Low T3 Research Articles

The Impact of Nutritional Support in Low T3 Syndrome

The Impact of Nutritional Support in Low T3 Syndrome

Characteristics of euthyroid sick syndrome in patients with breast cancer

Purpose. Determination of thyroid hormones (TH) and cortisol levels in blood in patients with breast cancer (BC) without previously detected endocrine pathology in the anamnesis.Patients and methods. Twenty-five primary luminal A breast cancer patients before and aſter surgical removal of the tumour and 25 breast cancer patients with secondary metastatic brain lesions were examined. The levels of total and free forms of TH (T4, FT4, T3 FT3) and cortisol were determined in serum by RIA method.Results. Before treatment in all patients with breast cancer the level of T3 was decreased 1.3 times and FT3 was increased 1.3 times (p < 0.05) against the background of normal TTH content. In 80 % of patients, blood cortisol concentration was 2 times higher than normal, and in 16 % of patients, T4 level was 1.8 times higher than normal (p < 0.05). Aſter tumour removal, FT3 levels in all patients and cortisol levels in 40 % of patients did not differ from normal. T4 content in 40 % of patients, and T3 and TTH in 28 % of women were above normal. A distinctive feature of patients with brain metastases of breast cancer was low T4 and cortisol levels in 36 % of patients against the background of low T3 levels.Conclusions. Euthyroid sick syndrome was detected in all patients with BC: low serum T3 levels against the background of normal serum levels of TTH. Patients with primary BC were characterized by high concentrations of FT3 and cortisol, which could promote proliferation of malignant cells and decrease antitumour immunity. The condition of 1/3 of patients with brain metastases was aggravated by low levels of T4 and cortisol which could indicate the depletion of the main regulatory systems and an unfavorable disease prognosis.

WPŁYW INFEKCJI SARS-CoV-2 NA FUNKCJĘ TARCZYCY – PATOMECHANIZM I IMPLIKACJE KLINICZNE

The SARS-CoV-2 virus is the pathogenic agent of the COVID-19 disease, which pandemic had caused 6.8 million deaths worldwide by February 2023. In the course of the disease, involvement of the thyroid gland is observed. The pathomechanism of damage to the thyroid gland is bidirectional – direct cytotoxicity of the virus and the indirect effect of a cytokine storm. Circulating pro-inflammatory cytokines lead to deiodinase activity dysregulation, resulting in changes in plasma concentrations of TSH, fT3, and fT4. These hormone abnormalities are observed in about 16% of patients during COVID-19 and may also result from the treatment itself – systemic corticosteroids. Dysregulation of the immune system also leads to autoinflammatory thyroid diseases. It seems crucial to monitor thyroid hormones to detect subclinical forms of thyroiditis early. This paper presents the prevalence and potential pathomechanism of thyroid disorders observed during SARS-CoV-2 infection – subacute thyroiditis, low T3 syndrome, Graves-Basedow disease, and Hashimoto’s disease.

Investigating the Predictive Value of Thyroid Hormone Levels for Stroke Prognosis.

Given the expansion of life expectancy, the aging of the population, and the anticipated rise in the number of stroke survivors in Europe with severe neurological consequences in the coming decades, stroke is becoming the most prevalent cause of functional disability. Therefore, the prognosis for a stroke must be timely and precise. Two databases (MEDLINE and Scopus) were searched to identify all relevant studies published between 1 January 2005 and 31 December 2022 that investigated the relationship between thyroid hormone levels and acute stroke severity, mortality, and post-hospital prognosis. Only full-text English-language articles were included. This review includes Thirty articles that were traced and incorporated into the present review. Emerging data regarding the potential predictive value of thyroid hormone levels suggests there may be a correlation between low T3 syndrome, subclinical hypothyroidism, and poor stroke outcome, especially in certain age groups. These findings may prove useful for rehabilitation and therapy planning in clinical practice. Serum thyroid hormone concentration measurement is a non-invasive, relatively harmless, and secure screening test that may be useful for this purpose.

Critically ill patients: Histopathological evidence of thyroid dysfunction

PurposeCritical illness is characterized by severe biphasic physical and metabolic stress as result of systemic inflammatory response syndrome and/or multiple organ dysfunction syndrome, and is frequently associated with non-thyroidal illness. Purpose of this study is to better understand the cytomorphological basis of NTI by performing histopathological examinations of thyroid gland on autopsies of patients who died from critical illness. MethodsHistopathological examination of thyroid gland of 58 critically ill patients was performed in our hospital. The cases included 24 cases of burn injury, 24 cases of traumatic brain injury, and 10 cases of cerebral stroke. Thyroid samples obtained during autopsy were preserved in formol saline and stained with hematoxylin and eosin. The sections were visualized under light microscopy. ResultsOut of 58 cases examined, 21 patients showed normal thyroid findings, and rest of the cases had unusual thyroid findings in the histopathological study. The principal finding was distortion of thyroid follicular architecture. Other findings include mononuclear cell infiltration, clumping of thyroglobulin, and exhaustion of thyroid follicles. ConclusionCritical illness produces metabolically damaging effects on thyroid gland, which functionally corresponds to a state of low T3 syndrome. These changes are more pronounced in BI and cerebral stroke than in TBI.

Thyroid Dysfunction at Different Stages of Chronic Kidney Disease: A Cross-Sectional Study at a Rural Teaching College in Central India.

Background The high prevalence of thyroid dysfunction in patients with chronic kidney disease (CKD) indicates a major correlation between the progression of CKD and thyroid dysfunction. In this study, we highlighted thyroid dysfunction and its relation to the severity and different stages of CKDs. Materials and methods From October 2018 to September 2020, 200 cases with CKD, admitted under the Department of Medicine at a rural teaching hospital in central India, were selected for the study. The collected data was analyzed and correlated using the Chi-square test, and the parameters suggested the presence or absence of low T3 syndrome, low T4 syndrome, and primary hypothyroidism. Results Out of 200 patients enrolled, 181 (91.5%) had thyroid abnormalities. Among these patients, the presence of low T3 syndrome was 57%, low T4 syndrome was 23%, and primary hypothyroidism was 10.5%. It was reported that as the CKD stages advanced, TSH levels increased with a statistically significant difference (p=0.04). Conclusions As kidney function progressively deteriorated, specifically in stage five, the chances of occurrence of hypothyroidism increased.

Low T3 syndrome as a predictor of poor prognosis in peripheral T-cell lymphomas.

The purpose of the study was to evaluate the prognostic value of low T3 syndrome in peripheral T-cell lymphomas (PTCLs). One hundred and seventy-four patients of newly diagnosed PTCLs were enrolled in the study. We performed statistical analysis based on the clinical data collected. Thirty-Six (20.69%) patients had low T3 syndrome at first admission. Results suggested that the patients with higher score of ECOG PS, International Prognostic Index (IPI) and Prognostic Index for T-cell lymphoma (PIT), bone marrow involvement and lower level of albumin tended to develop low T3 syndrome. The median progression-free survival (PFS) and overall survival (OS) were 10months and 36months, respectively, for all patients. Pre-existing low T3 syndrome was in correlation with worse PFS and OS. Patients with low T3 syndrome showed worse PFS (4months vs 13months, P = 0.0001) and OS (7months vs 83months, P < 0.0001) than patients without low T3 syndrome. IPI and PIT, respectively, combined with low T3 syndrome improved the ability to predict OS and PFS of PTCLs. The study indicated that low T3 syndrome may be a good candidate for predicting prognosis of peripheral T-cell lymphomas.

Transient low T3 syndrome in patients with COVID-19: a new window for prediction of disease severity.

To investigate the relationship of low T3 syndrome with disease severity in patients with COVID-19. The clinical data of 145 patients with COVID-19 were retrospectively collected, and patients were divided into a low T3 group and a normal T3 group. Logistic regression models were used to assess predictive performance of FT3. Receiver operating characteristic (ROC) analysis was used to evaluate the use of low T3 syndrome in predicting critical disease. Kaplan-Meier analysis was used to analyze the impact of low T3 syndrome on mortality. The prevalence of low T3 level among COVID-19 patients was 34.48%. The low T3 group was older, and had lower levels of hemoglobin, lymphocytes, prealbumin, and albumin, but higher levels of white blood cells, neutrophils, CRP, ESR, and D-dimer (all p<0.05). The low T3 group had greater prevalences of critical disease and mortality (all p <0.05). Multivariate logistic regression analysis showed that the Lymphocytes, free T3 (FT3), and D-dimer were independent risk factors for disease severity in patients with COVID-19. ROC analysis showed that FT3, lymphocyte count, and D-dimer, and all three parameters together provided reliable predictions of critical disease. Kaplan-Meier analysis showed the low T3 group had increased mortality (p<0.001). Six patients in the low T3 group and one patient in the normal T3 group died. All 42 patients whose T3 levels were measured after recovery had normal levels after discharge. Patients with COVID-19 may have transient low T3 syndrome at admission, and this may be useful for predicting critical illness.

Endocrinology for the hepatologist.

Endocrinology for the hepatologist.

Partial Thyroid Hormone-Binding Globulin Deficiency: A Case Report and Literature Review.

Thyroxine binding globulin (TBG) deficiency is a rare thyroid disease, mostly caused by genetic mutations and acquired by X-linked recessive inheritance. The clinical features of children with TBG deficiency and their family members were summarised and the Serpina7 gene mutation was analysed, providing a reference for the differentiation of TBG deficiency. Thyroid function was detected in TBG deficient patients, and genetic analysis was performed using polymerase chain reaction (PCR) and direct DNA sequencing to detect the characteristics of TBG mutants. Using "thyroxine binding globulin, gene and mutation" as keywords, PubMed (biomedical literature database), Web of Science and other databases were searched for relevant studies to collect and summarise relevant information. The TBG (14.7 μg/mL), 70% triiodothyronine (T3) (<0.3 nmol/L), total T3 (Tr3) (<0.05 ng/mL) and thyroxine (T4) (14.72 nmol/L) values were lower than normal, while the thyrotropin (TSH) (2.33 uIU/mL), free T3 (FT3) (1.62 pmol/L), and free T4 (FT4) (11.39 pmol/L) values were normal. These values indicate a TBG partially deficient phenotype. Using PCR amplification and direct sequencing of the target gene, a missense mutation in exon 4 of the Serpina7 gene was found in the patient and the father, and the nucleic acid variant was C.909 (exon 4) g > T; the patient was heterozygous and the father was hemizygous. The literature search retrieved a total of 45 studies, most of which were related to mutations in the Serpina7 gene. The mutation locations included exons, introns, enhancers and promoters, with exons the predominant location. A total of 49 variants of the Serpina7 gene were identified. Serpina7 C.909G (P.L303F) is a mutation acquired from the father by X-linked recessive inheritance. The main clinical features of TBG deficiency patients are low serum T4, T3 and TBG levels, normal TSH, FT3 and FT4 levels, and no clinical manifestations.

Status of thyroid hormones and its relation with eGFR in non-hemodialyzed advanced chronic kidney disease – A hospital-based cross-sectional study

Background: Patients with chronic kidney disease (CKD) and significantly low estimated glomerular filtration rate (eGFR) or end-stage kidney disease have been linked to thyroid dysfunction. Renal function is also negatively impacted by thyroid disease. Aims and Objectives: This study was conducted to find out magnitude of thyroid disorder in advanced CKD and to correlate eGFR with thyroid function status. Materials and Methods: A hospital-based study was conducted among CKD patients to assess the thyroid disorders and its associated factors. A thorough clinical history was taken on chief complaints, any additional precipitating factors or co-morbidities (such as diabetes and hypertension), the use of any medications other than those for CKD in the past, any significant surgical procedures, and any episodes of hemodialysis. A morning blood sample was collected for thyroid function (T3, Free T3, T4, Free T4, and thyroid-stimulating hormone [TSH]) and kidney function test. According to KDIGO’s criteria 2017, CKD was identified. Results: The current study included 60 individuals, with a majority of men (56.7%) and a mean (SD) age of 48.8 (8.4) completed years. 28.3% had low T3 syndrome. Hypothyroidism was seen by 15% and 28.3% had subclinical hypothyroidism. There was no identified hyperthyroidism patient. eGFR had positive correlation with free T3 (r=0.46, P=0.0002). It had a low positive (r=0.03, P=0.7) and weakly positive (r=0.14, P=0.2) correlation with total T3 and total T4. Free T4 and TSH both had negative correlations with eGFR (r=−0.17, P=0.1 and r=−0.09, P=0.4, respectively). Conclusion: Patients with CKD had non-specific thyroid impairment, or decreased total T3 alone but no hyperthyroidism at presentation. The progression of CKD stage made it worse. There was significant positive correlation between free T3 and eGFR.

Gratitude and psychological distress among first-year college students: The mediating roles of perceived social support and support provision.

Universities and colleges in the United States implemented remote learning and restrictions on in-person social events during the Fall 2020 academic semester. These changes and restrictions, in addition to the other numerous negative impacts of COVID-19, can exacerbate the already stressful transition from high school to college. This transition is a key developmental period during which the complexity of interpersonal relationships and the risk of internalizing symptoms such as anxiety and depression increase. As such, the present study examined dispositional gratitude as a protective factor against depressive symptoms and loneliness among a sample of first-year college students who began college during the peak of the COVID-19 pandemic. We also examined whether perceived social support and support provision mediated these relationships. Participants were 364 first-year college students who completed three online surveys during the 1st (T1), 7th (T2), and 14th (T3) weeks of the Fall 2020 academic semester. T1 gratitude was associated with lower T3 depressive symptoms and feelings of loneliness over time. These relationships were mediated by T2 perceived social support but not by T2 support provision. Implications of our findings are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Profiles of Thyroid Hormones in the Overweight Boys of District Rawalpindi, Punjab, Pakistan

We must understand hormonal pathways to solve the global problem of overweight children and adolescents. This study examines the relationship between thyroid hormone levels and body weight in Rawalpindi boys, where childhood obesity/BMI is more prevalent. Thyroid function and body weight have been linked in a few studies. In this case-control study, we recruited 166 boys (both normal and Obese) aged 5-15 from hospitals in District Rawalpindi, Pakistan. Heparinized syringes collected 1.5 ml antecubital blood samples from each subject. Blood plasma was immediately centrifuged following standard procedures and frozen at -20 °C. ELISA measured T3, T4, and TSH levels. A family history of Obesity or other endocrine or chronic diseases disqualified participants. Overweight boys had lower tri-iodothyronine (T3) levels than normal-weight boys (p&lt;0.05). Ordinary boys' T3 levels rose from 5 to 10 years old. Overweight boys had lower T3 levels than normal-weight 9–15-year-olds (p&lt;0.05). From 5 to 7, 9 to 11, and 15 years old, overweight boys had lower tetra iodothyronine (T4) levels than normal-weight males (p&lt;0.05). Chubby boys had higher TSH levels at 9, 11, and 13–15 than normal-weight males (p&lt;0.05). TSH correlated positively with body weight, while T3 and T4 correlated negatively. TSH linked with BMI, while T3 and T4 did not. This profile may explain overweight etiology. These findings can inform future research and interventions to address this serious public health concern in Rawalpindi and beyond.

#6633 DIURETIC RESISTANCE PREDICTORS IN ACUTE DECOMPENSATED HEART FAILURE ADMISSIONS: A BROADER LOOK

Abstract Background and Aims Failing to relieve congestion portends a rise in mortality rate and length of stay in acute decompensated heart failure (ADHF) hospitalizations. That situation corresponds to diuretic resistance (RDIUR). We sought to evaluate clinical and biochemical predictors of RDIUR, including those non-conventional ones we noticed as relevant in prognosis in our clinical practice. Method We conducted an observational, analytical and cross-sectional study, with prospective and consecutive patient (P) data acquisition. We included P over 18 years-old, who were admitted to the Intensive Care Telemetry Unit in our Hospital in the period between July, 2011 and May, 2022 due to ADHF diagnosis. All P received diuretic IV therapy as part of pharmacological treatment. As mentioned in earlier presentations, urine output (UO) was registered in all P, and failure to achieve an UO ≥ 1.5 ml/kg/hour under a pre-established protocol that included and initial 100 mg of IV furosemide bolus followed by a 2 hours of a 5 mg/hour furosemide continuous infusion. Under failure to achieve the goal, furosemide dose was doubled for two additional hours. Failure to respond to this strategy was called “diuretic resistance”. P who received a heart transplant during index admission or those who were on chronic dialysis were excluded from this study. Clinical, epidemiological and biochemical variables were registered. Missing data was imputed by means of multiple regression with chained equations. We constructed a multivariate logistic regression, with selection of relevant predictors completed by resampling and regularization of a Lasso regression model. Statistical significance was considered with a 5% of alpha error. Analysis was conducted using R (R Core Team, 2021), with RStudio (RStudio Team, 2020) as Integrated Development Environment for R, and the tidymodels package (Silge and Kuhn, 2022). Results A total of 1359 P were included. RDIUR was observed in 177 P (13%). These P were younger (69 years old vs 72 p = 0.02), with a higher prevalence of diabetes (39.5% vs 28%; p = 0.002), admission creatinine levels (1.4 vs 1.1 mg/dl; p &amp;lt; 0.001), lower total T3 serum levels (0.56 ng/ml vs 0.7; p &amp;lt; 0.001), with higher incidence of cholestasis (61 vs 40%; p &amp;lt; 0.001), and anasarca as clinical phenotype of systemic congestion (17.5% vs 8.5% p &amp;lt; 0.001). In-hospital mortality was higher in P who developed RDIUR (32.8 vs 5.6%, p &amp;lt; 0.001), in the same way that inotropic support (62 vs 16, p &amp;lt; 0.001), worsening heart failure (48% vs 11; p &amp;lt; 0.001), and furosemide dose at 2nd admission day (175.4 vs 123.4 p &amp;lt; 0.001) were higher in these P. We found no differences in left ventricular ejection fraction (38 vs 41 p = 0.21), first day natriuresis (75.5 vs 78.4, p = 0.093), coronary etiology vs others (20% vs 22; p = 0.26) or one month readmission rate (33% vs 37; p = 0.27). In the adjusted model, inotropic support (OR 5.2; IC95% 3.4-8; p &amp;lt; 0.001), worsening heart failure (OR 3.4; IC95% 2.2-5.3; P &amp;lt; 0.001), furosemide dose at 2nd day (OR 1, IC95%1, P 0.001), admission creatininemia (OR 2.05; IC95% 1.7-2.6; p &amp;lt; 0.001), anasarca phenotype (OR 2.3; IC95 1.4-3.9; p = 0.002) and normal T3 levels (OR 0.05; IC95% 0.02-0.14; p &amp;lt; 0.001) were identified as independent predictors of RDIUR development. Model accuracy was 0.89 and ROC-AUC 0.87. In the same way, RDIUR (OR 2.57; IC95% 1.5-4.3; p &amp;lt; 0.001), worsening heart failure (OR 4.1 IC95% 2.4-7; p &amp;lt; 0.001), inotropic support (OR 3; IC95% 1.7-5.2; p &amp;lt; 0.001) and cholestasis (OR 3.1; IC95% 1.9-5.2; p &amp;lt; 0.001) were found as independent predictors of in-hospital mortality. Conclusion Diuretic resistance is a serious event in patients hospitalized for ADHF, and considerably associated with mortality. A decreased renal reserve, low T3 levels, and anasarca at admission were significantly associated with diuretic resistance development. Considering “new” biochemical predictors as admission T3 levels might add strength to this subset of patients, opposed to information displayed by “classical” event predictors in ADHF patients, as ventricular function or etiology of cardiac disease. Due to clinical potential implications these observational results should be confirmed under evidence based protocols.

Thyroid, Gonadal and Adrenal Dysfunction in Kidney Transplant Recipients: A Review for the Clinician

While chronic kidney disease-associated mineral and bone disorders (CKD-MBD) prevail in the endocrinological assessment of CKD patients, other endocrine abnormalities are usually overlooked. CKD is associated with significant thyroid, adrenal and gonadal dysfunction, while persistent and de novo endocrinological abnormalities are frequent among kidney transplant recipients (KTR). Low T3 levels prior to transplantation may help identify those at risk for delayed graft function and are often found in KTR. Thyroid surveillance after kidney transplantation should be considered due to structural anomalies that may occur. Despite the rapid recovery of gonadal hormonal secretion after renal transplantation, fertility is not completely restored. Testosterone may improve anemia and general symptoms in KTR with persistent hypogonadism. Female KTR may still experience abnormal uterine bleeding, for which estroprogestative administration may be beneficial. Glucocorticoid administration suppresses the hypothalamic-pituitary–adrenal axis in KTR, leading to metabolic syndrome. Patients should be informed about signs and symptoms of hypoadrenalism that may occur after glucocorticoid withdrawal, prompting adrenal function assessment. Clinicians should be more aware of the endocrine abnormalities experienced by their KTR patients, as these may significantly impact the quality of life. In clinical practice, awareness of the specific endocrine dysfunctions experienced by KTR patients ensures the correct management of these complications in a multidisciplinary team, while avoiding unnecessary treatment.

Low T3 syndrome is associated with 30-day mortality in adult patients with fulminant myocarditis.

Fulminant myocarditis (FM) is a critical disease with high early mortality. Low triiodothyronine syndrome (LT3S) was a strong predictor of poor prognosis of critical diseases. This study investigated whether LT3S was associated with 30-day mortality in FM patients. Ninety-six FM patients were divided into LT3S (n=39, 40%) and normal free triiodothyronine (FT3) (n=57, 60%) groups based on serum FT3 level. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality. Kaplan-Meier curve was used to compare 30-day mortality between two groups. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to assess the value of FT3 level for 30-day mortality prediction. Compared to normal FT3 group, LT3S group had higher incidence of ventricular arrhythmias, worse hemodynamics, worse cardiac function, more severe kidney impairment, and higher 30-day mortality (48.7% vs. 12.3%, P<0.001). In univariable analysis, LT3S (odds ratio [OR]:6.786, 95% confidence interval [CI]:2.472-18.629, P<0.001) and serum FT3 (OR:0.272, 95%CI:0.139-0.532, P<0.001) were significant strong predictors of 30-day mortality. After adjustment for confounders in multivariable analysis, LT3S (OR:3.409, 95%CI:1.019-11.413, P=0.047) and serum FT3 (OR:0.408, 95%CI:0.199-0.837, P=0.014) remained independent 30-day mortality predictors. The area under the ROC curve of FT3 level was 0.774 (cut-off: 3.58, sensitivity: 88.46%, specificity: 62.86%). In DCA, FT3 level showed good clinical-application value for 30-day mortality prediction. In FM patients, LT3S could independently predict 30-day mortality. FT3 level was a strong 30-day mortality predictor and a potentially useful risk-stratification biomarker.

0423 The Role of Fear of Sleep in Cognitive Behavioral Therapy for Insomnia and Cognitive Processing Therapy

Abstract Introduction Fear of sleep (FoS) is linked to symptoms of PTSD. Additionally, cognitive behavioral therapy for insomnia (CBTi) can reduce FoS. Utilizing data from a randomized controlled trial of CBTi followed by Cognitive Processing Therapy for PTSD (CPT), this secondary data analysis sought to examine the relationship between FoS and PTSD symptoms, and how FoS is impacted by CBTi, in individuals exposed to interpersonal violence with PTSD. Additionally, we sought to extend the literature by examining whether FoS predicts the effect of subsequent CPT on PTSD severity or if CPT further reduces FoS. Methods A sample of 83 participants were randomly assigned to either receive sequential delivery of four weekly sessions of CBTi, which included modules to address FoS, followed by 12 weekly sessions of CPT (Group 1: CBTi+CPT) or receive four weekly phone check-ins (CTRL) followed by CPT (Group 2: CTRL+CPT). Participants were assessed at baseline (T1), after CBTi/CTRL (T2), and after CPT (T3). Relevant measures included the Fear of Sleep Inventory (FoSI) and Clinician Administered PTSD Scale (CAPS). Analyses included correlations, mean differences tests, and regression-based analyses. Results At T1 FoSI and CAPS were positively correlated (r = 0.47, p &amp;lt; 0.001). At T2 a significant reduction in FoSI scores was observed after CBTi/CTRL for Group 1 (t = 4.81, p &amp;lt; 0.001), but not Group 2, and a significant difference in FoSI scores between Group 1 and Group 2, all while controlling for baseline differences (F (1, 80) = 3.99, p &amp;lt; 0.05). Lastly, for the entire sample lower T2 FoSI scores predicted lower T3 CAPS scores (B = 0.42, p &amp;lt; 0.01) and FoS was not further reduced following CPT. Conclusion Results replicate previous work by demonstrating a positive relationship between FoS and PTSD severity. Additionally, FoSI was significantly reduced after CBTi. Lastly, lower levels of FoS predicted reduced PTSD symptoms following CPT, although CPT was not associated with significant reductions in FoS. Results highlight that CBTi that explicitly addresses FoS may reduce FoS, and findings also suggest that effectively reducing FoS prior to PTSD treatment may improve treatment outcomes. Support (if any) NIH/NINR R01 NR013909; VA Center of Excellence for Suicide Prevention

Association of Hypothyroidism and Subclinical Hypothyroidism with Covid-19 infection: A cross sectional study

Background: A complex relationship of viral infections and the functionality of thyroid gland mainly due to a complex role of immunomodulatory signaling molecules, receptors and hormones. Aim: To check the Association of Hypothyroidism and Subclinical Hypothyroidism with Covid 19 infection. Study Design: Cross sectional study. Methodology: 100 patients presenting to emergency and medical OPDs or already admitted with Covid 19 infections were enrolled into the study. Only those admitted patients whose previous reports of thyroid profile were available and showed no anomaly, were included in the study. Presence of SARS-Cov-2 was confirmed using nasal or throat swab using reverse transcriptase polymerase chain reaction. 3ml blood sample was taken from the anticubital fossa of the patients under sterile conditions in Gel tube containing clot activator. Thyroid function tests of patients were carried out in automated analyzer by chemiluminescence method. Data was analyzed using SPSS version 25.0. Results: Out of total 100 patients 60 (60%) were male and 40 (40%) were females. Mean age of the patients was 40.6 ± 10.5 years. 54 (54%) of the patients had normal T3 levels where as 46 (46%) of the patients had below normal T3 levels. 47(47%) of the patients had lower T4 levels. TSH levels were normal in 50 (50%) patients whereas 35 (35%) had reduced levels and 15(15%) had raised levels. Mean T3 levels of study population was 2.04 ±1.1 pg/ml (0.1-4.1), T4 levels were 0.93 ±0.50 ng/dl (0.1-1.7) and TSH levels were 2.5 ±2.1 mIU/L (0.1-8.1). Prevalence of hypothyroidism was greater in our Covid population under study. 2 (2%) patients were diagnosed as having subclinical hypothyroidism. Conclusion: Presence and development of Hypothyroidism is significantly associated with SARs-Cov-2 viral infection. It has prognostic and diagnostic significant. Practical Implication: Due to the emerging nature of the COVID-19 crisis, this study helped researchers to investigate the functionality of thyroid gland due to Covid-19 infection. Keywords: Covid 19, endocrine disorder, hypothyroidism, Serum T3, T4, Thyroid gland, thyroid stimulating hormone.

Hypothyroidism in induction chemotherapy of children with acute lymphoblastic leukaemia: A single-centre study.

Hypothyroidism as a long-term complication in cancer survivors has been an issue, but few studies have focused on changes in thyroid hormone levels during chemotherapy for leukaemia. This retrospective study was conducted to assess the characteristics of children with acute lymphoblastic leukaemia (ALL) and hypothyroidism during induction chemotherapy and to investigate the prognostic value of hypothyroidism in ALL. Patients with a detailed thyroid hormone profile at ALL diagnosis were enrolled. Hypothyroidism was defined as low serum levels of free tetraiodothyronine (FT4) and/or free triiodothyronine (FT3). The Kaplan-Meier method was used to create survival curves, and multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). There were 276 children eligible for the study, and 184 patients (66.67%) were diagnosed with hypothyroidism, including 90 cases (48.91%) with functional central hypothyroidism and 82 cases (44.57%) with low T3 syndrome. Hypothyroidism was correlated with the dosages of L-Asparaginase (L-Asp) (P = .004) and glucocorticoids (P = .010), central nervous system (CNS) status (P = .012), number of severe infections (grade 3, 4 or 5) (P = .026) and serum albumin level (P = .032). Hypothyroidism was an independent prognostic factor for PFS in ALL children (P = .024, 95% CI: 1.1-4.1). We conclude that hypothyroidism is commonly present in ALL children during induction remission, which is related to chemotherapy drugs and severe infections. Hypothyroidism was a predictor of poor prognosis in childhood ALL.

The TRH test is a valuable diagnostic test in central hypothyroidism with low T4

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)