Mean FT4 Research Articles

Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy.

Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Serum samples were collected from 124pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early.

Effectiveness of Bariatric Surgery for Improving Thyroid Function and Reducing Levothyroxine Dose in Patients With Obesity and Overt Hypothyroidism.

Hypothyroidism is a major hormonal condition that affects more women than men in Saudi Arabia. Studies indicate a bidirectional link between hypothyroidism and obesity, which may improve following bariatric surgery (BS). The focus of this research is to assess how hypothyroidism patients' thyroid function and levothyroxine dosage are impacted by bariatric surgery. This was an observational retrospective study conducted in two centres at Taif, Saudi Arabia. All morbidly obese patients who were diagnosed with overt hypothyroidism and underwent laparoscopic sleeve gastrectomy from January 2016 to December 2021 were included. The changes in the thyroid profile and the changes in the doses or cessation of levothyroxine were evaluated after the laparoscopic sleeve gastrectomy. Our results demonstrate that a total of 70 patients dominated by women out of 1202 from both centers who meet our inclusion criteria showeda statistically significant decrease on comparison of clinical parameters (thyroid-stimulating hormone [TSH], free T4 [FT4], free T3 [FT3], levothyroxine [L-T4]) before and after BS. The average TSH levels were determined to be 4.45 ± 4.41 mIU/L prior to BS, and they significantly decreased (3.17 ± 2.77 mIU/L) following BS (p=0.009). When compared to before BS (13.17 ± 2.73 pmol/L), the mean FT4 levels after BS (11.63 ± 5.88 pmol/L) exhibited a significant decline (p=0.046). The mean FT3 levels before and after BS also were statistically significantly lower (1.94 ± 2.12 pg/mL) than before (2.75 ± 1.96 pg/mL), p=0.009. The mean L-T4 levels after BS considerably decreased from before BS (98.68 ± 56.18 mcg) to after BS (79.39 ± 41.49 mcg), p=0.046. Better thyroid profiles and lower levothyroxine dosage show that bariatric surgery improves hypothyroidism.

Thyroid hormone profile in preeclampsia patients: a case control study

Objective: Preeclamptic women are reported to have a higher incidence of thyroid dysfunction that correlates with the severity of preeclampsia. The aim of this study was to assess thyroid hormone profiles in in pregnant women with preeclampsia and gestational hypertension and the risk for thyroid dysfunction. Methods: In this study, age-matched pregnant females in the second trimester of pregnancy, diagnosed with preeclampsia (PE), gestational hypertension (GH), as cases, and apparently healthy normotensive (NT) pregnant woman as controls were recruited. Blood samples were drawn for the assessment of thyroid hormone (TSH, FT3 and FT4) levels and thyroid dysfunction. Results: Out of the total of 133 pregnant women recruited for this study, sub-clinical hypothyroidism was the only thyroid dysfunction common to all study groups, with a prevalence of 3.3% in both PE and NT groups, and 4.3% in the GH group. 1% of women in the PE group had sub-clinical hyperthyroidism, compared to 3.3% in the NT group. Although TSH and FT3 were elevated in normotensives, mean differences between the three groups were not statistically significant. However, mean FT4 levels in the GH group (12.99 ± 1.24) and PE group (12.33 ± 2.26), when compared to the control group (11.55 ± 1.94), were significantly higher (p < 0.05). Conclusion: Undiagnosed subclinical hypothyroidism was found in all the categories of pregnant women studied, which if uncontrolled, could increase the risk of pregnancy-related complications, especially in pregnant women with preeclampsia and gestational hypertension.

Effect of Antiretroviral Therapy to Thyroid Function Status on New Stage 1 and 2 Human Immunodeficiency Virus Patient

Background: Thyroid hormone is very important in regulating energy metabolism in all tissues of the human body. Thyroid dysfunction plays an important role in osteoporosis, hyperlipidemia and cardiovascular disease, all of which are associated with Human Immunodeficiency Virus (HIV) infection or therapy for HIV. Medications used to treat HIV infection are also said to be important factors that can cause thyroid abnormalities. This study aim is to see the effect of giving Antiretroviral Therapy (ART) to the thyroid function of new HIV patients in stage 1 and 2.&#x0D; Method: This prospective cohort study was conducted at Medan city health center and Medan Haji Adam Malik Hospital in March-June 2019. HIV patients who met the inclusion criteria were tested for thyroid function (Ft4 and TSH) before and after 3 months on ART, BMI, routine blood, CD4 and quality of life using the SF-36 questionnaire. Data analysis used paired t test and Pearson correlation.&#x0D; Result: 34 patients with stage 1 and 2 HIV showed normal thyroid function ; the average FT4 level was 1.03 ± 0.14 ng / dl and the average TSH level was 1.44 ± 0.68 µIU / mL. After 3 months of antiretroviral therapy, the mean thyroid function changes were obtained from the study subjects, where the mean FT4 results were 0.87 ± 0.13 ng / dl and the average TSH results were 1.76 ± 0.91 µIU / mL and the results were statistically significant with p 0.006 (p &lt;0.05). There was a statistically significant relationship between TSH and CD4 levels with BMI after ART administration (p &lt;0.05), but no statistically significant relationship was found between FT4 and BMI (p = 0.957). No statistically significant relationship was found between CD4 levels in study subjects and changes in fT4 levels (p = 0.557, r = 0.104) and TSH (p = 0.267, r = 0.196). There was also no significant difference in the quality of life of study subjects as seen from the SF-36 questionnaire both from changes in thyroid function and from CD4 levels.&#x0D; Conclusion: Stage 1 and 2 HIV patients who are on ART for 3 months experienced thyroid dysfunction.

Long Term Post-Treatment Follow-Up of Pituitary Tumours

Aim: To study the spectrum of Pituitary tumours, their presentation, treatment and compliance with follow-up. Study design: Mixed retrospective and prospective study Place and duration of study: Medicell Institute of Diabetes, Endocrinology and Metabolism and Jinnah Postgraduate Medical Centre Karachi from 1st January 2012 to 31st July 2022. Methodology: One hundred and seventy three cases of pituitary tumours, were enrolled. Data regarding age, gender, duration of disease, symptoms, mode of treatment administered and compliance with the follow-up instructions was retrieved. Results: The mean age was 36.4±10.6 years. Female predominance was seen in 97(56.1%). Of the 136 married patients, subfertility was seen in 48(36.3%). Headache was observed in 164(94.8%) of patients. Prolactinoma was the lead tumour comprising of 76 cases (43.9%), followed by non-secretory tumours 47(27.2%), and acromegaly 43(24.9%). Other rare disorders including Cushing’s disease, craniopharyngioma and gonadotropinoma were also seen. Cabergoline was prescribed in 136 (78.6%) cases. Transsphenoidal surgery (TSS) was done in 74(42.8%) of patients. Out of 97 female patients, 38(39.2%) had persistent amenorrhea post-treatment, while this data was not available for 40(41.2%) of these women, who were lost to follow-up. The difference between mean prolactin levels prior and after the treatment (1390.048±2646.986 versus 116.360±163.369) were found to be statistically significant p&lt;0.001). Similarly, IGF-1 levels were significantly improved post treatment indicating tumour stability. Moreover, the level of mean FT4 post-treatment was 1.64, reflecting adequate replacement. Conclusion: Majority of the patients had improvement post-treatment in pituitary tumour symptoms including vision, headache and sexual function. Failure to attend for follow-up for tumour stability, control of excess hormone, and pituitary hormone replacement was seen in a large number of patients in this study. This requires careful consideration of different strategies to ensure better long term care in pituitary tumours. Keywords: Pituitary tumor, Prolactinoma, Craniopharyngioma, Gonadotropinoma, Acromegaly

Cardiothyreosis: Epidemiological, clinical and therapeutic approach.

Cardiothyreosis corresponds to the cellular effects of free thyroid hormones on the vascular wall and the myocardium. We aim to describe the clinical, para-clinical and therapeutic aspects of cardiothyreosis and to detail prognostic factors. We conducted a descriptive retrospective study at the Endocrinology-Diabetology Department of the Hedi Chaker University Hospital in Sfax-Tunisia. We collected medical records of 100 patients with cardiothyreosis between January 1999 and December 2019. We included patients with cardiothyreosis who underwent adequate cardiac evaluation. We excluded patients with cardiac abnormalities related to conditions other than hyperthyroidism, patients who died and patients without cardiothyreosis. We included 100 adult patients (43 men and 57 women). The mean age was 49.3 ±12.9 years (20-79 years). The diagnosis of cardiothyreosis was concomitant with that of hyperthyroidism in 72% of cases. Weight loss and palpitations were the two most frequently reported signs in 91% of cases each. Hypertension was systolic in 15 patients. The average heart rate was 103.1 beats/min (52-182 bpm). The mean TSH and FT4 levels were 0.042 μIU/ml and 59.6 pmol/l, respectively. Rhythm disorders and heart failure were the most common cardiac complications with 81 and 56 cases, respectively. Cardiac ultrasound showed dilatation of the left atrium in 28.3% of patients. Pulmonary arterial hypertension was present in 43% of cases. 57 patients had been treated with benzylthiouracil at a mean dose of 157.45 mg/day. Radical treatment with radioactive iodine was indicated in 81 patients. The evolution of cardiothyreosis was favourable in 58 patients. Cardiothyreosis is a serious complication of hyperthyroidism. Future prospective studies will be of great help to better characterise and manage cardiothyreosis.

Is there an association between endometriosis and thyroid autoimmunity?

It has been suggested that non-uterine endometrial implants can express thyroid-stimulating hormone receptors, thus inducing the formation of thyroid-stimulating immunoglobulin. We aimed to compare the autoantibody positivity in patients with and without endometriosis and to determine whether there is a difference in the incidence of thyroid diseases. This prospective observational study was conducted on 102 women who had been operated on for benign gynecological diseases. Cases enrolling in the study were divided into two groups: the study group with endometriosis (n=51) and the control group without endometriosis (n=51). The blood tests for thyroid-stimulating hormone, free thyroxine (fT4), thyroid-stimulating immunoglobulin, and anti-thyroid peroxidase antibody levels were checked. The mean thyroid-stimulating immunoglobulin level was found to be higher in the endometriosis group than in the control group. However, this difference was not statistically significant. No significant difference was detected between endometriosis and control groups in terms of anti-thyroid peroxidase antibody and thyroid-stimulating hormone levels. The mean fT4 value (0.97±0.13 ng/dL) of the endometriosis patients was found to be significantly lower than the control group (1.08±0.21 ng/dL) (p=0.002; p<0.05). The mean anti-thyroid peroxidase antibody value of cases with bilateral endometrioma (82.21±252.29 IU/mL) was significantly higher than cases with unilateral endometrioma (15.81±83.13 IU/mL) (p=0.028; p<0.05). There is a positive and significant relationship between the size of endometriosis and anti-thyroid peroxidase antibody values (p=0.011; p<0.05). This study points to an association between endometrioma diameter and anti-thyroid peroxidase antibody values which can be a stepping stone for new studies evaluating this hypothesis further.

Differences in the clinical picture at the onset of diagnosis of severe autoimmune hypothyroidism in children depending on the time of diagnosis: before or during the SARS-CoV-2 pandemic.

There are few data about effects of COVID-19 on thyroid disease presentation in children, due to difficulties in healthcare services access. To assess the differences in hypothyroidism presentation before and during the COVID-19 pandemic. All paediatric patients with autoimmune hypothyroidism (AIT) diagnosed from January 2017 to December 2022 were analysed. A total of 150 subjects were enrolled (94 in before and 56 during the pandemic period). Severe AIT was detected in 7.4% before and 12.5% during the pandemic. Age at the onset in the pre-pandemic period was lower ( p = 0.04). Diagnosis delay (time elapsed from onset of symptoms and diagnosis) was significantly different between the before and during the pandemic groups ( p = 0.02). In the pre-pandemic period the TSH value was 447.7 ±59.1, and it was 713.7 ±104.4 mUI/l during the pandemic ( p = 0.04), whereas mean fT4 values were 2.66 ±0.34 and 0.58 ±0.08 ng/l, respectively ( p = 0.0002). Significantly greater thyroid volume and bone age delay SDS were observed during the pandemic ( p = 0.04). Neurological symptoms were mostly observed during the pandemic, especially slow speech and impaired school performance. A higher rate of severe AIT was observed during the pandemic period, mostly related to difficulties in access to healthcare services. The diagnosis delay led to a more severe biochemical thyroid hormone profile, goitre, and more frequent presence of bone age delay and neurological symptoms at the onset. Recognizing hypothyroidism and recalling symptoms in child-hood, even if often non-specific, is fundamental for avoiding diagnosis delay.

Levothyroxine malabsorption or pseudomalabsorption? A question in the management of refractory hypothyroidism.

The levothyroxine absorption test (LT4AT) is an important tool for distinguishing hypothyroidism due to malabsorption from 'pseudomalabsorption' conditions. Our aim was to review our institution's LT4AT results and assess its role in the management of patients with refractory hypothyroidism. We performed a retrospective study of all patients evaluated for refractory hypothyroidism who underwent LT4AT in our tertiary center between 2014 and 2020. Its results and the impact on thyroid function management during follow-up were assessed. Ten female patients were included with a mean age of 40 years (min-max: 26-62). Mean weight was 72 kg (min-max: 43-88) and baseline LT4 dosage ranged from 2.5 to 5.3 µg/kg/day. The most common causes of hypothyroidism were postsurgical in 50% (n = 5) and autoimmune in 20% (n = 2). During LT4AT, normal LT4 absorption was found in all but one individual (mean FT4 increase of 231%, min-max: 85-668). The only patient with objective LT4 absorption impairment (maximal increase of 48% by hour 5) presented also Helicobacter pylori gastritis and prior history of 'intestinal surgery' during childhood. No adverse events were reported during any of the LT4ATs. During follow-up (median 11.5 months (IQR 23)), three patients obtained euthyroidism and six had improved their hypothyroidism state. The LT4AT is an effective and safe way to assess refractory hypothyroidism and provides valuable information to distinguish LT4 malabsorption from 'pseudomalabsorption'. Our data suggest that most patients with suspicious LT4 malabsorption perform normally during LT4AT. This test provides relevant information for better management of patients with refractory hypothyroidism.

Association of COVID-19 vaccination before conception with maternal thyroid function during early pregnancy: A single-center study in China.

Despite the high vaccination coverage, potential COVID-19 vaccine-induced adverse effects, especially in pregnant women, have not been fully characterized. We examined the association between COVID-19 vaccination before conception and maternal thyroid function during early pregnancy. We conducted a retrospective cohort study in Shanghai, China. A total of 6979 pregnant women were included. Vaccine administration was obtained from electronic vaccination records. Serum levels of thyroid hormone were measured by fluorescence and chemiluminescence immunoassays. Among the 6979 included pregnant women, 3470 (49.7%) received at least two doses of an inactivated vaccine. COVID-19 vaccination had a statistically significant association with both maternal serum levels of free thyroxine (FT4) and thyroid stimulating hormone (TSH). Compared with unvaccinated pregnant women, the mean FT4 levels were lower in pregnant women who had been vaccinated within 3 months before the date of conception by 0.27 pmol/L (β = -0.27, 95% confidence interval [CI], -0.42, -0.12), and the mean TSH levels were higher by 0.08 mIU/L (β = 0.08, 95% CI, 0.00, 0.15). However, when the interval from vaccination to conception was prolonged to more than 3 months, COVID-19 vaccination was not associated with serum FT4 or TSH levels. Moreover, we found that COVID-19 vaccination did not significantly associate with maternal hypothyroidism. Our study suggested that vaccination with inactivated COVID-19 vaccines before conception might result in a small change in maternal thyroid function, but this did not reach clinically significant levels.

EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Objective: Euthyroid sick syndrome (ESS) manifests by the decreased level of serum free thyroid hormones and with the normal or decreased secretion of thyroid-stimulating hormone. The study aims to identify the prevalence of ESS in elderly patients with sepsis and evaluate its possible effect on prognosis and mortality. Material and Methods: Two hundred and three patients diagnosed with sepsis were prospectively evaluated. They were divided into two groups, a geriatric group (≥65 years), and a control group (&lt;65 years). Patients with low free T3 (fT3) and/or free T4 (fT4) were considered to have euthyroid-sick syndrome. The demographic characteristics, comorbidities, laboratory results, hospitalization data, intensive care unit (ICU) duration, treatment outcomes, and mortality rates of the patients were recorded and compared. Results: The incidence of ESS was significantly higher in the geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference between the groups in regard to mortality rate and ICU stay. However, 91.3% of deceased patients in the entire group and all deceased patients in the geriatric group were ESS (+) patients. The mean fT3 was significantly decreased in the deceased patients, and ICU patients (p=0.017). Additionally, the decreased levels of fT4 in both the entire group and the geriatric group were significantly associated with mortality and ICU stay (p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly patients with sepsis was clearly demonstrated. Additionally, approximately two-fold higher mortality and ICU stay risk was documented in the ESS (+) group. Thus, simply screening of ESS in septic elderly patients will certainly contribute to treatment decisions and early prediction of complicated clinical course and poor prognosis.

Subclinical hypothyroidism among infertile women at a tertiary hospital in South-West Nigeria

Overt thyroid dysfunction is an accepted cause of female infertility. Its milder form, subclinical hypothyroidism have also been implicated as a contributing factor to disturbed reproductive function. To determine the contribution of subclinical hypothyroidism (SCH) to the burden of infertility. This is a cross sectional, comparative study of One hundred and twenty women with primary or secondaryinfertility who presented for evaluation at gynaecological clinic and controls which are clients that came to access Family planning services. The prevalence of infertility among gynaecological patients seen in the clinic was 38.8% (192/495). The prevalence of SCH among the studied infertile women was 11.7% (7/60) compared with 3.3% (2/60) of the control group (p=0.222). The commonest type of infertility was secondary, 76.7% (46/60). All thestudied infertile women with SCH presented with secondary infertility. There was an observed statistically significant difference in the mean serum TSH (3.19±4.38mIU /L vs 1.60±1.22mIU /L) and FT3, FT4 (0.29±0.074ng/dl vs 0.95±0.16ng/dl and 0.33±0.071ng/dl vs 1.09±0.19ng/dl respectively). Subclinical hypothyroidism was found to be higher among infertile women but this finding was not statistically significant, therefore, the routine screening for SCH among infertile women might be unnecessary.

Subacute Thyroiditis—Still a Diagnostic Challenge: Data from an Observational Study

Background: Subacute thyroiditis (SAT) is a relatively common cause of thyroid disease. However, only a few studies evaluating SAT have been published in recent years with varying diagnostic criteria. We evaluate the clinical presentation and long-term outcome of isotope scan-confirmed SAT. Methods: A retrospective study of 38 patients with isotope scan-confirmed SAT was performed at a single isotope department. All patients were contacted for long-term follow-up. Results: The female/male ratio was 1.4:1, and mean age was 47 ± 14 years and 62 ± 12 years in women and men, respectively (p = 0.002). Almost half of the cases (42%) occurred during the summer. The most common symptoms were neck pain (74%) and weakness (61%). Palpitations, weight loss, heat intolerance, and sweating appeared in 50%, 42%, 21%, and 21%, respectively. Only half of the patients reported fever. TSH level was low in all patients, and mean FT4 and FT3 level were about twice the upper limit of normal range. Elevated CRP and ESR occurred in the majority (88%) of patients. The mean time period between the first clinic visit and performing thyroid function tests was 8 ± 7 days. One-third of the patients initially received a diagnosis of upper respiratory tract infection (URI). NSAIDs and steroids were prescribed to 47% and 8% of patients, respectively. Long-term follow-up of 33.5 months (range 9–52) revealed that 25% remained with subclinical or overt hypothyroidism. Conclusions: These data demonstrate that although SAT is a common entity, there is still a significant delay in diagnosis, and in a third of our patients, the initial diagnosis was URI, with 25% developing long-term hypothyroidism.

Thyroid Hormones and Health-Related Quality of Life in Normal Pressure Hydrocephalus Patients before and after the Ventriculoperitoneal Shunt Surgery: A Longitudinal Study.

Objective: The aim of this study was to explore the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), and to correlate the hormone levels among iNPH patients with their self-reported quality of life before and three months after the surgery. Methods: Twenty-five patients (52% women), mean age 63.5 (SD 9.5) years, were operated on by inserting a VP shunt. Patients with FT3 level ≤3.34 pmol/L were diagnosed as having low T3 syndrome. Results: The changes in thyroid hormones resulted in a U-shaped curve throughout the follow-up period. The significant changes occurred the next day after the surgery, including a decrease in TSH, FT3, and an increase in FT4. Additionally, the decrease occurred in mean FT3 for six patients with preoperative low T3 syndrome. Three months after the surgery, thyroid hormones were restored to their baseline and/or normal values. All six patients with preoperative low T3 syndrome had significant improvement in all SF-36 subscales (except for the role emotional and physical). Patients with preoperative normal high FT3 and low FT4 had increased FT3/FT4 ratio which was associated with deterioration in all SF-36 subscales 3 months after the surgery. Conclusion: Routine assessment of the FT3/FT4 ratio might be a simple and effective tool for the risk stratification of iNPH patients before VP shunt surgery.

Association of free thyroxine with obstructive lung pattern in euthyroid middle-aged subjects: A population-based study.

BackgroundThe association between thyroid hormone levels and pulmonary function in euthyroid population is still unclear. We aimed to examine the relationship between thyroid function and lung function in a large cohort study of euthyroid subjects.MethodsWe analyzed biochemical and spirometry data from a nationwide, population-based, cross-sectional survey (KNHANES VI). A total of 1,261 middle-aged participants aged 45–65 years with spirometry tests and normal thyroid function were included in this study. The subjects were grouped according to free thyroxine (fT4) (ng/dL) quartiles (Q1, 0.89–1.09; Q2, 1.10–1.19; Q3, 1.20–1.30; Q4, 1.31–1.76). Obstructive lung pattern was defined as forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.7. The probability of obstructive lung patterns according to fT4 quartiles was assessed using logistic regression models, adjusted for potential confounders.ResultsOverall, 10.9% of the subjects had an obstructive lung pattern. The mean fT4 levels were significantly higher in those with obstructive lung pattern than in those with normal lung function (1.26 vs. 1.20 ng/dL, p<0.001). The proportion of participants with obstructive lung pattern increased across the fT4 quartile categories (p<0.001). With the Q1 group as reference, the multivariate-adjusted odds ratios (95% confidence intervals) for obstructive lung pattern in the Q3 and Q4 groups were 2.875 (1.265–6.535) and 2.970 (1.287–6.854), respectively, even after adjusting for confounding variables.ConclusionHigh fT4 levels are an independent predictor of obstructive lung pattern in euthyroid middle-aged subjects. Further prospective studies are needed to confirm these findings.

Frequency of Hyperthyroidism in Hypokalemic Periodic Paralysis

Objective: To determine the frequency of hyperthyroidism in hypokalemic periodic paralysis Study Type: Cross-sectional study Place and Duration of Study: Department of Neurology, Chandka Medical College Hospital, Larkana from 1st January 2016 to 30th June 2016. Methodology: Eighty four patients with hypokalemic periodic paralysis of both sexes aged 18 to 60 years enrolled. Later on, the blood sample was collected and sends to LINAR Hospital for measurement of serum TSH, FT3 and FT4. The hormone assays was analyzed by chemiluminescence assay using ADVIA Centuar manufactured by SIEMENS NewYork. Results: The mean age was 40.24±9.96 years, 49 (58.3%) were males and 35 (41.7%) were females, 57 (67.9%) has duration of illness was &gt;7 days and 27 (32.1%) had duration of illness &gt;7 days. Mean TSH was 0.48±0.25, mean FT3 was 198.17±19.38 and mean FT4 was 19.43±6.65. The frequency of hyperthyroidism in hypokalemic periodic paralysis was 29 (34.5%) cases. Conclusions: The frequency of hyperthyroidism in hypokalemic periodic paralysis was 34.5%. Keywords: Hypokalemia, Periodic paralysis, Hyperthyroidism

The Effect of Early Life Exposure to Triclosan on Thyroid Follicles and Hormone Levels in Zebrafish.

Triclosan (TCS) is an antimicrobial chemical widely used in personal care products. Most of the TCS component is discharged and enters the aquatic ecosystem after usage. TCS has a similar structure as thyroid hormones that are synthesized by thyroid follicular epithelial cells, thus TCS has a potential endocrine disrupting effect. It is still not clear how the different levels of the environmental TCS would affect early development in vivo. This study examines the effects of TCS on thyroid hormone secretion and the early development of zebrafish. The fertilized zebrafish eggs were exposed to TCS at 0 (control), 3, 30, 100, 300, and 900 ng/mL, and the hatching rate and the larvae mortality were inspected within the first 14 days. The total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and free thyroxine (FT4) were measured at 7, 14, and 120 days post-fertilization (dpf). The histopathological examinations of thyroid follicles were conducted at 120 dpf. TCS exposure at 30-300 ng/mL reduced the hatching rate of larvae to 34.5% to 28.2 % in the first 48 hours and 93.8 .7 % to 86.8 % at 72 h. Extremely high TCS exposure (900 ng/mL) strongly inhibited the hatching rate, and all the larvae died within 1 day. Exposure to TCS from 3 to 300 ng/mL reduced the thyroid hormones production. The mean TT3 and FT3 levels of zebrafish decreased in 300 ng/mL TCS at 14 dpf (300 ng/mL TCS vs. control : TT3 , 0.19 ± 0.08 vs. 0.39 ± 0.06; FT3, 19.21 ± 3.13 vs. 28.53 ± 1.98 pg/mg), and the FT4 decreased at 120 dpf ( 0.09 ± 0.04 vs. 0.20 ± 0.14 pg/mg). At 120 dpf , in the 300 ng/mL TCS exposure group, the nuclear area and the height of thyroid follicular epithelial cells became greater, and the follicle cell layer got thicker. This happened along with follicle hyperplasia, nuclear hypertrophy, and angiogenesis in the thyroid. Our study demonstrated that early life exposure to high TCS levels reduces the rate and speed of embryos hatching, and induces the histopathological change of thyroid follicle, and decreases the TT3, FT3, and FT4 production in zebrafish.

Thyroid stimulating hormone (thyrotrophin) and its relationship with chronic kidney disease before dialysis.

Objective: To measure glomerular filtration rate, free thyroxin, and thyrotrophin in chronic kidney disease patients and to find out the correlation between glomerular filtration rates, free thyroxin and thyrotrophin in these patients. Study Design: Cross Sectional Analytical study. Setting: Bacha Khan Medical Complex Swabi. Period: November 2018 to November 2019. Material &amp; Methods: Sixty five patients were included in the study. Serum Creatinine, TSH and Free T4 were measured; Thyroid function tests TSH, FT4 were measured in these chronic kidney disease patients through enzyme linked immunosorbant assay method. GFR was calculated through Cock-croft-Gualt formula and the relevant data was entered in a predesigned Proforma. Results: In the study total 65 chronic kidney disease patients were taken. Out of which thirty six (55.4%) were male and twenty nine (44.6%) were female. Thirty five (53.8%) CKD patients whose TSH level was above the normal limit while in the remaining patients the TSH values were in the normal range. Eight patients (12.3%) out of sixty five patients in whom FT4 values were below the normal limit while in the remaining fifty seven patients (87.6%) FT4 values were within the reference range. Those eight patients whose FT4 was below the normal value, their TSH values were above the normal value too. Thirty five patients, whose TSH levels were above the normal limit, their mean age was 50.60± 11.95, mean serum creatinine was 4.73± 2.94 mg/dl, mean GFR was 22.17± 12.48 ml/min/1.73m2, mean TSH was 6.68± 0.87 mIU/L and mean FT4 was 0.97± 0.35 ng/dl. The p-value of TSH was &lt; 0.001 and FT4 was &lt; 0.05 in comparing with control group. Glomerular filtrations rate with TSH and FT4 the co-efficient of correlation (r) value for 35 patients was – 0.713 and 0.47 for TSH and FT4 respectively. Their p- values were 0.000 and 0.004 respectively, and p &lt; 0.001 collectively. This was found to be statistically significant. Linear regression line was obtained between GFR and FT4 in CKD patients. Conclusion: chronic kidney disease is associated with biochemical thyroid dysfunctions causing most commonly subclinical hypothyroidism.

Triidothyronine (TT3), Total Thyroxine (TT4) and Free Thyroxine (FT4) Reference Range in Healthy Dogs by Radioimmunoassay (RIA)

Background: The thyroid function of the dog has been little studied in comparison with that of the human. This may have resulted, in part, from the apparent lack of reporting of thyroid-related disorders in the Indian canine population. There is, therefore, a need for a more detailed study of thyroid hormone levels (establish reference interval) in normal dogs using a specific and accurate technique like radioimmunoassay (RIA). Methods: Total 192 healthy dogs from the clinical setup of constituent colleges of MAFSU (viz. Mumbai, Nagpur, Parbhani, Shirwal, Udgir and Akola) were ethically enrolled to examine thyroid hormones levels (TT3, TT4 and FT4). Thyroid hormones were estimated using RIA. Result: The results of the present study recorded mean serum TT3, TT4 and FT4 values in healthy dogs as 1.29±0.04 nmol/l, 28.17±1.18 nmol/l and 13.03±0.68 pmol/l respectively. The reference interval (25th to 75th percentile) for TT3, TT4 and FT4 was found to be 0.88-1.51 nmol/l, 15.70-35.29 nmol/l and 7.80-14.75 pmol/l respectively. The median for TT3, TT4 and FT4 was found to be 1.13 nmol/l, 24.54 nmol/l and 10.00 pmol/l respectively. The baseline serum thyroid hormone concentration would be valuable for identifying thyroid dysfunction in dogs.

Correlation Between Thyroid Hormone Concentrations and Ultrasound Thyroid Volume in Preterm Infants Born Before 33 Weeks of Gestation.

ObjectiveThyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to a lack of gestational age (GA)-specific reference ranges. We aimed to evaluate the age-specific thyroid-stimulating hormone (TSH), free thyroxine (FT4) levels and the correlation between TSH and FT4 serum levels and ultrasound thyroid volume in preterm infants.Materials and MethodsThis was an observational, prospective, single-center study of 98 preterm infants born before 33 weeks GA. The infants were divided into the 24-28 weeks and 29-32 weeks GA groups. TSH and FT4 serum levels were measured at two time points: at postnatal age (PNA) 2 weeks and at postmenstrual age (PMA) 32 weeks; the results were compared between groups at two consecutive time points.ResultsThere was a statistically significant between-group difference in FT4 concentration. There was a positive correlation between FT4 and GA at both screening times. FT4 in the 24-28 weeks GA group was significantly lower than in the 29-32 weeks GA group. The mean (standard deviation [SD]) FT4 at PNA 2 weeks was 11.72 ± 2.16 pmol/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p<0.001). The mean (SD) FT4 at PMA 32 weeks was 11.96 ± 1.98 pmo/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p=0.001). Our results reflect a slow and gradual upward trend of FT4 in the 24-28 weeks GA. It is of interest that the correlation between thyroid volume and FT4 was statistically significant (rho=0.25, p=0.019) for all studied preterm infants. The correlation between thyroid volume and weight was statistically significant for the entire study group (rho=0.37, p<0.001). We did not find statistically significant differences in TSH and FT4 values between consecutive time points at 24-28 weeks GA. The thyroid volume was not significantly different between both groups. The total thyroid volume was 0.26 vs. 0.27 ml for the 24-28 and 29-32 weeks GA groups, respectively.ConclusionThe results of this study indicate that preterm infants require lower FT4 values depending on GA. Moreover, ultrasound thyroid imaging may facilitate the evaluation of questionable thyroid disorders.