Non-autoimmune Hypothyroidism Research Articles

Thyroid function evaluation in pediatric nephrotic syndrome: a study in a developing country

BackgroundIn steroid-resistant nephrotic syndrome (SRNS), protracted proteinuria leads to the loss of thyroxine-binding proteins resulting in low thyroid hormones and in damage renal tubules and exhausts the thyroid reserve. This study aimed to assess thyroid function in those patients with SRNS and steroid-sensitive nephrotic syndrome (SSNS). A comparative cross-sectional study evaluated the thyroid status of 50 children with an equal age- and sex-matched SSNS, and controls were enrolled in this study. Demographic data, clinical examination, renal profile, and thyroid function tests were conducted for them.ResultsSubclinical non-autoimmune hypothyroidism was significantly prevalent in 54% of SRNS patients and 12% of SSNS patients (p < 0.001). No cases of overt hypothyroidism were detected. Albumin and protein/creatinine ratio emerged as significant independent factors influencing subclinical hypothyroidism with odds ratio (OR) 0.624, 95% CI (0.425–0.916), and 1.315 OR (1.315) and 95% CI (1.035–1.672), respectively.ConclusionSubclinical non-autoimmune hypothyroidism among patients with SRNS might occur, especially with protracted proteinuria necessitating regular screening of thyroid function in this cohort.

The Association between Vitamin D Status and the Impact of Metformin on Hypothalamic-Pituitary-Thyroid Axis Activity in Women with Subclinical Hypothyroidism.

Metformin inhibits enhanced secretion of anterior pituitary hormones. Its impact on prolactin and gonadotropin concentrations is absent in individuals with hypovitaminosis D. The aim of this prospective cohort study was to investigate whether vitamin D status determines the effect of metformin on hypothalamic-pituitary-thyroid axis activity in levothyroxine-naïve women. The study included three groups of women of reproductive age with subclinical non-autoimmune hypothyroidism, which were matched for age, thyroid-stimulating hormone (TSH) concentration, and insulin sensitivity: untreated women with vitamin D deficiency/insufficiency (group A), women effectively supplemented with exogenous calciferol (group B), and untreated women with normal 25-hydroxyvitamin D concentrations (25OHD) (group C). Owing to concomitant type 2 diabetes or prediabetes, all subjects were treated with metformin. Concentrations of 25OHD, TSH, total and free thyroid hormones, glucose, insulin, glycated hemoglobin (HbA1c), prolactin, and peripheral markers of thyroid hormone action were assayed before metformin treatment and six months later. Based on hormone concentration, structure parameters of thyroid homeostasis were calculated. Except for 25OHD concentrations, there were no between-group differences in baseline values of the measured variables. Metformin reduced glucose, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), and HbA1c in all study group, but these effects were less pronounced in group A than in the remaining groups. The reduction in TSH and Jostel's index was observed only in groups B and C, and its degree correlated with baseline TSH concentrations, baseline 25OHD concentrations, and the degree of improvement in HOMA1-IR. The drug did not affect circulating levels of 25OHD, free and total thyroid hormones, prolactin, other structure parameters of thyroid homeostasis, and markers of thyroid hormone action. The obtained results allow us to conclude that low vitamin D status in young women mitigates the impact of metformin on thyrotroph secretory function.

Frequency of seropositive celiac disease and hypothyroidism among children and adolescents with congenital heart disease: A case-control study

BackgroundThe prevalence of celiac disease (CD) and hypothyroidism exhibit significant variation in different studies among patients with congenital heart disease (CHD). This study evaluated the frequency of laboratory test abnormalities in children and adolescents with CHD in Shiraz, Iran.MethodsThis prospective case-control study was conducted on 223 children and adolescents with CHD and healthy individuals referred to the heart clinic affiliated with Shiraz University of Medical Sciences between February 2019 and December 2021. They were classified into case and control groups. Blood tests were performed for total IgA antibody, anti-tissue transglutaminase IgA antibody (anti-TTG Ab), T4, and thyroid stimulating hormone (TSH) and anti-thyroid peroxidase antibodies in serum, along with transthoracic echocardiography. Likewise, demographic characteristics of patients, including age, sex, weight, height, and body mass index (BMI), were recorded. Also, anti-TTG Ab levels were compared among CHD patients according to cyanosis status, gender, age (above and below five years), and BMI (under and over 18.5).ResultsNinety-eight CHD patients and 100 healthy individuals with an average age of 5.32 ± 4.05 years (1–18 years) were examined. In children with CHD, atrial septal defect (27%), ventricular septal defect (20%), and tetralogy of Fallot (13%) were the most prevalent disorders. Only one CHD patient had an anti-TTG Ab level of 16.6 unit/mL, considered borderline for seropositive CD diagnosis. There was no difference in anti-TTG Ab levels between age (above and below five years), BMI (under and over 18.5), cyanosis status, and gender groups. Seven CHD patients had high TSH levels, three had cyanotic CHD, and one had Down syndrome. The TSH levels and non-autoimmune hypothyroidism were significantly higher in CHD patients than in normal subjects (p < 0.05).ConclusionsAccording to the results of this study, the serum level of TSH and prevalence of non-autoimmune hypothyroidism were higher in patients with CHD than in normal subjects, but the serum level of anti-TTG Ab was not different between the two groups.

Assessment of thiol-disulfide and glutathione homeostasis after levothyroxine replacement in individuals with autoimmune or nonautoimmune hypothyroidism.

Thyroid hormones are known to affect the biosynthesis and degradation of antioxidant compounds, suggesting a possible link between hypothyroidism and oxidative stress. However, there is no clear consensus in the literature regarding this association. The aim of this study was to evaluate oxidative stress markers (extracellular thiol-disulfide homeostasis and intracellular glutathione homeostasis) in patients with hypothyroidism due to autoimmune (Hashimoto's thyroiditis) or nonautoimmune thyroid disease rendered euthyroid after levothyroxine replacement. The study included 116 patients admitted to the Taksim Training and Research Hospital (Istanbul, Türkiye). Of these, 50 had hypothyroidism due to Hashimoto's thyroiditis (HT group), 30 had nonautoimmune hypothyroidism (NAIH group), and 36 were healthy controls (control group). All participants were women. Extracellular thiol-disulfide homeostasis and intracellular glutathione homeostasis tests were assessed as oxidative stress markers. Thiol-disulfide homeostasis in both HT and NAIH groups was shifted toward the oxidative spectrum. Compared with the control group, the HT and NAIH groups had lower levels of native (p < 0.001 and p = 0.001, respectively) and total (p = 0.002 and p = 0.012, respectively) thiol, as well as a lower native thiol/total thiol ratio (p < 0.001 for both). The HT group also had higher disulfide levels than the control group (p = 0.027). Reduced glutathione (GSH) and oxidized glutathione (GSSG) values were comparable across all three groups, but the HT and NAIH groups had higher GSSG/GSH (p < 0.001 for both) and GSSG/(GSH+GSSG) ratios (p = 0.003 and p = 0.005, respectively), along with lower GSH/(GSH+GSSG) ratio (p = 0.001 and p = 0.002, respectively) than the control group. Levothyroxine replacement was ineffective in ameliorating oxidative stress in patients with hypothyroidism due to Hashimoto's thyroiditis or nonautoimmune causes, as extracellular thiol-disulfide homeostasis was notably altered in these patients compared with healthy controls. The findings of this study suggest that oxidative stress remains a prevailing issue in patients with autoimmune or nonautoimmune hypothyroidism even after euthyroidism is restored.

Depression and anxiety levels among patients with thyroid disorders: A cross-sectional study

The aim of this study was to investigate the association between anxiety and depression among patients diagnosed with different thyroid disorders, as well as to identify the frequency of these comorbid conditions. A total of 181 (female/male; 142/39) patients with different thyroid diseases were assessed in this cross-sectional study. Patients were classified according to the type of thyroid disorder they were diagnosed with. The biochemical parameters were obtained from hospital database. The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were utilized to evaluate the association between thyroid disorders and anxiety/depression among patients. Upon classifying patients according to their thyroid disease, it was found that 24 patients (13.2%) were diagnosed with non-autoimmune hypothyroidism, 40 (22.1%) with autoimmune hyperthyroidism, 85 (47%) with autoimmune hypothyroidism, and 32 (17.7%) with nodular thyroid disease. The average scores for BDI and BAI were 15.50±10.19 and 17.83±12.01 in the whole study group. Anxiety and depression were both quite common among patients, with respective rates of 75.7% and 66.7%. BDI scores were significantly correlated with the levels of anti-TPO and anti-TG in patient groups with autoimmune thyroid diseases. Additionally, there was a significant correlation between the BAI scores and anti-TG levels. Patients with thyroid disorders in this study frequently have high levels of anxiety and depression. There is a relationship between depression and anxiety and the levels of thyroid autoantibodies. The presence of thyroid autoantibodies may be a sign of susceptibility to depression and anxiety in thyroid patients.

Clinical correlates of autoimmune thyroiditis and non-autoimmune hypothyroidism in treatment-naïve patients with major depressive disorders

BackgroundThyroid autoimmunity is a potentially critical factor that is often neglected in the association between subclinical hypothyroidism (SCH) and depressive disorders. This study aimed to investigate the clinical correlates of autoimmune thyroiditis (AIT) and non-autoimmune hypothyroidism (NAIH) in treatment-naïve patients with major depressive disorder (MDD). MethodUsing a cross-sectional design, we recruited a total of 1718 outpatients with treatment-naïve MDD. Demographic and relevant clinical information including duration of MDD, severity of depression and anxiety, psychotic symptoms, suicide attempts, thyroid function parameters, etc. were collected. According to thyroid function parameters, patients were classified as AIT, NAIH, latent Hashimoto's thyroiditis (LH) and euthyroidism (ET). ResultsPatients with SCH (including AIT and NAIH) had older age at onset, and were more likely to have psychotic symptoms compared to those with ET. Multiple linear regression analysis showed that SCH was associated with duration of MDD and HAMD scores. Logistic regression analysis showed that the odds of having more severe anxiety and metabolic syndrome were greater among patients with SCH compared to those with ET. The odds of having suicide attempts were greater among patients with AIT than among those with ET. LimitationBecause of the cross-sectional design of this study, we were unable to sort out causality between MDD and SCH. ConclusionOur findings suggested that AIT and NAIH were associated with duration of MDD, HAMD scores, severity of anxiety, and metabolic syndrome. However, only AIT in SCH was associated with suicide attempts.

Rosuvastatin potentiates the thyrotropin-lowering effect of metformin in men with non-autoimmune subclinical hypothyroidism and prediabetes.

Metformin treatment decreases thyrotropin levels in individuals with hypothyroidism and this effect seems to be mediated by the 5'-adenosine monophosphate-activated protein kinase pathway in the pituitary. The activity of this pathway is also stimulated by statins. The current study was aimed at investigating whether the impact of metformin on hypothalamic-pituitary-thyroid axis activity is affected by statin use. The study included three matched groups of men with non-autoimmune hypothyroidism and prediabetes: patients treated for at least 6 months with high-intensity rosuvastatin therapy (20-40 mg daily) [groups A (n=24) and C (n=19)] and men not receiving statin therapy [group B (n=24)]. Over the entire study period (6 months), groups A and B received metformin (2.55-3g daily). Moreover, groups A and C continued rosuvastatin therapy. The lipid profile, glucose homeostasis markers, and plasma concentrations of thyrotropin, total and free thyroid hormones, prolactin, FSH, LH, ACTH and insulin-like growth factor-1 were determined at baseline and 6 months later. Fifty-nine patients completed the study. There were differences between groups A and C and group B in baseline values of total cholesterol, LDL-cholesterol, gonadotropins and ACTH. Although observed in both groups of metformin-treated patients, the effect on thyrotropin levels was more pronounced in group A than in group B. The impact on fasting glucose and insulin sensitivity was stronger in group B than group A. In turn, only in group A metformin tended to reduce gonadotropin levels. There were no differences between follow-up and baseline values of lipids, total and free thyroid hormones, prolactin, ACTH and insulin-like growth factor-1 in both these groups. In group C, all assessed variables remained at a similar level. The results of the current study suggest that rosuvastatin potentiates the inhibitory effect of metformin on thyrotrope secretory function.

Systemic Lupus Erythematosus Patients With Related Organic Damage Are at High Risk of Hypothyroidism.

PurposeThe aim of this study included determining the prevalence of hypothyroidism in patients with systemic lupus erythematosus (SLE), clarifying the clinical characteristics of SLE patients with hypothyroidism, and identifying the relationship between hypothyroidism and SLE-related organic damage. Another purpose was to analyze the relationship between SLE and thyroid autoantibody. We also intended to discuss the pathogenesis of hypothyroidism in SLE patients, which would provide clues for further investigation.MethodsThis study recruited 856 SLE patients and 856 age- and sex-matched healthy population and compared the prevalence of hypothyroidism between the cases and controls. Univariate and multivariate logistic analyses were applied to identify risk factors for hypothyroidism in SLE patients.ResultsSLE patients had higher prevalence of clinical hypothyroidism (9.10%) and TgAb+TPOAb- (10.40%) than controls. The prevalence of hypothyroidism was the highest in SLE patients aged 16-26 years (18.9%) and decreased with age. The prevalence of autoimmune hypothyroidism in SLE group was higher than that in the control group (64.4% vs. 51.5%, P=0.042), which was mainly due to TgAb; the prevalence of non-autoimmune hypothyroidism in SLE group was also significantly higher than that in the control group (67.3% vs. 47.8%, P<0.001). Based on multivariate analysis, the use of glucocorticoids/immunosuppressants, liver abnormality, lupus nephritis (LN), and cardiac insufficiency were independently associated with hypothyroidism in SLE patients.ConclusionThe prevalence of hypothyroidism in SLE patients was higher than that in controls and decreased with age. The results suggested that young SLE patients combined with LN, liver abnormality and cardiac insufficiency were at higher risk of hypothyroidism. According to the results of this study, we speculated that SLE might have impact on thyroid, and SLE might be one of the causes of hypothyroidism.

Thyroid Disorders Following Hematopoietic Stem Cell Transplantation in Childhood: Impact of Conditioning Regimen on Thyroid Dysfunction, Volume Changes, and Occurrence of Nodules

Thyroid late effects are among the most frequent sequelae reported after pediatric hematopoietic stem cell transplantation (HSCT). Although the detrimental effects of radiotherapy on the developing thyroid gland have been extensively assessed, the role of chemotherapy-only conditioning regimens remains controversial. We aimed to describe the occurrence, monitoring, and management of thyroid function disorders (ie, Graves disease, Hashimoto thyroiditis, and nonautoimmune hypothyroidism), nodules, and volumetric changes over a 20-year observation period in a single pediatric transplantation unit. In addition, we assessed the impact of different conditioning regimens on thyroid health. The study population for this retrospective observational analysis comprised 244 pediatric patients who underwent HSCT for malignant or nonmalignant diseases between 1999 and 2018 and for whom at least 4 thyroid function tests and 1 or more thyroid ultrasound(s) assessed sequentially after HSCT were available. The 15-year cumulative incidence of either autoimmune or nonautoimmune thyroid dysfunctions (34%, SE 5.3%) did not differ statistically between total body irradiation (TBI)-based and chemotherapy-based regimens (P = .23). Indeed, the cumulative incidence after busulfan (Bu)-based conditioning was overall superimposable to that recorded after TBI (10-year cumulative incidence, 22.2% versus 25.9%, respectively). Nevertheless, the cumulative incidence of nonautoimmune hypothyroidism was statistically higher after Bu-based conditioning (12.4%, SE 3.7%) than after other chemotherapy-only-based conditioning regimens (3.1%, SE 3.1%; P = .02, 5-year cumulative incidence), treosulfan (Treo) included. The overall cumulative incidence of nodules was low for the first 5 years after HSCT (1.9%, SE .9%) but subsequently increased steeply over time, with a 15-year cumulative incidence as high as 52.1% (SE 7.5%). TBI-conditioned patients had a higher 15-year cumulative incidence of nodules (66.8%, SE 9.1%) compared with patients receiving chemotherapy-only regimens (33.6%, SE 9.5%; P = .02), whereas age >10 years at transplantation showed a protective effect (hazard ratio, .42, 95% confidence interval, .2 to .88). Finally, a systematic sonographic follow-up highlighted a progressive statistically significant reduction in thyroid anteroposterior diameter among patients conditioned with TBI (P=.005), but not in those who received chemotherapy-only regimens. TBI and younger age at HSCT have a statistically significant detrimental effect on the occurrence of thyroid nodules, both benign and malignant. TBI and Bu expose patients to a higher cumulative incidence of thyroid dysfunction compared with other chemotherapy-only regimens, Treo included. Accordingly, Bu can be considered the most thyrotoxic agent among those administered as a part of a chemotherapy-only conditioning regimen. Finally, patients conditioned with TBI, but not those with other regimens, show a progressive decrease in thyroid volume over time, as assessed by sequential ultrasound examinations.

Congenital Hypothyroidism and Hyperthyroidism Alters Adrenal Gene Expression, Development, and Function.

Background: The human adrenal cortex undergoes several rapid remodeling steps during its lifetime. In rodents, similar remodeling occurs postnatally in the "X-zone" layer through unknown mechanisms. Furthermore, little is known regarding the impact of thyroid hormone (TH) on adrenal glands in humans. Methods: To investigate the impact of TH on adrenal pathophysiology, we created two genetic murine models mimicking human nonautoimmune hypothyroidism and hyperthyroidism. Moreover, we analyzed serum thyrotropin (TSH) and steroid hormone concentrations in patients diagnosed with congenital hypothyroidism and premature adrenarche (PA). Results: We found that TH receptor beta-mediated hypertrophy of the X-zone significantly elevated the adrenal weights of hyperthyroid women. In the hypothyroid model, the X-zone was poorly developed in both sexes. Moreover, large reciprocal changes in the expression levels of genes that regulate adrenal cortical function were observed with both models. Unexpectedly, up- and downregulation of several genes involved in catecholamine synthesis were detected in the adrenal glands of the hypothyroid and hyperthyroid models, respectively. Furthermore, TSH and adrenal steroid concentrations correlated positively in pediatric patients with congenital hypothyroidism and PA. Conclusions: Our results revealed that congenital hypothyroidism and hyperthyroidism functionally affect adrenal gland development and related steroidogenic activity, as well as the adrenal medulla.

A commentary on: Vitamin D deficiency in non-autoimmune hypothyroidism; a case-control study

A commentary on: Vitamin D deficiency in non-autoimmune hypothyroidism; a case-control study

Frequency of comorbidities in Neuromyelitis Optica spectrum disorder

BackgroundComorbidity may influence clinical aspects of neuromyelitis optica spectrum disorder (NMOSD). We estimated the prevalence of comorbidities to assess their association with outcomes. MethodsThis retrospective study assessed records of NMOSD patients from 2008 to 2019, categorizing comorbidities into three groups: somatic, psychiatric and autoimmune. Severity of disease was evaluated by the Expanded Disability Status Scale, progression index (PI) and annualized relapse rate. The frequency of comorbidities was compared between anti-aquaporin 4 antibody (AQP4-IgG) seropositive and seronegative patients. ResultsA total of 67 NMOSD patients were enrolled. Thirty-five (52.2%) patients reported at least one comorbidity. In total, 44 comorbidities were found, of which 24 occurred prior to NMOSD onset: 29 somatic, 13 psychiatric and 2 autoimmune entities. The most common comorbidities were anxiety disorders 7/67 (10.4%), followed by migraine 6/67 (8.9%) major depression disorder 6/67 (8.9%), iron deficiency anemia 8/54 (14.8%), and non-autoimmune hypothyroidism 4/67 (6.0%). Psychiatric comorbidities associated with PI in unadjusted (OR=0.538, 95% CI=0.141, 0.935, P=0.009) and adjusted models (OR=0.386, 95% CI=0.022, 0.751, P=0.038). A significantly higher frequency of psychiatric comorbidities was observed in the AQP4-IgG positive patients (P=0.031). ConclusionHalf of the patients had comorbidities, suggesting screening for comorbidity as part of NMOSD care. The psychiatric comorbidities had impact on clinical outcome.

MTHFR C677T polymorphism frequency and DNA methylation status in Georgian population with non-autoimmune hypothyroidism

MTHFR C677T polymorphism frequency and DNA methylation status in Georgian population with non-autoimmune hypothyroidism

Different effects of metformin on hypothalamic-pituitary-thyroid axis activity in levothyroxine-treated and levothyroxine-naïve women with non-autoimmune hypothyroidism.

Metformin was found to reduce thyrotrophin levels in subjects with hypothyroidism. This case-control study was aimed at comparing metformin action on hypothalamic-pituitary-thyroid axis activity between levothyroxine-treated and levothyroxine-naïve women with non-autoimmune thyroid hypofunction. The study included two groups of thyroid antibody-negative women with thyrotrophin levels in the range between 4.5 and 10mIU/L and untreated prediabetes, matched for age, body mass index, thyrotrophin levels and glucose homeostasis markers. The first group had been treated for at least 6months with levothyroxine, whereas the second group had not received thyroid hormones. All these women were then managed with metformin (3g daily). Circulating levels of glucose, insulin, glycated haemoglobin, thyrotrophin, total and free thyroid hormones and prolactin were assessed at baseline and 6months later. Thirty-two women (16 in each treatment arm) completed the study. At baseline, both groups differed only in free and total thyroxine levels. Metformin reduced glucose levels and glycated haemoglobin, improved insulin sensitivity and decreased thyrotrophin levels. The impact on insulin sensitivity and thyrotrophin was stronger in women simultaneously treated with levothyroxine than in women not receiving this hormone. In levothyroxine-treated patients, metformin slightly reduced prolactin levels. In both study groups, metformin treatment exerted a neutral effect on freeand total thyroxine and triiodothyronine. The thyrotrophin-lowering effect of metformin correlated with the improvement in insulin sensitivity and in levothyroxine-treated women with the changes in prolactin levels. The obtained results suggest that metformin/levothyroxine combination therapy may be an interesting treatment option in women with non-autoimmune hypothyroidism poorly tolerating high-dose levothyroxine treatment.

Microstructural white matter abnormalities in hypothyroidism evaluation with diffusion tensor imaging tract-based spatial statistical analysis.

Hypothyroidism is presented in a wide range from neuropsychiatric problems including depression, memory and cognitive disorders to poor motor coordination. Against the background of morphologic, functional and molecular changes on the white and grey matter of the brain, we aimed to investigate the effects of hypothyroidism on white matter (WM) integrity using tract-based spatial statistics (TBSS). Eighteen patients with hyperthyroidism and 14 age-sex-matched healthy control subjects were included in this study. TBSS was used in the diffusion tensor imaging study for whole-brain voxel wise analysis of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) of WM. When compared to the control group, the whole brain TBSS revealed extensive reductions of FA in the supratentorial WM including corticospinal tract, posterior limb of the internal capsule (PLIC), uncinate fasciculus, inferior longitudinal fasciculus (p < 0.005). The ROI analyses showed RD increment of superior longitudinal fasciculus, AD decrement of cingulum (CIN), external capsule, PLIC and corpus callosum (CC) in patients with hypothyroidism (p < 0.005). Autoimmune and non-autoimmune hypothyroidism patient subgroups showed a significant difference in terms of hippocampus FA, CIN MD, CC MD, CC AD, CIN RD, SLF RD, CC RD (p < 0.005). CIN FA values showed a negative correlation with the Beck Depression Inventory (p = 0.007, r = - 852). These preliminary results of TBSS analyses represented FA and AD decrement, and RD increment in several WM tracts and indicates the demyelination process underlying pathophysiology of clinical aspects of hypothyroidism.

Vitamin D deficiency in non-autoimmune hypothyroidism: a case-control study

BackgroundAlthough in many studies, the relationship between autoimmune hypothyroidism (Hashimoto) and Vitamin D deficiency was shown, no research has been performed on the role of vitamin D in non-autoimmune hypothyroidism.MethodsThis was a case-control study in Endocrinology clinic of Jahrom (south of Iran). The patients with Hashimoto (n = 633) and non-Hashimoto hypothyroidism (n = 305), along with a control group (n = 200) were evaluated. 25(OH) D level, T3 and T4 levels were studied and Anti TPO and Anti TG tests were performed. The results of vitamin D level were analyzed and interpreted using SPSS in terms of the cause of hypothyroidism (immune and non-immune).ResultsThe results of the study showed a significantly lower level of vitamin D in both immune and non-immune Hashimoto’s thyroiditis (HT) in comparison to healthy controls (P < 0.05). We observed a significant inverse correlation between the vitamin D and TGAb level (p = 0.001, r = − 0.261) and a direct correlation of vitamin D with TSH level (p = 0.008, r = 0.108) in Hashimoto thyroiditis patients.ConclusionFinally, the results indicated that non-autoimmune hypothyroidism, as well as HT, is associated with vitamin D deficiency. The role of vitamin D deficiency in Hashimoto thyroiditis was thought to be in the association of higher autoantibody (TGAb) level; while, there should be further studies determining vitamin D deficiency’s role in non-immune hypothyroidism.

Prevalence of Non-autoimmune Hypothyroidism in Steroid Resistant Nephrotic Syndrome in Paediatric Age Group

Introduction: It was observed that approximately 10% of children with Nephrotic Syndrome (NS) are found as Steroid Resistant NS (SRNS). The data on the prevalence of non-autoimmune hypothyroidism among the SRNS in India is limited. Aim: To assess the prevalence of non-autoimmune hypothyroidism in the case of SRNS. Materials and Methods: A case control cross-sectional study was conducted in which 52 cases of SRNS and 52 healthy controls were enrolled. Thyroid profile like serum Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (T3), Free Thyroxine (T4) done in the all cases and controls but anti-Thyroid Peroxidase (TPO), and anti-thyroglobulin antibody test was done in the case and control group with deranged thyroid function test. Low Free T4 (normal: 0.7-2 ng/mL) and elevated serum TSH above the upper limit of the reference range (&gt;4.5 mIU/L) was defined as overt hypothyroidism, whereas elevation in serum TSH with a normal serum FT4 concentration was defined as sub clinical hypothyroidism. MedCalc statistical software Version 19.2.6 was used to do statistical analysis. Results: Prevalence of Non-autoimmune hypothyroidism was 38.46% (20 out of 52), 16 (30.76%) had subclinical and 4 (7.69%) had overt hypothyroidism in case of SRNS in comparison to 1.96% (1 out of 52) in control group. Out of 16 subclinical hypothyroid patients, two cases with grade 1, 12 cases with grade 2, and two cases with grade 3 found. Patients with SRNS had a mean (SD) TSH value of 4.5±4.7 mlU/L which was significantly higher than control (1.8±1.1 mlU/L). Serum levels of FT4 were within normal range. Anti-TPO and anti-thyroglobulin titre were in normal range in children with hypothyroidism. Conclusion: The prevalence of non-autoimmune hypothyroidism was high in cases of idiopathic SRNS. So, on the basis of this study estimation of thyroid profile in children with SRNS seems to be the rational approach which will lead to early diagnosis and timely management of hypothyroidism in SRNS.

The Impact of Testosterone on Metformin Action on Hypothalamic-Pituitary-Thyroid Axis Activity in Men: A Pilot Study.

The effect ofmetforminon thyrotrope function seems to be sex dependent. The aim of this study was to determine the role of endogenous testosterone in the impact of metformin on hypothalamic-pituitary-thyroidaxis activity. The study population consisted of 2 groups of men with nonautoimmune hypothyroidism matched for age, weight, insulin sensitivity, and thyrotropin levels. The first group (n = 11) included subjects with low serum testosterone levels, while the second (n = 12) men with testosterone levels within the reference range. Because of concomitant type 2 diabetes, all men were treated withmetformin(2550-3000 mg daily). Circulating levels of glucose, prolactin, testosterone, gonadotropins, thyrotropin, and freethyroidhormones were measured, while thestructure parameters of thyroid homeostasisand the degree of insulin sensitivity were calculated at baseline and 16 weeks later. In both study groups, metformindecreased plasma glucose levels and improved insulin sensitivity. However, only in men with low testosterone levels, the drug decreased thyrotropin levels, reduced Jostel's thyrotropin index, and increased SPINA-GT. Metformin-induced changes in thyrotropin and Jostel's index correlated with their baseline values, baseline levels of testosterone, and with the effect of treatment on insulin sensitivity. In men with neither low or normal testosterone levels, metformin affected free thyroid hormones, prolactin, testosterone, gonadotropins, and SPINA-GD. The obtained results suggest that the impact of metformin on thyrotrope function depends on the androgen status of a patient.

Analysis of Serum Il-6 and CRP Levels among Autoimmune and Non-Autoimmune Hypothyroid Patients

Hashimoto Thyroiditis (HT) is the most common autoimmune thyroid disease and the commonest cause of hypothyroidism. C-reactive protein (CRP) is synthesized in hepatocyte in response to autoimmune disorders; strongly induced by IL-6. This study aimed to estimate serum IL-6 and CRP levels in autoimmune and non- autoimmune hypothyroidism. The present study included 60 Iraqi female hypothyroid patients divided to 30 autoimmune and 30 non-autoimmune, with age ranged between 24-50 years and 30 healthy controls with age ranged between 27-52 years. Serum samples were collected from study groups. The levels of thyroid hormones (TSH, T4 and T3) were determined by using automated Chemiluminescence Immunoassay (CLIA) analysis system. Detection the levels of thyroid peroxidase antibody (TPO-Ab), thyroglobulin antibody (TgAb) and Interluekin-6 by enzyme linked immunosorbent assay (ELISA) kits. While latex agglutination slide test used for determination the presence of serum CRP. The current results revealed that serum TSH, TPO-Ab, Tg-Ab, IL-6 levels and CRP positive ratio are increased significantly (P<0.01) in autoimmune hypothyroid group as compared with non- autoimmune hypothyroid group and control group. But there are no significant differences (p?0.05) between non- autoimmune hypothyroid patient and control in the level of TSH, T4, T3, TPO-Ab, Tg-Ab, IL-6. Only the positive ratio of CRP is elevated significantly than ratio in control. This study showed significant increase (P<0.01) in IL-6 level and CRP positive ratio in autoimmune hypothyroidism, that indicates to the effect of autoimmune thyroid disease on inflammatory markers IL-6 and CRP in the serum; and increase CRP positive ratio in non-autoimmune hypothyroidism suggested the alteration in the levels of inflammatory marker has been independent from etiology of thyroid disease.

Concomitant Diagnosis of Primary Non-Autoimmune Hypothyroidism and Systemic Lupus Erythematosus

Concomitant Diagnosis of Primary Non-Autoimmune Hypothyroidism and Systemic Lupus Erythematosus