2%, 95% CI: 0-4%, I2: 66%), (Pooled P = 1%, 95% CI: 0-1%, I2: 0%), (Pooled P = 26%, 95% CI: 10-42%, I2: 98%), and (Pooled P = 10%, 95% CI: 4-16%, I2: 89%), respectively. Thyroid dysfunction is common in COVID-19 patients, with a high prevalence of non-thyroidal illness syndrome (NTIS) and thyrotoxicosis. Our meta-analysis found a 26% prevalence of NTIS and a 10% prevalence of thyrotoxicosis. PROSPERO CRD42022312601.

Preoperative Preparation in Hyperthyroidism and Surgery in the Hyperthyroid State.

Hyperthyroidism is a clinical condition that develops due to the excessive production and secretion of thyroid hormones by the thyroid gland, leading to an elevated concentration of thyroid hormones in tissues. Hyperthyroidism is characterized by low TSH and elevated T3 and/or T4, with the most common causes being Graves' disease, toxic multinodular goiter, and solitary toxic adenoma. T3 is the peripherally active form of thyroid hormone, affecting nearly each tissue and system. The most prominent aspects of hyperthyroidism are related to the cardiovascular system. The treatment of hyperthyroidism includes three options: antithyroid drugs (ATDs), radioactive iodine therapy (RAI), and surgery. Among these treatment modalities, surgery is considered as the most effective one. For patients who are candidates for surgery, preoperative preparation is required to ensure that the thyroidectomy can be performed under optimal conditions. Preoperative preparation should be a combination therapy aimed at preventing the synthesis, secretion, and peripheral effects of thyroid hormones from the thyroid gland. Medications that can be used in this treatment include thionamides, beta-blockers, iodine, corticosteroids, cholestyramine, perchlorate, lithium, and therapeutic plasma exchange. These treatment options can be combined based on the patient's condition. While it is recommended that patients be made euthyroid through preoperative antithyroid treatment to prevent the feared complication, which is the thyroid storm, the supporting evidence is limited. Preoperative treatment does not prevent against thyroid storm whether the patient is euthyroid or hyperthyroid during surgery. Whether surgery should be delayed until biochemical euthyroidism is achieved in hyperthyroid patients remains a topic of debate. Recent studies suggest that thyroidectomy can be safely performed during the hyperthyroid phase by experienced anesthesiologists and surgeons without precipitating thyroid storm or increasing intraoperative and postoperative complications. Although achieving the euthyroid state before surgery is ideal in hyperthyroid patients, it is not always possible. Factors such as allergies to medications, drug side effects, treatment-resistant disease, patient noncompliance, and the urgency of definitive treatment are critical in determining whether hyperthyroidism can be controlled preoperatively. When surgery is necessary in hyperthyroid patients without achieving euthyroidism, the patient's overall condition and comorbidities should be evaluated together by the anesthesiologist, surgeon and endocrinologist, with particular attention to stabilizing the cardiovascular system. We believe that in hyperthyroid patients who are cardiovascularly stable during the hyperthyroid phase, thyroid surgery may not need to be delayed and can be performed safely.

Lower Free T3 Levels Linked to Poorer Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Hypercapnic Respiratory Failure.

Non-thyroidal illness syndrome (NTIS) is often observed in critically ill patients. This study aimed to examine thyroid hormone changes in patients with chronic obstructive pulmonary disease (COPD) experiencing acute hypercapnic respiratory failure (AHRF) and to evaluate the impact of these alterations on clinical outcomes. This retrospective investigation involved 80 COPD patients (age 71.5±9.5 years; 57.5% male) admitted to the intensive care unit (ICU) due to AHRF. NTIS was identified when free triiodothyronine (fT3) levels were below the lower limit, and thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels were within the normal range or below the lower limits. NTIS was detected in 63.7% of the patients. Decreased fT3 levels were found in 36.3% of the patients, reduced T4 levels in 33.8%, and diminished TSH levels in 15%. Patients with low fT3 levels exhibited elevated C-reactive protein levels, white blood cell counts, and APACHE II scores, necessitated vasopressor infusion more frequently during their ICU stay, and had increased mortality. The in-hospital mortality rate was 28.8%. Logistic regression analysis revealed that fT3 level (odds ratio [OR]., 0.271; 95% confidence interval [CI]., 0.085-0.865; p=0.027), APACHE II score (OR, 1.155; 95% CI, 1.041-1.282; p=0.007), and vasopressor use (OR, 5.426; 95% CI, 1.439-20.468; p=0.013) were crucial predictors of in-hospital mortality. A high prevalence of NTIS is observed in COPD patients with AHRF, with low fT3 levels frequently observed. The presence of lower levels of fT3 is associated with a greater severity of the disease and a significant prognostic indicator.

Diabetes Mellitus & Thyroid Dysfunction in Vitiligo of Terai Regions of Nepal

INTRODUCTION Vitiligo is common acquired disease. Clinically it present with depigmented, macules and patches. Vitiligo has been shown association with many autoimmune diseases like Diabetes mellitus, Thyroid disorders, Graves disease, pernicious anemia, etc. This study was undertaken to assess the prevalence and association of diabetes mellitus and thyroid dysfunction in vitiligo patient. MATERIAL AND METHODS This study was a case control study carried out in Dermatology Department, Universal College of Medical Sciences – Teaching Hospital (UCMS-TH) from Dec 2022 to Nov 2023. 70 cases of Vitiligo and 70 control with same sex, ages and gender matched were enrolled. All patients in both the group, we performed thyroid function test and fasting blood sugar. RESULTS Out of 70 cases, 6 (8.6%) people has impaired FBS and 6 (8.6%) people have high T3 & T4 and 10 (14.3%) people have high TSH whereas 3 (4.3%) people have low T3 & T4 and 4 (5.7%) people have low TSH. Association with different age group in both case and control group with fasting blood sugar and thyroid function test was seen which was statistically not significant. CONCLUSION There were impaired fasting blood sugar and abnormal thyroid dysfunction in many cases. Therefore vitiligo patient needs to undergo thyroid function test and blood sugar level to prevent the complication.

Alcohol-induced hormonal and metabolic alterations in plasma and erythrocytes—a gender-based study

Purpose This study aimed to understand the gender-specific alcohol-induced biochemical changes and TBARS association with the endocrine system. Methods Human male and female subjects ranging from 35 ± 10 years old with an 8-10-year drinking history were included in the study. Results The results demonstrated that testosterone levels were lower in male alcoholics and higher in female alcoholics, as well as higher estrogen and cortisol levels in both genders. In addition, we found lower T3, T4, and thyroid-stimulating hormone (TSH) levels in alcoholics of both sexes. Furthermore, plasma TBARS, protein carbonyls, nitrite, and nitrate levels increased significantly with concomitant decrease in reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities in both male and female alcoholics. Furthermore, erythrocyte lysate nitrite and nitrate levels membrane total cholesterol, phospholipid and cholesterol/phospholipid (C/P) ratio with lower total membrane proteins in both genders of alcoholics. SDS-PAGE analysis of erythrocyte membrane proteins revealed increased density of band 3, protein 4.1, 4.2, 4.9 and glycophorins, whereas decreases in spectrin (α and β) were observed in both genders of alcoholics. Besides, alcoholics of both sexes had a lower ability to resist osmotic hemolysis. Plasma TBARS was negatively correlated with testosterone, TSH, T3 and T4 in male alcoholics, moreover, estradiol and cortisol were positively correlated in males and females respectively. Conclusion Female alcoholics may be more susceptible to osmotic hemolysis due to increased erythrocyte membrane lipid peroxidation with decreased antioxidant status, which results in an altered membrane C/P ratio and membrane protein composition.

Association of prolonged occupational co-exposures to electromagnetic fields, noise, and rotating shift work with thyroid hormone levels

The purpose of this study was to determine the association of prolonged occupational co-exposure to extremely low-frequency electromagnetic fields (ELF-EMFs), noise, and rotating shift work with the levels of thyroid hormones (triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH). From 2016 to 2017, we enrolled all male workers without a history of thyroid disorders and followed them until 2020. To measure ELF-EMFs and noise exposures, we calculated the 8-hour equivalent sound pressure levels (Leq) and the 8-hour average of ELF-EMFs, respectively. Shift work schedules involved 8-hr fixed day and 8-hr clockwise 3-rotating night schedules. The participant’s thyroid hormone levels were obtained from blood test results in their medical records. The percentage change in the levels of T3, T4, and TSH was estimated by using different mixed-effects linear regression models. The TSH levels were significantly elevated per a 10-dB increment of noise. The levels of T4 hormone were significantly changed per a unit increase in the levels of ELF-EMFs. Compared to the fixed-day workers, we observed workers exposed to shift work had a significantly lower T4 level. For T4 and TSH hormones, we found significant interactions among noise, ELF-EMFs, and shift work variables. In summary, this study warranted that prolonged exposure to ELF-EMFs, noise, and rotating shift work might be associated with thyroid dysfunction.

Average phenotype but not plasticity in two metabolic hormones covary in wild female bonobos (Pan paniscus)

Each individual is equipped with a distinct genetic disposition and ontogenetic history and experiences environmental conditions in a unique way. As a result, individuals vary in terms of phenotypic differences regarding their responses to internal and external conditions. By modulating hormone secretion, an individual can react to changing conditions, thus maintaining homeostasis. Cortisol and triiodothyronine (T3) are involved in mediating energy homeostasis. The secretion of metabolic hormones enables individuals to respond flexibly to internal and external conditions. However, this flexibility may be constrained by tradeoffs between average hormone levels and the degree of hormonal plasticity and the impact of the HPA axis on T3 secretion and effects. Like many other species, bonobos (Pan paniscus) are confronted with rapid ecological and climatic perturbations, resulting in challenges to energetic homeostasis. Due to their limited genetic diversity, K-strategist and stenoecious species characteristics, they are predicted to have only limited potential for adaptation. Therefore, it is important to quantify individual cortisol and T3 reaction norms and examine their relationship with each other to understand the level of flexibility of metabolic hormone phenotypes. Using a multivariate random slope model, we found that diurnal urinary excretion patterns of cortisol and T3 in wild female bonobos have (i) no relationship between average phenotype and plasticity within the reaction norms of both hormones. (ii) We also found a negative correlation between the intercepts of the two metabolic hormones, but (iii) no relationship between their slopes. (iv) Standard deviations of cortisol and T3 intercepts and slopes between females indicate little variation among females. Our data show that plasticity within and between the two metabolic hormones is not related to overall low or high hormone levels, but there is a linear negative relationship between cortisol and T3 average phenotypes. Thus, individuals with high average cortisol levels, investing in restoring energy depots, have low average T3 levels, reducing energy expenditure, and vice versa. From this we conclude that the plasticity of diurnal hormone excretion is not affected by average metabolic hormone phenotypes. Evaluations of cortisol and T3 plasticity along ecological gradients can enhance our understanding of the adaptive potential of a given species to environmental changes.

Are We Missing Hypothyroidism among Children with Sickle Cell Anaemia?

Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia. A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism. The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively. Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

Triiodothyronine hormone supplementation therapy in septic shock patients with euthyroid sick syndrome: two pilot, placebo-controlled, randomized trials

BackgroundTo assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3). MethodsA total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcomes. Laboratory data were analyzed on the day of admission (T0), on the first (T1), third (T2) and seventh day (T3) with hemodynamics analyzed for the first four days. ResultsIn the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (p = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (p = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (p = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population. ConclusionT3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients. RegistrationClinTrials.gov (NCT05270798).

Thyroid function and opium use disorder: a cross-sectional study on the Fasa adults cohort study (FACS), 2017

BackgroundAddiction increases the risk of different lifelong disorders. However, there are limited studies evaluating the effects of opioid use disorder (OUD) on thyroid function. The present study aimed to compare the thyroid function of individuals with and without OUD.MethodsThis cross-sectional study was conducted on 700 eligible participants of the Persian Cohort of Fasa, Iran. Pregnant women and participants with false or missing data were excluded from the study. Remained participants were divided into case and control groups based on the recorded history of OUD. Frozen plasma samples of the cohort bank were used to determine the levels of T3, T4, and thyroid-stimulating hormone (TSH). The thyroid function was compared between the two groups using the Mann-Whitney test (P < 0.05).ResultsThe mean age of the final studied population (n = 648) was 54.0 ± 9.8 years, including 336 men (49.1%) and 197 participants with OUD (28.8%). The median levels of TSH, T4, and T3 were 2.91 ± 4.61, 9.26 ± 3.65, and 1.22 ± 0.49, respectively. The case group had significantly higher TSH (3.72 ± 6.2 vs. 2.58 ± 3.75, P < 0.001) and lower T4 (8 ± 3.6 vs. 9.8 ± 3.5, P < 0.001). Also, T3 was slightly lower in the case group (1.1 ± 0.5 vs. 1.3 ± 0.5; P = 0.369), although this association was only significant in female opium users (P < 0.001).ConclusionsThe present findings revealed that OUD caused a reduction in T4 while increasing TSH. Therefore, OUD may lead to the development of primary hypothyroidism, which needs to be investigated in future studies.

Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

Follicular Thyroid Carcinoma (FTC), the second most common type of thyroid cancer, accounts for 10-20% of thyroid cancers, primarily affecting individuals over 40, and it tends to spread hematogenously to various organs. It often metastasizes to the lungs (49%) and bones (7-28%), including the spine, pelvis, skull, long bones, and rarely, the sternum. Metastatic FTC carries a poor prognosis, with a 3-21% ten-year survival rate when bone metastases are present. Sternal metastasis from thyroid carcinoma is exceptionally rare and significantly impacts prognosis. In this article, we present an unusual case of a 65-year-old patient who presented with a year-long compressive goiter. Examination revealed a firm, painless nodular goiter and a sternal mass. Tests showed a low TSH, normal T4, and thyroid nodules. Following thyroidectomy, a 7cm vesicular thyroid carcinoma was diagnosed. Sternal metastasis was confirmed through biopsy. The patient underwent sternal mass excision, responded well, and was referred for radioactive iodine therapy. Treatment options for metastases in FTC include surgery, radioactive iodine therapy and radiation. Surgical removal of metastases is crucial in such cases, as it can enhance the effectiveness of subsequent treatments and improve patient outcomes. This comprehensive management approach can offer a better quality of life and extended survival for patients facing this uncommon but challenging situation.

Deciphering the roles of triiodothyronine (T3) and thyroid-stimulating hormone (TSH) on cardiac electrical remodeling in clinical and experimental hypothyroidism.

Hypothyroidism is the most frequent endocrine pathology. Although clinical or overt hypothyroidism has been traditionally associated to low T3 / T4 and high thyrotropin (TSH) circulating levels, other forms exist such as subclinical hypothyroidism, characterized by normal blood T3 / T4 and high TSH. In its different forms is estimated to affect approximately 10% of the population, especially women, in a 5:1 ratio with respect to men. Among its consequences are alterations in cardiac electrical activity, especially in the repolarization phase, which is accompanied by an increased susceptibility to cardiac arrhythmias. Although these alterations have traditionally been attributed to thyroid hormone deficiency, recent studies, both clinical trials and experimental models, demonstrate a fundamental role of TSH in cardiac electrical remodeling. Thus, both metabolic thyroid hormones and TSH regulate cardiac ion channel expression in many and varied ways. This means that the different combinations of hormones that predominate in different types of hypothyroidism (overt, subclinic, primary, central) can generate different forms of cardiac electrical remodeling. These new findings are raising the relevant question of whether serum TSH reference ranges should be redefined.

Real-world evaluation of an acceptance and commitment therapy–based group programme for breast cancer survivors with fear of cancer recurrence

PurposeTo evaluate the effectiveness and acceptability of a 6-week acceptance and commitment therapy (ACT)–based group programme on participants’ fear of cancer recurrence (FCR), quality of life (QoL), psychological distress and psychological flexibility at the end of the programme and 12-week follow-up.MethodsA one-group, post-test service evaluation of a real-world psychological programme was carried out to evaluate collected outcome measures and attendance for a total of 21 groups facilitated between 2017 and 2019. Participants were breast cancer survivors who attended a 6-week group programme led by NHS clinicians. Descriptive statistics and repeated measures ANOVA analyses were carried out for each outcome measure. Attendance levels were examined to assess acceptability.ResultsA total of 97 group participants who had completed curative treatment for breast cancer took part. Of whom, 89% completed at least 4 of the 6 weekly group sessions and 76% attended the 12-week follow-up session. Eighty-four (87%) participants returned outcome measures at all three time points relative to group participation (T1 = pre, T2 = post T3 = 12-week follow-up). Group participants were female, mean age 51.9 years. FCR was highest at T1 (mean 25.2, SD 4.7), reduced T2 (mean 21.2, SD 5.4) and further lowered T3 (mean 19.5, SD 6.2). This difference was statistically significant (p < 0.001). QoL was lowest at T1 (mean 62.4, SD 15.7), increased T2 (mean 71.7, SD 18.1) and further increased at T3 (mean 75.9, SD 17.5). This difference was statistically significant (p < 0.001). Psychological distress measures were shown to reduce, and psychological flexibility increased.ConclusionsThis real-world evaluation of an ACT-based group programme led to improvements in FCR, QoL, psychological distress and psychological flexibility in this population. This evaluation provides basis for further investigation to determine if these results can be replicated by controlled research design across diverse populations.

The Impact of Hypothyroidism on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Introduction: Hypothyroidism either subclinical (SCH) or overt is independently associated with an increased risk of coronary artery disease (CAD). The combined effects of SCH and overt hypothyroidism on clinical outcomes after percutaneous coronary intervention (PCI) are largely unknown. Aim: The aim of the study is to assess the impact of subclinical and overt hypothyroidism among patients presenting with CAD undergoing PCI. Materials and Methods: A total of 102 patients who were referred to the Madras Medical Mission Hospital for PCI from September 2020 to March 2021 were enrolled in the study. These patients were categorized into three groups. Each group has 34 patients and was followed for one year. Group 1: Patients with normal TSH levels (TSH-0.45 -5mlU/Liter) and euthyroid at T3, T4 levels. Group 2: Patients with subclinical hypothyroidism with elevated TSH levels (TSH=5-15mlU/liter) and normal thyroid with T3, T4 levels. Group 3: Patients with a family history of overt hypothyroidism or high TSH levels(&lt;15mlU/liter) and low T3 and T4 levels [16]. Results: We applied ANOVA to find the PCI outcomes. A p-value of &lt;0.05 was accepted as significant. Age (p-0.03), recent myocardial infarction (p-0.04), diabetes mellitus (p&lt;0.001), HbA1C (p-0.012), and systolic blood pressure (p-0.04) were found to be significant. Post-PCI bleeding complications (p&lt;0.001) during one month, six months, and one-year follow-up were the main observation of the study. Conclusion: The prior history of DM and elevated HbA1c levels observed in the overt hypothyroid group indicate that DM was one of the key factors associated with overt hypothyroidism. Despite the fact that PCI was safe for patients with hypothyroidism, the risk of early post-PCI bleeding was of concern.

Amiodarone induced thyroid dysfunction

Abstract Introduction Amiodarone causes hypothyroidism in 12-25% of treated patients, depending on the classification of hypothyroidism. Amiodarone induced thyrotoxicosis is seen in 1.2%-12%. It is recommended to taper thyroid supplementation after discontinuing amiodarone. Purpose To investigate the prevalence of amiodarone induced thyroid dysfunction in Iceland and the effects of dosage and treatment duration. Design The study population comprised of all patients that were subscribed amiodarone in Iceland during the calendar year of 2014, a total of 1054 patients. Ten patients that never took amiodarone were excluded and there was missing data in 22. Hypothyroidism had been diagnosed in 91 patients before starting amiodarone and 59 took amiodarone for less than 90 days and were excluded from further analysis, leaving 871 patients. Follow up data was obtained from the national health care records both retrospectively and prospectively for first prescription of amiodarone and signs of thyroid related problems. Amiodarone induced hypothyroidism was defined as a raised TSH more than 90 days after starting treatment and further classified into subclinical (with normal T4) and overt (low T4). Amiodarone induced thyrotoxicosis was defined as low TSH with an elevated T4. Results Amiodarone induced hypothyroidism was seen in 22.2% of patients at a mean age of 74 years. 10.7% had overt AIH and 11.6% had subclinical hypothyroidism. Hypothyroidism occurred on average after 3.3 ±0.4 years of treatment. The incidence increased with treatment duration and peaked at 41.8% after 15 years of treatment. The risk did not change with dosage. Only 4.6% on thyroid supplementation therapy had stopped treatment after a mean follow-up of 4.5 years after discontinuing amiodarone. Amiodarone induced thyrotoxicosis was seen in 10.0% with a mean age of 65.6 years. The mean duration of treatment at diagnosis of thyrotoxicosis was 3.9 ±0.6 years. The cumulative risk of thyrotoxicosis was highest (9.9%) during years 3 to 5 but persisted with ongoing treatment and peaked at 17.6% after 13 years of treatment. Higher dosage of amiodarone increased the risk in a dose dependent manner. It was 5% with &amp;lt;200 mg, 11.8% with 200 mg and 14.1% with &amp;gt;200mg (p&amp;lt;0.01). Hospital admission due to thyrotoxicosis was required in 35.3% of patients, 8.8% had thyroidectomies, 2.0% died and 26.5% had hypothyroidism following thyrotoxicosis. 48% were treated with carbimazole, of them 2.0% suffered agranulocytosis, 4.1% had hepatitis and 4.1% had pancreatitis. Conclusion In this nationwide study we found that long term users of amiodarone are at a higher risk of amiodarone induced hypothyroidism or thyrotoxicosis than previously described. Thyroid supplementation treatment is rarely stopped despite the pro-arrhythmic risk of overtreating hypothyroid patients. The high incidence of thyroid related adverse effects is a reminder of the serious side effects of amiodarone treatment.Amiodarone induced hypothyroidismAmiodarone induced Thyrotoxicosis