Median TSH Level Research Articles

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

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

8408 Comparison of Free Thyroxine (fT4) Reference Ranges in Pregnancy: Evaluanting a Novel Equilibrium Dialysis Coupled with Liquid Cromatography Tandem Mass Spectrometry Analytical Method Versus a Standard Routine Immunoassay

Abstract Disclosure: R.M. Biscolla: Employee; Self; Fleury Medicina e Saude. A. Lebkuchen: Employee; Self; Fleury Medicina e Saude. K.H. Cardozo: Employee; Self; Fleury Medicina e Saude. V.M. Carvalho: Employee; Self; Fleury Medicina e Saude. M.T. Justa: Employee; Self; Fleury Medicina e Saude. J.G. Vieira: Owner/Co-Owner; Self; Fleury Medicina e Saude. M.I. Chiamolera: Employee; Self; Fleury Medicina e Saude. There is a difficulty in assessing thyroid function during the gestational period and one of the most important reasons is the changes in TBG during pregnancy, resulting from the increase in estrogen, lead to interference in the dosages of free thyroxine (fT4) measured by commercial competitive immunoassays, posing limitations on the accuracy and sensitivity of existing assessment methods. Therefore, it is necessary to establish specific reference values for each trimester and for the different methods, so the analysis of fT4 results could be more confidently used in clinical practice.Objective: This study aimed to describe a new direct method for measuring free thyroxine (fT4) utilizing equilibrium dialysis (ED) coupled with liquid chromatography tandem mass spectrometry (LC–MS/MS). Additionally, the performance of this method was compared to a commercial immunoassay, and trimester-specific normal reference ranges for fT4 in pregnancy were determined. Methods: We developed a novel ED LC–MS/MS analytical method employing 96-well dialysis plates for measuring fT4 that demonstrated an adequate sensitivity, precision, and linearity. A total of 291 samples from pregnant women were analyzed, the gestational trimester was determined using ultrasound. Additionally, serum fT4 was assessed using an immunoassay with Beckman Coulter kits to compare the two methods. Results: The lower limit of detection (LLOQ), and upper limit of detection (ULOQ) of the new method were respectively calculated to be 0.4 ng/dL and 20.8 ng/dL. The comparison between the two methods showed median FT4 concentrations of 0.7 ng/dL (range, 0.5–1.1 ng/dL) for the immunoassay and 1.1 ng/dL (0.6–2.1 ng/dL) for the ED LC–MS/MS assay (paired t test, p < 0.0001). A significant correlation between methods was observed (Spearman’s r= 0.4898, p < 0.0001). fT4 reference values for ED LC–MS/MS (2.5–97.5 percentiles) were 0.9–1.9 ng/dL, 0.7–1.4 ng/dL, and 0.7–1.5 ng/dL for the first, second, and third trimesters, respectively, whereas median TSH levels were 1.7 mIU/L (0.05–4.0 mIU/L), 1.7 mIU/L (0.44–3.7 mIU/L), and 1.9 mIU/L (0.28–3.5 mIU/L) for the first, second, and third trimesters, respectively.Conclusions: The study with a recent developed LC-MS/MS fT4 method pointed to the differences with an immunoassay method and underscores the importance of establishing trimester- and method- specific normal reference ranges in pregnancy. Presentation: 6/3/2024

8812 Incidence And Clinical Experience Of Immune Checkpoint Inhibitors-Induced Endocrine Side Effects Among Filipino Cancer Patients: A Single-Center Retrospective Study

Abstract Disclosure: N.B. Luna: None. E. Mendoza: None. S.A. Kho: None. Incidence And Clinical Experience Of Immune Checkpoint Inhibitors-Induced Endocrine Side Effects Among Filipino Cancer Patients: A Single-Center, Retrospective Study Immune checkpoint inhibitors (ICIs) serve as immunomodulatory antibodies, which enhance the immune system and substantially improve the prognosis for patients with advanced malignancies [1]. Referral to endocrinology have been increasing because ICIs were associated with endocrine-related adverse effects including hypothyroidism, hyperthyroidism, diabetes, hypophysitis and adrenalitis. Hence, the study aimed to retrospectively determine the local prevalence and profile of Filipino patients who developed endocrinopathies during ICI therapy at the University of Santo Tomas Hospital (USTH), Manila, Philippines from 2013-2019. A single-center retrospective study of ICI-treated cancer patients with serial biochemical and/or radiologic monitoring of endocrine adverse effects was done upon approval by the Research Ethics Committee. A total of 27 subjects were included with a median age of 60 years and male predominance. Pembrolizumab consisted 93% of the ICIs given. The incidence of thyroid dysfunction was 36% (18% overt hypothyroidism, 9% subclinical hypothyroidism, and 9% subclinical hyperthyroidism). The median time at risk for development of overt hypothyroidism is 4 weeks with median TSH level of 9.05 uIU/mL from baseline level of 3.77 uIU/mL. All patients who had baseline hypothyroidism worsened with increase from baseline levothyroxine dose by 50 to 230% in order to achieve euthyroidism (p 0.037). Serial monitoring was done every 2 weeks until euthyroidism. ICIs were temporarily put on hold in 75%. Diabetes (p 0.05), renal carcinoma (p 0.001) and dose of 200mg (p 0.42) were associated to developing overt hypothyroidism. Checking of glycemic levels was not routine among non-diabetic patients. Fifteen percent of diabetic patients had worsening of control (median HbA1c 8.5% [8-9] and 23% were newly diagnosed pre-diabetes (median fasting glucose 114mg/dL [104-120]). With the available imaging results, there were no abnormal adrenal metabolic uptake on PET scan and no evidence of hypophysitis in pituitary MRI. In conclusion, overt hypothyroidism is a common occurrence during ICI therapy (18%). Worsening occurred among all patients with hypothyroidism at baseline. New-onset pre-diabetes and worsening of glycemic control were seen in 15 and 23%, respectively. Serial clinical and biochemical monitoring is important and referral to endocrinology should be made if deemed necessary. [1] L Agrawal, A Bacal, S Jain, V Singh, N Emanuele, Ma Emanuele & F Meah (2020) Immune checkpoint inhibitors and endocrine side effects, a narrative review, Postgraduate Medicine, 132:2, 206-214, DOI: 10.1080/00325481. 2019. 1709344 Presentation: 6/1/2024

Endocrine immune-related adverse events by immune checkpoint inhibitors and potential predictive markers: a prospective study from a single tertiary center.

Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events (irAEs). The appearance pattern of irAEs, who is prone to them, and their mechanisms are still uncertain. In this study, we aimed to monitor patients initiated on ICIs for endocrinological aspects and to investigate the potential predictive markers in the development of endocrine-irAEs. The study prospectively included 43 patients with metastatic disease scheduled for anti-PD-1/L1 therapy. Endocrinological follow-up was conducted at specified intervals as well as in response to any additional reported complaints. Serum concentrations of CXCL10, IL-1beta, and IL-17A were measured prior to ICI and during the endocrine-irAEs. A total of 39.5% of the patients experienced endocrine-irAEs, with a median onset time of 3 months. Among patients, 34.9% developed thyroid-related adverse events, and 4.6% experienced hypophysitis. Thyroid autoantibodies were associated with a higher incidence of thyroid-related irAEs (P = 0.004). In the irAE group, median pre-ICI CXCL10 and baseline thyroid stimulating hormone (TSH) levels were significantly higher, baseline total testosterone level in men was lower than in the non-irAE group (P < 0.05), whereas IL-1beta and IL-17A levels did not differ (P > 0.05). Serum CXCL10, IL-1beta, and IL-17A concentrations did not differ significantly pre-ICI and during adverse events (P > 0.05). Pre-ICI CXCL10 concentration was correlated positively with anti-TPO levels in patients with at least one thyroid autoantibody positivity (r = 0.706, P = 0.01) and negatively with baseline total testosterone level of men (r = 0.509, P = 0.002). Our results suggest that higher pre-ICI serum CXCL10 and TSH levels might have a predictive role in the development of endocrinopathies. Besides, baseline thyroid antibody measurements could be beneficial in predicting thyroid dysfunction.

The effect of periodontal status on the TSH and FT4 levels

Background: Some bacteria and viruses cause thyroid gland inflammation. Periodontal diseases lead to the production of numerous bacteria in the mouth that spread to other tissues and organs, causing infection in those sites. This investigation’s goal was to the correlation between thyroid abnormalities with periodontal disorders. Methods: The research study was carried out on 96 patients who provided blood samples from the total of 1012 applicants who enrolled to the periodontology clinic. The patients were categorized into 4 categories based on their age: (i) ages ranging 0-20, (ii) ages ranging 21-40, (iii) ages ranging 41–60, and (iv) ages over 61. In addition, they were additionally divided into three groups according to both TSH and FT4 levels: The TSHa and FT4a group included patients with below-normal values, the TSHb and FT4b group included patients with normal TSH and FT4 values, and the TSHc and FT4c group included patients with above-normal TSH and FT4 values. The statistical analysis was performed using SPSS 21. Frequency analysis and the Mann-Whitney U Analyses were utilized for statistical analysis., and the level of significance was set at P&lt;0.05. Results: The median TSH and FT4 levels of the patients were 1.98±1.28 mIU/L and 1.19±0.32 mIU/L, in that order there were no significant statistical differences seen in TSH and FT4 levels between genders or age groups. According to their FT4 and TSH levels, 7.3% of the patients had subclinical hypothyroidism and 4.2% had subclinical hyperthyroidism. In total, 11.5% of the patients had thyroid dysfunction. Conclusion: The results indicated that thyroid dysfunction was present in a remarkably high proportion of patients (11.5%).

A Study Estimating the Serum TSH Levels in First Trimester Pregnant Women

Background Pregnancy is a physiological condition among women. Pregnancy brings about major changes in the hormonal levels. Thyroid stimulating hormone is a hormone produced by anterior pituitary. TSH provides the most common sensitive index to reliably detect thyroid function abnormalities.ObjectiveThe goal of this study was to estimate the levels of serum TSH at first trimester in pregnant women in the department of Biochemistry St. Johnrsquos Medical College amp Hospital and compare with the biological reference intervals as established in the laboratory. Methodology This retrospective study was conducted from January to December 2021 in the department of Biochemistry St. Johnrsquos Medical College amp Hospital. Lab data review of pregnant women has been analysed for serum TSH. The study included 228 pregnant women in their first trimester aged between 20 and 35 years. Serum TSH levels were measured using the ABBOTT ARCHITECT CI8200 through Chemiluminometric Immunoassay. The collected data underwent analysis and comparison to derive descriptive statistics.Result A total of 228 pregnant women in the first trimester fulfilling the inclusion criteria were included. Maternal age of the study population was 20-35 years. Among the pregnant women 12 5.3 women showed low values for TSH lt0.35 microIUMl 11 4.8 women showed higher values for TSH gt4.94 microIUmL and 205 89.9 showed normal TSH levels during first trimester. In this study the mean TSH level in pregnant women was found to be 1.94plusmn1.50 microIUmL. The median TSH levels was 1.51 microIUmL 2.5th and 97.5th percentiles P2.5-P97.5 0.23-5.86 microIUmL.Conclusion The observed connection between aberrant TSH serum levels during the first trimester and adverse pregnancy outcomes underscores the necessity for proactive screening. Identifying pregnant women with elevated or reduced TSH levels early on holds significant potential for preventing complications. The incorporation of such screening protocols can yield a range of benefits including timely interventions and enhanced management strategies to mitigate adverse outcomes. Our research contributes to the growing body of evidence supporting TSH screening during early pregnancy emphasizing its pivotal role in safeguarding maternal and foetal health.

Thyroid hormone levels and BMI-SDS changes in adolescents with obesity.

Thyroid hormones play an important role in energy metabolism and weight control, explained mostly by inducing thermogenesis and increasing basal metabolic rate. It has recently been shown that FT4 levels are associated with food preferences, which might also play a role in modulating body weight. The aim of this longitudinal follow-up study was to analyze the relationship of thyroid hormones levels (FT4, TSH) at baseline with weight/BMI-SDS changes in children and adolescents with obesity. Three hundred seventy-seven children and adolescents have been enrolled to this study and followed up without a systematic intervention program for 5.59 ± 1.85months. Children and adolescents were divided into three subgroups: 1) 144 adolescents with obesity (15-19 years), 2) 213 children with obesity (10-14.9 years), and 3) 20 lean adolescents (15-19 years). Thyroid hormones were measured at the baseline, and anthropometry was performed at the baseline and during the follow-up. For further analyses, participants were divided according to the BMI-SDS change into two groups: 1. with BMI-SDS decrease, and 2. with BMI-SDS increase. Adolescents with obesity from the BMI-SDS decrease group had significantly lower baseline serum levels of TSH compared to the BMI-SDS increase group (2.4 ± 1.0 vs. 3.2 ± 2.0mIU/l; p=0.005). Similar difference was found for FT4 levels (14.7 ± 2.2 in the BMI-SDS decrease group vs. 15.5 ± 2.7pmol/l in the BMI-SDS increase group, p=0.048). Moreover, the BMI-SDS decrease was present in significantly higher percentage of adolescents with obesity with lower than median TSH level compared to those with higher than median TSH level at baseline (61.1% vs 38.6%, p=0.011). Likewise, the BMI-SDS decrease was present in significantly higher percentage of adolescent females with obesity and lower than median FT4 compared to those with higher than median FT4 level at baseline (70.6% vs. 23.5%, p<0.001). No associations of baseline thyroid hormones with the BMI-SDS change were observed in children with obesity or lean adolescents. Adolescents with obesity and increased BMI-SDS during the follow-up had significantly higher baseline levels of both TSH and FT4 compared to BMI-SDS decrease group. These results support the previous findings that higher FT4 in individuals with obesity may influence weight gain.

Thyrotropin Screening of Newborns: Before or After 72 Hours of Life? Before Discharge or at Home?

Objective: Until November 2019 in Belgium, dried blood spot (DBS) sampling was performed between 72 and 120 hours of life, when a majority of newborns had already been discharged from the maternity. In November 2019, the policy for newborn screening in South Belgium changed to allow sampling as soon as 48 hours of life, with the objective to accelerate the process and to allow more sampling during the hospital stay. Our objective was to evaluate the impact of this policy modification and, in particular, to assess the effectiveness of screening for hypothyroidism based on sampling before or after 72 hours of life, as well as to compare the effectiveness of DBS collection before discharge or at home. Methods: This retrospective study included live births ≥37 weeks of gestation, screened by the Université Libre de Bruxelles Newborn Screening Center between January 2019 and December 2021. To evaluate the efficiency of early sampling, we compared thyrotropin (TSH) results for screening <72 hours and screening ≥72 hours. We also compared TSH results of DBS performed before discharge with those performed at home. Results: A total of 53,794 newborns were included. The results of 24,816 healthy newborns screened before 72 hours of life and of 28,978 healthy newborns screened between 72 and 144 hours of life were compared. The median TSH level was similar (1.50 and 1.20 mU/L, respectively). The percentage of false positives was similar (0.08% and 0.07%, respectively). Earlier sampling, before 72 hours, allowed treatment of positive cases at 6 days rather than 8.5 days. DBS sampling at home resulted in longer delay for transferring the sample to the laboratory (a median of 3.0 days for hospital sampling vs. 5.0 days for home sampling). A poorer quality of home blood sampling was observed, with 0.27% unusable samples compared with 0.06% unusable samples for hospital sampling (p < 0.001). Conclusions: In term newborns, TSH screening before discharge, as early as 48 hours of life, is a valid strategy. It allows earlier treatment of positive cases, does not increase the percentage of false positives, and results in fewer unusable samples.

Thyroid Function Tests in Children and Adolescents With Trisomy 21: Definition of Syndrome-Specific Reference Ranges.

The lack of syndrome-specific reference ranges for thyroid function tests (TFT) among pediatric patients with Down syndrome (DS) results in an overestimation of the occurrence of hypothyroidism in this population. To (a) outline the age-dependent distribution of TFT among pediatric patients with DS; (b) describe the intraindividual variability of TFT over time; and (c) assess the role of elevated thyrotropin (TSH) in predicting the future onset of overt hypothyroidism. In this retrospective, monocentric, observational analysis, we included 548 patients with DS (0-18 years) longitudinally assessed between 1992 and 2022. Exclusion criteria were abnormal thyroid anatomy, treatments affecting TFT, and positive thyroid autoantibodies. We determined the age-dependent distribution of TSH, FT3, and FT4 and outlined the relative nomograms for children with DS. Compared with non-syndromic patients, median TSH levels were statistically greater at any age (P < .001). Median FT3 and FT4 levels were statistically lower than controls (P < .001) only in specific age classes (0-11 for FT3, 11-18 years for FT4). TSH levels showed a remarkable fluctuation over time, with a poor (23%-53%) agreement between the TSH centile classes at 2 sequential assessments. Finally, the 75th centile was the threshold above which TSH values predicted future evolution into overt hypothyroidism with the best statistical accuracy, with a satisfactory negative predictive value (0.91), but poor positive predictive value (0.15). By longitudinally assessing TFT in a wide pediatric DS population, we outlined the syndrome-specific reference nomograms for TSH, FT3, and FT4 and demonstrated a persistent upward shift of TSH compared to non-syndromic children.

Evaluation of catch-up growth in severe pediatric Hashimoto's hypothyroidism

BackgroundWe aimed to evaluate catch-up growth in children with severe Hashimoto's hypothyroidism (HH) after thyroid hormone replacement therapy (HRT). MethodsA multicenter retrospective study was conducted including children referred for growth slowdown that led to the diagnosis of HH between 1998 and 2017. ResultsA total of 29 patients were included, with a median age of 9.7 years (13–172 months). Median height at diagnosis was -2.7 [-4.6; -0.1] standard deviation score (SDS), with a height loss of 2.5 [0.7; 5.4] SDS compared to height before growth deflection (p<0.0001). At diagnosis, the median TSH level was 819.5 mIU/L [100; 1844], the median FT4 level was 0 pmol/L [undetectable; 5.4], and the median anti-thyroperoxidase antibody level was 1601 UI/L [47; 25,500].In the 20 patients treated only with HRT, there were significant differences between height at diagnosis and height at 1 year (n = 19, p<0.0001), 2 years (n = 13, p = 0.0005), 3 years (n = 9, p = 0.0039), 4 years (n = 10, p = 0.0078), and 5 years (n = 10, p = 0.0018) of treatment but not in the case of final height (n = 6, p = 0.0625). Median final height was -1.4 [-2.7; 1,5] SDS (n = 6), with a significant difference between height loss at diagnosis and total catch-up growth (p = 0.003).The other nine patients were also given growth hormone (GH). They were smaller at diagnosis (p = 0.01); however, there was no difference in final height between those two groups (p = 0.68). ConclusionSevere HH can lead to a major height deficit, and catch-up growth seems to be insufficient after treatment with HRT alone. In the most severe cases, administration of GH may enhance this catch-up.

Effect of perinatal factors on neonatal thyroid stimulating hormone

Background: Congenital Hypothyroidism (CH) is a common cause of mental retardation. Its incidence varies in different parts of the world from 1:4000 to 1:2000. Objective: To study effect of perinatal factors on heel prick blood TSH levels and to find incidence of congenital hypothyroidism. Study Design: Prospective Observational birth cohort study. Method: Heel prick blood samples of total 3151babies, 1673 (53.1%) males and 1478 (46.9%) females was taken on special graded filter paper within 48 hours of life and screened by fluoroimmunometric assay. Babies with TSH value more than 9µU/ml were recalled at 5 to 7 days of life for repeat sample of T3, T4, TSH. Babies with low T4 less than 7 µgm/dl and TSH more than 20 µU/ml were labelled as congenital hypothyroidism. The effect of perinatal factors was analyzed statistically. Result: In our study, thyroid screening in two third of neonates was done at 12 to 24 hours of age. Median (IQR) TSH of 3151 neonates was 3(1.4-5.5) µU/ml. TSH level was significantly low in neonates with sampling at age of >24 hours. Recall rate in our study was 7.6% (238 cases) and 2 neonates were diagnosed as congenital hypothyroidism. Neonates with assisted deliveries showed a higher median (IQR) TSH level 5.3(3-9.1µU/ml) as compared to normal vaginal deliveries and lower segment caesarean section. This was statistically significant (p

Thyrotropin Levels in Patients with Coronavirus Disease 2019: Assessment during Hospitalization and in the Medium Term after Discharge.

The objectives of this study were (1) to compare TSH levels between inpatients with critical versus non-critical coronavirus disease 19 (COVID-19), and (2) to describe the status of TSH levels three months after hospitalization. We collected data on adult patients hospitalized with COVID-19 at Amiens University Hospital. We compared TSH levels between inpatients with critical (intensive care unit admission and/or death) versus non-critical COVID-19. Thereafter, survivors were invited to return for a three-month post-discharge visit where thyroid function tests were performed, regardless of the availability of TSH measurement during hospitalization. Among 448 inpatients with COVID-19, TSH assay data during hospitalization were available for 139 patients without prior thyroid disease. Patients with critical and non-critical forms of COVID-19 did not differ significantly with regard to the median (interquartile range) TSH level (0.96 (0.68-1.71) vs. 1.27 mIU/L (0.75-1.79), p = 0.40). Abnormal TSH level was encountered in 17 patients (12.2%); most of them had subclinical thyroid disease. TSH assay data at the three-month post-discharge visit were available for 151 patients without prior thyroid disease. Only seven of them (4.6%) had abnormal TSH levels. Median TSH level at the post-discharge visit was significantly higher than median TSH level during hospitalization. Our findings suggest that COVID-19 is associated with a transient suppression of TSH in a minority of patients regardless of the clinical form. The higher TSH levels three months after COVID-19 might suggest recovery from non-thyroidal illness syndrome.

Evaluation of IL-10, MCP-1, IFN gamma, and protectin D1 levels in patients with Hashimoto's thyroiditis.

Hashimoto's thyroiditis (HT) is one of the most prevalent autoimmune endocrine diseases and caused by the loss of immune tolerance for the thyroid gland. Many pathophysiological mechanisms were speculated about the development of HT. In our study, we aimed to reveal the relationship between HT and IL-10, MCP-1, IFNɤ, and PD1 levels and compare them with control subjects. We collected 37 patients with HT and 25 controls referred to our outpatient clinic. The diagnosis of HT was based on the detection of circulating antibodies to thyroid antigens and decreasing echogenicity on thyroid USG in patients with appropriate clinical characteristics. Serum IL-10, MCP-1, IFNɤ, and PD1 levels were detected using an ELISA KIT (96T) method according to the manufacturer's instructions. All subjects were euthyroid (median TSH level was 1.68mU/L in HT vs 1.83mU/L in the controls, p = 0.672). Twenty-three of 37 patients with HT were taking L-thyroxin replacement. Levels of serum IL-10, IFNɤ, and PD1 in patients with HT were higher than the controls, but the differences were not statistically significant (p = 0.393, p = 0.495, and p = 0.052 respectively). The serum levels of MCP-1 in HT patients were statistically different and higher than the controls (p = 0.018). Correlation analysis displayed significant associations between IL-10, MCP-1, IFNɤ, and PD1 levels. Our study demonstrated that serum MCP-1 levels in HT patients were significantly increased; on the other hand, significant difference was not found between HT patients and the controls in terms of serum IL-10, IFNɤ, and PD1 levels.

Effect of Suppressive Levothyroxine Therapy on Bone Mineral Density in Young Patients with Differentiated Thyroid Carcinoma.

Suppressive levothyroxine therapy (sT4) is a cornerstone in the management of differentiated thyroid cancer (DTC). Long-term sT4 may affect bone mineral density (BMD). We evaluated the effect of sT4 on the bone mass of young DTC patients. In this cross-sectional study, BMD was evaluated via dual-energy X-ray absorptiometry in DTC patients younger than 25 years at diagnosis and undergoing sT4 for ≥1 year. The two control groups comprised patients matched for sex, age, and body-mass-index who were thyroidectomized for indications other than DTC and undergoing L-T4-replacement therapy, and healthy individuals with no prior known thyroid disease. Ninety-three participants were included (thirty-one in each group). There were no differences in the mean age, female sex (77.4% in all groups), or BMI between the sT4 group and each control group. The median TSH level was lower (0.4 [0.04–6.5] vs. 2.7 [0.8–8.5] mIU/mL, p = 0.01) and the mean L-T4 mcg/Kg levels were higher (2.4 ± 0.6 vs. 1.6 ± 0.3, p = 0.01) in the sT4 group compared to the L-T4-replacement therapy group. Lumbar spine, femoral neck, and total femur BMD were all similar among the groups. sT4 does not impact BMD in young DTC patients after a median time of suppression of 8 years. These findings may help in the decision-making and risk/benefit evaluation of sT4 for this population.

Less basal thyrotropin levels predict antidepressant response in patients with major depression

IntroductionThe close association among thyroid metabolism, mood disorders and behavior has long been known. The role of basal thyroid axis in antidepressant treatment response is less known.ObjectivesThe aim of the present study was to study the association of basal serum thyrotropin (TSH) levels, with antidepressant treatment response in major depressive disorder.MethodsThirty-one depressed adult outpatients were included. Major depressive episode was diagnosed through the MINI (DSM-IV-TR) interview. Clinical symptomatology and blood samples were assessed at baseline, and at 4- and 8-weeks of either escitalopram or sertraline. Treatment response was defined by an improvement ≥50% in MADRS scores at 4-, and 8-weeks. Basal TSH levels were included in a linear regression model as predictor of treatment response.ResultsTwenty-seven patients finished 8-weeks of treatment. Response to treatment was of 74% at 4-weeks, and 63% at 8-weeks of antidepressant treatment. Basal median TSH levels were between normal ranges (M+SD=1.85+1,02 mlU/L). Basal TSH levels not correlated with basal MADRS scores, but with higher MADRS scores at week-4 (r=0,415, p=0,031) and at week-8 (r=0,392, p=0,043). Moreover, less baseline TSH levels trend to be a significant good predictor for treatment response at 4-weeks (R2=.116, p=.083); and a good predictor at 8-weeks treatment (R2=.147, p=.049).ConclusionsBaseline TSH levels even within the normal range may play a role in predicting antidepressant response.DisclosureNo significant relationships.

Serum TSH level in hospitalized patients with moderate-to-severe COVID-19

Objective: to measure the serum TSH level in hospitalized patients with moderate-to-severe COVID-19.Material and methods: this was a retrospective study at Almazov National Medical Research Centre enrolled 133 hospitalized COVID-19 patients without known thyroid disorders. Clinical data, biochemical parameters (TSH, 25(OH)D, C-reactive protein, Lactate dehydrogenase and Ferritin), fi ndings of chest computed tomography (CT) imaging as well as obtained corticosteroids therapy were analyzed.Results: the median TSH level at the 1st-2nd day of hospitalization and at the 9-10th day was 1,15 mIU/L [0, 76; 1, 8] and 1,04 mIU/L [0,7; 1,78] respectively. Th e initial level of TSH &lt;0,4 mIU/L was found in four patients, while by the 9-10th day of hospitalization their number doubled and reached 9 (11,7%). Furthermore, by the 9-10th day of hospitalization the TSH level more than 4,5 mIU/L was detected in four patients (4,2%). Th us, 13 out of 77 patients had the serum TSH level outside the reference range by the 9-10th day of hospitalization.Conclusions: in case of alteration in the serum TSH level it is necessary to take into account the personal history of thyroid disorders. Th e level of thyroid hormones and autoimmune markers as well as thyroid ultrasound results may be useful in clinical interpretation of thyroidal insults during and aft er COVID-19. Th e hypothalamic-pituitary-thyroid axis may also be aff ected by drugs used to treat COVID-19.

Aging-related Characteristics of Subclinical Hypothyroidism Detected in General Practice.

Subclinical hypothyroidism (SCH) is diagnosed when serum thyrotropin (TSH) is elevated despite a normal thyroxine level and is known to increase the risk of metabolic disorders. This study was conducted to identify potential laboratory markers suspicious for latent SCH. We retrospectively reviewed 958 outpatients in whom thyroid functions had been examined. Eighty-five (9.1%) of the 939 analyzed subjects had SCH (73% females). In the SCH group, median serum TSH and FT4 levels were 5.04 μU/ml and 1.19 ng/dl, respectively, and auto-thyroid antibodies were detected in 53.8% of patients. SCH group patients were significantly older than patients in the euthyroid group, while there was no intergroup difference in BMI. However, 56.5% of the SCH patients were asymptomatic. In the SCH group, serum aspartate aminotransferase and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher, and the estimated glomerular filtration rate (eGFR) was significantly lower than in the euthyroid group. Among patients less than 65 years of age, SCH patients tended to have lower eGFR and higher LDL-C than euthyroid patients. Age-dependent reductions of red blood cells and serum albumin were more prominent in the SCH than the euthyroid group. Biochemical changes with aging are useful as potential clues for suspecting latent SCH.

Endocrine and metabolic aspects of narcolepsy type 1 in children.

To study whether the onset of narcolepsy type 1 (NT1) in children and adolescents affects BMI, specific metabolic risk factors, the onset of puberty, longitudinal growth or other endocrine functions. A population-based study, comprising 34 patients, was performed with a clinical evaluation, an assessment of puberty and growth, actigraphy and blood samples at fasting, from patients and controls, to evaluate pituitary function, growth factors, thyroid gland, gonads, insulin sensitivity, appetite regulation and blood lipids. In the post-H1N1 vaccination (PHV) narcolepsy group, the median BMI SDS was higher 6-12 months after the onset of narcolepsy (p<0.01), but it was no different 10 years after the onset of narcolepsy (p=0.91), compared with 12-24 months before the onset of narcolepsy. There was a correlation between an increase in BMI and a decrease in total energy expenditure (R=-0.74). In the nPHV group, weight and BMI changes were smaller and no significant changes were recorded. Early puberty was more common in patients with puberty onset after narcolepsy onset (n=16/19) compared with patients with puberty onset before narcolepsy onset (n=3/11, p=0.02). There was no significant change in height SDS during the studied period. Although they were within normal ranges, both median HDL and median TSH levels were significantly lower in NT1 patients, compared with controls. We found a high prevalence of large BMI gain in the period immediately after the onset of narcolepsy, which had almost normalized at the long-term follow-up. The onset of narcolepsy led to early puberty in both sexes. Linear growth was not affected. We did not find any strong indicators of metabolic disturbances.

Multi-center clinical characterization of patients with pediatric vitiligo: a retrospective study in Colombia

Introduction. Pediatric vitiligo is a chronic acquired condition of the skin that differs from adult vitiligo in many clinical parameters. Few descriptive studies have been carried out to determine the clinical characteristics in Latin-American patients.Aim. To describe the clinical features of pediatric patients with vitiligo who consulted dermatology referral centers in Bogota D.C., Colombia.Methods. We carried out a descriptive study of all pediatric patients with a diagnosis of vitiligo treated at three referral centers in Bogota, Colombia between 2012-2018. Site distribution of the lesions and treatment features are presented using UpSet plots.Results. Of 377 patients with a diagnosis of vitiligo and age <18, 355 remained after applying our exclusion criteria. Median age at diagnosis was slightly over 9 years, and frequency was not higher in females (49.01%). Non-segmental vitiligo was the most frequent type (n=213). Lesions were predominantly found in the face and neck (62%) and pelvis (31%). In a subset group (n=98), median TSH level was 2.58 mIU/L. A family history of the disease and atopic dermatitis were found in 10.4% and 11.8%, respectively. Tacrolimus was the most commonly used medication (83.4%). In turn, the most common treatment regimen consisted of tacrolimus and topical corticosteroids (32.15%). However, treatment regimens were mostly heterogeneous. On follow-up, 106/160 subjects reported a clinically significant improvement.Conclusion. Findings such as the age of onset, lesion location distribution and first line treatments were consistent with previous reports. Some features, like family history of atopy, differed from North American, Asian, and European populations reports.

Relationship of TSH Levels with Cardiometabolic Risk Factors in US Youth and Reference Percentiles for Thyroid Function.

Thyroid hormones play an important role in metabolic homeostasis, and higher levels have been associated with cardiometabolic risk. To examine the association of cardiometabolic risk factors with TSH levels in US youth. Cross-sectional study of youth aged 12 to 18 years without known thyroid abnormalities from 5 National Health and Nutrition Examination Survey cycles (n = 2818) representing 15.4 million US children. Subclinical hypothyroidism (SH) was defined as thyrotropin (TSH) levels of 4.5 to 10 mIU/L. Assessed cardiometabolic risk factors include abdominal obesity (waist circumference >90th percentile), hypertriglyceridemia (triglyceride ≥130 mg/dL), low high-density lipoprotein cholesterol (<40 mg/dL), elevated blood pressure (systolic and diastolic blood pressure ≥90th percentile), hyperglycemia (fasting blood glucose ≥100 mg/dL, or known diabetes), insulin resistance (homeostatic model for insulin resistance > 3.16), and elevated alanine transferase (≥ 50 for boys and ≥44 U/L for girls). Age and sex- specific percentiles for thyroid parameters were calculated. In this cohort of youth (51.3% male), 31.2% had overweight/obesity. The prevalence of SH was 2.0% (95% CI 1.2-3.1). The median TSH levels were higher in youth with overweight/obesity (P < 0.001). Adjusting for age, sex, race/ethnicity, and obesity, youth with TSH in the fourth quantile had higher odds of abdominal obesity (OR 2.53 [1.43-4.46], P = .002), insulin resistance (OR 2.82 [1.42-5.57], P = .003), and ≥2 cardiometabolic risk factors (CMRF) (OR 2.20 [1.23-3.95], P = .009). The prevalence of SH is low in US youth. The higher odds of insulin resistance and cardiometabolic risk factors in youth with TSH levels >75th percentile requires further study.