Low Thyroxine Research Articles

Two siblings with congenital central hypothyroidism caused by a novel mutation in the IGSF1 gene.

.Genetic defects in the immunoglobulin superfamily member 1(IGSF1) protein are the cause of congenital central hypothyroidism (C-CH). Here we report two Japanese siblings with C-CH due to a novel IGSF1 mutation. The youngest brother showed a failure to thrive, hypothermia, and neonatal icterus six days after birth. Further endocrine evaluations led to the diagnosis of C-CH. In addition, PRL deficiency was later detected. In contrast, the elder brother did not show symptoms of severe hypothyroidism during the neonatal period, but he had been followed up by doctors due to psychomotor developmental delays since the age of 1 yr. At the age of 3 yr, he had low thyroxine and PRL levels and was also diagnosed with C-CH. Because of the C-CH and PRL deficiency, an IGSF1 deficiency was suspected. Sequence analysis of the IGSF1 gene identified a novel hemizygous mutation of p.Trp1173GlyfsTer8 (NM_001170961.1:c.3517del) in both siblings. In conclusion, the phenotypic severity of C-CH is different, even in siblings. Importantly, an IGSF1 deficiency may result in severe hypothyroidism during the neonatal period.

Effects of thyroxine on extremely severe traumatic brain injury

Objective To investigate the effects of thyroid hormone on extremely severe traumatic brain injury (TBI). Methods A retrospective case-control study was conducted to analyze the treatment of 105 patients with extremely severe TBI admitted from July 2010 to April 2014. There were 79 males and 26 females, with an average age of 32.9 years. The patients were divided into conventional treatment group (Group A, 35 cases), conventional treatment + thyroxine treatment group (Group B, 35 cases) and thyroxine treatment group after the condition that thyroxine level was low (Group C, 35 cases) according to the random number table method. The incidence of low T3 and T4, incidence of hypotension, the dosage of vasoactive drugs, function evaluation of liver and kidney damage, Glasgow outcome scale (GOS), and acute physiology and chronic health evaluation II (APACHE II) within 20 days after admission, and mortality rate within 30 days after admission were compared and analyzed. Results Within 20 days after admission, the rates of low thyroxine levels and hypotension of the Group B (22.9%, 77.1%) were significantly lower than those in the other two groups (Group A: 40%, 100%; Group C: 37%, 100%) (all P 0.05) . The corresponding data in Group A and Group C had no statistically significant difference (P>0.05). The liver and renal dysfunction rates of Group B (29%, 31%) were significantly lower than those of the other two groups (Group A: 49%, 51%; Group C: 43%, 51%) (all P 0.05). GOS in Group B [(4.8±1.9) points] was significantly higher than that in Group A [(3.3 ±0.2)points] (all P<0.05) within 30 days after admission and significantly higher than that of itself at the beginning [(3.6±1.1) points] (P<0.05). The APACHE II in Group A was significantly higher than those in other two groups as well as that in Group A at admission (P<0.05). Mortality rates in Group B (31%) and Group C (29%) were significantly lower than that in Group A (69%) within 30 days after admission (P<0.05). Conclusions Thyroxine can reduce the incidence of hypotension, liver and kidney injury rate in extremely severe TBI. Prevention is better than the supplementary treatment after severe TBI. Thyroxine can also reduce the mortality of extremely severe TBI within 30 days after admission. Key words: Thyroxine; Brain injuries; Hypotension; Mortality

Visual Vignette

Case presentation: A 50-year-old male with no significant past medical history presented to the emergency room with new-onset seizure. Prior to this, the patient had experienced intermittent mild headaches but no visual changes. A computed tomography scan of head revealed a large 8.9 × 5.1 × 5.7-cm anterior frontal mass with mass effect. Brain magnetic resonance imaging (MRI) showed a very large enhancing midline mass with supra- and intrasellar components and intraosseous extension into the clivus. Superiorly, large cystic areas extending into the anterior right frontal lobe and crossing the midline were noted. The large cystic areas contained T1-hyperintense fluid with T2-hypointense fluid levels, suggesting previous hemorrhage or altered protein content. Mass effect was present. The enhancing solid portion of the mass measured 4.5 × 6.0 × 3.2 cm, and the large cystic areas superiorly were about 4 × 5 cm. (Fig. 1 A). Visual field evaluation was normal. Biochemical evaluation included elevated prolactin of 14,540 ng/dL (2.6–13.1), hypogonadotropic hypogonadism with low testosterone of 19 ng/dL (normal: >320 for males), central hypothyroidism with low free thyroxine of 0.57 ng/dL (normal: 0.6–1.3) and thyroid-stimulating hormone of 0.48 mU/L (normal: 0.4–4.5), and central adrenal insufficiency with low morning cortisol of 1.1 μg/dL. What is the diagnosis?

Visfatin, PON-1 Levels in Iraqi Hyperthyroidism Patient's with Dyslipidemia.

In the study, it is aimed to research the likely role of visfatin in hyperthyroid and subclinical hyperthyroid status related to dislipidemia, after determining the visfatin and PON-1 levels thirty healthy individuals were enrolled in this study as control group and thirty hyperthyroidism patient's with dyslipidemia they were treated with. The subjects aged ranged (30-50) years and with BMI (25-29) kg/m2. Serum was used in determination of lipid profile total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), thyroid threonine (T3) and thyroxin (T4), thyroid stimulating hormone (TSH), visfatin and paraoxonase-1 (PON-1). The results showed significant increase in T3, T4, TC, TG, LDL and VLDL in patient group when comparing to control group. While significant decrease was found in TSH and HDL in patient group when comparing to control group. The results also represented significant increase in visfatin levels in patient group comparing to control group. While there are significant reducation in PON-1 levels in patient group comparing to control group. The conclusion could be drown from this study that visfatin and PON-1 effected hyperthyroidism patient's with dyslipidemia All the patients in hyperthyroid group were heterozygotes for Familial Hypercholesterolemia is a disorder that is passed down through families. It causes LDL (bad) cholesterol level to be very high. The condition begins at birth and can cause heart attacks at an early age.

Peripheral deiodinase activity: A potential explanation for the association between maternal weight and gestational hyperglycemia.

High maternal weight is known to associate with both low free thyroxine and gestational diabetes mellitus. We explore a deiodinase-related mechanism that may help explain these associations. Among 108 women receiving routine oral glucose tolerance testing for gestational diabetes mellitus, we collected biophysical data and measured free thyroxine and total triiodothyronine, using residual plasma samples. Fasting triiodothyronine/free thyroxine ratio and triiodothyronine were higher among women with gestational diabetes mellitus (p = 0.02; p = 0.04). The triiodothyronine/free thyroxine ratio and triiodothyronine measurements at 2 h were associated with weight (r = 0.20, p = 0.04; r = 0.22, p = 0.02); free thyroxine showed a non-significant inverse weight relationship (r = -0.06, p = 0.55). Glucose at all four intervals was associated with triiodothyronine/free thyroxine ratios, and triiodothyronine at 2 h. In stepwise regression, triiodothyronine/free thyroxine ratio predicted glucose more strongly than did weight. These relationships may be explained by higher maternal weight inducing peripheral deiodinase activity, resulting in higher plasma glucose (via triiodothyronine stimulation) and thereby increasing gestational diabetes mellitus risk.

Transient hypothyroidism in the newborn: to treat or not to treat.

Transient congenital hypothyroidism (CH) refers to a temporary deficiency of thyroid hormone identified after birth, with low thyroxine (T4) and elevated thyrotropin (TSH), which later recovers to improved thyroxine production, typically in first few months of infancy. Approximately 17% to 40% of children diagnosed with CH by newborn screening (NBS) programs were later determined to have transient hypothyroidism. Causes of transient CH are prematurity, iodine deficiency, maternal thyrotropin receptor blocking antibodies, maternal intake of anti-thyroid drugs, maternal or neonatal iodine exposure, loss of function mutations and hepatic hemangiomas. The classic clinical symptoms and signs of CH are usually absent immediately after birth in vast majority of infants due to temporary protection from maternal thyroxine. NBS has been largely successful in preventing intellectual disability by early detection of CH by performing thyroid function tests in infants with abnormal screening results. In this review we present the evidence for decision making regarding treatment vs. withholding treatment in infants with transient CH and present a rational approach to identifying transient CH based on American Academy of Pediatrics (AAP) recommendation.

Soy isoflavones inducing overt hypothyroidism in a patient with chronic lymphocytic thyroiditis: a case report

BackgroundMany people have thyroid conditions that make them susceptible to hypothyroidism. If the foods they eat may interfere with the production of thyroid hormone, which can lead to development of serious hypothyroidism. The danger of health drinks should always be noted.Case presentationA 72-year-old Japanese woman was previously diagnosed with chronic lymphocytic thyroiditis caused by a goiter and had an elevated thyroid-stimulating hormone level (6.56 μIU/ml), a high anti-thyroid peroxidase antibody level (>600 IU/ml), and a high antithyroglobulin level (> 4000 IU/ml) but normal levels of free triiodothyronine (3.08 pg/ml) and thyroxine (1.18 ng/ml). She presented to our hospital with sudden-onset general malaise, edema, and hoarseness with an elevated thyroid-stimulating hormone (373.3 μIU/ml) level and very low triiodothyronine (< 0.26 pg/ml) and thyroxine (0.10 ng/ml) levels. It was determined that for 6 months she had been consuming a processed, solved health drink (“barley young leaf”) in amounts of 9 g/day, which included soybean and kale powder extract. Hypothyroidism might be affected by ingredients of health drinks. She discontinued consumption of the health drink immediately and began taking 12.5 μg of levothyroxine. The amount of levothyroxine was gradually increased every 3 days up to 100 μg. At day 61, her thyroid-stimulating hormone level had decreased (6.12 μIU/ml), her free triiodothyronine (2.69 pg/ml) and thyroxine (1.56 ng/ml) levels had increased, and her general condition was improved. Among risky foods lowering thyroid function, some experimental studies have revealed that isoflavones reduce thyroid function. Therefore, we measured the presence of isoflavones in the patient’s frozen serum with thin-layer chromatography. After she discontinued consumption of the health drink, two components quickly disappeared, and the other three components gradually decreased. On the basis of developing solvent composition and a positive ferric chloride reaction in thin-layer chromatography experiment, the five ingredients that disappeared or decreased were highly suspected to be soy isoflavones.ConclusionsThis case emphasizes that consuming health drinks that include soy isoflavone powder extracts can lead to severe hypothyroidism.

Predictive value of scintigraphic (semi-)quantitative thyroid parameters on radioiodine therapy outcome in hyperthyroid cats.

Objectives The outcome of radioiodine therapy in hyperthyroid cats is suspected to be influenced by multiple factors. The degree of activity of the thyroid gland, represented by uptake of sodium pertechnetate or tracer activities of radioiodine by the thyroid gland on thyroid scintigraphy, has been suggested in the literature as one of those. Thyroid gland pertechnetate uptake can be represented by (semi-)quantitative factors such as the thyroid to salivary gland (T/S) ratio, the thyroid to background (T/B) ratio and the percentage technetium uptake by the thyroid glands (%TcU). The aim of this study was to investigate a possible relationship between these thyroid scan parameters and radioiodine therapy outcome. Methods Sodium pertechnetate thyroid scans of 75 hyperthyroid cats were retrospectively evaluated and statistical analysis was performed with and without correction for injected radioiodine activity. Three different background regions of interest (ROIs) were used to calculate the T/B ratio and %TcU: 'neck', 'circle' and 'copy ROI'. Results Higher T/S ratios were found to be significantly related to a persistent hyperthyroid outcome in both analyses. For the T/S ratio, a threshold value of 5.4 was determined, with a sensitivity of 73% and a specificity of 59%. An increased risk for persistent hyperthyroidism compared with a final euthyroid outcome with an increased T/Bcircle ratio was only found to be significant without correction for the activity of radioiodine administered. For the %TcU no statistical significance was reached. Regarding a low total thyroxine outcome, no significant relationships with any of the investigated parameters were found. Conclusions and relevance The findings of this study suggest that semi-quantification of thyroid gland uptake is best performed using the T/S ratio. A T/S ratio ⩾5.4 is a possible indicator for an increased risk of persistent hyperthyroidism.

Serum thyroxine and thyroid-stimulating hormone concentration in hyperthyroid cats that develop azotaemia after radioiodine therapy.

The objectives of this study were to determine which serum thyroid hormone test best identifies iatrogenic hypothyroidism in cats that develop azotaemia after radioiodine treatment and to determine which thyroid test best differentiates these azotaemic, hypothyroid cats from azotaemic, radioiodine-treated euthyroid cats, as well as from azotaemic cats with chronic kidney disease and no history of thyroid disease. A total of 42 hyperthyroid cats that developed azotaemia (serum creatinine ê220 µmol/L) after radioiodine treatment had serum concentrations of thyroxine and free thyroxine by dialysis and thyroid--stimulating hormone measured at 3, 6 and 12 months. Iatrogenic hypothyroidism was confirmed (n=28) or excluded (n=14) on the basis of thyroid scintigraphy. A total of 14 cats with chronic kidney disease and 166 clinically normal cats underwent similar serum thyroid testing and scintigraphy. Concentrations of thyroxine and free thyroxine were lower and thyroid-stimulating hormone higher in hypothyroid cats than in all three groups of euthyroid cats (P<0·0001). Of the hypothyroid cats, thyroxine and free thyroxine concentrations were low in 15 (53·6%) and seven (25%), respectively. Low serum thyroxine and free thyroxine concentrations were also detected in seven (50%) and two (14·3%) of the cats with chronic kidney disease. Thyroid-stimulating hormone concentrations were elevated in all hypothyroid cats but remained within the reference interval in all three groups of euthyroid cats. Serum thyroid--stimulating hormone had a higher test sensitivity and specificity than either thyroxine or free thyroxine concentration. The finding of high serum thyroid-stimulating hormone concentrations best identifies feline iatrogenic hypothyroidism and differentiates it from non-thyroidal illness syndrome in cats that develop azotaemia after treatment.

Gestational Hypothyroxinemia Imprints a Switch in the Capacity of Astrocytes and Microglial Cells of the Offspring to React in Inflammation.

Hypothyroxinemia (Hpx) is a highly frequent condition characterized by low thyroxine (T4) and normal 3,3',5'-triiodothyronine (T3) and thyroid stimulating hormone (TSH) levels in the blood. Gestational Hpx is closely related to cognitive impairment in the human offspring. In animal modelsgestational Hpx causesimpairmentat glutamatergic synapsis, spatial learning, and the susceptibility to suffer strong autoimmune diseases like experimental autoimmune encephalomyelitis (EAE). However, the mechanisms underlying these phenotypes are unknown. On the other hand, it has been shown that astrocytes and microglia affect the outcome of EAE. In fact, the activation of astrocytes and microglia in the central nervous system (CNS) contributes to EAE progression. Thus, in this work, the reactivity of astrocytes and microglia from rats gestated in Hpx was evaluated aiming to understand whether these cells are targets of gestational Hpx. Interestingly, microglia derived from the offspring gestated in Hpx were less reactive compared to microglia derived from offspring gestated in euthyroidism. Instead, astrocytes derived from the offspring gestated in Hpx were significantly more reactive than the astrocytes from the offspring gestated in euthyroidism. This work contributes with novel information regarding the effects of gestational Hpx over astrocytes and microglia in the offspring. It suggests that astrocyte could react strongly to an inflammatory insult inducing neuronal death in the CNS.

Maternal low thyroxin levels are associated with adverse pregnancy outcomes in a Chinese population.

Although thyroid dysfunction in early pregnancy may have adverse effects on pregnancy outcomes, few studies have examined the relationship between maternal low free thyroxin (FT4) levels in both first and third trimesters of pregnancy and the incidence of adverse pregnancy outcomes. We hypothesized that low FT4 levels in either first or third trimesters of pregnancy may have different effects on pregnancy outcomes. The study included 6,031 mothers who provided both first and third pregnancy serum samples for analyses of thyroid function. Adverse pregnancy outcomes, such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension and preeclampsia, were diagnosed using the oral glucose tolerance test, blood pressure and urine protein test. Serum metabolites like adenosine and its analogues were identified using hydrophilic interaction liquid chromatography (HILIC)-tandem mass spectrometry (MS/MS). The incidence of hypothyroidism in pregnant women tended to increase with age and pre-pregnancy body mass index (BMI). The incidence of GDM was negatively correlated with maternal FT4 levels during early pregnancy while the incidence of preeclampsia was negatively correlated with maternal FT4 levels during late pregnancy. The incidence of pregnancy-induced hypertension was not significantly correlated with maternal FT4 levels. The women who had isolated maternal hypothyroxemia (IMH) in the third trimester of pregnancy had an increased risk of developing preeclampsia. Some metabolites like adenosine and its analogues in the serum were significantly changed in pregnant mothers with IMH. In conclusion, low FT4 levels during pregnancy are a risk factor for GDM and preeclampsia. Adenosine and its analogues may be important bridges between IMH and preeclampsia.

Various levels of rapeseed meal in weaning pig diets from weaning to finishing periods.

ObjectiveThis experiment was conducted to investigate the influence of rapeseed meal (RSM) supplementation in weaning pig diet on growth performance, blood profile, carcass characteristics and economic analysis on weaning to finishing pigs.MethodsA total of 120 cross bred ([Yorkshire×Landrace]×Duroc) weaning pigs were allotted to 5 treatments in a randomized complete block design. Each treatment had 4 replications with 6 pigs per pen. Five different levels of RSM (0%, 2%, 4%, 6%, and 8%) were used as dietary treatments.ResultsOverall, no treatment showed significant differences in growth performance with increased dietary RSM levels. The concentration of blood urea nitrogen (BUN) decreased as dietary RSM levels increased in 6 weeks (linear response, p<0.01). Total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triiodothyronine, and thyroxine showed no significant differences, neither were there any significant differences in the immune response (IgG and IgA). As the dietary RSM levels of weaning pig diet were increased, no differences were found among dietary treatments upon performing proximate analyses of the pork after finishing. The influence of RSM supplementation on nutrient digestibility and nitrogen retention were not affected by dietary RSM levels either. With increased dietary RSM levels in the weaning pig diet, no differences among dietary treatments were found after performing proximate analyses of the pork’s physiochemical properties. In addition, there were no significant differences observed in pork colors, pH levels, and economic benefits.ConclusionConsequently, this experiment demonstrated that weaning pig’s diet containing RSM influenced BUN concentration, but there were no detrimental effects on the growth performance of weaning pigs with up to 8% RSM in the diet.

Deletion of the Thyroid Hormone-Activating Type 2 Deiodinase Rescues Cone Photoreceptor Degeneration but Not Deafness in Mice Lacking Type 3 Deiodinase.

Type 2 deiodinase amplifies and type 3 deiodinase depletes levels of the active form of thyroid hormone, triiodothyronine. Given the opposing activities of these enzymes, we tested the hypothesis that they counteract each other’s developmental functions by investigating whether deletion of type 2 deiodinase (encoded by Dio2) modifies sensory phenotypes in type 3 deiodinase-deficient (Dio3−/−) mice. Dio3−/− mice display degeneration of retinal cones, the photoreceptors that mediate daylight and color vision. In Dio2−/− mice, cone function was largely normal but deletion of Dio2 in Dio3−/− mice markedly recovered cone numbers and electroretinogram responses, suggesting counterbalancing roles for both enzymes in cone survival. Both Dio3−/− and Dio2−/− strains exhibit deafness with cochlear abnormalities. In Dio3−/−;Dio2−/− mice, deafness was exacerbated rather than alleviated, suggesting unevenly balanced actions by these enzymes during auditory development. Dio3−/− mice also exhibit an atrophic thyroid gland, low thyroxine, and high triiodothyronine levels, but this phenotype was ameliorated in Dio3−/−;Dio2−/− mice, indicating counterbalancing roles for the enzymes in determining the thyroid hormone status. The results suggest that the composite action of these two enzymes is a critical determinant in visual and auditory development and in setting the systemic thyroid hormone status.

Relationship of thyroid function with intracranial arterial stenosis and carotid atheromatous plaques in ischemic stroke patients with euthyroidism.

This study aimed to help clarify the possible relationships of thyroid function with intracranial arterial stenosis or carotid atheromatous plaques in ischemic stroke patients with euthyroidism. We retrospectively reviewed the medical records of a consecutive series of ischemic stroke patients prospectively entered into the Chengdu Stroke Registry between February 2010 and March2012. We performed univariate and multivariate analysis to assess possible relationships of thyroid function with intracranial artery stenosis or carotid atheromatous plaques. Of the 172 patients analyzed (42 women; 61.7 ± 14.0 years old), 62 (32.0%) had carotid atheromatous plaques, and 81 (47.1%) had intracranial artery stenosis. Free thyroxine levels were lower in patients with carotid atheromatous plaques than in patients without plaques (15.80±2.09 vs. 16.92±2.69, P = 0.005). After adjusting for age, gender, hyperlipidemia, and previous smoking, free thyroxine levels were independently associated with carotid atheromatous plaques (OR 0.73, 95% CI 0.54-0.99, P = 0.04). In contrast, thyroid function indicators showed no associations with intracranial arterial stenosis. In conclusion, low free thyroxine levels were independently associated with carotid atheromatous plaques in ischemic stroke patients with euthyroidism, but thyroid function indicators were not associated with intracranial artery stenosis.

Sick euthyroid syndrome: A myth or reality

Altered thyroid function in non-thyroidal illness(NTI) is a well-recognized finding. The term euthyroid sick syndrome (SES) identifies abnormalities in thyroid function observed in patients with systemic nonthyroidal illnesses (NTIs). SES being most common endocrine change seen in critically ill patients, is characterized by low triiodothyronine (T3), low or normal thyroxine (T4) and normal thyroid stimulating hormone (TSH). The extent of SES is associated with prognosis, but no proof exists for causality of this association. T3 levels reflect the patient’s clinical status, T4 levels can predict survival. Initially, SES is a consequence of the acute phase response to systemic illness and macro- nutrient restriction, which might be beneficial. Pathogenesis of SES in long term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. Distinguishing between SES and other primary thyroid disorders, can be difficult in ICU setting. Clinical benefits of supplementing thyroid hormone in SES has not been answered adequately. No evidence-based consensus or guideline advocates thyroid hormone treatment of SES at present.

Forty Years Of Unrecognized Hypopituitarism Diagnosed By Physical Exam

AbstractObjective: To describe the diagnosis of a case of hypopituitarism that went undiagnosed for 40 years, having been masked by inhaled glucocorticoids.Methods: We present the clinical, laboratory, exam, and imaging findings, along with a review of the literature.Results: A 58-year-old man with a history of intermittent hyponatremia of unknown etiology and chronic abdominal cramps presented with worsening cramps, confusion, and serum sodium of 112 mmol/L (reference range, 135 to 145 mmol/L). His urine sodium and osmolality suggested the syndrome of inappropriate antidiuretic hormone (SIADH), but serum sodium did not normalize with hypertonic saline and fluid restriction. Exam revealed no axillary or pubic hair and no palpable testes. He reported 3 episodes of traumatic head injury around the age of 18 and an inability to have an erection since that time. Further testing found undetectable luteinizing hormone, undetectable testosterone, low free thyroxine, low insulin-like growth factor 1, and a failed cosyntropin stimulation test. Magnetic resonance imaging showed an empty sella. His sodium and cramping improved rapidly with hydrocortisone. He had not used his glucocorticoid inhaler for 3 days prior to admission. He had a similar admission after stopping his inhaler 4 years ago, leading us to the conclusion that the chronic inhaled glucocorticoid may have masked his hypopituitarism.Conclusion: This case highlights the common and life-threatening delay in diagnosis of adrenal insufficiency, the need to consider SIADH a diagnosis of exclusion, and the importance of a thorough physical exam and history, even in this era of digital medicine.Abbreviations:Siadhsyndrome of inappropriate antidiuretic hormoneT4thyroxine

Supraglottic Myxedema: Two Cases And A Review Of The Literature

ABSTRACT Objective: We report 2 patients who presented with clinical symptoms of acute upper airway obstruction from presumed supraglottic myxedema and compare their clinical presentation, diagnosis, and management with previously reported cases. Methods: Clinical data, laboratory results, imaging, and procedure reports were reviewed for both cases. A literature search was performed in MEDLINE using the terms “supraglottic myxedema,” “myxedema,” and “laryngeal edema.” Relevant references were selected and reviewed. Results: A 63-year-old man presented with confusion and facial and neck edema. The patient was subsequently intubated for airway protection. During intubation the epiglottis could not be visualized due to airway edema. Thyroid function testing revealed elevated thyroid-stimulating hormone (TSH) and low free thyroxine (FT4). Computed tomography (CT) scan of the neck without contrast noted nonspecific mild, diffuse edema within the subcutaneous soft tissues. A 70-year-old man with a history of pa...

The Serological and Biochemical Markers of Adrenal Cortex and Endocrine Pancreas Dysfunction in Patients with Hashimoto's Thyroiditis: A Hospital-based Pilot Study.

Background:The prevalence of both islet cell and adrenal autoimmunity among Asian Indian hypothyroidism patients with Hashimoto's thyroiditis (HT) is lacking in literature.Objectives:The objective of this study was to assess the proportion of Addison's disease (AD) and type 1 diabetes mellitus (T1DM) in patients with HT.Materials and Methods:The patients with hypothyroidism due to HT were included in this study over 2 years. Primary hypothyroidism was defined as high serum thyroid-stimulating hormone (>5.5 mIU/L) with or without low thyroxine level. HT was defined by the presence of high thyroid peroxidase antibody (Ab) titer (>35 IU/ml). Autoimmune markers of AD and T1DM, i.e., adrenal (21-hydroxylase) Ab, glutamic acid decarboxylase (GAD) Ab, and insulinoma-associated antigen-2 (IA-2) Ab were measured among them. In addition, 250 μg adrenocorticotropic hormone (ACTH) stimulation test was done in patients with adrenal Ab. Similarly, beta cell function was assessed in patients with GAD and/or IA-2 Ab.Results:Out of 150 patients screened, 136 patients were included in this study. Seven patients had adrenal Ab while 15 had IA-2 Ab. The GAD Ab was not present in any of the patients in the study. ACTH stimulation test was done in four of seven patients with adrenal Ab and beta cell function was assessed in 8 of 15 patients with islet cell Ab. All patients with adrenal Ab had normal adrenal function and 1 out of 15 with IA-2 Ab developed diabetes mellitus during follow-up.Conclusions:Either adrenal or islet cell Ab was found in 16% Asian Indian hypothyroidism patients with HT.

Short Stature due to Ectopic Neurohypophysis: Case Report

Ectopic posterior pituitary is a disruption in the normal embryogenesis and is one of the rare but common causes of pituitary dwarfism. We report the MRI and clinical findings of a 13.5-year-old Saudi boy who was referred to the endocrine outpatient clinic with no significant complaints except for fatigue, exercise intolerance and short stature. Physical examination revealed short stature (below 2nd centile) with normal body proportion without any dysmorphic features and prepubertal secondary sexual characteristics and genitalia. Hormonal profile revealed: low thyroxine level, low gonadotrophins, low testosterone, low cortisol and blunted growth hormone (GH) response to insulin induced hypoglycaemia. Bone age was of 5 years old. The MRI result concluded with a diagnosis of ectopic posterior pituitary. A diagnosis of posterior pituitary ectopia (PPE) with panhypopituitarism was made.

Measurement of Fertility Benefits with Low Dose Thyroxine in Sub-fertile women

Introduction: High prevalence rate of thyroid dysfunction associated infertility is identified by a number of studies in Nepal. Thyroid dysfunction not only affects fertility but is also associated with miscarriage and fetal death. The objective of this study was to measure the fertility rate after low dose Thyroxine, 12.5 microgram, in women with subfertility.&#x0D; &#x0D; Methods: This was a descriptive and observational study done among women visiting infertility and in-vitro fertilization (IVF) center at Nepalgunj Medical College, Nepal. After undergoing baseline investigations for infertility, all women diagnosed with primary or secondary infertility were enrolled in the study. Male factor and tubal factor infertility was excluded. All 136 women who were enrolled in the study received 12.5 microgram of thyroxine supplementation for a period of three months and subsequently followed up until the same time period.&#x0D; &#x0D; Results: Out of 136 women, 83 (61.02%) women achieved pregnancy within three months of supplementation with low dose thyroxine. Among them, 34 (40.9%) women with primary infertility achieved pregnancy within three months. Similarly 14 (16.8%) women with previous miscarriage, 20 (24.09%) women with previous caesarean section within past five years back, and 15 (18.07%) with previous IUFD achieved pregnancy within three months.&#x0D; &#x0D; Conclusion: Low dose thyroxine supplementation would be beneficial and recommended to subfertile women of reproductive age group in the endemic regions of hypothyroidism. Dose adjustment would give extended benefits as soon as pregnancy is achieved.