Mean Thyroid-stimulating Hormone Level Research Articles

COMPARATIVE ANALYSIS OF THYROID FUNCTION PROFILES BETWEEN POLYCYSTIC OVARY SYNDROME PATIENTS AND HEALTHY CONTROLS: A COMPREHENSIVE STUDY

Objective: To assess the thyroid function status of patients with Polycystic Ovary Syndrome (PCOS) and to compare it with that of healthy women. Methods: This was a descriptive cross-sectional study conducted in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynecology of a tertiary care hospital in Northern India. 30 patients diagnosed to have polycystic ovarian syndrome on the basis of the Rotterdam criteria were included in this study as cases (Group P). 30 healthy women were enrolled as the control group (Group H). The mean age and marital status of the patients were assessed. The body mass index of all the patients was also determined and compared. Systolic blood pressure, diastolic blood pressure, and pulse rate were also compared. A thyroid function test was done in both groups. The mean triiodothyronine (T3), T4, and thyroid-stimulating hormone (TSH) levels were compared in both groups. p<0.05 was taken as statistically significant. Results: The mean age of patients with PCOS and healthy individuals was 22.10±3.97 years and 23.76±3.97 years, respectively. The mean ages of both groups were found to be comparable in both studies (p=0.1108). The mean body mass index (BMI) of groups P and H was found to be 27.23±5.82 and 23.15±4.12, respectively. The women in group P were found to have a higher BMI as compared to women in group H, and the difference was found to be statistically significant (p=0.0027). The mean pulse rate, systolic blood pressure, and diastolic blood pressure values were found to be comparable. The mean FT3 levels in groups P and H were found to be 3.11±0.88 and 3.13±0.42 ng/mL, whereas the mean free thyroxine levels in groups P and H were found to be 0.96±0.16 and 0.89±0.15, respectively, μg/dL. The mean T3 and T4 levels of both groups were found to be comparable in both groups. However, the mean TSH level in groups P and H was found to be 4.95±2.24 and 2.50±1.19 0.3–4.5 μIU/ml, respectively. The mean TSH level in group P was found to be higher than group H, and the difference was found to be statistically significant (p<0.001). Conclusion: The prevalence of subclinical hypothyroidism was found to be significantly high in women with PCOS, making it necessary to do periodic thyroid function tests in PCOS.

The Relationship Between Homocysteine and Autoimmune Subclinical Hypothyroidism

Objectives: The present study was to correlate the association of homocysteine level with various profile of autoimmune subclinical hypothyroidism patients. Methods: A 40 subclinical hypothyroidism patients and 40 healthy control subjects were enrolled. The relevant laboratory parameters of patients who had been diagnosed with subclinical hypothyroidism due to Hashimoto’s thyroiditis in the clinic and were in follow-up, and whose homocysteine level had been tested in addition to assessment of thyroid function, thyroid autoantibodies, lipid parameters, thyroid ultrasonography, and hs-CRP were recorded. Patients with a thyroid-stimulating hormone (TSH) level above the normal range but with a free thyroxin (fT4) level within the normal range were considered to have subclinical hypothyroidism. Results: Mean TSH level of case and control group subjects were 6.71±1.23 and 2.11±o.34 µIU/mL respectively. Which is extremely significant (p<0.0001). Mean FT4 (ng/dL) level of case and control group subjects were 1.3±0.38 and 1.4±0.43 ng/dL respectively. Which is not significant differences(p=0.273). Anti-Tg level of case and control group subjects were 221.6±06.65 and 12.2±04.24 IU/mL) respectively. Which is extremely significant (p<0.0001). There was significant higher anti-Tg level in subclinical hypothyroidism patients as compared to control subjects. Similarly, anti-TPO level of subclinical hypothyroidism (165.8±05.17) patients were extremely significant (p <0.0001) as compared to control (6.7±02.65) subjects. Homocysteine was significantly associated with TSH level (p=0.028), FT4 level (p=0.017), anti-TPO level (p=0.000), anti-Tg (p=0.024) and Hs-CRP level (p=0.011) in subclinical hypothyroidism patients. Conclusions: Increased level of homocysteine is an independent factors for the diagnosis of autoimmune subclinical hypothyroidism. Key words: Autoimmune Subclinical Hypothyroidism, Homocysteine, TSH level.

Laparoscopic Sleeve Gastrectomy: Impact on Body Mass Index and Thyroid Hormones in Euthyroid Obese Patients.

BACKGROUND Obesity is still a major global public health problem and its incidence is increasing. Obesity leads to deterioration in thyroid functions. Even when they are within normal ranges, high normal levels of thyroid-stimulating hormone (TSH) increase morbidity and mortality. This study aimed to evaluate the body mass index (BMI) and TSH levels in 300 euthyroid patients with obesity before and after laparoscopic sleeve gastrectomy (LSG). MATERIAL AND METHODS A total of 300 euthyroid patients who underwent LSG between 2019 and 2021 were included in the study. Body mass index (BMI), thyroid-stimulating hormone (TSH), and free triiodothyronine (FT) 3 and tetraiodothyronine (FT4) levels were recorded before surgery and at 6 and 12 months after surgery and subsequently analyzed. RESULTS Mean BMI values were significantly lower at 6 and 12 months after surgery (P<0.001). There was a significant difference between mean TSH and FT4 levels before surgery and those at 6 and 12 months after surgery (P<0.001). However, mean FT3 levels remained unchanged 1 year after surgery (P=0.005). CONCLUSIONS LSG is not only effective in terms of weight loss, but also exhibits improving effects on thyroid hormone homeostasis in obese patients and provides protection against further adverse effects of TSH.

FRI426 Raised Thyroid Stimulating Hormone In Girls With Polycystic Ovary SyndromeEffects Of Randomized Interventions

Abstract Disclosure: L. Ibanez: None. C. Garcia-Beltran: None. J. Bassols: None. G. Carreras-Badosa: None. A. Lopez-Bermejo: None. F.E. de Zegher: None. Introduction: Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in non-obese adolescents with PCOS, including the effects of randomized interventions. Methods: Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET, aiming at a reduction of ectopic fat without necessarily lowering body weight) in non-obese adolescents with PCOS. A post-hoc analysis compared: TSH levels in PCOS (N= 62) vs controls; TSH changes on treatment (1 year); TSH levels post treatment (1 year). Results: Mean TSH levels were higher in PCOS patients than in control girls (P&amp;lt;0.01). On-treatment TSH levels diverged (P&amp;lt;0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Post-treatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R= 0.307, P= 0.017). Conclusion: The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in non-obese adolescents with PCOS are herewith extended to include on- and post-treatment TSH. Presentation: Friday, June 16, 2023

The Relationship Between Maternal Hypothyroidism and the Incidence of Congenital Hypothyroidism in Infants: A Cross-Sectional Study

Background: Congenital hypothyroidism (CH) can influence neonates’ neurodevelopment. There are controversies on the cause of infantile hypothyroidism and its relationship with maternal hypothyroidism. Objectives: This study aimed to investigate the relationship between maternal hypothyroidism and the incidence of CH. Methods: This cross-sectional study was conducted on 712 newborns with hypothyroidism born in Fars province, Iran, between 2018 and 2020, identified through the national screening program for genetic, metabolic, and endocrine congenital diseases recruited by the census sampling method. The information on infants’ files was recorded in a researcher-made checklist. Descriptive data were reported by mean ± SD and No. (%). The independent t-test, chi-square test, Pearson correlation, and Spearman’s rank correlation coefficient were used to evaluate relationships between variables. Results: Of 179,448 infants screened, 712 (4 of 1,000 live births) had CH with a mean thyroid stimulating hormone (TSH) level of 22.34+24.8 mlU/L. Of these, 252 infants (35.4%) had a family history of hypothyroidism in the mother (OR = 4.951, P &lt; 0.001). There was a significant relationship between CH and maternal hypothyroidism. Moreover, there was a significant difference in the mean TSH level between hypothyroid infants born to mothers with a history of hypothyroidism (19.10 ± 21.30 mlU/L) and those who had healthy mothers (24.23 ± 26.44 mlU/L, P = 0.027). The prevalence of CH in 2018, 2019, and 2020 were reported to be 0.34%, 0.4%, and 0.45%, respectively. Conclusions: Our results showed a significant relationship between maternal hypothyroidism and CH. Considering the importance of the prompt diagnosis of CH, especially in high-risk groups such as infants of hypothyroid mothers, it is recommended to conduct more studies to design more precise guidelines to screen infants who are at risk of CH.

The Prevalence of Thyroid Abnormalities in Patients With Chronic Kidney Disease: A Cross-Sectional Study at a Tertiary Care Hospital.

Background and objective Chronic kidney disease (CKD) is a clinical syndrome characterized by the irreversible loss of kidney function. It is a widespread condition affecting populations worldwide. The kidneys play a crucial role in the metabolism, breakdown, and elimination of thyroid hormone and thyroid-stimulating hormone (TSH). Consequently, thyroid dysfunction can occur as an endocrine manifestation in CKD patients. Previous studies investigating thyroid abnormalities and the severity of CKD have yielded diverse outcomes. In light of this, this study aimed to determine the prevalence of thyroid dysfunction in CKD patients and explore the association between different thyroid dysfunctions and markers of kidney function. Methods A total of 140 CKD patients who met the inclusion criteria were recruited, and their demographic details and routine investigations were recorded. Blood samples were collected for kidney function tests and thyroid function tests. The primary outcome measures included markers of kidney function [urea, creatinine, and estimated glomerular filtration rate (e-GFR)] and thyroid profile [TSH, free thyroxine (FT4), and free triiodothyronine (FT3)]. Mean and standard deviation (SD) were calculated for continuous variables, while frequencies were calculated for categorical data. Fisher's exact test was employed to evaluate the association between two categorical variables, and p-values below 0.05 were considered statistically significant. Results The mean (± SD) urea, creatinine, and e-GFR were found to be 139 (± 81.1) mg/dL, 5.33 (± 4.1) mg/dL, and 20.1 (± 15) ml/min/1.73 m2, respectively. Of note,133 (95%) patients had elevated urea levels, with the majority (n = 109, 77.8%) having urea levels between 40 and 199 mg/dL; 70 (50%) patients had creatinine levels less than 4 mg/dL, and 107 (76.4%) had e-GFR of less than 30 ml/min/1.73 m2. The mean (± SD) TSH, FT4, and FT3 levels were found to be 6.64 (± 11.2) mIU/ml, 13.6 (± 4.54) pmol/L, and 2.65 (± 1.89) pmol/L, respectively. It was observed that 18 (12.9%, 95% CI: 8.29-19.4%) of the CKD patients had hypothyroidism and 21 (15%, 95% CI: 10.02-21.8%) had subclinical hypothyroidism (SCH), while only two (1.4%, 95% CI: 0.39-5.05%) and five (3.6%, 95% CI: 1.5-8.08%) had hyperthyroidism and subclinical hyperthyroidism, respectively. Thirty-nine (27.9%, 95% CI: 21.1-35.8%) patients had low FT4 levels, whereas a considerable majority (n = 123, 87.9%, 95% CI: 81.41-92.28%) of the patients suffering from CKD were found to have low FT3 levels. The associations of urea levels with SCH, low FT4, and FT3 status were found to be statistically significant with p-values of 0.002, 0.033, and <0.001, respectively. The association between e-GFR and low FT3 status was also statistically significant, with a p-value of 0.014. Conclusion Nine out of 10 patients with CKD were discovered to have low FT3 levels, whereas one in four patients had low FT4 levels. The study participants also exhibited a significant presence of SCH and hypothyroidism, with prevalence rates of 15% and 12.9%, respectively. Urea levels and e-GFR, indicating the severity of CKD, showed a significant association with the presence of various thyroid abnormalities. Hypothyroidism in CKD patients can complicate disease progression, impact mortality rates, and affect overall quality of life. Therefore, routine screening for thyroid abnormalities should be conducted in all CKD patients.

The Relationship between Thyroid Disease and Diabetes a Retrospective Descriptive Study

From January of 2017 to January of 2018, 1,683 individuals seeking Endocrinology Department services at the Hayatabad Medical Complex (HMC) in Peshawar, Pakistan were evaluated, and 350 of them were diagnosed with thyroid disease in addition to diabetes. Through analyzing the data, it was discovered that those suffering from both ailments had heightened thyroid-stimulating hormone (TSH) levels, body mass index (BMI), and age. This data unmistakably shows that there is a favorable correlation between the two conditions. Reducing morbidity and mortality in individuals with both diabetes and thyroid disease may be achievable through timely diagnosis and appropriate care, as the data indicates. Furthermore, in the field of healthcare, the findings of this investigation have the potential to guide future research and policy decisions for HMCs and comparable healthcare environments, regarding the issue of diabetes and thyroid disease. Objectives: Endocrinology Department in HMC Peshawar's patients from Jan 2017 to Jan 2018 have their correlation between thyroid disease and diabetes extensively studied by this research's aim. Methods: From January 2017 to January 2018, all patients who were 18 years or older and underwent evaluation at the Department of Endocrinology in HMC, Peshawar were included in this retrospective descriptive study. Most of the patients who had thyroid disease and diabetes were female, comprising 71.7% of the sample, with an average age of 52.7 11.6 years. The mean BMI was 28.3 6.2 kg/m2. The mean TSH level of patients with thyroid disease and diabetes was found to be 5.8-2.5 mIU/L. Demographic and clinical data were collected through careful review of patient medical records. Thyroid-stimulating hormone (TSH) level, treatment outcome, age, sex, BMI, and history of diabetes/thyroid disease were all noted in the gathered data. Results: In the department of endocrinology at HMC, 1683 patients were assessed during the study period, and among them, 350 were found to have thyroid disease and diabetes. As for gender division, most patients with both conditions were female (71.7%). Their average age was 52.7 11.6 years, and they had a mean BMI of 28.3 6.2 kg/m2. The TSH level in these patients averaged 5.8–2.5 mIU/L. On the whole, 97.1% of patients responded well to treatment, managing to either achieve remission or gain partial relief. Conclusion: The results of this study indicate that there is a positive correlation between diabetes and thyroid disease. The study also revealed that BMI, age, and TSH levels were significantly higher among those with diabetes and thyroid disease. These findings highlight the importance of early detection and effective management of both conditions to reduce morbidity and mortality in patients with diabetes and thyroid disease. The results of this study can also be used to inform future research and healthcare policies to address the issue of diabetes and thyroid disease in HMC and other healthcare settings. Keywords: diabetes, thyroid disease, correlation, HMC Peshawar, BMI, TSH, treatment, morbidity, mortality

Effect of Valproate Monotherapy on Thyroid Function Tests and Magnesium Levels in Children With Epilepsy.

Antiseizure drug valproate alters thyroid functions. Magnesium is implicated in the pathogenesis of epilepsy and it may affect the efficacy of valproate and thyroid functions. To study the effect of six months of valproate monotherapy on thyroid functions and serum magnesium levels. To study the association among these levels and the effects ofclinicodemographic profile. Children aged three to 12 years presenting with newly diagnosed epilepsy were enrolled. A venous blood sample was collected for estimation of thyroid function test (TFT), magnesium, and valproate levels at onset and after six months of valproate monotherapy. Valproate levels and TFT were analyzed by chemiluminescence and magnesium by colorimetric method. Thyroid stimulating hormone (TSH) increased significantly from 2.14±1.64 µIU/ml at enrollment to 3.64±2.15 µIU/ml at six months (p<0.001), free thyroxine (FT4) decreased significantly (p<0.001). Serum magnesium (Mg) decreasedfrom 2.30±0.29 mg/dlto 1.94±0.28 mg/dl(p<0.001). At six months, eight out of 45 (17.77%) participants had significantly increased mean TSH levels (p=0.008). Serum valproate levels were not associated significantly with TFT and Mg (p<0.05). There was no effect of age, sex, or repeat seizures on the measured parameters. The TFT and Mglevels are altered by six months of valproate monotherapy in children with epilepsy. Hence we suggest monitoring and supplementation if required.

The Association of Thyroid-Stimulating Hormone (TSH) Levels and Lipid Profile in Euthyroid Patients with Familial Hypercholesterolemia.

Previous studies reported a relationship between thyroid-stimulating hormone (TSH) and low-density lipoprotein cholesterol (LDL-C) levels. In this study, we aim to evaluate the impact of TSH levels on lipid profile in patients with familial hypercholesterolemia (FH) and euthyroid state. Patients were selected from the Isfahan FH registry. The Dutch Lipid Clinic Network (DLCN) criteria are used to detect FH. Patients were classified into no FH, possible FH, probable FH, and definite FH groups based on the DLCN scores. Patients with any cause of secondary hyperlipidemia, including hypothyroidism, were excluded from this study. The study group consisted of 103 patients with possible FH, 25 patients with definite FH, and 63 individuals with no FH. The mean TSH and LDL-C levels among participants were 2.10 ± 1.22 mU/l and 142.17 ± 62.56 mg/dl, respectively. No positive or negative correlation was found between serum TSH and total cholesterol (P value = 0.438), high-density lipoprotein cholesterol (P = 0.225), triglycerides (P value = 0.863), and LDL-C (P value = 0.203). We found no correlation between serum TSH levels and lipid profiles in euthyroid patients with FH.

Prevalence of Subclinical Hypothyroidism in Obese Adults Population

Objective: Determination of frequency of occurrence of subclinical hypothyroidism (SCH) in a local population of obese adults Study design: A cross-sectional study Place and Duration: This study was conducted at Sindh Government Lyari General Hospital Karachi from March 2022 to March2023 Methodology: The patients aged between 18 years to 55 years. All the participants had a body mass index (BMI)of more than 29 kg/m2. As per the exclusion criteria, those patients having kidney failure, liver failure, or already diagnosed with thyroid dysfunction, were not added to the study. Patients taking cholesterol-lowering drugs were also not considered in the study. A blood sample of all the patients was collected for the measurement of serum thyroxine levels and serum thyroid stimulating hormone (TSH) levels. Results: A total of 150 obese adults were considered in the study. The mean age of the participants was 35.7±8.1 years. Overall69 (46%) patients were male while 81 (54%) patients were females. The mean BMI of the patients was 32.1±2.1 kg/m2. The mean serum thyroxine level in the given population was 1.09±0.24 ng/dl and the mean serum TSH level was 3.12±1.09 mIU/L. A total of 24 (16%) patients were detected with subclinical hypothyroidism. Conclusion: Subclinical hypothyroidism is vastly prevalent in the obese adult population, particularly in adults with a BMI of more than 29 kg/m2. However, there is room for further studies to examine the correlation between obesity and SCH. Keywords: Subclinical Hypothyroidism, Obesity, TSH, Thyroxine, Body mass index

Correlation of Maternal Thyroid Stimulating Hormone Levels With Lipid Profile in Pregnant Women With Hypothyroidism.

Introduction Pregnancy leads to changes in hormonal levels and lipid profile. Thyroid hormones play a crucial role in embryonic growth and fetal development. Untreated thyroid disease during pregnancy can lead to a high risk of complications. Aim The aim of the study is to examine the correlation between thyroid stimulating hormone (TSH) and lipid profile in pregnant women with hypothyroidism. Materials and methods This cross-sectional case-control study was conducted at the Biochemistry Department, Alfalah School of Medical Science & Research Centre, Dhauj, Faridabad, Haryana, India.The study consisted of 500 patients (250 cases and 250 controls) who fulfilled the inclusion and exclusion criteria. Of the 250 cases recruited, 23 cases were in the 2nd trimester and 209 cases were in the 3rd trimester. Blood samples were collected from the participants to assess their lipid profile and TSH levels. Results The study showeda statistically significant difference between the mean TSH levels of hypothyroid pregnant females in the 2nd trimester (3.85 ± 0.59) and the 3rd trimester (4.71 ± 0.54). There was a significant positive correlation observed between TSH and Total Cholesterol, Triglycerides, and LDL-C in both the 2nd and 3rd trimesters.In the second trimester, there was a significant positive correlation observed between TSH & TC (r = 0.6634, p<0.0005), TSH & TG (r= 0.7346, p=0.00006), TSH & LDL (r= 0.5322, p= 0.008). In the third trimester, there was a significant positive correlation observed between TSH & TC (r = 0.8929, p<0.00001), TSH & TG (r= 0.430, p<0.00001), TSH & LDL (r= 0.168, p= 0.015). However, no significant correlation was found between TSH levels and HDL-C in either trimester. The correlation coefficient and p-value for TSH & HDL were r = 0.2083, p=0.340 in the second trimester, and r = 0.0189, p=0.2384 in the third trimester. Conclusion A significant increase in TSH levels in hypothyroid pregnant women was observed in the 3rd trimester compared to the second trimester. Moreover, a significant positive correlation was found between TSH and lipid profile (total cholesterol, triglycerides, and LDL) in both trimesters, but not with HDL. These findings highlight the importance of monitoring thyroid hormone levels in the later stages of pregnancy to avoid potential maternal & fetal complications.

Prevalence and outcomes of hypothyroidism-induced acute kidneyinjury.

Hypothyroidism is an important reversible cause of acute kidney injury (AKI), acting through various mechanisms, including rhabdomyolysis, metabolic, and systemic effects. We screened all patients presenting with AKI for hypothyroidism, and suspected hypothyroid-induced AKI patients were followed up. The prevalence of hypothyroidism-induced AKI was 1.9%, with the commonest presenting symptom being pedal edema. The mean thyroid-stimulating hormone levels (mIU/L) and estimated glomerular filtration rate (eGFR) (mL/min/1.73m2) were 123.5 ± 22.32 and 29.4 ± 20.54, respectively, at presentation, and 3.28 ± 4.91 and 71.39 ± 40.28, respectively, at the end of 8 weeks. Creatine Phosphokinase (CPK) was significantly elevated in only 1 patient. One patient became dialysis-dependent (11.1%), 2 had partial renal recovery (22.2%), and 6 patients had complete renal recovery (66.7%). There was a significant positive correlation between renal recovery and CPK at admission, eGFR at admission, and hemoglobin, and a significant negative correlation with the presence of chronic kidney disease, urea at admission, and creatinine at admission. Thyroid hormones exert various effects on the kidney, and their imbalance can significantly alter renal function. Elevated creatinine with normal GFR can occur due to increased release of creatinine. Our study is the first published series of hypothyroid-associated AKI with follow-up data.

Thyroid Disorders in Reproductive Females with Abnormal Uterine Bleeding

Methodology: One hundred outpatient females who were having difficulties related to their thyroid bleeding were accepted into the study. Patients with ages ranging from 40 to 55 years were included in this study. Every lady was evaluated to establish whether or not she was suffering from abnormal uterine bleeding, and her thyroid profile was analyzed as well. The procedure for the research study consisted of getting a detailed history from the participants regarding any anomalies in their periods. In addition to these, standard blood tests including random blood sugar, haemoglobin, erythrocyte sedimentation rate, liver function test, pap smear, bleeding time, clotting time, endometrial biopsy, transvaginal ultrasonography and transabdominal, serum T3 (T3), T4 (T4), and thyroid stimulating hormone (TSH) were performed. These tests were carried out on the patient. Results: Mean age as 46.8+5.98 years and mean BMI was calculated as 27.98+6.21(kg/m2). Mean TSH levels were 4.4+2.5(mIU/L), T3 level were 3.4 ± 1.7 (pmol/L), and T4 level were 1.8 ± 0.6 (pmol/L). We found Menorrhagia as the commonest bleeding pattern 49(49%) followed by Oligomenorrhea in 30(30%), Hypomenorrhea in 11(11%) and Metrorrhagia in 2(2%) of the cases. Conclusion: Among the patients with abnormal uterine bleeding, hypothyroidism was common finding and hyperthyroidism was associated with lesser amount of bleeding. Moreover abnormal BMI is a major risk factor for the abnormal uterine bleeding. Keywords: Abnormal uterine bleeding, hypothyroidism, body mass index

Raised Thyroid-Stimulating Hormone in Girls with Polycystic Ovary Syndrome: Effects of Randomized Interventions

Introduction: Polycystic ovary syndrome (PCOS) in women associates with raised levels of circulating thyroid-stimulating hormone (TSH) and with high rates of gestational complications. A low range of preconception TSH is followed by low rates of gestational complications. It is unknown whether TSH levels are elevated in adolescents with PCOS and, if so, whether traditional or exploratory treatments can lower them into safe preconception range. We investigated TSH in nonobese adolescents with PCOS, including the effects of randomized interventions. Methods: Morning TSH was a safety marker in randomized pilot studies comparing the effects of an oral contraceptive (OC) versus those of a low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) in nonobese adolescents with PCOS. A post hoc analysis compared TSH levels in PCOS (N = 62) versus controls, TSH changes on treatment (for 1 year), and TSH levels posttreatment (for 1 year). Results: Mean TSH levels were higher in PCOS patients than in control girls (p < 0.01). On-treatment TSH levels diverged (p < 0.001), remaining elevated on OC, and descending swiftly on SPIOMET, well into safe preconception range. Posttreatment TSH levels were stable in both subgroups. On-treatment changes of circulating TSH associated to those of liver fat (R = 0.307, p = 0.017). Conclusion: The endocrine signature of early PCOS is herewith extended to include modestly raised levels of circulating TSH; the normalizing effects of SPIOMET intervention in nonobese adolescents with PCOS are herewith extended to include on- and posttreatment TSH.

Evaluation of Serum Cortisol Levels in Patients with Hypothyroidism at a Tertiary Care Hospital, Telangana, India: A Case-control Study

Introduction: Serum Cortisol is a glucocorticoid hormone released from the zona fasciculata layer of the adrenal cortex, which plays an important role in regulation of blood pressure and metabolism. Hypothyroidism causes elevated cortisol levels due to both decreased clearance and negative feedback of cortisol on the hypothalamic pituitary-adrenal axis. Aim: To investigate the correlation of serum cortisol and with Triiodothyronine (T3), Thyroxine (T4), Thyroid Stimulating Hormone (TSH) and serum cortisol levels in patients with hypothyroidism. Materials and Methods: Present case-control study was carried out in the Department of Biochemistry, Gandhi Medical College and Hospital, Secunderabad, Telanagana, India, July 2022 to August 2022. A total of 60 patients with hypothyroidism (cases) aged between 35-60 years, and 60 controls were selected from Gandhi Medical College and Hospital. Samples were analysed in Siemens Advia centaur XPT. T3, T4, TSH and cortisol levels were estimated by “CLIA” method. Data were statistically analysed using Karl Pearson’s correlation test. Results: In present study, there were five males and 55 females in control group, 23 males and 37 females were in case group. The mean age in cases was 39.39±6.44 years and in control group was 39.38±10.97 years. The mean T3 in subjects cases was 10.74±5.34 ng/mL, as compared to 8.93±2.78 ng/mL, in controls. The mean TSH level in cases was 13.38±20.43 mIU/L, as compared to 3.47±4.20 mIU/L, in controls. The mean cortisol level in cases was 64.88.44±16.25 µg/dL, as compared to 9.55±5.59 µg/dL, in controls. There was significant positive correlation between serum cortisol level and T3 (r=0.12, p-value 0.02), T4 (r=0.12, p-value 0.02), and TSH Levels ( r= 0.31, p-value 0.01) in case group. Conclusion: The results of present study showed that serum levels of cortisol were significantly increased in hypothyroidism patients as compared to normal healthy controls.

Higher Levels of Plasma Fetuin-A, Nrf2, and Cytokeratin 18 in Patients with Hashimoto's Disease.

Fetuin-A is a protein that exhibits proatherogenic, pro-inflammatory, and anti-inflammatory effects with increased insulin resistance and adipocyte dysfunction. The nuclear factor erythroid 2-related factor (Nrf2) is a transcription factor that is crucial for protecting cells against oxidative damage. As a cell death product, cytokeratin 18 (CK18) levels increase during necrosis and apoptosis of both normal and tumor cells. We analyzed the plasma levels of three biomarkers based on the hypothesis that they might be related to some pathophysiological pathways in Hashimoto's disease. We compared 34 female patients with overt hypothyroidism due to Hashimoto's disease (Group 1) with 34 age-matched healthy females (Group 2). For comparison, plasma levels of thyroid-stimulating hormone (TSH), fetuin-A, Nrf2, and CK18 were measured in all participants. In group 1, the mean TSH levels (31.4±15.3) were significantly higher than those in group 2 (2.6±1.0) (p<0.001). The levels of mean fetuin-A (606.7±34.2) and Nrf2 (1.3±0.6) were found to be significantly higher in group 1 than in group 2 (440.0±34.2 vs. 0.7±0.2) (p<0.001 for both). CK18 levels in group 1 (0.36±0.13) were also significantly higher than in group 2 (0.26±0.16) (p=0.020). A significant correlation was observed between TSH levels and fetuin-A (r=0.401, p=0.001). Increased levels of fetuin-A, Nrf2, and CK18 may be a consequence or cause of the pathophysiological pathways of Hashimoto's disease. The clinical significance of increased levels of these biomarkers requires further investigation.

Thyroid Hormone Levels in Term Neonates with Early-onset Sepsis and Healthy Controls in Northwest India

Background: Neonatal sepsis is responsible for about 30%–50% of the total neonatal deaths in developing countries. Thyroid hormone changes are highly common in hospitalized patients or with critical illnesses. The aim of the study is to compare thyroid hormone profile in term neonates with early-onset sepsis (EOS) and healthy controls and their association with outcome of sepsis. Materials and Methods: A total of 150 neonates, 75 cases with EOS and 75 healthy controls, were included in this study. EOS was defined according to the European Medical Agency Sepsis Criteria of neonatal sepsis. Results: The mean free triiodothyronine and mean thyroid-stimulating hormone level in neonates with EOS were significantly lower than in control group. Conclusion: Neonatal sepsis causes significant alteration in thyroid hormone profile in term neonates with EOS.

Is a four-week hormone suspension necessary for thyroid remnant ablation in low and intermediate risk patients? A pilot study with quality-of-life assessment

Radioiodine therapy (RIT) is a complementary treatment to total thyroidectomy in differentiated thyroid cancer (DTC) patients. High levels of thyroid-stimulating hormone (TSH) are usually required in clinical practice to increase RIT efficacy. Suspension of levothyroxine hormone for weeks is usually necessary, greatly impacting patients' quality of life. Patients with DTC of low or intermediate-risk were divided into two groups - one where levothyroxine was suspended for 4-5 weeks and a TSH ≥ 30 mUI/L was required for radioiodine administration (group 1), and another where levothyroxine was suspended for two weeks only (group 2). The RIT efficacy was compared between the groups. The absorbed dose in the cervical region after 24 hours was also calculated and correlated with TSH. The quality of life was also accessed with the EORTC questionnaire. Thirty-one patients were included in this study (14 in group 1 and 17 in group 2), with a mean age of 45.7 ± 10.6 years and 29 (93.5%) females. The mean TSH level for group 1 was 67.0 ± 35.6 UI/ml, and for group 2 was 31.3 ± 29.4 UI/ml. After six months, the successful RIT frequency was 66.6% for group 1 and 73.3% for group 2. Patients from group 2 showed better quality of life. TSH level ≥ 30 mUI/L is not critical for the success of RIT in patients with low or intermediate risk DTC. A two-week suspension of thyroid hormone appears to meet similar RIT needs, providing a better quality of life.

Homoeopathic Treatment of Young Females with Subclinical Hypothyroidism: A Prospective Observational Study

Abstract Introduction Subclinical hypothyroidism (SCH) is defined as elevated levels of serum thyroid-stimulating hormone (TSH) (TSH: 5–20 μIU/mL; normal range: 0.15–3.5 μIU/mL) with normal serum levels of free thyroid hormones mainly free T4 (0.89–1.76 ng/dL). SCH does not affect the development process very much and hence there are no universally accepted recommendations for its treatment but it is important to have optimal thyroid function for normal growth and development in children; it may progress to overt hypothyroidism and other health issues. So, its diagnosis in early stage of life and hence its treatment will definitely benefit the growing children. Objective The objective of this study is to review the role of homoeopathy in SCH in younger aged females. Method Total 212 cases were screened, 54 diagnosed cases of SCH were enrolled on the basis of inclusion criteria and 4 cases dropped out from the study. Total 50 cases were given individualised homoeopathic medicines based on repertorisation of totality of symptoms and in consultation with Materia Medica. Result Results showed significant difference after comparing pre- and post-treatment values using paired t-test; the difference in mean values of Serum TSH values was found to be statistically significant (p-value &lt; 0.00001). At baseline, the mean TSH level was 7.158 μIU/mL which decreased to 4.368 μIU/mL (p &lt; 0.00001). Conclusion This study indicates the positive role of homoeopathic therapy in the management of SCH. Such study with bigger sample size through randomised controlled trial is needed for further validation.

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.