Low TSH Levels Research Articles

Methimazole for Prevention of Iodinated Contrast Media Induced Exacerbation of Thyrotoxicosis in Susceptible Patients

Iodinated contrast media (ICMs) are widely used in a variety of examinations and procedures. The aim of the current study was to investigate the efficacy of methimazole (MMI) in prevention of thyrotoxicosis after ICM exposure. A retrospective cohort study included patients aged ≥18 years admitted to a tertiary medical center who underwent ICM examination or procedure and received MMI prior to iodine exposure. A total of 179 patients with 202 hospitalizations were included. The mean age was 72.3 ± 13.5 years (female, 64%). Nearly all patients (99%) had a history of thyroid disease, and 91% were treated with MMI prior to admission. Seventy-five patients had low thyroid-stimulating hormone (TSH) levels prior to ICM exposure. In this high-risk group, MMI led to normalization of TSH after discharge in 19%, and 64% remained with low TSH levels after discharge but with a small median difference in free thyroxine levels of-0.5 (interquartile range [IQR],-5.9 to 5.2) pmol/L. In the 8 patients with dose increase during hospitalization, treatment with MMI was beneficial with a median free thyroxine decrease of-6.2 (IQR,-9.2 to-1) pmol/L and TSH increase of 0.2 (IQR, 0.02-0.7) mIU/L. In 110 patients with normal TSH levels before admission, with MMI treatment, most (71%) remained euthyroid after discharge, 13% had low TSH levels, and 9% had high TSH levels. In the 15 patients with high TSH levels prior to admission, the TSH levels of only 2 patients normalized, 47% remained with high TSH levels, and 27% had low TSH levels after discharge. In patients with pre-existing thyrotoxicosis treated with antithyroid drugs, MMI therapy before ICM exposure prevented exacerbations. In patients with low TSH levels before admission, increasing the dose of MMI before exposure led to improvement in thyroid functions after discharge.

Predictors for thyroid dysfunction after discontinuation of levothyroxine in children and adolescents with Hashimoto thyroiditis.

Few data on the clinical course after levothyroxine (L-T4) discontinuation in pediatric patients with Hashimoto thyroiditis (HT) are available. We investigated outcomes and predictors for successful withdrawal from L-T4 among children with HT. Among 168 patients diagnosed with HT between January 2000 and March 2021 at Seoul National University Children's Hospital and in whom L-T4 therapy was initiated during childhood, we attempted to discontinue this therapy in 47, 3 boys and 44 girls. L-T4 was restarted when patients developed overt or subclinical hypothyroidism (thyroid-stimulating hormone [TSH] levels≥10 mIU/L) after L-T4 discontinuation. Median age at discontinuation was 15.4 years (12.7-18.4 years) with a median duration of L-T4 therapy of 47 months (20.3-80.3 months). During the median 30 months of follow-up (10.6-61.0 months) after L-T4 discontinuation, 33 (70.2%) developed thyroid dysfunction. Among these patients, 17 were eventually restarted on L-T4. TSH levels over 50 mIU/L at L-T4 initiation (hazard ratio, HR 3.5, P=0.002), age under 12 years at L-T4 discontinuation (HR 11.1, P=0.0001), and TSH levels higher than the upper 50% of normal (above 2.25 mIU/L in the present study) at L-T4 discontinuation (HR 2.7, P=0.014) were significantly predictive for overt hypothyroidism or subclinical hypothyroidism after L-T4 discontinuation. In addition, age under 12 years at L-T4 discontinuation was only predictive factor for restarting L-T4 medication (HR 4.3, P=0.012). L-T4 discontinuation in pediatric patients with HT resulted in thyroid dysfunction in 70.2% of cases; 36.2% of patients who attempted discontinuation required resumption of L-T4. Older age and lower TSH levels at L-T4 discontinuation were advantageous for successful withdrawal.

Occupational Exposure to Unburnt Tobacco Dust and Thyroid Function: A Case-Control Study

Beedi rolling is one of the most common home-based occupations used to meet daily expenses. The process of making beedis is mainly done by women, especially in rural areas. Due to a lack of awareness regarding safety measures, beedi-rolling women are exposed to toxic components present in unburnt tobacco dust. This exposure leads to many health complications among women beedi-rollers. In this study, we investigated how unburnt tobacco dust disrupts thyroid gland homeostasis by altering levels of thyroid hormone and TSH. We included 421 beedi rolling women (BR) and 426 control subjects (NBR) who were not exposed occupationally to any chemical agents. Levels of thyroid hormones (T3, T4) were analysed using competitive ELISA, and TSH levels were analysed using sandwich ELISA. Serum nicotine metabolites were analysed using LC-MS. We observed a statistically significant increase in the levels of T3, T4, anabasine, nornicotine, and cotinine in BR compared to the NBR group. Additionally, significantly lower TSH levels were observed in the BR group. However, the Correlation between nicotine metabolites, and hormones did not show a significant difference in the BR group. We conclude that prolonged exposure to unburnt tobacco dust must have disrupted thyroid function by altering the thyroid hormone, and TSH levels.

Characterizing cognitive phenotypes and clinical correlates in type 2 diabetes using fuzzy clustering and decision tree analysis

Cognitive impairment is frequently seen in patients with type 2 diabetes (T2DM), ranging from mild impairment to dementia. However, our knowledge of the specific profiles and risk factors for these different levels of impairment is limited. In this study involving 152 patients with T2DM, cognitive function was assessed using the Montreal Cognitive Assessment test. The Fuzzy C-means clustering algorithm was utilized to group individuals with similar cognitive characteristics. The study evaluated how well clinical parameters could classify characteristics of clusters using the Classification and Regression Trees algorithm. ROC analysis was then used to assess the classification success. Three distinct cognitive clusters were identified. Cluster 1 had the poorest cognitive performance and was characterized by more women, lower education levels, and lower levels of iron, hemoglobin, and creatine. Cluster 3, the amnestic cluster, was distinguished by low TSH levels. The decision tree model highlighted several parameters, including education level, hemoglobin, duration of diabetes mellitus (DM), iron, TSH, gender, family history of diabetes, and microalbumin/creatinine ratio, as significantly affecting the distinction of cognitive clusters. Diabetes-associated cognitive impairment stems from multifaceted pathophysiological mechanisms influenced by complex risk factors, resulting in diverse types of cognitive deficits.

12217 Exploring Thyroid-stimulating Hormone As A Potential Cardiovascular Disease Risk Marker In Euthyroid Individuals

Abstract Disclosure: A.P. Neto: None. H. Lucchesi: None. C.C. Silva Janovsky: None. I. Bensenor: None. L.S. Ward: None. L.L. Cunha: None. Previous studies have suggested that TSH levels may predict longevity primarily in elderly individuals. Aging is associated with a high prevalence of cardiovascular and metabolic diseases that reduce survival. However, the relationship between serum TSH levels and these conditions, especially traditional cardiovascular risk markers, remains poorly explored. We employed data from the longitudinal multicenter cohort study ELSA-Brasil, which includes workers from five Brazilian Universities, to evaluate thyroid function in 8,452 participants aged between 34 and 75 years, classified as euthyroid and followed for 8.9 ± 0.6 years. The participants were evaluated for the presence of diabetes, hypertension, angina, peripheral arterial disease, and cardiovascular mortality. Additionally, we measured cardiovascular markers, including global cardiovascular risk score, HbA1c, microalbuminuria (mg/dl), LDL levels, and triglyceride levels. Statistical analysis was used to compare TSH levels with clinically relevant outcomes and classical cardiovascular risk markers. We observed that higher TSH levels correlated negatively with global cardiovascular risk (Spearman rank -0.023, p-value=0.038), microalbuminuria (Spearman rank -0.055, p<0.000), and HbA1c (Spearman rank -0.041, p<0.000). However, TSH levels were positively correlated with hypertriglyceridemia (Spearman rank +0.125, p<0.000) but had no relationship with LDL (p >0.05). The appraisal of cardio-metabolic diseases showed that individuals without diabetes had higher TSH levels (1.79 mIU/L, IQR 1.07) than individuals with diabetes (1.71 mIU/L, IQR 1.07). Patients with arteriosclerosis diseases, such as coronary and peripheral arterial disease, had lower TSH levels (1.66, IQR 0.98 and 1.67, IQR 0.94, respectively) than those who did not have these comorbidities (1.79, IQR 1.07, and 1.79, IQR 1.07). Furthermore, TSH levels did not correlate with the incidence of hypertension (p >0.05). Finally, we divided the population into two groups: higher and lower TSH levels based on the median TSH levels (1.78 mIU/L, IQR 1.06). The Kaplan-Meier curve did not show a difference between these groups (p=0.758) in survival after cardiovascular events (08 events in total) during follow-up. In conclusion, our results suggest that higher serum TSH levels in euthyroid individuals are associated with a lower prevalence of metabolic and cardiovascular disease. However, the relatively short observation duration and low frequency of cardiovascular events in our cohort made it difficult to statistically analyze several endpoints, such as survival. Further investigation is necessary to completely understand whether TSH is a cardiovascular risk indicator. Presentation: 6/2/2024

7078 Diagnostic Obstacles in Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma (TSH-oma): A Case Report

Abstract Disclosure: V.A. Mendpara: None. P.P. Rao: None. M.D. Lundholm: None. Background: Thyroid-stimulating hormone-secreting pituitary adenoma (TSH-oma) is a rare cause of hyperthyroidism, forming 0.5-3% of all functioning pituitary tumors and <1% of hyperthyroid cases. Here, TSH secretion is autonomous and unresponsive to the normal negative feedback of thyroid hormones, leading to inappropriate TSH, T4 and T3 elevation. In the absence of clinical symptoms it can be difficult to distinguish between thyroid hormone resistance (THR) and lab errors. Clinical Case: A 44-year-old Swahili-speaking female with a history of type 2 diabetes was admitted for hypoglycemia requiring insulin adjustment. In her workup, thyroid function tests were obtained, revealing normal or low TSH (0.28 mIU/L) and high free T4 levels (2.7 ng/dL). At outpatient follow-up, repeat labs showed elevated TSH, T3 and FT4 (5.22 mIU/L, 377 ng/dL and 4.7 ng/dL, respectively). She reported weight loss, occasional palpitations, and chronic insomnia but denied other symptoms. Graves' antibodies (TSI, TSHR Ab) were negative. On exam, she had a 30-40 gm, smooth, non-tender thyroid without adenopathy, and a BMI of 23 kg/m2. The initial differential diagnosis included TFT lab error, THR or TSH-oma. A FT4 by equilibrium dialysis was high at 7.8 ng/dL (1.1-2.4 ng/dL). N-telopeptide (NTX) and sex hormone-binding globulin (SHBG) were elevated, consistent with a true hyperthyroid state. Genetic testing for THR posed time and cost barriers. Elevated alpha-subunit levels (87 ng/mL, normal ≤1.8 ng/mL) with normal levels of other pituitary hormones prompted a pituitary MRI, unveiling a 4.7 cm suprasellar bilobed pituitary mass abutting the optic chiasm and invading the cavernous and sphenoidal sinuses. She denied peripheral vision loss or headaches. Hyperthyroidism was managed with methimazole until surgical intervention for the TSH-oma. A transsphenoidal resection was performed with histopathological confirmation of a TSH-staining pituitary adenoma. She was started on levothyroxine for central hypothyroidism thereafter. Discussion: It is challenging to find the cause of abnormal TFTs when patients are asymptomatic and the differential includes THR, lab errors or TSH-oma. Inaccurate diagnosis can lead to delays in care or unnecessary thyroid ablation or pituitary surgery. Conversely, early identification and appropriate treatment of TSH-omas can prevent neurological and endocrinological complications, such as optic chiasm compression, visual disturbances, headache and hypopituitarism. Despite a lack of convincing symptoms of hyperthyroidism, we used confirmatory labs (NTX, SHBG) to rule in biochemical hyperthyroidism along with alpha-subunit testing and pituitary MRI to solidify the TSH-oma diagnosis, leading to surgical intervention. This case highlights the vital steps in the diagnosis of a TSH-oma, emphasizing the need for logical evaluation and differentiation of this rare condition. Presentation: 6/1/2024

7314 The Thyroid Tetralogy: Hypothyroidism, Graves' Disease, AFTN, and Thyroid Cancer in a Single Patient

Abstract Disclosure: F. Sajid: None. F. Mohammadrezaei: None. K. Tiwari: None. J. Shapiro: None. F. Mohsin: None. T. Lin: None. Introduction: In this case, we explore a rare and complex situation involving a patient's shift from hypothyroidism to hyperthyroidism. This transition led to the diagnosis of Marine Lenhart Syndrome (MLS), an uncommon condition characterized by the coexistence of Graves' disease and autonomously functioning thyroid nodules (AFTNs). Adding to the complexity of the case, the patient was also diagnosed with papillary thyroid carcinoma (PTC). Case Presentation: A 47-year-old woman with a history of hypothyroidism, treated with levothyroxine for 14 years, presented with palpitations, weight loss, and insomnia for a few months. Her levothyroxine dose was gradually reduced and eventually discontinued by her primary care physician due to low TSH and high free T4 levels. Post-discontinuation, her symptoms were improving. Laboratory tests showed TSH 0.01 mIU/mL (0.39-4.08), Thyroglobulin (TG) 72 ng/mL (3-40), Free T4 2.5 ng/dL (0.8-1.8), Free T3 11.5 ng/dL (0.2-0.5ng/dL). Furthermore, Thyrotropin Receptor Antibody (TRAb), and Thyroid Peroxidase Antibody (TPO Ab) were positive leading to a diagnosis of Graves' Disease and initiation of Methimazole. After three months on Methimazole, her TSH remained suppressed with normalized free T4 and T3 levels. A thyroid ultrasound revealed bilateral nodules, with a calcified well-circumscribed nodule in the right mid-pole. A Radioactive iodine uptake (RAIU) scan showed a hyperfunctioning right mid-pole thyroid nodule. Fine-needle aspiration biopsy was consistent with Bethesda V, suggestive of possible malignancy. Consequently, she underwent a total thyroidectomy, with pathology confirming multifocal classic PTC, stage pT1bN0. Post-surgery, she developed hypothyroidism and was started on levothyroxine. Four weeks later, her TSH remain suppressed, other thyroid function tests and calcium levels were within normal range: TSH 0.01 mIU/mL, Free T4 1.0 ng/dL, TG 4.6 ng/mL, Thyroglobulin antibodies 1 IU/mL (less than or equal to 1), PTH intact 43 pg/mL (16-77), and Calcium 8.9 mg/dL (8.6-10.2). Conclusion: This case represents a complex and unusual medical scenario where a patient transitioned from hypothyroidism to hyperthyroidism, ultimately leading to the diagnosis of MLS in conjunction with PTC. The exact mechanism behind this transition is not fully understood. In the management of hypothyroidism, adjustments in thyroxine dosage are common, but significant tapering of the dose should prompt further investigation. The presence of PTC in AFTNs is considered rare, as AFTNs are typically characterized as hot nodules, implying they are hyperfunctioning and generally considered to be less likely malignant compared to cold nodules. This case underscores the need for comprehensive evaluation and follow-up in patients with thyroid disorders, especially when there is a change in thyroid function or the presence of nodules. Presentation: 6/3/2024

Pediatric Graves' Disease: Surgical Interventions in a Single Institution - A Comprehensive Case Series.

Graves' disease (GD) is the most common cause of hyperthyroidism in children and adolescents. Data regarding pediatric GD in Indonesia are limited and pose challenges to diagnosing and treating the patients. In many aspects the clinical presentation of GD in children and adolescents resembles that of the adult population. There are three treatments for pediatric GD: anti-thyroid drugs, radioiodine ablation, and thyroidectomy. Although surgery is gaining acceptance as the definitive first-line treatment for children with GD, several studies examining pediatric populations have shown high complication rates. This study aims to describe a series of pediatric GD cases from a tertiary care center over an eight-year period. Retrospective data of five patients with hyperthyroidism diagnosed with GD between 2014 and 2022 were reviewed. Clinical presentation, diagnosis, therapies, and short-term postoperative outcomes of GD were analyzed. All five GD patients presented with neck lumps. Low TSH levels and elevated FT4 levels were found in all patients preoperatively. Total thyroidectomy was performed in all patients, while one patient had lymphadenectomy concurrently. Histopathologic examination confirmed a diagnosis of GD in all patients. All patients in this study experienced postoperative complications such as hoarseness, while only three patients had hypocalcemia as a complication. Total thyroidectomy in pediatric patients remains challenging. The euthyroid condition in patient prior to surgery is recommended to avoid the risk of thyroid storm during surgery, but a few studies have revealed that there is no difference in outcomes for hyperthyroid individuals. Close postoperative surveillance for complications of total thyroidectomy is necessary. Results of this study showed that pediatric GD patients had the same symptoms of hyperthyroidism as adults with all patients complained of neck lumps. Total thyroidectomy is the definitive therapy for GD in pediatrics as well as in adults. The minority of patients will experience transient and benign morbidities, with hoarseness of the voice being the most common transient postoperative morbidity. In performing total thyroidectomy, meticulous surgery and good anatomical recognition are required to avoid postoperative complications. So that, follow-up of post-total thyroidectomy in pediatric GD patients needs to be done.

The association between serum soluble α-Klotho and thyroid profile among adults from NHANES 2007–2012

BackgroundThyroid hormone is the key endocrine regulator of growth, development, metabolism, and other bodily functions. α-Klotho has been involved in the aging process and acts as an endocrine factor involved in the regulation of various metabolic processes in humans. However, the relationship between α-Klotho and thyroid profile has not been uniformly recognize.ObjectiveTo determine the relationship between α-Klotho and thyroid profile in adult individuals.MethodsPopulation data of 4614 adult individuals were obtained from the NHANES database during the period of 2007–2012. Weighted multivariable regression analysis was performed using a general linear model with serum α-Klotho as the independent variable and thyroid profile as the dependent variables, respectively. The generalized additive model was used for smoothing curve fitting and threshold effect analysis.Resultsα-Klotho was associated with a slightly higher FT3, TT3 and TT4 level in unadjusted and adjusted regression models. However, a higher α-Klotho level was associated with a lower TSH level. After α-Klotho was grouped as quantiles with reference (Q1), α-Klotho still showed a statistically significant positive correlation with FT3 and TT3 levels in Q2, Q3 and Q4. In addition, α-Klotho was positively corrected with TT4, but negatively associated with TSH in Q4.ConclusionsSerum soluble α-Klotho was positively associated with FT3, TT3 and TT4, but negatively correlated with TSH. The significant effect of α-Klotho on thyroid profile suggests its potential as a predictive marker of thyroid functions, indicating its possible involvement in the regulation of thyroid hormone secretion.

Cytomorphological Profile of Graves' Disease and its Co-relation with anti-TPO Antibody

Objective: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland. FNAC plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost and with a diagnostic accuracy rate of 92%. This study was designed to cytomorphological profile of Graves’ disease and its co relation with anti TPO antibody. Materials and Methods: This is a prospective analytical study of fifty patients with clinically enlarged thyroid gland presenting at STG Hospital, Haldwani, Nainital during Oct 2019 to Oct 2022. FNAC smears of these patients were studied and correlated with cytomorphological findings of different types, grades of thyroiditis and hormone level of T4, T3 and T.S.H. Results: Females were mostly affected by thyroid diseases than males. Female patients were 39 (78%) and male patients were 11 (22%). In the present study, patients were in the age group of 13 to 74 years of age. High T3 levels were noted in 80% high T4 levels were found in 90%. Low TSH level was found in only 64%, normal TSH level found in 34% and 2% presented with high TSH level. 34 patients (68%) found high anti-thyroid peroxidase antibody titre >34 U/ml. Cytomorphology revealed moderate to high cellularity in 88% cases, mild to moderate nuclear atypia in 86% and presence of marginal vacuoles in 82%. Lymphocytic infiltrate found in 24% cases and epithelioid cell granuloma in 14% cases. Conclusion: Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. We recommend further studies with a larger population to validate our study. Keywords: Thyroiditis, Graves' Disease, Malignancy Goiter, Histopathology

IJCM_145A: A Clinico-Epidemiological Profile of Patients with Thyroid Disorders Admitted to Tertiary Care Hospitals in Mangalore

Background: Thyroid ailments are frequently encountered endocrine disorders next to diabetes. They arise either due to functional aberrations of the thyroid gland resulting in over or under secretion of thyroid hormone or due to structural anomalies. People have varied constitutional, non-specific manifestations that cause abnormal metabolic functioning of the thyroid gland. Objectives: 1. To describe the socio-demographic characteristics of patients with thyroid disorders. 2. To analyze the clinical features, laboratory findings, and clinical outcomes of these patients. Methodology: This hospital-based descriptive study was conducted at the Government Wenlock Hospital in Mangalore. The study included patients admitted with thyroid disorders in the last 2 years. Data extraction sheet was developed from patient medical records. The sheet comprised three sections: socio-demographic information, clinical features at admission, and investigations and outcomes. Results: Most of the patients (52.8%) belonged to the 20-40 age group, followed by 30.5% in the 40-60 age group. Females comprised 81.5% of the study population, males -18.5%. 74.8% had swelling, 3.2% had facial puffiness. 1.8% had weight gain, only 1.2% had weight loss .16.3% had other comorbid conditions. 31.5% had low TSH levels 49.3% had normal TSH levels, 64.5 % - normal T3 levels, 63.2% - normal T4 levels. Anaemia was reported in 15.2% o, while 7.2% developed oedema. 34.2% had multinodular goitre, 20.2% - hypothyroidism 9.5 % - hyperthyroidism and 11.1% - malignancy. Out of the total 97% recovered 1% died 1% had discharge against medical advice and 1 % got discharged on request. Conclusion: Majority were females in the 20-40 age group. Majority of them had swelling followed by facial puffiness. Most of them had normal TSH, T3 and T4 levels, anaemia and oedema was also reported in few. Majority had multinodular goitre followed by hypothyroidism, malignancy, and hyperthyroidism. Majority had recovered.

(O-05) ESTRADIOL LEVELS IN MEXICAN MEN WITH ERECTILE DYSFUNCTION

Abstract Introduction and Objective Erectile dysfunction is associated with various psychological and physiological causes, including hormone levels such as testosterone. The role of estradiol in male sexual function is controversial, and studies reporting its impact on erectile function have been inconsistent. The aim of this study was to describe the levels of testosterone and estradiol in Mexican men with erectile dysfunction, based on the severity of dysfunction. Materials and Methods Hormonal levels of TSH, T3, T4, LH, FSH, total and free testosterone, and estradiol were measured in men over 18 years of age with erectile dysfunction, attending a clinic in Mexico. Clinical variables were analyzed, estimating measures of central tendency and dispersion for numerical variables, and absolute and relative frequencies for categorical variables. The proportion of men with abnormal levels of estradiol and testosterone was calculated based on the severity of erectile dysfunction. Results A total of 70 participants were included. The average age was 53.9 years old (+/- 11.8); 18.5% had severe dysfunction, 65.7% had moderate dysfunction, 14.2% had mild to moderate dysfunction, and 1.4% had mild dysfunction. 35.7% were diabetic, and 34.2% were hypertensive. 62.8% had abnormal levels in at least one of the evaluated hormones: 5.7% had low TSH levels; 2.8% had low T3 levels; 1.4% had low T4 levels; 5.7% had low and 7.1% had high total testosterone levels; 12.8% had low and 2.8% had high free testosterone levels; 17.1% had high prolactin levels; 1.4% had low and 10% had high LH levels; 5.7% had high FSH levels. Estradiol level was high in 6 men (8.5%), 1 had mild-moderate and 5 moderate dysfunction; 8 men had low estradiol levels (11.42%), 1 had mild-moderate, 4 moderate and 3 severe dysfunction. Conclusions Alteration on the levels of Estradiol was common in the analyzed group of patients with erectile dysfunction, especially in men with moderate dysfunction, observed in 12.8% of them. Financing Boston Medical Group.

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.

Multi-trait analysis characterizes the genetics of thyroid function and identifies causal associations with clinical implications

To date only a fraction of the genetic footprint of thyroid function has been clarified. We report a genome-wide association study meta-analysis of thyroid function in up to 271,040 individuals of European ancestry, including reference range thyrotropin (TSH), free thyroxine (FT4), free and total triiodothyronine (T3), proxies for metabolism (T3/FT4 ratio) as well as dichotomized high and low TSH levels. We revealed 259 independent significant associations for TSH (61% novel), 85 for FT4 (67% novel), and 62 novel signals for the T3 related traits. The loci explained 14.1%, 6.0%, 9.5% and 1.1% of the total variation in TSH, FT4, total T3 and free T3 concentrations, respectively. Genetic correlations indicate that TSH associated loci reflect the thyroid function determined by free T3, whereas the FT4 associations represent the thyroid hormone metabolism. Polygenic risk score and Mendelian randomization analyses showed the effects of genetically determined variation in thyroid function on various clinical outcomes, including cardiovascular risk factors and diseases, autoimmune diseases, and cancer. In conclusion, our results improve the understanding of thyroid hormone physiology and highlight the pleiotropic effects of thyroid function on various diseases.

From Molar Pregnancy, Thyrotoxicosis, to Pulmonary Hypertension: A Case Report

Background: Molar pregnancy is a benign condition with the dominant symptom being dark brown to bright red bleeding from the vagina. This disease can induce hyperthyroidism and result in pulmonary hypertension. This case report describes a patient who had molar pregnancy with thyrotoxicosis and pulmonary hypertension.Case: A 30-year-old woman presented with complaints of lower abdominal pain for the last month. The patient feels that her stomach has enlarged in the last 3 months. Other complaints include bleeding and observed bubbles from the birth canal, shortness of breath, and chest pain. The serum cobas β-hCG level of 7954.00 mIU/mL. On abdominal ultrasound examination, vesicles formed a honeycomb appearance, measuring 7.4 cm×5.3 cm. Hematologic laboratory tests revealed low TSH levels (<0.01 μIU/mL), T3 levels of 2.35 ng/ml, and FT4 levels of 2.62 ng/dL. The results of the echocardiography examination showed there is a high probability of pulmonary hypertension.Conclusion: Molar pregnancy can exacerbate thyrotoxicosis through hCG activity. Smoking and breastfeeding also have similar effects. Consequently, increased thyroid hormone levels can worsen or cause pulmonary hypertension.

From Molar Pregnancy, Thyrotoxicosis, to Pulmonary Hypertension: A Case Report

Background: Molar pregnancy is a benign condition with the dominant symptom being dark brown to bright red bleeding from the vagina. This disease can induce hyperthyroidism and result in pulmonary hypertension. This case report describes a patient who had molar pregnancy with thyrotoxicosis and pulmonary hypertension.Case: A 30-year-old woman presented with complaints of lower abdominal pain for the last month. The patient feels that her stomach has enlarged in the last 3 months. Other complaints include bleeding and observed bubbles from the birth canal, shortness of breath, and chest pain. The serum cobas β-hCG level of 7954.00 mIU/mL. On abdominal ultrasound examination, vesicles formed a honeycomb appearance, measuring 7.4 cm×5.3 cm. Hematologic laboratory tests revealed low TSH levels (<0.01 μIU/mL), T3 levels of 2.35 ng/ml, and FT4 levels of 2.62 ng/dL. The results of the echocardiography examination showed there is a high probability of pulmonary hypertension.Conclusion: Molar pregnancy can exacerbate thyrotoxicosis through hCG activity. Smoking and breastfeeding also have similar effects. Consequently, increased thyroid hormone levels can worsen or cause pulmonary hypertension.

Anthropometric, Metabolic, and Endocrine Parameters as Predictors of Estimated Average Glucose and Other Biomarkers of Dysglycemia in Women with Different Phenotypes of Polycystic Ovary Syndrome.

The aim of the study was to evaluate the efficacy of anthropometric, metabolic, and endocrine abnormalities as predictors of estimated average glucose and other biomarkers of dysglycemia in women with different phenotypes of polycystic ovary syndrome (PCOS). This cross-sectional study included 648 women with PCOS and 330 controls. A single protocol of investigation was applied for all subjects. PCOS women were divided by phenotypes according to the Rotterdam criteria. Biomarkers of dysglycemia were considered dependent variables and anthropometric, lipid, and hormone alterations as independent variables using univariate and multivariate logistic regressions. Univariate logistic regression analysis, controlled for age and BMI, showed that many biomarkers of dysglycemia could be predicted by anthropometric, lipid, and endocrine variables. Multivariate logistic models showed that in non-PCOS women estimated average glucose (eAG) was predicted by lower TSH levels (OR=0.39; p=0.045); fasting glucose was predicted by increased T (OR=2.3). For PCOS, phenotype A, eAG was predicted by decreased HDL-C (OR=0.17, p=0.023) and high levels of free estradiol (OR=7.1, p<0.001). Otherwise, in PCOS, phenotype D, eAG was predicted by higher levels of HDL-C. The current study demonstrated that eAG was poorly predicted by anthropometric, lipid, and hormone parameters. Nevertheless, without adding significant benefits, it was comparable with other established markers of dysglycemia in women with different PCOS phenotypes.

Impact of Thyroid Status on Incident Kidney Dysfunction and Chronic Kidney Disease Progression in a Nationally Representative Cohort

ObjectiveTo examine the relationship between thyroid status and incident kidney dysfunction/chronic kidney disease (CKD) progression. Patients and MethodsWe examined incident thyroid status, ascertained by serum thyrotropin (TSH) levels measured from January 1, 2007, through December 31, 2018, among 4,152,830 patients from the Optum Labs Data Warehouse, containing deidentified retrospective administrative claims data from a large national health insurance plan and electronic health record data from a nationwide network of provider groups. Associations of thyroid status, categorized as hypothyroidism, euthyroidism, or hyperthyroidism (TSH levels >5.0, 0.5-5.0, and <0.5 mIU/L, respectively), with the composite end point of incident kidney dysfunction in patients without baseline kidney dysfunction and CKD progression in those with baseline CKD were examined using Cox models. ResultsPatients with hypothyroidism and hyperthyroidism had higher risk of incident kidney dysfunction/CKD progression in expanded case-mix analyses (reference: euthyroidism): adjusted hazard ratios (aHRs) (95% CIs) were 1.37 (1.34 to 1.40) and 1.42 (1.39 to 1.45), respectively. Incrementally higher TSH levels in the upper reference range and TSH ranges for subclinical, mild overt, and overt hypothyroidism (≥3.0-5.0, >5.0-10.0, >10.0-20.0, and >20.0 mIU/L, respectively) were associated with increasingly higher risk of the composite end point (reference: TSH level, 0.5 to <3.0 mIU/L): aHRs (95% CIs) were 1.10 (1.09 to 1.11), 1.37 (1.34 to 1.40), 1.70 (1.59 to 1.83), and 1.70 (1.50 to 1.93), respectively. Incrementally lower TSH levels in the subclinical (<0.5 mIU/L) and overt (<0.1 mIU/L) hyperthyroid ranges were also associated with the composite end point: aHRs (95% CIs) were 1.44 (1.41 to 1.47) and 1.48 (1.39 to 1.59), respectively. ConclusionIn a national cohort, TSH levels in the upper reference range or higher (≥3.0 mIU/L) and below the reference range (<0.5 mIU/L) were associated with incident kidney dysfunction/CKD progression.

Endogenous and Exogenous Thyrotoxicosis and Risk of Incident Cognitive Disorders in Older Adults

Thyroid hormone is among the most common prescriptions in the US and up to 20% may be overtreated. Endogenous hyperthyroidism may be a risk factor for dementia, but data are limited for iatrogenic thyrotoxicosis. To determine whether thyrotoxicosis, both endogenous and exogenous, is associated with increased risk of cognitive disorders. This cohort study performed a longitudinal time-varying analysis of electronic health records for patients receiving primary care in the Johns Hopkins Community Physicians Network between January 1, 2014, and May 6, 2023. Patients 65 years and older with at least 2 visits 30 days apart to their primary care physicians were eligible. None of the 65 931 included patients had a history of low thyrotropin (TSH) level or cognitive disorder diagnoses within 6 months of their first visit. Data analysis was performed from January 1 through August 5, 2023. The exposure variable was a low TSH level, characterized based on the clinical context as due to endogenous thyrotoxicosis, exogenous thyrotoxicosis, or unknown cause, excluding those attributable to acute illness or other medical factors such as medications. The outcome measure was cognitive disorders, including mild cognitive impairment and all-cause dementia, to improve sensitivity and account for the underdiagnosis of dementia in primary care. A total of 65 931 patients were included in the analysis (median [IQR] age at first visit, 68.0 [65.0-74.0] years; 37 208 [56%] were female; 46 106 [69.9%] were White). Patients exposed to thyrotoxicosis had cognitive disorder incidence of 11.0% (95% CI, 8.4%-14.2%) by age 75 years vs 6.4% (95% CI, 6.0%-6.8%) for those not exposed. After adjustment, all-cause thyrotoxicosis was significantly associated with risk of cognitive disorder diagnosis (adjusted hazard ratio, 1.39; 95% CI, 1.18-1.64; P < .001) across age groups. When stratified by cause and severity, exogenous thyrotoxicosis remained a significant risk factor (adjusted hazard ratio, 1.34; 95% CI, 1.10-1.63; P = .003) with point estimates suggestive of a dose response. In this cohort study among patients 65 years and older, a low TSH level from either endogenous or exogenous thyrotoxicosis was associated with higher risk of incident cognitive disorder. Iatrogenic thyrotoxicosis is a common result of thyroid hormone therapy. With thyroid hormone among the most common prescriptions in the US, understanding the negative effects of overtreatment is critical to help guide prescribing practice.

The Cross-sectional and Longitudinal Association Between Thyroid Function and Depression: A Population-Based Study.

An association of thyroid function with mood disorders has been widely suggested, but very few studies have examined this association longitudinally. We assessed the cross-sectional and longitudinal association between thyroid function and depression in a population-based cohort. A total of 9471 individuals were included in cross-sectional analyses, of whom 8366 had longitudinal data. At baseline, we assessed thyroid function using serum samples (thyrotropin [TSH], free thyroxine (FT4), and thyroid peroxidase antibodies) and depressive symptoms using the Centre for Epidemiologic Studies Depression (CES-D) scale. Incident depressive events (n = 1366) were continuously followed up with the CES-D and clinical interviews. We analyzed the cross-sectional association of thyroid function and thyroid disease with depressive symptoms using linear and logistic regression, and the longitudinal association with Cox proportional hazard models for depressive events. Lower TSH levels and lower and higher FT4 levels were cross-sectionally associated with more depressive symptoms with a B value of -0.07 per 1 unit increase of natural log-transformed TSH (95% CI -0.11; -0.04). Furthermore, hypothyroidism was cross-sectionally associated with less depressive symptoms and hyperthyroidism with more depressive symptoms. Longitudinally, there was a U-shaped association between FT4 and incident depressive events but only in euthyroid participants. We show a cross-sectional association between thyroid (dys)function with depressive symptoms, and a U-shaped association between FT4 and incident depressive events in euthyroid individuals. Our findings suggest an association of thyroid function with the risk of developing depression, albeit small. Reverse causation and additional underlying factors may also contribute to the association.