Normal FT4 Research Articles

The prevalence of hypothyroxinemia in premature newborns.

Congenital hypothyroidism diagnosed by TSH assessment in bloodspot screening may be overlooked in preterm newborns due to immaturity of the hypothalamus-pituitary-thyroid axis in them. The purpose of the study was to determine the prevalence and causes of hypothyroxinemia in preterm newborns, determined by TSH and FT4 serum concentration measurement, performed on the 3-5th day of life. We assessed TSH, FT4 and FT3 serum concentration on the 3-5th day of life in preterm children born at our centre within three consecutive years. We assessed the incidence of hypothyroxinemia, and its cause: primary hypothyroidism, secondary hypothyroidism or low FT4 syndrome - with normal TSH concentration, its dependence - among others - on gestational age (GA), birth body weight (BBW) and being SGA. A total of 525 preterm children were examined. FT4 concentration was decreased in 14.9% of preterm newborns. The most frequent cause of hypothyroxinemia was low FT4 syndrome (79.5%). More than 92% cases of hypothyroxinemia occurred in children born before the 32nd week and/or with BBW below 1500 g. Thus, every fourth child in these groups had a reduced FT4 concentration. Neonates with hypothyroxinemia were significantly lighter than those with normal FT4. In older and heavier neonates with hypothyroxinemia, serious congenital defects were observed. Neither IVH nor SGA nor twin pregnancies predispose children to hypothyroxinemia. Among newborns with untreated hypothyroxinemia in whom TSH and FT4 assessment was repeated within 2-5 weeks, a decreased FT4 concentration was confirmed in 56.1% of cases. As hypothyroxinemia affects 25% of newborns born before the 32nd week of gestation and those in whom BBW is less than 1500g, it seems that in this group of children the newborn screening should be extended to measure serum TSH and FT4 concentration between the 3-5th day of life. In older and heavier neonates, additional serum TSH and FT4 assessment should be limited to children with severe congenital abnormalities but not to all SGA or twins. Despite the fact that the most common form of preterm hypothyroxinemia is low FT4 syndrome, it should be emphasized that FT4 remains lowered on subsequent testing in more them 50% of cases.

Thyroid Hormones and Health-Related Quality of Life in Normal Pressure Hydrocephalus Patients before and after the Ventriculoperitoneal Shunt Surgery: A Longitudinal Study.

Objective: The aim of this study was to explore the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), and to correlate the hormone levels among iNPH patients with their self-reported quality of life before and three months after the surgery. Methods: Twenty-five patients (52% women), mean age 63.5 (SD 9.5) years, were operated on by inserting a VP shunt. Patients with FT3 level ≤3.34 pmol/L were diagnosed as having low T3 syndrome. Results: The changes in thyroid hormones resulted in a U-shaped curve throughout the follow-up period. The significant changes occurred the next day after the surgery, including a decrease in TSH, FT3, and an increase in FT4. Additionally, the decrease occurred in mean FT3 for six patients with preoperative low T3 syndrome. Three months after the surgery, thyroid hormones were restored to their baseline and/or normal values. All six patients with preoperative low T3 syndrome had significant improvement in all SF-36 subscales (except for the role emotional and physical). Patients with preoperative normal high FT3 and low FT4 had increased FT3/FT4 ratio which was associated with deterioration in all SF-36 subscales 3 months after the surgery. Conclusion: Routine assessment of the FT3/FT4 ratio might be a simple and effective tool for the risk stratification of iNPH patients before VP shunt surgery.

Study on thyroid functions in chronic liver disease

In the present study, thyroid functions have been evaluated with all the clinically available indices and confirms the abnormalities in many parameters of thyroid function test in chronic liver disease patients. However euthyroid state is maintained virtually in all patients, probably as a result of low normal Free T3 and high normal FT4. Furthermore, serum T3 concentration appear to directly correlate with the severity of liver dysfunction.

Evaluation of Anemia Frequency and Types in Patients with Subclinical and Clinical Hypothyroidism in the Endemic Goiter Region

ABSTRACT
 Objective: Hypothyroidism is a disease that occurs as a result of thyroid hormone deficiency or rarely, due to ineffectiveness at the tissue level. While the prevalence of clinical hypothyroidism is reported to be 2-5% worldwide, of subclinical hypothyroidism it is 4-8.5%, with the prevalence of subclinical hypothyroidism in women over 60 years of age being 14-20%. Hypothyroidism affects many organs and systems in the body, one of which is the hematopoietic system. Thyroid hormone deficiency plays a role in the development of microcytic, normocytic and macrocytic anemia. The frequency of anemia in patients with hypothyroidism varies between 20-60%. In this study, our aim was to determine the regional prevalence of subclinical and clinical hypothyroidism in adult patients in our region and to evaluate the frequency and types of anemia in patients with hypothyroidism.
 
 Method and Material: This study was prospectively conducted between 01.12.2012 and 01.05.2013 at the outpatient clinic of Recep Tayyip Erdogan University Faculty of Medicine Endocrinology. Included in the study were 96 patients who had subclinical hypothyroidism, 30 patients who had clinical hypothyroidism, and 100 healthy controls. Normal fT4 and fT3, high TSH values were used for the diagnosis of subclinical hypothyroidism, and low fT4 and/or fT3, high TSH values were used for the diagnosis of clinical hypothyroidism. The diagnosis of anemia was based on subclinical hypothyroidism, clinical hypothyroidism, and control group Hb value

Association of Maternal Mild Hypothyroidism With Offspring Neurodevelopment in TPOAb-Negative Women: A Prospective Cohort Study

ObjectivesAdequate maternal thyroid hormone availability is crucial for fetal neurodevelopment, but the role of maternal mild hypothyroidism is not clear. We aim to investigate the association of maternal mild hypothyroidism with neurodevelopment in infants at 1 year of age among TPOAb-negative women.MethodsThe present study was conducted within the Jiangsu Birth Cohort. A total of 793 mother–infant pairs were eligible for the present study. Maternal thyroid function was assessed by measuring serum thyroid-stimulating hormone, free thyroxine, and thyroid peroxidase antibodies. Neurodevelopment of infants was assessed by using the Bayley Scales of Infant and Toddler Development third edition screening test (Bayley-III screening test).ResultsIn the multivariate adjusted linear regression analyses, infants of women with subclinical hypothyroidism and isolated hypothyroxinemia were associated with decreased receptive communication scores (β = −0.68, p = 0.034) and decreased gross motor scores (β = −0.83, p = 0.008), respectively. Moreover, infants of women with high-normal TSH concentrations (3.0–4.0 mIU/L) and low FT4 concentrations were significantly associated with lower gross motor scores (β = −1.19, p = 0.032), while no differences were observed in infants when the mothers had a high-normal TSH concentration and normal FT4 levels.ConclusionsMaternal subclinical hypothyroidism is associated with decreased receptive communication scores in infants at 1 year of age. In addition, maternal TSH concentration greater than 4.0 mIU/L and maternal isolated hypothyroxinemia are associated with impaired gross motor ability of infants, especially in infants of women with high-normal TSH concentrations (3.0–4.0 mIU/L).

High First Trimester Levels of TSH as an Independent Risk Factor for Gestational Diabetes Mellitus: A Retrospective Cohort Study.

Although numerous articles have found an association between alterations in thyroid function and the risk of gestational diabetes mellitus (GDM), other studies have failed to demonstrate this association. This may be due to the different cut-off points used to define subclinical hypothyroidism. We aim to clarify the role of thyroid stimulating hormone (TSH) level in GDM within pregnant women with normal free thyroxine (fT4) levels. This retrospective cohort study was performed in 6775 pregnant women. The association between TSH and GDM was assessed by bivariate and multivariate logistic regression. Pregnant women with subclinical hypothyroidism are at significantly greater risk for GDM when compared with euthyroid pregnant women (OR = 1.85; 95% CI = 1.36–2.52). We have also observed that TSH levels increase the risk of GDM within euthyroid pregnant women, since the TSH levels between 2.5 and 4.71 showed a higher risk of GDM than those whose TSH levels are between 0.31 and 2.49 (OR = 1.54; 95% CI = 1.28–1.84). In addition, pregnant women with positive thyroid antibodies have almost 2.5 times the risk of developing GDM (OR = 2.47; 95% CI = 1.57–3.89). Our results support that in pregnant women with normal fT4 levels, higher first trimester TSH level implies a higher risk of GDM.

Correlation between dynamic changes in free triiodothyronine levels and 90-day prognosis in patients with HBV-related acute-on-chronic liver failure

BackgroundPatients with HBV-related acute-on-chronic liver failure (HBV–ACLF) have a high 90-day mortality rate, so early prognostic evaluation is important.AimWe aimed to explore the correlation between dynamic changes in free triiodothyronine (FT3) levels and 90-day prognosis of patients with HBV–ACLF.MethodsA prospective cohort study investigated 122 inpatients with HBV–ACLF. Patients were divided into three groups based on the dynamic change in FT3 level, as follows: continuous normal FT3; continuous decreased FT3; and FT3 U-shaped change groups, and patients were divided into survival group and non-survival group according to whether they were alive or not. The correlation between the change in FT3 level and 90-day prognosis was explored. Three factors that affected the prognosis most significantly were used to form an FT3 correlation formula to compare the difference in predicting prognosis between the formula score and the conventional score.ResultsThere were 98 patients with decreased FT3 level (80.33%), and the lowest FT3 level was at 8.52 ± 6.38 days after admission, which lasted for 16 days. There were no significant differences in FT3 levels at admission and at the lowest point between the survival and non-survival groups. Cox regression analysis showed that the FT3 level, FT3 change type, and hepatic encephalopathy (HE) grading were important factors related to prognosis. The area under the receiver operating characteristics curve for the FT3 correlation formula score was 0.892, which was significantly higher than that of the CTP, MELD, MELD–Na, CLIF–SOFA, CLIF–C OF, and AARC scores (P < 0.001).ConclusionsThe FT3 level and its dynamic change type together with the HE grading can facilitate prediction of 90-day prognosis for patients with HBV–ACLF.

Maternal Thyroid Function and Birth Weight in Twins.

ContextThyroid hormones are associated with birth weight in singleton pregnancy. Twin pregnancies need more thyroid hormones to maintain the normal growth and development of the fetuses compared with single pregnancy.ObjectiveWe aimed to investigate the association of thyroid hormones and birth weight in twins.MethodsThis was a retrospective cohort study in a Chinese population. Pregnant women who received regular antenatal health care and delivered live-born twins from 2014 to 2019 were included (n = 1626). Linear mixed model with restricted cubic splines and logistic regression models were used to estimate the association of thyroid hormones with birth weight and birth weight discordance in twins.ResultsWe observed that both thyrotropin (TSH) and free thyroxine (FT4) were not associated with birth weight in twins overall, while when stratifying on fetal sex or chorionicity, there were nonlinear association between FT4 levels and birth weight in boys (Pnonlinear < .001) and in dichorionic (DC) twins (Pnonlinear = 0.03). Women with levels of FT4 lower than the 10th percentile had a higher risk of birth weight discordance in their offspring than women with normal FT4 levels (range, 2.5 to 97.5 percentiles) (odds ratio = 1.58; 95% CI, 1.05-2.33).ConclusionOur study suggests there was an association of FT4, but not TSH, with birth weight and birth weight discordance varied by sex and chorionicity. These findings could have implications for obstetricians to be aware of the importance of FT4 levels in preventing birth weight discordance in twin pregnancy.

The effect of L-thyroxine replacement on blood pressure and heart rate in children with hypothyroidism

Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics. Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg. Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex. Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (−0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=−0.4). Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP and HR closely in relation to TSH and FT4 levels of these patients.

Postradioiodine Graves' management: The PRAGMA study.

Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post-RI and compare effectiveness of common management strategies. Retrospective, multicentreand observational study. Adult patients with Graves' disease treated with RI with 12 months' follow-up. Euthyroidism was defined as both serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and &lt;10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4. Of 812 patients studied post-RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%-28.7%). No negative outcomes (new-onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events)were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres. Dysthyroidism in the 12 months post-RI was common. Differences between post-RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism.

Abstract 8: Thyroid amyloidosis presenting as persistent painless thyroiditis

Case Report: A 34-year-old patient with ESRF, found to have hereditary-amyloidosis, was referred with low TSH: 0.112 (0.340-4.250 micIU/mL), low FT3: 1.77 (2.40-4.20 pg/mL) and normal FT4:1.49 (0.80-2.30 ng/dL) in May 2018. Clinically asymptomatic, euthyroid and no goitre; was diagnosed “Sick-Euthyroid-Syndrome”. He underwent renal transplant in August 2018; his subsequent treatment included Prednisolone 20mg daily and immunosuppressants. On follow-up, his TSH was 0.303 in Oct 2018. Over next year, he had persistently low TSH: 0.005-0.196, with normal FT3, but elevated FT4: 2.39-5.21. His clinical-features varied from being asymptomatic to developing mild thyrotoxicosis. ESR: normal, Thyroid-antibodies negative, USG showed diffuse thyroid and repeated Technetium-99 scans revealed ‘gross thyroiditis’. He was managed on beta-blockers and ongoing Prednisolone. His health deteriorated since late 2019, with multiple episodes of pancreatitis due to pancreatic-duct-stones and stricture. He returned back in 2021 with neck-swelling; non-tender large-goitre with multiple nodules. TFT: low TSH, high FT4 and normal FT3. USG revealed bulky thyroid with few nodules; FNAC suggested Amyloid. He underwent Total Thyroidectomy; Histopathology confirmed ‘Amyloidosis’. Conclusion: Our patient had chronic painless thyroiditis and his steroid-therapy for post-transplant-immunosuppression probably masked the thyrotoxic-features. USG-thyroid indicated gradual structural changes, and TFT suggested possible impaired peripheral conversion of T4 to T3.

Association Between Thyroid Parenchymal Echogenicity and Thyroid Function in Pediatric Population

Background: The association between the thyroid echo pattern and thyroid function has an important impact on the diagnosis and treatment of thyroid diseases in children. Objectives: The present study aimed to compare thyroid parenchymal echogenicity with thyroid function tests and evaluate the value of a thyroid ultrasound (US) in predicting thyroid function parameters in the pediatric population. Methods: A total of 434 children (age range: 5 - 18 years; mean age: 13.18 ± 3.42 years) were categorized into two groups based on the thyroid parenchymal appearance on the US as subjects with homogeneous (group 1) and heterogeneous (group 2) echo patterns. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin antibody (Tg-Ab), and thyroperoxidase antibody (TPO-Ab) levels were evaluated and compared between the two groups. Results: The levels of TSH, fT3, fT4, Tg-Ab, and TPO-Ab were significantly different between the two groups (P &lt; 0.0001). All thyroid function tests were within normal ranges in 73.4% (168/229) and 14.6% (30/205) of children with homogeneous and heterogeneous echo patterns, respectively. The homogeneous thyroid gland on the US had 73.8% sensitivity in predicting normal TSH and 100% sensitivity in predicting normal fT3 and fT4. The sensitivity for predicting negative Tg-Ab and TPO-Ab were 78.7 and 85.3%, respectively. Conclusions: The current study compared the homogeneous and heterogeneous thyroid echo patterns with the thyroid function tests in children. The obtained results confirmed the value of the thyroid US in predicting thyroid function in the pediatric population.

Utility of Epicardial Fat Thickness in Subclinical Hypothyroid Children to Determine Existence of Subclinical Atherosclerosis in Them.

Adult studies have shown the association of subclinical hypothyroid (SCH) with various cardiovascular dysfunction, which indicates SCH may be a potentially modifiable risk factor of CV disease and mortality. However, there is still controversy about the association of cardiovascular dysfunction in children with SCH. Epicardial fat thickness (EFT) is a reliable and sensitive marker of cardiovascular risk and has become an emerging modality to predict CV risks. To measure the EFT in children with subclinical hypothyroidism and compare with healthy children. To find its correlation with subclinical atherosclerosis. To compare EFT between TPO positive and TPO negative subclinical hypothyroid patients. Children of subclinical hypothyroidism (TSH >5 mIU/ml with normal FT3, FT4, and age and sex matched control were included as per inclusion and exclusion criteria. Clinical data was collected from all study subjects. Thyroid function tests including FT3, FT4 and TSH, TPO antibody, fasting insulin, hsCRP, Lp(a), USG neck for carotid intima media thickness (CIMT), USG brachial artery for flow mediated dilation (FMD) and echocardiography for epicardial fat thickness (EFT) were done in all patients. A total 42 number of SCH and 50 age and sex matched controls were recruited and screened for various parameters of subclinical atherosclerosis. EFT was significantly higher in the cases than in the controls (6.27 mm vs 4.54 mm) with P value < 0.001. Brachial FMD was significantly lower in cases than the cohort (4.5% vs 8.93%, P < 0.001). Difference in CIMT was not significant amongst the cases and controls. EFT failed to correlate with the level of TSH though it had significant positive correlation with hsCRP. The patients who were TPO positive, had higher fasting insulin, HOMAIR, hsCRP, Lp(a) than those who were TPO negative. Results of this study show the presence of subclinical atherosclerosis in children with SCH regardless of the aetiologies. The patients of Hashimoto thyroiditis had significantly high insulin resistance and inflammation than the SCH patients of other aetiologies.

Effect of Levothyroxine Replacement on Cognitive Function Impairment in a Sample of Egyptian Population with Subclinical Hypothyroidism

Introduction: Subclinical hypothyroidism (SHT) is characterized by a normal range of free thyroxin concentrations together with increased serum TSH levels. SHT is defined as serum thyroid-stimulating hormone (TSH) concentration above the upper limit of the reference range in the face of normal free FT4 and FT3 levels. The effect of SHT on cognitive function has been investigated in several preclinical studies, and a growing body of evidence has suggested a relevant link between thyroid hormones and the central nervous system. Objectives: This study aimed to investigate the effect of levothyroxine replacement on cognitive impairment in a sample of Egyptian patients with SHT. Methods: A prospective cohort study conducted on 30 patients with cognitive impairment and SHT attending an endocrine outpatient clinic at the Ain Shams University Hospital to study the effect of levothyroxine supplementation on cognitive impairment in patients with SHT. The study was conducted on 30 patients. All participants were subjected to a full history taking; thorough clinical examination; laboratory investigations including thyroid profile (FT3, FT4, TSH), anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and lipid profile; imaging tests as neck ultrasound, echocardiography, and carotid duplex; and finally Addenbrooke’s questionnaire used to diagnose mild cognitive impairment. Results: A highly statistically significant difference was found before, 3 months and 6 months after treatment with levothyroxine regarding all clinical data, TSH, LDL, T. cholesterol, FT3, FT4 and HDL, carotid intima-media thickness, and Addenbrooke’s questionnaire. Our study showed a statistically significant inverse correlation between TSH level and mild cognitive impairment before and after treatment with levothyroxine at 3 and 6 months intervals as when TSH increased, results of Addenbrooke’s questionnaire decreased and, so, cognitive impairment increased, while when TSH decreased in response to thyroxine replacement, cognitive impairment improved as detected by an increase in the patient’s score. Conclusion: SHT has a great effect on cognitive impairment, as normalization in TSH level results in improvement in cognitive function. Also, there was a significant reduction in carotid intima-media thickness, which may contribute to improvement of cognitive function in addition to a great improvement in lipid profile, which in turn positively affects cardiac and cognitive function.

Analysis of thyroid function in Japanese patients with coronavirus disease 2019.

Thyroid dysfunction that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming increasingly recognized. However, only a few reports in Japan have addressed this issue to date. In this study, we sought to clarify whether infection with SARS-CoV-2 affected thyroid hormone levels and whether these hormones could be better predictors of prognosis in patients with coronavirus disease 2019 (COVID-19). Accordingly, we retrospectively examined 147 cases wherein thyroid hormones were measured at the time of admission among 848 Japanese patients with COVID-19 admitted to the Hyogo Prefectural Kakogawa Medical Center. All patients underwent thyroid function testing upon hospital admission. More than half (59.1%) of the patients were euthyroid. Twenty-four percent of patients had serum thyroid-stimulating hormone (TSH) levels lower than the reference range with normal serum free thyroxine (fT4) levels, and 3.4% of the patients had low TSH with high fT4 levels. Over 70% of the patients with moderate and severe COVID-19 had low serum free triiodothyronine (fT3) levels. Serum TSH and fT3 levels were inversely correlated with disease severity. The mortality rate in patients with low serum fT3 levels was significantly higher than that in those with normal serum fT3 levels.

An Imaging Measurement Study of Normal Knee Parameters in Southeast China.

Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal Femoral Condyle Diameter (FCD), Tibial Plateau Diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, Proximal Tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

Indicators of cognitive activity of children with laboratory hypothyroidism

The growth rate of a healthy child, the peculiarities of its physical and intellectual development, the formation of reproductive function are largely determined by the state of the endocrine system. Thyroid hormones have a significant impact on the growth and development of the child's organism. Today, attention is focused on the consequences of intellectual disabilities in children with hypothyroidism, as well as the impact of chronic iodine deficiency in the environment on the development of children. Insufficient intake of iodine in the body leads to congenital dysontogenesis of higher mental functions, to the formation, in severe cases, of mental retardation of varying degrees, and, in mild forms - to the borderline or partial disorders of intelligence.&#x0D; The aim is to study the cognitive functions of children with laboratory hypothyroidism.&#x0D; Methods. For a screening study of the intellectual development of school-age children living in geographical areas of Chernivtsi region (Ukraine) with varying degrees of iodine supply, 399 schoolchildren aged 11-18 years were studied, including 194 boys and 205 girls. The main group consisted of children (99) with laboratory hypothyroidism (HL), with thyroid stimulating hormone (TSH) elevation or with diverse complaints and who had been found to have elevated TSH levels during routine examinations. Patients with any kind of systemic disease and/or taking medications were excluded from the study. Diagnosis of HL was based on mild increase of TSH (5-25mIU/L) with a normal fT4 level. Thyrotropin-releasing hormone (TRH) test was also performed in all children. TSH response to TRH stimulation was considered to be normal when TSH levels were between 5-25 mIU/L. The formation of intellectual function was determined using a fragment of the R. Kettel test (adapted modified version of the children's personality questionnaire R. Kettel).&#x0D; Іnclusion сriteria: age 11-18 years, living in the Chernivtsi region, the absence of organic pathology of the CNS and mental retardation, diseases of the eyesight and hearing, for 6 months, all subjects did not receive any treatment with iodine-containing drugs and thyroid hormones.&#x0D; Results. Analysis of the study results showed that children, for the most part, have an average degree of intellectual development (60%). The level of intellectual formation changed in the direction of decreasing with increasing degree of iodine deficiency. Among children with laboratory hypothyroidism, the number of those who had a low level of intelligence was almost twice as high as in children from the comparison group 25 [21.8-27.3] % against 13 [11.8-16.6] %, P &lt; 0.01). Children with laboratory hypothyroidism have a "debt" of 56% of attention, 36% of perception, 26% of motility, and 44% of memory. The pace of operating activities was reduced by 26%. Comparison of TSH concentration, ioduria and thyroid volume with the presence or absence of deficits in certain cognitive functions showed that in children with laboratory hypothyroidism and fine motor skills TSH G level was increased by 90%, thyroid volume by 28% , and with memory loss - 125% and 38%, respectively. Correlative analysis revealed a highly probable positive relationship between moderate strength in prepubertal children between thyroid volume and fine motor skills (r = 0.485, P &lt; 0.01), memory (r = 0.488, P &lt; 0.05) and efficiency (r = 0,321, P &lt; 0,05).&#x0D; Conclusion. Children with subclinical hypothyroidism are characterized by decreased memory, instability of attention and decreased ability to concentrate, impaired fine motor skills, which generally reduces their mental capacity.

Altered Thyroid Function Tests Observed in Hypophosphatasia Patients Treated with Asfotase Alfa.

Background Asfotase alfa is the only approved treatment that can normalize mineralization in patients with hypophosphatasia (HPP). Its interference in alkaline phosphatase (ALP) dependent immunoassays has been reported. Objective To describe thyroid function tests interfered with by asfotase alfa and elucidate the underlying mechanism. Patients and Methods. Three patients with HPP treated with asfotase alfa were included. Thyroid hormone levels measured using five different immunoassays with or without ALP as a labeling enzyme during asfotase alfa treatment were evaluated. Results After the initiation of asfotase alfa, three HPP patients showed low free triiodothyronine (FT3) and free thyroxine (FT4) measured with AIA-2000 (Tosoh, Tokyo, Japan), an enzyme immunoassay system that uses ALP as a labeling enzyme, but their thyroid-stimulating hormone (TSH) levels were within the normal range. The other CLEIA system using ALP as a label, AIA-CL2400 (Tosoh, Tokyo, Japan), and ALP-independent immunoassay systems demonstrated normal FT3 and FT4 levels. These data suggested that although the thyroid function of these three patients was normal, asfotase alfa interfered with the thyroid hormone measurements made with AIA-2000. AIA-2000 and AIA-CL2400 adopted one-step and delayed one-step measurements, respectively, and the same antibody was used for both immunoassays. However, asfotase alfa may be absorbed on the magnetic beads used in the AIA reagent with the AIA-2000 system but not absorbed on the microparticles used in AIA-CL2400. Conclusion Clinicians should be aware of the possible interference in thyroid function measurements by adopting specific types of immunoassays in asfotase alfa-treated HPP patients.

Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide.

ObjectivePatients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT).DesignA multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We compared the biochemical response to BR/DT in the first 6 months of therapy.MethodsPatients commenced 0.75 mg/kg carbimazole (CBZ) daily with randomisation to BR/DT. We examined baseline patient characteristics, CBZ dose, time to serum thyroid-stimulating hormone (TSH)/free thyroxine (FT4) normalisation and BMI Z-score change.ResultsThere were 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in time to non-suppressed TSH concentration; 16 of 39 patients (BR) and 11 of 39 (DT) had suppressed TSH at 6 months. Patients with suppressed TSH had higher mean baseline FT4 levels (72.7 vs 51.7 pmol/L; 95% CI for difference 1.73, 31.7; P = 0.029). Time to normalise FT4 levels was reduced in DT (log-rank test, P = 0.049) with 50% attaining normal FT4 at 28 days (95% CI 25, 32) vs 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (95% CI for difference 0.57, 0.86; P < 0.001) and was greatest in patients with higher baseline FT4 concentrations.ConclusionsDT-treated patients normalised FT4 concentrations more quickly than BR. Overall, 94% of patients have normal FT4 levels after 6 months, but 33% still have TSH suppression. Excessive weight gain occurs with both BR and DT therapy.

Thyroid testing paradigm switch from thyrotropin to thyroid hormones\u2014Future directions and opportunities in clinical medicine and research

PurposeRecently published papers have demonstrated that particularly in untreated individuals, clinical parameters more often associate with thyroid hormone, particularly free thyroxine (FT4), levels than with thyrotropin (TSH) levels. Clinical and research assessments of the thyroid state of peripheral tissues would therefore be more precise if they were based on FT4 levels rather than on TSH levels. In this paper we describe implications of, and opportunities provided by, this discovery.ConclusionsThe FT4 level may be the best single test of thyroid function. The addition of free triiodothyronine (FT3) and TSH levels would further enhance test sensitivity and distinguish primary from secondary thyroid dysfunction respectively. There are opportunities to reconsider testing algorithms. Additional potential thyroidology research subjects include the peripheral differences between circulating FT4 and FT3 action, and outcomes in patients on thyroid replacement therapy in terms of thyroid hormone levels. Previously performed negative studies of therapy for subclinical thyroid dysfunction could be repeated using thyroid hormone levels rather than TSH levels for subject selection and the monitoring of treatment. Studies of outcomes in older individuals with treatment of high normal FT4 levels, and pregnant women with borderline high or low FT4 levels would appear to be the most likely to show positive results. There are fresh indications to critically re-analyse the physiological rationale for the current preference for TSH levels in the assessment of the thyroid state of the peripheral tissues. There may be opportunities to apply these research principles to analogous parameters in other endocrine systems.