Mean Thyroid-stimulating Hormone Research Articles

Thyrotropin and body mass index, are they related?

It is well recognized that overt thyroid dysfunction is associated with changes in body mass index(BMI). However, there is ongoing debate regarding the influence of thyroid stimulating hormone (TSH) on BMI, in euthyroid subjects. The aim of this study is to examine the association of TSH with BMI in an outpatient population without evidence of thyroid disease. Cross-sectional study conducted in an Endocrinology Department. We identified the latest TSH andBMI measurements in 923 patients from the reference euthyroid population. All patients with positive thyroid autoimmunity and nodules were excluded. We performed alinear regression analysis using SPSSv.025. 923 adult patients were evaluated. 79.4% were males, with a mean age of 67.6 years old. Mean TSH levelwas 1.78mIU/L and mean BMI was 29.2kg/m2. A significant negative correlation between serum TSH concentration and BMI was evident (p=0.04; r=-0.067). Statistical significance was lost when performing subgroup analysis, for males and females (p=0.19 and p=0.075), elderly (≥65years) and non-elderly (p=0.55 and p=0.32) andalso obese (BMI≥30kg/m2) and non-obese (p=0.39 and p=0.13). The relationship between BMI and TSH is notconsensual in the literature. This study included a largecohort sample of euthyroid patients, majority men and with negative autoimmunity. Our results support the hypothesis that variation in thyroid status within the normal range, could have a negative effect on BMI, contrary to most published studies.

Hypothyroidism in Children with Β-Thalassemia at a Tertiary Hospital of South Punjab, Pakistan

Objective: To determine the prevalence of hypothyroidism among children with β-thalassemia major. Study Design: Cross-sectional study. Place and Duration of the Study: The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, Bahawal-Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from 1st January 2021 to 31st December 2021. Methodology: A total of 125 children of both genders (2 to 18 years) with diagnosis of β-thalassemia major were analyzed. Two ml blood sample under strict aseptic conditions was obtained from every study participant and sent to Institutional Pathological Laboratory for thyroid-stimulating hormone (TSH), T3, and T4. Results: In a total of 125 children with β-thalassemia major, 78 (62.4%) were male. Overall, mean age was 8.57±4.75 years while 57 (45.6%) children were aged between 6 to 10 years. Residential status of 84 (67.2%) children was rural. Parental consanguineous marriages were reported in 91 (72.8%) patients. Mean TSH, T3 and T4 levels were calculated to be 3.27±1.38 pmol/L, 4.71±0.75 pmol/L and 11.80±2.38 pmol/L respectively. Hypothyroidism was noticed in 38 (30.4%) children. Conclusion: Prevalence of hypothyroidism in children with β-thalassemia major was high. Early identification and management of hypothyroidism in β-thalassemia major may improve overall quality of life among these affected children Keywords: Β-thalassemia major, hypothyroidism, thyroid-stimulating hormone.

Assessment of Iodofolic Supplementation on Thyroid Function in Pregnant Women with Iodine Sufficient Status and their Infants in Birjand.

Maintaining iodine at sufficient levels is necessary throughout the pregnancy to prevent adverse outcomes in infants. This study aimed to assess iodofolic supplementation's impact on thyroid function in women at the end of the third trimesters of gestation. This case-control study was conducted on 130 pregnant women in the Birjand, east of Iran, during the period from August 2017 to February 2019. We assessed iodofolic supplementation effect in the women at the first trimesters of gestation and followed them at the end of the third trimesters and also their infants on days 3-5. Serum samples were obtained from women and infants for measuring levels of thyroid-stimulating hormone (TSH). Urinary iodine concentration (UIC) was also determined at the end of the third trimester. The median serum TSH concentration in the folic acid consumed group (3.26 ± 1.91) did not significantly differ from another group (2.98 ± 1.41), (p = 0.68). There is also no considerable difference in the mean serum TSH concentration between infants born from mothers who consumed folic acid in the first trimester of pregnancy and another group (p = 0.50). The TSH concentration in all infants was below 5 μM/L. The significant difference in the mean of UIC was also not observed between pregnant women in the folic acid consumed group (188.02 ± 105.38) and iodofolic consumed group (225.77 ± 130.26), (p = 0.13). Iodine intake in our study was sufficient according to the WHO recommendation and idofolic supplementation was not emphasized.

Thyroid Dysfunction During Combined Pegylated Interferon Alpha and Ribavirin Therapy in Patients of Chronic Hepatitis C-Virus Infection

Objective: To determine frequency of thyroid dysfunction among patients of chronic hepatitis C receiving combined pegylated interferon alpha and ribavirin therapy.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi, from Jan to Jul 2017.
 Methodology: One hundred and twenty patients, aged 18–60 years from both genders, with established hepatitis C were included; while the patients with decompensated liver disease, previous antiviral treatment, pre-existing thyroid, autoimmune or severe cardiopulmonary disease and on immuno-suppressants or steroids were excluded. After formal informed consent, they were prescribed 24 weeks pegylated interferon alpha-2 (3 million units subcutaneously thrice weekly) and oral ribavirin (1000–1200 mg daily) therapy. After 12 weeks, serum thyroid stimulating hormone, free thyroxine and triiodothyronine levels were determined by chemiluminescence technique.
 Results: Out of 120 patients, 100 (83.33%) were males and 20 (16.67%) were females with male to female ratio of 5:1. Mean thyroid stimulating hormone levels at baseline and 12 weeks were 2.86 ± 1.03uiu/ml and 2.16 ± 0.79 uiu/ml respectively. Mean triiodothyronine levels at baseline and 12 weeks were 3.27 ± 1.31pg/ml and 2.69 ± 1.01 pg/ml respectively. Mean thyroxine levels at baseline and 12 weeks were 1.26 ± 0.38 pg/ml and 1.07 ± 0.53 pg/ml respectively. Frequency of thyroid dysfunction was found in 40 (33.33%) patients.
 Conclusion: Frequency of thyroid dysfunction among hepatitis C patients receiving combined pegylated interferon alpha and ribavirin therapy is quite high.

Prevalence of Congenital Hypothyroidism in Neonates

Objective: To determine the frequency of congenital hypothyroidism in neonates. Patients and Methods: A total number of 200 neonates born through SVD and cesarean section after 37 weeks of gestation aged 48 hours of birth to 2 weeks of neonatal age (as serum of neonates less than 48 hours of life contain mother’s serum level of TSH were included. The study was conducted from 05-Nov-2020 to 04-May-2021. Data regarding neonates’ age, gender, weight, and height was taken. 2cc venous blood was taken for serum TSH and T4 level. Neonates having TSH hormone level more than 20mIU/mL were labelled as having congenital hypothyroidism (CH). Results: Mean age of neonates was 9.63±3.94 days. There were 113 (56.50%) females and 87 (43.50%) male neonates. Mean weight of neonates was 2970.28±516.32 grams. Mean height of neonates was 52.23±2.11 cm. Mean gestational age was weeks. Mean occipitofrontal circumference of neonates was 34.69±1.29 cm. Mean TSH level were 6.64±7.92 mIU/L. Mean T4 level was 23.70±4.25 µg/dL. CH was diagnosed in 4 (2.0%) neonates. Conclusion: Congenital hypothyroidism (CH) is common among neonates. In present study CH was diagnosed in 2.0% neonates who were screened for CH. So CH screening should be done in all neonates to diagnose CH at early stages and to prevent complication of CH in these neonates. Keywords: Thyroid Stimulating Hormone (TSH), Congenital Hypothyroidism (CH),

Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City.

Normal thyroid activity has an essential role in fetal development, its deficiency may hamper fetal neurodevelopment and neonatal growth. The quantitation of thyroid hormones although useful, still exposes differences on cut off levels to diagnose thyroid deficit accurately that can elicit under or over diagnosis of thyroid dysfuntion. A total of 839 pregnant patients were studied for thyroidal clinical assessment through quantitation of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) circulating levels. Patients evaluated for prenatal and neonatal outcomes. Thyroid function deficiencies were determined with the American Thyroid Association (ATA) 2011 and 2017 values. Statistical analysis searched for associations between variables, odds ratios (OR) and correlations were calculated to evaluate the reliability of the cutoff values recommended by the ATA. Mean age of our cases was 27.5+5.83 years at diagnosis, mean gestational age at first consultation was23.8+10.5weeks. Mean TSH levels detected were: 2.5+1.89mIU/L, total T3: 3.55+4.1ng/dL, FT4: 3.14+4.4ng/dL. The ATA 2011 values yielded 332 hypothyroidism cases vs. 507 euthyroid patients, a total incidence of39.6% vs. the ATA 2017 values, diagnosing 100 hypothyroidism cases and 739 euthyroid patients, total incidence of 11.9%. Association with complications were not significant. Using ATA 2017 values showed a decreased population with gestational hypothyroidism, hence preventing overdiagnosis and over-treatment. No significant complications were associated, requiring the determination of new regional values. Education and sensibilization of our population is needed to comply with early prenatal consultation and thyroid function testing.

Differences in Pre-Operative Mean Serum Concentration of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) in Patients with Benign Thyroid Nodules and Thyroid Carcinoma at Sanglah General Hospital Denpasar

Background: Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) concentration are currently highlighted in their relation to thyroid carcinoma development in thyroid nodule patients. This study aimed to identify the difference in the pre-operative mean serum concentration of TSH and FT4 in patients with benign thyroid nodules and thyroid carcinoma at Sanglah General Hospital Denpasar.Methods: : This study was a case-control study that involved 110 patients with thyroid nodules who underwent thyroidectomy at Sanglah General Hospital from January until December 2019, whose specimens were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah General Hospital. Cases were patients with thyroid carcinoma. Controls were patients with benign thyroid nodules. The data were collected from medical records. Results: Most subjects in the thyroid carcinoma group were female (72.7%). The thyroid carcinoma group had a higher mean age at the time of thyroidectomy (47.33 ± 13.4) compared to the benign thyroid nodule group (46.07 ± 12.5) (p = 0.61). Significant difference was found regarding the nodule size between the two groups (p < 0.001). There were no significant differences in terms of nodule lateralization (p = 0.56) and the number of nodules (p = 0.58). Papillary thyroid carcinoma was the most common type of thyroid carcinoma (89.1%). A significantly higher pre-operative mean serum TSH concentration was found in cases (1.0 ± 0.23 IU/mL) compared to controls (0.8 ± 0.23 IU/mL) (p < 0.001). The pre-operative mean serum FT4 concentration was significantly lower in cases (1.1 ± 0.25 IU/mL) compared to controls (1.2 ± 0.22 IU/mL) (p = 0.006). The optimal TSH and FT4 cut-off values for thyroid carcinoma were > 1.0 IU/mL (61% sensitivity, 71% specificity) and < 1.1 IU/mL (61% sensitivity, 51% specificity), respectively Conclusions: : Higher pre-operative mean TSH concentration and lower mean FT4 concentration were found in patients with thyroid carcinoma. There were statistically significant differences between patients with thyroid carcinoma and benign thyroid nodules in terms of these two laboratory parameters.

Thyroid status in children with severe acute malnutrition

Objectives: The objective of the study is to study thyroid hormone levels in children with severe acute malnutrition (SAM) and its correlation with serum total protein and albumin levels. Materials and Methods: A prospective cross-sectional study was carried out at Nutritional Rehabilitation Centre, Hubli, from Dec 2018 to Nov 2019. Inclusion criteria: All children in the age group of 6–59 months with SAM. Exclusion criteria: (i) Children suffering from metabolic disorders, tuberculosis, urinary tract infection, malabsorption syndrome (celiac disease), protein losing enteropathy, and nephrotic syndrome; (ii) Children with major congenital anomalies; and (iii) Children with chronic liver and kidney diseases. All enrolled children’s details of demography, clinical history, and examination were entered in a predesigned pro forma. Total triiodothyronine (TT3), total thyroxine (TT4), thyroid-stimulating hormone (TSH), and serum total protein and albumin were estimated. Data were analyzed using SPSS Version 16. Results: Total of 50 children fulfilled criteria during study period. Mean age of presentation was 18 ± 2.1 months with male-to-female ratio 0.8:1. The mean TT3 (ng/dl), TT4 (mcdg/l), and TSH (mIU/L) were 109.8 ± 50.6, 8.36 ± 3.7, and 2.5 ± 1.8, respectively. Mean total protein and albumin were 5.5 ± 1.4 g/dl and 2.97 ± 0.9 g/dl. Overall, 18 (36%) children had low total protein and 17 (34%) have low serum albumin. Low serum TT3, and TT4 levels were found in 11 (22%) and 14 (28%), respectively, and elevated TSH in 4 (8%) children. Low T3 was significantly associated with low albumin (P < 0.01). Conclusion: The impaired thyroid function and low serum T3 levels seen in SAM children were probably an adaptive change to malnutrition.

Predictive Significance of High Sensitive C-reactive Protein in Subclinical Hypothyroidism: A Prospective Observational Study

Introduction: Subclinical hypothyroidism (SCH) is more common than overt hypothyroidism. It is associated with increased risk of dyslipidaemia, Coronary Artery Disease (CAD), left ventricular diastolic dysfunction, peripheral vascular diseases and chronic inflammation. Chronic inflammation plays a significant role in clinical manifestations and systemic organs injury in hypothyroidism. High-sensitivity C-reactive Protein (hs-CRP) is a pentameric protein produced by the liver, and its level increases in response to inflammation. There are not much studies to prove that chronic inflammation could be a major risk factor for conversion of subclinical hypothyroidism in to overt hypothyroidism. Aim: To study the role of chronic inflammation as a risk factor for conversion of SCH in to overt hypothyroidism with lipid abnormalities and cardiac dysfunction, by using inflammatory markers like hs-CRP. Materials and Methods: This prospective observational study was conducted at KR hospital, Mysuru, Karnataka, India, from August 2019 to September 2020 among 112 subjects of subclinical hypothyroidism attending the Outpatient Department. The data regarding detailed history and clinical examination were collected from all the patients. Investigations such as Thyroid Stimulating Hormone (TSH), Triiodothyronine (T3), Thyroxine (T4) levels hs-CRP level, lipid profile, Electrocardiogram (ECG), Random Blood Sugar (RBS), Renal Function Test (RFT), Complete Blood Count (CBC), 2D-Echocardiography were done on day one and after 6 months. The data analyses was done by using the Chi-square test or Fisher’s-exact test. The factors which were significant as per the Chi-square test were selected and subjected to multivariate analysis. Results: The number of cases of subclinical hypothyroidism (hs-CRP >3 mg/L, mean TSH=9.1±2.1 microIU/mL) at first day were 23 (20.53%). At the end of 6 months those converted to overt hypothyroidism (mean TSH=11.4±2.3 microIU/mL) were 14 (12.5%) patients. The patients with hs-CRP of >3 mg/L, with mean TSH of 11.4±2.3 microIU/mL at the end of 6 months of study, had left ventricular dysfunction in 68 (60.07%) patients. In the same group, the low-density lipoprotein cholesterol >160 mg/dL was found in 60 (53.57%) patients and serum triglycerides level >200 mg/dL was found in 51 (45.53%) patients (p-value <0.05). Conclusion: Chronic inflammation is one of the major risk factor for conversion of subclinical hypothyroidism in to overt hypothyroidism with associated cardiovascular dysfunction and dyslipidaemia.

A Study of Thyroid Profile (FT3, FT4, TSH) in Liver Cirrhosis in Jharkhand - A Hospital based Study

in people with liver disorders. Aim: To determine the prevalence of thyroid dysfunction in liver cirrhosis patients. Materials and Methods: This case-control study was carried out in a group of randomly selected liver cirrhosis patients in the Department of Medicine at Rajendra Institute of Medical Sciences (R.I.M.S), Ranchi, Jharkhand (India) between September 2017 to August 2018. The equal number of age (>18 years) and sex-matched cases &controls were included in this study. Radioimmunoassays were used to evaluate early morning fasting blood thyroid-stimulating hormone (TSH), serum total free thyroxine (FT4), and free triiodothyronine (FT3) in 100 index patients with liver cirrhosis who had no history of thyroid disorders. Results: In the cases that were studied, which consisted of cirrhotic patients, males (80%) outnumbered females (20%). The mean age of cases was 47.9 years, and the maximum numbers of the patient were between 41-55 years of age group (47%). Among the cirrhotic patients, the commonest etiology was alcoholic liver disease which contributed to 78% of the total cases studied. The rest of the cases included cirrhotics from other etiologies, which included NAFLD (22%), HBsAg positive individuals (07%), and other cases of cryptogenic origin. The mean FT3, FT4, and TSH values in cases were 2.29±0.83; 1.20±0.55 & 3.76±2.43 respectively & the mean FT3, FT4, and TSH of the control group were 2.95±0.52; 1.40±0.25 & 2.70±0.94 respectively. From these data, we can say that there is significant derangement of thyroid function in liver cirrhosis in favor of hypothyroidism (p<0.05). Conclusion: Hypothyroidism, or abnormalities in circulating thyroid hormone concentrations, is seen in people with alcoholrelated liver cirrhosis and is linked to more severe liver disease

Obstructive sleep apnea in hypothyroidism.

Obstructive sleep apnea (OSA) and hypothyroidism are closely linked as hypothyroidism has been shown to lead to the development of OSA through multiple mechanisms. With the changing lifestyle patterns worldwide and increased prevalence of obesity, the burden of OSA has substantially increased. The association of OSA with hypothyroidism is essential to establish. If identified early, treatment of OSA and associated hypothyroidism can be done timely to minimize the potential harmful complications of OSA on all aspects of the patient's health. This study was done to find out the prevalence of OSA in hypothyroidism patients. It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. A total of 100 hypothyroidism patients were enrolled after taking written consent. All patients were subjected to STOP-Bang questionnaire and patient falling in intermediate-high risk (score3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). The Statistical Package for the Social Sciences version 21.0 statistical analysis software. Out of 100 patients, who underwent polysomnography, 74 (74%) cases had OSA (AHI ≥5). Out of total 74 OSA cases, 29 (39.2%) cases had mild OSA (AHI 5-14), 15 (20.3%) cases had moderate OSA (AHI 15-30), and 30 (40.5%) cases had severe OSA. The age of the study population ranged between 24 and 78 years and the mean age was 58.28 ± 11.22 years. The mean age of the patients in the OSA group (59.27 ± 11.17 years) was higher than the non-OSA group (55.46 ± 11.09 years). Majority (64%) of our cases were male, and the proportion of males was found to be higher than females in both the groups (OSA/non-OSA). The body mass index (BMI) of the OSA group was found to be statistically higher as compared to that of the non-OSA group (P = 0.040). The BMI was found to be higher in severe OSA, but it was not statistically significant (P = 0.128). The mean value of FT4 was lower and thyroid-stimulating hormone (TSH) was higher in the OSA group as compared with the non-OSA group. However, no significant association was found between FT4 and TSH values in both the groups. Out of 100 cases, 41 patients were treatment naïve with mean TSH value of 13.1 ± 7 and 59 were on treatment with mean TSH of 8.3 ± 4. Treatment-naïve patients had a statistically higher number (85.3%) of OSA cases in comparison to patients on treatment (66.1) (P = 0.030). Prevalence of OSA is quite high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.

Prevalence and predictors of thyroid dysfunction amongst patients with Type 2 diabetes mellitus in Pakistan.

ABSTRACTIntroduction:Diabetes and thyroid disorders are the two most common disorders amongst endocrine diseases. Uncontrolled diabetes mellitus (DM) may disturb thyroid metabolism by disturbing the levels of thyroid hormones in the plasma. This study was undertaken to determine the prevalence and thyroid dysfunction in type 2 diabetic population presenting in a public sector tertiary care teaching hospital.Materials and Methods:This descriptive cross-sectional study was conducted in Civil Hospital Karachi (CHK) in the department of medicine from October 01, 2018, to March 31, 2019. The study population consisted of 317 patients diagnosed with DM type 2 based on American Diabetes Association (ADA) criteria. Patients with fasting blood sugar ≥ 126 mg/dL, or HbA1c >6.5 (%), and 2 h postprandial blood glucose levels >200 mg/dL were included. After a minimum of 8 h of fasting, plasma samples of patients were collected and sent for fasting blood glucose, HbA1c, FT3, FT4, and thyroid-stimulating hormone (TSH). Descriptive statistics were calculated. Post-stratification Chi-squared test was applied, and a P value of ≤ 0.05 was considered significant.Results:Among all enrolled DM type 2 patients, 207 (65.3%) were male with a mean age of 46.54 ± 8.72 years. Mean fasting blood sugar (FBS), random blood sugar (RBS), and HbA1c were 212.76 ± 26.91 (mg/dL), 328.89 ± 52.89 (mg/dL), and 9.43 ± 2.47 (%), respectively. The mean duration of DM was 7.81 ± 3.15 years. Mean FT3, FT4, and TSH were 113.13 ± 44.40 (ng/dL), 7.63 ± 3.11 (mg/dL) and 2.64 ± 2.57 (mIU/mL), respectively. In the present study, 55 (17.4%) patients had subclinical hypothyroidism, 27 (8.5%) had hypothyroidism, 19 (6.0%) had hyperthyroidism, and 16 (5.0%) had subclinical hyperthyroidism. Significant association of thyroid dysfunction was established with age group, female gender, and family history of thyroid dysfunction (P =< 0.001).Conclusion:The prevalence of thyroid dysfunction is higher among patients with type 2 diabetes mellitus (T2DM), in which hypothyroidism was the most common dysfunction with more prevalence among female patients.

Serum Levels of Inflammatory Markers in Newly Diagnosed Hypothyroid Patients Before and After Levothyroxine Therapy

Introduction: Cytokines have a great significance in autoimmune thyroid disease. They are produced by thyroid follicular cells and have an indispensable role in T-cell and B-cell growth and differentiation. Tumour necrosis factor-alpha (TNF-α) is a cytokine having numerous immunological and metabolic activities and is an important stimulus for Interleukin-6 (IL-6) production. Interleukins play an important role in immune system function. Their deficiency causes autoimmune diseases or immune deficiency. Aim: To assess inflammatory markers IL-6 and TNF- α in hypothyroidism before and after attainment of euthyroid state by levothyroxine therapy and to find the correlation between serum levels of TNF-α and hypothyroid state. Materials and Methods: This quasi-experimental study was conducted at Department of Physiology at University College of Medical Sciences, Delhi, India, from January 2013 to October 2013. Total 30 newly diagnosed hypothyroid patients of the age group 18-45 years formed case group and 30 age and sexmatched subjects formed the control group, were recruited for the study. The patients were given levothyroxine replacement therapy for three months. The inflammatory biomarkers level was evaluated using solid-phase sandwich Enzyme Linked Immunosorbent Assay (ELISA), using kits from Diaclone. Paired and Unpaired t-tests respectively were used for hypothyroid patients in pre-post state and between two groups at baseline. Serum Thyroid Stimulating Hormone (TSH) levels of hypothyroid patients were correlated with serum levels of inflammatory markers using Pearson’s correlation test. Results: There was no statistical difference in age, sex, body mass index and lipid profile in the two groups. Hypothyroidism subjects achieved euthyroidism in three months months after obtaining levothyroxine therapy with the mean TSH levels 26.43±10.244 vs 3.4863±0.1963, mean free T3 levels 0.2980±.09408 vs 1.93±0.5690 and mean free T4 levels 0.2736±0.0973 vs 1.8986±0.2853 in pre-post states respectively. Serum levels of IL-6 and TNF-α were significantly higher (p-value&lt;0.001) in hypothyroid subjects compared to euthyroid controls. A positive correlation between serum levels of IL-6 (r-value= 0.5778, p-value= 0.0008) and TNF-α (r-value= 0.521, p-value= 0.003) with serum TSH levels were found. Conclusion: The study reported a significant effect of levothyroxine therapy in restoring serum levels of raised inflammatory markers among hypothyroid patients. A decrease in low-grade chronic inflammation after treatment showed some clinical importance as chronic inflammation is known to be associated with atherosclerosis and cardiac disease.

Relationship between vascular endothelial growth factor expression and thyroid stimulating hormone level in benign and malignant thyroid lesions.

ABSTRACTBackground:Vascular endothelial growth factor (VEGF) stimulates angiogenesis, increases vascular permeability and seems to correlate to aggressiveness of tumors. Thyroid cancer has been found to have higher levels of VEGF expression. Thyroid stimulating hormone (TSH) is the most important thyroid hormone, yet few researches have been done on its relationship with VEGF.Aim:To study the clinical and demographic profile of thyroid lesions (benign and malignant) and to explored the relationship between VEGF expression (using immunochemistry) and serum TSH level.Methods:This prospective, observational study includes 61 patients of thyroid lesions who underwent partial, hemi, subtotal or total thyroidectomy as the primary treatment from June 2014 and July 2016. Tissue specimens of thyroid lesions for immunohistochemistry study of VEGF expression were done. Serum TSH was done using Chemiluminiscence technique and correlated to VEGF expression.Results:The mean age of patient was 36.26 ± 11.53 years (range 20-50 years) with female preponderance. Swelling was the most common presenting symptom. Of 61 patients, 37 (60.65%) patients were benign and 24 (39.35%) were malignant thyroid lesions. The mean TSH level in benign group was 1.92 ± 0.94 mIU/liter and malignant group was 2.73 ± 1.74 mIU/liter which was statistically significant (P = 0.023). VEGF expression was strongly positive (3+) in 26 (42.62%) patients and negative/equivocal (1+ & 2+) in 35 (57.38%) patients. In benign group, 10 (27.0%) patients were strongly positive for VEGF whereas in malignant group, 16 (66.7%) patients were strongly positive for VEGF showed significant association (P = 0.002). On comparing TSH level of benign, malignant and total patients separately with VEGF expression, significant association were also observed (P < 0.001, P = 0.004 and P < 0.001, respectively).Conclusion:VEGF was strongly expressed in malignant thyroid lesions which are having high serum concentration of serum TSH level. Serum TSH levels reveal a significant correlation with VEGF expression.

Serum TSH Level as a Simple Efficient Tool to Assess the Risk of Thyroid Malignancy in Euthyroid Patients with Indeterminate Cytology - A Cohort Study.

A significant number of fine-needle aspiration cytology (FNAC) for thyroid nodules is reported as indeterminate. Expensive molecular testing can give a clue to the possibility of malignancy in this group. The effectiveness of serum thyroid-stimulating hormone (TSH) levels as a diagnostic tool in euthyroid patients with indeterminate cytology has not been previously studied, especially in the Indian population. This study was conducted to evaluate the predictive efficacy of serum TSH in the early diagnosis and treatment of malignancy. This is a retrospective cross-sectional study on a cohort of patients who presented to our department with complaints of thyroid swelling and underwent thyroidectomy. Euthyroid patients who underwent thyroid surgery for newly diagnosed thyroid nodules with FNAC reported as indeterminate cytology were included in our study. Based on the histopathological report, the patients were divided into two groups and into quartiles based on TSH values. The mean difference in the numerical variables between groups was compared using the independent two-sample 't' test for parametric data and Mann-Whitney 'u' test for non-parametric data. A logistic regression analysis was done with age, sex, TSH level and nodule size as dependant variables and malignancy as the independent variable. There were 211 patients in group A and 93 in group B. Patients with malignancy confirmed on final histopathology showed higher serum TSH levels compared to benign nodules (2.93 ± 1.067 vs 1.73 ± 1.051, P = <0.001). The mean TSH levels of all types of malignant nodules correlated with our test model (>2.185 mIU/L). Serum TSH above 2.185 mIU/mL is a good predictor of malignancy in indeterminate nodules. It is an inexpensive, safe and reliable diagnostic screening test for the risk of malignancy in an indeterminate nodule.

Association of Sub-Clinical Hypothyroidism with Abnormal Levels of Lipid in the Population of Nawabshah, Pakistan

Aims: Aim of this investigation was to access the association of dyslipidemia with subclinical hypothyroidism.&#x0D; Methodology: In this cross-sectional investigation, 1948 participants were recruited. Two groups were made; participants up to 18 years were in group A and Subjects over 18 years were incorporated in group 2. They were subdivided into control, subclinical hypothyroid 1, and subclinical hypothyroid 2. SPSS 21 was used for data analysis.&#x0D; Results: Data of 1619 individuals were analyzed. The mean age of Group A participants was 12.79 ± 2.779, and the mean age of Group B participants was 42.58 ± 18.012. The prevalence of subclinical hypothyroid was found at 13.5 %. Significant differences have been observed while comparing Group A and Group B (P &lt;0.001). Free tetraiodothyronine and Free triiodothyronine also showed a significant difference in both groups. (P&lt;0.05). No significant difference between mean Thyroid-stimulating hormone levels was observed (P&gt;0.05). No significant association between Controls and High-density Lipid values was found between Controls and subclinical hypothyroid.&#x0D; Conclusion: We conclude that subclinical hypothyroidism leads to increased dyslipidemia. Lower Serum total cholesterol and low-density lipid levels were detected among children and participants under the age of 18 with Thyroid-stimulating hormone greater than 10 mIU/L. Thyroid-stimulating hormone less than 10.0 mIU/L had no lipid abnormalities in subclinical hypothyroid participants.

First-Trimester Reference Intervals for Thyroid Function Testing among Women Screened at a Tertiary Care Hospital in India.

Objectives Due to differences in the method of assay and population-specific factors, each laboratory needs to establish its own gestation-specific reference intervals (GRIs) for thyroid hormones. Materials and Methods Three-hundred forty-one women with less than 14 weeks gestation were screened at a tertiary care hospital in Chhattisgarh, India. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibody (anti-TPO) were measured using an ADVIA Centaur XP immunoassay. GRIs (2.5th and 97.5th percentiles) were determined for TSH and fT4. TSH and fT4 concentrations were converted to multiples of the median (MoM) values. Effect of maternal age, gestational age, and maternal weight was analyzed.Statistical Analysis Quantitative variables were expressed as means and standard deviations (SD), and qualitative variables were expressed as frequencies and percentages. Normality of the data was checked using the Kolmogorov–Smirnov test. Values that were normally distributed were expressed only as means and SD. Those that were not normally distributed were expressed as medians and interquartile range. For all statistical analysis, p < 0.05 was considered as statistically significant. Results First-trimester GRI was 0.245 to 4.971 mIU/L for TSH, 10.2 to 18.9 pmol/L for fT4, and 27.0 to 56.89 kIU/L for anti-TPO. There was no significant difference in the mean serum TSH ( p = 0.920), fT4 ( p = 0.714), or anti-TPO ( p = 0.754) values among women in 4 to 7th week and 7 to 14th week of gestation. The 1st and 99th centile MoMs were 0.03 and 4.09 for TSH and 0.66 and 1.39 for fT4. There was a significant positive correlation between the maternal weight and TSH MoM values ( p = 0.027, r = 0.120). Conclusion These laboratory- and first-trimester-specific GRI for TSH and fT4 shall help in proper diagnosis and treatment of subclinical thyroid dysfunctions. TSH and fT4 MoM values can be used to indicate high or low values in a quantitative manner independent of the reference ranges and may be used by other laboratories.

Evaluation of Thyroid Dysfunction in Adult Patients of Celiac Disease

OBJECTIVES: &#x0D; To assess free thyroxine (fT4), thyroid stimulating hormone (TSH), and anti thyroid peroxidase antibodies (anti TPO abs) in adult Celiac disease patients and non-celiac controls and to find out any statistically significant difference in their corresponding means between the two groups.&#x0D; METHODOLOGY:&#x0D; The study design was analytical cross sectional. Sixty adult patients of celiac disease (CD) and 30 apparently healthy non-celiac adults were included in the study. CD patients had earlier been diagnosed by elevated levels of serological evidence of elevated (greater than 15X ULN) anti tissue transglutaminase (TTG) (IgA class) antibodies. CD was ruled out in the control group by normal levels of the antibodies. TSH, fT4 and anti TPO abs were obtained from all individuals of CD patient and control groups. &#x0D; RESULTS:&#x0D; Mean age of Celiac disease in patients was 23.85±5.43 years. Mean age of individuals in the control group was 24.26±5.55 years. Statistically significant difference in mean TSH and anti-TPO abs levels between the CD patient group and control group (p values of 0.03 and 0.038, respectively) was present. No statistically significant difference was seen between mean fT4 of patients and control group (p=0.74). Subclinical and overt hypothyroidism was present in 10% and 5% of CD patients, while anti TPO abs was positive in 16.6% of CD patients.&#x0D; CONCLUSION:&#x0D; There is a considerably high prevalence of subclinical and overt hypothyroidism as well as serological evidence of thyroid dysfunction in adult patients of CD.

Türk Bir Popülasyonda Normal Tiroid Teknesyum- 99m Perteknetat Alım Aralığının Belirlenmesi

Aim: This study aimed to determine the normal range for thyroid uptake of technetium-99m (99mTc) pertechnetate in a Turkish population.Methods: The retrospective study included 73 (54 females, 19 males) consecutive euthyroid patients, all of whom underwent thyroid scintigraphy using 99mTc-pertechnetate as a component of parathyroid scintigraphy for parathyroid adenoma localization. The value of thyroid uptake of 99mTc-pertechnetate at the 20th minute was calculated for each patient.Results: The mean patient age was 56.4±15.2 years; the mean thyroid-stimulating hormone level was 1.15±0.48 uIU/mL. The median and interquartile range values of 99mTc-pertechnetate uptake were 0.8% and 0.56–1.15%, respectively. The normal range for thyroid uptake of 99mTc-pertechnetate was determined to be 0.26–1.64%. There was a negative correlation between 99mTc-pertechnetate uptake and age (r =-0.33, p=0.002).Conclusion: We propose that our new normal range for thyroid uptake of 99mTc-pertechnetate based on significantly lower values compared with those currently in use in Turkey is appropriate for use to evaluate thyroid function in thyroid disorders in the population of Istanbul.

1402Thyroid stimulating hormone (TSH) is associated with general and abdominal obesity in girls during puberty

Abstract Background Childhood is an important public health issue. Although both thyroid hormone and menarche are known to play a role in body metabolism and energy expenditure, no population-based study has been conducted to investigate the impact of TSH on adipogenesis among population-based girls around puberty. Methods A multi-stage cluster sampling method was used to select one junior middle school from each of 4 study areas: Minhang District in Shanghai, Haimen City in Jiangsu Province, Yuhuan City and Deqing County in Zhejiang Province. A total of 474 girls aged 11 to 14 years from 4 schools were enrolled. Information on demographic factors and puberty stage were collected, and anthropometric measurements and thyroid hormones were determined. Multivariate logistic regression models were used to assess the associations of Thyroid stimulating hormone (TSH) with the risk of obesity measured by body mess index (BMI) and waist circumference (WC). Results Of the 474 girls, the prevalences of BMI-based general obesity and WC-based abdominal obesity were 19.8% (94/474) and 21.7% (103/474), respectively. Compared with normal weight girls, the mean serum TSH concentration was significantly higher in BMI-based general overweight or obese girls (P = 0.037), but not in WC-based central overweight or obese girls (P = 0.173). In the multiple logistic regression models, for girls with highest tertile of serum TSH concentration relative to those in the lowest tertile, the odds ratios were 2.58 (95% CI 1.32 to 5.04) and 2.50 (95% CI 1.30 to 4.81) for overweight or obesity based on BMI and WC after adjustment for puberty stage and other covariates. Conclusions Serum TSH concentration was positively associated with both general and abdominal obesity in school-age girls and the association was independent of puberty. Key messages thyroid stimulating hormone; general obesity; central obesity; school-aged girls; puberty