Mean Serum T4 Research Articles

Frequency of Subclinical Hypothyroidsim Among Patients with end Stage Renal Disease on Hemodialysis Presenting to A Tertiary Care Hospital

Objective: Aim of this study was to determine the frequency of subclinical hypothyroidism among patients with end stage renal disease presenting to tertiary care hospital.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Nephrology, Sharif Medical City Hospital, Lahore. Pakistan, from Mar 2020 toDec 2020.
 Methodology: A total of 200 cases studied. Informed consent was obtained from them. Data was noted in the proforma. Using aseptic techniques blood sample was taken for testing serum TSH and free T4 levels through radioimmunoassay. Results were collected by the researcher next day and were labeled and noted as subclinical hypothyroidism according to its clinical definition. Privacy of the data was maintained.
 Results: In 200 study cases age interval was 15-80 years with mean age of 46.22±19.67 years. The minimum Serum TSH level was 4.1 and maximum was 4.6 with mean serum TSH level was 4.31±0.16. The minimum Serum T4 levels was 0.5 and maximum was 2.1 with mean Serum T4 levels was 1.28±0.68. Duration of chronic kidney disease was 3-60 months with mean duration of 17.58±14.14 months. It was observed that there were 56.5% male patients while females were 43.5%. Subclinical Hypothyroidism was present in 9.5% patients with ESRD reporting to tertiary care hospital while it was absent in 90.5% patients. 
 Conclusion: The frequency of subclinical hypothyroidism was found as 9.5% among patients with end stage renal disease presenting to tertiary care hospital.

Evaluation of Thyroid Function Tests among Chronic Kidney Disease Patients attended at a Tertiary Care Hospital in Dhaka City

Background: Serological status of thyroid hormones is important among chronic kidney disease patients.
 Objective: The purpose of the present study was to see the status of thyroid hormones among chronic kidney disease patients.
 Methodology: This cross-sectional study was done From January 2013 to December 2013 in the Department of Nephrology, Dhaka Medical College Hospital. A total of 50 diagnosed cases of adult male with different stages of CKD (CKD stage 3, 4, 5 and 5D) patients along with age-matched 51 healthy individuals were included. Serum Thyroid hormone T3 done by [1251] RIA kit, T4 done by T4 [1251] RIA kit, TSH level done by Turbo TSH [1251] IRMA kit.
 Result: A total number of 101 patients were recruited for this study of which 51 cases were in the group A and the rest of the 50 cases were in the group B. The mean serum T3 level was found 1.85±0.7 nmoL/L in group A and 2.79±0.55 nmoL/L in group B (p<0.05) which indicated that low serum T3 level was significantly associated with CKD. The mean serum T4 level was found 104.65±34.9 nmol/L in group A and 138.8±31.5 nmol/L in group B (p<0.05). Serum TSH level of the study patients showed that the mean serum TSH level was found 4.23±4.6 mIU/L in group A and 2.06±2.5mIU/L in group B (p<0.05).
 Conclusion: In conclusion the mean with SD of serum level of T3, T4 and TSH were significantly associated with chronic kidney disease.
 Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):147-151

Study of thyroid dysfunction in people living with HIV in Nepalese population undergoing antiretroviral therapy: a cross-sectional study.

Thyroid dysfunction is one of the most common endocrine disorders in people living with HIV (PLHIV). The abnormality in thyroid function has been linked with the adverse effects of prolonged antiretroviral therapy (ART) in PLHIV, but its prevalence remains obscure. The present study aimed to determine the prevalence of impaired thyroid function and its relationship to ART duration in Nepalese people living with HIV. This cross-sectional clinical laboratory based study was conducted at SRL Diagnostics Nepal, Pvt. Ltd. from October 2021 to May 2022. Two hundred and three HIV-seropositive patients enrolled at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, Nepal were examined for their thyroid function test (TFT) by analyzing the serum T3, T4, and TSH concentrations using a fully automated COBAS e411 analyzer (Roche Diagnostics, USA) based on the electrochemiluminescence assay (ECLIA). Out of 203 PLHIV, 22 (10.83%) had a thyroid disorder, with subclinical hypothyroidism (n = 16, 72.73%) being the most common, followed by subclinical hyperthyroidism (n = 3, 13.63%). Thyroid dysfunction had no significant correlation with HIV/ART duration (p = 0.304) and sex (p = 0.419), whereas, the risk of thyroid dysfunction was induced with the rise in the age of the PLHIV (p = 0.002, ϕ = 0.274). There were no significant differences in the mean serum T3, T4 and TSH values among different sexes and the HIV/ART duration, however a significant difference in the mean values of TSH (F (3, 199) = 3.231, p = 0.023) and T3 (F (3, 199) = 4.587, p = 0.004) among the different age-groups were shown. The mean T3 values also indicated a gradual decrease with increasing age. The study revealed subclinical hypothyroidism as the prevailing thyroid disorder associated with PLHIV. The risk of thyroid dysfunction in PLHIV was neither gender specific nor being attributed by the ART duration in Nepalese population; however, elderly PLHIV were highly susceptible to the risk of thyroid disorder.

Study of thyroid profile in relation to glycemic control in type 2 diabetes mellitus patients

Diabetes mellitus is an endocrine metabolic disorder that causes significant morbidity and mortality around the world. Thyroid gland dysfunction is a significant problem in diabetic patients. In diabetics, hypothyroidism is the most common thyroid abnormality. When compared to healthy people, diabetic patients have a higher incidence of thyroid abnormalities. Diabetes mellitus treatment can be complicated due to irregular thyroid activity. A total of 120 people were studied, with 60 patients with type 2 diabetes mellitus (Cases group) and 60 healthy people (Control group). Patients with and without strong diabetic control are represented in 60 cases. Both subjects had their fasting venous blood samples taken. In both the cases and control groups, fasting blood sugar, HbA1c, serum T3 (Triiodothyronine), serum T4 (Thyroxine), and serum TSH (Thyroid-stimulating hormone) were measured.The thyroid abnormality was significantly seen in diabetic patients when compared to healthy individuals. The abnormality was more significant in patients with poor glycemic control. When comparing cases to controls, mean serum TSH levels were significantly higher, whereas mean serum T3 and T4 levels were significantly lower. Thyroid hormone levels in type 2 diabetics are abnormal due to a change in the hypothalamic–pituitary–thyroid axis. This in turn produces significant metabolic disturbances. This is more significant in diabetics with poor glycemic control. Routine screening for thyroid function should be done in diabetics, which helps in preventing complications. This contributes to improved treatment by lowering morbidity and improving quality of life.

Thyroid function in patients with idiopathic nephrotic syndrome

Albumin is the major protein excreted in urine in patients with nephrotic syndrome (NS). However, low-molecular-weight proteins including some binding proteins are also excreted. Thyroid hormone and its binding globulins are excreted in urine in excess in nephrotic syndrome. Therefore, it has been postulated that patients with nephrotic syndrome may show hypothyroidism, subclinical or overt. In this prospective observational study, patients of idiopathic nephrotic syndrome aged 1-40years of both gender were included. Serum T3, T4 and TSH were assayed at diagnosis and repeated at 12weeks or at remission whichever was earlier. Renal biopsy was performed as required. Among 100 patients taken for analysis (42 children, 58 adult), 30 cases were of first episode, 40 were of frequent relapse/steroid-dependent NS, and 30 patients had steroid-resistant NS (SRNS). Three (3%) cases had overt hypothyroidism and 18 (18%) patients had subclinical hypothyroidism. Most hypothyroid cases belonged to SRNS subgroup. Mean Serum T3, T4 and TSH values showed significant improvement in remission in comparison to nephrosis state (P < 0.01). Serum TSH had significant positive correlation (r = 0.391, P < 0.01) with 24-h proteinuria and negative correlation with serum albumin (r = - 0.303, P < 0.01) in nephrosis. Hypothyroidism is common among nephrotic syndrome patients especially in SRNS subgroup. Therefore, routine screening is recommended in steroid-resistant nephrotic syndrome patients.

OR01-05 Long-Term Efficacy of T3 Analogue Triac in MCT8 Deficiency

Background: MCT8 deficiency is a severe disorder caused by mutations in the thyroid hormone transporter MCT8. MCT8 deficiency is characterized by severe intellectual and motor disability and high serum T3 concentrations that result in thyrotoxic symptoms in peripheral tissues. This predisposes to substantial morbidity and mortality. Preclinical studies showed that the T3 analogue Triac can bypass defective MCT8 at the cellular level. Recently, we reported the results of an international multicenter trial, in which biochemical and clinical outcomes improved in patients with MCT8 deficiency who were treated with Triac for 12 months (1). However, long-term follow-up data of patients with MCT8 deficiency treated with Triac are lacking, particularly in young children. Therefore, we aimed to investigate the long-term efficacy of Triac therapy in a worldwide cohort of patients with MCT8 deficiency. Methods: We investigated the efficacy of oral Triac treatment in pediatric (n=78) and adult (n=5) patients with MCT8 deficiency in 20 countries. Triac dose was titrated according a predefined dose-escalation scheme aiming to normalize serum T3 concentrations (target 1.4-2.5 nmol/L). Thyroid function tests and biochemical markers of thyroid hormone action in peripheral tissues (SHBG, creatine kinase, creatinine) were measured at baseline and during control visits. Findings: In total, 83 patients with a median baseline age of 5 years (range 6 months – 66 years) were treated, including 24 patients aged 0-2.5 years and 17 patients aged 2.5-5 years. They were treated with Triac during 144 patient years, of whom the follow-up time was >5 years in 9 patients and 2-5 years in 22 patients. Mean dose was 45 µg/kg/day (range 11-107 µg/kg/day). Once a stable dose was achieved, no further dose adjustments were needed.Mean serum T3 concentrations decreased from 5.02 to 1.94 nmol/L (normal 1.4 – 2.5 nmol/L). SHBG concentrations improved from 238 to 204 nmol/L (normal 40-140 nmol/L). Mean creatine kinase and creatinine concentrations improved from 113 to 140 U/L (normal <230 U/L) and from 32 to 38 µmol/L (normal 31-68 μmol/L), respectively. No drug-related severe adverse events were reported. Interpretation: Triac is a safe treatment that results in sustainable improvements of the severe thyrotoxic state in pediatric and adult patients with MCT8 deficiency.

Thyroid Dysfunction In Patient With Nephrotic Syndrome

A large amount of protein is lost in urine along with thyroid hormones and hormone binding proteins in nephrotic syndrome (NS). This hormone loss may lead to low T4, T3 and sometimes high TSH level and often to be associated with subclinical or overt hypothyroidism. This study was done to assess thyroid dysfunction in patients with NS and to correlate thyroid hormones with albumin level of those subjects. Forty diagnosed patients of idiopathic NS and same number of age matched healthy control were selected in this study. Thyroid status was evaluated in all the subjects. In patients with NS mean (± SD) of T4, T3 and TSH were 39.34 (±29.49), 1.05 (±0.83) and 11.34 (±18.15) respectively. Mean (±SD) of T4, T3 and TSH in healthy control were 83.34 (±27.23), 2.04 (±0.70) and 2.73 (±1.79) respectively. Mean serum total T4 and T3 of patients with NS were found to be significantly lower (t= -6.935, df= 78, p&lt;0.001 and t = -5.750, df = 78, p&lt;0.001 respectively) and mean TSH was found to be significantly higher (t= 2.984, df = 78, p&lt;0.01) in patients with NS as compared to healthy control. Sub clinical hypothyroidism was observed in 20 (50%) and overt hypothyroidism in 4 (10%) of patients. Significant positive correlation was found between serum albumin and serum total T4 (r = 0.818, p &lt;0.001) and also with total T3 level (r = 0.903, p &lt;0.001). But no correlation was found between serum albumin and serum TSH (r = - 0. 292, p&gt;0.05) in patients with NS. So, nephrotic range proteinuria may be associated with loss of thyroid hormone in urine and can lead to subclinical or even overt hypothyroidism.TAJ 2015; 28(1): 40-44

Assessment of iodine supplementation program on thyroid function in Sudan

The aim of this Study is to investigate whether the Iodine Supplementation Programme is successful or not. This Programme was implemented in Nyala to treat the Iodine deficiency. In this Study Nyala was selected to act as (a study area), due to the history of Iodine deficiency of this region, while Khartoum was selected to act as (a control area). 2000 samples were collected from Khartoum versus 450 samples from Nyala. Thyroxine (T4) and triiodothyronine (T3) levels in two regions were measured and performed by using radioimmunoassay (RIA), also the immunoradiometric assay (IRMA) used for measurement of thyroid stimulating hormone (TSH). The obtained results analyzed by using Statistical Package for Social Sciences (SPSS). (Coherent retrospective) used to determine differences between the study groups. The results of this study showed, there was no significant difference between the mean serum concentrations of T3 and TSH for Khartoum and Nyala. T4of Khartoum (117.93 ± 42.797) nmol/L and the mean serum T4 of Nyala (114.54 ± 45.526) nmol/L, the (P-value = 0.133).T3for Khartoum (1.8040 ± 0.99047) nmol/L and T3of Nyala (1.7307 ± 0.96508) nmol/L, the (P-value = 0.153). TSH for Khartoum (1.4480 ± 0.95807)mIU/Land the mean serum TSH of Nyala (1.4553 ± 1.0244) mIU/L, the (P-value = 0.885). The study showed a clear observation of improvement of hypothyroidism cases in Nyala while the ratio decreased from 64.09% to 0.6%. All the results were carried out according to normal range of Sudanese. The conclusion from this study the iodine supplementation programme is successful. The study recommends rising the health awareness among people by explain the severity of iodine deficiency, and continue in iodine supplementation programme, also establishment of monitoring system including monitoring the presence of iodized diets (sugar, salt, oils, and bread) in the markets. Finally, further studies are needed in other parts of Sudan to assess the size of iodine deficiency problem.

Design, Synthesis, Molecular Modeling, and Biological Evaluation of Novel Thiouracil Derivatives as Potential Antithyroid Agents.

Hyperthyroidism is the result of uncontrolled overproduction of the thyroid hormones. One of the mostly used antithyroid agents is 6-n-propyl-2-thiouracil (PTU). The previously solved X-ray crystal structure of the PTU bound to mammalian lactoperoxidase (LPO) reveals that the LPO-PTU binding site is basically a hydrophobic channel. There are two hydrophobic side chains directed towards the oxygen atom in the C-4 position of the thiouracil ring. In the current study, the structural activity relationship (SAR) was performed on the thiouracil nucleus of PTU to target these hydrophobic side chains and gain more favorable interactions and, in return, more antithyroid activity. Most of the designed compounds show superiority over PTU in reducing the mean serum T4 levels of hyperthyroid rats by 3% to 60%. In addition, the effect of these compounds on the levels of serum T3 was found to be comparable to the effect of PTU treatment. The designed compounds in this study showed a promising activity profile in reducing levels of thyroid hormones and follow up experiments will be needed to confirm the use of the designed compounds as new potential antithyroid agents.

The Correlation Level Of Thyroid Stimulating Hormone Andthyroxinewith Spontaneus Abortion

Abortion is one of the causes of maternal death. The World Health Organization (WHO) estimates that 15-20% of maternal deaths are caused by abortion. Abnormal level of TSH and T4 during pregnancy will be at risk of abortion because the T4 hormone acts to regulate the body's metabolic processes. The purpose of this study to determine the relationship of TSH and T4 levels in the incidence of abortion. The research design is observational with cross sectional approach which is implemented in regency general hospital of Dr. Rasidin, hospital of Dr. Reksodiwiryo,Bhayangkara hospital, Islam hospital of IbnuSina Padang, and Biomedical Laboratory Faculty of Medicine Andalas University in Padang from September to November 2017. The study population is all pregnant women with gestational age ≤ 20 weeks with diagnosis of abortion. The sample of research 58 respondents by using consecutive sampling technique Examination of TSH and T4 using ELISA method. Test the normality of data by Kolmogorov Smirnov test. Analysis of comparative data by using Pearson correlation test. The conclusion of this study are the mean serum TSH level is 2.39 ± 1.59 mIU / I and the mean serum T4 level was 8.02 ± 1.43 μg / dl. There is no statistically significant relationship between TSH and T4 levels in aborted event, with p = 0.07 (p&gt; 0,05), with r = -0,23, the relation test is weak, the direction was negative which means more high levels of TSH, the smaller T4 levels in mother abortion The conclusion, the study proves that, there is no significant correlation between TSH and T4 levels in the incidence of abortion.

Changes in the thyroid hormone profiles in children with nephrotic syndrome.

PurposeWe compared thyroid hormone profiles in children with nephrotic syndrome (NS) during the nephrotic phase and after remission.MethodsThis study included 31 pediatric NS patients. The thyroid hormone profiles included serum levels of triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and free T4.ResultsOf the 31 patients, 16 (51.6%) showed abnormal thyroid hormone profiles: 6 had overt hypothyroidism, 8 had subclinical hypothyroidism, and 2 had low T3 syndrome. The mean serum T3, T4, and free T4 levels in the nephrotic phase and after remission were 82.37±23.64 and 117.88±29.49 ng/dL, 5.47±1.14 and 7.91±1.56 µg/dL, and 1.02±0.26 and 1.38±0.23 ng/dL, respectively; the levels were significantly lower in the NS nephrotic phase (P=0.0007, P<0.0001, and P=0.0002). The mean serum TSH levels during the nephrotic phase and after remission were 8.05±3.53 and 4.08±2.05 µIU/ mL, respectively; they were significantly higher in the nephrotic phase (P=0.0005). The urinary protein/ creatinine ratio during the nephrotic phase was significantly correlated with serum T3, T4, and free T4 levels (r=-0.5995, P=0.0032; r=-0.5797, P=0.0047; r=-0.5513, P=0.0078) as well as with TSH levels (r=0.5022, P=0.0172). A significant correlation was found between serum albumin and serum T3 levels during the nephrotic phase (r=0.5385, P=0.0018) but not between serum albumin and T4, TSH, or free T4 levels. These significant correlations all disappeared after remission.ConclusionAbnormal thyroid hormone profile findings were observed in 51.6% of pediatric patients with NS. Thyroid hormone levels normalized after remission, regardless of levothyroxine therapy.

Evaluation of Thyroid Function in Persons having Nodular Goiter without Thyroid Related Symptoms

Objective: Objective of this study was to evaluate thyroid hormone level in nodular goiter patient without thyroid related symptoms and normal individual among the population of north-west part along the belt of river Padma.Patients and methods: It was a cross sectional study during the period of one year between July 2005 to June 2006. Total 200 samples were taken within 15 to 50 years age who attended in Institute of Nuclear Medicine &amp; Allied Sciences (INMAS) Rajshahi and OPD Rajshahi Medical college Hospital (RMCH). Diagnosed cases of hypothyroidism, hyperthyroidism, patients treated with radioiodine, pregnant and lactating lady, chronic illness, chronic kidney disease and known cardiac patients were not included in this study. An informed written consent was taken after counseling. Data were collected in predesigned data collection sheet and statistical analysis was performed.Results: Total 100 patients of nodular goiter and 100 normal individual were enrolled for this study. About 37% of study groups were between the age of 20-30 years and 31% in between 30-40 years of age. Male female ratio was 1:2.6. Cold nodular goiter was 75 %, multinodular goiter in 16% cases and partially cold nodular goiter in 9%. The mean ± SD of serum T 3 was 1.89± 0.61 nmol/L and 1.88+-0.44 nmol/L in study and control groups respectively. The mean ± SD of serum T4 was 99.90 ± 29.03 nmol/L and 122.93 ±25.31nmol/L in study and control group and serum TSH was 1.42 ± 1.07 mIU/L and 1.34 ±- 0.54mIU/L in study and control group respectively.Conclusion: This study gave an impression in hormone status of nodular goiter patients in comparison to normal individual. Statistically no significance difference was seen in mean T3 and TSH value between study and control groups however significant difference was seen in mean serum T4 value (p&lt; 0.01).Bangladesh J. Nuclear Med. 19(1): 24-27, January 2016

Correlation of enhanced oxidative stress with altered thyroid profile: Probable role in spontaneous abortion.

Background:Spontaneous abortion or miscarriage is defined as the loss of a clinically recognized pregnancy that occurs before 20 weeks of gestational age. Changes in thyroid function can impact greatly on reproductive function before, during, and after conception. Oxidative stress affects both implantation and early embryo development by modifying the key of transcription. Malondialdehyde (MDA) is a major breakdown product of split off from lipid peroxidation. Superoxide dismutase (SOD) is responsible for detoxification of superoxide anion and required for normal health and reproduction.Aim:The aim of this study was to define the involvement of thyroid hormones, MDA and SOD levels and to establish MDA levels as an index of lipid peroxidation in women with spontaneous abortion by comparing the results with healthy pregnant females as controls.Materials and Methods:A cross-sectional case-control study was designed with two groups of women with 30 each in healthy pregnancy and with spontaneous abortion.Results:Demographic characteristics such as maternal age, paternal age, gestational age, body mass index, waist-hip ratio as well as biochemical parameters such as blood pressure, hemoglobin (Hb), sugar levels were found to be similar in both the participating groups. Characteristics like gravida and parity were found to be higher in the study group and differ significantly from control group. Spontaneous abortion before 24 weeks of gestational age was found to be associated with significant increase in mean serum thyroid stimulating hormone (TSH) (P = 0.0115) and MDA (P = 0.0001) levels and a significant decrease in mean serum T3 (P = 0.0003) and SOD (P = 0.0005) levels. The linear (Pearson) correlation analysis demonstrated a significant positive correlation of TSH with MDA and negative correlation with SOD in women with spontaneous abortion.Conclusion:The study demonstrates that altered thyroid profile, increased lipid peroxidation in terms of increased MDA levels and decreased SOD levels might be involved in the termination of otherwise wanted pregnancy.

A comparative study of sensory-motor coordination, executive function, and testosterone levels in hypothyroid and euthyroid males

Background: Hypothyroidism is an endocrine disorder that is seen much more commonly in females than in males. This could perhaps be due to factors that confer protection against the development of hypothyroidism in males. The male sex hormone testosterone would have protective action on the different systems, probably due to a mechanism of action which is complementary. Aims and Objective: To investigate the association between serum testosterone level, audiovisual reaction time, and working memory score in newly diagnosed hypothyroid and euthyroid men. Materials and Methods: This was a comparative study. 15 newly diagnosed hypothyroid males between 18 and 45 years of age, recruited from the Endocrinology Department of MS Ramaiah Medical College Hospital, Bangalore, and 15 euthyroid males were assessed for audiovisual reaction time, working memory, serum testosterone, T4, and serum thyroid hormones (TSH). Results: Independent t-test between hypothyroid and euthyroid groups revealed that there was statistically significant difference in group mean audio-visual reaction time, working memory, serum T4, and TSH levels (P < 0.05). Conclusion: Hypothyroid patients had longer audiovisual reaction time and the working memory scores were reduced. The serum T4 level was lower and serum TSH level was higher, but the serum testosterone level was not significantly different compared to euthyroid subjects.

Liothyronine Improves Biochemical Control of Congenital Hypothyroidism in Patients with Central Resistance to Thyroid Hormone

To assess whether adding liothyronine (LT3) to levothyroxine (LT4) monotherapy normalizes serum thyrotropin (TSH) and thyroxine (T4) concentrations in children with congenital hypothyroidism and central resistance to thyroid hormone. We retrospectively studied 12 patients with congenital hypothyroidism and central resistance to thyroid hormone (6 treated with LT3+LT4 combined therapy and 6 treated with LT4 monotherapy). In patients receiving combined therapy, we compared serum concentrations of TSH, T4, and triiodothyronine before and after addition of LT3. We used repeated measures analysis to compare thyroid function in participants receiving combined therapy vs monotherapy, while accounting for age and intrasubject correlation. In patients receiving combined therapy, the addition of LT3 was associated with normalization of mean TSH (9.2 vs 4.5 mIU/L, P=.002), a lower proportion of TSH values greater than 10 mIU/L (35% vs 8%, P=.03), and a decrease in mean serum T4 by 23±9% (P<.001). Compared with patients receiving LT4 monotherapy, patients receiving combined therapy had lower mean TSH (8.5±0.9 vs 4.3±0.4, P<.001), lower odds of TSH elevation greater than 10 mIU/L (OR 0.20, 95% CI 0.10-0.41, P<.001), and lower odds of T4 elevation (OR 0.21, 95% CI 0.04-1.09, P=.06). LT3 treatment did not increase serum T3 levels significantly. The addition of LT3 to LT4 monotherapy facilitates normalization of both serum TSH and T4 in patients with congenital hypothyroidism and central resistance to thyroid hormone. Larger prospective studies are needed to confirm these findings and to determine the effect of combined therapy on neurodevelopmental outcomes.

High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis.

Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T3 and T4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end-stage renal disease (ESRD). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis (HD). Sixty-one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T3, free T4 (FT4), thyroid-stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T3 and FT4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD.

Prolonged TSH receptor A subunit immunization of female mice leads to a long-term model of Graves' disease, tachycardia, and cardiac hypertrophy.

A transient model for human Graves' disease was successfully established in mice using up to 3 immunizations with recombinant adenovirus expressing the extracellular A-subunit of the human TSH receptor (TSHR) (Ad-TSHR). We studied extension of adenovirally induced TSHR A-subunit immunization in mice by using a novel protocol of long-term 3- and 4-weekly injections. Generation of TSHR binding stimulatory antibodies (capacity to stimulate cAMP activity in TSHR-expressing test cells), goiter, and histological thyroid alterations were maintained for at least 9 months in all Ad-TSHR-immunized mice. In response to injection of 10(10) plaque-forming units of Ad-TSHR, also elevated mean serum T4 levels were observed throughout the study. Moreover, cardiac organ involvement (tachycardia and hypertrophy) were consistently observed in these mice. Higher doses of Ad-TSHR (10(11) plaque-forming units) did not produce consistent elevation of T4 and were not associated with a clear increase in heart rate vs controls, probably because these high doses provoked an immune response-induced tachycardia on their own. In summary, a long-term model of Graves' disease induced by a relatively simple protocol of continuing monthly immunizations should allow to investigate long-term disease mechanisms and may possibly obviate the need for more complicated disease models. Moreover, the clinical outcome predictor of tachycardia and cardiac involvement was reliably detected in the model.

Thyroid hormones and prolactin levels in infertile women in southern Nigeria.

Human infertility is a complex global health problem. It has multiple social consequences which are especially profound for thyroid hormones in infertility with the aim of determining the degree of association of thyroid hormones with hyperprolactinemia in our population. The serum levels of prolactin, T3, T4 and TSH were determined in 90 hyperprolactinemic infertile women, 90 normoprolactinemic infertile women and 50 fertile women. The hormones were assayed using Enzyme Linked Immunosorbent Assay kits. Analysis of variance and Pearson's correlation were used to analyze the data, with the significant p-level set at 0.05. A significantly higher mean serum prolactin and TSH were observed among the infertile groups compared to the fertile controls (p<0.05). The mean serum T3 and T4 were significantly lower in the hyperprolactinemic infertile women compared to the fertile controls (p<0.05). The mean TSH and T3 of normoprolactinemic infertile women and controls were comparable (p>0.05). However, the mean T4 was significantly lower in normoprolactinemic infertile women compared to the fertile controls (p<0.05). In all the groups, TSH correlated inversely with T3 and T4, while T3 correlated positively with T4. It was only in the control group that prolactin correlated positively and significantly with TSH. It is therefore concluded that hyperprolactinemia with thyroid dysfunction may be a major contributory hormonal factor in infertility among infertile women and as such, estimation of prolactin, T3, T4 and TSH should be included in the workup for infertile women especially those with hyperprolactinaemia.

Environmental, urinary iodine status and prevalence of goitre among schoolchildren in a high altitude area of Saudi Arabia.

Objective:This study aimed to assess the iodine deficiency, prevalence of goitre among schoolchildren and measuring environmental iodine in Taif city, Saudi Arabia.Methods:A cross-sectional multistage cluster-sampling methodology was done on 1887 schoolchildren. Their urinary iodine concentration (UIC) and goitre prevalence was assessed. Blood level of triiodothyronin, thyroxine and thyroid-stimulating-hormone was carried out for students with normal, mild; moderate and sever iodine deficiency. The iodine content of salt, water and soil was also assessed.Results:Goitre prevalence was 7.4% and about 71% of the participants had UIC less than 100μg/L. An inverse relationship between median UIC and the percent prevalence of goitre was found. The mean serum T3, T4 and TSH were 1.05ng/dL, 6.81µg/dL, and 5.69mIU/L, respectively. A significant positive correlation was found between the mean value of urinary iodine and the mean value of both T3 and T4. While a significant negative correlation between the mean value of urinary iodine and the mean value of TSH was also noted.Conclusions:The results revealed the presence of a potential public health problem of iodine deficiency among school going children in high altitude areas of Saudi Arabia. There is a need to monitor and evaluate the salt iodization process, and distribute adequately iodized salt in the affected areas.

Thyroid function profile in cord blood and postnatal changes at 24 and 72hours in healthy term Nigerian neonates

Background: Studying the acute postnatal changes of newborn thyroid function is essential for determining the best timing of screening for congenital hypothyroidism. There is paucity of literature on neonatal thyroid function and particularly the postnatal changes in Nigeria.Objectives: To describe the profile of thyroid function in cord blood and the postnatal changes at 24hours and 72hours in healthy term neonates delivered in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Subjects and methods: This was a prospective, descriptive and cross sectional study conducted over a six month period (between July-December 2009). Forty seven consecutively delivered healthy term neonates had their serum T3, T4, TSH assayed at birth, 24 and 72hours using the Enzyme linked immunosorbent assay (ELISA) technique. Data obtained are presented as mean, median and standard deviation (SD). Paired- t- testwas used for statistical inference.Results: The mean (SD) of the serum hormone concentrations in cord blood, and venous blood at 24hours and 72hours, respectively were as follows: T3, 0.58 (0.56) nmol/l, 1.15 (0.77)nmol/l, 0.83 (0.74)nmol/l; T4, 91 (83.1)nmol/l, 121.5 (106.4)nmol/l, 104.2 (84.2) nmol/l; and TSH, 5.95 (5.81)mU/l, 8.61 (8.34)mU/l, 2.52 (2.61) mU/ l.. The mean serum T3, T4 and TSH at 24hours were higher than cord blood levels (p&lt;0.001, 0.03, 0.05 respectively). The mean serum T3 and T4 at 72hours, were higherthan cord blood levels (p = 0.07, 0.44), whereas TSH at 72hours was significantly lower than cord blood levels; (p&lt;0.001).Conclusions: There was a rise, above cord level, of T3, T4 and TSH at 24hours, and a decline at 72hours, the latter being most marked in TSH. It is recommended that serum TSH taken at or greater than 72hours of life may be utilized for screening for congenital hypothyroidism in term babies,using postnatal age appropriate reference ranges. Serum T3, T4 should then be assayed for confirmation in all neonates with a positive TSH screening.Key words: Thyroid profile, postnatal changes, Term, Healthy neonates.